Health and Education Landscape in India: An Overview of Key Indicators and Initiatives

India, with its vast population and diverse socio-economic landscape, presents a complex picture when it comes to health and education indicators. While the nation has made significant strides in various areas, challenges remain in ensuring equitable access and quality across all segments of society. This article aims to provide an overview of the current state of health and education in India, highlighting key indicators, ongoing initiatives, and persistent disparities.

Education Indicators in India

India's education system is vast and diverse, encompassing a wide range of institutions and programs. Data on schools, colleges, universities, teachers, enrollment, and infrastructure are collected annually by the departments under the Ministry of Education, originating at the level of each educational institution. Supplementing this administrative data are surveys, primarily the nationally representative household sample surveys from the National Statistics Office (NSO) and the Census, conducted every ten years.

Enrollment and Attainment

In 2023, a significant 60.3% of five-year-olds were enrolled in primary education, indicating a relatively early start to formal schooling despite potentially limited engagement in early childhood education programs. However, enrollment rates decline in higher education levels. The enrolment of students aged 15-19 in upper secondary education was 33% in 2023, one of the lowest among all countries. For the same age group, vocational enrolment was only 1.9%, showing very limited vocational participation.

Tertiary attainment among young adults has reached 48% on average across the OECD, but progress has slowed since 2021. Attainment remains unequal, with women generally outpacing men, and older generations showing lower rates.

Fields of Study and Gender Representation

In 2023, 29.1% of tertiary graduates completed degrees in arts and humanities, the highest level internationally. Natural sciences, mathematics, and statistics followed at 13.7%, also the highest share among all countries. Women are strongly represented in ICT at 43.7%, the highest level among countries. In contrast, health and welfare fields show a low female share of 61.1%, and services have only 25.2% of graduates who are women.

Read also: India's HDI Improvement

Fields of study strongly influence labour market outcomes. Graduates in engineering and in health and welfare fare particularly well, while women’s participation in STEM remains below parity (14% of graduates at tertiary level) despite being 58% of all tertiary graduates.

Internationalization

India has the lowest share of international students in tertiary education at 0.1% in 2023. Among these students, 24.2% are from Africa, while only 1.5% are from Europe, reflecting limited geographic diversity. The share of international students has grown steadily, and OECD countries host a large proportion of the world’s mobile students, reinforcing their global role in higher education.

Student-Teacher Ratios and Resources

India’s student-teacher ratios are very high: 27.2 in primary education, 18.6 in lower secondary, and 21.4 in upper secondary. This may point to strains on resources and potential challenges in providing individualized attention to students.

Governments spend on average USD 12 438 per student in primary, secondary and post-secondary non-tertiary education, and USD 15 102 per student in tertiary education including R&D.

Trends and Disparities

As of 2023, the majority of Indians above the age of 25 were either illiterate or had been educated up to the primary level. However, the level of educational attainment of Indians has improved substantially over time, but there are still significant differences between socio-economic groups, and while all groups have made progress in education, the gaps between them are yet to close. Illiteracy rates have fallen for both women and men, but gender differences persist, with even starker differences between urban and rural India and significant differences between social groups.

Public Health Education Programs

With the creation of public health management cadre in the state, district, and block levels of India, there is a need for a comprehensive, synergistic education system to ensure efficient public health across the country. A scoping review showed 84 unique institutions in 20 states and 3 UTs currently offering 116 public health programs across India's 28 states and 8 UTs. Private and public institutes were 65% and 35% respectfully. The majority of universities mainly provided Masters of Public Health (n = 73, 63%) programs followed by Postgraduate Diploma (PGD) and Diploma (n = 17, 15%), BPHSc (n = 14, 12%), and Ph.D. (n = 12, 10%). The majority of Ph.D. programs in public health are offered in Maharashtra, Karnataka, and Haryana, while Masters in Public Health programs are offered highest in Karnataka, Bachelors in Public Health programs in Rajasthan, Post Graduate Diploma in Public Health program in Delhi, and Tamil Nadu had the most number of Diploma in Public Health programs. Thirty-one percent (n = 36) of the public health programs are offered across the south, 28% (n = 32) across the north, and 22% (n = 26) across the west.

Health Indicators in India

India's health sector is characterized by a mix of public and private providers, with a decentralized approach to health care delivery where states are primarily responsible for organizing health services.

Healthcare Access and Infrastructure

All Indian citizens can get free outpatient and inpatient care at government facilities. However, because of severe shortages of staff and supplies at government facilities, many households seek care from private providers and pay out-of-pocket. Public hospitals account for only approximately 10 percent of the total number of hospitals throughout the country. The remainder are operated almost entirely by the private for-profit sector, and a small number by charitable organizations.

Under the Health and Wellness Centres program, 150,000 subcenters across the country are being upgraded to provide comprehensive primary health care services, free essential medicines, and free diagnostic services. Other primary health care providers include primary health centers (PHCs) and community health centers.

Health Insurance and Coverage

For low-income people, the government recently launched the tax-financed National Health Protection Scheme (Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana, or PM-JAY), which allows them to also get cashless secondary and tertiary care at private facilities. There are also a handful of health insurance arrangements for specific population groups like government employees and factory workers.

The constitution of India obliges the government to ensure the “right to health” for all. Historically, there have been several government-funded health insurance schemes intended to improve coverage for specific population groups, with variations across states. One important scheme aimed at reducing financial catastrophe and vulnerability for lower-income populations is the National Health Insurance Program (Rashtriya Swasthya Bima Yojana, or RSBY), launched in 2008. As of 2016, some 41 million families were enrolled in RSBY. In March 2018, the central government approved the implementation of PM-JAY, offering hospital coverage for the 40 percent of the country’s population that is poor or low-income. The new National Health Protection Scheme is for individuals in the bottom two income quintiles, providing INR 500,000 (USD 7,007) per family per year to cover secondary and tertiary health services, from inpatient to post-hospitalization care.

Another important health coverage scheme is the Central Government Health Scheme, organized and run by the Ministry of Health and Family Welfare for current and retired central government employees and their dependents. An important social health insurance scheme is the Employees’ State Insurance Scheme, which is organized by the Ministry of Labour and Employment for the workforces of companies with 10 or more employees, where employees contribute 0.75 percent of their wages, while employers contribute 3.25 percent.

Healthcare Delivery and Governance

At the federal level, the Ministry of Health and Family Welfare has regulatory power over the majority of health policy decisions but is not directly involved in health care delivery. In 2014, the government established the federal Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy. At the state level, the Directorates of Health Services and the Departments of Health and Family Welfare are responsible for organizing and delivering health care services to their populations. At the district level, Panchayati Raj (local governance) institutions are responsible for grassroots governance and administration in rural villages.

Quality and Standards

The National Accreditation Board for Hospitals and Healthcare Providers is responsible for accrediting all types of health facilities. Structural quality is also ensured through mandatory continuing medical education (CME), instituted by the Medical Council of India. The National Health Systems Resource Centre provides a quality certification for all facility types in the health system, and facilities that earn certifications receive financial incentives. The Clinical Establishments (Registration and Regulation) Act of 2010 was passed into law by the central government to register and regulate clinical establishments, while prescribing a minimum set of standards for them to adhere to.

Initiatives and Reforms

In addition to targeting vulnerable populations under the National Health Protection Scheme, there have been a number of initiatives over the years to help poor households afford care and to promote treatment-seeking behaviors. The Janani Suraksha Yojana, launched in 2005, is a centrally sponsored scheme to reduce maternal and neonatal mortality by promoting institutional delivery among poor pregnant women.

India has initiated a number of reforms that could have far-reaching implications for the health sector and the broader economy. The Ministry of Health and Family Welfare published the first national standards for electronic health records (EHRs) in 2013. The National Health Protection Scheme presents a new opportunity to use IT to improve quality of care and detect fraud. The program will run on a state-of-the-art system with built-in intelligence and data-processing capabilities. The new National Health Authority has already set up the PM-JAY Dashboard and other IT systems for hospital empanelment, beneficiary identification, and transaction management.

Cost-containment mechanisms include annual hospital budgets as well as prices for health care services, drugs, and other consumables set administratively by the central and state governments. The National Pharmaceutical Pricing Authority has made efforts to improve the affordability and accessibility of medicines by setting price ceilings on essential medicines and on selected commonly used medical devices. In addition, the Department of Pharmaceuticals increased the supply of generic pharmaceuticals through the launch of the Pradhan Mantri Bhartiya Jan Aushadhi Pariyojana Kendra (PMBJP) scheme in 2008.

Challenges and the Public Health Workforce

India's health care delivery system faces multiple shortages in the backdrop of poor health indicators across the country. The existing workforces that do not have requisite training are loaded with managerial functions. There are extremely few public health institutes in India, and national requirements for public health education are inadequate, resulting in ill-equipped public health workers with inadequate competencies.

The COVID-19 pandemic continues to be a major public health problem globally. The public health workforce has been undermined by decades of underinvestment. There is a need for capacity building and identifying gaps in academic programs and the requirements of employers. Adequate public health workforce training with the required skills to address complex public health challenges is the need of the hour, however, insufficient national standards for public health education, including curriculum and methods have resulted in a limited public health workforce

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