Editorial 1: The challenges of public health education in India
Context
The main challenge lies in the imbalance between supply and demand, driven by declining job opportunities and the predominance of the private sector.
Introduction
The U.S. decision to leave the World Health Organization (WHO) and cut back USAID has shocked the aid and public health sectors. This has disrupted important healthcare services in many poorer countries. However, India has been mostly unaffected since foreign aid makes up only 1% of its health spending. The halt in funding risks further shrinking the already limited public health development sector, which depends on international support. This directly affects the job market, reducing opportunities for thousands of MPH and related graduates.
The Need for a Strong Public Health Workforce in India
- Importance of Public Health: Public health is crucial for a nation’s well-being and healthcare system.
- Constitutional Responsibility: Article 47 of the Indian Constitution emphasizes the state’s duty to improve public health.
- Need for Specialized Expertise: Public health is a specialized field requiring specific knowledge and skills to meet health needs effectively.
- Urgent Need for a Trained Workforce: India needs a dedicated public health workforce, a necessity highlighted during the COVID-19 pandemic.
- Beyond Government Systems: A trained workforce is also vital for civil society organizations, academic institutions, and research organizations involved in public health.
The evolution of training and jobs in India
- Public health education in India began during the colonial era.
- Initially, it was part of medical teaching with a narrow focus.
- The All India Institute of Hygiene and Public Health, Kolkata, was established in 1932.
- Preventive and social medicine (later called community medicine) became part of medical education.
Limited Workforce and Overseas Education
- Community medicine specialists provided public health services but were few in number.
- Many students pursued Master of Public Health (MPH) courses abroad in countries like Australia, the UK, and the U.S.
- Despite this, the number of public health professionals remained low.
Expansion of Public Health Education in India
- Recognizing the demand, MPH programs grew rapidly in India.
- In 2000, only one institution offered MPH; today, over 100 institutions provide public health courses.
- The expansion aligned with the launch of the National Rural Health Mission (NRHM) in 2005.
- Non-medical public health specialists gained opportunities in government health roles.
- After an initial surge, government hiring of public health specialists slowed.
- The number of graduates continued to rise, making job placement more difficult.
Key Issues in Public Health Education
- Lack of standard training – No uniform curriculum across institutions.
- Limited practical exposure – Insufficient hands-on learning opportunities.
- Faculty shortages – Not enough trained teachers in public health.
- Unequal distribution of institutions – Many states, like Assam, Bihar, and Jharkhand, have few or no MPH programs.
- These challenges highlight the need for better planning, standardization, and job opportunities in public health education in India.
Hurdles graduates face, issues in education
| Challenges | Details |
| Mismatch Between Supply and Demand | Job opportunities for public health graduates are shrinking, leading to intense competition for entry-level positions like research or program assistants. The success rate is very low due to high competition. |
| Limited Public Sector Jobs | Public health roles within the government are reducing, and efforts to create public health management cadres in states have faced multiple obstacles. |
| Private Sector Preference | The private sector prioritizes hospital and business management professionals over public health specialists, limiting opportunities for MPH graduates. |
| Dependence on Foreign Grants | Research and development sectors, which employ many public health graduates, rely heavily on foreign funding. India is no longer a priority for international donors. |
| Declining Development Sector Funding | Limited financial support for development initiatives, further worsened by recent U.S. policy changes, restricts job opportunities in public health. |
| Underfunded National Research and Health Programs | Domestic funding for research and health development is in its early stages and remains inadequate. |
| Quality Concerns in MPH Education | The rapid expansion of public health schools has led to lowered admission standards and a lack of student preparedness for the field. |
| Lack of Trained Faculty | Many faculty members lack proper training and real-world experience, affecting the quality of education. |
| No Standardized Curriculum | Despite the Health Ministry’s model course framework, there is no mandatory standardized curriculum or clear outcome measures for MPH programs. |
| Absence of Regulatory Oversight | MPH courses are not regulated by the National Medical Commission (NMC) or University Grants Commission (UGC), leading to inconsistencies in education quality. |
Steps to Improve Public Health Education and Employment
- Increase Public Health Jobs
- Create more jobs in public health at all levels, from primary care to state and national health systems.
- Governments should become the primary employers of public health professionals, as seen in developed countries.
- Establish a dedicated public health workforce within state governments to boost employment and strengthen health systems.
- Set Up a Strong Regulatory System
- Create a public health regulatory body or a specialized division within existing agencies like NMC or UGC.
- Ensure public health experts lead this body to set curriculum standards and minimum training requirements.
- Maintain flexibility for innovation, as public health is a constantly evolving field.
- Enhance Practical Learning
- Public health education must include hands-on training within health systems.
- Institutions should focus on real-world applications to better prepare graduates for professional roles.
Conclusion
It is essential to establish and expand public health institutions in states that currently have few or none. The evolving global landscape demands increased national efforts and the development of local ecosystems to ensure sustainable progress in healthcare.
