Context

• Public health plays a critical role in shaping national healthcare systems, and the increasing demand for professionals in this field has led to the rapid expansion of public health education in India.
• However, a widening gap between training and employment, coupled with the absence of a standardised regulatory framework, has created challenges for aspiring public health professionals.
• Therefore, it is crucial to explore the evolution of public health training in India, the hurdles faced by graduates, and potential approaches to address these concerns.

Evolution of Public Health Training and Employment in India

• Colonial Legacy and Early Public Health Education
  • The roots of public health education in India can be traced back to the British colonial period when health interventions primarily focused on controlling infectious diseases and improving sanitation.
  • Public health training was embedded within medical education, with an emphasis on hygiene, epidemiology, and disease prevention.
  • However, it remained a peripheral subject rather than a distinct discipline.
  • A major milestone in the formalisation of public health education was the establishment of the All-India Institute of Hygiene and Public Health (AIIHPH) in Kolkata in 1932.
  • This institution became a pioneering centre for training professionals in hygiene, sanitation, and disease control.
  • Despite this effort, public health remained largely confined to medical colleges, where it was incorporated into preventive and social medicine (PSM), later known as community medicine.
• Post-Independence Developments and Expansion of Public Health Education
  • After India’s independence in 1947, the country faced significant public health challenges, including malnutrition, infectious diseases, and inadequate healthcare access.
  • Recognising the need for a strong public health workforce, the government introduced several initiatives to expand healthcare services.
  • However, public health training remained restricted to medical graduates, limiting the supply of specialists in the field.
  • During the 1970s and 1980s, there was a gradual shift towards broadening public health training beyond medical colleges.
  • New institutions such as the National Institute of Health and Family Welfare (NIHFW) in Delhi were established to provide advanced training in public health and family welfare.
  • Despite these developments, the field continued to be dominated by community medicine specialists, and there was little focus on interdisciplinary public health education.
• The Rise of MPH Programs and Institutional Growth (2000-Present)
  • A significant turning point in public health education in India occurred in the early 2000s, with the introduction of Master of Public Health (MPH) programs.
  • Unlike traditional community medicine courses, MPH programs were open to graduates from diverse academic backgrounds, including social sciences, nursing, and allied health sciences.
  • This shift allowed for a more interdisciplinary approach to public health, incorporating expertise from epidemiology, health policy, and health management.
  • In 2000, there was only one institution offering an MPH program in India, but by 2024, the number has grown to over 100 institutions.

Challenges Faced by Public Health Graduates

• Disparity between Graduates and Jobs
  • The demand for entry-level positions such as research or program assistants far exceeds supply, leading to fierce competition and low success rates.
  • The issue is compounded by a shrinking number of public health roles within the government, as efforts to establish dedicated public health management cadres in different states have encountered bureaucratic roadblocks.
• Growing Demand of Private Sector in Healthcare
  • Another significant factor limiting employment opportunities is the growing dominance of the private sector in healthcare.
  • Unlike government agencies, private hospitals and health institutions often prioritise hospital administration and business management over public health expertise.
  • Research and development organisations remain a major employer for public health professionals, but these rely heavily on foreign grants.
  • As India is no longer a priority country for international funding, these opportunities are also dwindling.
• The Quality of Health Education
  • Beyond employment challenges, the quality of public health education itself is a matter of concern.
  • The rapid increase in MPH programs has led to a competitive market where institutions sometimes compromise on admission standards.
  • Many students enrol without a clear understanding of the field, while faculty members often lack adequate training and real-world experience.
• Absence of a Standardised Curriculum
  • The absence of a standardised curriculum across institutions results in inconsistent quality among graduates.
  • Unlike medical degrees, which fall under the regulatory purview of the National Medical Commission (NMC) or the University Grants Commission (UGC), MPH programs remain unregulated, raising concerns about their credibility and effectiveness.
• Geographical Barriers
  • Many large and populous states such as Bihar, Jharkhand, and Assam, along with several smaller states, have limited or no institutions offering public health courses.
  • This not only restricts access to education for aspiring professionals in these regions but also weakens the overall public health infrastructure.

Approaches to Strengthening Public Health Education and Employment

• Creation of More Public Health Jobs
  • The first and most urgent priority is the creation of more public health jobs within government systems.
  • In developed nations with well-established public health education frameworks, governments serve as the primary employers of public health professionals.
  • India should follow a similar model by establishing dedicated public health cadres within state governments.
  • This would not only enhance employment prospects for graduates but also strengthen public health systems at multiple levels, from primary care to national health policy implementation.
• Regulation and Standardisation of Public Health Education
  • A specialised regulatory body should be established within the NMC or UGC to oversee MPH programs.
  • This agency, led by public health experts, would be responsible for setting curriculum standards, establishing minimum training requirements, and ensuring that graduates receive adequate practical exposure.
  • Given the dynamic nature of public health, institutions should still retain flexibility for innovation while maintaining a baseline of quality and competence.
• Incorporation of More Practical Learning Opportunities
  • To bridge the gap between education and employment, public health training programs must incorporate more practical learning opportunities.
  • Institutions should establish stronger ties with government agencies, research organisations, and non-governmental organizations (NGOs) to provide students with hands-on experience.
  • This integration will help graduates develop real-world skills that make them more competitive in the job market.
• Expansion of Public Health Education
  • Efforts should be made to expand public health education in states where access remains limited.
  • Encouraging the establishment of new institutions or introducing public health courses within existing universities can help distribute opportunities more evenly across the country.
  • Additionally, incentivising students to work in underserved regions by offering scholarships or guaranteed placements in government programs could help address regional disparities in public health infrastructure.

Conclusion

• The field of public health is critical for the well-being of any nation, yet India’s rapidly growing pool of public health graduates faces significant employment and educational challenges.
• The expansion of public health education, while a positive development, has not been matched by job creation, leading to an oversaturated market.
• Strengthening the public health workforce is essential not only for improving employment prospects but also for ensuring a robust and resilient healthcare system for the future.