Public Health need not be led by Doctors Alone
The need to change current system?
- In India, most of the time, heads of health services at national, whether, state or district levels are orthopaedic or cardiac surgeons or ophthalmologists who have no training in public health.
- This became evident during the pandemic when many doctors with no training in public health continued to provide expert advice on public health issues.
- Grassroots public health workers including ASHA workers, auxiliary nurse midwives and multipurpose workers are often treated as unqualified for giving advice on maintenance of public health systems.
What is the difference between public health as a discipline and the public health sector?
- Providing medical care at a primary health centre does not make the person a public health professional.
- All those who work for the State or Central government as public sector health workers are not doing public health.
- It is imperative to understand that public health is a separate profession with a specific set of competencies.
- It is important to recognise that the organ-/system-based medical training inculcates a deeper but narrower thinking as appropriate to it, but this is inappropriate for a broader public health approach aimed at working with communities or health systems.
What is public health work
- Public health work can be described using 4 ‘A’s
Which refers to a good understanding of evidence generation and synthesis by having a good grounding in epidemiology and biostatistics.
These skills are critical for monitoring and evaluating programmes, conducting surveillance, and interpreting data and routine reporting.
Public health is inherently linked to ‘social change’ and an element of activism is core to any significant social change.
Public health requires social mobilisation at the grassroots level by understanding community needs, community organisation, etc.
Which refers to administering health systems at different levels: from a primary health centre to the district, State, and national level.
This includes implementing and managing health programmes, addressing human resource issues, supply and logistical issues, etc.
In public health, there is little that one can do at an individual level; there must be communication with key stakeholders to change the status quo at different levels of government.
This requires clear enunciation of the need, analysis of alternative set of actions and the cost of implementation or non-implementation.
Good communication and negotiation skills are critical to perform this function.
What is current situation in India?
- Recent Central government guidelines have specified that only a person with an MBBS degree can become a public health specialist.
- Training in these competencies in India is provided through a three-year MD in Community Medicine and a two-year Masters in Public Health.
- The first is exclusively reserved for doctors (the extra year is devoted to provision of medical care), while the second is open to non-medical persons as well.
What needs to be done?
- Historically in India, public health has been medicalised as it was largely a medical college-driven discipline.
- This has also resulted in denying nursing, dental, and other health professionals to contribute more to public health which needs to be changed.
- It is critical that health professionals, the government, and the public recognise public health as a specific set of competencies and give it the importance that it deserves.
- There is also a need to improve the quality of public health training being provided.
Source The Hindu
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