Public health education can promote health equity, Health News, ET HealthWorld

Prof. Sanjay ZodpeyPresident, PHFI speaks to ETHealthworld’s Prathiba Raju on the importance and need to strengthen India’s public health institutions. Emphasizing a wide array of learning opportunities that include master’s level programs in public health and in hospital administration and their contribution towards creating trained manpower that can support the expanding activities in the public health space.

As the new president of PHFI, what would be your focus? What transformational change would you like to bring in?

Public health programs and policies are instruments for assuring the health of citizens. A healthy population has higher work productivity and provides an opportunity to fulfill individual and societal aspirations. The Public Health Foundation of India (PHFI) will continue to work closely on public health issues of concern for India. The Indian health system, particularly the public sector has demonstrated great resilience during the COVID-19 pandemic. We recognize that efficient and effective health systems, driven by robust and contextual evidence, and guided by equity principles will ensure further health improvements. PHFI will support the Ministry of Health and Family Welfare (MoHFW) and the state health departments in advancing initiatives in health and sustainable development.

How does PHFI contribute to the public health education space, particularly the various Indian Institutes of Public Health (IIPH) located in different states? How are these IIPHs helping in the public health management space?

PHFI has a vision to strengthen India’s public health institutions and systems capability and provide knowledge to achieve better health outcomes for all. A thrust on public health education through its network of Indian Institutes of Public Health (IIPH) located in states aligns with our vision and mission. The IIPHs in their pursuit of academic excellence, value-based education and providing a conducive environment for overall skill development strive to create a public health workforce that responds to the felt needs of the country. A wide array of learning opportunities that include master’s level programs in public health and in hospital administration are contributing towards creating trained manpower that can support the expanding activities in the public health space.

What kind of changes are needed in the public health programs, which are being offered in India? Is there a need for a standard curriculum to exist in the country when it comes to public health?

The MoHFW designed and published a model Master of Public Health (MPH) course curriculum in 2017-18. The curriculum model is competency-driven, aligned to the needs of India and has a strong focus on public health skills. The Ministry has also taken several efforts in developing such model curriculum in allied and healthcare streams. These are excellent efforts that guide institutions in their efforts. Overall, educational institutions have to produce graduates with the necessary skills and competencies for addressing current and future health challenges.

What are your thoughts on imparting medical education in vernacular languages, as many doctors have criticized the move?

I believe that the purpose of all education and training is to transform individuals for greater individual and societal good. Medical education at its core is a contribution to the greater societal good. In principle, knowledge acquisition is independent of the language of instruction. India has experience of several excellent degree programs and graduates, beyond medicine, in vernacular languages. Medicine has traditionally been offered in English and accordingly, there is access to a wide body of medical books and literature. A transition to vernacular languages ​​may have some immediate short-term challenges in designing learning materials in the vernacular languages. This challenge can be overcome with systematic efforts at the state level to develop high-quality materials in a timely manner. This effort to develop high-quality materials will have to be state-led and undertaken regularly to keep pace with the development of new interventions and therapies.

What kind of impact do you think COVID-19 has brought to the area of ​​policy development in the public healthcare space? Tell us about the approach of PHFI on infectious diseases, epidemiology and how as a nation we should prepare for future pandemics and health security.

COVID-19 reminded the world that we must collaboratively evolve a coordinated response to health challenges. India demonstrated to the world that we can effectively manage the health challenges posed by the pandemic, produced potent vaccines and more importantly, calibrated a coherent response that evolved with the magnitude of the challenge over the past two years. We have provided our population with a digital vaccination certificate at a scale that is unparalleled in the world. This is a matter of pride for all citizens. The COVID-19 pandemic reminded us of the central role of the public health system, in detection, management and service delivery. The IDSP of the Government is sensitive to the evolving needs and under the oversight of the Ministry is geared up for training district epidemiologists and surveillance teams.

PHFI works very closely with the national and state governments. During the COVID times also, we contributed technically and on the ground through our institutional network. Going forward, we are planning to establish a dedicated multidisciplinary team to work on infectious disease epidemiology and the economic consequences of such diseases to highlight the need for pandemic preparedness and health security.

With rising zoonotic diseases like COVID-19, and monkeypox how do you look at One-health? What kind of surveillance strategies should be implemented?

Human health is influenced by multiple factors which are outside the conventional health sector. An excellent example is the provision of water, sanitation and education. Similarly, there is now a clear acknowledgment that the health of people, animals and the environment are interrelated. One-health integrates these ideas to address root causes. Surveillance systems will have to eventually keep pace globally within the larger One-health framework. This will require greater coordination between relevant departments and operational clarity at the state and district levels.

How has 2022 been for the healthcare industry and what transformations should we see in 2023?

The recent pandemic has reminded us that we must invest in primary healthcare systems. We need prompt diagnosis with laboratory support, timely referral transport and state-of-the-art clinical care. The healthcare sector will have to build these services on the background of a sufficient and skilled workforce. We learned about the potential of digital health and its ability to transform last-mile access. We can witness accelerated growth in the vaccines and biologicals market in addition to our dominance in medicinal products. The potential of yoga in holistic health is also increasing and we are likely to see it emerge as a global phenomenon in the next decade.

  • Published On Dec 5, 2022 at 05:00 PM IST

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India needs an urgent cure for its medical education system, Health News, ET HealthWorld

by Dr. Anant Pandare

The state of medical education
As per the data published by the Medical Council of India, there are 606 recognized medical colleges that offer an MBBS degree in the country. Among these, 46 medical colleges are deemed universities, and 276 are private medical colleges. Every year around 1.5 million students appear for the all-India pre-medical entrance test to pursue undergraduate medical courses in government and private institutes but, only eight lakhs become eligible for admission – while 45,000 students get seats in government medical colleges, 40,000 of them find a seat in private and deemed medical colleges. The remaining have to either explore their options in countries that offer affordable medical education or choose another career. Reportedly, around 20,000 to 25,000 students go abroad to study medicine every year in countries like Russia, Ukraine, China, Philippines, Georgia, and Kyrgyzstan where medical education costs between 20-45 lakh rupees which is in contrast to India where it can cost between Rs. 60,000-2.5 lakhs in government colleges and between 40 lakhs to Rs. 1.5 crore in private colleges – a distant dream for most Indians.

A report published in 2019 indicates the dire need for doctors and healthcare workers in India. It states that the doctor-population ratio in India is 1:1456 –unevenly distributed between urban and rural areas – against the required 1:1000 as per the WHO standards.

The reasons behind enormous fees
The reasons behind the high fees in medical colleges are the mandated infrastructure requirements and high costs of facilities due to scarcity. Every medical college approved for MBBS admissions, as per the guidelines, should have 23 notified departments, a teaching hospital within the premises, laboratories, and hostels, to name a few. Further, the colleges with an annual intake of 150 MBBS students must have a functional hospital with 330 beds operational for at least two years. In addition to this, an air-conditioned central library of at least 1,000 square meters and one percent of the minimum books prescribed must be journals. Therefore, it costs more than Rs. 400 crores and takes at least five years to build a state-of-the-art government medical college which will further require a fairly hefty sum of money for the annual maintenance. In the case of private institutes, it can go up to unimaginable amounts.

Scaling up India’s medical education
To ensure India continues to produce trained doctors and healthcare workers it must expand its number of medical colleges at an affordable cost. In the past two years, there have been many lessons from the global pandemic for policymakers, doctors, and researchers. Therefore, this is the time to act. The MCI should double the intake of students in the existing medical colleges without compromising on the quality. It should also relax stringent norms laid down for setting up medical colleges to pave the path for the establishment of more medical institutions for aspiring doctors. In November 2020, the move by the National Medical Commission to remove the minimum land requirement of 20 acres for general areas and 10 acres for metro cities was a welcome step. When it comes to encouraging private investment in medical education, we need to relax certain conditions of hospital infrastructure and focus on the availability of clinical materials for training the students. Further, a cost and income sharing model between private and government hospitals should come into force to bring down the costs of setting up hospitals. There is a need to include practicing Doctors, DNB Graduates as faculties to expand the fleet of teachers. To improve the cash flow of medical colleges, low-cost and long-maturity loans should be given to entrepreneurs to set up medical colleges by creating long-term funding agencies. Special tax exemption for investments in medical college establishments could also bring fresh influx of funds in this sector. Last but not the least, the government should introduce urgent reforms in the medical sector to prevent the migration of Indian students to study medicine abroad, and it should also provide low-interest loans to students who get enrolled in medical colleges.

The government has already realized the importance of improving the quality of education and training for doctors and healthcare workers, and it has taken certain key initiatives in this regard. But still, there is a long way to go. Affordable medical education will, in all likelihood, set the tone for an ecosystem where healthcare would also be affordable as aspiring doctors would like to return what they have received. This sentiment will lead to the creation of an affordable health system where even a common person will be able to study medicine as well as get good medical care. Remember, the health of the nation comes even before the wealth of the nation.

Dr. Anant Pandhare, Medical Director- Dr. Hedgewar Hospital- BAVP

(DISCLAIMER: The views expressed are solely of the author and ETHealthworld does not necessarily subscribe to it. shall not be responsible for any damage caused to any person / organization directly or indirectly.)

  • Published On Aug 8, 2022 at 06:03 AM IST

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