Essential Public Health Functions as a Strategy for Improving Overall Health Systems Performance:
Trends and Challenges since the Public Health in the Americas Initiative, 2000-2007
Caroline Ramagem and José Ruales, Area of Health Systems Strengthening, Washington, D.C. February 2008
Pan American Health Organization/World Health Organization (PAHO/WHO)
“…..The Pan American Health Organization/World Health Organization (PAHO/WHO) defines the Essential Public Health Functions (EPHF) as the indispensable set of actions, under the primary responsibility of the state, that are fundamental for achieving the goal of public health which is to improve, promote, protect, and restore the health of the population through collective action. Through the Public Health in the Americas Initiative, PAHO/WHO defined the 11 Essential Public Health Functions and developed a methodology that allows countries to evaluate in a comprehensive manner their public health systems. As part of the Initiative, 41 countries and territories of the Region of the Americas applied the assessment tool…”
Essential Public Health Functions
- EPHF 1 - Monitoring, evaluation, and analysis of health status
- EPHF 2 - Surveillance, research, and control of the risks and threats to public health
- EPHF 3 - Health promotion
- EPHF 4 - Social participation in health
- EPHF 5 - Development of policies and institutional capacity for public health planning and management
- EPHF 6 - Strengthening of public health regulation and enforcement capacity
- EPHF 7 - Evaluation and promotion of equitable access to necessary health services
- EPHF 8 - Human resources development and training in public health
- EPHF 9 - Quality assurance in personal and population-based health services
- EPHF 10 - Research in public health
- EPHF 11 - Reduction of the impact of emergencies and disasters on health
Strengthening the EPHF – Experience from WHO Regions
Regional Office for Europe (EURO)
The European Office of WHO has started a process of defining and developing a performance evaluation methodology that can be applied to public health services. A Core Expert Group on the topic was created and was given the task of developing a Discussion Paper identifying the Essential Public Health Functions (EPHF) and proposing a methodological framework for their assessment, in the context of European countries. The methodology will be a comprehensive questionnaire for the identification of strengths and weaknesses in public health systems and a computer-based self-assessment tool. The Discussion Paper is currently undergoing consultations.
Regional Office for South-East Asia (SEARO)
In a significant step towards strengthening public health in the South-East Asia (SEA) Region, SEARO has launched the “South-East Asia Public Health Initiative, 2004-2008.” This initiative aims to achieve the following five major goals: (i) position public health high on the regional and national agendas, and to generate strong commitment by national policy makers; (ii) support the strengthening of public health education in the countries of the SEA Region; (iii) enhance technical cooperation on the development of national public health training institution(s) in selected countries; (iv) facilitate the establishment of a public health education institutions’ network and foster regular interaction among them; and (v) help countries to define an appropriate package of essential public health functions tailored to each country’s situation and needs and support them to implement these functions.
Regional Office for the Western Pacific (WPRO)
Between 2000 and 2003, the WHO Regional Office for the Western Pacific embarked on a process of EPHF definition and assessment. The process consisted on the development of a framework for the definition of the EPHF relevant for the Western Pacific Region, followed by the identification of an evaluation methodology and its application in Fiji, Malaysia and Vietnam. Nine EPHF were identified and a range of methods were used, which included, among others, document analysis, interviews, and surveys, adapted to the context of each country. The selection of Fiji, Malaysia and Vietnam was based on the relevance of the countries for others in the Western Pacific region (considerations of geography; differing socioeconomic, demographic and epidemiological situations; and the organization of the health systems). Finally, proposals for the strengthening and sustainable delivery of functions were to be identified in each country where the methodology was applied.
One of the main findings of the study was that primary health care was found to be crucial to the sustainable delivery of the EPHF. In the three countries surveyed, the key structural approach for delivering EPHF is through integration into PHC, which represents a significant portion of health service delivery in the three contexts. The study also found that the main challenges for the optimal delivery of EPHF were: tensions between externally funded programs (especially vertical programs) and implementation of the EPHF; inadequate capacity in research, development and implementation of innovative public health solutions, and inadequate funding as planning and allocation processes are dominated by hospital practitioners….”