Public Health Education in India- Explained Pointwise

The decision by the United States to withdraw from the WHO and drastically reduce the scale of the USAID has sent shock waves through the public health world, disrupting health-care services in many low and middle income countries. The US withdrawal/pullout will directly impact the public health job market in India, reducing opportunities for thousands who are pursuing their Master of Public Health (MPH) and similar postgraduate courses. Public Health Education in India.

What is Public Health and Public Health Education?

Public Health- According to WHO, Public health refers to all organized measures to prevent disease, promote health, and prolong life among the population as a whole.

Public health education (PHE) is the process of equipping individuals and communities with the knowledge, skills, and attitudes necessary to make informed decisions and promote healthy behaviors, ultimately aiming to improve population health and well-being. PHE differs from clinical health education in that it focuses on the health of entire populations, rather than individual patients. 

What steps have been taken in the direction of improvement of  Public Health Education in India?

1. Expansion of Public Health Institutional Framework– There has been a  growth in dedicated public health institutions, from just 23 institutions offering public health courses in 2000 to over 90 today. E.g. Public Health Foundation of India (PHFI) and Creation of Indian Institutes of Public Health (IIPH) in multiple states.

2. Diversification of Public Health Educational Programs- Introduction of Master of Public Health programs (MPH) across various universities, and specialized courses in epidemiology, health economics, health systems management and short-term certificate courses for working professionals. E.g. JIPMER Puducherry’s integrated MD-MPH program combines clinical and public health training.

3. Multidisciplinary Approach to Public Health Care– There has been increasing focus One Health approach connecting human, animal, and environmental health. Further, steps have been taken towards the Interdisciplinary integration of programs like combine epidemiology, biostatistics, social sciences, and management. E.g. Tata Institute of Social Sciences (TISS) Health Systems Studies program incorporating economics, sociology, and anthropology.

4. Industry-Academia Partnerships– Collaboration with international organizations like (WHO, UNICEF, World Bank), public-private partnerships for training and research and NGO involvement in practical training and field exposure.

5. Increased emphasis on research and Capacity Building- There has been a 5-fold increase in public health research publications from India between 2000-2020. E.g. National Centre for Disease Control’s Field Epidemiology Training Program.

6. Digital Health Integration/Health Informatics: Expansion of training in health informatics and digital health technologies along with skill development for telemedicine and remote healthcare delivery. E.g. IIT Kharagpur’s Certificate Program in Healthcare Informatics.

7. Emphasis on Field Experience: Increased focus on mandatory fieldwork and community-based learning, rural and urban health internships with exposure to primary healthcare centers and district health systems. E.g. PHFI’s evaluation of public health graduates, 2022 reported 76% adequate field experience in PHE, up from 43% in 2012.

8. Global Health Perspective: International collaborations with leading global health institutions and curriculum alignment with global competency frameworks have been increased. E.g. Joint MPH degree between Johns Hopkins and IIPH-Delhi.

What is the Significance of Public Health Education?

1. Essential for the development of Healthcare Workforce: Public health professionals play a vital role in disease prevention, epidemiology, and policy-making, beyond traditional medical practice.

2. Strengthened public health outcomes: Countries with strong public health cadres, such as the United Kingdom NHS and the United States CDC, have demonstrated better health outcomes.

3. Minimising the epidemic losses: The pandemic underscored India’s shortage of trained public health personnel, leading to delays in disease surveillance and response mechanisms.

4. Bridging the Gap in Rural Health Services: Programs like National Rural Health Mission NRHM require a trained public health workforce to enhance primary healthcare delivery.

5. Seed for Research & Development: Public health education supports evidence-based policymaking, crucial for disease prevention and health system planning.

6. Reduction of Out of Pocket Health Care Expenditure: According to the World Bank, every $1 invested in public health yields a return of $14 by reducing disease burden and healthcare costs.

7. Fulfillment of the Constitutional Mandate- The development of a dedicated public health workforce in India is a step towards the fulfillment of the state’s responsibility of improving public health care under Art 47 of the constitution.

What are the challenges?

1. Limited Employment Opportunities- Despite the increase in the institutions offering Master of Public Health MPH degrees, the public sector hiring has plateaued, leaving thousands of graduates without viable employment.

2. Low Government Investment in Healthcare- According to the Economic Survey 2023-24, India’s public health expenditure remains at just 2.1% of GDP, significantly lower than the WHO-recommended 5%.

3. International Aid & Funding Constraints- The shrinking of USAID and WHO funding has impacted research and public health projects.

4. Neglect of public health specialists by the Private Sector- With the private sector prioritizing hospital and business management professionals over public health specialists, the non-clinical public health professionals face an increasingly competitive job market.

5. Unequal Distribution of Public Health Institutes- Large states like Bihar, Assam, and Jharkhand have few or no institutions offering MPH degrees, creating regional disparities in public health education.

6. Lack of Regulation: Currently, MPH courses are not mandatorily regulated by any statutory body like the National Medical Commission (NMC) or University Grants Commission (UGC). The absence of a standardized curriculum results in inconsistencies in training.

What should be the way forward?

1. Establish a Dedicated Public Health Cadre: Create a state-level public health management cadre, similar to the Indian Administrative Service (IAS), to absorb trained professionals into government roles. E.g. UK’s National Health Service NHS Public Health Specialty Training.

2. Introduce a Regulatory Framework: Establish a public health education board under NMC or UGC to standardize MPH curricula, faculty training, and accreditation. E.g. U.S. Council on Education for Public Health CEPH.

3. Expand Government Recruitment: Increase public health job opportunities in primary healthcare, epidemiology, and health policy sectors. E.g. Thailand’s Health Promotion Foundation ThaiHealth, which integrates trained public health workers into government programs.

4. Enhance Practical Learning: Introduce mandatory field training in district health offices, research institutes, and public health projects. E.g. USA CDS’s Epidemic Intelligence Service EIS.

5. Incentivize Research & Development: Increase domestic research funding through ICMR and DBT, reducing dependence on foreign grants. E.g. Germany’s Helmholtz Association of Public Health Research.

6. Public-Private Partnerships PPP: Encourage collaborations between public health institutes and corporate CSR initiatives to create employment avenues. E.g. Singapore’s PPP model for health promotion and capacity building.

7. Increase MPH Seats in Underserved States: Prioritize MPH program expansion in Bihar, Assam, Jharkhand, and North-Eastern states.

8. Community Involvement and Feedback Mechanisms: Initiatives like Mera Aspataal allow patient feedback, helping improve the quality of services in public and private health facilities. Community involvement in health programs builds trust and ensures that health education meets local needs.