|PUBLIC HEALTH EDUCATION
|Year : 2010 | Volume
| Issue : 2 | Page : 84-91
Need and opportunities for health management education in India
Kavya Sharma, Sanjay Zodpey
Public Health Foundation of India, New Delhi, India
|Date of Web Publication||27-Nov-2010|
Public Health Foundation of India, New Delhi
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Public Health Management has taken a momentous leap and seeks to provide a plausible answer to many issues related to public health. A key area identified to aid the public health objectives in the country is human resource management. The country faces a dire crunch in the available work force in almost all the healthcare network. Countering the current health situation in the country, various institutes have come up offering specialized courses in public health management. The wide gap between supply and demand for trained health care managers/ administrators to work for hospitals, pharmaceutical companies, health insurance and third party administration and other health care provider organizations needs attention. The paper is a situational analysis of all such courses offered pan India. A systematic, predefined approach was used to collect and assemble the data. All the institutes offering such courses were contacted for detailed information. Fifty one institutes have been identified which annually produce around 2122 qualified professional to work in the domain of public health management. The paper also discusses the demand analysis where these prospective students can be placed. An estimated 19,930 professionals would be required based upon the country's present status, which reflects the dearth in their workforce capacity. The paper also enlightens the scope of strengthening the existing system, by effectively training the existing workforce for their capacity building, and highlights training opportunities for working professional to pursue a related academic program.
Keywords: Public Health Management, Human Resource, Health Administration
|How to cite this article:|
Sharma K, Zodpey S. Need and opportunities for health management education in India. Indian J Public Health 2010;54:84-91
|How to cite this URL:|
Sharma K, Zodpey S. Need and opportunities for health management education in India. Indian J Public Health [serial online] 2010 [cited 2020 Jan 25];54:84-91. Available from: http://www.ijph.in/text.asp?2010/54/2/84/73276
| Introduction|| |
All economic systems share the fundamental problem of unlimited human wants, while resources to satisfy these are limited and predefined. Management theories invariably revolve around this concept, searching for a plausible and feasible answer. The diversity and dimensions of managerial concepts are boundless, and the basic ideas are workable in almost all sectors. Management is viewed as a cyclical process encompassing a whole gamut of elements starting from policy through strategy to program formulation, implementation, monitoring, and evaluation.  The notion of capacity assessment and capacity development has historically been blurry and unclearly defined.  OECD (2006), in their document on capacity development, has recognized the continuing blurriness of this definition. In response to the need for a concrete meaning, capacity was then defined as the "ability of people, organization and society as a whole to manage their affairs successfully." Three analytical levels are employed in this definition: individual, organizational, and the enabling environment. The policies and methods used to manage human resources are at the core of any sustainable solution to healthcare system performance and can constrain or facilitate healthcare sector reforms. 
The healthcare industry in India, which comprises hospital and allied sectors, is projected to grow 23% per annum to touch US $77 billion by 2012 from the current estimated size of US $35 billion, according to Yes Bank and an industry body report published in November 2009.  The sector has registered a growth of 9.3% between 2000 and 2009, comparable to the sectoral growth rate of other emerging economies such as China, Brazil, and Mexico. During the past few decades, India has seen remarkable achievements in the healthcare sector, which have increased life expectancy in the country from 55 to 63 years, and reduced infant mortality rate to half. This is primarily due to the concerted efforts of the central and the state governments to initiate and implement comprehensive primary care schemes. Healthcare is one of the fastest growing and largest service sectors in India.  The Government of India has been focusing on many developmental schemes and programs to cater to the existing health situations in the country. Recognizing the importance of health in the process of economic and social development and improving the quality of life of the citizens, the Government of India resolved to launch the National Rural Health Mission in 2005 to carry out necessary architectural correction in the basic healthcare delivery system.
Until recently, doctors with limited professional training in management were entrusted with the responsibility of managing the health sector. The presence of trained management professionals in the health sector, including public hospitals is a growing phenomenon. Few institutions presently offering such courses in the country are unable to meet the growing need for healthcare professionals. The wide gap between supply and demand for trained healthcare managers/administrators to work for hospitals, pharmaceutical companies, health insurance and third-party administration, and other healthcare provider organizations needs attention. There are bright opportunities even in the government sector under the National Rural Health Mission (NRHM) where the government envisages appointment of healthcare administrators. This demand for healthcare professionals is envisaged to increase manifold in the years to come with more and more healthcare organizations expected to come up in semiurban and rural areas.
This paper attempts to analyze the existing demand and equivalent supply for health management professionals, and bridge the gap between the two segments and provide a comprehensive picture as a whole. The paper explores the available avenues in the field of Heath Management/Administration, fortified with the fact that no adequate information is currently on hand to measure the present state of affairs.
| Methodology|| |
The data regarding the existing courses in Health Management/Administration and related fields in the country were obtained using three strategies. A systematic, predefined approach was used for obtaining this information. Each step was conducted in a parallel manner, and the information was entered into a matrix. The methodology used was similar to that adopted in an earlier study. 
- The first search strategy comprised using the information available on the internet. The internet search was conducted using the Google search engine. The first step in this strategy involved identifying a set of key words encompassing various domains related to Health Management. The key words included were Health Management, Health Administration, Public Health Management, and Public Health Administration. The search was limited to courses offered in India and to collaborations between Indian and foreign institutes, if any. The websites of the Ministry of Health and Family Welfare (MoHFW) were searched using the key words of the identified subjects and training programs. A similar search was conducted through the websites of the World Health Organization (WHO), All India Council of Technical Education (AICTE), University Grants Commission (UGC), and Indira Gandhi National Open University (IGNOU). The search was not restricted by course duration or the type of degree/certification awarded on successful completion. Detailed information about the courses was collected from the respective institutions or from the designated websites of these institutions. Short-term courses offered by various institutions, lasting from a few days to a few weeks, were disregarded and not entered into the matrix. Leading newspapers were searched for their "education supplements," for information regarding the available institutes, courses, admission criteria, etc. to contribute to the search in the desired domain.
- The second strategy included discussions with the stakeholders. Informal discussions with students, faculty, and administrative staff of health and hospital management institutes were conducted to explore the existing options and how they chose their respective institutes, what are the programs offered, etc. Working professionals in the field of health management and administration were also included in a formal discussion to identify their educational background and dimensions for the study.
- The third strategy involved contacting experts in the field of the health management and administration in India. The institutes were contacted over the phone and through mails to get more information regarding the available courses, fee structure, number of seats, eligibility criteria, duration, nature of the program, etc. These parameters were incorporated into the matrix. The institutional data were entered and the findings were triangulated wherever possible. Any other salient features of relevance to the courses were also incorporated subjectively into this matrix.
| Results|| |
The description of various courses in Health Management/Administration offered in India is enlisted in the [Table 1]. A total of 51 institutions have been identified which offer such courses. Out of which 48 institutes offer regular in-house programs. A total of six institutes run programs in a distance learning mode. A breakdown of the yearly output by a cumulative summary of the intake capacity in each institute is done to study the supply side. Every year, around 2122 qualified professionals would be available to work in the field of Health Management/Administration based on the yearly intake capacity of these institutions. This number excludes the students from distance learning programs where the yearly intake is 350. Moreover, these numbers do not include yearly intake of three institutions as their intake capacity is variable and not clearly spelt out.
The Public Health Management program is a Government of India flagship program, which was launched by the MoHFW under the NRHM to address to the growing demand in the health management capacity. There are a total of nine national institutes that offer this diploma program, which is a one year, fully residential course aimed at capacity building of health professionals to bridge the existing gap between the demand and the supply.
Indian Institute of Health Management Research (IIHMR) group of institutions have a mandate to build capacity in the managerial cadre, and consist of three premier health management research Institutes in India. The institutes contribute toward management research, education, training, and development programs in the health sector through institutes located in Jaipur, New Delhi, and Bangalore. A new institute has been planned in Kolkata and would be operational in the coming academic session. Other government institutes which offer similar programs are All India Institute of Local Self Government, Mumbai; Institute of Management Studies, Devi Ahilya Vishwa Vidyalaya, Madhya Pradesh; Christian Medical College, Vellore; Faculty of Management Studies, University of Delhi; Jamia Hamdard University, New Delhi; and School of Health Sciences, IGNOU, New Delhi. Many private institutes and societies also provide related courses in Health Management and have been contributing to the growing demand of health professionals in the desired field. This list includes institutes like Symbiosis Institute of Health Sciences, Pune; Tata Institute of Social Sciences, Mumbai; Birla Institute of Science and Technology, Pilani; and Manipal Academy of Higher Education, Manipal.
The program offered by most of the institutes is usually 1 to 2 years regular Master's degree or a Post Graduate Diploma in Health Management. Some institutes are offering an MBA with specialization in Healthcare Management, and also a Master's in Health Administration (MHA). The eligibility criteria for these courses vary from institutes to institutes, with a minimum requirement of having a recognized Bachelor's degree in any stream, preferably with Medical or Paramedical and Life Sciences background. MBBS, BDS, AYUSH, or Physiotherapy, Allied Health Science, and Pharmacy are given preference over others.
The teaching methodology includes classroom lectures, group discussions, projects and assignments, role plays, case studies, field visits, simulations exercises, etc. The course modules cover management lessons like Principles of Management, Human Resource Management, Organizational Behavior, Strategic Management, etc. Health-specific modules include Demography, Epidemiology, Health Economics, Project Management, NGO Management, Survey Research Methods, Quality Assurance, Legal Aspects, and Research Methodology. Most programs require the students to undergo 3-6 months of internship to have an industry interface, during which they undergo a project in the related field.
| Discussion|| |
Public health has a national and a global impact, but suffers from an imbalance between the demand and the supply ratio to achieve the desired impetus. With the arrival of the Millennium Development Goals, there is renewed interest in global health. The ability of healthcare systems to provide safe, high-quality, effective, and patient-centered services depends on sufficient, well-motivated, and appropriately skilled personnel operating within service delivery models that optimize their performance. , The large size of the country, and vast cultural and economic diversity necessitate effective managerial endeavors at the grassroots level.
This paper talks of the available course in Health Management/Administration within the country, offered by all the public and the private players in this academic domain. Health managers working in various departments of Public Health are usually from a medical background, with limited training in terms of management and administration. Most of such positions, post-NRHM, are held by people with a core MBA/MSW background (without an understanding of health) often resulting in conflicting situations sometimes leading to adverse consequences. This can result in the loss or wastage of resources, logistical and financial issues, inequitable distribution of roles and responsibilities, and ultimately deteriorated service deliveries. At district and state levels, medical doctors are given the responsibilities to cater to the administrative issues. The doctors, nurses, paramedics, and the entire hospital staff are expected to multitask, in addition to routine clinical duties.
A demand analysis for the public health sector can be done through estimating the required workforce count. India with 35 states (28 states and 7 union territories) and 643 districts require a program manager at each level. Approximately 7000 trained professionals would be necessary at the block level. About 1000 consultants would be employed in institutes like NIHFW, NHSRC, SHSRCs, etc. About 200 consultants/specialists would be employed in each state at the state level across the country. Approximately 1250 trained professionals would be employed across 250 large NGOs in the country. About 500 professionals would be needed across international organizations, while 1500 professionals would be necessary in academic/research organizations across the country. The corporate sector is also providing employment to health management professionals and this number could be estimated to be around 1000 professionals. Thus, an estimated 19,930 qualified professionals are required to function in this capacity across the health sector.
These qualified professionals are increasingly in demand to cater to the dearth in this field. The NRHM, for instance, needs a strong component of technical support. This includes reorientation into public health management.  These areas require specialized and qualified staff in the management cadre to look into the various processes and programs adopted for the mission, leading to collaborations with various health resource institutes like Population Research Centre, Regional Resource Centers, and National and State Institutes of Health and Family Welfare.
The NGO sector, which is known to be contributing significantly to the social service sector, is also lately demanding a team of qualified managerial workforce to effectively deliver their desired targets and goals. Corporates are increasingly working on health-related projects as a part of "corporate social responsibility," and are also targeting health management graduates. Since this genre of professionals would be qualified in both the social/health sector as well as management, they are expected to strike a balance between the corporate and community interface.
Other prospective areas of employment are the Health Information Technology sector, which is booming with premier software industries' initiatives into Health Management. Pharmacological giants are also investing huge proportions to aid in health and development in the developing countries. World Health Organization, UNICEF, UNDP, and other global organizations are ever focused on the health-related reforms and expansions. An increasing vicinity of interest is encountered even in Health Insurance.
The idea is not just to reduce the administrative and the managerial burden from the clinicians, but transfer the same to the candidates well suited and trained for the job. These entitled managers would take up the administrative duties and other organizational issues and thus help strengthen the existing system of process outflow, thereby improving efficiency. With the implementation of the NRHM, a cadre with managerial implication was created to look into the effective functioning of the various programs under the Mission umbrella. State, regional, district, and block program managers were appointed to take up the mission objectives at the respective levels. There is an urgent need for a massive sharing of technical resources and networking of dedicated individuals and organizations that are willing to contribute to strengthening public health systems at the district level. The immediate context is the NRHM's thrust for district-level health planning and program implementation. 
The paper also enlightens the scope of strengthening the existing system, by effectively training the existing workforce for their capacity building, and highlights training opportunities for working professionals to pursue a related academic program. Enhancing staff members' roles through new competencies gives to its employees the opportunity to acquire competencies and expand their tasks so that they can take on responsibilities traditionally carried out at higher levels.  The MoHFW has taken the initiative with the launch of the NRHM and has started the academic program for Public Health Management. The program is a yearlong diploma course for state and self-sponsored candidates to build upon the administrative and managerial skills and capacity. Many public and private sector organizations have responded to the emerging need, with the advent of such courses, but not many have a yearlong history of their inception.
There is no serious effort to understand the extent of the supply side, that is, the prospective areas of employment for people with such a background. There has been no systematic review to measure the need of a health management program in the country. This exercise critically looks at both the demand and the supply sides and aims to address the existing gap. It might provide desiring candidates seeking admissions for this course, the available options, institute details, intake capacity, eligibility criteria, and all other relevant information. It also provides an opportunity for reviewing the choice of colleges based upon location preferences, timelines, or related criteria and helps act as an interface between the demand and the supply side.
There are also issues related to the accreditation of the above-mentioned courses. There is no formal body for the certification or official recognition of these courses, since it is postgraduation in a specialized domain. UGC and AICTE have been accrediting most of the courses, but these are university grants and they generally do not define the requisite curriculum. AICTE affiliates most PG Diploma programs but specifies only the general requirements in terms of infrastructure, student-faculty ratio, course duration, etc. Efforts are in pipeline for the formation of a recognized and registered council (National Council for Human Resource in Health)  to address to the courses dealing in Health as a whole, encompassing the entire medical, paramedical, managerial, technical, or vocational courses henceforth. Some new courses can be initiated, customized, and tailor-made according to specific needs or requirements of any national agenda, as was done for NRHM.
Time will tell if these courses and programs aid in overcoming the resource gap, or would just add as another academic degree. In developing countries, workforce imbalances have been identified as one of the main bottlenecks that compromise population health development.  It would be of importance to highlight and review success stories and contributions made by this cadre in improving the process outflow in the existing system. Since these programs have been lately initiated, it would be too early to comment upon their efficacy and effectiveness.
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