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Public Health Education

Courses in Reproductive and Child Health in India: An Overview *Sutapa Bandyopadhyay Neogi1, Ranjana Singh2, Sumit Malhotra3, Sanjay P. Zodpey4, Monika Chauhan5 1

Associate Professor, 2Senior Lecturer, 3Assistant Professor, 4Director, 5Program Officer, Indian Institute of Public Health Delhi, Public Health Foundation of India, New Delhi, India.

Summary Defining the human resource needs for providing quality maternal, newborn, and child health services across such a large and diverse population country like India is truly challenging. The effective response to significant challenges and increased requirements of evidence-based effectiveness of the public health projects on maternal and child health is putting pressure on existing program managers to acquire new advanced academic training and information. The data regarding the existing courses on reproductive and child health and related fields in the country were obtained by a predefined search made on the Internet through the Google search engine in December 2011. The collected data were the name and location of the institution offering the respective course, theme, course duration, course structure, eligibility criteria, and mode of learning. In India, around 15 institutes are offering certificate/postgraduate diploma courses on maternal and child health either as a regular program or through distance education program. The admission procedure for each institute is independent of others. The courses vary in terms of duration, eligibility criteria, and fee structure. Conceptualizing an educational initiative in response to national demands for increased workforce capacity to eliminate key medical and nonmedical educational barriers and financial and nonfinancial barriers to advanced academic preparation would enhance the quality of services available in the region.

Key words: Distance education, Management, Maternal and child health, Public health

Introduction

eight goals envisaged in Millennium Development Goals (MDGs) are relevant to maternal and child health.

Reproductive and child health (RCH) is a core component of the public health system that encompasses the provision of key services through a broad range of government, private, and not-for-profit organizations, partnerships, and professionals. This population is particularly important because they comprise of complex interdependence of conditions and outcomes that has direct implication on the present and the future of communities.[1] Two of the *Corresponding Author: Prof. Sutapa B Neogi, Indian Institute of Public Health (IIPH Delhi), Public Health Foundation of India (PHFI), Plot No. 34, Sector 44, Gurgaon, Haryana, India. E-mail: [email protected]

Access this article online Quick Response Code:

Website: www.ijph.in DOI: 10.4103/0019-557X.111360 PMID: ***

In India, there are 28 states and 7 union territories with more than 600 districts in total. Defining the human resource needs for providing quality maternal, newborn, and child health across such a large and diverse population is truly challenging. Despite strategies and interventions to address the burden of high maternal and child morbidity and mortality, the concerns still remain. Failure to achieve desirable results often puts blame on the health system. More often, the policies are laid down and programs are made at the national level, but their actual implementation at the field/district level does not meet the desired standards. Ever since National Rural Health Mission (NRHM) came into existence, a lot of managerial positions and cadres have been created within the district health systems to bridge the gap of human resources in the country. These positions are often occupied by management personnel without having sufficient healthcare background. Hence, the desired knowledge and skills for implementing the interventions as a part of RCH programs is lacking in them, which in turn results in poor planning, support, and supervision to

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Neogi, et al.: RCH Programs in India

grass root health workers that often require hand holding from these program managers.

made integrated course for program managers working in the area of maternal and child health.

On the other hand, doctors working at the district level and below lack an understanding of the principles of health management. They are also not adept with skills to use available data to improve the performance of programs. It is therefore necessary to develop the capacity of the district level workforce who can be the key personnel to coordinate and support the implementation of programs. The district management team is critical in handling the RCH data informing both low-level and top-level functionaries about the progress made and desired gaps in achieving targets. Eventually they can be a critical link between the policy makers and actual practices in the field level.

Materials and Methods

Several training programs and courses are already in existence in the field of RCH. These courses often operate in isolation from one another, and provide very few opportunities for collaboration, shared advocacy, coordination, and other capacity-building activities. Capacity building is desired both at the grass root level, as well as building greater collaboration within health systems, programs, and policy makers. Historically, academic preparation or capacity building in the field of RCH has been made available to those at the advanced end of the professional spectrum, especially clinicians with terminal degrees.[2] In other disciplines such as nursing, there have been concerted efforts since 1970s to create supportive educational opportunities such as bridge programs and career ladders for nontraditional students with technical or junior college degrees, but this has not been the case in public health.[3] Conditions have arisen, however, that require new efforts to increase public health workforce capacity at all levels, especially at the grass root level. Health care restructuring, welfare reforms, and recent demographic shifts in the world present new and complex challenges, and demand understanding of the values, languages, and other health behaviors of a variety of cultures.[4–7] Furthermore, funding agencies that fund public health projects on RCH now expect evidence-based effectiveness; these requirements increase the pressure on existing RCH program managers to acquire new advanced academic training and information, and pose to prepare the fresh manpower to reach the roots.[8] This study gives an overview of the existing RCH courses in India and highlights the importance of having a tailor-

The data regarding the existing courses on maternal/ RCH and related fields in the country were obtained by a predefined search made on the Internet through the Google search engine in December 2011. The key words included were: maternal and child health, courses, and India. The search was directed to the courses offered in India. Postgraduate degree courses and diploma courses on clinical medicine were specifically excluded since these are often offered by hospitals/medical colleges/ universities for medical professionals. The websites of international organizations such as WHO, UNICEF, Save the children, etc., were also searched to gather the information regarding the current international maternal and child health programs and courses. The search was not restricted by the course duration. Information collected was entered in a matrix. data were obtained on the following parameters and entered into the matrix: Name and location of the institution offering the respective course, theme, course duration, course structure, eligibility criteria, and mode of learning [Table 1]. In addition, experts in the field of RCH in India were contacted. This was done to learn about the possible courses offered by institutions that are not captured by the net search.

Results In India, around 15 institutes are offering courses on maternal and child health either as a regular program or through distance education program [Table 1]. Each institute has its own unique entry-level qualification and eligibility criteria. The admission procedure for each institute is independent of others. The courses offered vary from certificate courses to postgraduate diploma courses. Mostly, courses are utilizing the distance mode of learning with some full-time residential courses. The course duration ranges from 6 months to 3 years. A few institutes are offering similar educational certificate programs through distance learning mode. Indira Gandhi National Open University (IGNOU) offers two types of courses: Postgraduate diploma in Maternal and Child Health and Certificate Program in Maternal and Child Health with distance mode of education involving MBBS and nursing professionals as their participants.

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Table 1: List of National and International Institutions offering MCH courses Name of the institution

Name of the course

Eligibility

Duration

Mode of learning

1

IGNOU[11]

Post Graduate Diploma in Maternal and Child Health

MBBS

1 year

2

IGNOU[12]

Certificate in Maternal and Child Health Care

3

Annamalai University[13]

Nursing professionals with 6 months Diploma in General Nursing and Midwifery (GNM) or above and ANM/FHW/HS/LHV/PHN MBBS 1 year

Distance education (1 month contact session in media college, 1 week every alternate month. 200 h in district hospitals) Distance education

4

5

6

7 8 9 10 11 12 13

Post Graduate Diploma in Health Science in Maternity and Neonatal Care Post Graduate Diploma in Madhya Pradesh Bhoj Open Maternal and Child Health University[14] (PGDMCH) Post Graduate Diploma in Shivalik Institute of Paramedical Technology, Maternal and Child Health Chandigarh[15] (PGDMCH) Chhatrapati Shahuji Maharaj Post Graduate Diploma in Medical University, Lucknow[16] Maternal and Child Health (PGDMCH) Rashtrasant Tukadoji Maharaj Post Graduate Diploma in Maternity and Child Welfare Nagpur University[17] Post Graduate Diploma in NIMS University, Jaipur[18] Maternal and Child Health Dipoma in Mother and Child Dr. Babasaheb Ambedkar Open University, Gujarat[19] Health and Family Welfare Post Graduate Diploma in Medical College, Baroda, Maharaj Sayajirao University[20] Maternal and Child Health Post Graduate Diploma in Vinayaka Missions MCH University[21] Ruxmaniben Deepchand Gardi Post Graduate Diploma in MCH Medical College, Ujjain[22] Post Graduate Certificate IMA AKN Sinha Institute, Course in Reproductive and Patna, Bihar[23] Child Health

14

Lucknow University[24]

15

All India Institute of Hygiene and Public Health, Kolkata, West Bengal[25]

Post Graduate Diploma in Reproductive and Child Health Post Graduate Diploma in Maternity and Child Welfare

Distance education

MBBS with 2 years of experience

1 year

Distance education

MBBS

1 year

Distance education with no contact session

Bachelors

1 year

Regular

MBBS

3 years

Regular

MBBS

1 year

Distance education

10+2

1 year

Distance education

Bachelor

1 year

Regular

Bachelor

1 year

Distance Education

Distance education

Bachelor

Minimum 6 months to maximum 2 years 1 year

MBBS

2 years

Regular

Could not gather information MBBS

As per the available information, Rashtra Sant Tukdoji Maharaj Nagpur University was found to offer the PostGraduate Diploma in Maternity and Child Welfare for the longest duration of 3 years, which can be viewed as one of its major shortcomings. IGNOU offers a six-month certificate program in Maternal and Child health, which is of shortest duration. Only 4 out of the 13 courses listed (for which the information is available) are in regular mode. All the above-mentioned courses were reported to involve only medical professionals as per their eligibility criteria except for the PGDMCH course offered by Chhatrapati Shahuji Maharaj Medical University, Lucknow, Lucknow University Medical College, Baroda, and Vinayaka Missions University, which is open to bachelor level

Information not found

students. Strikingly Dr. Babasaheb Ambedkar Open University was found to involve 10+2 level students as per their eligibility criteria for Diploma in Mother and Child Health and Family Welfare. The course fee based on limited information is highly variable ranging from Rs. 11,000 to 26,000 for a oneyear course offered for medical graduates. The 6-month certificate course offered by IGNOU costs around Rs. 4000.

Discussion Despite this wide variety of institutes and learning programs in India and across the world, a comprehensive

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Neogi, et al.: RCH Programs in India

package of postgraduate diploma through distance learning mode with focus on program management, RCH is lacking. Although there are about 15 institutes offering various courses in RCH but looking at the large human resource working in this field to serve the huge population of India, these number are insufficient. Further, it can be very well said that the above-discussed programs are mainly carved for specialists such as clinicians and nurses and not meant for nonmedical persons who mainly occupy the positions at the district level health systems. Besides national courses, some international schools also offer courses in the area of maternal and child health. The MCH certificate program by Boston University and the Rocky Mountain Maternal and Child Health Certificate program by the Arizona College of Public Health are two notable courses. In addition, University of Albama and University of Minnesota School of Public Health are offering similar courses.[3,9,10] More often than not, these are part of the Masters of Public Health program offered as an elective track. In India, there are about 23 institutes having MCH/RCH in its curriculum; however, there are two institutes, Interdisciplinary School of Health Sciences, Pune, and Sam Higginbotom Institute of Agriculture and Technology, (Deemed University), which offer an MPH with specialization in maternal and child health and in reproductive health, respectively. Thus, a need for an integrated RCH course is being felt. An educational initiative, which can address training needs for both medical and nonmedical students and those with some work experience in the community, and build the capacity of program managers working on RCH at all levels, is very much required. The course with the focus on global concerns about determinants of maternal and child health, along with an exploration of the impact of government policies on the provisions of maternal and child health care must now come into action. This kind of course would enable the specialists to enhance their critical and analytical skills through the application of theories and concepts underpinning the relevant areas of practice. A few professional development courses have been initiated for those at the Chief Municipal Health Officer (CMHO) level and Medical Officer (MO) level, but the cadre of program managers in the district has not been adequately covered in the existing system. Thus, there is a need to equip the program managers for ongoing recent developments in the gamut of interventions and hence, a novel course having right and judicious blend of RCH relevant initiatives with principles of management

involved to operationalize the interventions is very much required. This type of course should provide an opportunity to fill in the gap between medical and nonmedical graduates across the country and can be counted as a concrete advantage over the courses offered by other institutes. Secondly, the course should also provide benefits, particularly to those who lack access to high education and have financial constraints to be enrolled in full time courses. The objectives of the integrated MCH course should be to develop a new educational initiative in response to national demands for increased workforce capacity to eliminate key medical and nonmedical educational barriers and financial and nonfinancial barriers to advanced academic preparation, which in turn would enhance the quality of services available to the region. Conceptualizing such a program would be an innovative approach toward the need for increasing the capacity of public health work force. The program would enhance students’ skill and core knowledge, and allow them to assume expanded and more independent professional role. It would also create a new niche in the public health career ladder.

Lessons for Practice • The actual implementation of national programs and policies does not meet the desired standards at the field/ district level. • The existing training program and courses, which operate in isolation from one another, should be bridged together to provide opportunities for collaboration, shared advocacy, coordination, and other capacity building activities. • There is a need to eliminate key medical and nonmedical educational barrier and financial and nonfinancial barrier to advanced MCH academic preparation to improve the quality of services available to the region.

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Cite this article as: Neogi SB, Singh R, Malhotra S, Zodpey SP, Chauhan M. Courses in reproductive and child health in India: An overview. Indian J Public Health 2013;57:15-9. Source of Support: Nil. Conflict of Interest: No.

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