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

The study addresses the capacity, structure, and key influences on public health education and training in India, particularly in the context of rising demand and the COVID-19 pandemic’s impact on health systems. India’s health workforce includes a wide spectrum of clinical and non-clinical cadres, with community medicine historically providing preventive and social medicine training. Despite growth in MPH and related programs—from 2 in 1997 to 46 in 2017—prior research indicates non-standardized curricula and lack of accreditation. Public health programs are still heavily populated by medical graduates, leaving other disciplines underrepresented, which limits the transdisciplinary approach needed to address social and environmental determinants of health. India faces an estimated additional need of 45,000 public health workers by 2026. This study aims to better understand current capacity for public health education and training, identify opportunities and challenges in curricula and student pathways, and provide recommendations to strengthen the public health workforce in India.

Design: Sequential explanatory mixed-methods study comprising a desk review followed by in-depth interviews. Ethics: Determined not to be human subjects research by IRBs at Johns Hopkins Bloomberg School of Public Health (FWA00000287) and the Indian Institute of Health Management Research (FWA00018806). Desk review:

• Objective: Map types, geographic distribution, target audiences, and characteristics of public health training opportunities in India.
• Identification: Extensive internet searches using combinations of terms (education/training and India or specific states), review of literature and existing capacity assessments, and expert faculty consultations.
• Inclusion: Institutions with a website presence offering public health-related courses (certificates, diplomas, degrees), including freestanding schools of public health and programs within other schools/colleges. Community medicine trainings within medical colleges were excluded.
• Data extraction: From institutional websites on variables including institution name, location, qualifications offered, core competencies, main topic areas, teaching modes, mentorship model, tuition/scholarships, estimated student numbers, faculty numbers, and collaborations (domestic/international).
• Final sample: 59 institutions identified (initial 40 via searches plus 19 added via literature and expert consultation).
• Analysis: Descriptive statistics, categorization by training type (certificates, MPH, diplomas, PhD, MS, executive trainings, workshops), and geographic mapping (custom Google Map) based on city locations. In-depth interviews:
• Sampling: Purposive selection of representatives from the 59 institutions to capture diversity (public/private, training types, established/newer programs, geographic spread).
• Data collection: 13 interviews via online conferencing (~1 hour each), recorded and transcribed by a third-party service; verbal consent obtained; responses anonymized. Interview guide covered general information, student/faculty characteristics, mentorship, funding, collaborations, strengths, and challenges. Qualitative analysis:
• Approach: Thematic analysis using Dedoose (v8.0.35). Initial codebook developed deductively from research questions and interview guide; refined inductively during pilot coding.
• Team process: Four researchers piloted and updated codes; each transcript double-coded for consistency; regular team meetings and memos maintained.
• Final coding structure: 10 main codes and 32 sub-codes. Themes explored for both strengths and weaknesses. Quantitative summary notes:
• Institutions categorized non-exclusively by offerings: MPH (25), MS (20), diploma (14), PhD (11), executive training certificates (3), workshops (2), plus stand-alone certificates.

• Landscape size and type:
  • 59 institutions offering public health training identified across India; 32 (54%) private, 26 (44%) public, and 1 public/private.
  • Offerings (non-exclusive): 25 MPH programs (most common), 20 MS, 14 diplomas, 11 PhD programs, 3 executive trainings, 2 workshops, plus various certificates.
  • Among 14 institutions with available data, average of 34 full-time faculty engaged in public health teaching.
• Geographic distribution:
  • Programs located in 45 cities across 19 states and 2 districts.
  • Highest concentrations: New Delhi district (11 programs) and Bengaluru city (5). States with most programs included Karnataka (8), Kerala (8), and Maharashtra (7).
  • Limited presence in the eastern/northeastern states (identified programs in West Bengal (3), Meghalaya (1), Assam (1), and Nagaland (1)).
• Competencies coverage:
  • Public health sciences domain most frequently represented across programs.
  • Leadership, communication, and financial management least represented.
• Student pathways and path dependency:
  • Careers often align closely with students’ prior backgrounds (e.g., clinicians leveraging public health as an add-on), creating path dependency and challenges for non-clinical entrants in identifying roles post-training.
• Key thematic factors influencing students and curricula (with observed strengths and weaknesses):
  • Collaborations: Practica/field placements valued for hands-on learning; availability and quality vary; international collaborations often prioritized over local ones; practice/leadership exposure can be limited.
  • Mentorship: Faculty and external mentors (e.g., IAS officers, policymakers) support theses and broader guidance; challenges include mentor turnover, limited time/incentives, and lack of formal structures; opportunities to expand online/distance mentorship.
  • Curriculum structure/standardization: Flexibility allows innovation and international exchanges; lack of national standards/accreditation leads to variability in rigor, over-medicalization, and gaps in social sciences and practice-oriented content.
  • Tuition/funding: Public institutions often have nominal fees, government support, and stipends; private institutions have higher fees with limited scholarships—students rely on loans—yet strong reputation sustains demand.
  • Student demand and careers: Public health degrees can yield promotions for in-service candidates and act as a steppingstone (including PhD or international opportunities). However, lack of clear career pathways and limited public sector specialist posts dampen demand; rural amenities can deter enrollment.
• Overall insight:
  • Field-based training and mentorship are critical but unevenly accessible; tuition is less of a barrier than the scarcity of defined public health career pathways, especially for non-medical graduates.

The study set out to assess the capacity and functioning of public health education in India and to identify factors influencing student experiences and curricula. The findings show substantial growth in programs, with MPH as the most common qualification and a geographically diverse distribution. However, critical gaps persist in standardized curricula, comprehensive competency coverage (notably leadership, communication, and financial management), and structured mentorship. Importantly, the linkage between education and employment is inconsistent, with strong path dependency on prior clinical backgrounds and insufficiently defined career pathways for non-clinical trainees. These findings address the research question by highlighting where educational offerings align with workforce needs (e.g., hands-on practica, valued mentorship, and diverse training options) and where misalignments remain (e.g., lack of standardization and limited recognition of public health specialties in government cadres). The significance lies in informing policy and institutional actions: advancing accreditation/standard frameworks to ensure core competencies and multidisciplinary content; strengthening local practice-oriented collaborations; formalizing and incentivizing mentorship; and aligning education more closely with defined career ladders in the public and private sectors. Enhancing recognition of public health as a distinct profession within the public sector, along with clear incentives and postings for public health specialists, is essential to meet the projected workforce needs and to support India’s UHC and SDG goals.

Public health education and training in India are well established with ample opportunities for expansion and strengthening. Key recommendations include: promoting multidisciplinary, multi-skilled training; sustained advocacy for public health careers and the value of public health competencies; ensuring credentials are recognized by employers, particularly in the public sector, and are strategically aligned for further training; formalizing, supporting, and incentivizing mentorship to sustain workforce engagement; and systematically incorporating faculty and learner feedback to keep curricula relevant. Aligning educational opportunities with the job market and enhancing recognition of public health roles will help build a robust public health workforce for India and contribute to global health advancement.

• The desk review captured only institutions with a web presence or those identified in prior literature and consultations; additional institutions may have been missed.
• Community medicine programs were excluded to focus on explicitly public health–oriented offerings, potentially omitting a significant segment of prevention-focused training.
• COVID-19–related constraints limited contact with institutions and reduced the ability to collect additional quantitative data as originally planned.
• The study did not include direct perspectives from students or workplace supervisors/mentors; these will be addressed in subsequent phases.
• Despite double-coding and team discussions, qualitative interpretation may not capture all nuances across diverse programs.