Department of Epidemiology, University of Pittsburgh

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Department of Epidemiology, University of
Pittsburgh Diabetic Association of Pakistan
WHO Collaborating Centers

• Public Health Training in Pakistan
• A joint effort of Aga Khan University, CPSP,
  Global Health Network University of Pittsburgh
• Drs Sunita Dodani, Ronald E LaPorte, Camer
  Vellani, Samad Shera Asma
  Fozia Qureshi
• www.pitt.edu/super1

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Outline

• Role of public health in Health improvement
• Current statistics of South Asian medical
  education programs
• Global Health Network Supercourse
• Pakistani Supercourse
• SAHPA a network of South Asian Scientists
• Mission of CPSP
• Proposed public health training in Pakistan
• Use of supercourse CDs in Phase 1

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Rising Life Expectancy (WHO Report, 1997)
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Disease Burden in South Asia

• In almost all South Asian countries (India,
  SriLanka, Bangladesh, Pakistan, Nepal etc) double
  burden of diseases is increasing
• Significant changes in the demographic and
  epidemiological profile of populations have
  created a growing demand for services
• Chronic diseases and injuries are competing for
  the scant health resources
• This double burden is difficult for our countries
  who have little health means

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Health Indicators facts and figures

• Sri Lanka has achieved impressive figures in
  health with relatively low levels of public
  expenditure.
• The gains in Sri Lanka are apparent with a 99
  vaccination
• Pakistan, and India has achieved 50 of children
  vaccination against measles
• Improvements in Sri Lanka are primarily due to
  public health, prevention, an emphasis on
  education in particularly womens education, and
  government commitment for linking health care and
  prevention

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Medical training programs

• There are more than 200 medical schools in south
  Asia, around 25 in Pakistan
• Every year, more than 7,000 students graduate
• Only 23 centers of public heath providing some
  training in whole of South Asia
• No School of Public Health

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Medical training in Pakistan

• Total of 25 medical colleges
• 12 have some kind of training programs in
  preventive medicine, public health, community
  medicine etc
• 10-20 times more people trained in clinical
  medicine than those trained in preventive
  medicine
• Training in public health has been neglected
• Medicine focuses on treating patients who are
  already ill.
• Little cross-fertilization

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Medical training in Pakistan

• Public health is considered a second-rated
  profession
• Very little emphasis is on research training in
  prevention
• Many of the clinicians well deserved promotions
  are delayed because of insufficient research work
  and publications
• There is no such program where clinicians can
  learn about how to conduct research
• This has resulted sparse baseline data on much
  of the diseases in South Asia.
• One example is seen in AIDS figures and
  prevention

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Current public health\Research design training in
Pakistan

• The main components of research are knowledge of
  public health, research design, statistics and
  epidemiology
• There are only few medical colleges Medical who
  offer this whole package together.
• Majority of the trainers have insufficient
  Biostatistics skills
• Publication in world class journals require
  statistical skills in new software packages
• These skills can only be learnt by education,
  discussion and application.

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AIDS In Pakistan

• Different figures of AIDS in Pakistan from
  different places, total burden not yet known
• A total of 200 cases in 145 M population (UNDP,
  Pak, 2004)
• 70,000-80,000 persons, or 0.10 of the adult
  population in Pakistan are infected (World Bank,
  2004)
• There is a 50 fold difference in the estimates of
  numbers of cases.
• The major problem is inadequate surveillance due
  to not having enough people trained in
  public health
• To have data on AIDS in Pakistan , need for
  proper epidemiological survey on AIDS is needed
  country wide
• This requires public health training

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Medical training in Pakistan

• There is an alarming need to produce accurate
  data/ statistics of our country for prevention
• This can only be possible if doctors know how to
  conduct good research work
• Public health training in medical schools
  students can be improved with better health
  prevention lectures

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Supercourse- Global Health Network
www.pitt.edu/super1

• The Global Health Network represents a group of
  leading public health and telecommunications
  officials who are bringing state of the art
  Internet technology into global health
• Established by Dr Ronald E LaPorte in 1996
• Originally funded by NASA and currently funded by
  National Library of Medicine (NLM)
• Mission
• To connect world class scientists by sharing
  their best prevention lectures and provide better
  material for teaching

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Supercourse- Global Health Network
www.pitt.edu/super1

• Global health network components
• Connecting health professionals of developed and
  developing countries together through internet
• Sharing best knowledge of public health/research
  design or prevention/statistics in a very cost
  effective manner
• Distributing prevention knowledge both in the
  rural and urban parts of the world with primary
  focus in developing countries
• Networking NGOs

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Supercourse- Global Health Network
www.pitt.edu/super1

• Currently more than 151 countries are connected
  through supercourse
• More than 1,800 lectures available on the website
  
• There are lectures from 8 noble prize winners and
  Surgeon General of USA
• More than 40 members are from developing
  countries.
• We share knowledge, all countries contribute the
  knowledge
• 42 mirrored servers Russian, Islamic, Indian
  many more
• Pakistani Supercourse

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Supercourse in Pakistanhttp//www.pitt.edu/super
1/pakistan/pakistan.htm

• Established and developed from the grass roots in
  September 2002.
• Currently this network consist of 600 scientists
  from all four provinces of Pakistan
• more than 20 medical schools scientists are part
  of Pakistani supercourse
• They share public health information in all part
  of Pakistan, both in urban and rural parts
• More than 60 lectures are available on the web
  for free

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South Asian Health Preventionists Association (
SAHPA) http//www.pitt.edu/super1/sahpa/sahpa.htm

• With the help of supercourse, SAHPA is a network
  of South Asian Public health scientists and
  teachers
• The objective is to promote public health
  training in south Asia (143 members)
• Recently published article in BMJ on this theme

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BMJ article

• http//bmj.bmjjournals.com/
• Hope of prevention training in South Asia

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College of Physicians and Surgeonsof Pakistan
(CPSP)

• Mission
• Established with the objective to promote
  specialist medical practice in various
  disciplines, arrange postgraduate medical
  training and research by maintaining high
  principles of medical profession
• (Prof Sultan Farooqi, President CPSP)

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CPSP

• CPSP was founded in 1962 as a central governing
  body for medical education systems of Pakistan
• Is a unique postgraduate medical institution in
  the whole of South Asia
• It overseas medical health training programs in
  Pakistan
• Awards post graduation degrees (FCPS , MCPS and
  DCPS and offers admission to the fellowship of
  the College in 47 specialties sub-specialties
• CPSP has made consistent progress and
  accomplished its objectives to a large extent.

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CPSP

• The College, today, is proud to provide the bulk
  of medical teachers and specialists in the
  country who are performing with a spirit to bring
  out their best in their related fields
• Strong international ties with Royal colleges of
  UK and South Asian medical institutes
• Recently established the department of Public
  health with the campus
• The objective is to improve public health
  training in all medical colleges of Pakistan

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Proposed Public health training Program

• With the help of Global health network,
  Supercourse , we can built public health/research
  design training program in Pakistan
• This will be achieved in two Phases
• Phase I Sharing of Prevention/statistics
  lectures among medical colleges
• Phase II Building Virtual School of Public
  Health

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Proposed Public health training Program

• Phase I
• To begin with, we link preventionists of
  supercourse (1500) and SAHPA (150) to share
  health/research design/statistics knowledge to
  all medical colleges of Pakistan
• CPSP would take the lead in South Asia
• The network is already in place.
• By using the internet based Supercourse
  (www.pitt.edu/super1) we can reach a large
  segment of clinicians and teachers
• This will to enrich curricula in the medical
  schools with the addition of free power point
  lecture library of over 1,800 lectures from
  across the world.

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Proposed Public health training Program

• The cost to accomplish this would be minimal as
  the content and faculty are readily available in
  the supercourse for free
• No cost to access lectures as majority of
  medical schools are connected to the internet
• The existing supercourse CDs of 1800 lectures can
  easily be spread in all medical colleges
• These CDs can provide best teaching tool for CPSP
  workshops
• 15,000 Faculty with expertise in prevention and
  research design will help us
• CPSP with the help of supercourse and SAHPA will
  develop a training module for Public health
  training

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Proposed Public health training Program

• Phase II
• A model of a school of public health in Pakistan
  has already been developed which can be used as a
  template www.pitt.edu/super1/lecture/lec11921/ind
  ex.htm
• CPSP-Supercourse could link medical schools in
  South Asia, with improved prevention lectures and
  networking of those engaged prevention
• We have the support of Dr Bernard Goldstein,
  Dean, Graduate School of Public Health (GSPH),
  University of Pittsburgh, esp. for accreditation
  of School of Public Health

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Proposed Public health training Program

• Accredited Schools of Public Health in Pakistan
• Brick and Mortar school of public health (like
  John Hopkins Harvard) is needed to build the
  upper level infrastructure for prevention and
  health.
• World-class schools of public health In Pakistan
  can be built for a fraction of the cost of a
  hospital, a medical school or a public health
  school in the US.
• Schools should be accredited to world class
  standards.
• These schools will compete with schools in US
  because of unique populations and type of
  diseases.

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Proposed Public health training Program

• Accredited Schools of Public Health in Pakistan
• Proper training in public health can
  inexpensively reduce the morbidity and mortality
  of diseases in Pakistan.
• It will also provide nations the best means for
  prevention.
• This will rapidly improve training of all medical
  students in public health virtually for free.
• The optimal approach to health in South Asia will
  be to train as many individuals in preventive
  medicine as those in clinical medicine.

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King Edward
Zaiuddin
Aga Khan University
DPA
Baqai
Supercourse
CPSP
Khyber medical college
Bolan medical
Fatima Jinnah
Allama Iqbal University
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Conclusion

• The growing double burden of diseases in Pakistan
  and other South Asian countries calls for focus
  on prevention
• To improve the health of the nation, clinical and
  public health training requires a balance
• We can train scientists, teachers and students
  all around Pakistan though supercourse lectures
  and faculty
• Linking CPSP, supercourse, SAHPA together will
  result in sharing of research design and
  prevention/statistics information
• The costs would be small, but the impact on
  health, immense