Essay Competition

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Strengthening Public Health: Translating Ideas into Action

“Strengthening Public Health: Translating Ideas into Action” is the need of the hour. Its high

time, we the people of India realized the futility of adding volumes upon volumes of various

health programs – plan their strategies, decide objectives, set targets and goals; using incentives

as a bait to people for adopting /practicing that which is for their own benefit ! A lot has been

said but with poor implementation and poorer show. So we need to reflect, rather meditate upon

the gaps that make all our good-intentioned, well planed, carefully maneuvered and highly

idealistic ideas and dreams to crumble down like a house of ‘pack of cards’ when it comes to

outcome and impact of these programs. In present scenario, the Health Programs suffers from

numerous gaps like lack of dedicated efforts & accountability, feeling of ownership and absence

of standardized method for planning and monitoring. There is multiplicity of registers &

reports. Voluminous data are collected, never to be used in planning.

On meditating upon the thought, a realization dawned upon me that we have been

using the twin instruments of fear and temptations to get the desired results- attain benefit for all

humanity in a complete sense, that is physical, mental, spiritual, economic; all that can possibly

affect our life. Then what is the cause of “near-failure” like impossible situation we have landed

ourselves into!

It is rooted deeply in our attitudes, our way of thinking; as wisely said, everything

begins in mind-a wrong thought leads to wrong action and ultimately the wrong result. What that

wrong thought is? That, ‘I’ and ‘Mine’ have shrunk in size to ‘Myself’, it doesn’t any more

include my neighbours, friends, my state, my country etc. ‘I’ stands for my selfish desires; and to

fullfill it I am ready to burry my conscience without ever realizing the fact that my happiness, my

health, peace of mind all are dependent on happiness, health etc. of my neighbourhood, my city,

my state, my country and the world as a whole; I am but a part of the ‘whole’ and hence

interconnected. I can’t just sit back and wait for miracle to happen and change the situation; I

have to make the miracle happen, each one contributing our small bit ! No amount of community

monitoring or any other external force can bring the desired impact. Finding faults with others &

shifting the blame on somebody else can’t bring the solution, remember when we point one

finger at someone, the four fingers point at us!

As rightly said “charity begins at home” , hence each one of us as individuals have to

understand and accept the fact that ‘HEALTH FOR ALL’ is possible when all of us are willing

to take upon ourselves the responsibility/accountability for ourselves and our fellow brothers.

Health is not a government responsibility but individuals right and individuals fight, but

fought together as our own battle, giving priority to the needs of all, enhancing the

transparency till the grassroot level. Then the battle is already won. That I think is the only way

of strengthening public health- translating ideas into Action !

Dr Sadhna Singh; Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun

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Public health training and education have existed for over a century, yet there is little systematic

evidence on whether current approaches prepare graduates to improve health by developing,

evaluating and implementing effective and equity oriented public health programmes. There are

three reasons to document and debate this topic worldwide and disproportionately focus on low-

and middle-income countries.

The first is that the global health workforce is in a state of crisis. The World health report

2006 describes this situation as a “major mismatch” between population needs and the available

public health workforce in terms of overall numbers, relevant training, practical competencies

and sufficient diversity to serve all individuals and communities. In many countries, public

health programmes led by clinicians with little or no public health training are plagued by poor

management and ineffective resource allocation. This cannot be overcome by simply building on

current policies: government oversight must ensure proper recruitment for public health jobs, and

new models are needed for pre-service and in-service training.

The second is that there is increasing demand for well-trained public health professionals

that can address the changing context of global health challenges, including complex and

persistent health problems, increasing health inequities, new and emerging diseases, necessity for

greater collaboration, and incorporation of social models and determinants of health.

Thirdly, such debate allows networking among schools, public health agencies, policy-

makers, student groups, professionals, United Nations agencies and other organizations. These

groups include the World Federation of Public Health Associations, regional associations of

public health schools, the People’s Health Movement, health ministries, other senior policy-

makers and the newly created International Association of National Public Health Institutes.

WHO estimates that about 400 schools of public health exist, not counting hundreds of

departments of public health, hygiene, epidemiology, community or social medicine, and other

units with similar mandates. These programmes need evidence on selecting and retaining an

optimal mix of students and professionals, on matching training to health systems challenges, on

meeting the demand for specialized competencies and on ways to involve alumni in enriching

learning approaches. Yet most research on public health training and education tends to focus

narrowly on educational measurements or new curricula. There is almost no evaluation of the

degree to which educational practices match real-world conditions. Possible avenues for

innovation include more strategic use of fellowships, foreign training experiences, student-led

research or institutional partnerships. Public health content also can enrich course work in

business, public policy, urban planning, foreign policy and international relations. Schools are

developing innovative models, public–private partnerships, wider ranges of students, networks of

faculty and other programmes with greater relevance to public health priorities.

Some suggestions to improve public health are-

- schools’ leadership role in influencing strategies and policies;

- intersectoral collaboration and networking with stakeholders;

- diversity of students and professionals, their retention through graduation;

- Community-based, problem-oriented teaching approaches addressing health challenges;

- learning how to commission research, build evidence and use results;

- steering student-led research towards global and national priorities;

- in-service or executive training of public sector officials;

- core competencies for public health practice;

- adding public health learning to other schools’ curricula.

Dr Kajal Srivastava, S N Medical College, Agra

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Public Health is Exciting; dynamic, multidisciplinary team approach where people work to

protect health of the community and population.

Taking into account, the level of development in India today, the theme of the Conference is

timely indeed. I am sure India can become a developed nation by the year 2020 as envisioned by

His Excellency Dr. A. P. J. Abdul Kalam, past President of India. Certainly, India has the

potential, especially, in the areas of know-how and human resources to move forward to that

level of development by 2020. Only health security for the entire population has to be the

overriding concern in the process of national development. Good health for all citizens has to be

ensured throughout such a process. Public health forms “the root” of the community

Here we outline a conceptual framework for strengthening the foundation for public health

practice and improving the understanding and use of ideas as a public health tool. The Future of

Public Health, which defines the core functions of public health as assessment of population

health, policy development, and assurance that high-quality public health services are available

Public Health forms the grass root of the community so strengthing ideas and actually converting

those into action forms the mainstay for the betterment of the community which directly effects

the entire nation, strengthing some of the essential public health services can bring a drastic

change in the system these are : (1) Monitor health status to identify and solve community health

problems; (2) diagnose and investigate health problems and hazards in the community; (3)

inform, educate, and empower people about health issues; (4) mobilize community partnerships

and action to solve health problems; (5) develop policies and plans that

support individual and

community health efforts; (6) enforce laws and regulations that protect health and ensure safety;

(7) link people to needed personal health services and ensure the provision of health care when

otherwise unavailable; (8) ensure a competent workforce—public health and personal

care; (9)

evaluate effectiveness, accessibility, and quality

of personal and population-based health

services; and (10) research for new insights and innovative like Health information systems.

Targeting onto the essential public health services and actually turning those into action can

cause the major up-liftment and a more core bonding of the various sectors in health and these

health services

Primary prevention in health is one of the cost-effective strategies to reduce poverty in any

community in developing countries. Since long, our health care services have been concentrated

in areas of secondary care. The secondary care places emphasis on treating the sick, especially in

the medical institutions. Our health systems have, therefore, been over oriented toward curative

and rehabilitative services; at the cost of promoting and preventive care.

In the end i will conclude that The nation’s attention should be focused on the vital need for a

strong public health infrastructure to protect community health and this could only be achieved

when ideas come to life and in full action.

Dr Sumit Jethani; Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun

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Mankind has long accepted a self-posed challenge. No development has happened to us without

an incumbent health risk – all medicines have side effects (some have proven abuse potential); so

many radiological processes have associated hazards! Notwithstanding the disparities and

impropriety in health between and within ‘worlds’, our quest for ‘health for all’ ambitiously

concerts with our requirements. Today, we are directed towards betterment of public health by

attempting to organize the efforts made by the society itself 1.

India’s desire to ensure its citizens a perfection in health is evident from the number of

committees (from Bhore’s Report 1946, till date), policies (e.g., NHP 1983, 2002; NPP 2000,

etc), plans (the Five Year Plans, etc) and programmes that have been worked out. The setting up

of the Planning Commission in March, 19502 was a very purposive approach towards an

organized and balanced nation building. Ever since, we have increasingly prioritized health as a

thrust area for action in our Five Year Plans (from the 1st in 1951 till the 11

th in 2007). Having

started with the welfare-state approach (post 1947)3, we have strengthened ourselves on the

principles of Primary Health Care (Alma Ata, 1978). We respond well to vertical campaign-like

approaches (e.g., the near eradication of poliomyelitis)4. However, strategies like decentralized

planning, convergence of service delivery at village levels, meeting the unmet needs for family

welfare services, diversification of health care providers, mainstreaming AYUSH, focusing on

crunch areas like MCH care and adolescents, and collaborating with NGOs have redefined our

health service delivery. Gradually moving towards a demand-driven system, we have further

streamlined ourselves under NRHM and NUHM.

Although claims exist regarding the rhetoric-reality divide, the Government of India strongly

affirms our consistent movement towards the attainment of the Millennium Development Goals.5

The repletion of innovations in the form of insightful ideas has compensated for our ‘resource

scarcity’(trained man-power, finances, logistics and of course, time!). In 1952, India was the first

country in the world to launch a national programme emphasizing family planning. We have

constantly surprised the Globe by managing health crises with confidence and élan, given the

contextual challenges (large population, illiteracy, malnutrition, prevalent beliefs, etc) and

improbabilities. Socio-cultural proselytization is never easy but we have made the girl child to

survive; and colostrum to be fed, at least in a certain portion of the society!

Public health in today’s India is much stronger than ever before. Absolute perfection in health

care may still appear elusive for us but we are aware of implementation strategies that should go

a long way in translating our ‘ideas’ into ‘reality’. A nation as vibrant as ours is unstoppable!

References

1. Acheson Report, 1988

2. http://planningcommission.nic.in/plans/planrel/fiveyr/1st/1pintro.htm

3. Nundy M. ; Primary Health Care in India: Review of Policy, Plan and Committee

Reports; http:// www.whoindia.org

4. http://www.unicef.org/india/overview_3696.htm

5. Jacob K.S. ; Millennium Development Goals & India; The Hindu; Oct 20th

, 2010.

Dr Archisman, IMS BHU

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The history of public health is the story of the search for effective means of preventing

disease in the population. Throughout centuries, public health evolved with trial and error, and

with expanding scientific medical knowledge, often stimulated by ideas innovated when struck

by war and natural disasters.

The transformation of ideas into action dated back to the time of Homer. Greek and

Roman cities appointed doctors to provide free care for the poor and the slaves. Medieval guilds

provided free medical services to their members. Following Bismarck’s 1881 introduction of

national health insurance for workers and their families, most countries in the industrialized

world introduced national health plans. So, the concept of health for general public is not new

but a refined modification presented in a comprehensible way called “Health for All”.

But the utopian dream of international and national health agencies to achieve “Health for

All” faces serious obstacles of inequities, lack of resources, distortions with overdevelopment of

some services at the expense of others, and competing priorities. It might seem appealing at the

first glance but realistically it is difficult – if not impossible – to accomplish. Limited resources

and overspending on high technology facilities in the capital cities leaves little for primary care

for the rural and urban poor. Here again comes the importance of taking practically feasible steps

which will see the conversion of theory into reality.

Another issue is policy making and implementation. Beaglehole and Bonita’s book

Public Health at the Crossroads (2004) defines public health as “Collective action for sustained

population-wide health improvement”. Selection of which direction to take in organizing health

services is usually based on a mix of factors, including the political view of the government,

public opinion, and rational assessment of needs as defined through epidemiologic data, cost–

benefit analysis, and recommendations by experts. A proper coordination in a balanced way thus

becomes very much crucial for construction of public health on a solid base.

Simultaneously focus should be on the redistribution of resources. The success that is

being made in community development will count for nothing unless national priorities switch

from nuclear weapons to maternal and child health. “This may sound like wishful thinking but

how else will we create hope from the despair of untold child death, wanton neglect of girls and

women, and a rich elite feasting on the misery of millions in poverty?” (Bhutta Z, Nundy S,

Abbasi K. Is there hope for South Asia? BMJ 2004;328:777-8)

Last but not the least, adoption of international initiatives deserves special consideration.

“The international system fails to meet the scientific and technological needs of the world's

poorest”. (Sachs J. Helping the world's poorest. Economist 1999 Aug 14:17-20). Little

sensitivity to the local needs has led to the eventual failure of many programs, with a few

exceptions.

We hope that we will embark on success in public health in near future by removing the

obstacles and paving the way for translating plausible ideas into meaningful action.

Dr. Manas Pratim Roy, Junior Resident, CSMMU UP, Lucknow

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"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."

– C. Everett Koop

Gaining new ideas are important, however understanding how ideas change our perceptions,

understanding and actions is even more important. We need to make sure we systematically

integrate new ideas into people’s lives, in a manner that changes community thinking and

ultimately people’s behaviour.

The field of public health changes the social conditions and systems that affect everyone within a

given community. It is because of public health that we understand that unclean water can carry

bacteria that cause disease, that second-hand smoke can be deadly, and that seat belts can save

lives.

From scientific discovery to policy change, there have been countless advances in public health

throughout human history. In 1999, the Centers for Disease Control and Prevention named the

ten greatest public health achievements of the 20th century, namely on vaccination, motor

vehicle safety, safer workplaces, control of infectious diseases, decline in deaths from coronary

heart disease & stroke, safer & healthier foods, healthier mothers & babies, family planning,

fluoridation of drinking water & recognition of tobacco use as a health hazard.

To shift the emphasis from disease-based health services to risk and determinant-based health

systems is really a formidable task. As a prerequisite, we need to have the right workforce to

engineer health systems toward the desired direction. To move efficiently along this course of

primary prevention, we need a public health and community-based health workforce. The

workforce should be able to effectively develop and implement public health programs. The

programs should deal primarily with health promotion, disease control, and prevention. The

workforce should ensure reaching the unreached. It is important to emphasize the critical role of

community-based health workers who work at the grassroot level, rendering services to the poor

& underprivileged.

There is an urgent need to reorient our strategy in the development of human resources for health

in this new direction. To be able to do this successfully, we need strong and sustained political

commitment and support. Besides, we need unwavering and long-term policy and strategy back-

up at the national level. The Rural Health Mission and Public Health Foundation are a clear

evidence of the Government's intention and commitment in this regard.

An effective public health specialist should be aware of the importance of reviewing the creation

process, as it moves from the idea concept to the action and the outcome. Once an idea has been

identified the translation into action can only take place once the individuals responsible for

action are able to use their own experiences, skills and ability to figure out the best possible

method of creating the outcome. In conclusion the literature portrays that there are enormous

ideas and plans about strengthening public health. A strong will, an impregnable determination

and an open mindset is all what is necessary to translate those ideas into action.

Dr Ashish Yadav, LLRM, Meerut

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Public health is “the science and art of preventing disease, prolonging life,

and promoting health through the organised efforts of society”.

Strengthening public health is a major challenge before all of us in the 21st century. Many health policies

and strategies have been formulated in the past with respect to public health but has not been able to

deliver the required outputs which were desired of them.

We should be honest enough to accept that there is a large gap between a volume of public health

knowledge generated through research and the application of research in community settings. The major

question before us is why do we need to strengthen our public health system? We all know what

happened with Health for All 2000 AD. The answer to this is that a robust and effective public health

system is essential if we need to deliver Government policies for improving health and wellbeing. A

strong public health will go a long way in solving most of the critical issues relating to health, as it will

provide necessary infrastructure to help change the social, economic and environmental factors which

lead to poor health. Also at the same time it will help address social exclusion, inequalities in health care

and provides support to local authorities and reoriented NHS in ensuring that local partners focus on

improving health as well as service quality.

There are certain areas that we need to work upon if we need to strengthen our public health or make our

ideas feasible, practical and action oriented. Emphasis should be laid upon framing healthy public policy,

create supportive environments for health planners and health professionals and at the same time

strengthen community action as it requires a coordinated effort from all to bring about a change and

efforts directed towards enchancing personal skills and reorienting health services. There is a serious need

to develop a national strategy to raise awareness and knowledge of specific public health issues and to

take effective action.eg through national campaigns, public information materials etc. Emphasis should be

given to grass root level workers as they are key leaders and they should be duly empowered, listened to

and given proper incentives. They should undergo training with HMIS so that the results are obtained at a

rapid rate. There should be appropriate feedback system as well as health workforce should be

strengthened and work with positive frame of mind.

There should be improved system of surveillance to tide over constantly occuring epidemics such as

Swine flu,sars or recently Dengue fever Saga.Emphasis should be laid upon imposing behavioural

changes such as avoidance of stress at workplace.Lifestyle changes and careful screening will bring about

drastic fall in levels of Hypertension and Diabetes and source of government information such as housing

indicators, should be fully utilised by public health departments in monitoring public health. There

should be overaching public health research and development strategy. There should be ways of

supporting the local approaches to implementation of local health programme and strengthen effective

joint working between academic and public health service departments. It is high time that we should give

an insight into this meticulous problem and come out with a solution sooner than later. To summarise,

remembers me a saying of Louis Pasteur

“To him who devotes his life to science, nothing can give more happiness than increasing the

number of discoveries, but his cup of joy is full when the results of his studies immediately find

practical applications.”

Dr Danish Imtiaz, Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun

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Public health can be strengthened by strengthening the existing system of health care delivery i.e.

Primary health care delivery system, which is a three tier model of health care in India. The first

step towards this goal would be to maintain the number, infrastructure and the manpower of the

health care facilities up to the standards (IPHS) and the second step would be a continuous

monitoring and evaluation of the health care facility and people working there.

Even after so many years of recommendations of Bhore Committee and Alma Ata Declaration of

“Health for All”, the current provision of health care by focussing on curative aspect in our

country defeats the very concept of comprehensive health care, which states it as preventive,

promotive and then curative health care. So we need to change our focus from CURATIVE to

PREVENTIVE AND PROMOTIVE and URBAN to RURAL+URBAN, if we really need to

improve the status of public health in our country. This change should be incorporated at the

national level by our eminent policy makers, which will percolate down to the most peripheral

level gradually. Besides, our leaders should make the provision of flexibility in the policy and

programs for the states to incorporate changes as per their needs and requirement keeping in

view the social, cultural, economic, educational and infrastructural diversity.

At the peripheral level we should make use of the existing systems to improve health care

delivery in a country as large as ours. Panchayati Raj Institutions, which are already functioning

in our country, should be involved in planning, implementation, monitoring and evaluation of

various health programs being implemented in our country. Apart from this more Non-

Governmental Organizations should be promoted to take active part in implementation,

monitoring and evaluation. As we make the government by the people for the people in the

largest democracy, we should also imply the same principal as far as health care is concerned.

We should try to increase the involvement of the community in all the process of health care

delivery, as is already being done with the help of ASHAs, AWWs, TBAs, etc. But this is not all,

every program should have a peripheral community based worker like ASHA, so that our health

force increases and also the ASHA is not overworked as is being done currently. These workers

should make a weekly or monthly report to submit to their superiors for monitoring and

evaluation just like being done in case of polio these days.

Public health scenario cannot be strengthened in isolation, instead it is the overall development

(not only economic) of the nation which will boost the status of public health in our country.

This statement can be justified by the example of Kerala, where the health indicators are the best

and which also has high literacy rate. So what we can do is that we can make the education

mandatory for every individual besides other interventions to open the path towards HEALTHY

INDIA.

DR. RITESH SHARMA, LLRM, Meerut

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“Knowing is not enough, we must apply; willing is not enough, we must act.”

(Johann Wolfgang von Goethe)

Now is the time to make it happen where it matters, by turning scientific knowledge into

effective action for people’s health.

Science has led to dramatic improvements in health worldwide. Yet all is not well. Disparities

and inequities in health remain major development challenges in the new millennium, and

malfunctioning health systems are at the heart of the problem. Half of the world’s deaths could

be prevented with simple and cost-effective interventions. But not enough is known about how to

make these more widely available to the people who need them.

Stronger emphasis should be placed on translating knowledge into action to improve public

health by bridging the gap between what is known and what is actually being done.

It is now a global imperative to find effective ways to strengthen health systems in order to

improve the lives of people, to meet the MDGs and to prepare for what is to come. Since the

time of Hippocrates humanity has struggled to grasp the fundamental principles of science and,

perhaps more importantly, their implications for human health.

Health systems in the developing world face major problems related to shortages, maldistribution

and waste of financial, human, knowledge and other resources, and coverage shortfalls.

Programmes can be national or international in scale but what is critical to success in terms of

improving health is how they function at the local level. Priority setting should occur mainly at

sub-national or regional levels rather than at the global level. Communities are powerful

influencers of acceptance and change in much of the developing world. Implementing a

programme without the acceptance and explicit support of community leaders is probably

doomed to fail.

To shift the emphasis from disease-based health services to risk and determinant-based health

systems is really a formidable task. However, for our future efforts in health development for

good health for all, this is a challenge indeed. We need to have the right workforce to develop

health systems toward the desired direction. To ensure balanced development in health care and

services, we need to pay special attention to the public health workforce. The workforce should

also include community-based health workers. For strengthening public health, we need strong

and sustained political commitment and support. As a requisite for this change, we need

unwavering and long-term policy and strategy back-up at the national level. With the current

government health policy, Preventive and Social Medicine can make an important contribution

to the achievement of India's Vision 2020.

At the end I would like to conclude with the thought of Tim Evans, “Health systems should

nurture a stronger culture of learning and problem-solving to tackle the major health challenges

of our times. This could be achieved through a greater understanding of how the diverse

elements within a health system interact with each other, and by finding innovative ways to solve

complex problems.” & do agree with him that this is the right approach to strengthen the health

of our nation.

Dr Deep Shikha, Himalayan Institute of Medical Sciences, Jolly Grant, Dehradun

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India has a rich public health heritage, which has led to public health actions during the first two

decades after Independence Known as the Golden age of public health.

The concept of public health has seen several radical transformations as follows:

I. Early 19th

century - Environmental phase

II. Mid 19th

century -Individualistic phase

III. Mid 20th

century -Therapeutic phase

IV. And Curently, concept of public health touches following parameters:

• Rapid and unplanned urbanization

• Ecological imbalance

• Side effects of globalization

• New diseases and epidemics

• Lifestyle modification for non-communicable diseases

• Equity in the accessibility to the healthcare

The current concept mainly deals with the preventive and promotive initiatives of health.

� Why the media feels that public health has changed?

Let us look at the media reports about the public health system

According to Times of India, dated 5.7.10 - “India has just one O.T. per 1 lakh

population and of the surgical facility available most lack the basic safety equipments”

The Times of India, dated 23.11.07 states that- that there are ample vacancies in the

PHCs as well as shortage of specialists and even if they are posted, they remain absent

from duties.

Some newspapers are highlighting the misuse of JSY by the doctors by not entertaining

them in the odd hours and going for caesarian section without any such indication.

Now let us look at some other critical comments of the expert authors: HEALTH FOR THE

MILLIONS vol 30, page 67-68, by Tejal Barai Jaitly

“At the village level,

• There is no sharing of information or co-ordination among the service providers.

• ANMs working according to their convenience and people referred by the ANMs

are not given priority in district hospitals

• AWWs provide irregular supplies, distribution of 3 days is done in 1 day and

their rates are not revised

• Distant location of PHCs, lack of staff, poor supply of medicines, and no

examination room etc...”

According to HEALTH FOR MILLIONS vol-32, page -7 “Janani Suraksha Yojna could

be a successful programe under public private partnership was discontinued by the state

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due to lack of trust in the ability of the non-profit sector. The report was not revealed

when asked by the UNICEF in the interest of few politicians.”

Human development report admits the increasing gap between rich and poor as a result

of certain policies.

Besides, the above comments, there are problems responsible for system failure e.g.

• If pulse polio immunization is being done, then the routine immunization is

forgotten

• Wastage of drugs - irrational use and inaccessibility to important drugs

What are the solutions? (There are many others but limitation of space here)

Most important is the strengthening of human resource especially doctors.

• Medical graduates should be oriented for traditional medicine - yoga and Ayurveda.

Streamline AYUSH with the integration of ayurvedic treatments.

• Incentives should be given to doctors like high allowance, accommodation etc.

• Strengthening the capacity of paramedical workers and their motivation.

• Higher involvement of local self government like Gram Panchayat.

• Proper accountability of money.

In the end, the policy makers require an equitable, appropriate and sustainable health

system, as health is the fundamental right of every human being.

Dr Rashmi Katyal, Subharti Medical College, Meerut

Date post:	01-Nov-2014
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Essay Competition

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