Building Public Health Workforce Model: Making It Relevant to Local Context

Victor Joseph

FPH Africa SIG Chair
Consultant in Public Health and Training Programme Director

Having an effective public health workforce is important in addressing public health challenges facing all nations across the world. However, there are critical factors – all too often overlooked by policymakers – that need to be addressed in order to realise an effective global public health workforce.

This article will explore a comprehensive model of public health workforce development focused on six key components:

1. Defining the public health problems facing the nation (state, region, province, county, etc).

2. Drawing up the job descriptions of the workforce that will address the problems.

3. Defining the competencies of the public health workforce.

4. Drawing up the curriculum and training programme for the public health workforce.

5. Establishing a national public health institution (body) that will accredit the public health workforce and sets standards.

6. Agreeing on the terms and conditions of trained staff.

This blog draws upon lessons on public health workforce development from different countries such as India, Malawi, the Sudan, Somaliland, South Africa, Zimbabwe, and Nigeria, among others. The key question is “how can public health training be relevant to the local context in different countries?”.

The primary target audience of this model is public health policy makers (e.g., government), public health educational institutions (universities and training institutes, standard setting bodies), and employers of the public health workforce (government, and private organisations). Those training in public health or who are already part of a public health system would find that the components of the models are relevant to them too, as they have a crucial role in influencing the model in order to ensure a thriving and resilient public health workforce fit for the future in their respective settings.

Many individuals and stakeholders with interests in building the public health capacity of their respective organisations or countries focus on the technical aspects of training the public health workforce to gain qualifications or competencies. Experience shows that policy makers and educational providers need to think beyond the technical expertise needed by professionals. There are several components of a public health workforce development model that need to be addressed to achieve the intended goal of improving health, protecting health and reducing health inequalities in any society. Some of the components of the model are often considered to be too sensitive or difficult to address and yet important, such as the issues of staff salaries. Failure to take into account these components of workforce development, risks undermining the development of a thriving and resilient public health workforce in any setting.

The Public Health Problems

The fundamental question in relation to public health workforce development that needs to be answered is “what are the national public health problems that need to be solved?”. Some of these challenges might vary from one country to another, and even within each country these can vary by regions, districts, provinces, counties, and communities. What is the commitment of the government to tackle the public health problems in terms of staff training, provision of necessary resources and equipment, salaries of staff, among other things. In order to understand the problems, a number of stakeholders need to be engaged, including public health professionals, the public, government, non-governmental organisations, civil society, etc.

Job Descriptions

Another important step to consider in the public health workforce development model is the need to identify what types of professionals are needed to do the job (to solve public health problems); what their job descriptions would look like; and who should be involved in writing their job descriptions. Experience shows that for this to be done fairly and well, it needs the involvement of diverse stakeholders such as employers (government, non-governmental organisations, etc.) and professional bodies, among others.

While it is necessary to think of public health leaders / experts (e.g., Consultants in Public Health), many countries do not have the means to train such leaders, it is therefore essential to think of the various levels of public health workforce that can do the job well, as categorised by the World Health Organisation in carrying out essential public health functions (EHPF) into: core public health personnel, health and care workers, and personnel from occupations allied to health.  

Competencies, Curriculum and Training Programme

The next task is to develop the competencies and standards needed to do the job. This will constitute a training curriculum for the public health workforce. Examples of this include the World Health Organisation’s Essential Public Health Functions; the training curricula of specialist public health training programme of the Faculty of Public Health in the UK or the South African Colleges of Medicine; the UK Public Health Practitioners programme which is accredited by the UK Public Health Register (UKPHR).

The curriculum that is developed needs to be accredited by a national professional body or a national institute of public health, in accordance with the structure in each country.

Staff and Salaries

Staffing and salaries are some of the most contentious issues in attracting and retaining public health workforce. Institutions and nations that get them right will attract and retain an essential public health workforce that is thriving and resilient, while continuing to develop them over time. There are several factors that need to be addressed when considering salaries or incentives for the public health workforce, including different levels of expertise, attractive salaries and terms and conditions, career development, available facilities and positive work environment, among others.

Throughout the stages of the proposed model, there are a number of key stakeholders that need to be part of addressing the key components of the training model. They need to include among others, employers, professional bodies, the public, regulatory bodies, and training institutions (Figure 1).

Figure 1: Public Health Workforce Development Model