|PUBLIC HEALTH EDUCATION
|Year : 2011 | Volume
| Issue : 1 | Page : 7-13
Understanding the current status and exploring the potential for distance education in public health in India
Kavya Sharma1, Sunil George2, Sanjay Zodpey3
1 Manager, Academic Programs and Adjunct Lecturer, Public Health Foundation of India, New Delhi, India
2 Senior Lecturer, Indian Institute of Public Health, New Delhi, India
3 Director, Public Health Education, Public Health Foundation of India, New Delhi, India
|Date of Web Publication||30-Jun-2011|
Manager, Academic Programs and Adjunct Lecturer, Public Health Foundation of India, ISID, 4, Institutional Area, Vasant Kunj, New Delhi - 110 070
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Continuing education of health care providers plays an important role in producing a health work force that is efficient and effective. In India public health education has primarily relied on conventional methods of training. However, such methods have limitations in equipping the health workforce of a vast and varied country like India. This paper analyzes the current status of distance education in public health and lists the various courses that are presently available in India through the distance education mode. Presently 25 institutions in India are offering 69 courses in various domains of public health through distance education. The providers of these programs comprised both government and private educational institutions. This paper also points out the role and importance of various stakeholders in the design and delivery of distance education programs in public health and raises key areas that need attention in the governance of such programs. It urges the use of digital technology in the delivery of distance education programs and points out how distance education that is designed and delivered using the latest technology could address the current gap in training human resources for health in India.
Keywords: Distance education, Distance learning, India, Public health, Public health education
|How to cite this article:|
Sharma K, George S, Zodpey S. Understanding the current status and exploring the potential for distance education in public health in India. Indian J Public Health 2011;55:7-13
|How to cite this URL:|
Sharma K, George S, Zodpey S. Understanding the current status and exploring the potential for distance education in public health in India. Indian J Public Health [serial online] 2011 [cited 2019 Nov 19];55:7-13. Available from: http://www.ijph.in/text.asp?2011/55/1/7/82533
| Introduction|| |
Well-trained personnel are crucial for the effective functioning of any health system more so in a country like India where the health needs of the population varies in each region. However, India suffers from a shortage of trained health care workers.  Moreover, personnel in the public health system suffer from a lack of systematic and continuing education that would enable them to perform their tasks more effectively and efficiently. Traditionally public health education in India is being offered through departments of community medicine in medical colleges. However, the total number of graduates who are being trained is much less than the critical mass of trained public health professionals required for a country like India.  Recently, various institutes with nonmedical background are engaged in offering courses in public health, such as Masters in Public Health (MPH), diploma, and masters programs in health and hospital management, and so on. Although till recently most of the public health education programs were available to medical graduates only, of late, many institutions have begun offering public health training for nonmedical graduates. 
Current training programs for public health in India limit themselves primarily to formal and long-term training that requires the presence of the student in a classroom for extended periods of time, thereby taking them away from their field of work. This poses a challenge since there is already a shortage of sufficient health care personnel, especially in rural areas and being away for extended periods of time from their work would have a negative impact on the provision of health care at these facilities during this period. One way out of this dilemma is to harness the potential of distance education technology for the purpose of training and capacity building of India's workforce in health. While several courses in public health are being conducted using distance education mode in India, a comprehensive database of all these courses is not available at any single location. Such a cataloging would help all the key stakeholders to understand the current status of distance education in public health in India and explore opportunities appropriately to respond to critical shortage of trained health professionals. Against this background the present research was carried out to catalog all relevant information regarding distance education courses in public health in India and explore their potential for human resource capacity building initiatives in health sector in India.
| Materials and Methods|| |
Searches were conducted on Google search engine using key words, such as "distance education," "distance learning," "public health courses/trainings," "public health education," "online courses," and "correspondence courses" for the purpose of procuring information on various distance education programs in public health that are offered in India. From the results obtained only courses offered in India and collaborations between Indian and foreign institutes if any were included. Furthermore, the websites of the Ministry of Health and Family Welfare (MoHFW) and Medical Council of India (MCI) were also searched using the key words mentioned above. A similar search was also conducted on the websites of the Distance Education Council, Academy of Hospital Administrators, All India Council of Technical Education (AICTE), University Grants Commission (UGC), and Indira Gandhi National Open University (IGNOU). Courses ranging from a span of 6 months and above were included. Short-term courses lasting from a few days to a few weeks were excluded. Searches were also carried out in the educational supplements of leading Indian newspapers regarding available institutes, courses, admission criteria, and so on. Finally, informal discussions were held over the phone and via email with students, faculty, and administrative staff of various public health institutes identified using the above search criteria to obtain details regarding the current programs. The institutional and program data were entered into the matrix and the findings were triangulated wherever possible.
| Results|| |
Currently 25 institutions in India offer 69 courses related to public health through distance education. The providers of these programs comprised both government and private educational institutions. Of the total courses presently being offered, around 57 courses are offered at the post graduate level (masters and post graduate diplomas) and require graduation as a minimum qualification in order to apply for the program. Courses offered via distance education mode include nine Masters Degree programs, and 48 post graduate diplomas and 12 certificate programs. Majority of the courses (57) are for a period of a year or more, the exception being the (12) certificate programs. Among those offering courses for nongraduates, IGNOU offers the maximum number of courses that are aimed at nurses, Auxiliary Nurse Midwives (ANMs), and female health workers. These courses are offered in the wide range of public health domains, such as nutrition, maternal and new born care, health and hospital management, and so on. A detailed list of distance education programs in public health currently being offered in India is described in [Table 1].
| Discussion|| |
India is currently in the process of transition on several fronts, including the health status of its population. While on one hand it is confronted with public health challenges related to infectious diseases and nutrition, it is also faced with the newer challenge of addressing the rising trends of noncommunicable diseases among its population. To respond effectively to these challenges the country needs trained professionals at all levels of the health system (both within and outside the system). Thus multidisciplinary training is essential for both existing personnel as well as fresh graduates in various areas of public health, including epidemiology, biostatistics, behavioral sciences, health economics, health services management, environmental health, health inequities and human rights, gender and health, health promotion and communication, ethics of health care, operations research, and others. Furthermore, continuous updating of skills and knowledge of health care workers has been shown to be a key factor in helping them to perform better.  The deployment of purely traditional classroom-based methods of education and training can hardly meet this need. Distance education methods have shown to be an effective means to increase the knowledge  and skills of health professionals.  However, this potential has not been tapped effectively in India. Although several programs have been in place, they mainly focus on specific areas of public health, for example, health and hospital management. There are several important areas where such programs are not available or available in limited scale. Moreover, quality of these programs is quite variable and it is not known that how much they have been successful in enhancing the knowledge and skills of enrolled participants, thereby contributing toward improvement in systems performance.
Currently, distance education programs in India have been largely limited to correspondence programs that involve the student receiving study material in the form of textbooks, course modules, or CDs that are then used for self-learning by the students. Periodic contact classes are held at select locations to compliment the self-learning by students and assessments including examinations are administered in the traditional manner. This requires students to travel from their locations to the centers, which can especially be disadvantageous to working professionals who are enrolled in such courses. Also the feedback offered in assignments is not provided immediately and hence the student has to wait till the instructor has reviewed the material that has been submitted. The use of technology in the entire process is minimal, and interaction between students who are enrolled and teachers as well as among the students themselves is highly limited.
The adoption of distance education platforms provide flexibility, increases coverage, and can be customized to meet a wide range of training needs for the purpose of equipping health care workers. Currently available technology allows for the use of e-learning platforms that allow for live interactive sessions in which students can join in. Moreover, learning management systems can be designed to enable access to training materials as well as online assignments and examinations. Furthermore, discussion among participants can also be achieved through online forums. At the same time the use of distance education also raises potential challenges in the design, delivery, and governance of such programs.
Design and delivery of a Distance Learning Package for public health education involves various stakeholders and it is important that in the process of developing such programs adequate consultations with all the stakeholders are carried out in order to evolve a program that is relevant, meets the felt needs of the constituency it proposes to address and makes use of appropriate technology that can best serve the public health training needs. Some of the stakeholders who could be part of this process include Governments (both at the center and states), institutions offering distance education programs, regulatory bodies, such as the MCI, UGC, as well as the Distance Education Council, NGOs working in health and development, development partners, IT companies, especially to provide appropriate technology for this purpose, and prospective students [Table 2].
|Table 2: Stakeholders for design and implementation of distance education programs in India|
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Prospective students or the end users of the program are usually left out while designing such educational/training programs. However, to develop a program that is tailored to meet their needs, it is important that their ideas and suggestions are taken into account. Students could also help with testing out components of the distance learning program, and especially provide useful suggestions on how the programs might be refined. Successful distance education programs need to include the critical element of feedback from end users as part of their design in order to constantly evolve it according to the needs of the student community. Further continual collaboration between the operations, the IT and the academic wings of institutes that offer such programs is important to develop a program that is adequate in content and user friendly.
Governance of distance education programs is an important area of concern. This poses greater challenge than the mere design of curriculum for a distance education program or the choice of appropriate technology. Well-defined governance structures are important if we do not wish to see the proliferation of institutions that do not have adequate credentials getting into these engagements. Therefore, it would be important to ensure that any initiative in public health that uses the distance education platform addresses issues related to accreditation of their courses by some competent authority. Given the multiple stakeholders involved in public health education and training in India, this issue assumes importance. Moreover, public health education through distance education modules poses the unique challenge of oversight not just for the content but also for the special mode of education that distance education poses. Thus it might be useful to involve key stakeholders in this arena, including the Medical Council of India, the All India Council for Technical Education, the University Grants Commission, as well as the Distance Education Council in the process. It is important that care is taken to make sure that the quality of public health education does not suffer and only competent organizations with adequate expertise in public health are encouraged to enter into this. Danley and Fetzner earlier pointed out that governance in distance education cannot limit itself to academic governance but must cover several other areas.  In the Indian context some of these areas include fiscal issues, such as fees, cost of technology, jurisdiction, staff training, accreditation, student support services, and legal issues, such as use of copyrighted material and liabilities of stakeholders who would be involved in the process.
In the context of governance it is also important to take into account that certain guidelines are developed to ensure quality and effectiveness of distance education-based training. Following guiding principles can be used in this regard:
While the use of technology does pose challenges as this paper discusses, administrators can address these issues through better governance of such programs so that they are effective and efficient. Distance education using latest technology can be effectively used to address various gaps in public health education for both long-term training as well as short-term courses and could bridge an important gap between the demand and supply of well trained and effective human resources for India's health system.
- Offering programs that are linked to established professional competencies
- The importance of designing programs on the assessed needs of the audience
- Designing training according to the cognitive levels of the audience
- Developing reusable learning objects, for example, modules that could be utilized across various programs
- Understanding the target audience and their training needs
- Developing programs that are well organized and have a standard format that can be followed easily
- Providing readily accessible technical support to the students
- Management of student and instructor expectations regarding the course
- Provision of continuous feedback to students including preprograms responses and email support from faculty and
- Continuous process of refinement and updating of the course both in terms of content as well as delivery. 
| References|| |
|1.||Rao M, Rao KD, Kumar AK, Chatterjee M, Sundararaman T. Human resources for health in India. Lancet 2011;377:587-98. |
|2.||Negandhi H, Sharma K, Zodpey SP. How can Departments of community medicine shape the future of Public Health Education in India? Indian J Public Health 2010;54:184-9. |
|3.||Sharma K, Zodpey S. Need and opportunities for health management education in India. Indian J Public Health 2010;54:84-91. |
|4.||WHO. Working together for Health: The World Health Report 2006. Geneva: World Health Organisation; 2006. |
|5.||Stewart M, Marshall JN, Ostbye T, Feightner JW, Brown JB, Harris S, et al. Effectiveness of case-based on-line learning of evidence-based practice guidelines. Fam Med 2005;37:131-8. |
|6.||Flores R, Robles J, Burkhalter BR. Distance education with tutoring improves diarrhea case management in Guatemala. Int J Qual Health Care 2002;14 Suppl 1:47-56. |
|7.||Danley BG, Fetzner MJ. Asking the really tough questions: Policy issues for distance learning. Online Journal of Distance Learning Administration. Vol 1. Spring: State University of West Georgia; 1998. Distance Education available from: http://www.westga.edu/~distance/danley11.html. [last accessed on 2011 May 4]. |
|8.||Alexander LK, Horney JA, Markiewicz M, MacDonald PD. 10 Guiding principles of a comprehensive Internet-based public health preparedness training and education program. Public Health Rep 2010;125 Suppl 5:51-60. |
[Table 1], [Table 2]
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