WISENET Journal37, April 1995, pp. 10-11.
by Heather Rossiter
Sue Irvine is part of a three-member team advising the Indian Government on the development of a broad-based School of Public Health within an Australian aid context. Initial talks between Indian and Australian Governments about Australian aid projects gave priority to two areas where Australia had particular expertise relevant to the needs of Indian rural development. One of these was community health.
The University of New South Wales was approached in regard to the community health project. More than twenty years ago the World Health Organisation selected UNSW's School of Medical Education as a site for a regional training centre for the Western Pacific Region. About the same time WHO set up similar centres in Sri Lanka, Chicago, South America and Iran. The latter centre, in Shiraz, is currently being re-activated after what was probably a fairly rocky time. The Australian centre, jointly established by WHO and the Australian Government, is now selfsupporting through student fees and consultancies. In the context of Australian aid to India, it was thought that this centre, linked to Unisearch of NSW, had strong relevant skills and could best identify the most effective way of using the small amount of money Australia could contribute to a large country like India.
A first visit to India identified, in consultation with health professionals in New Delhi, the urgent need for a broad-based School of Public Health. The Indian government said, essentially, 'We have a great number of skilled professionals but we need to be more effective at the community level. Where are the professionals needed and how do we service them?' It is true that India has a high doctor to population ratio, about 1:2000 people in contrast to, say, Nepal where it is closer to 1:100 000. Already existing, too, is a comprehensive infra-structure of community health centres, one for every 3000-5000 people, developed within the last ten years, but there is a shortage of middle-level health workers such as nurses, a profession previously regarded with social disfavour, and allied health professionals such as physiotherapists, and occupational and speech therapists.
To maximise outcomes from limited resources the Australian aid project aims to advise India on how best to fill the gap between physical infra-structure, community health centres, and the abundant doctors so as to make intervention in the overall health of the community more effective.
It has therefore been proposed that the Indian government should set up a School of Public Health within the All-India School of Medical Sciences in New Delhi. Australian involvement will be catalytic rather than implementational, a guidance of the process. Within the school professional retraining will be given and research directed into preventive health care at community level. Priorities within the programs will be set by the Indians. Australia is only process consulting, to assist in integrating an international network of professionals and the WHO preventive approach to community health.
Graduate study in the school of Public Health at Harvard University trained Sue Irvine, MBBS(Auckland), as a scientist. She came to Australia with a Masters in Public Health and a Master of Science in Health Services
Administrations.
For seven years from 1983, Sue Irvine was a lecturer in Community Education and Health Promotion in the Masters program in the WHO regional training centre. She ran courses in health administration, primary health care, health education. Her multidisciplinary course in women's health care aimed to delineate women's health and ways of investigating and researching it. The course was taken by students studying for Masters degrees in the diverse fields of Arts, Public Health, Education and Business Administration. Consequently the students were a mix of people with good qualifications in the health area but with narrow sociopolitical knowledge and others with wide sociopolitical perspective and little specific knowledge of health issues. Through group discussion on such things as the difference between the hard and soft scientific methodology of the pure sciences versus the social sciences, the feminist approach to biological issues, the students gave each other a wider interpretation.
Not only were the inclusive degree courses varied but so were the postgraduates themselves. As, world wide, the issues for women are very similar and the development of skills for meeting the needs of women is the same, the course was relevant to people from many parts of the region. In one stream of twenty people, twelve countries, nine religions, and eight ethnic backgrounds were represented.
Such experience qualified Sue for involvement in the India aid project.
While funding is being arranged and the School is being established, the first demonstration project is about to begin. Sue expects to leave shortly for India to implement a project in women's health at the district planning level. It is designed to support the contention that the public health approach improves health as much as individual prescriptions for medication. Sue sees the project as essentially a scientific procedure. To ensure the program has a sound theoretical framework, participants selected from a single province will define an hypothesis, undertake research to test it and critically evaluate the results. The project will inevitably involve integration of both biological and social science aspects. Recommendations for organisational change will be made based on the results.
Overall Australia's involvement in India can be expected to bring about organisational change at district level and health promotion may lead to social changes. Although the point of access will be at community rather than at individual level, the expected outcomes should improve the health of the individuals who constitute the community.
One recommendation Sue can be expected to make to the Indian Government towards the development of their School of Public Health is for provision of child care for the participators. Sue says the major reason she chose to go to Harvard for post-graduate work was that their child care facilities were so well organised.