Mentor’s Comment: UPSC Mains have focused on the ‘Public health system’ (in 2015) and  ‘role of Indian state in public healthcare system’ (2024).

The U.S. decision to leave the World Health Organization (WHO) and cut funding for the United States Agency for International Development (USAID) has caused major disruptions in healthcare services in many developing countries. However, India has remained mostly unaffected because it relies very little on international aid, which makes up only 1% of its total health spending.

Today’s editorial discusses the impact of the U.S. decision to withdraw from the World Health Organization (WHO) and reduce funding for the United States Agency for International Development (USAID). This analysis is relevant for GS Paper 2, covering International Relations (IR) and Governance in the health sector.

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Let’s learn!

Why in the News?

Recently, the U.S. decided to leave the World Health Organization (WHO) and cut funding for the United States Agency for International Development (USAID).

Why has the withdrawal of U.S. funding from WHO and USAID had a limited impact on India’s public health system?

• Low Dependence on Foreign Aid – International aid accounts for only 1% of India’s total health expenditure, making the system largely self-reliant. For example, India’s Ayushman Bharat scheme is fully funded by the government, reducing dependence on external grants.
• Strong Domestic Health Programs – India has large-scale, government-funded health programs like the National Health Mission (NHM) and the Universal Immunization Programme (UIP). For instance, India’s polio eradication drive was successful primarily due to government initiatives rather than foreign aid.
• Growing Private Healthcare Sector – The private sector plays a dominant role in healthcare delivery, reducing reliance on foreign-funded public health initiatives. For example, large hospital networks like Apollo Hospitals and Narayana Health operate independently of international funding.
• Diversified Funding Sources – India receives aid from multiple global organizations, including the Gavi Vaccine Alliance and the Global Fund, ensuring that a reduction in U.S. contributions does not severely impact the overall funding pool. For example, India’s HIV/AIDS control programs receive support from UNAIDS and the Global Fund, not just USAID.
• Increased Government Health Spending – The Union Budget allocations for health have consistently increased, helping sustain key health initiatives. For instance, India’s health budget in 2023-24 was ₹89,155 crore, allowing for the continued expansion of primary health infrastructure and insurance schemes without heavy reliance on foreign aid.

What are the key challenges faced by Master of Public Health (MPH) graduates in securing employment in India?

• Limited Government Job Opportunities – Despite the increasing number of MPH graduates, government recruitment has stagnated. For example, the National Rural Health Mission (NRHM) initially opened roles for non-medical public health specialists, but hiring has since slowed.
• Preference for Medical and Management Professionals – The private healthcare sector prioritizes hospital administrators and business managers over public health specialists. For instance, private hospitals often recruit MBA (Healthcare) graduates for leadership roles rather than MPH holders.
• Declining International Funding for Public Health – Many research institutions and NGOs rely on foreign grants, which are shrinking due to the U.S. withdrawal from WHO and USAID cuts. For example, NGOs working on tuberculosis control have faced funding reductions, limiting hiring capacity.
• Lack of Practical Training and Standardization – Many MPH programs lack field experience, making graduates less competitive. For example, graduates from institutions with strong internships (like PHFI) are often preferred over those from colleges with purely theoretical training.
• Absence of a Public Health Cadre – Unlike developed nations where public health professionals have dedicated government roles, India lacks a structured Public Health Management Cadre. For example, states like Tamil Nadu and Maharashtra have proposed such a cadre, but implementation remains slow.

How has the expansion of public health education in India led to concerns about the quality of MPH training?

• Lack of Standardized Curriculum – Different universities follow varied curricula, leading to inconsistencies in training quality. For example, Tata Institute of Social Sciences (TISS) emphasizes social determinants of health and policy, while Manipal Academy of Higher Education (MAHE) focuses more on epidemiology and biostatistics. This lack of uniformity affects the competencies of graduates.
• Insufficient Practical Training – Many MPH programs lack field-based learning, making graduates less prepared for real-world public health challenges. For instance, Public Health Foundation of India (PHFI) offers strong internship opportunities in collaboration with state governments, whereas some newer private universities, like Amity University, provide limited hands-on experience.
• Shortage of Qualified Faculty – Several institutions face a shortage of experienced public health faculty, affecting the depth of education. For example, Banaras Hindu University (BHU) has an established public health faculty, whereas some recently launched programs in private universities struggle to recruit trained professionals, leading to a reliance on general medical or social science faculty.

Way forward: 

• Establishment of a Public Health Cadre – The government should create a dedicated Public Health Management Cadre (PHMC) at the state and central levels to ensure structured employment for MPH graduates. For example, states like Tamil Nadu and Maharashtra have proposed such cadres, but national-level implementation is required.
• Standardization of MPH Curriculum – A central body like the National Medical Commission (NMC) or the University Grants Commission (UGC) should regulate MPH programs, ensuring a uniform curriculum with a balance of theoretical knowledge and practical skills. For instance, defining core competencies such as epidemiology, health policy, and program management would enhance graduate employability.

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