MAJOR CHALLENGIES IN EMERGING SCHOOLS OF PUBLIC HEALTH

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MAJOR CHALLENGIES IN EMERGING SCHOOLS OF PUBLIC
HEALTH
The Role of Graduate PH Education in Addressing
Health Challenges in CEE and NIS Countries Kyiv,
Ukraine, 1-2.07.2004

• Stojgniew Jacek SITKO
• Institute of Public Health
• Health Protection Dpt. Collegium Medicum
• Jagiellonian University, Kraków, Poland.
• ASPHER Executive Boardmxsitko_at_cyf-kr.edu.pl

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Reasons for this presentation

• OSI-ASPHER Program ends
• Questions
• Common categories of challengies in emerging SPH
  ?
• Lessons for other (new, old) SPH ?

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My background

• Deputy Director for few years of the one of the
  first newly established SPH in CEE region
  namely in Krakow, Poland, 1991
• Consultant of the OSI-ASPHER Program in
  Ukraine, Russia, Lithuenia, Estonia
• ASPHER - PEER Committee member and PEER reviewer
• Participant in international programs supporting
  the introduction and/or improvement the new PH
  education
• Member of the Board of ASPHER

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Content of this presentation

• Results of the pilot study
• Conclusions from the study
• General remarks

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--- CEE and NIS --- reforming Health System and
health Education especially in PH---
OSI-ASPHER Program beneficients
Countries of interest
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• Since what year your country is independent?
• In which year the 1st School of Public Health was
  formally and officially established in yr
  country and where? What is its name?
• Is Tthis 1st SPH was established in yr country at
  Medical Academy/Medical University (or
  equivalent) on the base of Sanitary and Hygiene
  Faculty (or equivalent) at Public/Private
  University or elsewhere? (please give as full
  name(s) as possible )
• How many SPHs are currently operating in yr
  country (if exact nr unknown - please estimate)
• Are those current SPH affiliated mostly at
  Medical Academy/Medical University (or
  equivalent) at Public/Private University? What
  are the proportion? (if exact data unknown please
  estimate)
• In which year your School of Public Health was
  formally and officially established? Please give
  its exact name in full.?
• Is yr SPH established at Medical Academy/Medical
  University (or equivalent) at Public/Private
  University or elsewhere? (please give full
  name(s) ) Which organizational status has
  currently yr SPH - faculty/department/part of
  (what organization) self-standing-organization?
  If it currently operates in different structure
  than at the beginning - please explain.
• Do you currently offer the BPH/MPH/other program
  in public health, please explain. How long it
  takes (how many semesters)? With what kind of
  diploma/certificate it finishes?
• Are there in yr country an official low/
  regulations which defines the status/place of
  public health professionalists - alumnae of the
  BPH and MPH program of SPH in the health system?
  Since then? What is the name of this regulation?
  When it was established? By whom?
• What is the level interest of the candidates to
  study BPH and/or MPH in yr SPH - how many
  candidates is currently striving for 1 place in
  your BPH/MPH programs?
• What is the proportion of medical (med.dr,
  nourses) to non-medical (eg. lowers, economists
  and others) students at the BPH and/or MPH
  studies you are offering at yr SPH? - in percent
  (if the exact data not available - please
  estimate for this academic yr) Is this proportion
  changing during last years? How - please describe
  (any more precise data available? do you do any
  statistics on that?)
• What kinds of specialization (if any) your PH
  programs offer to students?
• Is(are) your program(s) licensed by MoH/Ministry
  of Education?
• How important is the private health care sector
  (compared with a public one) in yr country to
  your knowledge? (please estimate the its share
  in the whole health care services, are there any
  evidence/research done of that?)
• How many of the SPH alumni just after completing
  their education start their careers in the
  private sector comparing with the public one?
  (please, estimate in , are any evidence/research
  done of that?)
• Do you perform the career track of your
  graduates? What are those tracksthe career tracks
  of your graduates? What kinds of positions they
  occupy?
• Does it exists in your country the formally
  established medical specialization in public
  health? If so, since when? What is the name of
  the relevant law regulations? Who established
  it?
• If this medical specialization is established -
  does it encompasses the course of BPH or MPH as a
  part (which part?) of the preparation/studies
  towards the specialization? If yes, what states
  exactly the relevant regulation?
• What are the major problems your SPH experienced
  in the past? Now?

Tool
20 points Questionnaire to SPHs
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Output

• 17 responses
• from different coutries
• open qs - some ambiguity present
• not all the answers
• not pretend to be a regular study
• interesting material

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Country scope

• ALBANIA
• ARMENIA
• AZERBAIJAN
• BULGARIA (2)
• CROATIA
• KAZAKHSTAN
• MACEDONIA
• MONGOLIA

• POLAND
• RUSSIA (2)
• ROMANIA
• SERBIA
• TADJIKISTAN
• UKRAINE
• UZBEKISTAN

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Preliminary Results
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1. Since what year yr country is independent
2. (In which year the 1st SPH was established)

• 1989 (1991)
• 1990 (2001)
• 1991x9 (1995)(1996x2)(1997)(2001)(2003)(2004)
• 1992 (1927)
• ... (2002)
• 4 other cases in course of establishment

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3. Affiliation of the 1st SPH

• (...) in course of establishment
• 8 (3) - Medical Academy/University
• 2 - University
• 2 (1) - others (Independant Institute,
  Joint-venture MA-Univ.)
• 2 (1?) out of them private

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4. Number of currently operated SPH in your
country

• (...) in course of establishment
• only ? in a country
• ?????????(????) 9 (4)
• ? and more...
• ?2,?3-5,?5-8,?7(?), 4

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8. BPH/MPH programs at your SPH?

• (...) in course of establishment
• MPH - 10 2y8, 1.5y1
• BPH - 2 2.5, 3y (6y)
• BPH/MPH part time 1 (3y)
• others
• SPECIALIZATION (MD) in PH -3 1,2,?y,
• Specialists in... - 1 4-5y
• PostGraduate studies - 1 2y
• not yet - 2

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8. ...kind of diploma/certificate?

• State Diploma - 2
• Diploma/Certificate - 3
• not yet - 2

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9. Official regulations - PH professionalists
position?

• Yes -
• No -

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10. Nr of candidates for 1 place in BPH/MPH
program ?

• 8-10 (MDspec.)
• 4
• 3-5
• 3
• 2.5
• 2 (2)
• lt1

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11. Proportion of Medical to Non-medical
students ()?

• 100(3)
• 95(2)
• 75
• 70
• 60
• 50
• 0

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12. Specializations in PH program?

• No
• PH Management
• PH Adminstration
• Epidemiology
• Preventive Med.

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13. Is yr program licenced by MoE?

• Yes
• No
• sometimes
• -- MoH
• -- teaching entity is licenced as a whole

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15. How much alumni works in private sector?
14. How important is the private health sector?

• 5 (2)
• ? (5-10)
• 5 (10)
• ? (12)
• (?) (15)
• 20 (20)
• 3 (40)
• 30 (50)
• 15 (?)

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16. Career track of the graduates?

• Yes
• No

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17. Medical specialization in PH?18. Is BPH/MPH
a part of this education?

• Yes (spec.)
• out of this
• the BPH and MPH is a part

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Major PROBLEMSapart from limited (financial)
resources

• old fashion medicalised view on PH
• establishing a PH education elswhere than at MA
• lack of awarness of PH
• misunderstanding and underestimation of PH
• low salaries in public sector
• lack of legislaton
• re-orientation of faculty members/lack of
  trainers
• cooperation of SPH with other PH institutions

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Summary Conclusions

• Diversity in
• degrees offered, length of studies
• No regualtions of PH professional status
• Quite high interest to study PH
• Still prevailing medical students
• Majority no specialization, someMgmt
• Up to 50 of graduates ? private sector
• Few cases of established MD spec. in PH

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• Is the CEE NIS Health Care System ready to
  absorb professionals in PH ?

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• rather NOT because usually
• there are no formal positions for them in a
  system
• they are not recognized by
• medical personnel
• health managers
• health administrators
• there is no status/esteem of this profession
• patient/citizen does not know what PH is

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• Possible
• recommendations?

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Range of recommendations for SPH

• Work intensively together with the abroad
  partners/experts to constructively solve your
  local problems
• be flexible, consider to set up the coalitions
  with other organizations if necessary, give them
  some benefits

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Range of recommendations

• involve the MDs into the project as teachers but
  also gain the influential representats from
  medical establishment
• the same with MoH representatives and politicians
• build the support of stakeholders !

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Range of recommendations

• as soon as possible
• start the postgraduate and graduate education
• fight for setting the regulations for employment
  of PH professionals
• the same for the regulations for degrees in PH
• build up a status of PH professionals

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Future of the OSI-ASPHER Program...?

• Further study and regular analysis of the
  experiences of those SPHs under auspicies of
  ASPHER?
• grant application Leonardo?
• Possible complementing activities
• ...?

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References

• Health care professionals on the way to improve
  the education level, Sitko S., Public Health,(PL)
  5-6, 2001, p.364.
• Study of educational services market and
  employment possibilities in the sphere of public
  health, Gryga I. et al., NaUKMA, Kiew, UA, July,
  2002
• Public Health Training in Albania Long way
  toward a School of Public Health, Roshi E.,
  Burazeri G., Croatian Med.J., 43(4)503-5, 2002.
• Schools of public health, bases of establishment
  and perspectives in Russia and abroad, Syrcova,
  L. et al. TACIS, Moscow 2000.
• Public Health Program (OSI-ASPHER) Project
  descriptions, Reports, OSI-NY, 2001-2004

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• Thank you
• for your attention and cooperation