**1. Introduction**

*"All other pleasures and possessions pale into nothingness before service, which is rendered in a spirit of joy."*

*—Mahatma Gandhi*

In the last century, there have been significant changes in the field of health-care delivery (both in private and public) system and in the functioning of academic institutions. On the one hand, there have been rapid progress in both fields, but at the same time, new challenges have also emerged. With the advent of market economy and globalization, both demographic transition and epidemiological transition have led to widening health disparities between the rich and poor segments of the society and also poor access of health care to a marginalized segment of population and also at times to the rural area. It is expected from the academic institutes to bring a change in the health status of the community, and they serve as well as to create a demand to provide a high-quality and cost-effective health system. Thus, the social responsiveness, social responsibility, and social accountability have posed a significant challenge to the academic health institutions [1, 2].

There is a substantial inequity in terms of health and development progress among the rural population in India. Among the states that are doing well, there also remain pockets where not much has changed since independence in 1947. This inequity further worsens with every passing year, resultant health being one of the major determinants for worsening inequity. In India, paying for health care has become a major source of impoverishment for the poor and even for the middle class. In this situation, the Gandhian Philosophy of serving the underserved and reaching the unreached has become more important. The medical institutes can make the Gandhian Dream, "people's health in people's hand," a reality.

#### **1.1 Gandhian concept of village development**

Mahatma Gandhi was always for "Swaraj," meaning self-rule, where villagers would be able to exercise authority/control on the happenings around them in the field of social, culture, education, health, agriculture, etc. Thus, it is clear that Gandhiji's "Swaraj" was to empower the village community in order to ensure that they have the control on the happenings around them. The Gandhian vision of ideal village or village Swaraj is that it is a complete republic, independent of its neighbors for its own wants and yet interdependent for many others in which dependence is necessary [3, 4].

Gandhiji said on ideal village, "An ideal Indian village will be so constructed as to lend itself to perfect sanitation. The cottages will have courtyards enabling householders to plant vegetables for domestic use and to house their cattle. It will have wells according to its needs and accessible to all. It will have houses of worship for all, also a common meeting place, a village common for grazing its cattle, a co-operative dairy, primary and secondary schools in which industrial education will be the central fact. It will produce its own grains, vegetables and fruit, and its own Khadi. This is roughly my idea of a model village . . . . I am convinced that the villagers can, under intelligent guidance, double the village income as distinguished from individual income. My ideal village will contain intelligent human beings. They will not live in dirt and darkness as animals. Men and women will be free and able to hold their own against anyone in the world." [3, 5].

At the Mahatma Gandhi Institute of Medical Sciences, we have strived hard to improve the quality, equity, relevance, and cost-effectiveness in the health-care delivery in order to discharge our social responsibility. The medical institutes' capacity is judged on the basis of their response and interaction with the constantly evolving health systems and community in order to produce a medical graduate who has a sense of social responsibility. The big question is whether our medical institutes are prepared for this. Are they ready and willing to shoulder the responsibility so as to contribute to the development of a healthier society? [6].

The experts believe that incorporating this fundamental issue in the institute mission may be a stepping-stone toward ensuring that these medical institutes discharge their social accountability that is deeply nested at the MGIMS in all its activities related to health care, both at the institution level and at the community level. The medical students, both undergraduates and postgraduates (PGs), experience their social responsibility while working both at the institute level and the community level, and at times they also participate actively [7].

"Community-based education is not only learning in the community but also learning with and from the community. As the communities actively participate in CBE, they not only contribute but also benefit from the CBE process. The ultimate goal of CBE is to help the students understand social dynamics of health promotion and disease prevention and to impart a sense of social justice and cultural humility in the health professions through the education process." [8].

Under "social responsibility," the medical education program focuses on producing a "good" practitioner, leaving the onus on the respective medical institute to define which competences are the most appropriate to meet health needs of patients. Under "social responsiveness," the medical education program focuses on attaining the clearly defined competences that are defined from an objective

*Community-Oriented Graduate Medical Education: A Gandhian Approach DOI: http://dx.doi.org/10.5772/intechopen.93302*

analysis of people's health needs. Under "social accountability," the medical education program aims to produce health system change agents that would have a greater impact on the health system performance and ultimately on people's health status, implying a quest for innovative practice modalities combining the individual- and population-based services [9, 10].

The available evidence suggests that implementing such a social accountability framework is feasible and yields the desired results of producing socially responsive, competent medical physicians [11]. We therefore share the experience of implementing community-based medical education for more than 5 decades at the Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram. Our humble submission is that the attempt at the MGIMS is not the most perfect model and may have its own limitations and flaws.

## **2. Methodology**

The literature search on community-oriented medical education, Gandhian philosophy, and social accountability was conducted. Further, a qualitative methodology was adopted to draw inferences based on personal interaction and interviews and discussion with the faculty and supportive staff at the Mahatma Gandhi Institute of Medical Sciences, Sewagram, with the health-care providers, with the public health system, and with community members representing various community-based organizations (CBOs), local panchayat members, and with village-level health functionaries like accredited social health activists (ASHAs) and anganwadi workers (AWWs). Wherever required, available secondary information was also utilized. It also includes the personal experience of the author over the last 27 years at the MGIMS.

## **3. The institute**

The Mahatma Gandhi Institute of Medical Sciences is India's first rural medical college. It is nestled in the karmbhoomi (workplace) of Mahatma Gandhi at Sewagram. The institute was stated in the Gandhi centenary year, 1969.

#### **3.1 Vision and mission**

The vision of the institute is to develop a replicable model of communityoriented medical education that is responsive to the changing needs and is rooted in an ethos of professional excellence. The Mahatma Gandhi Institute of Medical Sciences, Sewagram, is committed to develop a high standard of medical education, research, and health care by adopting a holistic approach, integrating modern medicines with the traditional Indian system of medicine. The institute in committed to provide affordable health care to the marginalized and underserved community, especially the underprivileged segment of the society from the rural area.

#### **3.2 History**

When Mahatma Gandhi left the Sabarmati Ashram and set up his ashram at Sewagram in 1936, the epicenter of India's independence struggle shifted to this obscure village in Maharashtra. In 1944, when Gandhiji returned from his last imprisonment at the Aga Khan Palace, Sewagram was experiencing a number of epidemics. In this situation, Bapu had no use of the guesthouse built for his guests. He got it converted into a dispensary, and later, into a 15-bedded hospital for women and children. It was christened as "Kasturba Hospital" in memory of Kasturba Gandhi, who had passed away in 1942. Kasturba Hospital has the distinction of being the only hospital in the country started by the Father of the Nation himself.

Dr. Sushila Nayar joined Mahatma Gandhi in the year 1939 as his personal physician and, in independent India, she joined as Union Health Minister with the then Prime Minister of India, Pandit Jawaharlal Nehru, in 1962. When Shri. Lal Bahadur Shastri, who had a rural background, became the prime minister, he desired to start a medical college in the rural area which can deliver the rural-oriented medical education. Dr. Sushila Nayar took this as a challenge and, in the process, the Mahatma Gandhi Institute of Medical Sciences was started in 1969 in the Gandhi centenary year as an experimentation in the medical education to create a rural bias among the medical students.

MGIMS is 50 years old now. From a 15-bedded hospital in 1944, the Kasturba Hospital has gradually grown into a 934-bedded hospital. The institute also runs a 50-bedded Dr. Sushila Nayar Hospital, in the tribal areas, in Melghat, 250 km away from Sewagram.
