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Volume 7, Issue 1, April 2018, 1–57

Editorial
Universal health coverage in the World Health Organization South-East Asia Region: how can we make it 1 ISSN 2224-3151 Volume 7, Issue 1, April 2018, 1–57
“business unusual”?
Poonam Khetrapal Singh, Phyllida Travis

Perspective
A framework for comparative analysis of health systems: experiences from the Asia Pacific Observatory on 5
Health Systems and Policies
Judith Mary Healy, Shenglan Tang, Walaiporn Patcharanarumol, Peter Leslie Annear
Pushing the boundaries of research on human resources for health: fresh approaches to understanding 13
health worker motivation
Aarushi Bhatnagar, Kerry Scott, Veloshnee Govender, Asha George
The burden of iron-deficiency anaemia among women in India: how have iron and folic acid interventions fared? 18

WHO
Rajesh Kumar Rai, Wafaie W Fawzi, Anamitra Barik, Abhijit Chowdhury
Social autopsy: a potential health-promotion tool for preventing maternal mortality in low-income countries 24
Preeti K Mahato, Elizabeth Waithaka, Edwin van Teijlingen, Puspa Raj Pant, Animesh Biswas

Review
Current status of Master of Public Health programmes in India: a scoping review 29

South-East Asia
Ritika Tiwari, Himanshu Negandhi, Sanjay Zodpey

Original research
Factors associated with delivery at home in Bhutan: findings from the National Health Survey 2012 36
Mongal Singh Gurung, Dorji Pelzom, Sonam Wangdi, Tashi Tshomo, Pema Lethro, Tashi Dema
Changes in neonatal mortality and newborn health-care practices: descriptive data from the Bangladesh 43

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Policy and practice

Large-scale mHealth professional support for health workers in rural Maharashtra, India 51

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Shailendra Kumar B Hegde, Sriranga Prasad Saride, Sudha Kuruganty, Niraja Banker,

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Chetan Patil, Vishal Phanse

Universal health coverage in the World Health

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 Review

Current status of Master of Public Health programmes in

India: a scoping review
Ritika Tiwari1, Himanshu Negandhi2, Sanjay Zodpey3
1
Symbiosis International (Deemed University), Pune, India, 2Indian Institute of Public Health – Delhi, Gurgaon, Haryana, India,
3
Public Health Foundation of India, New Delhi, India
Correspondence to: Ms Ritika Tiwari ([email protected])

Abstract
There is a recognized need to improve training in public health in India. Currently, several Indian
institutions and universities offer the Master of Public Health (MPH) programme. However, in the
absence of any formal body or council for regulating public health education in the country, there is
limited information available on these programmes. This scoping review was therefore undertaken
to review the current status of MPH programmes in India. Information on MPH programmes was
obtained using a two-step process. First, a list of all institutions offering MPH programmes in India
was compiled by use of an internet and literature search. Second, detailed information on each
programme was collected via an internet and literature search and through direct contact with the
institutions and recognized experts in public health education. Between 1997 and 2016–2017, the
number of institutions offering MPH programmes increased from 2 to 44. The eligibility criteria for the
MPH programmes are variable. All programmes include some field experience. The ratio of faculty
number to students enrolled ranged from 1:0.1 to 1:42. In the 2016–2017 academic year, 1190 places
were being offered on MPH programmes but only 704 students were enrolled. MPH programmes
being offered in India have witnessed a rapid expansion in the past two decades. This growth in
supply of public health graduates is not yet matched by an increased demand. Despite the recognized
need to strengthen the public health workforce in India, there is no clearly defined career pathway
for MPH graduates in the national public health infrastructure. Institutions and public health bodies
must collaborate to design and deliver MPH programmes to overcome the shortage of public health
professionals, such that the development goals for India might be met.
Keywords: India, Master of Public Health, MPH, public health, public health courses, public health education, public health
professional

Background and maintenance of a healthy community.4 This report defined

a public health professional as “a person educated in public
The combined rise in chronic, noncommunicable diseases health or a related discipline who is employed to improve health
and continuing burden of infectious diseases has highlighted through a population focus”.4 Public health is a fusion of many
the need for strengthened health systems in low- and middle- cross-cutting disciplines, including but not limited to: medicine,
income countries.1 A robust health system is necessary if the behavioural and social sciences, statistics, management,
Sustainable Development Goals (SDGs) are to be achieved;2 communication, environment, nutrition, law, and public policy.5
it is also central to designing, implementing and monitoring
health programmes; delivering quality health services; and India’s public health workforce
ensuring universal health coverage.3 Strong health systems An emerging economy like that of India has to plan for adequate
will need adequate and well-trained health professionals, and access to quality health care for its large population. There is a
a shortage of health workforce can often be a crucial limiting recognized need to initiate and appropriately strengthen public
factor in the delivery of quality health services in low- and health education in the country.6 Considerable investment in
middle-income countries. public health training is needed to create effective public health
Public health is a vital part of any health system and is professionals. In 2012, the High Level Expert Group for Universal
ultimately responsible for reducing health risks and maintaining Health Coverage for India recommended strengthening health-
and improving health status. Consequently, as noted in a sector management by supporting postgraduate courses in public
United States of America (USA) Institute of Medicine report, health and hospital management for health professionals, and
public health professionals play a pivotal role in the creation reiterated that health curricula in the country have not kept pace

WHO South-East Asia Journal of Public Health | April 2018 | 7(1) 29

 Tiwari et al.: Master of Public Health programmes in India

with the changing dynamics of public health, health policies and Diploma in Health Science (Public Health) offered by Annamalai
demographics.7 It recommended establishment of new public University, which is equivalent to a MPH of 1 year’s duration,16
health management institutions in three phases: 2012–2015, was not included, since the University Grants Commission
2015–2017 and 2017–2022.7 The High Level Expert Group regulations stipulate that a master’s degree programme should
also emphasized the immediate need to establish public health be a minimum of 2 years’ duration.17 The websites of the All India
training institutions and strong partnerships with public health Council of Technical Education, University Grants Commission,
management training institutions.7 The National Health Policy and universities and institutions were also searched. In addition,
2017 built on this theme, by explicitly proposing creation of a education supplements of leading newspapers and education-
public health management cadre in all states.8 The policy also based websites, including shiksha.com,18 targetstudy.com,19
advocates an appropriate career structure and recruitment policy getmyuni.com20 and career.webindia123.com,21 were searched.
to attract young and talented multidisciplinary professionals. Experts in the field of public health education were also
Medical professionals would be expected to form a major part contacted and related literature was also identified through
of this workforce, but professionals from diverse backgrounds, Google Scholar and PubMed.
including sociology, economics, anthropology, nursing, hospital In the second step, detailed information about the MPH
management, and communications, who have public health programmes was collected from the institutions and their
management training, should also be considered. The policy websites. The admissions office, relevant departments and
notes that states could decide to locate these public health faculty of these institutions were contacted by telephone and
managers, with medical and non-medical qualifications, in the email, to request information on the fee structures, number of
same or different cadre streams within their directorates of health.8 student places, eligibility criteria, duration of the programme
Traditionally in India, medical colleges were the centres for and programme details. Any other salient features of relevance
creating public health professionals.9 In the last two decades, to the programmes, such as the ownership, affiliation and
there has been a significant change in the way public health geographical location of the institution, specializations offered
professionals are trained in the country. There has been a (if any), or number of faculty for the MPH programme, were
conscious shift towards the creation of schools of public health also collected. The information was incorporated into a matrix
outside medical colleges, allowing non-medical personnel to and the findings were triangulated wherever possible.
acquire academic competencies in public health disciplines.6 The collated data were then analysed based on the year of
Currently the Master of Public Health (MPH) programme is launch of the MPH programme, the ownership, affiliation and
being offered by various institutions and universities under the geographical location of institutions, eligibility criteria, duration,
minimum standards for a masters degree laid down by University specializations offered, number of faculty, intake capacity and
Grants Commission regulations, 2003.10 In the absence of a enrolled numbers, and the accreditation/curriculum of courses.
formal body or council for regulating public health education,
to date, there has been limited information on evolution,
development and issues related to MPH programmes in India. Results
To remedy this situation, a Task Force for Public Health
Education of Sub-Group on Health Education and Training of This scoping review identified 46 institutions that have ever
UK–India Joint Working Group on Cooperation in the Field of offered a MPH programme in India. However, out of these 46,
Health has been constituted at the level of the Government two institutions discontinued their MPH programmes from 2013
of India, to work on developing a model MPH curriculum.11 onwards. In the academic year 2016–2017, 44 institutions offered
The model programme of study will focus on skills related to 46 MPH programmes (two institutions offered two different types
analysis and assessment, policy planning and development, of MPH programmes). Thus, for India in 2016–2017, there was
communication skills, financial planning, management and one MPH programme in existence per 28.7 million population.
leadership. Two authors of the present paper (SZ and HN) are Of these 44 institutions, 42 had at least one student enrolment
members of this taskforce. in 2016–2017, whereas, two institutions had no enrolments.
This paper reviews the current status of MPH programmes Findings on these 44 institutions and the 46 MPH programmes
in India. offered in 2016–2017 are summarized next.

Evolution and growth

Methodology The first MPH programme in India was launched at Mahatma
Gandhi University, Kottayam, Kerala, in 1995. This was followed
Data regarding the existing MPH programmes were obtained by the Achutha Menon Centre for Health Science Studies, Sree
using a two-step process originally used by Zodpey et al.,12 and Chitra Tirunal Institute for Medical Sciences and Technology,
subsequently replicated in several research studies related to Kerala in 1997. During the decade from 1997 to 2006, four
public health education.13–15 In the first step, a list of institutions institutions commenced MPH programmes – Sam Higginbottom
offering MPH programmes in India was constructed. An internet Institute of Agriculture, Technology and Sciences, Allahabad in
search was conducted, using the Google search engine and 2000; the National Centre for Disease Control, New Delhi in
keywords including “public health programmes”, “public health 2005; and both Jawaharlal Nehru University, New Delhi and
courses”, “Master of Public Health”, “MPH” and “schools of public the Interdisciplinary School of Health Sciences, University of
health”. The search was limited to programmes offered in India Pune, Pune in 2007. In the decade from 2007 to 2016, MPH
and to collaborations between Indian and foreign institutions, if programmes were launched by 40 institutions, including an
any. Only master’s-level programmes of a minimum of 2 years’ upsurge in the number of private institutions offering MPH
duration were included. For example, the Post Graduate programmes (see Fig. 1). MPH programmes offered at Birla

30 WHO South-East Asia Journal of Public Health | April 2018 | 7(1)

 Tiwari et al.: Master of Public Health programmes in India

Institute of Technology and Sciences, Pilani, Rajasthan and these eligibility criteria, some institutions give preference to
Chitkara University, Punjab were discontinued in 2013. candidates with a prior health background, i.e. of working in
health services. The eligibility criteria for MPH programmes
Ownership and geographical coverage are variable; for example, some institutions enrol AYUSH
Of the 44 institutions currently offering MPH programmes (see graduates in their MPH programmes, while some do not allow
Box 1), 26 are privately owned and 18 are in the public sector. them to enrol, even though they are trained in health sciences.
Tata Institute of Social Sciences offers two MPH programmes,
one in social epidemiology and the other in health policy, Duration
economics and finance. Sri Ramaswamy Memorial University Of the 46 MPH programmes offered, 44 are of 2  years’
also offers two programmes: a MPH and a Master of Business duration. In addition, there are two 3-year programmes: Rajiv
Administration (MBA)/MPH dual degree. Gandhi University of Health Sciences, Karnataka’s MPH
In terms of geographical location, eight institutions are (Honours)24 and Sri Ramaswamy Memorial University’s MBA/
situated in Karnataka; six in Delhi-National Capital Region; five MPH programme.25
in Maharashtra; four each in Uttar Pradesh and Tamil Nadu;
three in Kerala; two each in Chandigarh, Gujarat, Rajasthan, Specializations offered
Telangana and West Bengal; and one each in Himachal Thirty institutions do not offer any specialization as part of their
Pradesh, Nagaland, Odisha and Puducherry. The concentration MPH programme, whereas 14 offer specialization in domains
of institutions offering the MPH is therefore mostly outside the such as epidemiology, nutrition, health promotion and health
Empowered Action Group states that are targeted for special management, maternal and child health, field epidemiology,
government health and development assistance. community nutrition, health economics, financing and policy,
health systems, and occupational and environmental health.
Eligibility
MPH programmes in India are postgraduate-level courses17 Pedagogy
aimed at building the human resources capacity in public All MPH programmes are taught on-campus, apart from the
health.22 Most of the MPH programmes provide opportunity to programme offered by the Global Open University, Nagaland,
graduates from multidisciplinary medical backgrounds such which is a distance-learning course. Course work covers standard
as medicine, dentistry, physiotherapy, occupational therapy, fields of public health, including epidemiology, biostatistics,
AYUSH (ayurveda, yoga and naturopathy, unani, siddha and environmental health and health policy. Most on-campus
homoeopathy), nursing, veterinary sciences or pharmacy; programmes include teaching with practical/field experience.26
and non-medical backgrounds such as engineering, statistics/
biostatistics, demography, population studies, nutrition, Faculty
sociology, economics, psychology, anthropology, social work, The faculty in most of the institutions have a multidisciplinary
management, life sciences, social sciences, management, background. However, MPH programmes offered through
law, arts, etc., to enrol for the programme.23 In addition to medical colleges are predominantly taught by faculty with a

Fig. 1. Evolution of institutes offering Master of Public Health (MPH) programmes in India (n = 46a)

50
Public MPH programmes
Private MPH programmes
Cumulative number of programmes

40

30

20

10

0
1995 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015
Year
a
Includes two MPH programmes that were discontinued in 2013.

WHO South-East Asia Journal of Public Health | April 2018 | 7(1) 31

 Tiwari et al.: Master of Public Health programmes in India

Box 1. List of institutions offering Master of Public Health programmes in 2016–2017 (in alphabetical order; n = 44)
●● Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology,
Thiruvananthapuram, Kerala
●● Akal School of Public Health, Eternal University, Sirmour, Himachal Pradesh
●● All India Institute of Hygiene and Public Health, Kolkata, West Bengal
●● Amity University, Noida, Uttar Pradesh
●● Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala
●● Asian Institute of Public Health, Bhubaneswar, Odisha
●● Athar Institute of Health and Management Studies, Gautam Nagar, New Delhi
●● Centre for Emerging Areas in Science and Technology, Panjab University, Chandigarh
●● Christian Medical College, Vellore, Tamil Nadu
●● Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra
●● Delhi Pharmaceutical Sciences and Research University, Pusp Vihar, New Delhi
●● Global Institute of Healthcare Management, Najafgarh, Delhi-National Capital Region
●● Indian Institute of Public Health – Delhi, Gurgaon, Delhi-National Capital Region
●● Indian Institute of Public Health – Hyderabad, Hyderabad, Telangana
●● Indian Institute of Public Health – Gandhinagar, Gandhinagar, Gujarat
●● Institute of Health Management Research, Jaipur, Rajasthan
●● Institute of Public Health, Kalyani, West Bengal
●● Interdisciplinary School of Health Sciences, University of Pune, Pune, Maharashtra
●● Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, Puducherry
●● Jawaharlal Nehru University, Munirka, New Delhi
●● Jodhpur School of Public Health, Jodhpur, Rajasthan
●● Jagadguru Sri Shivarathreeswara University, Mysuru, Karnataka
●● Karnatak Lingayat Education University, Belgaum, Karnataka
●● Maharashtra University of Health Sciences, Nashik, Maharashtra
●● Mahatma Gandhi University, Kottayam, Kerala
●● National Centre for Disease Control, Sham Nath Marg, New Delhi
●● National Institute of Epidemiology, Chennai, Tamil Nadu
●● National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka
●● Nitte University, Mangaluru, Karnataka
●● Noida International University, Gautam Budh Nagar, Uttar Pradesh
●● Padmashree School of Public Health, Bengaluru, Karnataka
●● Parul University, Ahmedabad, Gujarat
●● Post Graduate Institute of Medical Education and Research, Chandigarh, Punjab
●● Pravara Institute of Medical Sciences, Ahmednagar, Maharashtra
●● Rajiv Gandhi Institute of Public Health and Centre for Disease Control, Bengaluru, Karnataka
●● Sam Higginbottom Institute of Agriculture, Technology and Sciences, Allahabad, Uttar Pradesh
●● Sri Ramaswamy Memorial Institute of Science and Technology , Chennai, Tamil Nadu
●● Sri Ramachandra Medical College and Research Institute , Chennai, Tamil Nadu
●● Tata Institute of Social Sciences, Mumbai, Maharashtra
●● Manipal University, Manipal, Karnataka
●● The Global Open University, Dimapur, Nagaland
●● University of Hyderabad, Hyderabad, Telangana
●● University of Lucknow, Lucknow, Uttar Pradesh
●● Yenepoya University, Mangaluru, Karnataka

medical background. Faculty numbers for MPH teaching were students were enrolled. Two institutions had zero enrolments,
available for 41 institutions and ranged from 1 to 25, with a 16 had fewer than 10 enrolments, 13 had 10–20 enrolments
median of 6. The ratio of faculty number to student enrolments and 13 had more than 20 enrolments. At 59%, the place
in 2016–2017 of these 41 institutions ranged between 1:0.1 and occupancy for MPH programmes in India compares poorly
1:42. Institutions with very minimal faculty, for example one, bring with that for the Bachelor of Medicine and Bachelor of Surgery
external faculty from other institutions to teach their programme. (MBBS) qualification, which is anecdotally 95%. However, place
occupancy for the Bachelor of Dental Surgery programme has
Intake capacity versus enrolments recently reduced to around 50%.27
In the 2016–2017 academic year, out of 44 institutions, 1190 The number of students graduating from an Indian institution
places were being offered on MPH programmes but only 704 with a MPH degree can only be estimated. During 2007–2016,

32 WHO South-East Asia Journal of Public Health | April 2018 | 7(1)

 Tiwari et al.: Master of Public Health programmes in India

more than 4300 enrolments took place in MPH programmes in ratio of at least 1:15. In turn, there is a need to generate a
India. Assuming 95% of students successfully graduated from faculty pipeline by, for example, starting PhD and DrPH
these MPH programmes, there have been around 4100 MPH programmes in public health.
graduates. Information on employment of MPH graduates was Similar to the finding of this study of the low occupancy
available for three institutions; 93% of MPH graduates were in of places on MPH programmes in 2016–2017, prior work
some form of employment. undertaken by the Public Health Foundation of India found
that in 2011, 23 institutions in India offered MPH programmes
Accreditation and curriculum with 5–15 enrolments per academic year.26 In 2010, out of 573
Currently, no formal regulatory mechanism exists in the places, only 430 candidates enrolled in a MPH programme,
country for the accreditation of public health courses, including which indicates a place occupancy of around 75%.26 Currently
MPH programmes.14 In 2011, the National Commission for the enrolment into MPH programmes is lower in percentage
Human Resources for Health Bill was introduced,28 which terms than the enrolments in 2011. The number of MPH places
included formation of a National Council for Human Resource available has already doubled from approximately 573 (23
in Health for the regulation and accreditation of health institutions in 2011) to 1190 (44 institutions in 2016–2017). It
education.14 However, the bill has not yet been enacted. The would therefore be more appropriate to focus on enhancing
curriculum of the MPH programmes is therefore variable, as enrolments to existing MPH programmes rather than launching
these programmes are offered by different universities and new MPH programmes.
institutions and no standard curriculum exists in the country.14 Currently, the Medical Council of India (MCI) and Indian
Nursing Council (INC) regulate only those courses that are
offered through medical and nursing schools respectively.
Discussion The current MPH programmes are regulated by the university
that grants the master’s qualification. As with the MCI
India is ranked in the bottom quarter worldwide in terms of and INC, a council or professional body for public health
overall SDG health index,29 and needs a well-trained public courses is needed for accreditation of MPH programmes in
health workforce. Traditionally, in India, medical colleges India.37 This professional body would develop a system for
were the centres for training public health professionals.30 determining and certifying minimum standards of education
However, this training has been criticized as failing to provide for the different occupations and professions in the health
exposure and develop expertise in health management, system.37 Accreditation of public health programmes will lay
administration and national health programmes.31 Of late, in standards for regulation for high-quality academic standards,
public health education, there has been a shift from medical responsiveness and ethical practices for public health
schools to public health schools. This is also occurring in education in India.
high-income countries, such as the United Kingdom of Great In 2006, the US ASPH identified core competencies for
Britain and Northern Ireland, where the need to develop a the MPH programmes in the USA.35 Similarly, the public
multidisciplinary public health specialist workforce has been health community in India needs to develop and adopt a MPH
recognized.32 competency framework tailored to the public health needs of
Across the world, the number of schools offering public India. In 2010, Sharma et al. proposed that MPH graduates
health programmes is growing, although some regions are less in India must have competencies such as: monitoring of
well supplied with higher education in public health disciplines health problems and epidemics in the community, applying
than others.33 Brazil, an emerging economy with more than biostatistics in public health, conducting action research,
40 schools of public health, probably now has one of the understanding social and community influences on public
greatest concentrations of public health training programmes health, developing indicators and instruments to monitor
in the world, at one course per 5 million population.34 Although and evaluate community health programmes, developing
the situation in Brazil is not necessarily a “gold standard”, proposals, and involving the community in planning, delivery,
it is striking that in in India there was only one course per and monitoring of health programmes.38 Professionals with
28.7 million population in 2016–2017. skills in monitoring and evaluation (M&E) are essential in
The Association of Schools of Public Health of the United public health systems, yet M&E capacity in many low- and
State of America (US ASPH) requires MPH programmes to middle-income countries is lacking.39 In 2013, Negandhi
include five core areas, namely, epidemiology, biostatistics, et al. used a group consultation involving institutions from
health management, behavioural and social sciences, Bangladesh, India, Nepal and Sri Lanka to identify a set
and environmental and occupational health, together with of 15 core competencies for M&E training relevant to the
other modules that are integral for acquiring public health south Asian context.39 Work on a public health competency
competencies.35 Faculty qualified to teach these core and framework has also been undertaken by Pandav et al., to
supplementary areas are essential for MPH programmes standardize the core and cross-cutting public health training
in India. The first step for some institutions will be to recruit needs of medical undergraduates in India.40
the appropriate number of appropriately qualified faculty. The There are no imperatives or incentives for institutions
University Grants Commission of India recommends that the that offer MPH programmes in India to collaborate or share
faculty:student ratio should be between 1:15 and 1:10 for resources. Each individual institution effectively functions
postgraduate-level programmes, to ensure teaching quality alone. A culture of collaboration among these institutions
and rigour.36 The faculty:student ratio in MPH institutions in would encourage a sharing of best practices in tuition and
India for 2016–2017 ranged between 1:0.1 and 1:42. Thus, for development of teaching materials, and widen the faculty
MPH programmes there is a need to maintain a faculty:student resource pool. For example, in the past the Indian Public Health

WHO South-East Asia Journal of Public Health | April 2018 | 7(1) 33

 Tiwari et al.: Master of Public Health programmes in India

Association, with support from the World Health Organization References

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