Academia to Public Health Policy

Community medicine is a branch of medicine which deals with health promotion and prevention of diseases with people’s participation utilizing professional management skills. The subject specialist must inculcate a holistic view of health and medicine in the community. He/she should be equipped with knowledge on primary, secondary and tertiary care, control and prevention of an outbreak or epidemic, health needs assessment, research and planning of evidence-based health policies and programmes. The competencies must cover a wide spectrum of skills viz., technical, managerial, administrative, organizational skills, applied skills in Health Information Management, software application and soft skills of communication, motivation, decision-making, team building, training in scientific communication and medical writing.

Going with current trends in education and skills required, the Medical Council of India (MCI) implemented Competency Based Medical Education (CBME) in all medical colleges in India from August 2019. It has described the basic competencies required of an Indian Medical Graduate (IMG) and designed a competency-based module on attitudes and communication. Fundamental characteristics of competency-based medical education is that it is an outcome-based approach, where the graduate is required to achieve predefined desired competencies. These predefined frameworks of competencies are derived from the needs of patients, learners, and institutions.

The Core Competencies of CBME are Competency, Entrustable Professional Activity and Milestones. The competencies expected of an IMG are that he/she needs to be a -

• Clinician who understands and provides preventive, promotive, curative, palliative and holistic care with compassion.

• Leader and member of the health care team and system with capabilities to collect analyse, synthesize and communicate health data appropriately.

• Communicator with patients, families, colleagues and community.

• Lifelong learner committed to continuous improvement of skills and knowledge.

• Professional, who is committed to excellence, is ethical, responsive and accountable to patients, community and profession.

Entrustable professional activity (EPA) helps bridge the gap between the theory and practice of CBME. While competencies are the abilities of a physician, EPAs are descriptors of work that define a profession. A competency is achieved gradually, step–by-step. These steps are designated as milestones. The Dreyfus model as applied to education would have five such steps or milestones. These are a novice, advanced beginner, competent, proficient, and expert.

NitiAyog which was established in place of planning commission in the year 2015 is an important evolutionary change in the Government of India think-tank policy which replaced one-way flow of policies from centreto-state, policies with centre-state partnership and it is a bottom-up approach. The main objectives of Niti Ayog is fostering cooperative federalism (active involvement of states), formulations of plans at village level, aggregation at higher level, partnership with national and international think tanks, creating a knowledge, innovation and entrepreneurial support system, platform for resolution of intersectoral and inter departmental issues focus on technology.

India is still in the long run to achieve the targets of SDGs and there exists a paramount gap between research and development of public health policy to action; a strategic approach would be development of public health workforce and capacity building.

Government and civil society agencies can play a vital role in building bridges between research and implementation in rapidly changing and politicized contexts. Health systems research has unique characteristics and faces unique challenges; these must be analysed to ensure that research evidence contributes fully to strengthening health systems and enabling them to meet their new challenges which indeed calls for the public health experts who are underutilized.

Of the many barriers to implement public health policy, lack of evidence base and isolation of researchers from policy making process are the prime deterrents. There is lack of personal contact between researchers and policymakers which can lead to lack of progress, and researchers do not see it as their responsibility to think through the policy implications of their work. Public health policy has had, and will continue to have, a vast impact on our daily lives and on public health indicators in part because of its long-term effects and relative low cost. Many of the public health programs now being implemented have a significant focus on policy.

To improve these programs and to further the evidencebased policy, we need to use the best available evidence and expand the role of researchers and practitioners to communicate evidence packaged appropriately for various policy audiences; to understand and engage all threestreams (problem, policy, politics) to implement an evidence-based policy process; to develop content based on specific policy elements that are most likely to be effective; and to document outcomes to improve, expand, or terminate policy.

In India, there are approximately 605 medical colleges and 76 stand-alone PG institutes whose qualifications are recognized by the Medical Council of India, with the state of Karnataka having around 60 medical colleges.

There are around 21 postgraduate broad specialities identified in the medical colleges. The purpose of PG education is to create specialists who would provide high quality health care and advance the cause of science through research and training. Community Medicine is one such speciality which has been designed to create a cadre of professionals who are competent enough to meaningfully contribute their expertise in planning, implementation, co-ordination, monitoring, evaluation of Primary Health Care Programs based on scientific evidence.

The faculty, postgraduates and students in these medical colleges or Academia in short, especially community medicine fuels public health practice, which in turn provides the fuel for academic growth. From the council on linkages of ‘Academia and Public Health’, certain competencies were identified which were desirable for practice of public health of which research was central.

For improving the health status of communities, innovative public health research is vital as it provides information for strengthening health systems, public health interventions and programme evaluation, to all concerned stakeholders.

Public health research at various levels is being conducted by academia (medical colleges, institutions), NGO’s and governmental organizations. A significant chunk is contributed by the academia through faculty and student research projects, though the primary purpose is different from NGO and Government sector.

Hence there is a need to utilize this rich resource of postgraduate students in the state to focus the research topics on health systems research to generate evidence for strengthening health systems and policy making.

“Most distinctive role of public health education lies in the preparation of public health professionals”