|Year : 2012 | Volume
| Issue : 1 | Page : 22-30
Influencing public health without authority
Public Health Consultant, New Delhi, India
|Date of Web Publication||6-Jun-2012|
Public Health Consultant, New Delhi
Source of Support: None, Conflict of Interest: None
| Abstract|| |
This paper analyzes the present processes, products and needs of post-graduate public health education for the health programming, implementation and oversight responsibilities at field level and suggests some solutions for the institutes to adopt or adapt for improving the quality of their scholars. Large number of institutions has cropped up in India in the recent years to meet the growing demand of public health specialists/practitioners in various national health projects, international development partners, national and international NGOs. Throwing open MPH courses to multi-disciplinary graduate's is a new phenomenon in India and may be a two edged sword. On one hand it is advantageous to produce multi-faceted Public health postgraduates to meet the multi tasking required, on the other hand getting all of them to a common basic understanding, demystifying technical teaching and churning out products that are acceptable to the traditional health system. These Institutions can and must influence public health in the country through producing professionals of MPH/ MD degree with right attitude and skill-mix. Engaging learners in experimentation, experience sharing projects, stepping into health professionals' roles and similar activities lead to development of relatively clear and permanent neural traces in the brain. The MPH institutes may not have all efficient faculties, for which they should try to achieve this by inviting veterans in public health and professionals from corporate health industry for interface with students on a regular basis. The corporate and public health stalwarts have the capacities to transmit the winning skills and knowledge and also inspire them to adopt or adapt in order to achieve the desired goals.
Keywords: Masters in public health, Learning oriented education system, Content, Incentive and acquisition, Public health practitioners, Corporate health industry and academia collaboration
|How to cite this article:|
Suresh K. Influencing public health without authority. Indian J Public Health 2012;56:22-30
| Introduction|| |
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" (1920, C.E.A. Winslow).  It is concerned with threats to health based on population health analysis. The population in question can be as small as a handful of people or as large as all the inhabitants of several continents. Public health incorporates the interdisciplinary approaches of epidemiology, biostatistics, and health services. Environmental health, community health, behavioral health, health economics, public policy, and occupational health are other subfields. Public health is a network of government-funded and nonprofit services that monitor the health of the population, watch for emerging diseases, establish medical policies and practices, and make sure all citizens, rich and poor, have access to medical services.  It is said that "Health care is vital to all of us some of the time, but public health is vital to all of us all of the time." The mission of public health/community health is to "fulfill society's interest in assuring conditions in which people can be healthy." The three core public health functions are (1) the assessment and monitoring of the health of communities and populations at risk to identify health problems and priorities; (2) the formulation of public policies designed to solve identified local and national health problems and priorities; and (3) to assure that all populations have access to appropriate and cost-effective care, including health promotion and disease prevention services, and evaluation of the effectiveness of that care. Public health comprises many disciplines such as medicine, dentistry, nursing, optometry, nutrition, social work, environmental sciences, health education, health services administration, and the behavioral sciences. 
Public health is the science and art of promoting health, preventing disease, and prolonging life, to maintain healthy and economically productive life so as to realize the birth right of each individual, by organizing a social machinery of community development to maintain healthy environment, empower the people for maintaining a healthy life and behavior, prevent epidemics, control communicable and noncommunicable diseases addressing the social, economic and cultural determinants influencing health and disease, and also organizing a personal care and public health service for caring the sick and disables specially during man-made or natural calamities and epidemics by evolving and organizing a health care delivery system, staffed with adequately trained appropriate health work force to deliver health promotion, prevention, early diagnosis, treatment, and rehabilitation of diseases as comprehensive package along with essential public health services which is to be universally available, equitably distributed, and accessible to all individuals and the community in need at an affordable cost, through intersectoral coordination organized collaborative effort, community participation, and ownership. The definition depicts goal of public health; the strategy of how to achieve it; specific health interventions; and the process of evolving and organizing health care delivery system, its package, and salient features. 
Except when there is a shortage of flu vaccine or vaccine-associated reaction, or a new disease, such as Crimean-Congo Hemorrhagic fever (CCHF) in January 2011 in Gujarat, Swine Flu Pandemic in 2009-2010, outbreaks of Japanese Encephalitis in UP, and Chickengunia since 2006-2007 or pulse polio immunization efforts fail in states such as UP and Bihar, public health rarely hits the national radar screen.
The health officers (Directors, Additional Directors, Joint Directors and Deputy Directors of Health in State Directorates of Health and FW Services, Chief Medical Officer of Health, Deputy CMOH, District Health Officers, Assistant District Health officers at District Level) entomologists, microbiologists, medical officers heading primary health centers, district health supervisors and senior health assistants (male and female- health inspectors, lady health visitors), junior health assistants (health workers male and female, lab scientists) who labor, often underpaid, in underfunded public health departments suddenly find themselves in the limelight. Once the poor cousins of the medical field, now they are cast as a kind of medical Delta Force standing between unknown microbial threats and an anxious nation. With Ministry of Health and FW, GOI creating a total of 766 posts at a single stroke in 2009-2010  (646 positions of epidemiologists, 85 positions of microbiologists, and 35 positions of entomologists) at district and state level under Integrated Disease Surveillance Project (IDSP) and similar contractual consultants positions (though in small numbers) in National TB control (NTCP), National AIDS Control (NACO) Organization and Vector borne Diseases Control Program (NVBDCP). Similar professional opportunities created in WHO India country office, UNICEF Delhi and field offices, UNFPA, National Polio Surveillance Project (NPSP), DFID, and other bilateral development partners and national and international NGOs have added-value career opportunities and competition for public health specialists. These are addition to teaching posts in large number of mushrooming private and government medical colleges all over India in the last 10 years and schools of public health in the last 5 years.
Postgraduate public health education in India is currently offered by four sets of institutions. First and oldest by All India Institutes (AIPH Kolkata, AIIMS, NIHFW, and PGI types) and medical colleges under regular universities, second as regular PG courses in some of the dedicated health universities, third by some Deemed Universities, all of them recognized by Medical Council of India (MCI) and University Grant Commission (UGC), last but not the least by institutions recognized by the All India Council for Technical Education (AICTE), the statutory body at national level for technical education, under the Department of Higher Education. Multiple degrees like DPH, MPH, PGDPHM, PGDHHM (Epidemiology, Public Health, Health Administration, Health services, community Health, Health Promotion, Health Care, International Public Health, Health Management and Policy, Social and Behavioral Sciences, and MBA (Health Care Administration, Health Administration, Hospital and Health Care Management) are offered. 
In a potential game-changer move, for India's education sector, the planning commission has recently suggested that the country allow establishing institutions of higher learning in private sector that could be for profit. "The not-for-profit tag for higher education should perhaps be re-examined in a more pragmatic manner so as to ensure the quality without losing focus on expansion and equity" says a paper prepared by the apex planning body.  This does signify the government's willingness to allow for profit institutions (like PHFI) to be set up for higher education. Anticipatory responses to such moves are not uncommon. Latest being the announcement of Apollo Hospitals and XLRI joining hands (27 August 2011) to offer a 1-year residential course-Executive Diploma in General Management and Health Care-that will train graduates to become better health care managers. 
"Postgraduate education in India lacks building skills among its students" inferred national and many regional conferences held in August 2011.  With higher education in India in general and public health in particular facing challenges, producing public health practitioners to take responsibilities independently at block-, district-, and state-level program planning, monitoring implementation in health system of the country in the lack of all efficient faculties who had played the game before and won the matches is a real challenge. As a result of economic and social pressures, the issues of accreditation and quality of higher education are a matter of concern. The Vice Chancellor of Rajasthan Health University responding to query by this author (in a convocation meeting early 2011) on the quality of postgraduation in medical, surgical and public health areas in the context of deemed universities said "the market forces will take care of the quality" particularly for private sector. I wonder if that is what is destined, what would happen to the postgraduates of institutions which do not meet market regulations.
Sharma and Zodpe  report that there are 51 institutions that provide health management courses, of which 48 run regular course and 6 offer programs on distance learning mode. Most of the course duration is for 2 years and few institutes provide a Diploma in 1 year for in-service candidates. Others offer 2 years Masters in Public Health (MPH) or Post graduate Diploma in Public Health Management (PGDPHM), Masters in Business Management (Health Care/Health and Hospital Management) for graduates from different medical fields (MBBS, BDS, Graduates in ISM-Homeopathy, Ayurveda, Siddha Nursing, Physiotherapy, Pharmacy) and life sciences (microbiology, biotechnology, information technology) and social science graduates (social work, anthropology, social science, mass communication, etc.).
There is a stark difference between the hype around higher education and the real picture as most of the universities/institutions in India are facing shortage of quality teachers, lack of funds, obsolete curriculum, and wrong government policies. The main questions to be answered are as flows:
- Will students doing there MPH/DPH/PGDHM/MD (P and SM/Community Medicine) today be groomed to face these new scenarios, with limited resources to work with?
- Will they be able to look at things from different pairs of lenses and derive meaningful and sustainable solutions?
Not many of the institutes as of now meet the requirement of developing core public health skills which is a matter of concern. Rise in institutions offering MPH is not surprising, inability to see real issues is!! The author strongly feels that there has to be some authority for certifying the quality of such postgraduate training and awarding degrees in higher education in general and public health in particular.
These institutions can influence public health in the country in many ways. The key contribution would be through providing professionals with right attitude and skill-mix. The discipline, dedication, and determination required will be easy to inculcate among their students if the institutions are also practicing public health (in-field practice areas and hospitals). The best case scenario would be for these institutes to manage a revenue district and setting islands of excellence for demonstration and leading the national health initiatives in addition to teaching. Other ways of influencing public health would be by participating in national health initiatives like NRHM planning, monitoring and evaluation, integrated diseases surveillance project (IDSP), Revised national TB program and National Vector Borne Diseases Control Program (NVBDCP), National AIDS Control (NACO for HIV/AIDS) program, the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), etc. Unfortunately, not many of these institutes manage even a health center or a block.
Ahmed FU brings a different dimension of public health human resource at block and district level in his article "Public health manpower-an alternate model."  He recommends a specific B.Sc. course in public health. The author came across a demand for such course in Bhutan in June 2011 during one of his consultancy assignment. This is an interesting proposal and needs serious discussion and adoption, as many of the first-level supervisors in India Health System are promotees in the age group of 40 plus and find rigorous field visits for monitoring taxing. Young and enthusiastic field supervisory workforce is the dire need of the effective health programming. It is going to be a long drawn battle, may not see the light of the day unless the Central Council of Health and Family Welfare gives a serious consideration and requests National Council for Human Resources in Health  (for prescribing standards with a view to proper planning and coordinated development of medical and allied health education throughout the country) to review the same.
Health system's expectation
The health system expects all scholars coming out of public health schools to be good mangers; also knows that "A few may excel as Public health leaders." The system needs practical and applied aspects of training and capacity building to meet global standards, keeping local reality at the top of the agenda in learning and experience.
- Rank race : Love them or hate them, rankings of institutions are here to stay 
- They have limited use to know relative standing
- Reflect the academic prominence and infrastructure
- Methodology relies on job placement, facility, and student surveys: students' expectation may bias
- They ignore strengths and weaknesses in specific areas
- Ranking is based on submerging a lot of diversity
- A heavy emphasis is on science-related indicators at the expense of humanities.
- Similarly, there is heavy emphasis on theoretical potentials than field public health activities of the institutions
- Do not take job requirement but degree/diploma awards
- What students, guardians and hiring institutions are scouting for? May be as of now?
- Brand name, past placement records
- Infrastructure for training and hostels
- But things change and soon start looking for signs of futuristic PH management programs like
- Subjects that inculcate the present state/national PH needs
- Subjects that inculcate innovation and creative thinking
- Understanding of the social, economic, political issues, and changes they are fostering
- Supervision, management, communication, and leadership skills
- Climate and environment-related subjects and activities
- The opportunities provided by the institutes for interaction with people of different walks of life so as to understand the changes in the social structure over time and build/strengthen community systems for betterment of public health at large.
| Materials and Methods|| |
This article is the result of a systematic information collection (between 2006 and 2011), both on the processes and the interaction with products. The key sources of information gathered were (1) The process of the courses, i.e., eligibility criteria, facilities available, the practical exposures given, field exercises for observations, practice or role play, assessment, monitoring and evaluation the examination methods, and internship collated from institutions. (2) Direct observation of the facilities, faculty and the guest faculty brought in time to time, laboratory, library and IT and Internet facilities, and field practice areas, if any. (3) Third and most important through interaction with PG students (of some these institutions as a guest faculty) and by interviewing/interaction with the new recruits (with MPH) under IDSP, UNICEF, UNFPA, NIHFW, NCDC, NPSP, etc. The author has been visiting the Indian Institute of Health and Research Jaipur, Punjab Technical University Chandigarh, National Institute of Health and Family Welfare (NIHFW) New Delhi, National Center for Disease Control (NCDC) Delhi, and BLDEA Medical College Bijapur and MS Ramaiah Medical College Bangalore (both in Karnataka) as guest faculty for MD/MPH courses and interacting with PGs and faculty since February 2006. The author also had the opportunity of closely following the recruitment and induction training of epidemiologists and field epidemiology trainings conducted by some of these institutions in IDSP as a consultant to the World Bank, the key funding agency of the project. The author also holds capacity building workshops of the district coordinators of UNICEF in Bihar and Orissa that provided ample opportunities to interact and draw the inferences. The following table summarizes the quantitative aspects of such interactions [Table 1].
|Table 1: Evaluation of strength and weakness of different health institutes|
Click here to view
This article analyzes the present processes, products, and needs of postgraduate public health education for the health programming mainly implementation and oversight responsibilities at field level and suggests some solutions for the institutes to adopt or adapt for improving the quality of their scholars, to fulfill the needs of public health in the developing countries and particularly in India .
| Discussions|| |
"Whatever public health person do they must do twice as well as clinicians to be thought half as good," says a proverb. It is also a personal experience of the author as a public health practitioner at various levels (PHC, subdistrict, district, state, and national level) since 9 July 1968. I also believe and say that "whatever we give or do, must delight us (the Public Health Persons) just the same to have been asked."
As described earlier, the public health department or public health persons in India did not get noticed except when there was a shortage of vaccine or a vaccine-associated reaction or a new disease such as swine flu, chickengunia, CCHF, a tick-borne viral disease that hit Gujarat, in January 2011, public health rarely hits the national radar screen. The health officers, epidemiologists, microbiologists, entomologists, doctors, public health nurses, health inspectors and supervisors, and lab scientists who labor, are often underpaid, in underfunded public health departments. Public health specialists and workers-once the poorer cousins of the medical field-suddenly find themselves in the limelight in India thanks to various national health projects in recent years.
The public health specialists in India can be grouped into three categories based on the type of responsibilities they may be entrusted. Most of the specialists in the department of health and family welfare are PG DPH or MPH holders. They are expected to manage majority of health and FW programs that involve planning, oversight, monitoring implementation, and meeting the expected outcomes of the programs at district and state level. They need to be strong in translating the theoretical knowledge into concrete actions based on the environment (district/state/the health indicators, etc.) which they are working. They need to be more of facilitators of participatory learning for actions. The second set of specialists is teachers in the medical colleges and public health schools. Their mandatory skills include teaching and research methods, biostatistics, etc. The third group is of researchers who need to practice research methodology and build evidences.
While the core public health skills remain the same as global recommendations,  the job-specific requirements change a bit. , Many district- and block-level job profiles may need strong field supervision, monitoring, and on-job training skills. District-level jobs may need strength in program implementation plan (PIP) analysis, documentation, and report writing. The positions in training institutes may demand participatory learning and training skills; some vertical programs may need strong technical skills and knowledge and others may need skills for communication and social mobilization. The future of public health being affected by climate and environment change, corporate governance, e-governance, geo-political issues, socio-economic variables, redundancy, innovation, and inclusive growth (NGO, PPP) empathy will define strategies in public health human resource, social marketing, financing and program designs, implementation, monitoring, and almost every aspect of public health business. Going beyond the jobs, future PH managers should learn to focus on putting theory into practice, honing skill and understanding the basics.
From the point of view of field requirements, the skill-mix expected from postgraduates in public health in India is shown in [Table 2].
|Table 2: Key skills and Knowledge expected from Postgraduates in Public Health|
Click here to view
Fortunately in Indian Public Health, there are many issues that need to be resolved in everyday walk of life, making environment conducive to problem solving, called "JUGAAD." During epidemics and emergencies, even the worst of the state/districts rises to occasion and meets the demand. The key is how this one time "Jugaad" can be converted into something sustainable. All this requires public health schools to look for students beyond their cognitive, academic abilities and also give due weightage to qualities such as creative abilities, capacity to work in unstructured environment, ability to observe beyond the obvious empathy and responding to needs, and other soft skills.
Public health teaching in India in the past has taught us how to fish (how to plan and implement PH services for better coverage and environment). It is time to look for how to teach to sustain the fish in the pond (improve the health of the people in existing limitations) and keep the planet breathing (manage climate/environment change, health resource planning, PPP and cost efficiency, budgeting for bottlenecks to improve effective coverage, and impacts). Public health management is not merely lucrative career option but also an attitude. MPH students today come from different backgrounds. Many aspirants have some vague ideas of public health. MPH/DPH studies can build only basic understanding of all essential sciences and tools of PH, without leaving the students to learn on job. The syllabus is more or less university degree/AICTE certificate driven, but all that matters in public health is its applied aspects. For this, hands-on exposure to planning, implementation, oversight and monitoring, and experiencing the job of health staff are essential.
The rules of the game (public health HR requirements) are changing and all MPH institutions need to pay attention. The need of time is flawless and speedy learning of modern knowledge era that requires institutionalized attempts to facilitate lifelong learning by adopting an education system, which is learning and doing oriented rather than teaching or a PG degree oriented. The central task of MPH education institutions is to implant a will and provide facilities for learning. The effective learning needs a simultaneous activation of three dimensions, viz. (i) content, (ii) incentive, and (iii) interaction.
The key responsibility of such institutes is to produce not learned but learning people. The entire human society is a learning society, where grandparents, parents, children, friends, teachers, and every person you come in contact are students together. Learning ability is innate in mankind and we learn continuously/effortlessly from the surroundings. Learning is inherent to human, but the modern world demands for manpower that can learn quickly and coherently about the changing world. Flawless and speedy learning is the need of the modern knowledge era. This requires institutionalized attempts to facilitate lifelong learning by adopting an education system, which is learning oriented rather than teaching or a university degree oriented. Learning occurs when an individual interacts with her/his environment (interaction) and develops mental schemes to capture the experience (acquisition). This leads to permanent capacity change, which cannot be attributed to biological maturation (age). Therefore, the central task of education is to implant a will and facility for learning. Public health teachers should assume to be high-level learners and are expected to devise mechanisms of interactions with the field of learning (individuals, families, people at large, community, implementers, supervisors, program planners, managers, and PH leaders) that engage MPH students for quick and appropriate learning so that the students utilize their creativity for interaction.
Globally, public health is growing fast as there are super-specializations like health management, hospital management, health economics, health human resource management, demography, health statistics/management information system (HMIS), health marketing, health insurance, advocacy, biodesign, information and communication, program communication, and information technology (IT) for health. MPH schools can and should give basic understanding of all these issues and create a solid foundation for further learning by individuals. There are also certain evolving areas like field epidemiology, integrated health program planning, state/district specific strategic analysis for investment in health, district (NRHM, IDSP, other national programs) action plans, facility-based surveillance and outbreak identification, and blue ocean strategy. Current public health affairs, health research, health economics, under nutrition puzzle, national health programs, disaster management, etc. cannot be incorporated in routine syllabus.
The public health schools should organize seminars and workshops on issues like the above and climate change, bioterrorism, health financing, e-governance, e-learning, medical practice laws, human rights, gender issues, and minimum wages act. They should aim to hone scholar's skills, and attitude and build the right approaches to develop competence, and then success follows.
Most students entering MPH courses have scant knowledge of public health sector intricacies or the functional areas or the requirements. Most of them are in their early 20s and have the basic knowledge of their basic graduation subjects and the aspirations that they want a good career. They are obviously dependent on their parents or elder siblings, and whenever confronted with an imponderable, go to their parents/siblings. Once they complete MPH, the roles get reversed. They have to depend on their own skills and parents are not able to help and may even become dependent on them. MPH schools have to inculcate a mindset that now on they are the movers and shakers, breadwinners, and responsible for their family and the public in general of health issues.
Add to this the acceptability of these fresh postgraduates (especially with nonmedical background) by traditional senior colleagues, most of who are not comfortable with computer and e-learning skills and feel threatened. The young postgraduate finds the system to be slow in action without realizing the processes to be followed. The start realizing that computer-based classroom exercises and problem-solving skills they learn in schools are difficult to apply in actual field. Field strategies combine common sense with cutting edge techniques that will prove useful to both new and seasoned managers. 
The MPH institutes may not have all efficient faculties who had played the game before and won the matches… Where to find them?
Public health professionals and academia collaboration is the need of the time. The institutions should try to achieve this by inviting veterans in public health for interface with students on a regular basis. The corporate and PH stalwarts have the capacities to transmit this knowledge and also inspire them to adopt or adapt in order to achieve the desired goals. They can also guide on career options for the students. No MPH school can install all the capacities in all students and should be satisfied if it can instill 50% competencies. The rest will have to be earned by the individuals. For that, discipline, dedication, and determination play the crucial role. That is what institutions can and need to develop.
From Principles to Practice Some Suggestive list (not all inclusive):
- University/AICTE recommended: however one can find a scope to add/delete/modify to the present need or even offer the opportunity to customize the curriculum to student's interest areas in PH in last semester. ,
- Each subject teachers of a university to consult and decide the contents and methods to teach, i.e.
- To be dealt in details: fundamentals of concept of health and disease, epidemiology, nutrition, biostatistics, environment and health, health education and communication, and health planning and management. Stress on epidemiology of newer or emerging communicable diseases like swine flu, chickengunia, and latest national programs like noncommunicable disease program.
- To be introduced and left for peer interactions (desirables): epidemiology of individual diseases, occupational health, community pediatrics, social obstetrics, blindness (ophthalmology), skin and STD, geriatrics, international health, climate change and health, disaster management, health care of the community, and health insurance.
- To be deleted: select items in each section, e.g., slow sand filters, small pox, guinea worm disease.
Incentives (teaching methods)
- Lectures: for most of theory classes to introduce subjects (<20%).
- Tutorials: small group discussion with faculty, where students come prepared on identified subjects (individual diseases, FP methods, etc.).
- Opportunities for pedagogy/training/PLA/orientation: In health workers (M and F), schools and community and undergraduates.
- Practicals: microbiology (TB, leprosy, malaria, etc.) slide making, staining, examining, stool examination, human and environment sample collection for lab investigations/use of rapid test kits etc.
- Demonstrations and supervised performance: depth interviews (DI), focus group discussions (FGDs), family interactions, counseling for ANC, immunization, IMNCI.
- Journal clubs: Review articles in IPHA, IAP, Lancet, ICMR journal.
- Observation visits: CMO's office, city corporation (municipal) health office, water works, NCDC, NIHFW, NVBDCP, NTCP, ICMR, etc.
- Seminars/workshops: National health programs, health insurance, climate change, human rights, gender issues, and disaster and media management.
- Familiarize learning methods like:
- Basic computer skills, this is laptop PH era!
- Internet and downloading from Websites
- Power presentations and MS words
- Use of Excel sheets and statistical softwares
- Progress report (daily/weekly/monthly) making
- Planning, proposal, and report writing for undernutrition, JSY, IMNCI, RCH Camps evaluation studies
- Secondary data/district plan of actions analysis and comments
- Media scanning for health/outbreak news and monthly debate
- Life cycle observation approach to learning: Allocate 20-25 HH in the city slums and nearest rural area for follow-up for at least 52 weeks throughout the course.
- Hands-on experience (supervised performance of Household surveys, DIs, FI, FGDs, Rapid appraisals and skills for IMNCI, Newborn care, ANC, PNC, etc.).
- Counseling skills (role play followed by counseling patients/health promotion among school children /specific protection).
- Skill buildings in mothers/clients (ORS making, hand washing, breastfeeding)
- Collating feedback from clients (FP acceptors, patients, mothers/care takers)
- Outbreak investigations and report writing
- Integrated planning for NRHM and NUHM (service mode based)
- Job experiencing (slipping into shoes) of HW/HA/MO/District program officers/integrated planning, finance, budgeting, etc.
Personal and professional development
To make students confident and committed, encouraging both personal and professional development is an value-add the institutions can take upon them. It would be advisable to facilitate personal development with professional in the PG course period alone. Issues like defining career and personal goals, monitoring self learning and personal development, ensuring self health and fitness, diet and weight control, cardiovascular health, develop strong bones and muscle mass, flexibility, focus on the positive thinking, help to get organized, thanking as often as possible, recognizing others contribution, and manage personal finances [Table 3].
| References|| |
|1.||Winslow CE. The untilled fields of public health. Science 1920;51:23-33. |
|2.||Manning A. Public health on front burner after Sept. 11. Careers in Public Health, CDC Atlanta; 2001. |
|3.||Ahmed FU. Defining Pubic health. Indian J Public Health 2011;55:241-5. |
|4.||GOI. TOR for recruitment of Epidemiologists in IDSP. MOH and FW GOI 2008-09. |
|5.||Sharma K, Zodpe S. Need and opportunities for Health Management Education in India. Indian J Public Health 2010;54:84-91. |
|6.||"Indian Government Panel Says Higher Education Needs For-Profit Players". Available from: http://www.LiveMint.com. August 30, 2011, 10:30 am. |
|7.||Apollo Hospitals and XLRI joining hands to offer "Executive Diploma in General Management and Health Care" -Times of India, 27 August 2011. |
|8.||Dubois CA, Singh D. From staff- mix to skill-mix and beyond: Towards a systematic approach to health workforce management. Hum Res Health 2009;7:87. |
|9.||Ahmed FU. Public Health Manpower: An alternative Model. Indian J Public Health 2010;54:137-44. |
|10.||"The Cabinet on Tuesday cleared the National Council of Human Resources in Health (NCHRH)", Kounteya Sinha, TNN Dec 14, 2011, 11.50PM. |
|11.||Best Healthcare Management Institutes in India, India Today review: Thu 13 Jan 2011. |
|12.||"Offering students the opportunity to customize their own needs "Build your own Curriculum"-Education Times, Time of India, New Delhi, 12 Sept. 2011. |
|13.||Barney JB, Clifford TG. "What I didn't learn in Business School" how strategy works in the Real World, USA: Harvard Business Review Press; 2010. |
|14.||GOI, MOHFW. NRHM Mission documents. Available from: htpp://wwwmohfw.nic.in. [Last cited in 2011 Mar]. |
[Table 1], [Table 2], [Table 3]