Division of Public Health Systems and Workforce Development Center for Global Health Public Health in Global Health Systems Strengthening Efforts Peter B. Bloland, DVM, MPVM Director Division of Public Health Systems and Workforce Development Center for Global Health Centers for Disease Control and Prevention Global Health Leadership Forum 2011

A CENTRAL ROLE FOR PUBLIC HEALTH Public Health and Health Systems Strengthening

Health System Strengthening HSS is generally defined as those activities that aim to improve a country’s ability to successfully perform the essential functions described or implied by WHO’s building blocks. From WHO (2007). Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action.

Public Health within Health System Strengthening Broad definitions of “health systems”, “health system strengthening” obscure important interrelationships Public health (i.e., prevention-oriented population health) relatively small when compared to overall health system, especially compared to individual curative services Nonetheless, core functions of public health and the contribution of public health practice to any health system are central to that system functioning effectively, efficiently Impact of public health efforts on the public’s health and functioning of health systems generally is disproportionate to visibility and funding it receives Essential to be strategic about where limited resources for public health are invested to get maximum impact

Six Key Targets for Public Health Systems Strengthening 6 core functions of public health that have the widest influence on the effectiveness of the health system itself. If these functions are themselves strengthened, they would in turn have the greatest impact on strengthening the health system as a whole and, therefore, the greatest impact on the public’s health. * Bloland et al., Protecting the Public’s Health - A vision for investments in public health within the context of global health system strengthening efforts (submitted for publication – PLoS Medicine)

Six Key Targets for Public Health Systems Strengthening  Ensuring Availability of Critical Strategic Information Evidence-based health policies Design and implementation of interventions safe, effective, affordable, deliverable, acceptable Appropriate/ effective use of human & financial resources International law– International Health Regulations 6 core functions of public health that have the widest influence on the effectiveness of the health system itself. If these functions are themselves strengthened, they would in turn have the greatest impact on strengthening the health system as a whole and, therefore, the greatest impact on the public’s health.

Six Key Targets for Public Health Systems Strengthening  Ensuring Availability of Critical Strategic Information  Strengthening Key Public Health Institutions and Infrastructure Ministries of Health Dedicated National Public Health Institutions Preparedness & Response Infrastructure Reconstruction & Stabilization of Public Health Institutions & Systems in Fragile States * Bloland et al., (2011) Protecting the Public’s Health - A vision for investments in public health within the context of global health system strengthening efforts 6 core functions of public health that have the widest influence on the effectiveness of the health system itself. If these functions are themselves strengthened, they would in turn have the greatest impact on strengthening the health system as a whole and, therefore, the greatest impact on the public’s health.

Six Key Targets for Public Health Systems Strengthening  Ensuring Availability of Critical Strategic Information  Strengthening Key Public Health Institutions and Infrastructure  Establishing Strong Public Health Laboratory Networks Laboratory Systems Integration Quality Standards & Accreditation Appropriate Technology Rapid, point of care diagnostics for HIV, malaria, others 6 core functions of public health that have the widest influence on the effectiveness of the health system itself. If these functions are themselves strengthened, they would in turn have the greatest impact on strengthening the health system as a whole and, therefore, the greatest impact on the public’s health.

Six Key Targets for Public Health Systems Strengthening  Ensuring Availability of Critical Strategic Information  Strengthening Key Public Health Institutions and Infrastructure  Establishing Strong Public Health Laboratory Networks  Building a Skilled and Capable Workforce Inherently governmental responsibilities: - Surveillance, outbreak and other health emergency response, reporting (IHR) 6 core functions of public health that have the widest influence on the effectiveness of the health system itself. If these functions are themselves strengthened, they would in turn have the greatest impact on strengthening the health system as a whole and, therefore, the greatest impact on the public’s health.

Six Key Targets for Public Health Systems Strengthening  Ensuring Availability of Critical Strategic Information  Strengthening Key Public Health Institutions and Infrastructure  Establishing Strong Public Health Laboratory Network  Building a Skilled and Capable Workforce  Implementing Key Public Health Programs Disease Control & Prevention Programs: - HIV/AIDS, TB, malaria, Neglected Tropical Diseases, non-communicable diseases, maternal & child health, road safety Disease elimination/ eradication: - polio, measles, guinea worm 6 core functions of public health that have the widest influence on the effectiveness of the health system itself. If these functions are themselves strengthened, they would in turn have the greatest impact on strengthening the health system as a whole and, therefore, the greatest impact on the public’s health.

Six Key Targets for Public Health Systems Strengthening  Ensuring Availability of Critical Strategic Information  Strengthening Key Public Health Institutions and Infrastructure  Establishing Strong Public Health Laboratory Network  Building a Skilled and Capable Workforce  Implementing Key Public Health Programs  Supporting Critical Operational or Applied Research Identifying new public health interventions Improving existing interventions Halting or modifying ineffective interventions 6 core functions of public health that have the widest influence on the effectiveness of the health system itself. If these functions are themselves strengthened, they would in turn have the greatest impact on strengthening the health system as a whole and, therefore, the greatest impact on the public’s health.

THE MACHINERY OF PUBLIC HEALTH Strengthening the A Framework for Public Health Systems Strengthening within the Division of Public Health Systems and Workforce Development

“The Machinery of Public Health”  Four interdependent components of the public health system  Public Health Workforce  Critical Public Health Systems  Public Health Institutions  “Culture” of Public Health WORKFORCE SYSTEMS INSTITUTIONS “CULTURE”

 Four interdependent components of the public health system  Public Health Workforce  Critical Public Health Systems  Public Health Institutions  “Culture” of Public Health  Weakness in any one can diminish the effectiveness of the others WORKFORCE SYSTEMS INSTITUTIONS “CULTURE” “The Machinery of Public Health”

 Four interdependent components of the public health system  Public Health Workforce  Critical Public Health Systems  Public Health Institutions  “Culture” of Public Health  Weakness in any one can diminish the effectiveness of the others  By addressing all 4, we can achieve greater impact, faster, and more sustainably than if address only 1 or address each sequentially WORKFORCE SYSTEMS INSTITUTIONS “CULTURE” “The Machinery of Public Health”

Building a Skilled and Capable Workforce WORKFORCE

Building a Skilled and Capable Workforce Success of any health system depends on availability of an appropriately trained, competent workforce Staff key national public health institutions Conduct core functions of public health Implement and manage critical health programs WORKFORCE

Building a Skilled and Capable Workforce Success of any health systems depends on availability of an appropriately trained, competent workforce Important to build skills of those already in government service as well as train future generations of public health practitioners Sustainable Management Development Program (SMDP) Field Epidemiology (and Laboratory) Training Programs (FETP) Medical Education Partnership Initiative (MEPI) Partnerships with US-based and host country schools of medicine and public health WORKFORCE

Strengthening Critical Public Health Systems SYSTEMS

Strengthening Critical Public Health Systems SYSTEMS A skilled and capable workforce cannot be fully effective if they do not have functional tools with which to do their jobs

Strengthening Critical Public Health Systems SYSTEMS A skilled and capable workforce cannot be fully effective if they do not have functional tools with which to do their jobs Critical Public Health Systems Health Risk Detection Disease Surveillance Investigating & Responding to Health Risks/ Disease Outbreaks Health & Risk Communications Information Management/ Informatics Operational Research Monitoring & Evaluation Biosecurity/ Biosafety Human-Animal Health Coordination Field Operations

Building or Strengthening Public Health Institutions INSTITUTIONS

Building or Strengthening Public Health Institutions INSTITUTIONS Public health institutions: Ministries of health and allied ministries Dedicated National Public Health Institutions Preparedness and response infrastructure Public health laboratories and networks

Building or Strengthening Public Health Institutions INSTITUTIONS Public health institutions are responsible for: Supporting and managing the public health workforce Managing critical public health systems Generating and interpreting public health data Ensuring translation of data into policy, policy into action, action into measurable improvements in health

Facilitating the development of a sustainable “culture” of public health “CULTURE”

What is Public Health? Facilitating the development of a sustainable “culture” of public health “CULTURE”

What is Public Health? Definition “the science and art of preventing disease, prolonging life and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of communicable infections, the education of the individual in personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual a standard of living adequate for the maintenance of health; organizing these benefits in such a fashion as to enable every citizen to realize his birthright of health and longevity” * C.-E.A. Winslow, 1920 “CULTURE” Facilitating the development of a sustainable “culture” of public health

What is Public Health?  Population-level orientation  Data-driven, evidence-based  Linked to action  “Consequential Epidemiology” – Dr William Foege, former CDC Director  Disease prevention and health promotion as prime intervention strategies  Reliance on coordination & communication between multiple sectors & disciplines:  Health, Environment, Social Welfare, Education, Business  Medicine (human, veterinary), Epidemiology, Mathematics, Social Science, Communications Definition “the science and art of preventing disease, prolonging life and promoting physical health and efficiency through organized community efforts for the sanitation of the environment, the control of communicable infections, the education of the individual in personal hygiene, the organization of medical and nursing services for the early diagnosis and preventive treatment of disease, and the development of the social machinery which will ensure to every individual a standard of living adequate for the maintenance of health; organizing these benefits in such a fashion as to enable every citizen to realize his birthright of health and longevity” * C.-E.A. Winslow, 1920 “CULTURE” Facilitating the development of a sustainable “culture” of public health

“CULTURE” Institutionalization of the core values and characteristics that define public health practice Establishing a “way of doing business” that is driven by those values and characteristics Instituting a philosophy of continual quality improvement and creating the policies and management systems that support that philosophy Doing so in a way that transcends individuals, persists through changes in leadership, and continues over time Facilitating the development of a sustainable “culture” of public health What is Culture of Public Health?

FINAL THOUGHTS WORKFORCE SYSTEMS INSTITUTIONS “CULTURE”

For more information please contact Centers for Disease Control and Prevention 1600 Clifton Road NE, Atlanta, GA Telephone, CDC-INFO ( )/TTY: Web: THANK YOU Center for Global Health The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.