Public Health Education in India, Evolution and Challenges

Context: The United States’ decision to withdraw from the World Health Organization (WHO) and significantly downsize the United States Agency for International Development (USAID) has caused major disruption in the aid and public health sectors.

Public Health Education in India

• Article 47 of the Indian Constitution assigns the state the responsibility to improve public health care.
• Public health requires specific knowledge and skills to address health needs.
• The COVID-19 pandemic highlighted the urgent need for a dedicated public health workforce.
• Such a workforce is essential for government systems, civil society organisations, academic institutions, and research bodies.

Evolution of Public Health Education and Jobs in India

Colonial Era Roots

Public health education began during the colonial era, embedded within medical teaching.

• The All India Institute of Hygiene and Public Health, Kolkata was established in 1932 to formalise public health training.
• Preventive and social medicine, later termed community medicine, became part of medical education.
• However, specialists in community medicine were few and focused mainly on medical teaching.

Rise in Demand and Expansion

In the early 2000s, most students pursuing public health degrees went abroad to countries like Australia, the European Union, the UK, and the US.

• Recognising the growing need, public health institutions and teaching expanded in India.
• In 2000, only one institution offered an MPH (Master of Public Health) course; currently, over 100 institutions offer master’s level courses in public health.
• The expansion coincided with the launch of the National Rural Health Mission (NRHM) in 2005, which opened public health roles to non-medical specialists.

Mismatch Between Supply and Demand

• After an initial rise in government recruitment, hiring plateaued while the number of institutions and graduates continued to grow.
• Securing jobs has become increasingly difficult for MPH graduates.

Challenges in Public Health Education and Employment

• Mismatch Between Supply and Demand: Entry-level jobs (e.g., research or programme assistants) attract high competition.
  • The success rate for securing jobs is low due to the limited availability of positions.
  • Shrinking public health roles and institutions further limits job opportunities.
• Challenges in Establishing Public Health Cadres: Attempts to create public health management cadres in States face bureaucratic hurdles and policy issues.
• Impact of Private Sector Dominance: Private sector health care focuses more on hospital and business management, limiting opportunities for public health graduates.
  • Research and development sectors remain the main employers but rely heavily on foreign grants.
  • India is no longer a priority for international funders, further reducing job opportunities.
• Poor Quality of Public Health Education
  • Lack of Standardisation: No single regulatory body oversees MPH training.
  • Insufficient Practical Learning: Training lacks real-world exposure.
• Unregulated Institutions: The number of institutions has increased, but many compromise on quality to attract students.
  • Faculty members often lack practical experience.
  • Students often enrol without a clear understanding of the field.
• Uneven Regional Distribution: Large States like Assam, Bihar, and Jharkhand have very few public health institutions.
  • Hilly and smaller States face similar gaps in training facilities.
• Regulatory Gaps: MPH courses are not regulated by the National Medical Commission (NMC) or the University Grants Commission (UGC).
  • Lack of standardised curriculum and outcome measures reduces overall graduate quality.

Recommendations and Approaches

• Create More Public Health Jobs: Governments are the largest employers of public health professionals in most developed countries.
  • India should establish a dedicated public health cadre at the State and national levels to increase employment opportunities and strengthen public health infrastructure.
• Introduce Robust Regulatory Mechanisms: A dedicated public health education division should be created within the NMC or UGC.
  • The division should set curriculum standards and minimum training requirements while allowing for innovation.
• Improve Practical Learning and Training: Integrate public health training with real-world health systems.
  • Encourage States with limited training facilities to establish new public health institutions.
• Build National Ecosystems for Sustainable Funding: Reduced foreign aid necessitates increased domestic funding for public health research and development.
  • Establish national-level funding to support research and program implementation.

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