What are the essential skills for a career in Public Health?

Public health in India has, for long, been the domain of medical professionals. To a large extent, it still is and there are many reasons for this. The primary reason probably is a lack of a wide-angled systemic view of the public health system in India. Historically, we had failed to appreciate the multi-faceted nature of public health problems and have sought medical solutions to everything. This has led to over medicalisation of public health problems ignoring the fact that solutions lay in other disciplines. However, it is also true that the other disciplines also did not see public health as an allied domain and did little to broaden their horizons. Academic domains kept operating in silos, not aware of the natural crossovers. Hence, apart from medical education, no other academic domain was actively contributing to the public health workforce.

Medical education, being focused on clinical care, public health, definitely was the top priority of neither the educators nor the learners.

However, the situation has changed over the past two decades. Again, the change can be traced to multiple reasons. But if I have to identify the single largest cause for this change, it is the change in the way public health is currently financed. Development challenges globally have multiplied resulting in higher pressure on the existing limited resources. Policymakers and donors are having to prioritise before committing funds. This makes the demonstration of aid-effectiveness or outcome evaluation imperative.

While some outcomes are clinical, a majority of public health outcomes are behavioural and social. Public health interventions aim to leave behind sustainable behaviours, structures and systems and this has created an opportunity for the convergence of other domains like social and behavioural sciences. For outcomes to be critically measured and evaluated, they need to be planned for in the first place. Programme design and development has assumed more importance than ever before. A robust design needs to be managed according to performance standards, executed as per expected timelines and measured against pre-decided indicators. This necessitates knowledge and skills in programme management. The discipline of management sciences have assumed increasingly important roles in public health and has become an essential skill for the public health workforce. Starting from programme designing in multi-stakeholder settings, managing programme execution, human resources, and logistics have become more and more complex and have created synergies of public health and management.

While on one hand, the demand for limited resources for multiple development needs has become intense, the outlay in public health has also increased manifold. The Government of India proposes to increase the allocation in health significantly in the National Health Policy launched in 2015. As mentioned in the policy, the allocation in health will be increased to reach 2.5 per cent of the Gross Domestic Product (GDP) of India. The scale of expansion will be evident when one compares this to the allocation of about one per cent of GDP in health in 2014. This translates to roughly an additional Rs 50 billion into the sector. This almost brings the discussion to appropriate financial management, budgetary control, economics and econometrics. Thus opening up the sector to further cross-pollination.

What needs to be appreciated is that the cross-linkages with other domains like management, economics, social and behavioural sciences is no longer a desirable good, but an essential skill set.

A career in public health will be severely jeopardised without them. It also goes without saying that, in the current environment of uncertainty, economic slow- down and contraction of the job market, the public health sector remains a relatively secured sector. The expansion of this sector has caused public health to be considered as a viable career option for young graduates from different fields.

Unfortunately, comprehensive pre-career training in these convergent domains are few. Yet these essential skill sets are necessary to make even the breakthrough in the job market.

A well-designed Diploma programme in Public Health Management must aim to provide the necessary knowledge and skills to provide a thrust to public health career aspirants.

The course must be designed and led by management specialists with advanced public health knowledge and experience, social scientists, researchers and practitioners to provide the right mix of public health science and other domains especially management.

The course must be exceptionally applied in nature and aims to provide the graduate with an extensive and tested tool kit that will improve employability and subsequent utility in work settings. The programme should aim to produce smart public health managers for the modern era in public health management in India and the region.

About the author:

Shomik Ray is Associate Professor at PHFI Delhi - Indian Institute of Public Health

Note:The views expressed in this article are solely author’s own and do not reflect/represent those of Shiksha