The challenges of scaling-up
Andy Haines a, Sharon Huttly a
Petrakova and Sadana make an important distinction between the science and the art of public health, where the art is concerned with application. However, while it is correct to say there is still much to be learned about how to deliver public health interventions, there is a growing body of research on health systems and policies that helps to guide the delivery of preventive and curative services at different levels of socioeconomic development.1 Schools of public health should therefore aim to address health systems and policies through research and teaching as well as through the traditional public health approaches to understanding the causation of disease, the determinants of health and the evaluation of specific interventions.
Modern public health is an interdisciplinary endeavour that needs to integrate within broader development policies, requiring closer linkages with a range of sectors and disciplines such as agriculture, education, veterinary sciences and development economics. While schools of public health clearly need to maintain their focus on improving population health and reducing inequalities, they also need to reach out more broadly into the academic community. At London School of Hygiene and Tropical Medicine (LSHTM), for example, we have been engaged in setting up the London International Development Centre (LIDC), which will bring together staff in a range of disciplines from six colleges of the University of London (http://www.bloomsbury.ac.uk) to promote interdisciplinary research, teaching and capacity-building to address international development from an intersectoral perspective.
Scaling-up research and teaching
Meeting the growing needs for more public health professionals, including the expansion of the research workforce, will require international cooperation, increased resources and long-term commitment. LSHTM’s experience of free licensing materials for course development in low-income settings has assisted in establishing local teaching programmes. It has often been difficult to get research funders to support long-term capacity-building initiatives but the situation is changing, and several major research funding bodies are now actively discussing how best to provide support. It will be essential to develop strategies for expanding masters’ and doctoral training programmes, and also to ensure that able researchers can be sustained in their country of origin through the use of postdoctoral fellowships and international collaborations that allow them to develop as independent researchers.2
Governments and multi- and bilateral donors must also prioritize the development of human resources to underpin the attainment of international goals such as the Millennium Development Goals (MDGs). In addition to the formation of large numbers of new public health professionals, a further challenge is the need to improve the retention and performance of the existing public health workforce. Schools of public health need to respond to the needs of 21st-century students and to think ambitiously about scaling-up access to appropriate education and training. This should include how they can provide on-going support for lifelong learning, conducted as far as feasible in the workplace, which in turn will require provision of learning opportunities that are flexible in terms of location, time, approach, pace and content. Information technology used appropriately can support the necessary changes, which should capitalize on both distance and classroom-based learning to create new opportunities for scaling up access to education and training throughout the careers of public health professionals. ■
- Strengthening health systems: the role and promise of health systems research. Geneva: Alliance for Health Policy and Systems Research; 2004. Available at: http://www.who.int/alliance-hpsr/resources/Strengthening_complet.pdf
- BM Greenwood, A Bhasin, CH Bowler, H Naylor, GA Targett. Capacity strengthening in malaria research: the Gates Malaria Partnership. Trends Parasitol 2006; 22: 278-84.
- London School of Hygiene and Tropical Medicine, London, England.