MPH Graduates in South Africa Flag Gaps in Crisis and Leadership Training

A landmark survey of Master of Public Health graduates from South African universities has revealed that while most alumni feel well equipped for the demands of public health practice, persistent weaknesses in crisis management, leadership and health promotion training could leave the country’s public health workforce exposed at precisely the moments when it matters most. The study, published in PLOS One, represents the most systematic attempt yet to map what South Africa’s MPH programs actually deliver to the people who pass through them, and it arrives at a moment when the COVID-19 pandemic has made the cost of an underprepared workforce painfully visible.

The research was carried out by a consortium of academics from across South African universities, led by Virginia Zweigenthal and Laetitia Rispel, who recognized a striking blind spot in the country’s professional education landscape. Although the MPH degree has become the standard qualification for public health practice in low- and middle-income countries, no one had previously measured whether South African graduates exiting these programs actually possessed the competencies their jobs demand. Graduates step into managerial, technical and research positions where they confront complex health problems ranging from epidemic outbreaks to chronic disease burdens, and the assumption had always been that the degree prepared them for this breadth of responsibility. The new study tested that assumption directly.

The team surveyed alumni who completed their MPH degrees between 2012 and 2016, using an online questionnaire designed to capture self-reported competencies across eleven distinct domains of public health practice. The cohort ultimately numbered 221 graduates, most of them in their mid-thirties, drawn largely from South Africa itself and from across sub-Saharan Africa. This age profile matters: these are mid-career professionals, several years into their working lives, well placed to judge which parts of their education proved useful and which parts fell short. Rather than asking a single blunt question about preparedness, the researchers examined each competency domain through three separate lenses, a design that gives the findings unusual analytical depth.

The three lenses were, first, whether graduates found each competency useful in their actual work; second, whether they believed they had obtained that competency through their MPH program; and third, how confident they felt applying it in practice. This triangulation matters because a skill can be essential at work yet never taught, or taught thoroughly yet rarely needed. By separating usefulness from acquisition from confidence, the researchers could pinpoint exactly where the educational pipeline was leaking. Across the eleven domains, the headline result was reassuring: more than 80 percent of graduates reported needing the competencies in all eleven domains at work, felt they had largely obtained them through the MPH, and expressed confidence in using them. For a degree that serves as the gateway credential to an entire profession, that broad endorsement is a meaningful validation.

Beneath the averages, however, the survey exposed cracks that cluster around the competencies most tested by real-world emergencies. One in five graduates reported lacking confidence in crisis management, a finding that resonates strongly in a country and region that has navigated HIV, tuberculosis, cholera outbreaks, listeriosis and, most recently, a global pandemic. Thirteen percent were not confident in health promotion, the preventive arm of public health that many health systems in the region still underinvest in. Perhaps most telling for program designers, on average 30 percent of respondents said they had not obtained either crisis management or leadership skills from their MPH at all. These are not marginal specializations; they are the capabilities that determine whether a health department can coordinate a response to an outbreak or whether a program manager can steer a team through budget cuts and shifting priorities.

The pattern suggests a structural feature of how MPH curricula are built. Programs tend to excel at transmitting the technical and analytical foundations of public health, epidemiology, biostatistics, health systems knowledge, where teaching can be delivered through lectures, coursework and assessments. Leadership and crisis management, by contrast, are dispositional and experiential competencies: they develop through simulation, supervised practice, reflection on real decisions and exposure to the ambiguity of actual health systems. If a third of graduates report never acquiring leadership skills during a degree designed to produce future managers and program leaders, the gap is not a matter of individual motivation but of curriculum architecture. The same logic applies to monitoring and evaluation, another domain where respondents indicated that existing training needed strengthening.

The graduates themselves did not merely diagnose problems; they proposed remedies. Their recommendations for improving course content and organization converged on three themes: more experiential learning woven into the degree, structured mentorship connecting students with experienced practitioners, and faculty advocacy to help graduates find employment after completing their studies. The call for experiential learning aligns closely with the specific skill gaps identified, since problem-solving and project management are precisely the competencies that classroom instruction struggles to instill and that workplace immersion builds most efficiently. The demand for mentorship points to a recognition that public health is learned as much through apprenticeship as through pedagogy, while the plea for employment advocacy reflects a harder truth about the transition from graduation to meaningful work in constrained labor markets.

The study’s authors frame their findings as a first step toward something South Africa currently lacks: country-wide governance of public health education. In the absence of a national framework defining core competencies that every MPH program must deliver, individual universities design curricula independently, and the resulting variation means that the competencies of the national workforce depend heavily on where a practitioner happened to study. The survey provides the empirical baseline from which such core competencies could be negotiated, giving educators, employers and professional bodies a shared evidence base rather than competing intuitions about what the degree should contain. Comparable competency frameworks have reshaped public health education in other national contexts, and the South African findings now make a locally grounded version feasible.

The practical implications extend immediately into existing program reviews. The authors recommend that MPH curricula be revised to enhance leadership, crisis management and monitoring and evaluation training within current courses, and that experiential learning components be expanded to fill the identified gaps in problem-solving and project management. They also emphasize a broader systems argument: producing a fit-for-purpose public health workforce requires aligning educational objectives with the country’s health workforce systems so that the transition between learning and working is seamless. A graduate who is competent but unemployed, or employed in a role that never uses the competencies the degree conferred, represents a failure of alignment rather than of education alone, and the graduates’ request for faculty advocacy on employment acknowledges that the university’s responsibility does not end at the exam hall door.

For a region carrying a disproportionate share of the world’s disease burden with a constrained share of its health workforce, the stakes of this research reach well beyond curriculum committees. Every percentage point of graduates unconfident in crisis management translates into weaker outbreak response capacity; every cohort that graduates without leadership training deepens the management deficit in health systems already stretched thin. The study’s central message is ultimately an optimistic one: South African MPH programs are broadly delivering competent graduates, the raw material for a strong workforce exists, and the specific deficiencies identified are the kind that deliberate curricular reform, experiential design and national coordination can fix. What the survey has done is replace anecdote with evidence, giving South Africa’s public health educators, for the first time, a clear, graduate-verified map of where their programs succeed and where they must now act.

Subject of Research: Self-perceived public health competencies of Master of Public Health graduates in South Africa

Article Title: Self-perceived competencies of Master of Public Health graduates and recommendations for programs in South Africa

Article References: Zweigenthal, V., Christofides, N., Dlungwane, T., Matlala, S. F., Mokgatle, M. M., Opare, A., Patrick, S. M., Schaay, N., Shung-King, M., Tshitangano, T., & Rispel, L. (2026). Self-perceived competencies of Master of Public Health graduates and recommendations for programs in South Africa. PLOS One, 21(10), e0360789. https://doi.org/10.1371/journal.pone.0360789

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0360789

Keywords: public health, MPH graduates, South Africa, competencies, crisis management, leadership, health promotion, curriculum reform, experiential learning, health workforce, PLOS One, graduate survey