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Challenges and Strategies: Public Health Education and Training of Human Resources


Adapting to new realities. A ... A new cadre of Community Health Workers (Lady Health Workers) ... 30,000 new Health Extension Workers (HEWs) trained ... – PowerPoint PPT presentation

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Title: Challenges and Strategies: Public Health Education and Training of Human Resources

Challenges and Strategies Public Health
Education and Training of Human Resources
  • Dr Mubashar Sheikh
  • Executive Director
  • Global Health Workforce Alliance
  • 12th World Congress on Public Health
  • Istanbul, Turkey, 28 April 2009

Millennium Development Goals at Midpoint
  • This year mark half way point in the efforts to
    achieve the Millennium Development Goals (MDGs)
    by 2015.
  • Assessment of the MDGs at midpoint presents a
    mixed picture, one of both significant progress
    and formidable challenges.
  • There is considerable variation across regions
    and countries.
  • While many developing countries are making
    impressive progress toward the MDGs, many others
    are falling behind.
  • Assessment at the MDGs halfway point shows a
    clear, urgent need to accelerate progress and
    make it more inclusive.

Source MDG progress various internet sources
Projected deaths by cause for high-, middle, and
low-income countries
Source World Health Statistics, WHO, 2008
Public Health New Challenges
  • Unequal growth, unequal outcomes
  • Adapting to new realities
  • A globalized, urbanized and ageing world
  • Transformed relations between citizens,
    professionals and politicians
  • Factors that undermine the health systems
  • Hospital-centrism
  • Fragmentation
  • Commercialization
  • Epidemiological, socio-economic and demographic
  • Conflicts and emergencies

Time Trend of Natural Disasters1975 - 2005
Changing Values andRising Expectations
  • Health services as a commodity
  • Greater health equity and solidarity
  • Care that puts people first
  • Securing the health of communities
  • Protection from emerging health problems
  • Health governance and transparency
  • Participation and coordination

The heart of the response
  • Health workers are the cornerstone and drivers of
    health systems

Health system performance
Adequate Health workforce
Health Workers Availability Comparison of WHO
Source JLI 2004.
Global Agenda
  • To train, deploy and retain motivated,
    skilled and supported health workers (over 59
    million existing and 4.3 million additional
    required) who can deliver the appropriate,
    affordable and equitable packages of health
    services (including in emergencies)

Responding to Public Health Challenges
  • Traditional methods will not work (going beyond
    the bio-medical models)
  • New approaches to produce
  • Health leaders
  • Advocates
  • Negotiators
  • Communicators
  • Multi-tasked and multi-functional
  • Representatives and oriented of local communities
  • Team players consensus builders
  • Responsive and accountable

Life Span Approach toHealth Workforce
Lifespan approach need to be incorporated into
HRH policies, Education, training and management
Strategies for Education and Training Health
Task shifting
Based on projected needs, considering contexts
like equity, access, quality, programme
requirements and others
Existing workforce
Skill mix
Continuous develop.
Scaling up
New workforce
Multipurpose HW
Essential categories
Actions Needed
  • Success factors
  • Political commitment and good governance
  • Evidence and need based planning
  • Enabling environment
  • Policy actions
  • Setting a clear vision with short, medium and
    long term actions for education and training by
    all stakeholders
  • Developing community, competency and team based
    curricula along with training trainers,
    increasing qualifies faculty, reducing attrition
    of teaching staff and students and maximizing
    use of existing facilities
  • 3. Allocating funds to pre-service education and
    to achieve balance between pre-service education
    and in-service training, and develop equipped

Actions Needed
  • 4. Building south-south, south-north and
    public-private partnerships to
  • Develop expertise and knowledge in public health,
    basic sciences and management
  • Create centers of excellence
  • Deliver innovative education and training based
    on BOD
  • 5. Immediate priority to be given to a
    country-relevant expansion of education and
    training to increase community and mid-level
    health workers, alongside highly skilled staff
  • 6. Agree and apply quality standards, appropriate
    regulatory framework and accreditation systems

Role of Professionals Associations
  • Active participation and support to governments
    (north and south).
  • Multi-professional capacity development through
    national and international educational
  • Developing national guidelines, training programs
    and regulatory framework for task shifting with
    Ministries of Health.
  • Putting in place quality assurance mechanisms
    including accredited competency based training,
    licensing, supportive supervision and clinical

An Exciting and Challenging Time
  • New tools, evidence and knowledge (SDH)
  • Revitalization of PHC
  • Expanded health architecture
  • More political and financial commitments than
  • Best practices and tangible progress in countries
  • First Global Forum on Human Resources for Health

New Opportunities and Initiatives
Political support
New tools guidelines
Public Private Partnerships
Kampala declaration AGA
Global Funds
Iran Integration of Medical Education and
Health Services
  • Increase in Medical Universities from 4 to 40
  • Decentralization of health management system
  • Increase in production of health workforce
  • - Physicians from few thousand to 61,870,
    dentist to 13210, Pharmacist to 13900, and
    Nurses Midwifes 111107 (WHO-2006)
  • Improvement in PHC coverage and health outcomes
  • Promoted health research on PHC / Population
    Health Labs
  • Improved referral system / technical support to

Source Evaluation of Integration of Medical
Education and Health services, 2006
Brazil Scaling-up Through PHC
  • The strategy to reorganize primary health care
  • Family health strategy (a group of health
    professionals based locally with a local
    community with approx. 4,000 individuals)
  • Community health workers form a critical part of
    this strategy and are the bridge between the
    health professionals and the communities they
  • More than 28,000 family health teams developed by
  • Of 5,564 municipalities, more than 90 have at
    least 1 family health team

Pakistan National Program for Family Planning
and Primary Health Care
  • Initiative by Government of Pakistan in 1994
  • A new cadre of Community Health Workers (Lady
    Health Workers).
  • in parallel with an expansion of other categories
    of health professionals
  • Trained for 3 months, with in-service continuous
    education for 12 months
  • One LHW for 200 households or 1000 population
  • Establishing health houses one dedicated room
  • By 2007, strength increased to 100,000

Health house in one room of LHWs home
Ethiopia Health Extension Program
  • 30,000 new Health Extension Workers (HEWs)
  • Training of trainers with 700 faculty members
  • 5000 additional health officers will be trained
    by end 2009
  • Cascade training approach
  • Strong political leadership
  • Cross-government cooperation and financial
  • Effective collaboration with development partners

Public Health Movement in South-East Asia
  • South-East Asia have less than 5 of the worlds
    schools of public health, but almost a third of
    the worlds population.
  • The South-East Asia Public Health Initiative
    launched in 2004 with the aim of strengthening
    public health planning.
  • BRAC University James P Grant School of Public
    Health aims to train a cadre of professionals to
    improve the health outcomes of populations in
    disadvantaged areas of the world.
  • First batch of 25 students graduated in January
  • .In India, the newly created Public Health
    Foundation is mobilizing resources to establish
    five schools of public health spread across the
    country. The foundation reflects a publicprivate
    partnership. The programmes include
  • structured, multidisciplinary educational
  • shorter and longer term training of health and
    allied professionals
  • research on the prioritized health problems
  • knowledge generation and knowledge translation.

Global Health Workforce Alliance
  • What is it?
  • A partnership dedicated
  • to identifying and implementing
  • solutions to the health workforce
  • Vision
  • All people everywhere
  • will have access to a skilled, motivated and
    supported health
  • worker, within a robust health system.
  • Mission
  • To advocate and catalyze global and country
    actions to resolve the human resources for health
    crisis, to support the achievement of the
    health-related millennium development goals and
    health for all.

First Global Forum on HRH, 2 7 March 2008,
Kampala, Uganda
Six fundamental and interconnected strategies to
address the global health workforce crisis
  • Building coherent national and global leadership
  • Ensuring capacity for an informed response based
    on evidence and joint learning
  • Scaling up education and training
  • Managing pressures of the international health
    workforce market and its impact on migration
  • Retaining an effective, responsive and equitably
    distributed health workforce
  • Securing additional and more productive
    investment in the health workforce

Looking Forward
  • New dynamics
  • New expectations
  • New thinking
  • Clarifications
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