oa South African Health Review - The contribution of specialist training programmes to the development of a public health workforce in South Africa
A population perspective on health underpins the 17 newly adopted Sustainable Development Goals (SDGs) and South Africa's recently promulgated White Paper on National Health Insurance (NHI). Monitoring their progress, identifying health service priorities and implementing effective delivery strategies requires a skilled public health (PH) workforce. Yet several key policies intended to transform the country's health system radically make no mention of this workforce.
This chapter investigates the potential contribution of the Public Health Medicine (PHM) specialty to a public health workforce in South Africa. We describe the nature of PH, the competencies anticipated of a PH workforce and the training programmes for PHM specialists and the Master of Public Health (MPH). The discordance between the need for PH expertise generated by the current policy juncture in South Africa and the current invisibility of graduates of PH programmes is explored.
PH is an inter-disciplinary field that aims to understand health problems, and to develop and evaluate programmes to improve the health status of populations. The evolution of PH in South Africa reflects two trends: one focused on compliance with measures protecting human health, and the other focused on the development of innovative participatory models and policy emphasising comprehensive care.
Both trends were led by doctors and historically, PH training was reserved for doctors. After 1994, graduate PH programmes were opened to other health professionals and social scientists. Legislation no longer reserved senior PH functions for doctors. However, current South African health reform initiatives - the NHI, PHC re-engineering and health workforce policies - whilst flagging the importance of PH for the health service, give little detail on the role of PH professionals.
Understanding the history of PH in South Africa, the broadening of its inclusive professional identity and the multi-disciplinarity of the PH workforce should facilitate use of these skills to deliver on national and international development goals.
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