The challenge for public health education of implementing PHC in decentralized systems

Thirty years after the Declaration of Alma Ata, many countries’ health policies are based on the Primary Health Care Approach. A key challenge in achieving the goals of Alma Ata is reorienting health personnel in decentralized systems to managing all aspects of health service implementation, working in health and other sector professional teams and facilitating the participation of the communities they serve to address the local social determinants of ill-health. If decentralization is to be successful, health and education policy must respond to the above imperative in ensuring that training is accessible, appropriate and funded.  Health personnel development constitutes the primary step in developing a decentralised health system. Competence-led Public Health education in planning, advocacy, programme design, programme implementation and monitoring and evaluation is fundamental to  successful implementation of PHC in decentralised health systems.

 In this presentation we argue that Public Health is an integral, albeit under-recognised, component of PHC. Decentralisation of health system organisation and management has significantly increased the need for a greater range of substantive Public Health skills. Thus different competences are required at different levels of the services and in different contexts. To achieve this, the content of Public Health education needs to be far more differentiated than has hitherto been the case. Additionally, there needs to be situated learning, supplemented by mentored practice in the workplace.
 Decentralisation has greatly increased the numbers of potential candidates for Public Health education. Traditional residential (face to face) education, supplied in the past by metropolitan institutions, cannot effectively meet this need, nor is it financially sustainable. This challenge requires strengthened capacity of educational institutions in the “periphery”, and also innovative approaches that combine residential teaching with applied practice, supported with appropriate learning media and materials. Here distance learning supported by mentored practice offers a pragmatic way forward.