Curriculum Development Consultation and Workshop
Item
- Title
- Curriculum Development Consultation and Workshop
- extracted text
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---- -- J!U.-
22nd December 2011
Society for Community Health Awareness, Research and Action
(SOCHARA)
Center for Public Health and Equity (CPHE - Bangalore & Bhopal)
Community Health Cell (CHC- Bangalore & Chennai)
'IP
Curriculum Development Consultation and Workshop
27-29th December, 2011
Towards the School of Public Elealth and Equity (SOPHE)
Objectives
1. To reflect on concepts in curriculum development and the steps involved in curriculum
planning and development, in the context of application to SOCHARA’s various learning
programs.
2. a) To deepen our understanding of the context/ situation to which the community health
learning programs of SOPHE respond, b) to define public health and community health
which are at the core of our teaching learning programs.
3. rl'o review the core public health competencies being evolved by the national expert group
and to identify the competencies that will be the basis and at the core of SOPHE programs.
4. To identify the following for all SOPHE training programme
a) Core components of community health;
b) Core teaching learning principles and methods;
c) Core approaches to the assessment of participants and the evaluation of training.
5. To evolve individual and cluster plans and to finalize a more detailed framework and content
of curricula and mechanisms to complete these tasks within certain timelines.
lime
Provisional Program
Day One 27th December, Tuesday, Venue — CHC, Madiwala__________
10 am to
11 am
11.15 am
to 12.15
noon
Introductory Session WELCOME
Self introductions (creative!)
Expectations from the three days
Follow up to Learning Facilitation Workshop (LFW) held from 26th-28th July 2011 (RN)
Objectives and outline of consultation and workshop (TN)___________________________
Input Session - I
Curriculum Planning-An Overview
What is a curriculum;
Steps in curriculum development;
Planning and situation analysis;
Formulation of objectives;
Selection of contents;
Selection and organization of learning experiences;
Evaluation; and Checking for balance and sequence;
Evaluating the curriculum by teachers and students.
Resource Person/ Facilitator: Dr. D.K. Srinivasa [SOCHARA member/ Rajiv Gandhi
University of Health Sciences (RGUHS) ]
1
12.15 to
12.45 pm
Question and Answer session ( DKS, TN to moderate )
University Regulations and Requirements - An Overview
12.45 to
1.15 noon
1.15 to
Resource Person: Dr. Munir Ahmed, RGUHS
Lunch & interaction
2.30 pm
2.30 to
3.30 pm
Group Discussions -1
(Group to decide on small group composition & rapporteur for the plenary)
• Situation Analysis
• Definitions for the SGPHE (community health, public health, learning facilitation skills,
managing learning programs and processes)
• Objectives of a CH Curriculum (New Public Health) - for the 1 year & 2 year programs
and for shorter programs ________________________________________
3.30 to
3.45 pm
Tea
Situation Analysis,
Definition
- Objectives (TN, ASM to facilitate)
3.45 to
4.45 pm
Plenary - Session: Building Consensus on -
4.45 to
’5.45 pm
Group Discussions - II
Exploring Competencies and priority setting using national expert group template
Identify areas that will be core for any teaching program of SOPHE (RN)
Day Two 28th December, Wednesday, Venue - CPHE, Koramangala
9.30 to
10.00am
10.00 to
1 1.00 am
Reflection on Day One Key learnings / More questions ( RG, PS, AK to lead)
Plenary Sessions: Building Consensus (ASM / RN)
Competencies
Priority setting
Tea
11.00 to
1 1.15 am_________________
1 1.15 to
12.15
noon
12.15 to
! Illicit Session - II
Selection / organizing learning experiences (RN)
Teaching learning methods that are core to a community health approach
Question & Answer session (TN / ASM / RN)
1.15 pm
1.15 to
2.30 pm
2.30 to
3.30 pm
3.30 to
3.45 pm
3.45 to
4.45 pm
4.45 to
6.00 pm
Lunch
MANAGEMENT
SEMINAR and SHARING
Management, Administration and Accounts - Overview (KG, VF)
(For Heads of Units)
Tea
Management - Check list, Reviewing systems ( KG, VF, RN)
Open space discussion (RG, PS to lead)
2
Day Three 29th December, Thursday, Venue - CPHE, Koramangala
Reflection on Day Two: Key learning / More questions (RG, PS, AK to lead)
9.30 to
10.00 am
Input session - III
Plenary Session: Assessment of Student progress (Methods / Grading ) - (ASM)
Monitoring and evaluation of training - the community
health approach
Tea
10.00 to
1 1.00 am
11.00 to
1 1.15am
11.15 to
12.15 am
Plenary Session
Integration of Research in the community health teaching learning programs of
SOCHARA ( TN, ASM )
12.15 to
1.15pm
1.15to
2.30 pm
Question and Answer session, Discussion (RG, PS, All)
2.30 to
3.30 pm
3.30 to
3.45 pm
Lunch
I
I Planning a) CULP and CEU training initiatives - 2012 (CHC) (Bangalore and Chennai )
________ b) CHFP - Feb 2012 (CPHE) Bangalore and Bhopal________________ •
Tea
3.45 to
5.00 pm
Plenary Concluding Session: Next steps, winding up
a) Individual plans
b) Cluster plans - Specific and priority training commitments
- mechanisms to take these forward
Abbreviations
RN - Dr. Ravi Narayan, TN - Dr. Thelma Narayan, DKS - Dr. D.K. Srinivasa,
KG - Mr. K. Gopinathan, ASM - Mr. As Mohammed & VF - Mr. Victor Fernandes
Participants
1. Dr. Ravi Narayan
2. Dr. Thelma Narayan
3. Mr. K. Gopinathan (will join some sessions)
4. Mr. As Mohammed
5. Mr. Victor Fernandes (will join some sessions)
6. Dr. Rakhal Gaitonde
7. Mr. Prasanna Saligrama
8. Mr. S.J. Chander
9. Mr. Ameer Khan
10. Mr. H R Mahadeva Swamy
11. Dr. Durbha Rohini Kumar
Rapporteurs
1. Dr. P Adithya
2. Mr. Venkatesan
3
Background Papers
Ihese wili be circulated as a spiral bound document to all participants on arrival.
1. Curriculum Planning - Dr. DK Srinivasa from 'Medical Education: Principles
and Practice National Teacher Training Centre (NTTC), JIPMER. 1995.
2. Teaching for Better Learning - F R Abbatt, A Guide for Teachers ofPrimary
Healthcare Staff, 2nd edition WHO, 1992.
a) Explanation of terms
b) Overview of the problem
c) Curriculum design
d) Introduction to teaching methods
e) General issues and assessment
f) Assessment methods
3. Public Health Definitions and Competencies [extracts from SOCHARA
Contribution to the Indian Public Health Association (IPHA) Project]
a) Public health definitions
b) Public health competencies
c) Convergence and hierarchy of levels of public health competencies
d) Sub-themes for competencies
e) Dialogue on public health definitions
1) A list of definitions.
4. Perspectives, Principles and Key Components for CHFP (from 'Learning
Programs for Community Health and Public Health ’ - Report from a National
Workshop, CHC and CPHE, Bangalore, April, 2008)
5. Consolidated themes and sessions, reference books and reading materials
(from 'A Journey of a Thousand Lives.: Building Community Health through
Fellowships \ SOCHARA, CHC, September, 2011)
*
*
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A
USHERING IN CHANGE
19. CURRICULUM PLANNING
D./r.Srfn/vaM
OBJECTIVES
At the end of this chapter, the read would be able to:
1. Define curriculum.
2. Describe the steps of curriculum planning.
3. Understand the interrelationship between the various
elements of curriculum.
INTRODUCTION
A curriculum is a plan of educational experiences and
activities provided to a learner by an institution. It states general and
specific objectives, indicates selection and organisation of contents
(subjects,
scheduling
time table, giving
list of books),
mentions/suggests certain patterns of learning and teaching, and a
programme of evaluation of the learning outcomes.
Curriculum planning is a dynamic process and the curriculum
planners should be guided by curriculum determinants to make
decision about the scope, goals, and objectives of the course being
* planned, as well as the educational contents, training methods and
evaluation. (Fig-1)
STEPS OF CURRICULUM PLANNING
The following is a description of the steps and procedure
involved in planning a curriculum. (Rg-2)
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II
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1
166
Ushering in Change
OBJECTIVES
METHOD > OROANISATION
SUBJECT MATTER
E\*LUATIOH
Flg.1 Elements of Curriculum
|
■ .
>■ pl
x-
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CURRICULUM PROCESS
;
11 a&te;:
CURRICULUM
DETERMINANT'
WHICH OVIDE
WHICH SHOULD HSFLECr
[curriculum plans ]
JcUftRICULUM PLANNERS]
WHO MAKE
WHICH RESULT M
CURRICULUM
decisions
Fig .2 Curriculum Development Process
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Curriculum
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167
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1. Situation Analysis and Curriculum Determinants
I
The first step in planning a curriculum requires an analysis of
the existing situation, such as the goals enunciated in the National
Health Policy; health needs and demands of the people; trends and
patterns of morbidity and mortality; socio-economic status; scientific
progress; professional requirements and standards; and the
expectation of the students. This might require collection of large.
amount of data. Inquiry driven strategy may be used for this purpose.'
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Such an analysis helps in finding out the health needs. It can
also be used to prepare the job specification -- which in turn helps in
deciding what the students should learn.
The next step involves identifying the scope as well as the
tasks or job functions and the conditions under which a graduate
doctor is expected to work. For instance, the functions of a doctor in
a primary health centre is different from those in a tertiary hospital.
While he should be able to independently manage common endemic
disease conditions, he should have the necessary skills to recognise
and refer cases that cannot be managed.
Determining the essential tasks is a complex process. It may
require inputs from various sources as already mentioned and reaching
a consensus is not easy. An example of how a set of essential tasks
were identified is given in the Fig-3.
These are the determinants of curriculum. They guide in
defining the objectives of the course. .
2. Formulation of Educational Objectives
The educational objectives describe what knowledge, attitude
and skills medical students should acquire during their education. They
also define the goals of the course and describe the characteristics
and the attributes of the end product. The objectives should be based
on the tasks which the students are expected to learn. An example of
the Institutional Objectives of MBBS course followed at JIPMER is
3
168
Ushering in Change
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Fig.3 STRATEGY FOR CURRICULUM DESIGNING
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Curriculum Planning
169
given (Annexure).
Through inter-desciplinary and intra-disciplinary meetings
departmental objectives should be developed. It would be desirable to
formulate the objectives in the different domains and taxonomic levels
described by Bloom and others.
3. Selection of Contents
Both the analysis of needs and the statement of objectives
provide a preliminary guide for the selection of contents, i.e., the
subject matter. The content chosen must be relevant to the needs,
feasible and significant to the concept and the ideas connected to the
learning experience, and also create interest.
The content areas may be grouped with scaled priority and as
'must learn' and 'desirable to learn’ as it is not possible to learn
everything during the course. Some priority is essential. According to
Abbatt, " 'Must Learn' is the target. These are the things which every
student must learn if he is going to be competent in his job. These are
the things which the teacher should stress when he is helping
students to learn. These are the things tested in exams". There are
many other things which are 'desirable to learn'. Teachers should not
prevent students from learning. But these do not need the same
emphasis. Nor they may be tested as thoroughly in examination.
• .
o
Some elements that assume prominence during actual medical
practice needs special consideration. They are: the practice of primary
health care, ethical decision making skills, and practice management,
self assessment and self directed learning skills.
4. Selection and Organisation of Learning Experience
It is important to visualise as to what exactly are the
educational objectives and the expected competencies. The criteria for
desirable learning experiences must be applied by asking questions like
the following: Do they serve the objectives? Are they appropriate to
the nature of work and the level of are (primary, secondary and
170
Ushering in Change
tertiary)? Have opportunities been provided for learning the skills
required?
The learning experiences
b71mploV advance organisers' to relate basic concepts to more
difficult concepts; (cl integrate basic sciences teacl}'n9 ''J'ed
subjects; (d> encourage deep learning; le) provide for
learning; (e) incorporate evaluative mechamsms that give learners
meaningful feedback about their achievement.
include da variety of ways of
Care also must be
be taken
taken to
to inciuue
learning. In addition to the conventional methods other
video films, field trips, group discussions, role play, practice on
simulators and models should also find place.
Organisation includes the scheduling and arranging the time
table for various learning activities.
4
5. Evaluation
■
The curriculum should have a description of nature, frequency
and methods that will be used to evaluate different learning outcomes
These should include not only of knowledge, practical and clinica
skills but also of other abilities related to attitudes.
ethical decision making. It should contam a pan o interna
assessment, .specify the weightage or proport.on of marks that are
carried over to the summative evaluation. A scheme of
containing guidelines to paper setter, model question paper
procedures for practical and clinical exammat.ons would be of great
help.
CHECKING FOR BALANCE AND SEQUENCE
A written curriculum is needed to keep the course as a whole
well organised. After an outline of the curriculum is completed it is
essential to check the overall consistency and balance among various
components. Such an overview of the total plan .s requ.red as <t wdl
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Curriculum Planning
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171
help one to see that there is no serious oversights or inconsistencies.
This would help in avoiding content overloading as well as major
omissions.
I
EVALUATING THE CURRICULUM
The curriculum should be evaluated by teachers, students and
by critical incident studies. Evaluation may lead to changes in the
objectives, course content or teaching methods.
SUMMARY
I
5
Curriculum is a written description of what happens during a
course. It should be based on the health needs of the community and
on the tasks which students must learn. Teachers should be involved
in planning. It should include the objectives of the course, i.e., the
tasks and sub-tasks which the students will learn; the general
methods which will be used to teach the objectives; the time and
place where the students learn - a time table; and methods planned
to assess student's learning outcome.
The curriculum must include a high proportion of time for
practising problem solving, thinking, clinical and communication skills.
Periodic evaluation of curriculum is necessary. It may lead to
changes in the course contents and teaching.
SUGGESTED READING
1.
2.
i
3.
4.
Abbatt, F.R. Teaching for better learning. Geneva, World
Health Organisation, 1980.
Bloom, 8.S. ed. Taxonomy of educational objectives. The
classification of educational goals. Handbook I: Cognitive
domain. Handbook II: Affective domain. New York, David
Mackay Comapny Inc., 1956,
Harrow, A.J. A Taxonomy of Psychomotor Domain. New
York, David Mckay Company Inc., 1972.
Inquiry driven strategies for innovations in medical education
in India, The Consortium of Medical Institutions, New Delhi.
All India Institute of Medical Sciences, 1992.
f*
Teaching for
better learning
A guide for teachers of
primary health care staff
Second edition
F. R. Abbatt
World Health Organization
Geneva
1992
WHO Library Cataloguing in Publication Data
Abbatt, F. R.
Teaching for better learning: a guide for teachers of
primary health care staff. — 2nd ed.
1. Allied health personnel - education
ISBN 92 4 154442 2
2. Teaching - methods
I. Title
(NLM Classification: W 18)
© World Health Organization J992
Publications of the World Health Organization enjoy copyright protection in accordance with the
provisions of Protocol 2 of the Universal Copyright Convention. For rights of reproduction or
translation of WHO publications, in part or in lolo, application should be made to the Office of
Publications, World Health Organization, Geneva, Switzerland. The World Health Organization
welcomes such applications.
The designations employed and the presentation ot the material in this publication do not imply the
expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization
concerning the legal status of any country, territory, city or area or of its authorities, or concerning the
delimitation of its frontiers or boundaries.
The mention of specific companies or of certain manufacturers’ products does not imply that they are
endorsed or recommended by the World Health Organization in preference to others of a similar
nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are
distinguished by initial capital letters.
The author alone is responsible lor the views expressed in this publication.
Types®! in fnOia
Pdnt&d in England
91 /0920—Macniillan/C lays—7000
Contents
Foreword
v
Acknowledgements
vii
Chapter 1
1
Introduction
Part 1 What should your students learn?
1
II
II
II
x/Chapter 2
An overview ot the problem
7
Situation analysis
13
Task analysis
20
Curriculum design
36
Part 2 How you can help your students learn
45
Chapter 3
Chapter 4
^y'dhapter 5
II
sybhapter 6
II
II.
II
II '
II
II
5
Introduction to teaching methods
47
Chapter 7
How to teach attitudes
65
Chapter 8
How to teach skills
74
Chapter 9
How to teach knowledge
88
Planning a teaching session
97
^/Chapter 10
Part 3 Finding out how much your students have learned
x/6hapter 11
•^Chapter 12
General issues in assessment
Assessment methods
105
107
117
Part 4 Preparing teaching materials
133
Chapter 13
Initial planning
135
Chapter 14
Writing and evaluating the teaching material
142
II
II
II
II
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CONTENTS
Chapter 15
Layout and illustration
Chapter 16
Production and distribution of teaching materials
153
171
and manuals
s/' Explanation of terms used in this book
Index
iv
181
186
Explanation of terms used in this book
.•academic discipline A branch of instruction or learning, such as anatomy,
physiology, ophthalmology or history.
active learning The way in .which students learn by doing things, such as
solving problems, doing a project or working in a health centre. Sitting
listening to a lecture or reading a book is not active learning (Section 6.5).
assessment The process of testing a student’s ability or skill. This may be done
in an examination or by more informal methods.
attitude A tendency to behave or think in a certain way. For example, one health
worker may refuse to see patients when the health centre is closed. Another
may be willing to see patients at any time. This is because they have different
attitudes to their job.
book learning The kind of learning that can be achieved by reading books. The
phrase is usually used to imply that what is learned is too theoretical and not
sufficiently practical lo be useful.
case history The information about a patient that is used in treatment. It
includes details of the patient’s symptoms, the results of any tests or
examinations performed, and treatment.
cognitive
Associated with thinking (see also skill).
communication The process of transferring information or skills to other
people. For communication to take place, a message must be sent by one
person and received by the other. Communication is not just a matter of
speaking or writing. It also involves listening to and accepting other people’s
opinions and beliefs. Skills in communication are very important in health care
(see skill).
community A group of people who live in the same geographical area such as a
village or part of a city. The word can also be used to refer to a group of people
who have something in common, such as a religion or a profession.
181
‘Tl-ACHING FOR BETTER LEARNING
critical incident studies Studies of events or situations that trained health
workers have not felt able to handle. By analysing these incidents, the teacher
can find out where more training is required.
curriculum The written description of what happens during a course. It
describes the objectives of the course, the teaching methods, the amount of
time allotted to each part of the course, and the methods to be used to
assess the students. The word curriculum is also used to describe what
actually happens during the course (which may not be the same as the
written curriculum).
curriculum design The process of planning a curriculum for a course. Briefly,
Ibis involves deciding:
— what the students need to learn;
— what teaching methods will be used;
— how students will be assessed;
— the time and place where students will learn (the timetable).
evaluation The process of collecting information about assessing the value of a
course, a book, a lesson or even a student. Evaluation may be used to improve
the quality of the course or teaching material. This type of evaluation is called
formative evaluation. Evaluation may also be used to describe and assess the
overall value of the course or teaching material. This is called summative
evaluation.
facHIlator A person who makes things easier. For example, a teacher should be
a facilitator of learning—i.e., the teacher should make it easier for students to
learn.
feedback The process of telling people how well they are doing. For example,
teachers give feedback to students whenever they comment on the quality of
the students’ work. Ideally, the teacher should point out how well the work has
been done, any errors or faults, and how the quality could be improved
(Section 6.6).
field experience Experience of doing the job in the community. Trainee health
workers often join qualified health workers for periods of attachment. In this
way they gain experience of doing the job for which they are being trained.
The students work under supervision, and are given feedback on their
performance (see feedback).
health care team A group of people who provide health care in a community.
This may include a midwife, a nurse, a health inspector, a health educator, a
nutritionist, a health extension officer, and/or a doctor.
182
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EXPLANATION OF TERMS USED IN THIS BOOK
job description A description of the work that a particular category of health
worker is expected to do. It usually consists of a list of the tasks to be done,
such as "measure blood pressure" or "select sites for wells". It may also
describe the conditions under which the work will be done.
learning The process of acquiring information'or skills. For example, students
can learn from reading books or manuals, listening to lectures, and practising
what they have been taught (see active learning).
learning experience Anything which happens to a student that helps him or
her to learn. For example, a student might visit a village where the people have
improved the water supply. If the student learned how other villages could do
the same, this would be a learning experience.
lesson plan The set of notes that teachers write to guide themselves as they
give a lesson. The lesson plan might include the main points to be covered in
the lesson, activities for the students to do, questions related to the topic being
taught and some form of assessment.
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manual A book that describes in detail how to do various tasks. The word
manual is now often used to describe any book that provides information.
MCH clinic A maternal and child health clinic. The staff are responsible for
checking the growth and health of children and mothers and for providing
preventive health care (see preventive health care).
mother tongue The language spoken by a person at the time when he or she
first learns to speak.
motivation . Interest or drive which causes a person to behave in a certain way.
For example, a student with a strong motivation will tend to work hard and
learn quickly. Motivation is also used to describe the process of encouraging
or “motivating*' a person. For example, motivation occurs when a student is
inspired or persuaded to study hard. This may be because the teacher has
made the course more interesting, easier to learn, or more relevant to the job
(Chapter 6),
I
objective The target or goal of teaching. For example, when the students have
completed the course, they should be able to do tasks such as "construct
a latrine" or "teach mothers how to breast-feed a baby".
!
patient-management problem An exercise based on a case report, which can
be used to help students to learn (as a basis for discussion or in self
assessment) or as a method of assessment. Briefly, the students are given
183
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TEACHING FOR BETTER LEARNING
some information about a case and are then asked to answer a series of
questions (see Section 12.5)’
peer A person who is of the same ability or standing. For example, a student’s
peers are the other students on the course. A teacher’s peers are the other
teachers.
preventive health care Health care designed to prevent people becoming ill,
rather than to cure them once they are ill. Examples of preventive health care
include immunization, education, monitoring growth of children, and elimina
ting sources of disease.
reference materials Books, records, notes, tables or other sources of informa
tion used by students or health workers in order to find factual information.
reliability A measure of the accuracy and consistency of the marking of tests or
examinations. For example, if a student was given a mark of 75% by one
examiner and 50% by another examiner for the same performance, the
reliability of the marking would be poor.
resources Anything that is needed to do a job. For example, some of the
resources needed for running a course are a classroom, teachers, and
writing materials.
self-assessment The process of testing and judging one’s own performance.
For example, a student who attempts some problems, then looks up the
answers to see how well he or she has done is using self-assessment. Self
assessment can help students to learn.
situation analysis The process of finding out exactly what a health worker
should do in his or her work. This leads to a list of all the tasks done by the
health worker.
skill The ability to perform a task through the application of knowledge and
experience. There are different kinds of skills. For example, cognitive skills are
skills of thinking such as making decisions or reaching a diagnosis. Psycho
motor skills are skills of coordinating the mind and body. For example,
stitching a wound is a psychomotor skill—deciding whether stitching is
appropriate is a cognitive skill. Communication skills are the skills of talking,
explaining, persuading and listening.
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syllabus A written description of what should be learned by the students in a
course. Usually it is a brief statement outlining the topics to be covered.
184
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EXPLANATION OF TERMS USED IN THIS BOOK
task Anything that a person does as part of his or her job. For example, a health
inspector may investigate water tanks to find out whether they could be
breeding sites for mosquitos.
task analysis The process of studying a task in order to find out exactly how the
task is done and exactly what knowledge and attitudes are needed in order to
do the task.
teaching materials Materials that help students to learn, such as books,
handouts, models, exercises, and written questions.
trainee A person who is being trained. For example, a trainee health worker is a
person who is being trained to be a health worker.
typeface The style of lettering. If teaching materials are printed, there is usually
a wide choice of typefaces available. The typeface can vary in size, boldness
and style. For example, the letter “a” may be printed as an italic ua" or in
various styles of roman fettering e.g. “a".
validity A measure of the usefulness of tests or examinations, A test is valid if it
really does test the kinds of skill or knowledge that the students need in order
to do a job. For example, if a teacher wants to find out whether students can
measure blood pressure, he or she might ask them to write an essay on “ The
reasons for measuring blood pressure". This would not be valid. A valid test
would be to ask the students to measure a patient's blood pressure and to
watch them doing the task.
visual aid Anything that is used to show a diagram or picture. For example, if
a teacher wants to explain an idea to the students, he or she will often draw a
diagram or picture oh the blackboard or chalkboard, or show photographs,
films, or flip charts, etc.
workshop A meeting at which a group of people learn together. Often they will
meet to discuss and’solve a specific problem. Sometimes the workshop is
more like a short course in which the participants discuss problems, attempt
projects, and learn skills.
185
CHAPTER 2
An overview of the problem
• The purpose of a training programme is to teach students to do
a job.
• Teachers should concentrate on the essential facts, skills and
attitudes. It is neither possible nor desirable to teach everything.
< Teachers should base their teaching on the health problems of the
community and on the work their students will be expected to do.
e Teachers should plan courses and lessons using situation
analysis and task analysis.
A story
il
il
.1
I
II
I
A community nurse completed her training and passed all the exams at the end
of the course. She was given two weeks leave before starting work, so she went
back to her village to spend some time with her family. It was a long journey
because the family lived in a remote village, but everybody was pleased to
see her again. Her mother was specially pleased and very proud that her
daughter had done so well.
After the first greetings, the mother said "// is good that you are back because
your baby cousin is ill. The baby has diarrhoea and doesn't look well to me. Do
you think that you could help?" The nurse went.to see the baby and realized that
it was very dehydrated. She thought the baby should go to a health centre, but
the journey was too far. So she thought about what she had been taught. She
could remember details about the anatomy of the gastrointestinal tract and the
balance of electrolytes. She also remembered that a mixture of salt and sugar in
water would help to rehydrate the baby, but she couldn’t remember what
amounts to use.
She was very worried that the amounts would be wrong. She didn’t know whether
to send for help or to guess the amounts. By this time, the baby was very ill. She
made up the solution and gave it to the baby. The solution contained the wrong
proportions of salt and sugar. The baby died.
7
n
€
PARI 1. WHAT SHOULD YOUR STUDENTS LEARN?
Moral
Some courses for health workers may be ineffective or even harmful because
they spend a lol of time teaching facts that are not important. The courses may
fail to spend enough time teaching the skills that are really, needed.
2.1
Some basic principles
The story shows what can happen when a course for training health
care staff is unsuccessful. But what makes a course successful? The
following are basic principles.
Basic principles
1. The main aim of a course should be to train students to do a job.
2. The job determines what the students should learn.
3. Only those facts, skills and attitudes that are relevant to the job
should be taught and learned. Those that are not essential should
not be taught.
These may seem very obvious points, but they do have important
consequences, which are briefly explained in the next few para
graphs.
2.2
The main aim of a course should be to train students to
do a job
This is the basic principle on which this book is based. It means that
if students can do their job competently at the end of a course then it
has been successful. If they cannot do the work they have been
trained for, then the course has failed.
This means that the teachers must know a lot about the work
which the students will be doing. The teachers should watch experi
enced health staff doing their work. They should ask them about the
problems of providing health care. The whole course should be
closely linked to the way in which health care is provided. Chapter 3
explains how this may be done.
If this principle is followed, students will be able to do a job at the
end of the course, rather than just know about it.
8
AN OVERVIEW OF THE PROBLEM
Some people feel that this aim of ^training to do a job" is too
limited. They feel that there should be much more to education than
this. While there is some truth in this point of view, the wider goals
should be secondary. The first and most important goal is that the
students should be able to do their work in an intelligent, under
standing and competent way. This is the whole emphasis of this
book.
For example, a broadly educated health worker who infects
patients because he or she does not follow aseptic techniques is a
danger to the community. So it is important that students get the
basic competence first. When this has been achieved, other aspects
may be added to the training if time permits.
I
I
;|
23
The job determines what the students should learn
In all courses, choices have to be made about what facts, skills and
attitudes students should learn. Choices also have to be made about
what details should be left out of the course. It is simply not possible
to learn everything that is known about medical sciences and health
care. So some selection is essential.
:|
II
II
II
II
must learn
II
II
useful to leam
II
interesting to leam
II
II
II
II
II
"Must learn" is the target. These are the facts and skills that all
students need to learn in order to be competent in their work.
Teachers should stress the importance of these facts and skills when
9
II
I
1 ■
PART 1. WHAT SHOULD YOUR STUDENTS LEARN?
they are helping students to learn. These facts and skills should be
tested in examinations.
There are very many other facts and skills that are "useful to
learn”, but they do not need the same emphasis. Nor should they be
tested as thoroughly in examinations.
There are also very many other facts and skills that are "inter
esting to learn”. Of course, teachers should not prevent students
learning anything. In fact they should show students how to learn
from books, conversations and their own and other people’s experi
ence of the world. However, the teacher’s main responsibility is
to decide what students must learn and to make sure that they
learn it.
Facts and skills that must be taught are those that are needed to
do the job competently and thoughtfully. These are discussed in
Chapters 3 and 4.
2.4
Learning objectives
An important idea which should be introduced now is the concept of
learning objectives”.
A learning objective is a statement that describes what the
student should know, feel or be able to do at the end of the course.
This definition includes some important points. First of all, the
learning objectives concern the student and not the teacher. Sec
ond, the learning objectives describe the state of the student at the
end of the course. The learning objectives therefore do not describe
what the teacher will teach or the experiences the student will have
during the course. The learning objectives are therefore a state
ment of the targets which the course is trying to achieve.
Some writers also use the phrases ''learning goals" or "aims”.
Some writers make distinctions between "specific” and "general”
objectives. The distinctions between these terms are not very clear
and are probably not important.
2.5
Making use of learning objectives
The crucial importance of learning objectives ia that they define
what the students must learn.
They can do this at a very general level, e.g. “the learning objective
io
■ II
AN OVERVIEW OF THE PROBLEM
of this course is that the students should be able to do the work of a
maternal and child health (MCH) assistant”.
Or at a very specific level, e.g. “the students should know the
quantities of each ingredient in home-made oral rehydration solu
tion”.
So the learning objectives can refer to a whole course or to just a
few mi mites; of a lesson—or anything in between.
In all these situations, the learning objectives are vital because
they control (or should control) the whole process of teaching and
learning. The learning objectives determine:
^1
’I
e what is included in a lesson or course,
« how the teaching is done, and
• how the students are tested.
For example, if the learning objective is that "the students will be
able to diagnose anaemia from clinical signs”, then:
the students must be taught about the clinical signs of anaemia,
how to observe them, and how to distinguish between people who
are anaemic and those who are not. For this objective there would
be no point in teaching students about the structure of haemo
globin or how to test for anaemia using laboratory methods.
the students must be able to practise their skills of clinical
diagnosis on some patients with anaemia and some who are not
anaemic. There will be little need for lecturing.
9 each student should examine some patients and decide whether
they are anaemic or not. The teacher will then be able to assess
whether the students have achieved the learning objective. The
students should not be asked to write essays on anaemia, because
this is not related to the learning objective.
&
:l
il
il
a
•i
LEARNING OBJECTIVES
control
CONTENT
(what is taught)
a
METHODS
(teaching methods)
11
ASSESSMENT
(examinations/tests)
PART 1. WHAT SHOULD YOUR STUDENTS LEARN?
2.6
How can you decide what are the learning objectives?
The most important thing about learning objectives is that they
should be relevant to the job that students are being trained to do.
Because learning objectives determine what is included in a course,
they can damage all aspects of it if they are not relevant. The way in
which teachers and course designers decide what the learning
objectives should be goes back to the basic principle stated in
Section 2.1.
The main purpose of a course should be to train students to
do a job.
Therefore the learning objectives should be based on the job
description.
In summary, this is done by making a list of all the tasks that the
health worker will be expected to do. This process is called situation
analysis in this book, and is described in Chapter 3. Then each task is
analysed to find out what skills are involved and what knowledge
and attitudes are needed in order to do it competently. This process
is called task analysis and is described in Chapter 4.
These two processes together give a list of all the learning
objectives for a course—i.e., the skills, knowledge and attitudes
that should be learned. If all the learning objectives are achieved,
the health worker will be fully competent to do his or her work and
the overall purpose of the course will have been achieved.
12
CHAPTER 5
Curriculum design
Situation
- health needs
- resources of health system
- job description
situation analysis
Chapter 3
I
List of tasks
task analysis
Chapter 4
I
Learning objectives
- list of skills
- facts, attitudes needed
curriculum design
Chapter 5
I--------
Curriculum + lesson plans
- objectives
- teaching methods
: assessment methods
. -timetable
- evaluation
This chapter describes how the results of the situation analysis
and task analysis can be used in planning and evaluating the
curriculum.
5.1
What is a curriculum?
The word curriculum can be used in two different ways. It can be
used to mean what actually happens during the course—the lec
tures, the work with patients and so on. The other meaning is the
36
X3
CURRICULUM DESIGN
written description of what happens. This chapter will use
^curriculum" to mean the written curriculum.
What should a curriculum include?
A written curriculum is needed to help teachers to organize the
course. It should contain the necessary information to keep the
course well run, such as:
I•
I•
1. The objective of the course —i.e. the tasks and sub-tasks that the
students must learn.
2. The general methods that should be used to teach the students
the various objectives.
The
time and place where the students will learn i.e. a time
3.
table.
4. The methods used to assess the students.
5.2
Lesson plans and the curriculum
The written curriculum is needed to keep the course as a whole well
organized. In the same way a lesson plan is necessary to organize a
shorter period of teaching. It will need the same kind of information
about the objectives, teaching methods, timetable, and possibly
some note about the assessment methods.
It is essential to write down the curriculum for a course. On the
other hand, many good teachers do not need to write down their
lesson plans. There are many good reasons why teachers should
record a lesson plan. In practice, time is usually limited and experi
enced teachers can often manage without a written plan or with just
very brief notes.
A lesson plan is a small curriculum.
Suggestions for ways in which teachers can plan teaching ses
sions (i.e. make lesson plans) are given in Chapter 10.
5.3
When should teachers be involved in planning
curricula?
Teachers are often involved in planning the curriculum. They may
be involved as a member of a team planning a completely new course
or planning improvements in existing courses. Alternatively, they
may be asked to comment on a cuiTicuIum planned by other people.
37
PART 1. WHAT SHOULD YOUR STUDENTS LEARN?
They must be involved when they are teaching a curriculum,
because they should be trying to find ways to improve it.
5.4
Planning the course outline
Courses for health workers require a great deal of planning. The
first stage should be to plan a course outline. This breaks the course
down into smaller parts which can be analysed more easily.
It is obviously very important to make sure that this outline will
make it as easy as possible for the students to learn. Look at the
example below where learning is made difficult.
An example of a poor course outline
Course for community health nurses
Subject
Hours
Anatomy and physiology
Microbiology
Psychology
Sociology
Hygiene
Nutrition
Fundamentals of nursing
Community health nursing I ■
Community health nursing-II
Community health nursing III
90
30
60
60
60
60
210
. 225
120
345
This course outline has a number of poor features:
The basic science courses probably give much more detail than is
necessary for the job. This means that students waste time learn
ing unnecessary facts.
e The basic facts (e.g. sociology, nutrition) are taught quite sepa
rately from their application (community health nursing).
The separate courses—microbiology, psychology, sociology,
etc.—mean that the timetable is probably based on short fixed
teaching periods.
*
38
‘>5
CURRICULUM DESIGN
A better way of planning the curriculum would be to base it on the
tasks of the community health nurse.
Example—A course outline based on tasks
Community health—water supply, food storage and waste disposal
Family health—nutrition and health education
Maternal and child health care
Midwifery
Prevention and control of communicable diseases
First aid and emergency medical care
Training village health workers
Promotion of community development
This outline is designed to train students to do exactly the same job
as the previous example, but it has .a number of important differ
ences.
The whole course is designed to give the students the necessary
skills to do the job.
The underlying theory is learned at the same time as the practical
applications. This is likely to lead to faster and more thorough
learning because the students can understand exactly why the
theory is needed.
The timetable can be much more flexible. This makes it easier to
arrange longer periods of work such as project work or supervised
practical work in the community. It gets away from the rigid
pattern of one-hour lectures.
I
Base the curriculum on the tasks that the students need to learn.
5.5
What kinds of teaching methods will be used?
Many courses for health workers include too much classroom
teaching and concentrate too much on teaching facts.
I
I
39
PART 1. WHAT SHOULD YOUR STUDENTS LEARN?
If you prepare a list of tasks for any category of health worker you
will find that most of the tasks involve:
© using the hands (e.g. giving an injection)
• making decisions (e.g. deciding whether a cough is a symptom of
pneumonia)
© communication (e.g. explaining to a mother the need for protein
in the diet).
You must give students opportunities to practise these skills during
the course. Unfortunately this practice often takes a lot of time and
effort to organize. It may be quicker and easier to give a lot of
lectures, but the students will not learn the necessary skills.
The curriculum should include enough time for students to prac
tise the tasks they need to learn. Sometimes this will involve them in
working in the community, for example, in a hospital or nearby
health centre. Sometimes they can practise on each other in the
classroom. Specific suggestions for teaching methods are given in
Part 2. In planning the curriculum, teachers must allow enough
time for this practice.
It is impossible to specify how much time is required for every
course. However, most courses should allow much more time for
practising skills than for theoretical teaching.
Less lime for theory
More time for practice
5.6
What kind of assessment methods should be used?
It is important that the course should be based on the job that the
students are learning to do. Therefore the assessment must test
whether they can do the job. This approach is called performance
testing. It means that assessment methods such as those based on
multiple-choice questionnaires and essays are used less often.
Such methods usually only test the students’ knowledge. Other
assessment methods such as those based on case-studies and case
books are used more frequently. These methods test the important
skills and attitudes.
More details on methods of assessment are given in Part 3.
40
2^1
CUHRICMLUM DESIGN
57
Evaluating the curriculum
The students should be assessed to see whether they have learned
the necessary skills and facts. In the same way, the curriculum
should also be examined to find out whether any changes are
needed. This process is called curriculum evaluation.
The aim of curriculum evaluation is to find out how successful the
curriculum is and to find out ways in which it can be made better.
The basis for the evaluation is to see whether the students learn how
to do their job satisfactorily.
The curriculum can be evaluated by testing the students at the
end of the course. If they complete their examinations satisfactorily,
this suggests that the course has been good enough. However,
the examinations must be relevant and based on the job that the
students are being trained to do. Also, the course may help the
students to reach a satisfactory standard, but it may take much
more time than necessary.
The curriculum can also be evaluated by finding out how well the
students are doing after they have left the school or college and
sLifted work.
i
|
-
iJ
Examp/e—On-the-job evaluation
!>■ ' ne district a group of health workers were trained to do a number of tasks.
One of the tasks was to conduct an immunization programme. After a few
months it was'.found, that a lot of the mothers brought their children for the first
vaccination. Only a few came back for the necessary second injection.
J
Comnienis
Clearly this part of the training programme had not been successful.
I
I here are many reasons why the programme may not have succeeded, for
example:
w the health workers may have had too many other responsibilities and so did
not have enough time to talk to the mothers about the need for the second
injection.
the programme may not have trained the workers how to communicate.
the programme may have failed to teach them suitable attitudes.
41
I
1
PART 1. WHAT SHOULD YOUR STUDENTS LEARN?
5.8
Methods of evaluating the curriculum
Analysis of health needs
In the example above, the weakness of the training programme—or
the curriculum—was shown by an analysis of the health statistics
for the district. This is the best way to evaluate a curriculum,
.* although it may not always be possible. It is the best way because
the purpose of the curriculum is to train people to solve health
problems. If the health workers can solve the problems, the curri
culum is probably satisfactory. If not, it may need to be improved.
Health statistics are usually available for details such as:
— the number of children immunized,
— the number of live births,
— the number of infant deaths, and
— the number of cases of disease.
If the statistics are available, they can help the teacher to decide
which parts of the curriculum need improvement.
But remember that some of the things health workers are trained
to do cannot be easily shown in statistics. Also, in many areas the
information collected may not be very reliable or complete. For
example, the number of reported cases of diphtheria may go up
because the system of reporting the disease has improved—not
because more people are suffering from diphtheria.
Critical incident studies
Critical incident studies are a fairly simple method of finding out
from the health workers themselves how successful a curriculum is.
The teacher asks an experienced health worker to desciibe five or
six recent events that he or she has not felt able to handle. These
situations are the critical incidents. This kind of questioning is then
repeated among a sample of recently trained health workers. Using
this approach, the teacher can build up a picture of the situations
that have caused problems for health workers.
Some of the critical incidents may be very unusual or rare. In
some cases it may not be necessary to change the curriculum. Again,
if only one worker finds that a particular situation causes problems,
while all the others report that they can deal with it, then probably
42
CURRICULUM DESIGN
no action needs to be taken. However, if several workers report
difficulty with similar situations, then clearly the curriculum should
be looked at.
Supervisors' reports
In many countries the work done by the health workers is super
vised. In some cases this supervision is carried out almost continuOusly—as in hospital wards. In other cases the supervision is very
restricted—for example when health workers work alone in remote
villages. Therefore the value of supervisors’ reports will vary from
one situation to another.
However, all of these reports can be more useful if the supervisors
are asked to comment on specific points. For example, you may have
tided teaching part of the curriculum differently, so ask the super
visors whether they notice any differences in the way the new
health workers do that particular job. Supervisors can also help if
they identify the tasks that the students do well or badly at the end
of the course.
They may also be able to point out the tasks that are taught
wrongly. For example, students may not have been taught about
local traditions or how to cooperate with village councils.
If the teacher asks for advice from supervisors and acts on that
advice, the curriculum will be made more effective.
5.9 Evaluating lessons
Lessons can and should be evaluated. This is just as important as
evaluating the curriculum.
Broadly the same methods should be used. After a lesson (or
possibly a group of lessons), the teacher should find out how much
the students have learned. This evaluation should be based on
performance testing. The teacher should find out whether the
students can do the tasks that they have been taught to do.
If the students cannot do the tasks, then the teacher must change
the content of the lessons or the teaching methods.
43
PART 1. WHAT SHOULD YOVR STUDENTS LEARN?
5.10 Summary
1. The aim of a curriculum or a lesson should be to give the students
the skills and the knowledge needed to do the job,
2. The content should be organized on a "task^. basis.
3. The curriculum must include a high proportion of time for
practising the skills of communication, thinking, and using
equipment.
4. Evaluation may lead to changes in the content or the teaching
methods.
I
44
CHAPTER 6
Introduction to teaching methods
Part 1 dealt with what your students should learn. This part goes on
to explain how you can teach them. The two parts should be read
and used together, because students will only be well trained if the
teacher uses good methods and teaches the right skills.
Part 1 pointed out the importance of training students how to do a
job rather than just know about it. Again in this part the main
emphasis will be on students ''learning by doing” rather than simply
listening. This principle could be summed up by the old Chinese
proverb:
"hear and forget . . . see and remember ... do and understand”.
The aim of this part therefore is to help you to choose the best
teaching method for each part of the course and to give some advice
on using each method effectively.
The part is arranged as follows. Chapter 6 gives general guidance
about problems such as motivating students and making subjects
meaningful to them. The three remaining chapters describe par
ticular methods that can be used in teaching attitudes (Chapter
7), skills (Chapter 8) and knowledge (Chapter 9). Chapter 10 brings
all the ideas together in a description of how to plan a lesson.
6.1
The rote of the teacher
How can the teacher help students to learn? It used to be thought
that teachers needed to tell students as much as possible, passing on
their knowledge. Now teachers arrange for students to gain experi
ence by working in health centres. They may also advise students
to read a few pages from a manual and set questions for students to
discuss in groups. In all these ways the teacher is helping students
to learn.
Some teachers feel that they must do all the talking themselves.
They feel that they are not really teaching unless they are telling
the students some new information. But this is quite wrong.
47
PART 2. HOW YOU CAN HELP YOUR STUDENTS LEARN
If a teacher gives a lecture and the students do not learn, then the
teacher is talking—not teaching.
The following chapters explain different ways in which you can
help students to learn. You may already use some of these methods.
You may feel that some of the methods will not work for your
students. However, all the methods described have been used by
teachers. Even if you cannot use a method as described here, you
will probably be able to adapt it so that you can use it.
Remember that change is always difficult. It is easier for teachers
to carry on using the same teaching methods. When you have
prepared a course of lectures, it takes only a little effort to keep on
giving the same lectures year after year. If you want to try new ideas
you need to work to make those ideas succeed. Some students will
find it difficult to use some of the more active forms of learning. You
must explain to your students what you are trying to do and make
them interested in the new teaching methods. If students have been
used to sitting in classes just listening to the teacher it will be
uncomfortable for them to learn for themselves. You need to under
stand this feeling and reassure the students that they can learn from
their own experience—with a little guidance from you.
6.2
How well do you teach?
Below there are a list of questions for you to answer about your own
teaching. If'you can answer “yes" to most of the questions, then you
are probably teaching well. If you answer “no” or are not quite sure
what the question means, look at the corresponding section. For
example, the first three questions are concerned with “clarity",
which is discussed in Section 6.3.
Clarity (Section 6.3)
Can the students hear what you say and read what you write?
Do you use simple language?
Do you use visual aids?
Do you summarize the main points?
48
33
if
ii
INTRODUCTION TO TEACHING METHODS
Making your teaching meaningful to students (Section 6.4)
Do you relate what you are talking about to the students' lives?
Do you give a lot of examples?
Do you relate what you are talking about to the work the stu
dents will be doing?
!
Active learning (Section 6.5)
Do you ask students to answer questions?
Do you ask students to apply information in solving problems?
Do you arrange for students to practise thinking and practical
skills?
Giving feedback (Section 6.6)
Do you tell students how well they are doing?
Do you point out any errors or faults?
Do you explain how students could do better work?
Ensuring mastery (Section 6.7)
i
Do you check that all your students understand each point?
Do you frequently check whether every student has learned the
necessary skills and knowledge?
individualize (Section 6.8)
Do you allow students to work at different speeds?
Do you encourage students to learn in their own way?
Do you use several teaching methods?
Caring (Section 6.9)
Do you show the students that you care whether they do well?
Do you prepare thoroughly for teaching sessions?
Do you listen to students' comments about your teaching?
49
PART 2. HOW YOU CAN HELP YOUR STUDENTS LEARN
6.3
Clarity
Obviously your teaching must be clear. The students must be able to
hear what you say and read what you write. All teachers believe
that what they say and write is clear—but are they right? Can your
students read what you write? Ask another teacher to sit at the back
of your class and tell you whether he or she can see and hear clearly.
Look at your board at the end of a lesson and see whether it is set
out clearly. Can you read your own writing? If you cannot, the
students definitely will not be able to.
The students may be able to hear the words you say but not
understand them. If you use words that are unfamiliar to students or
speak a different form of the language, it will be difficult for them to
learn. Make sure that you talk in a way that the students can
understand.
WHO 9X-S92
The students may be able to hear the words you aay, but they may not ready understand
them.
To help you make writing or diagrams clearer you may be able to
use visual aids such as charts, posters, flannelboards and pos
sibly slide-projectors or overhead projectors. These will all help
to improve clarity. Some useful tips are given in Section 9.7,
Most teachers use a blackboard or chalkboard of some kind.
Sometimes the board will look a mess at the end of a lesson, with no
pattern to the words and untidy diagrams. Decide before the start of
50
INTRODUCTION TO TEACHING METHODS
the lesson what you are going to show on the board. Then during
the lesson, write the key words or phrases in order so that they show
the structure of the lesson. Remember that students tend to copy the
words and the layout the teacher writes on the board. Make sure
that what you write would look good in the students’ notes.
At the end of the lesson, summarize the main points—as this book
does.
Summary
Make sure that your students can hear what you say and read what you write.
Also check that your students understand the words you use.
Al the end of the lesson summarize the main points.
6.4
Making your teaching meaningful
Exercise
Look for about 2 or 3 seconds at the two diagrams below.
A.
B.
WHO 9f590
Now turn over the book and try to draw the two diagrams. Then read on.
51
....
PART 2. HOW YOU CAN HELP YOUR STUDENTS LEARN
Comments
You could probably draw diagram B. It has a pattern to it that makes sense
three squares joined together. Diagram A was probably much more difficult to
remember. There was no shape or meaning to it. But in each case the number of
lines was exactly the same.
What does this have to do with teaching? The diagram that was
easier to remember has “meaning”. It is similar to patterns you have
seen before. If you can make your teaching have meaning then
your students will learn more easily.
How can you achieve this in practice? Here are some suggestions.
(a) Explain in advance what you are going to say. This can be
done by telling your students what the objectives are for a part of
the course. In this way the students will know what they need to
learn and so they can make more sense of the teaching.
(b) Try to relate what you teach to students’ lives. Your
students will have a lot of experience which is useful and important.
For example, when you are talking about sanitation, find out what
your students know about the subject. You can then use their
knowledge as a basis for teaching. Do not assume that students
know nothing about the subject you are teaching. If you are talking
about diseases such as schistosomiasis, find out whether the stu
dents know people suffering from the disease. If you do this, the
teaching will have meaning for the students.
This book tries to make the ideas meaningful to you by explaining
them as problems that you may face in your teaching.
(c) Explain new words. When you are giving information to
students, you will have to use and explain new words and concepts.
Some teachers like to use long and complicated words just to show
how clever they are. This must obviously be avoided, but you will
need to use some new words. When you do, you should define them
carefully. You should also use a lot of examples to explain their
meaning and, if possible, arrange for the students to practise using
the words. This may be in discussion or in writing. In this way the
students will begin to get a fuller understanding of the meaning of
t he words or concepts you use.
52
H
INTRODUCTION TO TEACHING METHODS
Examples of explaining a new idea
i'
I
For example, you may want to explain the concept of circulation of the blood
to students. This will involve the use of a possibly unfamiliar word “circula
tion:' It will also introduce the idea of blood travelling round the body, which
may also be unfamiliar. To teach this idea you might define the word circula
tion and then ask students to think of other things which circulate, such as
money or traffic.
Then encourage the students to use the concept. For example, ask them to tell
you what are the effects of the blood circulation. They might say that it allows
certain substances to be carried from one part of the body to another. They
might describe what would happen if the body was badly cut. In this way your
students will quickly gain an understanding of the concept involved.
I
I
(d) Use examples. When you are describing a new idea or a
method of treatment, give examples. You might talk about an
experience that you have had recently. Even better you might
talk about a patient that the students have just seen, or the
water supply for a village that they know.
Note that this book uses a lot of examples to explain the ideas.
(e) Relate the teaching to the work that the students will be
doing. Information and skills will have much more meaning to
students if they know how they will be using the information in
their job. You might, for example, want your students to be able to
use a microscope. Some students will be interested in microscopes.
Others may not be so interested and so will not learn well. However,
if you explain that the students will use a microscope in their job as
a way of confirming diagnosis of common illnesses, then they are
likely to be much more interested and to learn better. The learning
will have more meaning for the students.
I
Summary
You can help your students to learn by making sure that what you teach has
meaning for them.
— explain in advance what your students are expected to learn
— relate what you teach to the students’ lives
— explain new words and ideas
53
PART 2. HOW YOU CAN HELP YOUR STUDENTS LEARN
— use many examples to explain what you mean
relate the teaching to the work that the students will be doing.
6.5
Active learning
Many experiments have shown that students learn very little when
they are listening to a teacher giving a lecture.
They learn a little more if the teacher writes on the board and uses
diagrams and pictures. In this way the students can see what they
have to learn as well as hear it. But still rather little is learned.
To help students to learn you should give them some exercises to
do, such as answering questions, writing notes or explaining an idea
(to a friend or to the whole class). Tire students will also need to
practise any skills that you teach them. The importance of these
exercises is highlighted in the Chinese proverb at the beginning of
the chapter.
f
WHO 91593
“hear and forget... sec and remember ... do and understand”.
Of course some exercises will be more helpful than others. As a
rule, the exercise should make the students use information rathet
than just repeat it. Active learning can also be used in books or
handouts. To illustrate the method here is an exercise for you
to do.
54
3^
I'
f
I
INTRODUCTION TO TEACHING METHODS
I
Exercise
Imagine you are teaching students how to take a patient’s temperature. Which
of the following activities would be most useful after you have explained how
to do the task?
I
I
A. Read a section from a manual on taking temperatures.
B. Copy your notes from the board.
C. Make notes in their own words on how to take temperatures.
D. Write down the temperature reading shown in five drawings of a thermo
meter.
E. Use a thermometer to find out the temperature of another student.
F. Calculate the change in volume of 5 cm3 of mercury when its temperature
changes from 10 °C to 40 °C.
Write down your answers and give reasons.
I
t
Comments
!•'
I
With the exception of F, all of the activities are better than no activities at all. E is
probably most useful because the students will need to use all the information
you have given. They will have to read the thermometer as well as use antiseptic
techniques, shake the mercury down, place the thermometer correctly under the
tongue, etc.
Activity D is also useful as some students may have difficulty reading off a scale. It
would help the teacher to find out exactly which students needed more help.
Activity C is better than B because the students- have to explain the task
themselves instead of just copying the teacher’s explanation.
I
I
Activity A might be worth doing so that any points in the manual which were
difficult to understand could be explained.
Activity F is probably not worth while because the students will not have to do
this kind of calculation in their job. It will waste time and may confuse the
students.
I
I
You should not use all the activities. Some may not be possible—for example, do
you have enough thermometers? Instead, you should choose one or a few ol the
activities that you feel would help the students to learn best.
I
55
I4-O
PAAT 2. HOW YOU CAN HELP YOUR STUDENTS LEARN
There are many different kinds of activities which are useful for
different kinds of objectives. For” example, you might develop
projects for the students to do in which they collect data about
health needs. You might use role-playing exercises in which stu
dents act the parts of different people they are likely to meet in their
work. You might ask groups of students how they would solve a
health problem in their community: All these methods will give you
more work to do, but they will also help the students to learn. These
methods are explained in more detail in Chapters 8, 9 and 10.
This book gives you exercises to do while you are reading. In this
way the book uses active learning methods. Do you find that tile
exercises help you to learn?
Summary
it is easier for teachers to keep talking during a lesson, but it does not help
learning. Instead, teachers should think of activities that will torce the students to
use the information that they have been taught. Teachers should use as many
activities as are realistic, and so help students to learn.
Do not just talk—make your students do the work.
6.6
Giving feedback
Feedback is one of the fashionable words in education at the
moment. What does it mean? Simply that when the students have
done a piece of work, the teacher should tell them whether they
have done it well. The teacher should also point out any errors or
faults and explain to the students how the work could have been
done better. This process of telling students how well they are doing
is called feedback.
Feedback can also come from written material. If you ask students
a number of questions and then give them the answers on a sheet of
paper, this is also feedback. If you give guidance to the students they
can sometimes give feedback to each other (see self-assessment in
Part 3).
Of course, many teachers have been doing this for a long time, so
the idea of feedback is not at all new or different. What are the ways
in which feedback can be given?
56
L0
INTRODUCTION TO TEACHING METHODS
The first point is that if students only listen to a teacher talking,
there is nothing to give feedback on. So feedback and activity go4
together. To give feedback, you must first arrange for the students
to do things that can be assessed. This means that there should be
frequent tests of the students’ ability to do the practical tasks
required, to remember the necessary facts, and to use those facts in
solving problems or communicating.
These tests may be formal examinations. If these are held, the
teachers will have to do a lot of extra work and the students may
become interested only in passing examinations and forget the
real reasons for their training. A better way is for the activities
and feedback to become part of the normal pattern of teaching.
The students will be able to assess their own performance or that
of other students if they are given guidance by the teacher. The
feedback should usually have three parts.
1. Feedback should give some encouragement and praise for what
has been done well.
2. Feedback should give an indication of the overall standard of the
work. For example, “5 out of 10” or "Pass”.
3. Feedback should point out any errors or faults and show how the
performance can be improved.
Example of giving feedback
You might watch a student practising .how to bandage a patient to provide
support for an injured arm. When the student has finished, you might say "Weil
done. You have done quite a good job. The bandage is tied firmly so it should not
come undone by itself. You have also used the right method of bandaging, so
overall the standard is satisfactory. But you should have made sure that the lower
arm was held level. You have made the bandage lift the patient's hand slightly
higher than his elbow. To do this better you should. .
Note that this example shows the teacher giving some praise—
"well done”.
The teacher gives an indication of the standard of the work—
"quite a good job” . . . "it will not come undone by itself” . , . "right
method” etc.
The teacher also points out the faults and shows the student how
to do the job better— "you should have made sure that the lower arm
was held level”.
57
PART 2. HOW YOU CAN HELP YOUR STUDENTS LEARN
Summary
Give as much information as possible to students about the standard of their
work. Praise the good things, but also show how they can eliminate errors.
6.7
Ensuring mastery
The phrase "ensuring mastery1 simply means that you make sure
that all the students know the facts and skills that they need at each
stage.
Ideally this is done at the beginning of each lesson.
When you are teaching some topics, the students may need to
have understood ideas taught in an earlier lesson. For example, if
you are discussing a growth chart.for babies, the students will need
to know what a graph is and how to record data on a graph. These
ideas may have been taught some time ago, so the students may have
WHO 91594
. , bo the etudente may have forgotten or postibly never understood”.
58
INTRODUCTION TO TEACHING METHODS
forgotten or possibly never have understood. This means that they
will not be able to understand the growth’chart.
To overcome this difficulty you should check at the beginning of
the lesson that all students know the necessary facts and skills.
Do not ask “Does everybody know about graphs?^ If you do, the
students will probably say “yes”, whether they understand or not.
Nobody likes to admit that they do not kndw something. Instead you
should give a very short test. For example, you could draw a graph
on the board and ask the students to write down what a specific
point on the graph means.
You should also find out how much your students know at the end
of the lesson—or even at various stages during the lesson. Again, do
not just ask “Do you understand?^ Instead ask the students to use
the skill or tell you the facts.
This technique may seem obvious. Most teachers think that they
do ''efisure mastery1'. In fact if you talk to students and find out
exactly what they know, you may be surprised at how little they
remember from previous lectures.
Summary
At the beginning of the lesson, check whether all your students know the
facts and skills that they will need. Then, at the end of the lesson, make sure
that all the students have learned these essential facts and skills.
6.8
Individualize
Most teachers agree that different students learn in different ways.
Some students are very intelligent, while others seem to be rather
less clever. Some students may be very good at learning facts but
rather poor at doing practical work. Others are the opposite. Some
students can learn from books, while others prefer to listen to the
teacher talking. Other students learn best by practical experience of
doing the job.
However, schools often treat all students as if they were identical.
All students go to the same teaching sessions. There they listen to
the same lecture and then do the same practical work.
Of course, it is much simpler and cheaper to treat all students in
exactly the same way. It is also easier to keep control of their
59
PART 2. HOW YOU CAN HELP YOUR STUDENTS LEARN
whereabouts because the timetable will say where every student
should be at any given time. But is this the most effective way of
learning? Does it prepare students to take more responsibility for
their own learning? Remember that after they leave the training
school they will usually need to work and learn on their own.
WHO
Schools often treat all students as If they were identical.
What can teachers do to help the individual students to learn?
Here are a number of suggestions which would be realistic in
many training schools.
(a) Make sure that there is enough time for students to
. learn on their own. To do this you may have to cut down the
number of lectures. Some people suggest that there should be as
much as 2 hours of time free for individual studying for every hour
in a class. This would allow the students to learn at their own pace
outside the lecture room.
(b) Use some different teaching methods. Some students learn
better from books, while some learn better when topics are discussed
in a group. Some students learn well from films or film-strips (if these
are available).
It is not usually possible to give a choice of teaching methods.
However, teachers can use a variety of methods and so meet the
needs of a larger number of students.
60
INTRODUCTION TO TEACHING METHODS
(c) Make more use of project work. To do this you set students
a large-scale task such as finding out what village people think are
their major health problems. Project work allows a lot more scope
for students to learn in their own way. It also gives a contrast to the
lectures.
(d) Talk to students individually. If you talk to the students by
themselves you will find that some students are confused by one idea
while others find the idea quite easy to understand. You will then be
able to explain the idea yourself, or tell the students where to find
the relevant information.
(e) Use self-instruction methods. Where possible use tape-slide
programmes or programmed texts. Where this is not possible
because of lack of equipment or suitable programmes, you can
help students by giving them written notes. These notes can
guide the students in using manuals for health workers. Notes
can also be used in practical work to remind, students of the
skills that they need to learn.
Summary
Remember that your students are individuals. They learn at different rates and in
different ways. They have different interests, experiences and abilities. Try to find
out what each student is like. Then use this information to vary your teaching so
that as far as possible each student can learn in his or her own way.
6.9
Caring
Students will often do things for one teacher that they will not do
for another. How then can you use this to help your students learn?
One thing that encourages students to make more effort is the
belief that the teacher cares about them. Note that it is not
enough for the teacher to care. The students must know that the
teacher cares.
This does not mean that you should give higher marks than other
teachers or allow poor standards of work or behaviour. This gives
the opposite impression. Nor should you be content to say “I care
about . . y. Simply saying the words will not persuade many of
your students for very long. Instead, the way that you as a
teacher behave will show whether you care or not.
61
PART 2. HOW YOU CAN HELP YOUR STUDENTS LEARN
Exercise
Look at the list of statements about a teacher. Which statements would you like
to be true of you?
A. She wears clean and tidy clothes.
B. He always arrives for teaching sessions on time.
J
C. She prepares thoroughly for leaching sessions.
D. He shows that he is very knowledgeable about the subject by using all the
technical words.
E. She is a very important and very busy person. So she has to hurry away from
teaching sessions to do other work.
F. He never smiles or jokes, because learning is a very serious business.
G. She always praises students’ work, however bad it is.
H. He talks to students and finds out what their personal interests and ambitions
are.
I. ‘ She asks students to comment on the teaching sessions so that the sessions
can be improved.
J. - He ignores the comments students make about the lessons.
K. She requires the students to do work of a high standard.
Comments
The "correct" answers are probably obvious. The only statements that need
expanding are D, G and H.
Statement D reflects one of the worst things that some teachers do. Teachers
should not use technical words just to show how clever they are. They should
take pride in the way they make ideas easy to understand.
Statement G is typical of teachers who are trying to encourage their students. But
teachers should not praise bad work. Your aim should be to praise whatever is
worth praise, but point out the weak points and insist on a high standard.
Statement H may seem unrealistic. Teachers do not have time to talk to all their
students for long periods of time. But you should try to talk and listen as much as
possible. When you are talking, try to find some shared interest. For example, you
may know someone from the student’s village. You may be interested in the
same sport as the student The important point is for you to show the students
that you care.
62
INTRODUCTION TO TEACHING METHODS
Summary
If the students believe that the teacher cares about them, they will have an extra
reason for learning.
6,10 Motivation
Some mention must also be made of motivation. It is often said
that motivation is the key to successful teaching. All that a teacher
needs to do is motivate students and they will learn.
How can teachers motivate students? The answer is simply to use
the ideas described in Sections 6.2 to 6.9. Each of these ideas will
help to make the courses more interesting, easier to learn or more
relevant to the student’s career. Above all they will help students
realize that you care about their success. All these ideas will help to
motivate students.
6.11 Conclusion
Some people argue about whether teaching is an art or a science. In
other words, some people believe that the talent for teaching is a
natural gift that good teachers are born with. Other people believe
that teaching is a science which is controlled by rules.
This part of the book is designed to show you that there are some
general rules for teaching. If you follow these, your teaching will
improve. If you do the opposite to these rules, then your teaching
will almost certainly be poor and the students will not learn.
In order to teach well, you will need to apply the rules for your
students, your subject and your school or college. You still have to
think of ways to make your teaching sessions have more meaning
for your students. You have to be imaginative and think of activities
which will be useful to your students. You have to take the trouble
to give feedback to your students and to show that you care about
their success.
63
4-8
PART 2. HOW YOU CAN HELP YOUR STUDENTS LEARN
Summary
1. Make the learning active ask questions, set problems and
organize projects.
2. Give feedback—explain how well each student is doing and how
his or her work could be improved.
3. Make your teaching clear—check that the students can hear
what you say and see what you write. Speak loudly, use simple
language, write tidily, and use visual aids.
4. Make your teaching meaningful—explain how it will help stu
dents to do their job better.
5. Ensure mastery—check that all students know the necessary
tasks and can perform the necessary skills before and after each
session.
6. Allow for individual differences—let students learn at their own
pace, leave enough free time for individual study and use a
variety of teaching methods.
7. Show that you care whether students learn—set high standards
and get to know each student.
64
CHAPTER 11
General issues in assessment
One of the most important parts of the teacher’s job is to find out
how much students have learned. This process is called assessment
atXkThTcha0^
examinations or watching students
,ssuea and
.0
11.1 A'hy must students be assessed?
Most teachers agree that students should take some kind of
examination or that students’ ability should be measured in some
way. In other words, students should be assessed.
It is important to assess students because:
L
need 10 >make SUre that the students will be able to do
professions^16" y’ 1S13 eSpecialIy imPortant in all the health
{-'a vi i vobiuno,
2. Examinations and tests encourage students to work harder
which5™611?3
be
tO gUide teachers and students about
need to bXro^OUrSe h£'’''’ b“n SU“MS'fUl ',"'i Wh“h P’rts
Naturally no single assessment during the course can achieve all •
these objectives. For example, a final examination may be good for
seeing whether students are able to do the job. But it will not be
much use m guiding students about what they should learn
It is important to think about the reason why you are assessing
students in any test or examination. Then you can design the test
accordingly. You need to decide who will do the assessing, when it
wi be done, and what kinds of questions you will use.
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PART 3. FINDING OUT HOW MUCH YOUR STUDENTS HAVE LEARNED
11.2 What makes a good assessment?
When you design the assessment methods for a course or lesson,
there are five questions that you need to consider.
1. Does the assessment comply with the regulations for the course?
2. Is the assessment reasonably economical in terms of materials
and time?
3. Does the assessment test the important skills and abilities? (Is the
method valid?)
4, Are you sure that the marks gained by each student are accurate?
(Is the marking reliable?)
o. Does the assessment give information that will help the students
to learn better and help you to improve your teaching?
The first two points are fairly straightforward. Sometimes there
are regulations about the kinds of examinations that must be
used. These regulations must be observed, but often the regula
tions only concern the final examinations and allow teachers to
choose which methods of assessment to use during the course. If
you feel that the regulations prevent you assessing the students
in a satisfactory way, talk to other teachers and the people
responsible for making the regulations. They may decide that
the regulations need to be changed.
Assessments must not involve too much time and effort. Methods
such as oral examinations and essays have disadvantages because
they take up so much of the teachers’ and examiners’ time.
The remaining questions are discussed in Sections 11.3-11.5.
11.3 Making sure that the assessment tests the important
skiHs and abilities
After some recent anatomy and physiology examinations in a medi
cal school, a senior clinician said
could not answer the questions,
nor could any of the other doctors who read the examination paper. I
could not understand why the students needed to know these things.”
This case highlights a serious problem that can occur in any
schools that train health workers—students are often asked about
facts that are not important.
This problem is serious because students naturally want to do
108
51
e
GENERAL ISSUES IN ASSESSMENT
...
well in examinations and so they learn what they think will be in
the examination. The solution is to test only those skills and
abilities that you believe are important.
If the learning objectives have been derived properly, then all the
learning objectives will be important. Therefore the assessment
should test directly whether the learning objectives have been
achieved. If this is done, then the assessment will test the important
skills and abilities. When this happens, the assessment is said to be ualid.
Sometimes examinations focus mainly on knowledge and tend to
ignore the performance of students. This is bad. For example,
consider one of the tasks ofhealth educators—"persuade mothers to
breast-feed their babies?'. In a bad examination, health educators
might be asked to write essays on the nutritional value of breast
miik. This assessment would only test a few of the skills needed (it
does not cover the skills of talking to mothers) and so it is not valid.
It is easy to advise teachers to make examinations valid by testing
the performance of their students. It is much more difficult for the
teachers to plan assessments that will do this. Some ideas are
given in Chapter 12.
11.4 Making assessment reliable
In a recent examination, the students were asked to write an essay
about the treatment of bums. The papers were marked by the
teacher who had taught the course. Then another teacher marked
the same examination papers. The scores given by the two teachers
were very different. For example, one student was given 45% by one
teacher (a fail) and 70% by the other.
This demonstrates that in this examination the marking was not
reliable.
Clearly, the final mark should be reliable or it becomes meaning
less. How can you be sure that a mark is reliable? The answer is to
try to cut out the errors involved in the assessment process. Use
assessment methods that are less likely to lead to errors. (For
example, the marking of multiple-choice questions is more reliable
than that of essays.)
You should also use techniques that help the people marking the
examination to work to a uniform standard. These methods are
described in more detail in Chapter 12.
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PART 3, FINDING OUT HOW MUCH YOUR STUDENTS HAVE LEARNED
11.5 Using assessment to help students to learn
Tests and examinations can encourage students to do more work —
and so they help them to learn. However, assessment can also show
students exactly what they need to spend more time on. In many
courses the teachers give frequent tests and then tell the students
what exactly they have done badly. In this way students get feed
back about the quality of their work and can improve their
performance.
To illustrate this point, look at the results for five students who
took a 4-part test in the middle of a course.
Exercise: Using assessment to help students to learn
Student
Part 1
A
Part 2
Part 3
x
x
B
Part 4
x
C
D
x
x
E
x
x
y— satisfactory standard
x— unsatisfactory standard.
What would you do if you were the teacher?
Comments
Probably you would be satisfied with Part 1. For Part 2, you should advise
student A that his standard was not good enough. You should explain why
the work was not good and how it could be made better. Ideally the student
should be tested again on this part at a later date.
The results for Part 3 show that only one student reached a satisfactory
standard. Probably this part needs to be taught again. Here the teacher gets
no
S3
GENERAL ISSUES IN ASSESSMENT
feedback about his or her own performance—so perhaps next year the topic
will be taught differently.
Pari 4 shows that two students need more guidance. However, it would
probably be a waste of time to repeat Part 4 for the whole class.
If you do everything suggested in the;comments above, you will find
that it will take you a lot of time to assess students. This is a
problem, but giving students this kind of individual guidance is one
of the most valuable things that a teacher can do. You must try to
make time. One way is to spend less time lecturing to the class and
instead to let students learn directly from manuals, handouts and
practical experience.
Note that this frequent testing and guidance applies equally well
to both the knowledge and the skills that need to be learned.
11.6 Continuous assessment
In some courses, students sit one final examination at the end of the
course. In other courses, students work under constant supervision.
Between these two extremes, there are courses with tests or assess
ments every week, month or term. This type of assessment is usually
called “continuous assessment”, although “frequent assessment”
would be a more accurate description.
What are the advantages of continuous assessment?
& Because there are several assessments, an error in any one
assessment is less important. Continuous assessment tends to be
more reliable.
The tensions and worries of the single final examination are
reduced.
Because students are assessed throughout the course, they tend
to work harder during the course instead of making a single
desperate effort at the end.
If students do poorly in one test, they have time to correct their
errors before the end of the course. Continuous assessment gives
more guidance to both teachers and students.
Students are shown throughout the course what standard is
expected.
111
51}-
PART 3. FINDING OUT HOW MUCH YOUR STUDENTS HAVE LEARNED
WHO 916P2
The tensions and worries of a single final examination.
Of course there are some disadvantages as well. The main dis
advantage is that continuous assessment takes more time and effort
for teachers to organize.
Continuous assessment can take many forms. It may be a series of
written tests. It may involve observation of students while they are
working on a ward, in the laboratory or in the field. The marks given
may be recorded to decide whether students eventually pass or fail.
Or the marks may be used only to guide students. Whatever system
is followed, continuous assessment offers important advantages
both in helping students to learn and in making more accurate
and reliable judgements about how much they have learned.
117 Self-assessment
Self-assessment is the name given to assessment where students
assess their own performance.
Some teachers are very worried by this idea because they feel that
students are not responsible enough or do not know enough. This is
probably true at the beginning of the course. However, some health
workers will be working with very little supervision after they have
112
GENERAL ISSUES IN ASSESSMENT
'
I
i
qualified. So in the job they must assess themselves. Therefore it is
a good idea to give the students some experience of self-assessment
while they are still being trained.
Naturally self-assessment is a method that is used for only part of
the time. Teachers or external examiners will be used to decide
whether students should pass or fail at the end of a course. However,
self-assessment can be used during the course. It will help to save
time and give students a greater sense of responsibility.
In self-assessment, students need clear guidance about what
standards are required. They must also be given a very clear idea of
the task. For example, you might ask students to:
1. Inspect 50 microscope slides of blood samples to determine
whether malaria parasites are present.
2. Fili in standard forms for stock control in a pharmacy.
3. Plot a patient's temperature on a chart.
4. Weigh and record the approximate weight of a baby.
In all these exam pies, the students can compare their own work with
a correct answer and so learn whether their work is satisfactory.
Note that cheating is not a problem, because the purpose of self
assessment is to learn—not to score points in an examination.
118 Peer-assessment
An alternative to self assessment is peer-assessment. This is the
name given to assessment where students assess each other.
This method is not suitable for deciding whether students pass or
fail at the end of a course. But it is a very good method for helping
students to learn.
Many students ask a friend to test them when they are revising for
an examination. This practice can be encouraged and guided by the
teacher. For example, you could give the students written instruc
tions for doing a job. Then one of the students attempts to do the job,
while the other one watches and comments. The students then
change over and the second student does the job watched by the first
one.
You must of course provide the written instructions. These can be
prepared either from your own experience or from a manual.
Peer-assessment can help to make field experience have more
meaning and relevance for students. Instead of vaguely trying to
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PA?n 3. FINDING OUT HOW MUCH YOUR STUDENTS HAVE LEARNED
MMv*
_____________
“Then one of the students attempts to do the Job .,
do a job as well as possible, each student will be supervised by a
fellow student who is there to watch and advise.
11.9 Summary
Exerc^e
Look at the three examples of assessment methods givSn below. Then com
ment on them using some of the points made in Section 11.2:
— Is the assessment economical in terms of materials and lime?
— Does the assessment test the important skills and abilities? (Is il valid?)
— Are the marks accurate (reliable)?
— Does the assessment help students to learn?
Now look ai the foilowincj examples.
174
GENERAL ISSUES IN ASSESSMENT
A. At the end of the course, a written examination is held in which the students
have to write four essays in 3 ho.urs...Then an external examiner meets all the
students individually for 15 minutes to give them an oral examination on what
they have learned.
B Every 2 weeks during the course, students have to answer 20 multiple-choice
questions on topics such as signs and symptoms of diseases, methods of
treatment, and prevention of disease. The students mark the papers them
selves by comparing the answers with the correct answers supplied by the
teacher.
C. Trainee community health nurses (CHNs) spend 1 month working with
...
- ,,
an
experienced CHN (two students work with each CHN). The students do most
of the work themselves under supervision. The supervisor then writes a report
on the students,
Write down your comments on each assessment method.
Comments
Method
Economy of
time
Validity
Reliability
Helping
A
Poor
Poor
Poor
Poor
B
Good—after
1st year
Misses many
important
skills
Very good
Good
C-
Poor
Very good
Moderate
Good
A. This method is bad in almost every way. It will take a long time to mark the
essays and to conduct the oral examinations. Students will not have to write
essays or talk to external examiners after the course—so the skills tested are
not important. Essay-marking and marks given in oral examinations are
frequently not reliable. The timing of the examination also means that
students will not learn much from it.
B. It will take a lot of time to set the multiple-choice questions. But the questions
can be used year after year (with a few changes) and they are very quick to
mark. The assessment may test important skills, depending on the exact
questions asked and what work the students are being trained to do.
However, multiple-choice questions usually only test factual knowledge so
they cannot test many of the important skills that should be tested The
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58
PART 3. FINDING OUT HOW MUCH YOUR STUDENTS HAVE LEARNED
reliability is excellent—there should be very few marking errors. Students
should learn both from marking each other’s work and from seeing exactly
what errors they have made. But note that it will only help them to learn factual
knowledge.
C. This method will take quite a lot of time because the supervisor writes
individual reports. However, the important skills are being tested. The reli
ability may be low because different supervisors may have different stand
ards. The assessment should help learning very effectively.
These examples illustrate that each assessment method has some
disadvantages. You should be aware of these problems and try to
reduce them as far as possible. Specific guidance on different
assessment methods is given in Chapter 12.
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I
I
i
i
CHAPTER 12
Assessment methods
i
The previous chapter discussed the general issues related io the
assessment of students. This chapter describes specific methods that
will help to improve the way you assess your students. Examples of
each method are given and their advantages and disadvantages are
discussed.
12.1 Oral examinations
In an oral examination, each student is interviewed by one or two
examiners. Usually students are asked to tell the examiner what
they know about some topic or what they would do in some situation
that might happen in their job.
I he mam advantages of oral examinations are that the examiner
can ask for more detailed information and can probe to find out how
much each student knows.
However, this is not a very satisfactory method of assessment.
Students are often made extremely anxious by examiners, even
though the examiners try to be friendly. This is unfair on the
students, because they will not face this kind of stress in their job.
Many students get worse results in oral examinations than they
deserve. Oral examinations also take up a lot of time and are often
criticized because the marking is unreliable. Further, oral exami
nations rarely test the important skills and do not usually help
students to learn.
p
You should not use oral examinations to assess students unless
you have some specific reason for doing so.
12.2 Essays
Essays have been widely used in <assessing students in the health
professions. But again, this method---hasj very serious disadvantages.
117
i
I
PART 3. FINDING OUT HOW MUCH YOUR STUDENTS HAVE LEARNED
In one course, students were asked to write an essay on polio
immunization. This is a very poor test even though the topic was
of some relevance to the students. (The students were going to be
responsible for immunizing people against polio as part of their
jobs.)
The test is poor because:
*
The students cannot know what information the examiner con
siders to be important. For example, should they describe the
administration of an immunization programme? Should they out
line how immunization prevents polio? Or should they describe
the side-effects?
© The marking is likely to be unreliable. Because the topic is not
clearly defined, different teachers will think different points are
more important—and give different marks as a result. Whether a
student passes will depend very much on who marks the paper.
e The test is not valid. Students are not going to write essays in
their job. They are going to immunize people. Therefore it would
be much better to test the skills required for this task.
« The essays will take a long time to mark—if teachers do this job
thoroughly.
© The students are unlikely to learn very much from the test.
1
How could the essay be improved?
The first point is that a different method of assessment would
probably be better—some examples are described in the following
paragraphs. However, if an essay must be used, you should:
1. Make the title much more specific, for example:
l<Describe how you would explain to mothers why their children
should be immunized against polio” or “Explain how polio
vaccine should be transported and given to children”.
These essay titles are fairer because it is more clear to stu
dents what they should write about. They are also more
valid because they ask students to describe the skills that are
important.
2. Prepare a marking scheme and follow it. This scheme should
include a list of the major points that should be covered in the
essay and specify how many marks should be given for accurate
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61
ASSESSMENT METHODS
spelling, general clarity of explanation, etc. The scheme should
be used by all teachers marking the essay. This improves reliability.
3. After the examination, show the marking scheme to the students
and discuss it with them. This helps them to learn.
12.3 Short-answer questions
Short-answer questions allow teachers Lto ask questions about a
larger proportion of the course and to mark; more accurately and
quickly.
Example of short-answer questions
The following quesiions were part of an examination for trainee health
inspectors.
1. List four advantages io a household of proper rubbish disposal.
(i)
(ii)
(Hi)
(iv)
2. Draw a diagram showing the construction of a simple incinerator suitable for
use in a small village.
3. Give two examples of situations when burying rubbish
is better than com■posting.
(0
('•)
Short-answer questions often ask students to give examples, write
down some advantages or draw a diagram. Because they are so
m rChmore specific than essays, they are quicker to mark and more
reliable. They are also very much quicker to answer. This means
that the students can be tested on many more topics during the
examination.
The main disadvantage of this method is that it may simply test
the students’ ability to remember facts rather than apply knowledge
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PART 3. FINDING OUT HOW MUCH YOUR STUDENTS HAVE LEARNED
12 4 Multiple-choice questions
Multiple-choice questions are often called MCQs. They are a stage
beyond short-answer questions, because the students do not write
any words. They just choose which of several answers is best.
Although you can use four or six choices in multiple-choice
questions, five is the most common number. This type of question is
sometimes called the ^one-from-five11 type of multiple-choice ques
tion.
Example of an MCQ of the one-from-five type
A patient tells you that he is worried because one of his eyes is red. You cannot
find any foreign bodies in the eye, but note that the pupil is bigger and does not
respond to light. What is the most likely diagnosis?
A.
B.
C.
D.
E.
Trachoma
Conjunctivitis
Iritis
Corneal ulcer
Glaucoma
In this example, the student has to choose between the possible
answers and select the best one—in this case
In this type of
question, there is a stem—“A patient tells you . , , likely diag
nosis1—and five choices.
Another type of MCQ is the true/false type.
Example of a true/false MCQ
In glaucoma
A.
B.
C.
D.
E.
There are usually white or grey spots on the cornea.
The pupils are irregular.
Only one eye may be red.
The patient should be referred to a health centre.
A foreign body is the most likely cause.
T. F.
T F.
T. F.
T . F.
T. F,
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G3
ASSESSMENT METHODS
Again there is a stem—in this example it is very short—"In glau... comay\
But this time the stem is followed by several statements. For each
statement the student has to decide whether the statement is true or
false. In this case A is false, so the student should draw a circle
round "F .
is also false, but
and
are true while “JS” is
w false, so the student should draw circles round F, F, T, T, and F
- respectively. In this example the student has to answer all five parts
of the question.
Both these types of questions are used fairly commonly,
although true/false questions are often preferred because they
are easier to understand and can be used to test the students
on a wider range of facts.
How useful are MCQs?
MCQb can be marked very quickly and accurately. They can also be
answered quickly, bo a lot of questions can be set in an examination.
This means that a lot of the course can be covered.
On the other hand, there are serious disadvantages. It is quite
difficult to write clear questions—so writing the questions takes a
lot of time. There is also the very serious problem that MCQs
usually only test the students’ knowledge. Only rarely do they test
decision-making skills and they cannot test the students’ ability to
communicate or to perform procedures. This means that MCQs are
likely to be valid for only a small part of your course.
Despite these problems, MCQs can be useful. They can be used to
check factual knowledge, especially during the course. They are
also very helpful when used for self-assessment or peer-assessment.
If you decide to use MCQs, the following points may be helpful:
& You should allow roughly 2 minutes for each 5-part true/false
question in an examination. So in an hour students can be
expected to answer about 30 questions. If you find that students
are not finishing the examination, cut down the number of ques
tions. It is not a race.
For true/false questions, give the students one mark for each
correct choice, zero for no answer and take away one mark for
each wrong choice.
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PART 3. FINDING OUT HOW MUCH YOUR STUDENTS HAVE LEARNED
Use the same scheme for marking one-from-five questions, but do not
take away marks for wrong answers.
a The pass mark for MCQs should be quite high. This is because
the MCQs should be testing basic knowledge that all students
should know. Therefore a pass mark of 80% or 90% can be used
successfully. It is better to use easy questions with a high pass
mark rather than harder questions with a pass mark of 50% or
60%.
Marking is made much faster if a separate response sheet is used
for the students' answers. Then a mask can be laid over the
response sheet, with holes cut out for the correct answers.
Look at the example below. Three correct answers will show
through the holes—so you would give 3 marks. There are four ticks
Response sheet
Name:
Q1 -------A
v
A.N. Other
B
C
Marking mask .
D
Correct responses
QI
E
————j-----------------
I
I
Q>
B
E
122
^5
ASSESSMENT METHODS
altogether, so one answer must be wrong—so you would take away
one mark. This leaves a score.of 2 (3-1) for the student.
12.5 Patient-management problems
Patient-management problems are a development of short-answer
questions. The main feature is that a series of questions are asked
about a case. This method can be used to test students on a wide
range of subjects. It can be used wherever students are being trained
to make decisions. So it is very useful for assessing students who are
training to be health educators, community health workers, com
munity nurses, health inspectors, etc.
Example of a patient-management problem
Mrs A comes to the health centre and tells you that she feels tired al) the time. She
asks you for a tonic. You find out that she is 30 years old and about 5 months’
pregnant.
List 3 things that you think might cause the tiredness.
2. Write down 2 other questions that you would like to ask Mrs A,
3. As a result of Mrs A’s answers, you suspect she is anaemic. What physical
signs would you look for?
4, Your examination confirms your diagnosis of anaemia. What treatment {if
any) would you prescribe and what other advice would you give?
this example has the advantages of a short-answer question. It is
clear to the student what is required and it will be quick and reliable
to mark (providing that all teachers involved agree what the pos
sible causes of tiredness are). It is also much more valid as a test
because it is based on the kind of work the students are being
trained to do. (It would, of course, be much better if each student
met Mrs A and took a history and examined her.) If students are
given the marking scheme after the examination, they will also
be able to learn from this.
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PART 3. FINDING OUT HOW MUCH YOUR STUDENTS HAVE LEARNED
How can you prepare patient-management problems?
It is usually easiest if you base the problem on a case that you have
dealt with, such as a boy who presented with severe abdominal pain
or a mother who rejected any advice on nutrition, even though her
children were malnourished. Of course you can only do this if you
still work as a health worker yourself. However, if you teach full
time, talk to health workers or, even better, spend half a day with a
health worker to write down examples of cases.
The next stage is to divide the case into stages. What happened
first? What decisions had to be made? What alternatives were
available?
Then you need to decide what items of information to give the
students and what questions to ask them.
At this stage you will have a patient-management problem, but
you will still need to develop a marking scheme. List all the answers
that you think students might give—both right and wrong. Then
decide how many marks you will give for each of the possible
answers.
12.6 Project reports
In a number of courses, students are asked to work on a project. This
may involve such tasks as doing a survey of a community or working
in a health care team for a few weeks. Often the students then
present a report on the project and this can take a lot of time.
Naturally students will be more motivated in the project if their
reports are assessed and the marks count towards the final examination score.
However, project reports are extremely difficult to mark fairly
because there are usually no clear standards for teachers to follow.
Some students may do very good work but present a poor report.
Others will present a very clear and full report of poor work. Which
is best and what standard should you accept?
The following guidelines may help you to assess project work.
1. Project work should be assessed by at least two people marking
independently. The two marks should then be compared and
discussed to reach a final mark.
2. Where possible, explain to students what standards they should
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G1
ASSESSMENT METHODS
*1
aim for. Tell the students what you think a good project would be
like. Where possible, explain how much data should be collected,how many cases should be seen, and what kind of graphs or tables
would be useful. But be careful not to restrict the students too
much.
3. Show the students some project work done in previous years that
you think is good and also some that you think is bad. Explain:
your reasons. Of course you cannot do this when you first use
projects—so it may be better not to count the marks for the first
projects in the overall assessment.
Clearly, the use of projects in assessment causes some problems for
the teacher. What is their value? Project reports take a lot of time to
mark and the score may not be reliable. However, this method of
assessment can be valid if the projects are chosen carefully to
involve the students in practising the important skills. Above all,
projects can be very powerful learning experiences and they should
be assessed to encourage students to make the maximum effort.
12.7 Casebooks
Casebooks have been used quite widely in training nurses and they
can also be used in courses for other groups of primary health care
staff.
The casebook contains a list of skills or tasks that the students
should be able to do. These tasks are the objectives, or at least some
of the objectives, for the course. The students are responsible for
learning how to do each of the tasks, and when they are ready they
can ask a teacher to assess their performance. During the course the
studen ts must perform all of the tasks to a satisfactory standard. If
the teacher thinks that a student’s performance is not good enough,
the faults are explained and the student can try again later.
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68
PART 3. FINDING OUT HOW MUCH YOUR STUDENTS HAVE LEARNED
Example—A page from a student's casebook
Date
Task
17. Prepare a flip chart for use with
an audience of 30 people
18. Give advice to a pregnant woman
about antenatal care
Signature
20/10/90
This assessment method uses quite a lot of the teacher’s time
because each student must be seen and his or her performance must
be assessed. It can be difficult to organize because teachers may not
be available when the student is ready to be assessed. There may be
problems with reliability. On the other hand, there are a number of
advantages. The main advantage is that casebooks help learning.
They do this by making clear to the students what needs to be
learned. They also make sure that when students are not up to
standard, the teacher is there to give advice. The second advantage
is that the method is highly valid, because students are assessed on
how well they can do the tasks and jobs that they are being trained
to do.
This is a slightly different type of assessment. You do not give
students a mark out of ten for each performance—you simply decide
whether they are good enough or not. So at the end of the course, a
student may have performed 23 out of the 29 set tasks to a satis
factory standard. It is then up to the examiners to decide whether
this is a “pass”. For some courses, students will need to achieve a
satisfactory standard on all the tasks. For others, it may be unneces
sary to insist on this high standard.
12.8 Checklists
Checklists are not so much a method of assessment as a way of
improving other forms of assessment. Assessments of practical and
clinical work are often criticized because the mark is unreliable.
Different examiners use different standards. Checklists reduce this
problem and they also make sure that the ivay in which the student
does the task is assessed.
126
ASSESSMENT METHODS
Example—A checklist for the task “Prepare a thin blood film
using a sample of your own blood”
not done done correctly
1. Uses middle finger or ring finger
2. Cleans the finger using surgical spirit or alcohol
3. Dries finger with a clean piece of cotton wool
4. Allows blood to flow freely after pricking with
needle
I
5. Puts a single drop of blood in the middle of the
microscope slide
6. Uses a second slide as a spreader. Allows the
blood to spread along the end of the second
slide
7. Pushes spreader quickly along the slide
8. Draws blood along behind the spreader
9. Does not blow on slide or shake it
The examiner can watch the student preparing the blood film and
pul a tick in the right-hand column for each part done correctly. At
the end of the test, the examiner adds up the number of.ticks in the
rignt-hand column and gives the student a score out of 9. The pass
mark for this test needs to be decided by the examiner.. In this
example, the examiner may feel that 7 out of 9 would be a suitable
ono/S 8tfndard- For other tests, the examiner might expect 50% or
90/o. T. he pass mark will depend on the specific test.
The advantage of a checklist is that it makes the marking fairer
Different examiners watching a student do a test are more likely to
give the same score if they have a checklist. Checklists are also very
useful for giving feedback to students or teachers because the
evidence is clear and simple. The examiner might tell the teacher
“Most of your students did the blood film test quite well, but 1 noticed
that about half of them pushed the drop of blood instead of drawing it
behind the spreader slide". This would help the teacher realize that
this point needed more emphasis during the next course.
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PAH1 3 FINDING OUT HOW MUCH YOUR STUDENTS HAVE LEARNED
I
In the same way, detailed information can be given to each
student. For example, students might be allowed to see the check
list for their own performance.
The above example is for assessing a psychomotor skill. Similar
checklists can be prepared for assessing communication skills and
attitudes, but this is often rather more difficult.
Note that you can prepare a checklist from a task analysis.
12.9 in-course assessment
During the training course, your students will probably spend time
working in hospitals, health centres or dispensaries. There they will
be practising the communication skills and the psychomotor skills
needed in their job. This time can be used for assessment as well as
teaching.
Many different people will assess the students, so in-course assess
ment is likely to be more reliable if supervisors are given a checklist
to follow. This checklist should be fairly simple, as shown in the
example below.
Example—A checklist ior assessing students in a health centre
completely
satisfactory
just good
enough
not good
enough
1. Keeps complete and accurate
records
2. Observes sterile procedures
3. Establishes good relationships
with patients
and so on
Nurses or health workers supervising students can use simple
checklists to give a clear picture of what the students can or cannot
do. You can then use this information:
128
'll
1
I
I
ASSESSMENT METHODS
1. To make decisions on whether students should pass or fail.
2. To give specific advice to students about what they need to
learn.
3. To improve the course in areas that are poorly learned.
This kind of checklist
------ isi again prepared from a task analysis,
Checklists can also be used to help assess attitudes.
Example—A cfiecklist for assessing attitudes
I
1. Very keen willing worker
Does as little work
as possible
Resents or ignores
instructions
Not interested in
patients
Not interested in
learning
Always late
2. Accepts instructions
willingly
3. Very interested in
patients
4. Always keen to learn
I
5. Always on time
This checklist might be used by a senior nursing officer or super
visor on a ward where student nurses spend part of their training.
e supervisor would use one form for each student nurse. At the
end of the trainmg per!Od, the supervisor would think about the way
each of the nurses had worked during their time on the ward
for example, some nurses might have been quite willing to do
w at they were asked to do, but never seemed very keen or offered to
do extra work. The supervisor would note this down on their forms
by putting .a cross at about the middle of the line1. Very keen willing worker
Does as little work
as possible
in this way the supervisor can give a fair
f and quick summary of the
attitudes of the student nurses to the teacher responsible for the
course. 1 his checklist can be used to give advice to student nurses
and can form part of the overall assessment that is used to decide
whether they pass or fail the course.
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PART 3. FINDING OUT HOW MUCH YOUR STUDENTS HAVE LEARNED
12.10 Summary
No assessment method is perfect. Each has some advantages and
some disadvantages. You should therefore use a variety of methods
whenever possible.
Ideally, you should first decide what skills need to be assessed.
These skills are the performance objectives of the course. •
Then you should choose the best method for assessing these skills.
The method should be chosen on the basis of:
regulations for the course
economy of time
reliability
validity
value as a learning took
130
This document summarizes the main work done by CPHE SOCHARA with the assistance of Dr
Adithya P (Policy Research Assistant) on Public Health Definition and Competencies to support the
SOCHARA contribution to the IPHA initiative. Four key elements of this work were operationalized
through the following tasks:
1.
Exploring Public Health definitions to help evolve an India-relevant definition
2. Exploring Public Health Competencies for public health professionals by scanning curricula
and competency lists from various public health institutions/universities all over the world
including India, using the concept of Core and Cross-cutting Competencies which has been
accepted as the framework in the IPHA initiative.
To create a framework of convergence and hierarchy of levels of competence built by
different existing public health courses (MDBS, MPH, MD).
4. Identifying sub-themes for these competencies to evolve check lists for those who are
considering new public health education programmes.
For further information/clarification/dialogue kindly contact:
Dr Ravi Narayan: chcravi@grnail.com
Dr Adi thya P: adithya.pradyumna@gmail.com
1
14'
Task 1: Public Health definition
Various definitions of public health, community health and primary health care were looked for,
reviewed and considered in the Indian context. These definitions, along with their sources, are
available in the appendix of this document. Relevant themes were identified from these definitions
and from professional experience in relation to the Indian setting to come up with the proposed
definition which built further on the initial template provided by Dr Farooque Ahmed and Hie
suggestions of Dr Sanjay Chaturvedi (see appendices). The suggested definition and compilat.on of
phrases is as follows:
"Public Health is the science and art ofpromoting health, preventing disease, and prolonging life
-to ensure for everyone a standard of living adequate for the maintenance of a healthy and productive
life.
-by developing a social movement, as an integral part ofcommunity development,
through intersectoral coordination and organized community effort emphasising equity, participation,
ownership, rights and responsibilities
- while maintaining healthy environment; empowering people to maintain a healthy life style &
behaviour; controlling communicable and non communicable diseases,
■ -addressing social, cultural, eSpnpmic^plit^^
realities havl^ a
bearing on health;
-formulating health policies, interventions and programmes; and by evolving and ^aniHng human
resource and health care systems to facilitate health promotion, dtsease prevention, early dtagpo ,
treatment and rehabilitation, through informed choices of our society, commumttes and tndMs.
.M is available universally, distributed equitably, efuad^ll^levam and accessible to all
: ie sijye of their ability to pay_. ”
.This definition has been submitted for peer review, comments and further additions/modifications.
2
Task 2: Public Health competencies for health professionals in India
Several documents on public health competencies were reviewed from Indian and foreign institutions
and universities (see list in appendix). Contact was maintained with other members working on this
project, and their feedback was considered. A potential list of core and cross-cutting competencies
was prepared and dispatched for peer-review and comments:
Core competencies:
I.
Health planning
2.
Epidemiological skills
3.
Family and community diagnosis
4.
Health management (including financial management)
5.
Managing and implementing health programmes (including program planning)
6.
Monitoring and evaluation (including health surveillance)
7.
Health promotion (including prevention and protection)
8.
Training
9.
Research (including biostatistics and demography)
10. Working with community (including community dimensions of practice)
11. Partnership and advocacy
12. Public health laws and ethics
13. Public health biology competency
14. Environmental health competency
Cross cutting:
1.
Critical analysis and systems thinking (including problem solving)
2.
Socio-cultural competency (including all social and behavioural sciences like ecpnomics.and political sciences)
3.
Leadership
4.
Communication (including informatics)
5.
Life-long learning
6.
Equity
7.
Human resource development
8.
Policy and advocacy
9.
Governance and decentralisation
10. Conflict resolution
3
Task 3: Convergence and hierarchy of levels of public health competencies
An ad-hoc assessment was also made on the degree and type of competencies needed at each level of education. This
comparison was made to clarify that competencies may be shared between various types and levels of education, but
competencies may be of differing levels.
Comparative competencies and dcgrce/level of competencies for the Indian scenario:
Competency
MBBS
(PSM/CM)
CORE
_____________________
+
Health planning ____________________
Epidemiological skills_________________
Family and community diagnosis________ ++
+
Health management (including financial
management)
__________________
Managing and implementing health
programmes (including program planning)
+
Monitoring and evaluation (including
health surveillance) _________________
++
Health promotion (including prevention
and protection)___________________ _
+
^Training_________
+
Research (including biostatistics and
demography)_____
Working with community (including
community dimensions of practice)
Partnership and advocacy_______________ 44Public health laws and ethics
4-4Public health biology competency_______
Environmental health competency_______ 4CROSS-CUTTING
~
Critical analysis and systems thinking
(including problem solving)____________
Socio-cultural competency (including all
social and behavioural sciences like
economics and political sciences)
+
Leadership__________
Communication (including informatics)
Life-long learning___________________
4Equity_____________________________
4Human resource development
+
Policy and advocacy__________________
+
Governance and decentralisation
+
Conflict resolution___________________
Key:
MD-PSM
(Consultant)
+++
+++
+++
+++
MPH
MH A
(Practitioner) | /MSc
_______ L_
+++
+++
+++
+++
+++
+++
+++
+++
-F+4-
+++
+++
-H-+
+-H-
+++
+++
+
+++
+++
+4-
+++
+++
+++
++
•4-4-4-
4-4-4-
4-4-4-
4--F4-
4-4-4-
4-4-44-4-44-4-4-
+: basic understanding (public health oriented general practitioner)
++: basic understanding and skill/capacity for practice (public health practitioners)
+++: advanced understanding for both practice and system-development (public health consultants)
(this applies only to MBBS, MPH and MD. Special masters programmes for example MSc
Epidemiology, MSc Health Promotion, MSc Health Services Management, MSc Health Policy
and Planning etc may be specialist enough to produce consultants for system-development in
those areas)
Task 4: Sub-themes for competencies evolved out of scan of relevant documents
4
Please note that the language varies since we have extracted directly from documents without too
much further editing. Sources of each sub-theme has been indicated in brackets using acronyms listed
out at the end of the main list. This list needs further standardisation in framework, format and
language for coherent construction of relevant competencies and use in curriculum construction.
CORE COMPETENCIES
Epidemiological skills
Examine public health problems in terms of magnitude, person, time and place, and calculate basic
epidemiologic measures.(LSU)
Propose valid and efficient epidemiologic studies to address public health problems, including
understanding the strengths and limitations of descriptive, observational and experimental studies.
(LSU)
Identify key sources of data for epidemiologic purposes.(UOH)(ASPH)
Identify the principles and limitations of public health screening programs. (UOH)(ASPH)
Explain the importance of epidemiology for informing scientific, ethical, economic and political
discussion of health issues. (UOH)(ASPH)
Comprehend basic ethical and legal principles pertaining, to the collection, maintenance, use and
dissemination of epidemiologic data. (UOH)(ASPH)
Apply the basic terminology and definitions of epidemiology. (UOH)(ASPH)
Calculate basic epidemiology measures. (UOH)(ASPH)
Communicate epidemiologic information to lay and professional audiences. (UOH)(ASPH)
Interpret results of statistical analyses found in public health studies (draw appropriate inferences
from epi data). (UOH)
Evaluate strengths and limitations of epidemiologic reports. (UOH)(ASPH)
Apply descriptive techniques commonly used to summarize public health data. (UOH)
Apply common statistical methods for inference. (UOH)'
Describe a public health problem in terms of magnitude, person, time, and place. (UOH)(ASPH)
Apply descriptive and inferential methodologies according the type of study design for answering a
particular research question. (UOH)(ASPH)
Describe and present population health problems using available data and appropriate epidemiologic
and bio-statistical concepts.(TUS)
Conduct epidemiological investigation of comm., non-com and other disease of public health
importance and suggest appropriate solution (MAU)
Use effectively the tools of epidemiology for understanding disease causation determinants of
disease(MAU)
Develop epidemiological approach(MAU)
5
Measurement of disease frequency (MCI)
Cause and effect relationship: concept of association, causation, chance and biases(MCl)
Descriptive epidemiology (MCI)
Formulation of hypothesis(MCI)
Analytical epidemiology(MCI)
Experimental epidemiology (randomized and non-randomized controlled trials) (MCI)
Testing of hypothesis(MCI)
Errors in testing of hypothesis(MCI)
Epidemiological intelligence and forecasting(MCI)
Principal sources of epidemiological data(MCl)
Definition, calculation and interpretation of morbidity and mortality rates(MCI)
Hospital epidemiology(MCI)
Concept of disease eradication/ elimination, review of smallpox eradication strategy(MCI)
Rapid assessment techniques(MCI)
Application of computers in epidemiology(MCI)
Screening test: selection criteria, validity including likelihood ratios and ROC curve, evaluation,
predictive accuracy(MCI)
Evolution of epidemioIogy(MCI)
Epidemiology : definition, concepts and its role in health & disease(MCI)
Geographical information system (GIS) and remote sensing(MCI)
Epidemiology of communicable and non-communicable diseases(MCl)
Communicable and non-communicable diseases of public health importance (MCI)
Family and community diagnosis
Use of basic epidemiological tools to make a community diagnosis of health situation, in order to
formulate appropriate intervention measures(MCl)
Screening for diseases(MCI)
Screening : definition, types, uses and principles(MCI)
Skills as Community Physician(MCI)
Ability to identify local health needs of community. (MCI)
Ability to demonstrate leadership qualities & function as effective team leader. (MCI)
Ability to make community diagnosis including application of Rapid assessment techniques. (MCI)
Ability to organize health camps. (MCI)
Ability to organize health surveys & ongoing comprehensive health delivery
programme. (MCI)
Ability for effective liaison with PRIs & local opinion leaders, mustering of local resources, advocacy
& mobilization of administration & political will for
health care programmes. (MCI)
Diagnosis & management of common illness. (MCI)
Diagnosis & management of chronic diseases & disabilities including rehabilitation.
Nutritional assessment & nutritional therapy. (MCI)
Family planning practices. (MCI)
Diagnosis & management of Pediatric, Geriatric, Gynecological illness with special emphasis on
RCH & integrated management of childhood illness. (MCI)
Perform all immunization procedures. (MCI)
5
Ability to organize & conduct MCH services including antenatal clinic, intranatal & postnatal care,
care of newborn, growth monitoring & care of toddler. (MCI)
Conduct / attend 20 normal deliveries & 5 abnormal deliveries. (MCI)
Skills of Occupational Health(MCI)
Describe how social, behavioural, environmental and biological factors contribute to specific
individual and community health outcomes (ASPH).
Health management (including financial management)
Describe and analyze population health systems, including their stakeholders, components, and
attributes. (TUS)
Identify the main components and issues of the organization, financing and delivery of health services
and public health systems in the US. (UOH)
Describe the legal and ethical bases for public health and health services. (UOH)
Apply the principles of program planning, development, budgeting, management and evaluation in
organizational and community initiatives. (UOH)
Apply "systems thinking" for resolving organizational problems. (UOH)
Describe the internal and external environment and issues that affect organizational behavior. (TUS)
Prioritise health problems(MAU)
Identify threats to the environment(MAU)
Set objectives, prepare action plan, implement programmes and monitor, supervise and evaluate
them(MAU)
Manage health information system and respond appropriately to the info gathered(MAU)
Assess costs and carry out program budgeting (MAU)
Anticipate, prepare for and respond to disasters(MAU)
Manage manpower, logistics and materials effectively(MAU)
Hospital Administration(MCl)
Students will be posted to learn organization and administration of hospital services and understand
system used for collection, recording and reporting of hospital statistics, inventory control of medical
stores, hospital laundry, hospital dietary, CSSD, ensuring quality of health care, clientele satisfaction,
hospital infection control, medical audit. (MCI)
Job responsibilities of different categories of workers in health system(MCI)
Voluntary health agencies working in IndiaQAQX)
Pattern of health care services in certain south Asian and western countries(MCI)
Health insurance(MCI)
Group dynamics(MCl)
7
i ‘ pital psychology(MCl)
; ilih planning, management and administration(MCI)
C oncepts of planning, management, public health administration(MCI)
> ossification and understanding of various qualitative and quantitative health management
t<xs;si quest MCI)
O,. r view of administration at village, block, district, state and center level in India(MCI)
C- rg a n i za t i o n a 1 co n cept(MCI)
Organizational behaviour(MCI)
1 r . material and personnel management(MCI)
Integrated disease surveillance project (IDSP) (MCI)
C- ' .cepts, scope and methods of Health Audit(MCI)
Public health administration of the future(MCl)
i search in administration, operational & action oriented research(MCI)
New concepts in public health administration(MCI)
Pi iciples of hospital administration(MCl)
M <. ..-.‘I audit, quality assurance, quality improvement and client satisfaction(MCI)
Alternative approaches to planning(MCI)
In;.’ stance ofhospital records, their retrieval, International classification of diseases, medical
certification ofdeath(MCI)
.4/ .: ■■^ing and implementing health programmes (including program planning)
Illustrate the principles of program planning, development, budgeting, management and evaluation in
organizational and community initiatives.(LSU)
Dcsi.r'bc he tasks necessary to assure that program implementation occurs as intended. .
(UOH)(ASPH)
; xpiain how the findings of a program evaluation can be used. (UOH)(ASPH)
I Explain I he contribution of logic models in program development, implementation and
evaluation.(ASPH)
Difb?rem;ale among goals, measurable objectives, related activities and expected outcomes for a
public health program(ASPH)
Differentiate the purposes of formative, process and outcome evaluation(ASPH)
D . icrentiate between qualitative and quantitative evaluation methods in relation to their strengths ,
limitations and appropriate uses, and emphases on reliability and validity(ASPH)
Prepare a program budget with justification(ASPH)
In collaboration with others, prioritise individual, organisational, and community concerns and
resources for public health programs(ASPH)
Assess evaluation reports in relation to their quality, utility and impact on public health(ASPH)
Use data to improve population health interventions. (TUS)
S
'S'l
Conceive, design, implement, monitor, and evaluate public health actions taken to improve the health
of a population. (TUS)
Revise or adapt an intervention proposal and plan in response to changing circumstances. (TUS)
Initiate, implement and supervise national health programmes(MAU)
Monitor and assure quality in programme implernentation(MAU)
Training
Assess the learning needs of any group(MAU)
Formulate learning objectives(MAU)
Plan curriculum and prepare materials(MAU)
Select ad implement appropriate learning methods(MAU)
Evaluate learning experiences and identify barriers(MAU)
Learn proper use of teaching aids(MAU)
Research (including biost'atistics and demography)
Apply exploratory data analysis and descriptive statistics to summarize public health data. (LSU)
Apply common statistical methods for estimation and inference appropriately according to underlying
assumptions and study design principles. (LSU)
Describe the roles of biostatistics in the discipline of public health. (UOH)(ASPH)
Describe the basic biostatist-ics concepts such as summary statistics, probability, and statistic
inference. (UOH)(ASPH) ’.
Apply exploratory data analysis and descriptive statistics to summarize public health data.
(UOH)(ASPH)
Set up null hypotheses for public health research questions, use corresponding statistics method to test
the null hypotheses, and draw conclusions based on the testing results. (UOH)
Apply common statistics methods to analyze public health data. (UOH)(ASPH)
Interpret results of statistical analyses found in public health studies. (UOH)(ASPH)
Compute sample size needed for give power and Type I error rate for basic study designs in public
health studies. (UOH)
Understand and interpret health related data(MAU)
9
S'!—
Based on the health problems formulate research questions(MAU)
Analyse data and present findings with use of appropriate available statistical software(MAU)
Design and implement epidemiological and health systems research studies(MAU)
Effectively communicate findings and public health information(MAU)
Concept of Health & Disease(MCI)
History of medicine, evolution of public health, alternative systems of medicine(MCI)
Definition and concepts of public health(MCI)
Definition of health, holistic concepts of health including concept of spiritual health, appreciation of
health as a relative concept, determinants of health(MCl)
Characteristics of agent, host and environmental factors in health and disease and the multifactorial
etiology of disease(MCI)
Understanding the natural history of disease and application of interventions at various levels of
prevention(MCI)
Health indicators(MCl)
Health profile of India(MCl)
Concept of rehabilitation, its types and techniques(MCI)
Survival analysis(MCl)
Meta analysis(MCI) *
Measurement of risk and risk reduction(MCI)
Use of constructs/scales and their validity in research(MCI)
Concepts and techniques of qualitative research(MCI)
Health Statistics(MCI)
• Introduction
• Role of statistics in Public Health
• Collection of data
• Sampling in Public Health
• Statistical classification of health data
• Handling and processing of statistical information
•
•
•
Analysis of demographic data
Measurement of‘morbidity, mortality and fertility
Standardization of rates and standard indices
•
•
Life tables
Statistical techniques of evaluation in Public Health
Descriptive Statistics(MCI)
• Introduction to biostatistics- aim and scope
• Collection of data- basic ideas
• Presentation of data- tabulation, diagram and graphs
• Measures of central tendency and dispersion
•
•
•
Normal distribution
Elementary idea of skewness
Concepts of correlation and regression
Statistical inferences(MCI)
• Elementary idea of probability
10
83
•
•
•
«
Sampling techniques
Test of Significance-Chi Square, t-test, z-test, ANOVA
Basic idea of testing of hypothesis
Advanced statistical techniques, multivariate regression analysis,
statistical models. Use of Epi info, SPSS/ other computer software
Special topics in Biostatistics
Clinical trials-Aim and scope, general principles, use of controls,
placebos and dommios, final presentation of results-discussion of some
well known clinical trials
Prophylactic trials-Assessment by time trends and geographical
comparison, controlled prophylactic trials, discussion of some well known
clinical trails
Retrospective and prospective studies and follow up studies, discussion
of important studies
Field studies, prevalence surveys, guiding principles for data collection
Controls in field studies & hospital studies
Propose and frame a research question related to population health. (TUS)
Understand and critique public health literature. (TUS)
Identify appropriate methods and study designs for answering a specific research question. (TUS)
Demography and Vital Statistics(MCI)
Concepts of demography, demographic cycle, vital statistics
Definition, calculation and interpretation of various demographic indices
Declining sex ratio and its social implication
Population explosion, population dynamics of India
Population control
€
National population policy
Sources of vital statistics like census, SRS, NFHS, NSSO etc.
Public health laws and ethics
Analyze issues Of public health practice and policy based upon basic principles of ethics (e.g. the
Public Health Code Of Ethics, Human rights framework, other moral theories). (LSU)
Discuss sentinel events in the history and development of the public health profession and their
relevance for practice in the field. (UOH)(ASPH)
Apply basic principles of ethical analysis (e.g. the Public Health Code of Ethics, human rights
framework, other moral theories) to issues of public health practice and policy. (UOH)(ASPH)
Apply evidence-based principles and the scientific knowledge base to critical evaluation and decision
making in public health. (UOH)(ASPH)
Apply the core functions of assessment, policy development, and assurance in the analysis of public
health problems and their solutions. (UOH)(ASPH)
11
Promote high standards of personal and organizational integrity, compassion, honesty and respect for
all people. (UOH)(ASPH)
Anav/se determinants of health and disease using an ecological framework(ASPH)
Analyse the potential impact of legal and regulatory environments on the conduct-of ethical public
heUU research and practice(ASPH)
Distinguish between population and individual ethical considerations in relation to the benefits, costs,
and burdens of public health programs. (UOH)(ASPH)
Embrace a definition of public health that captures the unique characteristics of the field (e.g.,
population-focused, community-oriented, prevention-motivated and rooted in social justice) and tow
these contribute to professional practice. (UOH)(ASPH)
Appreciate the importance of working collaboratively with diverse communities and constituencies
(e.g. researchers, practitioners, agencies and organizations). (UOH)(ASPH)
Value commitment to lifelong learning and professional service including active participation in
professional organizations. (UOH)(ASPH)
Fird and negotiate public health work appropriate to one’s skills and strengths. (TUS)
Utilize appropriate ethical, legal and administrative frameworks in safeguarding human subjects and
co
. unity needs and concerns associated with project work. (TUS)
Work effectively in a professional organization by adapting the content and process of one’s work to
the organization’s mission, culture, organizational chart, and mechanisms for decision making. (TUS)
Vv : . effectively with multiple professional and non-professional stakeholders in a community
seeing. (TUS)
Give and receive constructive feedback with all stakeholders. (TUS)
B. accountable and take responsibility for all actions and behaviors taken with respect to professional
work. (TUS)
Birfhand'deathSst'ration act^ PFA act, MTP act, CPA, Child labour act, PNDT act, Transplantation
of human organ act in India etc. (MCI)
Other public health legislations(MCI)
International Health(MCI)
...
Tnnrcc
Rnle of various multilateral, bilateral international health organizations like WHO, UNICEF, UND ,
Vi orld Bank etc. (MCI)
G- ganization structure of these organizations(MCI)
International Health Regulations (IHR) (MCI)
.
R ile of Planning Commission and five year plans in development of health sector in India(MC )
Various health committees of Govt, of India and their important recommendations(MCI)
12
Implement public health laws(MAU)
Apply ethical principles to the collection, maintenance, use and dissemination of data and
information(MAU)
Public health biology competency
Apply biological principles toward the development and implementation of disease prevention,
control, or management programs(LSU)
Demonstrate ability to acquire and understand the critical biological factors that influence public
health efforts related to any disease. (TUS)
•
Specify the role of the immune system in population health. (UOH)(ASPH)
Describe how behaviour alters human biology(ASPH)
Identify the ethical, legal and social issues implied by public health biology(ASPH)
Explain the biological and molecular basis of public health(ASPH)
Explain the role of biology in the ecological model of population-based health. (UOH)(ASPH)
Explain how genetics and genomics affect disease processes and public health policy and
practice(ASPH)
Articulate how biological, chemical and physical agents affect human health(ASPH)
Apply biological principles to development and implementation of disease prevention, control, or
management programs. (LJOH)(ASPH)
Apply evidence-based biological and molecular concepts to inform public health laws, policies and
regulations(ASPH)
13
8G
Mental Health(MCI)
_ Importance of mental health care in primary care settings
_ Common psychiatric/ neurotic/ other mental health disorders, mental
retardation
_ Comprehensive mental health care at primary care settings
_ Psychotherapy, its place in mental health
_ Psychology and field research
Human Genetics(MCI)
_ Genes and development
_ Blood groups- Medico-Legal applications
_ Genetic and chromosomal disorders in man
_ Genetic counseling
_ Genetics and public health
_ Genetic engineering and related health issues including genetically modified
foods
_ Gene therapy
_ Human genome project
Health care delivery system in India(MCI)
_ Concepts of primary health care and comprehensive health care.
_ Health profile of India
_ Evolution of health care delivery system in India
_ Health care delivery in India and infrastructure at primary, secondary and
tertiary care level
Environmental health competency (including Occupational Health)
Appraise the human health effects, both acute and chronic, of major environmental and occupational
hazards such as air pollution, metals, organic pollutants, microbial contamination of drinking water,
and physical hazards. (LSU)
Assess the mechanisms and the degree to which environmental and occupational exposures impact
public health and welfare. (LSU)
Describe environmental and occupational influences on public health. (TVS)
Apply a critical thinking and systems approach to the analysis of environmental and occupational
determinants of disease and injury. (THS)
Design, critique, and evaluate interventions directed at environmental and occupational disease and
injury (TUS)
Describe the direct and indirect human, ecological and safety effects of major environmental and
occupational agents. (UOH)(ASPH)
Describe genetic, physiologic and psychosocial factors that affect susceptibility to adverse health
outcomes following exposure to environmental hazards. (UOH)(ASPH)
Describe federal and state regulatory programs, guidelines and authorities that control environmental
health issues. (UOH)(ASPH)
14
Specify current environmental risk assessment methods/technology. (UOH)(ASPH)
Specify approaches for assessing, preventing and controlling environmental hazards that pose risks to
human health and safety. (UOH)(ASPH)
Explain the general mechanisms of toxicity in eliciting a toxic response to various environmental
exposures(ASPH)
.
.
—
Discuss various risk management and risk communication approaches in relation to issues of
environmental justice and equity. (ASPH)
Develop a testable model of environmental insult. (7\SPH)
Environment and Health(MCI)
_ Water: concepts of safe and wholesome water, sanitary sources of water,
water borne diseases, water purification processes
_ Physical and chemical standards of drinking water quality and tests for
assessing bacteriological quality of water
_ National rural water supply and sanitation programme
_ Concepts of water conservation and rainwater harvesting
_ Health hazards of air, water, noise, radiation pollution and their prevention &
control including indoor air pollution
_ Rural and Urban sanitation
_ Concepts of solid waste / human excreta / sewage disposal
_ Awareness of standards of housing and the effect of housing on health
_ Aerospace medicine
_ Health hazards related to climate, altitude, and depth
_ Human health in a changing world
_ Medical Entomology
Role of vectors in the causation of diseases
_ Identifying features of vectors and their control measures
_ Life cycles of vectors and advantages and limitations of various vector
control measures
_ Mode of action, application cycle of commonly used insecticides and
rodenticides
_ Integrated vector control
_ Entomological survey techniques
_ Biomedical Waste & its disposal
_ Classification / categories, sources, health hazards and treatment of
biomedical waste as per current regulations
_ Application of principles of biomedical waste management in different
settings of health care delivery system
_ Disaster Management
Principles of disaster preparedness and application of these in disaster
management
Occupational Health(MCI)
_ Relate the history of symptoms with specific occupations including
agriculture related occupation
15
32>
Asbc
.nd other fibers, coal workers lung diseases, silicosis, health
significance of metal exposures, diseases associated with exposure to
chemical substances, multiple chemical sensitivities, pulmonary responses
to gases and particles, pesticides, illness due to thermal extremes, ionizing
radiations, non-ionizing radiations, effects of physical environment- noise,
vibration, work related musculo-skeletal disorders
_ Em|-io_\ ees State Insurance (ESI) scheme
_ Concepts of ergonomics
Diagnostic criteria of various occupation related diseases
_ Industrial hygiene
_ Surveillance, monitoring and screening in occupational health
_ Occupational problems of special working groups
_•
_ Occupational safety and health standards
_ Legislations related to occupational health
Health planning
Components of planning a health activity (MCI)
Concepts of health economics in health planning and management (MCI)
(no appi op'-iate sub-competencies found in reviewed documents)
Monitoring and evaluation (including health surveillance)
Screening programmes and their evaluation(MCl)
Establish/utilise the existing surveillance systems and respond to public health threats efficiently and
effecti vely(MAU)
(no appropriate sub-competencies found in reviewed documents)
Working with community (including community dimensions ofpractice)
Ensur . community participation(MAU)
(no appropriate sub-competencies found in reviewed documents)
Partnership and advocacy (no appropriate sub-competencies found in reviewed documents)
Health promotion (including prevention and protection) (no appropriate sub-competencies found in
reviewed documents)
CROSS CUTTING COMPETENCIES
Critical analysis and systems thinking (including problem solving)
Identify characteristics of a system. (UOH)(ASPH)
Identify unintended consequences produced by changes made to a public health system(ASPH)
16
8^
Provide examples of feedback loops and “stocks and flows” within a public health system(ASPH)
Explain how systems (e.g. individuals, social networks, organizations, and communities) may be
viewed as systems within systems in the analysis of public health problems. (UOH)(ASPH)
Explain how systems models can be tested and validated(ASPH)
Explain how the contexts of gender, race, poverty, history, migration and culture are important in the
design of interventions within public health systems(ASPH)
Illustrate how changes in the public health systems (including input, processes and output) can be
measured(ASPH)
Analyse the interrelationships among systems that influence the quality of life of people in their
communities(ASPH)
Discuss (analyse) the effects of political, social and economic policies on public health systems at the
local, state, national and international levels. (UOH)(ASPH)
Discuss (analyse) the impact of global trends and interdependencies on public health related problems
and systems. (UOH)(ASPH)
Assess the strengths and weaknesses of applying the systems approach to public health problems.
(ASPH)
Socio-cultural competency (including all social and behavioural sciences like economics and
political sciences)
Identify health problems of the community in context of the socio-cultural milieu(MAU)
Identify groups that require special attention including those facing occupational hazards(MAU)
Describe the roles of history, power, privilege and structural inequality in producing health disparities.
(UQH)(ASPH)
Understand how class, culture, race, ethnicity, socio-economic status, gender, sexual orientation and
other aspects of identity and diversity affect health and health-related behaviors and attitudes. (TUS)
Incorporate understanding of cultures, histories, beliefs and practices in designing and implementing
public health actions. (TUS)
Work effectively with diverse populations and within diverse communities. (TUS)
Treat all people with dignity and respect. (TUS)
Explain how professional ethics and practices relate to equity and accountability in diverse
community settings. (UOH)(ASPH)
Explain why cultural competence alone cannot address health disparity. (ASPH)
17
°lo
Discuss the importance and characteristics of a sustainable diverse public heatlh workforce. (ASPH)
Use the basic concepts and skills involved in culturally appropriate community engagement and
empowerment with diverse communities(ASPH)
Apply the principles of community-based participatory research to improve health in diverse
populations(ASPH)
Differentiate between linguistic competence, cultural competency, and health literacy in public health
practice(ASPH)
Cite examples of situations where consideration bf culture specific needs resulted in a more effective
modification or adaptation of a health intervention. (ASPH)
Develop public health programs and strategies responsive to the diverse cultural values and traditions
of the communities being served(ASPH)
Differentiate among availability, acceptability, and accessibility of health care across diverse
populations. (UOH)(ASPH)
Demonstrate ability to interact effectively in diverse groups in class, practicum, student governance,
and committees. (UOH)
Examine social, developmental and behavioral theories of health, health behavior and illness, and
their applicability to different types of health problems. (LSU)
Design social and behavioral change interventions based on these theories that are appropriate and
responsive to the social and cultural context. (LSU)
Apply the socio-ecological model to understand and improve public health (TUS)
Apply theoretical models of health behavior and health communication to understand and evaluate
public health problems, and to design, implement and evaluate public health interventions. (TUS)
Identify basic theories, concepts and models from a range of social and behavioral disciplines that are
used in public health research and practice. (UOH)
Identify the causes of social and behavioral factors that affect health of individuals and populations.
(UOH)
Identify individual, organizational and community concerns, assets, resources and deficits for social
and behavioral science interventions. (UOH)
Describe the role of social and community factors in both the onset and solution of public health
problems. (UOH)
Describe the merits of social and behavioral science interventions and policies. (UOH)
Apply evidence-based approaches in the development and evaluation of social and behavioral science
interventions. (UOH)
18
Specify multiple targets and levels of intervention for social and behavioral science programs and/or
policies. (UOH)
Culture and its impact on health(MCI)
Customs, taboos and mores(MCI)
Clinico- social, cultural and demographic evolution of the individual, family and community(MCI)
Humanities and Community Medicine(MCI)
Social organizations with special reference to family(MCI)
Religion, its evolution as a special instance of the evolution of social institutions(MCI)
Major tenets of the common religions in India & their influence on health & disease(MCI)
Assessment of barriers to good health and health seeking behavior(MCI)
Methodology in social research (Attitude surveys, Questionnaires, Interviews) (MCI)
Health economics(MCl)
Social security in India(MCI)
Medical social worker(MCI)
Doctor patient relationship(MCI)
Social problems e.g. child abusejuvenile delinquency, drug addiction, alcoholism, marital
maladjustment, domestic violence, suicide and attempted suicide, problems of the old, caste
system(MCI)
Psychology and its concepts(MCI)
The Psycho analytic theory(MCI)
Human personality, its foundations, development and organization(MCI)
Development of child and its impact on its personality(MCI)
Psychological tests-personality tests, intelligence tests(MCl)
Leadership
Describe the attributes of leadership in public health. (UOH)(ASPH)
Describe alternative strategies for collaboration and partnership among organisations, focused on • .
public health goals(ASPH)
Articulate an achievable mission, set of core values, and vision. (UOH)(ASPH)
Engage in dialogue and learning from others to advance public health goals. (UOH)(ASPH)
Demonstrate team building, negotiation and conflict management skills(ASPH)
Demonstrate transparency, integrity and honesty in all actions(ASPH)
Use collaborative methods for achieving organisational and community health goals(ASPH)
Apply social justice and human rights principles when addressing community needs(ASPH)
Develop strategies to motivate others for collaborative problem solving, decision-making, and
evaluation. (ASPH)
19
Demonstrate the ability to work independently and in groups to foster positive change. (TUS)
Accurately assess one’s ability to create change, identifying and acting upon critical information and
opportunities in a public health organization or system. (TUS)
Take action tojmprove team and coalition effectiveness. (TUS)
Interact, communicate and educate effectively persons from diverse backgrounds, ages and
preferences to promote healthy behaviour through community participation(MAU)
Explain scientific info to public, decision makers and opinion leaders and all stakeholders(MAU)
Nurture teamipirit and harmonise activities of various members(MAU)
Facilitate intersectoral coordination(MAU)
Promote and establish partnerships and networking (e.g.: with institutions of local self governance).
(MAU)
Communication (including informatics)
Describe how the public health information infrastructure is used to collect, process, maintain, and
disseminate data. (UOH)
Describe how societal, organizational, and individual factors influence and are influenced by public
health communications. (UOH)
Apply legal and ethical principles to the use of information technology and resources in public health
settings. (UOH)
Demonstrate effective written and oral skills for communicating with different audiences in the
context of professional public health activities. (UOH)
Listen to, learn about, and understand differing perspectives on a public health issue from diverse
populations and stakeholders. (TUS)
Use theory, evidence, and stakeholder input to communicate appropriately with diverse populations
and stakeholders. (TUS)
Communicate effectively in writing and orally with professional and lay audiences. (TUS)
Information, Education, Communication & Health Promotion(MCI)
Understand the concepts of health promotion and education, IEC, behavioral change
communication(MCI)
Principles & methods of health promotion and education(MCI)
Barriers to effective communication and methods to overcome them. (MCI)
Process of learning and its principles(MCI)
Various methods of health education with their advantages and limitations(MCI)
Aids for imparting health education(MCI)
20
^3
Organizing health promotion and education activities at individual, family and community
settings(MCI)
Evaluation of health promotion and education programme(MCI)
Pedagogical methods: introduction, elements and techniques(MCI)
Communicate effectively with individuals and groups(MAU)
Policy and advocacy
Examine the main components and policy issues regarding the organization, financing and delivery of
health services and public health systems in the United States. (LSU)
Identify, propose and analyze policy interventions to improve population health in a variety of societal
levels and sectors (TUS)
Apply basic financial and economic principles to the analysis of health policy and systems, and
program management (TUS)
Life-long learning (no appropriate sub competencies found in reviewed documents)
Health related Millennium Development Goals(MCI)
Operational research(MCI)
National Health Policy and National Rural Health Mission(MCI)
Human resource development (no appropriate sub competenciesfound in reviewed documents)
Plan human resources development(MAU)
Equity (no appropriate sub competencies found in reviewed documents)
Governance and decentralisation (no appropriate sub competencies found in reviewed documents)
Conflict resolution (no appropriate sub competencies found in reviewed documents)
21
Acronyms used in the document
MCI - Medical Council of India MD Community Medicine syllabus
'http://bfuhs.ac.in/Examination/SYllabus/Coinmunity%20Medicine.pdf
LSU - Louisiana State University Health Sciences Center School of Public Health (New Orleans)
(htW/publichealth.lsuhsc.edu/pdf/LSUSPH MPH Competencies.pdf)
UOH - University of Hawai’l http://www.hawaii.edu/publichealth/academics/mphcom p.html
ASP-H - Association of Schools of Public Health http://www.asph.org/document.cfm7 page-85 L
MAV - Maulana Azad Medical College competency list
TUS - Tufts University MPH Core Competencies Listed by Domain
http://www.tufts.edu/med/docs/phpd/CoreCompetencies.pdf
(a larger list was screened, but only these were included as the others were similar)
22
"IS
APPENDIX 1
Dialogue on public health definition
Definition of Public Health: C.E.A. Winslow’s Definition of Public Health as quoted in Hanlon &
Picket 1984: “Public Health is the science and the art of (1) preventing disease. (2) Prolonging life
and organized community efforts for (a) the sanitation of the environment (b) the control of
communicable infections, (c) the education of individuals in personal hygiene (d) organization of
medical and nursing services for early diagnosis and preventive treatment of disease and (e) the
development of social machinery to ensure everyone a standard of living adequate for the
maintenance of health, so organizing these benefits as to enable every citizen to realize his birth right
of health and longevity ”
Farooque’s modified definition: “Public Health is the science and art ofPromoting Health,
Preventing disease, prolonging life, to ensure everyone a standard ofliving adequate for the
maintenance of health andPe economically active life, and to enable every citizen to realize his birth
right ofhealth and longevity, by developing a social machinery, as an integral part of Community
Development, through intersectoral coordination and organized community effort & participation to
maintain a healthy environment, to educate people to maintain a healthy life style & behavior, to
control communicable, non communicable diseases and other social & behavioral maladies, by
organizing a medical and nursing services to deliver a comprehensive health care package consisting
ofhealth promotion, prevention, early diagnosis, treatment and rehabilitation ofdiseases which is to
be universally available, equitably distributed and accessible to all at an affordable cost”.
Sanjay’s modified definition: "Public Health is the science and art ofpromoting health, preventing
disease, and prolonging life to ensure for everyone a standard ofliving adequate for the maintenance
of a healthy and productive life, by developing a social movement, as an integral part of community
development, through intersectoral coordination and organized community effort, participation,
equity and ownership - while maintaining healthy environment; empowering people to maintain a
healthy life style & behavior; controlling communicable and non communicable diseases; addressing
social and cultural realities having a bearing on health; informing health policies, interventions and
programmes; and by evolving and organizing human resource and health care systems to deliver
health promotion, disease prevention, early diagnosis, treatment and rehabilitation, which is
available universally, distributed equitably and accessible to all at an affordable cost."
SOCHARA’s modified definition: "Public Health is the science and art ofpromoting health,
preventing disease, and prolonging life
-to ensure for everyone a standard ofliving adequatefor the maintenance ofa healthy and productive
life,
-by developing a social movement, as an integral part ofcommunity development,
through intersectoral coordination and organized community effort emphasising equity, participation,
ownership, rights and responsibilities
- while maintaining healthy environment; empowering people to maintain a healthy life style &
behaviour; controlling communicable and non communicable diseases;
23
^6
-addressing social, cultural, economic, political, ecological and environmental realities having a
bearing on health;
-formulating health policies, interventions and programmes; and by evolving and organizing human
resource and health care systems to facilitate health promotion, disease prevention, early diagnosis,
treatment and rehabilitation, through informed choices of our society, communities and individuals^
-which is available universally, distributed equitably, ethical, socially relevant and accessible to all
irrespective of their ability to pay."
Iplease note that the items underlined in the above modified definitions by Dr Sanjay and SOCHAR.A
are’the suggested changes/additions to Dr Farooque’s original suggested definition!
Dr Farooque’s explanation for modifications:
The modified definition of Winslow on Public Health by Indian Academy of Public Health is an
overarching one encompassing the whole gamut of Health activity enshrined in the HFA and its
strategy document. The definition has three distinctive sections. The first section depicts the Goal of
public health as
“Promoting Health, Preventing disease, prolonging life, to ensure everyone a standard of living
adequate for the maintenance of health and be economically active life, and to enable every citizen to
realize his birth right of health and longevity”. The second sections includes the broad strategy of
“developing a social machinery, as an integral part of Community Development, through intersectoral
coordination and organized community effort & participation” The penultimate and the third section
of the definition outlines the specific health intervention activities “maintain a healthy environment, to
educate people to maintain a healthy life style & behavior, to control communicable, non
communicable diseases and other social & behavioral maladies”. And the last and the fourth section
depicts the service delivery system and the package and the manner of its delivery “organizing a
medical and nursing services to deliver a comprehensive health care package consisting of health
promotion, prevention, early diagnosis, treatment and rehabilitation of diseases which is to be
universally available, equitably distributed and accessible to all at an affordable cost”
To translate the definition of public health C.E.A. Winslow’s or the modified one of IPHA one
should refer to the chapter on Organization of Public Health services-of Hanlon’s Book on Public
Health administration. It states of two distinct approaches for providing public health services in a
community. They are “personal health care Services” focusing on individual health services and
“Public health care/ Community care services” focussing on the community. One should have a deal
understanding of the basic difference between the “personal Health Care”& “Public Health/
community care services. The focus of personal health care service is to deliver the health care
package as described in the definition of Public Health which speaks of a “comprehensive health care
package consisting of health promotion, prevention, early diagnosis, treatment and rehabilitation of
diseases.” And to achieve the characteristics of services as defined in Public Health “to be
universally available, equitably distributed and accessible to all at an affordable cost” the health
service in India is organized on the concept of ^Regionalized Graded Institution supported
community based Health care System,f Briefly it describes the Indian Health care system. The most
peripheral service unit is the community (village), and a community based health worker
ASHA/AWW provides a support base and acts as a link worker to provide essential health care
services by the most peripheral trained health worker from her community based institution of “Sub
centre”.
The services and referral support is provided by a chain of health Institution in an
hierarchical pattern (Graded)and serving an ear marked catchment.area (Regionalized). To start with
it is the Primary Health Centre manned by Medical Officers, supported by a Community Health
24
Centre acting as a First referral unit for treatment purpose which is manned by specialists (or trained
generalist) of Obstetrics & Gynecology, Pediatrics or Medicine, Surgery and , Anesthesia. The next
health Institution is s Sub-divisional/ Taluka Hospital with specialist in major disciplines( not
available all throughout) but which is universally supported by a District Hospital having all the
facilities of specialist care. The care given by a Female health worker to an Antenatal mother in her
area which includes delivery of Antenatal, intra-natal and post natal packages both institutions based
as well as at home if during this process she develops permanent disability she is also supposed to
provide some rehabilitative package (may not be included in the program). One can extend the same
thinking to other public health programs like RNTCP, Malaria, AID’S control etc. This type of
workers should essentially be equipped primarily with clinical skills to deal with the individual
medical problem. And to interact effectively with the patients, beneficiaries and the family members
and the other members of the health team he/ she should be equipped with a communication and
behavioral skill. Besides these two specific skills she/he should be familiar with the basic office
management skills for reporting and recording and be familiar with the public health programs and
ready to cooperate.
On the other hand the Public/ community Health care service provider’s focus is on the
public/community. Its main as per the definition of Public Health is to “maintain a healthy
environment, to educate people to maintain a healthy life style & behavior , to control communicable,
non communicable diseases and other social & behavioral maladies, by organizing a medical and
nursing services and to deliver a comprehensive health care package consisting of health promotion,
prevention, early diagnosis, treatment and rehabilitation of diseases which is to be universally
available, equitably distributed and accessible to all at an affordable cost” . The job responsibility of a
public health worker is to monitor the health status & environment, disease surveillance, of the
community he serves and assist/arrive at a community diagnosis, devising and implementing a health
intervention program, organizing a health services to deliver the comprehensive health care package
and to ensure its effective utilization by the community at large. The core competencies required for
such job will be Basic human biology which should include social & psychological aspect,
Environmental & Ecological science, Behavioural sciences. Biostatistics, Demography,
Epidemiology, Management sciences, History & evolution of Health & Public Health services. The
skills to be developed in a public health worker are epidemiological skill, Basic Public Health skills,
Communication skills Health system management skills. The health system management skills should
include skills to manage organizational, personal, material and financial issues. Addressing the health
needs of the community as well as for effective functioning of a health service system, requires a
seamless relationship between different type of service institutions like hospitals and the community
based service programs requiring communities participation and the support and coordination of other
departments related to human development. As such the public health worker should also have the
ability to interact with the public as well as other service providers.
At present all the existing health work force is providing both the personal and public health care. Can
one believe that the main players of the personal care service providers are also providing a complex
package of public health service all throughout the country and implementing health programs galore
including NRHM? With the non existence (in most of the states) of Male Health worker the Female
Health worker is the key worker most inadequately supported by a dwindling species of Lady Health
Visitors ( in many a states and if at all they are mostly untrained promoted on attaining a service
seniority) and the so called Public Health nurses. The poor medical officer is blamed. But please
examine the support he is getting in providing a community based public health services. While for
providing institution based Clinical care he has the option to have the support of Nurse, Pharmacist,
laboratory technician, OT technician. Blood bank technician, CT technician and hordes of others but
in public health none except a Computer and a Block extension educator under the Family welfare
program. They too are not formally trained. No one has to do another multi-centric study under the
25
^3
aegis of ICMR or the Planning commission to find out the inadequacies of a dedicated public Health
work force. This is evident as it exists today in our health services. This is because of our ignorance
of the exact nature and scope of public health and an “ostrich” like attitude for not listening to others’
views on the issue. Understanding the basic difference between the two and appreciating the
necessity of these complimentary approaches to improve the health services will be epoch making
>i?p in ameliorating the ruts afflicting the health care delivery system and lead to fulfill the MDG goal
as well as make the definition of Public Health as achievable.
Dr Sanjay’s explanantion for modification:
reservations and explanation:
(based on Winslow’s definition):
Winslow inherited a lot. Will it be rational (or scientific) and fair to ‘totemize’ a whole heritage
with one name? Emancipation from a Eurocentric discourse may have other ideas and options
too. Ungual structure and framework do not belong to an individual. An if that has been a tradition, it
needs to be stopped. Winslow’s work should be referred to, instead.
....and be economically active life,
Why place a premium on ‘economical’ alone-and trap ourselves?
...every citizen..... :
Citizen is a loaded word. Public health should aim to reach out to non-citizen as well. To non-people
(not people like us) as well.
... to educate people...:
Betrays a patronizing sentiment. Empowering may be a better word.
SOC HAR4's explanation for modifications:
We would also agree that we should not only refer to Winslow’s definition, but to others as well.
While putting another document together from various sources (see document “public health
definition database”), we also felt the need to review two other terms that are now commonly being
used in public health circles, sometimes synonymously and sometimes with clarity of understanding
of the subtle difference. These are the “new public health” and “community health”. While reviewing
these we discovered that both Farooque and Sanjay have already introduced these newer ideas and
concepts, but there are three additions we would like to suggest to locate the definition in today’s
context.
The first is to add the concept of both “rights and responsibilities” taking from the newer community
health and new public health definitions.
The second is to add “economic/political/ecological ” when we mention “social and cultural realities”.
You will recall, that this was accepted in the WHO SEARO meeting of Epidemiologists in the region
in February 2009 when they accepted in the declaration of the meeting and added the following:
“The scope and reach of epidemiology, which is an integral part of public health must be expanded to
include the study of social, cultural, economic, environmental, ecological and political determinants
of health, and constitute the key stone for use of evidence for development of public health policy.”
The third is to add “ethical and socially relevant” when we describe the system and not just make it
“universal, distributed equitably and affordable”.
26
The fourth is to add words like “formulating/facilitating” rather than “delivering” to ensure that we
are less “top-down” and more process oriented, or bottoms-up in our policy making.
The fifth is to question whether “accessible to all at an affordable cost”, is an acceptance of today’s
economic policy since the Shore committee had used “irrespective of their ability to pay”. If IPHA is
committed to “Health for All” and not “Health for those who can pay” we have to change this phrase
as well.
While we are happy to move beyond Winslow’s definition - we would like to emphasise that the
original definition also had an additional phrase which was - “informed choices of
society/organisation, public and private, communities and individuals”. 1 feel this phrase emphasising
both “informed choice” which is evidence driven rather than idea, opinion or emotion driven, is very
important in today’s public health policy evolution. The same phrase also shows the diversities of
sectors - government, private and civil/community which emphasises partnerships. We need to
consider this aspect as well.
27
I6o
APPENDIX 2
List of definitions
PUBLIC HEALTH DEFINITIONS
PUBLIC HEALTH
Public health (International Association of Epidemiology dictionary - JM Last, 1983)
Public Health is one of the efforts organized by society to protect, promote, and restore the peoples’
health. It is the combination of sciences, skills, and beliefs that is directed to the maintenance and
improvement of the health of all the people through collective or social actions. The programs,
services, and institutions involved emphasize the prevention of disease and the health needs of the
population as a whole. Public health activities change with changing technology and social values, but
the goals remain the same: to reduce the amount of disease, premature death, and disease-produced
discomfort and disability in the population.
(Public health is thus a social institution, a discipline, and a practice).
http://www.merriam-webster.com/dictionary/publ ic+health?show=Q&t-l 317192822
Public health: the art and science dealing with the protection and improvement of community health
by organized community effort and including preventive medicine and sanitary and social science
http://medical-dictionary.thefreedictionary.com/publicHiealth
public health (pub I ik)
The science and practice of protecting and improving the health of a community, as by preventive
medicine, health education, control of communicable diseases, application of sanitary measures, and
monitoring of environmental hazards.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin
Company. Published by Houghton Mifflin Company. All rights reserved.
public health
a field of medicine that deals with the physical and mental health of the community, particularly in
such areas as water supply, waste disposal, air pollution, and food safety. In the United States there
are more than 3000 state, county, or city public health agencies. The U.S. Public Health Service was
organized in 1798 to provide hospital care for American merchant seamen. Subsequent legislation has
expanded the role of the federal agency to include such services as the Food and Drug Administration;
the National Library of Medicine; health care for Native Americans and Alaska Natives; protection
28
\O'|
against impure and unsafe foods, drugs, cosmetics, and medical devices; control of alcohol and drug
abuse; and protection against unsafe radiation-producing projects.
Mosby's Medical Dictionary, Sth edition. ©2009, Elsevier.
public health
the field of health science that is concerned with safeguarding and improving the physical, mental,
and social well-being of the community as a whole. The UNITED STATES PUBLIC HEALTH SERVICE
(USPHS) is a federal health agency that is part of the United States Department of Health and Human
Services. State and county public health agencies function under the supervision of and with financial
support from the Department of Health and Human Services.
public health nursing the branch of nursing concerned with providing nursing care and health
guidance to individuals, families, and other population groups in settings such as the home, school,
workplace, and other community settings such as medical and health centers. The nurse in this field, a
COMMUNITY HEALTH NURSE, must have a baccalaureate degree and training in public health nursing
theory and practice; employment is typically with a local agency such as a nonprofit proprietary
organization or with an agency under the United States Department of Health and Human Services.
The work involves implementing such programs as school and preschool health programs,
immunization and treatment of communicable diseases, maternal and child health clinics, and home
visits for the purpose of providing health education and nursing care. There is also frequent
participation in educational programs for nurses, allied professional workers, and civic organizations,
and involvement in studying, planning, formulating public policy, and putting into action local and
national health programs.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition.
© 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.
public health,
/? a field of medicine that deals with the physical and mental health of the community, particularly in
such areas as water supply, waste disposal, air pollution, and food safety.
Mosby's Dental Dictionary, 2nd edition. ©2008 Elsevier, Inc. All rights reserved.
29
public health
the field of human medicine that is concerned with safeguarding and improving the physical, mental
and social well-being of the community as a whole. There are marginal roles for veterinarians in this
service, especially in the area of zoonoses.
Saunders Comprehensive Veterinary Dictionary, 3 ed. © 2007 Elsevier, Inc. All rights reserved
littp://www.medterms.com/script/main/art.asp?articlekey-5120
Public health: The approach to medicine that is concerned with the health of the community as a
whole. Public health is community health. It has been said that: "Health care is vital to all of us some
of the time, but public health is vital to all of us all of the time.
The mission of public health is to "fulfill society’s interest in assuring conditions in which people can
be healthy." The three core public health functions are:
•
The assessment and monitoring of the health of communities and populations at risk to
identify health problems and priorities;
.
The formulation of public policies designed to solve identified local and national health
problems and priorities;
•
To assure that all populations have access to appropriate and cost-effective care, including
health promotion and disease prevention services, and evaluation of the effectiveness of that
care.
http: cn.wikipedia.org/wiki/Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health
through the organized efforts and informed choices of society, organizations, public and private,
communities and individuals" (1920, C.E.A. Winslow)
■ w,whatispublichealth.org/
NEW PUBLIC HEALTH
http://heapro.oxfordiournals.Org/content/4/4/265.extract [Ilona Kickbusch. Approaches to an
ecological base for public health. Health promotion. Vol 4, no.4, 265]
A new public health approach would therefore not only move from its present behavioural
epidemiology” and “surveillance” mode to a more environmental and social approach, but would aim
to tackle the risk patterns of our societies with new basic assumptions.
http://ww.ncbi.nlm.nih.gov/pmc/articles/PMC144832 l/
36
What’s new about new public health? Am J Public Health. 2004 May; 94(5): 705-709. Niyi Awofeso
By the early 1990s, there was general agreement within the public health community that health
promotion, based on the Ottawa Charter principles, constituted the “new public health.”!3,14 Yet
analysis of the health promotion framework reveals the legacies of previous eras, thus prompting the
question, “What’s new about the ‘new public health’?” In addressing this question, I demonstrate that
original health promotion innovations, and the legacies of previous eras, are “new” in the sense that
the latter have been revised in the light of advances in knowledge, increasing concerns about human
rights, and emerging threats to health.
What is new about the new public health is not the originality of strategies to ensure healthy
conditions, but the manner in which health promotion discourse has adapted core doctrines of
previous eras to address the public health threats of our era. New public health eras usually arise when
the dominant public health framework becomes obsolete as a result of changing health patterns and
advances in health knowledge. Currently, public health theorists and commentators appear to be
losing confidence in the capacity of the health promotion paradigm to effectively address major
contemporary public health threats, such as health inequalities and terrorism.
http://www.google.co.in/url?sa^&source=web&cd=7&ved=0CHoQFjAG&url=http%3A%2F%2Fw
wvv.elsevierdirect.com%2Fcompanions%2F9780123708908%2Fcasestudies%2FNPH%2520Teaching
%2520guide.doc&ei=lvabTpyJM4L5rQe iQGmBA&usg=AFOiCNGe5gDqWWUyh-
KKzGq6CXNUS6YcDQ&sig2= ZRgFTzmz3biGlHYJFFrHw
The New Public Health is derived from the experience of history. Organized activity to prevent
disease and promote health had to be relearned from the ancient and post-industrial revolution worlds.
As the-2Qth century draws to a close, we need to learn from a wider framework how to use all health
modalities, including clinical and prevention-oriented services to effectively and economically
preserve, protect and promote the health of the individual and of society. The New Public Health, as
public health did in the past, faces ethical issues that relate to health expenditures, priorities and social
philosophy. Throughout the course of this book, we discuss these issues, and try to indicate a balanced
approach toward the New Public Health.
"The New Public Health is not so much a concept as it is a philosophy which endeavors to broaden the
older understanding of public health so that, for example, it includes the health of the individual in
addition to the health of populations, and seeks to address such contemporary health issues as are
concerned with equitable access to health services, the environment, political governance and social
and economic development. It seeks to put health in the development framework to ensure that health
is protected in public policy. Above all, the New Public Health is concerned with action. It is
concerned with finding a blueprint to address many of the burning issues of our time, but also with
31
I
identify ng implementable strategies in the endeavor to solve these problems." [Ncaayiyana D,
Goldstein G, Yach D. New Public Health and the WHO’s Ninth General Program of Work: A
discussion Paper. Geneva: World Health Organization, 1995.]
Defining new public health (NPH):
Tl'se NPH is a comprehensive approach to protecting and promoting the health status of the individual
arid the society, based on a balance of sanitary, environmental, health promotion, personal and
community oriented preventive services, coordinated with a wide range of curative, rehabilitative and
long term care services.
The NPH requires an organized context of national, regional and local governmental and non
go vemmcntal programs with the object of creating healthful social, nutritional and physical
en\ ironmental conditions. The content, quality, organization and management of component services
arid programs are all vital to its successful implementation.
1 he NPH is based on responsibility and accountability for defined populations in which financial
sy terns promote achievement of these targets through effective and efficient management, and coste ective use of financial, human and other resources, it requires continuous monitoring of
er , lemiological, economic and social aspects of health status as an integral part of the process of
n magement, evaluation and planning for improved health.
I he NPH provides a framework for industrialized and developing countries, as well as countries in
political-economic transition such as those of the former Soviet system. They are at different stages of
ec onomic, epidemiologic and socio-political development, each attempting to assure adequate health for
it • copulation with limited resources.
C MM LMTY HEALTH
I
p://ww‘a cornmunityhealthJn/~coniniun26/wiki/index.plip?title=Community health
C immunity health is a process of enabling people to exercise collectively their responsibility for
th ir own health and to demand health as their right. It involves the increasing of the individual,
family and community autonomy over health and over organisations, means, opportunities,
knowledge, skills and supportive structures that make health possible.111
The components of community health action include111
•
Integrating curative with preventive, promotive and rehabilitative activities.
•
Experimenting with low-cost, effective, appropriate technology.
•
Involving local, indigenous health knowledge, resources and personnel.
32
|o5
®
Training village based health workers.
•
Initiating and supporting community organisations in all aspects of health planning and
management.
•
Generating community support by mobilising financial resources, labour skills and manpower
resources from the community.
Community Health: http://en.wik.ipedia.org/wiki/Community health
•
Community health, a field of public health, is a discipline that concerns itself with the study
and betterment of the health characteristics of biological communities.
PRIMARY HEALTH CARE
Primary health care, often abbreviated as “PHC”, has been defined as "essential health care based
on practical, scientifically sound and socially acceptable methods and technology made universally
accessible to individuals and families in the community through their full participation and at a cost
that the community and the country can afford to maintain at every stage of their development in the
spirit of self-reliance and self-determination".
Source: The Alma-ata Declaration
33
APPENDIX 3
References used for preparing public health competency list
Indian institutions:
A II M S: http://www.aiims.edu/aiims/academic/aiims-syllabus/Syllabiis%20%20md%20ms%20mds%20mha.pdf
RGUHS: http://www.kimscommunitymedicine.org/mdcurriculurn.pdf
CMC: Syllabus document sent by email by Dr Sara Bhattacharji
MCI MBBS
http://www.mciindia.org/RulesandRegulations/GraduateMedicalEducationRegulationsl997.aspx
MCI MD http://bfuhs.ac.in/Examination/Syllabus/Community%20Medicine.pdf
Rest of the world:
University of Hawai’l (MPH Competencies (ASPH) in 2006)
http://www.hawaii.edu/publichealth/acadcmics/mphcomp.html
Louisiana State University Health Sciences Center School of Public Health (New Orleans) - SchoolWide Public Health Competencies for MPH Students
http://publichealth.lsuhsc.edu/pdf/LSUSPH MPH Competencies.pdf
Epidemiology Core Competencies for Master of Public Health Students
Public Health Reports, 2008 supplement 1, volume 123, pg 59
http://www.publichealthreports.org/issueopen. cfm?articleID=2018
Tufts University MPH Core Competencies Listed by Domainhttp://www.tufts.edu/med/docs/phpd/CoreCompetencies.pdf
ASPH - MPH core competencies http://www.asph.org/document.cfm?page=:851
And http://www.asph.org/userfiles/WordFormat-DomainsandCompetenciesOnly.doc
The council on linkages between academia and public health practice
https://www.train.org/DesktopShel l.aspx?tabid:=94
St Louis University SPH - PUBLIC HEALTH LEADERSHIP COMPETENCY FRAMEWORK
DEVELOPED BY NATIONAL PUBLIC HEALTH LEADERSHIP DEVELOPMENT NETWORK
http://www.heai-tlandcenters.slu.edu/nln/about/framework.pdf
Core competencies for public health in Canada http://www.phac-aspc.gc.ca/php-psp/ccph-cesp/stmtsenon-eng.php
Core competencies in public health literature review - CIHR - The Institute of Population and Public
Health - FREQUENTLY CITED CANADIAN CORE PUBLIC HEALTH FUNCTIONS
http://www.phlr.anaphi.unsw.edu.au/IMAGES/CC litreview cphf.pdf
* *+♦ ♦
34
Perspectives, Principles and key components for CHFP
&lk>'S|1gPeCtiVeS”that Sh°Uld 8Uide tHe Community Health FeHowship Programme include the
PERSPECTIVES
• Community based and led approaches - understand community dynamics, perceptions,
community mobilisation, community capacity building and societal analysis
•
People’s perspectives of health systems
•
Social, economic, political and cultural analysis
•
Gender perspectives
•
Political economy of health and the forces of liberalization, privatization and
globalization and their impact on health and equity
Secularism
«
Epidemiological perspective understand data, analyse data/situation and respond
•
Perspective on self-transformation while engaging in social action
PRINCIPLES
«»
Health equity (understand the differences based on factors such as caste, class, urban/rural
location, region, culture, gender and religion)
Health rights/entitlements (health as a fundamental human right, universal access to
health
care and comparison with other country models)
Governance
0
»
State responsibility and role for health, including universal access to health care
Leadership and activism in health that is enabling
KEY COMPONENTS IN HEALTH
Health systems - history and evolution of health systems in India - traditional, public and
private health systems and their current status
•
Issues of access, acceptability, affordability, availability, quality of care
•
History and relevance of comprehensive primary health care as an approach or strategy
towards achieving Health for All or equity in health.
•
Learning from peoples health initiatives and local health traditions
•
People’s struggles/movements and people’s health initiatives
There are often competing perspectives and their methods of interaction, negotiation, gaining
dSussedanCe °ne °r 116 °ther approach and consequences for communities need to be
uibvii ssea.
1
\O2>
Perspective building should not be onlyideologically driven. It is important to present
various perspectives with equal attention and help develop the analytical capacity of the
participants to dialogue and discuss with all concerned and to choose the best perspective
with the communities in focus and to grow through a process of praxis and reflection.
Contents
The contents of this Fellowship Programme is very comprehensive and organized into the
following
categories / topics .
1. Health and Society
a. an understanding of health, development, and equity
b. what is community health and public health
c. values, social justice, health human rightsand public health ethics;
a’ m^derstanding5 underlying socio-political, economic and cultural determinants of health and
their inter-relationships and dynamics
b. situation analysis of health and health determinants in India and specifically in MP;
c. Culture and health - further details
d. environment and health and worker’s health; social security and social protection of
the workers
e. social determinants of health and social movements for health; related social sector
programs that impact on health;
.3. Health system and Alternatives
3a) Health system
a. historical understanding of health policies and programs m India
b. understanding the entire health sector (public, private, voluntary, Indian systems, peoples
sector); role
contribution of different components; Pharmaceutical policy and all health related policies
c. health system issues - at different levels
d. Health for All and comprehensive Primary Health Care - with a focus on experiences from
India and
Asia in training of community health workers and community participation in small projects
and scaled
up ro state level; inter sectoral action tor nealth
e. health planning, administration and management
f. basics of health financing, health budget analysis, health insurance
2
\ O'A
g. National Rural Health Mission; implementation and organizational issues; understandingall its
components; tracking the website, review reports; studying innovations; skills required to
realize the
communitisation components
h. urbanization, health and health care for the urban poor. National Urban Health Mission
analysis and
action;
3b) Alternatives
a. Health for All and comprehensive Primary Health Care - with a focus on experiences from
India and
Asia in training of community health workers
b. the voluntary sector in health in India; different perspectives and approaches; NGOs and their
federations; the role of civil society in health; people's organizations; health empowerment
strategies
c. the global People’s Health Movement (PHM), People's Charter for Health, country circles,
campaigns,
WHO advocacy circle, Global Health Watch, PH exchange, International People's Health
University
d. the Jan Swasthya Abhiyan (PHM India) and state units; People's rural Health Watch;
community
mobilication and campaigns on various issues, booklets produced for two Jan Swasthya
Sabhas;
IV Situation analysis of health and major public health problems
4a) Situation analysis of health
a. distribution and trends; critical analysis of data and data sources; socially disaggregated
analysis;
social exclusion and health in India and MP
b. priority health problems - nutrition / food issues; communicable diseases including TB,
Malaria and
other vector borne diseases, water borne and water related diseases; reproductive tract
infections;
cardiovascular diseases; diabetes and cancer
c. women’s health, gender and health, children’s health
d. ui banization, health and health care for the urban poor;
—
WO
4b) Special groups and situations
Disaster, conflict, displacement, HIV-AIDS, Mental Health, Disability, Environment and
health, and worker’s health
V Communitization: Community process, Dynamics (Panchayati Raj institutions and health;
perspective
and capacity building ofPRI members), Stratification, Institutions
VI Right to Health and Health Care
Constitutional and legal aspects of health
VII Research
Health enquiries and research,
critical reading of reports and data.
The course participants will be encouraged to develop a mix of an adequate knowledge base,
perspectives, skills (networking, advocacy, CH skills) and attitudes that are sensitive to diverse
communities and to field implementers. They should know the public health system, and also be
able to collect data, present and interpret data. Essential reading lists would need regular updation.
Distance learning modules may be used.
Source: Learning Programmes for Community Health and Public Health - Report from a
national Workshop -April 2008 (A CHC Silver Jubilee Publication)
4
COURSE CONTENT
The content of the next phase teaching learning Programme is developed based on the 2008 National
Workshop “Learning Programmes for Community Public Health and Public Health”, and its subsequent
application in the two year Madhya Pradesh Community Health Fellowship Program. It will evolve further
through a Curriculum Development Consultation that is being organized from 27th to 29th December 2011
and through an Academic and Research Council that is being established in 2012.
The contents covered are comprehensive and organized under the following categories/ topics .
1 Health and Society
a. An understanding of health, development, and equity
b. What is community health and public health
c. Values, social justice, health human rights and public health ethics
d. Understanding oneself; intrapersonal and interpersonal skills; social skills
e. Understanding society- structures, stratification, power dynamics, transitions
II Determinants of Health
a. Understanding underlying socio-political, economic and cultural
determinants of health and their inter-relationships and dynamics
b. Situation analysis of health and health determinants in India and
c. Culture and health - further details
d. Environment and health and worker's health; social security and social
protection of workers
e. Social determinants of health and social movements for health;
f. Related social sector programs that impact on health;
g. Concept of interconnected rights
HI Health system and Alternatives
3a) Health system
a. Historical understanding of health policies and programs in India
b. Understanding the entire health sector (public, private, voluntary,
Indian systems and AYUSH, peoples sector and local health traditions); role and
contribution of different components; pharmaceutical policy and all health related
policies
c. Health system issues - at different levels
d. Health for All and comprehensive Primary Health Care - with a
focus on experiences from India and Asia in training of community
health workers and community participation in small projects and
scaled up to state level; inter sectoral action for health
e. Health planning, administration and management
f. Basics of health financing, health budget analysis, health insurance
g. National Rural Health Mission; implementation and organizational
issues; understanding all its components; tracking the website,
review reports; studying innovations; skills required to realize the
communitisation components
h. Urbanization, health and health care for the urban poor. National
Urban Health Mission analysis and action;
i. AYUSH and public health
3b) Alternatives
a. Health for All and comprehensive Primary Health Care - with a
focus on experiences from India and Asia in training of community
health workers
b. The voluntary sector in health in India; different perspectives and
approaches; NGOs and their federations; the role of civil society in
health; people's organizations; health empowerment strategies
c. The global People’s Health Movement (PHM), People's Charter for
Health, country circles, campaigns, WHO advocacy circle, Global
Health Watch, PH exchange, International People's Health
University
d. The Jan Swasthya Abhiyan (PHM India) and state units; People s
rural Health Watch; community mobilication and campaigns on
various issues, booklets produced for two Jan Swasthya Sabhas,
IV Situation analysis of health and major public health problems
4a) Situation analysis of health
a . Distribution and trends; critical analysis of data and data sources;
socially disaggregated analysis; social exclusion and health in India
b. Basic epidemiology and research methods, including qualitative methods
b. Priority health problems - nutrition / food issues; communicable
diseases including TB, Malaria, HIV-AIDS and other vector borne diseases,
water borne and water related diseases; reproductive tract
infections; cardiovascular diseases; diabetes and cancer
c. Women's health, gender and health, children's health
d. Mental health and Disability
d. Urbanization, health and health care for the urban poor;
4b) Special groups and situations: Disaster, conflict, displacement, AIDS, Environment and health,
Worker's Health
V Community Processes and Dynamics (Panchayati Raj institutions and health;
perspective and capacity building ofPRI members), Stratification,
Institutions
VI Right to Health and Health Care
Constitutional and legal/legislative aspects of health and health care
VII Research
Health enquiries and research, critical reading of reports and data.
The course participants will be encouraged to develop a mix of an adequate knowledge base, perspectives,
skills (networking, advocacy, CH skills) and attitudes that are sensitive to diverse communities and to field
implementers. They should know the public health system, and also be able to collect data, present and
interpret data. Essential reading lists would need regular updation. Distance learning modules may be used.
OVER ALL PERSPECTIVES
.
♦ Community based and led approaches - understand community dynamics, perceptions, community
mobilisation, community capacity building and societal analysis
x
♦
♦
♦
♦
♦
♦
♦
People’s perspectives of health systems
Social, economic, political and cultural analysis
Gender perspectives
Political economy of health and the forces of liberalization, privatization and globalization and their
impact on health and equity
Secularism
Epidemiological perspective-understand data, analyse data/situation and respond
Perspective on self-transformation while engaging in social action
PRINCIPLES
♦ Health equity (understand the differences based on factors such as caste, class, urban/rural location,
region, culture, gender and religion)
♦ Health rights/entitlements (health as a fundamental human right, universal access to health care and
comparison with other country models)
♦ Governance
♦ State responsibility and role for health, including universal access to health care
Leadership and activism in health that is enabling
106
7
r\
■■
APPENDIX
WPt1
OL1DATED LIST OF THEMES
CONSO"~
OF SESSIONS (2008-2010)
1 WV
J
■
■
Rw-W
»
-24
.
’ r-;
r
_____ ______________ ___
-■
■
;
,/fE
‘
‘
____
Ah '
Thematic List of Topics
Orientation and Introduction to the
Programme
Getting to know each other (CHC
team and interns) and Participant’s
expectations
2. Overview of the Learning methods
of CHLP (Core components of CHLP)
1.
3.
4.
5.
6.
7.
8.
Introduction to SOCHARA, CHC,
CPHE, CLIC, and formation of
participants into committees and
study circles
Principles of learning, mentoring
How do you evolve your learning
needs?
Approaches to Training
Writing Sessions and Feedback
Introduction to CHLP Administrative
matters
Inside Learning
9.
Group Lab - I (Decision to Join,
Sharing Anxieties, Understanding
and building a community of
learning, Learning opportunities.
Inside and outside learning,
Individual and collective learning).
10. Group Lab - 11 (Sharing / Feedback,
Listening,
Working
together,
Leadership Styles, Agreeing to
disagree and Who am I?)
11. Group Lab - III Basic TA/Relationships,
Conflict
Resolution,
Counselling
Health and Development (General)
12. Health and Development
13. Understanding the concept of Health
(Definition of Health, Community
Health)
14. Understanding the conceptof Health
(social determinants of health and
health as a human right)
15. Web of causation
16. Monsoon Game and Debriefing
Community Health
paradigm in
12. The alternative
a CHC
community health
perspective
13. Skills and values needed for
community health - What they are?
How to cultivate them?
14. Axioms of Community Health
Primary Health Care
20. The Story of Health and Health care
in India - A birds eye over view
II) Buildin8 Community Health Through Fellowship: CHLP2011 |
MS
107
from Bhore committee to NRHM :
Challenges, crises, and responses
Health as a Right
30. Understanding the right to health of
communities
21,.. What is Primary Health Care?, How
do PHC components get translated
to practice?, Critique of selective
• approach
Health Situation in India
22'. Whatever happened to Health for
•' All by 2000 AD? The story from
Alma Ata to the present time
32. Data sources and health indicators
23. Challenges in Primary Health Work
- role of community health worker
in PHC approach, challenges in
community participation
Understanding Social
Marginalisation
Structures/
24. Understanding society
25. Caste, class, gender as determinants
of health- case study
26. Understanding Marginalization and
movements of marginalized people
(especially women)
27. Health issues of
groups (Seminar)
marginalized
31. Understanding the health situation
in India.
Public Health Challenges
33. Public health approach to control of
diseases - role of the health system.
34. Approaches
to
communicable
disease control - (Immunization
policy and challenges, disease
surveillance)
35. Overview
of some
national
programmes-vector borne diseases
36. Environment
health
and
occupational
37. Community approaches to mental
health problems
38. Women's health issues
28. Gender and health
39. Issues of health and development:
mining, issues of child labour
Socio-epidemiology
40. Maternal health
29. Community health
approaches
to public health problems and
communicablediseases-tuberculosis;
HIV/ AIDS vector borne diseases
41. The realities of the Public Health
System in India (systems and
sectors, cross cutting themes and
policy imperatives)
30. Community health approaches to
non-communicable diseases
Health Policy Challenges
31. Tobacco and alcohol control community based responses and
initiatives
42. Rational Therapeutics and Essential
Drugs
43. Confronting commercialization of
health care
Building Community Health Through Fellowship: CHLP2011 | |||j
/
108
Globalisation and Health
Globalization and People's Health
44.
Documentary on Globalisation
45.
People’s Health Movement
46. Understanding
movements
of
marginalized people (especially
women)
and
understanding
movement's in the context of health
47. The People's Health Movement
response to globalization
48. Understanding People’s Charter for
Health (global) and Indian People's
Health Charter
National Rural Health Mission
49. Introduction to public health
system, structure and its function
and role of the health system
50. National Rural Health Mission : A
nation's effort to strengthening of
health systems
51. Sharing of Community Monitoring
experiences qf Tamil Nadu and
Karnataka
59. Visit to Karnataka State Natural
Disaster
Monitoring
Centre
(KSNDMC)
Alternative systems
60. Questioning the dominant paradigm
61. Understanding alternative system
62. Acupressure and Herbal Medicine
Field Placement-preparation and
mentorship
Mentors
meeting.
63. Mentor’s
interaction with interns
64. Orientation to field placements
65. Completion of reports and meeting
with mentors
66. Preparing for presentations on
learning objectives and plan of ation
67. Presentation by interns-Learning
Objectives and Plan of Action
68. Group discussion on roles and
responsibilities of interns and
mentors; Assessment of mentoring
process and progress of intern
Field Visits
Disaster
69. Public Hearing-right to health
52. Overview on disasters
approach and open learning session
53. Disasters: An Institutional Response
- public hearing at Haveri
54. Documentary
and Discussion:
70. Introduction to group assignment
Goodwill is not enough
- District Health Profile and
55. Learning's from CHC's experience in
Referencing
responding to disasters
56. First aid and transport of the injured 71. Interaction with JMS team and
knowing their work
57. Psychosocial aspects of disasters
58. Civil Defence and Demonstration of 72. Interaction with children of Chilipili
Child Labour School and interaction
using Fire Extinguishers
Building Community Health Through Fellowship: CHLP2011 |
its
i i. i
\\
109
with CHWs/Herbal Medicine Unit,
interaction with Terracotta and
Neem Unit, Visit to Sanghas in the
villages
78. Visit to urban slums
79. Visit to NGOs working with
marginalized groups - street
children, people’s with disability,
people’s with mental health, sexual
minorities, PLWHA's etc
73. Visit to Panchayats, PHC's, PDS
Stores and 1CDS centres and floodaffected villages. Debriefing of the • Additional Sessions
morning visit
80. Reading time
74. Meeting the NJMO team and
81. Attending CHC Team Meetings
other local
organizations in
Raichur. Sharing of experiences of 82. Open Learning Sessions
community monitoring
83. Celebrating Special Days [Women's
Day, Environment etc)
75. Visit to Holy Cross Comprehensive
Rural Health Project, Hannur - PHC 84. Sharing of SOCHARA work [from
visit HCCRHP activities
different clusters)
76. Visit to PHCs/herbal medicines clinic 85. Meeting
visiting
SOCHARA
members and briefing on their
77. Interaction with Workers of
work/project
unorganized workers
Building Community Health Through Fellowship: CHLP2011 |
|110
_ __L____ ______ > - .
: -
.
«
APPENDIX THREE
dll
•
- S ’
EFERENCE
I CONS O LI DAT E D L 1ST OFJ
BOOKSAND READING MATERIALS
SIT::
3ackground Reference Books
1.
2.
3.
Health for All Now! - The People’s
Health Source Book CJSA) 2004. Jan
Swasthya Abhiyan - People's Health
Movement in India
Health for All Now: Revive Alma Ata.
A PHM Compilation for the Alma Ata
Anniversary, 2003 QRavi Narayan
and Unnikrishnan P V)
Rakku's Story: Structures of Ill
Health and the Source of Change.
Sheila Zurbrigg, Centre for Social
Action, India
Background Reference Papers
Community Health Fellowships
4.
Community
Health
Learning
Programme, CHLP - Orientation
programme tentative schedule
5.
Guidelines for Community Health
Cell Interns - Administration, CHC,
SOCHARA
6.
Orientation Note for Community
Health Interns - CHC Library and
Information Centre (CLIO)
7.
Community
Health
Learning
. Programme Feedback Form
Health (General)
8.
Health Promotion Glossary- World
Health Organisation, Geneva
Community Health
9. Community Health: Search for a New
Paradigm- Dr. Ravi Narayan, Health
Action Vol. 1'2, No.ll, November
1999 p 5-31.
Primary Health Care
10. Declaration of Alma Ata, Health For
All Now, Revive Alma Ata. p 57-58
11. Public Health and Primary Health
Care.Chapters,Karnataka: Towards
Equity, Quality and Integrity in
Health, Final Report of the Task
Force on Health and Family Welfare,
GoK, April 2001. Page 52-57
12. Why Renew Primary Health Care?
Renewing Primary Health Care in
the Americas, A Position Paper of the
Pan American Health Organisation/
World Health Organisation (PAHO/
WHO), March 2007. Page 2-4
Social Determinants and Structures
13. Social Structures: Patricarchy, Caste,
Class, Towards Understanding
Indian Society. Gabriele Dietrich
it Building Community Health Through Fellowship: CHLP2011 |
\\
Ill
and Bas Wielenga, Centre for Social
Analysis, Madurai, (1997). p 31-49
14. Organising Societal Life, Towards
Understanding Indian Society.
Gabriele Dietrich and Bas Wielenga,
Centre for Social Analysis, Madurai,
(1997). p 49-58
15. Final form ofthe Commission on Social
Determinants of Health framework
Socio-epidemiology
16. Educational
approaches
in
Tuberculosis control: Building on
the Social Paradigm, Tuberculosis:
An interdisciplinary perspective,
Thelma Narayan and Ravi Narayan,
Editors: John D. H. Porter and John
M. Grange, Imperial College Press,
London, 1999. P 489-509
17. The Community Health Paradigm
in Diarrhoeal Diseases Control
by Dr. Ravi Narayan. Chapter
selected from the book ‘Diarrhoeal
Diseases: Current Status, Research
Trends and Field Studies. Edited
by D. Raghunath and R Nayak. The
Third Sir Dorabji Tata Symposium,
Bangalore. P299-304
18. Agriculture Malaria and Canal
Irrigation: Some
Observations
from Early Studies in South India
by V.R. Muraleedharan. Medico
Friend Circle Bulletin No. 246-247,
September-October 1997. pl-4
Health as a Right
19. A Guided Tour through Key
Principles and Issues of the Human
Rights-Based
Framework
as
Applied to Health, Claudio Schuftan,
Editorial, Social Medicine, Vol.2,
No.2, April 2007. p 68-78
Community Health Worker
20. The Village Health Worker- Lackey
or Liberator, David
Werner,
California, USA, 1977. p 1-14
21. Compulsions behind Community
Health Worker (CHW) Programmes,
CHW paradigms, concepts and
origin. External evaluative study
of the State Health Resource Centre
and Mitanin Programme, Final
Report, CHC, December 2005. p 1719
22. Literature
review
regarding
Community Health Worker (CHW)
programmes. Chapter selected from
the report An external evaluative
study of the State Health Resource
Centre and Mitanin Programme.
CHC, Bangalore. Dec. 2005. p50-59
Health Situation in India
23. National ' Fact
Sheet
India
(Provisional Data). National Family
Health Survey 2005-2006 (NFHS-3).
24. Rural Health Care System in India.
pl-13
(mohfw.nic.in/Rural%20
Health%20Care%2 0System%2 0
in%20India.pdf)
25. India. Chapter selected from the book
'11 health questions about the 11
SEAR countries. Published by WHOSEAR0, New Delhi in 2007. pBO-109
Building Community Health Through Fellowship: CHLP2011 |
rj
112
Globalisation and Health
26. The Globalization of Health: Risks,
Responses and Alternatives by
Richard L Harris, and Melinda
J. Seid. Article selected from the
Journal 'Perspectives on Global
Development
and Technology',
Volume 3, No. 1-2 (2004)
People’s Health Movement
27. The Peoples Health Movement: A
People's Campaign for Health for
All - Now!, Narayan, R. and Schuftan,
C. in K. Heggenhougen and S. Quah,
Eds., International Encyclopaedia
of Public Health, Vol.5, San Diego
Academic Press, 2008.
28. Public Mobilization and Lobbying
Strategies in the South: The People's
Health
Welfare, Government of India, 2006
32. A Promise of Better Healthcare
Service for the Poor- NRHM,
A
summary
of
Community
Entitlements and
Mechanisms
for Community Participation and
Ownership for Community Leaders
by Community Monitoring of NRHM,
First Phase, 2007
33. National Rural Health MissionA Promise of Better Healthcare
Service for the Poor: A summary
of Community Entitlements and
Mechanisms
for
Community
Participation and Ownership for
Community
Leaders.
Ministry
of Health and Family Welfare,
Government of India, 2006. pl-24
Health challenges of the future
34. Health is Still Social: Contemporary
29. Movement in India, by Thelma
Examples in the Age of the GenomeNarayan presented at the conference
PLoS Medicine, Volume 3, Issue 10,
on “What to Do? Critical Campaign
October 2006. p 1663-1666
Work in Times of Globalization” .
Organized by Medico International, 35. Evolving Models of Human Health
Toward an Ecosystem Context by
Germany, Bad Boll, 23rd - 24th Nov
Vanleeuwen ] A et al. Ecosystem
2006. pl-11
Health, Vol. 5, No.3, September
30. Introduction
by
Ghanshyam
1999. p204-219
Shah. Chapter selected from the
book “Social Movements and the Kannada Reading Materials
State" Edited by Ghanshyam Shah. 1. Arogyakke Hanakaasu Needikeya
Published by Sage Publications in
Kurita
Diksuchi
Prabhandha
2002. P 13-54.
(Perspective Paper on Health
Financing by Ravi Duggal, Medico
National Rural Health Mission
Friend Circle, February - March
31. Mission Document- 1,
National
2010. pll-14)
Rural Health Mission (2005 - 2012)
Kaigetukuva Arogya
- Ministry of Health and Family 2. Sarvarigu
[itS Building Community Health Through Fellowship: CHLP2O11 |
1
113
Paalanaa Vyavstheyede Saaguvudu:
Prastuta Arogya Vyavastheyallina
Nyunathe
mattu
Adetadegalu
(Moving towards Universal Access
to Health Care: Gaps and Barriers
in Existing Health System by Anant
Phadke, Rakhal Gaitonde, Abhay
Shukla, Medico friend circle, October
2009 - January 2010. pl-6
3.
Samudaaya
ArogyaHosa
Madariyondara
Hudukaata
(Community Health: Search for a
New Paradigm - Dr. Ravi Narayan,
Health Action, Vol. 12, No. 11,
November 1999. p5-31)
Janarogya Sabhe Pusthaka Malike 5.
Published by Bharath Cyan Vigyan
Samithi, Bangalore. P 1-95
9.
Arogya mattu Manava Hakkugalu
(Kannada).
Translated
and
Published by Community Health
Cell. December 2008. P 39
10. Arogya Vyavastheya mele Rajakeeya
Prerita Arthika Hodeta (Kannada).
Translated and
Published by
Community Health Cell. December
2008. P 17
11. Arogyada
HakkuHakkugalaadhaarita Arogya mattu
Arogya Palaneya Drustikoona- ondu
4. Jaagathikaranadinda
sankalita paramarshe (Kannada).
Janarogyakkenadeethu? Janarogya ■
Translated and
Published by
Sabhe Pusthaka Malike 1. Published
Community Health Cell. December
by Bharath Cyan Vigyan Samithi,
2008. P 62
Bangalore. P 1-54
12. Samathe mattuAsamathe-Arogyada
5. Kri. Sha 2000da Velege Ellarigu
Saamaajika
Nirdharakagala
ArogyaNirdharavenayithu.
kuritu Vishleshane mattu Tippani
Janarogya Sabhe Pusthaka Malike 2.
(Kannada).
Translated
and
Published by Bharath Cyan Vigyan
Published by Community Health
Samithi, Bangalore. P 1-68
■ Cell. December 2008. P 12
Badukalu
Yogyavada
Badukigagi.
6.
Additional Reference Materials in
Janarogya Sabhe Pusthaka Malike 3.
. Indian languages
Published by Bharath Cyan Vigyan
Kannada
Samithi, Bangalore. P 1-65
7.
8.
Namma
Asthithwavu
Pramukhavaguva
Jagatthu.
Janarogya Sabhe Pusthaka Malike 4.
Published by Bharath Cyan Vigyan
Samithi, Bangalore. P 1-66
A r o g y a p a 1 a y a n a
Vyaparikaranavannu Edurisuvudu.
13. Health
Inter-Network (HINJ
Community Participatory Approach
Suddhi Pathra, Samputa 1, Sanchike
1, August 2003.
14. HIN Suddhi Pathra, Samputa 1,
Sanchike 2, September 2003.
Khshayada Viruddha Hoorata. Pl,
Building Community Health Through Fellowship: CHLP2011 |
114
Mah ila Arogya-Karn a takaArogya
Karyapadeya
Shiparassugalu.
P2, Mahileyara Arogya mattu
Sashaktate. P 3 and 4
15. HIN Suddhi Pathra, Samputa 1,
Sanchike 3, September - Oct. 2003,
Janarogya Sannadu jJBharateeya
Akruti).Pl-3
Declarations) translation of PHM
charters and declarations- 64 pages
- Published by MNI
2..
Nalavazhvum Manitha Urimaigalum
- 25 Khelvigal (Health and Human
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16. HIN Suddhi Pathra, Samputa 1,
Sanchike 4, October 2003, Dengue
Jvara Niyanthrana. P 1-2
17. Alma Ata Ghoshane. P 3-4
18. HIN Suddhi Pathra, Samputa 1,
Sanchike 5, January 2004. Jana
hvasdya Abhiyana (Janatha Arogya .
Chaluvaii). P 1-4, Neeti Rachane
Sankshitpa Varadi- Sarvajanika
Arogya Rakshisi. P 5-9, Mumbai
Prakatane (Ghoshane) January
2004. p 9-12
naivgya Andolana- Karnataka,
Samputa. 1, Sanchike. 6, December
2008. Arogyada Hakku Moolabhoota
Hakkemba
Kanasintta.
P
1,
Janarogya Andholana - Karnataka
Karyakramagalu. P 2-4 Sarvajanika
Argoya Vyavastheya Kaavalu. P 6-7,
Angavikalate Iruvavarige Igiruva
Sarvajanika Arogya Vyavastheyalli,
Sulabhalabhyavaagi
Kaigetukuva
Reetiyalli Sukta Arogya Sevegalannu
Odagisuvudu Hege? P 7-8
Tamil
1 Nalavazhvu Sasanagal, Piraadanankal- (Health Charters and
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