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CHLP National Workshop 2016
Mainstreaming the
Alternative:
Community Health
and Public Health
Education - Needs,
Prospects and
Challenges
Background Papers
SOCHARA-SOPHEA
4'h & 5,h October, 2016
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CONTENTS
SI.
Pages
Content
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
1995: Report of the Expert Committee on Public Health System, GOI (Extracts)____________________________________
____________
1999: Calcutta Declaration on Public Health
2002: Towards a Public Health Curriculum for WHO - SEARO Region
(Extracts)
____________________________________________
2004: Capacity Building For Public Health In The Asia Pacific Region - A
policy reflection for UNESCAP, Bangkok - SOCHARA________________
2004: South East Asia Public Health Initiatives 2004 - 2Q08
(Extracts)__________________________________ ___________________
2006: Policy, Academic and Research Agenda for Public Health in India PHFI Inaugural workshops
__________________________________
2007: Public Health Education In India - Some Reflections on
- Public Health Education Policy; Education Initiatives; Teaching,
learning, and competency building and public health movement
___________________________ (mfc meeting background paper)________
2008: Learning Programmes for Community Health and Public Health
Community Health Fellowship Scheme - Vision, Mission, Objectives,
Perspectives, Principles and Framework (SOCHARA Report)___________
2008: Extending the Frontiers: Integrating Public Health Consciousness into
other Acadeipic Programmes (SOCHARA Contribution to PHFI Conference)
2009: Application of Epidemiological Principles for Public Health Action SEARO Regional Meeting: Conclusions and recommendations (WHO
SEARO)_____________________________________________________
2010: Revitalizing Primary Health Care: How can epidemiology help? Keynote at South East Asia Regional Conference on Epidemiology SOCHARA Contribution (WHO SEARO)___________________________
2012: A Journey of a Thousand Lives: Building Community Health through
Fellowships: Learnings and Challenges (Extracts) - SOCHARA Report
2013: Towards a Community Oriented Public Health System in Karnataka
(Report of Mission Group on Public Health, Karnataka Jnana Aayoga) (Extracts)
A State Public Health Charter
Strengthening State Public Health Capacity and HRD
1-6
7
8-13
14-25
26-30
31-34
35-48
49-56
57-77
78-83
84-95
96-110
111-125
14
Public Health in India Score (www.communityhealth.in )
126-132
15
Community Health Learning Programme of SOCHARA: 52 Week
Curriculum_______________________________________________ ____
Community Health Oriented, competency based modules by SOCHARA for
training in India (RGIPH-MPH Honors Course)
Values orientation in Public Health
Socio-cultural and Community Health
Plural Health Systems
133-136
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137-158
Background Paper - 1
1.
•
•
REPORT OF THE EXPERT COMMITTEE ON PUBLIC HEALTH SYSTEM, (1995)*
The committee constituted on 8th March 1995, consisted on Prof. J S Bajaj, Member,
Planning Commission, Chairman, Dr Jai Prakash Muliyil, Deptt. of Community Medicine,
Christian
Medical
College,
Vellore.
Member,
Dr
Harcharan
Singh,
Ex-Adviser (Health),
Planning
Commission
Member,
Dr N S Deodhar, Ex-Officer on Special Duty, MOH&FW, Member, Dr K J Nath, Director, All
India
Institute
of
Hygiene
&
Public
Health,
Calcutta.
Member,
Dr K K Datta, Director, NICD, Delhi, Member-Secretary
The Terms of Reference of the committee were as follows - to comprehensively review:
a) the public health system in general and the quality of epidemic surveillance and control
strategies in particular;
b) the effectiveness of the existing health schemes, the institutional arrangements and
the role of the States and local authorities in improving the public health system;
c) the status of the Primary Health infrastructure (sub-centres and primary health centres)
in rural areas,, especially their role in providing intelligence and alerting the system to
respond to the signs of outbreak of diseases and effectiveness of the district level
administration for timely remedial action; and
d) the existing Health Management Information System and its capability to provide up-todate intelligence for effective surveillance, prevention and remedial action.
The final report presented on 6th July 1996 was 246 pages. The recommendations of the Expert
Committee were as follows (pages : 11-20)
E-IO RECOMMENDATIONS
E-IO.I Short-term
E-IO.I.I Policy Initiatives
E-IO.I.1.1 Review of National Health Policy
The National Health Policy was formulated and adopted in 1983. During the years since then
major changes have occurred through continuing population growth, rapid urbanisation, industrial
revolution, changing health and demographic scenario, appearance of new, emerging and reemerging health problems etc. Newer technologies are also available. In view of the same, the
National Health Policy needs a careful and critical reappraisal. The committee, therefore,
recommends constitution of a Group of Experts to prepare the draft of the new National Health
Policy by the end of 1996.
E-IO.I.1.2 Establishment of health impact assessment cell
There is a need to enhance the capacity and capability of the Ministry of Health & F.W. to
undertake health impact assessment for major development projects, industrial units etc. so that
the project/ industrial authorities could be appropriately advised & guided to incorporate proper
intervention measures/ changes as the case may be. All large projects of different ministries
should invariably have health component in the proposal itself and this should be examined and
approved by the Ministry of Health & Family Welfare. Regular analysis of various public policies
and practices of other ministries viz. agriculture, industry, urban development, rural development
and environment, which have direct link with the health of the people, must be considered as an
essential prerequisite for a meaningful inter-ministerial co-ordination.
E-IO.I.1.3 Surveillance of critically polluted areas
Health impact and environmental epidemiology related to air, water, and soil pollution need to be
monitored 'and evaluated particularly in the critically polluted areas in the country. Ministry of
Health and Family Welfare should initiate actions in this regard urgently, in co-ordination with the
* Government of India, Ministry of Health & Family Welfare, Nirman Bhavan,
New Delhi 110 01
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not so easily achieved, the Committee is of the opinion that until and unless a formal mechanism
of co-ordination and co-operation is established involving all concerned and guidelines indicating
detailed responsibilities in respect of all participating units precisely defined, even in Spite of
individual schemes appearing to be technically sound, the same will not be able to deliver what is
expected of them in terms of effective improvement in the Public Health System.
E-iO.I.1.28 Non-Governmental organizations (NGOs):
The committee recommends that the NGOs should be increasingly involved through an
appropriately developed action plan with suitable funding.
E-I0.I.I.29 Involvement of ISM & Homoeopathy:
The practitioners of Indian System of Medicine can be gainfully employed in the area of National
Health Programmes like the National Malaria Eradication Programme, National Leprosy
Eradication Programme, Blindness Control Programme, Family Welfare and universal
immunisation, nutrition programme etc. Within the health care system, these practitioners can
strengthen the components of (i) health education, (ii) drug distribution for national disease
control programmes, (iii) motivation for family welfare, and (vi) motivation for immunisation,
control of environment etc.
E-10.2 Long-term
iripicniir;.1..Broad set up of Ministry:
ap-U- cr
The recommendations of the Shore Committee that the Ministry of Health should b.e^pder
the charge of a separate Minister is being followed and is currently in practice. However,
the members of the committee are of the opinion that the several activities linked with the
human health are presently undertaken by Ministry of Welfare, Ministry of Human
Resource Development, Ministry of Urban Development, Ministry of Environment, Ministry
of Rural Development etc. The work of sanitation and environmental health was earlier
with the Ministry of Health but now it is being undertaken by several ministries viz.
Ministry of Environment and Forests, Ministry of Rural Areas and Employment, Ministry of
Urban Affairs and Employment and Ministry of Chemicals. It has been further seen that the
inter-sectoral co-ordination which is very vital in successful implementation of various
programmes is not readily available through a formalised mechanism resulting in ppor
achievements under various programmes. Therefore, involving all the activities pertaining
to human health, creation of a new ministry such as Human Welfare may require serious
consideration. Alternatively a National Council of Human Welfare be constituted under the
chairmanship of Prime Minister of India, and other members being Deputy Chairman,
Planning Commission, Ministers of Concerned Ministers, eminent medical and health
professionals and representatives of professional organizations and NGOs etc.
***
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Background Paper- 2
Journal ofHealth & Population in Developing Countries; 2000, 3(1): 5
CALCUTTA DECLARATION ON PUBLIC HEALTH
The following declaration, based on the deliberations and recommendations of the Conference, was unani
mously adopted by the delegates at a special session on the concluding day presided over by Mr Jyoti Basu,
Honorable Chief Minister of West Bengal, India.
We, the participants in this Regional Conference on Public Health in South-East Asia in the 21st
Century, appreciate the substantial achievements made in improving the health status of the people
in the countries of the South-East Asia Region during the past decades. However, we enter the 21st
century with an unfinished agenda of existing health concerns, and new and complex challenges
that demand innovative solutions. We uphold the centrality ofmeeting the health needs of the com
munity and our responsibility topreserve, protect and promote the health of the people. We commit
ourselves to the goals ofpoverty alleviation, equity and socialjustice, gender equality and universal
primary education, which are all essential elements in the pursuit ofhealthfor alL We recognize that
expertise and experience in Public Health and capacity-building are essentialfor sustaining partner
ships in designing, developing andproviding healthfor the community. And we emphasize the impor
tance ofPublic Health as a multidisciplinary endeavor to meet the health needs ofpeople.
Having noted the progress in public health practice, education, training, and research in the countries
ofthe South-East Asia Region, and having reviewed the lessons from Public Health-relatedpolicies
andprograms, we endorse thefollowing strategies and directionsfor enhancing health development
in the South-East Asia Region in the 2 J st Century:
(1) Promote Public Health as a discipline and as an essential requirementfor health development
in the Region. In addition to addressing the challenges posed by ill-health and promoting positive
health, Public Health should also address issues related to poverty, equity, ethics, quality, socialjus
tice, environment, community development and globalization;
(2) Recognize the leadership role ofpublic health in formulating and implementing evidence-based
healthy public policies; creating supportive environments; enhancing social responsibility by involv
ingcommunities, and increasing the allocations ofhuman andfinancial resources;
(3) Strengthen Public Health by creating career structures at national, state, provincial and district
levels, and by establishing policies to mandate competent background and relevant expertise for
persons responsiblefor the health ofpopulations; and
(4) Strengthen and reform Public Health education, training, and research, as supported by the
networking of institutions and the use of information technology, for improving human resources
development.
We urge all Member Countries as well as WHO to continue to provide leadership and technical coop
eration in building partnerships between governments and UN and bilateral development agencies;
the academia; NGOs; the private sector; the media, and other organs ofcivil society, and to jointly
advocate and actively follow-up on all aspects of this Calcutta Declaration on public health.
1
CHLP NW 04102016
Background Paper - 3
•
TOWARDS A PUBLIC HEALTH CURRICULUM FOR WHO-SEARO REGION
(2002)*
4.2 Recommendations on Public Health Training and Education
Public health training takes' place at different levels. Unless the training of health
professionals working in all these areas was addressed simultaneously, it was considered
that the desired effect would not be achieved.
The public health training needs of three levels were identified, "subcentre", or "community
level", the "primary health centre" level or '—district level" and the "provincial or regional level".
Since these terminologies are used with different meanings, the three levels were re-defined
by the size of the population to make comparisons easier.
(1) The "community level" or "sub-centre" level provides health service to a population of
5000 or less.
(2) The "primary health centre" provides health services to a population between
30 000 to 50 000.
(3) The "district level" provides health services for more than 100 000. This level can be
applied to provincial or regional level in some countries.
(1) Sub-Centre level
Generic skills and competencies
At the sub-centre level, health workers 1 were considered to be the first level functionaries.
These functionaries were expected to have essential attitudes such as empathy, ability to
listen and communicate and develop specific technical skills.
Using each country's experience, the group could show that there were similarities in the skills
required by workers in different countries. Technical skills in the following areas were
considered essential:
•
Community needs assessment including high risk identification;
•
Data collection and interpretation, facilitating the surveillance system;
•
Record-keeping and timely reporting;
•
Basic planning and management;
•
Health promotion;
•
Providing specific protection;
•
Diagnostic and treatment skills with timely referrals;
•
Community-based rehabilitation;
•
Disease control of local importance and
•
Women's issues and gender concerns.
Eligibility criteria
The group recommended that workers at the sub-centre level be recruited locally from
districts, after completion of secondary schooling and put through training lasting for
1 >2 to 2 years. For those in service, a bridge course be established.
Curriculum: Nature and design
The following guiding principles were recommended for the design and teaching of the
curriculum. It should be
•
problem/practice oriented;
•
job/tasks oriented;
•
focussed on hands-on training;
•
balanced combination of theory and practice with appropriate apportionment of time;
•
an integrated curriculum with emphasis on attitudinal skills and nurturing and supportive
supervision, and » strengthen supervisory and managerial skills._____
* Taken from the Report of the Regional Consultation, Chennai, India, 30 January - 1
February 2002, “Accreditation Guidelines for Educational / Training Institutions and
Programmes in Public Health" (WHO Project: ICP OSD 002)
8
Faculty / Teachers
• A trainee-tutor ratio of 1 0-15:1 was suggested.
• Teachers should have received training to be teachers, with experience/exposure in field
situation and experience in carrying field studies.
• Teachers should have received training to at least one level above the course they have
to impart training to. There should be core faculty and extended faculty.
Teaching/learning resources
Besides adequacy of infrastructure (money, materials and manpower), the continued
professional development for staff from the private and government sector and provision for
National Teachers Training Centres for SEAR countries were discussed and recommended.
Teaching/learning methods and processes
Besides lectures, emphasis should be laid on site visits to field, health facilities, and hospitals
for demonstration and participatory observation, on-the-job practical training and focus on
active learning, close to reality using simulation, and role-plays.
Monitoring and assessment
A basic requirement was that a plan for monitoring and assessment should be in place with
an emphasis on improving quality.
Assessment was needed for both students and teachers including, internal and external
assessment.
Continuous assessment of skills and performance were considered necessary and to be
given higher weightage rather than terminal assessment.
(2) PHC level
The categones of persons who would need training to work in a 30 to 50000 population would
include: medical officer, public health nurse, district level public health officer and allied health
supervisors. Some of the allied health personnel are country-specific in nomenclature, usually
at a basic degree level of competence.
Generic skills and .competencies
At the PHC level, (30 to 50000 population), the group identified skills needed under three
main categories: (i) Technical skills; (ii) Administrative and management skill and (iii) Self
development skills.
Technical skills were needed in areas relating to
Community diagnosis and health promotion; prevention and control diseases of public health
importance; supervising and monitoring health programmes; investigation and management
of outbreaks, and disease surveillance.
Administrative and management skills were needed
to manage health promotion and disease prevention activity; to use of health information
for management; implement health legislation; influence public health policy; provide
cooperation between health and other sectors; design and implement IEC; implement
ongoing continuing in-service training; manage human resources; address quality control
issues and set up systems to monitor quality; mobilize the community to participate and
use local resources for public health programmes effectively; initiate action to promote
environmental health and report on circumstances that may be hazardous to the
environment; take proactive steps towards women's issues, and initiate and participate in
applied research.
Self development skills such as accessing and utilizing information from different
sources, particularly in using the Internet and a computer are also necessary.
These guidelines were suggested for staff functioning at PHC level such as the medical
officer, public health nurse and allied health supervisors.
0
vary the level/number of skills that could be managed in the different geographies of the
Region.
If-
The group identified the minimum .competencies required at the district level and suggested
that the course bridge the academic and service divide, with uniformity in achieving credit
transfers. The courses identified at this level were MPH, MSc, MD, M.Phil and Ph.D. Core
and optional units were identified (See Annex 3) the courses were left flexible so that parttime and distance learning options were available. Teaching methods and processes required
that the 50% of the study was field-based. Self-directed learning, and team training were
some of the other methods suggested. Effort should be made to bridge the academic/service
divide.
Internal and external assessment were suggested, including continuous self-monitoring and
periodic evaluation of faculty by students. Externally conducted examinations would be a
method of measuring the progress. There should be uniformity across countries, thus
achieving credit transferability between accredited institutions nationally and internationally.
Courses identified - MPH; M Sc.; M D; M Phil.; Ph D
Curriculum content
Core units
• Epidemiology
• Biostatistics
• Research methods
• Environmental health
• Public health laws
• Health planning and management
• Population sciences (Sociology, social work, anthropology, demography)
• Health information management systems
Optional units
• Maternal and child health
• Reproductive health
• Nutrition
• Occupational health
• Health economics
• Policy analysis
• Public health microbiology/Parasitology
• Medical entomology
• Health systems development
• Disaster preparedness/Response
• Advanced biostatistics
Curriculum design
Could be a residential course or part time - credit-based programme or distance learning
format.
Faculty and teachers
Qualifications
PhD, MD (Community Medicine) or Masters' degree with three years' research/teaching
experience and published papers
Experience
Experience in public health services may be equated in a proportion of one year of research
to three years in public health experience.
Teaching methods and processes
Field based study, Case studies and Didactic teaching, self directed learning, Integrated
teaching, Adult learning methods, Team training, Portfolio learning
*
Resources
• Field practice Area: to consist of urban areas, semiurban area, rural area, and urban
slums.
Material resources to include: Public health laboratory, computers and web access,
library with adequate books and journals, and teaching aids. Institutional linkages may
be considered for specific faculty.
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Monitoring
Internal
Continuous self-monitoring, in class room/field and project monitoring were suggested.
Periodic evaluation of faculty by students.
External
Monitoring should be considered using examinations and progress measurement.
Assessments
Methods: multiple assessment methods to be used such as MCQ, short answers (these may
be optional, but should be kept to a minimum), projects and practicals.
Requirements
• Content validity of the method to be ensured
• Credit for internal assessment
• Every area of the competency grid should be assessed at some point in time.
4.3 Continuing Professional Development
The group suggested that the goal would be to improve delivery of health services at all
levels. The following objectives were identified to achieve this goal:
The public health workers/professionals should be able to: maintain acquired knowledge
and skill; upgrade knowledge and skill in response to changing needs of community at
large; acquire new skills, and develop cadre/ pool of resource people - e.g., trainers of
trainees.
Formal and informal methods to use innovatives techniques wherever possible in order
to make training community-based, participatory and problem-solving, innovative
methods to be used with greater use of information technology. CPO should be I
introduced as a policy in public health using innovation.
In the discussion that followed, the group felt that in the current context, continuing
education be used for updating the knowledge and skills to serve the community better,
and not for recertification or re-registration.
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Background Paper - 4
4.
CAPACITY BUILDING FOR PUBLIC HEALTH IN THE ASIA PACIFIC REGION*
(2004)
Introduction
1.
The historic sixtieth session of UNESCAP held in Shanghai, through its resolution 60/2 on
28th April 2004 gave a “Regional Call for Action to enhance capacity building in public health”.
It recalled the Millennium Development Goals, especially those that were health related, and
the UN General Assembly resolution 58/3 of 2003 to enhance capacity building in global
public health.
In a significant step it has mandated the formation of a Health and
Development subcommittee which is scheduled to have its first meeting in December 2004.
2.
The Asia Pacific region, with 62% of the global population, has several strengths. The region
has shown consistent economic progress and dynamism over the past few decades, which in
turn has contributed to improved living conditions and health of people. It also has a wealth
of rich cultural, spiritual, health and healing traditions. However poverty, hunger, disease and
disability continue to afflict significant proportions of the population, with growing intra and
inter-country inequities in income levels. Current global macro-economic policies and trends
have also affected the region, resulting in loss of livelihoods, increased rural distress and
migration, environmental pollution and destruction, and an increase in conflicts. These
deeper socio-economic and environmental determinants have a major impact on the health of
people and enhance the transmission and incidence of disease.
3.
The cost of diagnostics, drugs, and of health care in general, are increasing, while public
expenditure on health and health care is declining. Health gains achieved over five decades
are beginning to reverse in some population groups and countries. Inequities in health status
and access to health care are growing.
4.
In more recent times HIV/AIDS, SARS and avian flu provide a wake up call and a challenge
to the health systems of countries in the Region. Older, long standing problems such as
tuberculosis, malaria, diarrhea, anemia and under-nutrition take a heavier toll in suffering and
death but do not attract media or political attention. There is therefore an urgent need, and
an opportunity to revitalize public health and its practice, and strengthen health systems,
building on the infrastructure, experience and expertise, developed over the decades.
5.
Capacity building for public health and strengthening of health systems in response to the
emerging problems and social context will need to be done through a process of dialogue,
consultation and international cooperation. This will be undertaken within the region, with
public health professionals in the region and with community participation. Collaboration with
WHO, UNICEF, FAO,UNDP, ILO and other international and bilateral agencies will be
explored with a strong focus on building local capacity and self reliance, rather than being
dependant on external experts and consultants. Special focus will be given to the needs of
least developed economies, landlocked and island developing economics and economies in
transition. Sharing of human, technical, knowledge-based and financial resources within the
Region will be encouraged through institutional mechanisms. Given the mandate and
traditions of ESCAP multi-ministerial support and involvement will be sought for capacity
building in public health. Reviews using participatory, qualitative and quantitative methods
will be undertaken with strengthened monitoring and evaluation systems, in order to assess
the health, social and economic impact of the strategy an to learn from innovative
approaches and processes that may be used. ESCAP and its member countries will work in
close partnership with the World Health Organization, including its regional and country
offices. The public health expertise of the WHO is a valued asset. It will be drawn upon
extensively for strengthening public health capacity in the Asia Pacific Region. ESCAP
in turn will
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* A Policy Document prepared for UNESCAP Health Unit by Dr. Thelma Narayan, CHC, Bangalore
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contribute through its mandate of working on the economic, social and environmental
determinants of health. It can assist capacity building of public health systems in the region by
expanding horizons beyond a disease focused approach, to include policy action directed at the
broader determinants.
Evolving Definitions of Public Health and Primary Healthcare
6.
Public heath is an evolving, dynamic concept. The practice of public health, together with
improved economic and living conditions, have resulted in major health gains for populations
in several countries around the world since the early nineteenth century. This took place
through social policies introduced even before the development of vaccines and antibiotics.
They included measures to improve sanitation, hygiene, water supply, housing, nutrition,
social security etc.
7.
The Primary Health Care (PHC) approach as a strategy to attain the international social goal
of Health for All by 2000 was articulated at the landmark Alma Ata Conference organized by
WHO and UNICEF in 1978. It drew on community level experience sand challenges from
countries in different continents including the Asia Pacific. It received a mandate from 134
member countries. PHC expanded the scope and strategies for public health through
increasing social control and democratic political processes over health and related services.
It attempted to give communities greater voice in health systems through decentralization and
institutional mechanisms for participation in health decision making. Moving beyond bio
medicine PHC stressed inter-sectoral collaboration to address the deeper determinants of
health. It was rooted in principles of equity and social justice in health and health care. In
order to reach the social goal of health for all, PHC emphasized self-reliance at individual,
community and national level, and recommended the use of appropriate technology to serve
peoples needs. It promoted social means to reach these goals. Primary health care not
unsurprisingly met with resistance early on.
8.
The International Association of Epidemiologists also defines public health with a broad
perspective “Public health is one of the efforts organized by society to protect, promote and
restore people’s health. It is the combination of services, skills and beliefs that are directed to
the maintenance and improvement of the health of all people through collective or social
action. 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" (JM Last, 1995).
9.
More recently the Oxford Textbook of Public Health (2002) describes public health as "the
process of mobilizing and engaging local, state, national and international resources to
assure the conditions in which people can be healthy." It recognizes that public health is only
one of the major influences on the health of communities and that basic economic and social
conditions impact directly on people’s health and wellbeing.
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10. The initiative for public health capacity building can experiment with social arrangements for
greater involvement of people, particularly the poor and vulnerable, in the development of
their own health services. Thus the public can be brought back into public health. Public
health has focused on improving the health of communities and individual persons through
comprehensive preventive, promotive, curative and rehabilitative interventions addressing
risk factors that could be social or behavioral. The present challenge is to include the deeper
layer of social, economic and environmental or developmental determinants of health. The
way has already been shown by some communities and countries. The need and challenges
have been articulated in the Peoples Charter for Health of the Peoples Health Movement.
The World Health Organization is making initiatives to set up a commission for social and
environmental determinants of health. The contribution of UNESCAP and its member
countries in this regard would be pioneering and would help the achievement of the
millennium Development Goals. The current initiative offers an opportunity to further build
the concept, principles, and practice of public health in relation to the current times and
challenges in the regional context.
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Strategies for capacity building in Public Health
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11. Human resource development- Developing a pool of well-trained, competent, highly
motivated professionals and workers in public health is a priority for all countries in the
region. There is an urgent requirement for a range of public health skills and competencies including specialist epidemiologists, policy analysts, health administrators, program
managers, trainers, health economists demographers, statisticians, researchers, social and
behavioral scientists, public health nurses, health promoters/educators, laboratory
technicians, social workers, multipurpose workers, health assistants, community health
workers, health animators and others. While specialization in sub-sections of public health
will be inevitable, the key focus should be on training more multi purpose, integrated, socially
relevant, public health generalists at different levels.
12. Planning and forecasting the numbers of trained staff in public health required at different
levels of the health system is a task to be undertaken by each country. Based on a needs
assessment, numbers retiring per year, and overall attrition rates, the numbers to be trained
every year can be calculated, keeping in hand a reserve stock of personnel who can manage
leave vacancies, respond to emergencies, undertake consultancies etc. Most important is
the policy recognition that in order to achieve effectiveness, relevance and quality, some
positions at specific levels in the health system will necessarily need professionals with
competency and training in public health. The tendency to appoint clinicians to public health
positions, and to be susceptible to political compulsions, needs to be avoided if public health
objectives are to be met.
13. Public health staffs are often given a lower social status as compared to clinicians, though
their jobs may be more complex and thankless. This results in lower morale and self-esteem
and needs to be rectified through an enabling environment with adequate recognition,
remuneration, and encouragement. Considering the complexity of their tasks and the
multidisciplinary multi-tasking nature of their activities, they should be given opportunities for
professional growth. Along with these reforms a realistic focus on outcomes, impact, quality,
integrity, and responsiveness to feedback from the community, is required.
14. Team work in public health is crucial for it success. Adequate training is needed in team
functioning with clarity about roles and responsibilities and lines of communication.
Supportive supervision, trust building and problem solving exercises are essential. Public
health professionals can be drawn from both medical and social sciences streams and should
not become doctor dominated.
15. Continuing education of staff is essential, given the rapid growth in knowledge and the
contextual changes that are occurring. Distance education courses, workshops, seminars,
newsletters and access to electronic means of updation need to be well developed.
Accreditation systems at district or state levels for public health staff will help to ensure basic
standards with mandatory requirements for attending a certain number of courses and
achieving competencies required for different levels.
16. Ability to work with communities and local government functionaries, with community
organizations, and community leaders both informal and formal, is an important skill for public
health professionals. This is best developed through experiential learning and in-service
training.
17. There is an urgent need to build capacity in developing an evidence based approach for
public health interventions.
Investment is required in training and retaining research
professionals competent in qualitative and quantitative methods. Their findings would be
used by a multidisciplinary policy team for developing, reviewing and evolving public health
interventions. Skill development is required for recording and reporting systems to be
strengthened, with adequately disaggregated data collection to measure differences in social
groupings. Analysis and utilization of data for decision making should be done as close to
the point of data collection as possible. This in itself will enable capacity development closer
to the community.
\ 6
n
18. Capacity needs to be developed across sectors to deepen the understanding of the inter
sectoral dimension of health and health action. We need to strengthen the ability to dialogue
and involve counterparts in other departments of development, be it food, water, sanitation,
environment, women and children’s welfare, education, agriculture, labour, and other
departments.
Training Methodologies for Public Health Practitioners for the Asia -Pacific Region
19. An alternative pedagogical method that is participatory, reflective, transforming and
located in a socio-cultural paradigm, should be sued in teaching public health workers
and professionals.
20. It is important for countries in the region to consider the underlying philosophy,
educational methods and processes of learning, adopted in the higher education of
public health professionals. Two foundational premises that continue to have a major
influence have been the biomedical scientific roots of public health and its proximity
with state power. These developed historically within the then dominant social context
often linked with the industrial revolution, capitalism and colonialism. At the interface
with people in the Asia Pacific region, who have their won culture and knowledge
base, there is often an alienation of philosophy, concept and praxis. Public health
practice is often perceived to be an expert driven, top-down, centralized, prescriptive
approach, implemented in a heavy handed manner by the government bureaucracy.
This does not win the hearts and minds of people and is often met with scepticism if
not with resistance, non-action and non-adherence. Development of pedagogical
methods, and the learning environment and process, will need careful thought in
order for students of public health to identify and retain the core principles and
elements of the discipline, to be sensitive to the cultural and social context of
communities with whom they work and to best utilize the right knowledge base and
traditional health and healing practices in the region.
Since the 1970s much
experience has been gained, particularly through community health and development
project^ in the voluntary sector, in the use of participatory, experiential, reflective and
transformatory learning processes. While these methods initially evolved through
working with communities, they have also been used in the education of professionals
who find it a more liberating, meaningful and motivating process of learning and
personal growth.
Besides theoretical content and competencies, it includes
experiential learning in community based programmes, self awareness and reflection,
teamwork, social skills, understanding culture and community dynamics, spiritual and
ethical dimensions of health and public ethics, among others. This qualitative change
in the method of teaching-learning, enhances social effectiveness and community
support increases personal motivation, prevents burnout and helps the creation of a
social network among public health workers.
21. These aspects have not been adequately stressed or integrated in public health
training programmes in the West.
While international collaborative efforts to
strengthen public health capacity in the ESCAP region will involve linkages with
training centres in the west based on a different history and paradigm, a creative
contextual local adaptation of theory and practice of public health is a necessary.
Training Approaches
22. Medical officers of Primary Health Centres and other levels of government health
centres play an important role as leaders of health teams. They need to be adequately
trained in public health and health management. In practice in several countries a
large proportion do not have a post-graduate qualification in the subject and are more
clinically oriented. They will need an in-service public health training for at least 6
months which would include the basic theoretical concepts and a period of
experiential training under guidance. A mentorship programme could be considered.
Exercises in leadership training, communication, team-work, gender sensitization,
social analysis, understanding community dynamics and community organization, and
I'l
public health ethics are important to supplement the traditional public health
components.
23. Participatory training methods that are learner - centered, using principles of adult
learning, and problem solving and experiential innovative approaches are very helpful.
Use of role plays, simulation games, case-studies, films and field visits help the
learning process. Debriefing, with analytical reflections of different experiences and
method help in the personal growth and motivation of participants besides enabling a
deeper understanding of the issue.
24. Team training of primary health care teams for up to 5 -7 days is also a useful method
to enhance the quality of public health work. Training is undertaken together as a
team to understand each other and internalize the goals and objectives of their
collective endeavors. Their different roles and responsibilities are clarified. Systems
for communication, recording and reporting, measuring indicators of progress, getting
community feedback and of participatory reviews can be discussed. This process
helps in bonding together and creating better working relationships. Efficacy of public
health work depends to a large extent on the cohesiveness of the teams, their conflict
resolution mechanisms, and the feeling of community among themselves, which need
to be constantly developed and nurtured.
25. In several countries there has been good inter-action between health systems, and
integration of indigenous systems of health and healing into the national health
system. Indigenous systems and practices that are beneficial to health cold find an
explicit place in national health policies and systems, rather than being a parallel
system that is under resourced and sometimes subaltern. This spirit of mutual
cooperation between systems needs to be reflected in the training of health workers
and health professionals.
Training Content
26. Both traditional public health, as well as the new public health, recognize the close
links between the underlying determinants of health and the health status of
populations. Teaching curricula for public health however are still dominated by
biomedical components, based on a reductionist paradigm. Consequently public
health interventions tend to be narrowly focused, vertical programmes; lacking a
societal process element. For instance the delivery or social marketing of public
goods such as diagnostics, drugs vaccines, condoms etc are given much greater
importance than social relationships and processes through which change can occur
and where people have a voice. The contextual complexities of social, economic and
environmental determinants of health are discussed and researched in very few
schools of public health across the world. The Asia Pacific region could be a potential
leader in introducing systematic teaching and research into these issues with a public
health perspective in order to protect public interest and human rights and to reduce
social inequality, with resultant benefits to the health, and wellbeing of people.
27. Content areas to be covered in the training would include
•
Guiding principles and values of public health, which include social justice and
equity in health and health care; health and access to health care as a fundamental
human right; health as central to sustainable development; community
participation and self-reliance; good governance, oversight and accountability.
•
Public health ethics and law
•
Food security and nutrition
•
Poverty and health inter linkages
•
Gender perspectives on health
•
Macro-economic and trade policies and health.
•
TRIPS, GATS and implications for access to medicines and to health care
•
Conflict, violence, disasters and health
I 8
•
•
•
•
Environmental health issues with corporate and government accountability
Peoples social movements, peoples health movement
Environmental health movement
Population movement; migration, urbanization.
28. Preparation of learner friendly teaching material and modules; developing a critical
mass of teaching staff in the region; and establishing centres that research and
intervene in these areas, will need to be undertaken in a systematic manner.
Enhancing and disseminating databases on these complex subjects will also need to
be undertaken.
Developing Centres of Excellence for Teaching and Research
29. There is a need for a number of centres of excellence for teaching and research in
public health and community health in the Asia Pacific region. While countries with
large populations may have more than one centre, smaller countries could share a
centre or send their professionals to recognized centres. Mechanisms for generation
of financial and technical resources could be developed. Regular exchange and
electronic networking between academic and research centres in the region, and close
collaboration with WHO regional and country offices would be beneficial. Mapping of
existing centres and resource groups in the region could be initiated by the
secretariat
Scholarships could be established for least developed economies.
Electronic methods of communication could be institutionalized so that whenever
required rapid mobilization of expertise and quick sharing of information is facilitated.
These centres will be the nerve centers for knowledge generation and application, and
will need to be very dynamic and alive. Countries are advised that the leadership,
management systems, library and information centres and financial security of these
centres are critical areas for development. Their purpose would be to be socially
relevant to the public heath related issues and concerns in their countries and
neighboring areas. Interaction and alliance building with the local health services,
NGOs and social movements would enable them as a group to impact on the
determinants of health.
Strengthening Health Systems Financially
30. Health systems form the basic skeletal framework for public health action. Over the past
century public sector health systems in the region have undertaken preventive health work,
health promotion, communicable disease and outbreak control, and other measures on a
countrywide basis with resultant public health gains. However over the past decade a
weakening of the public health system has taken place in some countries where decision
makers have uncritically supported and promoted the privatization of the health services. In
other countries investment in public health systems has been consistently low and
unproductive. In these cases there is a need for strengthening of public health systems to
meet public health goals, and to privatize further. The Commission on Microeconomics and
Health has pointed out the critical importance of adequate investments in health in the public
sector and the economic and social benefits of these investments. Countries have been
strongly encouraged to increase their public health expenditure up to the minimum norms.
31. There I an urgent need for countries in the region to build national and local capacity in health
financing and in establishing and running National Health Accounts Systems. Capacity
building in financial management with accountability and transparency for health institutions
at sub-district and district levels and for primary health care is also required.
Capacity Building for Priority Public Health Problems
Environmental health, water, sanitation and waste disposal
32. Despite significant improvements, there is a long standing lack of access to water and
sanitation facilities for a significant section of the population particularly the poor in some
countries of the region. This is compounded by new challenges. Groundwater is being used
faster than it is being recharged.
If water conservation strategies are ineffectively
implemented, drinking water shortages are predicted to occur. Contaminated water is a
vehicle for disease transmission. Poor quality and inadequate quantities of water are
estimated to account for about 10% of the total disease burden in developing countries.
Privatization of water is reducing access for the poorer sections of society. Industrial and
chemical pollution of rivers, groundwater and water bodies and agricultural runoffs
contaminated by fertilizers and pesticides are rapidly growing areas of concern.
33. Countries are encouraged to ensure universal access to safe, potable water supply by 2010.
Inter-sectoral action between water supply and sanitation boards pollution control boards,
departments of health, local government bodies communities and consumer groups is
essential to ensure adequate provision and utilization of water, without wastage, and to
undertake health promotion and public awareness campaigns so as to reduce prevalence of
water and sanitation related diseases.
34. There is a need for adequate technical capacity in the region to work effectively and
efficiently on this issue. Time bound goals and indicators could be set to reduce mortality
and morbidity due to the following conditions:
a) water washed disease - scabies, trachoma
b) water based diseases - schistosomiosis and dracunculiasis (guinea worm disease)
c) water related diseases - malaria, filariasis, dengue fever.
d) Waterborne disease - diarrhea, dysentery, cholera, typhoid, hepatitis A, amoebiasis,
giardiasis, helminthic infestation / intestinal worms, camphlobacter etc.
Prevalence and incidence rates will be collected and analyzed through the disease
surveillance system / health information system, for which capacity is also being
developed.
35. Capacities need to be strengthened for accelerated interventions to ensure access to
household and environmental sanitation facilities (toilets, drainage systems, sanitary waste
disposal). This will help minimize disease spread by the faecal-oral route of transmission,
which continues to be widespread. Control of these diseases requires a combination of
interventions including improved water quantity and quality, sanitation systems but also food
hygiene and good personal hygiene. This requires health promotion, advocacy, social
mobilization in addition to infrastructure development and regulation. A multi-sectoral
approach involving public health engineers, sewage boards, and departments of urban and
rural development, water supply and elected representative and community members is
critical.
36. Capacities to handle waste management in a professional, toxic free manner are also
urgently required to be developed. This area has become very complex over the past few
decades and encompassed household waste; solid waste at village, town and city level, nonbiodegradable waste; hospital and health care waste; hazardous industrial and chemical
wastes; nuclear waste; agricultural wastes etc. Some waste disposal methods, such as
incineration are themselves toxic. Short and long term consequences on public health and
the environment are significant.
37. In addressing issues of water, sanitation and waste disposal, the role of the state is
important. Public health specialists need to work in collaboration with public health engineers
and a host of stakeholders, including the environmental justice movement and legal advisors.
Adequate sensitization and awareness regarding the issues need to be ensured in the
training and continuing education of all public health workers. A few would opt for more
specialized training in this area. This stream would need to have an institutional base
wherein their higher education, job opportunities and career planning would be considered.
38. The public health system would required the skills and capacity to pick up instances of
impact on human health following environmental pollution from industry, including the
chemical industry, agriculture (pesticides, fertilizers etc) and the dumping of toxic waste.
This is a major emerging social and health problem in the region, which has become the
global manufacturing base at low economic cost.
Health and safety of workers and
communities need to be safeguarded. Other major environmental, issues affecting human
life, health and wellbeing including climate change, global warming, ozone layer depletion
etc, need urgent research and action. Health impact assessments of new technologies,
industries and development projects need to be undertaken. Environmental epidemiologists
and occupational health specialists are still scarce in the region and need to be trained in
larger numbers. They would need to work closely with government policy makers, health
providers, NGOs, the environmental movement and communities.
Nutrition
39. The public health systems of many countries in the region are inadequately equipped to
address the challenges of nutritional deficiencies and under nutrition, or the emerging
challenge of non-communicable disease which have a food, diet and lifestyle component to
their causation. The magnitude of nutrition related health disorders in the Asia Pacific region
is large. The impact on mortality, morbidity, vulnerability to other infections and disease,
disability and economic productivity is enormous. However the significance and potential for
positive health and development impacts through policy measures has often not been
adequately understood or acted upon by policy makers and public health practitioners.
Advocacy, sensitization, capacity building and effective action on nutrition deserve the
highest priority.
40. Practical training on nutrition needs to be mandatory for all levels of health workers and
professionals. The teaching content will need to be relevant to the nutrition problems and
issues obtaining in a country or area, keeping in mind the dynamic changes that keep
occurring. District-wise nutrition mapping would provide an information base. Centers for
nutrition research need support and the findings and recommendations from their work need
to be acted upon and also introduced into training programmes, public education and policy
interventions.
41. Broader issues of agricultural policy, food diversity, food security, international trade and
pricing of agricultural products are issues of national and regional priority. Public health policy
workers and practitioners need to have a general awareness about these issues. They need
to understand their specific roles and responsibilities in regard to nutrition security, and in
improving the nutrition status of people of different age groups, at individual and community
levels and through integrated health and nutrition interventions.
Disability
42. The Asian and Pacific is home to an estimated 400 million persons with disability, the biggest
number in the world. A large majority are poor, and lack social opportunities and access to
good rehabilitative care, that can enable and assure a meaningful productive life. Many
disabilities are also preventable.
43. The first Asian and Pacific Decade of Disabled Persons (1993 to 2002), and the recently
launched second decade (2003 - 2012), have facilitated many positive regional and country
level initiatives. These include a comprehensive and integral approach to the protection of
promotion of the rights and dignity of persons with disabilities; improving disability measures
for policy use, promoting active participation of women with disabilities; poverty alleviation
among people with disabilities; among others.
44. The public health community in the Region needs to be capacitated and encouraged to join,
support and expand these initiatives. Multi-ministerial and inter- country cooperation, already
initiated, will be further strengthened. Active participation of persons with disability in
planning oversight and reviews will be ensured. There will be a special focus on children with
disability.
Promoting Mental Health
45. Mental illness takes a heavy toll through the long-term suffering of affected persons and their
families. Patients continue to experience stigma and discrimination, and the treatment and
7-1
care of the mentally ill persons is still an orphan area in most health systems. Mental and
emotional ill health, tobacco and alcohol related problems and violence have been widely
recognized during the past decade, as major public health issues. The time now is to act.
This is a complex issue of human behaviour and social relations in an increasingly stressful
environment. Health personnel working in primary care settings in both the public and private
sector need to be trained adequately to recognize and diagnose mental health problems.
Treatment options that are currently available should be widely accessible. In order to make
this a reality there is a need to enhance the number of psychiatrists, clinical psychologists,
counselors and social workers, and also to take appropriate measures to reduce their
migration. Drug patenting issues will need to be considered to ensure availability of newer
drugs at affordable prices. More importantly initiatives to promote positive mental health and
to build caring, supportive communities need to be expanded through training of trainers and
other methods. These include parenting skills, life skills education, meditation and yoga.
Parents, school teachers, religious bodies, and community leaders all have an important role.
Legal, regulatory and related capacities will need to be strengthened to dealt with control of
tobacco, alcohol and substance abuse.
Infectious Disease Control
46. Old and new infectious diseases take a heavy toll in terms of disease burden and
mortality in the region. The risk of transmission within and between countries has
become higher with social instability, conflict displacement, migration and increased
mobility. Capacity building for control of infectious diseases is one of the highest
priorities in the region. This needs to be implemented with a sense of urgency in a time
bound manner. Infectious disease control requires widespread public education and
awareness, sharing the known scientific features of the diseases, stressing preventive
and control measures at individual and community level, and minimizing misinformation
which results in fear and panic. Government departments of health education and
health promotion need to be alert, up-do-date, pro-active and creative, using a mix of
communication methods and interacting with mass media groups. Health systems need
strengthening with adequate budgets, trained health personnel, good laboratory
facilities, supply systems for drugs and consumables, communication systems and
disease surveillance systems/health information systems. Inter-country collaboration
needs improvement. However, most importantly there is a need to focus on the
developmental determinants of these diseases through intersectoral, multiministerial
interventions, as many of these diseases thrive in conditions of poverty. There is a need
to ensure that dominant paradigms eg the bio-medical approach, and dominant
institutions do not monopolise policy making. Independent implementation audits and
public hearings can be utilized to elicit peoples perspectives on how effective and
accessible infectious disease control efforts are. Capacity building is required for all
these components.
47. Tuberculosis, malaria, filariasis, dengue hemorrhagic fever and vector borne diseases
need special attention, and close collaboration with WHO control programmes. However,
rather than managing a multitude of vertical, single disease focused programmes,
countries in the region could adopt an integrated primary health care approach wherein
early detection, complete treatment, recording and reporting systems function through
comprehensions primary health care centres dispersed in the community.
Health
promotion and community participation are integral components of the approach. Most
countries have over the past 3-4 decades established a primary health care
infrastructure. This needs to be strengthened, guarding against policy advice from
international financial agencies and others who suggest a targeted approach with
enhanced privatization. The international community and public health experts have
universally recognized the important role of the state in infectious disease control
through public health systems, popular education and people’s participation, In the
current neo-liberal context this role needs to be re-inforced.
the
48. Newer problems of HIV/AIDS, SARS AND Avian flu have been addressed by
I
i
of
the
UNESCAP over the past few years in its resolutions. The recent 3x5 initiative
WHO, which aims to increase access to treatment is welcome as a timely response to
the severity and magnitude of the disease and to the treatment access campaign.
Dialogue between UNESCAP and WHO will help to enhance coverage and capacity
building in Asia as early as possible. Newer treatment protocols, simplified procedures,
etc will be adopted, monitored and constantly updated as new knowledge becomes
available, after reviewing its social applicability. Most importantly countries could use the
existing provisions in the WTO clauses to ensure adequate supply of good quality,
generic drugs at affordable prices. Lessons could be learnt from Thailand, Cambodia,
India and other countries. Health education efforts regarding these diseases should not
generate fear but spread positive messages. Methods of positive living for persons
already infected could been encouraged. Use of adjunct therapies such as herbal
remedies, massage and other forms of healing that recognized not to cause harm will be
encouraged. Life skills education and women’s health empowerment that has already
been initiated in most countries will be expanded through widespread capacity building.
49. The region is faced with a double burden of diseases with non-communicable diseases
(NCD) and traffic accidents taking a heavy toll. The Pacific island countries, Japan,
China, Australia and New Zealand have already initiated health promotion campaigns
through the government, voluntary sector, private sector and professional associations to
bring about lifestyle changes such as adequate exercise, healthy diets, stress
management, compulsory use of helmets and seat belts, rules about drinking and driving
etc. With an ageing population these measures are necessary to reduce the burden of
cardiovascular diseases, hypertension, stroke, diabetes and other NCDs. Abuild up of
capacity in the public and private sector for management of these disorders is
necessary. Ratification of the Framework Convention for Tobacco Control (FCTC) and
implementation of bans on advertising and sponsorship of tobacco products, smoking in
public places and stringent curbs on smuggling, would help control the epidemic of
tobacco related diseases, including cancers in the Region.
Other measures for
prevention, control and care of cancer also need to be instituted.
50. The health internet work project of the WHO has piloted the use of the internet and
information and communication technology (ICT) for providing easy access to research
information on important public health problems to health providers and citizens. ICT
offers great potential and needs to be widely used. Internet based public health training
programmes are being designed. The use of hand held computers by health workers in
the field for recording and reporting will greatly reduce their burden of work.
Community capacity building for public health
51. Traditional public health has been critiques for being rigid, with a techno-managerial,
bureaucratic approach which leaves little scope for the creative, empowering and
enabling involvement of communities to collectively address the deeper determinants of
disease. There is an opportunity now for a change in paradigm based on greater
community participation and control, with mechanisms for social accountability and
measurement of progress in achieving goals. We could move forward towards achieving
the global vision of better health for all, based on the universally accepted premise that
the Right to Health and Health care is a basic human right.
52. Capacity building for public health is therefore understood in its broadest sense. This will
involve representation from all sections of communities including women, children,
persons with disabilities, disadvantaged section of society, the elderly, and persons with
HIV/AIDS and other illnesses, so that their perspectives, concerns, and valuable
suggestions based on lived experience, will help to evolve the strategies.
53. Where elected representatives function at the level of local bodies and have
responsibilities for health, there is a need for innovative training to enable them to
improve the governance of the public health system. This exercise may take a few
years, but has proved to be effective in several places such as Kerala state in South
India.
54. Formation of self-help groups of women is widespread in the region. The value of adding
a health and social dimension to their economic activities has been shown to be effective
in Bangladesh, Nepal and several countries. This approach could be more widely used.
Care needs to be taken that methods used are empowering and liberating without
adding additional responsibilities and burdens to women who are already overworked
and fatigued.
55. Self-help groups of persons living with particular illnesses who also become advocates
for preventive and promotive action play an important role. Involvement of persons living
with HIV/AIDS at all levels of health decision making has significantly altered the public
health discourse. Shifting the balance between experts, health providers and patients
from one of dependency to one of greater autonomy and equality has been an important
step forward.
56. Involvement of school teachers and parent sis critical to health promotion. It is important
for young people to be touched or moved at a personal level, for personal motivation for
positive health to be ignited. Training of trainers for parenting education, life skills
education, counseling and health promotion on the basis of the Ottawa charter and
subsequent charters would bear great fruit.
57. Politicians and bureaucrats are often placed in positions where they make major
decisions that impact on health and health care. They may not have the requisite
information and knowledge easily available to weigh the matter objectively. Various
lobbies and interest groups present them with sophisticated material favoring their
position. Public health groups need to prepare well-researched, objective policy briefs
that protect and promote public interest.
58. Experience across the region has shown the great value addition of involving
communities with health institutions through a variety of institutional mechanisms that
include:
a) ^Setting up health communities at health centre and sub-centre level.
b) Establishing boards of visitors, help-desks and help-lines run by volunteers in
hospitals and elsewhere.
C) Mandating local bodies or elected representatives with specific constitutional
responsibilities for the governance of health institutions and programmes
d) Making adequate provisions for the citizen’s right to information to include the heath
sector as well.
e) Establishing mechanisms for participatory management of health institutions, making
space for community voice to be heard and responded to.
All these efforts help to increase community ownership and management of health
institutions.
59. Information and communication technology (ICT) could be used proactively by
governments to overcome the digital and knowledge divide in health. The necessary
infrastructure will need to be established and skill training undertaken. A community
participatory model to the Health Internetwork project being piloted by WHO has shown
that the sharing of health information with communities, health workers and staff from
health related departments using a mix of communication methods including ICT served
an unmet information need.
60. Communities have also participated actively and effectively in participatory action
research that study some of the developmental determinate of health such as
environmental an health consequences resulting from industrial pollution, use of
pesticides, mining etc.
Community involvement in the research as river-keepers
measuring water quality, as community patrols measuring air quality or as bucket
brigades has enabled them to gather evidence and become agents for change in a
positive manner.
61. Public campaigns on health related issues have become increasingly common in the
region as well as globally. The women’s movement has been effective in increasing
gender sensitization of health policies, in promoting reproductive rights, and in raising
gender concerns in health research and in medical education. One of the current
campaigns is to increase women’s access to primary health care and to reduce violence
against women.
The people’s health movement has been campaigning for a
revitalization of the spirit and principles of primary healthcare. The Peoples Charter for
HIV/AIDS has resulted in formation of the Asian Peoples Alliance for Combating
HIV/AIDS (APACHA). The Peoples Charter for Health of the PHM has also become a
rallying point for a campaign to reduce wars, conflicts and violence. The pulse of people
can be felt and responded to by listening to the issues raised by people’s campaigns and
movements. This is an important third fore that is countering the threats to peoples
health caused by corporate globalization, liberalization and the commercialization of
health care.
62. Use of the principle of subsidiarity in decentralization of health care services, with
appropriate training, management and preparation of people, helps to bring services
closer to people. However it is necessary to take adequate measures to ensure a focus
on primary health care and public health.
References
ESCAP (2003 a) Tacking HIV/AIDS as a development Challenge (E/ESCAO/CESI/4).
ESCAP (2003 b) Investing in health for development (E/ESCAP/CEST/5).
ESCAP (2003 c) SARS: Lessons for public Health (E/ESCAP/CEST/6).
ESCAP (2003 d) Report of the Committee on emerging social issues on its first session
(E/ESCAP/CEST/Rep).
ESCAP(2004 a) Resolutions adopted by the commission at its sixtieth session - 60/1 Shanghai
Declaration.
Detels R. Me Ewen J.Beaglehole R, Tanaka H, (2002) Oxford Textbook of Public Health Fourth
edition, Oxford University Press.
Last J.M {ed) (1995) A Dictionary of Epidemiology Third Edition.
Epidemiological Association. Oxford University Press.
International
CHLP NW 04102016
Background Paper - 5
SEA-HSD-282
Distribution: General
South-East Asia Public
Health Initiative
2004-2008
Strategic Framework for Strengthening
Public Health Education
WHO Project: ICR OSD 001
World Health Organization
Regional Office for South-East Asia
New Delhi
June 2005
CONTENTS
Page
EXECUTIVE SUMMARY
V
1
INTRODUCTION
1
2
A FEW DEFINITIONS
3
3.
CURRENT ISSUES IN PUBLIC HEALTH IN SOUTH-EAST ASIA
5
4
MODEL OF EDUCATION AND TRAINING IN PUBLIC HEALTH
6
5.
CURRENT PUBLIC HEALTH INSTITUTIONS (PHI)
8
6.
STREAMLINING THE CATEGORIES OF PUBLIC HEALTH WORKERS
12
7.
REQUIREMENTS FOR PUBLIC HEALTH PROFESSIONALS
13
8.
ESSENTIAL PUBLIC HEALTH FUNCTIONS OR
QUALITATIVE REQUIREMENTS....................
15
ACCREDITATION
17
10. BENCHMARKING
20
9.
yil. RECOGNITION OF PUBLIC HEALTH AS A DISCIPLINE
23
_/2. PARTNERSHIPS.........................................................
23
13. GOVERNANCE AND MODELS OF SCHOOLS
OF PUBLIC HEALTH.....................................
26
14. RESOURCE MOBILIZATION
26
15. FUTURE ACTIONS TO STRENGTHEN SCHOOLS
OF PUBLIC HEALTH......................................... 27
Annex
Sample Questions for Benchmarking
32
Page Hi
2-n
4»
Strategic Framework for Strengthening Public Health Education
It is anticipated that the results of such a survey will exert a high positive
inducement on the faculty members of SPHs to reorient their education to
redress perceived weaknesses of their programmes and to better address the
needs perceived by employers.
11.
RECOGNITION OF PUBLIC HEALTH AS A DISCIPLINE
In many countries, while public health is recognized as part of the medical
discipline and is also regarded as an important area, there is no statutory
requirement to have a formal public health qualification for employment in
the public health arena. The recognition of public health as a distinct and
valuable multi-disciplinary profession is a political process. The Schools of
Public Health can play a key role in influencing such processes.
The faculty should be involved in various community-based and national
political processes where the future of public health programmes is discussed.
For instance, the national consultation on institutes of public health in India in
September 2004 provided such a forum for inputs - where public health
professionals were invited to give their views.
Influencing public policies requires partnerships and coalition building
with many groups and bodies - both governmental and from civil society. The
results of such coalition building will not be immediately obvious but with
persistence, a multi-disciplinary public health profession will be recognized by
the political leadership.
Recommendation: The art of politics must become a part of the
educational process and both faculty and students must become
conversant with identification of influential actors, agenda setting,
influencing decisions and creating coalitions.
Learning in politics is often best done through case studies of real
examples of decisions made. Emphasis must be placed on learning
through analysis of cases which reflect both the complexities of society as
well as indicate ways to move forward.
12.
PARTNERSHIPS
Many alternative institutions, both organized and informal, have been actively
involved in public health work as well as public health capacity building.
Page 23
South-East Asia Public Health Initiative 2004-2008
Sometimes, they have been termed as alternative sectors. For example, in
India, the following organizations, among others, have been active in public
health education and training - some since the 1980s and others more
recently:
> VHAI Educational
management);
Council
(diploma
in
community
health
> Network of community health trainers: with inputs from many
voluntary organizations, they have conducted short courses in
community health development and management;
> People's Health Movement;
> Society for Community Health Awareness, Research and Action
(CHC); human resources development in Karnataka and Orissa;
> Centre for Enquiry into Health and Alternatives (CEHAT): gender
issues, etc.
The list can be enriched by examples from other countries, as well as
with more examples from India. These organizations have become active in
public health development due to dissatisfaction with existing governmentowned PH institutions, usually run by conventional Preventive and Social
Medicine departments, and also having low status for public health and
increasing inequity and social exclusion. A wave of community health NGO
movements has taken place to try alternative experiments and actions, and to
build capacity from communities and grassroot workers. Unless the national
apex institutions or schools of public health recognize these alternative sectors
as strong resources and involve them in training and research, a large portion
of creative energy in public health will remain untapped.
The second category of institutions for partnership are the "development
and training institutions" established by other sectors, with a major
component of social development. For example, the Indian Institute of
Management (IIM), Ahmedabad, includes rural poverty as one of the modules
that the students have to take in order to expose them to the real conditions
of India. Similarly, some components of public health would be a welcome
addition to the curricula of these students. In addition, teachers and
researchers from these institutions can be invited to give guest lectures to the
students in other SPHs. Such active collaboration will demonstrate the validity
Page 24
Strategic Framework for Strengthening Public Health Education
of the ecological or multisectoral basis of health development. Examples
abound of institutions from different disciplines or sectors getting together to
produce learning materials for students or to produce case studies to support
such materials.
The third category of institutions belong to the private sector. Currently,
private-public partnership is very much in vogue and PH education should
also benefit from this concept. Many of the private sector companies are
seeking to support selected social and health development activities (like Tata
Institute of Social Science or IIHMR in India) and can perhaps be motivated to
provide resources for the health needs of defined areas or populations. In the
USA, private philanthropies have always been active in supporting
educational institutions including SPHs. For example, Johns Hopkins SPH has
been the beneficiary of such philanthropy not only from Hopkins but also
from the Rockefeller Foundation. Although the SPHs in the Region have not
been privy to such heritage from their own institutions, new enterprises
probably would be willing to fund or support some activities including
possibly funding some professorships in schools of PH. They maybe willing to
establish endowed Chairs or Professorships which also give them visibility
among social activists.
The concept of "twinning" is an attractive course of action and has been
covered in the section on Benchmarking. The twinning of two institutions, or
two associations, can yield many benefits of partnership to each other.
Twinning can also be used to bring the weaker institutions at par in a short
time since examples and involved commitment are important catalysts in
institutional development.
Partnerships as described above deal with country linkages, while there
are several bodies at the international level that promote and actively
encourage partnerships and networks. Apart from SEAPHEIN, there are
various networks, such as the International Network of Clinical Epidemiology
(INCLEN), the Asia-Pacific Academic Consortium for Public Health (APACPH),
Association of Schools of Public Health in the European Region (ASPHER), the
American Public Health Association (APHA) and, the World Federation of
Public health Associations (WFPHA), which are important resources to tap
into. All of them have valuable web-sites for dissemination of information and
knowledge.
Page 25
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CHLP NW 04102016
Background Paper-6
5.
POLICY, ACADEMIC AND RESEARCH AGENDA FOR PUBLIC HEALTH IN INDIA
(2006)
PHFI Inaugural Workshops
A summary of the key suggestions raised by workshop participants for consideration by PHFI as
it evolves its academic, research and advocacy agenda. This summary represents views of
participants who were invited from a wide variety of backgrounds - government, academia,
research institutions and civil society
A. Stimulating demand for public health professionals
PHFI should address the perception of public health professionals (including PSM
departments) that they are at the bottom of the pyramid in terms of status and positions
among health professionals and enhance their self confidence an esteem as very important
members of the future health team.
2. The NGO sector and the civil society in India have made great contributions to public health
by maintaining the perspectives and practice of public health and giving it a new people
oriented - community health perspective, inspite of the opposite trend in the government and
the mainstream. PHFI must tap these resources and build on this rich experience and
tradition.
3. Public health services and systems especially by government need to be made more
accountable and NGOs and civil society have done this by evolving the concept of People’s
Health Movements and rights based approaches to health care which have begun to engage
with government policy and programmes and challenge them to be more effective and
accountable. PHFI must link into this sector be involve in advocacy and other initiatives.
4. The big challenge of advocacy is to move away from the bio-medical model focusing on
drugs and vaccines to a more social / community health / public health module that focuses
on public education and social processes.
5. There is urgent need to focus on and stimulate public demand for quality public health
services which will strengthen the public health systems and increase the utilization of public
health professionals who are available or may become available through various efforts
including those of PHFI.
6. We need to expose the community and health systems to the benefits of trained public health
personnel by creating a cadre of public health professionals on the line of the IAS and IPS
7. We need to create a large number of fellowships in order to get young people in larger
numbers to train in public health.
8. Human power management systems in government and other sectors also need modification
to attract young people into this professional.
9. Post training opportunities must also be created in the NGO and the private sector and all the
focus must not be only on the government sector.
10. Programmes like NRHM need public health professionals or public health oriented
professionals at all levels of the pyramid to be successful. We need to have 4 to 5 time more
people at every level.
11. Advocacy for public health must go hand in hand with greater decentralization of resources
including human resources and we must communitise these untied resource at local level for
strengthening public health.
12. Before we promote public health professionals we must be clear about who is a public health
professional and what type of specialists are we looking for. The selection criteria must
always focussed on those who spent time in a village or urban slum working with government
or private sector or an individual who has done something in the field of community health.
13. Public health specialists and health workers should respect and trust each other and
specialists must not see workers as impediment but as help in their work. This has been the
experience of Bangladesh.
14. Public health professionals must have basic clinical knowledge or we end up with
bureaucrats.
They must also have training and experience in public speaking and
communication and be able to go to the local bazaar and talk about public health measures.
1.
3i
15. The biggest challenge of PHFI institutions is to promote the values among its students that
local health workers can do a lot in public health, that the doctor is a friend of the people and
that they have an awe and respect for life, nature and the community. The present market
economy is moving in the opposite direction.
16. Public health is a vast multi-disciplinary field and we must have a clear plan about the type of
public health skills and capacities we need at different levels and also where the products of
these institutions will be placed in the health system.
17. We need to replace clinicians and generalists managers of India’s health systems and
national health programmes by public health professionals who are both problem analysts
and problem solvers and are promoted as equivalent to the best in medical and engineering.
18. Beyond producing public health professionals, we should also seriously re-look at promoting
public health perspectives and skills to all cadre of health professionals including health
workers. Some of this may need to be taught in the local vernacular and inter-sectoral
coordination should be important part of the training.
19. We should be cautious that the PHFI institutions do not glamorize public health and make
them a privileged professional class that will not go to the remote districts and areas of
country.
We need less glamorous and more practical field oriented public health
practitioners.
20. Public health practitioners need to be of different types - some practitioners, some teachers,
some managers. We need to keep these distinctions in mind.
21. We should promote PHFI in a collaborative mode building on existing initiatives and
experiences and promoting a new group of professionals that will create energy and synergy
needed to inculcate a deep sense of respect for public health and improve the practice of
public health in the country.
(based on inputs from
Arjun Rajagopalan (Sundaram Medical Foundation), Vijay Aruldas (CMAl), T. Sundarraman (SHRC),
N.K. Arora (Clinical Epidemiology Network), Salim Habayeb (WHO SEARO), Amarjeet Sinha (MOHFW),
Zafrullah Chowdhry (Gonoshasthya Kendra-Bangladesh).
N.H. Antia (FRCH), Thelma Narayan (CHC/SOCHARA), Vinayak Hussein (MOHFW),
Sunil Kaul (ANT), Arvind Mathur (WHO India office)
B. Creating‘& Sustaining Excellence, & Relevance & Designing the PHFI Institutes
1.
A core group of people need to be passionate about this institution and a shared
vision.
2. Detailed planning exercise should be undertaken to make sure we plan exactly what is
needed / to happen.
3. Every institution must have its own philosophy and must respond to real life problems
not just theoretical issue.
4. The centre should be multidimensional and develop knowledge, skills and attitudes.
5. There should be strong and effective leadership.
. 6. Facilities for community based learning process (learn it in the field) with a strong
focus on primary health care, which is the weakest link in our present medical
education.
7. External embedded cycles?? (Shah Ebrahim)
8. The institution needs to emerge with a Vision and Mission not just be designed and
staffed.
9. It must encourage a culture of learning that is constant among both students and
faculty.
10. A core faculty team that have vision / capacity provided with a career development
programme and judged by outcomes.
11. Autonomy for institution.
12. Building capacity to solve problems
13. Institutions should be residential to have better chance to orient students and faculty
to values and institutional culture.
14. PHFI institutions should work in partnership with NRHM and other governmental
initiatives. Isolated work will not succeed.
15. The institutions should promote field exposure and dialogue with the community to
have a lived experience of poverty and inequity which will make an impact on the
hearts and minds of the students.
16. Excellence should be measured not by number of papers published but by the
concrete output that the student or the faculty contributes to the community.
17. Public health is too serious a matter to leave only to health professionals - hence the
public and community representatives should be deeply involved with the institutions.
18. The PHFI institutions should not promote internal brain drain leading to collapse of
other institutions but must work in the context of a collaborative network.
19. There should be career tracking within the system of public health for all students who
graduate from these institutions.
20. Identify all the existing institutional and community experiences from which students
and faculty can benefit.
(based on the inputs from
Jahar Saha (IIM), Shah Ebrahim (LSHTM), J.P. Muliyil (CMC-Vellore), Sanjana Bharadwaj (UNICEF),
K.R. Thangappan (SCTIMS), Madhav Menon (NLSUI), Sneha Bhargava (AllMS), Mirai Chatterjee (SEWA),
Prem John (ACHAN) and Pat Naidoo (Rockerfeller Foundation)
C. Developing as a reputed research and advocacy group
1.
The Foundation should work to foster networking, creating policies and working on areas of
research that are not adequately addressed as of now. It should not compete with existing
research institutions and public health departments which are already doing research in a
number of public health problems - eg., communicable diseases, cancer, diabetes, cardio
vascular diseases, etc.
2. It should promote an interaction between research and the health care system - so that
locally generated research that is responsive to an adverse economic situation is used by
the health care system.
3. It should promote the nation wide acceptance of research methodologies and modules that
have been set up by ICMR and other institutions.
4. It should promote interactive dialogue between researchers - biomedical and social and
behavioural scientists and also with advocacy groups, planners and civil society and
community.
5. It should promote the spread of research information to the community by more active
partnership with grass root workers.
6. It should also promote evidence based decision making in health care planning by making
available research evidence to help planners.
7. It must strengthen evidence based research in public health in general (only 3.3% of research
papers in 2002 were dealing with public health) and not allow emotion based research.
8. It must strengthen the commitment of public health community to public health research (if
something is not respected it does not get done).
9. It must foster research i.e., India centric and innovative because especially in public health
we have to deal with less resources, large numbers and large distances. Focus of research
should be on poor population not well to do.
10. It must assess new technology critically especially looking at how it can improve the health of
our country and also promote technological innovations.
11. Research priorities could include
a. studying implementation gap and implementation science
b. socio-economic determinants of health including gender disparity, equity and access
c. focus on unorganized sector and its impact on health
d. women’s health
e. starvation and food / nutrition security as a public health issue.
f. decentralization of public health system
9- health as a human right issue
h. health system research which should be fed back to the system to increase efficiency
of the system.
Public - private partnerships and their efficacy
Health and social policy research including measurements of existing policy.
J12. It should promote evidence based introduction of public health measures for communicable
and non-communicable disease control.
13. The research promoter should be with a strong social medicine and community health
approach and not just the orthodox bio-medical approach.
14. Research partnership should promote links with community based organizations, peoples
movement, groups of rational practitioners and PSM departments in medical colleges.
15. Research should reflect on entire health spectrum of disease and problems and systems and
not just be bio-medical in its approach. It should be fostered by encouraging a deeper
understanding of the social, economic, cultural, political and ecological dimensions of health
and disease at the graduate education level and in the orientation and training of young
researchers.
16. The research policies supported by PHFI must ensure that the benefits of research must
reach the community / population otherwise the policy should be seen as incomplete.
17. It should balance focus on drugs, vaccines and new technologies with strong commitments to
health system research, health promotion, and approaches that foster education and social
processes.
(based on inputs from
Prof. Nirmal Ganguly (ICMR), Prof. Mashelkar (CSIR), Sapna Desai (SEWA), Abhay Shukla (CEHAT),
Andres de Francisco (Global Forum for Health Research) and Ravi Narayan (CHC/PHM)
Compiled by Dr. Ravi Narayan and Sunil George (CHC Fellow)
Community Health Cell, Bangalore.
25th July 2006.
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CHLP NW 04102016
Background Paper- 7
7.
PUBLIC HEALTH EDUCATION IN INDIA - Some Reflections* (2007)
7.1 Context: Public Health Education Policy : 1946 to 2002
To understand the true significance of the crisis and challenges of Public Health Education in
India, one must recall the main recommendations of the Bhore Committee (1946) and Mudaliar
Committee (1961) reports, that tried to set the framework of pubic health education in India.
The Bhore Committee recommended the setting up of departments of preventive and social
medicine (PSM) in medical colleges with the mandate to incorporate the then popular Diploma in
Public Health into the training of all undergraduates as the syllabus for PSM, highlighting the
need for all Indian doctors to be public health oriented - the ‘social physician’.
It also
recommended post-graduate training of two types - a shorter training in PSM / Public Health for
health workers (three months to one year); and a longer training for specialists in preventive
health work for teaching, research and administrative needs of the public health system (3-5
years). It also recommended training of nurses in public health and a cadre of public health
engineers, public health inspectors and public health laboratory workers to be trained by the All
India Institute of Hygiene and Public Health and other institutions.
Fifteen years later, the Mudaliar Committee further strengthened public health education in the
country by recommending schools of public health in every state to train medical officers, public
health nurses, maternity and child welfare workers, public health engineers and sanitarians,
dieticians, epidemiologists, nutrition workers malariologists and field workers. It also
recommended degrees in public health in University for non medical personnel covering general
public health, communicable diseases, immunization, environment sanitation, statistics, school
health and the teaching of public health principles and hygiene in primary school with practical
demonstrations. In addition, one year training in public health for a large number of medical
officers to carry out public health / sanitation measures and higher training of MD/PhD to support
public health system policy and development were also recommended.
While these recommendations were made in an era when public health was seen as a special
skill and education of health personnel in these skills were seen as necessary for health system
development in India, the first two decades of national health planning saw a series of negative
policy trends that prevented the public health system and policy development from reaching its
full potential with many of the Bhore and Mudaliar committee recommendations not being
operationalised. Banerji (1985 and 1986) and Narayan (1984 and 1991) and Deodhar (2004)
have written extensively, on what happened and why - highlighting the reasons and reviewing
policy trends and policy distortions as well. They focused on many aspects of the health system
including medical education and human resource development in public health education.
Banerji (1985) noted that “both the Government of India and the Medical Council of India had
taken steps to establish upgraded departments of preventive and social medicine. However,
these departments have not been able to attract the quality of scholars who could fulfill the
challenging role assigned to the departments and, in the course of the past three decades, most
of these find themselves at the very bottom of the prestige hierarchy in medical colleges”. In his
detailed epidemiological, socio-cultural and political analysis on Health and Family Planning
Services in India, he concluded highlighting “the need for managerial physicians that understood
health service development as a socio-cultural process, a political process, a technological and
managerial process with a epidemiological and sociological perspective". In many ways without
using the term ‘public health professionals’ - he was setting the agenda for public health oriented
capacity building in the country. In a later oration, Banerji (1988) made a strong appeal for such
an All India Public Health Cadre . He suggested “
Action to strengthen public health practice
must start from the political level.________________________________________________________
*This paper is based on Power Point presentations - presented recently at a CHC Workshop on the
Community Health Fellowship Scheme in July 2006 and an earlier seminar at the London School of Hygiene
& Tropical Medicine on Public Health Education of India, in June 2006, later published in mfc bulletin,
December 2006 - March 2007
Formation of an all India cadre or at least strengthening of the existing cadre of Central Health
Services is urgently called for. To improve the quality, it would be necessary for the political
leadership to actively search for highly intelligent and dedicated public health workers and
bringing them together to form a ‘critical mass’, which could strengthen the key institutions for
practice, research, education and training in public health”.
Narayan (1991) in a detailed analysis of 150 years of medical education as part of the medical
education anthology process of mfc, noted that “hierarchical trends in medical colleges, non
democratic spirit in curriculum planning and authoritarian methods in bringing about changes in
medical colleges have prevented serious and meaningful change in the inherited structure”. This
was probably true not only of the main stream experiment but also of many of the emerging
alternatives. He also commented on the “myths of PSM including a gross confusion between
means and ends and inability to stimulate teachers and students to see the importance of socio
economic cultural and ecological factors in management of health and disease” - which were the
original hopes when the department was created and integrated into medical education.
Later, Narayan, (1997) endorsed “
the reorientation of all postgraduate education towards the
goals of the National Health Policy and primary health care and enhanced commitment to post
graduate training in public health and allied disciplines. Linked to this would be the development
of all India Public Health Cadres to strengthen the public health services in the country....”. This
was in the Chapter on Perspectives in Medical, Nursing and Paramedical Training and Education,
the Independent Commission on Health in India, report by VHAI, New Delhi.
The same report (ICHI 1997) also recommended that “all major states should have at least one
school of public health, along with modern public health research laboratories, smaller states may
collaborate and have common public health schools..”. It also recommended that Institutes of
Health and Family Welfare established in many states should be developed into Schools of Public
Health. The analysis by Deodhar (2004) of the regression of public health education in India in
the last three decades is particularly relevant - since it focuses on PSM departments that were
primarily set up to strengthen public health. “Departments of Preventive and Social Medicine
have been the victims of neglect, assignment of lowest priority, low prestige, poor quality of staff,
inadequate.facilities, the staff full insulated themselves from the practice of public health and even
of preventive medicine”
While academics, researchers and activists mentioned above have been highlighting the crisis
and challenge of public health education from the 1980s, national policy documents also began to
identify these trends and problems and suggested strategies of action to strengthen public health
education in various ways.
-
The National Health Policy document of 1982 identified three significant problems:
1. “‘ Wholesale adoption of health manpower development policies...based on western
models... inappropriate and irrelevant to real needs.. ”
2. “Continued high emphasis on curative approach led to neglect of preventive, promotive,
public health and rehabilitative aspects of health care”
3. "Prevailing policies in regard to education and training... resulting in development of a
cultural gap between people and personnel providing care”
It recommended many strategies of action - foremost of which were the need to formulate a
national medical and health education policy, and the establishment of comprehensive
primary health care and public health services within an integrated referral system.
The National Education Policy for health sciences in 1989, which grew out of a response to
the NHP 82 identified the problems as:
1. Medical bias in the entire process of health systems planning and health manpower
2.
development
.
...
Inadequate continuing education for updating existing skills and facilitating acquisition of
new skills and knowledge by health team.
It recommended the following strategies for action relevant to public health education:
1. Efforts to produce adequate number of first level of specialists in medicine, surgery,
paediatrics, OBG and public health / community health
2. Essential that speciality of health management is recognized and an appropriate step
taken to produce good health managers.
3G
Mandatory to establish linkages between health care delivery and education in health
sciences to make the whole system efficient and effective.
The most comprehensive analysis of needs assessment and strategies for action was by the
Expert Committee on Public Health System 1996, constituted by Government of India, which
included public health stalwarts like Dr. Harcharan Singh (Planning Commission), Dr.
Jayaprakash Muliyil (CMC Vellore), Dr. N.S. Deodhar, (MOHFW), Dr. K.J. Nath, (AIIHPH-Kolkata)
and K.K. Datta, (NICD). This report which unfortunately did not receive attention it should have
received was significant in its findings and recommendations. (See Annexure -1)
3.
After 50 years of national planning and policy evaluation, it identified the problems as
■
Public health services do not have requisite number of senior level public health
professionals
■
Many programme managers at national and state level are without any public health
orientation or public health qualification.
It suggested many strategies for action to strengthen both the public health system in the country
as well as public health education. The recommendation on the latter were:
■
Need to open new schools of public health - so that more public health and para
professionals can be trained.
■
Existing public health schools to be strengthened (AIIHPH) - Eastern region and four regional
schools to be set up - central, northern, western and southern.
■
Existing medical colleges with significant expertise in PSM / Community Medicine should be
upgraded as advanced centres for teaching public health and producing public health
professionals (at least 25% of existing departments to be upgraded).
They also very succinctly reoriented the public health system concept by emphasizing eight policy
constituents that were necessary for these systems to become more relevant to Indian
community realities and public health challenges. These included :
decentralised health planning; higher budgetary allocation to the health sector; strengthening
health information and early warning systems; inter-sectoral coordination; community
participation; continuing education of all categories of health personnel; health services research;
involvement of practitioners of the Indian Systems of Medicine.
Six years later, the National Health Policy 2002 reechoed these concerns in a different way by
noting :
■
Limited success of the public health system in meeting preventive and curative requirements
of general population
■
Financial resources and public health administration capacity far short of needs
■
Public health machinery inadequate in quality, efficiency and too vertical and inadequately
decentralised.
■
Public health expertise non existent in private health sector and far short of requirement in
public health sector.
It included the following strategies for action relevant to strengthening public health systems and
public health education in the country:
■
“Ensuring adequate availability of personnel with specialization in pubic health and family
medicine disciplines to discharge public health responsibilities in the country
■
Need to entrust limited public health functions to nurses / para medicals, practitioners of
Indian systems of medicine and other personnel after adequate training, to enhance outreach
of public health programmes.
■
To increase efforts to strengthen decentralised state level public health systems and involving
panchayat raj institutions in the governance and delivery.
■
Developing capacity of state public health administration for scientific designing of public
health projects suited to the local situation.
■
All rural health staff to be available for the entire gamut of public health activities at
decentralized levels”.
A recent review of all these critiques in Narayan (2006) identifies four broad sets of issues that
explains why public health education had been devalued or neglected in spite of all the debate,
dialogue and policy recommendations. These include:
■
■
■
■
Medicalisation of public health by preventive and social medicine departments, and their
aloofness from state health programme managers, as well as th fact that these post-graduate
degrees have been available only to medical professionals, though this trend is now
beginning to slowly change.
Devaluation of public health as a discipline in the 1960’s and 70s by generalist
administrators and clinicians becoming public health managers and state HRD policies not
requiring public health degrees as job requirement for public health managers. This trend is
also seen in a more subtle way in the NGO / civil society sector as well.
Disintegration of public health systems by vertical national disease oriented programmes
rather than sector wide approaches and externally funded projects focused on single disease
programmes rather than on strengthening public health systems. New economic policies also
reduced social sector expenditures including health budget further distorting the public health
systems.
Dialectics of National Health Policy
The challenges of balancing public health / primary health care system development with the
present trends towards privatization of health care and medical tourism and unregulated
private sector development and commercialization of health care has led to inadequate focus
on public health human resource development. This is also linked to new economic policies
that focus on the needs of ‘India’ rather than of ‘Bharath’.
It must however be noted that by early 2000 AD, a National consensus had begun to emerge
especially in policy circles for comprehensive initiatives in strengthening public health capacities
in the country. This emerging consensus included
need for many more schools of public health / institutions and public health courses to
cover state and regional needs;
need for making available public health training for health and social science professional
other than doctors;
need for strengthening public health planning, management and response to
emergencies in state and national health systems and
need to ensure public health human power development policies at state and central
level that gave public health qualifications, skill s and capacities their due importance.
Any public health capacity building dialogue like the one being undertaken by the medico friends
circle or capacity building initiative like the Public Health Foundation of India must take into
account these historical documents, the critiques and the pleas for action and the emerging policy
consensus.
References
Bhore Committee (1946), Health Survey & Development Committee, Compendium of Recommendations of various
1.
committees on health development, 1943-1975, Central Bureau of Health Intelligence, DGHS, Ministry of Health &
Family Welfare, GOI, Nirman Bhavan, New Delhi - 110 001.
2. Mudaliar Committee (1961), Health Survey & Planning Committee, Compendium of Recommendations of various
committees on health development, 1943-1975, Central Bureau of Health Intelligence, DGHS, Ministry of Health &
Family Welfare, GOI, Nirman Bhavan, New Delhi - 110 001
Narayan, Ravi (1984), 150 years of Medical EducatiomRhetoric and Relevance, Medico Friend Circle Bulletin,
3.
No.97-98, Pune, pp1-9.
Banerji, Debabar (1985), Health and Family Planning Services in India - An epidemiological, socio-cultural and
4.
political analysis and a perspective, Lok Paksh, New Delhi - 110 067.
Banerji, Debabar (1986), Social Sciences and Health Service Development in India - Sociology of Formation of an
5.
Alternative Paradigm, Lok Paksh, New Delhi - 110 067.
Banerji, Debabar (1988), Trends in Public Health Practice in India - A plea for a new Public Health, B.C. Dasgupta
6.
Oration, 32nd Annual Conference of the IPHA, Hyderabad, February 5-7,1988.
Narayan, Ravi (1997), Perspectives in Medical, Nursing and Paramedical Training and Education, page 23-34,
7.
Chapter III, Report of the Independent Commission on Health in India, Voluntary Health Association of India, New
Delhi, 1997.
8. VHAI (1997), Report of the Independent Commission on Health in India, Chapter VI, Public Health Institutions, VHAI,
1997,
Deodhar, N.S. (2004), Public Health System in India with special reference to school of Public health, National
9.
Consultation on Schools of Public Health, New Delhi, September 2004.
10. Narayan, Ravi (2006), Public Health and Community Health Education in India - A Historical Overview, CHC
Workshop on ‘Community Health & Public Health Education : Towards a New Social Paradigm', Community Health
Cell, Bangalore.
7.2 Overview of Public Health / Community Health Education initiatives
in India since 1970
A very large number of initiatives to strengthen public health/community health education have
evolved in India since 1970s with an increasing spurt of activity since the 1990s. These have
been in response to the emerging unmet needs in public health oriented personnel. They also
represent the emerging national consensus at policy and other levels for greater initiatives to
strengthen capacity, quality and quantity of community oriented, public health personnel. An
important clarification is necessary, since the alternative sector uses ‘community health’ more
than ‘public health’ in its description of courses. These are not synonymous. However, for the
sake of this document, community health will be defined as ‘the new public health- which
includes a strong focus on social, economic, political and cultural determinants and the
involvement of the community in the organization of the action as a right and a responsibility’.
These initiatives have been primarily of two types: (a) Mainstream; (b) Alternative.
A.
MAINSTREAM INITIATIVES:
Institutes I Courses
These include all the newly created PSM departments since Independence which have begun to
produce post-graduate MDs and older institutions like AIIHPH and NIHFW which have continued
their earlier degrees and added new ones. Some of these institutions have also developed
diploma in public health and related courses.
There is no directory as yet of all these programmes but the South East Asia Public Health
Education Institutional Network (SEAPHEIN) has began to document these recently (WHOSEARO 2002) as part of a process to evolve an accreditation system. This listing shows that as
of 2002, we have 180 medical colleges teaching PSM as part of the MBBS curriculum, Of these
58 offer a degree of MD in Social & Preventive Medicine or Community Medicine of 3 years
duration; and 13 offer a Diploma in Public Health of 2 years duration. All these courses
recognized by the Medical Council of India and are available only to medical professionals. All
India Institute of Public Health & Hygiene-Kolkata offers DPH, MD and Ph.D courses with some of
the shorter public health courses open to other health professionals.
Apart from this, we have the Masters in Community Health of JNU; the Masters in Public Health
of Sri Chitra; the Masters in Epidemiology of CMC-Vellore - all of which are open to graduates
any discipline. Since 2001, we also have a Masters of Applied Epidemiology from the National
Institute of Epidemiology - Chennai, which is open to state and district level public health
programme managers. In addition we have the short courses and in-service training by NIHFWNew Delhi, for deputies and CMOs of districts. In 2005-06, the ICMR announced its plans for 4
school of public health of which the Kolkata and Chennai schools have been inaugurated in June
and October 2006. Finally NICD-New Delhi; PGIMER-Chandigarh; and Centre for
Interdisciplinary Studies, Pune University, have also announced their new MPH programmes.
The proposed Institutes and courses to be started by the Public Health Foundation of India (
PHFI) will be over and above all these existing institutes and courses .
Networks
Three professional networks have contributed to a varying degree,
experimentation in public health education in the country. These include
a)
b)
c)
to the debate and
The Indian Public Health Association (IPHA), which is a very old network of public
health professionals meeting annually and producing the Indian Journal of Public Health.
They tend to be mostly public health professionals working in the Government Public
Health system with some exceptions.
The Indian Association of Preventive and Social Medicine (IAPSM) which is national
association of Teachers of PSM departments with some exceptions.
The Indian Clinical Epidemiology Network (INCLEN) - which is a network that
emerged through a Rockefeller initiative that stimulated and strengthened the training of
clinicians in epidemiology and field based research, making them more public health
oriented.
Some issues relevant to the mainstream sector
While it may seem relevant, that so many institutions and colleges are already running or initiating
public health courses in mainstream institutions, some issues of concern need to be noted. Some
of these are anecdotal and not based on a comprehensive review but are valid since CHC has
had a close contact with most of these initiatives and has participated in many of the courses.
a) Each institution is evolving its own public health course without any standardization or
reference to a national consensus.
The
Medical Council of India and the National Academy of Medical Sciences have not
b)
been very proactive in recognizing courses opened to non medicos in public health.
Therefore, in exploring accreditation for public health courses for non medicos, each
institution is evolving its own recognition with the local University or other Universities.
There
is urgent need for a National Accreditation council - perhaps a Public Health
c)
Council of India - so that all these DPH and MPH courses are part of some nationally,
relevant framework. Such a council however must encourage experimentation, diversity
d)
e)
f)
and autonomy.
There are no national standards for faculty requirements, course contents, methodology
of teaching, requirements of field centers and field experiences for these newer MPH and
DPH courses. MCI has recommendations for PSM departments and the undergraduate
and MD curricula. The WHO-SEARO has just started this process since 2000 AD through
the SEAPHEIN network (see details later in the paper).
Finally, there is urgent need for policy advocacy with States, to recognize these DPH and
MPH courses as requirements for specific jobs in the public health systems at state level.
Only then will these education efforts help strengthen state capacity and programme
effectivity. In the absence of such a proactive policy advocacy process, this anarchic
development of institutions and courses could result in the human resources generated
serving a market need and fueling a ‘brain-drain’ rather than responding to the national
public health system needs.
A brief word, about the three professional networks, that should be logically involved in
any discussion on public health capacity building in India. The two associations - IPHA
and IAPSM have not been working as closely as they should because of a subtle
hierarchy between the three year MD and the one to two year DPH/MPH course, though
this is now beginning to change. In Karnataka state we have managed to bring these
two groups in to one association — The Karnataka Association of Community Health. In
addition the INCLEN network is also not so closely associated with the other two
because of the subtle differences between the clinical epidemiologists and the ‘purists’.
The dialogue of all this networks with the policy makers has been relatively weak.
B) THE ALTERNATIVE SECTOR:
The ‘alternative sector’ is a term we have used to describe a group of public health / community
health training and educational initiatives that have not followed the orthodox MD- PSM and
MPH/DPH tracks. This sector evolved through the experimentation of a large number of
community health action initiators in the late 1970’s mostly from the NGO/ Voluntary sector. After
many years of community based action some of these projects metamorphosed into training
centres, that could orient other doctors, nurses and health professionals to initiate and innovate
similar community health projects. We can classify them into two groups: (a) short term training
programmes and (b) long term training programmes
Short term training programmes
These include Community Health training programmes of Deenabandhu Medical Mission
(Tamil Nadu); Christian Medical Centre (Miraj); Christian Fellowship Hospital, (Ambilikkai;,
Tamil Nadu), Institute for Rural Health Management - (Pachod, Maharashtra); International
Nurses Service Association, INSA (Bangalore); THREAD (Orissa), Child in Need Institute —
(Kolkata). Many of these courses, were particularly popular in the 1970s to 1990s. Some of
them have now been discontinued.
ii. NGO Networks like VHAI, CHAI and CMAI also started short courses in community health
planning and management particularly for their member institutions.
iii.
Some educational institutions like St. John's Medical CoHege-Bangalore <3 ^0"th “^Se'n
Community Health), and NIMHANS -Bangalore (one month course in Mental Health Care),
also started such short term courses.
Long term training programmes
i.
The Voluntary Health Association of India evolved a VHAI Educational Council which has
been offering a Diploma in Community Health Management, in collabora on with Rura Unit
for Health and Social Affairs (RUHSA) and Christian Medical College Vellore since 1983.
This course is for a year. A distance learning module was also attempted.
ii.
In 2003 the Society for Community Health Awareness, Research and Action (SOCHARA /
CHC Bangalore) - has evolved a six month internship / fellowship for medical and social
science graduates, to strengthen public health as choice of career / vocation. This initiative
entitled the Community Health Fellowship Scheme is an ongoing experimental project, which
has just been externally evaluated and discussed at a national workshop of Public health
/community health trainers in July 2006 at Bangalore.
Some issues relevant to the alternative sector
important features of these short courses have been described in CHC studies (Narayan,
Some
1993 and Kasturi .A. 1993). These included the following:
R et al, '
The courses experimented with an alternative philosophy of education that was
i.
participatory, experiential, learner centred and action oriented.
They used small group techniques and methodologies.
ii.
They had a strong community orientation, since most of the training was community
iii.
based and non hospital oriented.
iv. They had a strong social analysis, exploring broader determinants of health
v. There was a focus on skill development for community based work.
There was a greater learner centredness with participants giving feedback and evo vmg
vi.
the curriculum further course by course.
The focus of training was on cognitive and affective aspects of training and on work
vii.
related skills as well.
Many of them evolved innovative case studies, simulation games and problem solving
viii.
exercises.
While the orientation of the courses were very different the over view suggested that
ix.
they focused on two sets of roles - the first as alternative service providers or
programme managers and the second as enablers and empoweres of the community
or process managers.
A very important and significant characteristic of this group of innovative trainers, was that
nearly all the trainers had been trained in public health mostly in US and UK universities and
had returned to the country to initiative community health projects as part of such a movement
in the 70’s. Most of them actively and creatively modified their own public health skills to the
challenges of local realities. Some of them strengthened their initial efforts as generalist by
acquiring public health degrees along the way.
The current anxiety that somehow a foreign education in skills or capacities makes
to be a creative adaptor to a different social, economic, cultural, and political real'^ a^\9hly
exaggerated fear not borne by Indian experience. In fact if the voluntary sector of health in India
is to9be studied as an indicator, then there is significant evidence that an Indian educational
exoerience especially from a mainstream institution kills the innovative spirit rather than
stimulates it, with foreign trained and foreign returned professionals continuing to show more
capacity and initiative then their local counter parts. This may be more an indicator of the
training methodology and the dialogue environment of academic centres abroad as opposed to
the more hierarchical and didactic academic environment locally.
C) OTHER DEVELOPMENTS
While the earlier sections focused on courses and training centres in the main stream and
alternative sector, two process of networking in the region, since 2000 AD are beginning to have
an important impact on public health/community health dialogue and health human power
development in the country. This includes a) A public health demand creating movemen - e
People’s Health Movement- Global and Indian, b) A public health education network - the South
East Asian Public Health Education Institution Network (SEAPHEIN)
i.
People’s Health Movement (PHM) - Global and India
A Global Peoples Health Movement and a People’s Charter for Health arose out of an
important People’s Health Assembly, held at Gonoshasthya Kendra, Savar, Bangladesh, in
December 2000. when over 1454 people from 75 countries gathered to reflect on why ‘Health
for AH’ had not been reached by 2000 AD. This had been the goal of the famous Alma Ata
declaration of 1978 committed to primary health care. This global assembly was preceded
by the First National People’s Health Assembly in Kolkata, which also resulted in an Indian
People’s Charter for Health. Both these documents have led to the emergence of a growing
People’s Health Movement in India, known as Jana Swasthya Abhiyan (JSA), which brings
together over 18 national networks committed to strengthening the Right to Health and Health
Care in the country. The leadership of this Movement includes a wide variety of public health
/ community health oriented professionals and activists from all over the country and are
slowly becoming a force to reckon with in public health policy and system development. The
Charters both global and national have a series of recommendations of great significance to
public health, public health system development and public health education in India and
abroad. (PHM 2000 and JSA 2000) Members of the JSA are now actively involved with
advocacy initiatives with the Ministry of Health and Family Welfare, Planning Commission,
and other national bodies and also participating on task forces of the National Rural Health
Mission and other schemes.
ii.
The South East Asia Public Health Education Institutes Network (SEAPHEIN) is an
■
•* * regional conference of ‘Public Health in
initiative that has evolved as an outcome
of' the
South-East Asia in the 21st ccentury
, ’ in 1999, hosted by the IPHA which led to the ‘Kolkata
Declaration’. The Declaration had four major strategic directions relevant to India as well:
essential requirement for health
a) Promoting public health as a discipline and as an
development in the region;
b) Recognizing the leadership role of public health in formulating and implementing
evidence-based healthy public policies;
c) .Strengthening public health by creating career structures at national, state, provincial
and district levels; and
d) Strengthening and reforming public health education and training and research.
Five consultations have followed in the South East Asia Region in which some of the
existing public health institutes in India have participated especially CMC-Vellore,; Sri
Chitra, Trivandrum; AIIHPH-Kolkata; IHMR- Jaipur; and NIE-ICMR- Chennai; and more
recently CHC and PHFI. These consultations have focused on:
a) Accreditation Guidelines; (b) Curriculum structure (c) Networking (d) Future Directions;
(e) Regional Guidelines for Public health education standards and accreditation (WHOSEARO 2000, 2005 and 2006). (See Annexure -2)
This over view of development in public health/ community health education in the main
stream and alternative sectors and related developments of key networks would be an eye opener for many of us in mfc, who may have been unaware of all these diverse, plural and
anarchic nature of development of public health and community health courses in India. Very
few reviews or overviews are available on them except those undertaken by CHC and
mentioned in this paper earlier. There is need for a more evidence based and standardized
assessment of the content, methodology and relevance of all these ongoing experiments and
initiatives even as we focus on the newer developments like the PHFI. Many institutions like
AIIHPH, NIHFW JNU-CSM CH, CHAD-CMCV, NIE-Chennai, IRHM-Jaipur and Sri Chitra Trivandrum - have contributed to the challenge of public health education in India. By
focusing on the practitioners who have been trained by these institutions and feedback from
them on the relevance of the training, we can help build an evidence based national
consensus on what works and what doesn’t from a people’s health and a Health for All
perspective. This is an urgent imperative and the MFC dialogue could be the initiator of such
a process especially if we want to move from being a ‘thought current to also being an action
current’
D) POLICY RECOGNITION OF THE ‘ALTERNATIVE SECTOR’:
In 2004, CHC was invited to the First National Consultation on Schools of Public Health
organized by the Ministry of Health & Family Welfare, in New Delhi, to reflect on the contributions
of the alternative sector of public health / community health education in India. Taking an
overview of the sector and building on all the previous studies and reports , Narayan, R (2004)
identified some of the key challenges faced by the alternative sector, which included: the
experience of building capacity from grass-roots workers up to reorientation and skill
development of health professionals: community capacity building including strategies for system
development and demand creation; the evolution of the concept of a ‘new public health’ with
strong focus on community dynamics, social and development determinants and alternative
pedagogy: and various efforts through campaigns and movements to counter distortions and
market deviations in public health policy and action.
Three recommendations were made to the policy makers and public health professionals
gathered at this consultation:
6. “Recognize alternative sector as strong public health resource in the
country for training, policy action, system development and demand
creation (not as ‘appendage’ or ‘after thought’);
7. Involve alternative sector in development of relevant / creative learning
modules which could be included in the mainstream courses. The themes
would include (a) social and developmental determinants (including social,
economic, political, cultural and environmental factors; (b) public health
policy and action; (c) public health and social science research ethics; (d)
public health and community process management, etc.
8. Include some alternative training centres in evolving networks to
strengthen public health capacity in the country, which would be offering
MPH and shorter courses”.
There were some interesting outcomes of this strong plea by CHC on behalf of the alternative
sector at the National Consultation:
i. In the strategic framework evolved for strengthening public health education in WHO-SEARO
region entitled ‘South East Asia Public Health Initiative 2004-2008 (WHO-SEARO, 2004), the
following significant inclusion in the section on Partnerships shows that the demand has been
taken seriously. (See box item)
Partnerships with Alternative Sector
“Many alternative institutions, both organized and informal, have been actively involved in
public health work as well as public health capacity building. Sometimes, they have been
termed as alternative sectors. For example, in India, the following organizations, among others
have been active in public health education and training - some since the 1980s and others
more recently:
•
VHAI Educational Council (diploma in community health management);
•
Network of community health trainers: with inputs from many voluntary organizations, they
have conducted short courses in community health development and management;
•
People’s Health Movement;
•
Society for Community Health Awareness, Research and Action (CHC);
•
Centre for Enquiry into Health and Alternatives (CEHAT)
The list can be enriched by examples from other countries, as well as with more examples from
India.
These organizations have become active in public health development due to
dissatisfaction with existing government-owned PH institutions, usually run by conventional
Preventive and Social Medicine Departments, and also having low status for public health and
increasing inequity and social exclusion. A wave of community health NGO movements have
taken place to try alternative experiments and actions, and to build capacity from communities
and grass root workers. Unless the national apex institutions or schools of public health
recognize these alternative sectors as strong resources and involve them in training and
research, a large portion of creative energy in public health will remain untapped”
Source:
South-East Asia Public Health Initiative 2004-2008, WHO-SEARO
ii.
When the Public Health Foundation of India was set up in consultation with the Ministry
of Health and Family Welfare, the Planning Commission and the PMO’s office, in
February 2004, a representative of the alternative sector of public health / community
health was included as a stakeholder in the Governing Board and it is in that capacity
that CHC is represented on the Governing Board. This is therefore, an opportunity for
all of us in the alternative sector to engage with the initiative and make its academic,
research and policy endeavours more India relevant and pro-people oriented. By this
active engagement we may be successful in countering other agendas that any such
multi stake holder initiative is bound to be subjected to. This opportunity rather than
threat is described in the next section.
In conclusion, as we dialogue and debate on public health education in India at our mfc
meeting, we should recognize the large plurality and diversity of ongoing initiatives and
not just focus on one of them - however high profile. We need to identify trends including
externalities and agendas and also recognize both opportunities for engagements with a
wide variety of on going initiatives while at the same time evolving our own initiatives to
counter ‘market oriented and other trends. A great challenge would be to build up as soon
as possible the India relevant pro-people public health capacity building curriculum that
many centres and initiatives are talking about today.
References:
1. CHC (1991), Proceedings of the Community Health Trainers Dialogue, Bangalore.
2. Narayan, R, Narayan, T and Tekur, S.P. (1993), Strategies for Social Relevance and Community
Orientation in Medical Education - Building on the Indian Experience, A CHC/CMAI/CHAI Medical
Education Project Report, Community Health Cell, Bangalore.
3. Narayan, R (1993), the Primary Health Course at Jamkhed - Building the framework further - some
issues and perspectives based on an overview and experience of training in India’ (Jamkhed
Conference handout)
4. Kasturi A (1993), A checklist of ideas options and alternatives : an overview of fifteen community health
training programmes in India (A short term CHC project) Appendix A to 2.
5. VHAI (1997), Perspectives in Medical, Nursing and Paramedical Training and Education, Chapter 3,
Report of the Independent Commission on Health in India (by CHC).
6. Narayan, R (2001), Perspectives in Medical Education, Health Policy series, Independent Health
Commission in India, VHAI, New Delhi.
7. WHO- SEARO (2002) Accreditation Guidelines for Educational /Training Institutions and Programmes in
Public Health , Report of Regional Consultation , Chennai, Jan-Feb 2002, WHO-SEARO, New Delhi.
(SEA-HMD 213)
8. Dutta, G.P. and Narayan, R (2004), Perspective in Health Human Power Development in India Medical, Nursing and Paramedical Education, The Independent Commission on Development on Health
in India, VHAI, New Delhi.
9. Narayan, R (2004), Public Health Capacity Building - Initiatives by the Alternative Sector, National
Consultation on Schools of Public Health, New Delhi, September 2004 (Power Point presentation).
10. Gupte, M.D. (2004), Public Health Education in India : Status and Key Challenges, National
Consultation on Schools of Public Health, New Delhi, September 2004.
11. Thankappan, K.R. (2004), Public Health Education in India : Status and Key Challenges, National
Consultation on Schools of Public Health, New Delhi, September 2004.
12. WHO-SEARO, (2005), South East Asia Public Health Initiative 2004-2008 - Strategic Framework for
Strengthening Public Health Education, WHO SEARO, (SEA-HSD 282).
13. SEAPHEIN, (2006), Regional Guidelines for Public Health Education Standard and Accreditation, 2nd
SEAPHEIN Annual Meeting, South East Asia Public Health Education Institutes Network
7.3 Reflections on ‘public health teaching, learning and competency
building*
For over three decades, we have facilitated teaching, learning experiences in public health,
preventive and social medicine, occupational health and community health. Since the 1970s, we
have had ‘real life’ experience and engagement with all aspects and dimensions of the topic
being discussed. This includes being students of post-graduate courses in India and abroad;
teaching in India for a decade in St. John’s Medical College as faculty members of the
department of Community Health; Ravi has been an overseas lecturer of the London School of
Hygiene and Tropical Medicine (LSHTM); a visiting professor for a year each at the School in mid
80s and mid 90s; during the years in CHC evolving the ‘alternative paradigm’ of Community
Health (the new public health) we have been involved through praxis and engagement with
movements and health systems - both alternative and mainstream; and have lectured and
facilitated teaching sessions in public health schools in India, and several countries. More
recently, we have taught modules on public health policy and public health system management
at the National Institute of Epidemiology, Chennai and interacted with public health faculty,
students and colleagues in the PHM from all over the world at conferences, the International
People’s Health University (IPHU) and at the annual Global Forum for Health Research (GFHR).
From this more global and ‘praxis’ perspective, we wish to highlight issues that may be relevant
for discussion.
1)
2)
3)
Public health with a community health perspective (the new public health) is not only an
attitude of mind and a perspective - but also a discipline. While an undergraduate, clinician,
general practitioner or allied health professional can develop attitudes and perspectives, the
discipline needs periods of discipleship to develop skills and competencies based on public
health principles and methods. Public health practice requires academic rigour, the capacity
to analyze a public health problem not only bio-medically and techno-managerially, but also
to consider the social, economic, political, cultural, and environmental roots of the problem,
and thereby evolve responses and systems that address this complexity with the involvement
of the public or the community.
Knowledge of the discipline can be built to some extent through didactics and classroom
teaching, utilizing new pedagogical approaches like problem solving methods, case studies
and simulations, audio-visual aids and computer assisted learning. However what is more
urgent as a prerequisite is ‘hands on’ learning by involvement in programmes/systems at field
level. This involvement should include:
•
meeting, observing, interacting and working with the community supported by ‘mentors’
involved in ‘public health system building’ or ‘public health movement building’.
•
Learning from practitioners of public health, at different levels of the system, tackling
public health problems in 'real life’ situations;
•
listening to their sharing in a spirit of learning and identifying the strengths, weaknesses,
opportunities and threats of their action at community level, system level, or policy level.
Teaching programmes that only include theoretical analysis both quantitative and
qualitative without a live contact with the system as found in many mainstream and
alternative public health educational programmes in the country continue to be less
inspiring and effective.
The Community Health Fellowship Scheme of CHC - which recently concluded its first
four year phase and was externally evaluated and reported in July 2006 was based on
these principles. We are confident that this method is capable of creating in young public
health / community health students, a passion for this discipline. Further work is
progressing to develop modules and frameworks of learning that can build further skills
and capacities. CHC now has nearly 40 young people who can share about this initiative
from their own diverse learning experiences.
The academic environment in which public health and community health skills and capacities
are best developed are also environments which foster a spirit of self learning and a capacity
for analysis by the student. To sharpen this skill, it is also necessary to expose students to
different streams of thought, different types of public health action, and new paradigms and
new approaches. This is important even if the trainers have a certain definitive point of view
or preference for a certain paradigm.
We have surprisingly discovered this more in academic environments and public health
schools abroad - rather than in teaching /training centers in India (both mainstream and
alternative). The culture of hierarchy together with dependency, part of our wider social
traditions, prevails greatly affecting the learning process.
We need to actively
encourage a culture of interactive, participatory discussion; of student feedback
completing the full loop of educational planning; learning that challenges gender bias,
caste and class hierarchies even within our institutional ethos; and a culture that allows
the teacher and taught to discover and analyze perspectives together. All these need
to be internalized in training programmes, teaching methodologies, assessment and
examination systems in order to produce practitioners and personal and social
transformation.
4)
Too much emphasis has been on placed on basic training and post graduate courses. There
is need for an equal emphasis on continuing education, in-service training and distance
learning since the complexity of public health challenges is changing everyday. No course
however well planned or however long can cover everything that needs to be taught and
every skill that needs to be developed. All public health educational institutions must build
working links with public health systems, and not be confined to over-utilized, over funded,
over-studied and over staffed field practice areas. The faculty can then prepare students for
real life situations and not models. This will also move faculty from theoretical analysis and /
or unrealistic models to praxis based on engagement with real life systems and situations.
Institutions will discover opportunities for offering short courses, distance learning modules
and learning by doing.
5)
We often hold on to some notions of reality based on past situation analysis and not
necessarily grounded in today’s complex and changing situations. We just share a few
examples.
(a) There is a continuing belief that public health /community health is still low priority in
student careers choice in India. While this may be true of the 70’s or 80’s, the situation
has changed dramatically. Many good students, keen and competent are now opting for
a post graduation in public health. While cynics may link this to increasing job
opportunities in international health, or to a back door entry into the US medical system
(since public health courses do not require medical registration to begin with), close
interaction with many students in recent years shows that this is not always true. Even if
25% of those who are starting this journey are serious, we still have the prospect of a
very large number of public health professionals arriving on the scene, seeking training,
research and work opportunities. Already in many schools abroad, Asians including
Indians and not only NRIs are a substantial percentage of the student population.
Similarly, there is the phenomena of NRIs increasing on the faculty of these schools.
Both these factors are also additional pull and push factors for initiatives such as the
PHFI.
1. We have been tracking interesting public health training programmes and research
projects in many parts of the world - both North and South, developed and
developing countries - trying to learn from praxis everywhere. The older and new
public health institutes and departments of public health in India need to be open to
a wide variety of ideas which include initiatives such as the National School of
Brazil; modular courses of the University of Western Cape, South Africa, which
starts with rural nurses and offer credits and courses to health team members at
different levels; distance learning initiatives in many countries; special courses in
socio-epidemiology, inequalities in health and health care, social determinants and
human rights in universities in the USA and other countries.
2. In many parts of the world, alternative and mainstream public health professionals
are also much more in dialogue with each other through professional associations
and meetings unlike in India. If we, in the alternative sector feel we have evolved
knowledge or alternative skills and capacities, we need to share them with the
mainstream more proactively. Our recent experiences as part of the PHM team, in
the World Public Health Congress at Rio or in the Global Forum for Health
Research meetings since 2002 show that dialogue is possible and necessary (see
report on Research Priorities for Schools of Public Health in the Global South and
<+f>
the Social Vaccine on
www.phmovement.orq)
the
CHC
and
PHM
website
(www.sochara.org;
Evolving a public health movement
We would like to conclude by making a plea for a public health movement in India initiated in
2006, to supplement the People’s Health Movement that evolved in 2000 AD. The rationale is as
follows:
Public health capacity building, including establishment of a stand alone public health
cadre is long overdue in the country, in order to strengthen public health systems and
make them responsive to complex public health challenges. The introduction of PSM in
under-graduate medical education and growth of post-graduate courses in PSM have not
produced enough numbers of public health physicians with adequate practical skills and
capacities to tackle challenges in health and the health system, currently under further
assault by neo-liberal economic policies. The issues are not of tension between
generalist vs. specialists; doctors vs. health workers; primary health care vs. public
health; clinicians vs. public health; communicable vs. non communicable diseases; bio
medical vs social community models. These are old debates and will continue, though
they mask deeper more difficult societal conditions that produce ill-health. The situation of
public health and health systems is so bleak that we need action on all fronts with a
strong- ‘new public health / community health movement’ that can support ‘demand
creation’ with a rights based perspective among the disempowered on the one hand; and
support development of public policies and systems, that are responsive and relevant to
the demands of the people on the other. In other words, a pincer strategy is required for
a public health movement and a public health system development policy initiative. It is
only when this complexity is understood in the context of today’s political economy of
health that these debates will lead to concrete action. Already many people’s health
movement activists have dual involvements - proactive watching as well as critical
engagement.
2. Today’s complexity also requires that the focus of attention is not just on PHFI and its
emerging institutions and initiatives however high profile they may be in the media - but
on all the ongoing and evolving initiatives in educational, strategies for public health and
community health in India - subjecting them to the same questions and scrutiny,
reviewing their relevance, contribution, lessons learnt through their experience, and their
potential contribution or continued irrelevance to the new challenges.
3. The questions we are asking of PHFI are also questions that we should be asking
ourselves in the context of the pre-PHFI developments in HRD in India in both the
mainstream and the alternative sector. Have any of our initiatives made a significant
difference?
4. In the current market place that prevails in policy and system development, and with the
dialectics of medial tourism vs the National Rural Health Mission, this debate needs to
move from radical spaces to critical engagement. This engagement could be through a
public health watch and a public health movement that tackles the continuing lacunae of
human resources for Health for All in the country.
5. A few years before the national and global people’s health assemblies and the adoption
of the Indian and Global People’s Charter for Health, CHC identified a 12 point agenda
for action to strengthen health human resource development in the country to counter the
disturbing and distorting trends evident in the 1990s. These included:
•
Banning medical college expansion;
•
Strengthening MCI - making it more professional and socially oriented;
•
Setting up a National Human Power Development Commission with a strong
multi-disciplinary focus to evolve need based and evidence based change;
•
Strengthening existing medical education efforts including medical education
cells and social and community orientation;
•
Examination reforms towards rational and ethical systems;
•
Promoting creative autonomy for experimentation towards primary health care,
community health and general practice;
•
Strengthening continuing education of health and allied professions involving
IGNOU approaches and expertise;
1.
•
•
•
•
Strengthening public health capacity building and development of public health
cadre;
Research in health human power development including implications of
privatization, brain-drain and new economic policies;
Regulation of privatization and commercialization of medical education and
health;
Promoting training of health worker training ; and finally,
strengthening the movement dimension of health which ip 1997, we had defined as follows:
"What is needed is a strong countervailing movement initiated by health and development
activists, consumer and people’s organizations that will bring health care and medical education
(including public health education) and their right orientation high on the political agenda of the
country"
Since 2000 AD, the People’s Health Movement in India {Jan Swasthya Abhiyan) has developed
as this emerging countervailing movement in which we all are actively involved. What is also
needed urgently is an alternative public health network that brings together all those united in
their concerns for public health capacity building - both civil society networks like JSA, MFC or
professional associations like the Indian Association of Preventive and Social Medicine (IAPSM),
Indian Public Health Association (IPHA), INCLEN and other alternative training groups. An active
engagement with initiatives such as NRHM, PHFI, SEAPHEIN as well as with social movements
are part of the challenges and opportunities ahead.
Can the mfc meeting in December 2006 or the second National Health Assembly in March
2007 be the starting point for such a network - the Public Health Movement of India to
complement and strengthen the people’s health movement? Our inaction or failure to
move beyond discussion in radical spaces to offer concrete, well defined alternatives may
be the greatest threat of all. This is the imperative before us.
References
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16
Reddy, K S (2006) Boosting Public Health Capacity in India, NMJI, Vol.19, No.3, 2006 p122-125.
Qadeer, I (2006) Whither Public Health, Letters, EPW, May 20, 2006
Sathyamala. C (2006) Public Health Foundation of India - Redifining Pubic Health, EPW, July 29,
2006, p3280-3284.
Banerji, D (2006) Personal communication to Dr. Sathyamala, mfc yahoogroup.com, August 24,
2006.
Reddy, K S & Sivaramakrishnan.K (2006) Unmet National Health Needs - Visions of Public Health
Foundation of India, EPW, September 16, 2006, p3927-3933.
Rao, M & Nayar K.R. (2006) Public Health in Private Hands? A note on the Public Health Foundation
of India, Speaking for Ourselves, NMJI, Vol.19, No.4, 2006, p221-224.
Reddy, K S (2006) Public Health needs a Boost, not Bickering, Speaking in spite of Myself, NMJI,
Vol. 19, No.4, 2006, p224-226.
Shukla, Abhay (2006) Public Health Foundation of India - Will the Public be placed at the Center?
Indian Journal of Community Medicine, Vol 31, No.2, April-June 2006.
Prakash, P (2006) Manushi article.
Narayan, R (2001), Perspectives in Medical Education, Health Policy series, Independent Health
Commission in India, VHAI, New Delhi.
WHO- SEARO (2002) Accreditation Guidelines for Educational /Training Institutions and Programmes
in Public Health, Report of Regional Consultation, Chennai, Jan-Feb 2002, WHO-SEARO, New Delhi.
(SEA-HMD 213)
Dutta, G.P. and Narayan, R (2004), Perspective in Health Human Power Development in India Medical, Nursing and Paramedical Education, The Independent Commission on Development on
Health in India, VHAI, New Delhi.
Narayan, R (2004), Public Health Capacity Building - Initiatives by the Alternative Sector, National
Consultation on Schools of Public Health, New Delhi, September 2004 (Power Point presentation).
Narayan, T (2005), Capacity building for public health in the Asia pacific region - A policy reflection for
Economic and Social Commission for Asia and the Pacific, (UNESCAP), Bangkok.
Narayan, R & George, S (2006), PHFI Inaugural Workshops - summary of key suggestions, July
2006, A compilation.
Task Force on Medical Education for the National Rural Health Mission (2006), A report from Ministry
of Health and Family Welfare, GOI.
CHLP NW 04102016
Background Paper- 8
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Learning Programmes for Community Health & Public Health
Way Forward-the Fellowship Initiative in Madhya Pradesh
Presently, academic courses in public health/community health are Ibeing
'
offered by medical
colleges, universities, public health institutes as short courses, distance programmes and as full time
two-year programmes. In most of these programmes, community based teaching is limited and
there is also very little interaction with civil society initiatives in public health education.
The role of civil society initiatives in public health has been increasingly recognised by the
Government, the WHO-SEARO and this resonates with the global recognition of pubic health
reform with inputs from various players. (Refer Annexure 2)
The CHES and the CHIP are attempts of civil society in strengthening capacity of individuals to be
oriented to public health and community health and work on broad areas of community health.
One of the recent spaces for such strengthening of community health has been facilitated by the
Dr.Thelma Shares about Madhya Pradesh Initiative
NRHM- a nationally important initiative to
strengthen the public health system. Over these
years of implementation of the NRHM, the need
for strengthening the communitisation
components of the NRHM, especially the
Accredited Social Health Activist (ASHA) has been
recognised. The National Health System Resource
Centre (NHSRC) established by the Government
of India to build resources in public health has
embarked on building a cadre of community
health fellows who will support the ASHA and
other community level processes under the NRHM
in selected states.
It is in this context that the Fellowship programme in M.P. has been proposed with the main
objective of training young professionals in community capacity building for health; in engaging
with and in strengthening the public health system from below and in functioning as an interphase
between the community and the health system
There have been other models like the SHRC, Chattisgarh that works with the State. In the NRHMCommunity monitoring project, civil society organisations have been working with the NRHM at
the district and sub-district level. Similarly, the Fellows in the Madhya Pradesh Initiative would be
working at the sub-district or district level supporting the ASHA to raise issues and solve conflicts.
They will ajso engage with the health system and develop networks with NGOs/CBOs and peoples
movements in the districts.
There are many questions on the Madhya Pradesh Initiative (see box in next page) that need to be
addressed with greater clarity , in the background of the conflicting roles of the Government, the
7
T.earning Programmes for Community Health & Public Health
increasing role of civil society working with the Government for strengthening public health
systems and thedire need of resources in public health and community health.
•
How should this initiative be positioned?
•
How should it be structured in terms of classroom time, field work etc?-
•
What should the vision and mission of such an initiative be? What should be its goals and
objectives?
•
What should the course contents be and how should assessments be done?
•
What innovative learning approaches can be used?
•
How do we strengthen the community health resource network and support field mentors?
The above questions were discussed by the participants of the National Workshop on Learning
Programs for Community Health and Public Health on April 9th and IO1", 2008 in Bangalore. The
overall vision, mission, goal and objectives of the proposed Fellowship have been summarised in the
following sections.
The VISION of the alternative Community Health Fellowship Programme in Madhya Pradesh would
be to develop a critical mass of vibrant, optimistic community health professionals in the High Focus
states,
•
who will be people centric,
•
who are well grounded in the public health reality of India through critical analysis and
experiential learning process, and
•
who will impact the health system by engaging with the health system, and
•
strengthening the communitisation processes.
The MISSION for the Madhya Pradesh initiative would be to create a system for training such
leaders in Community Health through establishing -
1.
An Academic Framework - to develop the selection criteria, curriculum, educational and
training design, evaluation process, certification and accreditation ;
2.
Mentoring - to create a group of mentors through identification and capacity building of
field mentors and to develop the framework of collaboration of field mentors,
3.
Organisational Framework and processes — to set in place an advisory group, field
office, and processes of partnership with the health system.
8
Learning Programmes for Community Health & Public Health
This vision and mission should help attain the GOAL of preparing community health leaders who
will work towards 'better health for the people and by the people'.
The Objectives of the proposed Fellowship programme would include 1. To be committed to community based initiatives.
2. To gain skills to analyse the social and cultural context and develop strategies to reduce
inequalities in health, and
3. To create leaders/advocates in community health
In order to worj< towards establishing such an Initiative with such clarity, specific activities that need
be focused during the Preparatory Phase emerged. These include:
Sensitizing the health system to this initiative.
Preparing mentors - mapping of potential mentors and organizations
Developing mechanisms for mentoring with the organizations.
Identifying and engaging with potential resource persons in the health system and civil
society.
Profiling a District with its health care services and a detailed first person account of
working of the health system, the various functioning units of the NRHM, the public
private partnerships and the community interphase with the private health system.
Positioning of the Programmeand the Fellow
i i-5
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Participants of the workshop discussing the Fellowship in MP
The qualifications requisite for the potential
fellow to join this programme would have
to be based on an understanding on howto
locate the programme within the existing
academic public health programmes. As
this course would be pitched differently in
terms of its learning methodologies as
compared to a MPH course, a lot of thinking
has to be given whether the Fellowship
should be a MPH programme. As most MPH
programmes have different set of objectives
and outcomes, this Community Health
Fellowship should not be clouded within
the mainstream.
9
Learning Programmes for Community Health & Public Health
The Fellowship is unique as its mission is to develop a cadre of young professionals sensitive to
community health issues and to community health action and therefore would require suitably
motivated candidates. As there is potential for this Fellowship programme to lead into an
alternative MPH programme in the future, it is imperative to select post graduates or graduates with
two years work experience if in the long run, there is a plan to make this Fellowship equivalent to a
two year MPH in Community Health. This MPH programme would stand apart for the objectives,
learning methodologies and the outcomes.
One of the important challenges to plan this field-based programme is the structuring of the field
component, the contact sessions, the continuing education in the field, and suitably matching it
with mentoring.
Aspects of accreditation, course curriculum and affiliation with academic councils are necessary for
a MPH course. The first three years of the Fellowship would be an experimental phase for
establishing the above mentioned aspects of the Fellowship. An MPH course requires solid
grounding in Community Health concepts and not merely developing perspectives. This time would
also help CHC-CPHE to create the institutional backing in Madhya Pradesh as much desired for any
teaching programme. In due course, accreditation for the MPH by a University in Madhya Pradesh
could be explored.
Another challenge perceived is the resistance from within the health system by medical
professionals who are generally averse to non-medical people talking about public health. There is
a need to look at various aspects of how the Fellows would interact with the health system. The
Fellows have to be located within civil society and interacting with and having leverage with the
health system. For this to happen, the processes of interaction and responsiveness of the health
system would have to be worked out. One of the ideas being explored is whether the National
Health Systems Resource Centre (NHSRC) could draw up a letter of understanding with respective
state governments to acknowledge the role of the Community Health Fellows.
There was a wide discussion on the medium of instruction. Being a postgraduate course, English
should be a medium of instruction. There is a lot of teaching material (books, manuals, articles) both
from the mainstream and voluntary sector in English. At a practical level many aspects of the
sharing and learning would be in Hindi. A dual language Hindi - English learning could be tried as
CHC has already been using multi-lingual approaches to teaching. It is important to acknowledge
the difficulties faced by students trained in vernacular language to switch to English. This would
require intense inputs, by resource persons who help the participants with their English.
10
Learning Programmes for Community Health & Public Health
Perspectives, Principlesand key components
The "perspectives" that should guide the Community Health Fellowship Programme include the
following:
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
r 4^?
and equity
A
Group discussion on the perspectives and
principles of the Fellowship
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, genderand 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
11
5 Lt
Learning Programmes for Community Health & Public Health
KEY COMPONENTS IN HEALTH
Health Systems - history and evolution of the health system in M.P and 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 of
dominance by one or the other approach and consequences for communities need to be discussed.
Perspective building should not be only ideologically 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 growthrough a process of praxis and reflection.
Contents
The contents of this Fellowship Programme is very comprehensive and organized into the following
categories/topics.
Health and Society
II
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;
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 specifically in MP;
culture and health - further details
12
Learning Programmes for Community Health & Public Health
III
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;
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, peoples sector); role contribution of different components;
Pharmaceutical policy and all health related policies
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
9- 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;
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
13
CHLP NW 04102016
Background Paper - 9
Extending the Frontiers: Integrating Public
Health Consciousness into other Academic
Programmes*
Ravi Narayan **
Outline:
1. Introduction : Public Health Consciousness - beyond
definitions
2. Distortions of Public Health Consciousness in recent decades
3. Emerging paradigms and challenges
4. Expanding Frontiers in
D Academic programmes : School Level
Academic programmes : Medical
ii)
iii)
Academic programmes : Social Sciences
iv)
Academic programmes : other disciplines ( non
medical)
5. Some reflections on perspective, content and alternative
pedagogy
*This paper is published in conference report “Report of the International
Conference on New Directions for Public Health Education in Low & Middle
Income Countries” held in 12-14 August 2008, Hyderabad, India - Processes,
proceedings and Proposed Next Steps, PHFI, 2008
** Dr. Ravi Narayan, Community Health Advisor, SOCHARA, Bengalore
(www.sochara.org)
sn
1) Introduction:
Over the last few decades the challenges of Public Health have grown, simultaneously the
understanding of the framework of public health policy and action have also expanded
from, an earlier bio-medical framework with a focus on disease control and
environmental hygiene, to a more broad- based and comprehensive engagement with the
social, economic, political, cultural and ecological determinants of health and a policy
and action framework, that seeks the participation and partnership of all sectors of
society. A collection of definitions and reflections over the last few decades symbolize
the broadening of what may be considered as ‘public health’ consciousness (See
box.No.l.).
Box.No.l. Expanding consciousness of Public Health
Improvement in health is likely to come in the future as in the past from
i) Modification of the conditions which lead to disease, rather than from
interventions into the mechanisms of diseases after it has occurred.
Thomas Me Keown, 1976
Public health is one of the efforts organized by society to protect, promote and
restore people’s health. It is the combination of services, skills and beliefs that are
directed to the maintenance and improvement of the health of all people through
collective or social action.
J.M. Last, 1983 (,)
Health service development is a socio cultural process, a political process, and a
technological and managerial process with an epidemiological and sociological
perspective. Formation of a critical mass of community health physicians and other
members of the team which can take full advantage of the scope, offered by the
complex of ecological, epidemiological, cultural, social, political and economic factors
needed and require a new approach to education of community health physician and
other members of the team.
D. Banerji, 1986 (4)
Medicines has indeed delivered effective answers to some health problems and it has
found the means to lessen the symptoms of many others. But by and large we remain
with the necessity to do something about the incidence of diseases and that means a
new partnership between the health services and all those whose decisions influence
the determinants of incidence. The primary determinants of diseases are mainly
economic, and social and therefore its remedies must also be economic and social.
G. Rose 1992 (5)
Public Health has been defined as the art and science of preventing disease and
promoting health and extending life through the organized efforts of society.
“Acheson Report” - London , 1998 (8)
From the above reflections the key elements of this emerging public health consciousness
are:
• Organized efforts of society
• Collective and social action
• Focus on social, economic and other determinants beyond bio medicine
• An art and a science with believes services and skills.
•
•
•
•
Governments must take the fundamental responsibilities to ensure universal
access to quality health care, education and other social services that their people
need.
A more equitable, participatory and intersectoral approach to health and health
care is needed.
The participation of people and people’s organization is essential to the
formulation, implementing and evaluation of all health and social policies and
programmes
since inequality, poverty, exploitation, violence and injustice are at the roots of ill
health, the political and economic priorities of globalization have to be drastically
changed
Both public health policy researchers and public health policy activists have between
them in the new millennium have offered a rather complementary and new framework
of an expanded public health consciousness in society and the dynamic context in which
this has to be researched and promoted.
Much of the focus of the other papers in this conference will be on public health
education efforts at different levels of the health system; different categories of health
personnel; how these institutions and initiatives can be governed, resourced; how needs
and demands can be bridged; and how
models can be evaluated, accredited,
standardized, or quality controlled, this paper will seek to address the larger challenge
spreading a public health consciousness beyond the public health academic, research
and operational systems to the larger academic , research and policy community.
4. Expanding Frontiers.
In this section the paper will try and explore four areas of expanding frontiers by
classifying disciplines and opportunities into four broad groups. While this is some what
arbitrary, the idea is to highlight some common justification and challenges within each
group. Examples of such programmes if they already exist have been included in detailed
tables that are provided at the end of the paper. These tables focus on low and middle
income country experience but also highlight separately, experiences from high income
countries like North America and Europe and Australia. These are included as
experiences that could be reviewed and adapted to our, some what different context and
challenge in low and middle income countries. These tables are not exhaustive but only
illustrative and represent academic programmes and .initiatives that are available on the
internet and identified through web searches.
This exploration cannot claim to be very comprehensive because this is a very dynamic
area of experimentation and creative action and new initiatives and experiments are
evolving all the time. However in a ‘generic’ sort of way this exploration will help to
identify various courses and inter disciplinary initiatives that foundations like Public
Health Foundation of India, Rockefeller Foundation and the large number of institutions
representation in this consultation, can initiate and develop creatively, to sustain a
public health consciousness in the policy , academic, research and system development
community. As this happens public health will grow and develop to meet more and more
of the unmet needs and new challenges.
Go
4.1. Expanding Public Health Consciousness at School Level (Primary to Secondary
Education)
Efforts have been made in various countries including India to evolve health curriculum
for different levels of the school system and these curriculum have evolved progressively
to include health and well being, understanding of human body and function, population
and environmental concerns, hygiene, healthy habits and more recently, life skill
educations. (See Table 1 on health / public health in school curricula)
Most of these experiments have focused on individual health rather than the need for
societal and collective action. New initiatives could add the ‘public health consciousness’
dimension or include new sections or modules in the existing programmes.
It is important also to consider that these new or additional public health modules at
school level should have interesting interactive, participatory and action oriented
approaches that would enhance the interest of the students and make the learning
experience very relevant. As part of evolving guidelines for vector control modules as
part of interactive environmental health education one of our colleagues evolved a
interesting module for teaching school children the basics of vector identification and
control and tested it out successfully in rural and urban schools some years ago. Such
modules should become parts of teachers training courses at certificate, diploma and
bachelors level, so that all teachers are encouraged to improve the concepts of healthy
living, well being and healthy life skills as a core part of education at all levels. These
principles and concepts should be considered such an important aspect of child education
that all teachers training courses should have a module - the time for which can vary
according to the nature and duration of the course and the contents of the module can
also be modified or graded into primary, middle and school levels.
Not only will this produce healthy children of the future but also ‘healthy citizens’ who
will understand the importance of public health laws, pubic health regulations and public
health systems that strengthen the societal and collective dimensions of action.
4.2 Expanding Frontiers: Building Public Health consciousness in the medical and
health fraternity (non public health)
In 1946, the Shore committee report (9) - a pre independence health policy document
showed phenomenal foresight by suggesting that since ‘public health orientation’ was so
important for the training of ‘social physicians’ in the newly emerging country like
India, all undergraduates should be taught public health compulsorily. It was then decided
that everything that was being taught at Diploma in Public Health levels in India at that
time for doctors and nurses at the All Indian Institute of Hygiene and Public Health,
should be introduced into the undergraduate medical course.
The introduction of public health in the undergraduate MBBS, under the new title of
Preventive and Social Medicine and the additional period of three months of rural
internship after graduation were geared to this overall objective of raising the public
health consciousness of young doctors in India (9J0) . Not surprisingly this is probably one
of the explanatory factors why such a large number of Indian doctors have been opting
for public health careers, both in India and abroad. Anecdotally we can affirm that
positive internship experience, especially with National health programmes and health
campaigns have a major reorientation effect.
61
A similar trend has been seen in undergraduate nurses training in India with increasing
time allotment at both theory and practical levels including field training beyond the
teaching hospital. This area of community health nursing includes public health
orientation as well as primary health care and domiciliary midwifery.
It is now being increasingly recommended that all health professionals and health team
members irrespective of their specialty must have a ‘public health consciousness’ and a
deeper understanding of the community and social determinants of health. Even if the
focus of their skills and capacities are geared to clinical challenges at secondary and
tertiary level of care this additional orientation is seen as an essential component of
training. In policy document while public health is often not used, other terminologies
like primary health care orientation, community orientation, people’s orientation, social
orientation usually signify this thrust. .
Banerji(4) talks of‘Community orientation of education and training of every category of
health workers, right from the senior most member holding the most prestigious
professional qualification down to the junior most level of auxiliary health worker’ . He
also emphasizes that ‘Health Managers’ need a wide range of capabilities epidemiological, managerial and social’.
Considering that in the current HRD policies at both national and state levels a country
like India allows clinicians and generalists to reach senior public health - administrative
positions without post graduates degrees in public health makes this effort of increasing
public health consciousness at undergraduate level very important. Even though policy
researchers have suggested that public health degrees become mandatory for certain
positions in the public health system, in the short term this effort at strengthening public
health consciousness among doctors and nurses is a temporary corrective.
The National Education Policy for Health Sciences (draft 1986) had recommended that
there is ‘need for a major transformation of education so as to make it more humanistic,
nationally relevant and socially committed’. The growth of general public health
consciousness was also emphasized by suggesting ‘a more holistic approach covering
promotive, preventive, curative and rehabilitative aspects of medicine’ and ‘a proper
balance between hospital based and primary care/ community based education’ for all
undergraduate and post graduates in the country..
Earlier the ICSSR/ ICMR Health for All Report (H) had also emphasized that all those
possessing a post graduate degree in a clinical discipline should be allowed a PG diploma
in Public Health to prepare them for higher ranks and administrative posts in the public
health system.
Taking these recommendation forward one could also suggest that the term health
professionals need not mean only doctors and nurses but also dentist , pharmacists,
nutritionists, biomedical engineers, and those in the laboratory sciences including
pathology, microbiology, virology, and other allied health professionals. These trends
are already seen in many of these disciplines but much more needs to be done. Table two
lists out some examples of such public health modules/courses in postgraduate medical
education, microbiology, dentistry, pharmacy and biomedical engineering., some courses
in health informatics and medical genetics were also found to feature public health
modules. While most of the courses included in the table are in United Kingdom and
North America, a much more thorough search of internet sources and grey literature
needs to be done for India and other low and middle income countries. It will probably
show that this trend is beginning in this region as well. Much more needs to be done in a
more concentrated way, learning from all the on going experiences from all over the
world, adapting the contents, and methodology to the local situation and perhaps different
public health challenges.
4.3 Expanding frontiers in Academic programmes : Social Sciences
Banerji (12) in a comprehensive review of ‘Social Science and Health Service
Development in India’ has emphasized the need to strengthen the development of social
scientists of all related disciplines to work in the health field.. Social scientists,
anthropologists, economists, political scientists and social workers - all need to be trained
to ‘work as equal’ members of an interdisciplinary team and encourage to make ‘social
science contribution to health and health service development, to education and training
of health workers, and to implementation and evaluation of health services’ He has also
suggested social scientists to be trained with competence ‘to study a hospital as a
complex social system’ so that they could be trained for hospital and public health
administration.
The Centre for Social Medicine and Community Health at the Jawaharlal Nehru
Univeristy have pioneer an interdisciplinary approach to public health with a strong
dialogue with the social sciences. Some social work schools have also added a public
health/ community health module to strengthen this interdisciplinary public health
consciousness, in the country though much more needs to be done. Table three outlines
different courses in social sciences, social work, development studies, and
communications/ media studies linked to social science departments and joining upon
social science expertise.
Two new developments in the last few years offers a greater stimulus and potential for
interdisciplinary approaches in public health especially linked to the social sciences.
i) . The increasing recognition of social, economic, political, and cultural determinants
of health and public health challenges and the same multidimensional framework for
system building. The recent work of the WHO commission on social determinants of
health will be reporting soon after a multicontinent, multisectoral dialogue process.
ii) While the Alma Ata declaration on Primary Health Care in 1978 had included
community participation as one of the basic tenets of primary health care this had
been increasingly neglected in primary health care and public health policy circles
or paid lipservice only. In recent years the recognition of the partnership in public
health with communities and societies is being reemphasized
These two developments will lead to a renewal and an increase need for a public health
dialogue with the social sciences. We hope that it will also lead to the inclusion of
health / public health modules and perspectives in all the academic disciplines related
to the social sciences including anthropology, sociology, economics, political sciences,
social work and also community development, community and consumer education,
communication, media and the other humanities.
This dialogue should lead to a two way process i) Modular inputs from the social
sciences in to all current and new pubic health courses ii) All academic programme in
social sciences to include a short module in public health / community health. .
G3
agreements like IPR, TRIPS, & GATTS which have consequences for the health system
have been recent developments bringing the relationship between public health and law
into focus. Courses that explore the public health dimensions of law and all these new
agreements is important so that , every law graduate gets a basic public health
consciousness which can be further supported by elective modules that explore this
dimensions further.
Architecture
r..
Similarly Architecture and institutional design can be both eco friendly and health
friendly but can also contribute to ill health by enhancing vector development, poor
water management, and inadequate or inappropriate ventilation, heating and cooling
systems. This is becoming crucial in urban development. Considering that the estimates
are that 40% of our population in LMIC are likely to become urban migrants, this gioup
of professions need to be urgently oriented to healthy principles of design for human
habitation and other construction
Agriculture
.
Agricultural development and policy have phenomenal positive and negative health
implications. While the positive have often been highlighted because of the ‘hype’ about
the green revolution (agriculture), white revolution ( milk production) and blue revolution
(fisheries development), the public health impacts and the contribution to the increase in
some diseases especially the re-emergence of arborviruses and zoonoss and the continued
ill health effects of excess pesticide use have not been highlighted ir)sphe of lot of
evidence through high quality academic and research work on the theme
. Efforts to
evolve alternatives of eco- sensitive development, integrated, vector control and organic
farming - have also not received the sort of attention they required because the public
health links of agriculture and related disciplines have been neglected. While greatei
interest is emerging in recent years there is urgent need for a module on public health
implications of agricultural development and the skills of health impact assessment to be
introduced in the training of all divisions of agricultural sciences.
Management:
...
Management studies is another area where public health orientation has to be increased.
Whereas many management schools have begun to explore specialized management
courses in hospital and health management, there is need to advance public health
consciousness by introducing shorter public health oriented modules in all management
training recognizing that health, health care and public health responsibilities are
becoming important components of all managers especially as an important factor and
investment in human resource development and personnel management. In addition there
is growing recognition of the challenges of work place safety and hazards and the
environmental impacts of industrial and other forms of development. So a public health
consciousness for all management graduates should be explored even as more specialist
courses for public health managers evolve.
Existing and evolving courses
Tables 7A and 7B - show some of the disciplines in India and some other countries
where such synergies between academic training in certain disciplines and health /public
health have already been explored. Much more can be done in a more systematic way by
promoting more effective academic linkages between these disciplines and the emerging
schools of public health and public health resource centers in India.
The involvement of professional associations of these disciplines should be encouraged.
Also the special universities for various disciplines like NLSUI and others can also be
encouraged to support such interdisciplinary modules with a stronger, core pubic health
content and orientation. In the table (see 7A) these sorts of linkages with national
institutions, professional societies and associations, and universities are already becoming
a welcome trend. Much more can be done
The situation in the higher income countries (see 7 B) is also diverse but there seems to be
more of university involvement and linkages with National institutes. This is a sign that
multidisciplinary perspective formation in public health has received greater acceptance
by the academic and policy community.
5. Some Reflections on perspective, content and alternative pedagogy:
In the previous chapters various academic disciplines and sectors in which a public
health consciousness’ could be integrated by the introduction of short modules , longer
courses or even a separate interdisciplinary course with a strong public health orientation
have been explored and many examples, given in the accompanying tables.
In this section some general principles will be discussed which could be applied to all
such courses in academic disciplines and also in public health modules and courses in
general.. These new principles are discussed in three groups, i) Alternative Pedagogy ii)
New Paradigms and iii) New partnerships.
5.1 Alternative Pedagogy:
Public Health captures the imagination of students, academic and researchers of all
disciplines, when the training is field oriented and community based. It is in the real life
situation, that the relevance of an epidemiological or statistical approach to a problem or
a social science perspective in problem analysis becomes more evident. This focus on
praxis rather than just theory is one of the greatest challenges in public health capacity
building. It can take many forms:
• Sitting with members of a community to understand a public health problem;
• Grappling with the disparities of access due to ethnic class or gender barriers in
society; assessing the realities of a functioning or non functioning public health
system or primary health care facility;
• Participation in public health campaigns and programmes;
• Actual practical involvement in a community based primary health care facility
in a remote geographical area;
• Participating as a short term volunteer to work in a disaster affected community
or environmental hazard impacted community
can be very inspiring and insightful learning experience apart from being an effective
method for skill development.
While such interactive / participatory learning experience must find central place in more
public health training in the future this unfortunately is not happening. Most of the
courses are less practice oriented and more theoretical and cut off from community
realities. In an earlier report by our centre we had listed out the methods used by 13
programmes in India which had evolved with a strong community health content in the
civil society sector in India (16’17). The use of these methods had been a major reason for
their success in orienting so many doctors, nurses and professionals and volunteers from
diverse sector and backgrounds and making them more effective then those trained by the
public health main stream institutions. These methods listed out in out study include:
•
•
•
•
•
•
•
•
Experimentation with an alternative philosophy of education which is more
participatory, experimental, learner centered and action oriented.
Introduction ofa larger number of ‘small group ’ techniques and methodologies in the
learning process.
Strong community orientation in the methods since most of the training in comm unity
based and non -hospital oriented.
Strong social analysis, which explores broader factors in society that affected health
and exploration of community/societal responses and initiatives to problem
solution
Focus on all skill development especially those important for community base work
viz, planning, organization, communication, health education, training of health
workers, community diagnosis, needs assessment, participatory management,
evaluation etc. There is greater emphasis on learning by doing.
Greater learner centeredness with participants of training programmes involved in
planning and giving shape to learning experiences through feed back
Exploration of training beyond ‘cognitive aspects’ to include training in ‘affective
aspects’ of work/skills eg., value orientation, motivation, selfanalysis, group dynamic
skills, team work etc.
Evolution of numerous case studies, simulation games and role play and other
interesting problem solving and situation analysis learning methods that help
participants get a deeper and more relevant understanding of the realities in which
they have to operate in their future work.
The experience of our centre in the evolution of a Community Health Fellowship
Scheme and learning programme as a sort of foundational course for young people from
different disciplines using all these methods has reinforced our confidence that these
methods make the participants more self assured and confident as well as continuous and
autonomous learners (18). This is particularly important in public health which needs
multidimensional skills and capacities. Our programme evolved round a framework of
interactive - participatory group learning and field placements with inspired mentorship
( www.sochara.org) Nearly 40 young people from as diverse background as, medicine,
nursing, ayurveda, dentistry, social work, social sciences, management, engineering and
information technology, and even theology, have participated in this course and have
developed a radical public health consciousness. Where ever they are and what ever they
do this consciousness will orient their actions We are presently collation the lessons from
this experiment which has relevance to both the pedagogy and content for public health
and other academic disciplines.
5.2 Content/ Perspective: Need for a paradigm shift
Public health theory and practice has tended to be more focused on technological and
managerial dimensions, especially with the growth of selective national and international
health programmes and the increasing presence of international public private
partnerships, that have focused on single health problems. They often overemphasized
the commodity distribution aspects of public health rather than the social processes and
health promotion aspects.. In many national and international public health problems the
focus has shifted away from developing more comprehensive and decentralized public
health system and approaches involving community based health team, decentralized
governance and community organizations including and self help group and community
based health workers which are much better and long term system development options.
Even if these are included, the focus on single diseases and limited approaches means
that distortions are not common. Today malaria programmes are too focused on drugs
and bednets distributions;. HIV-AIDS programmes on ARV’s and condom distribution;
and TB on directly observed treatment services rather than more comprehensive
approaches that mobilize community partnerships and decentralized public health system
development and promote larger diversity of options. This perspective must change. The
new paradigm shift is being recognized at several national and international conference.
In recent years the Ottawa declaration; The People’s Charter for Health of the global
People’s Health Movement and the recent evolving documents of the WHO commission
on social determinants of health have emphasized this emerging paradigm.. Table No.l
identifies some elements of this paradigm shift from papers that were presented at the
Global Forum For Health Research in 2005 and 2007 (l9,20). Public Health courses need
to reflect this paradigm shift more and more in the years to come.
Table.No.l. The new paradigm in Public Health (19)
THE NEED FOR A PARADIGM SHIFT
Approach
Biomedical deterministic
Model
Participatory social/
community Model
Focus
Individual
Community
Dimensions
Physical / pathological
Psycho- social, cultural,
economic, political,
ecological
Technology
Drugs / vaccines
Education and social
processes
Type of
service
Providing/ Dependence
creating / Social marketing
Link with
people
Patient as passive beneficiary
Community as active
Participant
Research
Molecular biology
Socio - epidemiology
Pharmaco - therapeutics
Social determinants
Clinical Epidemiology
Enabling / Empowering
Autonomy Building
Health Systems
Social Policy
Source : Global forum for health research - Forum reports 2005/2007
5.3 The role of community partnerships.
Finally bringing the ‘people or public’ into the core of public health consciousness not
just as ‘beneficiaries’ or as ‘consumers’ should become the central and core element of
the planning, management and evaluation dimension of the public health systems and
programmes. This renewal of the significance and critical importance of community
partnership has been emphasized by public health researchers and policy activists (“'6) .
This needs to be reflected more and more in the orientation of modules and in public
health training in general.
Taken together, these elements which include i) an alternative pedagogy ii) a paradigm
shift iii) a new community partnership can also be termed today as ‘the new public
health’ This term has been used in other parts of the world emphasizing other dimensions
but there is an increasing resonance since all of them are moving towards the broader
determinants of ill health and public health challenges and questioning the more orthodox
and reductionist approaches that have prevailed so far. Some have termed this evolving
shift as the alternative sector in public health.
We believe that rather than projecting this as a conflict between mainstream versus
alternative approaches, this new understanding which is evolving from the discovery of a
deeper synergy between public health and the social sciences and the emerging social
movements this should become an opportunity for engagement and greater dialogue. Not
surprisingly, a recent WHO- SEARO document recognizes this urgent need for dialogue
and integration and also suggests the need for a public health movement (2l’22)!
Box.No.2. Recognising the alternative sector (21)
Partnerships with Alternative Sector
“Many alternative institutions, both organized and informal, have been actively involved in
public health work as well as public health capacity building. Sometimes, they have been
termed as alternative sectors. For example, in India, the following organizations, among
others have been active in public health education and training - some since the 1980s
and others more recently:
Network of community health trainers: with inputs from many voluntary organizations,
they have conducted short courses in community health development and
management;
•
People’s Health Movement;
•
Society for Community Health Awareness, Research and Action (CHC);
•
Centre for Enquiry into Health and Alternatives (CEHAT)
The list can be enriched by examples from other countries, as well as with more examples
from India. These organizations have become active in public health development due to
dissatisfaction with existing government-owned PH institutions, usually run by conventional
Preventive and Social Medicine Departments, and also having low status for public health
and increasing inequity and social exclusion. A wave of community health NGO movements
have taken place to try alternative experiments and actions, and to build capacity from
communities and grass root workers. Unless the national apex institutions or schools of
public health recognize these alternative sectors as strong resources and involve them in
training and research, a large portion of creative energy in public health will remain
untapped”
•
Source: South-East Asia Public Health Initiative 2004-2008, WHO-SEARO
6. The way Ahead:
Integrating public health consciousness into other academic programme need to be seen
not just as the dialogue between public health approaches and other disciplines even
though this can be a very exciting and multi-dimensional challenge as has been
enumerated in the earlier sections. It needs to be seen as much larger consciousness
raising effort in society so that the Health for All goal is not just a concept to which we
can pay lip service from time to time but a reachable goal in the context of a global
commitment to equity and social justice. .
€"1
In an interesting effort that brought a wide range of disciplines including clinical
medicine, social science, epidemiology, health policy economics, nursing, education,
ethics, and history to look at the problem of Tuberculosis through an interdisciplinary
perspective, Porter and Grange (23) in 1999 emphasized that this may be good for public
health itself. They noted that ‘by bringing together different academic disciplines to
address a health issue (such as tuberculosis) we are provided with an opportunity to study
and understand different version to approaches the global issue of disease control in more
creative and effective ways
The effort at expanding frontier by public health dialogue
with other academic disciplines may be a way forward..... ’.
To conclude, the way forward in integrating the public health consciousness in to other
academic programmes would include the following key steps:
1. A systematic websearch and review of all the programmes in different academic
disciplines that have already included a health/ public health oriented module with
a focus on experiences in all countries. The tables in this paper provide a cross
section of such courses and inititiatives but a much more comprehensive search
including ‘grey literature’ sources is urgently required. Where possible scans of
curricula and reports of on going courses would help to identify issues of both
content and process that can be used to adapt them to different country situations
and public health system realities.
2. A systematic inter disciplinary dialogue with professional associations of various
professional disciplines and of national institutions and research centres on the
implications and contributions of these disciplines to public health challenges and
public health responses should be initiated so that public health can become truly
interdisciplinary and intersectoral .This dialogue should be oriented to policy and
practice and hence would lead to the evolution of initiatives to introduce short
modules and longer courses so that such dialogue can lead to practical
contributions from each discipline.
3. While the extension of public health consciousness in to other academic
disciplines will contribute to a growing public health awareness in the academic,
research, and policy community it would also encourage larger numbers of
professionals from other disciplines to seriously explore higher education and
career and work options in public health system development leading to an inter
disciplinary mix of public health professionals that is important national and
global imperative.
4. All these efforts must ultimately lead not just to the development of public health
as a satisfying and popular career option, but more importantly it should
contribute to the development of public health systems that can strengthen
national and global efforts to reach Health For All through a commitment to
equity and social justice.
In the ultimate analysis all the recent interest, revival and rejuvenation of
public health will have global significance only in as much as it contributes to the
development of public health effort as global good and a human right.
no
Promoting an inter disciplinary ethos and commitment will be a significant
contribution to this effort.
^Public health education needs to embrace other disciplines , eg such as social
sciences and management, and the public health work force needs to be diversified
to include other professionals in addition to medical graduates
Today's public health worker needs leadership ability , strategic thinking and
planning capacity, flexible management skills, and enhanced communication ability
to coupe with the demands of new public health
Through the active engagement of scientist advocacy experts, policy makers, media
and individuals, a mass movementfor public health would be initiated".
Source: South East Public Health Initiative. 2004-2008 ( )
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Community Orientation in Medical Education- Building on the Indian
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Ref Type: Unpublished Work
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Request to the readers
Kindly review the tables in
the Annexure No.l. that
follow this paper and keep
me informed of any courses
in your country and/or
institution which fall into
any of the categories
mentioned in the tables.
Even though the tables are
only representative and
comprehensive,
such
additional
information
would be helpful. Please
note the heading under
which the courses have been
described and send similar
informationto
chcravi@gmail.com .
ANNEXURE: Tables of courses
Table No.l. Public Health Courses as an integral part of non-public health courses in Low & Middle Income Countries-
SCIENCE STREAM
________________________ _
Discipline of
Education
University
Countr
Course Name
y
Engineering
All India Institute of
Hygiene & Public
Health___________
Sarawak health
department
Law
Indian Law Society
(ILS) & WHO
School of Planning
and Architecture
Architecture
India
Master of Engg in Public Health
(18-mths)
Malyasia
Public Health Engineering
Program
India
International Diploma in Mental
Health Law and Human Rights
Postgraduate diploma and
masters courses in medical
architecture, health engineering
and management
India
Module
Link to the website
Rural Environmental Sanitation Program,
Drinking Water Quality Surveillance,
Protection Of Environmental Health,
Radiation Safety and Minor Civil Engineering
Works.
http://jknsarawak.moh.gov.my/rn
odules/xt_conteudo/index.php?id
=38
Healthcare facility, planning and architecture,
healthcare engineering and architecture
http://www.mentalhealthlaw.in/c
ourse.html______
http ://ww w. expresshealthcaremg
mt.com/200701 /market 10.shtm 1
Table No.2. Public Health Courses as an integral part of non-public health courses in Low & Middle Income Countries,
Discipline of
Education
Social
Sciences
Social Work
Development
Studies
Education
___________ _________ ___________ SOCIAL SCIENCE STREAM
University
Country
Bharatidasan
University
Amity University
India
Tata Institute of
Social Sciences
IIT Madras (with
Swiss Federal Institute
of Technology,
Lausanne)
The University of
Hong Kong
Course Name
Module
Link to the website
Public Health
http://www.bdu.ac.in/depa/arts/
ws/wsact.htm
India
Masters Program in Women
Studies
MSW
Health, Public Health
http://www.amity .edu/ngom/M
SWSyllabus.pdf
India
BSW
Public Health
http://www.tiss.edu/ba.htm
India
Technology and Sustainable
Development - Innovative and
integrated approaches in emerging
countries
Society, Technology and Global Health
http://www.epfl.ch/tsd/
Hong
Bachelor in Education
Health-related aspects of primary physical
education
http://www.hku.hk/student/al 1/u
regcourse/html 1997/bedpe.htm
Kong
Table No.3. Public Health Courses as an integral part of non-public health courses in High Income Countries:
SCIENCE STREAM
Discipline of
Education
University
Country
Course Name
Module
Link to the website
Agriculture
UAB South Central
Center for Public
Health Preparedness
USA
Agricultural Incident Response
and Investigation Training
Public Health and Agriculture
http ://www.southcentralpartner
ship.org/agriculturaljoint_trai
ning
Nutri-Tech Solutions
(NTS)
Australia
Certificate in Sustainable
Agriculture
Human Health Management
Canada
Graduate Training Program in
Public Health and the
Agricultural Rural Ecosystem
(PHARE)
Healthy, safe and sustainable lifestyle in rural
communities
http://www.cihrirsc.gc.ca/e/19995 .html
USA
Short term courses for engineers
from different streams
Safety and Health Awareness for Preventive
Engineering
http://www.cdc.gov/niosh/topic
s/SHAPE/
Canada
Fellowship program to
Bridging public health, engineering and policy
research
http://www.bridge.ubc.ca/
City University
London
UK
Civil Engineering BEng/MEng
Environmental control and public health
Harvard Law School
USA
J.D. and L.L.M.
Law and Public Health
Edinburgh Law
School
UK
LLM in Innovation, Technology
and the Law
International Public Health: Law and Security
http://www.law.ed.ac.uk/pg/tau
ght/llmitandlaw.aspx
Lancaster University
Law School
UK
LLM in Bioethics and Medical
Law
Public Health
http://www.lancs.ac.uk/fass/la
w/prospective/postgrad/llmbio
med.htm
Clemson University
USA
Graduate studies in Architecture
Relationship Between, Architecture, Human
Health and Sustainable Environments
Architecture, Human Health
and Sustainable Environments
Institute of Infection
and Immunity,
University of British
Columbia
Engineering
Law
Architecture
National Institute for
Occupational Health
and Safety
University of British
Columbia
3
http://www.city.ac.uk/study/co
urses/eng ineering-maths/c ivilengi ngeering-bengmeng. htm 1
http://www.law.harvard.edu/ac
ademics/courses/200708/?id=4144
TabIe.No.4. Public Health Courses as an integral part of non-public health courses in High Income CountriesSOCIAL SCIENCES STREAM
Discipline of
Education
University
Country
Course Name
Module
Link to the website
Social Sciences
The Open University
Scotland
BA/BSc
Health and Social Care
http://www.open.ac.uk/you/what-can-istudy/degrees/social-sciences.php#5
Sarah Lawrence College
USA
MA in Health Advocacy
Public Health
http://www.sarahlawrence.edU/health-programs/#hap
Social Work
Tulane University
USA
MSW in Social Policy & Practice
Public Health
http://www.tulane.edu/~tssw/New_TSSW/Programs/spp.ht
ml
Development
Studies
University of Colorado
Denver
USA
MSc and PhD in IGERTSustainable urban infrastructure
Public Health
http://thunder 1 .cudenver.edu/IGERT/courses.html
Multidisciplina
ry
BBC (British
Broadcasting
Corporation)
UK
Short courses in Health and
Safety
Health and safety
http://www.bbctraining.com/healthAndSafety.asp
Education
Diakonhjemmet
University College
Norway
Bachelor of Social Education
Health and health care in society
http://www.diakonhjemmeths.no/ects?lang=en&omraade=
program&program=program_03
Culture, Communication
and Media Studies
South
Africa
Postgraduate course in
Communication for Social
Change
Honours level course that acquaints participants with the various
approaches to health promotion through the intervention of
entertainment education
http://ccms.ukzn.ac.za/index.php?option=com_content&ta
sk=view&id=640&Iternid=20
University of Colorado
Denver
USA
Geography courses for
undergraduate and postgraduate
students
GIS Applications in the Health Sciences
http://thunder 1 .cudenver.edu/clas/ges/courseGeog.html
Strathclyde/Glasgow
University
UK
M.Sc. in Social History
Disease and Society; Dangerous Drugs and Magic bullets; Politics
of health policy; Gender, Health and Medicine
http://www.gcal.ac.uk/historyofhealth/
College of Liberal Ans
and Sciences, Arizona
State University
USA
Study Abroad in New Zealand &
Fiji for students of Bachelor of
Arts (B.A.) in Global Health
Cross-Cultural Studies in Global Health; Community Partnerships
for Global Health; Social Science Applications in Community
Health; Urban and Environmental Health; Poverty, Social Justice,
& Global Health
http://shesc.asu.edu/node/383
University college of
London
UK
MSc in Culture and Health
Concepts and practice of transcultural psychiatry and methods and
techniques required for research into this area
http://www.ucl.ac.uk/medicine/behaviouralsocial/prospective/index.html#MScinCuItureandHealth
Communicatio
n and media
studies
Geography
Anthropology
TabIe.No.5. Public Health Courses as an integral part of professional medical and allied sciences in low and middle income countries
Discipline of
Education
University
Country
Course Name
Module
Link to
the website
Medical
Genetics
Institute of
biosciences and
technology
India
M.Sc. Medical Genetics
Public Health
http://www.mgmibt.com/mscinfo 1 .html
India
Dental Hygienist
Certificate (DHC) course
Public Health
http://www.hindu.com/edu/2004/08/24/st
ories/2004082400200400.htm
India
P.G. in Public Health
Dentistry
Public Health
http://www.gettarget.com/Search_Colleg
e/final.asp?College_id=KA250
Singapor
e
Bachelor and Masters in
dentistry
Dental Public Health
http://www.dentistry.nus.edu.sg/academi
c/online.htm
Pakistan
Biomedical engineering
Biostatistics
http://www.neduet.edu.pk/BioMedical/faqs. html
India
P.G Diploma in Nutrition
and Dietetics
Public Health
India
P.G Diploma in Nutrition
and Dietetics
Public Health
Dentistry
Biomedical
engineering
Nutrition
Government
Dental College,
Thiruvananthapura
m
Government
Dental College,
Bangalore
National
University of
Singapore
NED University of
Engineering &
Technology
Sri Ramachandra
Medical College &
Research Institute
University of
Mumbai
http://www.webindial23.com/career/Ho
me%20science/list.asp?action=P.G+Dipl
oma+in+Nutrtiton+and+Dietetics
http://www. webindia 123 .com/career/Ho
me%20science/list.asp?action=P.G+Dipl
oma+in+Nutrtiton+and+Dietetics
TabIe.No.6. Public Health Courses as an integral part of professional medical and allied sciences in high income countries
Discipline of
Education
University
Country
Course Name
Module
Microbiology
LSHTM
UK
MSc Microbiology
Public Health & microbiology
University of
Alabany, School
of Public Health
USA
Continuing education in
microbiology
Public Health Microbiology &
Communicable Disease Control
http://www.albany.edu/sph/coned/behpmi
cro.htm
University of
Birmingham
UK
Postgraduate teaching
under centre for
professional development
Postgraduate module in Public Health
Microbiology
http://medweb4.bham.ac.uk/cpd/moduled
isplay.aspx?id=PubIic%20Health%20Mic
robiology%20&S A= 1
New Castle
University
UK
Honors in microbiology
and immunology
Public health strand in microbiology
http://www.ncl.ac.uk/biomed/undergrad/
Honours%20Modules%20in%20Microbi
ology%20and%20Immunology.htm
Medical
Genetics
Institute of
biosciences and
technology
India
M.Sc. Medical Genetics
Public Health
http://www.mgmibt.com/mscinfol .htm I
Health
Informatics
University of
Columbia
USA
Applied and research
masters in Health
informatics
Public Health informatics
UK
Msc Health Sciences and
MSc Health Sciences with
special interest
Public Health (Core module) with module
on public health aspects of topic special
interest like diabetes, hypertension,
cardiovascular risk, social determinants of
childhood development, etc.
http://www2.warwick.ac.uk/study/postgra
duate/courses/depts/medschool/taught/hs/
UK
MSc courses for medical
graduates working in NHS
Public Health (Core module) with module
on public health aspects of topics of special
interest like Diabetes Practice in Primary
Care, women’s health, etc.
http://www.sovereignpublications.com/brighton-ac.htm
Postgraduate
medical
education
University of
Warwick
University of
Brighton
Link to
___________ the website___________
http://www.lshtm.ac.uk/prospectus/maste
rs/msmm.html
Dentistry
Pharmacy
Biomedical
engineering
Nutrition
University of
Nottingham
UK
Short courses for doctors
in lieu with national
priorities
Public health perspective on colorectal
cancer, coronary, heart disease and diabetes
for non-public health Specialist Registrars
http://www.nottingham.ac.uk/cpcme/edu/
courses.htm
University of
Sheffield
UK
Master in Clinical
Dentistry in Dental Public
Health
Public Health, Epidemiology, etc.
http://www.findamasters.com/search/sho
wcourse. asp?cour_id=5762
Queen Mary
University of
London
UK
MSc in Dental Public
Health
Public Health, Epidemiology, etc.
http://www.qmul.ac.Uk/courses/courses.p
hp?dept_id= 17&pgcourses=:2&course_id
=3 65&course_level= 1 &article_id=345
UK
MSc in Dental Public
Health
Public Health, Epidemiology, etc.
UK
Bachelors and Masters in
pharmacy
Public Health Aspects of Clinical
Pharmacy
Kings College,
London
UK
MSc in Primary Care and
Community Pharmacy
Public Health
University of Hull
Programme
UK
Bachelors and Masters in
pharmacy
Public health and prescribing
http://www.courses.hull.ac.Uk/modules/0
607Sl/47376.html
University of
hertfordshire
UK
Public health
www.herts.ac.uk/courses/AdvancingPharmacy-Practice.cfm
Tufts University
USA
Public Health
http://www.ece.tufts.edu/~vanvo/biomed.
html
http://www.bu. edu/eng/ugrad/engmed ic/#
Program
http://www.nottingham.ac.uk/biosciences
/courses/bsc nutrition.php
Kings College,
London
The Robert
Gordon
University
University of
Boston
The University of
Nottingham
MSc in Advancing
Pharmacy Practice
Masters in biomedical
engineering
USA
ENG MED program
Public Health
UK
BSc Nutrition
Public health nutrition
http://www.kcl.ac.Uk/gsp08/programme/3
______4________
http://www.rgu.ac.uk/prospectus/modules
/disp_moduleView.cfrn?Descriptor=PHM
_ ______________ 006_______________
http://www.kcl.ac.uk/kis/schools/life_scie
nces/health/pharmacy/coursei n fo/mph il_
pgrad/commphar.html
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Application of Epidemiological Principles
for Public Health Action
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Report of a Regional Meeting
SEARO, New Delhi,. 2.6-27 February 2009
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Contents
Page
Acronyms
v
1.
Introduction and objectives
1
2.
Opening address
3
3.
Epidemiology, its history, concepts and new paradigms
5
4.
Epidemiology in the context of current crises
.7
4.1
The global economic crisis
4.2
Climate change and its impact on health: role of epidemiology...
..8
4.3
Emerging infectious diseases and international health security
10
Importance of the laboratory in supporting epidemiology for
public health action
13
6.
Epidemiology and chronic noncommunicable diseases
15
7.
Role of epidemiology in achieving MDGs 4 and 5:
the example of Bangladesh
q7
5.
8.
Epidemiology and its application in health policy development and programme
planning
.............................
9.
Building capacity of the epidemiology workforce in the
South-East Asia Region (Panel discussion)
23
Field epidemiology training programme (FETP): lessons learnt and plans
Epidemiology training in medical schools/schools of public health
Roadmap for the future
25
28
10.
Application of epidemiology for public health action: key action points....
30
11.
Networking, intercountry collaboraton and partnerships for epidemiology
challenges and opportunities ahead (Panel discussion)
36
..........................................
39
9.1
9.2
9.3
Conclusions and recommendations
13.
Closing session
23
43
texes
1.
Agenda of the meeting
44
2.
List of participants
46
Page Hi
Application of Epidemiological Principles for Public Health Action
12.
Conclusions and recommendations*
The participants of the Regional Meeting on Application of Epidemiological
Principles for Public Health Action, held in the WHO Regional Office for
South-East Asia In New Delhi from 26 to 27 February 2009, recognized that
in view of the challenges posed by the recent economic crisis, climate
change, emergence of new infectious diseases, rising burden of NCDs, and
the continuing problems of high child and maternal mortality, there is a need
to strengthen the culture of epidemiology in the South-East Asia Region.
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 keystone for use of evidence for development of public
health policy. It must be used not only to plan, but also manage and
evaluate public health programmes. In order to address the old as well as
the new challenges to public health, epidemiological surveillance and
response capacity must be further strengthened in Member States, with a
sufficient number of trained epidemiologists, the support of public health
laboratories and use of information technology (e.g. open source software
that provides a common language).
A greater level of interaction is needed between epidemiologists and
social scientists including for development of new methodologies in a
multidisciplinary manner and to bring in the concept of socio
epidemiology. Such an approach will help In moving beyond health
problems per se to new complex social and human developmental
challenges such as the current crisis and threat to public health posed by
the global financial meltdown and climate change.
Training in epidemiology in medical and public health schools should
be skills-oriented or field-based, with teaching-learning methodologies
based on learning by doing. Imparting epidemiological skills and an
analytical approach to problem-solving is imperative at all levels of the
health services—from national to state/province to district and primary care
levels. Epidemiological capacity, however, does not lie in medical schools
and schools of public health alone but also in so-called alternate sectors
such as management and social science institutions, professional
‘ Rapporteur - Virasakdi Chongsuvivatwong, Professor of Epidemiology, Prince of Songkla University, Thailand
Page 39
so
Report of a Regional Meeting
associations and civil society, which also need to be tapped in a spirit of
partnership in order to address the various health dimensions.
Recommendations
Member States should:
>
Promote and strengthen the use of principles of epidemiology
and of quality epidemiological data for formulating national
policies/strategies and managing health programmes;
>
Invest in and establish a recognized career path for
epidemiologists and public health specialists with a
skills/competency profile at all levels of health services;
>
Build capacity of the national health staff at all levels of health
service delivery including those working in national disease
control programmes in effective application of epidemiological
principles for evidence-based public health action;
>
Develop and/or further strengthen networking among national
institutes and centres active in epidemiology, and harness their
expertise for promoting and protecting public health and for
sharing information for action;
>
Enhance teaching and ’training of epidemiology in the
undergraduate
medical/nursing/dental/laboratory/veterinary
courses, with emphasis on quality, in order to instil
epidemiological thinking in students;
>
Foster better collaboration with environmental, ecological and
social scientists to understand the influence of these factors on
diseases and to apply this knowledge for planning, programme
implementation, monitoring and evaluation; conducting special
surveys such as demographic health surveys at regular intervals
could help in generating data relevant for this purpose;
>
Collaborate and support utilization of existing epidemiologyrelated capacity available in each country, not only in medical
schools and schools of public health but also in the so-called
alternate sector such as civil society, professional associations,
and management and social science institutions. Similarly, use
Page 40
Si
o
Application of Epidemiological Principles for Public Health Action
laboratory inputs and information technology in improving
epidemiological analysis; and
>
Consider organizing annually a national epidemiology seminar to
share information on and experiences in epidemiological
research and training initiatives under way in the country.
WHO should:
>
Organize, in collaboration with interested partners' and
stakeholders, a regional conference to enhance the visibility and
relevance of epidemiology in the South-East Asia Region and
advocate with policy-makers on the critical role of evidence for
public health action, at ail levels of the health services;
>
Provide technical support to Member States in building the
capacity of national programme staff in epidemiology and
application of its principles for programme development and
management;
>
Continue to facilitate networking and partnerships among
institutes active in conducting epidemiological training or
research both in medical schools and schools of public health,
and in the so-called alternate sector, and provide a forum for
sharing of information and expertise within the Region;
>
Prepare and share with Member States standard/uniform
epidemiology training materials, and protocols developed based
on consensus;
>
Assist Member States in the formulation and implementation of
research that could determine the influence of social, cultural,
economic, environmental, ecological and political factors on
disease epidemiology and delivery of and access to health
interventions, and in better translation of such epidemiological
evidence to the policy and programme context;
>
Develop various short (1-2-week) epidemiology training courses
that are participatory, interactive and field practice-oriented for:
-
health programme managers so that epidemiological data
are used to plan, monitor and evaluate public health
programmes;
Page 41
8 2_
Report of a Regional Meeting
medical/public health school students through FETP-type
training methods to engage them in the application of
epidemiological principles to field investigations;
laboratory specialists to enhance a stronger involvement and
constant collaboration between public health laboratories
and epidemiologists;
nongovernmental organizations to encourage them to use
epidemiological principles in their programmes; and
journalists and community organizations on communicating
epidemiological information/data as an evidence base for
public health action.
Page 42
S’WitOSfftj
vs.
CHLP NW 04102016
Background Paper- 11
World Health
WW/j' Organization
Regional Office for South-East Asia
South-East Asia Regional Conference on
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New Delhi, 8-10 March 2010
In partnership with:
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World Bank
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McGill H^X’^Conv..^
Plenary 1
The enduring relevance of
epidemiology
Chairpersons:
R.K. Srivastava
Ron Waldman
Session
Coordinator:
Rajesh Bhatia
Epidemiology in action: past, present
and future - DavidHeymann
/ Revitalizing primary health care: how
V epidemiology can help - Ravi Narayan
Revitalizing primary health care: how can
epidemiology help?
Ravi Narayan
A recent guideline in a declaration (1) made by the Consultation on the Application of Epidemiological
Principles for Public Health Action, organized by the WHO Regional Office for South-East Asia in
February 2009, states that, “The scope and reach of epidemiology which is an integral part of public
health must be expanded to include the study of the social, cultural, economic, ecological and political
determinants of health and constitute the keystone for use of evidence for development of public
health policy.” This guideline summarizes the main point of this paper that explores the shift in the
paradigm of epidemiology which is required if this discipline has to support the revitalization and
renewal of primary health care that is taking place today.
In 1978, when the Alma Ata Declaration (2) was announced, the focus of epidemiology was on
vaccine-preventable diseases, tuberculosis, mother and child health, environmental sanitation and other
diseases, primarily communicable, often described as the diseases of poverty and underdevelopment.
Epidemiologists, in the early years of the primary health care (PHC) era, focused on communicable
diseases and maternal and child health problems, with a more orthodox approach of watching mortality
and morbidity trends of these problems, resulting in single-disease approaches and programmes. While
the Alma Ata Declaration also emphasized new concepts such as equity, appropriate technology,
intersectoral development, community participation and health as a right, the true significance of
these radical concepts was lost among public health practitioners, policy-makers, epidemiologists and
researchers in those days.
In the years that followed, noncommunicable diseases, including cardiovascular diseases, diabetes,
mental health, and occupational/environmental health problems emerged as newer priorities. These
newer, more complex challenges led epidemiologists to identify broader determinants like lifestyles,
behaviour, individual and collective risks and other such factors, that led to more broad-based health
promotion and risk amelioration strategies.
Today, the primary health care challenges at community level in a country like India include
agrarian distress exemplified by both growing childhood malnutrition and farmers’ suicides; economic
downturns that affect primary health care systems; and climate change, war and social conflicts and
other disasters that affect the broader context in which primary health care systems are developing
and need to be sustained. These require epidemiologists to be able to study factors such as poverty,
inequality, exploitation, violence and marginalization and make epidemiology relevant to the new
challenges. It will require a shift towards a new paradigm.
What is this new paradigm in epidemiology and what is the evidence required to study and
understand this new context? To answer this question, 1 share in this paper three short reviews that
will illustrate the challenges to epidemiology today, especially in the context of community-based
comprehensive primary health care.
South-East Asia Regional Conference on Epidemiology
The first is a gradual evolutionary journey of the Centre for Public Health and Equity, Society
for Community Health Awareness, Research and Action (SOCH ARA), Bengaluru, India, trying,
over two decade, to understand this epidemiological complexity in both situation analysis and
health programme response. This journey was a study, a reflection and action experiment at the
interface between the public health system and the community.
• The second is a brief overview of some of the emerging dialectics within epidemiological thinking at
the theoretical level as it grapples with the increasing complexity, moving from the epidemiological
understanding of disease to the epidemiology of determinants and structures in society.
• The third is a brief outline of some recently published key documents that are beginning to
reflect this paradigm shift in public health and epidemiology.
Finally, I shall illustrate through a few evolving diagrams how epidemiology can metamorphose to
be more supportive of the current policy imperative of a revitalized primary health care system.
•
The journey towards a new paradigm
We began our journey into understanding the community-based challenges and framework of primary
health care in the pre-Alma Ata years in the department of community medicine in a medical college
in south India. We worked at the community level using health cooperatives, local health workers and
partnership strategies with the government and the community to enhance the goals of primary health
care (3,4)- This led to expanding the range of primary health care activities to preventive and promotive
services, appropriate technology and development activities. We were, however, constantly faced with
the dilemma before most PHC workers, realizing early in their action-response that the biomedical
response was inadequate for a more complex social/community context of the PHC challenge. Cough
syrup as treatment for a patient with chronic cough is inadequate for the cough which may be linked
to poverty, injustice, lack of protective facilities at home and work, myths, social exclusion and other
factors that may be important determinants of the chronic condition.
We were inspired by the work of two professors whose research work symbolized a shift from a
biomedical paradigm to a socio-epidemiological paradigm.
Prof. D. Banerji of Jawaharlal Nehru University, New Delhi, worked in 17 villages in India, in
the 1980s, visiting them year after year to understand their experiences and perceptions of health
and health services. He concluded that, “Health service development is a social-cultural process, a
political process, a technology and managerial process, with an epidemiological and sociological
perspective” (5).
Similarly, Prof. Geoffrey Rose, an illustrious epidemiologist at the London School of Hygiene and
Tropical Medicine, well-known for his work on salt and hypertension, wrote a freatise after a very
successfill career in teaching and practising epidemiology that, “The primary detenninants of disease are
mainly economic and social and... medicine and politics cannot and should not be kept apart” (6).
One of our team members used the approach of these two professors to study tuberculosis as
a community health problem. In this doctoral study, over 200 patients who had been labelled as
‘defaulters’ of the TB treatment programme in rural districts of Mysore in Karnataka, were interviewed
to understand the processes leading to the default. Many social, economic, political and cultural factors
were identified which distorted the TB programme. From all the evidence gathered, a new framework
of the understanding of TB and its causation was hypothesized, which covered different levels of
analysis and each level of analysis, leading to a different level of control strategy (Table 1). The study
also made a critique of the recently introduced directly observed treatment, short-course (DOTS)
programme from a socio-epidemiological point of view, identifying its limited biomedical focus and
suggesting a community-based reorientation. From DOTS to community-oriented treatment service
(COTS) was the suggested paradigm shift (7, 8).
31
32 | South-East Asia Regional Conference on Epidemiology
Table 1: Researching levels of analysis and solutions for TB: a common health problem
Levels of analysis of
tuberculosis
Causal understanding of
tuberculosis
Solutions/Control strategies for
tuberculosis
Surface phenomenon (medical
and public health problem)
Infectious disease/germ theory
BCG, case-finding and
domiciliary chemotherapy
Immediate cause
Under-nutrition/low resistance,
poor housing, low income/ poor
purchasing capacity
Development and welfare income-generation/housing
Underlying cause (symptom of
inequitable relations)
Poverty/deprivation, unequal
access to resources
Land reforms, social movements
towards a more egalitarian society
Basic cause (international
problem)
Contraindications and inequalities
in socio-economic and political
systems at international, national
and local levels
More just international relations,
trade relations, etc.
Source: Narayan T, 1998
Many researchers of PHC constantly identify such social, economic, political and cultural
determinants in their studies but fail to interpret their significance or integrate this evidence into an
evolving solution. For example, an excellent study (9) on bednets use in a malaria programme among
adivasi (tribal) people in Mandla, Madhya Pradesh, identified that 60% of the people were outside the
bednet at peak mosquito biting time due to survival tasks linked to their economic activity. A follow
up over six months of those who used the net identified many cultural, economic and climatic reasons
for the non-use of nets. The evidence that has been gathered by the epidemiologists of the malaria
centre was an excellent social evidence, indicating poverty, survival, marginalization and cultural
determinants that affected the decision-making process of the adivasis. Unfortunately, the researchers
used this evidence in a more orthodox way, interpreting the evidence as factors to be included while
social marketing the use of nets to the affected population rather than using the evidence to link bednet
programmes to women’s health cooperatives, income generation and community empowerment
initiatives, as has been done by civil society groups in Orissa and other states.
It is a challenge for epidemiologists to move beyond superficial epidemiology that focuses in an
orthodox way on the biomedical aspects of a health problem and therefore results in techno-managerial
programme solutions, to a deeper assessment and measurement of social, economic, cultural, political and
ecological evidences that will enable them to look al deeper determinants of ill health like poverty, gender
bias, conflicts, stigma and social exclusion. They should evolve social and community interventions
to respond to this larger framework of understanding. Many health professionals who look at these
deeper social determinants and social solutions are often labelled as health activists, whereas they are
actually socio-epidemiologists who look at the determinants of an unhealthy society in a holistic manner
rather than just disease and individual ill health. Prof. Denis Burkitt (well-known for the epidemiological
description of Burkitt’s lymphoma in Africa) described this dichotomy in the 1970s by creating two
categories of public health professionals - “floor moppers” and “tap turners off’— and two categories
of public health researchers - “intracellularists” studying the molecular basis of disease and health in
their quest for new drugs and vaccines and “balloonists” studying the determinants at community and
societal levels (Fig. 1). These are the types of future epidemiologists urgently needed with special skills
and social sensitivity to support PHC challenges at community level.
^3
South-East Asia Regional Conference on Epidemiology
Fig. 1: What sort of researcher do you want to be?
What type of hedlh researcher areyw ?
Jntracellulaj'isL 2
0^
Ba kw i?
Source: Community Health Cell
In 2000 , SOCHARA was an active participant in a gathering of primary health care enthusiasts,
public health professionals, epidemiologists and health and social activists from 75 countries, who
had gathered in Bangladesh for the first People’s Health Assembly, to assess and explore why the
Health for All by the Year 2000 goal had not been achieved. The People’s Health Charter (10), which
evolved as a situation analysis and an action manifesto, presented a new epidemiological framework
for public health professionals and policy activists. It reiterated that, “Health is a social, economic and
political issue and a fundamental human right”, and that, “Inequality, poverty, exploitation, violence
and injustice were at the root of ill health”. Based on this new socio-epidemiology, it prescribed
actions that tackled the economic, political and social challenges of health; countered war, conflict,
disaster and environmental health challenges; and promoted a people-oriented health care based on the
rights paradigm. Since 2000, two alternative world health reports - Global Health Watch-I and Global
Health Watch-II - have provided the socio- epidemiological evidence to back this new framework of
health and health action (11). Professors and researchers from all over the world have contributed
their evidence and analysis to these documents and reiterated the challenges of the multidisciplinary
evidence that epidemiologists must begin to measure and analyse to support public health policy.
Presently, SOCHARA is a part of a global initiative collecting evidence on comprehensive primary
health care (12). A study is being done on six projects in India, Bangladesh, Pakistan and Iran to
look at gender challenges in primary health care, the role of health workers (the Accredited Social
Health Activist of the National Rural Health Mission in India and the behervaz in Iran), the role of
community mobilization and empowerment, and the multiple approaches to urban primary health care.
This research partnership will try to take its epidemiology into social, economic, political and cultural
determinants to widen the understanding of PHC. This is an urgent policy imperative in line with the
Bamako Declaration, which encouraged greater partnership between civil society and academia.
I33
34 | South-East Asia Regional Conference on Epidemiology
The dialectics of epidemiology
A brief overview of debates and discussions on new eras and new paradigms of epidemiology in
scientific literature since the mid-1990s, shows that the dialectic towards a deeper framework for
epidemiological analysis is also emerging in academia.
An interesting paper (13) published in 1996 identified the shift in the paradigm of epidemiology
to four phases - the sanitary era, the infectious disease era, the chronic disease era and the ecoepidemiology era - and described the paradigms for each era, the analytical approaches during each era,
and the preventive approaches that emerged as a result of this understanding and analysis (Table 2).
Table 2: Future of epidemiology eras and paradigms
p^d21m
Analytical approach
Preventive approach
Preventive
Sanitary1
Miasma
Clustering of morbidity and
mortality
Drainage and sanitation
Infectious disease1
Germ theory
Lab isolation and experimental
transmission
Vaccines and antibiotics
Chronic diseases1
Black box
Risk ratios of exposure to
outcome
Control risk factors
Eco-epidemiology1
Chinese boxes
Analysis of determinants and
outcomes at different levels
Information and bio
medical technology
22
7
Social, economic, cultural,
political and ecological
analyses
Source: 'Susser M, Susser E, 1996; 2Narayan R, 2006; Baum F et al. 2009
Socio- epidemiology2
Multilayered/
Multicentric circles
Social vaccine and
community empowerment
through CPHC
More recently, a group of socio-epidemiologists has built an understanding inspired by the Alma
Ata Declaration and the people’s health charter, evolving the concept of the ‘social vaccine’ and the
epidemiological analysis that is required to understand and evolve it (14, 15).
Another interesting paper in the mid-1990s has compared traditional epidemiology with modem
epidemiology and identified the increasing problem of the directions in which modern epidemiology
has progressed, which has the focus on the individual, organ, tissue, cell and molecule; on the clinical
trial; a positivist, epistemological approach, and a reductionist epidemiological strategy with an
increasing focus on the individual rather than the collective (16). What is interesting about this paper
is the call it makes to ‘go back to the epidemiology of John Snow’. This traditional epidemiology was
public health-oriented and population-based, historical and cultural in its context of study, linked to
the paradigms of demography and social science: realist in its epistemological approach and focused
on population-based interventions. This paper makes an earnest appeal that, “Epidemiology must
reintegrate into public health and must rediscover the population perspective”.
The challenge today is to move beyond all the focus on molecular biology, clinical and vaccine
trials, biotechnology, genomic imprinting and stem cells research, to socio-epidemiology, behavioural
science research, political economy studies and ethnography so that the research agenda is more
balanced and the translation of evidence into policy and action is more comprehensive and evidence
based (Fig. 2).
In many ways, the new socio-epidemiology described more recently has a somewhat similar
framework to what this paper describes as traditional epidemiology, except for the fact that the new
determinants are not only social, economic, political and cultural but also structural - in-society rather
than in populations and individuals.
°| 0
South-East Asia Regional Conference on Epidemiology
Fig. 2: Developing a research and advocacy agenda for primary health care
A plea for balance
Molecular biology
Clinical trials
Vaccine trials
Immunology
Biotechnology
Genomic imprinting
Stem cell research
tell
Socio-epidemiology
KAP studies
Policy studies
Behavioural sciences research
Political economy studies
Participatory research
Recognizing the new paradigm
Many recent documents at the global levell are beginning to recognize both the limitations of the
current dominant epidemiology and also exploring some of the complexity of public health systems
and policies, including the challenges of revitalizing PHC.
The World Health Report 2008 has again placed pri mary health care on the global agenda. It has very
strongly brought into public health thinking the issues of social justice, right to health, participation
and solidarity (17). This report emphasizes that public health researchers and system developers
must now focus the evidence on universal coverage, service delivery, public policy and leadership
refonns. It also talks about mobilizing organizations, imagination, intelligence and ingenuity for
supporting system development. All this requires new research evidence like the epidemiology of
social determinants and societal structures.
The Commission on Social Determinants of Health (CSDH) (18,19) also places social determinants
of health on the map of epidemiological and public health research. It reiterates that evidence should
come from multiple disciplines and multiple methodological traditions. Only with that sort of creative
cross-fertilization one can bring rich and diverse evidence base for today’s complexity. The report
mentions with great clarity that, “Evaluations of social determinants of health interventions require
rich qualitative data in order to understand the ways in which context affects the intervention and
the reasons for its success or failure”. It supports all evidence as important and not just randomized
controlled trials (RCTs) and laboratory experiments, and suggests various upstream determinants
such as socio-economic context and position, differential exposure, vulnerability, health outcomes
and consequences as important issues for study.
The Global Health Watch Report 2008, which is also called the Alternative World Health Report
from civil society, on the state of global health, says that people’s health is safest in people’s hands (11);
therefore, the objective is to empower individuals and community with knowledge and skills for
achieving good health. Civil society needs to strengthen their efforts with epidemiological evidence.
The consensus emerging more recently from a wide range of sources is that:
• there is a need to revitalize primary health care;
• the evidence base should have a much broader focus on upstream determinants;
• new models and paradigms are required, one of which should be to involve communities in
evidence-gathering and system development.
|35
36 | South-East Asia Regional Conference on Epidemiology
Building the new epidemiology - step by step
SOCHARA has begun to work step by step to change the focus of epidemiology from biomedical
determinism to a broader social analysis. This is necessary to tackle the complexity of health and
health care challenges at the primary health care level. In recent years, SOCHARA has tried to create
a diagrammatic model that constructs this complexity in concentric circles or boxes to emphasize that
this is not clinical versus public health versus social/structural analysis but is actually a complexity
that enhances problem-understanding and challenge as the analysis gets broader and more societal.
This diagrammatic model (Fig. 3) shows the primary health care model surrounded by the biomedical
determinants, then surrounded by the public health factors and challenges, and then further surrounded
by the social, political and cultural determinants.
Fig. 3:Towards a new epidemiological analysis for primary health care research
Social^Economic-Political^ulffimiSfflarrtintfSsn
Public health challenges
j
—
Biomedical determinants
1
up
.
,
■
/
\
Primary health
care
problems
■
!
;I I
_____________
___
■
___________
________
-
The diagrammatic model can be constructed by identifying through literature review all that is
known about a primary health care problem at the three levels - biomedical (clinical and pathological);
public health; and societal (social, economic, political, cultural determinants).
In diarrhoeal diseases, the public health box focuses on poverty, malnutrition, personal and
community hygiene, unsafe water supply and inadequate sanitation, inappropriate feeding and weaning
practices, and contaminated food as well as fly/vermin breeding. The broader social determinants
include inequality and marginalization, migration and displacement, inaccessible and unaffordable
PHC, unethical drug promotion, disasters - natural and man-made - and so on (20). Through this model
one can widen the lens to give the larger determinants the same sort of rigour in both quantitative and
qualitative evidence-gathering as one does to the immediate causes.
Using this new model, a recent analysis of the vector-borne diseases highlighted problems from
animal husbandry, forestry, wildlife, sports, international travel, urbanization, labour migration,
inequality, marginalization, new economic policies, unsustainable development, privatization,
etc. (21).
South-East Asia Regional Conference on Epidemiology
These models have been presented in various national and global forums to encourage
epidemiologists and researchers to move to a much more social-oriented research. This overall shift in
our understanding of primary health care problems and public health challenges is also now represented
in a diagrammatic way to encourage a shift in the emphasis in research and action from a biomedical
model to a social /community model of health research and system building (22) (Table 3).
Focus
Table 3: New public health/epidemiology:the paradigm shift
......
Jical deterministic research :<
.
Community
Individual
Dimensions
Physical/Pathological
Psychosocial, cultural, economic,
political, ecological
Technology
Dmgs/Vaccines
Education and social processes
Type of service
Providing/Dependence-creating /Social
marketing
Enabling/Empowering/
Autonomy building
Link with people
Patient as passive beneficiary
Community as active participant
Research
Molecular biology
Pharmaco-therapeutics
Clinical epidemiology
Socio-epidemiology
Social determinants
Health systems
Social policy
This paradigm shift involves at least six elements:
•
•
•
A shift in focus from individual to community.
A shift in dimensions from physical and pathological to broader psychosocial, cultural,
economic, political and ecological dimensions.
A shift in technology from drugs and vaccines to education and social processes.
A shift in the type of service from social marketing and providing models to enabling,
empowering and autonomy-building processes and initiatives.
• A shift in the attitude of people from patients and/or passive beneficiaries to people and
communities as active participants.
• A shift in research focus from molecular biology, pharmaco therapeutics and clinical
epidemiology to socio-epidemiology, social determinants, health systems and social policy
research.
This paradigm shift is just beginning to be recognized in the recent literature. When it takes place,
then the quest will move to social vaccines that will begin to tackle some of our key primary health
care problems and public health challenges at a much broader level.
There was some concern when many of us recently began to use the concept of ‘social vaccine’
to describe actions against the social determinants ol disease. Many public health researchers felt
that vaccine was a biomedical terminology and we may inadvertently biomedicalize the action on
social determinants. However, it was also felt that it was a good metaphor and that social vaccines
would actually protect people from the commodification of health and health care. This will be a new
terminology for prevention and promotion and probably excite the imagination of primary health care
and public health policy activists and professionals.
•
137
38
South-East Asia Regional Conference on Epidemiology
The task ahead
There is an urgent policy imperative to make epidemiology relevant to primary health care by an
active dialogue between public health professionals and epidemiologists and PHC action initiators
and civil society activists. This dialogue would result in a lot of cross-fertilization of ideas and
experiences, building on the ongoing micro and macro experiments in our countries. Many interesting
new experiments can be initiated.
Will epidemiologists learn how to measure equity? How to do class and gender analysis?
•
Will epidemiologists work with lay people to give them the tools of epidemiology? A lot of
work has been done recently in the environmental health movement in India where lay activists
aie collecting evidence for environmental epidemiology and community action.
Will epidemiologists work with the National Rural Health Mission and give serious
methodological direction to new initiatives, such as community monitoring, social audit and
people health watch?
This is the epidemiology of the future and a more definitive answer to the question raised at the
beginning of this keynote paper - how can epidemiology help primary health care services.
Conclusion
Epidemiology will help the revival of primary health care if it accepts the following directional
changes:
Moves from medical colleges and research laboratories to community;
Includes the social, economic, political, cultural and environmental analysis in epidemiological
studies;
•
Introduces the equity, rights and gender analysis;
Involves the community not as objects of research or as sources of data but as participants in
evidence-gathering;
•
Understands evidence of social determinants as evidence for social and public health action.
This is the challenge before public health professionals and epidemiologists today. This is the
challenge of the Alma Ata Declaration. And this is the challenge of the Bamako Declaration.
References
(i)
WHO/SEARO. Conclusions and recommendations of the Regional Meeting on Application of
Epidemiological Principles for Public Health Action. 2009. http:// www.searo.who.int/LinkFiles/CDS
Epid meet C&R 26-27feb09.pdf
(2)
WHO. The report of the International Conference on Primary Health Care, Alma Ata, 1978. Health for All
Series No 1. Geneva, World Health Organization, 1978.
Mahadevan B. The Mallur Health Cooperative. In: Alternative Approaches to Healthcare, A report on
symposium organized jointly by Indian Council of Medical Research and Indian Council of Social Science
Research. New Delhi, Indian Council of Medical Research, 1976, pp 1-241.
Narayan R, Mahadevan B. Mallur Health Cooperative and Evaluation of Primary Health Care. Proceedings
of National Conference on Evaluation of Primary Health Care Programmes. New Delhi, Indian Council of
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(3)
(4)
(5)
Banerji D. Health and Family Planning Services in India - An Epidemiological, Socio-cultural and Political
Analysis and a Perspective. New Delhi, Lok Paksh, 1985.
(6)
Rose G, Khaw KT, Michael M. The Strategy of Preventive Medicine. Second Edition. Great Britain:
Oxford University Press, 2008.
South-East Asia Regional Conference on Epidemiology
(7)
(8)
(9)
(10)
(H)
(12)
(13)
(14)
(15)
(16)
(17)
(18)
(19)
(20)
(21)
(22)
Narayan T. A Study of Policy Process and Implementation of the National Tuberculosis Control Programme
in India. Doctor of Philosophy, London School of Topical Medicine and Hygiene, 1998.
Narayan Thelma, Narayan R. Educational Approaches in Tuberculosis Control: Building on a Social
Paradigm. In: Porter DHJ, Grange MJ, eds. Tuberculosis, an Interdisciplinary Perspective. London,
Imperial College Press; 1999:489-509.
Singh N, Mishra AK, Khan MT. Introduction of insecticide-treated bednets for malaria control in Gond
tribal population of Mandla district, Madhya Pradesh. In: Sharma VP ed. Community participation in
malaria control. New Delhi, Malaria Research Centre (ICMR), 1993:283-295.
Peoples’ Health Assembly. The Peoples’ Charter for Health, Savar. The Peoples’ Health Movement,
2000. Available from http://www.phmovement.org/files/phm-pch-english.pdf, [Accessed 5th April
2010]
Peoples’ Health Movement, Bangalore; Medact, London; Global Equity Gauge Alliance, Durban. Global
Health Watch 2005-2006. Ari Alternative World Health Report. New York, Global Health Watch, 2008.
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Institute of Population Health, University of Ottawa. Revitalizing Health For All: Learning from
Comprehensive Primary Health Care Experiences. Available from Http://www.Globalhealthequity.
Ca/Projects/Proj_Revitalizing/Index.Shtml, [Accessed 5th April 2010]
Susser M, Susser E. Choosing a future for epidemiology: I. Eras and paradigms. Am J Public
Health,1996,86:668-73.
Narayan R. Towards a Social Vaccine Challenge for Research. Forum 10 Global Forum for Health
Research, Cairo, Egypt, 2006. Available from: http://www.globalforumhealth.org/layout/set/print/
Forums/Annual-Forums/Previous-Forums/Forum-10/Forum-10-Final-documents [Accessed 5th
April 2010]
Baum F, Narayan R, Sanders D, Patel V, Quizhpe A. Social vaccines to resist and change unhealthy
social and economic structures: a useful metaphor for health promotion. Health Promotion
International, 2009,24(4):428-433.
Pearce N. Traditional epidemiology, modern epidemiology, and public health. American Journal of Public
Health, 1996, 86(5):678-83.
WHO. World Health Report 2008: Primary health care: now more than ever. Geneva, World Health
Organization, 2008. Available from: http://www.who.int/whr/2008/whr08_en.pdf [Accessed 5th April
2010]
Commission on Social Determinants of Health. Closing the gap in a generation: health equity through
action on the social determinants of health. Final Report of the Commission on Social Determinants of
Health. Geneva, World Health Organization. 2008.
Measurement and Evidence Knowledge Network. The social determinants of health: Developing an
evidence base for political action, Final Report to World Health Organization Commission on the Social
Determinants of Health, Measurement and Evidence Knowledge Network: Universidad del Desarrollo,
Chile, and National Institute for Health and Clinical Excellence, United Kingdom, October 2007. Available
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5th April 2010]
Narayan R. The Community Health Paradigm in Diarrhoeal Disease Control. In: Raghunath D, Rao DC,
eds. Diarrhoeal diseases - current status, research trends and field studies. New Delhi, Tata McGraw Hill,
2003, pp 299-303.
Narayan R. Health-Development-Agriculture-Environment: New Linkages and New Paradigms (challenge
of arbo viruses in India). In: Raghunath D, Rao DC. eds. Arthropod-borne viral infections current status
and research. New Delhi, Tata McGraw Hill, 2008, pp 409-416.
Narayan R. What evidence? Whose evidence? Who decides? Challenges in health research to achieve the
MDGs and respond to the 10/90 gap. In: Beverly PS, ed. Health Research for the Millennium Development
Goals. Forum 8 Mexico, Geneva, Global Forum for Health Research 2005, pp29-30. Available from:
http://www.globalfonimhealth.org/content/download/527/3384/file/sl4835e.pdf [Accessed 5th April
2010]
139
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FOREWORD
7
EXECUTIVE SUMMARY
9
CHLP: AN INTRODUCTION
13
Public Health and Community Health Educational Initiatives
14
SOCHARA'S Role in Community Health Education.................
15
Need for Analytical Review of the Teaching Programmes.....
16
CHLP: AN EXPLORATION THROUGH LIFES JOURNEY.
17
Full-Time Programme for Community Health Learning
18
Selection of Interns.......................................................
20
Profile of Full-Time Interns.........................................
20
Flexible Programme for Community Health Learning.
21
Advisory Committee...................................................
22
Community Health Teaching......................................
22
Field Placement..........................................................
25
Collective Teaching Sessions
25
Field Practice......................
26
Specialized Workshops
27
v^COMMUNITY HEALTH TEACHING: LEARNINGS' AND CHALLENGES
30
Challenges and Learning during Field Placements
31
Challenges and Learning's during Field Work.......
32
4
Person-Centric Approach,
33
Inward Learning
34
Perspective Development,
34
Assessments
36
V^ENTORING: CHALLENGESAND LEARNINGS
38
ALUMNI EXTENSION LEARNING
42
Alumni Support Cell
46
CHLP Publications: Building Blocks December 2010 .
46
Alumni Linkages with the Training Programme
47
The Evolving Resource Network
48
DOCUMENTATION AND ADVOCACY OF THE CHLP
49
.
51
Advocacy of the CHLP.................................................................................................
51
National Workshop on Community Health and Public Health Learning Programmes
51
CHLP: TOWARDS CHANGE
55
Advisory Committee Meetings
56
Internal Review of the CHLP....
56
Feedback from Interns and Alumni
58
Mapping of outputs of the CHLP,
58
Towards Change
67
CONCLUSION
71
APPENDIX ONE: SOCHARA CHLP ALUMNI
74
Batch of 2008
74
Batch of 2009
80
Batch of 2010
84
Batch of 2011
89
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( he interns expand their understanding of ill health3, community health, the
social determinants of health and learn about the larger vision of attainment
of‘Health For All’4 through a primary health care approach and strategies that
help reduce poverty, that help to organize the underprivileged communities
and that builds community based models.
The interns understand that health is
intrinsic to all issues that plague society
and the community health approach5
is necessary and a holistic approach
3
Community Health is a process of enabling people to exercise collectively their responsibility to
their own health and to demand health as their right.
4
Health for All by 2000 was the goal of the Alma Ata declaration, 1978 that stated "the attainment
by all peoples of the world by the year 2000 of a level of health that will permit them to lead a
socially and economically productive life.
The community health approach involves the increasing of the individual, family and community
autonomy over health and over the organization, the means, the opportunities, the knowledge and
the supportive structures that make health possible. (Points 3,4, 6 are from the book, Community
health: the search for an alternative process, Centre for Non-Formal and Continuing Education
1987).
5
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Building Community Health Through Fellowship: CHLP2011 |
°I9
31
I
I
towards ‘health for all'. There was a
challenge in finding a balance between
the extent of theoretical grounding in
community health, the guided exposure
visits and the time for reflection.
The interns appreciated the use of
participatory methods like role-play,
skits, simulation exercises that helped
them to internalise the concepts very
well as it also allowed time for reflection.
The challenge has been in facilitating
teaching-learning processes among
interns
with
diverse
language
backgrounds and varied levels
1
in
their grasp of English. This has meant
longer time spent for sessions due to
translations done in different languages.
The diverse language abilities of the
interns also required for person centric
methods of learning with mentors
proficient in vernacular languages. The
team should be able to develop learning
tools and resources keeping in mind
the diverse levels of knowledge, skill
and comfort in using English among
the interns. This was a constraint
as to whether enough topics were
discussed and whether the diversity was
hampering the teaching.
Feedback from interns emphasized
that the rich grounded experiences,
and sharing of this diverse group was
useful. Discussions drawing from the
group's experiences and perspectives
were also emphasized as an important
learning method. The interns initially
found it difficult to articulate their
viewpoints, but gradually the group
created an atmosphere wherein each
individual could express their thoughts
and feelings, as well as relate to their
past experiences, and share in a more
meaningful way.
It was also observed that interns more
fluent with English took on a leadership
and mentoring role to help the others.
The educational system in schools and
colleges do not generally inculcate the
practice of reading and writing, and
therefore self-reading and Writing has
been a difficult starting point for many.
This is compounded by the fact that
most reading resources in community
health and public health are in English.
Interns have varying capacities and
skills in reading and speaking in English.
The field trips during the orientation
were very well received, as the interns
bonded during the residential stay
and it is common lived experience of
understanding and sharing the realities
of health of communities. The extent of
learning that takes place during a field
trip is immense if planned well.
Challenges and Learning during
Field Placements
The interns were oriented on how to
work with and make use of learning
opportunities within a field organization
and not be expected to be spoon fed.
The need for discipline during field
Building Community Health Through Fellowship: CHLP2O11 |
loo
32
placement was as crucial as the space to
pursue each individual's objectives.
Often interns felt limited by the lack of
mentoring during field placement. A visit
by CHC mentors to the field organization
during the intern's placement and a
triangular discussion with the field
mentor and intern, facilitated better
learning for the intern. Regular
interaction with the field mentor by
the CHC mentor also helped in drawing
out learning opportunities during the
intern's placement.
The need for a formal system of feedback
and assessment during the field
placement has been felt and requires
careful thought in the context of the
diverse learning curves of the interns.
Sometimes when the interns learning
objectives were distant from what
they were experiencing in the field
organization, they felt disillusioned.
Communication between the intern and
the CHC mentor, and the CHC mentor
and field mentor was crucial to tide over
such difficult situations and helped the
intern learn further.
Some interns had broad learning
objectives
and
visited
many
organizations during the field placement
instead of spending a significant period
of time in one place. It was a challenge
for the team to guide the interns based
on their learning capacity and to help
them to retain their focus on community
health.
As communication during the field
placement was important, the mentors
and interns used all methods like
telephone, email, internet and personal
meetings. In addition, interns who came
back to CHC in between could interact
with the team and share and learn more,
as compared to the interns who rarely
visited.
There are practical difficulties while
doing field work that range from living
accommodation, mobility in a new area,
accessibility to the community, social
support mechanisms during illness
to name a few. These are profound,
especially for women interns. The
interns and previous reviews have
suggested that they should be placed
in pairs, as they would support
each other negotiate the practical
difficulties while in field organisation
and enhance their learning through
sharing and reflection.
Challenges and Learning's
during Field Work
The interns and mentors had to discuss
and plan the fieldwork well in advance,
so that the three months were used
productively in implementing activities
and learning.
Experience in drawing up a plan of
action with a budget was an important
skill that many developed.
Some interns encountered practical
problems in contacting and developing
fl— Building Community Health Through Fellowship: CHLP2011 |
■
OH - \ 0^0
I0I
33
rapport in the area where they had to
initiate field practice work.
periodically, facilitate reflection to gain
new learning, and guide to enhance
knowledge and practice based on each
individual.
The important highlights of the
'alternative' teaching learning processes
that have evolved in the organisation It is a challenge for mentors to balance
over time, include the use of a person proactive guidance and allow the
centric approach; encouragement and intern to chart her/his own course.
flexibility to examine, explore and learn The flexibility allowed to the intern to
about the wide range of underlying issues pursue their interests in the context of a
related to health also called the distal community health pose some challenges
determinants of health; ]perspective to the interns. Many are not used to such
developmentthrough reflective learning; self directed learning and seek guidance
non-hierarchical, imutually respectful to the extent of being spoon fed. At the
relationships in the teaching process; same time too much of directed learning
and the use of participatory, interactive would hinder the natural evolution of
and innovative teaching methodology the intern. Mentoring by the CHC team
that enhances the self confidence of member and the field mentor is crucial
participants and attempts to enhance in keeping the spirit of the person centric
their spirit of enquiry.
learning. The extent of mentoring was
dependent on the relationship of the
Person-Centric Approach
mentor and mentee with quite a number
The CHLP focuses on individuals to of challenges.
develop their own learning objectives
and frame a plan of action based on the
inputs from the mentor and the CHC
team. The learning curve of the intern
is based on their individual pace of
learning. This enables them to develop
self-directed learning abilities and
helps to focus their course of action.
This requires sincere efforts and a
deep involvement of their mentors and
the partner organizations where they
are placed. These range from enabling
interns to discuss the interns learning
needs, develop learning objectives, plan
a course of action, review their work
The other challenge is that intern’s
gain insights in one particular issue
without learning the basic minimum of
:
,
//
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a/nd
— &
d
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,
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Building Community Health Through Fellowship: CHLP2011 |
I n
t
5
34
community health. The team was able to
categorize perspective development into
three broad approaches: community
health, rights based and development
oriented, and ensuring that all of the
interns do a community health field
placement.
Inward Learning
The interns are also facilitated through
an exploration of understanding self,
attitudes of working together and how
to reinforce the positive aspects of the
self through a group exercise by Dr. Ravi
Narayan during the orientation and
follow up during the end of six months.
This helped the interns to explore and
understand dimensions of their self and
how the self could facilitate an enabling
atmosphere of learning and imbibe
values necessary for engaging with
communities.
They also had a workshop on
orientation
to
life
skills
and
understanding self by a professional
psychologist during the internship. The
interns identified through the various
participatory exercises-importance of
self, understanding values necessary
for managing situations or conflicts
and understanding values required for
working with communities.
Person centeredness’ demands an
intense and committed investment of
both the interns and mentors and their
organizations towards the intern's
A/ / '/A
a/nd uMwAwna
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'
teaching and learning. The CHIP has
been appreciated by all interns for the
space in exploring their learning needs.
The challenge has been to a balance the
individual learning objectives within the
framework of community health. For
example, an intern who is exploring to
understand the right to food security
and right to food needs to understand
practically issues of nutrition at
the household and the means and
opportunities at the community's level.
Perspective Development
Interactive
lecture
discussions,
documen-taries,
exposure
visits,
discussions within groups and structured
feedback sessions within the programme
and individually with mentors facilitated
the gaining of new perspectives through
reflection. Reflective thinking is the
expansion of an understanding from
a point of view held by a person to a
newer dimension on learning a new fact.
This is contrary to theoretical teaching
in academic schools where there is no
attempt to make students understand
fll BU''C*'n® ('omrr’un'tV Health Through Fellowship: CHLP2011 |
I 03
35
\
■ r
z
*
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one
1 •:
~
/t/n,
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TT
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____
how a new fact is relevant to their body
of knowledge.
Reflective thinking is useful way of
learning only if the individual allows
oneself to open up and is therefore an
emotionally intense process. Sometimes,
the reflection has been only group
reflection. At the end of the internship,
the interns gain some level of reflective
thinking as they link their learning
objectives, their experiential learning
to plan and execute their field practice
work.
Field placement was useful for the
realistic experience that helped shape
perspective and mould skills for
community health work. There have
been limitations in field mentors guide
reflective thinking and the role of
CHC mentor during field placement is
crucial to help the interns continue their
learning.
The non-hierarchical nature of the CHC
team facilitated an openness to unlearn
and learn. The interns felt that the CHC
team behaved like a community which
was inspiring to their learning. Learning
from . the group's experiences and
perspectives was also emphasized as an
important learning method. The interns
felt difficult to air their viewpoints, the
group created an atmosphere where each
individual could express their thoughts
and relate to their past experiences and
share in a more meaningful way. Thus,
the interns were also resource persons
and mentors for their colleagues.
The orientation to the newer concepts
and the new paradigm of thinking
have been very intense and for some
overwhelming. The mentoring from
the CHC team and peer support of co
interns have helped them to manage this
paradigm shift.
Assessments
This training programme focuses on
behavioural change in 'deepening the
There was flexibility and freedom
to learn and express ws. The five■
■
week orientation brok ; many past
myths^dbbutf^ nmu
>-and health,
■
l he sharing from e
h fellow at
different points of th
was enriching." -Jeyar
pifagramme
............................................................................. ’
.
_____________________ _____________ .
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Building Community Health Through Fellowship: CHLP2011 |
1 nu-
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36
understanding of social paradigm of
health', which in turn could facilitate
'sharpening of the analytical skills'
of each participant. The interns had
developed a broader understanding of
the social determinants of health evident
from their presentations and reports.
Capacity building would range from
understanding socio political analysis to
skills of being a community leader.
While attitudinal change is fairly explicit
and is uniformly expressed by all interns,
knowledge and skill based changes and
gains are more heterogeneous that do not
conform to a uniform measuring tool.
The advisory committee and the CHC
team had discussions on the need
for assessment and the challenges in
assessment of a programme that is
person centric and therefore flexible to
individual intern’s needs. Each intern
had to be assessed from where they
started and what has been their learning
curve. The challenge is to capture the
individual and personal journeys, and to
assess attitudinal change, and also make
the assessments more objective and
quantitative.
There were a few frameworks that were
suggested. In one method, the team
discussed about developing indicators
with an ordinal score for each of the
indicators. Theindicatorscouldrepresent
6
the various components in knowledge,
skills and values in community health,
for example, right to health care is a
component. Similar to this is the spider
web tool that maps the components as
different dimensions. These above tools
would map the interns' progress over
time. They have the advantage of being
used by the intern for self-assessment
and by the mentor to assess the intern's
learning.
The framework of 'outcome mapping’
is described by the International
Development Research Centre, Canada
(1DRC)6. This framework focuses on
measuring outcomes as behaviour
change. This is a tool for evaluation
that takes cognizance that change is
complex, interlinked to multiple factors
and actors, continuous and therefore not
limited to the project timelines. Outcome
mapping also helps in understanding
the role of boundary partners (mentors,
field organisations, resource persons,
fellow colleagues) in the behaviour
change within the intern. Such change
is measured through a set of progress
markers - set of statements that traces
the behavioural change. This framework
helps in assessing the intangible output
of attitudinal change and gaining skills
in community health and therefore how
and in what manner interns are able to
improve communities’ health.
Earl S, Carden F, Smutylo T. The Challenges of assessing developmental impacts. Brochure on
Outcome mapping: developing learning and reflection into developmental programmes.IDRC,
2001.
HU Building Community Health Through Fellowship: CHLP2O11 |
Mr?
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■/
■r
Fellows
Manjula, Shivamma and Prahalad interacting with the women of Kota village in Richur on
.
the importance of sanitation, which is important for a life of helath and dignity.
The learning's from the CHLP have
speared CHC into refining the process
of training. There have been significant
inputs on the role of mentors in such a
training process. The inputs from senior
public health professionals, interns and
alumni have given the CHC team an
impetus to develop more experiential
learning opportunities within the
framework of the internship structure.
Building Community Health Through Fellowship: CHLP2O11 | j|||
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V r ^entering is a process for the informal transmission of knowledge, social
capital, and the psychosocial support perceived by the recipient as relevant
to work, career, or professional development; mentoring entails informal
communication, usually face-to-face and during a sustained period of time,
between a person who is perceived to have greater relevant knowledge,
wisdom, or experience (the mentor) and a person who is perceived to have
less (the protege) (Bozeman, Feeney, 2007).
The CHC team mentored all the interns
[flex! and full time). The interns were
allocated between the CHC team on the
basis of their learning needs, their field
of interest and geographical location.
The interns interacted with their
CHC mentor to frame their learning
objectives and plan of action, review
their learning and seek direction and
guidance in their training needs.
Many SOCHARA society members,
associates and extended team members
also participated in the training sessions
and provided technical support to the
mentoring process (See Appendix One,
SOCHARA CHLP Alumni). In the field
organisation, they were expected to
interact with the field mentor (usually a
senior person in the field organisation)
and with the CHC mentor to plan their
Building Community Health Through Fellowship: CHLP2011 |
I O']
39
activities and reflect on their experiences.
The discussions between the mentor and
intern ranged from guiding their plan of
action, explaining concepts, drawing out
a plan for reading resources, discussions
on field experiences, sorting out
confusions related to field placement,
updates on intern’s activities, reviewing
their presentations and reports and
facilitating reflective learning.
A note on mentoring prepared during
the first phase of the Fellowship was
useful for the CHC team to get oriented
to the concept and ethos of mentoring.
The strengths and opportunities that the
fellowship programme presented were
many - each making a distinct impacton each Fellow. The study-reflectionaction helped each of the fellows to
chalk out their mission, objectives and
growth path to be achieved through the
fellowship programme and beyond.
The SOCHARA fellowship programme
facilitated by CHC builds and nurtures
the next generation of community
health catalysts, facilitators and leaders.
Reaching a multidisciplinary group,
the fellowship harnesses youthful
energy to nurture scholar activists,
Today it continues to promote social
activism where each one becomes
change agents. Today, many Fellows
are strengthening grassroots linkages
and movements working in the areas
of dalit empowerment, disability and
mental health, child rights, right to
food, and environment. The fellowship
enriches both the lives of the fellows and
empowers them to help communities in
the quest for equitable and just societies.
Mentors have been the backbone, the
anchor and the board of reflection - where
ideas, thoughts and sometimes confusions
and doubts have been brought to a rest
- through the bonding and camaraderie
built through the year and beyond.
Today
SOCHARA
Alumni
have
spearheaded movements, research, and
community development. Through their
rich experience, they take on the mantle
of mentorship sharing the experience,
knowledge, personal journey along with
fellows.
There were challenges in metering
experienced by the mentores and the
interns. The core element of SOCHARA
mentorship is to facilitate the search for
a deeper meaning that young persons
are seeking through community health.
A supportive, encouraging environment,
with gentle direction is provided by the
mentor, where the ethos of reflective
action is integral to the life's journey.
The technical component supplements
equally through the progamme through
the bonding of humane relationship that
facilitates the growth of the young person
in unique ways and direction - which
often is special to each one. Mentor is a
friend, philosopher and guide.
There is a need to pay attention to the
finer nuances of reciprocity that is built
Building Community Health Through Fellowship: CHLP2O11 |
I o>>,
40
on mutually respectful relationship.
Sometimes fellows have to work on the
pathways to overcome communication
and cultural barriers that may arise due
to the nature of the field organization's
work, the organization's mandate of
development, and the availability for
mentoring by the field mentor who
are often busy in their organizations
programmes. This has often enabled
fellows to work on the spaces of social
interaction to counter such challenges
through the process of guided learning.
placement, mentoring and other aspects
of the CHLP. The meeting with the
Mentors has been an opportunity to
share expectations, get suggestions from
the field, create awareness regarding
concepts and skills of mentoring based
on the experience of the CHC team and
others.
The experience of mentoring gave raise
to new insights that was shared through
the learing programmes:
The experience of the CHLP fellowship
bears witness to the fact that the field
placement is mutually beneficial to
the intern and the field organizations.
Interns have contributed positively
to the running programmes of the
organisations. In some cases, the interns
have help design the programme in field
organisations.
Feedback from the interns of the first
phase and the current phase reiterated
the need for strengthening field
mentoring. The advisory committee
strongly recommended that a meeting
with the field mentors be organised at
the end of the orientation programme
every year so that field mentors come to
CHC to understand the programme, the
interns backgrounds and interests and
their role as a mentor in the field much
better.
The CHC team mentors felt that
proactive contact by the mentor
would help ease the physical and
emotional distances and facilitate
sharing. Also, interns who came
back to meet the CHC mentor in
between their field placement could
interact with the team and share
more. Communication between
intern and both CHC and field
mentors and between the CHC and
field mentor is crucial for a smooth
field placement.
Efforts are made to create an
encouraging atmosphere for self
reflection and inner learning by
the interns and facilitating team
members. The gains from this
process depends on the extent to
which there is an openess to explore,
share and communicate between
the group of interns and between
interns and mentors.
The field mentors were invited in
2009 and 2010 during the orientation
programme to discuss the field
The field mentors were busy and
could not spend enough time
Building Community Health Through Fellowship: CHLP2011 |
I
41
with the intern. They desired
to understand the concept and
expectations related to mentoring.
The first meeting enabled the CHC team
to revise the note on the concept of
mentoring and the role of mentoring in
the learning process. The interactions
helped the team to understand the
expectations of and from the field
mentors and evolve further the Meeting with the field mentors in 2009 to share
about CHLP and discuss on the role
principles and framework on mentoring of mentoring
intheCHLP.
Important suggestions that evolved from
the meeting include:
Mentoring should be a mutual
learning process involving the
mentor and mentee and grounded in
the values and skills of community
health.
The entire team and the communities
with whom partner organizations
work are an integral part of the rich
learning environment for the interns.
In the second meeting in 2010, the
team was able to further discuss on
assessment tools of mentoring and how
to systematize mentoring.
Mid-level team members from the
partner institutions can be involved
Some practical ways of ensuring
in a day-to-day support of the
mentoring by field organizations were
intern. The idea of two mentors in
explored as the nature of work of each
each organization was also mooted.
organization was different.
The interns could relate more to
young faculty/members in that The internal review of the CHLP
organization who could help in also brought out important points
day-to-day supervision. The senior on mentoring and systematizing the
members of the organization could process. The members emphasised the
share on the larger context and need for formalizing the relationship
with the field organization; specifying
discuss issues.
a framework of mentoring and build
Discussion between the CHC, field within it assessment of interns.
mentor and intern would enable
communication and facilitate the
intern’s learning process.
Building Community Health Through Fellowship: CHLP2O11 |
\I0
CHLP NW 04102016
Background Paper- 13
Towards a Community Oriented
Public Health System
in Karnataka
Mission Group on Public Health
Karnataka Jnana Aayoga
(Karnataka Knowledge Commission)
Government of Karnataka
www.jnanaayoga.in
U|
Table of Contents
Message
iii
Preface
iv
Foreward
v
Mission Group on Public Health
vi
Table of Contents
vii
Introduction
1-3
\^A State Public Health Charter
4-7
Universal Access to Free Medicines
8-13
Evolving an Urban Primary Health Policy
14-17
Promoting a Plural Public Health System through a
Convergence Mission with AYUSH
18-23
Strengthening-State Public Health Capacity and HRD
24-32
Promoting Integrated, Community Based
Management of Chronic Illness
33-37
The Way Forward
38-39
List of Recommendations
39-40
References
Members of KJA
41
42-46
A STATE PUBLIC HEALTH CHARTER
-phe Karnataka State Task Force on Health and Family Welfare considered the following
I definition by the Association of Epidemiologists as the frame work for public health
system development.
"Public Health is one of the efforts organised by society to protect, promote and restore
people's health. It is the combination of services, skills and beliefs that are directed to the
maintenance and improvement of the health of all people through collective or social
actions. The programs, services and institutions involved emphasize the prevention of
disease and the health needs of the population on the 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 discomfort of diseases in the
population".
The Task Force also emphasized the following principles when considering Public Health
System development in the State. These included:
1. State's primary responsibility for Health and Health Care
2. Recognizing the political economy of public health system development and
the challenge of access and universality
3. The challenge of Inter-sectoral action including safe water supply, sanitation
and nutrition
4. The
Primary
Health
Care
approach
to
infectious
disease
and
non-
communicable disease control
5. The focus on Equity and Social Justice in health and health care
6.
The convergence of AYUSH, LHTs and the Public Health System
The Mission Group on Public Health endorsed the above definition and principles
and held many deliberations to evolve the following Public Health Charter:
The Public Health Charter for Karnataka
Building on the historic Public Health consciousness in the State which has been neglected
and distorted in recent years, the State has to evolve policies and programs based on
recommendations of the taskforce to cover the following challenges and system
development issues outlined in this Public Health Charter.
Through the Public Health Charter, the Karnataka State will continue to develop a
comprehensive, integrated Public Health System that will be committed to the following
values:
Equity,
Quality
and
Integrity
emphasized
HR
V13
by
the
earlier
Taskforce
and
Communitization, Pluralism, Gender Sensitivity and Accountability added by the current
Mission Group.
The existing system will be further strengthened by initiatives in the following six
dimensions:
1. Public Health-Capacity building
• The State will evolve and establish a Public Health Cadre to strengthen the
capacity of the health system particularly focusing on the district and beyond.
• The state will develop a HRD unit in Health Department which will rationalize
the functions, salaries, promotions and transfers and also focus on capacity
development and continuing education of all cadres.
• The State will promote a School of Public Health to strengthen public health
capacity and skills at all levels from district level health administrators to
ANM's and ASHA's. This will enhance the development of evidence based
policies, strengthen institutional capacities and human resources, promote
health promotion, public health regulations and research towards the goal for
Health for All.
2. Public Health - Governance
•
The State will evolve mechanisms of Accountability and Transparency in all its
public health programs and campaigns.
•
The State will enhance governance and supervision of peripheral Public Health
care systems with a special focus on decentralization and partnership with
Panchayat Raj Institutions.
The State will promote community participation in all its programs and also
enhance the role of community in monitoring and providing feedback through
the Communitization process now evolved by the National Rural Health
Mission.
•
To enhance outreach and access, within the public health system the State in
partnership with NGOs and private sector will promote values of equity,
social justice and strengthen the government's role towards 'Health for All'
without compromising the constitutional mandate and taking care to prevent
market distortions of such partnerships. To enhance outreach and access,
within the public health system the State in partnership with private sector
agencies.
3. Public Health - Inter-sectoral action
• Nutrition: The State will tackle the increasing malnutrition challenges using inter
sectoral and multi-disciplinary approaches that address the problem from grass
root level upwards by strengthening the public distribution systems and food
security, food and agricultural policy, Anganawadi and school feeding programs,
individual and community nutrition education and health promotion campaigns.
• Safe water supply: The State will promoting safe water supply and mechanisms to
apply standards for water quality at all levels using appropriate technology to
enhance access and purification of water, while preventing commercialization and
commodification of water.
• Sanitation Campaigns:
> The State will support the recently announced Total Sanitation Abhiyan and
enhance promotion of sanitation with the focus on schools, meeting halls, bus
stands and public places even as individual house and communities are
encouraged to adapt sanitation systems.
> While promoting sanitation, the State will also take steps to:
■
Abolish manual scavenging
■
Strengthen measures to enhance the Health of Pourakarmikas
■
Nirmala
4. Public Health-Response to some current health system challenges
•
The State will enhance access to Free Medicines for Primary Health Care
throughout the State by adopting an essential medicines list, rationalizing
logistics of medicine warehousing and distribution mechanisms, promoting
rational medicine prescribing and policy initiatives and tackling some of the
obstacles to universalizing access to medicines.
•
The State will evolve an urban primary health charter that will focus on multi
sectoral services integrated through a primary health care approach focusing
on women and children's health, violence against women. The Charter should
include access to basic health services, mental health and other emerging
urban health challenges.
•
The State will adopt the newly announced national program for non-
communicable diseases and enhance the primary health care approach to
chronic diseases with focus on management and re-orientation of personnel,
providing support and upgrading services, improving HMIS, building new
partnerships and strengthening operational research.
15?
115
The State will enhance healthy life style promotion as part of the youth
oriented policies of the State while simultaneously linking it to health
promotion and education against substance abuse.
5. Public Health - Promoting pluralism and Integration
•
The State will evolve Accreditation and Certification System for local Health
Practitioners and Knowledgeable Women involving Universities such as
IGNOU to support Traditional /Community Knowledge Systems.
•
The State will promote Public Health Orientation and Training for all AYUSH
Health Personnel starting with Government sector and later offering it to
private registered medical practitioners as well as including community
supported LH practitioners on voluntary basis.
•
The State will strengthen Swasthya Vritta Programme presently being
experimented in five districts and enlarge this program to cover the whole
State gradually. It will also draw upon the health promoting traditions of other
system as well.
•
The State will strengthen Yoga awareness and skills through
Health
Promotion in School and college curriculum.
•
The State will strengthen community health and knowledge practices related
to food and dietary practices using traditional knowledge and practices for
promoting healthy nutritional status.
•
The State will strengthen documentation of clinical outcomes in AYUSH sector
including LHTs at all levels by introducing a standardized system.
6. Public health - Strengthening HMIS and Knowledge translation
•
The State will further strengthen the Health Information system by providing
universal access to available information to all categories of users by removing
the present imbalance between providers and users.
•
The State will adopt and enhance e-governance within public health system at
all levels.
•
The State in collaboration of the Health Department and the evolving State GIS
platform will enhance the development of an effective health GIS.
In conclusion, through the adoption of this six point, Public Health Charter, committed to
the above values, the State will enhance the capacity of the Public Health System to handle
the emerging health problems and challenges; enhance the commitment to human resource
development; enhance accountability, decentralised government, communitization and
strengthen the ability of the existing system to deal with the new emerging challenges.
Ilf,
STRENGTHENING STATE PUBLIC HEALTH CAPACITY AND HRD
Strengthening Public Health Capacity
. - uman Resource Development in Health and their public health orientation and capacity
|| remain the biggest challenge of public health system development in the State. The
four major challenges of HRD are coverage, competence, motivation and governance.
These challenges operate at all levels from primary health centre to taluk hospitals and
upwards and need responses that are both standard management practice and out of the
box solutions.
The three most important recommendations that the Mission Group would like to
propose the following:
> A Human Resource Development unit in the Health Department
> The formation of a Public Health Cadre and its expansion, continuing education
and sustainability
> Strengthening public health capacity and training at all levels including the
development of a State School of Public Health that will spearhead the capacity
building at all levels
The
first
two
recommendations
had
been
deliberated
upon
and
detail
recommendations had been made to the Health Department in the earlier phase of the KJA.
The present Mission Group has focused specifically on public health capacity building
and recommends the following:
> A State School of Public Health
> Some general steps to strengthen public health capacity
A State School of Public health - A capacity building policy imperative
Karnataka
State
urgently
a
path
breaking
needs
strengthen
to
initiative
Primary health care and
Public
Health
system
development in the State
to address equity, quality
and integrity of health and
health care. Karnataka had
a
good
practice
appointing
trained
Public
Health
individuals
Government
of
for
Health
Services. But over a period
Recently on the recommendation of the Knowledge
Commission an expert group has already reported
on the need for public health cadre development
and this welcome development now needs an
important complimentary initiative for urgent
state intervention and investment. This initiative is
to focus on the evolution and sustained
development of a range of Public Health courses
and educational initiatives to strengthen the
capacities and public health skills of the relevant
health human power in the State. A State School of
Public Health is therefore an urgent policy
imperative.
of time, this mandatory requirement was dropped. Health professional and health officers
must have a public health skills and capacities and for this all those in public health positions
need to undergo a formal training in public health to get an insight and skills in the practice
of public health and capacity to strengthen the systems and improve outcomes. It is only
then that health services will be manned by appropriately trained health professionals.
1. Towards multidisciplinary and multi-sectoral Public Health
The Task Force on Health and Family
Welfare, 2001 and Integrated State Health
Policy, 2003 proposed to have a State School
of Public Health in Karnataka. On the
similar lines, Karnataka JnanaAayoga had
already recommended a School ofPublic
Health in Karnataka in its first phase to
cater to the needs of human resources
development. The re-constituted commission
now wishes to re-endorse this path breaking
initiative for a “State School ofPublic Health”
to address the specific public health training
needs of Karnataka.
multi-disciplinary,
The
multi-sectoral
and
disciplinary,
inter
nature and challenges of public
health
this
should
School
collaborate with Universities and
multidisciplinary
other
institutions
professional
bodies to
make
the
school
comprehensive
learning
drawing
the
upon
institutional
and
and
centre
state's
rich
educational
resource network.
2. Structure
In addition to All India Institute of Hygiene and
Public Health which was started before Independence and
the Achutha Menon Centre of Sri Chitra which started in
1996, there has been recently a new revival of public health
education.
In
other
states
well
known
educational
institutional like TISS- Mumbai, CMC- Vellore etc have also
introduced public health courses. As part of this revival
there is urgent need for a
School of Public Health in
Karnataka which could be a governmental initiative with a
strong core public purpose supported by a network of
partner institutions and networks, but similar in focus and
framework to these other schools.
This School of Public Health would interact and build
further on the State Institute of Health and Family Welfare
and the more recently created State Health Systems
Resource Centre, both of which are mandated to strengthen
last
11 S
a
Since 2006 the Public
Health Foundation of
India (PHFI) has
already startedfour
Schools of Public Health
one each at Delhi,
Hyderabad.
Gandhinagar, and
Bhubaneshwar. Other
schools have been
started by Indian
Council of Medical
Research at NIE
Chennai, NICD Delhi,
and other centres.
public health skills and capacities and resources including policy research in the state. Based
on the Magadi Road Campus, these institutions already form a strong core of state
resources that can be creatively upgraded into a more well resourced and comprehensive
multidisciplinary School of Public Health.
3. Additional Features
•
Campus: One alternative would be to creatively evolve the SOPH in the Magadi
road campus which has adequate land for the purpose. This has often been the
main constraining factor in many states.
•
Departments: Keeping in mind the core multidisciplinary nature of public
health, the school will need to develop core expertise in:
>
Public health planning and management
>
Epidemiology & bio statistics
>
Social and
population sciences (Sociology; Social Work, Anthropology,
Demography)
>
Health information and communication systems including IT for health
>
Environmental and occupational health
>
Health policy and health systems (including economics)
This core expertise will be in-house resource and will also draw upon additional
human resources from a supportive network of institutions already available in
the city of Bangalore.
•
University affiliations & Accreditation of courses: To be negotiated with
RGUHS and or later with any National autonomous University or accrediting
body. RGUHS has recently created a new unit of Public Health in the University
campus.
•
Financial Support:
An initial Corpus fund should be provided by the State
supplemented by funds for training from all existing national and state health
programs. In addition, in keeping with the importance of public health systems
research the State should also consider a basic core research endowment to
enhance this evidence gathering and policy development aspect of the SOPH.
4. Governance
A governing body of Advisory and Resource persons drawn from multi disciplinary and
multi-sectoral
backgrounds who are already contributing to
Public Health system
development in the State and/or Country should be formed to support the growth and
development of the institution.
I®
IK
5. Bench Marking
An Academic Research Council to set benchmarks for SOPH at all levels and resource
network that can be brought in to enhance the training/teaching resources. This should
include mission and objectives; curriculum models and instructional methods; public health
competencies; curriculum structure, composition and duration; faculty position and
recruitment, assessment methodology, admission policy; student support and counseling
pedagogy expertise; exchange with other educational institutions; student performance;
interaction of health sector and continuous renewal of the school.
6. Technical Resources
The State including Bengaluru already has the stronger cluster of Public Health Institutions
and multi-disciplinary hubs that are already involved on State and National level in public
health system development and policy advocacy. These include NIMHANS, KACH, SOCHARA
IPH, IHMRJIM, NLSUI, ISEC and so many others already supporting national activities like
NRHM, NHSRC, PHFI and NIHFW. Drawing upon these resources through a network would
be the most cost effective and realistic way to evolve this SOPH.
7. Educational and IT Technology
In keeping with the latest developments in educational and IT technology a planned
continuing medical education program for all cadres of public health staff at all levels should
be operational using distant learning, methods and modules, and supplemented by contact
workshops and telemedicine so that all parts of the State can be reached through a
decentralized and disperse network, enhancing accessibility of training and human resource
development.
8. Courses and Training Programmes
WHO has recommended that Schools of Public Health in the region should focus on
the following:
•
Post basic and post graduate training for public health professionals
•
Pre-service training for public health workers
•
Public health content in pre-service training of other health workers
•
In service training of health workers
•
Continuing education of public health workers and
•
Public health content in the training of workers in related sectors.
Based on the recommendations of the Task force and various expert groups over the
years, the School of Public Health would be involved in:
IS
12^0
> Public Health (Short certificate course)
A 3 month induction course in Public Health for PHC Medical Officers, Dental
Surgeons, Public Health Nurses and AYUSH Physicians posted in co-located
Public Health Services in the State
> Public Health Management (PG Diploma)
A one year or 6 months crash Public Health program and induction training for
existing and or newly appointed District Level Medical Officers on the lines of
the present NRHM
linked
PG
Diploma
in
Public Health
(PGDPHM). Already the State is sending such
Management
candidates to different
institutions in other states but the SOPH could start a similar course and greatly
enhance learning opportunities and career development in the State.
> Public Health Masters programe
A Two year MPH Program for Doctors, Nurses, Dental Surgeons and AYUSH
Physicians before they are appointed as District MOs or even at CHCs or before
promotion
to
higher
levels
of public
health
technical
/administrative
responsibilities.
> Public Health: Special Courses
Focused Public Health Training programmes for special groups that can
supplement the public health cadre derived from bio-medical backgrounds. To
begin with this could include the following:
a.
Public Health Engineers-Young engineers trained for a Masters in Public health
engineering
b.
Health Promoters-Young social scientist trained for a Masters in Health
promotion and advocacy
> Public Health : Induction orientation courses
Shorter Public Health Oriented capacity building courses for PHC team
members including Public Health Nurses, ANM's, Aanganwadi workers and
ASHAs and operationalised through TOTs for staff of the numerous Health
Training centres in the State. If this is based on incremental modules then they
can also be linked into a step ladder type, career enhancement initiative.
> Strengthening Public Health Consciousness: Public Health modules in other
disciplines
The SOPH would ultimately also dialogue with other academic disciplines like
social and behavioral sciences, social work, law, management, engineering,
agriculture, environment, journalism, and evolve Public Health oriented
modules to supplement the teachings in those disciplines and enhance the
overall Public health consciousness in the State and in academia and research.
Simultaneously the SOPH would also work closely with the PSM/ community
12^
medicine
departments
of
medical
colleges,
nursing,
dentistry,
AYUSH
institutions and enhance the multidisciplinary public health competence of the
under graduates from this institutions which will ultimately feed into many
considering post graduate opportunities in public health. A module is also
required for clinicians to orient them in all public health aspects.
9. Competency based Skill Development
Public Health capacity building is increasingly becoming
competency based skill
development with increasing focus on Ihow to do rather than only what and why. Last year
the Ministry of Health along with IPHA,
, WHO India Office and many other public health
resource groups evolved a set of 24 competencies relevant
to the Indian situation and
evolved a table of the level of this c----- '
competency to be taught at DPH; MPH; MHA; and MD
levels. The State school of public health could t
----- -------- 1 use this frame work as a background and
evolve training needs and frame work for each
—i category of public health worker. The
competencies are outlined below.
BOX-1
COMPETENCIES IN PUBLIC HEALTH RELEVANT TO THE INDIAN SCENARIO:
CORE
1. Health Planning
2. Epidemiological Skills
3. Family and Community diagnosis
4. Health Management including Financial Management
5. Managing and Implementing Health Programmes
6. Monitoring and Evaluation including health surveillance
7. Health Promotion including prevention and protection.
8. Training and Capacity Building
9. Research including Bio Statistics and demography
10. Working with community including communitization
11. Building Partnership and Network
12. Public Health Law and Ethics
13. Public Health Biology
14. Environmental Health
15. Socio cultural competency including SEPC analysis
16. Health Policy and advocacy
CROSS CUTTING:
17. Critical analysis and systems thinking including problem solving
18. Leadership
19. Communications including informatics
20. Lifelong learning
21. Equity
22. Human Resources Development
23. Governance and decentralization
24. Conflict resolution
IS!
12-2-
10. Research
There is an urgent need to support the public health policy and system development in the
state through multidisciplinary research that should include focus on:
•
Socio epidemiological research
•
Health system research
•
Health policy research
Health economics
•
Health impact assessment
•
Health policy advocacy and knowledge translation
This will enhance public health policy and system development in the State based on
evidence rather than just expert opinion. This is a major lacuna in public health system
development in the Country and the State School of Public Health should invest strongly in
this dimension of learning activity to enhance sustainable and relevant public health
development in the State. Research projects could be introduced to enhance partnership
with other research and training institutions interested and involved in public health.
Strengthening Public Health Capacity: some additional initiatives
At the stakeholders' consultation a small sub-group deliberated on public health
capacity building focusing on additional initiatives other than the school of public health.
1. Basic orientation and exposure to public health: All persons involved in the
delivery of health care and health services at various levels (right from ASHAs
to Medical Officers) should at least have a basic orientation to and awareness
of the concept and practice of public health. They must be made aware of their
place in the public health system and the specific role they are expected to
execute.
2. Training and capacity building: Apart from the basic orientation, all personnel
within the health system must be equipped with the necessary knowledge and
skills to handle the public health functions at their respective levels and make
them fit for purpose. We need a knowledge (formal/informal, accredited/non-
accredited) skills matrix to define these competencies and assist in the training
and capacity building of the public health cadre.
3.
Infusion of trained public health professionals: Public health must be made
more broad-based. The public health cadre should include the existing health
workforce (equipped with public health training) as well as the emerging class
of qualified and trained public health professionals to fill in the current deficit
m capacity for planning and execution of public health activities. A major
challenge in this regard will be to overcome the inherent tensions between the
entrenched medical fraternity within the establishment and new public health
professionals entering the system, especially when the latter may be better
equipped for certain public health roles. Ways to bridge traditional boundaries
and promote joint efforts will have to be found.
4.
Interdepartmental convergence: Current approaches to public health are
disjointed and lack functional linkages between the relevant Government
Departments concerned with public health, viz. between the Departments of
Health and Family Welfare Services, Women and Child Development, Medical
Education, Public Work? etc. This is a major issue since public health is
essentially interdisciplinary. Interdepartmental convergence is essential for a
more comprehensive approach to public health.
The following recommendations were made:
>
Develop a separate training cadre for building public health capacity in the
state. Set up a faculty development programme to upgrade the training skills in
both the state and regional training institutes
> Training needs assessment and curriculum development for all health cadres
(especially for frontline health workers)
>
Clear policies for graded capacity building and career advancement
>
Develop district public health cadres to facilitate faster promotions and better
career advancement.
>
Health supervisor training, mentoring and supportive supervision for frontline
health workers (particularly LHVs)
> Short term (one month)
management training courses for Taluka Health
Officers
> Clearly define and establish operational roles and responsibilities for AYUSH
doctors in the health system.
>
Capacity building for AYUSH doctors for public health roles with a strong focus
on national health programmes (possibly a three month training at induction
and continual in-service training)
>
Public health training for at least one faculty member in each AYUSH medical
institute with relevant job roles, incentives and
career opportunities
>
Develop the public health curriculum
in
medical
(AYUSH/non-AYUSH)/
paramedical education (e.g. one month NRHM module)
> Cross-pollination between persons involved with medical education and those
providing health services:
a.
Compulsory postings for postgraduate medical trainees in preventive and
social medicine (six months) and those in other specialities like obstetrics
and gynaecology, surgery and general medicine (three months) in PHCs,
CHCs and District Health Offices
b. Systematically involve persons engaged in the delivery of public health
services at various levels as resource persons or faculty in medical
education programmes
> Public health capacity building for private family/general practitioners and their
involvement in public health programmes/activities
A healthy human resource policy must continually balance the
need for functional health teams at primary, secondary and
tertiary levels of health care and also facilitate a judicious mix of
public health practitioners and clinical practitioners and
specialists. The problem of non-availability and uneven
distribution of skilled health care providers is the central
challenge to meeting our health goals
Source: Annual Report to the People on Health, Gol, September, 2010
12-5
CHLP NW 04102016
Background Paper- 14
14. PUBLIC HEALTH IN INDIA SCORE (WWW.COMMUNITYHEALTH.IN)
PUBLIC HEALTH IN INDIA - SCORE
SOCHARA-SOPHEA
What is your PHIN - SCORE?
Note: This compilation of key documents, reports, publications, experiments, events and
initiatives covers most of the important aspects of Public Health Policy and System
Development in India since Independence.
■
As a staff / faculty member of a school of public health and or ngo/ institution / network
involved in public health education, research, system development, policy advocacy and
community health action, it is necessary to be aware of all these important and historical
contributions to India relevant public health.
■
The list covers ten groups of resources and ten key items in each. Together they form a list
of hundred resources that every public health professionals or activist in India should be
aware of.
■
You are invited to tick these hundred items and find your PHIN Score (Public Health in
India score). You should tick this item only if you feel you can actually share the key
features or describe the significance / content of the document / item to another
colleague or to your students. Just knowing the name or having heard vaguely about it is
not enough.
If you cannot tick some of the items then write to us for another complementary
document that gives you web reference for each of these items. (cphe@sochara.org, or
clic@sochara.org)
■
This effort is not to find out whether you have a high or low score but to encourage you to
improve your score so that your team member, students, fellows and others will be
oriented to India relevant Public Health through your informed writings, reflections,
teaching and learning facilitation.
This self assessment score sheet has been tested out on a series of postgraduates in public
health, preventive and social medicine, and fellows and ngo staff members from various
organizations. We thank them for their participation in the test run of this document and
for all the suggestions given.
■
We hope you have enjoyed participating in this small self assessment score sheet that we
are releasing to support team/ faculty / institutional development in Public Health in
India.
From
time
to
time
we
hope
to
update
this
list
or add
supplementary/complementary lists to enhance the India relevant context and focus in all
our efforts.
1 ^6
■
Please note that all the documents/publications that we considered significant for
evolving the score were not available always on the internet. We have currently included
shortnotes/reviews in the list of web references prepared by us as supplementary
documents. We are making efforts to scan the originals with permission where required
and hope to constantly update the score and the reference list.
■
The score may be used freely by all crediting SOCHARA and ensuring that we receive
information about this use, to continue producing revised and updated scoring
instruments. These communications may be sent to clic@sochara.org or
cphe@sochara.org.
Team CPHE
10/1/2013.
-SOCHARA
(Ravi Narayan, Deepak Kumaraswamy, HRM Swamy, Lalit Narayan, Prashanth NS.)
PHIN Score
A. POLICY DOCUMENTS
1. National Health Policy (GOI-1983).
2. National Education Policy (GOI-1986).
3. National Education Policy for Health Sciences (GOI-1989).
4. National Population Policy (GOI-2000).
5. National Health Policy (GOI-2002).
6. National Policy and Programs on Ayurveda, Yoga and Naturopathy, Unani, Siddha
and Homeopathy (GOI-2002).
7. National Pharmaceutical Policy (GOI-2002).
8. Karnataka State Integrated Health Policy (GOI-2003).
9. National Rural Health Mission (GOI-2005 - 2012).
10. National Knowledge Commission Repot of Working group on Medical Education
and Community Health (GOI-2007).
B. EXPERT COMMITTEE REPORTS
1. Health Survey and Development Committee (Bhore, 1946).
2. Health Survey and Planning Committee (Mudaliar, 1961).
PHIN Score
3.Report on Multipurpose Workers (Kartar Singh, 1973).
4. Report on Medical Education and Support Manpcwer (Srivastava, 1974).
5. Report of the Committee on Drugs and Pharmaceutical Industry, Ministry of
Petroleum and Chemicals, GOI. - (HATHI committee, 1975).
6. Health For All: An alternative Strategy (ICSSR- ICMR, 1981).
7. Report of the Expert Committee on Public Health Systems (Draft-GOI-1996).
8. Report of the National Commission on Macroeconomic and Health (GOI-2005).
9 Annual Report to the People on Health (MOHFW - GOI, 2010).
10. High Level Expert Group Report on Universal Health Coverage for India- (GOIPlanning Commission-2010).
C. KEY MONOGRAPHS / REFERENCE BOOKS
PHIN Score
1. Alternative Approaches to Health Care, (ICMR - 1976).
2. Evaluation of Primary Health Care Programmes, (ICMR -1980).
3. Appropriate technology for primary health care, (ICMR-1981).
4. Health and Family Planning Services in India: An Epidemiological,SocioCultural and Political Analysis a Perspective, (Banerji, D. 1985).
5. Experiences in Community Health, (Anubhav Series) (VHAI / Ford Foundation - 1987).
6. State of India's Health Report (VHAI - 1992).
7. Report of the Independent Commission on Health in India, (VHAI - 1997).
8. Towards Equity, Quality and Integrity in Health - Report of the Task Force on Health and
Family Welfare, (Govt, of Karnataka. 2001).
9. Review of Health care in India (CEHAT-2005)
10. Report: Task force on Medical education for The National Rural Health Mission, (MoHFW-
I 'Z-S
D. ALTERNATIVE SECTOR - KEY PUBLICATIONS
1. In Search of Diagnosis: Analysis of the Present System of Healthcare (Patel, A. 1977)
2. Poverty, class and health culture in India, (Banerji. D, 1982)
3. Health Care Which Way to go?: Examination of issues and alternatives, (Bang, A & Patel A, -1982).
4. Rakku's Story: Structures of ill-health and the source of change,(Zurbrigg, S, 1984).
5. Under the Lens - Health and Medicine, (Rao, Kamala. & Patel, Ashwin. 1985).
6. Taking Sides: Choices before health worker, (Sathyamala. C et al, -1986).
7.Medical Education Re-examined, (Mankad, Dhruv. 1991).
8.People's Health in People's Hands - A model for panchayati raj, (Antia, N.H. and Bhatia, K - 1993).
9.Health for All Now!: The People's Health Source Book, (JSA 2000).
. 10. The Rights Approach to Health and Health Care - A compiled review- 2007.
E. GOVERNMENT/NATIONAL PROJECTS EXPERIMENTS
l.Narangwal Project.
2.Najafgarh Project.
3.Singur Project.
4.Gandhigram Insitute of Rural Health and Family Welfare.
S.Chittaranjan Mobile Hospitals.
6.ROME Scheme (Reorientation of Medical Education).
7.Expanded Program of Immunization.
8.Integrated Disease Surveillance Programme.
9Janswasthya Rakshak - Janata Scheme.
lO.State Health Systems Resource Centre- Mitanin
□
F. INSTITUTES OF PUBLIC HEALTH SIGNIFICANCE (NATIONAL)
1. All India Institute of Hygiene and Public Health, Kolkatta.
2. Centre for Social Medicine and Community Health, JNU, New Delhi.
3. Malaria Research Centre/ National Institute of Malaria Research.
4. National Health Systems Resource Centre (NHSRC), New Delhi.
5. National Institute of Communicable Diseases, New Delhi.
6. National Institute of Epidemiology-Chennai.
7. National Institute of Health and Family Welfare, New Delhi.
8. National Institute of Nutrition, Hyderabad.
9. National Institute of Occupational Health, Ahmadabad.
10. National Tuberculosis Institute, Bangalore.
SECTOR1)6 HEALTH/C0MMUN,TY HEALTH RESOURCE CENTRES / NETWORKS (ALTERNATIVE
1. Anusandhan Trust (
CEHAT, Mumbai; SATHI, Pune, and CSER, Mumbai).
2. All India Drug Action Network (AIDAN)
3. Catholic Health Association of India, Secunderabad, (CHAI).
4. Christian Medical Association of India, New Delhi, (CMAI).
5. Foundations for Research in Community Health, Mumbai, (FRCH).
6. Jan Swasthya Abhiyan, (People's Health Movement, India).
7. Medico friend circle, (mfc).
8. Public Health Resource Network, India, (PHRN).
9. Society for Community Health Awareness, Research and Action, Bangalore. (SOCHARA)
10. Voluntary Health Association of India, New Delhi. (VHAI).
iso
H. EVENTS/DEVELOPMENT OF PUBLIC HEALTH SIGNIFICANCE (Mainstream)
l.The Calcutta Declaration - 1999
2. South East Asia Public Health Education Information Network, SEARO - 2003, (SEAPEN)
3. National Consultation on Institutes of Public Health in India - 2004
4. NRHM - Advisory Group for Community Action (AGCA)-2005
5. Public Health Foundation of India (PHFI) - 2006
6. Public Health Global Network, (PHGN) New Directions for Public Health Education in Low and
Middle Income Countries' 2008
7. Strengthening Epidemiological Principles for Public Health Action - SEARO Initiatives
2009
8. National Consultation on Public Health Workforce -WHO India Office, 2009.
9. Indian Public Health Standards, NRHM - 2010.
10. Indian Public Health Association (IPHA) and Indian Association of Preventive and Social
Medicine (IAPSM).
I. EVENTS/DEVELOPMENT OF PUBLIC HEALTH SIGNIFICANCE (Civil Society)
1. Indian People's Health Charter, 2000.
2. Community Health Environment Skill Shares (CHESS) - 2002.
3. The Mumbai Declaration- 2004.
4. Pre Election Policy Briefs/ Health Manifestos for 2004 & 2009.
5. National Human Rights Commission -Right to Health Initiative including Peoples Health
Tribunals-2004.
6. The Second National Health Assembly-2007.
7. Learning Programmes for Community Health and Public Health- Report of a National Workshop.
-2009.
8. People's Rural Health Watch -2009.
9. South East Asia Regional Conference on Epidemiology-WHOSEARO/IEA-2010.
131
10. Community health Wikipedia-2010.
J. GLOBAL EVENTS /DEVELOPMENTS THAT HAVE A NATIONAL CONNECTION /LINKAGE
l.Alma Ata Declaration - WHO UNICEF - (1978)
2.Ottawa Charter on Health Promotion - (1986)
3.World Development Report - Investing in Health (1993)
4.Millennium Development Goals -(1999)
5.People's Charter for Health of PHM -(2000)
6. Commission on Macro Economics and Health (CMH)-2003
7. Global Health Watches -I (2005) and II - (2008) and III- (2011)
8. International People's Health University (IPHU) - (2005 )
9. The World Health Report,- Primary Health Care- Now More Than Ever-(2008)
10. WHO Commission on Social Determinants of Health (WHO CSDH) (2008)
Count the ticks to get your score
Date:
Total Score
? /100
Now check the list of internet references available on line from www.communityhealth.in and or
www.sochara.org
CHLP NW 04102016
Background Paper- 15
15. COMMUNITY HEALTH LEARNING PROGRAMME OF SOCHARA: 52 Week
Curriculum
COLLECTIVE -X
( 8 Weeks) Week: 1-8
Week-1
Week-2
Week-3
Week-4
Week-5
THEMES
COX-BUILDING BLOCKS FOR FELLOWSHIP - LEARNING
TOGETHER _______________________________________________
Understanding oneself - intra personal and Inter personal skills__________
Inside learning, outside learning, learning skills, social skills and selflearning__________________________ ____________________________
What is Health? Physical, Mental, Social, Economic, Political, Cultural.
Ecological. Differentiating Health and Medical Paradigms______________
Values: Equity, rights, gender, social justice, inclusiveness, respect for local
health culture, solidarity, secularism________________________________
Perspective on self-transformation while engaging in social action________
C02-UNDERSTANDING COMMUNITY/ SOCIETY /
DEVELOPMENT AND HEALTH________________________________
What is community, society, family, collective, cooperative
Class, caste, gender, social exclusion, marginalization
Structures, stratification, power dynamics, conflicts, transitions___________
Understanding dalit issue; adivasi issue; agrarian distress;
Community dynamics, perceptions, mobilization, capacity building
C03-UNDERSTANDING COMMUNITY HEALTH/ PUBLIC
HEALTH - PRINCIPLES AND AXIOMS and Primary Health Care
Community Health, Public Health, Community Medicine, Preventive and
Social Medicine________________________________________________
Social, economic, political, cultural, ecological determinants of health and
their inter relationships and dynamics_______________________________
Axioms and principles of Community Health
History and relevance of comprehensive primary health care and strategy /
approach towards health for all____________________________________
Learning from community health initiatives and action for health
C04-SITUATION ANALYSIS OF HEALTH AND HEALTH CARE IN
INDIA_______________________________________________________
Situation Analysis of Health and Health Determinants in India
Regional Disparities and inequalities, trends
Understanding Health care sectors - public, private, voluntary tradition,
people sector and local health tradition - strengthens / weaknesses_______
C05-SOCIAL DETERMINANTS OF HEALTH AND SOCIAL
ACTION_________________________________________________
Social Determinants of Health, action on determinants and social vaccine
Environmental Sanitation and Community led total sanitation
Environmental and Health
Culture and health and cross cultural dialogue
I3J
Week-6
C06-GLOBALIZATIQN AND HEALTH
Political economy of health and forces of liberalization, privatization and
globalization_______
____ What *s Globalization and its impact and consequences and health and equity
Challenge of equity — geographical, gender, social exclusion and
marginalization___________
Challenges: Social Dimension, Health Equity, Health Policy, Access to
---- Health, Disease Risks, Patents, Trade and Health, Technology
(PHM^2^011 RiSkS’ ResPonses’ Alternatives and solidarity from below
Week-7
___ C07-RESEARCH-1 - Measuring Health and Disease
__ Measuring Health and Disease - why and how
“
~
__ Basic Biostatics: Concepts and Tools
Summarizing data- tables, graphics, Pie-charts, Maps, Bar Charts, Line
Graphs, Frequency distribution________
Defining health, Measuring disease frequency
__ Summarising numbers: mean, mode, median, variances, standard deviation
__ C08-HEALTH SYSTEMS AND HEALTH POLICY - (3 days)
___ Health systems and health policy in India - history and evo 1 ution
Health system at different levels - local, district, state, central
__ Issues of access acceptability, affordability, availability, quality
__ CONSOLIDATING FELLOWSHIP PLAN - (3 days)
Planning the fellowship learning journey
__ Goal Setting objectives and learning framework
Interaction with mentor and planning field work
~~
Week-8
IWSi & I S I:SJ 1 Wl-UNDERSTANDINC. COMMUNITY
,
COLLECTIVE-II
( 4 Weeks) Week: 17-20
Week-17
Week-18
Week-19
(Understanding 'and describing a community, Understanding community
priorities,-Understanding.the field placement organisation and their projects,
Social determinants of health and Intersectoral collaboration, Framework for
a Situational miaiYbi
Analysis, Health Care Providers and Medical Pluralism,
- UnderstandingNRHM
P-.....________ _. J and Communitization, Understanding Mental Health)
THEMES
^09-NUTRITIQN, and WOMEN and CHILDRENS HEALTH
Understanding Nutrition & Food Security
Understanding Women’s Health (beyond RCHT
Understanding Child Health
^Understanding Adolescent Health and Life Skill Education
CIO-COMMUNICABLE DISEASES- Community heal thresponses
TB/Malaria/ HIV/AIDS
-------Water borne diseases
Vector borne diseases — Malaria, Dengue, Filaria and other diseases
Cll-RESEARCH-II - Epidemiology ( data and responses)
Basic Epidemiology - What / Who/ When/ Where/ Why/ How
Epidemiological perspective and understanding data
Analysis of situation and data and response________
131^
Week-20
Field Work IT
COLLECTIVE-HI
( 4 Weeks) Week: 29-32
Week-29
Week-30
Week-31
Week-32
FIELD WORK-III
(9 Weeks) Week:33-40
FINAL COLLECTIVE
(10 Weeks)Week:41-49
Week-41
Week-42
Understanding steps in research
C12-NON-COMMUNICABLE DISEASES - Community health
responses____________________________________________________
Heart Disease/ Stroke/ Diabetes
Mental Health and Substance abuse
Cancer/ Accidents etc
Risk reduction, life style change, prevention and promotion
EW2-11NPERSTANDING COMMUNITY HEALTH APPROACH TO
'A PUBLIC\HEALTH
PROBLEM (learning and reflective on the
1
community health axioms)
THEMES
C13-HEALTH TECHNOLOGY AND INNOVATION______________
Understanding rational drug policy and prescription, pharmaceutical policy
Immunization challenges, policy and action_________________________
Appropriate Technology and innovation ,___________________________
Information and communication technology (ICT)____________________
C14-EQUITYIN HEALTH_________________
Promoting community mental health and intervention
Understanding Social Exclusion/ Marginalisation including stigma and
discrimination__________________________________________
People with Disability
C15-RESEARCH- HI- DESIGN AND METHODS
Qualitative Methods in research
Quantitative Methods in research
C-16OCCUPATIONAL HEALTH AND URBAN HEALTH
Occupational health of workers - organized and unorganized
Social security and social protection and occupational safety
Urbanization and urban health challenges___________________________
National Urban Health Mission
WW3-CdNDUCTING FIELD STUDY/COMMUNITY HEALTH
ACTION’
THEMES
C17-HEALTH POLICY___________________________
Understanding health policy process
Understanding health policy history and current situation
Primary Health Care and Health For All
Universal Health Coverage
CIS-PUBLIC HEALTH MANAGEMENT
Understanding Systems and Management Principles______
Public Health Management at community and district levels
Managing partnerships with community and other sectors
Health research project- planning basic steps
IS5
Week-43
Week-44
Week-45
Week-46
Week-47
Week-48
Week-49
Week-50-52
C19-RESEARCH IV
------------- --------------Participatory Action Research ~
~
"----------Knowledge Translation and Advocacy
—
C20-HEALTH MOVEMENTS, SOCIAL MOVEMENTS AND
SOCIAL CHANGE
_______________
Community Health Movement in India and Networking"
'
People s Health Movement (Global, National and State Levels), GHW and
IPHU
Social Movements and Social Change (beyond PHM)
’
Community action for accountability including monitoring , health watches
people’s tribunals (COPASAH)
Decentralization in health and panchayat raj
C21-SPECIAL CHALLENGES
Climate Change and Health
'
AYUSH and Public Health - Challenges and Opportunities including LHTs
War / conflict / disaster / displacement
Agrarian Distress and Farmers Suicide
"
"----------C22-RIGHT TO HEALTH
-----------------------------Right to Health and Health Care, entitlements and fundamental human right
Constitutional and legal aspects of health
Ethics of health and health care
C23-HEALTH ECONOMICS
--------Health Equity and Universal Health Coverage
"----Basics of Health Economics including Health Financing, Budget analysis
Community Financing and insurance
C24SPECIAL COMPETENCIES -1
------------------------ ~—
Leadership
‘ _
Governance and Decentralization
----Partnership and Advocacy
-----------C25SPECIAL COMPETENCIES - II
-----Communication including informatics
Monitoring and Evaluation
'
Conflict Resolution
'
FINAL ASSESSMENT AND PLAN FOR NEXT STEPS /
FINALIZATION OF REPORTS ( see FA-1, FA-2)
THE BEGINNING OF COMMUNITY HEALTH JOURNEY
J
25 Week of collective teaching learning
24 weeks of field work
3 week final assessment and next steps
Total 52 Weeks
CHLP NW 04102016
Background Paper- 10
16. COMMUNITY HEALTH ORIENTED, COMPETENCY BASED MODULES BY SOCHARA
FOR TRAINING IN INDIA (RGIPH-MPH HONORS COURSE)
16.1 - VALUES ORIENTATION IN PUBLIC HEALTH
16.2 - SOCIO-CULTURAL AND COMMUNITY HEALTH
16.3 - PLURAL HEALTH SYSTEMS
Community Health Oriented, Competency based Special Modules
for Community/Public Health/Sociai Work Training in India
Introduction
The Community Health Learning Programme (CHLP) of SOCHARA is an interactive,
participatory, person centric, field based programme which has evolved since 2003. It caters
to young people from multi-disciplinary backgrounds wanting to explore community health
and take-up practice of community health as a career.
The Rajiv Gandhi University of Health Sciences established the Rajiv Gandhi Institute of
Public Health and Centre for Disease Control (RGIPH&CDC), Bengaluru in 2013 and
SOCHARA was invited to be part of the Advisory Committee to evolve a three year Masters
of Public Health (Honors)1 course to be recognised by University Grants Commission and to
be an innovative, India relevant training with some special additional modules and features.
Two members of SOCHARA (Drs. Ravi Narayan and Rahul ASGR) were part of the
Advisory Committee and based on a review of syllabus of existing MPH courses in India
identified areas lacking in these and introduce some additional competency based modules
and re-orient some existing ones through a consultative process.
SOCHARA was then requested to develop the syllabus for some of these unique modules and
different team members contributed to evolving them in designated framework suggested by
RGIPH.
These modules were developed incorporating ideas and experiences of the ongoing
Community Health Learning Programme and were submitted to RGIPH for their use and
further modification/adaptation based on teaching-learning experience for different batches.
SOCHARA is uploading these modules to its website, www.SOCHARA.org. so that other
community/public health learning programmes and courses can use and adapt it according to
their needs and contexts:
1. Values Orientation in Public Health (Contributors Narayan and Prasanna Saligram)
2. Socio-Cultural and Community Health
3. Universal Health Policy
4. Ecological Sensitivity
5. Plural Health Systems
6. Global and International Health
7. Public Health Capacity Building
8. Research Competency
Ravi Narayan, Thelma
Each of these modules is available separately on the website.
'Rajiv Gandhi Institute of Public Health and Centre for Disease Control. Ordinance
Governing Master of Public Health (Honors) Regulations and Curriculum. Karnataka:
Department of Public Health Rajiv Gandhi University of Health Sciences; 2014
SOCHARA
May 2016
133
16.1 COURSE ON VALUE ORIENTATION IN PUBLIC HEALTH
(5 Credits, 3 Weeks Teaching Learning with 14 days of sessions)
•
•
•
•
•
VALUE ORIENTATION IN PUBLIC HEALTH
• Lectures and lecture discussions
Right to Health
• Case scenarios
Equity and health
• Student presentations
Gender and health
• Journal Club
Ethics/integrity and health
Quality in health
Source: RGUHS - MPH (Hons)
Regulations and Curriculum (2014)
1. OBJECTIVES
a. To understand and appreciate the values dimension in public
health
b. To be able to apply these values
i. in the practice of public health
ii. Programmes related to achievement of Health for All
To
appreciate the challenges in the application of these values
c.
2. SPECIFIC OBJECTIVES
To explore, appreciate and apply the following value dimensions in Public
health practice:
a. Right to Health
b. Equity in Health
c. Gender equality
d. Ethics and Integrity
e. Quality in public health
3. ASSESSMENT
a. Formative Assessment- based on participation in group discussions and
critical reading sessions
b. Summative- Written test with short questions and case scenarios
4. EVALUATION
Participants will evaluate the sessions and programs of the above module,
especially regarding the topics, quality of content, delivery of content and
assessment
5. ORGANISATION
General introduction and exploration of documents- 2 days
Right to Health - 3 days
Equity and health- 3 days
Gender and health- 3 days
Ethics/integrity and health- 3 days
f. Quality in health- 3 days
g. Assessment- 1 day
(Three days for each value includes lecture discussions. Critical reading. Student
presentations. Group discussions)
a.
b.
c.
d.
e.
•5^-
\ 3?^
6. SCHEDULE based on experience of 2014-17 batch of RGIPH
which incorporated the 5th National Bio-ethics Conference
sessions into it as part of learning of Ethics/integrity in health (Can be adapted further according to context, situation and
available resource persons)
Time
10 am - 1 pm
1.30 pm - 3.00
pm
3.15 pm - 4.30
pm
10 am - 1 pm
1.30 pm - 4.30
pm
10 am to 5 pm
Refer to
programme
Day One
Theme______ ____________________________
Introduction to Values and their role in public
health practice____________________________
Review key documents to identify values
• Alma Ata Declaration
• National Health Policy 2002
• Peoples Health Charter 2000
• NRHM Mission Statement 2005
EQUITY AND HEALTH:
• Understanding equity and equality
• Inequalities in health status, access to
healthcare and services, and health
enhancing environments;
• Inequities due to geography, gender,
marginalization and social exclusion
Case studies on Equity Challenges in Bhopal,
CHESS and Environmental Health
Day Two
EQUITY AND HEALTH(continued)
An introduction to Equity gauge:
• Measuring equity, indices and equity
stratifiers
• Equity lens, equity gauges, equity
assessment, equity oriented health system
_______and health equity audits______________
Case Study on Regional Disparities in Health in
Karnataka (2001)
Planning Exercise on Equity and regional
Inequalities in Health in Karnataka - Current
(DLHS 2012-13)
Day Three
Field visit to Ayush Grama, Gollahalli,
Devanahalli Taluk (field practice area of I-AIM)
to explore the community context of the values Right to Health, Equity in Health., Gender
equality, Ethics and Integrity, Quality in public
health
(Or any other suitable community field practice
area can be chosen)
Day Four, Five and Six
Attend National Bio-ethics Conference at St Johns
National Academy for Health Sciences. An
Method
Interactive Discussion
Lecture
Discussion
Case Study
Lecture
Discussion
Presentation and
planning exercise
Group discussions
with the community each student will focus
on one value and two
on quality (Anganwadi
Centre and Health
Centre)
All students will be
allotted certain
10 am - 1 pm
2.00 pm - 3.00
pm
3.15 pm - 5.00
pm
0 am - 1 pm
indicative list of public health oriented plenaries sessions or
and
parallel
sessions
(workshops
and presentations to focus
presentations) will be given to the students to on and present
guide their participation. Workshops to attend:
summaries at
1. Corruption in healthcare- Working towards
debriefing session
solutions
indicated later in the
2. Professional and civil society
schedule.
perspectives on challenges and
approaches in ethical practice of
occupational health in India
3. Accountability for Reasonableness:
Addressing Challenges in Public Health by
Harmonizing Ethics, Economics & Evidence
4. Public Health Ethics
5. Policy Ethics and Just Health Systems: The
Pursuit of People-Centred Care
6. WHO session on integrity and corruption in
healthcare
Plenaries for later discussion:
1. Day 1- PLENARY -1: Keynote address 2
2. Day 2- PLENARY
Ill: Keynote
address- 1,2 and 3
3. Day 3- PLENARY - V: Keynote address
1 and 2
________ Day Seven
GENDER AND HEALTH:
• Understanding gender, roles, unequal
social and economic variables and power
• Gender inequity including vulnerabilities, Lecture
nature-severity and symptoms of health
Discussion
problems, health seeking behaviour and
long term health and social consequences
• Global issues related to gender
• Victoria Hospital - Bums report: Gender
Case study
and Epidemiological Perspective
• Gender, Sanitation and Mental Health- A
study
Case study
Group discussion on Gender and HealthChallenges in Public Health and Primary Health
Practice (From participants perspective)
Day Eight
GENDER AND HEALTH (continued)
• Gender discrimination and violence
against women
• Legal aspects related to gender
• Developing gender sensitivity through a
Lecture
Discussion
1.30 pm - 4.30
pm
10 am - 1 pm
1.30 pm - 3.15
pm
3.30 pm-4.30
pm
10 am - 1 pm
1.30 pm-4.30
pm
10 am - 1 pm
1.30 pm - 4.30
pm
10 am - 1 pm
10 am - 4.30
pm
gender lens
Debriefing on Ethics and Integrity in Health
(NBC)
Day Nine
RIGHT TO HEALTH-1:
• The Right to Health and Health Care
including theoretical perspectives,
political economy of assault on health,
paradigm shift from charity to rights,
RIGHT TO HEALTH-2:
• Universal Declaration on Human Rights
and the International Covenant on
Economic, Social and Cultural Rights and
the emerging rights language in various
international declarations.
RIGHT TO HEALTH-3^
The Right to Health movement at national,
regional and international level.
Day Ten
Reviewing the Universal Declaration on Human
Rights and the International Covenant on
Economic, Social and Cultural Rights
QUALITY IN HEALTH-1:
~
• Understanding dimensions of quality,
tools of quality assurance, standards
• Quality improvement programs, quality
circle and accreditations
• Balancing quality and equity
Day Eleven
QUALITY IN HEALTH -2:
• Understanding current standards Reviewing Indian Public Health
Standards (NHM) with exercises
National Accreditation Board for
Hospital standards
Understanding standards under
Clinical Establishments Act
Day Twelve
Case Discussion of sterilisation deaths in
Chhattisgarh and exploring the compromise in
all the five values- Right to Health, Equity in
Health., Gender equality, Ethics and Integrity,
Quality in public health___________________ __
Day Thirteen
Seminar based on journal articles on all the
values. Each student will be allotted one
article.
Presentation of student
assignments and
summaries
Lecture
Discussion
Lecture
Discussion
Lecture
Discussion
Review
Lecture
Discussion
Review and exercises
Review and exercises
Presentation of one
paper each by the
students
10 am - 1 pm
__________
Session l(Values: Philosophy, relevance and
guidelines)
______ _________ Day Fourteen
Summative Assessment- Written test with
short questions and case scenarios
7. LEARNING RESOURCE MATERIAL
I. Exercises and journal club
a. Values Exercise
i. World Health Organization. Alma Ata Declaration. Geneva World Health
1978.
Available
at:
www.who.int/publications/almaata_declaration_en.pdf
ii. National Health Policy-2002. Government of India. Available at:
http://mohfw.nic.in/showfile.php?lid=2325
iii. People’s Charter for Health. Peoples Health Movement. Available at:
http://www.phmovement.org/en/resources
iv. A Promise of Better Healthcare Service for the Poor. National Rural
Health Mission. Ministry of Health and Family Welfare. Government of
IndiaAvailable
at:
www-chsj.org/uploads/l/Q/2/1/10215849/entitlement endish.ndf
b. Review Exercise for Rights
i. The Universal Declaration of Human Rights, Available at:
http://www.un.org/en/documents/udhr/
ii. International Covenant on Economic, Social and Cultural Rights.
Available
at:
http://www.ohchr.org/en/professionalinterest/pages/cescr.aspx
c. Understanding current standards
i. Indian Public Health Standards. Available at:
http.//nrhm.gov. in/nhm/nrhm/guidelines/indian-public-healthstandards.html
ii. National Accreditation Board for Hospitals & Healthcare Providers - See
more at;http://www.nabh.co/Index.aspx#sthash.MuMqHOFw.dpuf
iii. Draft Minimum Standards. The Clinical Establishments (Registration and
Regulation) Act, 2010. Available at:
http://clinicalestablishments.nic.in/cms/Home.aspx
d. For Journal Club
i. Session l(Values: Philosophy, relevance and guidelines)
1. Stewart KA, Keusch GT, Kleinman A. Values and moral experience in
global health: Bridging the local and the global. Glob Public Health
2010;5(2):l 15-21.
2. Jesani A, Barai T. Ethical guidelines for social science research in health.
Mumbai Centre for Enquiry into Health and Allied Themes. 2000
3. Mann JM, Gostin L, Gruskin S, Brennan T, Lazzarini Z, Fineberg HV.
Health and human rights. Health Hum Rights. 1994;6-23
ii. Session 2(Values: Evidence gathering and analysis)
4. Babu GR, TN S, Bhan A, Lakshmi JK, Kishore M. An appraisal of the
tuberculosis programme in India using an ethics framework. Indian J
Med Ethics.2014;H(l):12-15
5. Subramanian S, Nandy S, Irving M, Gordon D, Lambert H, Smith GD.
The mortality divide in India: the differential contributions of gender,
caste, and standard of living across the life course. Am J Public Health.
2006;96(5):818.
6. Roy T, Kulkarni S, Vaidehi Y. Social inequalities in health and nutrition
in selected states. Econ Polit Wkly. 2004;677-83.
IL Basic Reading
a. Values(General)
i. Public Health Management at District Level - Concepts and Values. A
hand out from the project on “Integrated management of public health
programmes at district level. SOCHARA-SEARO
ii. Issues of concern and an agenda for action. Towards Equity, Quality
and Integrity in Health: Final Report of the Taskforce on Health &
Family Welfare. Government of Karnataka; 2001:xv-xxiv
iii. Macinko J, Montenegro H, Nebot Adell C, Etienne C. Renewing
primary health care in the Americas. Revista Panamericana de Salud
Publica. 2007
b. Right to Health
i. Shukla A. The Rights Approach to Health and Health Care- A
Compiled Review. MASUM Publications; 2007
ii. London L. What is a human rights-based approach to health and does it
matter? Health Hum Rights. 2008; 10(l):65-80
c. Equity and health
i. Feachem RG. Poverty and inequity: a proper focus for the new century.
Bull World Health Organ. 2000;78(l): 1-2.
ii. Anand S. The concern for equity in health. J Epidemiol Community
Health. 2002;56(7):485.
iii. Braveman P, Gruskin S. Defining equity in health. J Epidemiol
Community Health. 2003;57(4):254-8.
iv. Global Equity Gauge Alliance, Concepts and Definitions, Available
from http://www. gega. org. za/concepts.php
d. Gender and health
i. Garcia-Moreno C. Gender and health: Technical Paper. Geneva World
Health Organ. 1998;
ii. Narayan T. Gender and power issues in medical education. Gender and
Medical Education : Report of National Consultation and Background
Material. Eds: Jesani A and Neha M. Centre for Enquiry into Health
and Allied Themes, Mumbai: 2002
iii. World Health Organization. Integrating gender perspectives in the
work of WHO: WHO Gender Policy. 2002;
iv. Gaitonde R. Community medicine: incorporating gender sensitivity
EconPolitWkly. 2005; 1887-92
~
e.
Ethics/integrity and health
Macer DRJ. A cross-cultural introduction to bioethics. Eubios Ethics
Institute Prakanong, Bangkok, Thailand; 2006
ii.
Jesani A, Barai T. Ethical guidelines for social science research in
health. Mumbai: Centre for Enquiry into Health and Allied Themes
2000
iii.
Ethical Guidelines for Biomedical Research on Human
Human Participants.
Participants.
Indian Council for Medical Research. New Delhi: 2006
iv.
Timms O.
i.
f. Quality in health
i. Quality concepts and tools. Quality and accreditation in health care
services, a global review. World Health Organization, Geneva'
2003;51-102
ii. Gupta JP and Sood AK. Quality of Care in Contemporary Public
Health: Policy, Planning, Management. Apothecaries Foundation- New
Delhi, 2005: 2.57-2.61
iii. Richard KS. Quality Assurance and Quality Improvement in Public
Health and Preventive Medicine. Eds: Rober Wallace. McGraw Hill
Medical: New York, 2008: 1277- 1280
III. Additional Reading
a. Values(General)
i.x. ^uixiiuimng
Confronting Commercialization
commercialization of
oi Health Care! Towards the Peoples
Health Assembly Section-5. National Coordination Committee Jan
Swasthya Sabha; 2000
ii. Benatar SR. Moral imagination: The missing component in global
health. PLoS Medicine. 2005;2(12):e400.
iii. Stewart KA, Keusch GT, Kleinman A. Values and moral experience in
global health: Bridging the local and the global. Global public health
2010;5(2): 115-21.
b. Right to Health
1. Mann JM, Gostin L, Gruskin S, Brennan T, Lazzarini Z, Fineberg HV.
Health and human rights. Health Hum Rights. 1994;6-23.
ii. International Dual Loyalty Working Group, Physicians for Human
Rights (US), University of Cape Town. School of Public Health, Primary
Health Care. Dual loyalty & human rights in health professional
practice, proposed guidelines & institutional mechanisms. Physicians for
Human Rights; 2002.
iii. The assessment of the Right to Health and Healthcare at the country
level. A People’s Health Movement Guide; 2006
c. Equity and health
IlkS
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
Sen G, Iyer A, George A. Structural reforms and health equity: a
comparison of NSS surveys, 1986-87 and 1995-96. Econ Polit Wkly.
2002; 1342-52.
Sen A. Why health equity? Health Econ. 2002; 11(8):659-66.
Gupta I, Datta A. Inequities in health and health care in India: can the
poor hope for a respite. Inst Econ Growth: Delhi Univ. 2003
Schuftan C. Poverty and inequity in the era of globalization: our need to
change and to re-conceptualize. Int J Equity Health. 2003;2(l):4.
Roy T, Kulkarni S, Vaidehi Y. Social inequalities in health and nutrition
in selected states. Econ Polit Wkly. 2004;677-83.
Srinivasan K, Mohanty S. Deprivation of basic amenities by caste and
religion: Empirical study using NFHS data. Econ Polit Wkly. 2004;72835.
Dilip T. Extent of inequity in access to health care services in India. Rev
Health Care India. 2005;247-68.
Subramanian S, Nandy S, Irving M, Gordon D, Lambert H, Smith GD.
The mortality divide in India: the differential contributions of gender,
caste, and standard of living across the life course. Am J Public Health.
2006;96(5):818.
Subramanian S, Kawachi I, Smith GD. Income inequality and the double
burden of under-and ovemutrition in India. J Epidemiol Community
Health. 2007;61(9):802-9.
Linares-Pereza N, Lopez-Arellano O. Health equity: conceptual models,
essential aspects and the perspective of collective health. Soc Med.
2008;3(3): 194-206.
d. Gender and health
i. Garcia-Moreno C. Gender and health: Technical Paper. Geneva World
Health Organ. 1998;
ii. Narayan T. Gender and power issues in medical education. Gender and
Medical Education : Report of National Consultation and Background
Material. Eds: Jesani A and Neha M. Centre for Enquiry into Health and
Allied Themes, Mumbai: 2002
iii. World Health Organization. Integrating gender perspectives in the work
of WHO: WHO Gender Policy. 2002;
iv. Gaitonde R. Community medicine: incorporating gender sensitivity.
Econ Polit Wkly. 2005; 1887-92
e. Ethics/integrity and health
i. Francis CM. Medical Ethics. New Delhi: Jaypee Publications; 1993
ii. Teaching of medical ethics in Undergraduate Medical Education.
Proceedings of Workshop. Bangalore: RGUHS; 1999
iii. Indian Journal of Medical Ethics
16.2 SOCIO-CULTURAL AND COMMUNITY HEALTH
COMPETENCY-1
(5 Credits, 3 Weeks Teaching Learning)
SOCIO-CULTURAL AND COMMUNITY HEALTH COMPETENCY !
• Social Determinants of Health
• Lectures and lecture discussions
• Social and behavioral sciences
• Case studies
• Health economics
• Visits */Postings/ Study /Internship
• Anthropological perspectives in health
to district and community level
• Political economy of health
centers to explore social determinants
• Community empowerment skill
training
Source: RGUHS - MPH (Hons)
_______________ Regulations and Curriculum (2014)
1. GENERAL OBJECTIVES - (COURSE DESCRIPTION):
Students in this competency would be exposed to alternative paradigms in
addressing issues of health and health care. They would learn to appreciate how
health and ill health are produced at the intersections between biology, culture,
politics and society and why perspectives other than the biomedicine are needed
to address the complexity of health, diseases and health system management.
They would learn core concepts and theories in community health and learn the
scope and challenges in building healthy communities.
2. SPECIFIC OBJECTIVES - (LEARNING OUTCOMES):
a. r
Develop sensitivity to the need for plural perspectives, more specifically
the contributions of social sciences to public health
b. Develop a critical and deeper understanding of notions of ‘culture’,
power’ and ‘actors’ as these shape the domain of health, health systems
and its management
c. Ability to examine the social, cultural, economic
and political
determinants of health in order to develop strategies to improve the
health of communities and populations
d. Acquire skills in engaging with different kinds of data - visual text,
narratives, ethnography
3. CONTENT/LEARNING METHODS/ORGANISATION
(INTEGRATED):
i.
WEEK 1: SOCIAL AND CULTURAL CONTEXT OF HEALTH
AND ILLNESS
In this week, students would develop a deeper understanding of the contributions
of social sciences, more specifically, Sociology, Anthropology, Economics and
Political Science to understand the social, cultural, economic and political context
of health and health care. They would learn about how to approach the complex
reality of health and diseases in society. This would involve a discussion of what
is health, who constitutes a community, what are some of the analytical
lip-]
perspectives in social and behavioral sciences that help to understand community
health including the classic social science debate on structure and agency. The
perspective building exercises in this week would be carried out through lectures
followed by discussions, watching a documentary film followed by discussion and
analyzing two case studies from two different cultural contexts.
MODES OF TEACHING
•
Talk- Reflection on Professional Journey by SOCHARA into Community
Health discovering the Social- Economic- Political- Cultural- Ecological
determinants of health and potential for action on these determinants- followed
by discussion (as an ice breaker)
•
Film ‘Yesterday’ that documents the travails of a poor young mother named
‘Yesterday’ infected with HIV/AIDS along with her husband who had been a
migrant worker in the South African mines. Based in South Africa, the film
succinctly captures the economic and gender dynamics at household level,
plight of migrant mine workers, disease related stigma practices at community
level, health system constraints to access timely treatment and the role of
individual agency to cope with the illness hoping to give a better future for the
next generation through education.
•
Case study discussion:
o Case Study 1 ‘Rakku’s Story’ (India) in Shiela Zurbrigg Structures of
ill health and social change 1991
o Case Study 2: Jean’s story (Haiti, Africa) in Paul Farmer Infections
and Inequalities
ii.
WEEK 2: SOCIAL DETERMINANTS OF HEALTH, POLITICAL
ECONOMY OF HEALTH
During this week, students would learn about evidence on health inequities at a
global level and learn to identify the social and political determinants of health
that explain such inequities. They would learn how politics is key to understand
social determinants of health as factors like gender, caste, residence, education as
determinants of health are neither natural nor inevitable. It would discuss the
recent WHO Commission on Social Determinants of Health framework (2008)
and unpack the role of different actors and processes that have contributed to
health inequities at global, nation and local levels. The discussion on
understanding social determinants of health would essentially take a political
economy approach. Students would be taught to examine actions taken on social
determinants of health through specific case studies at international, national and
local levels.
MODES OF TEACHING/LEARNING
• Field visits and writing health diaries. Students would be divided in groups.
They would visit different communities and prepare health diaries based on
I
household and community experiences of illness, seeking care, managing
chronic illness if any, barriers faced identifying these at different levels
(household, community, health system). These dairies would be presented in
the class for discussion.
• Field visits would also involve observations of Health and Nutrition Days as
part of inter-sectoral actions within the NRHM.
• Facilitating class debates on specific actions on social determinants of health
undertaken in key select sites.
• Group work based on case scenarios (eg: infant mortality, diabetes, maternal
health) identifying social determinants of health and possible actions (what,
who, where) that could be taken to intervene in these determinants.
iii.
WEEK 3: HEALTH ECONOMICS AND HEALTH SYSTEM
FINANCING
During this week, students would learn about key principles of health economics
in terms of the role of the state, market and community in health care provision.
These will be discussed in the philosophical debates about theories of social
justice and health, health equity and role of the state. Topics on health spending in
India and other countries, out of pocket expenditure, need, demand and supply of
health care, economic rationale for government interventions, subsidies, public
provision, cash transfer schemes, performance based financing would be
discussed. Students would learn the larger economic and political context within
which provision of health care is placed. They would be equipped with skills to
evaluate different health financing measures as part of health systems reforms in
different countries.
MODES OF TEACHING
• Lectures followed by discussion
• Film Sicko on insurance in US followed by discussion
4. ASSESSMENT
d. Formative Assessment- based on participation in group discussions and
critical reading sessions
e. Summative- Written test with short questions and case scenarios
5. EVALUATION
Participants will evaluate the sessions and programs of the above module,
especially regarding the topics, quality of content, delivery of content and assessment
6. LEARNING RESOURCES MATERIALS
i. WEEK ONE:
• Cecil Helman Culture, Health and Illness (Fifth Edition), Chapters 5 and 15
• Nichter, Mark (2003) Smoking: What does culture have to do with it?
Addiction, 98: 139-145
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Austin, La Toya T et al (2002) Breast and cervical cancer screening in
Hispanic Women: A literature review using a health belief model, Women's
Health Issues, Vol. 12(3): 1-7
Arthur Kleinman, Leon Isenberg and Byron Good 1978 Culture, illness and
care: Lessons from Anthropologic and cross-cultural research, Ann Internal
Medicine 88 (2): 251-258
Gilson, Lucy et al (2011) Building the field of health policy and systems
research: Social Science matters, PLoS Medicine, 8 (8)
NIH (2005) Theory at a glance: A Guide for Health Promotion Practice (2nd
edition) select chapters
ii. WEEK TWO:
James Hargreaves et al (2011) The social determinants of tuberculosis: From
Evidence to Action, American Journal ofPublic Health, 101: 654-662
Iyer, Aditi, Asha George and Gita Sen (2007) Systematic hierarchies and
systematic failures, Economic and Political Weekly, Vol. XLII (8)
Marmot M. Social determinants of health inequalities. Lancet 2005; 365:
1099-1014.
WHO (2008) Closing the gap in a generation: Health equity through action
on social determinants of health. Geneva: World Health Organization
http :/www. who. int/social_determinants/the
commission/fmal
report/en/index.html (Executive Summary)
Erik Blas et al (2008) Addressing social determinants of health inequities:
What can the state and civil society do? The Lancet 372: 1684-1689
Paul Farmer et al (2006) Structural violence and clinical medicine, PLoS
Medicine, 3(10): 1-6
Sabrina T. Wong et al (2011) Enhancing measurement of primary health care
indicators using an equity lens: An Ethnographic study, International journal
for equity in health, 10: 1-12
Minkler, M., Wallace SP and McDonald, M (1994) The political economy of
health: A useful theoretical tool for health education practice, International
Quarterlyfor Community Health Education, 15(2): 111-126.
Prasad, Amit Mohan et al (2013) Addressing the social determinants of health
through health system strengthening and social determinants of health: The
case of the Indian National Rural Health Mission, Global Health Action 6: 111
The physician as public health professional in the 21st century. JAMA 2008;
300 (24):2916-2918.
iii. WEEK THREE
Culyer AJ and JP Newhouse (eds.) (2000): Handbook of Health Economics
(Volume 1), Elsevier Science. (Chapter 2: An overview of the normative
economics of the health sector by Jeremiah Herley, pp. 55-118.)
\So
•
•
Lagarde, Mylene, Haines Andy and Palmer, Natasha (2007) Conditional cash
transfers for improving uptake of health interventions in low and middle
income countries: A systematic Review, JAMA, Vol. 298 (8)
Cutler, David M. and Jonathan Gruber (1996) "Does Public Insurance Crowd
Out Private Insurance?" The Quarterly Journal of Economics, 111 (2): 391430
•
M. GovindaRao & Choudhury, Mita, (2012) Health Care Financing Reforms
in India, Working Paper, 12/100, National Institute of Public Finance and
Policy, New Delhi
•
World Bank (1993) World Development Report 1993: Investing in Health,
Oxford University Press. (Chapter 3: The roles of the government and market
in health).
SOCIO-CULTURAL AND COMMUNITY HEALTH
COMPETENCY - II
(5 Credits, 3 Weeks Teaching Learning)
1. GENERAL OBJECTIVES
SOCIO-CULTURAL AND COMMUNITY HEALTH COMPETENCY-II
• Communitisation: community needs
• Lectures and lecture discussions
assessment, community participation
• Case studies
and working with community
• Visits */Postings/ Study to district
• Social exclusion and Vulnerable
and community level centers to
groups- working child, elderly, people
explore social determinants
with disabilities, Dalit and Adivasi,
• Community empowerment skill
sexual minorities
training (During internship)
• Community action on Social
determinants
Source: RGUHS - MPH (Hons)
• Community mental health
Regulations and Curriculum (2014)
• Foundations of Social Care Policy
a. To understand the principles of Communitisation: community
needs assessment, community participation and working with
community
b. To understand the concept of social exclusion, marginalization and
vulnerability and health related challenges with focus on specific
groups
c. To be oriented towards community action on social determinants
including social exclusion and vulnerability
d. To understand community mental health and community
responses
e. To be oriented towards Social Care Policy and its key component
as part of public health policy
2. SPECIFIC OBJECTIVES
a. To be able to perform community needs assessment and mobilise
communities for monitoring and action
b. To understand the concept of social exclusion, marginalization and
vulnerability and health related challenges with focus on
i. working child,
ii. elderly,
iii. people with disabilities,
iv. Dalit
v. Adivasi,
vi. sexual minorities
c. To explore the basic principles and axioms of community health
action with a focus on social determinants
d. To explore the challenges of mental health at the community level
and evolve responses at both community and primary health care
system levels
e. To be conversant with all social care policies and actions that
affect health and well-being, and explore convergence health and
social policy
3. CONTENTS
•
•
•
•
CommunitisationCommunity needs assessment
Community monitoring
- Mobilising Community participation
Community action for health
Social exclusion and Vulnerable groups
Working child
- Elderly
- People with disabilities
- Dalit
Adivasi
Sexual minorities
Community action on Social determinants
Improving basic needs and living conditions
Fair employment and decent work
Social protection across the life course
- Tackling inequalities of power, money and resources
Political empowerment- inclusion and voice
Measurement of problems and measuring impacts of action
Community mental health
Mental Health Situation in India: The Challenges
Recognition of The Rights of Persons with Mental Illness
National Responses to Mental Health Challenges
o National Mental Health Programme
o Community-Level Mental Health Services Including Family
Support
H^CrO
,
•
o Traditional Responses to Mental Health
- Human Resource Development, Training And Resreach
- The Evolving new Mental Health Policy
Foundations of Social Care Policy
- Legislation
Social Insurance
Social Care Policy and Support
- Community based action
4. LEARNING METHODS
a. Lecture discussions
b. Case Studies- ICMR Monographs, ANUBHAV Series and others
c. Community visits and interactions with NGO’s, PHC teams involved
in community action
d. Interactive visits to NGO’s and government programmes involved with
socially excluded and vulnerable groups
e. Interactive visits to NGO’s and government programmes involved with
mental health
f. Journal clubs and seminars
g. Simulation games like Monsoons and Chikkanahalli
5. ORGANISATION
a. Communitisation- 2 days
b. Social exclusion and Vulnerable groups- 5 days (including field visit)
c. Community action on Social determinants- 5 days (including field
visit)
d. Community mental health- 4 days (including field visit)
e. Foundations of Social Care Policy- 2 days
6. ASSESSMENT
a. Formative Assessment- based on participation in group discussions and
critical reading sessions
b. Summative- Written test with short questions and case scenarios
7. EVALUATION
Participants will evaluate the sessions and programs of the above module,
especially regarding the topics, quality of content, delivery of content and
assessment
8. RESOURCE MATERIALS (Being prepared)
16.3 PLURAL HEALTH SYSTEMS COMPETENCY
(5 CREDITS, 3 WEEKS TEACHING LEARNING)
_______________PLURAL HEALTH SYS EMS COMPETENCY___________
• Plural public health systems
• Lectures and lecture discussions
• Local health traditions
• Visits */Postings/ Study
/Internship to district and
• Local healers and
community level centres where
• Alternative systems of healthcare
AYUSH staff are located
(AYUSH/TCAM)
•
Interactions with local healers,
• Mainstreaming AYUSH in public health
AYUSH doctors and AYUSH
• Trans disciplinary research- an
institutions including department
introduction
of AYUSH and I-AIM
Source: RGUHS - MPH (Hons)
Regulations and Curriculum (2014)
1. GENERAL OBJECTIVE
•
•
To understand the potential of Plural Health systems
To understand the plurality within the health systems and
approaches for community health/ public health through plural
health systems
2. SPECIFIC OBJECTIVES
•
•
•
•
•
To explore the plural options, and opportunities in the public
health systems and services in India(AYUSH), Japan, Sri Lanka,
China
To explore the availability, access, content and process of health
care through local health traditions (LHTs) and all other Indian
Systems of Medicine and Homeopathy in the country (AYUSH)
To understand the role of LHTs and AYUSH in primary health
care and Universal health coverage
To explore the Public Health policy development and challenges in
evolving and sustaining a plural health policy and systems
To explore the intercultural aspects and challenges of health
seeking and health care in a pluralistic health system
3. CONTENTS
The contents of the above module are as follows:
i.
Introduction to Plural Health Systems
• Plural Health systems an overview
• Understanding Plurality within health systems
• Mapping Plural Health systems in India and selected other
countries
ii.
Culture, health and disease/illness
• Concepts of medical anthropology relating to pluralism and public
health such as
i. Intercultural aspects of knowledge systems
Epistemology
Inter/trans disciplinarity
Hierarchical pluralism
Medical absorption
Other concepts in pluralisms such as iromanticism,
’
syncretism, co-evolution, complematarity, integration
iii.
Understanding the role of Local health traditions and Local healers
including traditional birth attendants
• Community based Oral Health traditions in rural India
• Contemporary History of community based oral health traditions
• Local Health traditions and AYUSH
• Mapping Local Health Traditions in India
• Our living Medical heritage; Examples of successful local healers
• Documenting Local health Traditions
• A participatory approach in assessing health traditions
• Community health registers
• Community role of Indigenous healers
• Validity of documentation and assessments
• Health at our door steps: Home herbal garden
iv.
Ecosystems and health
• Traditional medicine and efforts to medicinal plant conservation,
• Protection of traditional knowledge,
• Relevance biodiversity and ecosystem services in health and
wellbeing including therapeutic landscapes
v.
Understanding the principles and practice and public health
contributions of Alternative health care Systems (Ayurveda, Yoga,
Unani, Siddha, Sow-rigpa and Homeopathy)
• Introduction to Ayurveda: History, Concepts, Principles, current
infrastructure and practice
• Introduction to Unani: History, Concepts, Principles, current
infrastructure and practice
• Introduction to Siddha: History, Concepts, Principles, current
infrastructure and practice
• Introduction to Sow- rigpa: History, Concepts, Principles, current
infrastructure and practice
• Introduction to Yoga: History, Concepts, Principles, current
infrastructure and practice
• Introduction to Naturopathy: History, Concepts, Principles, current
infrastructure and practice
• Introduction to Homeopathy: History, Concepts, Principles, current
infrastructure and practice
vi.
Policy options and challenges in regulating and mainstreaming LHT
and AYUSH in primary health care and public health systems
towards a national Integrated Health Mission
• Medical pluralism from a multilevel perspective including WHO
policies, national policies as well as policy practice linkages
ii.
iii.
iv.
v.
vi.
•
•
•
•
•
What is Mainstreaming AYUSH in Public Health
Integrating Traditional Medicine into Modern Health Care Systems
The Indian Health Care System & the Diversity of Traditional
Medicine in India
Status and Role of AYUSH in Public Health and local health
traditions Under NRHM
Role of traditional medicines in primary health care
Perspectives and principles of Trans-Disciplinary Research in the
context of pluralistic health systems
vii.
4. LEARNING METHODS
The learning-teaching methods shall include lectures/ presentations, lecture
discussions, demonstrations, case studies, visits, interactions with local
healers, AYUSH doctors, AYUSH institutions including Department of
AYUSH and Institute of Ayurveda and Integrative Medicine and postings,
internship to district and community level AYUSH clinics and health centres
and NGOs Integrating AYUSH in their services:
1.
2.
3.
4.
5.
Lectures
Case studies
Journal clubs
Group work: Plural health systems and Public Health - Check Lists.
Panel Discussion: Public Health Systemic Challenges to integrate local
health traditions and AYUSH (practitioners and Policy makers)
6. Visit to AYUSH Directorate, I-AIM- (A short report to be submitted about
the learnings from the visit)
7. Visit to a AYUSH co-located PHCs- (A short report to be submitted about
the learnings from the visit)
8. Internship to district and community level AYUSH clinics and health
centres and NGOs Integrating AYUSH in their services (during internship
phase)
5. ORGANISATION_______________
Day 1; Introduction to Plural Health Systems,______________________________
Days 2: Culture, Health and Disease__________ ____ _______________________
Day3 - day 5: Understanding the role of Herbal medicines, Local health
traditions and Local healers including traditional birth attendants.____________
Day 6 Visit to I-AIM/Any
7th day - Weekend
Day 8 to Day 13: Alternative health care Systems ______
_________________________ 141 day-Weekend _______
Day 15 to Day 16: Mainstreaming AYUSH in Public Health
Day 17: Trans-Disciplinary Research________________________________
Day 18 to Day 19: Visits, Interactions with local healers, AYUSH doctors,
AYUSH institutions including Department of AYUSH and community level
AYUSH clinics and health centres
\ st
Day 20: Evaluation
21st day - Weekend
6. ASSESSMENT
i.
11.
m.
Multiple choice questionnaire at the end of topics
Weekly assignments in topics covered under syllabus to be submitted by
the 4 day of every week.
At the end of the module, a written examination and viva voce will be
conducted on the 20th day of the module.
7. EVALUATION
The participants will evaluate the sessions and programs of the above module
especially regarding the topics, quality of content, delivery of content and
assessment.
8. LEARNING RESOURCE MATERIAL
Must read:
1. Darshan Shankar, Unnikrishnan PM, (ed); Challenging the Indian
Medical Heritage , New Delhi, foundation Books, 2004.
2. Lokhare, M., Davar, BV., The community role of Indigenous Healers In
Sheikh, K, George, A.,Health providers in India on the front lines of
Change, New Delhi, Routledge, 161 -181. 2010
3. Unnikrishnan PM, lokesh kuamr HP, Darshan Shankar. Traditional
Orthopedic practitioners in Contemporary Health In Sheikh, K,
George, A.,Health providers in India on the front lines of Change, New
Delhi, Routledge, 182-199.2010
4. Robert H. Bannerman, John Bruton, Ch’en Wen -Chieh, Traditional
Medicine and Health care Coverage A reader for Health
Administrators and practitioners, Geneva, World Heallth Organization,
5. Narayan R, Mankad D, Medical Pluralism A case for Critical
Attention, Medico Friend Circle Bulletin 155-156.
6. Consensus statement —South Asian regional conference on traditional
medicine, 2006
7. Priya R, conceptualizing UAHC Bottom UP: implications for
Provisioning and financing, Medico Friend Circle Bulletin 2011- 345347; 15-27.
8. National Health systems Resource Centre, Mainstreaming AYUSH and
Revitalizing local health traditions under NRHM- a health systems
perspective.
9. Report by Shailaja Chandra on AYUSH and LHTs
10. Wujastyk, Dominik, Evolution Traditional Medicine Policy in India
11. AIFO Bangalore Seminar
12. Planning Commission 12lh Plan AYUSH Steering Group
Additional Reading:
1. Introduction to Ayurveda by C. Dwarakanath and selected books, articles
from Amruth Heritage, Ancient Science of Life and journals i.e. Journal of
Ayurveda and Integrative Medicine
ISg
ONLINE PUBLIC HEALTH INFORMATION SOURCES
Public Health Institutions and Initiatives in Karnataka (arrangedaiphabetical(y)
Health, Nutrition and Development Initiative of Azim Premji University
The Health, Nutrition and Development Initiative aims to offer a broader and
integrated understanding of health by locating it within the larger development
/sZlim Pirwfljli ZI'T'd6 t"? by necessari|y engaging With multiple perspectives, approaches and
U'nlWm-iV rJT
f
'!tlVe COmprising of a multi-disciplinary faculty focuses on the
,f creation of new and relevant knowledge through a series of teaching and research
activities based at the University.
rthlntfeMAT": 0' *',e,l?“a,'VC
a SpeeM.a,™ o„ He.i.h, Nu.rita .„d Devetopm.„t
profess’onals m health and development through short courses. Research activities of the Initiative have a broader
httoV/a;
r'8°rhealt,,SyStems research and translating the research knowledge into evidence
http.7/azimprem|iuniversity.edu.in/hndi/
eviaence.
Centre for Public Policy
Urban Development and also by Ministry of Housing and Urban Poverty Alleviation CCP offers
ding
program management, and dissemination of program and policy experiences. The Resource Group wil
sis xx:.xna,i”ai and '“e's ” k "■
http://wwwjimb.ernetJn/centres/cpp
Grassroots Research And Advocacy Movement- GRAAM
GRAAM is an organization based in Mysore, it researches issues faced by communities and
advocates the research outcomes to ensure relevant and sound public policy. GRAAM aims to
enrich the interaction between primary players - the community, the state, the NGO sector, & the
private sector to ensure sustained development at the grassroots level.
http://www.graam.org.in/
Indian Institute of Health Management and Research -I1HMR
t0
'mprrement ^ndards of health through better management of health care
manLX lthr°gramS'
k°
extensively on capacity building of health professionals to effectively
manage health services at the national, global level and to disseminate latest knowledge and management
technology in India and other developing countries. The Institute offers a two-year full-time Postgraduate
Program with specialization in Hospital Management and Health Management and very recentlv also the
postgraduate diploma in health information technology.
http.7/bangalore, iihmr.org/
SOCHARA - CHIP Mainstreaming WS 04&05/1Q/2016 @ Bengaluru
1
Institute oOhjhHc Health -IPH
The Institute of Public Health, Bangalore is a public health research and
training institute based in Bangalore, India. IPH is a value based, communityoriented public health institute, involved in the entire gamut of public health
irnastitute of RutjUc Hsaitz-s
activities- training, research, consultancy and advocacy. The institute is also
BAin^jalor*
involved in IPH formed a consortium of five organisations, [Institute of Public
Health, Bangalore (IPH); Centre for Global Health Research, Bangalore (CGHR); Centre for Leadership and
Management in Public Services (C-LAMPS); Institute of Health Management and Research (IHMR), Bangalore;
Karuna Trust (KT); and Karnataka Health Promotion trust (KHPT)] called Swasthya Karnataka (SK) which aims to
improve the management capacity at a district and sub district level. IPH conducts a PhD programme in public health
in collaboration with the Institute of Tropical Medicine (ITM), Antwerp, Belgium. The programme is a part of a long
term partnership with ITM and is funded under the Belgian Government's DGDC grant. The PhD programme is for 4
years and the focus is on research in health systems.
http://www.iphindia.org
The Institute of Trans-disciplinary Health Sciences and Technology (ITD-HST)
The Institute of Trans-disciplinary Health Sciences and Technology (ITD-HST) is focused on the
modernization of India's healthcare in the 21st century by bridging, in an epistemologically
l»r.
informed way, the traditional health science and practices of India, with western sciences and
technology. The central purpose of the university is lowering costs and enhancing access,
quality and reach of healthcare and creation of transformative knowledge and making original Indian contributions,
to the world of medicine and life sciences. The institute grew out of the earlier Foundation of Revitalization of Local
Health Traditions (FRLHT) and Institute of Ayurveda and Integrative Medicine (l-AIM). The University has school of
health sciences where principles from Ayurveda and other holistic health sciences like Siddha, Unani and
authenticated Folk-cure along with biomedical sciences are put through modern day R&D to give shape to the
'integrative medicine' approach.
http://ihstuniversity.org/, http://www.iaimhealthcare.com/ ,
Karnataka Association for Community Health
The Karnataka Association of Community Health is a registered as an association of
community health and public health professionals since January 1984.The association was
■ V\
born out of the necessity to nurture and encourage local talent, which would have otherwise
got tost in the ocean of national / regional scientific deliberations. Since inception, KACH has
regmllarly con-ducted annual conferences, which have been hosted bya local medical college
along with a local self-government orNGOs. With more than 500 members on its rolls, it is
striving to foster and nurture Public Health talent in our state.
The next 26th annual conference of KACH on the theme Nutrition and Health: Challenges and
Opportunities will be held on 10th & 11th October, organised by Department of community medicine KLE University's
Jawaharlal Nehru Medical College, Belgaum.
www.kachcon.in
I
Karnataka Health Promotion Trust
A KHPT
Ka.-,- jUq -itjjtr, Prwnctor. VuH
Karnataka Health Promotion Trust (KHPT) was set up as a partnership between Karnataka
State AIDS prevention Society (KSAPS) and the University of Manitoba, Canada in the year
2003. KHPT focuses on supporting and implementing initiatives related to HIV/ AIDS and
reproductive health. KHPT works towards reducing the risk and vulnerability to HIV among
high risk groups and building an enabling environment for HIV prevention work.
SOCHARA - CHIP Mainstreaming WS 04&05/10/2016 @ Bengaluru
2
http://www.khpt.org/
National Institute of Mental Health and Neuro Sciences- N1MHANS
NIMHANS is a multidisciplinary Institute for patient care and academic pursuit in the frontier area of
Mental Health and Neuro Sciences. The Institute functions under the direction of Ministry of Health
and Family Welfare, Govt, of India and Ministry of Health and Family Welfare, Government of
Karnataka. NIMHANS started Centre for Public Health, which run a 2 years masters in public health.
This Centre has been established at NIMHANS to address the public health needs in mental health;
to bridge the existing gaps and to find solutions together.
http://www.nimhans.kar.nic.in/cph/index.html
National Institute of Malaria Research
National Institute of Malaria Research (NIMR) was established in 1977 as 'Malaria Research Centre' NIMR has a
network of 10 field units located in various parts of India each one having different ecological and epidemiological
paradigm. The institutes works towards short term as well as long term solutions to the problems of malaria through
basic, applied and operational field research and also plays a key role in man power resource development through
trainings/workshops and transfer of technology. NIMR has a field unit in Bangalore which focuses particularly on
bioenvironmental control.
http://www.mrcindia.org/bangalore.htm
National TB Institute, Bangalore.
The NTI is designated as WHO Collaborating centre for TB research & training since June 1985. The activities as
a collaborating centre are as follows: To organise training activities in TB control for medical and paramedical
personnel, in policies and Procedures consistent with the WHO-recommended DOTS strategy; to monitor and
supervise TB Control programme in the country; to plan, coordinate and execute TB research in epidemiology,
surveillance of drug resistance and operations of control strategies relevant to regional and national programme
delivery; to augment the dissemination of information on TB and its control by tapping the potentials of the
existing Library and Information Dissemination Services.
http://ntiindia.kar.nic.in/
Public Health Foundation of India- PHFI (Bangalore Campus)
z
The Public Health Foundation of India (PHFI) is a public private initiative that has collaboratively
evolved through consultations with multiple constituencies. It is an independent foundation which
((
adopts a broad, integrative approach to public health, tailored to Indian conditions. It has
Established 5 Institutes of Public health which runs Academic Programmes. The Indian Institute of
Public Health (IIPH) Hyderabad commenced its activftres on July 1, 2008, with a mission to deliver
public health education, pursue research and advocacy and support policy development. It lays strong emphasis on
pursuing public health policy, practice, training and research, positioning its programmes according to the public
health priorities of the state and the nation. The IIPH Hyderabad has now established a Bangalore campus, which
conducts one year postgraduate diploma in public health management and also conducts a short course in Field
Epidemiology Training Program (FETP).
http://phfi.org
Rajiv Gandhi Institute of Public Health and Centre for Disease Control
The Rajiv Gandhi University of Health Sciences (RGUHS) established the Rajiv Gandhi Institute of
Public Health and the Centre for Disease Control (RGIPH&CDC) in July 2013 as its renewed
commitment towards strengthening public health capacity and system development in the state,
country and region. The University has launched a special post graduate degree - Master of Public
SOCHARA - CHIP Mainstreaming WS 04&05/10/2016 @ Bengaluru
3
Health-(Honours) in the academic year 2014-15, committed to the broad objectives of promoting 'Right to Health'
and 'Social Determinants'. Through this course the RGUHS is initiating a new focus which goes much beyond the
scope of the current public health courses in the country, http://www.rguhs.ac.in/
Ppgiona! 0< - upational Health Centre (Southern) Bengaluru, of the National
Institute of Occupational health
ROCH was instituted in 1977, since inception has been engaged in occupational health research addressing issues of
the Southern states - Andhra Pradesh, Karnataka, Tamil Nadu, Kerala and the Union Territory of Pondicherry.
Research studies include occupational hazards of workers in coir, electroplating, grain handlers, ferro alloy, lead
battery, tea plantation, catalyst processing, printing press, beedi rolling, latex industry, tyre manufacturing,
instrument manufacturing factory, match factories, steel manufacturing plant, waste disposal, sheep wool shearing'
road paving, etc. Air pollution studies, in rural and urban areas, PAH in high density traffic areas, steel manufacturing
plant and exposure assessment of benzene. Noise in watch industry, diesel engine power plant, national
environmental health profile.
http.7/www.nioh.org/rohc(s).html
< ciety for Community Health Awareness Research and Action- SOCHARA
seehara-
SOCHARA is a Community health resource group who are committed to the 'Health
for AH' goal. SOCHARA works with a large network of non-government and
government institutions, health and developmental campaign groups and people's
movements to make them part of this 'Health for AH' movement. SOCHARA team
provided space, support, peer encouragement, vocational guidance and facilitation of self-study to young
professionals in community health. This was formalized into Community Health Fellowship Programme, and now as
building community health
SOCHARA School of Public Health, Equity and Action (SOPHEA). Presently SOPHEA runs the fellowship Programme in
MP and Karnataka.
www.sochara.org
St. John s Medical College
One of the main objectives of St John's Medical College is "outreach". The Department of
I1? .
Community Health at the college is primarily responsible for these activities. They run a rural
centre at Mugalur, not far from Bangalore, and historically have been known from some
innovations in community health, such as the Malur Health Cooperative. They also have health
worker training programmes, besides an MD programme in Community Health with an intake of 6
students each year. Occupational Health, Geriatric Health and Biomedical Waste Management are
a major foci, besides maternal and child health, and mental health.
http://www.stjohns.in/
St John's Research Institute
f£
-
A
This is a relatively new addition to St John's National Academy of Health Sciences. While there is a
lot of population health research that is taking place in various aspects of public health, there is
also a Division of Health and Humanities, probably the first of its kind on a medical college campus
in India. The Division of Health and Humanities also deals with questions of bioethics, which is
critical in the field of community health. Efforts have been made to make the campus more ecofriendly.
http://sjri.res.in/index.php
SOCHARA - CHIP Mainstreaming WS 04&05/10/2016 @ Bengaluru
4
Public Health Institutions, Organizations and
Networks outside Karnataka
SOITie Public Health Institutions (arranged alphabetically)
Achutha Menon Centre for Health Science Studies- AMCHSS
AMCHSS is a centre of excellence for public health training by the Ministry of Health and Family Welfare
government of India. The centre focuses on research in the areas of non-communicable diseases,
gender and health, health policy and management. AMCHSS conducts a Master of Public Health (MPH)
program, Diploma in Public Health and Phd Programme.
http://www.sctimst.ac.in
National Institute of Epidemiology-NIE
National Institute of Epidemiology conducts training programmes annually in bio-statistics, controlled
clinical trials and basic epidemiology for medical doctors, PG medical students and para-medical
workers. The Institute has expertise in the areas of bio-statistics and epidemiology. The institute has
strated a school of public heafth which offers a range of courses.
http://www. nie.gov.in
National Institute of Health and Family Welfare-NIHFW
*
NIHFW iS an autonomous organization, under the Ministry of Health and Family Welfare, Government
of lndia' and acts as an 'aps* technical institute' to addresses a wide range of issues on health and
fly family welfare from a variety of perspectives through various departments. The Institute offers arnge
°f courses like Phd, certificate courses and teaching programme.
http://www.nihfw.org
National Health Mission (NHM)
The National Health Mission (2005-12) is a flagship programme of the Government of India and
it
J'
seeks t0 Provide effective healthcare to the rural population throughout the country with special
focus on 18 states, namely, Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal Pradesh,
Jharkhand, Jammu & Kashmir, Manipur, Mizoram, Meghalaya , Madhya Pradesh, Nagaland,
Orissa, Rajasthan, Sikkim, Tripura, Uttarakhand and Uttar Pradesh. The Mission aims to raise
public spending on the health sector to 2-3% of the Gross Domestic Product (GDP), by undertaking architectural
correction of the health system and promote policies that strengthen public health management and service delivery
in the country. It has, as its key components, provision of a female health activist in each village (known as ASHA); a
village health plan prepared through a local team headed by the Health & Sanitation Committee of the Panchayat;
strengthening of the rural hospital for effective curative care and made accountable to the community through
Indian Public Health Standards (IPHS); integration of vertical Health & Family Welfare Programmes and Funds for
optimal utilization of funds and infrastructure and strengthening delivery of primary healthcare.
To monitor the performance and quality of the health services being provided under the NHM, the Ministry of
Health & Family Welfare, Government of India, is putting in place several mechanisms that would strengthen the
SOCHARA - CHIP Mainstreaming WS 04&05/10/2016 @ Bengaluru
5
monitoring and evaluation systems, through performance statistics, surveys, community monitoring, quality
assurance etc.
National Rural Health Mission (NRHM)
The National Rural Health mission (NRHM) was launched by the Hon'ble Prime Minister on 12th April 2005, to
provide accessible, affordable and quality health care to the rural population, especially the vulnerable groups. The
key features in order to achieve the goals of the Mission include making the public health delivery system fully
functional
and
accountable
to the community,
human
resources
management,
community involvement,
decentralization, rigorous monitoring & evaluation against standards, convergence of health
and related
programmes from village level upwards, innovations and flexible financing and also interventions for improving the
health indictors.
National Urban Health Mission (NUHM)
The Uffiion Cabinet vide its decision dated 1st May 2013 has approved the launch of National Urban Health Mission
(NUH^/I) as a Sub-mission of an over-arching National Health Mission (NHM), with National Rural Health Mission
(NRHM) being the other Sub-mission of National Health Mission. Withinthe broad six national parameters and
priorities, states would have the flexibility to plan and implement state specific action plans. The state PIP would
spell out the key strategies, activities undertaken, budgetary requirements and key health outputs and outcomes.
In order to effectively address the health concerns of the urban poor population, the Ministry proposes to launch a
National Health Mission with two sub-missions NHM (already approved by Cabinet for continuation upto 2017) and a
new sub-mission National Urban Health Mission (NUHM). The Mission Steering Group of the NHM will be expanded
to work as the apex body for NUHM also. Every Municipal Corporation, Municipality, Notified Area Committee, and
Town Panchayat will become a unit of planning with its own approved broad norms for setting up of health facilities.
The separate plans for Notified Area Committees, Town Panchayats and Municipalities will be part of the District
Health Action Plan drawn up for sub-mission NUHM. The Municipal Corporations will have a separate plan of action
as perbroad norms for urban areas. The existing structures and mechanisms of governance under NHM will be
suita bfy adapted to fulfill the needs of sub-mission NUHM also.
National Health Management Information System (HMIS)
The Health Statistics Information Portal facilitates the flow of physical and financial
performance from the District level to the State HQ and the Centre using a web based Health
W&f Digita/ India
i
Management Information System (HMIS) interface. The portal will provide periodic reports on
the status of the health sector. This portal will be our gateway to a wealth of information
--
regarding the Health Indicators of India and other varied information sources such as National Family Health Survey
(NFHSj), District Level Household Survey (DLHS), Census, SRS and performance statistics.
http://nrhm.gov.in/
https://nrhm-mis.nic.in/SitePages/Home.aspx
National Health Systems Resource Centre - NHSRC
RC
National Health Systems Resource Centre (NHSRC), is India’s Technical Support unit under
the Ministry of Health & Family Welfare working across the country through the National
Rural Health Mission (NRHM).NHSRC facilitate the attainment of universal access to
equitable, affordable and quality healthcare through technical support and capacity building
for strengthening public health systems.
http://nhsrcindia.org
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I ata Institute of Social Sciences -TISS
TCe Tata institute of Social Sciences is a post-graduate school of social work which engages continuous
study of Indian social issues and problems and impart education in social work to meet the emerging
3s
It has Various Schools like, Education, Management and Labour Studies, Rural Development
In
■■ 5 need
T I S S Social Work Health Systems Studies, Habitat Studies, Law, Rights and Constitutional Governance'
Tata institute of Vocational Education, Development Studies, Media and Cultural Studies.
Social Sciences http://www.tiss.edu
Professional Networks and associations
Indian Association of preventive and Social Medicine- 1APSM
X 1APSM provides a forum for the regular exchange of views & information on education, research and
YS programs of Community Medicine and is dedicated to the promotion of public health It works
towards improving teaching standards of Preventive and Social Medicine at all levels They also
publish a peer reviewed quarterly journal.
http://www.iaDsm.org
(O'
Indian Association of Occupational Health
specialists in l^rThe ass^iaZSraces Dolgins b^cZZ'LcZZTtLTofZustHa! Medicinestarted bj
three industrial health experts, Lt.J.R.Kochar, Col.Najib Khan and Maj.R C.Tarapore in Jamshedpur in 1948 It
publishes an official journal called Indian Journal of Occupational and Environmental Medicine.
www.iaohindia.com;www.iioem.com
Indian Clinical epidemiology Network - IndiaClen.
Indiaclen is a network of Academic Health Care researchers across 135 Medical colleges/lnstitutions in
Inrfia including IPEN. It is dedicated to improving the health by promoting clinical practice based on the
best evidence of effectiveness and the efficient use of resources.
http://indiacleni.org
Indian Public Health Association-IPHA
PHA works towards promotion and advancement of public health and allied sciences in India. They
■ „
h° d annUa conventlon and Periodic meetings or conferences. They publish a Scientific Journal
public health in Ma
adminiStratOrS< ProS“e managers and research workers in the field of
;
http://www.iphaonline.org
International Epidemiological Association South East Asia
ncludZsocial
/ ep.,demiology throughout the world, and to encourage its use in all fields of health
me udmg soaal, commumty and preventative medicine. International Epidemiological Association South East Asia's
natona 'oXr “ h^?016
°f epiden’i0'0gy for Pub,ic health a«ion and advocate for its application for
maternal and cZ JZh”
management, be it communicable diseases, non-communicable diseases,
maternal and cMd health, environmental healthor health system development.
SOCHARA - CHIP Mainstreaming WS 04&05/10/2016 @ Bengaluru
7
http://www.ieasea.org/index.php
Civil society Institutions and networks
Catholic Health Association oflndia-CHAI
Catholic Health Association of India is charitable, voluntary, non-profit Catholic Christian
organization working with a commitment for Health For All. It promotes community health as a
process of enabling the people to be collectively responsible to attain and maintain their health
and demand health as a right while ensuring availability of health care of reasonable quality at
reasonable cost.
http://chai-india.org
Christian Medical Association of India-CMAI
CO
CMAI is the non-profit registered organization and a health arm of national council of churches in
India. They undertake programmes in training, research, community service, policy advocacy,
information dissemination and others, http://www.cmai.org
Public Health Resource Network-PHRN
...... I PHRN works through NGO networks and state health societies, to accelerate and consolidate the
potential gains from the NIRHM. They run module based programme for capacity building which is
mot'e informal, open ended participatory learning. This programme complements the official
processes of capacity building and is not a substitute for the formal training and certification of
public health management.
http://www.phrnindia.org
Voluntary Health Association of India-VHAI
VHAI is a non-profit, registered society and one of the largest health and development networks
promoting health issue of human right and development. It advocates people-centered policies and
support innovative health and development programmes at the grassroots with the active participation of
the people.
http://www.vhai.org
Networks
All India Drug Action Network- AIDAN
AIDAN is an independent network of several non government organizations working to increase access and improve
the rational use of essential medicines. It works to promote Essential medicine Concept, for better controls on drug
promotion and the provision of balanced, independent information for prescribers and consumers.
http ://a idanindia.wordpress.com/
Jan Swasthya Abhiyan- JSA
The Jan Swasthya Abhiyan is the Indian circle of the People's Health Movement, a worldwide movement to establish
health and equitable development as top priorities through comprehensive primary health care and action on the
social determinants of health. JSA is a coalition of networks and organisations as well of individuals who have
endorsed the Indian People's Health Charter.
SOCHARA - CHIP Mainstreaming WS 04&05/10/2016 @ Bengaluru
8
_http://www, phmindia.org
Medico Friend Circle-mfc
n^eft0 Friend CirCle iS 3 natiOn’Wide platform of secular- Pluralist, and pro-people, pro-poor hea!th
“ c;z~rsoc,ai ac“s,s '",eres,ed in ,he hea’,h pr°w™s »f -“p''
Others social networks in public Health in India and related.
Communityhealth.in
Bl
Communityhealth.in is a collaborative project which aims to create a comprehensive, online resource
on community health and the Health For All movement in India.
http://www.communityhealth.in
communityhealth.in
Community Practice on Accountability and Social Action in Health -COPASAH
COPASAH is a community of practitioners who share an interest and nassion Mr r
monitoring on accountability in health, they exchang^eXriences and e sonTT '
resources capacities and methods; in the towards strengthening and in networking5 and
capacity building among member organizations for accountability and social action in health
This Community of practitioners
> was established as result of a three day 'Practitioners
Convening on C
‘
Community
Monitoring for Accountability in Health' organized by the
, ; Public Health Program in July 2011.
Health Systems Research India- initiative-HSRII
|
13
3
“"trrds "“"8 and “'"8 toi,h
HsitfcSjtfw* Research
Mdu iiiitiatiw
http://hsriindia.blog5pot.in/
Public Health in India
XZZX”on ”ce book-is a
p-'* Health, technical guidance.
https.7/www.facebool<.com/groups/publichealthindia/
Peoples Health Movement
fev All Noi^f
J,
/M PeoP<e’s Health Movement
The PHM is a global network bringing together grassroots
health activists, civil society organizations and academic
institutions from around the world, particularly from low and
noddle income countries (L&Miq. The People's Charter for
0^ suawc
,0 the
XSXZ
SOCHARA - CHIP Mainstreaming WS04&05/10/2016 @> Bengaluru
9
and is committed to Comprehensive Primary Health Care and addressing the Social, Environmental and Economic
Determinants of Health.
https://www.phmovement,org
International Peoples Health University
The International People's Health University aims to contribute to 'health for all' by
strengthening people's health movements around the globe, by organising and
resourcing learning, sharing and planning opportunities for people's health activists,
International People's Health University
particularly from Third World countries. IPHU: organizes short course opportunities
for health activists from around the world but particularly from Third World countries; presents a range of learning
opportunities; a growing collection of resource materials; and a wider network of resource people to progressively
enhance its programs; sponsors research into the barriers to Health for All and strategies to support the people's
struggle for health.
http://www.iphu.org/
k J
IPHU
Global Health watch
The Global Health Watch is designed to seek answers to widening disparities in both health and access to health
care, and an unacceptable level of human suffering and premature mortality and also to start articulating solutions.
It is an endeavour to propose to the global community an alternate vision of health that is located in a vision of
equity, rightsand empowerment. It is a collaborative exercise, initiated by the Peoples Health Movement (PHM),
Global Equity Gauge Alliance (GEGA) and Medact in 2004. An important outcome of the process is the periodic
publication of a document termed the Global Health Watch - a document that is contributed to by researchers,
academics and activists from across the globe. So far 3 versions of the document have been published.
http://www.ghwatch.org/
WHO watch
WHO Watch is designed to contribute to improved population health (and health equity) through new alliances and
information flows. WHO Watch is a resource for advocacy and mobilisation and an intervention in global health
governance. Components of WHO Watch are
Watching (includes documentation, analysis and advocacy as appropriate) at the governing bodies meetings in
Geneva;
Watching (documentation, analysis and advocacy as appropriate) at the regional committee meetings;
Watching (monitoring, liaison, collaboration, advocacy) with WHO country representatives;
Liaison with national representatives before their participation at the WHA, EB and regional committee meetings;
Maintenance and development of WHO Watch website providing accessible, high value policy analysis and a portal
to other relevant resources;
Collaboration with other CSOs who are involved in health-relevant watching in relation to WHO and other
international organisations;
http: //www.ghwatch.org/who-watch/about
Journals
•
Indian Journal of Public Health-LPH- http://www.iiph.in/
Indian Journal of Public Health is a peer-reviewed international journal published Quarterly by the Indian
Public Health Association. It is indexed by major international indexing systems and allows for free access
(Open Access) to its contents. The jounnal's full text is available online at www.ijph.in.
•
Indian Journal of Community medicine-IJCM- http://www.iicm.ors.in
SOCHARA - CHIP Mainstreaming WS 04&05/10/2016 @ Bengaluru
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Indian Journal of Community medicine is a
Preventive and Social Medicine (IAPSM).
available on line.
•
Indian
Journal
peer-reviewed quarterly publication of the Indian Association of
It is indexed across various indexing systems and full text is
of
Medical
http://www.icmr.nic.in/Publications/IJMR.html
Research-IJMR-
The indlan Journe! of Mefal Research Is on. of the oldest medical Journals which strated as nuarterly
pu“«s'»" “11S13 presently it ,s published monthly, In two volumes and 12 Issues per year. The journal Is
published from Indian Council of medical research.
•
Indian Journal of Medical Ethics-IJME- http://www.iime.in
The Indian Journal of Medical Ethics (formerly Issues in Medical Ethics) is a platform for discussion on health
care ethics with special reference to the problems of developing countries like India.
•
National Medical Journal of India-NMJI- http.7/www.nmji.in/
The National Medical Journal of India is a premier bi-monthly health sciences journal published from India
The archives are available online from 1998.
The Economic and Political weekly (EPW)- www.epw.in
EPW, is the only social science journal published by the Sameeksha Trust. The weekly publication contains
analysis of contemporary affairs side by side with academic papers in the social sciences. Access to current
four issues are available from www.epw.in.
Others bulletins and educational materials
Policy Briefs of 'Fostering Knowledge-Implementation Links' Project
'Fostering Knowiedge-lmplementation Links' Project ( a joint initiative of the Centre for Public Policy at IIMB
and the Karnataka Health System Development and Reform Project) has launched a series of policy briefs on
critical health and health system issues in Karnataka based on research findings and consultations The briefs
are intended communicate the implications of research and recommendations for programme and policy
The policy briefscan be accessed from- http://fkilp.iimb.ernet.in/policv briefs.html
•
Health Action
Started as a in-house bulletin named Catholic Hospital -Medical Service evolved into Health Action published
under a separate society registered as Health Accessories for all (HAFA) in 1987. Health Action disseminates
information on various health topics to enable people to gain adequate knowledge of health so that they can
take care of their health as well as that of others. It promotes health, health activism and
development and promotes alternative systems of medicine and low-cost therapies.
•
community
Health for the millions
Bimonthly magazine since 1975. It provides insights into innovative and fascinating grassroots interventions
as well as important policy changes, which affect the lives of millions.
•
Health Round-up
Community Heaith Library and Information Centre produces a monthly newsletter "Health Roundup" a
bibliography of the monthly new arrival of books and list of articles related to health appearing in various
journals and magazines. This feature would be further customized to suit the user's interest and needs The
copy o the Health Roundups is being sent to all organisations, networks, campaigns, institutions and
networks working m the area of health through email and is also uploaded on the website for wider
dissemination. Write to _clic@sochara.org to receive the compilation.
•
Health Digest
Community Health Library and Information Centre f
produces a fortnightly publication "Health Digest", a
collection of HeaGth related issues appearing in the book,
, newspapers, journals and magazines. SOCHARA
SOCHARA - CHIP Mainstreaming WS 04&05/10/2016 @ Bengaluru
11
staff writes summary of the articles and gives link to access the full articles from internet. It will be circulated
to SOCHARA friends on e-group. Write to clic@sochara.org to receive the compilation.
•
Medico Friend Circle Bulletin
The MFC bulletin (first published in 1975) is the main medium of communication through which
experiences, ideas and information about MFC and its activities are shared. It carries articles which usually
represent varying points of view of our membership within the broad mfc perspective. Archives of the
bulletin are available from http://www.mfcindia.org/main/bulletins.html .
•
NRHM News Letter
NRHM Newsletter is a bi-monthly publication brought out by the Department of Health and Family Welfare,
MOHFW
on
the
National
Rural
Health
Mission.
The
issues
are
available
from
http://wwwjnohfw.nic.in/NRHM.htm, Address: 409-D, Nirman Bhavan, Department of Health and Family
Welfare, Miwstry of Health and Family Welfare, New Delhi -110 011
Other websites
Gap minder
Gapminder Foundation is a non-profit venture registered in Stockholm, Sweden, that promotes sustainable global
development and achievement of the United Nations Millennium Development Goals by increased use and
understanding of statistics and other information about social, economic and environmental development at local,
national and global‘levels. Objectives of foundation are
use and development of information technology for easily understandable visualization of statistics and other
information; ownership, protection and free dissemination of development results; use, together with various
cooperation partners, of the development results with a view to making statistics and other information about
development available and understandable to broad user groups via the Internet and other media.
http://www.gapminrfer.org/
E Groups -discussion mails
o
Communityhealth.in-discuss:
Discussion group for communityhealth.in project members and
editors. Write to Ialit82@gmail.com to become a member of the group.
o
Disease Surveillance - Disease Surveillance e-Group is conceptualized to exchange innovative
ideas> strategies and sharing of field/personal expereinces not only in surveillance but any aspect of
Pubic health practice. Write to prabirkc@yahoo.com to become a member of the group
o
KPHP- This group is for professionals interested and committed for Public health infrastructure and
o
services in Karnataka state. Write to epigiridhar@gmail.com to become a member of the group.
MFC - Discussion groups of mfc members Membership to the group requires introduction from
existing member. - Write to sunil@theant.org to become a member of the group.
High Level Expert Group on Universal Health Coverage for India
The
High-Level Expert Group (HLEG) on Universal Health Coverage (UHC) was constituted by the Planning
Commission of India in October 2010, under the chairmanship of Prof. K. Srinath Reddy, with the mandate of
developing a framework for providing easily accessible and affordable health care to all Indians which submitted its
repo rt in October, 2010. HLEG recognized that it is possible for India, even within the financial resources available to
it, to devise an effective architecture of health financing and financial protection that can offer UHC to every citizen.
SOCHARA - CHIP Mainstreaming WS04&05/10/2016 @ Bengaluru
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http://planningcommission.nicJn/reports/genrep/rep uhc0812.pdf
Compiled by Deepak Kumaraswamy, SOCHARA. 5th September 2014. deepaktBsochara.ore
SOCHARA- CHIP Mainstreaming WS 04&05/10/2016 @ Bengaluru
13
Updated with inputs received through National workshop on Mainstreaming CHIP held on Sep
2016, Bengaluru by Suresh, SIMS (info@sochara.org) (arrangedalphabetically)
GLOBAL ORGANISATIONS (arranged alphabetically)
Health Systems Trust
A
HEALTH
Health Systems Trust (HST) is an innovative non-profit organisation working to strengthen ongoing
development of comprehensive health systems in southern Africa. Using a primary health care
approach, we specialise in conducting health research, providing technical support, and information
dissemination. Our strategies are designed to promote equity and efficiency in health and healthcare
delivery.
http://Gega.org.za or http://www.hst.org.za/
National Health Service (NHS)
For the individual national healthcare services of England, Scotland, Wales and Northern Ireland, see National Health
Service (England), NHS Scotland, NHS Wales, and Health and Social Care in Northern Ireland.
Each of the four countries of the United Kingdom has a publicly funded health care
system referred to as the National Health Service (NHS). The terms "National Health
Service" or "NHS" are also used to refer to the four systems collectively. All of the
® A ¥
f AT
. a
services were founded in 1948, based on legislation passed in 1946, 1947 and 1948,
implementing the Beveridge Report recommendation to create "comprehensive health and rehabilitation services
for prevention and cure of disease". The NHS was launched in 1948. It was born out of a long-held ideal that good
healthcare should be available to all, regardless of wealth - one of the NHS's core principles. With the exception of
some charges, such as prescriptions, optical services and dental services, the NHS in England remains free at the
point of use for all UK residents. This currently stands at more than 64.6 million people in the UK and 54.3 million
people in England alone. The NHS in England deals with over 1 million patients every 36 hours. It covers everything,
including antenatal screening, routine screenings (such as the NHS Health Check), treatments for long-term
conditions, transplants, emergency treatment and end-of-life care. Responsibility for healthcare in Northern Ireland,
Scotland and Wales is devolved to the Northern Ireland Assembly, the Scottish Government and the Welsh Assembly
Government respectivelly.
http://www.nhs.uk/pages/home.aspx
United Nations Children's Fund (UNICEF)
miceI
$
SR
UNICEF is a leading humanitarian and development agency working globally for
the rights of every child. Child rights begin with safe shelter, nutrition,
protection from disaster and conflict and traverse the life cycle: pre-natal care
70 YEARS FOR EVERY CHILD for healthy births, clean water and sanitation, healthcare and education.
UNICEF has spent nearly 70 years working to improve the lives of children and their families. Working with and for
children through adolescence and into adulthood requires a global presence whose goal is to produce results and
monitor their effects. UNICEF also lobbies and partners with leaders, thinkers and policy makers to help all children
realize their rights—especially the most disadvantaged.
SOCHARA-CHLP Mainstreaming WS04&05/10/2016 @ Bengaluru
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http://www.unicef.org/
World Health Organization (WHO)
Its goal is to build a better, healthier future for people all over the world and
working through country offices in more than 150 countries, WHO staff work
side by side with governments and other partners to ensure the highest
1
attainable level of health for all people.
j Together we strive to combat diseases - infectious diseases like influenza and
HIV and noncommunicable ones like cancer and heart disease. We help mothers
9
•J 11
and children survive and thrive so they can look forward to a healthy old age. We
ensure the safety of the air people breathe, the food they eat, the water they
drink - and the medicines and vaccines they need.
http://www.who.int/en/
ONLINE LEARNING PLATFORMS (arranged alphabetically)
CDC- Epidemiology
The Centers for Disease Control and Prevention (CDC) is one of the major operating
components of the Department of Health and Human Services as a self-study centre. CDC's
Center, Institute, and Offices (CIOs) allow the agency to be more responsive and effective
when dealing with public health concerns. Each group implements CDC's response in their
CINTBM FOR DlSBASE
Control ano Prevention
areas of expertise, while also providing intra-agency support and resource-sharing for cross
cutting issues and specific health threats.
https://www.cdc.gov/
COURSERA
Ii Coursera is an (education
’
'
platform
that partners with top universities and organizations worldwide,
I to offer courses online for anyone to take. It's simple. We want to help you learn better and faster.
ZZS That's why we designed our platform based on proven teaching methods verified by top
covrsera
IHH researchers.
Here are 4 key ideas that were influential in shaping our vision:
1.
2.
3.
4.
Effectiveness of online learning
Mastery learning
Peer assessments
Blended learning
https://www.coursera.org
SOCHARA - CHIP Mainstreaming WS 04&05/10/2016 @ Bengaluru
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open source Learning Platform
We were founded by and continue to be governed by colleges and universities. We are the only
JI
leading MOOC provider that is both nonprofit and open source. Open edX is the open-source
platform that powers edX courses and is freely available. With Open edX, educators and
technologists can build learning tools and contribute new features to the platform, creating innovative solutions to
benefit students everywhere.Founded by Harvard University and MIT in 2012, edX is an online learning destination
and MOOC provider, offering high-quality courses from the world's best universities and institutions to learners
everywhere. With more than 90 global partners, we are proud to count the world's leading universities, nonprofits,
and institutions as our members. EdX university members top the QS World University Rankings® with our founders
receiving the top honors, andedX partner institutions ranking highly on the full list.
https://www.edx.org
FroQuest
ProQuest is committed to empowering researchers and librarians around the world. Its
ProQuest-
innovative information content and technologies increase the productivity of students,
scholars, professionals and the libraries that serve them. Through partnerships with
content holders, ProQuest preserves rich, vast and varied information - whether
historical archives or today's scientific breakthroughs - and packages it with digital
technologies that enhance itsdiscovery, sharing and management. For academic, corporate, government, school and
public libraries, as well as professional researchers, ProQuest provides services that enable strategic acquisition,
management and discovery of information collections.
http://www.proquest.com/
MEDIA PLATFORMS (arranged alphabetically)
The National Library of Medicine (NLM)
The National Library of Medicine (NLM), on the campus of the National Institutes of Health in
Bethesda, Maryland, has been a center of information innovation since its founding in 1836.
The world's largest biomedical library, NLM maintains and makes available a vast print
collection and produces electronic information resources on a wide range of topics that are
searched billions of times each year by millions of people around the globe. It also supports
and conducts research, development, and training in biomedical informatics and health
information technology. In addition, the Library coordinates a 6,000-member National
Network of Libraries of Medicine that promotes and provides access to health information in communities across the
United States.
https://www.nlm.nih.gov/
Scribd is the membership for readers the world's favorite open publishing platform. Its mission is to change the
way the world reads. It aim to empower readers to indulge their curiosities and expand their knowledge. Builts a
II
library of millions of books, audiobooks, comics, documents, and sheet music selections,
and
adding more every day. In addition .to making the best membership book service
around, we've also built the world's most popular open platform for publishing and sharing documents of all kinds.
To date, people all over the world have shared more than 60 million documents via Scribd, from landmark court
filings to business presentations to academic papers from scholars around the world.
SOCHARA - CHIP Mainstreaming WS 04&05/l(#2016 @ Bengaluru
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https://www.scribd.com/
YouTube Media Centre
YouTube is an American video-sharing website operates as one of Google's subsidiaries. The
site allows users to upload, view, rate, share, and comment on videos, and it makes use of
video technology to display a wide variety of user-generated and corporate media videos.
Available content includes video clips, TV show clips, music videos, audio recordings, movie trailers, and other
You Tube
content such as video blogging, short original videos, and educational videos. Most of the content on YouTube has
been uploaded by individuals and other organizations offer some of their material via YouTube.
http://youtube.com/
SOCHARA - CHIP Mainstreaming WS 04&05/10/2016 @ Bengaluru
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Position: 4700 (1 views)