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Public Health Education

History and Evolution of Public Health Education in India

Himanshu Negandhi1, Kavya Sharma2, *Sanjay P. Zodpey3
1
Assistant Professor, 2Manager–Academic Programs and Adjunct Lecturer, 3Director, Public Health Education,
Public Health Foundation of India, New Delhi, India

Summary
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.

Key words: History and evolution, India, Public health education

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.1,2
The moot question therefore is as to who will produce
*Corresponding Author: Prof. Sanjay P. Zodpey,
Director, Public Health Education,
Public Health Foundation of India, ISID, 4, Institutional Area,
Vasant Kunj, New Delhi – 110 070, India.
E-mail: sanjay.zodpey@phfi.org
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 21st 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.1,2

Access this article online With the advent of the British in India, the system
Quick Response Code: of medicine known as western medicine or modern
Website: www.ijph.in
medicine was introduced in this country. At first the aim
was largely to train apprentices to help the army medical
DOI: 10.4103/0019-557X.96950
personnel, the qualification required of such trainees
PMID: 22684167
being elementary.3 It was in the year 1835 that a more
comprehensive system of training was instituted in India.

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Negandhi H, et al.: Evolution of Public Health Education in India
The evolution of public health in colonial India has been
chronicled earlier.4 The Calcutta Medical College was
established by an order in 1835 to fulfill the growing
need for health professionals.4 In 1846, a two-year course,
later extended to three years, was started for the training
of Hospital Assistants.3 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.3 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.5 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.3
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.5
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 Asia6 was a welcome development toward
Indian Journal of Public Health, Volume 56, Issue 1, January-March, 2012
13
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.7 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.3
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.3 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.3 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,
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14 Negandhi H, et al.: Evolution of Public Health Education in India

including premedical studies, curriculum of medical requirements of health care and plan adequately for the
education, examinations, fulltime teaching units, and future.11 The committee noted that the role of the general
so on. The Medical Education Conference agreed that practitioner is far from the treatment of sickness and the
the present methods of examinations and assessment prevention of disease, but extends to include the social
were unsatisfactory, that written examinations required and cultural problems that contribute to the fabric of
considerable modification and that great importance health. It went on to recommend the content, structure,
should be given to the day-to-day assessment of the and process of change in order to orient the medical
student during his medical course. It was recommended education across the country.
that each medical college should have a Preventive and
Social Medicine Department with fulltime staff. The The ROME scheme was planned to impart community-
teaching of Preventive and Social Medicine should start oriented training to medical undergraduates in primary
from the very beginning and continue throughout the health care.12 The Government of India launched the
period of training including the period of internship. Re-orientation of Medical Education (ROME) scheme
The functions of the Preventive and Social Medicine in 1977 to involve medical colleges by encouraging the
Department should be integrated with the teaching of the adoption of preventive, promotive, and curative health
other departments along with a co-ordinated outpatient
service. This department should have rural and urban
Table 1: Milestones in Public Health Education in India
health centers which will give the necessary facilities Milestones Year of
for rural training. A separate examination in Preventive inception
and Social Medicine should be made part of the final Establishment of the Calcutta Medical College 1835
M.B.B.S.3 Two-year course for training of Hospital Assistants 1846
Establishment of Calcutta, Bombay and Madras 1857
Universities
The Indian Public Health Association was formed in 1956 Establishment of the Indian Medical Services 1896
with the main objective of “promotion and advancement New department for education and health 1912
of public health and allied sciences in their different Transfer of public health, sanitation, and vital statistics to 1919
the provinces
branches in India, protection and promotion of public
Establishment of the School of Tropical Medicine, Kolkata 1922
and personal health of the people of the country and Establishment of the All India Institute of Hygiene and 1932
promotion of co-operation and fellowship among the Public Health, Kolkata
members of the Association.” This association solicited Establishment of the Medical Council of India 1934
membership from different cadres of public health The Health Survey and Development (Bhore) Committee 1946
Report of the WHO Expert Committee on Professional and 1952
professionals across the country. Technical Education of medical and ancillary personnel
1st World Medical Education Conference 1953
The Mudaliar Committee8 further sought to strengthen Medical Education Conference in India 1955
public health education in the country by recommending Indian Public Health Association 1956
schools of public health in every state to train medical The Mudaliar Committee 1959
Medical Education Committee 1960
officers, public health nurses, maternity and child
2nd Medical Education Conference 1968
welfare workers, public health engineers and sanitarians, Indian Association of Preventive and Social Medicine 1974
dieticians, epidemiologists, nutrition workers, Report of the group on Medical Education and Support 1975
malariologists, and field workers.9 Manpower (Shrivastava Committee Report)
Re-orientation of Medical Education Scheme 1977
The Indian Association of Preventive and Social National Institute of Health and Family Welfare 1977
The Medical Education Review Committee 1983
Medicine,10 which was founded in 1974, is a “not for profit”
The Health Manpower Planning, Production and 1987
professional organization dedicated to the promotion of Management
public health by bringing its members’ expertise to the Expert Committee on Public Health System 1996
development of public health policies, an advocate Calcutta Declaration 1999
Task Force on Medical Education 2005
for education, research, and programs of Community
Public Health Foundation of India 2006
Medicine and providing a forum for the regular exchange Initiation of Post Graduate Diploma in Public Health 2008
of views and information. The Shrivastava committee Management
report in 1975 went on to advocate for a change in the Public Health Education and Research Consortium 2009
structure of medical education to meet the changing India Public Health Education Institution Network 2010

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Negandhi H, et al.: Evolution of Public Health Education in India
care in Community Development Blocks across the
country.13 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.14
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 NRHM15 has recommended
reformative and remedial action in medical education
and health manpower development. The Public Health
Indian Journal of Public Health, Volume 56, Issue 1, January-March, 2012
15
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
[Downloaded free from http://www.ijph.in on Thursday, June 21, 2018, IP: 190.198.91.11]

16 Negandhi H, et al.: Evolution of Public Health Education in India

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].
Cite this article as: Negandhi H, Sharma K, Zodpey SP. History and evolution
of public health education in India. Indian J Public Health 2012;56:12-6.
Source of Support: Nil. Conflict of Interest: None declared.

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