Sunday, April 15, 2012

Challenges for healthcare education in 21st Century and the Role of Health Science Universities


Higher education is juxtaposed between the needs to sustain the singularity of knowledge in higher echelons of intellect and a compulsion to provide pragmatic solutions to the issues that matter for a sustainable world. If one factor places intellectual demand on the system, the other factor tweaks at the conscience of the establishment. Such a position demands a delicate balance to strike, so that the scarce resources can be optimised.

Healthcare education is in a much more edgy flux. A significant portion of knowledge in healthcare education is drawn from various components of higher education, which could range from anthropology to zoology. Thus, healthcare education can essentially be termed to be deriving philosophical moorings from higher education and practically responding to the needs of society.

Further, healthcare is not a monolithic entity. It is more of a team-based service that includes medical, nursing and allied healthcare professionals. The medical profession encompasses clinicians of western biomedical stream, the dentists, surgeons and the various AYUSH healthcare professionals. Pluralism of healthcare sector is not only an opportunity for the policy makers, but also a challenge to provide inclusive growth.

With this unique position, it would be worthwhile to examine the challenges in the healthcare sector, what are the resources needed to address to these issues and what role should a health university play in moderating the resource generation.

Challenges in the healthcare sector

The century we just left behind has been a remarkable one for human development. Fifty years ago, the majority of the world's population died before the age of 50. Today average life expectancy in developing countries is 64 years and is projected to reach around 70 years by the year 2020.

Health demography is concerned with study of the characteristics of human populations, such as size, growth, density, distribution, and vital statistics. This is a newly emerging discipline that emphasizes the interdisciplinary nature between the population science and health science. Studies conducted in this domain reveal changing landscape of health awareness among populations. This has brought in a paradigm shift in their healthcare priorities.

Moreover, epidemiological trends have undergone a seismic shift in the pattern of morbidities. If a century ago, the major healthcare concern was infectious diseases, today, the need is to tackle non communicable chronic metabolic disorders. Changes in lifestyle and cultural shift have contributed to this change.

A look at the population pyramid of India today and its projections over the next fifty years shows that nearly half of our country’s population will be below 25 years of age. This is a determining force in understanding the nature of morbidity that we can expect on a mass scale.

Increased urbanisation has also given rise to many cross cultural practices. Coupled with this is the phenomenon of democratisation of information with internet as a medium. Such a cultural shift has enabled people to become aware of many health beliefs that were not well known on a larger scale. Many traditional healthcare practices which were confined to select geographical or cultural zones are now in the public domain.

The importance of community based healthcare, rural healthcare, etc, have become influential variables in the healthcare domain. The flagship project of India’s healthcare broadband –National Rural Health Mission, and now proposed National Urban Health Mission have fired public imagination on the multitude of healthcare options. These projects have also challenged the policy makers to rethink and relook on the need for policies that would be sensitive to the needs of people.

Along the way, the corporatisation of healthcare in various forms like swanky hospitals, healthcare insurance, package deals in health check-ups, medical tourism have bred a new wave of practices. These have also had a salutary effect in innovating mass health projects like health insurance for populations Below Poverty Line.

Thus, on the whole, the outlook of healthcare sector presents a dynamic kaleidoscope of opportunities and some unexplored vistas of potential solutions.

Resources needed to address to these challenges

The resources needed to address these challenges could fall into infrastructure development and capacity building of human resources. What is significant for the Universities is to generate resources that are either human in nature or resources that could be utilised by human component of healthcare system.

This effectively means generating knowledge, skills and values that are relevant for the practice of healthcare and capacity building of human resources to optimally utilise these resources.

Thus far, the medical education was an exclusivist and discipline based study, with some amount of informal vertical integration during the clinical postings. This would apply to all disciplines of healthcare education like medical, dental, nursing, pharmacy, AYUSH, allied health sciences, etc. What is remarkable is that all these professions are interdependent on one another at some point in time.

A perusal of human resources available under various categories of health professions as per the official documents, can be listed as below –

  • Doctors having medical qualifications under Indian Medical Council Act are around 640,000
  • Dental Surgeon registered with Dental Council of India are around 80,000.
  • Registered AYUSH Doctors is around 850,000
  • Nursing staff is around 1800,000
  • Pharmacists are around 700,000

As per the documents of World Health Organisation, the number of physicians per 10,000 populations for the world is 1.5. For India it is 7, which is at par with low income countries. Similarly, number of nurses per 10,000 population in India is 8, while it is 33 for the world and 16 for low income countries.

India has an abysmally low doctor-patient ratio - one doctor for 1,953 people, or a density of 0.5 doctors per 1,000 population. This reflects a serious issue in human resource management is huge gaps in critical health manpower in government institutions, particularly in rural areas, that provide healthcare to the poorer segments of population. These statistics reiterate a need for both long term and short term measures to overcome this serious challenge.

The Indian Government is seized of the gravity of this matter and therefore has asked the health ministry to work towards "strengthening of public health through creation of necessary human resources capacities at all levels." The Planning Commission's high-level expert group recently suggested the setting up of a Public Health Service Cadre that would be responsible for all public health functions starting at the block level, and going up to state and national levels.

We also need to look at the leadership role that India is expected to play in the future, especially in contributing to the mentoring of healthcare and education systems of the underdeveloped countries. Passing over the phenomenon of Brain Drain to the developed western countries, we need to frame a policy of intellectual and social harvest for the unfortunate humanity in countries like Africa and Asia. We need to prepare some fraction of our health human resources with a global outlook.

The challenge for future is certainly a human resource cadre that is responsive to the needs of India’s healthcare needs. Alongside, we also have an obligation towards the international community of underprivileged countries that look at us with hope and expectations to mitigate their sufferings.

Role of health sciences’ universities for resource generation

Health Sciences Universities were envisaged as hubs for the generation, nurturing and dissemination of knowledge, skills and values that are essential for viable and valuable healthcare practices. Various committees appointed by the World Health Organisation have stressed on the need for a inclusive and integrative healthcare education. Such an education is desirable to mirror the realities of healthcare practices.

Healthcare education faces several important challenges. Changes in healthcare scenario have had an enormous impact on the relevance of the current healthcare training. Such a situation calls for strong academic leadership in healthcare sector. We need to be aware of the complexities and challenges that confront the academic leadership of healthcare. There is a need to answer questions like ‘how do we prepare tomorrow’s doctors and nurses and pharmacists and a host of healthcare professionals today?’. Education of health professionals is critical to meeting global and national health challenges.

This throws up the challenge as to how best we could converge the needs of future healthcare and the emerging frontiers of knowledge into the curriculum so as to produce a more complete physician – the one who meets the needs of individuals and communities. We also need to look at the best way to mainstream disciplines as significant as molecular medicine, genetics, palliative care, AYUSH systems, nutrition, medical ethics, information technology, and many more into the existing curriculum. Exclusion of these neglected areas of medical education produces an incomplete physician.

Information and Communication Technology is another area that needs to converge with healthcare practices. There is a trend in healthcare education to absorb the best of all inventions and innovations. This healthy trend has given rise to not only many effective solutions in patient care, but also thrown up many interdisciplinary areas like Healthcare Informatics, Tele Medicine, etc.

Application of technology in healthcare education has also sprouted newer ways of teaching and learning. Blended Learning, which is a judicious mix of face-to-face teaching methods and digital teaching techniques offers new panorama of educational landscape. Considering that the future practitioners of healthcare would use computer technology as a matter of routine for many of their clinical decision making, we need to train our students to be able to survive and flourish in such an environment. We should train our students in such a way that they use the computer technology for their self-directed learning. It is not only a matter of using technology, but also being critical in evaluating the information available through technology.

The success of Open and Distance Learning as a medium in the Higher Education Domain opens up newer avenues of administering healthcare education. It may not be an alternative to the conventional form of undergraduate and postgraduate healthcare education. There is possibility to include certain modules of learning in this medium. However, a significant application of this form of education could be harnessed for Continuing Professional Development. This is because, healthcare education is also is about teaching how to manage change.

We live in a rapidly changing world. As educators, we need to inspire the future health professionals to embark upon a lifelong learning and applying quest. That will be their assurance of being able to provide their future patients with the best quality care they need for many years from now.


The challenges of healthcare in the new millennium are complex and multiple. The solutions for these ought to be appropriate and dynamic. Health Universities have their role cut out, not just to generate relevant human resources who are capable of solving the health related issues, but also instil into them ethical and social responsibility to perform as leaders of healthcare movement.


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