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

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

Rising Life Expectancy (WHO Report, 1997 )

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

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 women’s education, and government commitment for linking health care and prevention

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

Medical training in Pakistan Total of 25 medical colleges 12 have some kind of training programs in preventive medicine, public health, community medicine etc 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

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

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.

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

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

Supercourse- Global Health Network 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

Supercourse- Global Health Network 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

Supercourse- Global Health Network 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

Established and developed from the grass roots in September 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 Supercourse in Pakistan

South Asian Health Preventionists Association ( SAHPA) 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 South Asian countriesMembers count Pakistan60 India65 Srilanka10 Nepal8

BMJ article Hope of prevention training in South Asia

College of Physicians and Surgeons of 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)

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-specialtiesFCPS MCPSDCPS CPSP has made consistent progress and accomplished its objectives to a large extent. 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

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 ISharing of Prevention/statistics lectures among medical colleges Phase II Building Virtual School of Public Health

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 ( we can reach a large segment of clinicians and teacherswww.pitt.edu/~super1 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.

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

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 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

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.

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.

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

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