Introduction
A rise in emergencies in India
Emergencies, whether they are caused by natural disasters or conflicts, have a significant impact on people’s lives and disrupt essential systems, including education (Obura, 2003). Long-lasting or frequent emergencies cause severe damage to educational infrastructure, leading to an educational emergency that requires immediate intervention and long-term recovery (UNESCO, 2000). Epidemics like the Ebola outbreak in West Africa and the Covid-19 pandemic fall into the category of natural emergencies (Shaluf, 2007). Apart from this, India, in particular, faces extraordinary vulnerability to natural emergencies. According to the International Disaster Database, India ranks third globally in the number of natural emergencies experienced in the twenty-first century (Centre for Research on the Epidemiology of Disasters, 2024). The National Disaster Management Authority ( https://ndma.gov.in/) underscores this risk, reporting that over half of India’s landmass is prone to earthquakes, 12 per cent is vulnerable to floods and a significant portion faces risks from cyclones, landslides and droughts. The harrowing situation is exacerbated by India’s social vulnerabilities, which amplify disaster risks (World Bank Group, 2021). These vulnerabilities are not isolated events; India faces significant emergencies almost annually, leaving the education sector in a perpetual state of strain (Rai and Mishra, 2021).
Teachers in India: dual roles in education and emergencies
In India, schools are classified as public or private, but private schools that meet government regulations may receive public funding (Kingdon, 2007; Ramachandran et al., 2018). Once funded, these schools adopt similar responsibilities to public institutions and are known as aided schools. During emergencies, public and aided schools often transform into social enterprises, with teachers stepping into the role of relief worker. They not only provide educational support but also offer emotional and social guidance, and logistical support to help children and families navigate crises. These expectations align with social pedagogy principles, which emphasise a holistic approach to education that integrates care, social support and learning to enhance overall well-being and inclusion (Cameron and Moss, 2011; Petrie, 2020).
Research purpose and questions
Education is a fundamental human right (United Nations, 1948), and every educational emergency should lead to the establishment of an Education in Emergency (EiE) programme. However, implementing EiE programmes is a complex challenge (UNHCR, 2021) that requires seamless coordination among multiple organisations and clear role expectations. These networks play a vital role in advancing the Education 2030 Agenda for Sustainable Development Goals (SDG 4), which focuses on creating education systems that are resilient and adaptable to crises (United Nations, 2015).
Teachers are at the heart of EiE implementation and hence understanding their specific responsibilities and the challenges that they encounter is essential. Unfortunately, there is limited knowledge of the full range of tasks that teachers in India undertake during emergencies or how they are prepared to handle such circumstances. This gap in understanding forms the basis of this research, which seeks to address three key questions:
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What are the job demands faced by teachers working in emergencies?
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What resources are made available to support them in these unique situations?
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What can we implement from comparative contexts to develop/enhance EiE programmes?
Desk research suggests a gap between understanding the specific tasks and duties of teachers and the available policy guidance for their fulfilment. Moreover, a comprehensive EiE plan is still missing in India.
Professional well-being within a job demand-resource model through a social pedagogical lens in the education in emergencies context
In emergency contexts, teachers assume dual roles: they maintain academic continuity while also providing emotional and logistical support to students and their communities which aligns with the key tenets of social pedagogy. Social pedagogy highlights the essential connection between care and education in the simplest terms. It promotes a comprehensive approach, known as the ‘head, heart, and hands’ model, which involves intellectual engagement, emotional connection and practical action (Higgins, 2011; Sipos et al., 2008) by a teacher with an individual and, thus, with the community at large. So, when trying to understand the positionality of a teacher during emergencies, social pedagogy offers a seamless theoretical foundation, integrating care, education and social action (Hämäläinen, 2003). This dual responsibility of a teacher highlights the challenges inherent in managing complex roles during crises (Mendenhall et al., 2018; Sarangapani et al., 2021) and thus the job demand-resource (JD-R) model (Demerouti et al., 2001) provides a practical perspective to explore how the balance between job demands and resources affects teachers’ professional well-being and their ability to have an impact as social pedagogues (Smith, 2012). The JD-R model complements social pedagogy by differentiating between job demands and job resources. On the one hand, job demands, such as heavy workloads, prolonged working hours and the emotional toll of teaching in crisis situations, consume significant effort and, if unbalanced, lead to energy depletion and stress. On the other hand, job resources, including supportive leadership, access to training and collaborative work environments, act as buffers that enhance motivation and reduce strain. Furthermore, the quality of the teachers’ impact as social pedagogues is connected to their professional well-being. Higgins (2011) highlights the emotional labour required of teachers, describing the moral and phenomenological nature of their work. Teachers are expected to remain adaptable, demonstrate continuous attention and improvise effectively, even in the most challenging circumstances. However, when job demands become overwhelming and resources are insufficient, a vicious cycle can emerge. This cycle often manifests as emotional exhaustion, diminished self-efficacy and reduced job satisfaction, which further amplifies demands and undermines performance (Keller et al., 2014; Lavy and Eshet, 2018). Conversely, access to strong resources can enable teachers to engage in job crafting – a process of proactively reshaping their roles to align with personal strengths, motivations and goals. This practice has the potential to enhance their professional well-being by mitigating the negative effects of demands, and it aligns closely with social pedagogy’s emphasis on self-determination and agency. By empowering teachers to address both their own needs and those of their students, job crafting becomes an essential tool for sustaining professional well-being (Bakker and Demerouti, 2018). Thus, the JD-R model and social pedagogy offer a synergistic framework for supporting teachers’ professional well-being and impact in emergencies, as illustrated in Figure 1.
Teachers’ professional well-being can be shaped by several interrelated factors that may include but are not limited to:
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situated factors such as the physical and social environment of the school, which influences daily experiences and interactions
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professional factors such as institutional and state norms, expectations and responsibilities that define teachers’ dual roles as educators and caregivers
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personal factors such as coping mechanisms, family responsibilities, ability for job crafting and personal resilience (Day et al., 2006), all of which significantly affect their quality of work as social pedagogues.
Thus, social pedagogy offers a valuable framework for Indian teachers to address the challenges that they face in the education system. With its focus on holistic development, relational approaches and fostering well-being, social pedagogy recognises the importance of considering systemic, community and individual factors. It views education as a means of empowerment and inclusion, making it particularly relevant in contexts of inequality, crisis and limited resources.
Research method and settings
The study was conducted via semi-structured interviews in a virtual setting during the Covid-19 pandemic, in which teachers were performing emergency-related duties as well as their teaching (and related) duties.
Method
Following a phenomenological approach, two teachers were engaged in a semi-structured interview to understand the demands of their job and the available resources, and how they functioned during emergencies. These semi-formal virtual interviews followed an interview-guide format (Morris, 2015). The general subjects and concerns to be addressed were established in advance, in outline form, allowing for increased data comprehensiveness and a more methodical approach to data gathering for each responder. This structure kept the interviews conversational and situational, ensuring respondents felt safe revealing and exploring the nuanced descriptions of their life-worlds (Brinkmann and Kvale, 2018). The interviews were conducted in English and Hindi, as both the interviewer and interviewees were fluent in these languages. Transcriptions of the recordings were made and subsequently analysed. The primary aim of the analysis was to thematise the job demands and job resources within the framework (Figure 1) and at various levels of their occurrence – individual, micro (community level) and macro (state level).
Setting and sampling
The school was initially selected based on the study’s requirements – a government-funded school functioning during an emergency. Purposive sampling was used to choose the teachers to gain a broad overview of school duties during emergencies. The principal, a primary-level teacher and a secondary-level teacher were selected. It is known that primary-level teachers have somewhat different responsibilities from secondary-level teachers. The primary-level teacher was also considered because she had recently returned from bereavement leave after losing her mother to Covid-19. She had an emotional challenge that the study wanted to document. The study’s objectives were explained to the participants, and their consent was acquired. Unfortunately, the principal withdrew at the last minute, citing a hectic schedule due to an upcoming management meeting. To prevent retrospective narratives sensitive to memory bias (Schwarz and Strack, 1999) and heuristic biases such as peak-and-end effects (Fredrickson, 2000), the decision was made to conduct the study with the available participants. Demographic information about the participants (pseudonyms used) is provided in Table 1.
Participant profiles
Level of education | Years of experience | Position | |
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Tara | Master’s degree in science, bachelor’s degree in education | 10 years | Primary-level teacher |
Neesa | Master’s degree in English, bachelor’s degree in education | 25 years | Secondary-level teacher |
Demographic information about the school is provided in the list below:
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Location: Farrukhabad, Uttar Pradesh (UP)
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Setting: semi-urban
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Grades: 1–12. The school is aided up to grade 10, and grades 11 and 12 are privately funded. Grades 1–5 are co-ed. Grade 6 onwards admits girls only.
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Number of students: 1,300. It was challenging to provide the actual number, as many students had yet to connect with the school since its closure in February 2020.
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Number of teachers: 16 teachers in total: 11 teachers were appointed under the aided scheme, and the school board appointed the remaining 5. The school has an all-female staff, including the principal.
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Number of support staff: 5 supporting staff
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Average student–teacher ratio: 1:70
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Curriculum: The school implements the UP board curriculum up to grade 8 and Central Board of Secondary Education (CBSE) beyond that.
Findings
When asked about their experiences at work during an EiE situation, the teachers discussed the nature of work and complications arising from a lack of adequate infrastructure and relevant training:
I have not seen many of my kids since the school closed … I work with very young children whom I was instructing in reading and writing before the school closed. Occasionally, when children come to collect coupons with their caregivers, I write work in their notebooks so they may practise at home. The government has launched an app called Deeksha, and we are expected to teach using it, but several of my students in my class do not have smartphones or access to Wi-Fi. What good is an app if kids cannot access it? Should not the government, which distributes books yearly, partner with some organisation and provide personal phones instead? Also, not all teachers can use phones to teach effectively. I sometimes have to help the older teachers and explain how to use apps.
(Tara)
I teach English in high school, and it has been challenging since the government imposed the CBSE course. Our pupils come from a low-income family (indicating that they have no access to English speakers at home). I teach them English via Hindi. Now, when pupils are absent from school, it makes the whole process even more difficult.
(Neesa)
On being questioned about collaborative practices that may assist them in this circumstance, Neesa responded, ‘Well, I am the senior teacher. There is another teacher, but she is also B.Ed. [indicating she is professionally qualified], so she does not require my assistance. When she seeks instruction from me, I assist her’. About the training, she stated, ‘At the beginning [referring to the time when the government altered the curriculum], there was one training that I attended but nothing after that’.
Along with their teaching responsibilities, both teachers were questioned about their non-teaching duties. Neesa stated:
Because I work with older children, at present, I have slightly fewer obligations of such nature. We [referring to secondary school teachers] are teaching in two shifts because of the new government guidelines on social distancing. Half of the class [relating to the classes she teaches] have not attended school this year. I am not sure how to contact many of them because the [phone] numbers they supplied are invalid. As a senior teacher at the school, I also assist with administrative duties, such as monitoring the school when the principal is away. I compile annual task lists and have allocated students to their shifts this year.
Tara replied to the same question:
In my situation, teaching constitutes less than a tenth of my work. Most of my time is spent locating and meeting with caregivers since I distribute midday-meal and ration coupons to them. I am also responsible for the distribution of books and bags. Occasionally, caregivers do not have the necessary paperwork, [photo identification and bank-related documents that caregivers must produce to obtain aid], and I am tasked with advising them on how to obtain them. I enter all of this [transactional data] into the register and provide reasons for instances when a caregiver did not appear to gather them [the aid material]. I was invigilating the teachers entrance test (TET) test on Sunday, which means I have been working non-stop for the whole week.
When questioned about the difficulties they face, the assistance they get and their professional well-being, Tara said:
The pupils at our school come from low socio-economic homes, and their caregivers are illiterate. I have a difficult time communicating with them and am always explaining all the procedures to them [referring to opening bank accounts, getting photo ID cards, steps to collect the aid etc.]. The government requires them to produce documentation that they do not possess, and obtaining them at this point is a major burden. I believe it would be much easier if they simply gave them cash. Things would go more quickly. Consider how difficult it is for a low-wage worker to return to school frequently for these items. Many lack the funds necessary for printouts. Many caregivers have returned to their villages because of a lack of employment opportunities in the town [referring to internal migrants]. How am I to locate them now? After my mother’s death, when I go home I also have to cook and do other things [referring to household chores]. Even at home, I am constantly on edge about maintaining these registers and contacting caregivers who have failed to pick up their coupons.
Neesa stated, ‘Working two shifts a day is quite exhausting. Until the very end of last year, we did not know if the government would stop year-end exams or not, and so we were attempting to complete the curriculum by all means necessary. I am dissatisfied with what I accomplished and how I accomplished it’.
Both unanimously underlined the importance of policymakers hearing teachers’ voices when structuring EiE programmes, inclusive of the curriculum, to understand what support they require. Tara stated:
Why are they not enquiring how things should be done? We operate on the ground and can provide them with valuable insights into what will work and what will not. There is no point of contact inside the government who will listen to our issue. The principal lays out the expectations and the type of reporting that is expected after each meeting.
Neesa noted, ‘I have heard teachers are contacted, but these teachers are primarily from towns surrounding the capital city … But, there is a great deal of variation [in demands] between villages and towns near the capital and those located further away’.
Concerned about excessive work hours, they emphasised once again that the school’s hours were unduly long and that working six days a week in such settings left them exhausted.
Limitations
While the findings of this small-scale, qualitative case study are not generalisable (Yin, 2006), the value of this study lies in its reflection, which further paves the way for suggestions from comparative settings.
The exclusive use of virtual interviews could come across as a limitation, too. However, it should be remembered that strict social distancing rules during the peak of the Covid-19 pandemic necessitated this method, and virtual interviews are not necessarily limiting as they offer the spontaneity of face-to-face conversations while allowing respondents to express themselves freely (Chen and Hinton, 1999). Sometimes online settings can also empower reserved individuals to share their insights confidently, fostering richer discussions (Rheingold, 1994).
The small scale is also due to the fact that convincing teachers to share their struggles during the crisis was challenging. Many declined to participate, overwhelmed by the demands of their dual roles and the limited time available amid the emergency. Despite these constraints, the study maintained its integrity. Furthermore, since this research delved into the dynamic nature of emergencies, it relied more on participants’ perceptions and emotions rather than external social contexts, making a small sample size less problematic (Crouch and McKenzie, 2006).
Summary of findings
The research addressed three primary questions, two of which were:
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What are the job demands faced by teachers working in emergencies?
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What resources are made available to support them in these unique situations?
In summary, teachers in emergency settings undertake a dual role encompassing various responsibilities and they also function as social pedagogues for both the students and their families. First, they continue teaching-learning, adapting their pedagogical skills to suit the specific emergency. In addition, they acquire and upgrade other relevant skills required for virtual or app-based instruction. They are expected to distribute essential supplies such as ration coupons, money coupons for midday meals, textbooks and school bags to their students. They are also responsible for maintaining accurate data records, including students’ and caregivers’ national identification numbers (Aadhaar cards), contact information, addresses, bank account details and Indian financial system (IFS) code. (This 11-digit alphanumeric code identifies a specific bank branch in India. IFSC codes are used to facilitate electronic fund transfers between bank accounts similar to IBAN in the West.) Furthermore, teachers actively communicate with caregivers, providing guidance on acquiring Aadhaar cards, setting up bank accounts, monitoring financial records and obtaining IFSC codes, among other necessary steps. They proactively inform caregivers about government programmes and eligibility requirements through telephone calls. Additionally, teachers face the challenge of locating caregivers who have relocated to their ancestral villages or have limited contact information. They may be assigned election-related responsibilities and sometimes supervise external examinations on weekends, if applicable. Importantly, teachers working in emergencies are expected to make themselves available beyond regular working hours to address the evolving needs of their students and communities through phone calls and WhatsApp.
Discussions
Analysis, implications and recommendations
Indian teachers, especially during the Covid-19 pandemic, have encountered significant pressures, such as navigating digital poverty and managing their own mental well-being. This section presents an analysis of the findings and explores potential solutions to these challenges by drawing on comparative contexts and global best practices, while also critically examining the realities of implementing such recommendations in India. Hence, responding to the question, what can we implement from comparative contexts to develop/enhance EiE programmes?
On a personal level, many teachers carried the unspoken burden of grief and trauma from the pandemic. Such an experience is not limited to Covid-19, as all emergency situations may have teachers working in such situations (Harris et al., 2016; Wang et al., 2013). Apart from personal loss, the toll of witnessing widespread loss and disruption is an emotionally draining experience and can add to teachers’ challenges when interacting with the community as social pedagogues. Teachers would often need to stretch themselves much more than usual to balance their domestic responsibilities with their professional duties. The pervasive lack of support can erode their confidence, making them question their ability to make a meaningful difference in their students’ lives during such an unprecedented crisis. One way to support teachers could be to introduce psycho-emotional support systems for them. This can be done by introducing well-equipped counselling units, the top recommendation by teachers in Africa under similar contexts (Ashipala et al., 2024). This can be understood as a preferred strategy as teachers often need emotional support to process their own feelings and understanding before venturing out into the community. In 2018, India introduced a revised health-care plan which envisioned an expansion of the functions of health and wellness units and aimed to ensure financial protection for accessing secondary and tertiary care from public and private providers with insurance but only for ‘poor and vulnerable families’ (Ayushman Bharat, 2021). Even though a thorough realisation of this project is yet to be implemented (Hooda, 2020), expanding such a scheme for all by increasing investment in the mental health support system (Ranjan and Crasta, 2023) would allow teachers to access mental health-care benefits frequently and more easily. Perhaps on-site nurseries or subsidised childcare, such as in Nordic countries (Nordic Council of Ministers, 2019), would relieve some pressure from working parents and reduce teacher absenteeism.
At the school level too, teachers felt the sting of increased workloads perhaps due to a lack of collegiality (Löfgren and Karlsson, 2016) and underestimating the effectiveness of collaboration (Sun et al., 2017). A lack of teamwork among staff often leaves them overwhelmed, specifically when they take on disproportionate responsibilities with little support. Ambiguity in their roles often creates confusion, leaving teachers uncertain about how best to contribute to their school’s efforts. In such situations collegial interactions help produce an emotionally supportive work environment and engender significant professional development (Harris and Anthony, 2001; Shah, 2012). Social pedagogy is concerned with finding ways to solve social problems through education (Hämäläinen, 2003) and thus pre-teacher education and professional development programmes can be used to inform teachers about the what, how and why of collaboration and collegiality. Another limitation that gave rise to a lack of time was the use of traditional models of timetabling during stressful periods; perhaps the use of innovative learning environments, as suggested by the Organisation for Economic Co-operation and Development (OECD, 2013), could be a prospective solution to this issue. When tested in New Zealand with the Indigenous population it showed promise, as it found students to be more authentically engaged (Mittermeier and Benade, 2024), something envisioned by Kant-infused social pedagogy, according to which individuals can achieve consciousness and sustain the process of self-formation (Moss and Petrie, 2019). Yet, the challenge of these timetable-free schools lies in organisation, clarity of roles and teachers’ skill and knowledge to support multiple learning objectives at the same time. Another approach to shoulder the burden of time management could be through leveraging virtual or physical communities of practice (Wenger-Trayner, 2008) and mentorship communities that allow teachers to collaborate, share best practices and experiences, and co-create teaching materials tailored to local needs. These approaches have been instrumental in crisis education settings in Rwanda and South Africa, where teachers developed context-specific solutions for emergency education (Godwin et al., 2023). In the VidyaDaan (2021) project, the Indian government encouraged individuals and organisations to publish open licence learning-related resources; however, when I attempted to contribute, none of the links to submit materials worked. If operationalised properly, this kind of community of practice does have potential. Furthermore, actualising mentor–mentee programmes could support teachers to develop the necessary skills and attitudes, such as the National Mentoring Programme (National Council for Teacher Education, 2021), which was started by the central government to actualise the national education policy (Ministry of Human Resource Development, 2020) on a large scale but based on needs rather than a one-programme-fits-all approach.
Beyond the school community, teachers found themselves isolated from caregivers and families, especially in marginalised communities. The socio-economic hardships of these families weighed heavily on educators, who struggled to form meaningful partnerships to support children’s learning. Teachers struggled in their attempts to reach out to out-of-school children, as technological barriers and migration patterns made engagement nearly impossible. Communication with government officials was sporadic and unclear, leaving teachers without the guidance or tools they needed to address local challenges effectively. Such situations can be mitigated through efficient data management by leveraging cloud technology, which has proved successful for addressing inefficiencies in resource allocation and aid distribution in Brazil where cloud-based systems have streamlined educational planning by providing real-time, detailed information on gender, age and socio-economic indicators (Sinclair, 2002). In India, although programmes such as the Unified District Information System for Education (UDISE+) exist ( https://udiseplus.gov.in/), their implementation is often fragmented. If these programmes were managed and maintained properly, they would show great potential. Transitioning to secure and user-friendly cloud systems, along with providing training to teachers on data utilisation, can ensure better targeting of marginalised students. However, it is important to address connectivity issues and data privacy concerns during this transition.
At the global, regional and national levels, teachers often felt disempowered as they navigated systemic hurdles that left them unable to support their students effectively. Many educators were heartbroken by their students’ exclusion from remote learning. The PM-eVidya (Ministry of Education, Government of India, 2021) initiative makes provision for free virtual textbooks and informative videos, pre-recorded lectures and online courses; however, due to digital poverty, families lacked devices, internet access or even electricity to avail of these offers. Drawing from Kenya’s success in public–private partnerships that provided devices and internet access to underserved communities, India must enhance its PM-eVIDYA programmes. Current efforts must be upscaled to address the vast disparities in access. Subsidising devices, expanding internet coverage in rural areas and developing offline learning resources can ensure inclusivity in digital education.
Another issue that arose was the absence of clear guidelines for aid distribution, adding to teachers’ frustration as they were left unsure how to help their communities. Policymaking processes, which excluded teachers from offering feedback, deepened this sense of helplessness, as there was no room for their insights to inform better solutions. Training programmes – rare and inadequately tailored to the demands of a crisis – left teachers feeling unprepared and unsupported. Top-down policies dismissed their expertise, making them feel sidelined and undervalued. Adding to their burden, extended working hours left them physically and emotionally drained, eroding their ability to perform effectively and maintain their well-being. Such situations can be addressed by reimagining teacher training through social pedagogy principles by preparing them for complex, crisis-driven environments. Germany’s emphasis on experiential learning and socio-emotional skills offers valuable insight (Cameron et al., 2021). Indian teacher-training programmes often prioritise academic content, leaving gaps in relational and community-focused skills. Integrating modules on empathy, trauma-informed practices and relational approaches can empower teachers to engage more effectively with students and communities. As emphasised by Schugurensky and Silver (2013):
These traditions tend to work primarily with the most marginalized members of society, have a holistic approach to learning, are oriented towards community building, draw on the experience and knowledge of participants, connect the curriculum to local problems, encourage a dialogical relationship between educators and learners, and acknowledge that, in order to be effective in the long run, pedagogical interventions must be accompanied by justice-oriented policies.
(p. 3)
The effectiveness of education can be enhanced by collaboration between teachers, caregivers and local stakeholders. In India, initiatives like school management committees often lack funding and training. Strengthening these committees and fostering partnerships with local non-governmental organisations can create more robust support systems for marginalised students. It has also been noted that including teachers in policymaking processes ensures that ground realities inform systemic reforms. Using participatory governance can be a way forward; however, it must be employed with caution (Escobar, 2022). In India, teachers are often excluded from such processes, leading to policies that are misaligned with classroom realities. Establishing teacher advisory committees and creating regular forums for feedback can address this gap, ensuring that policies reflect teachers’ lived experiences.
Finally, each recommendation must be accompanied by mechanisms for monitoring and evaluation to ensure its effectiveness and sustainability. Metrics such as teacher satisfaction surveys, student performance indicators that go beyond percentage scores and feedback loops with stakeholders can guide iterative improvements. Including teachers in the evaluation process reinforces their agency, a key tenet of social pedagogy.
Conclusion
India can effectively address the challenges faced by its teachers during emergencies by embracing the principles of social pedagogy. This approach empowers teachers to thrive as holistic educators, while also tackling systemic, community and personal obstacles. To achieve this, India must commit to inclusive policymaking, develop a robust infrastructure and make sustained investments in teacher education and well-being. By drawing from experiences worldwide, the recommendations presented here offer pathways towards building a resilient and inclusive education system that acknowledges teachers as central agents of social change. It is crucial to bridge the gap between international best practices and local realities in order to turn this vision into reality.
Declarations and conflicts of interest
Research ethics statement
The author conducted the research reported in this article in accordance with European Code of Conduct for Research Integrity standards.
Consent for publication statement
The author declares that research participants’ informed consent to publication of findings – including photos, videos and any personal or identifiable information – was secured prior to publication.
Conflicts of interest statement
The author declares no conflict of interest with this work. All efforts to sufficiently anonymise the author during peer review of this article have been made. The author declares no further conflicts with this article.
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