PRODUCTION AND QUALITY of PUBLIC HEALTH MANPOWER

1. PRODUCTION AND QUALITY of PUBLIC HEALTH MANPOWER Prof. Dr Sujan B Marahatta PhD(Epidemiology ); Post Doc Member of American College of Epidemiology (MACE) Member of Society for Healthcare Epidemiology of America (SHEA)  Member of International Epidemiology Association (IEA) Visiting Faculty, Liverpool John Moores University UK SBM

2. Health Workers Save Lives! Source: World Health Organization (WHO). Working together for health. World Health Report 2006

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4. Did You Choose PUBLIC HEALTHBecause You Wanted To… • Make a difference? • Address society’s health needs? • Help improve quality of life? • Apply science to challenging problems? • Pursue opportunities for leadership? OR OTHER ????

5. Public Health Defined “The science and art of preventingdisease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals.” —CEA Winslow Photo: IF Fisher and EL Fisk Winslow CEA. The untilled field of public health. Mod Med 1920;2:183–91. 5

6. Current Public Health Issues • Socio-economic impact on health - poverty, inequality • Changing patterns of diseases - infections, aging • Environmental change - global warming, cyclones • Political change - free markets, capitalism • Population change – family planning, population growth • Public vs individual rights - human rights, immunization • Disease eradication and eliminations - small pox, polio • Trauma - violence, road traffic accident • Wars and civil unrest- biological, nuclear, guerrilla • Travel- cholera, malaria • Major infections – Malaria, TB, HIV/AIDS

7. Current Public Health Issues • Behavioural change – smoking, sexual • Health Care Technology – impact on iniquity • Health sector reforms - decentralisation • Private Health Care- solution to under-funded state provisions For PH schools • Global competition • Need to fulfil the national and international demands • Lack of workforce • Epidemiology, medical statistics, health economics, and social science

8. Emerging challenges for Public Health Professionals Epidemiological and demographic transitions Health System Professional differentiation Technological innovation Population demands SBM

9. FUTURE OF PUBLIC HEALTH EDUCATION • Public health professionals have a major role to play in addressing these complex health challenges, but to do so effectively they must have a framework for action and an understanding of the ways in which what they do affects the health of individuals and populations. SBM

10. CONTEXT • An effective public health system requires well-educated public health professionals. • Public health professionals receive education and training in a wide range of disciplines, come from a variety of professions, work in many types of settings, and are engaged in numerous kinds of activities. SBM

11. A public health professional is a person educated in public health or a related discipline who is employed to improve health through a population focus. SBM

12. Public Health Workforce Professionals • Public health specialists • Epidemiologists • Biostatisticians • Health administrators • Health educators • Occupational & environmental health specialists • Public health nutritionists • Health economists, planners, and policy analysts. Employed by: • Governmental public health agencies • Community-based organizations • Academic and research institutions, • Hospitals, health plans, and medical groups, • Private industry • Global health organizations SBM

13. Distribution of Public Health Schools SBM

14. Labor market for health professionals Provision Demand Population Needs Needs A Systems Approach Supply of health workforce Demand for health workforce Provision Health System Education System Demand SBM

15. Core Functions of Public Health 3. Assurance 1. Manage resources and organizational structure 2. Implement programs 3. Evaluate programs quality assurance 4. Inform and educate the public • 1. Assessment • Assess health needs • Investigate hazards and effects • Analyze determinants of identified health needs Governance and Practice • 2. Policy Development • Advocate for public health • 2. Set priorities among health needs • Develop policies to address priorities SBM

16. Three Core Functions of Public Health Systematically collect, analyze, and make available information on healthy communities Assessment Promote the use of a scientific knowledge base in policy and decision making Policy Development Assurance Ensure provision of services to those in need Institute of Medicine. The future of public health. Washington, DC: National Academies Press; 1988. 16

17. Core Functions at Government Levels Policy Development Assessment Assurance Federal grantsfor antismoking research National tobacco public health surveillance Increase tobacco tax, Federal State Fundinggeneration through implementation of taxation Monitor state tobacco use Smoking banon public places, Public campaign for anti-smoking, ban advertisement in media Local Report on local tobacco use Smoking zones in bars, SBM

18. Ten Essential Public Health Services Monitor Health Diagnose and Investigate Inform, Educate, Empower Mobilize Community Partnership Develop Policies Enforce Laws Link to/Provide Care Assure a Competent Workforce Evaluate Research SBM

19. Ten Essential Public Health Services that Health Professionals Provide • Monitor health status to identify and solve community health problems. • Diagnose and investigatehealth problems and health hazards in the community. • Inform, educateand empowerpeople about health issues. • Mobilizecommunity partnerships and action to identify and solve health problems. • Develop policies and plansthat support individual and community health efforts. SBM

20. Ten Essential Public Health Services that Health Professionals Provide • Enforce laws and regulations that protect health and ensure safety. • Link people to needed personal health services and assure the provision of health care when otherwise unavailable. • Assure competent public and personal health care workforce. • Evaluate effectiveness, accessibility, and quality of personal and population-based health services. • Research for new insights and innovative solutions to health problems. SBM

21. Public Health Education : Human Resource Production 1. Institutionalization of Public Health Education in Nepal • Public Health Education formally started in Nepal in the year 2043 BS at Maharajgunj Campus, TU • It was named as Bachelor in Public Health (BPH) • Initially the course was designed for 2 years and limited only for 10 students having Health Science background SBM

22. Maharajgunj campus also started certificate level course in Health Education and Sanitation during 2044/45 BS. • In the year 2048/49 BS, Master level course was started at Maharajgunj Campus (named as MSc PH, course duration: 2 yrs) • However, the course duration has changed in different period of time SBM

23. Initially started with 2 year course, then made to 1 year, changed to 18 months (in 2006 AD) and presently 2 years (from 2014 AD) • IOM has initiated specialization in MPH: Public Health nutrition and Health Promotion SBM

24. 2. Broadening and Privatization of Public Health Education • In the year 2002 AD, BPH program was also started by Purbanchal University under some of the PU affiliated Private health academic Institutions • Course duration was for 3 years and student enrollments limitation was 40 in each batch • In the year 2005 AD, BPH program was also started by Pokhara University SBM

25. In 2005/2006 BPKIHS started MPH program (2 year program with 10 seats) • In 2011 AD, TU affiliated MPH was initiated at Private medical College at Chitwan. • In 2011 AD, TU affiliate MPH program was initiated by another private medical college at Birgunj. • In the year 2016, Purbanchal University and Pokhara University has also started MPH program (2 year course) • In 2018 TU affiliate MPH program was initiated at MMIHS SBM

26. In the Year 2009/2010, Maharajgunj campus, TU started PhD program on Public Health (2 seats): 3 Graduated so far! SBM

27. 3. MPH-PRODCTION IN NEPAL

28. Tentative number of Public Health graduates produced in Nepal per Year: • Bachelor level: About 1000 (from 4 colleges under TU, 5 colleges under Pokhara University and 17 colleges under Purbanchal University) • Master level: Around 150 (from 5 colleges under TU, BPKIHS, 2 colleges under Pokhara and 1 college under Purbanchal University) • PhD level: About 2 (from Maharajgunj campus) SBM

29. Similarly about 100 master level graduates and above level are completing their Public Health Education from abroad (India, Bangladesh, Thailand, Australia, Europe, America etc) • So, every year around 1250 Public Health Personnel are produced in Nepal, though the actual number available in the market are less. SBM

30. Opportunities of Public Health Education • Broadening scope in both governmental and non-governmental sector (at different level, from peripheral level of health care delivery to planners and policy makers in health sector) • Involvement in Public Health research • Involvement in academic institutions (teaching learning activities) SBM

31. Job opportunities at International level • Opportunity for Public Health Education Tourism SBM

32. Involvement in other sector as a (Municipality, DDC, organizations related with agriculture, veterinary, environment etc) • Being a low income countries, many areas area of PH are still unexplored, which can be taken as potential areas and opportunities for career development. • Increase in the areas of specialization • Abroad studies SBM

33. Challenges of Public Health Education in Nepal • Ensuring the quality of PH education • Mismatchin production and consumption of Public Health graduates (unemployment rate is increasing) • Lack of academic environment to support the public health educational activities in the academic institutions (especially in the private academic institutions) SBM

34. Insufficient and inefficient academic experts in the academic institutions to support the teaching learning activates • High turn-over of the Public Health faculties in the academic institutions (especially in Private academic institutions) • Lack of training, opportunities and support to develop the competency of Public Health faculties (especially in Private institutions) SBM

35. Poor linkage of academic institutions with the MoH, DoHS, DHO/DPHOs and other governmental and Non-governmental organizations. • Inefficient and lack of monitoring and supervision from concern authorities at the academic institutions (by University, Councils etc). As well as lack of constructive feedback and follow-up. SBM

36. Lack of appropriate environment for promoting Public health research activities • University enrollment criteria for students is inefficient (being technical course also the competency of students during the entrance is not well considered) • Lack of curriculum revision contextually (based on the need and demand of the society and country). SBM

37. Lack of inter-university coordination • Drop-out of enrolled students • Students enrolled under Public Health seems to be politically more sensitive, that often affect the academic calendar. SBM

38. WE CAN MAKE DIFFERENCE!!!!! SBM

39. BLOOMS TAXONOMY

40. INCREASING APPLICATION OF DATA

41. KNOWLEDGE TO PRODUCT SBM

42. Take Home Message • Need of innovation in public health education as per-Epidemiological and demographic transitions • Public Health education need to comply as per the technological innovation • Need of the professionalism and specialization in public health education • Need of strong quality control mechanism to ensure the production of competent public health professionals SBM

43. Take Home Message • There is acute shortage of public health faculties in Nepal. In this regard, there is the essence of forming network amongst the universities and institution for the sharing of the faculties to strengthen one another. • Inter -university and inter-institutional collaboration is needed. • The health professional council should inspect on availability of the permanent faculties, modern facilities and equipments in the institutions with focus on quality education not only on quantity. • The field practice is an integral part of public health education and the universities as well as the affiliated colleges are suffering this problem. • It would be better if we could move ahead with the proper coordination between the universities to sort out the problem being faced in conducting field practices. • There is need of the coordination between health ministry and education ministry to address the public health education in Nepal. SBM

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