|Year : 2018 | Volume
| Issue : 3 | Page : 165-166
Leadership in public health
VK Srivastava1, R Kunwar2
1 Ex. Professor of Social and Preventive Medicine, KG's Medical University, Lucknow and Chairperson, Organizing Committee, 62nd Annual National Conference of Indian Public Health Association, Lucknow, UP, India
2 Professor of Community Medicine, TS Misra Medical College, Lucknow, UP, India
|Date of Web Publication||12-Sep-2018|
V K Srivastava
Ex. Professor of Social and Preventive Medicine, KG's Medical University, Lucknow and Chairperson, Organizing Committee, 62nd Annual National Conference of Indian Public Health Association, Lucknow, UP
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Srivastava V K, Kunwar R. Leadership in public health. Indian J Public Health 2018;62:165-6
The concept of leadership is as old as the origin of the human race. Be it a team or a community or a nation, a leader has always been required for the progress of the society, for achieving a desired goal or even solving a problem faced by the masses. In the process, while some became a leader because of the dynasty, they were born in such as kings, chieftains, and headmen, some were chosen and made leaders because of their vision and charismatic personality they possessed such as political leaders, corporate leaders, and military commanders. Leaders, who excelled in their field and accomplished the tasks even beyond their assigned roles, are remembered as great leaders. Effective leadership is a vital component of health-care systems and has an extensive range of functions in improving organizational effectiveness and efficiency. Leadership is a process whereby an individual influences a group of individuals to achieve a common goal.
Public health of today is at a crossroad and is in need of a leader who can help materialize the true public health, as defined by Acheson, i.e., to prevent disease, prolong life, and promote health through the organized efforts of the society. The leader is expected to be a person who has a clear understanding of the goal, is efficient at health decision-making, is able to communicate and motivate all agencies under command to work as a team and is able to show an attributable improvement in the health of a population or community. The presence of competent leaders is crucial to solving unprecedented public health challenges and achieving progress in the field. In the current health-care sector where there is rapid change, leadership is the key to manage increasing demand, with limited resources. Lack of effective leadership in health coupled with a weak public health capacity is one of the bottlenecks in achieving the targets and health goals.
The medical curricula at undergraduate and postgraduate levels lack the managerial and leadership teaching. Public Health Administration is included to some extent in the MD (Preventive and Social Medicine)/Diploma in Public Health courses. This leaves a big gap in managerial and leadership skills among the doctors as they reach senior positions. All the doctors play a leadership role right from their first assignment while working in a team of staff with them and managing their own clinical work and dealing with their attendants and other influencers. The scope of leadership expands as they move into senior positions by virtue of the length of service and not because they have acquired the leadership skills. An average health professional reaching leadership position acquires these skills, essentially by hit and trial, by observing others, and through individual driven self-learning by reading or taking up some available courses. Thus, there is a strong feeling that public health organizations should engage in building leadership capacity at every level wherever possible. The Lancet Commissioners identified leadership as one of the global systemic failures and recommended major reforms of the health professionals' education setting up a new professionalism for the 21st century, which should promote quality, embrace teamwork, uphold a strong service ethics, and be centered around the interests of patients and populations. This wide-ranging contexts, within which public health leaders need to function, may require a reconceptualization of professional training and support mechanisms.
There are some institutions in the country which offer in-service leadership and strategic management courses with funding from Government of India, World Health Organization, or self-payment. There are also established in-service training institutes at the national, state, divisional and district level. However, these efforts need to be mainstreamed in both basic and in-service training.
In India, diseases, such as polio, guinea worm disease, yaws, and tetanus, have been eradicated. Many of the health indicators such as life expectancy, infant mortality rate, and maternal mortality rate have shown marked improvement in the previous decades. However, these are still far behind the global average. The burden of communicable diseases continues to be high but the leading causes of death now, are noncommunicable diseases. The epidemiological transition is being fueled by the social and economic determinants such as globalization; unplanned and unregulated urbanization; changing lifestyles; climate change and air pollution; and increasing influence of media and advertising. Great disparities between the rich and the poor, between urban dwellers and rural dwellers, in access to health services, continue to exist in the society. The health-care system is overstretched, and the cost of health care is high.
The scope of public health is massive and limitless. The challenges, it poses are complex and intricate. The public health challenges faced by developing nations are substantially more than that faced by developed nations. Majority of the developing world still have their public health infrastructures in forming a state; their monetary resources are meager and not adequate to bear the cost of expenditure on health; their health workers many of whom are not adequately trained, are not enough in numbers to provide adequate health coverage. Many of these nations have a high burden of largely preventable and treatable conditions. Poor maternal and child health exacerbated by malnutrition and poverty are still rampant. Inequality in health-care access is markedly high.
Sustainable Development Goals, built on the success of Millennium Development Goals, now cover all walks of life including poverty, hunger, health, education, climate change, gender equality, water, sanitation, energy, urbanization, environment, and social justice. There is hardly any field of a man's life which has remained untouched and not included in the gambit of public health. In other words, affecting all stages of human life, covering all aspects of man and its surrounding, entwined around the intricacies of the society, and dealing with a multitude of stakeholders, the public health of today is posing a serious challenge for all public health practitioners.
However, the practice of public health is not easy. As is often the case, the good work of its practitioner is rarely recognized. But, whenever, there is an outbreak or a massive breakdown in the system affecting the health of masses, he is brought to limelight, severely criticized and asked by multiple stakeholders to be transparent, forward explanations, and control the situation at the drop of a hat. The power to resolve such situations is not the domain of an ordinary practitioner of public health. Sustainable solutions often demand broad societal changes. Inputs from health experts and multiple interactions with policymakers, many government and nongovernment agencies, legal advisors, religious teachers, local authorities, and stakeholders for support may be required. Only likes of Sir Edwin Chadwick who was a barrister – cum-journalist, had no training in medicine or sanitary engineering or public administration; was tenacious in pushing a reform by all available means until action was taken; and did not negotiate or converse but lectured at people, again and again, until they acted, succeed in such situations. Only a person who takes the call as a mission, who is highly adept in communication skills, who has a lot of convincing power, who is dynamic, firm and flexible at the same time, and is able to lead his team successfully during a public health crisis proves himself as a public health leader.
A public health leader should have core transformational leadership competencies which include personal mastery over analytical thinking, communication, visioning of potential future, ethical decision-making and taking decisive action; legal and political competencies for effective negotiations; transorganizational competencies for garnering support from agencies beyond the organization or system boundaries; and competencies related to team leadership and dynamics for building capacity to develop integrated systems to accomplish mutual objectives.
Leadership in public health is a demanding task and its need today is more than it ever was. It needs a person – preferred but not necessarily a public health practitioner – who is competent, is ready to take risks and utilize opportunities, has a vision, is charismatic, and is able to lead his team successfully in materializing the goal of public health. However, for the leadership to be effective, it must be built on a solid foundation consisting of a clear mission, a vision for the future, a specific strategy, and a culture conducive to success.
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