Implementation of Family Adoption Program (FAP) in medical colleges of India: A snapshot

In India, 65.5% of the population resides in rural areas (as per 2020 statistics) whereas availability of healthcare services is better in urban areas. Access to healthcare for a rural citizen is of major concern. Issues such as health illiteracy, ignorance about communicable and noncommunicable diseases, means to reach a health facility, etc. are some of the hurdles which need to be addressed.^1–3 Community engagement in medical education gives students an insight into the living conditions of the people and how they influence their health. Various determinants of health that can influence patients in real life can also be understood through such interactions.⁴

The family adoption programme (FAP) is a part of the undergraduate curriculum of community medicine.^1,2 Being a ‘new’ initiative, it is expected that it would have its own challenges and opportunities. It involves allotting families to each student and following them up through the undergraduate course. Hence, it is important to understand and address the challenges faced by the colleges in the process of implementation of FAP.

We did a cross-sectional study over 6 months in 2023 after obtaining institutional ethics committee approval. A semi-structured questionnaire, as a Google form through WhatsApp, was sent to heads of departments of community medicine of medical colleges in India. We requested that the form be filled by the designated FAP coordinator/FAP in charge of their institution. The responses from the forms were exported to Microsoft Excel and the data were analyzed.

Of the 52 respondents (<10% of all medical colleges from India), 28 colleges were private institutions, all had implemented FAP and 24 were government colleges, of which 20 had implemented the FAP (Table I).

Seventeen (36.2%) colleges allocated 5 families per student, while in 3 (5.8%) colleges a single family was shared by more than one student. The manpower allotted for conducting FAP visits included faculty, field staff (auxiliary nurse midwife, medical social worker), postgraduate students/junior residents and senior residents. However, 11 (23.4%), colleges, along with the above staff, included interns as well as laboratory technicians, health educators, public health nurses, attendants, local community influencers, etc.

Prior sensitization was conducted for both students and staff members involved in implementation.

Thirty-two (69.6%) medical colleges used in-house transport facilities, while 10 (23.9%) outsourced it. Minority used a hybrid mode of transport.

Most of the colleges which implemented FAP from the academic year 2021 had challenges in terms of transport, lack of manpower, time constraints, etc. The factors which facilitated the smooth implementation and conduct of FAP included proper planning and coordination, faculty commitment, adequate manpower, availability of transport, prior sensitization of the families, cooperation from local leaders, student’s willingness, etc. However, 11 (23.4%) of the study respondents felt that in addition to the regular staff, enrolment of interns, and other hospital staff namely clerical staff and laboratory technician aided in the conduct of the programme.

We noticed that a majority of hurdles were student-related 28(57.4%) followed by logistics 27 (55.3%) and faculty related 19 (38.3%). The student-related hurdles were lack of interest, clinical knowledge, absenteeism, language barriers, and syllabus overload. Faculty-related hurdles were centered on staff shortages, particularly during vacations, and coordination difficulties. The absence of transport facilities was a major obstacle to FAP implementation, while some colleges faced challenges in arranging logistics such as weighing machines, BP apparatus, and medications. Others encountered obstacles in selecting implementation sites, coordinating with field staff, liaising with other departments, insufficient support from local bodies, family preference for private facilities hindering cooperation.

The National Medical Commission has mandated FAP for medical students from the first year and continued throughout the curriculum. The majority of colleges preferred to divide students into teams and rotate them with the other preclinical departments. Since the NMC criteria states that the villages adopted have to be beyond the field practice area, colleges may have difficulty in complying to the 5 family per student norm.

Arumugan et al.⁵ posted the entire batch for FAP wherein students were divided into 3 batches which was further divided into smaller teams. Prior sensitization was carried out for the students, faculty, paramedical staff, etc. in all the medical colleges in the current study, which was comparable to the study by Langde et al.⁶ and Arumugan et al.⁵ As suggested by Vanikar et al.² it is essential to introduce FAP to the villagers and the stakeholders by addressing Gram Sabha’s to sensitize the villagers and gain their confidence and acceptance.

Vanikar et al.² recommended that at least 10 visits must be planned in the first professional year which was followed by 36 (72%) of the colleges. They also insist that students must be trained to interact with the families prior to the community exposure. There should be at least one ASHA worker with every 25 students who will be entrusted with the responsibility of training students to facilitate interaction with the families and gain their confidence.²

We observed that the major hurdles encountered in the smooth implementation of the program were mainly due to lack of transport and logistics, shortage of manpower, language barrier, lack of interest and clinical knowledge in the students. Similar concerns were reported by Yalamanchali et al.⁷ and Langde et al.⁶ It was apparent that proper planning, coordination and support was crucial to facilitate smooth implementation of the programme, this was comparable to the views expressed by Langde et al.⁶