Public Health Education in India  Introduction 

• The United States’ decision to withdraw from the World Health Organization (WHO) and reduce United States Agency for International Development (USAID) funding has created ripples in the global public health landscape, significantly impacting healthcare systems in low- and middle-income countries like India.
•  This shift in funding is expected to limit public health opportunities, especially for those pursuing careers in public health. However, India has been largely unaffected, as international aid accounts for just 1% of its total health expenditure. 
•  As a result, understanding the current status and evolution of public health education in India, along with the steps taken to strengthen it, has never been more important.

What is Public Health and Public Health Education?

• Public health, as defined by the World Health Organization (WHO), refers to organized efforts to prevent disease, promote health, and prolong life across entire populations. 
• Public health education (PHE) involves equipping individuals and communities with the knowledge, skills, and attitudes necessary to make informed health decisions and promote healthy behaviors. Unlike clinical education, which focuses on individual patients, public health education targets the well-being of entire populations.

Steps Towards Improving Public Health Education in India

• India has made remarkable progress in enhancing public health education over the years. The following efforts outline the key milestones and innovations that have helped shape the country’s public health landscape:
• Multidisciplinary Approach to Public Health: One Health, a holistic approach connecting human, animal, and environmental health, has gained traction in India. Educational institutions have integrated interdisciplinary approaches by combining fields such as epidemiology, biostatistics, social sciences, and management. For example, the Tata Institute of Social Sciences (TISS) Health Systems Studies program incorporates economics, sociology, and anthropology to address health challenges from various perspectives.
• Industry-Academia Partnerships: Public health institutions in India have increasingly formed partnerships with global organizations like WHO, UNICEF, and the World Bank, as well as public-private collaborations, to enhance training and research. NGOs are also playing a key role by providing students with field exposure and practical experience in public health interventions.
• Increased Focus on Research and Capacity Building: Public health research output from India has increased five-fold between 2000 and 2020. This growth is largely driven by institutions like the National Centre for Disease Control’s Field Epidemiology Training Program (FETP), which focuses on improving public health research and response to health emergencies.
• Expansion of Public Health Institutions: From just 23 public health institutions offering courses in the year 2000, the number has grown to over 90 today, reflecting the significant demand for public health professionals. Notable institutions such as the Public Health Foundation of India (PHFI) and the creation of Indian Institutes of Public Health (IIPH) in multiple states have been at the forefront of this expansion, promoting higher standards in public health education.
• Diversification of Public Health Educational Programs: The range of public health programs has increased significantly. The introduction of Master of Public Health (MPH) programs across universities, along with specialized courses in epidemiology, health economics, health systems management, and short-term certificate programs for working professionals, has enabled a wider range of individuals to pursue public health careers. For instance, JIPMER Puducherry’s integrated MD-MPH program is an example of combining clinical and public health education.
• Digital Health Integration: With the rapid advancement of digital health technologies, there has been an expansion of training programs in health informatics and digital health technologies. Institutions like IIT Kharagpur offer specialized courses such as the Certificate Program in Healthcare Informatics to equip public health professionals with skills in telemedicine and remote healthcare delivery.
• Global Health Perspective: India’s public health institutions have increasingly aligned their curricula with global health competency frameworks and engaged in international collaborations with leading global health institutions. For example, the joint MPH program between Johns Hopkins University and IIPH-Delhi reflects India’s growing emphasis on global health education.
• Emphasis on Field Experience: There is a growing focus on mandatory field training for public health students. Rural and urban health internships, exposure to primary healthcare centers, and fieldwork in district health systems are now key components of public health education. A recent PHFI evaluation in 2022 reported that 76% of public health graduates had adequate field experience, a significant improvement from just 43% in 2012.

The Significance of Public Health Education

• Development of a Strong Healthcare Workforce: Public health professionals are indispensable in disease prevention, epidemiology, policy-making, and other non-clinical areas. They complement the efforts of clinical healthcare professionals and play an essential role in ensuring the health of entire populations.
• Improved Public Health Outcomes: Countries with well-established public health systems, such as the UK’s NHS and the US’s CDC, have demonstrated better health outcomes. India can benefit from similar initiatives to improve its overall public health infrastructure.
• Minimizing the Impact of Epidemics: India’s experience with the COVID-19 pandemic highlighted the country’s shortage of trained public health professionals. The lack of a well-prepared workforce delayed disease surveillance and response, underlining the need for stronger public health education.
• Bridging Gaps in Rural Health Services: The National Rural Health Mission (NRHM) and other initiatives designed to strengthen primary healthcare in rural areas rely heavily on the deployment of skilled public health professionals. Public health education is pivotal in addressing health disparities and ensuring equitable healthcare access.
• Fostering Research and Development: Public health education supports evidence-based policymaking and innovation in disease prevention and health systems. A robust research-driven approach is essential for tackling emerging health challenges.
• Reducing Out-of-Pocket Healthcare Expenditure: Public health investments have a high return on investment. According to the World Bank, every dollar spent on public health returns $14 by reducing disease burden and healthcare costs, demonstrating the economic value of a well-educated public health workforce.
• Fulfilling Constitutional Mandates: Article 47 of the Indian Constitution mandates the state to raise the level of nutrition and the standard of living and improve public health. A dedicated public health workforce is integral to fulfilling this constitutional responsibility.

Challenges in Public Health Education

• Impact of Shrinking International Aid: The reduction in USAID and WHO funding has led to a decline in research and public health projects, limiting opportunities for professionals in the sector. Between 2017 and 2020, USAID’s funding to India’s public health programs decreased by nearly 30%, resulting in cutbacks in several ongoing projects, particularly those aimed at disease prevention and maternal health. The reduction in USAID funding led to delays in key programs such as the National AIDS Control Program, which saw a decrease in funding, impacting efforts to curb HIV transmission. Similarly, WHO’s reduced involvement in India has slowed down efforts in capacity-building and disease control projects, limiting the resources available to health professionals.
• Private Sector Neglect: The private sector in India often prioritizes hospital management professionals over public health specialists, which creates a competitive job market for non-clinical public health professionals. Leading private hospitals like Fortis and Apollo are increasingly hiring hospital management professionals, rather than public health experts, to handle healthcare systems. As a result, many public health professionals, particularly those from MPH programs, face an uphill battle to secure positions, even in private healthcare organizations that could benefit from public health expertise in areas like population health management.
• Limited Employment Opportunities: While the number of MPH programs has risen, public sector job openings have plateaued. The Economic Survey of India (2023-24) showed that public health hiring in government sectors like the Ministry of Health and Family Welfare has stagnated. This limits employment opportunities for graduates who have invested considerable time and resources in public health education. States like Uttar Pradesh and Rajasthan, despite having several public health institutions, have not created sufficient government positions in primary healthcare or epidemiology, leaving thousands of qualified professionals unemployed or underemployed.
• Low Government Investment in Healthcare: India’s public health expenditure is just 2.1% of GDP, significantly lower than the WHO-recommended 5%. The National Health Policy (2017) aimed to raise this expenditure to 2.5% by 2025, but the pace of this increase has been slow. In 2021, India’s health expenditure was less than half the global average of 6.2% of GDP, placing significant pressure on healthcare infrastructure and limiting job creation in public health sectors. The shortage of resources also affects the quality and coverage of public health programs, like immunization campaigns, disease prevention, and health promotion. 
• Regional Disparities in Public Health Education: States such as Bihar, Assam, and Jharkhand have fewer institutions offering MPH programs, which creates significant regional disparities in the availability of public health education.
• Lack of Regulation and Standardization: Public health education programs are not currently regulated by statutory bodies like the National Medical Commission (NMC) or University Grants Commission (UGC). This lack of regulation results in inconsistencies in curricula, faculty standards, and program quality across institutions. 

• Public health is a specialised field that requires specific knowledge and skills to effectively address people’s health needs. There is an urgent need for a dedicated workforce in India trained in public health, a fact that was very starkly realised during the COVID-19 pandemic. 

The Way Forward

• Establish a Dedicated Public Health Cadre: India should create a state-level public health 
• Expand Public Health Job Opportunities: The government should increase recruitment in primary healthcare, epidemiology, and health policy sectors to create more job opportunities for public health professionals.
• Enhance Practical Learning: Field training should be mandatory for all public health students, with internships in district health offices, research institutes, and public health projects, akin to the USA’s Epidemic Intelligence Service (EIS).
• Incentivize Research and Development: India should allocate more domestic funding for public health research through agencies like the Indian Council of Medical Research (ICMR) and the Department of Biotechnology (DBT) to reduce dependency on foreign grants.
• Promote Public-Private Partnerships (PPP): Public health institutes should collaborate with corporate CSR initiatives to create employment avenues for public health professionals.
• Increase MPH Seats in Underserved States: Expanding MPH programs in underserved regions like Bihar, Assam, Jharkhand, and the North-Eastern states will help address regional disparities in public health education.
• Community Involvement and Feedback Mechanisms: Incorporating patient feedback systems and community involvement, like Mera Aspataal, will help improve healthcare quality and ensure public health education aligns with local needs.
• management cadre, similar to the UK’s NHS Public Health Specialty Training, to absorb trained public health professionals into government roles.
• Introduce a Regulatory Framework: A public health education board should be established under the NMC or UGC to standardize MPH curricula, faculty training, and accreditation, ensuring consistency in education quality.