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| EDITORIAL |
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| Year : 2013 | Volume
: 57
| Issue : 2 | Page : 57-58 |
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Manpower planning in public health: What do we need to do?
Arun Kumar Sharma
Joint Editor, Indian Journal of Public Health and Professor, Department of Community Medicine, University College of Medical Sciences, Dilshad Garden, New Delhi, India
| Date of Web Publication | 15-Jul-2013 |
Correspondence Address:
Arun Kumar Sharma
Joint Editor, Indian Journal of Public Health and Professor, Department of Community Medicine, University College of Medical Sciences, Dilshad Garden, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0019-557X.114980
How to cite this article:
Sharma AK. Manpower planning in public health: What do we need to do?. Indian J Public Health 2013;57:57-8 |
It may not be out of place to begin this essay with a reflection on the historical perspective of manpower planning in public health in India. Sticking purely to the Indian context, I would like to say that Public Health emerged as an identity very recently. In the past, it was an integral part of medical care. Doctors per se were to look after the public health as well. Way back in 1960s, it was the responsibility of the medical officer posted at the erstwhile PHC to look after all the health parameters in his area of functional jurisdiction and he was essentially guided by the Superintendent of the District Hospital, popularly known as Civil Surgeon in most states. The public health knowledge of the Medical Officer at PHC was the residual recall of what he had learnt in his Preventive and Social Medicine classes, which he more often chose to give less priority over clinical subjects. In practice, he learnt from his peers not how to practice public health but how to keep the bosses in good humor and paint the picture that "ALL IS WELL." There were exceptions for sure, but exceptions are called exceptions because they stand out as minority and thus are too small in number to make any visible impact. On the other hand, crusaders of public health in higher levels of administration were the deputy directors and directors, who had been working as administrators for long time and therefore had lost touch with the public health at the grass root level on one hand and on the other hand bureaucratic paper work kept them glued to the office more often and ironically holding academic qualifications as surgeon, ophthalmologist, gynecologist, or internist. As a result public health lagged behind and it received a knee jerk reaction every time there was an outbreak or an epidemic. Later on guided by the World Health Organization and similar global bodies of the United Nations which were essentially lead by public health specialists taught, trained and groomed in developed nations, to advocate policies that failed to match the need of the developing nations. It is not that the intentions were wrong but it is simply because their ground realities of the third world countries were different.
The teaching of public health was essentially carried out by the department of Preventive and Social Medicine, which taught more theory than practical applications. Taking students to the field was practice only in affluent departments who could afford a bus and had something to show in large cities. In state medical colleges, located in small cities and towns, non-availability of transport restricted visits to field areas. As a result, interest in the subject never matched that of the clinical subjects; thus making PSM as the less desirable choice as a post-graduation compared to clinical subjects. Consequently, aspirants who could not score well enough in competitive entrance exam to get clinical seat of their choice, had to not by choice but by default join the PSM department. They loved clinical sciences but were forced to marry PSM. And such alliances are bound to deliver congenitally malformed entities. Today, when public health has become a buzz word, the PSM fraternity is at a loss; neither it can shy away from it nor it can fully claim itself to be the rightful heir of it. As a result we see a clear cut dichotomy between the PSM people and the public health people. And this divide is unfortunately not helping the cause of both the fraternity as well as the nation which desperately needs both the groups to join hands and save the country from public health disasters.
But the PSM fraternity, now rechristened as Community Medicine, as a knee jerk reaction, rushed to create its own public health institutions. In some places, Community Medicine department and Public Health schools are coexisting in a state of fractured union. It raises a question: How is Community Medicine different from Public Health? If so, then till 5 years ago India had no public health and what was Community Medicine then? And if what is public health now according to them, then what is Community Medicine supposed to be for? Often students in both the streams appear confused about their future professional goals. Many a times, the MPH or potential MPH student puts across this uncomfortable question: Will I get a teaching position in a medical college with my MPH degree? On the other hand the Community Medicine student asks: Am I a clinician with public health knowledge or a public health expert with clinical knowledge? Am I eligible for a post of Public Health Consultant?
When I posed this question of confusion to Pranab, the First year PG in my department, he made a very candid observation, "it is high time to harness the incoming manpower and employ them (that is, people like us PGs) gainfully before they become infected with the cynicism and pessimism of the preceding generation." Pranab is one of the prototypes of the young generation joining Community Medicine by choice; he also pleads on the behalf of his generation's aspirations and desires, "we're in the throes of an identity crisis and we need to make a call where we are headed for. Unless we do that, Community Medicine teaching will be half-hearted, dated and, simply put, boring."
At such a crucial juncture, how will things shape up in future will certainly be hinged upon what we want to do with this confusion. We may let it take its own course and after 10 years, fill the pages of the then journals with stories of missed opportunities or sit down together and plan the course of action that will give a direction to the younger generation from both Public Health and Community Medicine qualifications; use their respective expertise in addressing the public health problems of the country.
I see it as an opportunity to use this human capital that is being created in numbers larger than ever before. For meaningful utilization, we have to understand what skill and competencies the MPH, the PhD, and the MD (Community Medicine) are acquiring and where can those be rightly utilized. In fact the country needs three levels of public health personnel. Firstly, the grass root level worker, who is able to manage the public health issues at the village and block level; his/her competencies will be more related to practice of public health at community level. Secondly, the middle level workers, who have more administrative and managerial skills as their core competencies. They will be the public health cadre at the middle level, namely district and state level. The number of such personnel should be at least one at each district, at state level, more than two for large states, two for medium size states and one for smaller states only. Besides being administrators and managers, they are expected to have sufficient knowledge of research and teaching, so that they can facilitate these activities besides their managerial roles. The third level is the group of researchers, academicians, policy makers and planners who will act as think tank and guide the public health policies for the country. Besides having academic qualification, at the third level people should have demonstrated expertise in policy making, planning innovative research, and a rich experience that proves their understanding of public health needs of the country in its entire heterogeneity at the national level and unique peculiarity at the micro level, i.e. village or block or district level.
I am not talking of three water tight compartments here; there is enough scope as well as need for two way interaction between the three levels, as these are essentially complimentary to each other. Those who are recruited at the first level should be provided with opportunities of upward movement based on purely objective assessment of their competency to move to the next level.
Teaching programs should be such that they could train the basic public health worker to take up the responsibilities of public health practice up to a district level. Their competencies should include ability to work at community level, understand the disease epidemiology and dynamics at micro level, ability to implement public health interventions at community level, and above all develops the commitment to perform with measurable outputs; it's our responsibility to train them in such a manner.
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