An innovative National Rural Health Mission capacity development initiative for improving public health practice in India

National Rural Health Mission (NRHM) foresaw improved health management in India through sustained capacity development of in-service health personnel and their post-training duties in the public health system. Acknowledging the urgency of addressing this issue, the Indian Government, under the NRHM, launched a 1-year Post Graduate Diploma in Public Health Management (PGDPHM) to impart public health management knowledge and skills to these professionals in the state health services. Four institutes partnered this program in 2008, its first year. Between 2008 and 2011, this expanded to 10 institutes and 386 students have graduated the program. The program offered across all these institutes is uniquely identified as against other Health Management courses being offered across the country. The NRHM context in its content and pedagogy is its prime feature. The program offers multiple opportunities to encourage states and the central government to clearly delineate a much needed specialized public health cadre in India. The efforts of this program emphasize on improved public health practice and are a unique pathway to a better health system. Its multidisciplinary facets are aimed at addressing the mismatch of demand and supply of health professionals who could contribute effectively to strengthening the public health system in India through proficient public health practice.     

Public Health Social Work

Despite the disparate historical evolution, public image, and traditional approaches to problem solving characteristic of the social work profession and the field of public health, the potential for professional collaboration has never been greater. Indeed, the comprehensive management of social-health problems demands an interdisciplinary educational program designed to train upcoming professionals. The 4-year old, joint MSW-MPH program at the University of Minnesota provides a setting in which the public health social work student develops the philosophies, values, and skills of both social work and public health, and applies them to appropriate social-health settings. The purpose of this paper is to describe the Minnesota model and examine its implications for faculty and community professionals interested in developing similar training programs.     

Equipping clinical leaders for system and service improvements in quality and safety: an Australian experience

Objective : To develop clinical leadership among health professionals working in public sector organisations to improve their skills in ensuring high quality and safe health services. Methods : A longitudinal pre‐post‐intervention mixed methods study that included 60 health professionals working in one state in Australia. Results : The program was successful in the development of clinical leaders. Conclusions : An interdisciplinary, inter‐sectoral leadership development program involving health professionals from metropolitan, regional and rural areas can be successful in developing knowledge, skills and competencies among these health professionals in health service quality and safety. Implications : Health professionals can participate in a development program to enhance their clinical leadership skills. While this was a post‐qualification course, targeting experienced health professionals, the learnings could be applied to pre‐qualification education of health professionals.     

Short course training in epidemiology and biostatistics for graduate and undergraduate public health professionals.

The University of South Florida has developed short courses of 2 to 3 days in epidemiology and biostatistics geared to public health workers. A key focus is providing skills which will assist local and State public health units to assess their status and measure progress with respect to achieving their explicitly stated health objectives for the year 2000. The courses were developed after the identification of the training needs in health departments and other public health settings. The training objectives were (a) to enhance the biostatistics skills of professionals involved in the analysis of health data; (b) to reinforce basic knowledge of epidemiologic methods and its practical applications in public health settings, including measures of disease frequency and association, epidemic outbreak investigations, and the identification and use of surveillance data; and (c) to demonstrate the application of the risk factor approach to select the interventions needed to reach health objectives for year 2000 and how to evaluate such interventions. A total of 43 students have taken this course series. Professional staff in health departments cannot always enroll in formal training in epidemiology and biostatistics because of time limitations or a lack of a bachelor''s degree. However, the need exists. An alternative to such training could be the short course program described in this paper.     

The crucible of public health practice: major trends shaping the design of the Management Academy for Public Health.

Public health leaders and managers need new leadership and management skills as well as greater entrepreneurial acumen to respond effectively to broad demographic, socioeconomic, and political trends reshaping public health. This article asserts that the need for such training and skills was the impetus for the conceptualization, design, and launch of the Management Academy for Public Health--an innovative executive education program jointly offered by the schools of business and public health at the University of North Carolina at Chapel Hill.     

Public health management: Time for a new start?

One of the themes of health care reform Is a renewed focus onhealth rather than health care. The role of the purchaser isdirected towards health gain rather than merely the maintenanceof health care services. This goal can only be achieved if publichealth specialists and health services managers work togetherand share skills. There is a need for public health physicians,non-clinical public health specialists and health service managersto find an intellectual focus for joint working since theirrespective skills are complementary. Whereas public health haslooked outwards towards the health needs of the population,health care management has focused inwards on the organizationof health services. The concept of public health managementoffers a unifying focus. It centres on the mobilization of society'sresources, including those of the health service sector, toimprove the health of populations through whatever means ismost appropriate. Public health has suffered from a tensionbetween knowledge and action. Public health management seeksto resolve this tension. The paper explores the concept of publichealth management, analyses the skills required for its successfulpractice and considers the training programmes required to developpublic health managers. The authors call on European organizationsto champion the concept of public health management.     

Guidelines for public health practitioners serving as student preceptors

Student fieldwork and service learning are valuable strategies for developing the skills of future public health professionals. Practitioners who serve as preceptors to students often receive little preparation for guiding and evaluating students. Findings from a review of fieldwork and service learning literature and a program evaluation of an undergraduate public health program at a large southern public university were used to construct guidelines for the practitioners supervising students in the field. These guidelines should aid practitioners in their role as preceptors of public health students. The guidelines address assessing student competencies, developing student competencies, writing learning objectives, evaluating students, maximizing the student precept or relationship, and managing problems.     

Generic Versus Specific Competencies of Entry-Level Public Health Graduates: Employers’ Perceptions in Poland,the UK,and the Netherlands

Constant changes in society and the public health domain force public health professionals into new roles and the development of new competencies. Public health professionals will need to be trained to respond to this challenge. The aim of this comparative study among Poland, the UK and the Netherlands is to identify competence needs for Master of Public Health graduates entering the labour market from a European perspective. A self-administered questionnaire was sent to employers in the three countries, rating the importance of competency in public health on a master’s level. In all three countries, interpersonal competencies, like team working and communication skills, are rated as highly important. However, employers in the UK and Poland generally rate public health specific competencies as much more important than their Dutch colleagues. It is concluded that while public health specific knowledge is providing a useful starting point for entry-level public health professionals, employers increasingly recognise the value of generic competencies such as communication and team working skills. The results suggest a stronger emphasis on teaching methods that encourage active learning and the integration of skills, which is crucial for enhancing graduates’ employability, and foster an open attitude to multidisciplinary working, which is essential in modern health care.     

四川省疾病预防控制机构专业人员突发公共卫生事件应急能力现况研究

目的 了解四川省疾病预防控制机构专业人员突发公共卫生事件应急能力现状及影响因素,为提高专业人员应对能力提供参考。 方法 抽取该省9家疾病预防控制中心(centers for disease control and prevention,CDC)的319名专业人员,对其突发公共卫生事件应急能力现况进行问卷调查; 在对其应对能力现况进行描述的基础上,采用秩和检验和秩相关分析影响专业人员应急能力的主要因素。结果 319名CDC专业人员8个方面的应急能力平均得分在2.55～3.08分之间,有7个方面的平均得分低于3分(满分为5分)。不同级别CDC专业人员的8个方面应急能力(包括分析评价能力、政策制定和发展规划技能、交流沟通技能、文化知识技能、社区实践技能、公共卫生基础科学技能、财政预算和管理技能、领导和系统思考技能)得分具有统计学差异(依次为:H=12.159,P=0.002; H=22.784,P<0.001; H=26.253,P<0.001; H=24.694,P<0.001; H=34.816,P<0.001; H=23.661,P<0.001; H=12.144,P=0.002; H=21.509,P<0.001)。省级CDC专业人员8个方面应急能力得分均高于区县级CDC专业人员,且有6个方面的应急能力得分高于巿级CDC专业人员,巿级CDC专业人员有2个方面的应急能力得分高于区县级CDC。专业人员的年龄、工作年限及近一年参加应急处置培训的级别与其8个方面的应急能力得分呈正相关。 结论 该省疾病预防控制机构专业人员的突发公共卫生事件应急能力一般,市级、区县级CDC专业人员的应急能力相对较差; 今后应加强专业人员的应急处置培训,尤其是高级别的应急处置培训,提升其突发公共卫生事件应对能力。     

Identificación de las competencias actuales y futuras de los profesionales de la salud pública

Objectives

To identify current and future competencies (managers and technicians) for public health professionals in Catalonia (Spain).

Methods

Qualitative research with a phenomenological approach. Between November 2009 and February 2010, 31 semistructured interviews were completed with public health professionals working in Catalonia. We purposely used a theoretical sample to include the maximum multiplicity of discourses. We conducted a thematic content analysis.

Results

We obtained a wide range of current professional competencies, as well as those required for the future, classified according to professional profile. The participants highlighted transversal competencies, such as the importance of sharing a general theoretical framework of the discipline and the institution. Among the most frequently reported competencies were knowledge management, communication skills, teamwork, multidisciplinary and intersectoral orientation, legal knowledge, computer skills and languages, particularly English. It was also important for individual professionals to have specific skills in their areas of activity. In terms of differences between managers and technicians, the study showed that technicians prioritize management skills concerning human and material resources, while managers emphasize organizational and professional public health expertise.

Conclusions

There is a need for transversal and specific competencies in distinct areas. Public health is a multidisciplinary field, which collaborates with a wide range of professionals and organizations.     

Developing leaders in public health: the role of executive training programs

The growing complexity of the nation's health care system is creating new challenges and opportunities for public health officials, and a renewed concern for leadership training among these officials. A focus group conducted with public health officials at local, state, and national levels reveals perceptions about the predominant trends effecting public health practice, the leadership skills required for effective public health practice, and the strategies that are needed for providing appropriate leadership training to public health executives. Officials indicate that public health practice is undergoing substantial changes in response to the growth of managed care and integrated delivery systems, changes in public health funding sources and levels, and efforts to privatize the delivery of public health services. The skills identified as critical for effective leadership in this environment include the ability to guide organizational behavior and cultivate interorganizational relationships; apply scientific knowledge to public health problems, and build and sustain community coalitions. In light of these skills, public health officials identify four essential components of an optimally effective executive training program in public health leadership: exposure to the core scientific disciplines within public health; exposure to organization theory and management science; training in community development and empowerment; and training in ethics and social justice. All of the officials agree with the need for distance learning programs for executives in public health leadership, and most officials also support the need for doctoral-level training in public health practice.     

Partnering with public health: a model for baccalaureate nursing education

This article discusses the implementation of a one-year project developed to increase and improve the quality of public health nursing experiences for baccalaureate nursing students at one state-assisted university. The partnership model involved collaboration with public health departments, the academic nursing programs, and community agencies and leaders. The project led to the development of increased student skills related to interdisciplinary team work, program development, and cultural competency skills. A needs assessment questionnaire of the public health department partner staff supported a need to develop public health work force skills. The project provided opportunities for nursing faculty development. The project results support the need for service-academic partnerships to develop the public health nursing workforce.     

Undergraduate public health education: a workforce perspective

OBJECTIVE: To describe the career paths of students who majored in public health at the undergraduate level and to assess the skills and knowledge these graduates believed were most useful to them in the public health workforce. METHOD: A telephone survey was conducted of all graduates from Adelaide University's Bachelor of Health Sciences degree from 1992-99 who had majored in public health (124 graduates). RESULTS: The response rate to the graduate survey was 71%. Using the definition of public health functions from the National Delphi Study on Public Health Functions to delineate the public health workforce, 59% of respondents were employed in public health. Graduates working in public health valued generic skills such as communication and collaboration more highly than more specific public health skills and knowledge areas. However, they also believed their undergraduate course would have been improved by a more practical orientation. CONCLUSIONS: A high proportion of graduates from this generalist degree who major in public health find employment in the public health workforce. They greatly value the generic skills associated with their undergraduate public health education and believe their entry into the workforce would have been further facilitated by stronger links between their academic program and the working environment of public health professionals. Implications: Studies of workforce training programs in public health must differentiate between the educational needs of undergraduate and postgraduate students. In particular, strategies need to be developed to provide stronger links between undergraduate students and the public health workforce.     

Improving access to cardiac rehabilitation for remote Indigenous clients

OBJECTIVE: To identify barriers to Indigenous patients taking up a rural general practice-based cardiac rehabilitation program. We investigated the accessibility and appropriateness of the program and the role of Indigenous health workers (IHWs) in caring for Indigenous cardiac patients. METHODS: A cross-sectional survey of knowledge and views relating to cardiac rehabilitation was undertaken with 47 Indigenous cardiac patients and 41 health professionals in remote Queensland. RESULTS: Only three patients were fully engaged in the program. Reasons for non-participation included: lack of knowledge about rehabilitation, low income, and having a large extended family. Although the program incorporated a training component for IHWs covering prevention and follow-up, most did not monitor patients specifically for their heart problems and thought they did not have adequate skills. Shared care was occurring in some settings but without the participation of IHWs. CONCLUSIONS: There was general agreement that IHWs do have a role in cardiac rehabilitation. There is a need for ongoing in-service education or inclusion in training programs. Lack of understanding of the role of IHWs is a barrier to shared care. Cardiovascular disease needs to be addressed as part of the raft of chronic illnesses. IMPLICATIONS: Training about chronic illnesses and their management needs to be linked to structural adaptations in the delivery of health services to allow efficient use of each professional's skills. Clear role delineation needs to be negotiated to allow all health professionals to carry out their job effectively.     

Sustainable waste management in the UK: the public health role

This paper discusses waste management in the UK and its relationship with health. It aims to outline the role of health professionals in the promotion of waste management, and argues for a change in their role in waste management regulation to help make the process more sustainable. The most common definition of sustainable development is that by the Brundtland commission, i.e. "development that meets the needs of the present without compromising the ability of future generations to meet their own needs". Managing waste sites in a manner that minimises toxic impacts on the current and future generations is obviously a crucial part of this. Although the management of waste facilities is extremely complex, the Integrated Pollution Prevention and Control regime, which requires the input of public health professionals on the regulation of such sites, means that all waste management installations should now be operating in a fashion that minimises any toxicological risks to human health. However, the impacts upon climate change, resource use and health inequalities, as well as the effects of waste transportation, are currently not considered to be part of public health professionals' responsibilities when dealing with these sites. There is also no requirement for public health professionals to become involved in waste management planning issues. The fact that public health professionals are not involved in any of these issues makes it unlikely that the potential impacts upon health are being considered fully, and even more unlikely that waste management will become more sustainable. This paper aims to show that by only considering direct toxicological impacts, public health professionals are not fully addressing all the health issues and are not contributing towards sustainability. There is a need for a change in the way that health professionals deal with waste management issues.     

Transforming a Master of Public Health program to address public health practice needs

The future of the constantly changing public health profession is tied to the development of practice skills through competency-based training. In this article, we describe a program change in the Master of Public Health program at East Stroudsburg University in northeastern Pennsylvania. The first goal of the program transition was to ensure that all program elements included the relevant vision, values, mission, goals, and objectives. The second goal was to use continuous data input and evaluation to incorporate opportunities for flexible assessments. The change process helped the university faculty define the program's vision and fostered an environment of community collaboration that guides training for public health professionals.     

The health educator's role in advocacy and policy: principles, processes, programs, and partnerships

Advocacy skills are essential for the public health practitioner. Recognizing this need, two statewide public health organizations partnered for a series of advocacy trainings. Outcomes included an increased competence for such advocacy as providing expert testimony, writing position papers, forging stronger relationships with policy makers, and committing to ongoing advocacy. An increase in statewide initiatives also included a legislative scorecard, development of a model advocacy network by voting districts, advocacy policy for associations, fact sheets for legislators on pending public health issues, a new university advocacy course, and advocacy action by two associations' members to reach common goals. The trainings and subsequent initiatives provide a template for organizations and individuals to build advocacy skills and increase the role of public health professionals in setting state public health policy.     

Public health. How to get promoted

Public health professionals are uncertain about the future of the specialty. Organisational changes will require developing the public health capacity of those outside the profession. Public health professionals will need to develop influencing skills.     

Mass casualty chemical incidents--towards guidance for public health management

The aim of this paper is two-fold. A review of mass casualty chemical incidents occurring naturally or as a result of industrial activities or deliberate release provided an opportunity to consider the problems experienced in medical and public health response. In addition, a literature review of procedures to assist in the management of chemical incidents by medical and public health professionals was conducted, targeted at summarising what tools exist to minimise the impact on public health from such events. We found that most of the large chemical incidents worldwide were unprecedented and unexpected, and as a consequence emergency services, hospitals and public health had access to very little relevant information in the first few hours. Several lessons were highlighted that would aid future response. The review of procedures showed that there are currently no written procedures that are both sufficiently generic and sufficiently detailed to effectively support the public health management of the emergency response to chemical incidents. There is therefore a need to fill this obvious gap and to develop a procedural guide for the emergency management of chemical incidents by public health professionals. This work is now under way.