Education in India
Governments, media, academic
institutions and NGOs, have to work in close collaboration to give India
an effective health education
system, write Dr
B P MAHESH CHANDRA GURU, SAPNA
M S and MADHURA VEENA M L
What is India News Service
is everyone's concern.
It is also an important component of human resources development.
Health goes hand in hand with social-economic development.
The Health for All strategy calls for concerted action in all
sectors and demands coordinated efforts to enlist active people’s
participation in the process of health management.
It is the responsibility of the state to ensure health for all. Health
development is indeed a multi-dimensional activity.
education is a fundamental necessity in a welfare state.
People need health education consistently.
Formal programmes in health education did not develop until recent
times in India and other developing nations. The International Union for Health Education has stated its
position on school health education in a policy paper thus: “Any
subject, whether AIDS or tobacco or nutrition is best taught not as a
single stand-alone course, but rather within a more comprehensive school
health education programme that provides planned sequential education
about health at every grade level, that focus on behavioural skills (e.g.
decision-making, communication skills, negotiations skills etc.) and that
consequently establishes a foundation for understanding relationship
between personal behaviour and health” 1.
subject of health is widely discussed throughout the world. Health is not a gift that is bestowed by any supernatural
power. ‘Health’ is an
Anglo-Saxon term which means the condition of being safe and sound or
whole. According to Goetz
Philip, the term ‘health’ comprises the state of complete physical,
mental and social well-being and not merely the absence of disease or
infirmity 2. Health
is earned by the people through conscious, planned and sustainable efforts
all through the life. Ruslink
Doris emphasizes the role of family in health management thus: “The
family which regards good health as a precious possession takes
precautions to protect it and to avoid those conditions which may
jeopardize it. Such a family
safeguards the health of each member in many ways by providing a
healthful, happy home environment, a well balanced diet, a good balance of
work, rest and recreation, by having periodic health and dental check ups
and by taking immunization measures” 3.
The state has an obligation to ensure
enjoyment of the highest attainable standards of health as one of
the fundamental rights of every human being without distinction of race,
religion, political belief, economic or social distinction.
OF HEALTH EDUCATION
Health education is a term
commonly used and referred to by health professionals.
Health education is indispensable in achieving individual and
collective health. There is
no single acceptable definition of health education which is normally
perceived as an instrument of changing attitudes and behavioural patterns
of people toward attaining better health status through adoption of health
innovations and practices which are tested and tried.
Health Organization defines it thus: “Health education is the part of health
care that is concerned with promoting healthy behaviour” 4.
Health education is the translation of what is known about health
into desirable individual and community behaviour patterns by means of an
educational process 5. John
M Last defines health communication as "the process by which individuals
and groups of people learn to behave in a manner conducive to the
promotion, maintenance or restoration of health” 6.
Green L W observes: “Any combination of learning opportunities
and teaching activities designed to facilitate voluntary adaptation of
behaviour that are conducive to health” 7.
The definition adapted by the National Conference on Preventive
Medicine in USA reads: “Health education is a process that informs,
motivates and helps people to adopt and maintain healthy practices and
lifestyles, advocates environmental changes as needed to facilitate this
goal and conducts professional training and research to the same end” 8.
Thus, health education encompasses all strategies and activities
which are meant of the attainment of better health status of the people.
OF HEALTH EDUCATION
education is required to increase knowledge and to reinforce desired
attitudinal and behavioural patterns concerning health management of
individuals as well as communities. The
Alma-Ata Declaration (1978) emphasized the need for individual and
community participation in the process of health education.
It has also revolutionized the concepts and aims of health
education. Following the
Alma-Ata Declaration the emphasis has shifted from prevention of disease
to promotion of healthy life styles; the modification of individual
behaviour to modification of ‘social environment’ in which the
individual lives; community participation to community involvement; and
promotion of individual and community ’self-reliance’.
It also provides a useful basis for formulating the aims and
objectives of health education which may be stated as follow:
encourage people to adopt and sustain health promoting life style and
promote the proper use of health services available to them;
arouse interest, provide new knowledge, improve skills and change
attitudes in making rational decisions to solve their own problems;
stimulate individual and community self-reliance and participation to
achieve health development through individual and community
involvement at every step from identifying problems to solving them.
includes the regulatory approach, service
approach, health education approach and primary health care approach.
The regulatory approach involves governmental intervention designed
to alter human behaviour through regulations ranging from prohibition to
imprisonment. This approach
seeks change in health behaviour and improvement in health through a
variety of external controls or legislations.
The service approach involves providing necessary health services
needed by the people as and when required through the spirit of
volunteerism or social obligation. The
health education approach involves changing the behavioural patterns of
the people through planned learning experiences without conflicting with
the masses. The primary
health care approach involves enabling individuals to become self-reliant
in matters of health.
scope of health education covers every aspect of individual health, family
health and community health. Health
communication essentially involves individual approach, group approach and
mass approach which are universally witnessed.
The contents of health education include human biology, nutrition,
hygiene, family health, disease prevention and control, mental health,
prevention of accidents and so on. The principles of health education include: volunteerism,
dedication, determination, drive, comprehension, experimentation,
reinforcement, achievement motivation, participatory approaches,
leadership development, social activism, persuasive efforts and so on.
Health communication planning involves the various stages such as,
1. identifying the health problems and health needs, 2. understanding the
communication resources and requirements in tune with the health project,
3. identification of the priorities, 4. setting communication
goals, 5. assessment of communication resources, 6. mobilization of
communication resources, 7. planning communication activities, 8.
implementation of communication plans, 9. monitoring and
evaluation of communication programmes and 10. reassessment of the
EDUCATION IN INDIA
of Central Government
Government of India is responsible for providing countrywide education to
the people on health care and management.
The Directorate General of Health Services set up Central Health
Education Bureau (CHEB) in 1956 to coordinate health education services
through various divisions in the country.
The goals and objectives of the division include educating the
people about health plans and programmes, training health educators and
workers, supplying health education materials, conducting health
research activities, providing technical assistance to government and
non-government agencies in the field of health education, developing
health education syllabi for different target groups and collaborating
with international agencies in promoting health education.
The School Health Education Division of CHEB provides and monitors
the centrally sponsored school health service scheme since April 1977
meant for primary school students in rural areas.
CHEB also works with UGC, NCERT, Board of Secondary Education and
other agencies in imparting health education by enlisting the
participation of universities, colleges and schools.
of State Governments, Union Territories
and Local-Self Government Bodies:
health services are managed by respective State Governments and Union
Territories. The aim of
school health programme is to provide comprehensive health care to all
school children in both urban and rural areas.
It comprises of medical examination, treatment, preventive
medicine, follow-up action, sanitation, hygiene, safe environment and
other aspects of health management. There
is a provision for health check-up twice in a year undertaken by
government or private agencies under the supervision of a Medical Officer
who is in charge of medical inspection.
Medical fee is collected in schools for the purpose of health care
which is compulsory. This
arrangement is made with a view to bring about awareness among parents and
teachers. The Primary Health Centers of Karnataka State implement the
National School Health Programme. The
local-self government bodies are also involved at the grassroots level
health education activities at district, block and village panchayat
of Educational Institutions
education is indeed an inter-disciplinary
approach which draws contents and initiatives from physical,
biological, medical and behavioural sciences.
Health instruction is not considered a part of the total school
instruction component is missing from primary school to university levels
in India. Formal health
education programmes are not designed and implemented in our country.
Significant health aspects such as health care, nutrition,
sanitation, hygiene, preventive medicine, community health, environment
protection, drug addiction, mental health, prevention of AIDS and so on
are not covered systematically by our schools, colleges and universities.
Healthy habits are not cultivated by the students due to lack of
health education. Systematical
health instruction is not imparted on mandatory and regular basis.
The students do not get the benefit of incidental teaching on
health care resources and methods. Printed
materials, audio-visual programmes, demonstrations, exhibitions, poster
campaigns, group discussions, lecture programmes, field trips, health
clubs and other health instructional opportunities are not made available
to the students at various levels. Very
few health universities and medical colleges are imparting professional
health education and training. Thus,
health education in India is not imparted at various levels formally or
informally to the best of the satisfaction of students, parents, teachers
and other sections of society.
of Mass Media
media like newspapers, magazines, film, radio and television are diffusing
health information throughout the country in their own way. Attainment of health and family welfare needs the presence of
informed, active and alive citizenry.
Mass media can play a complementary role in facilitating health for
all. In reality, mass media
in India have not accorded a place of pride to health education.
print media have played a limited role in promoting health consciousness
among the people. Once in a
while reports, articles, features, profiles and other health-centered
contents appear in the press. Occasionally
some investigative reports about mismanagement of health sector also
appear in the print media. Health
centered advertisements appear in the press regularly because of the
economics of advertising. Some
professional journals carry serious write-ups on health management.
Medium and small newspapers and magazines predominantly contain
health-centered advertisements. They
hardly provide any worthy writings pertaining to health management. Thus, print media have not contributed adequate writings in
the field of health education mainly due to lack of will, commitment and
is a powerful medium of communication.
India produces largest feature films, newsreels and documentaries
in the world. Feature films
which focus on health management are hardly produced in this country. The Films Division produces newsreels and documentaries which
focus the attention of the audience on health, nutrition, family welfare
and environment protection. These
newsreels and documentaries are screened in cinema theatres and
non-theatrical channels which include community halls, educational
institutions, industrial houses, cultural organizations etc.
These newsreels and documentaries are not regularly screened and
discussed in the countryside. Therefore,
newsreels and documentaries mainly cater to the informational needs of the
audiences. They have a
limited impact on society from the point of view of health education.
India Radio is well known in the world as the largest radio network.
Radio is the only mass medium which is accessible to both rural and
urban audiences in plenty. Radio
also provides series of special audiences programmes on variety of
subjects including health management.
In the age of television revolution, radio listening habits have
reduced to a considerable extent. Talks,
plays, quizzes, question and answer programmes are popularly used in
health broadcasting programmes. Women
and children welfare programmes are also broadcast to some extent with a
focus on health care. However,
radio programmes too have increased awareness among the listeners on
health management. The time, duration, coverage and quality of health education
programmes are not appreciated by the people in large number.
has become the massest of all mass media in India and everywhere.
Doordarshan which is managed by the Prasar Bharathi Corporation
provides Information, Education and Communication (IEC) support to Health
and Family Welfare through telecasts during different time slots allover
the country. The regional
centers telecast video spots and quickies on various aspects of health
management. Special programmes are also broadcast on the eve of women’s
day, children’s day, worker’s day, world population day, world health
day, no tobacco day, world AIDS day and so on.
Discussions, interviews, quickies, quizzes, special chunks, spots,
jingles etc., are broadcast by Doordarshan Kendras with a focus on burning
health issues of our times. The
Satellite Instructional Television Experiment (SITE) mainly focused on
education, agriculture, health and family welfare, national integration
and so on. Cable TV channels
provide programmes and commercials which have limited focus on health
education. TV has not emerged
over the years as a prominent medium of health education.
of New Communication Technologies
channels, satellite communication channels and computer communication
channels predominantly constitute new communication technologies in the
present times. These
technologies have given rise to telemedicine, video conferencing and other
latest tools of health communication.
Telemedicine application requires information which include images,
voice and digital data created by instruments like electrocardiograph,
electroencephalograph, image scanner etc., about the patient which is
necessary for diagnosis and treatment.
This information is transported to long-distant places through
satellite links, optical fiber links, cables or the Internet.
Doctors can also discuss medical diagnosis and prescriptions with
experts in India and abroad through video conferencing which has become an
important sector in health communication.
These advantages have enriched the process of health communication
in India and elsewhere. However,
these new media have not become true instruments of formal and informal
health education in India due to policy constraints.
are many NGOs operating in urban and rural
areas. They are providing
education, training and guidance to the people on various developmental
themes including health management. They
are also using multi-media for the purpose of health education.
They include: posters, wall writings, tin plates, lectures, group
discussions, seminars, workshops, photo exhibitions, demonstrations and so
on. NGOs are playing an
active role in promoting health education in urban and rural areas even
under certain constraints and limitations.
FUTURE OF HEALTH EDUCATION IN INDIA
education has not been accorded a place of pride in government
organizations, non-government agencies, educational institutions and media
organizations in India. The
dream of ‘Health for All By 2000 AD’ has not been translated into
a reality mainly due to lack of formal and informal health education in
India. Health education is
not managed compulsorily, systematically and meticulously
in India. The vision
‘Health for All By 2000 AD’ may remain empty and the progress toward
that goal tardy if we fail to rejuvenate the health education system
throughout the country both formally and informally.
The future agenda for the Central Government, State
Governments/Union Territories and Panchayati Raj institutions must deal
with the process of people’s participation in health education in which
related processes such as evolving a suitable health education policy,
developing health curriculum, imparting health education, training health
educators, monitoring health education services and achieving the goal of
‘Health for All’ are also addressed at various levels.
a) A national health education policy is necessary to prepare
grounds for nation-wide health education; b) Health education should be
accorded a place of pride and treated as an independent subject on par
with other subjects; c) Separate communication, training and evaluation
division should be created in Health Ministry at National level, state
level and grassroots levels; d) Co-ordination committees should be
established to implement health education programmes at central, state and
grassroots levels; e) There should be region-specific health curricula
which fits into ground realities; f) Health educators should be trained
and recruited from primary to higher education levels; g) A specialized
cadre of health communicators is of utmost importance in mass media
organizations; h) Multi-media campaigns should be envisaged as a holistic
approach to health; i) The government media networks should be
decentralized with a view to provide sustainable health education services
informally; j) Outdoor media
which are more effective channels of health education especially in rural
areas should be utilized adequately for health promotion; k) Newspapers
and television which are accessible to a majority of people should get
government sponsored health advertisement among mass media; l) Health
education messages should be formulated by experts in communication.
Using simple language, authentic facts, local idioms and phrases
and attention compellers can enhance the quality of health messages; m)
Formal evaluation of health education services is required at various to
felicitate better modifications; n) Media institutions could be persuaded
to provide adequate health education services regularly on a priority
basis by increasing time and space; o) NGOs should also actively
participate in health campaigns by providing adequate publicity and
advertising support; p) Policy makers, health administrators, media
professionals and academicians can be involved in directing health
policy makers, health administrators, health educationists, media owners
and professionals and organizers of NGOs have to accord a place of pride
to health education which is a neglected sector.
Health education must
emerge as a critical factor in the process of health development in
particular and national development in general.
Compulsory health education will go a long way in improving the
health status of people.
So long as health education remains
neglected, the dream of ‘Health for All By 2000 AD’ would remain
unfulfilled. As Michael
Traber once observed, people cannot develop or attain their full potential
if they are cut off from communication 9.
The government, media institutions, academic institutions, NGOs,
research and development organizations have to work in close collaboration
toward designing an effective health education
system in the country.
The International Journal of Health Education, 1988.
Goetz (1989); The New World Encyclopedia Britannica Inc., Vol 12, p.
Ruslink (1963); Family Health and Home, Mac Millian Company, New York,
(1988); Education for Health; A Manual on Health Education in Primary
Health Care, p. 9.
A Guide to Communication System in Hospitals, Technical Report 16,
Glossary, p. 33.
J M Dictionary.
L W (1979); International Journal of Health Education, 22 pp. 161 –
Anne R (1977); Preventive Medicine 6(3) 406.
J V (2002), The Media and the Environment, Journal of Communication
Studies, Vol. No. 2 Grishm (Summer) April – June 2002, pp. 91-92.
B P Mahesh Chandra Guru is
Professor & Chairman, Department of Communication and Journalism, University of
M S is
a lecturer and
M L a UGC Junior Research Fellow in the same department