PUBLIC HEALTH EDUCATION
Year : 2013 | Volume
: 57 | Issue : 3 | Page : 155--160
Transforming public health education in India through networking and collaborations: Opportunities and challenges
Anjali Sharma1, Sanjay P Zodpey2,
1 Program Officer - Academics, Public Health Foundation of India, New Delhi, India
2 Director, Public Health Education, Public Health Foundation of India, New Delhi, India
Sanjay P Zodpey
Director, Public Health Education, Public Health Foundation of India, ISID, 4, Institutional Area,Vasant Kunj, New Delhi - 110 070
A competent and motivated health workforce is indispensable to achieve the best health outcomes possible through given available resources and circumstances. However, apart from the shortages and unequal distribution, the workforce has fallen short of responding to the public health challenges of 21 st century also because of primarily the traditional training of health professionals. Although, health professionals have made enormous contributions to health and development over the past century, the 20 th century educational strategies are unfit to tackle 21 st century challenges. One of the key recommendations of the Lancet Commission on Education of Health Professionals is to improve health through reforms of professional education by establishing networks and partnerships which takes advantage of information and communication linkages. The primary goal of this manuscript is to highlight the potential of networks and partnerships in advancing the agenda of educational reforms to revitalize public health education in India. It outlines the current status and expanding scope of public health education in India, existing networks of public health professionals and public health education institutions in the country, and opportunities, advantages and challenges for such networks. Although, we have networks of individuals and institutions in the country, there potential to bring about change has still not being utilized fully and effectively. Immediate collaborative efforts could be directed towards designing and adaptation of competency driven curriculum frameworks suitable of addressing public health challenges of 21 st century, shifting the current focus of curriculum to multidisciplinary public health outlook, developing accreditation mechanisms for both the programs and institutions, engaging in creating job opportunities and designing career pathways for public health professionals in public and private sector. These efforts could certainly be facilitated through existing networks.
|How to cite this article:|
Sharma A, Zodpey SP. Transforming public health education in India through networking and collaborations: Opportunities and challenges.Indian J Public Health 2013;57:155-160
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Sharma A, Zodpey SP. Transforming public health education in India through networking and collaborations: Opportunities and challenges. Indian J Public Health [serial online] 2013 [cited 2022 May 18 ];57:155-160
Available from: https://www.ijph.in/text.asp?2013/57/3/155/119833
Health systems are expected to serve the population needs in an effective, efficient, and equitable manner.  They are the crux in designing, implementing, and monitoring health programs and delivering quality health services. A strong health system can help translate healthcare services into improved health outcomes. The World Health Organization (WHO) has developed a framework in 2007 entitled, "Everybody's Business: Strengthening Health Systems to Improve Health Outcomes".  The framework has six building blocks leading to specific goals and outcomes and builds on previous WHO work. The six building blocks are financing, health workforce, information, medical products and technologies, service delivery, and leadership/governance. Building upon the foundation of these six blocks, if the coverage and access to safe and quality health services is ensured, these can lead to the intended goals and outcomes of the health systems. 
Amongst other important factors, a well-performing health workforce is indispensable to achieve the best health outcomes possible through given available resources and circumstances. However, apart from the shortages and unequal distribution in both developed and developing countries, the workforce has fallen short of responding to the challenges of 21 st century healthcare reforms also because of primarily the traditional training of healthcare professionals. Although, health professionals have made enormous contributions to health and development over the past century, the 20 th century educational strategies are unfit to tackle 21 st century challenges. Hence, redesigning the architecture of health professional education is necessary and timely. 
The Lancet Commission on Education of Health Professionals identified three key dimensions of education after specification of the linkages between the health and education systems, institutional design (which specifies the structure and functions of the education system), instructional design (which focuses on processes), and educational outcomes (which deal with the desired results). The institutional design at the systemic level comprised of stewardship and governance, financing, resource generation, and service provision; at the organizational level it is comprised of ownership, affiliation, and internal structure; and at the global level it is comprised of stewardship and networks and partnerships. 
One of the key recommendations of the Commission is to improve health through reforms of professional education by establishing networks and partnerships which takes advantage of information and communication linkages. With the focus primarily on Indian scenario, this paper intends to explore the potential of this emerging but vital instrument to advance the reforms agenda to revitalize public health education in India.
Public Health Education in India
Historically, public health education in India has been offered through medical colleges and it usually refers to undergraduate (Bachelor of Medicine and Bachelor of Surgery (MBBS) (Community Medicine is a compulsory subject for all medical undergraduates during the course of their medical education)) and postgraduate education (Doctor of Medicine (MD) (Community Medicine/Preventive and Social Medicine), Diploma in Public Health (DPH), and Diploma in Community Medicine (DCM)), which is primarily training in core public health without any specialization in specific domains of public health. Moreover, these postgraduate courses are available for medical graduates only. Few medical colleges also offer PhD in Community Medicine/Preventive and Social Medicine. In addition to these traditional programs, some of the medical colleges/institutions offer following specialized courses for medical graduates with limited annual intake capacity: MD (Community Health Administration), MD (Hospital Administration), Masters in Hospital Administration (MHA), MD (Tropical Medicine), MD (Maternity and Child Health), PhD (Hospital Administration), Diploma in Hospital Administration (DHA), Diploma in Health Administration (DHA), Diploma in Health Education (DHE), and Diploma in Industrial Health (DIH). Moreover, few institutions in the country offer Diplomat of National Board (DNB) (Social and Preventive Medicine, Health Administration and Maternal and Child Health) courses. 
The All India Institute of Hygiene and Public Health (AIIHPH), Kolkata is the oldest public health institute in India, which offers diploma, masters, and doctoral level programs in various domains of public health: Core public health, social and preventive medicine, public health management, public health engineering, maternal and child welfare, dietetics, nutrition, industrial health, health statistics, health education, veterinary public health, community health for nursing professionals, etc. Recently, in 2006, Public Health Foundation of India (PHFI) was launched to establish Indian Institutes of Public Health (IIPHs) in the country. The mandate of PHFI is to build the capacity of human resources in public health through these institutions. At present four IIPHs are operational and are offering postgraduate diploma programs in following specialized areas of public health: Public health management, biostatistics and data management, health economics, and healthcare financing and policy. PHFI also recently launched integrated MSc and PhD programs in clinical research and health informatics in collaboration with Academy of Scientific and Innovative Research (AcSIR).
In recent past there is a conscious shift in public health education in India with several institutions (with medical and nonmedical background) initiating public health programs for both medical and nonmedical graduates. Some of them offer core public health programs (General Masters in Public Health (MPH)) and some of them offer specialized courses (MPH with tracks/specialization).  Some institutions have launched specialized courses in public health related disciplines. These courses include: Masters and diploma programs in health and hospital management/administration, epidemiology, health economics and healthcare financing, biostatistics and data management, public health nutrition, etc. Except for the programs in health and hospital management/administration there is limited intake capacity of other specialized programs which is generally attributed to less demand for such programs.  Recently, we have also seen growth of institutions offering public health courses through distance education. 
Thus, it is very clear that the scope of public health education has been expanded significantly with more number of institutions engaging in offering public health programs in different disciplines of public health, thereby resulting in increase of yearly output of public health professionals. Moreover, several of these programs are available for both medical and nonmedical background professionals. However, despite this growth, public health education in India is facing challenges related to accreditation of institutions and programs, competency driven curriculum, and career pathways for trained public health professionals. , As recommended by Lancet Commission there is an urgent need to revisit the both institutional and instructional frameworks of public health education in India. Public health education must be reconfigured to meet complex contemporary challenges and respond to exciting new opportunities that are evident and emerging in Indian public health scenario. This is the right time to revisit overall public health education framework in India and design appropriate strategies to transform the existing architecture of public health education in India. This would certainly require interventions at several levels from governance to implementation. One of the critical recommendations of the Commission in the context of reforms agenda is using 'networking and partnerships' for transforming public health education. 
Networks of Public Health Professionals and Public Health Education Institutions
Networks can become valuable tool to enhance the management, sharing and co-creation of knowledge in public health. They can also prove to be beneficial in augmenting professional and organizational capacity development and system change. Following are the two kinds of public health networks that exist in India depending on their purpose and structure: Networks of individuals and networks of institutions.
Networks of individuals
These networks exist as professional associations which comprise of specialists having a set of commonalities and such associations are dedicated to the promotion of public health by bringing its members' expertise together and provide platforms for deliberations on public health policies, for advocating education and research agenda and exchange of views and information. Indian Public Health Association (IPHA)  and Indian Association of Preventive and Social Medicine (IAPSM)  are the leading associations of public health professionals in India and have played significant role in shaping several public health initiatives through active engagement of their members. IPHA was established with the mission of promotion and advancement of public health and allied sciences through their branches in India, protection and promotion of public and personal health of the people of the country and promotion of cooperation and fellowship among the members of the association. The association has multidisciplinary membership and provides a platform to members to deliberate on key public health issues and challenges. It also publishes Indian Journal of Public Health, which is a peer reviewed journal and indexed in several databases. The association is also engaged in several initiatives related to public health education in India. Recently, IPHA was involved in designing competency-driven framework for public health professionals in India, which was supported by WHO Country Office. IAPSM is a "not for profit" professional organization of specialists in Community Medicine, Epidemiology, Health Management, Health Promotion, Family Medicine, and other allied disciplines of public health. The membership of IAPSM includes predominantly faculty members of Departments of Community Medicine/Preventive and Social Medicine across medical colleges in India. It also publishes Indian Journal of Community Medicine which is a peer reviewed journal and indexed in several databases. IAPSM has been actively engaged in advancing the agenda of public health education in India.
Domain specific associations in public health and allied fields have also proven to be instrumental in promoting health professional education and public health research viz. Indian Association of Epidemiologists (IAE), India Clinical Epidemiology Network (India CLEN), Indian Society for Medical Statistics (ISMS), Nutrition Society of India (NSI), Indian Association of Occupational Health (IAOH), Indian Association for Social Sciences and Health (IASSH), Indian Medical Association (IMA), Indian Society for Malaria and other Communicable Diseases, Association of Agricultural Medicine and Rural Health in India, Indian Society for the Study of Reproduction and Fertility (ISSRF), AIDS Society of India, National Academy of Medical Sciences (India), All India Medico Informatics Society (AIMIS), Council of Sex Education and Parenthood (International)-India, National Academy of Vector Borne Diseases, South East Asian Regional Association for Medical Education, Health Economics Association of India, Urban Health Society of India, etc. These associations provide a forum to its members to engage in domain specific issues and contribute towards enhancing overall public health agenda in the country. Several of them have been actively engaged in public health capacity building initiatives through educational and training initiatives.
Networks of institutions
The South East Asia Public Health Education Institutions Network (SEAPHEIN) has been developed and promoted under the stewardship of the World Health Organization's South-East Asia Regional Office (WHO-SEARO), to promote and strengthen public health education and training in the member countries. The Indian Chapter of SEAHPEIN, India Public Health Education Institutions Network (India PHEIN) was established in July 2010. It has both individual and institutional membership. It has the mission to collaborate with Indian member institutes in partnership to improve and sustain the quality and relevance of public health education to address the increasing challenges of health improvement in the country. It thus provides platform for institutes engaged in public health education to share experiences and resources with each other.  India PHEIN is involved in facilitating solutions to several critical challenges surrounding public health education and training in India.
The National Rural Health Mission (NRHM) has envisioned the training of in service health professionals in public health management; so that they would oversee a range of functions, including community-based disease surveillance, program planning, implementation, monitoring, and evaluation. This has led to the development of a 1-year Post Graduate Diploma Program in Public Health Management (PGDPHM). Four national public health education institutes formed a consortium to conceptualize and develop this program in 2008. Between 2008 and 2013, seven more institutes joined the consortium. All of these institutes enrolled in service candidates for this program who have been nominated by State Governments, follow common curriculum and evaluation system. This is a unique capacity building initiative launched by Ministry of Health and Family Welfare, Government of India to strengthen the public health system in partnership with academic institutions. This has also provided opportunity to these institutions to collaborate and share resources in advancing the agenda of public health education and training in India. 
The National Institute of Health and Family Welfare, New Delhi has developed a Public Health Education and Research Consortium (PHERC) to link individuals and organizations in order to develop strategies for greater involvement of partner institutions in national public health programs through capacity building for education and research. This consortium links medical colleges, State Institutes of Health and Family Welfare, Health and Family Welfare Training Centers, nursing schools, and nongovernmental organizations (NGOs) to pool all available human resources, thus presenting an excellent opportunity to engage in public health training initiatives. 
There also exist groups of institutions viz. Indian Institutes of Health Management Research (IIHMR)  and Indian Institutes of Public Health (IIPHs)  who are engaged in several educational initiatives through their network of institutes and contribute significantly in capacity building in public health in India. IIHMR group has its campuses in Jaipur, Delhi, and Bangalore. Public Health Foundation of India has established IIPHs at Gandhinagar, Hyderabad, Delhi, and Bhubaneswar. It has also partnered with Government of Madhya Pradesh and Karnataka to launch postgraduate diploma programs from state institutes in Gwalior and Bangalore.
Collaborations and Partnerships for Public Health Education
Collaboration, a potentially powerful instrument of academic systems, describes the opportunities to enhance educational quality and productivity through sharing of information, academic exchange, pursuit of joint work, and synergies between institutions.  Collaboration can serve many purposes, deploy several instruments, and takes place at different levels. It ultimately involves the relationship between individuals, but it can be structured and sustained through formalized institutional arrangements that promote, finance, and sustain relationships over time. The institutional purposes in education, research, and service can be advanced through sharing of curricula, exchange of faculty and students, collaborative research, and other activities. Many organizational arrangements have been used to facilitate these synergies: networks,consortia, alliances, and partnerships. 
Two types of institutional collaborations are worthy of consideration: Between public health schools and between educational and other types of institutions. Collaboration between schools mostly enhances capacity in key institutional functions such as education, research, and service. Collaboration between other types of institutions links educational institutions with partner organizations; such as government, nongovernmental organizations, business, and the media; which can bring together complementary assets for mutual benefit. 
The Commission's Report placed emphasis on the institutions that engage in educational projects becoming more accountable by increasing the cooperation between ministries of health and ministries that govern such projects. Such external collaborations can contribute to strengthening health systems by making the education system more responsive, dynamic, and accountable. 
Advantages of Networks, Collaborations, Partnerships
Network is a means for collaboration between different players towards action on common goals. Networks provide an alternative to managing through hierarchies, and can achieve collaboration by creating opportunities for the different players to identify mutual benefits and 'win-win' situations.  Networks reflect the importance of relationships and partnership working in public health, and offer an opportunity to share resources and competencies across organization and health systems. They also have the potency for promotion of interprofessional and transprofessional education by breaking down professional silos and enhancing collaborative and nonhierarchical relationships in effective teams. Institutions can collaborate together by leveraging each other's strengths and undertake joint programs. There is also a significant scope for engaging in accreditation of programs and institutions through networks and partnerships. Cross-institutional collaborations can link educational centers to policies and practices; while offering partner governments, nongovernmental organizations, business, and media organizations complementary academic resources. Students can be offered training, internships, or work-study experiences in such collaborating institutions, and the partner group can capitalize on the faculty resources of the educational institution.  Faculty members are the ultimate resource of all educational institutions. However, several institutions struggle on this front both in numbers and quality. Collaborations provide wonderful opportunity to share faculty resources and create win-win situation for partnering institutions. Recent developments in IT applications in distance education have considerably reduced the cost of faculty sharing. Teaching sessions could be conducted through video conferencing facility from anywhere in the world. It has potential for compressing distances, bridging borders, reducing costs, and expanding participation; all in real time. The solidarity developed from sharing mission, resources, knowledge, and experiences can strengthen and motivate all participating institutions.  Professional public health education as a field has insufficient information and a weak culture of monitoring and evaluation. There are several questions related to mapping of institutions, admissions criteria, intake capacity and yearly output, faculty profile, public health pedagogy, infrastructure, financing, governance, accreditation (programs and institutions), career pathways for graduates, coordinating mechanisms, etc., which need answers. Networks of individuals/institutions can also be resourceful in engaging in research to answer these questions.
Challenges of Networks, Collaborations, and Partnerships
Networks may be necessary tools for knowledge management, transfer, and exchange. However, they do have potential disadvantages as well. Networks can build and use power in various ways, both positively and negatively. In many networks, power is shared; however, in others, prominence and power of some actors can become distorted by such variables as the roles they assume, the network structure or the network leadership.  This distortion of power enables certain network members to use power abusively to manipulate other members, impact the direction of the network to their own advantage (and to the detriment of others), create closed networks or silos, and enhance their own or another's status.  Network sustainability can also be a problem as significant investment is required to create and maintain them; they may be slow to deliver identifiable outputs; and they may experience tensions between network integration and the local interests of members. It must be remembered that there are real-time, talent, and financial costs of collaboration, so that its yields must outweigh investments.
India is experiencing rapid development in the arena of public health and has achieved great strides in improving public health education over the past several decades. However, much remains to be done. In order to strengthen public health system in India, we need to position adequately trained, multi disciplinary, and competent public health professionals at all the levels. Public health education is a tool to produce these professionals. Hence, it is critical to address deficiencies in our professional public health education system through the reforms agenda. The Lancet Commission Framework provides an excellent starting-point for this development. Networks, collaborations, and partnerships have been identified key drivers for advancing the agenda of reforms in public health education. Although, we have existing networks of individuals and institutions, there potential to bring about change has still not being utilized fully and effectively.
Immediate collaborative efforts could be directed towards designing and adaptation of competency driven frameworks suitable of addressing public health challenges of 21 st century, shifting the current focus of curriculum to multidisciplinary public health outlook, developing accreditation mechanisms for both the programs and institutions, engaging in creating job opportunities, and designing career pathways for public health professionals in public and private sector. This could certainly be facilitated through existing networks.
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