Public Health Education in South Asia: A Basis for Structuring a Master Degree Course

Abstract

Countries in South Asian Association for Regional Cooperation (SAARC) lack enough public health workforces to address their poor public health situation. Recently, there have been efforts to develop capacity building in public health in these countries by producing competent public health workforce through public health institutes and schools. Considering the wide nature of public health, the public health education and curricula should be linked with skills, knowledge, and competencies needed for public health practice and professionalism. The 3 domains of public health practice and the 10 essential public health services provide an operational framework to explore this link between public health practice and public health education. This framework incorporates five core areas of public health education. A master degree course in public health can be structured by incorporating these core areas as basic and reinforcing one of these areas as an elective followed by a dissertation work.

Full text

PUBLIC HEALTH
PERSPECTIVE ARTICLE
published: 21 July 2014
doi: 10.3389/fpubh.2014.00088
Public health education in South Asia: a basis for
structuring a master degree course
Rajendra Karkee*
School of Public Health and Community Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal
Edited by:
Sanjay P. Zodpey, Public Health
Foundation of India, India
Reviewed by:
Sanjay P. Zodpey, Public Health
Foundation of India, India
Himanshu Negandhi, Public Health
Foundation of India, India
*Correspondence:
Rajendra Karkee, B. P. Koirala Institute
of Health Sciences, Dharan, Nepal
P.O. Box 7053, Kathmandu
e-mail: rkarkee@gmail.com
Countries in South Asian Association for Regional Cooperation (SAARC) lack enough public
health workforces to address their poor public health situation. Recently, there have been
efforts to develop capacity building in public health in these countries by producing compe-
tent public health workforce through public health institutes and schools. Considering the
wide nature of public health, the public health education and curricula should be linked with
skills, knowledge, and competencies needed for public health practice and professionalism.
The 3 domains of public health practice and the 10 essential public health services provide
an operational framework to explore this link between public health practice and public
health education.This framework incorporates five core areas of public health education. A
master degree course in public health can be structured by incorporating these core areas
as basic and reinforcing one of these areas as an elective followed by a dissertation work.
Keywords:public health education, postgraduate course, SouthAsia, public health practice, public health workforce
INTRODUCTION
Health is an important determinant of economic prosperity and
development of a nation (1), and central to the achievement of
all millenium development goals (2). One way to improve health
is to build up public health capacity by strengthening the public
health education and by producing public health workforce (3),
since the empirical evidence suggests that major improvement of
health does not come from new medical findings or cures, but
from the broad development and application of population-based
preventive programs (4).
The South Asian countries under the South Asian Associ-
ation for Regional Cooperation (SAARC) include Afghanistan,
Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri
Lanka. Excluding Maldives and Sri Lanka, the remaining six
countries have nearly one-fifth of the world’s population with
about 27% of global disease burden (680,859 thousands disability-
adjusted life years lost in 2010) (5). These countries are undergoing
an epidemiological transition with a double burden of diseases,
unfinished agenda of infectious diseases, nutritional deficiencies,
and unsafe pregnancies, as well as the challenge of escalating
epidemics of non-communicable diseases (6). Despite this sit-
uation, public health education in these countries has largely
been neglected compared with medical education until recently,
resulting in inadequate public health schools and workforce (3,7).
WHO Regional Office for South-East Asia has called for a para-
digm shift in approach to public health by focusing on a preventive
and promotive health system that can actively change conditions
that make people sick and by producing a public health workforce
through public health institutes and schools in its landmark con-
ference in Calcutta (8,9). As a result, efforts have been already
made to establish new public health institutes, schools, and public
health education networking in these countries (6). For example,
Public Health Foundation of India has been working to estab-
lish several Indian institutes of public health since 2006 and BP
Koirala Institute of Health Sciences in Nepal started a School of
Public Health in 2005 (7,10).
NATURE OF PUBLIC HEALTH
It has been noted that health is determined not only by indi-
vidual behavioral factors but also by population related social,
economic, political, cultural, and environmental factors (11).
In fact, public health evolved from narrow disease-focused to
broader population-based, multidisciplinary, and multisectoral
disciplines as “collective action for sustained population-wide
health improvement” (12). It needs contributions from various
disciplines: sociologist, economist, politician, environmentalist,
epidemiologist, statistician, clinician, etc. It needs to collaborate
with different sectors: education, nutrition and food production,
employment and income generating activities, water and sanita-
tion, housing, etc. This means that public health is everybody’s
business and responsibility, achievable only if health in a broad
sense becomes a central concern of the policy-making process
with prime role played by the state. Such wide nature of public
health might pose a challenge to organizing public health educa-
tion and developing capacity building when compared to medicine
or nursing education (13). In fact, there is a great variation in
institutes and courses offered in the South Asian countries (9).
A post-graduate course needs to incorporate intersectorial, inter-
disciplinary, and community-oriented nature of public health. A
framework of post-graduate course provision can guide the course
development (14).
THE THREE DOMAINS AND 10 ACTIVITIES OF PUBLIC HEALTH
A framework consisting of three domains of public health is use-
ful to manage the wide nature of public health and to clarify its
boundaries in terms of public health practice and public health
education (15). The three domains, health improvement, health
protection, and health services, are inter-related with a common
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Karkee Public health education in South Asia
Health
Protecon
Health
Services
Health
Improvement
(Epidemiology and Biostatistics) Ethics and
Use of Information
4. Assure a competent health
services workforce
5) Evaluate health services
6) Link people to needed health
services
7) Develop policies and plans.
8) Inform, educate, and empower
9) Monitor the health status of the
population
10) Mobilize community action.
1) Enforce laws and regulations
2) Protect the environment and workplaces
3) Diagnose and investigate health problem
5
)
6
)
v
es
ti
g
Im
h
e
FIGURE 1 | The 3 domains and 10 activities of public health practice. Modified from Ref. (15).
core (Figure 1). The common core includes research methods
(epidemiology and biostatistics), ethics, and use of information.
Health improvement domain includes socio-economic influences
and health promotion, tackling the underlying determinants of
health; health protection domain includes infectious diseases con-
trol, disaster prevention, environmental health regulation, and
occupational health; and health services domain includes health
care system and policy, service quality, health care management,
evidence-based practice, and health economics. The 10 essential
public health services have been identified (16), which can be
divided among the three domains (Figure 1).
The 10 public health services indicate the settings where public
health professionals work. Thus, the framework can also guide to
outline the basic competencies required for public health gradu-
ates. It can help to discover the interface between public health
education and public health practice, thereby showing how the
public health education can be organized to support the develop-
ment of competent public health workforce to deliverpublic health
programs. It can be utilized to construct a basic competency-
based model in post-graduate education in public health to achieve
10 essential public health services. Building on this basic model,
detail competencies need to be specified in chosen concentra-
tion area and be tailored to the individual need of a school
or institute so that the post-graduate program is effective and
relevant to its context. Competencies for public health course
have been formulated in different countries: by the council on
linkages between Academia and Public Health Practice (17); by
Association of School of Public Health in USA (18); by pub-
lic health Agency of Canada (19); and by the Association of
Schools of Public Health in the European Region (20). Simi-
larly,competencies for Master of Public Health course in Australia,
India, and in other low and middle-income countries have been
prepared (14,21,22).
BASIS OF STRUCTURING A POST-GRADUATE PUBLIC
HEALTH COURSE
A post-graduate course in public health can start with core courses
representing all the three domains, with an opportunity to gain
advanced knowledge in one of those core courses. This can be ful-
filled by structuring the post-graduate course in three parts: core
course, electives, and thesis.
CORE COURSE
The core course is not considered as in depth study but basic
knowledge and skills needed to perform all public health services
in all the three domains. The core course should include basic
knowledge in these areas: epidemiology; biostatistics; health pol-
icy,management, and economics (health services administration);
social and behavioral sciences (medical sociology, health edu-
cation, health promotion, behavior change); and environmental
health. These are internationally agreed five core areas of pub-
lic health, which are consistent with the three domains of public
health practice, and with curriculum proposed by the Associa-
tions of School of Public Health in USA and Europe (18,20); and
competencies based course design for Public Health in Australia
(22). The core course also needs to incorporate the globalization
impact on health as globalization has been acknowledged as one
of the determinants of health in this era of interdependence (23).
Besides, urbanization, population aging, and health disparities are
new challenges in the twenty-first century, and hence, worthy of
inclusion in core component. These new challenges will largely
shape the national and global health (24).
In addition to these core areas, public health ethics and public
health skill development (writing and speaking skills, manage-
ment and leadership skills, conflict management, interpersonal
relationship, negotiation skills with politicians and media, liter-
ature search, computer skills) should also be added to the basic
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Karkee Public health education in South Asia
Table 1 | Examples of elective modules in each domain of public health practice.
Health improvement Health protection Health services
Primary health care
Public health nutrition
Advanced epidemiology and biostatistics Health care policy and management
•Design and analysis of epidemiological studies •Health leadership and management
•Maternal and child nutrition •Statistical methods in epidemiology •District health management
•Nutrition policy and programing •Designing disease control programs •Health systems design and management
•Nutrition assessment and malnutrition •Infectious diseases epidemiology •Health system research
Medical sociology and anthropology •Non-communicable diseases epidemiology Maternal and child health
Health promotion AIDS •Integrated management of childhood illness
Health education and behavior change Disaster and post-disaster management •Safe motherhood and prenatal health
Environmental health Reproductive/sexual health
•Medical entomology •Family planning programs
•Hygiene, water, and sanitation inter ventions Health economics
Occupational health •Health care financing
Globalization and health •Health sector reform and financing
•Health care evaluation
Hospital administration
component. These skills have been increasingly recognized as
crucial for effective public health practice (18,25). Especially,
a recent Lancet report on education of health professionals for
the twenty-first century has made three recommendations for
future health education that include public health skill devel-
opment: informative and transformative learning that bridges
the gap between science and practice; training in teamwork
and interpersonal relationships; and technology (computers and
communication) (13).
ELECTIVE COURSES
Owing to broad nature of public health, it is desirable to gain in
depth knowledge in a particular concentration area. A wide vari-
ety of elective courses and modules can be offered in each domain
(Table 1). The elective courses can focus on particular population
groups, for example, maternal and child health, mental health, etc.
Elective courses should be guided by what type of health profes-
sionals the community or the country needs more, what the most
unmet health needs of the communities are, and what employment
opportunities for the graduates exist. Incorporation of practical
field-based studies should be encouraged and included because
the public health skills and management are best learnt in the
field. Such community based field studies can be conducted as fre-
quent small mini projects, field site observations in parallel with
classroom teaching or as an internship in the form of real public
health practice by placing students in relevant community orga-
nizations, government health departments, or non-government
organizations.
THESIS
The master research project is an opportunity for a student to deal
with a public health issue, commonly in his/her concentration
area. It demands integration of empirical data, theory, and meth-
ods. Students are familiarized with data collection, study design,
literature search, interpretation of data, and independent scien-
tific writing. It is desirable that thesis be based on primary data
obtained from fieldwork but thesis can also be based on secondary
data, desk-study in the form of systematic review,metaanalysis, or
other project work.
CONCLUSION
The multidisciplinary and multisectorial nature of public health
might pose a challenge to organizing public health education.
The three domains of public health practice provide an opera-
tional framework to explore the interface between public health
practice and public health education. This framework incor-
porates five core areas of public health education. A post-
graduate course in public health can be structured by incorpo-
rating the five core areas of public health as basic subjects and
reinforcing one of those subjects as an elective followed by a
dissertation work.
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Conflict of Interest Statement: The author declares that the researchwas conducted
in the absence of any commercial or financial relationships that could be construed
as a potential conflict of interest.
Received: 22 May 2014; accepted: 05 July 2014; published online: 21 July 2014.
Citation: Karkee R (2014) Public health education in South Asia: a basis for structuring
a master degree course. Front. Public Health 2:88. doi: 10.3389/fpubh.2014.00088
This article was submitted to Public Health Education and Promotion, a section of the
journal Frontiers in Public Health.
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