Strengthening institutions for public health education: results of an SWOT analysis from India to inform global best practices

Historically, educational systems that produce the healthcare workforce in countries of all income levels have been inefficient in preparing adequate numbers or appropriate skill mixes of workers needed to solve complex health system challenges. This holds true in India, with problems compounded by understaffed health systems, workforce shortages, under-subscribed training programs and inadequate distribution of qualified workers. The significance of public health education in India has gained traction in recognition of current and projected human resource gaps that threaten progress towards global health priorities, prompting exploration of the public health training landscape and calls to prioritize public health education. Defining public health education itself is challenging, as disciplines from clinical programs to healthcare administration to community medicine are often encompassed due to overlapping topics or historical connections. Recent efforts to standardize public health education include the Ministry of Health and Family Welfare Model Curriculum Handbook for MPH, aiming to prepare competent professionals for Indian public health challenges. While the number of public health trainings and institutions has increased, demand for trained personnel remains low and graduates face uncertain career pathways. Quality of training, multidisciplinary approaches beyond a medicalized lens, and elevating public health and community medicine from a perceived backup option are needed. This study undertook a landscape analysis and qualitative inquiry to understand strengths, weaknesses, opportunities, and threats facing public health educational institutions in India to inform a more interconnected and optimized approach to training.

Study design: Landscape analysis combined with qualitative in-depth interviews and a SWOT analysis using a strategic management orientation informed by constructivism and pragmatism. Desk review: A web-based search (Appendix 1 terms) identified public health training offerings across India, cataloguing programs by institution with descriptors such as location, qualification types, and core competencies. The focus was on programs covering broader aspects of public health; specialized community medicine programs with more clinical focus were excluded. In-depth interviews: Thirteen 1-hour interviews were conducted (September–December 2020) with faculty/representatives from a purposive sample of institutions identified in the desk review. Interview guides drew on competency-based education literature to capture data on departments, research areas, courses, mentorship models, and collaborations. Interviews were conducted remotely (Zoom) due to COVID-19; consent obtained; privacy maintained. Audio was recorded, de-identified, securely stored, and professionally transcribed. Interviews continued until data saturation was achieved. Not all 59 institutions were included due to practical considerations and saturation. Qualitative analysis: Transcripts were imported into Dedoose (v8.0.35) for thematic analysis. A data-driven approach identified key themes; a codebook was developed and finalized via team consensus, comprising 10 parent codes and 32 child codes. Each transcript was double-coded (primary and secondary reviewer) to ensure consistency. Weekly team meetings built consensus on interpretation and theme organization. SWOT analysis: Themes were categorized as internal (strengths/weaknesses intrinsic to or within control of institutions) or external (opportunities/threats from the broader political, social, economic environment) and plotted into a SWOT framework. Leading themes were further grouped into broader domains.

Landscape: The desk review identified 59 institutions offering public health-related training across universities, medical colleges, social science colleges, and research/technology institutes. Program types included: 25 MPH; 20 Master of Science (related disciplines such as Epidemiology, Population Studies, Disaster Management, Health Informatics, Applied Nutrition); 14 diplomas; 11 PhDs; 4 certificates; 3 executive trainings; 2 workshops. Representation included both private and government institutions (54% and 55% of identified institutions, respectively), public–private partnerships, and non-traditional hubs (e.g., a community health resource center). Geographically, programs spanned 41 cities across 21 states, with three institutions having multiple branches. Strengths (internal): - Tuition affordability at publicly funded institutions, with scholarships/stipends and support for underrepresented groups (e.g., SC/STs). Some private institutions maintained full enrollment due to reputation despite higher fees. - Innovation, especially rapid adaptation during COVID-19 (e.g., virtual/online training modalities, real-time government advisory roles, protocol/guideline development). - Research capacity and productivity, with multidisciplinary faculty, strong collaborations, and high expectations for student research competencies. Weaknesses (internal): - Suboptimal collaborations: need for better alignment, structured interactions, and co-owned, equitable partnerships. - Lack of clear career pathways and incentives: additional degrees not translating into advancement; limited prestige; challenging work conditions; lack of compensated mentorship roles. Opportunities (external): - Growing interest in public health heightened by COVID-19: increased program applicants and research activity; potential for sustained government–academia partnerships. - Community engagement embedded in training/research to expose learners to real-world challenges, inform priorities, and build soft skills. - Technological advancements: sustained use of online research tools and digital platforms to enable collaboration, mentorship, and reduced geographic constraints. Threats (external): - Misaligned supply and demand: few clearly defined jobs requiring public health qualifications; uneven geographic distribution of trainees; need for systematic assessment of human resource needs. - Officialism/bureaucratic rigidity: quotas and outdated curriculum mandates limiting institutional autonomy and responsiveness. - Lack of urgency: insufficient capacity and preparedness for increasingly complex public health challenges (e.g., pandemics, climate change, urbanization), underscoring need for interdisciplinary education and stronger primary care networks.

Findings indicate India’s public health education landscape is expansive and diverse, with institutional strengths in affordability, innovation, and robust research cultures. However, optimization is needed in collaboration mechanisms and alignment of education with employment pathways. Leveraging heightened attention to public health, institutions can scale high-quality, context-specific training, strengthen community engagement, and harness digital tools to enhance access and collaboration. Effective networks between educational institutions, governments, employers, and other stakeholders are essential yet challenging; regional networks (ANHER, SEAPHEIN, India PHEIN) should be actively leveraged for knowledge exchange and south–south collaboration. Addressing the demand side—through creation of public health-specific posts, standardized career pathways, accreditation, and recognition of public health as a distinct discipline—can increase program attractiveness and workforce retention. Competency-based curricula aligned with health system needs, along with integration of planetary health and One Health frameworks, can better prepare graduates for real-world, systems-oriented challenges. Given projected workforce gaps (shortfall of ~45,000 public health professionals by 2026 without interventions), expansion should be intentional, geographically balanced, and data-driven. Policy advocacy, investment in training institutions (especially in underserved geographies), and robust HRH data systems can support strategic planning and alignment of supply with need.

The urgency to strengthen institutional capacity for public health education in India has escalated to a critical level. With a unique combination of need and potential, India can serve as a global model for intentional, rapid reform. Lessons from COVID-19 underscore the importance of transdisciplinary knowledge-sharing, cross-sectoral collaborations, and reciprocal partnerships. Future public health training must be responsive to evolving, interdependent real-world environments, embracing flexibility and challenging conventional paradigms to build a capable, multidisciplinary workforce.

Desk review relied on internet searches, potentially missing institutions without an online presence; medical public health education and non-English language institutions were not captured. Institutional website information varied in completeness, limiting uniform data extraction. The qualitative sample (13 interviews) provided rich insights but limits generalizability to all institutions. Despite these limitations, the study offers an improved understanding of successes and opportunities in India’s public health education sector.