Key factors influencing public health students and curricula in India: Recommendations from a mixed methods analysis

The study addresses the capacity, structure, and needs of public health education and training in India in the context of a growing and evolving health workforce. India’s public health functions have historically been supported by community medicine within medical education, with increasing diversification into master’s and doctoral public health programs. The COVID-19 pandemic highlighted systemic challenges, disruptions to essential services, and the urgency of universal health coverage, emphasizing the importance of high-quality, adaptable public health education. Prior work shows rapid growth in MPH programs but limited standardization and accreditation, a predominance of medical backgrounds among trainees, and underrepresentation of non-medical disciplines necessary for transdisciplinary public health practice. Projections suggest India will need an additional 45,000 public health workers by 2026. This study aims to assess current capacity for public health education and training across India, identify key themes and gaps related to curricula and student pathways, and provide recommendations to strengthen workforce readiness and relevance.

Design: Sequential explanatory mixed-methods comprising a desk review followed by in-depth interviews. Ethical review: Determined not to be human subjects research by IRBs at Johns Hopkins Bloomberg School of Public Health and IIHMR. Desk review: Extensive internet searches and literature review identified institutions offering public health education/training (certificates, diplomas, degrees), including freestanding schools of public health and programs within broader institutions; community medicine trainings within medical colleges were excluded. Data extracted included institution name and location, qualifications offered, core competencies, topic areas, delivery modes, mentorship models, estimated student numbers, faculty numbers, tuition/scholarships, and collaborations. Initial searches identified 40 institutions; literature and expert consultation added 19, totaling 59 institutions. Data analysis: Programs were categorized by qualification type (non-exclusive). Geographic distribution was mapped by city. Descriptive statistics summarized program characteristics. In-depth interviews: Thirteen interviews were conducted with purposively selected representatives from the 59 institutions to capture diverse perspectives (public/private, program types, age of programs, geographic spread). Interviews (about 1 hour) were held via virtual platforms, recorded, transcribed, and anonymized. Analysis: Thematic analysis using Dedoose software. A codebook was developed deductively from the interview guide and refined inductively during pilot coding. Four researchers double-coded transcripts to ensure consistency. The final codebook had 10 main codes and 32 sub-codes. Themes were examined for strengths and weaknesses, focusing on collaborations, mentorship, curriculum structure/standardization, tuition/funding, and student demand/career pathways.

• Institutions and types: 59 institutions identified; 32 (54%) private, 26 (44%) public, 1 public/private. Among 14 institutions with available data, average of 34 full-time faculty engaged in public health teaching. - Geography: Programs located in 45 cities; clusters in New Delhi (11 programs) and Bangalore (5). States with highest concentrations: Karnataka (8), Kerala (8), Maharashtra (7). Easternmost coverage limited (West Bengal (3), Meghalaya (1), Assam (1), Nagaland (1)). - Qualifications offered (non-exclusive across institutions): MPH (25), MS (20), Diploma (14), PhD (11), executive training certificates (3), workshops (2), plus certificates. - Competencies: Public health sciences commonly covered; leadership, communication, and financial management least represented. - Collaborations: Practicums/field placements widely used and valued for hands-on learning; quality and availability of partnerships varied. International collaborations often emphasized more than local ones; opportunities tended to be asymmetric (more inbound international placements). - Mentorship: Faculty and external mentors (including IAS officials, policymakers, health officers, and other academics) supported thesis work and broader guidance; alumni sometimes mentored. Challenges included mentor time constraints, limited incentives, turnover, and lack of formalized structures. - Curriculum structure/standardization: Flexibility enabled innovation and exchanges (e.g., dual PhDs, module exchanges), but lack of national standards/accreditation led to variability in rigor, duplication across institutions, and a predominantly medicalized lens with insufficient social science integration. - Tuition/funding: Public sector programs generally affordable, with low fees and, in some cases, stipends; government funding supported key programs. Private institutions had higher fees with limited scholarships; students often relied on loans, though strong institutional reputation sustained demand. - Student demand and career pathways: In-service candidates often pursued training for promotions; immediate roles included research officers/associates, program officers at district/state level, positions in NGOs, think tanks, industry (health technology), or further education (PhD). Barriers included unclear career pathways, limited public sector postings in public health specialties, and weaker incentives for advancement based on additional degrees. Rural-based programs cited fewer amenities as a deterrent for enrollment.

The study demonstrates substantial and growing capacity in public health education in India, with master’s-level programs most prevalent and a diverse set of qualifications emerging. Field-based placements are central to job preparedness but require more consistent and practice-oriented partnerships, including with local health systems and NGOs. Tuition was not typically a primary barrier—especially in public institutions—but a lack of clearly defined career pathways and limited public sector recognition of public health specializations hinder demand and the translation of education into employment, particularly for non-medical graduates. The findings affirm the need for a multidisciplinary approach that goes beyond a medicalized framework, integrating social sciences, leadership, communication, and management competencies to address social and environmental determinants of health. Aligning curricula with evolving national priorities (UHC, National Health Policy 2017) and educational reforms (NEP 2020) can strengthen relevance, while standardization and accreditation mechanisms could enhance quality, ensure recognition of credentials, and reduce duplication. Strengthened mentorship structures, incentivized and formalized, can support student progression and retention in public health careers. Overall, the findings address the research aim by identifying systemic strengths and gaps and by highlighting actionable levers—collaboration quality, mentorship, curriculum standards, and career pathway development—to improve workforce readiness and public health impact.

Public health education and training in India are well established with significant potential for expansion and strengthening to support a robust, multidisciplinary workforce that advances national health goals. Key recommendations include: - Center training on multi-skilled, multidisciplinary competencies relevant to real-world public health practice. - Advocate for and elevate public health career pathways, particularly within the public sector, ensuring recognition and incentives for advanced credentials. - Enhance credential recognition by local employers and align qualifications with opportunities for further education. - Institutionalize and incentivize mentorship to sustain motivation and career development. - Systematically integrate faculty and learner feedback to keep curricula and student support responsive and effective. Better alignment of training with the job market, coupled with continued curriculum enhancement and standardization, can further strengthen India’s public health workforce and contribute to global health advancement.

• Coverage bias: Desk review included institutions with web presence and those identified in prior reviews; some programs may have been missed. - Scope: Community medicine programs were excluded to focus on explicitly public health–focused offerings, potentially omitting a major training pathway historically linked to public health functions. - Data gaps: Difficulty contacting institutions during COVID-19 hindered collection of additional quantitative data (e.g., student intake). - Perspectives: Student and workforce supervisor/mentor perspectives were not captured in this phase; these are planned for subsequent work. - Qualitative limits: Despite double-coding and team deliberation, some nuances may not have been fully captured. - Generalizability: Findings reflect the sampled institutions and interviewees and may not represent all programs nationwide.