Composite inclusive development of gastroenterology in resource constrained settings

India/South Asia is a region with widely disparate populations having extremes of healthcare facilities. At one end there are the affluent with state of the art five star facilities available for them, and at the other end are ignorant malnourished poor people who neither have any idea about the maladies which afflict them or are stalking them, nor are aware of the meager facilities available for their use. Awareness programs/Preventive Gastroenterology:Awareness programs about the different diseases especially preventable gastrointestinal diseases is essential. The importance of hygiene, safe water and availability of effective vaccine for especially Hepatitis B vaccine is of paramount importance. Simultaneously, the affluent have to be educated about the problems associated with 'plenty' especially alcohol related diseases, metabolic syndrome and fatty liver. The mix of alcohol, NAFLD and hepatitis viruses are playing havoc. Besides, there is urgent need for accelerated Hepatitis B Vaccination Program which must include catch-up vaccination. Serious research for development of vaccine for Hepatitis E should also be made. Optimal Utilization of healthcare resources:This is of utmost importance in view of resource constraints, and for this along with augmentation of the facilities, it is also essential to create awareness amongst the beneficiaries. Facilities devoted for HIV management should also be utilized for tackling the menace of Hepatitis B and C. Development of Training centres/skilled manpower in the field of Gastroenterology:It is essential to develop regional centres all over the country where physicians and surgeons have to be educated to handle different gastrointestinal diseases more efficiently, and identify situations in time where referral to appropriate facility is essential. Besides, specific tailored practice guidelines should also be evolved for managing common gastrointestinal diseases, and these should be made available to all primary physicians and primary hospitals. Development of affordable centres of excellence in Gastroenterology: While it is important to create awareness and prevent diseases, it is also important to develop facilities for advanced Endoscopic Intervention and Liver Transplantation in different regions of the country, where state of the art facilities are available for those who cannot afford these treatment modalities in sophisticated private institutions. Conclusion: The key to improvement of gastrointestinal health for this region is a composite inclusive development of Gastroenterology resources and education of the masses about the importance of their gastrointestinal health.