The decision by the United States to withdraw from the World Health Organization (WHO) and drastically reduce the scale of the United States Agency for International Development (USAID) is one that has sent shock waves through the aid and public health world. This move has disrupted essential health-care services in many low- and middle-income countries. However, India has been largely unaffected, as international aid accounts for just 1% of its total health expenditure. Nevertheless, the cessation of such funding threatens to further shrink an already constrained public health development sector, which relies heavily on international support. More importantly, this development directly impacts the public health job market, reducing opportunities for thousands who are pursuing their Master of Public Health (MPH) and similar postgraduate courses.
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Public health plays a critical role in shaping a nation’s well-being and health-care delivery. The Constitution of India, through Article 47, underlines the state’s responsibility to improve public health care. Public health is a specialised field that requires specific knowledge and skills to effectively address people’s health needs. There is an urgent need for a dedicated workforce in India trained in public health, a fact that was very starkly realised during the COVID-19 pandemic. Beyond government systems, such a workforce is essential for civil society organisations, academic institutions, and research organisations engaged in public health.
The evolution of training and jobs in India
Though the surge in public health education in India is relatively recent, its history dates to the colonial era. In the early days, public health was largely embedded within medical teaching. This narrow approach persisted despite the establishment of the All India Institute of Hygiene and Public Health, Kolkata in 1932 and the subsequent inclusion of preventive and social medicine — later known as community medicine — as an essential part of medical education. Specialists in community medicine, well-trained in public health provided public health services and met human resource needs in this field. However, their numbers were limited, and they were often engaged in medical teaching. Many students pursued MPH courses abroad in countries such as Australia, the European Union, the United Kingdom and the U.S. Yet, the supply of public health professionals remained constrained. Recognising the growing need and demand, MPH institutions and teaching expanded in India.
The number of institutions offering MPH and related courses in India has grown rapidly. Currently, over 100 institutions offer master’s level courses in public health, whereas in 2000, there was only one. This expansion coincided with the launch of the National Rural Health Mission (NRHM) in 2005, which opened public health system roles to non-medical public health specialists. A wide range of institutions, from social science faculties to community medicine departments within medical institutions, have begun offering MPH courses. However, after an initial surge in demand, government recruitment for public health specialists plateaued, while the number of schools, programmes, and graduates continued to rise. As a result, securing jobs has become increasingly difficult for graduates.
Compounding this issue are challenges such as the lack of standardised training, insufficient practical learning opportunities, faculty shortages, and varied curricula that inadequately prepare students for real-world public health challenges. In addition, institutions offering public health courses are unevenly distributed, with large and populous States such as Assam, Bihar and Jharkhand, and many smaller and hilly States, having none or only a limited number of seats.
Hurdles graduates face, issues in education
The foremost challenge is the mismatch between supply and demand, with limited and shrinking job opportunities for graduates. Today, entry-level positions in public health, such as research or programme assistants, attract a very high number of applications, with a significant proportion of candidates being eligible. The success rate remains exceptionally low, with only a few positions available. Moreover, the shrinking of public health roles and institutions within the public system has further limited job prospects. Efforts to establish public health management cadres in States have been hindered by multiple factors.
In recent times, the changing landscape of health care, marked by the growing dominance of the private sector in public health, further restricts employment opportunities. The private sector prioritises hospital and business management professionals over public health specialists. With limited opportunities in both the public and private sectors, the research and development sectors remain the primary employers for graduates. However, these sectors rely largely on foreign grants, and India is no longer one of the priority countries for such international funders. Similarly, the development sector is constrained by limited funding, which is expected to worsen further due to recent decisions in the U.S. The national research and health development funding remains in its early development and is significantly underfunded. Thus, the job scarcity for public health professionals continues and can exacerbate further.
Beyond job scarcity, there are concerns about the quality of MPH education. The rapid spread of public health schools has led to intense competition to attract students, often at the expense of compromising admission standards. Many students enrol in these courses without a clear understanding of the field or passion needed to thrive in this field. Further, public health faculty often lack adequate training and real-world experience. The absence of a standardised curriculum and clear outcome measures, despite the Health Ministry’s model course framework further exacerbates concerns. In India, MPH courses are currently not mandatorily regulated by any regulatory body. Neither the National Medical Commission (NMC) nor umbrella organisations such as the University Grants Commission (UGC) oversee MPH training. In the absence of these quality measures, the overall quality of graduates is also impacted.
Approaches to consider
To address these challenges, a multi-pronged approach is required. The most urgent priority is to create public health jobs at all levels, from primary care to State and national health systems. In most developed countries with established public health education systems, governments are the largest employers of public health professionals. Similarly, establishing a dedicated public health cadre within State governments would be a significant step. This would not only create employment but also strengthen public health systems.
Next, a robust regulatory mechanism must be introduced by constituting a dedicated regulatory body or a specialised public health education division within existing regulatory agencies such as the NMC or UGC. This department, led by public health experts, should be responsible for setting curriculum standards and minimum training requirements while allowing room for institutional innovation, given that public health is a dynamic and evolving discipline. Moreover, public health training in all institutions must be closely integrated with practical learning opportunities within public health systems. There is a need to foster the growth of public health institutions in States where there are none or only a limited number. The emerging global situation calls for more national action and the building of local ecosystems for sustainable development in health.
Dr. Vikash R. Keshri is a senior public health and health policy expert and an Adjunct Senior Lecturer at the School of Population Health, University of New South Wales, Sydney, Australia. The views expressed are personal
Published – March 17, 2025 12:16 am IST
