Harvard Public Health Review
Summer Fall 2006




HSPH Report: China and India

A Dose of Prevention

HSPH joins India's ambitious effort to create a new public health school

Rajat Gupta, McKinsey & Company's Senior Partner Worldwide, was having breakfast six years ago with Harvard School of Public Health Dean Barry Bloom, when the conversation turned to Gupta's success in helping launch a new business school in his native India. A 1973 graduate of Harvard Business School, he was proud of having brought something of what he'd learned back to his home country.

Dean Bloom had a suggestion. "If you really want to have an impact in India," he told Gupta, "start a school of public health."

Gupta didn't forget.

Describing his next steps to HSPH supporters at a meeting in New York City in May, Gupta explained that, as a member of the HSPH Dean's Council, he decided to take advantage of his access to Bloom and faculty by jumpstarting research projects involving the School's experts in India, "but that didn't get us where we wanted to go."

A turning point came in 2004 when Gupta, whose management consulting firm advises leading companies worldwide, took part in meetings with several deans of the American Association of Schools of Public Health that involved government representatives from India and business leaders like himself. The result: an idea to forge a public-private partnership to develop a better public health infrastructure--including a network of preventive health services and professionals--that might help solve India's massive health challenges, which range from a lack of clean water and malnutrition to epidemics of tuberculosis, HIV/AIDS, and chronic diseases, including obesity and heart disease.

"You can't expect to solve India's health problems by focusing on curative health interventions," Gupta observed at a recent HSPH Dean's Council gathering in New York. "The U.S. hasn't been successful in doing that, and it spends 16 percent of its gross domestic product on health care." By contrast, India spends less than 1 percent--although the government aims to triple that figure in the coming decade.

Out of these meetings, a desire grew among Gupta and a small group of other Indian nationals and expatriates to do something really big. A comprehensive assessment to determine the demand and supply gap for public health professionals was conducted through interviews with Indian academics, civil society groups, agencies such as USAID, the UK Department for International Development, the World Health Organization, the U.S. Centers for Disease Control, and the World Bank; and India's central and state governments.

Last spring, their work culminated in the launch in New Delhi of the Public Health Foundation of India (PHFI), a public-private partnership that will create five to ten new schools of public health, two by 2008. PHFI's primary objectives are to develop qualified public health professionals, undertake research, and set schools' educational policy. The foundation is modeled after the American Academy of Sciences in the United States, with a board made up of representatives from national and state governments in India, and non-governmental organizations, corporations, and universities from around the world. While it has the enthusiastic support of Indian Prime Minister Manmohan Singh, PHFI will operate autonomously, unfettered by governmental controls.

HSPH's role
HSPH will continue to be actively involved, having signed a memorandum of understanding with PHFI to provide assistance on several levels. As Gupta explained, "Our goal is not necessarily to create schools in the model of the Harvard School of Public Health, but we believe the School can be immensely helpful in advising us on developing curricula and educational standards, and in attracting and training faculty.

"Just 18 months ago there were about 300 people graduating with masters' in public health in the entire country each year. We need so many more," Gupta said. "If India is to put even a single public health worker in each village, as the government plans to do, ultimately we will need 500,000 trained people just to deliver public health programs and messages. We'll need experts to train workers, address myriad health policy issues, and conduct research." The vision for PHFI is to train people at multiple levels: public health professionals, district health workers, field epidemiologists, and high-level researchers. HSPH's role is to help train leaders and trainers at each level.

In addition, HSPH, Harvard University, and PHFI will foster a "think-tank environment," Gupta said, in which to conduct research that will lead to new policy and action. Citing a 2005 McKinsey report, he stressed that creating a demand for research in India will be challenging, given the lack of public-health-oriented academics and policy makers.

A priority for PHFI is to set educational standards. The foundation will establish an accrediting mechanism for new and existing schools, and recruit permanent faculties. More than 150 academics around the world have already signaled interest in helping.

Preparing for take-off
Fundraising is well underway. Launching five schools will require about $100 million, half of which has already been raised by Gupta and others. That total includes $15 million from the Bill & Melinda Gates Foundation, $20 million from corporations, and $15 million from India's federal government. HSPH will raise funds for scholarships for Indian nationals, and will help enlist other U.S. public health schools in preparing native students for teaching posts.

India's 28 states are in competition for the first two schools; those demonstrating the greatest commitment to building a better public health infrastructure will win out. With 80 percent of health care run by the private sector, Gupta said, it's unclear what role India's national government, states, 540 districts, and half a million villages will play in developing a web of professionals capable of delivering preventive services population-wide.

Some infrastructure does exist, noted Dean Bloom, pointing to India's immunization of 100-million-plus children against polio within six days in 2004. "It will be interesting to see a high-functioning public health system created from the ground up," Bloom said. "It's estimated that huge numbers of India's citizens will soon have cell phones. How might technologies like this be used to track delivery of services that will be innovative and low-cost?"

"We've accomplished a lot in the last 18 months," Gupta said, "but the work has just begun. I've never been as excited about a project in my life as I am about this one."

Julie Rafferty is the senior director of development marketing and planning in the Office for Resource Development at HSPH.

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