The process of health education is defined as something that imparts information about health in such a way that the people are motivated to use the information for the protection and promotion of health and individuals, their families and communities. Making the people aware of their health needs and risks, payment options to reduce their out-of-pocket medical expense and others are some of the aspects on which even a well-educated, city-bred person may need some help. India must utilise the access of its community health workers, Anganwadi and Accredited Social Health Activist (ASHA), to inform and assure people of the options they have, failing which even the best technology and most efficient staff will fall short of making an Impact.
India needs a multipronged approach towards training medical corps. For the medical training providers, the most important criterion to adhere is the quality of education. However, cost is a bigger factor for the aspirants. India has 492 medical colleges, out of which 233 are government-owned and produce around 62,960 MBBS doctors. While aspirants hoard at the government medical colleges offering subsidised education, the lack of infrastructural upgrade is a major concern. Private institutions have better infrastructure but charge a little higher. However, no institution can teach an aspiring doctor to be empathetic towards the need of people. As a result, the mandatory rural posting is often considered to be a compulsory dose of quinine rather than an opportunity to gather first-hand information for a better service.
In 2018, the government launched Ayushman Bharat, an ambitious healthcare protection scheme that will cover 10 lakh families below the poverty level. According to a study published in the Indian Journal of Public Health, India would need 2.07 million registered doctors to achieve the World Health Organisation directed doctor population ratio of 1:1000 by 2030. Effectively, this would thrust a growth of 151% between 2010 and 2030 against a growth rate of 14.41% until 2014.
The looming crisis can be addressed by roping in licentiate medical practioneers (LMP), primary care physicians selected locally, trained under short-term courses, enrolled and then licensed who can facilitate the supply of trained healthcare providers in villages. Not only will they weed out quacks, deputing LMPs in rural healthcare centres will alleviate the suspicion of being treated as a second-class citizen among village dwellers.
The focus on doctors as the mainstay of the public health system is doing more harm than good. Doctors need ample support from the allied healthcare professionals (AHP) – nurses, midwives, anaesthetists etc. in order to make it work. The prevalent practice of equating a doctor only with an MBBS degree holder is also impeding the expansion of healthcare education. India has around 7 lakh AYUSH doctors and 1.92 lakh Bachelor of Dental Surgery (BDS) degree holders who are barely counted as a part of the formal healthcare system. By drawing them into a system, a more holistic approach can be adopted and the MBBS doctors can be freed to take care of ailments that are more serious. Unfortunately, they are the lesser cousins of the MBBS degree and in most cases these courses are opted as a second choice.
Public health education in India
The All India Institute of Hygiene and Public Health (AIIHPH), Kolkata is the oldest public health institute in India. It offers diploma, masters and doctoral level programmes in various domains of public health. In the recent past there is a conscious shift in public health education in India with several institutions (with medical and non-medical background) initiating public health programmes for both medical and non-medical graduates. Some of them offer core public health programmes like General Masters in Public Health (MPH) and some of them offer specialised courses (MPH with specialisations). Some institutions have launched specialised courses in public health related disciplines. Recently, there has also been a growth of institutions offering public health courses through distance education.
Network of public health professionals and public health education institutions
The networks of individuals exist as professional associations which comprise of specialists having a set of commonalities and such associations are dedicated to the promotion of public health by bringing its members’ expertise together and provide platforms for deliberations on public health policies, for advocating education and research agenda and exchange of views and information. Indian Public Health Association (IPHA) and Indian Association of Preventive and Social Medicine (IAPSM) are the leading associations of public health professionals in India and have played a significant role in shaping several public health initiatives through active engagement of their members.
The South East Asia Public Health Education Institutions Network (SEAPHEIN) has been developed and promoted under the stewardship of the World Health Organisation’s South-East Asia Regional Office (WHO-SEARO), to promote and strengthen public health education and training in the member countries. The National Rural Health Mission (NRHM) has envisioned the training of in-service health professionals in public health management; so that they would oversee a range of functions, including community-based disease surveillance, programme planning, implementation, monitoring and evaluation. This has led to the development of a one year Post Graduate diploma in Public Health Management (PGDPHM).
The National institute of Health and Family Welfare, New Delhi has developed a Public Health Education and Research Consortium (PHERC) to link individuals and organisations in order to develop strategies for greater involvement of partner institutions in national public health programmes through capacity building for education and research.
India is experiencing rapid development in the arena of public health and has achieved great strides in improving public health education over the past several decades. However, much remains to be done. In order to strengthen the public health system in India, it is necessary to position adequately trained, multi-disciplinary and competent public health professionals at all levels. Public health education is a tool to produce these professionals.
Immediate collaborative efforts could be directed towards designing and adaptation of competency driven frameworks suitable of addressing public health challenges of the 21st century, shifting the current focus of curriculum to multi-disciplinary public health outlook, developing accreditation mechanism for both the programmes and institutions, engaging in creating job opportunities and designing career pathways for public health professionals in public and private sector.