Charmaine Vassell- Shettlewood SPHN

In-service Officer
At the end of the session, participants will be able to:
 Define Essential Public Health Functions
 Define community health services
 List the Essential Public Health services
 Compare performance levels of Public health
Functions among Caribbean islands
 List the ways of improving and maintaining Public
Health Functions
 List strategies for building and sustaining Public
Health Functions
 The Essential Public Health Functions (EPHF) are
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 actions.
 It outlines indicators and standards for measuring
public health, which strengthen public health
practices.
 Health sector reform in the Americas focus was
primarily on structural, financial and organizational
changes in the health systems as well as an
adjustment in the delivery of health services to
individuals
 As a result of the change, the functions and
responsibilities of delivery of care by the health
teams were grossly affected
 Public Health as a social and institutional
responsibility was neglected or placed on the
peripheries of these processes of change
THE Public Health of the Americas Initiative saw the need for a
public health plan as an important element of health sector
reform.
 The initiative provide a theoretical and practical basis for
strengthening the public health practice, maintenance of the role
of health authorities and development of public health
infrastructure
 As a result PAHO under the “Public Health in the Americas”
initiative developed a conceptual and methodological
framework for improving public health practice through
definition and performance measurement of EPHF
To improve public health practice at both the
national and subnational levels through the health
systems as a whole
 To Promote understanding of public health and
EPHFS throughout the America
 Develop a framework for evaluating the exercise of
EPHF in countries
 Conduct an evaluation of public health practice in
every country in the Americas by measuring the
degree to which EPHF are being discharged
 Develop a uniform plan of action for strengthening
public health infrastructure and improving practice
These are essential prevention and medical services
specifically designed for and offered to a
particular group of people based on their social
welfare system. These services are designed to
safeguard the health of the entire population.
 Community Health Services include:
1. Maternal and Child Health
2. Nutrition
3. Family Planning
4. Control of STIs and Communicable Diseases
5. Mental Health
6. Dental Health
7. Health Education
8. Surveillance of Disease Pattern
9. Environmental Health
10. Prevention and Early Detection of Cancer

11. Pharmaceutical Service

12. Laboratory Services

13. Curative

The system of CHS is so structured that basic services

required by the community can be available at
different levels with specific channels for referral
to those clients needing more advance treatment.
 `
 EPHF 1
THIS function includes evaluating the country’s
current health status, trends and determinants
with a focus on inedtifying inequalities in risk
threats and access to health services.
Identifying the population health needs which
includes evaluating the health risk and demands
for services. Managing important strategies and
the situation of high risk and or specific group.
Developing technology and methods to manage,
interpret and communicate information to public
health decisions makers, external action supplies
and citizens. Defining and developing agencies
to evaluate the quality of the collected data.
EPHF 2
This function includes the capacity to carry out
research and surveillance of epidemic outbreaks
and communicable and non communicable disease
models, behavorial factors, accidents and
exposure to toxic substances or environmental
agents detrimental to health.
EPHF 3
This function has the responsibility to assess the
impact on public health policy promoting
changes in life style and environmental
conditions that will promote the development of
a health culture.
 EPHF 4
This function includes strengthening the power of
citizens to change their own life styles and take
an active role in developing healthy behavior and
environment, thus giving them influence over the
decisions that affect their health and access to
adequate public health services.
EPHF 5
This function includes the definition of Public
Health Objectives at all levels, measurable and
consistent with a framework of values that
promote equality.
EPHF 6
This function has the responsibility for institutional
capacity to develop the regulatory framework
necessary to monitor and protect the populations
health.
EPHF 7
This function is responsible for the promotion of
equitable access to necessary health services for
all citizens.
 EPHF 8
This function has the responsibility for education,
training and evaluation of public health personnel
in order to identify public health services need
effectively, face presenting public health issues
and adequately evaluate actions in these matter.
Ethical training for public health personnel with
special attention to the values of solidarity,
equality and respect for human dignity.
 EPHF 9
This function has the capacity to utilize scientific
methods for evaluate health interventions of
various degrees.
EPHF 10
Rigorous research directed to increase the
knowledge that supports decision making in its
various levels. The establishment of partnership
with research centers and academic institutions
from both within and out
of the health sector to conduct studies to support
the NHA decision making process.
EPHF 11
This function has the responsibility for policy
development, planning and the implementation of
measures to prevent mitigation, reduce and
prepare for the impact of disasters on public
health.
An assessment carried by PAHO on the EPHFs the in the LAC Regions in
2007 revealed that :

 In the sub-region of the English-speaking Caribbean and Netherlands

Antilles, countries exhibited low to intermediate performance in nearly
all of the EPHF, with only one function, EPHF 11 (reducing the impact
of emergencies and disasters in health), performing adequately (PAHO,
2007).
 The lowest performance was exhibited in the areas of
public health research (EPHF 10) and quality assurance
(EPHF 9). These results show that there is a clear need
for strengthening the functions related to the steering
role of the health sector as a mechanism to improve
overall performance of the EPHF (PAHO, 2007).
 In the sub-region of Central America, Spanish-
speaking Caribbean and Haiti, relatively good
performance was observed for the functions of
public health surveillance (EPHF 2) and reducing
the impact of emergencies and disasters (EPHF
11).
 The lowest performance levels were observed in
the areas of quality assurance (EPHF 9) and
human resources training and development
(EPHF 8). The analysis of the results shows that
there are several critical areas in need of
improvement in the sub-region in question.
 These are: strengthening the capacity to evaluate
public health actions and strategies, designing
and implementing an incentive system for
achieving public health results, and improving
public health information systems.
Source: PAHO/WHO, Public Health in the Americas.
 Measurement to Action

 British Virgin Island (BVI) recent

measurement led to the development of a
proposal to restructure the entire Ministry of
Health (MOH)

 Barbados, results revealed that EPHF #6 was

in most need of strengthening and an initial
step would be an “Enforcement Workshop” to
train public health workers in prosecuting
public health offenders.
 Measurement to Action

 In Mexico, a major effort to improve EPHF 8 has

been made by the Veracruzana University through the
implementation of a new curriculum for its Master of
Public Health Program entirely based on the EPHF.
 The goal of the program is to produce graduates that
will become professionals committed to the
development of the EPHF. (PAHO)
 Improving and Maintaining EPHFs in
Community Health Services in the Caribbean

 As was identified earlier, the English

Speaking Caribbean performed poorly with
EPHFs 8, 9 & 10.
 Improving and Maintaining EPHFs in
Community Health Services in the Caribbean

 Firstly, greater than 5% of the national budget

should be allocated to Health. At least 9-12 % of
the national budget should be allocated. With
provisions for capital expenditure if EPHF are to
be effectively promoted ( World Bank).
 Human Resources Development and Training in the Caribbean
 Policy-making and planning is crucial to ensure that the Public Health
Work Force(PHWF) is adequately trained and distributed equitably
and in sufficient numbers. In this context, a more integrated,
independent and systemic approach to the PHWF needs to be adopted

when elaborating and implementing policies (PAHO, 2007).

 Continuing education and Graduate training
in public health.

 Masters in Public Health to enforce EPHFs

Program. Support candidates for the existing
Masters Program. Subsidizing tuition fees and
implement a closely monitor bonding system.
 Improving the work force quality. “Salaries “ -
“Working Conditions”-Another challenge refers to
the recruitment and retention of the workforce.
Generally, public health professions do not offer high
salaries and demand a strong commitment.
 Better match the workforce training and
development with the real health needs of the
population. Specialized doctors outnumber
community health practitioners. This can pose a
problem given that diseases that are prevalent in
the Region such as TB, HIV/AIDS and Malaria
are better handled with a community based
approach.
 Revamp the traditional approaches to public
health training. There are several limitations
that must be addressed. An emphasis on
epidemiology and other hard sciences have
resulted in the neglect of health promotion and
other public health areas.
 Integration between academic institutions and
decision-making bodies.
(i) Monitoring workforce Composition

(ii) Identifying competencies and developing

related curriculum

(iii) Designing an integrated life-long learning

delivery system
(iv) Providing individual and organizational
incentives to ensure competency development

(v) Conducting evaluation and research

(vi) Assuring financial support.

 This must be part of the country’s continuous
current budget expenditure with respect to
maintenance.
 Equip the national bureau of standard with the
capacity to manage and assess health technologies. –
support decision making in public health. Exposure
and training of officer / inspectors would be key.

 Devise and support an information exchange and

training program with technological advance nations
that provided equipment and services to community
health.
 Special arrangement (monetary scheme) should be
established to encourage professionals who
conducts research of national and regional
relevance , to disseminate results among themselves
and the scientific community .

 Effort to maintain this initiative through a regional

funding mechanism can be solicited in the very best
interest of All..!
 Quality Assurance in Personal and Population –Based Health
Services

 Establishing clear definition of standards and evaluation

criteria tailored to improve the quality of personal and
community health services.
 Developed specific and deliberate steps to improve user
satisfaction with community health services.
(questionnaires and service appraisal points for 6 months )
use results for improvement to services.
 EPHF # 10 Public Health Research.

 We proposed the development and building of a public

health research agenda in collaboration. UWI and funded
by PAHO for the regions benefit.

 Strengthening of the existing research capacity for

institutions.

 Technical assistance and support for research in public

health at the national and regional level. Research for the
efficient and effective delivery of community health
services would be emphasized.
 The process of building and maintaining
community health services without the assessment
and or measurement of EPHF would be solid by
intention but flawed in design.

 EPHFs are requisite priorities for the process of

building and maintaining community health
services that ultimately strengthen the capacity of
individual and communities to make informed
choices that will improve and maintain their
physical, mental, social and spiritual Wellbeing.

 Bettcher DW, Saprie S, Goon EH. Essential public health functions: results of the international
Delphi Study. Geneva: WHO, World Health Statistics N. o 51; 1998.
 Reymond Khaleghian, Monica Das Gupta; Public Management and the EPHF World Bank (policy
research working paper 3220 , February 2004.
 Pan American Health Organization/World Health Organization (PAHO/WHO)The Essential Public
Health Functions as a Strategy for Improving Overall Health
 Systems Performance: Trends and Challenges since the Public Health in the Americas Initiative,
2000-20071Pan American Health Organization/World Health Organization (PAHO/WHO): Public
Health in the Americas: Conceptual Renewal, Performance Assessment, and Bases for Action
(Washington, DC: PAHO/WHO, 2002).

 PAHO: Public Health in the Americas; Conceptual Renewal Performance Assessment and Bases for
Action, Scientific Publication, No 589
 Ministry of Health, Jamaica: Primary Health Care, the Jamaica Perspective Ra 427.J36, 1978.

 Bader, Michael B: The International Transfer of Medical Technology- an Analysis and a Proposal for
Effective Monitoring.