It is clear that the critical factor in providing access to career pathways in public health is the availability of relevant education and training.
Issues relating to pre-entry routes and training form part of the discussion of the Entry Points information in Section 6.2.1. The need for some specialised public health training at an early stage of entry into the sector both at secondary and tertiary education levels is highlighted by this material.
In post entry training in public health an international phenomenon is that whilst there are a number of structured training programmes in public health, these vary considerably and currently there is no universally accepted accreditation comparable to entry on a medical specialist register.
With the establishment of Faculties of Public Health in a number of countries, public health medical practitioners have had a significantly structured and formalised pathway towards becoming an ‘accredited’ Public Health Specialist.
Conversely training for non-medical personnel is fragmented and only recently have some training schemes been established. In the UK, for example, at the start of 2002 there were only 40 non-medical10 specialist trainees in some 6 schemes, compared with 433 specialist registrars training at the same time. There still remains considerable variation in the structure of the non-medical training schemes including their duration, level of remuneration, and the resultant qualification.
In a major step forward, the status of public health non-medical specialists was enhanced during the 1990s with the UK Faculty appointing a number of ‘non-medicals’ as honorary members. Further developments took place in 1998 with the Faculty’s decision to open up Part 1 of its professional examinations to non-medical candidates – those who were successful were granted diplomate membership. In 2001 Part 2 was opened up to non- medicals and thus enabled this group to attain full membership of the Faculty.
In New Zealand, the Phoenix Foundation’s (2004) research found that most public health employees (83%) have some tertiary qualifications. Forty five percent have degrees, with 3% of these being Masters of Public Health, 4% holding a Diploma in Public Health and a further 10% other Masters degrees. The balance is diplomas (45%) and certificates (29%). Some people hold more than one qualification.
However this overall picture of the public health sector was somewhat different when a non-medical group within it was examined. They found that significantly fewer Community Health Workers have completed a tertiary qualification (61% as compared with 83% overall). Fewer have degrees or diplomas and significantly more have other qualifications - 21% compared with 11% overall).
The implementation of the National Qualifications Framework and the development of sector specific training have provided greater access to training for the non medical groups and this is reflected in the holding of certificate qualifications as identified above. However this training is often generic and non- public health specific or, conversely, highly specific topic areas such as health promotion training. Both types of training limit opportunities for people to move across into other disciplines.
7.3.1 Available training
A wide range of science/health11 related courses have been identified at tertiary institutions in New Zealand. This information12 is attached as Appendix 2. These include degrees, diplomas and certificate programmes and may offer entry point training (6 year undergraduate medicine programme), specialist training (a 3 day course is to provide Registered Nurses with the opportunity to further develop their knowledge in assessment and management of the person with cancer) or general courses (1 year Heke Mātauranga Mauriora (HMM) that aims to produce graduates with the basic skills to assist individuals, whānau, hapū and iwi in reducing or avoiding the overuse of drugs and alcohol and to promote total well being) or public health specific post graduate training (the 1 year Postgraduate Certificate in Public Health (PGCertPH) provides a specialised programme of study in a range of public health topics and is principally for future or current health professionals in public health, policy making, planning and research positions).
One of the points of interest identified in the consultations for this project was the wide range of in-house training providing within the sector. Identified by the participants, but by no means exclusive were the following:
• HP Forum courses around the country
11
Courses that may be used by public health practitioners such as Certificates in Adult Education, Te Reo, Communications, but are not health or science specific are not included but are available on request
12
As courses change quite frequently, this information is as up to date as possible, but some current courses may not be included
42
• TUHANZ programme
• Outreach community support workers course • Certificate in Breast and Cervical Screening
• Professional RAEBURN (community support) ongoing training • Treaty of Waitangi training
• Waipereira ‘Kai’ course
• Te Hotu Manna Maori training • Injury Prevention Network training • QUIPPS (Australia)
• JIGSAW
• Maori models of health
• Samoan cultural competencies training • Introduction to Problem Gambling • Project management
• Managing difficult situations
• Thematic training e.g. smoke free, alcohol, drugs • Pacific cultural training
• Computer training • Presentation skills • Training of trainers
The consultation participants also noted that while these courses were often useful they would like them to be recognised as formal Continuing Professional Development or as credits towards recognised qualification. Moreover, subsidy by the employer was the factor that participants identified as most likely to increase their doing formal tertiary training, as would the availability of in service/on job training in the employees’ regions.
Recommended Actions
1. Develop learning/training programmes linked to the public health career pathway that:
• Create learning opportunities for obtaining the core competencies for pre entry and immediate post entry levels, taking into consideration that practitioners will enter with differing ranges of knowledge, skills and experience and systems will need to be developed to recognise this
• Provide progression from the initial core competency attainment through the routes in the public health career pathway
• Identify the links to current training and assessment programmes including National Qualification Framework qualifications and provide benchmarking procedures
• Identify and establish relationships with providers to design and deliver the learning resources. These must be flexible and accessible and in line with current good practice in adult learning13
• Explore ways of facilitating learning and development within and across sectors using approaches such as secondments, internships, scholarships and employer subsidies
• Promote collaboration between the government departments who work in public health or on the peripheries of its activities and explore how practitioners may access learning opportunities through such collaboration
• Provide for the development of assessment methodologies that: i. are credible, fair and consistent
ii. provide for a range of approaches
iii. facilitate access to recognition of current competence processes, linked, where possible to recognised qualifications, particularly for community health workers and health promoters. This must include provision for recognition of cultural competencies
Rationale: The provision of learning/training pathways is critical to ensuring that practitioners have the competencies required for progression in the sector.
2. Explore alternative funding mechanisms that promote on-going training in small organisations. Funding is often based on short term contracts that make it difficult to plan and support learning
Rationale: Cost and access to funding are two of the main barriers identified to further training. Small organisations, in particular, need assistance in planning and supporting practitioner development in a structured approach that some funding mechanisms do not assist. 3. Actively promote the increased promotion opportunities that
interaction with the public health career pathway provides.
Rationale: Practitioners need to be made aware of the opportunities that exist for progression and learning/training pathways that support this.