Service-Oriented Training in Public
Health
A Model for Enhancing Public Health Surveillance in the Pacific
Mahomed Said Patel
National Centre for Epidemiology and Population Health
Australian National University, Canberra, AUSTRALIA
The need
Every country needs the capacity to measure and analyse continuously
the health status of its population. It does so through public health
surveillance. Surveillance is not simply the collection and reporting of health
data. Surveillance tells us where health problems are, who is affected, and
where prevention and control activities should be directed. It helps us to
define priorities for health programs and policies, and also to evaluate their
effectiveness.
Without practitioners skilled in managing a system of public health
surveillance, the quality of assessment of a population’s health status will
be deficient and the resultant public health responses may even be harmful.
Without valid surveillance data, the allocation of scarce health resources will
be more likely to be driven by other vested interests, and not primarily by the
needs of the community.
In December 1995, SPC in collaboration with WHO and UNICEF sponsored
the Inter-agency Meeting on Health Information Requirements. This meeting
recorded the concerns on the accuracy, quality and usefulness of surveillance
data in the Pacific. Later on, the Pacific Public Health Surveillance Network
was formed to develop and implement strategies for enhancing surveillance.
The challenge
While various agencies conduct training in surveillance for health
professionals from the Pacific, such training is not done in a coordinated and
efficient manner to ensure professional and institutional development aimed at
capacity building.
Training in surveillance should not be conducted as another vertical
program. It should embody the principles for training articulated in the Pacific
through the Yanuca Declaration, the meeting on Postgraduate Medical Education in
the Pacific, and at the conferences on Community Health in Medical Education
held between 1991 and 1997.
The response
The Pacific should adopt the service-oriented model of training that
integrates training in surveillance with training in public health.
In this model, the trainee is based in the workplace, and the process
of training itself contributes immediately and directly to enhancing
surveillance and other public health activities and capacity building.
1. Who to train?
Training should be offered to all health professionals. As many public
health practitioners and generalist clinicians in the Pacific provide clinical
and public health services concurrently, they could participate in the same
training pathway in public health. Clinical specialists are important role
models in society; their commitment for enhancing surveillance must be secured.
2. How to train?
The training model is integrated with public health practice and
incorporates continuing education and graduate degree training. It would include
training in data collection and using the data for decision-making at the point
of collection, i.e. at the primary health care level.
Specific educational objectives for continuing education and graduate
degree training should be based on the needs of the practice environment.
Training should be hierarchical so that it provides the competencies that are
necessary for effective performance at different levels of the health system.
Graduate degree training in surveillance should be integrated with
public health training (basic, intermediate and advanced). The graduate program
includes the Field Epidemiology Training Program with its major strength in
enhancing competencies for managing all aspects of surveillance, including
public health responses and policy making.
3. Where to train?
Continuing education and graduate degree training should be conducted
primarily at the workplace. Some didactic work will be required, but tutorials
and exercises or assignments should be anchored to the real-life experiences in
public health units to be accredited as training centres based on specified
criteria.
4. How to organise the training program?
The organisational framework of the training program should
incorporate all the potential partners. The SPC should provide leadership as the
Centre for Coordinating Service-oriented Training in Surveillance, appoint an
advisory board constituted of the program partners, and coordinate the
development of the continuing education program.
The University of PNG and the Fiji School of Medicine should be
invited to submit expressions of interest in developing and incorporating
training modules in surveillance into their graduate degree programs. Graduate
degree trainees should have supervisory academic and field support. Field
support should be provided through the senior public health practitioner based
in public health unit and in health agencies.
Looking ahead
Options in planning, implementing and evaluating the training program
should be considered and judged against criteria for ensuring sustainability and
capacity building.
The benefits should be sustained through the efforts of trainees and
graduates, as well as through the national health departments, training
institutions and regional and international agencies. The result should be
strong surveillance programs with national and regional capability for
responding to adverse health problems and, for promoting a healthy Pacific.