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More power to health

Despite tremendous economic growth, India lags on many human development indices. If you feel saddened by this but are not armed with an MBBS degree, you can help.

education Updated: Mar 24, 2010 10:21 IST
Rahat Bano

India ranks 134th among 182 countries in the 2009 Human Development Report, an annual report released by the United Nations Development Programme. Clearly, health care delivery in the country is far from perfect. The estimated shortage in India of health workers – going by WHO standards of 25 per 10,000 – is 20 per cent, or around four to six lakh, says a background paper by Dr KK Datta written for the National Consultation on Public Health Workforce in India, organised by the Ministry of Health and Family Welfare, in association with the WHO Country Office in June 2009 in Delhi.

Despite its tremendous economic growth, India is lagging on many human development indices. If you feel saddened by the poor health in our country but are not armed with an MBBS degree, you can still make a difference. This is because one’s health depends as much on the availability of clean drinking water, sanitary toilets as well as unpolluted air as on access to a primary health centre. As a public health official you could be a communication specialist, an environmental engineer, or even an economist, and ensure an illiterate mother gets her baby protected against polio, reduce the chances of a child developing asthma in a highly polluted city or make judicious use of stretched finances. Some experts have been pointing to the need of roping in such a varied profile of professionals to manage public health.

Says Dr Deepak Raut, professor and head, department of community medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, “There is plenty of scope in this area.” This includes opportunities in more than 20 national health programmes, such as the National Rural Health Programme and the Pulse Polio Immunisation programme.

Dr Raut says that the dual responsibilities of patient care and working on target-oriented national programmes excessively burden medical professionals. “So, they can’t do justice to both.”

In such a case, non-medical public health professionals can serve many roles, “from the start” of a project. They can be involved in the planning, implementation and monitoring and evaluation of a programme, says Dr Raut.

The Indian Public Health Association (IPHA) says India needs professionals with managerial skills who are also clued in to the practice of health care. “In the changing scenario, issues like public health standards, public-private partnership and accreditation, and health insurance need special inputs in the training and attitude of health managers. This requires sound knowledge and professional skills of epidemiology, biostatistics, health management, etc. This can be done by those with PG qualification in public health and not a generalist.”

Dr Datta says in his paper, “Apart from public health physicians, human resources from the allied non-medical disciplines are also needed i.e., statisticians, demographers, environmentalist(s), engineers, biologist(s), nutritionists, sociologists, economists, nurses, laboratory technicians, mass media and extension educators, vector biologist(s), public health nurses, food inspectors, drug inspectors and industry inspectors to provide preventive health care, enforce public health laws and monitor public health services,” says the paper. Also required are sanitarians, policy analysts, epidemiologists, behavioural scientists, health promoters, social workers and community health workers, etc.

These professionals or specialists are supposed to prevent diseases and improve the health of the population.

The concept of public health management is relatively new in India, but there is some forward movement. States like Tamil Nadu, Maharashtra and West Bengal have public health cadres.

So, what’s the aptitude required for it? K Srinath Reddy of PHFI says, “You should be interested in working preferably both in (executing) policies and (implementing) programmes for community-based activities for influencing determinants of health. It’s not so much about individual patient care but about policy, urban design, organisation, resourcing, monitoring and evaluation of health services.”

You may explore one of the profiles, depending on your disposition and abilities.

What's it about?
Public health professionals prevent diseases and improve the health of the population but are not involved in patient care. Public health is a composite discipline “considered distinct from but complementary to clinical medicine…” says a background paper by Dr KK Datta written for the National Consultation on Public Health Workforce in India, an event that brought together various stakeholders in June 2009 in Delhi. Tamil Nadu’s Public Health Act defines public health as “the science and the art of preventing disease, prolonging life and promoting physical health and efficiency through organised state effort, by the sanitation of the environment, the control of infections, the education of the individual in principles of personal hygiene, the organisation of medical and nursing service and the early diagnosis and preventive treatment of disease and the development of social machinery that will ensure to every individual a standard of living adequate for the maintenance of health: It is the organising of these benefits... to enable every citizen to realise his birthright of health and longevity”

Clock Work
Public health professionals’ workdays can vary widely, depending on their qualifications/specialisations and their work setting — a hospital, an international agency, such as the WHO, or an NGO. A public health worker performs multiple activities, including research, preparing answers for parliamentary questions, etc. An example:

9.30 am: Check daily/weekly/monthly reports of health programmes
10.30 am: Assess the progress of the programme and its targets. Depending upon the reports, initiate action
11.30 am: Call/discuss report with concerned medical officer and prepare for field visits
12.30 pm: Assess/plan/ organise training programmes
1.30 pm: Lunch
3 pm: Attend meetings with senior public health professionals to give feedback and discuss progress reports of activities OR visit field area where programme
is being implemented
6 pm: Back at office. Write report based on assessment

The Payoff
The starting monthly salary may range between Rs 15,000 and Rs 75,000, depending on the position and the employer. The average will be around Rs 30,000. A fresh entrant can earn Rs 40,000 to Rs 50,000 a month in a Central government post and Rs 20,000 to Rs 40,000 a month at the state government level

. The skill requirement varies from one profile to another. For example, quantitative and analytical skills for a biostatistician, and strong language and creative skills
for a communication specialist. But generally, the requirements are:
. Managerial acumen
. Project management skills
. Decision-making ability
. Social commitment and responsiveness

How do i get there?
Although people from widely different disciplines can work in public health, it’s preferable if they study science up to the Bachelor’s level, suggests Dr Deepak Raut, professor and head, department of community medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi. This will enable you to get a grasp of diseases and their progress, he adds. After that, you may choose from one of the many programmes, such as health economics and public health management, to name two

Institutes & urls
Indian Institute of Public Health Gurgaon, Gandhinagar, Hyderabad and Shillong
. National Institute of Health and Family Welfare, New Delhi
. Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvanthapuram
. All India Institute of Hygiene and Public Health, Kolkata
. Postgraduate Institute of Medical Education and Research, Chandigarh
. BITS Pilani
. Christian Medical College, Vellore

Pros & Cons
Healthcare is a very important sector
. Your efforts make a difference to a lot of lives – a source of great satisfaction. At the same time, the results are often visible after many years
. Most jobs at present are in the government sector and in NGOs
. The concept of public health is relatively new in India, with its attendant birth pangs
. Work may involve travel and you may be posted in rural or remote areas

Prof. K Srinath Reddy,Governments are moving towards creating public health cadres, says Prof. K Srinath Reddy, president, Public Health Foundation of India, New Delhi

What needs are public health managers/professionals supposed to fulfil? Can you tell us how they are different from MBAs in healthcare or hospital management?
Public health professionals can be broadly trained generalists engaged in designing and developing health programmes or specialists with additional expertise in fields such as epidemiology, health economics, health policy, biostatistics, clinical research, environmental and occupational health, public health nutrition, social and behavioural services, health communication, health promotion or public health management. They generate the knowledge needed to identify the dimensions and determinants of major health problems that different sections of our population experience and help to develop the appropriate policy and programme responses. They also possess the right skill mix to evaluate health programmes and provide correctives when needed.

Public health management combines essential knowledge of public health with relevant management skills for improving the delivery of a wide range of public health services, such as immunization programmes, or the HIV-AIDS prevention programme, control programmes for tuberculosis or hypertension which have to be delivered across the country. While performance with profit is the mantra of classical MBA training, performance with equity is the mantra of public health management which is especially concerned with public health problems of the poor. Public health management adds management principles to core public health knowledge and adapts them for application to enhance the efficiency of the health system. Hospital management is confined to the functioning of hospitals only and does not extend to all other components of the health system. It is, however, also a sub-component of public health management.

The concept of public health as well as of public health professionals is relatively new in India? How is it going? What are the challenges before public health professionals in the country?
There is a greater commitment by the Central and most state governments for strengthening health services, especially in primary health care, and for improving the performance of health programmes. However, the need for public health professionals is just beginning to get recognised. Contractual appointments, now available in major public health programmes, like the National Rural Health Mission (NRHM), provide early opportunities for engaging public health professionals with health services even as states move towards the creation of public health cadres. The soon-to-be launched National Urban Health Mission (which along with NRHM will form a common National Health Mission) will expand the employment opportunities for public health professionals.

Last year, you had said that there is no clear-cut career path for non-medical professionals entering public health services. Has anything changed about this? Do you have any new information on the committee under the Director General of Health Services (DGHS), which was looking into the eligibility requirements and career options for both medically- and non-medically-qualified public health professionals? Is there any scope of employment for people with, for example a PG diploma in public health management, in the private sector?

The DGHS Committee recommendations are still awaited. However, some states are beginning to engage non-medical health professionals, too, in some of the NRHM-related positions. This trend is expected to increase over the next two years. NGOs, foundations, international organisations dealing with health and development as well as health research organisations are seeking such professionals in increasing numbers. The private sector will also open up soon, with positions in industrial public health, hospital management, clinical research and health financing.

Any new plans of PHFI?
PHFI is set to open its fourth Indian Institute of Public Health (IIPH) at Bhubaneswar, in July 2010. Its currently functioning IIPHs at Gandhinagar, Hyderabad and Delhi are running four post-graduate diploma programmes, a certificate course in diabetes management and several short-term training programmes. Distance education programmes are soon to commence in epidemiology, public health nutrition, health promotion and chronic care management. PHFI is also seeking university status and will commence MPH (Master of public health) and PhD programmes as soon as it obtains this status.

What are the pros and cons of a job in public health?
The pros of a public health job are that it responds to a great social need, connects you to many people and communities, provides inter-disciplinary learning and multi-sectoral experience, and will surely grow in demand over the next two decades.
The cons are that it is an emerging field and career growth may have a slow trajectory in the initial years and may also involve considerable travel to the 'field' (where health programmes are being implemented).
For people who want to change society for the better, through committed action and not just by slogans, public health will be an excellent career choice. It is what 'people who love people' will really enjoy doing. As Barbara Streisand memorably sang, aren't such people the luckiest people?

- Interviewed by Rahat Bano