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

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
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
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
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
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
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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