|PUBLIC HEALTH EDUCATION
|Year : 2012 | Volume
| Issue : 1 | Page : 12-16
History and evolution of public health education in India
Himanshu Negandhi1, Kavya Sharma2, Sanjay P Zodpey3
1 Assistant Professor, Public Health Education, Public Health Foundation of India, New Delhi, India
2 Manager–Academic Programs and Adjunct Lecturer, Public Health Education, Public Health Foundation of India, New Delhi, India
3 Director, Public Health Education, Public Health Foundation of India, New Delhi, India
|Date of Web Publication||6-Jun-2012|
Sanjay P Zodpey
Director, Public Health Education, Public Health Foundation of India, New Delhi
Source of Support: None, Conflict of Interest: None
| Abstract|| |
In order to respond to the changing paradigm of public health challenges, India needs adequately trained public health professionals. Public health education is a tool to create public health professionals. Public health education in India is at cross-roads on several fronts. Traditionally, public health education in India was offered through medical schools and was open for medical graduates only. However, recently the country has witnessed an emergence of institutions offering public health programs to nonmedical background graduates. An examination of the history and current status of public health education can provide us with an insight into the evolution of the discipline in the country. This is important as in order to respond to the public health education challenges in the present time, we need to understand the historical directions taken by the discipline in the past. This review captures how the public health education efforts in the country have been aided by concerted actions within the discipline and by an enabling environment and a positive intent at the national level, whereby we can better understand the context for the recent developments in Indian public health.
Keywords: History and evolution, India, Public health education
|How to cite this article:|
Negandhi H, Sharma K, Zodpey SP. History and evolution of public health education in India. Indian J Public Health 2012;56:12-6
|How to cite this URL:|
Negandhi H, Sharma K, Zodpey SP. History and evolution of public health education in India. Indian J Public Health [serial online] 2012 [cited 2017 Sep 23];56:12-6. Available from: http://www.ijph.in/text.asp?2012/56/1/12/96950
Adam Smith has stated that the "capacities of individuals depended on their access to education." Public Health Education is important in producing high-quality, effective public health professionals who can contribute toward achieving the health goals. The public health system needs a numerical adequacy of professionals possessing the core competencies to deliver their functions. Additionally, as public health is multidisciplinary, health systems would also need a sufficient number of competent professionals in all appropriate disciplines. ,
The moot question therefore is as to who will produce these professionals? Traditionally, in India, medical colleges were the hubs for creating the public health professionals. The last two decades saw a sea change in the way public health professionals are trained in the country. There is a conscious shift toward the creation of public health schools outside the corridors of medical colleges, thereby opening the doors for nonmedical personnel to acquire academic competencies in public health disciplines. These new institutions reflect a change in the way public health professionals in India will be produced and lead India in the 21 st century. However, there is inadequate information detailing the origin, evolution, and the current status of public health education in India. This brief review examines the historical evolution of public health education in India, which will help us to better understand the context for the recent developments in Indian public health. ,
With the advent of the British in India, the system of medicine known as western medicine or modern medicine was introduced in this country. At first the aim was largely to train apprentices to help the army medical personnel, the qualification required of such trainees being elementary.  It was in the year 1835 that a more comprehensive system of training was instituted in India. The evolution of public health in colonial India has been chronicled earlier.  The Calcutta Medical College was established by an order in 1835 to fulfill the growing need for health professionals.  In 1846, a two-year course, later extended to three years, was started for the training of Hospital Assistants.  This enabled them to join the subordinate medical services in the Army and in the civil cadres in British India. After the establishment of the three Universities of Calcutta, Bombay, and Madras, in 1857, medical education was taken over by Universities, which granted the qualifications of a Licentiate in Medicines and Surgery (the L.M.S.) and the Bachelor of Medicine and Master of Surgery (M.B.C.M. degree). The entrance qualification for the former course was a pass in the Matriculation examination and for the latter course, the Intermediates were eligible. Subsequently, the Licentiate qualification was abolished and the degree M.B.B.S. was awarded by the Universities.  The qualification of M.B.B.S. granted by the different Universities was recognized by the General Medical Council of Great Britain and the standards were in conformity with the requirements laid down by the General Medical Council for such recognition. The Indian Medical Services was formed in 1896 and the subsequent transfer of public health, sanitation, and vital statistics to the provinces took place in 1919. A new department to cater to education and health was constituted in 1912, with public health physicians in medical colleges entrusted with teaching hygiene.  A School of Tropical Medicine was established in 1922 at Kolkata in eastern India. The establishment of this school marked a conscious shift from medical to a public health school. In 1933, the Medical Council of India was constituted, which took over the functions hitherto exercised by the General Medical Council of Great Britain for the maintenance of uniform standards for medical education in the country. 
Formal public health activities in pre-independence India were backed by the introduction of physicians with both clinical and public health responsibilities. The public health workforce constituted personnel from a medical and nonmedical background that included ANMs, nurses, midwives, traditional birth attendants, sanitary inspectors, sanitary assistants, health officers, and physicians. 
The establishment of The All India Institute of Hygiene and Public Health (AIIH and PH), Kolkata, in December 1932, making it the oldest school of public health in southeast Asia  was a welcome development toward imparting public health education in India. The institute was established with a generous donation from the Rockefeller Foundation with an objective to develop health manpower by providing postgraduate (training) facilities of the highest order and to conduct research directed toward the solution of various problems of health and diseases in the community, thus prompting an application of knowledge to a large community and training students in these methods.
Public health and medicine have been mutually dependent and interact with each other, in the past as well as in modern times.  Such an interaction can be seen in the history of development of the discipline in India as well where there was a healthy mix of clinical and public health responsibilities.
The Health Survey and Development Committee (Bhore committee) not only dealt with professional education in health under the following heads: Medical education, Dental education, Nursing education, The training of certain types of public health personnel, Pharmaceutical education, Training of technicians, and training of hospital social workers but also laid the foundation for community service by advocating for the institution a three-month training in preventive and social medicine for physicians as part of the medical education system.
The WHO Expert Committee on Professional and Technical Education of medical and ancillary personnel in its report in 1952 stressed the relationship between the basic and clinical sciences and the necessity for internship after completion of the formal course. 
The First World Medical Education Conference that met in London in August 1953 reviewed the requirements of entry into medical schools, the aim and content of the medical curriculum, the technique and method of education, and the importance of preventive and social medicine in the training of physicians.  The southeast Asia Regional Office of the W.H.O., in their analytical study of Medical Education, recommended the reorientation of medical teaching from the predominantly individual and curative approach to a more community-minded and a preventive one.  The Medical Education Conference organized by the Government of India in 1955 after the World Medical Education Conference recommended major reforms in medical education in India. This Conference made several suggestions in regard to selection of students, entrance qualifications, including premedical studies, curriculum of medical education, examinations, fulltime teaching units, and so on. The Medical Education Conference agreed that the present methods of examinations and assessment were unsatisfactory, that written examinations required considerable modification and that great importance should be given to the day-to-day assessment of the student during his medical course. It was recommended that each medical college should have a Preventive and Social Medicine Department with fulltime staff. The teaching of Preventive and Social Medicine should start from the very beginning and continue throughout the period of training including the period of internship. The functions of the Preventive and Social Medicine Department should be integrated with the teaching of the other departments along with a co-ordinated outpatient service. This department should have rural and urban health centers which will give the necessary facilities for rural training. A separate examination in Preventive and Social Medicine should be made part of the final M.B.B.S. 
The Indian Public Health Association was formed in 1956 with the main objective of "promotion and advancement of public health and allied sciences in their different branches in India, protection and promotion of public and personal health of the people of the country and promotion of co-operation and fellowship among the members of the Association." This association solicited membership from different cadres of public health professionals across the country.
The Mudaliar Committee  further sought to strengthen public health education in the country by recommending schools of public health in every state to train medical officers, public health nurses, maternity and child welfare workers, public health engineers and sanitarians, dieticians, epidemiologists, nutrition workers, malariologists, and field workers. 
The Indian Association of Preventive and Social Medicine,  which was founded in 1974, is a "not for profit" professional organization dedicated to the promotion of public health by bringing its members' expertise to the development of public health policies, an advocate for education, research, and programs of Community Medicine and providing a forum for the regular exchange of views and information. The Shrivastava committee report in 1975 went on to advocate for a change in the structure of medical education to meet the changing requirements of health care and plan adequately for the future.  The committee noted that the role of the general practitioner is far from the treatment of sickness and the prevention of disease, but extends to include the social and cultural problems that contribute to the fabric of health. It went on to recommend the content, structure, and process of change in order to orient the medical education across the country.
The ROME scheme was planned to impart community-oriented training to medical undergraduates in primary health care.  The Government of India launched the Re-orientation of Medical Education (ROME) scheme in 1977 to involve medical colleges by encouraging the adoption of preventive, promotive, and curative health care in Community Development Blocks across the country.  In the same year, the National Institute of Health and Family Welfare was set up for promotion of Health and Family Welfare programs in the country through education, training, research, evaluation, consultancy, and specialized services.
The Medical Education Review Committee of 1983 was set up for suggesting measures aimed at bringing about overall improvement in the undergraduate and postgraduate medical education, paying due attention to institutional goals; content, relevance, and quality of teaching and training and learning settings; and the evaluation systems and standards. The Bajaj committee was formulated in 1987 suggest remedial measures consequent to a dichotomous growth of health services and manpower, thereby affecting the planning, production, and management of allied health professionals. It provided an assessment of existing and projected national health manpower requirements primary and the intermediate level health care programs and also to recommend the essential educational institutions and facilities to facilitate the production of appropriate categories of health manpower. 
The expert committee on public health systems of 1996 stated that there is a need to open new schools of public health where more public health professionals and paraprofessionals could be trained. The existing public health schools must also be appropriately strengthened. The committee recommended that at least four more regional schools of public health be set up in Central, Northern, Western, and Southern regions. The Calcutta Declaration of 1999 stressed upon the primacy of creating career structures at the national, state, provincial, and district levels and mandating competent background and relevant expertise for persons responsible for the health of populations. The resolution also stressed upon the need to strengthen and reform the public health education, training and research, as supported by the networking of institutions and the use of information technology for improving human resources development.
The Task Force on Medical Education was set up in 2005 with the context of an increased sense of urgency in contextualizing the medical education to the National Rural Health Mission (NRHM). The Task Force on Medical Education for the NRHM  has recommended reformative and remedial action in medical education and health manpower development. The Public Health Foundation of India was setup in 2006 with the mandate of establishing new institutes of public health, assist the growth of existing public health training institutions, establish a strong national research network, generate policy recommendations, and develop a vigorous advocacy platform. The Indian Institutes of Public Health established by the Foundation are not only engaged in the delivery of long-term academic programs in vital public health areas, but also in health system strengthening through short-term trainings and research. Recently, there have been networking of institutions with the initiation of collaborative academic programs (PGDPHM partnership), Indian Public Health Education Institution Network, and the Public Health Education and Research Consortium [Table 1].
| References|| |
|1.||Zodpey S, Sharma K, Negandhi H. Master of Public Health Programs in India. New Delhi: Public Health Foundation of India; 2011. |
|2.||Zodpey SP, Sharma K, Negandhi H. Public Health Education Initiatives in India. New Delhi: Public Health Foundation of India; 2011. |
|3.||Ministry of Health and Family Welfare. Report of the Health Survey and Planning Committee. MOHFW; 1961. Available from: http://nihfw.org/NDC/DocumentationServices/Reports/Mudalier%20%20Vol.pdf. [Last cited 2011 Apr 11]. |
|4.||Mushtaq MU. Public health in British India: A brief account of the history of medical services and disease prevention in colonial India. Indian J Community Med 2009;34:6-14. |
|5.||Datta KK. Public Health Workforce in India: Career pathways for public health personnel. New Delhi; 2009. |
|6.||Habbick BF, Leeder SR. Orienting medical education to community need: A review. Med Educ 1996;30:163-71. |
|7.||Ahmed FU. Public health, preventive and social medicine and community medicine--The name game. Indian J Public Health 2008;52:194-6. |
|8.||National Institute of Health and Family Welfare. Committee and Commission. Available from: http://nihfw.org/NDC/DocumentationServices/Committe_and_commission.html. [Last cited 2010 Dec 6]. |
|9.||Reddy KS, Sivaramakrishnan K. Unmet National Health Needs. Econ Polit Wkly 2006:3927-33. |
|10.||IAPSM. Indian Association of Preventive and Social Medicine. Available from: http://www.iapsm.org/aboutus.html. [Last cited 2011 Feb 1]. |
|11.||Health services and medical education: A programme for immediate action, (Shrivastava Committee Report); 1975. |
|12.||Dongre AR, Deshmukh PR, Gupta SS, Garg BS. An evaluation of ROME Camp: Forgotten innovation in medical education. Educ Health (Abingdon) 2010;23:363. |
|13.||Poulose KP, Natarajan PK. Re-orientation of medical education in India past, present and future. Indian J Public Health 1989;33:55-8. |
|14.||Expert Review Committee for Health Manpower Planning, Production and Management (Bajaj Committee); 1986. Available from: http://nihfw.org/NDC/DocumentationServices/Reports/Bajaj%20Committee%20report.pdf. [Last cited 2012 Mar 5]. |
|15.||Ministry of Health and Family Welfare. Task Force on Medical Education for the National Rural Health Mission. Available from: http://mohfw.nic.in/NRHM/Documents/Task_Group_Medical_Education.pdf. [Last cited 2010 Dec 6]. |