COVID-19: Why India needs a robust public health infrastructure

The novel coronavirus disease (COVID-19) pandemic brought several lessons in its wake. For India, it has served as a wake-up call to strengthen its public health infrastructure.

What does a public health professional do? Why do we not see a more robust public health response that engages these trained professionals in the country?

The answer lies in the kind of training provided to aspirants, the job market as well as the ineligibility of several Masters in Public Health (MPH) graduates to join hardcore epidemiology services.

There is no shortage of public health colleges in India. A simple Google search yields results for more than 78 MPH colleges in the country. Many of the old renowned MPH (or similar) programmes were started as part-time courses.

Recently, state health universities (Maharashtra University of Health Sciences, MUHS, for instance) mandated their government medical colleges to offer MPH courses. Students and practitioners from all the medical streams (allopathy, dentistry, Ayurveda, Unani, etc.), allied health sciences as well as the pharmaceutical industry can take up these courses.

There is, however, no formal accreditation body in India for MPH courses. Through its National Centre for Disease Control (NCDC), the Government of India offers a robust two-year field epidemiology training program (Epidemic Intelligence Services). However, only allopathic graduates or MDs in community medicine are eligible for this programme.

A recent scoping review provides details on the status of MPH courses in the country. The competencies acquired by these graduates may differ due to the lack of a robust and unified curriculum. 

Not all public health graduates work directly in public health. A few who come on deputation from health departments join back their cadre. Graduates with MBBS background get picked by international agencies on their priority programmes. Few others get absorbed at the lower ranks.

The rest end up working in the development sector. Many of my colleagues are currently working on development projects funded by international and domestic funding organisations. Thus, the lines are blurred between India’s public health and development sector, often creating a confusing picture about the field among policymakers, administrators and politicians alike.

While we need these professionals to work in the development sector, we miss the opportunity to train them in epidemiological investigations that could help create a robust public health infrastructure. 

A majority of MPH graduates have non-MBBS health degrees (dentistry, ayurveda, homeopathy, Unani, nursing, and pharmacy), which makes them ineligible to get proper epidemiology positions. At their bachelor level too, they do not get sufficiently exposed to epidemiology 101 which could enhance their understanding of modern infectious diseases and public health response.

Surveying the population and collecting critical data are essential skills for public health graduates. Unfortunately, these skills are not taught properly among India’s health system graduates.

On the contrary, health sciences aspirants take public health courses at the undergraduate level in developed countries. Many medical colleges now require completion of public health courses and experience at the undergraduate level as eligibility for their MD programmes.

Also, several conjointly offer an opportunity in MPH to their medical graduates. Many MPH colleges worked with local country departments in organising and managing local public health responses during the pandemic. Many MPH students from my college in Arizona worked with the local county department, helping them collect vital epidemiological information from the field.

Unfortunately, no such examples can be cited from India.

India has a pluralistic healthcare system, and therefore, the western model of public health education may not work here entirely. However, public health can’t be bound to any geographic boundaries. The public health challenges faced globally are the same as in India. Therefore, public health education needs to be stand up to the international level.

It is a multidisciplinary field where experts from other fields such as sociology, medicine, engineering, etc are required. There is little understanding among the public about what a public health expert does. People often do not distinguish between medical services and public health.

As a public health professional, I frequently get questions on what exactly I do, and I must explain at a great length what public health is and how it is different from medical services. As public health education percolates across fields, we can hope that the perception also changes.

While it is pertinent to repair India’s healthcare system, it is also time for the country to develop a public health culture by creating a robust public health education system.

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