ROUND TABLE DISCUSSION
Lessons, challenges and future plans from Kerala, India
K R Thankappan1
Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695011, India
The Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), an institute in Kerala established by an act of the Indian parliament in 1980, introduced India's first master's programme in public health (MPH) in January 1997, and so far, nine batches of students have graduated. Today, it remains the only MPH programme recognized by the Medical Council of India, the accrediting body for medical degrees in India.1 It was implemented when the MPH was not a required qualification for any job position in India. Despite this, the course has gained demand and recognition, and all the graduates have been able to find gainful and meaningful employment. Several institutions in India are now planning to start an MPH programme and the demand for guidance from the SCTIMST for such initiatives is increasing. Demand for the MPH programme is also increasing from the student community, as is evident from the increase in the number of applications for the entrance test at SCTIMST since 2006.
Over 40% of our graduates work with the various Indian state government health departments, 21% with nongovernmental organizations, 16% with academic institutions, 10% with WHO/United Nations Children's Fund (UNICEF), 8% work outside India, while the remainder are enrolled for advanced (PhD) studies. Obtaining employment for our graduates is easy, as the demand for qualified public health professionals in India is huge. It has been estimated that more than 10 000 public health professionals at different levels are required by the Indian government health system alone every year and the current availability is less than 400.2 In addition, there are several opportunities for short-term appointments with the WHO-supported polio eradication programme, revised national tuberculosis control programme and several other vertical programmes.
The major challenge for the programme is recruiting and retaining good faculty; this is consistent with the expected challenge for a developing country, even in an innovative educational setting. Ours is a multidisciplinary programme that requires faculty in health economics, health policy, gender issues in health, anthropology, health management, epidemiology and biostatistics. There are reports claiming that health economics are neglected in the south Asia region.3 There are also severe shortages of good faculty in other public health disciplines. Human resources for health in general, and for public health in particular, are facing major challenges in developing countries and there is an urgent need for national governments to invest in human resources.4 It has also been argued that investment in human resources must be considered as part of a strategy to achieve the Millennium Development Goals.5 Another challenge is to create career paths for public health professionals, in order to enhance the quality of the public health system.
Future plans for the programme are: (i) to increase both student and faculty strength; (ii) to network with other public health institutions, such as the public health foundation of India and the Indian Council of Medial Research schools of public health; and (iii) to develop a plan to pool faculty and other resources for teaching and research in public health.
References
1. mciindia.org [homepage on the Internet]. New Delhi: Medical Council of India; 2007. Available at: http://www.mciindia.org
2. Reddy KS. Establishing schools of public health in India. In: Matlin S, ed. The global forum for research for health, vol. 2. Poverty, equity and health research. London: Pro-brook Publishing; 2005. pp. 149-53.
3. Varatharajan D. Special issue on South Asia: health economics is neglected in this region. BMJ 2004; 328: 288.
4. Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, et al. Human resources for health: overcoming the crisis. Lancet 2004; 364: 1984-90.
5. Anand S, Barnighausen T. Human resources and health outcomes: cross-country econometric study. Lancet 2004; 364: 1603-9.
1 Correspondence to K R Thankappan (e-mail: kavumpurathu@yahoo.com).