Healthcare career pathways: a case study of strengthening health workforce and empowering marginalised women in Bihar, India.

The Healthcare Career Pathways (HCCP) programme, implemented by EMMS International and Duncan Hospital in Bihar, India, addresses dual public health challenges: the shortage of long-term healthcare workforce in hard-to-staff health facilities, and the systemic exclusion of vulnerable women from higher education and professional employment. Since its expansion in 2019 to Bihar, India, HCCP has ensured targeted advocacy and selection, mentoring, financial support to pursue accredited healthcare qualifications, and guaranteed employment to economically and socially vulnerable women. This case study presents the HCCP model as implemented in Raxaul, Bihar, India, including its outcomes between 2019 and 2025, impacts, strengths and challenges. It is based on the findings of a comprehensive, independent, objective evaluation of HCCP, which was conducted using quantitative review of programme records and documents, qualitative study design comprising semi-structured interviews and focus groups, and thematic analysis of the data. By the year 2025, HCCP has supported 54 economically and socially marginalised young women in healthcare training and qualifications, with 24 of these graduates employed at The Duncan Hospital. The evaluation findings reveal substantial impacts on the young women and their families' economic independence and self-efficacy; gender norms including delayed marriage and reduction in dowry demands; and shifts in community perceptions and attitudes towards girls' marriageability, education and employment particularly in the healthcare sector as well as intergenerational educational and childbirth aspirations whereby families now welcome the birth of a girl child rather than opposing it. Key challenges include limited geographical reach, partial financial support, and narrowing of career aspirations to nursing among the young women and families. This evaluation demonstrates HCCP as an evidence-based model with potential for replicability and sustainability in lower and middle-income countries to strengthen health systems in rural and underserved regions through workforce development and guaranteed recruitment in the local geographical setting while advancing gender equity and empowerment aligned with the sustainable development goals. As of 2025, HCCP is already being replicated in Madhipura Hospital in Bihar and Jiwan Jyoti Hospital in Uttar Pradesh in India. Recommendations focus on positioning HCCP within the local socio-cultural and geographical context, diversifying career pathways, strengthening mentorship, and appropriate follow-up, monitoring and evaluation mechanisms.