Editor: P. Nair (2005). 226 pages. Paperback. Punjagutta, Hyderabad, India: The ICFAI University Press. ISBN 81-7881-747-0
Review by: Sherri Melrose, Assistant Professor, Centre for Nursing and Health Studies, Athabasca University, Athabasca, Alberta, Canada.
Education and health structure: An overview, edited by P. Nair presents a series of articles on health and education infrastructure. These articles are written by authors from India, Korea, and Singapore and examine health and education delivery systems and policy frameworks. While these authors do refer briefly to European and North American systems, the focus is mainly on India and South Asia. My key critique of this work is with the title. Without clearly identifying that the focus of the writing is on health and education in India, the reader is initially left wondering where the structures are that the book seeks to overview.
However, while the authors target India and other developing countries, the issues raised are remarkably similar to those in North America. And, some of the projects suggested may offer insight to professionals outside of India. For example, discussing educational infrastructure in India, Sivaram Mallela called for re-engineering processes within institutions to accommodate more cost effective solutions such as distance delivery systems. Models could include a campus-based institution that uses the internet for distributed learning, a mixed mode institution that operates in both a physical and virtual environment, and an institution that operates in a completely electronic environment offering programs as well as teleconference and videoconference sessions.
Discussing the financing of higher education, Deepak Kumar argued against state funded institutions and identified the world-wide trend of self financing. He stressed the role of private-public partnerships and posited examples such as subsidized loans, student grants or vouchers, and private sector donations. In his view, more opportunities for synchronizing higher education with the job market are needed.
In vocational and technical training, Law Song Seng considered the practical challenges involved with vocational technical education and training (VTET) and presented an interesting study with participants from Switzerland, Japan, the United States, and Singapore. Conclusions from the study included noting that VTET has a “less than positive image” across societies and countries and expressing “concern about whether sufficient attention has been paid to those who need and can benefit most from VTET” (p. 59). Emphasizing how his own technical education institution in Singapore built up a positive public image and brand name, Seng identified that key ingredients for success were strong governmental support, right policy decisions, effective governance structure, stakeholder support, community partnership, management leadership, and staff commitment.
Two examples of Web-based systems for teacher training through distance learning are presented. Creating cost effective upgrading programs for hundreds of thousands of primary and secondary school teachers from different geographic areas is challenging. In Kerala, India, K. R. Srivathsan described the launch of Edusat, an emerging Broadband connectivity and development in Technology Enhanced Learning and Teaching (TELT). In Korea, where all schools do have government financed internet connections, Insung Jung described the launch of a training package that teachers could access easily from their classrooms.
The education section concludes with a discussion about the usefulness of a Benefit Incidence Analysis (BIA) of public education and health spending by Hamid Davoodi, Erwin Tiongson, and Sawitree Asawanuchit. The findings suggest that “overall education and health spending are poorly targeted; benefits from primary education and primary healthcare go disproportionately to the middle class.” The analysis also showed that “countries with a more pro-poor incidence of education and health spending, tend to have better education and health outcomes, good governance, high per-capita income, and wider accessibility to information” (p. 112).
The health section begins with a review of a book which provides strategies for developing countries to work with private sector providers to achieve accessible healthcare, particularly for the poor. Next, H Karnick proposes a Balanced Healthcare Complex Model (BHCM) that is geared more to preventing than simply diagnosing and treating disease. The BHCM addresses issues India faces such as shortages of professional staff, limited access for rural patients, and a specific need to improve the health and education of women. The model recommends the inclusion of mobile units equipped with computers and diagnostic devices that could travel directly to rural villages to balance the existing public and private hospital buildings in urban centers.
Then, Surya Pala discusses a case study in India illustrating telemedicine, where patients can be examined, monitored, and treated by a physician from a distance. The importance of humanizing technology to prevent patients from feeling detached and virtually presenting physical data to physicians in the absence of face-to-face seeing, hearing, and touching are noted. Issues of the high cost of the technology and patients’ preference for face-to-face interaction were identified.
Finally, the book concludes with a synopsis of a European study on standardization issues in e-health. The focus of the study was to seek ways to achieve interoperability based on standards and to facilitate cooperation between member states. Recommendations centered on using technology to establish a Europe wide platform for standardized systems of record keeping, certification, and information dissemination.
In summary, this edited book does offer a picture of education and health infrastructure.
However, the picture is more of a snapshot than an overview, and the work clearly
focuses on the India experience. An important strength of the book is how the
editor, P. Nair, extends our existing definition of ‘infrastructure’
to include frameworks that guide health and education systems. The contributing
authors all provide illustrations of how technological innovations can be woven
in to existing health and education delivery systems to strengthen services.
These illustrations are useful and creative responses to systems that often
seem ineffective, and they will appeal to an international audience. The book
will be of particular value to leaders in education and health who are interested
in comparing different delivery systems.