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"There is a severe shortfall of public health professionals"

Aarti Dhar

CardiologistK. Srinath Reddyexplains the aims and tasks of the Public Health Foundation of India, which he heads. Excerpts from a recent interview:

Photo: V. Sudershan

K. Srinath Reddy: "Policies should be directed more towards prevention than cure."

What exactly will the Foundation do?

The Public Health Foundation of India is a response to address the limited institutional capacity in India for strengthening training, research, and policy development in the area of public health. It is a public-private partnership that was collaboratively evolved with multiple constituencies including the Indian and international academia, State and Central Government, multi- and bilateral agencies, and civil society groups. There is a severe shortfall of public health professionals in the country that is one of the root causes of India's public health challenges.

The Foundation will benchmark quality standards for public health education, establishing public health institutes of excellence based on these standards to undertake meaningful research, and to advocate for public policy linked to broader public health goals.

Notwithstanding the substantial progress that India has made since Independence, the country faces a serious health challenge — rising disease burden coupled with inadequate investment in the health sector. The root causes of this challenge are inadequate human resource capacity and poor support systems in the health sector.

The concern over the past years had been inadequate resource allocation which was less than 0.9 per cent. However, it has now gone up to 3 per cent. But whatever the allocations, the problem is also of insufficient utilisation of funds because of lack of trained people to guide planning and ensure delivery.

How far have you achieved the targets?

Prime Minister Manmohan Singh launched the Public Health Foundation of India in March 2006. So far, we have identified seven places — Chennai, Hyderabad, Ahmedabad, Lucknow, Delhi, Kolkata, and Punjab — for establishing the Indian Institutes of Public Health that would train health professionals and eventually conduct courses in public health for undergraduate students.

The foundation stone for the first institute was laid at Hyderabad on April 7 and we expect the institute to be fully functional by the next academic year (2008), though the courses will start at the State Institute of Health and Family Welfare from June this year. The Gujarat Government has also allowed us to use their Health and Family Welfare Institute from this month-end for starting the courses until a proper setup is in place.

All seven new institutions of public health and eight existing institutions to be upgraded will be fully functional within the next six years. Discussions are on and agreements have already been signed with some existing institutions, including those run by private managements, for upgradation.

Since the Foundation is a public-private enterprise, what would be its funding pattern?

The Centre, through the Planning Commission, has allocated one-time grant of Rs.65 crore to the corpus and the Bill and Melinda Gates Foundation has contributed $15 million. The initiative enjoys substantial support in India and internationally. There are a large number of multi- and bilateral funding agencies, philanthropists, civil society groups, and private organisations that have donated generously or expressed their desire to do so. In the States, where we intend to open an institute, the Governments will also provide funds and the land. In Andhra Pradesh where the first institute is coming up, the Government has announced Rs.30 crore and another Rs.30 crore has been raised by the private sector. The remaining Rs.60 crore required for this project would be provided by the Foundation.

Does the private sector expect anything in lieu of the contributions?

Not really. Most of them want to work as partners in the Foundation's endeavour in addressing the public health issues. It is difficult to explain but India's human resource is an asset. International stakes in India are high and it is for this purpose that public health is important. We are a young nation and will have the youngest working population in the world in the coming years. The stakeholders, obviously, are interested in the well-being of the people.

How autonomous will the Foundation be in its functioning?

The Foundation is an autonomous society with multiple stakeholders, the largest being the Government. However, there will be no overwhelming control by the Centre and we will ensure that the autonomy of the institution is not eroded. The Planning Commission Deputy Chairperson Montek Singh Ahluwalia and the Principal Secretary to the Prime Minister T.K.A. Nair are members of the governing body.

We hope there are no conflicts of interest and everyone is benefited.

What are the courses these public health institutions will conduct and how affordable will these be to the people?

The institutes will begin with postgraduate and diploma courses in public health. These would be followed by research facilities and ultimately we intend to offer a Bachelor's degree in public health. The intention is to begin with a one-year diploma and two years Masters in Public Health, followed by PhD and other research projects. Once this is in place, we will start Bachelor's courses for undergraduate students.

As far as training of professionals is concerned, most of these would be sponsored by the State governments or the private institutions, as the case may be. However, we will ensure that the cost of training is not a barrier to students and the courses are within the reach of most people. We will also have short term training programmes lasting from one to 12 weeks that would involve people from the health services, policy makers, those involved in service delivery, academia and researchers.

What would be the focus of the curriculum and how will you find trained faculty considering there is a huge dearth of professionals in this sector?

We have scanned through the best of Indian and international courses for drafting the curriculum and made innovations before developing our programmes. Our focus is more on a practically oriented curriculum with fieldwork being an important component. The inputs might be international but the context is predominantly Indian.

Yes, there is an acute shortage of faculty but we have no intention of poaching on existing institutions to overcome this. We are looking at three levels of faculty — senior or retired people with huge experience in policy making; mid-career level professionals who are serving abroad and want to either relocate themselves to India permanently or for sometime; and ultimately the young faculty from diverse disciplines with impeccable academic credentials and relevant work experience.

In the second category, we have received CVs of over 100 mid-career professionals who have shown keen interest in serving here and as for the last category, we sent about a dozen people for training to the U.S. and the U.K. last year and will be sending another 20-25 to Europe this year. The target is to churn out 100 young professionals in the next three years and train 600-800 professionals in short and medium term courses annually.

Who are your partners in this endeavour?

The Association of Schools of Public Health (U.S. and Australia) and the London School of Hygiene and Tropical Medicines and similar institutions from across the developed and developing nations have extended support either by way of sponsoring candidates or offering technical assistance.

In terms of policy-making, what kind of policies would the Foundation recommend?

Any policy within or outside the health sector that has an impact on health. The policy recommendations would be based on expert consensus, driven by evidence and context-relevant. Of course, these would be put in the policy-makers domain as well as the public domain before being finalised.

Public health is not only about health of the people. It involves human nutrition, agriculture, environment and urban development because all these have a direct impact on the health of an individual. Just setting up more hospitals and clinics does not mean we have healthier people. If we have an Environmental Impact Assessment (EIA), we need to have a health impact assessment also. This can be done by identifying the areas that impact the health of the people like nutrition, agriculture, and livestock.

Instead of focussing on treating lifestyle-related diseases like cardiovascular ailments and diabetes, why can't we teach people to live a health life or even ban the items which can cause these diseases? Policies should be directed more towards prevention than cure.

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"There is a severe shortfall of public health professionals"

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