MAJOR C HALLENGIES IN EMERGING S CHOOL S OF PUBLIC HEALTH

1. The Role of Graduate PH Education in Addressing Health Challenges in CEE and NIS Countries Kyiv, Ukraine, 1-2.07.2004 MAJOR CHALLENGIES IN EMERGING SCHOOLS OF PUBLIC HEALTH Stojgniew JacekSITKO Institute of Public Health Health Protection Dpt. Collegium Medicum Jagiellonian University, Kraków, Poland. ASPHER Executive Boardmxsitko@cyf-kr.edu.pl

2. Reasons for this presentation • OSI-ASPHER Program ends Questions: • Common categories of challengies in emerging SPH ? • Lessons for other (new, old) SPH ?

3. My background • Deputy Director for few years of the one of the first newly established SPH in CEE region – namely in Krakow, Poland, 1991 • Consultant of the OSI-ASPHER Program in Ukraine, Russia, Lithuenia, Estonia • ASPHER - PEER Committee member and PEER reviewer • Participant in international programs supporting the introduction and/or improvement the new PH education • Member of the Board of ASPHER

4. Content of this presentation • Results of the pilot study • Conclusions from the study • General remarks

5. --- CEE and NIS --- reforming Health System and health Education especially in PH--- OSI-ASPHER Program beneficients Countries of interest:

6. Since what year your country is independent? • In which year the 1st School of Public Health was formally and officially established in yr country and where? What is its name? • Is Tthis 1st SPH was established in yr country at Medical Academy/Medical University (or equivalent) on the base of Sanitary and Hygiene Faculty (or equivalent) at Public/Private University or elsewhere? (please give as full name(s) as possible ) • How many SPHs are currently operating in yr country (if exact nr unknown - please estimate) • Are those current SPH affiliated mostly at Medical Academy/Medical University (or equivalent) at Public/Private University? What are the proportion? (if exact data unknown please estimate) • In which year your School of Public Health was formally and officially established? Please give its exact name in full.? • Is yr SPH established at Medical Academy/Medical University (or equivalent) at Public/Private University or elsewhere? (please give full name(s) ) Which organizational status has currently yr SPH - faculty/department/part of (what organization) self-standing-organization? If it currently operates in different structure than at the beginning - please explain. • Do you currently offer the BPH/MPH/other program in public health, please explain. How long it takes (how many semesters)? With what kind of diploma/certificate it finishes? • Are there in yr country an official low/ regulations which defines the status/place of public health professionalists - alumnae of the BPH and MPH program of SPH in the health system? Since then? What is the name of this regulation? When it was established? By whom? • What is the level interest of the candidates to study BPH and/or MPH in yr SPH - how many candidates is currently striving for 1 place in your BPH/MPH programs? • What is the proportion of medical (med.dr, nourses) to non-medical (eg. lowers, economists and others) students at the BPH and/or MPH studies you are offering at yr SPH? - in percent (if the exact data not available - please estimate for this academic yr) Is this proportion changing during last years? How - please describe (any more precise data available? do you do any statistics on that?) • What kinds of specialization (if any) your PH programs offer to students? • Is(are) your program(s) licensed by MoH/Ministry of Education? • How important is the private health care sector (compared with a public one) in yr country to your knowledge? (please estimate the % its share in the whole health care services, are there any evidence/research done of that?) • How many of the SPHalumni just after completing their education start their careers in the private sector comparing with the public one? (please, estimate in %, are any evidence/research done of that?) • Do you perform the career track of your graduates? What are those tracksthe career tracks of your graduates? What kinds of positions they occupy? • Does it exists in your country the formally established medical specialization in public health? If so, since when? What is the name of the relevant law regulations? Who established it? • If this medical specialization is established - does it encompasses the course of BPH or MPH as a part (which part?) of the preparation/studies towards the specialization? If yes, what states exactly the relevant regulation? • What are the major problems your SPH experienced in the past? Now? • Would you like to add something which have not been asked? Tool: 20 points Questionnaire to SPHs

7. Output: • 17 responses • from different coutries • open q’s - some ambiguity present • not all the answers • not pretend to be a regular study • interesting material

8. Country scope: • ALBANIA • ARMENIA • AZERBAIJAN • BULGARIA (2) • CROATIA • KAZAKHSTAN • MACEDONIA • MONGOLIA • POLAND • RUSSIA (2) • ROMANIA • SERBIA • TADJIKISTAN • UKRAINE • UZBEKISTAN

9. Preliminary Results

10. 1. Since what year yr country is independent 2. (In which year the 1st SPH was established) • 1989 (1991) • 1990 (2001) • 1991x9(1995)(1996x2)(1997)(2001)(2003)(2004) • 1992 (1927) • ... (2002) 4 other cases – in course of establishment

11. 3. „Affiliation” of the 1st SPH (...) = in course of establishment • 8 (3) - Medical Academy/University • 2 - University • 2 (1) - others(Independant Institute, Joint-venture MA-Univ.) • 2 (1?) out of them: private

12. 4. Number of currently operated SPH in your country (...) = in course of establishment only in a country: () = 9 (4)  and more... 2,3-5,5-8,7(?), = 4

13. 8. BPH/MPH programs at your SPH? (...) = in course of establishment • MPH - 10 [2y8, 1.5y1] • BPH - 2 [2.5, 3y] (6y) • BPH/MPH part time – 1 (3y) • others • SPECIALIZATION (MD) in PH -3 [1,2,?y], • Specialists in... - 1 [4-5y] • PostGraduate studies - 1 [2y] • „not yet” - 2

14. 8. ...kind of diploma/certificate? • State Diploma - 2 • Diploma/Certificate - 3 • „not yet” - 2

15. 9. Official regulations - PH professionalists position? • Yes - * • No - **************

16. 10. Nr of candidates for 1 place in BPH/MPH program ? • 8-10 (MDspec.) • 4 • 3-5 • 3 • 2.5 • 2 (2) • <1

17. 11. Proportion of Medical to Non-medical students (%)? • 100(3) • 95(2) • 75 • 70 • 60 • 50 • 0

18. 12. Specializations in PH program? • No ******* • PH Management *** • PH Adminstration * • Epidemiology * • Preventive Med. *

19. 13. Is yr program licenced by MoE? • Yes ********* • No **** sometimes: -- MoH -- teaching entity is licenced as a whole

20. 14. How important is the private health sector? 15. How much alumni works in private sector? • 5% (2%) • ? (5-10%) • 5% (10%) • ? (12%) • (?) (15%) • 20% (20%) • 3% (40%) • 30% (50%) • 15% (?)

21. 16. Career track of the graduates? • Yes *** • No *****

22. 17. Medical specialization in PH?18. Is BPH/MPH a part of this education? • Yes (spec.) ***** out of this: • the BPH and MPH is a part: **

23. Major PROBLEMSapart from limited (financial) resources • old fashion medicalised view on PH • establishing a PH education elswhere than at MA • lack of awarness of PH • misunderstanding and underestimation of PH • low salaries in public sector • lack of legislaton • re-orientation of faculty members/lack of trainers • cooperation of SPH with other PH institutions

24. Summary Conclusions • Diversity in: • degrees offered, length of studies • No regualtions of PH professional status • Quite high interest to study PH • Still prevailing medical students • Majority – no specialization, some:Mgmt • Up to 50% of graduates  private sector • Few cases of established MD spec. in PH

25. Is the CEE & NIS Health Care System ready to absorb professionals in PH ?

26. rather NOT because usually: • there are no formal positions for them in a system • they are not recognized by • medical personnel • health managers • health administrators • there is no status/esteem of this profession • patient/citizen does not know what PH is

27. Possible recommendations?

28. Range of recommendations for SPH * • Work intensively together with the abroad partners/experts to constructively solve your local problems • be flexible, consider to set up the coalitions with other organizations if necessary, give them some benefits

29. Range of recommendations ** • involve the MD’s into the project as teachers but also gain the influential representats from medical establishment • the same with MoH representatives and politicians • build the support of stakeholders !

30. Range of recommendations *** as soon as possible: • start the postgraduate and graduate education • fight for setting the regulations for employment of PH professionals • the same for the regulations for degrees in PH • build up a status of PH professionals

31. Future of the OSI-ASPHER Program...? • Further study and regular analysis of the experiences of those SPHs under auspicies of ASPHER? • grant application – Leonardo? • Possible complementing activities: • ...?

32. References • Health care professionals – on the way to improve the education level, Sitko S., Public Health,(PL) 5-6, 2001, p.364. • Study of educational services market and employment possibilities in the sphere of public health, Gryga I. et al., NaUKMA, Kiew, UA, July, 2002 • Public Health Training in Albania: Long way toward a School of Public Health, Roshi E., Burazeri G., Croatian Med.J., 43(4):503-5, 2002. • Schools of public health, bases of establishment and perspectives in Russia and abroad, Syrcova, L. et al. TACIS, Moscow 2000. • Public Health Program (OSI-ASPHER) Project descriptions, Reports, OSI-NY, 2001-2004

33. Thank you for your attention and cooperation