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EDITORIAL
Year : 2016  |  Volume : 60  |  Issue : 3  |  Page : 169-170  

Bachelor of public health course to upgrade the competencies of health assistants


Professor and Head, Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India; National Advisor, Indian Journal of Public Health

Date of Web Publication24-Aug-2016

Correspondence Address:
Rajesh Kumar
Professor and Head, Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India; National Advisor, Indian Journal of Public Health

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-557X.188991

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How to cite this article:
Kumar R. Bachelor of public health course to upgrade the competencies of health assistants. Indian J Public Health 2016;60:169-70

How to cite this URL:
Kumar R. Bachelor of public health course to upgrade the competencies of health assistants. Indian J Public Health [serial online] 2016 [cited 2019 Sep 22];60:169-70. Available from: http://www.ijph.in/text.asp?2016/60/3/169/188991

It is well known that the level of health in a community is largely related to the access to personal preventive and curative care as well as public health services, i.e., environmental sanitation, quality of water and air, housing, and nutrition, etc. Therefore, on recommendations of the Bhore Committee in 1946, the delivery of public health and medical care services were integrated in India. [1] Medical officers were made responsible for the delivery of integrated promotive, preventive, curative, and rehabilitative services. That is why, medical students in India are required to study Preventive and Social Medicine, later rechristened as Community Medicine.

According to the Indian Public Health Standards (2012), two medical officers are entrusted to carry out integrated medical care and public health functions in the Primary Health Center (PHC). [2] As a PHC caters to about 20,000-30,000 population in about 20-30 villages, access to medical care is limited due to geographical barriers. Hence, two health workers (one male and one female) have been deployed at each of its six sub-health centers; each catering to about 2000-5000 population spread into 2-5 villages. In the last decade, national rural health mission has encouraged enrollment of community health volunteers called Accredited Social Health Activist (ASHAs) in every village (about 1000 population) to facilitate linkage of health services with the people. [3] Two health assistants (one male and one female) are also posted in PHCs to assist medical officers beside a pharmacist, laboratory technician, nurses, data entry operator, and attendants. Similar organizational structure has been advocated for the urban areas also.

While teaching programs for medical officers, female and male health workers, nurses, pharmacists, and laboratory technicians are well established, the content and curriculum for the health assistant course are not well standardized. Mostly, experienced health workers are promoted to the position of health assistant; in some instances, a 6-month promotional course is conducted for them. There is a need for having a formal course for health assistants at the graduate level such as Bachelor of Public Health (BPH). Since setting up of BPH courses may take time, in the interim period, bridge course can be offered to the existing workforce of health assistants, who are working in the health services. Several countries have established BPH courses. [4] These are also available in our neighboring countries (Nepal and Bhutan).

Placement of health assistants, who have upgraded knowledge and skills for managing public health programs, at PHCs/subcenters will improve the public health component of the primary health care in the rural and urban areas of the country. Minimum qualifications for admission to the BPH course should be 10 th and + 2. As existing health workers and health assistants have already been through a 12-18 months course after matriculation, they should also be eligible to join this course. Institutes of National Importance such as Postgraduate Institute of Medical Education and Research, JIPMER, AIIH, and PH should be encouraged to pilot this course in their public health schools. However, these institutions may require strengthening in terms of new teaching positions and related infrastructure. The possibility of delivering this course in the distance learning mode through Indira Gandhi National Open University should also be explored. The BPH degree course should be eventually recognized by University Grant Commission or All India Council for Technical Education.

In the absence of a middle-level health manager, i.e., health assistant, the capacity of ambitious health programs as outlined in the draft National Health Policy (2015) [5] will continue to be limited. Investments in establishing a BPH education program will build the capacity of health services for many years to come. On completion of BPH course, the graduate should be able to possess the knowledge and skills of the basic sciences of public health and their application in health programs; identify health problems of the community in the context of the sociocultural milieu, and find out population groups that require special attention including those facing occupational hazards; set objectives, prepare action plan, implement programs, and monitor, supervise and evaluate health programs; develop and manage health information system and respond appropriately to the information gathered; and measure and assure quality in public health program implementation.

Syllabus of the BPH course should have social sciences, life sciences, and environmental sciences in the 1 st year; and health sciences, health administration, and public health principles should be covered in the 2 nd year; and 3 rd year should have primary health care, epidemiology, and health promotion. Each year about one-fourth of the time should be devoted to public health practice. The coursework would also need to be structured to have a balance of learning in the classroom/clinics and practice in the community/field. Course evaluation should include not only knowledge and skills but also competencies to deliver public healthcare with right values and attitudes.

The demand for BPH will depend on the career options available to them in the current central, state, district, and local government health organizations. The draft National Health Policy (2015) has articulated the need to have "mid-level managers" in the PHC teams. Placement of BPH graduates as a health assistant at PHC level as a mid-level manager would be a great help to the medical officer-in-charge of PHC, who is currently overburdened. He/she has to perform clinical duties as well as implement public health programs in the PHC area, where a workforce of about 25 ASHAs and 10 auxiliary nurse midwives provide services in about 25 villages spread into a large geographical zone. Some of the BPH graduates could be employed as block health managers, food safety officers, and health/sanitary inspectors in the municipal committees. Few of the BPH can subsequently take up MPH course to qualify for higher positions in the health organization at block or district level. Their role would be to assist the medical officer of health, senior medical officer or chief medical officer in planning, organizing, implementing, and supervising/monitoring of health programs in a defined rural or urban geographical area.

To a large extent, the success of an organization is dependent on the quality of human resources it has and the way; they are organized and their performance evaluated. Further expansion of health services under the national health mission requires the support of technically qualified public health workforce for achieving universal health care which is one of the sustainable development goals to be achieved by 2030. [6]

 
   References Top

1.
Report of the Health Survey and Development Committee. Government of India, New Delhi; 1946. Available from: http://www.nhp.gov.in/bhore-committee-1946_pg. [Last cited on 2016 Mar 20].  Back to cited text no. 1
    
2.
Indian Public Health Standards: Guidelines for PHC. Ministry of Health and Family Welfare, Government of India, New Delhi; 2012. Available from: http://www.health.bih.nic.in/Docs/Guidelines/Guidelines-PHC-2012.pdf. [Last cited on 2016 Mar 20].  Back to cited text no. 2
    
3.
Accredited Social Health Activist (ASHA). Ministry of Health & Family Welfare, Government of India, New Delhi. Available from: http://www.nrhm.gov.in/communitisation/asha/about-asha.html. [Last cited on 2016 Mar 20].  Back to cited text no. 3
    
4.
Public Health Online. Campus and Online Bachelor′s Degree in Public Health. Available from: http://www.publichealthonline.org/degree-programs/bachelors/#context/api/listings/prefilter. [Last cited on 2016 Mar 20].  Back to cited text no. 4
    
5.
Draft National Health Policy 2015. Ministry of Health & Family Welfare, Government of India, New Delhi; 2014. Available from: http://www.mohfw.nic.in/WriteReadData/l892s/35367973441419937754.pdf. [Last cited on 2016 Mar 20].  Back to cited text no. 5
    
6.
United Nations. Sustainable Goals: 17 Goals to Transform Our World. Available from: http://www.un.org/sustainabledevelopment/sustainable-development-goals/. [Last cited on 2016 Mar 20].  Back to cited text no. 6
    




 

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