ICP!HMD/17
~ MEE'l'Il«l OF DIRIiX:TORS <Jl. REPRESEl'll'ATIVES
//
OF SCHOOIB OF PUBLIC HEAIllH
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Sponsored by the WORID HEAIIllI ORGANIZATION RIDIONAL OFFICE FOR '!HE WES'l'JmN PACIFIC
Manila. Fh1l1ppines 10-14 March 1975
FINAL REPORT
Not for sale Printed and Distributed by
the
Regional Office for the Western Pac1fic of the World Health Organization Manila. Philippines
TABIB OP CCIIT.I!m'S
1. 2.
Ilfl'IlOmmIClJf • '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" AGENDA AND ComJCT OP THE MEi!!l'OO •••••••••••••••••••••••
1
4
SlJlII4ARY' 0,. DI8ICllJSSI()E •.'" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '"
4
SUDDa1'7 review of h1ghl.1gbta in the development of publio health weob'ng/researoh/oa.am1ty servioe .inoe the lut Meting. Brassaville. 1973 ••
4
Health
~
reaouro•••••••••••••••••••••••••••
6 11
Plrture of .aboola of publio bealtb '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" Cooperation 1U1d. oollaboration between schools of publio health in the Afrioan. Euwrn JIIed1tarranem. South-Eut AIIia IU1d Weswrn
Pacifio Res1ana ••••••••••••••••••••••••••••••••••• Visita .•..........................................
14 19
4.
EV'AIDA'l'ICIf '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" .. '" '" '" '" '" '" '" '" '" '" '"
19 21
5.
CONCLUSIONS AND RECOMMENDATIONS ••••••••••••••••••••••••• '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '"
2, 24
LIST OF ANNEXES •• ;...................................... ANNEX: 1
LtST OF PARTICIPANTS
'" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '"
27 }}
AIlDI>A '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" '" , ," '" '" '" '" '" '" '" '"
ANNElt , - PROOJWIE OP W<IUt
........................•.... :39
ANNEX: ,... WalICIlIJ GRruPS •••••••••••••••••••••••••••••••• ANNEX: 4 - THE HEAInI MANPOIER PROCESS: 'l'fIE ROlE OF salOOIB OP PUBLIC HEAIll'H IN HEAIll'H AND MANPOWIR PLAIiNI!Il AND IEVEIDPMBRl' ••••••••••••• ANNEX: ~ - THAILAND'S HEAIlI.'H MANPOWER PlANNING IN P'EltSm:'l'IVE ••••••••••••••••••••••••••••••••••• ANNEX: 6 - ROlE OF SCHOOIB OF PUBLIC HEAIllH IN THE EVAWATION OF HEAIlI.'H AND MEDICAL CARE SE3VICES:
41
53
ME'l'HOOOImY OP EV'AWATION ••••••••••••••••••••• ANNEX 7 - THE RElATIONSHIP BZ'WEEN CWSUMERS (MINISTRIES OF HEAIlI.'H AND SOCIAL WEIPARE) AND PROOOCERS (SCJfOOIS OF PUBLIC HEAIlI.'H)' ••••••••••••••••••••
- 11 .,
ANNEX 8 - 'mE FUTURE OP SCHOOIB OP PUBLIC HEAImI IN" PEElSP.liXirl VE ."."""."."..".""".."."..".,,..,,.. ANNEX 9 - A NOTE 00 'mE 1iUTIlRE OP SCHOOIB OF PUBLIC ImAmI ."" •• " ••• "".""" •• ".".""""""""""""",,.,,",,.
73
83 89 91
ANNEX 10 - TBACHING A NEW DISCIPLrNE ••••••••••••••••••••• ANNEX 11 - 'mE lIUWRE OF SCHOOIB OF PUBLIC HEAIJl'H: IMPLICATIONS OF KJIll'IDISCIPLINARY COOPERATION..
1.
INTRODUCTION
'lbe Meeting of Directors or Representatives of Schoob of Public Health opened. at the wm> Regional Oftice for the Westem Pacific, Manila, on 10 March 1975. 'lbe purpose of the Meeting was to follow up the discuesions of the previoua _t1.nga held in Geneya (1966), Manila (1967), Alexandria (1969), New Delhi (1971) and Bruzaville (1973), to review the progress lIIBde in teIlCh 1 ngjresearch/o]_m 1 t;y sernce sinoe the laat _ting and to define further the oIIJectiYes and role of schools of public health.l
lAn Expert health, as:
~., 1961, No. 216) the warJdng definition for a school of public
C0IIIII1:~tee
acoepted in 1960 (Wid. Hlth. arg. techno Rep.
"An institution with adequate resources which in addition
to reseerah in public health and service to the cosa.mi ty provides a tull-time course lsating not less than one aoadem1o year, or its equivalent, covering the subJects essential to the UDd.eretsnding of the various problelDS of public health and the oaneepts, organization aDd techniques required for dealing with theBl, aDd which is open to lllelllbers of the medical and allied profeSSions seeking qualifications in public health." An Expert Ca.a1ttee convened in 1973 (Wld. Hlth. Org. techno Rep. Ser., 1973, No. 533) reta1lled the above definition aDd added, Ha School -;;rPubl1c Health shOQl.d be viewed as a functional entity whose main purpose is to provide general and specialist public health tra1lling for members of health aDd other professions who require it. Among the oourses offered there should be a basiC course leading to a postgraduate level qualification in public health. Schools of Public Health BljQ' also have research respoasibilities and provide direct aDd advisory services to the community." Consequently, it should be appreciated that the term "schools of public health" all referred to in this report, covers two types of inst1tut1ons: (1) Schools or inst1tut1ons admin1stered by universit1es or ministries independent of BIed1cal sohools, which perform all the above-mentioned functions; and (2) Departments of public health/preventive and socialmedic1ne/ cODllllWlity aied1oine/o~t;y healthjbuBlan ecology, etc., 1Ihich form an integral part of medical schools primarily caneemad with undergraduate teaching, but also provide post-graduate training for physicians and 80 perf01'll at least this iJBPOrtant function of. a school of public health. Theae diviSions are not mutual17 exclueive as there are schools engaged in both t7P8S ot work IDl de~ts whose training activi ties exteDd. be;yClDi1 thOM relating to Mdical undergraduates and postgraduates.
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- 2 Atterapts were made to define further the role of achools of public health in health Ifld IIIIIlpower pl8!!ning aDd development. i.e ••. the health manpower process (planning. production aDd utilization). In this context. the classification and qualifications of various categories of staff in the field of public health. the relevance of educational progr_s. the methodolog)' for evaluation of health IIIIId medical care sel'Vices and. finally. the relationship between IIIin1stries of health and social welfare and schools of public health were discussed. Special attention was paid to the future of schools of public health. with particular. reference to structural and orgsnizational patterns. the teaching of new disciplines and IIIulti-disciplinary cooperation. all of IIh10h are faPtors in the adaptation of the school progr_s to the changing needs of societies. The opportunity was also used to hold the Third General Assembly of the Association of Schools of Public Health in the Afrioan. Eastern Mediterrsnesn. South-East Asia IIIId the Western Pacific Regions. The Assembly reviewed the action taken in implementing the various ."acoJlllllendations of the previous five meetings of directors or representatives of schools of public health. In this exeroise. progress a..'ld success were noted end. at the s _ tille. special attention was paid to the problems end failures in applying the reca.Jendations and the reasons thereof. There were 35 participsnts in the l118etlng. from 28 countries in four WHO Regions (Africa. Eastern Mediterranean. South-East Asia IIIIId Western Pacific). O~e"ers troll the Assooiatim.s of Schools of Public :lealth of North Alll8r1ca and of the World Peeleration ot Medical Education were also present. together with the D1rectors of the Africllll. Eastern Med1terranesn. South-East Asia end Western PlIIDific Regional Off1ces of WHO. the D1rector of the D1vision of aealth Manpower Developaent. WHO Headquarters. and other staff from three Regional Offices. The list of partic1pants IIIIId observers IIIId secretariat appears in Annex 1. The meeting opened under the chairmanship of Dr F.J. Dy. WHO Regional Director for Western PaPific. After welcoming the Reg10nal Directors and participants he said that following the inter-regional conferences in Geneva in 1966. the gathering of directors or representat1ves of SChools of public health had taken pllllDe at the Western Pacific Regional Office in 1967 and. eight years later. af'ter three successful meetings in Alexandria. New Delhi and Brazzaville. the group was blllDk at the place where the 1dea of holding regim.al _tings had been c<lOQeived. Outstanding changes had taken pllllDe in the past few years. with the growth in the number of schools and instituti(lllll teaPhing public health. Furthermore. the canaern of educators and administrators of those academiC institutions had shifted t!I1If&:3 from the consideration of 1solated top1cs. towards a more holistic approaPh in confronting the f'undamental issues of health manpower developaent in the present d&:3 and the future of schools of public health. •
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-, Dr H. Mahler. tiRO Direotor-General. in a _ssage trlllllmitt.ecl b7 Dr T. FuloP. Director. Div1a1on of Health Manpower Develo~t. 1110 Headquarters. Geneva. said that aohools of public health had maJor reapoaaib1lity for health .ervlces and _power develOJlMDt oClllllelvecl 118 a slngle progr_ a1IIed at 1IIproving health and the quall t;r of lUe of the entire population. 1he;r had to orient thelr research. develo.-nt and tr.ining aat1Yltles towards pr1mar;r health oare and probl_ connected wlth It. 1here WII8 aleo an ursent need for health lllllnagers who oould plan. admin1ster. organize and evaluate health servlces With a s;rate118 approach. at both natlonal aDd lIub-natlonal (reglonal) level. Schools of public health had to faae the challenge of Il!1UdiDg up capaclties to facllitate the acquillition of the knowledge. sk11111 and attitutde necessary for those llllDagera. Meetings of directors of aohools of publio health helped those schools to live up to the great 8ltP8Ctationa of the people and to orient their attenticm to the real health neade and demands of the population in their own countrie••
In hi. address. Dr Coalan A.A. QuenwD. tiRO Regional Director for Afrioa. after referring to the extensive progr_ for strengthening the teaching of health servioe ak111s to all members of the health tau in the Afrioan Reglon. said that the MsnUa meeting WII8 tak1ng place at a t1me tlben people were becOll1ng IIOre and IIOre oonvinced of the importance of publio health in prollOting national health servioell designed to benefit the lell8t-priv1leged sectlons of the people. As eduoators responsible tor health. the maJor conoem of the particlpants in the i-.d1ate future would have to be unequal distribution in the deli ver'1 of soolal servioes. Dr A.H. Taba. tiRO Reg10nal Dlrector for the Butem Med1tarrsnellll. said that the eUeotl_ss of health lIervioes depeDded to a oonaiderable extent upon sohools of publlc health. If they were doing their Job . .11. the'1 should be source. of fUDd_tal and applied re.earch in the tlbole broad field of Jigbllo health IIDd place. ot leaming for thon eo would direot its practioe. The groll8 inadequacies that existed in the oover.,.e of health servioes for the .aJorit'1 of the people would have to be oorreoted. In that connexion. there WII8 a need for a renewed effort on the part of ever., sohool of publl0 health to II8ke a .ore intensive eUort to improve the qual1t;r. dea1gn IIDd 1~1_tat1on of health .ervioes. Dr V.T.R. G_atM. tIRO Reg10nal Director for S~Eut Mia. referred to the need for the currioula of schools of publlo health to be in a oonstant process of change in order to -.at new needs IIDd challenges. and he w.. glad to .ee that erapbasis w.. now being placed on task-based ourrioula. A proble. tlhioh remained in varying degree WII8 how eduoaticoal and serrloe inst1tutions lind their personnel oould work together for _tual benefit.· A ~r of challenges in publio health lq mead. suob 118 .uaria. whlob was staging a forceful oa.eback. p&raa1tio dille..es. tlhioh had alwqll been present. and nutritional deUoi_ie•• tlhioh were Wideapread throughout the Reg1C1lB • 1hese were challenges facing the lIobools of publio health. wbere teaohlng. rellearch and lIervioe abould be directed towards the better.mlt of the people.
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- 4At the end of the session. Dr BenJIIJIIin D. Cabrera. President of the Association of the Schools of PUblic Health in the four Regions. addressed the _ting and tbaDked lifO for all its assistance and support in the establishment and activities of the Association. 'lbe following were elected as officers for the meeting: Dr B. Cabrera (l'hilippines)
Vice-Chai1'llen
Dr A. Aden1yi-Jones (Nigeria) Dr A.K. BanerJee (India) Dr A. TaJeldine (Iraq)
General Rapporteur Daily Rapporteurs
Professor C.W. Dixon (New Zealand) Dr Dr Dr Dr Dr
H.J. Park (Korea) Paul C.Y. Chen (Mal8¥sia) A. Nadim (Iran) Papasarathorn (Thailand) S.J. Farsey (Uganda)
2.
AGnIDA AND CCtiJlJCT OF THE MEErINl
'lbe agenda and detailed progr_ of the _ting are given in Annexes 2 and 3. Daily plenary sessions were held. at which baCkground working papers introduced by the consultants and some invited participants were discussed. (See Annexes 4-11 for text of papers). After the plenary sessions. the participants were divided into three working groups for discussion of the s ... topics in depth. Summaries of group discussione were presented by the respective rapporteurs to the following plenary sessions.
3.
SOJI4ARY OF DISCUSSIONS
3.1
~ review of highlights in the developElt of p!!blic health te!!lh1Dg/l'eselll'Ch/coaaun! ty service since the last l118etiDg. Bruzaville. 1973
Participants presented written reports on their schools or departlll8nts and briefly discussed maJor changes or problema occuring since the Bruzavile _ting in 1973. 'lbe following were the prinCipal points brousbt out during the plenary session: (a) TIle general impression is one of considerable progress in a number of different w8¥s. many in line with policies recoaaended at previous I1188t1ngs.
- 5(b) There i. 1ncreallillg cooperaUQII. and 11&1.on bet.een .chool. of public health IIId cle~te of cc_ mi t7 health/pNvenUve .ed1cine in medical 8Ohoole. (0) Moat echoole of PUb11c health al.o teach medical undergraduate. and there hall been 1nare. .ed reoosnition of the need for schoole of public health to be in or .tlll in the IIa1n .tre. . of medicine.
(d) In keep1ns with prev10ue reccall!ndatione _.t .chool. are tend 1 ng to r..triot their te8llbing to graduate. (medical and rum-medical) or to teach.n who will be re.pQII.8ible for tra1n1ng health .ervice per.annel at the lower l.vel•• (.) Incre..iDa int8reet 18 beiDa eho1m in .olving the problem of .uppl71Ds prevenUve and curatiT. Mdical cere at the (,'~mit7 (PE'1.aIar7 car.) l.vel QII. a general bailie rather than dealing with di....e. in i.olatiQII. tl'oII QII.. another. '!he le"l at which the phya1cian should come into the total picture i. being considered in relation to national health .7.te.. and the ditter1ng urban/rlll'al aupPl7 .ituatione. (f) 'filer. i. 1ncr.8HCl cooperation between .choole and lI1n1atrie. of health with reglSl'll to the relennee of teaching and national or regional pl_' "IS. (g) V.r)' few JIOIItcraduate coura•• cater excluaive17 for their own national; and . . a reault cl..... of an international charact.r are being created. 1Ih1ch o_ot f&1l to be of educational and cro.acultural benefit. (h) Increalling attention 18 being given to planned of training (part 81181ln1C. part PE'acUcal) lasting three to four 7eara. for future teach.n of .chool. of public health end d.partmenta of coamm1t7 health. Schools are now increaaingl7 rel71ng on their own graduate. for their
progr_.
.taft.
(i) A mmber of new dipla.a coura•• have been instituted: and aome dipla.a courae. have been changed to _terah1p courae.. br1Dsing the. into line with _ hirer qualificatiQ11.8 in clinical .ed1cine. De"lopiDa countries in general appear to have llede the _.t PE'ogrea. in thi. direotiQII..
(J) CQll.8iderllble re••.reb relevant to .ach countr7'. proble_ ia in 'lbere i. increalling intereat in operational re.earch related 100 the need for andclel1ver)' of medical care. Study of chronic non.oOllllUDicllble dia..... haa al.o rec.ived particular attention b7 .chool••
progre...
.0lIl8
-6}.2 Health -mpower p=oce. . apd.
, IIIIllpower
}.2.1 Role of schools of publ1c health in health pl!!ll!l1ng and developaent
The subject wu introduced by Dr T. l.IIU~p lCho POinted 0\1t. that. an 1IIportmt. problem regard1ns the health proceu 1s the lack of int.egrat.10n among the d1fferent. element.s of health manpower development. or HMO (planning, product.10n apd. ut.1lization) apd. the lack of coordinat1on bet.ween health m.npower development. apd. development of health serv1ces. Pol' exaIIPle. publ1c health workers are often not. trained for the t.asks theT have to perform. Thus the HMO concept ahO\1ld be replaced bT the newer concept of health serv1ces and manpower development (BSMD). This 1Iap11es both 1nt.egrat1on w1thin the menpower proceas 1tself apd. 1ntagration between the health -mpower process apd. the health serv1cea development proceas.
}.2.2 Relevance of educat10nal progr...... of schools of pub11c health to the needs apd. local condit1ons in each COllDtz:z: Tha1land i s health manpower plann1ns 1n per.pect1 ve The top1c wu 1nt.roduced by Profe.sor Tongcha1 Papuarathom who descr1bed problems that face schools 1n,relat.10n to the health manpower planning proceu 1n 'lba11and, 1ncluding the problem of manpower requ1rements at. each level of the sk1ll p)'l'lUII1d apd. the translation of these requ1rement.s 1nto educat10nal obJect.1ves. To overcOlle some of these problema, schools need to mon1t.or the procesa by means of "f1eld laborator1es" md to bear 1n mind all the components of the lIanpower develos-nt a,..tem. 3.2.} 'lbe role of achools of publ1c health 1n the evaluation of health aDd lIed1cal care aerv1cea Methodo1oq of evaluat10n 'lbe t.op1c was introduced by Prote.sor C.W. Dixon lCho descr1bed several stud1es conducted by the Univers1t.T of Ot.ago 1n New Zealand regarding the problema that ar1se from the 1nteraction of health consumers and health supp11ers. 'lbe use of quest10nnaires t.o studT such proble. . 1s of value. '!here 1a a need for studies in relation to t.uk performance by various categor1ea of workera, u theT pera1t better planning of manpower needs. 'lbe use of quest1onna1Ns sent. to pract1s1ns doctors 1n relat.10n to the1r cert1f1cation has enables the Med1cal Counc1l of New Zealand aDd the Department. of Health to obtain data on age, sex apd. ut.111zat.10n by special t.T aDd IIIIke a IIOre accurate predict10n of III8d1cal manpower needs. Such operat1onal research lIethodologT is an 1111J1Ortant part of the work of achools of publ1c health.
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The topio ... introduced bT Dr A.P.A. El SIler:l.f Idlo pointed out that the f1nal ail! of tb8 relatiOllllh1p between II1D18tries IUId 8CIboola of pubU. health 18 to prepare I11III develop a health worker 1Ibo is able to oops better with tile health needs I11III .obieve the obJeotlves precleterll1Ded bT the health_thor!ties. When expressed in tar. of the role of schools, tb1a obJective .pecifioally _ _ that tra1n1ng and re. .arch und.rtaken bT .chools IIhould. be in relation to the IIIIIDpow.r
needs of the oountr;y. 3.2.5 H.alth ••rY1o. developent research in Iran Dr P. AIW11 descr:l.bed a Joint, .otlOil-oriented res.arch Pl'oJect Idlo•• participants inolude the N1n1.tr;y of H.alth, the Plan Organization, the School of Publio H.alth, UlUv.reit7 of Teheran, WHO, IUId the -.lor organizations in oharg. of deliv.r)< of h.alth and aaedical care in Iran, and lIh10h ... o8lT1ed out in 011. Pl'Ov1noe of Iran since 1971. ~. naa1n obJ.otive of tile Pl'OJect was to UD4eretllDd, develop IUId teat innovationa in h.alth ••rY1oes, with . . . .i. OIl the t.pl..lIIIIDtation of an aco.ptabl. IUId f ...ibl. plan for th.ir dev.lo~t.
'!'he wruid of ••rY1o.s includ.s the e.:t.llbl1Bh11ent of health . hou••s at village level with front line h.alth workers; the OOlalllity health oentre at di.triot level, the hoap1tal-otl_m1t7 health oentre at .ecOlldar;y or referral level, &lid. the h.alth department at Pl'ovincial l.v.l. 'l'h. Pl'OJ.ot al.o inolud•• an e l _ t of h.alth IIIIIDpow.r d.velo~t.
3.2.6
Disoue.ion
Th. fir.t plenar;y ••••1on oonoentratedon paper. oonc.rned .ith the role of .chool. of publio h.al th in h.al th IUId IIIanPOWIII' plenn' og IUldd.velol*lll1t (3.2.1), the rel.v_e of eduoational ~_. of .ohool. of publio health to tile needs mid local oOlld1tions in • .ch countr;y (3.2.2) mid the relationabJ.p between oona-.s 8IId produoera (3.2.4). '!'he follow1D& points were apbulaed dur:I.ns the disouuiOilI - There i. a need far flex1bilit7 in the ooapo.ition of the ak1ll wruld to _ t the att-· 'n 'hl. needs of • .ch oountry. !
- A better te. . .p1r:l. t abolll.d be developed betwaen _-bars of tile health 1MI"Y10. .,...... I11III It i. lJIportaat that th. .tatf of school. of publ10 h.alth tr;y to eart a areatar lntllleno. on their 0011.l1l\I•• to und.erl1ne the need of approPl'iate health _powar planning.
- 8Orientating students to the relevant needs of society does not reduce the value of their training but enhances it. standarda should be related to such needs than the obtaining of recognition by others. Training 1Datitutions IIbould work closely with govel'JlllleJlt planning bodies so that the iDdividual produots fit into the national manpower plan. Field work used for teaching should preferably be in conjUDCtion with existing health servioes over a wide area rather than a small special teaching and research area, whioh often becomes overservioed and thereby unrepresentative. 'lb1s 1s especially true of the working environment, a factor that has tended to be neglected. 'lbe grOUP discUlls10ns allowed attention to be paid to IIOre specifiC points such as classification of categories of public health workers, their qualificat1ons, roles and task allocation. 'lb1s term gave rise to some diffioulties of interpretation as to tlhether i t W88 11111ted to public health in an ad"'n1strat1ve sense or health and medical care in its widest oontext. All groups folUld it d1ff1cult to classify existing, let alone poss1ble new oategor1es of health workers. The spectrum of skills of health workers in different cOWltries was recognized, as well as a variation in the length of training from the specialist physician to the front line health worker. Terminology differs from country to country, and the taska performed vary greatly depending on the resources and availability of staff. - It is desirable that tasks performed by personnel be examined critically if overtraining and/or overproduotion of some highly skilled and expensive pereonnel is to be avoided. 'lbe groups in general felt that relevanoe of teaching to the needs and local cond1tions of each country was achieved. However, one group felt that in the training of high level health professionals, principles of publio health should be given more iIIIportance than mere factual knowledge if such persons are to become competent in the management and planning of health services. 'lbe more lim1ted the task to be dcoe, the more specifio the training needS to be. Ccotinulng education _ t be emphasized • - Develo~nt of methodologies of evaluation is regarded as being very important. It is so essential to attain objectives in planning that budgetary provision for eValuation studies should be made in the in1 tial planning stage. Schools have an iaportant part to play in evaluating health and medical services, and teaching such methodologies. etc. has curative needed. Evaluation of specific progr_s, e.g. tuberculosis, malaria, been the major field covered to date; but as more integrated and preventive services are provided, new techniques will be In th1e ccotext, it should be noted that simple evaluation
- 9 procedures wch as mortalit;,. record keeplng are st11l ven inadequate in SOlll8 areas ot the world. EYaluaUon is alao neeessar;y to ensure that the lIOat eftecti ve use is l118de ot the ditterent members ot the health te8ll. The pertoNaJlCe ot evaluation Will help schools ot public health to III&1nta1n their knowledge of cOllll\ln1 t;,. needs, and association With Ministries ot Health and Welfare for this pgrpose Will be ot IllUtual benetit • Schools ot public health should be tree to C8rr;r out the independent reaearch that ia particulsrl7 nee. .aar;y in devising evaluation techniques. This IIIlBt be done, however, With due regard to ethical as well as political and administrative considerations. - Professional advice should alao be available to other agencies, professional groups or govern.ent departments in the fields of labour, agriculture, ecOllOll1c planning, etc. - The groups all felt that there should be close liaison between teaching and practice. Min1str;y ot Health start should be part-time or occasional lecturers and assist at ex am1 nations, and some statf of a school ot public health should have a service coaa1tment. Statf of schools should Whenever possible be co-opted to the planning committee of the m1nistr;y ot health and other agencies. During tourth plenar;r session, a number ot points were discussed further. One speaker thought that schools in developed countries could not train personnel tor developing countries. Although the tu. required. for the training of basic health workers mq be ditterent, the principles involVed in the tra' n1 ng ot h1ghl;,. &killed professionals are universal. Schools should develop more advanced training for a few selected. health workers including, mere appropriate, doctoral training. If the institution has good start and fadli ties the place of such advanced. training is of little iaportance. Cooperation between schools aDd mtnistriea ot health should be at the level of the M1n1ater rather than the Senior Director. Regional llleetings are alresd;y planned. to carn out the logisticall;,. dif'ticult task of getting a number of mtniaters ot health and deans of achools together. The international character of the debate is usuall;,. an advantage in stilllUlating wch II1n1sters. Although there ... general interest in papers an role of schools of public health in the evaluation of health and medical care services (3.2.3) and health services develo~t research in Iran (3.2.5) and complete agreement on the need for developing evaluation techniques, the detail of an;y method ... not discussed.. Th1s 1IIIportant field could well provide the main topic for a future meeting.
- 10 '!.'he apectrua of reqII1.red IIId.lls of .orkers in the prevent1ve and curat1ve health f1elds ... turther developed by a number of speakera. Part1cular reference ... IIIIde to the tunct10ns of schools of pul)l1c health, IIIed1cal school departments of c~ty med1cine (including prevent1ve and soc1al II8d1cine, ac mity health, etc.) and other training 1natitut1ona, e.g. schools of health sciences and schools for b ..1c health .orkera. The health IlaDpoIJel"
pyrllll1d II&Y be shown as tollon:
,--\ \ \ A
ar-
----I j
Knowledge pyrllll1d
j spec1al1ats IVery var1able 1n use of different categor1es
\ s\
I
\
c D
Diatr1at health pbyaic1an \ealth centi
/ \ Baaia ~al
I worker Health worker pyrllll1d
The required knowledge pyrUl1d 1a the inversion of the manpewer one. :aAt the teaching IIId.lls needed are more related to the manpewer pyrllll1d, as aategoriea A. B and C are more likely to be personnel cepabl.e of le~ for.:~elves. However, they do need an intellectually at1mlating en~nt otherwise rearui tllent will suffer in quality and quantity.
- 11 1he role of the YIIr10ua teMh' ns 1Dat.1tutiona IIII¥ be portrQed thus:
A Po•• ible future B
direction of llaJor activity
C
D
B
,
Pou11t1e tut.ee direction of Jl'CIIRb 'Dle tunoti_ ot aateaor1.. A ..s B lIl'e very a1a1llll' in developing IIIId developed oountr1... 1I'Imctiona of categories C. D ..s E vary cona1derab17. depend 1 na . ,..17 on h18torical _ociation IIIId the widely difter1n& ave1labiliq- of -,io1. IIIIDpower in pr1lllll'7 CIIl'e IIIId MJIH/DPH Jlh781ci. IIIIDpower in public health. With the .trencl towG'dAI integration ot .ervioe. in developed countr1... there 18 lID 1ncre..1ns tendenc1 to use Pel'II_l re.pCllUlible for JIl'1..:I7 01ll'8 for 'publ1c he health' wol'k prertoua17 UDdei'takell ~ J!h781ci_ with MPH/Dl'B qualificat1QIIIJ.
J.J
Future of 8Cboo18 of .PI!blic health
3.3.1 Future ot .chool. of pablio health in J!!l'!!P!Ot.1ve '!.'he aubJeot ... introduced. b)' Dr C.M.H. Mofidi. WHO conaultlilt. After
he _tioned that the7 haM fulfilled lID 1aportant role in the tra1ni ns ot p!lblic health Jlh18io1_ IIIId pde1n1.tratora, .. well .. oUler categori.. of public health workers. All haTe .erved their countr1e. dutiful11 in the fia12t aca1Dat c mt cable 41....... 1mpro~t of the envi_t. IIIId ~t1on IIIId delivery of health cere and .erric... 'l'bere 18 lID ursent need tor new .1BteaIa of delivery ot health _ -.dioal 01ll'8' part1cullll'17 at pr1JIery cere level in developing oountries; and SOCieties ere ...ldnS su1dallce on the•• new .18tea1a from the .choo18, because the7 are qualified to help and. there 1& noIIIlere elae to turn. After the introduot.1on of refo~ in -Uoal eduoation and. the estllbli~t ot aohoola of health soiences. the schoola ot public health abould )lay a greater role in activities oonnected with
siv1:as a briet hiator1 ot the 8'8' ...:1. of the .choola 18 the world,
- 12 -
the deli very of health services, inoluding .lIJlpcMer developDent plans, the training of leaders such as health pllllUlers, speoialists and, partioularly, teachers. '1he sobools should partioipate in the eduoation of the collllUll1ty at large and in research on co-.uUty problelllS. However, as long as other institutions, especially JDedioal schools, have not become tully active in the teaching of health sciences in their curriculum aDd do not train specifio community physicians, the schools of public health should continue with their present progr_s of training professional health workers. Efforts ahould lie made to shift the activities of the schools toward the multidisciplinary goal of health service, manpower planning and develo~t in the near future. 3.3.2 Structural and organizational considerations The subject was introduced by Dr Banerjee (India). After mentioning the great differences among schools of public health from the point of view of size and scope of work, he pointed out that their common purpose is the preparation of physicians and alUed personnel for work in pubUc health. Although organizationally speakins some of the schools have many departments, a novel pattern of _trix organization, with four or five areas of knowledge, could be oonsidered 1n order to assure harmonious multidisciplinary functioning. Pull-time staff are necessary, but the use of part-time teachers f'roIII health or related departments 1s adv1sable to cover spec1fic topics. Premises containing adequate facilities are necessary, as well as rural and urban practice fields. Whatever relationship a school IIq have With governmental agencies, it should have university level standing. In the development of curricula, the schools should consult health services and students. If the elellleDtary aspects of public health were taught in medical schools, schools of public health would be able to divert BIOre attention to speeial1aed courses and continuing education, and become IIOre involved in assessing health problems and manpower needs and in evaluating health care delivery system. '1here is a need for a IIUltidisciplinary tep approach, with integrated teaching progr_s for _ltidisciplinary groups of learners. 3.3.3 Teaching of new discipl1Des Professor Phoon (Singapore) discussed the problelllS of mek1ng a decision an offering a new course. Before introduoing a new subject into the curriculum, there DUlt be valid reasons to start to teach this new discipline (1Ihy, how, 1Ihen, who), including consideration of its relevanoe to local situation. Sa.et1.es the reasons presented to support the teaching of a new diSCipline IIq not be stroog enough. However, once it has been. decided to introduce a new course, modern teaching methods should be used. Several new disciplines should not be started at cq one time. It is iIIportant that teachers of the new discipline should be practitioners in that field, with enough experience. i'here should be consultatione with the staff, students and the c~rs before the introdUction of new disciplines; aDd after the course has c~ed constllDt mODi toring of the quali t;v of teaching is neo •••ary.
- 13 3.3.4 Implications of mu1tid1sciplinary cooperation
The subject w.. introduced by Dr Lichtenwalner (Lebanon). In the future, the traditional functions of sohools of public health, i.e. teaching, research and service, will remain the Slllle; but the manner in mich they are carried out will evolve with changes in the world (patterns of d1se ..es, IlWIIber and d1stribution of population, new knowledge, changes in needs and delllands of the society, etc.). In the future, there must be more collaboration between the schools and departments of health SCiences, and more coordination with other disciplines such as education, sociology, PSYChology, managerial science and business administration, because future health problema will be more of a multidisciplinary future than the present ones. Dr SOIIeya (Japan) gave a brief BUDDary of the activities and future plans of the Institute of Public Health of Japan, mentioning the willingness of the Institute to start an international course on public health.
3.3.5
Discussion
In the plenary d1scussions 1Ib1ch followed, the first item commanded most attention due to the involvement of most partiCipants in the subject. Views ranged from tho. . mo felt that schools of public health were sufficiently different from departments of community health for the latter to concentrate on teaching I implementation I to medical and other students milst the former should mostly prepare personnel for the higher echelons of planning.and management. This notion was refuted by others mo claimed that many departments of community health were functioning like the schools of public health. As pointed out the Technical Iteport on postgraduate education and tra1ning in public healthl, the majority of the schools are operating curricula of the socio-lI8dical type. so in effect over the yeare the differences have grown progressively smaller and the similarities greater. The groups reinforced this general opinion by stressing that due to varying local conditions a common pattern. even though molly desirable. would take a long tt.e to evolve. The main change in direction of the schools . . . towarda the main stream of medioine and some felt this w.. not only deSirable but essential.
One difference in organization between sohools of public health ot ern- m1 t;, health relates to 8Ilt<lb.OIIO'. SUpport tor the IIIltonOll7 of schools is deoliniDC. beollllae it . .abI bllt'l'inI them from the JII&1n stream ot l1114ioine libioh is open to cl.J\tIMIiIIl~. ot crn-mity health. and departments
~ld.
Hlth. Qrg. techn. Rep. Ser ••
1m.
No. 533.
- 14 Association with a univenity is essential. With the change in many older universities towards not restrioting all teaching to degree oourses and the inoreasing use of non-medioal teachers in medioal schools. the main reasons for separate sohools of publio health that existed in the past are no longer valid. ']be creation of separate schools of public health as teaching institutions is not Justifiable as long as viable departments of oo-.m1ty health with adequate staff oan be set up and provide training at the highest level. In discussing the introduction of new disoiplines. mention was made of the implications with regard to teaching and to increased multidisciplinary cooperation in teaching and research. SChools of public health have from their very nature always been multidisciplinary. and the increasing use of non-medioal graduates in many medical sohool departments. including those of co-.m1ty health. poses no real problem. On the general question of introducing new disoiplines into teaching progr_s. there was some difference of opinion. possibly due to semantics. I t was asked whether the revision of existing course content might be preferable to the introduction of new disoiplines. realizing that major ohanges are unlikely to be feasible Wi th.,ut removing or substantially reducing some old established oourse.
In some fields auch as oncology. geriatrics or primary oare. the new disciplines II1ght be ma1nl:r medioal. so enchancing the link With medical sohoob. Pr1IIIary medioal oare is probably the most important 'new' field whioh requires attention in the teaching. research and service functions of schools of public health; and it was suggested that it was of sufficient importance to be discussed at a future meeting. It was generall:r agreed that. where appropriate. medical leadership was desirable so long as the existence of the expertise of other disciplines was tully recognized. 3.4 Cooperation and collaboration between schools of public health in the Afrioan. Butem Med1 terr_an. South-But Asia and Westem Pacifio Regions
. The need for closer oooperation and oollaboration among schools of public health was stressed. as in the previous meetings. and the value of such relationships in facilitating mutual recognition and in providing a mechanism for achieving efficiency. excellence and teamwork was re-emphasized. The partioipants gave examples of faculty exchanges, use of extemal examinei'll, and exchange of students. reports, literature, specimens and teaching materials.
- 15 The different .etings have provided an excellent forum for the participants to become better llllquainted with the organization and progr_s of the diUerent IIChoole in tellllbing. research and
comqunlty servic.s.
In add1tioo. the report. of the five previous meet1nga have covered IDIIIl7 areas iJllportant to the planning of progrlUllllles for the schools. The following is a cheok list of recommendations and topics on 1Ih1ch rec~atiODs were made at meet1Dga: Geneva Manila Topics/rec-mations CUrriculum development for developing countries to be task based Special courses Community health Field training Teaching of public heal th in medical schools Mutual recognition of medical schools Nomenclature used in public health prllllt1ce Training of teachers
Alexandria New Delhi
Brazzaville
1966
1967
1969
1971
1973
+ +
+
+ +
+
+ +
+ +
+
+
+
+
+ +
+
for undergraduates and postgraduates study of staffing Study of fllllulties of heal th sciences Schools of public health to develop local special studi"; and researah methodolog (operational. administrati ve, socialmedical and environmental) to be included in curricula + Relationship of schools of public health with planners. finance units and economists in socio-economic development
+ + +
+ +
+
+
+
+
+
- 16 Geneva Man11a Alexendria New Delhi 1969 1971 1967 1966 Brazzaville 1973
TOPics/recaa.endationa
Collaboration with ministries of health and education, national planning bodies end other educational institutiona F'acul t;r ..-ben to work in ministries of public health end health deeart-ent personnel to teach in schools of public health WHO to assist in facult;r and student exchllllges
+
+
+
+ + + Dl"att of
+ + First General A118Ulbl;r held Second General AIIsellb17 held
Proposal to fol'll association of schools of' public health for AlIRO. DlRO, BEARO and WPRO WHO to hold further conferences
articles of as80dation prapareci
+
+
+
+
Development of new schools of public health, especiall;r in Atr1can Region Educational objectives to be defined in _aaurable tel'll8 end to be task orientated Evaluation of teaching and research Health pleMing and health JII8IlPOWer studies to be tllUght in schools of public health Emphasis on educational research and Qualit;r of of teaching Schools of public health to utilize eoonOlaists and social, behavioural, manegelleDt and c~icationa
+
+ +
+
+
+
+
+
+
scientists
+
- 17 Geneva Topics/reco. . ndatioua Continuing education for all health workers Status ot public health workers to be comparable with those in clinical fields Interchange of ex.1ners between School ot Public Health EpideJD101og)' and ecology to be basic in the ourriculum Role ot schools of publio health in auxiliary training Manila Alexandria New Delhi BrazzAville
1966
1967
1969
1971
1973
+
+
+
+
+
+
+
+
+
+
+
The participants appreciated that WHO has g1 van strong support to educatim and training in PIlblic health in general, and that assbtaDce to schools ot PIlblic health in the tour regions concerned was a high priority with the provision ot tellowshipa, consultants, Visiting protessors, eto. In addition, WHO has oontributed to reviewing deVelopments, to prolDOting the adaptation of oourses to sooietal needs, with all the .eduoational methods that oalls for, and to incorporating new knowledge, espaoially lII8Ilagerial, into the curriculum. So_ iDatitutioua have received 1110 tellowa tor tra1n1ng. Others have received tellOWllh1pa ~ling their teaching staft to go abroad tor IlION advanced studies, tor exchange ot ideas and experiences or for observation ot the conditions prevailing in the countries from Which ~ ot their students COllIe. Theae activities have ~led them to ~t their teaching progr_s appropriately. Other institutions have had the benefit ot consultants, and of vis1t.1ng profellBors and external e nm1ners provided by WHO and ~ have rece1 ved supplies, equ1r-ent and 11terature. WHO has also been instrumental in the establishlllent ot a number of the newer schools, in the support ot applied research IIIId in the creation of new oourses at established schools. The ~ WHO publications including WHO Expert Committee reports, have also JRBde a valuable oontribution.
- 18 These activities have also contributed towards a cOllDllOn understanding of the eaaence and objectives of postgraduate training in public health and to the establishment of IIBsociations of these and similar institutions. The Third General Assembly of the Association of Schools of Public Health in the four Regions represented WIIB held outside the meeting proper but complementary to it. The actions taken by various schools in implementing the recommendations of the· five previous meetings were reviewed. Progress in curriculum development, expansion of research and special studies, promotion of relationships between schools and health administrators, increllBed use of teaching methods and educational technology, and efforts by schools for the training of teachers, continuing education and training of auxiliaries were noted particularly. During the discussion that followed, the assistance offered by WHO in the formation of the Association of Schools of Public Health in the four Regions WIIB recognized with appreciation. Several topics were suggested for future discussion, including the role of schools of public health in the establishment of departments of preventive medicine in newly founded medical schools,a and in the delivery of primary health care. One participant proposed that minimum requirements for core or other special courses, staff and student ratios and the organization of the smallest operative unit be studied. For the smaller nations, which cannot afford to have a school of public health of their own, regionalization of the schools may be beneficial. The efforts towards collaboration and cooperation of the schools with other institutions training health personnel were briefly discussed. A brief description was given of the organization and aims of the World Federation for Medical Education, and hope WIIB expressed for closer cooperation of the Association of Schools of Public Health with the Federation. In general, the participants felt that the meetings of directors or representatives of schools of public health had facilitated the activities of the AsSOCiation and played an important role in promoting standards of organization and the teaching/research and cOllllllWlity service activities of the schools. It was hoped that they would be continued in the future. It WIIB recoamended that the schools should continue to review the action taken in implementing previous recoamendations, and that all replies should be further analysed and consolidated.
- 19It was also rec~ed that reporta of the lleetings should receive a wider diatribution and be sent not only to ministries of public health and social welfare, schools of public health and of medicine, but also to all departments ot cOlllllUllity health and other institutions responsible for training of protessional health workers. 3.5 Visits TWo visits were planned tor the participants. (a) Visit to reseal'Oh and tra1ning field area ot the Mahidol University Faculty of Public Health and Korat Province, Thailand Some of the participants from the African, Eastem Mediterranean and South-East Asia Regions had a chanae to stop over for three days in Thailand on their way to Manila and to visit the FaQulty of Public Health, Mahidol University, Bangkok, the Provincial Health Oftice at lCorat Province, the medioal and health services, and the reseal'Oh and tr8.1ning field areas of the li'aoulty. The participants also paid a visit to the Rector of Mah1dol Uni versity and the Undersecretary ot State for Public Health in Bangkok. (b) Visit to the Institute ot Public Health, University ot the Philippines, and the Rizal health service development project, Philippines During a moming sessiOll of the meeting all participants visited the Institute of Public Health and were welcomed by the Dean and his start. The organization of the Institute was explained and the statf were presented. The project for reseal'Oh in primary medical care in Rizal Province was discussed. The party saw the health tacilities in both urban (r.a Pinas) and rural areas, including those of Peg_tang Hqon Talon, r.a Pinas, where III1dwi ves are taught general primary care. The participante were invited by Govemor I.S. Rodriguez of Rizal Province to a lunch at Pasig Capitol &1ilding, at which he empbasized the Joint role in the reseal'Oh of the Provincial Health Admin1strators, the Institute of Public Health and WHO.
4.
EVAWATIOH
At the conclusion of the Meeting, an evaluation questionnaire was distributed. Thirty out of 35 participants cOllPleted and retumed the for... Analysis of the replies showed that 85JC of those answering were satisfied with the administrative aspects and ~ with the technical aspects of the lleeting. Almost all participants expressed their appreoiatiClll of the excellent Brrllll8ements made and the overall succ. .s ot the _ting.
- 20 -
Some of the
o~ts
and lI1.I8&estions were as follows:
- Sudden changes should not be lIIIIde in the progr_. - At least one afternoon should be .at uide for personal bwlineee. so that participants will not leave the oonference to attend to urgent matte1'll. - Progress reports from different schools should be sent to the Association earlier and be processed in the form of an analysis that could be distributed to participants beforehand so as to save time. so that - Visits should be paid to both 'pilot' and 'non-pilot' areas. Ii comparison ma;y be made.
- WHO ma;y consider financing some follow-up meetings to study the main themes of the oonference in depth. - At future meetings there is a need for presentation of more working papers by experts on the subject concerned, followed by brief forum sessions and discuasions by partioipants. - Consideration might be given to holding the meeting in more than one public health centre in succession, e.g. for two da;ys each in two to three centres in Iran. - Meetings should not alwa;ys be conduoted with the same general style and pattern. Some variation would be welcome. - More time should be given to see the features of the country.
- The more important requirement is to convince universities and deans of medical schools with regard to the trends of thought of the participants in the meetings and their recol1lllendations. This is always tried but it would be a great help i f the reconunendations at the meetings are sent to them. - Manpower development cannot be considered only by the schools. The presence of representatives of national policy makers is also necessary. - A system should be developed for more continuous communication between schools of publio health (and departments of social and preventive medicine) of the four Regions.
- 21 -
'!'be ocacluaicma and reoo_ "'at1cma ot the _ting were aa tollows: 5.1
In..aT oountrl.s the respons1b1l1ties tor·h.alth s.rvic.s
and h.alth _power deftlo~t are invested in different orgllll1sat1cma, in sp1te of the fact that· the,. ousht to f'orm integral parts of a natlODal health develo~t plan. '!'bere is need for clos. cooperation IIDCl oollaboration between thos. responsible for the d.11Yer7 of h.alth s.rvio •• and for the development of health _power, so tbat· ODe int.gra1;ed prosr_ may be formed, bringing th... el.lIeIlte q.ther in accordance With the new ooncept of h.alth servioe. and _power developaant (HSMD).
develo~t
5.2 Health _rare represent a spectrwl of *illa, troll the top specialist pb;yaioian to the front line health workar (includiqg trad.1tiODal h.alere), IIDCl all lIhould be viewed and included in plana aa an integrated lIbole. '!'be claaa1t1oat1on of theae worar. 18 ditt1cul t in n.w of d1ff.reno.. in task de8cr1pt10ns IIDCl specific cCllld1t1cma of each oount1'7 and partioularly in the abIIenee of' a 8tandard tel'll1nol0S7. Pllrtber attellPtB to solft thi8 problem baaed on the evaluation of tunot101l8 are h1ghl.;y desirable and should be undertaken br the Schoola. 5.3 Schoola of public health and departMnts of' coa-.m1tJ' health should reoognis. that they have a respons1bility to influence membere of the IIIId1cal profesBion, particularl,. th088 1n teaching and at health sernoes deo1a1on making levels, to see the need for 1ntegrated health aernces and II&npowr d.veloJDBllt planning and to recognbe the1r 01111 1IIIportant role in 1 te iIIpl.ementation. 5.4 '!'be schools should be respons1ble f'or or proIIOte the tra1n1ng of health _rk.re at all levela of' the health sernces and II&nJlC*8l' pyramid, as public health related knowledge, *ills and attitudes are obviousl,. neo ••sllZ7 at all tho•• levela. 5.5 '!'b• •chool. have a .aJor respons1b1lity in the tra1n1ng of' teachere of all Ir:1nda for .tatt1ng pre.ent or future 1natitutiona, BDd f'or tra1n1ng h.alth pare_l With due regard to eduoatiODal planning. aDd Another 1IIportant role of' the schools is the tra1n1ng of health lead... , lIIIIUIg.re, plllllllere and specialiste. and every neo •••&r7 . .uure should be tllken to include such activities 1n their teaah1ng Deftlo~nt of progr_s at postgraduate level 1s h1ghly des1rable to _ t theae de..ndB BDd also to prevent brain drain. It 18 reo.- mded that WHO should otter the kind of support neoess&r7 for devel~nt of' INCh capsci ty to those schools that have the potential for such end.avours.
proo......
progr_.
-22-
5.6 Governments should note that although the number of qualified health speoialists appears insuff'ioient in many oountries. unfortunately. many of those available are deployed in Jobs Whioh make little demand on their special skills. This practioe is not only wasteful but also detrimental to the morale of those Who had hoped to devots their lives to publio health. 5.7 The schools have an important role to plq in evaluating health and medioal servioes and in this oonnexion they should also teach the appropriate methodology. Operational researoh proJeots and studies related to the delivery of health and medioal oare are being oarried out by some sohools of publio health and departments on a pilot basis. These should be further developed, partioularly in prilll8l'Y oare; and those sohools that have not yet embarked on this type of research are urged to initiate progr8llllleS in this field. Partioipants suggested the following as possible topios for di80ussion at future meetings: (a) The role of the sohool of publio health in the development of primary oare. (b) (0) personnel.
Methodology of evaluation of health and medioal servioes. Preparation of teachers for institutions training health
(d) Task analysis of health workers at various levels of servioe and their olassifioation. (e) The perception people have of ohanging attitudes to health and dis.ease. (f) ReasCDS 1Ib7 doctors are not attracted to publio health oareers, and how the situation oan be improved. During the olosing session the draft report was reviewed and approved. The partioipants expressed their gratitude to the Government of the Ph11ipPinss for the excellent arrangements and facilities placed at their disposal, Whioh had oontributed greatly to the suooess of the meeting. They also thanked Dr A.H. Tabs, Regional Director for the Eastern Mediterranean. Dr A. Quenum, Regional Direotor for Afrioa, and Dr V.T .H. Gunaratne, Regional Dire... tor for South-East Asia, for their oontinuing encouragement, support and assistanoe. Dr Taba said that he was hopeful of arranging a similar meeting in his Region in 1977.
- 23 P1nal17, the partiol)*lta then!reci the ol'leD1Hra of the vial til in Bangkok mil Korat (Dean'rollgoha1 PapuU'athom) mil in MIIn1la mil IUsal (Dean BenJ.mn Cabrera); at the _ _ t1.e the)' thanked the ThallaDd aDd 1'b11lppine health w'wf D1 atrationa mil WHO for the intereat1n& opportun1t)' prov1cI.ed to til.- to go OIl theae viaits mil for the usef'lll uperi_e gained. '!'be)' also th.nked the Pre.ident, the Bacutive D1l'eotor mil the Meillbera of the Bxeoutiyo Board of the 1'b11lpp1ne AIIaooiation of Medioal Collesea, IIId tbe PNa1dent IIId lIoII1'd of D1l'eotora of the Phillppine Publlo Health AII.ooiation, for the excellent reception and ho.pit.allt)' extended to tbu.
Doc_til iuued d!!riDg the
-tin&*
to. 1. 2.
Health!l!!!pO!!r ProcH.
Health . .moea deYOlop.ent re.earch in Irllll The health -.power proce•• (Jlenn1ng, productiOll, _ i l l _ e ) . The role of aohoo18 of pOllo health in health mil _power plennfDS and 4eYOlO)lMDt. Background papera related to the role of
WPR,MMD/BPH6-7517
WP!ylIMD/S1'H6-75J8 •
,.
li.
aolloo18 of publlo health in the evaluation of health mil -.dioal oare .emoea llethodologie. of evaluatlon Pro~al for a health HmOea network: rB ture of IllaDpower require_til B.
WPft/HJIID/BPH6-75/ll WPft,MMD/B1'H6-75/12
ruture
of .oboola of publio health
5. Background
PIIP81" on the future of aohoola of
publio health C. Allaistanoe ot WHO to aohoola of publio health
WPft,MMD/BPIf6-75/9
6. Brief
~ of WlO .ctiviti. . related to achoo18 or public health, 1966-;1974
WPft,MMD/BPH6-75/6
7. WlO u.latanoe to, mil .cUviU_ with, Med1~an
.oboola of publlc health in the Butem Regioo
8.
Briet ~ of WHO aaaiatanoe to aohool. ot public health, or altemate ineUtutiona, in the Weatern Paoifio Region, 1966-1974
WPft,MMD/BPH6-75/l0
of the above world.ng PIIP81"II U¥ be obtafned upon request fro. the WHO BegiODal Office for the W . .tem Paolfic, P.O. Box 2932, ManUa, l'b1lipp1nu
•Copt..
- 24 -
9. Review ot eigbt "ears ot '110 eupport tor schools ot publio health and other training 1nstitutiOll8 in the African Region 10.
WPR/HMD/SPH6-75/16
A review ot the impleaentation ot rec~dati0D8 ot the Meeting ot Directors or Representatives ot Ichools ot Publio Healttl WPR/IDID/SPH6-75/18 An analJ'8is ot replies rece1ved to the questionnaire oOllOerning the 1mple_ntat1on ot reoommendations ot the Meetings ot D1reotol'8 or Representatives of SChools ot Public Health. 1973 WPR/HMD/SPH6-75fc!0
11.
D. 12.
Additional .1ntormation doouments ~ic1ne
Onooline service. in
end beJ'Ond
WPR/HMD/SPH6-75/4
List ot Annexes Annex 1 2 -
List of participants Agenda
WPR/fIMD/IB/4
3 -
Progr_ of work; list of
1I01'king groups List of bBCkground papers lUIIlexed 4 _ Health anpower process: the role of sohools of public health in health and anpower plBDning developaent Thailand's health manpower planning in perspective Roleot schools of publio health in the evaluation ot health end Md.loal care services. . MethodoloQ ot evaluation. 'l'he relationship between CClllllUlDerB
WPR,MMD/IB/2
5 -6 -
WPR/HMD/SPH6-75/13
WPRt9D/SPH6-75/19
7 -
(lI1D1strles ot health and soolal welfare) and producers (schools of public healttl)
WPR/fIMD/SPH6-75/5
- 25/26 Annex 8 The future ot: schools ot: public health in perspective A note on the public health futur~
WPR!HMD/SPH6-75/17 WPR/HMD/SPH6-75/3 WPfV1IMD/SPH6-75/14
910 11 -
ot: schools ot:
Teaching a new discipline The future ot: schools ot: public health; implications of multidisciplinary cooperation
WPR/HMD/SPH6-75/15
ANNEX 1
LIS'.r or PARrICIPAlI'l'S Dr Sayed )l:)h' ad Sediq Salah Deau Sebool ot Public li!alth Inati tIlte ot l'Ilbl1c Baalth II1l1btl'7 ot l'Ilbl1c Baal th Dblll AUSTRALIA
Protenor 1i.X:. Macpbersoll Prillcipal. Sebool ot Public" Health &lid Tropical Medicine '!he lJniverait,. ot S,-dna7. II.S.W. 2006 Dr as. Jtlbarak Ali Associata Protessor and Baad De pt. ot CollllllWli t,. Medi cine ])&cca Medical College Dacca Dr U !Chin MaWlS Ir1ws A.. bteDt Lecturer Department ot Epidellliolog;y Sebool ot Preventive • Tropical Medicine D.p&r"Iaent Medical Education
BAlIGLAllESH
Benmu UNITED REPUBLIC OF CAMEROON
ot
Prote..or G. L. Monekosso D1ftctor Univerait,. Centre tor Baalth Sciences '!he lJniverait,. ot C.sroon YIIOund4 Protessor !'MaJ. Bl. D111 Sha1lk;y Ina1l Prot...or aud Cb&i1'llllD De~nt"ot Preventive. Social Medicine Jaclllt7 ot Med1cina AiD Shau Universit,. CUro
Protessor n Sherit Deau II1gh Inat1tute ot l'Ilblie Baalth Un1vers1t7 ot AleX&Ddr1a Alexaudria GHAIIIA
A.".
Dr 0t08QooMaab Acting Head Departaent ot Colllllll1llit,. Health Un1vers1t7 ot Ghana Medical Scbool Accra Dr A.L Banerjee D1rector All-India Inst1tute aud Public Baalth Calcutta
• ot lJ;ys1ene
- 28 Annex 1
Dr Iwan Soetjabja D!!an Faculty of Public &alth University ot lDdonesia Jakarta Dr F. Amini Protessor and Chail'lllll.ll D!!partment ot Public &al th Practice School ot Public &alth VDiverBity ot 1'eheran !eheran Dr G. It>tamedi Chancellor University ot Istahan Isfahan Dr A. lfadim D!!an School ot Public Health and Director, Institute ot Public Health Research t1Diversity ot Teheran '1'eheran Dr II. Itmagb1 Protessor and Chul'lllll.ll D!!partlllent of (l)a!uoi ty Medicine School ot Medicine Pahlavi University Shiraz
IRAQ
Dr II. TaJeldin D!!partment of Preventive Medicine and Public Health - Faculty of Medicine l1ni versi ty ot Baghdad Baghdad Dr Leon Epstein Public Health- Pract1ce Unit D!!partment ot Social Medicine !be Hebrew University Badassab Medical School Jerusalem Professor Edmond Bertrand D!!an Faculty ot Medicine University ot Abidjan Abidjan Dr da Ki:lnan Director lfational Institute ot Public Health B.P. vtl.7 Abidjan
ISRAEL
!VORI COAST
.t
- 29
~
Annex 1 Dr Shiro SoMp
Director Institute of Public Haalth M1n1str:r of Haaltb and Welfare 6-1, Sh1rolrAmedi It- cboM, M1aato-ku
'ltIbo 106 KENYA Dr J_s Kqia
Dep&r1aent of eo-uuit;r Bealth Facult;r of Medicine Universit;r of Ba1robi lia1robi
REPUBLIC OF IIDJIEA
Dr I)uDg .10118 Park
Dean School of Public Bealtb Seoul Bational UDiversit;r 28 Yon Keun J))Il8, Cbongno KI1 Seoul Dr C.S. Licbtenwalner
Dean Faculties of Medical Sciences American Univvsit;r of Beirut Beirut
MALAYSIA
Dr Paul C.Y. Chen
Associate Professor Departaent of Social. Preventive Medicine J'acult;r of "dicine Universi t;r of MllJ.a7& Iilala Lnapur Professor C.W. Dixon Professor of Preventive. Social Medicine and llI.rector of the Departaent of Preventive and Social Medicine UDiyersit;r of Otago DmediD NIGERIA
Professor A. Adan1Ti-Jones Bead, llI.v1sion of eo.mmity Facnlt;r of Bealth Sciences UDivereit;r of Ife
care
na-Ue Dr A. B. O. Oyed1ran J'acul t;r of Medicine UDiversit;r of Ibadan Ibadan
ProfessorUmaru Sbebu llI.rector Institute of Haaltb Abudu Bello University Zaria
- 30 Annex 1 Dr A.H. Awan
Prof'essor of' Public Health Practice and Administration and Dean, Institute of' HYgiene and Preventive Medicine Labore PHILIPPINES Dr Benjamin D. Cabrera
Dean Institute of' Public Health University of' the Philippines Manila
SENEGAL
Professor H. de Lauture Department of' Preventive Medicine, HYgiene and Public Health university of' Dakar Dakar-Fann
SINGAPORE
·Prof'essor Wai-On Phoon Head .
Department of' Social Medicine and Public Health University of' Singapore, CUtram Hill Singapore 3 • Prof'essor i'ongchai Papasarathorn Dean Faculty of' Public Health Mahidol University Bangkok
TOOO
Prof'essor Agrege J. K. lrekeh Director School of' Medicine Unive~8ity of' Benin IDme Prof'essor Suleiman Jabir Farsey Head
Institute of' Public Health Faculty of Medicine Makerere university Kaapala
ZAMBIA
Prof'essor John W. K1bukBmusoke Head
Departments of' Medicine and Community Medicine Faculty of' Medicine University of' Zambia Lusaka
- 31 .;,
Annex 1 OBSERVERS
Association ot Schools ot Public Health ot North America Dr Jerrold M. Michae 1
D!!an School ot Public Health University ot Hawaii at Manoa 1860 East-West &ad Honolulu. Hawaii 96822 World Federation tor Medical Education Dr Jose CUye~Dg EXecutive Director Association ot Philippine Medical Colleges and Vice-President World Federation tor Medical Education Manila
Dr C.M.H. M::lfidi
Protessor ot BaIIIIn Ecology Graduate School ot Public Health University ot ~heran Secret&r7 General Central Council of Universities and ACade1l1c Institut10ns ot Iran Ministry ot Science and Higber Education ~beran
Iran
WHO Regional Ottioe tor the We.tem Peo1t1o! MM11a Dr Francisco J. D,yRegional Director
Dr L. Hesselvik Director ot lI!laltb Services Dr C.J. &ss-Sm1tb Assistant Director ot Health Services Dr E.G. ltapal Consultant Health Manpower D!!velopment
Dr A. D. R&Jlmvic Regional Adviser Health Manpower Development
- 32 ADnelt 1 ~ARIAT
WHO Regional Offioe tor the' western Pacific, Manila
JIll K. Abbott Regional Adrtaer on Nura1Dg Educat10n ])r O.K. Ii:llel'7 Regional Adviser on StreDgthen1Dg ot Health Senicea
WHO Regional Oftioe for Africa. Brazzaville Collllll1 A.A. QuellUll Regional Direotor ])r
Dr A.R. H. ..,. El Neil Regional Adv1aer on Health Manpower Development
WHO Regional Office for the Eutern Mediterranean. Alexandria Dr A.H. Taba
Regional Director WHO Regional Office for South-Eut Asia. New Delhi Dr V.T .H. Gunaratne
Regional Director Dr A.R. Mills Regional Adv1ser on Medical Education
World Health Organization. Geneva Dr T. l'Ulop Direotor Div1aion of Health Manpower Developaeot Geneva
- 33/34 -
ANNEX 2
AGENDA
1.
Opening of the _ting.
2. 3. 4.
Election of Chairman, Vice-Chairmen and Rapporteurs. Adoption of agenda. Progress reports and highlights of the development of public health teach1ng/research/collllllUJl1t:y service since the last meet1ng at Brazzav1lle 1n 1913. '!'he health manpower process (planning, product1on, ut1l1zat1on). The role of schools of public health 1n health and manpower planning and development. (a) Class1fication of categories of public health workers, their qualifications, role and task allocation. Relevance of educat10nal progr8lllDeS of schools of public health to the needs and local conditions 1n each country. The role of schools of public health in the evaluation of health and medical care services. Methodolog1es of evaluation. The relationship between consumers (ministries of health and social welfare) and producers (schools of public health).
5.
(b)
(c>
(d)
6.
The future of schools of public health: (a> (b) (c) Structural and organizational considerations. Teaching of new discipl1nes. Implications of mul tidi.scipl1nar:y cooperation.
7.
Cooperation and collaboration between schools of public health in the African, Eastern Mediterranean, South-East As1a and Western Pacifio Regions. WHO sssistsnoe to schools of publio health.
8
Conclusions and reoOllllleDdations. Adoption of the report.
- 35ANNEX 3
Mo!!4H, 10 March 1975
0800 08:30 - ~5
-
AlTival aDd regiatration of participants Opening of the meeting (Item 1) by WHO Regional Director for the Weatern Pacific Region Me_age tro. the Director-General of the World Health Organization
-
-
Addreu by the 1ti0 Regional Director tor Atrica Addreae by the WHO Regional Director tor Eaatern Med1 terrenean
-
AddreIIa by the WHO Regional Director tor South-But Asia Addreaa b7 the Preaident ot the Aallociation ot Sohoo1a of Public Health
1000 - 1015
-
Election ot the Chairman, J Vice-chairmen aDd Rapporteurs (Item 2) Adoption of the agenda and progr_ (Ita 3) Eltplanation of the work1ng procedure of the . .et1Dg State.ents of participanta and observers on the progrella and highlighta of the deve10~t of public health teach1ngj' rea.arch/c c_ mt t7 aervicell aince the 1ut _tiJIg at Brazzaville in 1973 (ItelD 4)
1015 - 1200
Second p1en!1'l lIellaion
13:30 - 15:30
It.. 4 (cont'd)
-36Annex
3
Tueed!l. 11 March
Third plenary session 0815 - 0900 Introduction of the topic: The health manpower process (planning. production. aurvei11anoe). The role of aohools of public health in health and manpower planning and development (Item 5). General discussion Introduction to the working group sessions
0900 - 1015
1030 - 1230
Working group session (I) Working Group (A) Working Group (B) ItelllS 5. 5a. 5b Working Group (C) Working group session (II) Working Group (A) Working Group (B) Items 50. 5d Working Group (C) Conclusions on Item 5
1330 - 1530
Wednesd..,. 12 March Pourth plenary seuion
0815 - 0915
Presentation of the main pointe discussed by the groups on Item 5 D1soussion
0915 - ~5 ~5
Introduction of the topic: The future of schools of public health (Item 6) General c11sousaion Working group session (III) Working Group (D) Items 6. 6a. 6b Working Group (E) Working Group (F) Working group session (IV) Working Group (D) Working Group (E) Item 60. conclusions Working Group (F) on Item 6
- 1015
1030 - 1230
1330 - 1530
Annex 3 'lhurad!.y. 13 March
0745
-
Arrhal ot partj,clpantll and departure ot the IP"OIIP by buB to the Instltute ot PUblic Health. 1JD1vel'lllty ot the Phillppinea s7stea Vial t to the Inati tute Departun by buB to Risal and observatlon ot the health centre activities.
0800 - 0900 0900 - 1200 1300 - 1400 -
Return by bus to WHO Regional Ottice. Manila Teclm10al MeetiDg ot the Third General Asaellbll ot the Asaociatlon IntroductiOll ot the report on the review ot the aation taken tor the lmplelll8lltation ot the varioua reo· .xlat1ons IIIIIde by the IINvioua JlleetiDga ot D1rectol'll or RellNsentatives ot Schools ot Publio Health (Geneva 1966. IllPila 1967. Alexlllldr1a 1969. New Delhi 1971. Brusaville 1m) GeDeral diaouaaion OIl PI'081'e.s and success. probl_. taUuns aDd frustrations (
1400 - 14~
-
1530 - 1630
-
lWI1neas Jlleet1ng ot the Third General Assembly ot the AsSOCiation of SChools ot Public Health
~tth
plenarz session Presentaticn of the main points dlscuaaed by thegroupa on Item
0815 - 0845
-
6
0845 - 0915
Introduoticn ot the topic: Cooparat1on and collaboration between sohools ot public health 111 the Atr1CIlll. Eastern Med1terrllllellll, SouthEast Asia aDd Western Paa1t1c Regions. WHO ...1ataDie to achools of public health (Item 7)
-38Annex 3 Fridlll. 14 March 1975 0915 - 1015 General discussion Sixth p1enarz session 1030 - 1100 Distribution of the sUIIIDary draft report and recoDlDendations Adoption of the report and recommendations _ Closure of the meeting
1100 - 1230
-~ANNEX 3a
WCIRKIHl GROOPS Partlolpmt. _ tentat1vell' divided in 2 ut. and (D,E,P) u follo. . : Group A Awan Dixon El-Mell Parpour 1l1li&11 Jt1blJkI_okeGroup B All Bertrand Chen
ot groupe (A,B,C) Group C Aden1yl-Jone. AIII1nlBanerjee Cabrera CU7egkeng De Llluture El Motty El SIlerif PI1l~
Epetein* P_.,. Kekeh K)'We
ban Michael Madill
Of'oau-AIIub Oyedlran PapaaarathorD Park soetJabJa*
LlchtmwalDerJIIaoJi1eraon Mot1d1 fIIonekOllao MoteMdl RaJkovio Ronaghi Sed1q Salah
Mille Oluaola Phoon* Shehu
Someya TaJeld1ne
Group D Ali De Llluture El Mottl' El-Nell Jrekeh Konlll lIIIIoJi1eracm Michael** Mot8Md1* Park Phocm Secl1q Sal.tl Shehu TaJeld1ne
Group E
Group P
AIa1n1
Awan Banerjee Chell Cu7egkens Perpour
-
Aden1yl-Jonee* Bertrand Cabrera Dixon Epstein El Sherif PI1l~p
Para.,. 1l1li&11** Mille Mot1cl1
Jt1J;w'QpJ8oke
otoau- AIIaah Oluaola Oyecl1ran papuarathOl'll SOIIQ'a
K'1We Llchtenwalner Monekoeeo Mad1mRajkovio Ronaghi soetJahJa
-110-
Ple.e note the tolllllf1Dg:
(a)
...t1D& plaoe:
Group A - Conterence Hall " B - Conterence Lobby
" " n
C - ContereDCe
RooBl
423 - 424
D - Conterence Hall E _ CCIDf'erenoe Lobby
" (b)
F - Conterence Room 423 - 424
lEMh srouP will elect a Cha1rllan and a Rapporteur. Propoud 0 - _ 1Dd1oated b7 .tertak: Chairman (*) Rapporteur (**). '!.'he group Rt.ppCI1"te\In are requ. .ted to take notes ot the b1Pl1&hta ot the dUo_1ou and any reoo-mationa tol'la&lated b7 their srouP. pre~e a ~ report and to deliver tn_ to the General Rapporteur (not later than 6 p ••• ) tor the pre~at1on ot a .~ report ot the 4117.
(0)
- 41 ANNEX 4
srrm MEI!Il'OO OF DIRECTORS OR REPRESEhTATIVES OF SCHooIS OF PUBLIC HEAIll'H
WPR/HMD/SPH6-75/l 7 March 1975 mGLISH ONLY
Manila, 10 - 14 March 1975 Provisional Agenda Item
5
THE HEAIll'H MANPOWER PROCESS: THE ROlE OF SCHooIS OF PUBLIC HEALTH IN HEAIll'H AND MANPOWER PLANNING DEVEUlPME!n' by
T.
PUl~p,
M.D., Ph. D.
Director, Division of Health Menpower Development WHO, Geneva 1975
- 41a-
1.
mmOOOCTION
............................................
42 42 43
2.
AN IMP<Rl'ANT PRCEIEM OF '!HE HEAIllH MANFamR PROCESS
.....
'!HE HEAL'lH BmlVICES AND MANPQIER IEVEIDPIIENr (HSMD) CatCEPr ••••••••••••••••••••••••••••••••••••••••••
4. 5.
IMPIEMENTATION. 01' '!BE HSMD COI«:EPl' •••••••••••••••••••••• '!HE ROIE AND l'mIlTIONS OF SCHOOIB OF .PUBI.IC HEAII1H IN '!HE IMPIEMENTATION OF '!HE HSMD CONCEPl' •••••••••••••••
44 45
6.
CWSIFICATION OF CA'mG<JUES OF .PUBI.IC HEAL'lH WaucERS ••• SUJtftARY •••••••••••••••••••••••••••••••••••••••••••••••••
46
7.
50
-42Annex 4
1.
INTROIUCTION
It 18 a great honour and pleasure to meet onoe mre the directors ot 1DIItitutee providing postgrlMiuate public health education in Africa and Auatraluia. I had the privilege of participating in the last four meetiDp and have t:lNs had an opportunity of admiring both the rapid develop.ent observed recently in this field, and the serioua concern that the.e 1DIItitutes demonstrate towards the solution of the most pressing health problema of their countries. AN IMI'tRl'Alfl' PRClBIat OF 'mE H!At:rR MANl'<*ER PROCESS
2.
Among these problems there is one which is so complex that its solution would require a concerted effort on behalf of all those responsible for health and for the training of health personnel. This problem is the lack of integration or even co-ordination among the different elemente of the health manpower process (planning, production and utilization), as well as between the health manpower process and the development of health services. The three main elements of the health manpower process mentioned above are generally being developed separately in a rather isolated way, and the stage of their development in the different countries is very varied. The planning of health manpower, that is the definition of the quality and quantity of manpower needed for the efficient coverage by at least basic health services for the entire population, is being developed in manu countries, but in IIIOst cases it has no, or hardly any influence on the "production" of health manpower. Thus the health manpower production phase is rather isolated from that of planning and hence from the health services for mich it is meant to meet, or hardly meets, the needs of the country. The third important element of the manpower process, following the phases ot planning and production, is that of utilization; it involves also the mon1toring of health manpower, ~ly (i) the assessment of mether the health peraonnel t:INs trained is able and read¥ to cope with the tasks for which it has been trained; and (11) the feeding back of data into the planning and production phases with a view to correcting them (and thus closing the cybernetic cycle of the manpower process). This latter element has hardly been developed anywhere. This problem has resulted in the fact that to the very real problem of univeraal shortage of health personnel, another has been added in the past few decades, namely that even those few trained health workere who ere available are either: a) not always oriented towards the local health probl_ of the COIIIDnn1 ty they are to serve and, . . a conaequence of this, b) tend to congregate in large cities
- 43Annex 4
wh.11e the ""or1ty of the populat1.co is living in rural lI1'eas. or they Juet leave their country to serve other less neede cOlllllUllities. or devote ~lve. to Ind.1v1dual patient CIl1'8, serving Just a few inateed of the ~, wi'tA little t1lle or concern for health protection and prOllOt1.on; 0) they _ not alwqa employed. in the work for which they have been tra1necl - an4 'tAua their services lI1'e used wastefully _ while II~ of the activ1t1.. . they carry out could be delegated. to less highly. and theretore _h.ore econoaically. trained members of the health te8lll; and d) too often health workers are not well prePll1'ed for the work they OUSbt to pertOl'l8 tint and foremost in the field of health protection and ~Ii1C11l. In ~ countries these proble. are compounded bec_ there 1a no provlsiOll for a systematic and organized type of eont1luW:l& eduoation which would allow the maintenance and cOlllltaiat 1IIpro~t of the quality of pertoZ'lllllllCe. 'ftle present syete. of health ~po1llllr 4evelo~t tlhich tendII to perPetuate the ex1atiIIC tred1 ticmal types of health personnel with all the biues and 1rralevanci88 built into the sTlltem. is unlikely to iaprove the 81tuat:LCIIl.
3.
'DIE BBAIm SERVICES AND MANPOWER
IEYBIDPMIDfr (HSMD) CC»ICEPr A new concept is 'tAerefore needed. and 18. in fllOt. emerging. 'ftlis replaces the health ampgwer daveloPlll8llt concept by "\;hat of the health services and - . o - r developaent (HSMD) concept. It implies a double integration. lI'1rIItly. an integration within the health manpower process i teelf 1Ib1ch 81gnifies that health manpower planning forma the bads for heal'tA IMIlpo1llllr productiOll (this is not the case in ~ 1netances tod~ becawse health manpower planning. when it exists, does not noel. . ..rt'1c1ct attent1.an by the schools actually produciDg the health -are). The health personnel schools and s1m1lar train 1n! 1II8t.ltutlons should produce the types and nwabera ot health ])erBOllllel . . def1ned by health JIIIUlpo1llllr planning. 'ftle students aboulcl be preparecl with tba ald.lls required to _ t the health needs 8Dd de M. of the c« IDity establlahed on 'tAe basis of rigorous reseerch work. TheIl. 0 _ the 'tA1l'd II&1n el8118nt of the process. the ut1.1izat1.on 1UIIl, wittW1 Its tr~rk, the mon1toriDg of health peraoanel duriJI& eIIPlor-t to _ s tlbether they _ being properly e.ployed. and _ MI.e 8Dd.. read¥ to cope with the taaka for tlhich they have been tra1necl. «DIe reaul.ta of th1s 8OJl1toriDg is being fed bllOk both into the IDl into the production II1'8U. and the latter two ed.)uated accord 1 ngly. 'Jh1s proces. should work as a cybernet1.c c701e 1n a . .It-correotiDS w~. Wi'tA1n 1 t each subsystem haa 1ta own proper IMIl.f-cUzoect1D& oyole. e.g. within the training process: defining the lelll'll1na objectives on the baais of Job
pl._'.
-44Annex
4
descriptiona provided by III8Ilpower planning; building the learning experiences (defining the curriculum end selecting the methods) on the bllllis of the objectives; and then evsluating how far the objectives have been achieved by the learners l1li well l1li the whole teachinglearning proce. . , and eventuslly feeding back the evsluation results into the process of defining objectives and learning experiences. Secondly. integration is required between the health manpower process and the hesl th services development process. This /Ileana that the only aim of the heslth IIIIIIlpower process is and should be to contribute to. end to support. the efforts towards the strengthening of the hesl th services. '!be only yardstick to mellllure the effectiveness and efficiency of the health .m:Ipower process is: how far and with what results has it contributed to the development of heslth servioes and - throught it to the iIIIprovement of the heslth status of the population. Putting into practice the HSMD ooncept involves the full develoPll8llt of health III8Ilpower planning and. blllled on it. the development of completely new types of schools which reslly cater for the heslth services. Both the new schools end the old ones should aim at preparing gIle required hesl th-tesm members. training them in a teu and orienting them towards the heslth problema of the cOlllDlllli ty • ready to contribute. with other teu members. to the solution of these problema from the angle of their speoific knowledge and skills. Eventuslly the full development of an appropriate information (surveillance) system will be required to mellllure performance against obJeotives and to feed back this information into the planning and production process.
4.
IMPIEMENl'ATION OF '!HE HSMD CCliCEPr
The putting into practice of the HSMD concept will require time and further elaboration of even theoreticsl details. An effort in this direction has already been made and. slthough the bulk of the work remains to be done. the first results are promising. '!be mechanism to being about such a double integration will. of course. differ from country to country. For example. a councilor a committee, with or without a permanent seoretariat, within whioh all those interested in any part of the HSMD process. would be represented at the highest level. It may slso take any other fol'lll, the structure being without significance; the important thing is that the mechanism f'unation in an efficient wq and on a permanent besis. In brief, the structure should serve the proper functioning of the mechanism (double integration) • These are rather radiosl changes which would slso lead to the appearance of n_ types of health personnel. Even the village health workers and traditionsl healers would be integrated into the system. together with the environmentsl heslth personnel. This would slso put
- 45 Amlex 4
an end to the present ove1'oollled1calizatlon of the system bacllLlse doctol'll and nurses would perform. within the health team. only those tllllkll for whioh they wel'll tra1ned. Lelldel'llof the health teu would be especially tra1nBd in lIalWgerial sOiances and teohn1ques in order to be able to oope with their tulcs. Be1nc a doctor or a nurse would be just a buis for suoh training. althOUSh other health tau I118l11bel'll. attar proper training. would also qualify for tau leadersh1p. Moreover. teu leaderah1p may change in differant situatlons according to chsns1nc needls.
5.
THE Rom AND liUl«lTIONS OF BCHOOm OF PUBLIC HEAmH IN THE DlPIDIEIfl'ATION OF THE HSMD CONCEPr
The question naturally emerges: what will be the role and f'unotian of the inst1tutes provid1nc postgraduate education in public health (for the sake of brevity: sohools of publ1c health (SFH). in the above-desoribed proaess and mechan1sJII. 'lbey will obviously have a key-role. The SFH w1th its undel'lltanding of the probleJIIB of community health and w1th its orientat10n towards the cOlllllll1lity - rather than towards individual health needs and delllsnds with its knowledge and skills in planning. organ1zation. adIII1n1stration and evaluation of health services can be. and should be. in a certain sense the real proJllOter of the development and functioning of the double integration desoribed above. As far u the f'unot1ana are oonoerned. the SPII. within the fr_work of the well-known three-pronged activity (tra1n1nc. research. service). IIIay perform the following tasks:
5.1 In all training activities the SFH should strive to assist learners in undel'lltsnd1ng all the implications of the HSMD process and in contributing to i til l'IIal1zation and implementation at the place Idlere they will be working. 5.1.1 'lbe SFH should provide. Idlere this has not yet been done. proper learning opportunities for top- and III1ddle-level health managers to enable them to plan. organize. eciJll1ni ster and evaluate health services with due regard to the HSMD process. 5.2 In the research .rea the possibilities are countless. 'lbere is a need to develop a proper scientific basis for: health IIIIIIlpowsr planning. u well u for 1ta 1ntegrat1on into the general health planning and. through 1t. into the general socio-8Oonolll1o planning process: for the des1gn1ng of an evaluation system of a JlleChanism for control and feed back: for the development and/or strengthening of a health manpower infol'lll&tion system. etc. etc.
- 46Annex 4
5.3 Within the f'l'~rk of ita service tunctions. the SPH could help to develop tully the "three main elementa of the health manpower process. and especially the planning and IIIOnitoring of health IIIIIIlpower as well as the double integration we have talked about here. The SPH could contribute to the solution of the IIIOst important problem within the f'l'lIIIIework of the HSMD concept. e.g. that the problem of prillllll'Y health care be approached holistically and in the context of the entire national health needs. FurtherJDOre. an evaluation mechani_ mOllld be dea1gned to monitor the implementation of the relevant national policies and plana as a single Whole. including the utilization of qealth personnel. This is meant to ensure that institutional objectives of both health aervice and manpower develop. ment acencies/-sente" are not mtually supportive but also are consistent With explicit national policies in health and other related matters (education. employment. rural development. etc.). These are Just a few examples to give a sample of the tunctions Which !light be carried out by SPHs Wi thin the f'l'amework of. and for the implementation and putting into practice of the HSMD concept.
6.
CIASSIFICATION OF CATHlCIUES OF PUBLIC HEAIlI.lI WORKERS
In the light of the new concept there is a need to discuss once IIIOre the kind of "product" expected f'l'om an SPH. An expert co_Utee dealing with postgraduate education and training in public health. convened by lifO in 1973 gave the following definition of an SPH: An SPR "should be viewed as a tunctional entity Whose main purpoee is to provide general and specialist public health training for meillbers of health and other professions Who require it. Among the courses offered there should be a basic course leading to a postgraduate level qualification in public health. Schools of public health JIIIQ" also have research responsiblli ties and provide direct and adviso17 services to the c~ ty".l Then the report goes on to s~ that "in the present context public health training is taken broadly to _an the postgraduate training required by health planners. adIII1n1strators and personnel engaged in public health services Who need such competence".l It seems clear that two basiC types of personnel are expected from en SPR: the generalist and the specialist. It is indeed very difficult to go beyond this statement if we look for proper classifications. The previously quoted report states: "the graduates
~ld
Hlth Org. techn. Rep. Ser •• 1973. No. 533. p. 7
- 47Annex 4
of different schools 11111 have to function in d1fferent CtRWm:l ties and thus _ t different local needs. These d1tferences IIWIt be reflected in their training. Basic postgraduate education in public health cannot be un1form 1n all sobools: one can no longer speak of a "standard" core curriculum. Instead. schools must e.uize those competences that their graduates will need to perform effeotively u public health workers 1n the particular cOlllllUI11ty they plan to serve. A suitable approach to educational planning. therefore. is to establish a set of objectives. bued on local health needs and demands. that the selected cOUl'lles DUst help the student to lIIlhieve." 1 Obviously. the clusification of categories of publio health workers hu alwIITS been a diffioult question to deal 1I1th. It appeared on the agenda of the previous meeting of Directors or Representatives of Schools of Public Health (held 1n Brazzav1lle 1n 1973). In introducing this subject on that occasion I said that the present pattern of aanpower 1n pub11c health. u well u 1n other health fielda. had daveloped spontaneously 111 thout prior deliberate and comprehensive planning. 'lb1s pattern has been changing constantly following. with greater or lesser delq and accuracy. the ohanging pattern of health needs and deJllllllda of society. For example. the team working 1n the field of public health is becOllling IIOre and more multiprofessional. in character. reflecting the growing complexity of relationships between the health of the oClllll.lll1ty on the one hand. and tne physical and social anv1rcm.ent on the other. Moreover. the place of the physician in this team 1s alao obanging; this 1& also reflected in the decreu1ng Pl'oportion of the number of Pl7sicians in the team. which fell from halt in the'oeg1nning of the century to one-tenth in the late 60's. Among the _bars of the pub11c health team we are now finding sanitary engineers. sociologists. psycholog1sts. chemists. nurses. microb101og1sts .veter1narians. dent1sts • statisticians. mathematicians. electronio data processing speCialists. and others. as well as the1r auxiliaries. It appears that the time has come to define both quantitative and qualitative health manpower needs on the basis of scientific investigationa, and here the public health field 1& no exception. These definitions should take into acoount differing needs in oountries and regions. but should nevertheless be based on un1form methodology (or at least on oo-ordinated studies). The SPH should plq a key role in the Association of Schools of Public Health. in oollaboration 1I1th the WHO reg10nal offioes. could undertake the co-ord1nation of such studies.
lwld Hltn Org. techno Rep. Ser •• 1973. No. 533. pp. 12-13
- 48Annex
4
Onoe the aategort. . or publia health workers requ1red to perrOl'll aertain tub to _ t . .u-cler1Ded DHda ·aDd de-ppd. are establ1shed, thelr alua1fioat1an aould be undertaken, 1r at all needed; and, in add1t1an - . . . . ~t - the quallfiaatlQ1111 they should have to enable 'tile. to aarr;r out their tuka could be exactly desarlbed. All tb1e would tbua be baud on Job desartptlQ1111 elltabl1ahed an the b_1. or tMIt anal.7ae.. Such an uerol8e would certalnly reeult in a new allocatlon or teaks and the appearance or new categorles or health worker. and a more eCfectlve and eff1clent ut1li&atlan or all personnel. It 18 ne1ther l1kelJ', nor perhapa necessary, that SIBs will ever be able to prepuoe all the profesa1onal8 needed in the fleld of ao...uty health. KftD a:tter a_M unpower planning, publia health workers will aClDlltltute a II1x or 1nd1v1.duals requiring a wide range or soedlllll1c, teobn1oal and prore.a1ODal preparatlon, whiah cannot - and should not - be proY14ed by one .~e 1DBt1tut1on. Nevertheless, SIBil _ t .trive to provide auah training in suff1clent quant1ty and of the deslred qual1 tV. 'DleV aaD contribute to such IIUIIlpower develo.-nt JIl"OCl'- in var10us .~., 1Doludlns by _ _ or: (a) reorult.ent and preparatlan of teaohers, both in subject matter and in pedagOU', ror the different types or tra1n1ng progr_s; (b) elltabUsh_t or pilot tellQhing progr_1I for experimental or detllOlllltrat1an purpo... , as well ea with a v1ew to preparing and proIIOt1ng their .toptian in other sohools; (a) enoouragT T·t or other tra1n1ng inst1tut1ons in adopting tra1n1ns progr_s alrelld;r exper!e. .nted and tested; (d) ...1atenoe to progr_ _t1cmed under (b) and (c) by: 1. 11. 111. 1 v. helping to prepare the1r teaching lltaff; keeping their cantent and me1:bods up-to-date througb. OQllllultet1one; aooperating in the evaluat1an or the. . progr_lI; and. aantrolling the 8PJIl'Opl'iatenesll or thelle progr_ in _ting the evel'oooheng1ng aOlllll.lll1ty health needs;
(e) degreell; (f)
prorl.1on or progr_1I granting formal soademia and other
aant1nuing ed.uaat1an IIICt1v1 t1es; and
(g) psrt101pat1an in .tudiell 1dent1rv1n8 IIIIIl1power needs in the JII,lbl1a health field.
- 49Annex 4
It 18 \Ulderat ... that no ·offioial" olaaaifioation of oategoriee of publio bealth worbra baa been dr_ up. In the Un! ted States of Mel'1oa the SPHa _ard .are thaD ~ graduate degNee in ocmneJd.on with whioh a report etated in 1969 that their "ooaap",llity. one with enother. ie ' . . . .ible to work out. A complete refOl'lll of the dell'!! .tructure ie 1DIl1eate4. A .1IIple. but 8)'8tem would teature two deCh. . at the Maater'. level and two degreee at the Doctor' e level (one teolm1oal or .cientitic and the other general or adJI1n1etrativa at eMb ,level) •nl 'DUe e),etem h.. .till not been oreated. even ....en thOU8b . . a b;;I; list ot eduoational. qualitioations for a number ot oategoriee ot publio health workera were published in the Merioan Journal. ot PUblio Healtll rr- the late 19JOa CII1WU'ds. 2 'lbe probl_ of the ol...itioation of health pereormel was aleo oonsidered twent)' ye_ ago b), Troupin. mo etated: "Auxili8l')' workers should be cl...it1ed by tuDctional. oategorie. and by eduoation and training. eo that oOllPC'abili t)' of tem1nolO8)' mIlT be attained in the future."' 'lbe oOllPG'abili t)' of terminolog)' all,vooated b)' Troupin has not ),et been attained. the ILO hu not even attempted to ol. .eif)' publio health workers. 4 'lbe problem ot ol..eifloation hu been tackled fi'0III various other angles but baa not been eolved.5.5.7.8
wu.
-an1nsful.
.OM
~pin. J.L. (1969) Schoole of publio health in the USA and ClllUlda Crear J _ 1969). Doct cPE-69 B5. Amerioan PUblio Health As.ociation. MI.,
.'ng
~r elUIIIPle: De.irllble qualit1oations of nursee appointed to publio healtll lNI'IIiDa poalt1ona in induetry. Am. J. Publ. Hlth. 1m. !2. No.7. pp. 43-48. Pzopoaed report on educational. qualifications of directors of publio health departmenta, All. J. PUbl. Hltll. ~. pp. 363-'70. 'TrouPin. J.L. (1955) H_lature and ol...it1oation of health persormel. VUll. Wld. Hltll. Org •• 12. p. 421. 4 Intem&tional. LIbour ott1ce (1969) International. etandard cl. .eit1oation of occupations. Rerteed ed1tian 1968. Geneva. lID •. 5Un!ted Itinsd- General Medioal Council. Reoa ndations (1967) as to dipl_ in public healtll IIId eUd.lar qual,ifioat.iona. IDndan. it. ot EIaplopmt. Cl...ification of occupationa aDd d1reo~ ot occupational. titles. vol. 2 Det1n1tiona of ".'n 1 etrativajtea!m1oal/oler1oal/. .rv1ce occupations. 1972. pp. 80-99.
60reat Britain Depa'
7 Prot_ional. heal.tIl Mnps-er tor OCi 11'01 t)' health United States De..... ' It ot Health Mwdm.tration. School ot Public Healtll. Un1vara1t)' of Kortb CVol1na. 0lQa1 Hill. 1m.
progr_.
8
Eduo. ~. Sal.\ICl. l~.
8. No. ,.
- 50Annex 4
Eventually we have to accept that functions perta1n1ng to public health will have to be carried out at all levels of the health manpower pyramid. Village health tIOrker. will have to pl~ an important role in this. 'lheir trainer., consultants and supervisors at middle level, be they lledical ...istant., public health nurse. or, in rare c .... , PlJ'aicillllll, will have to be able to carry out public health taaIaI at their own level . . generalista, in Idd1tion to their functions in conneldon with tra1n1ng, .upervision, conaultation and continuing education in the public health tield provided to the village health worker.. Besides these generalist., health managers who are another tJ'PII ot generalists, should also be trained tor top.. and middle-level posts. Specialists, and their IIIIX1liaries, will be needed tirst at national and. later on - in IIIDaller numbers - at pt'Ov1ncial level .. well. SPHs will partly train. partly provide trainers tor all these categori. . ot public health personnel and will ellllUl'e that their training is relevant .. to the real health needs and dellllUlda ot the c-ru. ty • ibey will also work out, and assist in the application ot appropriate methods ot evaluating the health and medical care services and the whole HSMD process. ibi. process, .. we discussed. will al.o ensure the relat10nllh1p between consumers (Ministries ot Health and Social Welfare) and producer. (schools ot health personnel). These latter questions .. well as the whole complex problem ot the future ot SPHs, will be discuased by other more competent speakers and I shall there tore now thank you tor your kind attention and wish you a very successful and fruitful debate.
1.
S\DIIIARY
One ot the serious proble. countries have to tackle in the health tield is the lack ot integration or even co-ordination IIIIIOIIg the main elements ot the health manpower process (planning, production, ut11isation) on the one hand. and between the health services development and health IIIIIlpower development on the other. A new concept has emerged to help solve the above problem: the health services and manpower development concept. In the implementation ot this concept. in the functioning ot the permanent mechan1sm to be established in order to ensure pt'Oper impl_ntation, the schools ot public health (SPHs) have an important role to pl~ in tra1n1ng as well .. in research and service tields.
-5J"ISQ• Annex 4
In the l1&ht of the Dell' ooooept there i. a need to reView the categorie. of health perilannel to be tra1Ded by SPHa. "I'le.e 1nat1tutions should be involYed, in ODe wlq or 1IDOtber, in the tra1n1ns of the whole rllllSe of health personnel, HIIIbera of the health team workirls in the publio health field, at all level. of the health naanpower PJI'u1d, and not only IIn1 .irlsle category of th_. A cl...ifioat1on ot categories ot public health workers haa .0 tar not been ••tablished, in .pite of the dirterent effort. made. What ...... to be 1IIportant i. the relevance of the tra1n1ns to the health needs and. dalllllllda ot the local coDlWl1ty, and the PNpu'atian of h.alth workers, in .urtioiant nWlbers and of the right quality, to meet tho•• needs. Cl..a1fication and than even comparabllity have IIIIlch leas import_e, and should be baaed, i f needed at all, an taak de.oriptions and ol.arly .tated eduoational objective••
- 53 ANNEX 5
snm JiiiIffOO 01' DlItIIC'l'ORS at REI'RBSBII'l'ATIVBS 01' SCHOOIB 01' PUBLIC BEAIJrH Manila, 10 - 14 Maroh 1975
WPR,MMD/SPH6-75/l3 10 March 1975
Prov181C111al yeuda 1 tali 5b
'lHAILAND'S HEAIlI.H MANPOWER PIANNING IN Pl1JI8Pl!X:TIVE by
Prof•••or Tcmaoha1 Papuarathorn D..n, I'aculty of Pu.bl1o Health lIIah1do1 Un1vere1ty, Bllngkok
-54Annex
5 1. INl'ROWCTION
Health _power plllDll1ng and forecaatlng i. a matter of inoreuins ocmoem at all levela of economic planning both national and intemational. At the present tiM, 'lba11and i. in the period of 1IIple~tat".. the 'l'h1rd National BoOllom1c and Social Plan (1972-1976). in 1Ib10h health sector is oonaiclered., for the f1rat tiM, an integral part of overall d • .,.los-nt of the 00lm1ol7. It i. now in the procesa ot preparing the Pourtb Pive Year Plan, 1977-1962, and three groupe of oOBDittee are plllDll1ng: a national health aub-oOllllll1ttee, a ooordinatins ocall1ttee and • work1ng c~1ttee. 'lbe methods. pl'OOedures and teohDiquea of plaaniDg tollow the WHO Guideline. of Coun1ol7 Health Prosr_' ns, Little conaideration has been paid to health manpower develo~nt. 'lbe followins are . , personal vie. . pre.ented here for 41acuaaion.
'lbe objeotive. ot health IUllpower plannins are to Slaure the opt1muDl uae ot the human rsaourcea ourrently employed, and to provide tor the future manpower needs in te1'lll8 of akill.. knowledge and" capal31ties IKltual17 or potentially available for econom1.c and .ooial cl.evelo~t. Man is the most 1mportant re.auroe in the health syetem. By his IKltion he oan affect the total etfioiency of a health del1very ayate. at all level. of its operation. In oonaider1D8 the meana by 1Ib10h a oountry oan make the moat effective uae of its manpower. it i. helpful to think in te1'lll8 of a manpower develoJDent .ystem. 'lhe oomponents of the l17atem are cluaters of IKltivitiea. relatins to: (a) 'lbe oollection of baaic data on number and categories of health manpower of those alreadT worldns for health service., potential health workers and prospective health personnel; job de.cription and pattem of utilization of health JIIIIlI)OW8r; and tra1n1ns atandarcl.a. (b) 'lbe analyai. of needs and re.ource. to identity the major health manpower problema and Job/man tra 1n1 ns needs. (0) Planning to _ t the needs by recruitment, tra1n1ns. oareer profeasion and replacement. (d) TIIk1n8 action to _ t the needs by cOlllllUllioationa, adm1n1.tration, .election, tra1n1ns oourse., performanoe development. and oarrer development. (e) Monitorins the effectivene•• of the action on tumover rate, evaluation of tra1D1ng, review of objective. and performance .tandard.
-55!S6 Annex 5 '!he role of the Faaulty ot PUblic Health, Mabidol Unive1'llity in the Fourth I'1ve-Year BcCll10ldc and Social Planning 18 concerned and reapcmaible tar: (1) the to1W.llation ot national health policiea, objectives and plma; (2) the trmalation ot the health needa and resources available to produce the right DWlbe1'll and right level ot knowledge, lIk111a and capacitie. ot public health personnel in the right t1llle tor the country; C~) the studies ot .ocial, technological and other t.,tors that aftect de-.m and supply ot health manpower, the patterns ot health aanpower utilization, manpower forecasting, career development, etc. At the JIl"8sent time, 'Iha1land has 42 061 000 population and 8~
ot them live in rural _as 1II1ere infrastructure for economic
and social development is poor. Insufficient quantity, low quality and maldistribution (between urban and rural _as) of health manpower _ uaong the JlaJor Pl"Obl_, (aee Annex 1, health manpower by aelectee! oatecorie. and 1natitut.ionsfor 1972). The analysis of health probl_ and d.......".. for health servioea, (aee Annex 2, mortality and ..orbidity, 1II10le oountry, 1972; Annex " classification of population .,oording to their eoonomio status, showing the methods of utili&ins medical treatment serYtcea of various categories and expre.ses of ellQh category) reflects the necesaity of oloaed cooperation with oonsumers of health personnel and related health manpower ageneies, i.e. Budget Bureau, Civil Service Department, National Economic and Development Board, in the reviaion of national lDanpower policiea, objectives and plma, inolud.1ng the improveMnt ot eduoation planning and reaearch stud)' in the field of health manpower development syatsm.
The emphasis in manpower"development should be on self-development. This requires that the adIII1n1strators helpe their subordinatea to check their own pertol'lllBnoe, and to channel their particular talents in a manner that will enable the. to .ate the ..ost effective use of their talents. The reapcmaibllity of the Faculty of PUblic Health should develop wqa and _ _ of Pl"Ovision of education and training on administration, eapecially personnel managelDBllt, superviaiCll and oClltrol, col1llllU1l1cation, etc. far both health adw1n i .trations, and undergraduated level of health Pl"Ofessiona.
.£nnox 1
~ 1. Physician
2. Dentist J. VeterinareOll 4. ::hnrnaeist 5. Dental IIygiontist 6. Nurse 7. Fractical nurse 8. Midwifo 9. Ibalth ..,rker 10. Dietician 11. Physiotherapist 12. Scientist 13. Social ..,rer 14. Psychologist Health educator 16. Engineer 17. kchit.at 18. Technician
1'.
'Ie,lth )!onpowur by Soloctod Catogories md Institutions for 1972 other .admini- Speci al Pregr8l'llllO Spocial Hoalth Ccntor ~.:n:~-:, 2nd Mini ... t. • strativ. Ibs ital 1st a SH trios 5;Jf 50: Prov. 50: PC p3KK PC ",KK PC IlKK Prcv ~ 1'5 VD Frov. (.23 103 72 258 167 15 P1 27 22 14 39 1 1,888 6 14 183 8 1 9 85 320 15 34 3 - 2 1 2 3 94 117 1 5 2 3 289 13 17 16 98 7 2 17 3 53 38 9 4 221 216 311 8 12 67 15 2 05 14 3,735 215 60S 12,~14 19 P95 9 91 201 171 2,043 57 8 54 13; 60 15 271 ~~ 126 493 2 19 20 1141 117 936 47 67 9 4 7~i 31. 319 1067 58 21 ~~ :l e 79 1 j40 9 10 II 20 1 2 32 28 3 7 2 6 8 50 6 - 2 - 115 129 12 9 15 9 4 26 37 16 10 2 -13 18 4 35 4 27 16 31 3 7 27 6 a 14 3 26 2 28 3 4 11 20 13 126 14 5 586 3 3' 169 145 34
State Enterprise**
Municipality
-
-
-
-
-
-
-
- - - - - - - - - - --- - - - - -
-
-
-
-
-
lI!lllWl
--- - - -- - --- -~~ ~;~ - -- - - - -- - - - -- - - -- -- - - - -- - - - -- - -- -- - - -- - --- - - --- -
-
BO: !Prov. 231 20
720 2
133
72 7 369
-, ~
98
-
1 21
46
18 5 3 4
~
11 1 - - 2 J ... 1975.
1
18 6 5 5 3
-
6 4 1 2
Fri-• vato BKK Prev. 83 39 271 14 1 44 19 IJ) 19 3 2209 20 6 5 203 110 6)9 14 17 881 12 25 353 181 142
( V1
1 -4
2 3 8
-
-
-
§
V1
-
• No data for Ramathibodi Ibspital. No data tor Solldej Sriraja Ibspital • •** Data tor Spacial Pregr81111111 includes Bangkok and Previncial areas. P.C.
*.
Health Planning Division 110. Pln./7/T.51/C.58
c MOH & FP
= PrevinUal
AnneX
2
lDR1ALIlY AJ,1l lD!l1ltDITI, 1IRILE COUi:'l'RY, l.9'12
KlRl'ALI'lY AIID IDRBIlI'lT (1972) Il£ATHS PBOBLEI·j a.uPS
110.
IIi - PAl'IIIIl' DISClWlGES Rate lIoap. Rate per 1000 pop par Total 1000 !'rov. IIIDt ~. BlCK pop.
Hosp.
OUT - 'UlBIT (VISITS AIlD mISS or II.DIISS) R.C. Other Rate per 1000 pop. Surve7 froj. IIosp B.C. Oth'!l SUmT Total froj.
1. Accidents.
~S,720 pre~oy,
.73 121,450 12,7'lt 3.44 .10 92,660 57,60( 2.6
.36 3.80 549,830
497,610 31,590
1,501,86< ~.38 ~.07 83,440 1h.45
42.47 -
74.92 49.58&
2. CoonIIlpliostiona ot
3,450
1.6· 4.2"
51,000
.89
2.36&
childbirth aoi the
l""l'P"r1\111l. 3. ~Jom&l
deliver;r.
-
-
82,590 79,17( 2.2&
a.,·
4.5&
r-n,OOO 22.090
55,290 ~52,900
1,001,240
1.56
28.31&
40 Infeotiaun IIIld pe.ro.si t1c water and tood borne diaeU81
41,920 1.18 ~1.600 5,950 .17 53,080
9,78C 2.87 3,26C 1.50
.28 3.:"5
55,340 8,510,570 9.11 ~.64 1.56
fuoo·68
~66.99
J
5. Infectious vectot-bo..... disoues.
.09 1.59 p5.170 •44 3.32 .15 .10 .12
•
51,340 l.31,25O •
8)4,250 4.95 1.45 3.71 23.60 60.1,54,50( 33.24 3.40
33.71
6. RBspirator;r tract inteotiona. 98.060 2.77 ~~,700 15.49C 2.88 7. Infoctious disease a 26,990 5,l6C .76 controllable by 1IIImun1za~n
175,)40 1.180,850 39.550
161.27 ~27.91 61.39
.91 .53
86.980 41,767 296.490 414,.3'10 209.310 150,070
2.002.481 1.12 2.46 1.13 56.63 4,255,28C 3.20 8.38 11.72 3.170,60( 3.36 5.92 ~.34
58,460 1.65 15,290 3.530 15.470 .44 23,390 4,350 69.500 1.96 73,770 ~.020 I
8. Other infeotious diseuee. 9. Diseuea due to deficiencies. II.ltri tional
.43 .66 2.09
m,OlO 118,660
.. t43.44 98.95 89.67 .05 75.51
.78
1.16 3.25
293.840
8,821
2.669,9&: 8.31 4.24
I! I
88.11 .
•
,~.':C' 3 Classificc.tion of Population according to their ·te theip econor.lic status, showing the
~thods of
utilizing r.tedical treatment so~Jices of various cattlcories and expenses of aach category, by region.
IWgion/:::conomic No. ot time. of illnesses
. lilnesses and exppenses lncurre<l.1n meclical. l'umber of times of the utilizstion of services of various category and e>1"'n888 thereof. &xpen.es Average in one
I! OTHERS Tima. pense.
Buy drug. tromdrug stores
Iioalth Centers
Government
expenses
!k>spital.
in one
lIIOnth
each tima
Private Clinic. & !k>spital.
lferb Doctor Quack. & GrSllllY Miclvive.
Times
Expenses
(Baht) C3I1tral, Total Poor Middle c10 •• Rich Total Foor
Tima. ExTime. Ex- rima. Ex- Tima pen ..... penses pensos
ExpenS8S
Ex-
(Baht) 76 2,382
North.
1,208 233 489 486 63 259 120 617 158 294 165 568 68 339 161 1,094 279 565 250 3,929 ,
94,550 15,133 31,731 47,686 18,539 1,153 9.604 7,782 32,421 5,168 17,191 10,062 28,667 3,280 17,247 8,140 1)0,300 19,525 ,57,825 52,950 304,477
78.27 64,95 64.90 98.11 41.95 18.30 37.08 64.85 52.54 32.71 58.47 61.00 50.47 48.23 50.87 50.56 119.10 102.34 211.80 77.49
~ 338 240 43 143 54
19,365 5,635 7,341 269 6,389 4,202 333 2,136 1,733
13 488 32 745 31 1,149 8 1 5 2
145 22,815 19 2,338 59 12,137 67 8,340 72 4 37 31 43 4 21 18 49 4 23 22 5,564 160 3,034 2,370 4,705 385 2,761 1,559 5,894 640 4,026 1,228
231 24 77 130 67 '4 32 31 79 12 33 34 115 10 62 43 470 85 242 143
42,1)1 3,728 9,858 28,545 3,665 105 1,081 2,479 9,293 485 4,352 4,456 10,461 1,069 5,914 3,478
99
35 40 24 60 19 34 7 96 33 41 22
7,837 2,944 1,630 3,263 4,723 555 3.293 875 4,487 1,375 2,770 342 3,832 189 2,595 1.048
1 17 2 11 4
1
442
Hidd10 clr •• Rich Northeast, Total Poor Midd10 t1as. Rich South, Total Poor Micldlec1ass Rich Bongkok-l'bonburi, Total Poor Middle c1as. Rich Total
20 70
90
• 295 40 255 200
20 20
i
436 11,778 120 2,596 211 5,587 105 3,595 341 44 214 83 6,289 1,079 3,923 1,287
43 1,958 16 327 22 1,521 110 5 49 2,191 303 5 27 789 17 1,099 14 10 2 2 190 375 275 50
1 1 5 1 4
2
200
-
57 10 37 10 14
69.98
405 21.400 121 4,200 227 12,475 57 4,725 2,197 63,034 1
50 ~,996
142 136,300 5,025 15,950 32 15,325 451 75,278
3 1 1
t:
70,775 9,975 29,275 31,525 962 136,325
275 0 ~ 75 150 4 326 21,154 i
1 28
515
- 2 -
KlP"::.LIT'1 AWl DZd.1".dS
:il,~UIT'l
(1972) OUT - PATml! (VISITS AIm TINES OF ILnlESSl
..
tlo.
Rate per
DI - PATIEl!! DISCHARGES Hosp. Rate per 1000 pop
1000 pop. U. Diseases associated \lith
Prov.
IllY.
Prov.
BKK :!btal
IioDp.
H.C.
Other Oroj.
lla.te per 1000 pop. SUrve7 Hosp.
H.C. ~ther Proj.
~7
:!btal . ..
3,600
.lO 44,080 6,520 1.25 .18
1.43
259.930
189.570
171,601: 1,585,30( 7.35 5.36 ~.85 ~.83 ..
62.39
.tre ••
@d
mental disorder<
12. Iliseaso. of
.kin.
2,010 lO lO,07O
.06 13,490 1,630 .38 .05 .00 .28~
.43 .02 .23
90,410 141,270 11,300
157,970 42,950 3,950
1,251,55C 2.56 4.47 6,68( 2,002,48( 3.99 1.21 142,2OC .32 .U
p5.39 .19 56.63 4.02
42.42 62.02 4.45 ~
13. Dental dise""e •• 14. Congenital anomalies, handicap. and relmbillteti,
900
50 .02 .00
3,600 4,080 .U .12
• -.
. .41 134,05( 23,090 3.79 .65 9.8 abnormal labour ~
disoases. 15. other di ••as.. requiring medical care. aU cases
~ .99E 7.78 f,s3083
14,400
4.44
299,490
233,OlO
35,09C 23,612,670 8.47 6.59
.. Rates per 1000 "",,",n aged 15 - 49 are
labour
I
death
.44 U.73 Bangkok
,
bospttal disclmrges Provincial :!btal out - patient :!btal
7.38 19.U
10.02 lO.45 20.47 221.92 Health Pl. ... ning Division
b. Rate per 1000 live births is 8.46
!b. St... /.~T.69 / C.a2 11 !Tov. 1974
~
-65AIINBlC 6 9Ilm JiEi'1'lNG OF I)~ at REPJlBSEllTATIVBS OF SCHOOIB OF PUBLIC HBAIll'H Manila, Pb1l1pp1J1e. 10-14 March 1975
WPR,MMD/SPB6-75/19 13 March 1975
ROlE OF IJ:HOOIB OF PUBLIC HBAIll'H IN THE EVAWATION OF HBAmI AND MBDICAL CARE SERVICES
MImIODOUlGY OF BVAWATION
Prot...or C. W. Dixon Prote.or ot Praventtve a: 9001&1 Medicine D1rector of the De~t ot Preventive and 9001&1 Medicine UD1veNl t;r ot otago, Dunedin
•
-66Annex
6 Role of Schools of Public H~alth in the Evaluation of Health and Medical Care Services. METHODOLOGY OF EVALUATION
A great deal is written about the need for evaluation but unfortunately, much less is known of the effective methodology. It haa been customary to judge health from the absence of disease and declining morbidity rates for a few diseases have been accepted as indicating the success of health or medical care. Whether this is really simple cause and effect is often doubtful. Once comprehensive and expensive services are being provided. evaluation of the effectiveness on a cost benefit basis is very somplex and we are only just beginning to appreciate the difficulties. Services provided for one disease may have beneficial or harmful effects on other disease services and vice-versa. In medicine, we have traditionally assumed and the public has come to accept, that doing aomethiD8 for the patient must automatically be good. Hence the importance of understanding the difference between strictly medical need and patient demand. Although a fair proportion of what is demanded is needed it is often forgotten what a high proportion of disease is self curing. Even medical need can vary with cultural difference in the acceptance of pain or disability and demand can be influenced by many things. Availability of service probably comes first but the doctor, the patient, the relative, public opinion, fashion, etc. all play their part in determining ultimate use. A further increasingly important factor is the effective use of health service personnel whether doctor, nurse, social worker, auxiliary etc. and their roles are in a constant state od change. In this very brief introduction, I am therefore going to tell you something about some projects being done in my school which attempt to provide basic information for the evaluation of medical care. The first project was to determine public attitudes to various aspects of medical care in New Zealand, a somewhat neglected aspect of assessment. We included the preference for public or private hoapitals. satisfaction with general practitioner services and the method for payment of them, satisfaction with the free supply of drugs or the alternative of prescription charges. etc. and a number of other matters of considerable administrative and political importance. A previous pilot investigation had shown that the medical profession and the politicians. although very confident, were very ignorant of what real public opinion was in many matters of vital importance both to the profession and to the politician as well as from the point of view of determining cost benefit.
.
,
... /
- 67 -
The sample of cities in about 800
method was to use trained interviewers calling on a random adults randomized by street and family etc. in two large New Zealand. About 1,000 were interviewed in Dunedin and in Auckland the former being about a 1% sample of the population.
A questionnaire of some 68 questions passed through a number of stages of development including a pilot run until it was considered satisfactory for use. One very important feature of the method was the creation of an interviewers manual details of all the procedures to be followed in relation to answers; even the most unexpected. Non cooperation from the public was negligible for which the method must have made some contribution. I would like to emphasize that toe questionnaire technique appears so easy but in fact it is very difficult to do it well. Data transcribing is a costly and time consuming process anu some saving could have been made in designing questionnaires with at least part capable of mark sense but we had no equipment able to do this at the time. On the other hand, (mark sense) questions have very distinct limitations in recording the gray areas of opinions and an examination of the efficiency of an accident and emergency service at a hospital had also been very successful but had also suffered from the same problem of delay in producing results. To aummarize: From ezperience in this field, I believe questionnaire techniques well deSigned and administered to proper samples of population by well trained and supervised interviewers is a most valuable technique in measuring various aspects of health and medical care including consumer attitudes, staff attitudes and opinions etc. and copies of four of the six papers in this series have been made available to you. The major problems are being over ambitious collecting too much information with emphasiS perhaps on quantity rather than quality and not paying sufficient attention to cutting out irrelevant material even if it is interesting. If there is a considerable delay between the survey and the production of results this will reduce the value of the information to the medical director of the services who is doubtless being pressed to effect changes to improve the standard. The survey must represent the 'near present' rather than the 'remote past' although in the field of political decision the machine moves so much slower than this of much less importance. The second method of evaluation which 1 have experience of is in the role of health professionals. It is always that we know what the doctors, nurses, radiographers, etc. do when in most countries we have very little accurate information. The total number of names on a register of doctors or nurse gives very little information as to what their effective manpower strength is at any particular point of time. In New Zealand, after many years of effort, 1 have persuaded the Medical Council, the registration authority, to collect information with the annual practising certificate which each doctor is required to possess. ·1 have circulated a questionnaire which is a copy of my own for confidentiality reasons only, gives information of the type of work done by doctors in different specialties or their special interests as determined by themselves. From their replies it is possible to calculate an effective full time manpower or womanpower figure,
... / ,
- 68 Annex 6
the latter very different in almost all categories, and to measure this for each specialty including general practice. Verying rate of recruitment of young doctors to the different specialties can be examined and the future manpower situations measured with greater precision than the haphazard guesswork of the past. By making this information available to the young graduate it may be possible to avoid over production for few years followed by under production in cycles which occurs in most specialties • This type of research utilizes the principle of making use of some existing facility for example the need for practising certificates and for a school of Public Health to work steadily towards the final objective in spite of the difficulties. In the case of the medical profesSion one has to be patient over designing the questionnaire and obtaining the replies. The methodology of repeating to the doctors the previous years return has been most successful about 97% now returning with increasing accuracy year by year. Even the old conservative doctors who at first refused to cooperate with anybody about what they did. respond quietly in the end. The Medical Council which itself was hesitant to permit me to do this work and which doubted its value is now almost embarrassing me in its demands for data and as with other forms of operational resesrch has taxed our resources to deliver well presented data as quickly as possible. Those who are used to laboratory research have no idea of the amount of work involved in these large scale exercises but in the future I hope it will be easier in that the Health Department will probably finance aD additional medical information scientist on my staff who can deal with the data handling aspects of this and produce data within three months. We now have data for 1972, 1973. 1974 and 1975. This will allow examination of trends should be available by June. Both these projects and others such as assessment of the type of medical care. the utilization of services in an area before and after the building of a multidisciplinary health centre was set uP. are projects which we Bre doing. I feel that this mixture of pure and operational research is of great value to health administrators and academic departments alike. Their value in the teaching situation is also very considerable and in the long run should also aid recruitment to'this important branch of medicine.
C.W. DIXON
-69ANNElC 7 Provi.ional Ap!!da lte.. 5d
WPRjlIMD/sPH&. 75/5
THE RELATIONSHIP EBl'WBBH CON9lJ1IIIBRS (MINIS'DUES OF HEAI:lH AND SOCIAL WlWI'ARE) AND PftOWClDlS (SCHooIB OF PUBLIC HEAIlI.'H)
by Dl' A.F. El Sherit Dean, H1ch Inatitute ot Public Health University ot Alexandria, Alexandria
The final a1lI i. to prepare and develop the health worker mo i. able to oope with the health needa and achieve the obJeotive. predetermined by the health IlUthoritie•• The role ot School. ot Public Health covers:
1.
Trai nhlg
<a) <b) 2.
In-.ervioe and poatgraduate Undergraduate
Reselll'Ch 1. TRAINING
Training could .erve the tollow1n& purpose.:
<a) Acquaint the health workers with the functions of the various bodie. and health unite working in the health fieldll e.g. rural unite, health oentre., M:H oentre., aohool health centres and unite, health offices, heap! tals, etc. <b) Develop the cODOept of f'IIDctional integration 1Ihich serves the new policy of health lIIIIIl8gement. 'DliB is achieved through tra1n1ng in f'IIDctional analysis, determining the various activities and tasks pertor.ed in the various unite and reca.bination of activitie. and taka into ~s eaah serving the various functions ot M:H, achool health and endeIII1c din.... oontrol e.g., a progr_ of vacoination, ot health eduoation or ot t1nd1ns each .erves all the tunctione predeterm1ned by the health IlUthoritie••
0'"
- 70 Amex
7
(0) RecogDise the 1IIportance of the health t e _ tIbere the mellbers of the te_ oa.pl~t and .upport ellOh other to lIDh1eve the objectives of the health department••
(d) Incre.e the eftloieno;y of servioe in te~ of output for worker per unit tiM tbrou8h the stud;v and observation of di.tribution and average lien'. hOUl'll/dentrejunl t/ti_ • regarda 1IdIII1n1.tr.tive and teohD1oal activiU... (e) Deoia1on-m.ting and everyday planning and management through anal,.siDg the problem for whioh clecia10n 1e to be taken, f1nd1ng alternative solutiona, projecting the results of each alternative, and final17 rational choice of one course of action. (f) Promotion of publio health teaching in IIed1cal schools for the developamt of the oOBDUnit;y general practitioner who is able to cope with the health needs of the cota.m1ty. Another aim is to discourage the develo,..nt of a high quality speoialized IIed1cal care dootor who would rarel;y _ t this type of care in hi. dally practice at the looal level, except in specialized hospital fields. (g) P1:00m0tion of tra1ning in the Institutes of Health Technioians to prepare and develop a multi-purpose health worker who 1e able to cover the fem1ly and cota.m1ty health servioe.
2.
RESEA1IC2I
JuaUtloaticme for re.earch are: (a) To e.timate the future demllllde of IIIarlponr quantit;y and quality (how IIal7 and what type of llenpower are needed to oare for the uplodlng population in the next 10-15 ;reare). (b) To find how .oon oan we provide manpower no~ in order to aoh1eve broad national goal. (ODe Dr-.I'OOO to cover rural are.). (0) How mob will it oost to provide the.e no1'lllll over a fixed period of tiM.
(d) How to avoid over-production or IUlder-produoUon of manpower (tra1n1ng IIOre dootors than the cCUlltry can support - brain drain - training le•• nurse. than doctors results in creating a oategory of highly pald and trained doctors doing tMka of simple prevention and oare done better and cheaply by nurses).
- 71/72 Annex 7
Research 1n .-power plann1ng oould be developed through schools of publio health in the tollow1Da: (a) Supply lIIlal;rs1_ 1DclwiiJIg sources of auppl;r and projection of suppl)' 1n future. (b) DeIIand mal;ra18 baaed on tilDe needed to cope for biological neecia or obaerveci no~ tor the health workers and projection of this deJllll'ld according to predictable changes. ( c ) Cost-effioiency in te~ of oosts of different progr_s (manpower and resources) in atta1n1ng a oertain output of servioe or cost of the s_ prosr- at different times in attaining the __ output. (d) Cost-effectiven.ss in t.rms of comparing how much oost is needed 1n aChieving how much objectives. . (e) Co.t-beneti t in te~ of the cost of present and future manpower develo~nt .. oOllPar~ to benefits 1n eoonomy gained thro~ control of di....e and more productivity.
-73ANNEX 8
WHI,MMD/Sl'H6-75/17
'DIE PO'l'URB OJ' SCHOOIS OJ' PUBLIC HEAI.IlH IN PERSPJilCTIVE by
Dl' C.III.H. JIIotic11l
Prot...or ot HUalIII1 EcolOQ Gralluate School. ot Public Heelttl and Vioe-ChaDcel1or tor Research and Gl'IIduate Studie. Uni verei t)" ot Teherlll1. Teherlll1
1wH0COI'l8ILltlll1t
- 74 Annex
8 1. IN'l'ROOOCTICR
The ph1losophical buis for special tra1n1rlg in public health and the orgllll1l1ational origins of speoial 1Mtitutes for this purpose go b8lllk to the nineteenth oentun. In 1865 an Inatitute of Hn;iene, the first Institute of its kind, wu established in Munich, Germany, to train profes.ional personael for publio health activiti... In 1871 a .1Id.lar institute w. . developed in Dublin, Ireland. In 1888 legislat10n w. . pu.ed in Great Britain requiring every med10al off1cer of health to have a diploma in public health. In 1889, the first publ10 health oourse . . . 1ntroduced 1n Michigan, U.S.A. At a oonference on training for pub11c health service held at the ott10e of the General Eduoation Board in New York, on October 16, 1914, 1t wu stated that a tund_ntal need in the public health serv1ce (at that tiM) wu of men adequately trained for the work and that a d1stinct oontr1but1on toward meeting th1s need oould be rude by establiah1Dg at scae oonvenient place a school of publ1c health of high standard. The 1916 -report by W1ll111111 A. Welch and W1ckl1ffe Rose, prepared on ~t of the said board, and its adOption by the Rookefeller Foundat1on, resulted in the founding of four graduate schools of public health by 1922 - at John Hopldna, Yale, ColWDb1a and Harvard. S1milar needs felt by these and other - partioularly industrial1sed oountries of the world led to the establi~t of numerous schoola of publio health. There wu a time when foreign students oonstituted 20 per oent of the enrollment in schools of public health in the United States. Moreover, at one time these sohools, together with the Landon Sohool of Hygiene and Trop10al Medioine, _re training 98 to 99 per oent of ph:yaic1ana for publ1c health leaderah1p positions in other areu of the Wcrld. Th1s is no longer true, u IIOre and IIOre countries are establishing the1r own schools. Whatever their looation, it 1s fair to grate tully state that the.. schoola have tult1lled an important role in the tra1n1rlg of public health ph:ya1c1an and adm1n1strators as well u other categories of public health workers, wo have served dutifully their countr1es in the fight against ccww m 1cable diseues, sanitation of the envirOllMIlt and the pJ'OIIIOtion and deli very of various health oare services. It oould be argued that inspite of all the pxvgress and achievements in the establi~t and development of health services in the world to date, there is st1ll a great and urgent need for new SJllt... of delivery of health and medioal oare part1cularly in developing countries. Until now universit1es and medical institutions have been training high level profeaaional personnel for delivery of hospital based medical care. But the health services needed in the country cannot be met only through hospi tala.
-75Annex 8
Generally speakina IIIId betore the introduction ot the new changes in the concepta IIIId soopes ot medical education, the curriculUJI ot the sohoou ot medicine tor the orientation of their graduates in social IIIId piNventive medicine looked only adequate in theory. In pr.otioe this ... never achieved, bec_e the attention ot these \UI1 te (bo'tIb trca the stlllldpoint ot ad.III1n1stration IIIId lIIIID88ement .. well . . obJeotives and operational support) had alwq. been concentrat6d to hospital te.,hing and .ervice.. Consequently, in -/1117 parts of the .orld, the. . service. had. evolved as a result of the eduoational and resear.oh .,tiv1ties of the .chool. of publio health. With the general .,oeptance now of the need tor the development of a national health polioy and of aational health .ervioe. and _power develo....nt pl_ and health care delivery .ysteu, in whioh all categories of health _anpower will be dealt with and planned for as a p.oksge, there i. high time for the school. ot public health and institutions responsible tor advanced training in public health to revise their objective. and progr..... ot .otivitie. and look forward to their future. SCHOOIB OF PUBLIC HEAIll'H IN AF, EM, SEA AND WP RmIONS
2.
Give or take one or two, there are now (1975) about 125 schools of publio health or institutions responsible for advanced training in publio health in the World. l ot the.e only one-fifth are in Africa, Asia and Oceania and the re.t are conoentrated in Europa and Americ ... School. ot public health existing in the D, EM, SEA and WP Regions, which are the main subject ot this stydy, are all the product of the present century; the oldest one ... established in 1913 in New Zealand and more thlll1 6oJ' ot th. . have bean established after 1950. ibe mo.t recent ones are 1) the graduate School of Public Health ot Institute ot Public Health, Ministry of Public Health, Kabul, Republic ot Afghanl.tan and 2) ibe Da~t of Preventive Medicine and Public Health, F.,ulty of Med1c1ns, University of BsgdC, Iraq in 1971. Ten schools are primarily undergraduate JDedical .chools and the rest (15) _ postgraduate .chools or institutions. Of these lEi echools _ ~istered by un!versi ties. four by ministries of public health and five are organized. Jointly by \UI1verslties and ministries ot public health (.ee ~able 1).
~ed on the detinitions given by the Eltpert C~ttses of the World Health Organ1&ati_ (W14 Hlth Org. techn Rep. Ser. 1961, No. 216 and 1973, No. 533).
- 76 Annex
8
,
Table 1 Chronologr of the Establishment ot Schools of Public Health in 117. EM. SEA and WP ReSions •
Year Public Health Courses started
No. of Sc ools starting courses Postgraduate Prilll&rY Schools and All Undergraduate Inatitu·· Rev School
1911 - 1920 1921 - 1930 19,1 - 1940 1941 - 1950 1951 - 1960 1961 - 1970 1971 -
, 2
-
2
, 4 1 15
2
2
, 2 2 5
2
4 1 10
8 2 25.
Total
* Based on data in (a) the World Directory of Schools of Public Health 1971 - WHO Geneva 1972 and (b) SUIIIIIIIl'Y report on the activities of the Schools of Public Health and Institutions responsible for advanced training in Public Health in the Af'rican. Eastern Mediterranean•. South-East Asia and Western Pacific Regions. 1971 - 1973 Publications No. 1 of the Associationa of Schools of Public Health in the 117. EM. SEA and WP resiona in 1973 (c) additional data reported to the secretariat of the association.
Note:
This table does not include Departments of Preventive MediCine or Schools or univerSity centres for Health Sciences recently established in the 4 resions who have not yet offered any post graduate PH course.
~77-
Annex 8
,.
wnm:I OF CHAIIJE
The aixtiea aaw a arowing aelf-awareneaa Wi thin the aOhoola of publio health ~ehea, CODCei'Decl With the resultll of their actIvIt1es and d ..iroua of 1ntroduo1ng aubataDUal refor.. It w.. part of the urge for total renewal that II1f8pt the whole health aector. Thia aelfawareneas 1Ih1oh w.. initiated in the fifUea through many . .aemblies, expert oc.d.tte. IID4 gatherings of eduoators and health worker. organiZed mainly by litO IID4 otber international and national fOllDdat1ana IIDd l!Iociet1es, took a conatruoti ve shape in 1961 Wi tb the appearlUlOe of the tenth report of the WHO expert oommittee on profesa10nal and technioal eduoation of 1IIed10al and auxl1i817 personnel on "ReoODael1ded Requirements for Schools of Publio Health", Techn. Rep. Ser. 216. It w.. oanaolidated turtber tbrougb aubaequent expert oCBDittees, scienUf1c grou.-, interregional, reg10nal and field activit1el!l of WHO. The reports of the series of meet1ng1!l of Directors or Repreaentatives of Sohools of Publio Health wb10h took place in Geneva 1966) - Manila (1967), Alexandr1a (1969), New Delh1 (1971), Brazzaville (1m) are good Witnesl!les to these trends. In addition totbe.e "indigenous fllQtora", many happenings and innovatiana have .1I11larl;r affeoted this state of mralten1ng. New medioal discoverie., iDDovati'1e environmental and laborator;r teohnolOCies, the val1ditl' of ..adem lISMgerlal teohn1quea and the greater acoeptance of the .ocieti•• of the reppanaibilities for the health of the individual ad of the populat1on u mole, are but few pos1t1ve examplel!l. There 81'8 IBIIIQ' .are ezuple. on the negaU ve .1de: - 1;be re~ar_. of lIIalaria epiclem10s during the vigilance or oanaolidation llhuea in .0118 oountr1es where the absence of properll' organised bu10 health . .rvioe to take over IIDd the premature deviat10n of attention to, other health prebl_ _re c0Dll1clered as theIr o_e;
- the of the world;
.pre_
of sllallpox, cholera, etc. to non-infected areas
- the great ooat of tra1n1ng of ~1oI_ versus the lI1graUon of ...uoal -power out of developing oountries: _ the great deal of d1aaat1sfaoticm With the .tate of publio health, partioularl;r health servioes IIDd preble. of env1rcllmental oontrol even in developed oountries, mere about five up to l2l' of GNP i • •pent on heal th but people do not, in any reasonable degree, receive 1Ibat they are pq1ng for; - the rising ooat of medical and partioularly the hospital care.
- the inorease of populat1on: - the rise of expectations of the people:
-78Annex 8 - the inadequate 87stems ot 1nd.1rect or direct payments tor llled.ical expenIIes and the appearanoe ot various t7Jl8S ot llled.ical insurance, capitation, tee-tor-service, etc. - Wide gap (whioh is not closing) in health statue bet_n countries and between different groape Wi thin countries: and - tinally, the IIIOst 1mportant ot all the abaence ot health oare coverage.
4.
THECHALIENGE
This state of affair is very challenging because in this era of rapid social ohange, with increasing national awakenings and the demand for sooial welfare and. justice, With a high proportion of rural population and. the rising problema of: environmental pollution: uncontrolled population growth: nutritional deficienoies: and. the high risk of diseases: with, &t the s _ time, shortage and maldistribution of trained staff: insufficient finenaial, material and. physical resources prevailing to higher or lower degree in different oountries, the haphazard utilization of these services and. resources is neither fair nor acoeptable. In the majority of countries With some or all of the problems oited ~, there exists also a fragmentation of responsibilities tor the delivery ot health care, with overlapping, oontlicting and oOllP8ting organizations Within the health system, and. wide17 soattered tund1ng mechanisms with little control over costs. Health services authorities give only token recognition to those segments of the services that are not under their direct executive or financial control, and often plan only for that part of the national budget which is 8aid to be their responaibili ty • As stated by the executive board of lIfO at its fifty-tirst ses8ion, this state of affaire is unjustified and harmtul. The health service must be thought of and taken as a coherent whole, public and private, national and. international, curative and preventive, peripheral, interllled.1ate and. central. '!hus there is a great need tor a health plan, Within the context and. in harmony With national 800io-economio development, with stated policies and definition of aims and objectives, With established priorities inside the health system, taking into account the essential needs of the population and the available resources (human, material and financial) with provision for public acceptance and. partiCipation and politioal eadoreement. '!he plan should also provide. in addition to a health 8ervioes and Jlllllll(llfer develoPl8Ilt plllll, the neceas&ry mechanism for illlPlementation. ooordination, evaluation and continuoua feedback and review. It is obvioua from the start that the preparation of this plan tor the develo.-ent of health services and the delivery of health
- 79Annex 8
oare. with a
0 . . . . . . . . .ive
ad integrated approach (in other words
the plNIII'. ad..... tnt ot the health .;rsta) is not an easy task and 1 t 18 oerta1nl,. .ore so tor develoPing oountrie.. HOIfttver. the art ot admfntatrative l18li88' Int ad the behavioural soiences have
alrelld7 dneloped _tboda ot . . ._ t that have PI'OYed capable of oopins with s1ltl.lar oa.plex1t1es in other sectors. '!hey are available to be tested and exploited to the best advantage of the health ..rvioes. The lIlIII8g_t probl_ whether in the health servioes or elsewhere. involves activities of the following kind: (1)
diagnoaina present Im4 anticipated prooblema 1n the field of
concern; (s) _ e. .ina the .1gn1f1olllloe of problema leading to the det1n1tion of ai_ and objectives in relation to them;
f1nd1ns alternative _ _ for meeting objective•• exam1n1ng 1 thy and av na rational ctloices between them; (4) obtaining the neoeaaary re.ources (material, human and f1nallcial) to iJIpleMDt the ohosen _ _ ; (5) definina taaka of organizations and of groupe or individuals so as to -.lEe the ne.t use of available ald.lls;
(,)
develos-nt of pereonnel IIIld enlargement of lIkill. IIIld capabil1ties; (6) towards theaI b;r the.,ghoaen _ _ ;
(7)
IDOtivatina people to .ccapt the objeotive. and to worle
(8) IDCID1torina. oontrol and evabation so as to adapt and learn in the light of experienoe.
'!here 18 an ever-1Dcreaaina arrey of methode and technique. available to _lat in lIIIIP..:_t and it becomes a matter of .cme oonoern to decide 1Ibat resources lIhould be devoted to their adaptation and utiliaatiClll in the bealth CCllltext. All a _tter of f.ct. the ~l1o.tlon of IIIIIIIIIS8rial techniques in the field of p,lbllo health 1. not very old. and has not proceeded very far. '!hls 1. beo_ of DUlleroua diffioultie. inherent within the health aerv1o.s. 1DcludiJIg difficulties of fOl'llUl.atina precise objeotives or anaweriD& the question: what i. it for? as well as def1n1tiClll and _~t ot "output". etc. on the one hIIIld. and lack of proper G' m10atlClll betwHn health worure and l811D8&_t technologists and aoaro1t;r of the latter group on the other.
-80Annex
8
It is necesslll'7, however, to ellbark upon a well-planned educational effort rClf' the orientation or health workers to these techniques and the art or "",nistrative lIIIIIl8ge.-nt, and their inclusion in the training progr_s of schools of public health, or institutions for adVllllCed training in public health. As a Q,tter or ract, the fifth meeting or Directors or Representatives or Schools or Public Health, in Brazzaville, 1973 considered this, as well as the need ror more involvement of schoolll of public health in research on the delivery cf health care and health planning.
5.
fIm'(Il
OJ' QlAll;ES
One IIq re. .onab17 wonder 1Ih7 sooiet7 should turn to the schools of public health, seeking lIolutions to these probl_ and that the IIchools or public health have become conscientious about them. The answer, in part, is that there is nowhere else to turn. The schoolll of public health are unique among educational institutions b7 virtue of: (1) the breadth of skills reprellented on their faculties, and especial17 the melding of Jlh7aical, biological and behavioural sciences. (2) (3) disease. the startling diversit7 of background of their students. their preoccupation with II
central theme - human health and
Here, . . in no other environment, the ingredients exist to make a genuine stab of developing and testing solutions and to learn how to create multidisciplinary learning environments in which faculties can learn to cCllllllWl10ate wi tb each other to coalesoe their ID8Il7 skillll to attack COlllllOn probl_.
As stated betore, schools of public health CUIII into beint to do so_thing nob0d7 else w.. doing and particularll to do _thing the medical schools were not doing. With the trelDSldoua effort on part ot schools ot medioine on cme side, to create strong departments of communitl medicine and to expose their students to epidemiologz, biostatistics, env1ronJMntal health and health care administration, inclurUng field research and o - m 101 diagnosis and even in SOllIe IIchools the rural internah1p and the adoption, and application of the new reto~ in the whole philosophy ot medical education on the other, and finalll the establishment, with multid1sciplinlll'7 approach, of the new schools or uniVe1'sitl centres of health sciences, the schools of public health should agdn do ....thing nobodl else is doing, particular17 do s~th1ng that c . e t e s and oOllPl-u. mat other Organizations are doing and rinalll do lI~thing that nobody else can do.
- 81 Annex 8 Thia obviously pl.acea the schools of public health in the center of activitiea for the eatabliat.ent aDd implementation of health aervicea aDd ~poIfer develo..-nt pl_. In thia cantext. the achoola of public health atill have three main taaka aa before: teaching. reaearch and cOllllllUJl1ty aervioe. all focused an the probl_ of the ooDlWlity health. The knOWledge inherent in the co_mity baaed health activ1tiea and the JDallpolfer required are valuable reaource. for the future development of the health service. aDd blueprints for the future progr_. of sohoola of publio health. A aeri_ of lI&,Ior natianal efforts to develop primary health oare serv1cea at the oa.am1ty level is seen aa the only wq in 1Ih10h the health serv10es oan "'eftlop rapidly and effeot1 vely • The prevailing approach to the development of pr1mary health care haa been the '.;ransfer of health technology from ane oontext to another - developed 'IE> develop1ng as well aa urban to rural. Th1s approach has failed to meet the needs of today. as noted 1n the introduotion; a radical departure from canventional health serv10es approaches 1s requ1red. To depart rad1cally from these approaches 1s to requ1re that new services are bull t up out of a series of peripheral structures that are designed for the oontaxt they are to aerve. Certain basic principles IIIWIt be adhered to 1f these des1gn efforts are to be successful. These follow d1rectly from the above d1scuss1an and 1nclude: (a) Primary health oare should be shaped around the life patterns of the populatian it should aerve. (b) The local populatian should be actively involved in the foraulat1an of health care activit1ea so that health care cen be brought into line with local needs and priorities. (0) Health oare offered should place a maxI._ reliance on available oc m1 tJ' reaourcea. eape01ally thoae 1Ih1oh have hitherto remained untapped. and should remain within the atringent coat 11m! tationa that are often preaent. (d) Pr1lDar7 health oare should be an integrated approach of preventive. curative and promotive aerviceafor both the CO!!IIIlDity and the 1nd1vidual. (e) Prialllr7 health care .ervices should be fully integrated with the aervioea of the other aectors involved in ctllmlID1 ty develo..-nt (-sr10ulture, educatiClll. publio works. hous1ng and communicat1ana).
-82Annex 8 (f) All healtb intervention mould. be undertaken at the most peripheral practicable level of tbe healtb services by "healtb teams" including tbe worker most sillpl.y trained for tbis activity • (g) Other echelons of services mould be designed in support of the needs of tbe peripheral level, especially as this pertains to technioal. eduoational. supply, supervisory and referral support. '.thus tbe teachingjresearch/cOlllllUll1 ty servioe prograJlllle the sohools of publio healtb lIhould be so designed to assure: (a) tbe planning and execution of tbe above-mentioned plan and to assist in i te oontinuous evaluation; (b) preparation of health aIlagers. planners. speoial1ats in various disoipl1ne of health soiellCes. research workers and teachers;
,
(0) continuous eduoation of healtb workers at mnagerial and professional levels; and (d) finally. the education of the oo-.m1ty at large as to tlbat the _Jlbere ...., do to be healthy. Of oourse. for sa.e tiMs to COllIe, and until other institutions have not beoOlll8 tully active in this. the sohools of public healtb should continue with their present training prog!'8111118S of professional health workers. BIlt preparation mould be lllade (organizational or progr_ wise) to shift tbeir !letivities toward the above-lII8lltioned BU1tidisciplinary eduoational goals as soon as possible.
- a, ANNEX 9
A NOTE ON THE MmJRE OF SCHOOIB OF PUBLIC HEAIll'H
Profe••or A.K. Banerjee Direotor. All-India Inat1tute of Jl7s1ene and Publio Health Calou1its, India
-84-
Annex 9 I. S'l'RroTURAL AND ORGANIZATIONAL C(JiSlIERATIONS
A Hhool of publ1c health has been defined as "an institution with adequate resources which, in addition to research in publ1c health and service to the ca.unity, provides a full-time course lasting not less than ons IItlidemc year or its equivalent covering the subjects essential to the understanding of the various problems of public health and the concepts, organization, and techniques required for dealing with them end 1Ihich is open to members of the medical and allied professions seeking qualification in public health." It is well-1moIm that the institutions providing postgraduate training in publ10 health differ poeatly among thelllBelves. Man:y are institutions of h1&her eduoation that are equivalent in statue to institutions offering h1&her education in medicine and may have a faculty of more than a hundred full-time teaching staff members. Other sohools _ developed within the fr_work of medical schools and may have only two or three full-time staff members in addition to the normal oomplement of staff of the department of preventive and social medioine, for running the basic public health course, or 1n other words, they are simply enlarged departments of social medicine, preventive medioine or hygiene; sometimes these enlarged departments function in olose asaooiatiali with other departments of medical schools and universitiea and such a group of departments fulfills the role of a school of publ1c health. The number of such inst1tut1ons is substantial, aooounting for at least half the number of schools l1sted in the World DireCtory of Schools of Publ1c Health, 1971. In other cases, the organizat1on of a postgraduate course in publ1c health is but one function of a post8raduate school of medical sciences or health sc1enc.s. In spite of these and other differences, there is clearly a community of purpoee amongst sohools of publ1c health in that all of them provide postgraduate training to prepare P1Ysicians and other all1ed personnel for work 1n public health.
,
<
'lbe full-fledged schools of plubl10 health which are not enlarged departments of preventive medicine are usually structured in departments representing different public health disciplines wi th both full-time and part-time teaohing and other staff. In some schools, the number of departments has of late been increasing with the addition of more and more disciplines. According to ons sohool of thousht, the structuring of staff strictly by departments is considered too rigid and not amenable to integrated teaching and research. A novel pattern has been suggested based on a matrix organization repreaenting four or five areas of knowledge. 'lbe idea is to set task foro.a or problem solving groups on a sem1-
- 85 Armex 9 permanent basis from these different disciplines to undertake specified research or training activities. With this system, it is hoped that each staff member will feel allsgiance not only to a particular discipline but to the problem-oriented group with whom he has to work. It ill felt, however, that the same purpose would be served .mile locating the staff memberll all usual in the individual departments but creating interdillciplinary working groupe as and when needed. Part-time teachers recruited from health departments and other departments are best used for presenting circumscribed topics in .mich they have specialized experience. They are also valuable, all are visiting professors and other persons of eminence in conducting seminars and discussion groups. A properly organized school of public health should have fulltime staff representation in all major public health disciplines for implementing teaching progr/lllDl1es and specially for establishing and maintaininh a continuing student-teacher relationship. For teaching perili\eral subjects like economics, sociology, psychology, etc •• it might be necessary to use lecturers attached to university departments. The system of employing part-time teachers or lecturers from university departments is not wholly satisfactory. as it is not easy to control the course content and method of presentation. A lot of efforts is needed on behalf of the full-time staff to coordinate the whole teaching curriculum. It is desirable for a school of public health to have premises containing an adequate number of lecture theatres. libraries. seminar rooms. laboratories. administrative offices together with the usual amenities for staff and students. A technical department for the preparation of visual and teaching material can serve to increase teaching efficiency • .mile. at the same time, reducing routine chores of the teachers themselves. In addition to the provision for the suitable facilities for the school itself. proper attention must be paid to the development and use of rural and urban practice fields and to the availability of adequate li\ysical facilities for the staff working there. '!he Director of such practice areas should have a fair degree of autonomy and adequate budget and staff to fulfill his function properly.
-86Annex
9
Ditteren10 Vie. . ha" been expl'eued regll1'd1Dg the organ1za1010nal sta10ua ot IIOboola ot publlo health. 'l'be aohool IIIIQ' be run .. a Gove~t de~1o UDder tbe Idnistry ot health or III1ght be an autOI"J.IU orgmisa101on rith1n a IID1vere1ty or 110 II1aht be a department of a IID1Ye1'111ty .-bool or 0111 baYe a llnkage With the IID1vera1ty Without beiDa a par1;. of 1t. 'Dle iIIpalotant thiDa. however. b to enaure the mainten_. of 1ID1vera11oy level stlllll1arda and 1t 1s felt that for flexib111ty and 1IO.sa.10 treeda.. a school...,. best be run .. an 8Il~ organ1sa101on With a ••pera1oa buds.t and tull oon"trol over the tn ini .,. procr-.
Reslll'dl••• of the WII;Y8 in 1IIh1ch a school 1s lIdm1n1s1oered. the adIII1nistration should be . .s1a1oad by oonsultative ooaa:t.ttees 1noludtng repreaenta'tivu of 1Ihole-t:t.e teachers. health serVic•• and studente to brirlll in the different Viewpoints to the proViders and consumer•• Schoola ot public health. eVID 1Ihen no1o bel_iDa to a IID1veraity. oan benefit poeatly fro. olose _ _ iation With one _ well _ With other institutions of higher eduoation SO . . to avoid duplication of faciliti... A olos. relationship between a .ohool of publio health and health services of the Government rill permit the schools to pl~ a fundUlental role in the shaping of governmental health polioi.s.
2.
TEACHING OF NJIf DISCIPLINES
To the extent that poett;rllduate training progr_ no longer need to oover the el~'tai7 upec10s of publio health bee_e of their inclusion in UDdergr.sua1oe tra1n1Da. the .chools of public health Will be able to divert IIOre attention to .:lv_ed oourses for .pecialized tra1ni rlll and oont1nu1Dg education. 'l'be daand for le8dersh1p in improved. health 0 _ delivery Will find proper upbuis in the cU1'l'1oul_ and the aohools Will beec.e 1noreu1ngl.y involved in "BeAing health probl_ and ~power needs. evalua1oion aerv10ea and desi&n1Dg lIOI'e eftective planning. IIIIIIU11ng and evaluatins health oere delivery .ysteaB. Whereu there b DO doubt that a public health s1oud.en1o ahould be exposed to health ..npower planning and develo~t and 1;0 IDDdern 1IIIIIlII8er1al oU1'l'1oula. ep1dewtolosloal and ~o situations ot developills oOUlltri•• 'together With their l1la1ted budgetllJ'7 resources and IIOUte soeroity ot trained IIII1power. require that san1tation of the enVi~t. control ot 0' mtcable dis...ea and nutritional soienoe. should. however. u a rule. oontinue to occuJIT a central place in publio health training tor quite ac.e t:t.e to COM.
,
- /37j88 Annex 9
3.
IMPUCATION OF MJIll'IDISCIPLINARY COOPE3ATION
The need for a comprehensive, integrated and m ltidisciplinary team approach to oommuni ty health problems will inoreasingly be met through integrated tesohing prosr_s for multidisoiplinary groups of learners, Whioh will oonsist largely of problem-solving exercises oonduoted on a team basis. Conoomitant with these developaents will be Uhe widespread adoption of eduoational methods, including oompetence in problem identit10ation, problem solving and decision making, and equally important, a oapability for oritical, oonstruotive thinking. These methods will take the form of group disoussions, seminara, workshipa, role playing, oase studies, supervised research projects, and the use of simulation models, with or without oomputers, permitting active student partioipation. '!bere will also be a further inorease in the renge of eleotive and alternative oourses offered by schools within the basio currioulum.
- 89ANNEX 10
WPR,/lIMD/SPR6-75/l4 TEACHDIl A NE.W DISCIPLINE Notes of a paper presented by Professor W.O. Phoon at The Sixth WHO Meeting of D1rectors or Representat1 ves of SChools of Pub11c Health Manila, 10-14 March 1975 "There 1s nothing new under the sun" 1. Before introducing a new subject into what 1s usually an already overloaded curr1culUIII, we IIIWIt ask ourselves several questions. 2. Why teach a new· d1so1pline? '!bere IIIUIIt be val1d reasons before a deoision 1s taken to introduoe teaching in a new disoipline. 111e usual reason g1ven 1s that the new discipline would strengthen the tra1n1ng of health personnel in the1r job performance. If that 1s the reason, the autharit1es and teachers. of a sohool of publio health or s1m11ar 1nstitution _ t be very oonversant with the job requirements of d1fferent types of health personnel. Could the discipline be poss1bly useful for one oategory of health personnel and not for the others? I t that 111 so, then it is not right that all personnel should be exposed or equally exposed to the subject. Even 1f we knew all about the diUerent Job requirements of different students, we do not know the future Job demmJda on them. In BIOst countr1es in the developing world health personnel are transferred from plsce to place and from Job to Job. Henoe it is not enough to introduoe teaching matter whioh may be relevlIIlt to Job pertol'lllllDOe of present students in their present oiroumatenoes. A health oareer is a long one and there are rapid develop!lllllts in the health sc1enoes whioh may make subjects oonsidered 1mportant today. totally 1rrelevant in future d~. }. How to teach? Obv1ously the usual I118thods including the modern methods of tesching should be used. The teohniques may d1ffer from discipline to disc1pline but geDerally there should be both classroom teaching, field training, seminars and tutorials. Some new disc1plines lend th_elves easlly to ~ teaching, some others may not.
-90Annex 10
-. Whan to tellOh? Here. there _ t be proper coneidenlt.iGll IIIld pllllUl1ng given so that there will be max1_ integration with the rest of the ourrioulum or other teaching modules. SOIIIIItime. it is necessal'J' to ~t around before one arr1vee at the opt1lllwa tt.. for tellChing a pertioulardi.oipline. Generally. it is preferable to teach the __ trlld1tionally buic di.oipline first end then introduce new dieoipl1nea later. It i. al.o preferable not to introduoe too IIIaIIy subjects or disoiplines at any one time but perhaps intersperee the. with the tellOhing of other aubjeote.
5. Who should tellOh? It is sOlllClt1lles woree than useless to introduoe tellOh1ng in a new discipline if there are no sui table teachers. ~e o8DDOt _en sngtul17 tellOh UDle.. GIle ha experienaed an expertise in one'. subject. '!here i • •000000tt..S a rielt of aohoola of public health j\mlP1Dll on the bed wagon of newly fangled dieoipline. end introducing tIh10h _ mainly bued on book knowledge alane. Woree .Ull. the Imcwledae IIIIQ' have been gle.-d f'roID books tIh10h are wr1 tten thouaenU ot 11118• .-q MId 1Ib1oh . . , be unauitable for local usage. a_rally .pealdJls. pnotitiGllere in a particular field _ the _ t su11;able to tellCb a disoipline. ~e _ t prellOh not only by precept but by exuple . . . .11.
progr_.
6. '!'bere abou.ld be oloee ooneultaUone with both staff end also studente befON new dieoiplines are introduoed if possible. Espeo1ally during the early dqa ot introduotion there should be oonstant monitoring of the quality of tellOhing. Evaluation can be done by observation IIIld questionnaires to be filled in by both staft IIIld students. 'lbe new diaoiplines IllU8t have relevance to the looal situation. 'lbere i. a rielt of tellOhere fl'OIa developuw oountries ~1aiting centres in developed ones .ad. OOlling back nlled with sest to introduce disoiplines merel;r becllWle the.e diSCiplines are included in the Curriculum ot centres in the developed countrie.. "Pestina r.nte" is a good IIOtto to apply in II\lOh o1J:o. . .t _ _ • SOIIIIIt1mes the so-oalled "new disoipline" oontellplated is DOt reall;r new. It is lin old subject 00ldng under the guise ot a new _ or tel'll1nolOU. 'lbere IIhould be hllJ'd th1nk1ng ebcIIlt the OGlltmlte of the tellOhing in new disoiplines IIIld . . should not be oarr1ed ~ by oliches or slagena.
7.
progr_
It SOlllll new disoipline is introduoed into the ourrioul_. aeriOWl cGll8ideratiGll IIhould be g1ven to the reduction or e11ll1na1:1G1l of oerte1n other subjecte. It is not 'fair to either .taft or students to overload an alreq heavy teaMs ng PNsr s IIIIQ' look wonderful on paper but oannot be evaluated UDle.. the,. ere studied' in practioe IIIld unless there is proper teedblllDk f'roID tha studente end other "cOIlINIIIers".
8.
progr_.
•
- 91 ANNEX 11
WPRj!Dm/SPH6-75/l5
THE J.i\JTURE OF SCHooIB OF PUBLIC HEAIlm: IMPLICATIONS OF KIIlL'IDISCIPLINARY COOPERATION
Dr craig S. L1chtellllalner Dean. FaIIulti•• ot Med10al Scienc •• Amerioan UniTera1ty ot Beirut Beirut. Lebanon
- 92 AmIelt 11
•
1.
IN'l'ROOOCTIOJf
, '1'he Sixth MHtiDs ot Direotors or Repre.entative. ot Schools ot Publia H.alth will dillOWlS in depth the tollOWing topia. 118 Agenda It_ 6: '!be future of .chools
.ot publia h.alth:
(a) (b)
Stl'llOtural.xl Ol"Banl.at1Cl11al cCll1SideratiCll1S. T.aoh1ng ot new discipline •• •
(a) _
IlIPlioatiCll1S ot mlt1d1aoipl1narJ" aooperation.
bMkgrowId uterial. partioipants have reoeived with the1r oCll1te~e ~ta a Rn ot ,the m..eocrlllh entitled "School. of Publia Health: PreHnt all PaWN". edited b7 Bowers .xl Purc.ll. end pubtt..... ." t.IIe .lode 1Iaq. Jr. PoaDdat1Cll1. 1974. wbioh ahCNld be
reterred to.
reo""''''' that i. tirst ot the future. It i. equal17 true that pcotioil*lta at this conferenoe have the re.ponaibili ty tor su1d1nl the inatitutiona that they repre.ent into the future. '!be tred1tiCll1al fImotiona of schools ot publio health: namely tellChing. researoh. end .ervioe: will remain the same. However. the manner in whioh they are oarried out _ t ot neoesaity ohange if the a,ohoola are to be reapona1va to the ahans1ng world around WI: changes in patterns ot in popglation I1UIIIbere end diatribut1on. in new knowledge through rea.arch. and changes in the needs end demenda of the sooietie. we .erve.
I t 18 a tru.t.. tbat the future i. ot tl8 hOW the dq
~18te
conoern to
WI
all.
41...... 5. 2.
'lh1. note baa been prepared wi th ~10ular ret.rence to
1ta
"IlIIPlloati_ otlmlUd1P1Plinar7 oooperation". IMPLICATIOte OF MJIlrIDISCIPLIHARY COOPBRATI<If
SOhools ot public health have been pioneers end le"'rs in develop1Jls .u.t1d1aoiplinary proSl'-.. Cooperati va progr_s involving the ...uaal so1eno.s with engineering sc1enaes end with sooial soienoea are exaaple. that oame q~oltly to 1I1nd. But what are the iaplioationa tor the future? W1thin the univers1ty. one oan toresee 1ncrell8iDs collabOration with other aohools (or departmenta) ot the health sc1enoes. 'lb. ~rend toward developMtnt ot tllllUltie. of the health .01enc.s 11111 no doubt'
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- 93/94 Annex 11
increase. Elsewhere in the university, stranger ties will be developed with the disciplines o~ education, sociology, and psychology as programmes develop ~er in health education, population studies, and ~1UII11y planning. Programmes in health services administration require modern management methods that are found in schools o~ business IIdministration. National health planning and health manpower projections need refined data procea:sing techniques and access to computer resources. FUrther examples should not be necessary to lluatrate the necessity for • increasing multidisciplinary ties for sohools of public health. Publio health is a multidisoiplinary pro~ession. Any disoipline, old or new, that can make a oontribution to the solution of health problems must be brought into the health team. Therefore, we oan predict with some confidenoe that sohools of public health in the future will demonstrate increasing multidisciplinary links •
•