Laura Magaa Valladares, Gustavo Nigenda,

1
Training, Employment and Performance of Public
Health Workers in Latin America and the Caribbean

• Laura Magaña Valladares, Gustavo Nigenda,
• Jose Arturo Ruiz, Nidia Sosa, Rodolfo Mendez
• National Institute of Public Health, México

2
Overview

• Purpose to investigate the characteristics of
  public health educational programs and their
  relation to the needs of national health systems
  in Latin American and the Caribbean
• Outline
• Introduction
• Methodology
• Findings
• Discussion

Article published in Report of the International
Conference on New Directions for Public Health
Education in Low and Middle Income Countries,
Public Health Foundation of India, Hyderabad,
India, August 2008 and published in a revised
form in Salud Pública de México , vol. 51, no. 1,
January-February2009
3
Background

• Health System Challenges
• Problems with populations accessing services
• Scarce resources available to finance health
• Inequality in access to available resources
• Issues concerning efficiency and quality of
  services
• Demographic and epidemological changes

2. Re-defining of Model of Care Shift from
focus on providing clinical services to focus
on the facilitation of health promotion and risk
prevention programs.
4

• Essential Public Health Functions (EPHF)
• requirements
• Coordination of health ministries, social
  security institutions and professional
  associations
• Technically capable leadership
• Informed civil society
• Organization of public health interventions
  according to
• functional groups that are limited
  and identifiable from an
• operational perspective.
• - Defined purpose, objectives,
  activities, resources, and organization
  according to that which is essential to the
  improvement of population health

5
4. Health Personnel Fundamental to Process of
ImplementingHealth Reforms

• Human resources in the sector play an active
  change role, as their functions as educators,
  trainers, and counselors are determining factors
  for the successful development of such models.
  
• graduates tend to not be attracted to the labor
  markets, which tend to generate high attrition
  rates and, consequently, result in wastage in
  human and financial capital.
• Needs
• Revise curricula at academic institutions to
  ensure incorporation of new competencies
• Seek educational formats that respond to demand
  for human resources on the job training
• Guarantee integration into the workforce

6
Methodology

• Countries consulted
• Sources
• Primary sources
• Secondary sources
• Review of the Pan American Health Organization
  (PAHO) Observatories of Human Resources and other
  specialized literature
• Telephone interviews with key informants
• Limitation lack of formal information about
  educational institutions

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• Part 1
• Existing Programmatic Frameworks and Curricula
  for Public Health Education

8

• Major Institutions Affiliated with the
• ALAESP with Training Programs in
• Public Health and Related Areas

• Public Health Education Origen
• 1922 - founding of the School of Health and
  Hygiene in Mexico (now National Institute of
  Public Health)
• 1927 - founding of Cubas National School of
  Public Health, which serves as a regional
  reference center
• 1964 - founding of Public Health Department of
  the University of Antioquia in Colombia
• 1980s - growth of academic programs
• Main institutions founded between 1975-2000
• Currently 42 well-known public health
  institutions in the region

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Main Findings
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Public Health Education Training Programs
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MPH Programs
Only one Environmental Health Program
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Pedagogical Models

• Strong emphasis on research and lack of practical
  approach
• Academic programs are seen as more serious than
  Professional programs
• Trend in the last decade to redesign programs
  with a competency-based model, incorporating
  participatory methodology case studies,
  problem-based learning, and active learning
• Notable Examples University of Veracruz, Mexico
  National Institute of Public Health, Mexico

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Delivery Methods

• Full-time, classroom-based
• used across degrees in practically all
  institutions
• most common
• Of the 42 institutions surveyed, 57.7 use a
  full-time, face-to-face format only.

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PART-TIME

• Part-time, classroom-based popular for working
  students
• Of the 42 institutions surveyed, 22.2 have
  incorporated
• a part-time face-to-face format.

15
E-LEARNING

• Innovative format based on Information and
  Communication Technologies (ICTs)
• Slowly increasing in the region, mostly in
  continuing education.
• Of 42 institutions surveyed, 4.4 use an online
  format.

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B-learning

• Combines e-learning with classroom-based
  activities
• Relatively new in the region and becoming more
  popular
• Of the 42 institutions surveyed, 2 institutions
  use b-learning (National Institute of Public
  Health, Mexico, and the Central University of
  Venezuela).

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Faculty
Lack of accreditation of regional public health
programs
School and Program Accreditation

• Generally, graduate program faculty hold masters
  degrees
• - Only in Cuba do almost all faculty members
  possess doctorate degrees

• In 90 of countries studied, the entrance exam is
  defined by the institution itself
• a national graduate admissions evaluation
  instrument only exists in Mexico
• Student profiles have changed in the last 10
  years from being mostly medical to professionally
  diverse

Admissions Requirements
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Alumni Tracking Program
Scholarship Programs

• The main limitation of graduate education in the
  region, is lack of financial support
• Most programs in the region lack alumni tracking
  programs

• Only 6 institutions report having
• career services

Career Services

• Institutions are developing continuing
• education programs in collaboration with
• health systems

Continuing Education
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• Part 2
• Public Health Workforce

Few studies advance the analysis of the
relationship between world of educational
instutitions and world of work.
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Human Resources by Country

• Challenges.
• In most countries there is no precise information
  on the number of health sector workers or the
  number of public health workers.
• There are country differences in the
  identification of public health workforce.
• There is no individual data for occupational
  categories.
• - Only in Belize, Guatemala, Honduras, and
  Panama was there a group of health personnel
  characterized as Public Health Workers and
  Environmentalists

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Health Human Resources, Rates per 10,000
Inhabitants in 17 Latin American Countries
Sources a PAHO. Health Situation in the
Americas, Basic Indicators 2007. b PAHO. Health
Situation in the Americas, Basic Indicators
2005. c PAHO. Health in the Americas 2007. Vol.
II Countries. 2007. d WHO. World Health
Statistics 2006. 2007 e Dirección Nacional de
Estadística de Cuba. Anuario Estadístico de Salud
2006. 2006 f Secretaría de Salud de México.
Boletín de Información Estadística 2005, 2006 g
2001 National Census of the population of
Dominica, http//sakafete.com/Election_Race_2005/2
001-POPULATION-AND-HOUSING-CENSUS.html consulted
June 2008. h Population Division of the
Department of Economic and Social Affairs of the
United Nations Secretariat, 2002.
http//earthtrends.wri.org/text/population-health/
country-profile-74.html Consulted June 2008 i
PAHO, Country health profile, 2001.
http//www.paho.org/english/sha/prflhai.htm
Consulted June 2008 j Ministerio de Salud de
Nicaragua. Observatorio de los RHS de Nicaragua.
http//www.minsa.gob.ni/bns/observatorio/datos.htm
l Consulted June 2008 k WHO. World Health Report
2001. 2001 l WHO. World Health Report 2002.
2002 Notes Does not include nursing
assistants. Medical personnel with patient
contact.
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Conditions in Labor Market

• Observatories have reported
• loss of contractual benefits
• increased flexibility in hiring methods
• coexistence of various work regimes for similar
  occupational categories
• Labor Wastage. Unemployed working in unrelated
  jobs (Mexican nurses 33 unemployed, 2l7.4
  unrelated jobs 60.5 labor wastage)

• Outsourcing and subcontracting activities
• Previously for cleaning, food, and security
  services
• Currently for offer other services through hiring
  of medical cooperatives and nursing organizations
  for home care or rehabilitation.

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Elements for Discussion

• Different criteria and classification used in
  statistical and qualitative data determine who
  makes up public health workforce
• General findings
• 1) people with training in Public Health
• a. do not work in primary care
• b. are concentrated in urban areas
• c. lack skills to work with communities
• d. dedicated to coordinating programs
• 2) occupational categories that perform work
  related to public health (ie primary care
  medical personnel, nursing technicians and
  assistants, health promoters, etc.)
• a. work not recognized as contribution to
  public health
• b. majority of occupations in this category
  are low-level
• in regard to hierarchy and income

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Conclusion

• Need to incorporate new competencies and models
  of primary health care into curricula.
• Promote collaboration between academia and health
  systems
• Diversify educational program delivery formats
• -part-time, weekend, and online programs
• Follow-up graduates
• Provide continuing education programs in
  collaboration with health systems
• Regional public health associations look into
  the agenda of accreditation to ensure quality
  training
• We need to increase research into workforce,
  categories, competencies, evaluation and
  promotion.

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• 
  
• 
  

WE HAVE TO BE CREATIVE TO MEET THE
REGIONAL CHALLENGES AND MOVE FORWARD THE
PUBLIC HEALTH WORKFORCE EDUCATION AND
TRAINING AGENDA.

Thank you!