Turning a corner for public health workers: Updates on a global workforce roadmap

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Adj. Assoc Prof Priscilla Robinson and Hon. Assoc Prof Leanne Coombe, PHAA Policy and Advocacy Manager

Public health has achieved a great deal of visibility because of the pandemic, but it is important that this momentum is not now lost as we ‘return to normal’. This is the first of a set of blogs to keep you updated about a World Health Organization (WHO) programme, colloquially referred to as the ‘Public Health and Emergency Workforce Roadmap’. This Roadmap will drive the international face of public health training and workforce development for a long time.

The Roadmap was ‘born’ a year ago, and has now reached the end of its first phase. The two of us are on the Roadmap Taskforce Steering Committee, and fellow PHAA member Assoc Prof Meru Sheel represents on aspects of research and practice in the Pacific region.

Many international public health institutions have endorsed and are supporting the Roadmap’s work, including the:

  • World Federation of Public Health Associations (WFPHA) (of which PHAA is a member)
  • Global Network for Academic Public Health (GNAPH) (of which the Council of Academic Public Health Institutions Australasia (CAPHIA) is a member)
  • United Kingdom’s Faculty of Public Health (UKFPH)
  • International Association of National Public Health Institutes (IANPHI)
  • Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET)
  • Global Outbreak Alert and Response Network (GOARN)

The Roadmap’s Steering Committee has met three times in the last eight months to progress this work, with the Roadmap’s first phase culminating in a July meeting in Rome. Meeting outcomes included the endorsement of a series of reports and toolkits designed to be implemented by countries around the globe.

Which workers perform public health functions?

When this programme of work began, the public health workforce was defined as shown in Figure 1. It includes a core, but relatively small professional group who are formally trained and work entirely in public health; as compared to other health and care workers (e.g. doctors, nurses, pharmacists) and allied professions (e.g. engineers, lawyers, food providers). These latter groups generally work in other areas of practice and may not even see themselves as being public health workers. However, they also perform various essential public health functions, and their work is critical to public health.

Venn diagram: 'core public health personnel' is name of middle circle, with its two overlapping circles named 'Health and care workers who perform one or more public health functions' and 'Personnel from other allied occupations'.

Figure 1: Composition of the workforce which delivers the essential public health functions (© World Health Organization 2022).

 

What can the Roadmap achieve?

The aim of the Roadmap Taskforce is ultimately to bolster the public health and emergency workforce, to better deliver the full range of essential public health functions, including emergency preparedness and response. The Roadmap has three main action areas (AA):

  1. Revision of the essential public health functions.
  2. Framework for competency-based public health education and training (as co-chairs of the WFPHA Professional Education and Training Working Group, we respectively contribute as a co-chair and technical advisor for the Technical Advisory Group leading this aspect of work).
  3. Mapping and measuring the public health workforce.

Two additional action areas deal with dissemination of Roadmap information, and coordination of the entire project.

AA1 – Updating the essential public health functions.

The first action area focused on re-examining and unpacking the revised 12 essential public health functions published by the WHO in 2021. The Roadmap’s action area helped unify the list, and also identified 48 sub-functions. Additionally, it identified and defined the 20 public health services and 12 system enablers required to enact these functions. These lists are both globally relevant and allow for local contextualisation and prioritisation. An early publication of some of this work is available here.

Consequent work involved designing self-assessment tools that member states can use internally to evaluate their own public health capacities and services against the essential public health functions. Case studies of successful evaluations trialled in Azerbaijan and Northern Ireland were presented during the July 2023 meeting, resulting in endorsement by the Steering Committee and a strengthened WHO commitment to the essential public health functions.

AA2 – Framework for competency-based education.

The second action area developed a framework that identifies competencies and behaviours essential for effective public health practice. These are relevant for the breadth of the public health and emergency workforce, at all career stages, and for the breadth of practice activities and tasks that operationalise the essential public health functions according to role responsibility.

The 20 interrelated competencies and related behaviours needed by individual workers are grouped in the following six domains:

  1. Community-centredness
  2. Decision-making
  3. Communication
  4. Collaboration
  5. Evidence-informed practice
  6. Personal conduct

The 40 practice activities and associated tasks that may be implemented by the public health workforce are grouped in the following five areas:

  1. Systems for public health
  2. Public health intelligence
  3. Public health programmes and services
  4. Management of resources for public health programmes and services
  5. Public health emergency management

Each practice activity area also contains curricular guides covering elements to support their inclusion in education programmes, with resources and illustrative examples shown for each competency.

AA3 – Mapping and measuring the public health workforce

Informed by the understanding that a national or local setting is important, the group completing AA3 focussed on developing, adapting, and circulating data collection tools to:

  1. Identify what tasks are undertaken by which groups of people or professionals
  2. Identify workforce gaps that can be used for workforce planning and policymaking, to address these gaps.

This involves mapping public health personnel and the broader workforce (based on job titles and occupations) who deliver essential public health functions against the International Standard Classification of Occupations. This enables consistent global enumeration of the workforce.

Next steps

As all three action areas are interrelated, some minor synchronisation across the suite of toolkits and suggested simplifications were needed following the meeting, prior to making them publicly available. In the meantime, there’s substantial information about the Roadmap here.

The focus will now shift to enacting the Roadmap’s three core sections, aiming to utilize these toolkits in 100 countries by 2024. As 179 countries have applied to the Pandemic Fund for funding, of which 129 are low-middle income countries, it’s likely many will be included in the next phase of the Roadmap implementation to professionalise the global public health workforce.

 

 

Adjunct Associate Professor Priscilla Robinson and Honorary Associate Professor Leanne Coombe are PHAA members, and the Co-Chairs of the WFPHA Professional Education and Training Working Group.

 

Featured image: Greg Rosenke/Unsplash

 

Figure 1 is an excerpt from page four of National workforce capacity to implement the essential public health functions including a focus on emergency preparedness and response: roadmap for aligning WHO and partner contributions. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.

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