Phusit PrakongsaiViroj TangcharoensathienSuwit Wibulpolprasert

International Health Policy Program (IHPP)Ministry of Public Health, Thailand

Asian Consultation on Education for Global Health LeadershipHanoi, Vietnam

November 4-5, 2008

Rethinking Public Health function,

core competencies, training and the new direction of education

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Objectives

1. What are core public health functions and core public health competencies?

2. Why do we need to rethink public health competencies?

3. Why do we need to assess public health competencies if they are relevant and address the needs of health systems?

4. Why do we need to revisit public health education and training?

5. What are the ways forward and collaborations?

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I. Core public health functions and public health competencies

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Core public health functions

• A number of definitions

– WHO 2002 – UK 2002 – Australia 2002 – Advisory Committee on Population Health, Canada, 2001– Institute of Medicine, USA, 1988

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Core public health functionsInstitute of Medicine, USA• Assessment

1. Monitor health status to identify community health problems,2. Diagnose, investigate health problems, health hazards in the

community.• Policy development

3. Inform, educate, empower people about health issues,4. Mobilize community partnerships to identify and solve health

problems,5. Develop policies and plans that support individual and

community health efforts.• Assurance

6. Enforce laws, regulations that protect health, ensure safety7. Link people to needed personal health services and assure the

provision of health care8. Assure a competent public health and personal health care

workforce 9. Evaluate effectiveness, accessibility, quality of personal and

population-based health services

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Core competencies

• Competency: – The ability to perform an integrative task; knowledge,

attitude and skills.

• Core public health competencies: – Are fundamental and essential in designing, performing

the public health functions and meeting health of the population.

• Key question – Do health professionals in my country have these core

competencies to meet the emerging challenges?

Core public health competencies: skill required by three levels of professionals

Core competencies Front Line Staff

Senior Level Staff

Supervisory, Management Staff

Analytic Assessment Skill Policy Development, Program Planning Skills Communication Skills Cultural Competency Skills Community Dimensions of Practice Skills Basic Public Health Sciences Skills Financial Planning and Management Skills Leadership and Systems Thinking Skills

Awareness, Acknowledgement

Proficiencies

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II. Why do we need to rethink public health competencies?

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Changing context 1

– The MDG stake is high,• Commitments to MDG by 2015 can be achieved but

uneven, some are not on track, esp. South Asia and Africa.

– Health systems face several key challenges, • Demographic transitions: huge resources and long term

care • Demographic transitions: chronic NCD requires resources • Emerging new public health threats: H5N1, MDR TB and

Malaria, zoonotic diseases and food safety issues • Major determinants of ill-health and interventions lie

outside the direct mandates of health sector [CSDH2008], requires strong inter-sectoral interventions and healthy public policies

• Increase expectation and healthcare costs

– Key messages • These challenges requires capacity to generate evidence

and translate evidences into health policies, effective capacity to implement policies

Global projection mortality, 2005 WHO (2006) Preventing chronic diseases: a vital investment

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Changing context 2

– Multiple players in health fields, • Global Health Initiatives, weak national capacity in

harmonizing and aligning with national priorities and tendency of fragmentations.

– Globalization and impact on health of the population,• Intellectual property, • Trade in health services.

– Key messages • There is a need to strengthen institutional capacity to

harmonize donor programs along the line of national priorities, install effective information systems for M&E and policies towards minimizing negative impacts of globalization on health of the population

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Changing context 3

• Given the MDG stakes, – Evidence indicates low-cost, effective interventions do

exist but countries failed to scale up these interventions to address the significant burden of diseases.

• Failure to scale up cost-effective interventions is the result of

• Fragile health system capacity, • Lack of political and financial commitment, • Lack of capacity to translate evidences into program

design, implementation and M&E• Limited number, inadequate clinical and public health

competencies among health workers

– Key messages • Public health competency at various levels of health

systems are required to translate evidence into policy, and to implement and evaluate programs.

WHO Framework for Health Systems

• Health system metrics work: during 2004-2007 development of measurement approaches and indicators for the six building blocks of health systems

– Major data availability and quality gaps in many countries• Enhanced data collection in countries on coverage, outcomes

– Data availability and quality has improved but still major gaps in many countries• Measurement progress in health systems performance assessment

– Substantial work in OECD countries, including comparative analyses, benchmarking

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III. Why do we need to assess public health competencies?

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Need to assess PH competencies 1Source: WHO Bulletin 2007, 85(12): 903-04.

• A review of public health education in the WHO South-East Asia Region in 2005 showed mixed results. – Challenges:

• Quality assurance, teaching standards and faculty members’ competency in practical field experience, especially in public health management and outbreak control,

• Absence of policy-relevant research and publication by faculty staff,

• Indicates the weakness of public health education and dissociation from real-life public health policies and practices.

• At the national level,

• It is doubtful that senior policy-makers are competent in public health,

• Yet they play a vital role in stewardship of health systems and in translating evidence into policy and program implementation.

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Need to assess PH competencies 2

– In such bleak outlook, there are some good news: • Australia: public health competencies fostered by

• on-the-job in-service training, context-specific continuing education, short courses, distant self-directed learning packages, postgraduate university-level courses.

• Thailand FETP, founded in 1980, applied the concept “linking education and practice”, now become international course

• Trainees spend 25% time in the classroom, 75% in the field and “learning by doing”.

• Conduct outbreak investigation and control.

• FETP graduates become

• Back-bone of epidemiological surveillance and broader public health responses in Thailand.

• Key players in the MOPH response to AIDS epidemics, 2003 SARS outbreak, detection of human avian influenza cases

• Played a vital role in coordinating 1,070 surveillance and rapid response teams nationwide

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Need to assess PH competencies 3

– Key messages • There is no doubt on clinical competencies among

health professionals and workers in Thailand, however,

• There are doubts of the public health competencies at all levels

• Dissociation from real life public health practices, public health education in Thailand tends to be obsolete, not relevant to the contemporary health systems challenges

• A conventional “ivory-tower” public health schools cannot meet these challenges, this requires major revisit.

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IV. Why do we need to revisit public health education and

training?

Conceptual approaches:Review public health education

B. Assessment of country specific requirement of core public health competencies to meet contemporary health challenges

A. Changing context: Demographic, epidemiologic transition, multiple players in the health fields, Global Health Initiatives, public private sector interactions at country levels

C. Assess current core public health competencies of staff at service delivery and management levels

D. Gap assessment of core public health competencies

E. Assess if public health schools adequately fill the gap of public health competencies

F. Reform of curriculum and training capacity of faculty members

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V. The ways forward

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New direction for PH education 1

– Key message • Critical gap assessment of existing core public health competencies

at different level.• Front line, senior and management

• PH education and training must be relevant to the country changing context and needs

– The role of PHC in the context of decentralized health systems,• Capacity to work with the local government• Sustain the merit of past 30 years health achievement

• Lancet 2008; 372: 950–61

– Improve connectivity between health systems and public health education

• Training and education curricula must base on evidences generated from health systems and policy researches

– Recognize the role of multiple players: global health governance and initiatives, various actors in global health:

• Competencies in inter-sectoral coordination • Donor harmonization• Effective public private partnership to achieve health systems goals

A growing market: increasing health aid

PHC reforms: refocus Health Systems towards HFA

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New direction for PH education 2

• Integrating public health education across different levels and categories of health personnel, especially medical specialists,

• Improving indicators for monitoring the impact of public health on health system goals,– Equity– Quality of health services– Efficiency– Improved health status of the population

• Ability to transform health information systems to support primary health care reforms,– Data analyses,– Dissemination,– Communication with policy makers and key stakeholders.

Transforming info systems to support PHC reform

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Epilogues

• Public health education that is irrelevant to national health priorities, and divorced from public health practice and health system goals, is useless and constitutes a lost opportunity.

• Given the MDG stakes, challenges of re-emerging infectious diseases and the increasing complexity of chronic non-communicable diseases, it is the right time to revisit public health education.

• Reform of public health education and training is URGENTLY required.

Source: Tangcharoensathien V, Prakongsai P. Regional public health education: current situation and challenges. WHO Bulletin 2007, 85(12): 903-04.

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Thank you for your kind attention