Session 2: Building Resilient Health Systems through Stronger Institutions and Workforce to Deliver the Essential Public Health Functions
Dr. Theresa Tam introduced the session, emphasizing the importance of building resilient health systems and strengthening the delivery of essential public health functions. Given the context of facing complex emergencies and health challenges such as the COVID-19 pandemic and climate-related events, this session's significance laid in the knowledge, expertise, and collective sharing of experiences. She stressed the need to invest in and support the public health workforce, recognizing them as vital assets and advocating for the development of surge capacity networks. During this session, a diverse panel of experts, including representatives from the WHO, discussed global collaborative approaches.
Essential Public Health Functions as Comprehensive Approach to Strengthening Public Health and Services
Dr. Sohel Saikat, Senior Advisor Primary Health Care and Lead Health Systems Resilience and Essential Public Health Functions, World Health Organization (WHO)
Public health plays a central role in addressing diverse challenges, such as those posed by the COVID-19 pandemic and other complex stressors. While these challenges cannot be effectively addressed by isolated systems, public health considers intersecting factors, intervene early to prevent the escalation of minor events, and relieve pressure on secondary and tertiary care by bolstering primary care services. Given the under-prioritization of public health investment across all countries including European countries, which currently amounts to 0.6% of GDP, and the lack of a comprehensive understanding of the scope of public health and its operational aspects, the WHO identified 12 fundamental EPHFs. These are divided into service delivery-related functions (protection to promotion, prevention, and public health emergency management) and eight enabling functions, all interconnected and interdependent. WHO unpacked each of the 12 EPHFs into sub functions, resulting in a comprehensive package of 20 public health services and 12 system enablers, which could serve as reference for countries to set their baseline and improvement strategy for public health based on their current and future population health needs. The Framework as articulated in a WHO and IANPHI joint publication not only brings all aspects of public health und er one umbrella but also addresses blind spots, allowing for a comprehensive and integrated approach. Moreover, the EPH Fs complement existing frameworks under health systems, primary health care, International Health Regulations (IHR) (2005), and emergency disaster risk management. WHO has applied this framework at country levels to evaluate their public health baseline across various domains, including national policy and planning, infrastructure, service provision, coordination, learning, monitoring and evaluation. By adopting this approach, countries can establish a solid foundation for public health, informing future policy decisions, and the role of national public health institutes (NPHls). Several countries have already started implementing this approach to inform public health reform for building more resilient health systems.
Setting out the WHO Roadmap toBuild the Public Health and Emergency Workforce and the Important Role that NPHls Play
Dr. Khassoum Dialo, Coordinator for Data, Evidence and Knowledge Management, World Health Organization (WHO)
Together with leading public health organizations, WHO has developed its Roadmap on Public Health and Emergency Workforce, aimed at strengthening national capacity by identifying the necessary workforce to implement the EPHFs and address challenges. Dr. Khassoum Diallo stressed the need for a comprehensive approach, involving both core public health workers and non-health sector engaged in public health activities, such as water sanitation, road traffic, air pollution, etc. The Road map focus es on three action areas: the EPHFs as developed by Dr. Sohel Saikat, competencybased education, and mapping and measurement of occupations. Piloting in multiple countries has provided insights and tools for implementation. At the national level, governance and collaboration must be multisectoral, in volving key stakeholders in conceptualization, implementation, and support. EPHFs are interdependent and require a coordinated approach to building public health workforce capacity.
Building Resilient Public Health Systems through Stronger Institutions and Workforce to Deliver the EPHFs
Dr. Laura Magana, President and CEO, Association of Schools and Programs of Public Health (ASPPH) & Global Network for Academic Public Health (GNAPH)
The Global Network of Academic Public Health (GNAPH) is an alliance comprised of seven regional associations. Its primary goal is to enhance academic public health globally through collaborative learning and multilateral partnerships aimed at safeguarding people 's health. GNAPH's mission aligns closely with the vision of IANPHI, particularly in strengthening the current and future public health workforce. This alignment is evident in their joint efforts to contribute to the WHO Roadmap, among other initiatives. The challenges facing global public health highlight the urgent need for a resilient and well-prepared workforce. These challenges include disease outbreaks, violence, shortages in the public health workforce, persistent under investment, lack of robust information systems, health emergencies, demographic trends, and increasing inequalities. These factors underscore the necessity for comprehensive and immediate reforms. Public health schools and programs are actively engaged in supporting the existing workforce and training the next generation of health professionals. The COVID-19 pandemic has further emphasized the importance of updating competencies beyond traditional domains to effectively respond to crises. These competencies include leadership, communication, advocacy, technological skills, and understanding key global public health concepts such as One Health, climate change, health equity, and social justice. Furthermore, Dr. Laura Magana advocates for lifelong learning and interdisciplinary collaboration to address evolving health threat and ensure workforce resilience, while also prioritizing the mental well-being of health professionals. In conclusion, it is imperative for public health schools and NPHls to partner in identifying training gaps, designing educational pathways, and strengthening collaborations to effectively address current and future public health challenges.
Working with Ministries of Health and NPHls to Build Consensus on the EPHFs
Dr. Fethiye Gulin Gedik, Coordinator Health Workforce, World Health Organization Rehional Office for the Eastern Mediterranean
A decade ago, the WHO Regional Office for the Eastern Mediterranean collaborated with public health institutions to develop the EPHF conceptual franweork, aiming to define their roles in providing essential public health services. Testing the Framework with an assessment tool in several countries involved close cooperation with Ministries of Health. The onset of the COVID- 19 pandemic prompted a revision of the Framework, informed by lessons learned and previous consultations. The updated and resulting Frame work identified five core functions, including health protection, surveillance, public health services, health promotion, and disasters and emergencies, supported by enabling functions such as governance, workforce, research, and communication. Dr. Fethiye Gulin Gedik emphasized the interdisciplinary nature of public health and the importance of multi-sectoral collaboration beyond the health sector. Competencies for the public health workforce were outlined, guided by a framework developed with the UK Health Security Agency. Resolutions in 2022 and 2023 highlighted the significance of resilient health systems and paved the way for the implementation of health workforce strategies. Ongoing discussion and consultation with Member States ensures the Framework's relevance in shaping health policies and strengthening public health institutions.
Strengthening NPHls and Emergency Workforce Capacity in Africa
Dr. Raji Tajudeen, Head of Division Public Health Institutes and Research, Africa Centres for Disease Control and Prevention (Africa CDC)
Dr. Raji Tajudeen gave an overview of the Africa CDC's efforts in promoting NPHls and strengthening emergency workforce capacity in the region. Africa CDC's fourth strategic priority focuses on strengthening NPHls, which is further supported by cross-cutting enablers such as supporting health workforce development in the continent. Since its creation in 2017, Africa CDC has made significant strides in establishing and supporting NPHls across Member States, with a decrease in the number of states without any form of NPHI and an increase of the number of fully established NPHls. Africa CDC developed various initiatives and tools to support NPHls, including peer-to-peer training programs and regional meetings. Collaboration with WHO is paramount in advancing the agenda of NPHls. Africa CDC is actively involved in workforce capacity-building efforts, namely through the Kofi Annan Global Health Leadership Program and the support for field epidemiology training programs (FETP). Furthermore, Africa CDC launched the Joint Emergency Preparedness and Response Action Plan (JEAP) in collaboration with WHO Regional Office for Africa and EMRO aimed at strengthening emergency workforce capacity. The African Epidemic Services (AES) program focuses on building capacity in applied epidemiology, lab leadership, and health informatics. Partnerships with various organizations, including USCDC, RKI, SIDA, have been instrumental in supporting these initiatives. Efforts are also underway to strengthen legal instruments, establish public health emergency operation centers, and expand the African Volunteer Health Corps (AVoHC) to ensure a robust response to emergencies at national, regional, and continental levels.EU Team Europe Initiative on Strengthening NPHls
Dr. Anders Tegnell, State Epidemiologist, Public Health Agency of Sweden
Ms. Diana Van Daele MD, Program Officer, Directorate-General for International Partnerships. European Commission, Belgium
The Team Europe Initiative (TEI) to support NPHls in Africa was established within the framework of the global gateway package for a reinforced partnership between Africa and Europe presented at the 6th EU-AU Summit. It comprises of four flagships, including one focusing on strengthening health systems. Ms. Diana Van Daele clarified that the TEI involves both funding from the European Union Commission and contributions from all Member States, which have existing bilateral country support. Within the health systems strengthening flagship, there are three regional TEIs, focusing on health security, on support to public health institutes, and on strengthening digital health systems. These initiatives aim to address the African Union's call for a new public health order and support Africa CDC in its efforts to strengthen NPHls across the continent. The launch of the three TEis is scheduled for the end of March.
This initiative focuses on supporting public health institutes in horizontal manner rather than vertical programs. The goal is to support the core functions defined by organizations like the WHO and Africa CDC, while also fostering better collaboration and networks, particularly South to South and between Europe and African countries. Dr. Anders Tegnell underscored the significance of regional cooperation, especially in light of lessons learned from the pandemic, and stressed the alignment of the program with the work of Africa CDC and other TEIs to avoid overlap and ensure efficiency in capacity building efforts. The initiative aims to strengthen health systems in multiple African countries,
focusing primarily on 10 countries covered by the Member States. At present, there are ongoing initiatives to enhance coordination among EU Member States and foster collaboration with the Africa CDC to identify and address gaps.
South Africa's Experience - Reform of the Public Health System and Building Epidemiology Capacities
Dr. Natalie Mayet, Deputy Director, National Institute for Communicable Diseases (NICD)
The field epidemiology training program established in 2006 in South Africa in collaboration with the Ministry of Health, academia, and the National Institute for Communicable Diseases (NICD), aims to enhance capacity, strengthen health systems, and prevent public health threats through competency-based learning and service-oriented training. Despite its multidisciplinary nature, the program faces challenges in attracting medical doctors and is experiencing a shift towards reliance on donor funding. Dr. Natalie Moyet emphasized the importance of inclusivity and recognizing diverse cadres in pandemic preparedness and response. Credentialing interdisciplinary healthcare professionals and fostering collaborative efforts across public and private sectors are essential. To achieve universal healthcare coverage, prepare for future pandemics, address colliding syndemics, and respond effectively to new public health challenges, NPHls must prioritize competency-based and interprofessional education. It should be grounded in extensive information technology and health economics, fostering healthcare professionals who act as science diplomats, advocating for patient care, and influencing policy. Additionally, it is crucial to enhance the attractiveness of healthcare professions and the public healthcare workforce, through recognition of value and fostering partnerships, including global initiatives such as IANPHI, the global public health workforce in epidemiology, Training Programs in Epidemiology and Public Health Intervention Network (TEPHINET), Africa CDC, and other collaborative efforts.
Panel Discussion
Overall, the panelists discussed various challenges and considerations related to workforce development, deployment, and sustainability, emphasizing the importance of collaboration, advocacy, and holistic approaches to address these issues effectively.
Prof. Duncan Selbie, President of IANPHI, expressed admiration for Dr. Raji Tajudeen's insights on Africa CDC's role, finding inspiring how progress had been made in just seven years. He emphasize d the crucial role of the workforce in implementing strategies, reflecting on lessons learned from the pandemic. He also stressed the significance of understanding the public health workforce and appreciated the interdependencies between various public health efforts, including discussions on emergency response.
Dr. Augusto Paulo Silva from the Oswaldo Cruz Foundation (FIOCRUZ) of Brazil, raised concerns about deploying and paying healthcare professionals, particularly in countries with a financially weak Ministry of Health. He emphasized the need to involve institutions like the World Bank in discussions about fiscal challenges and to consider constitutional provisions regarding healthcare expenditure.
Dr. Mesay Hailu Dangisso from the Ethiopian Public Health Institute (EPHI) highlighted challenges in Ethiopia regarding the training and deployment of epidemiology workforce, emphasizing the need for clearer lines of responsibility and accountability. He stressed the importance of collaboration between public health institutions and government ministries of other sectors, including finance ministries.
Following Dr. Natalie Mayet's presentation, Dr. Joconiah Chirenda from the University of Zimbabwe elaborated on Zimbabwe's experience in training epidemiologists. He highlighted deliberate efforts to attract clinicians by proactively reaching out to them and providing information, which has led to the increase of the number of subscriptions. He emphasized the joint responsibility of academic institutions and the Ministry of Health in workforce development, aiming for sustainability and avoiding challenges.
Prof. Babatunde Lawal Salako from the Nigerian Institute of Medical Research (NIMR) echoed the need to expand the definition of the workforce to include roles like finance and procurement, which are often overlooked but crucial during emergencies. He emphasized the importance of training these individuals to understand public health processes and facilitate fast responses.
Dr. Andrea Ammon from the Europe an Centre for Disease Prevention and Control (ECDC) advocated for recognizing and addressing the multifaceted challenges within the health workforce. She stressed the importance of advocating for public health inclusion in workforce strategies and improving working conditions, salaries, and career prospects. Additionally, she highlighted the need for diversifying training to meet immediate needs and upskill existing workforce members.
Conclusions & Key Action Points
Advocate for Recognition and Support: NPHls must actively engage decision-makers and stakeholders to advocate for the recognition and support of the public health workforce. It includes clarifying the roles and functions of public health professionals to ensure their contributions are understood and valued.Comprehensive Collaboration: Take a comprehensive approach to addressing workforce challenges by involving various sectors both within and outside the health system. This includes collaboration between NPHls, academia, government ministries, finance sectors, and international organizations to develop holistic solutions.Competency-Based Education and Training: Emphasize competency-based education and training for the public health workforce to ensure professionals have the necessary skills and expertise to address current and future public health challenges effectively. It involves continuous professional development and lifelong learning to keep pace with evolving public health needs.