Stakeholders’ perspectives on Public Health Medicine in South Africa

Abstract

South Africa (SA) is reforming its health system in preparation for an anticipated national health insurance (NHI) scheme that aims to improve the delivery of affordable, equitable, accessible health care. Public health (PH) language is explicit in the policy and skilled PH professionals would be expected to play a key role in its implementation. In South Africa, training of doctors as Public Health Medicine (PHM) specialists is funded by the state, yet there are few positions for PHM specialists in the health services. We explored stakeholders’ perspectives about this absence, and their views on PHM specialist’ roles and contribution in an era of health reform. A qualitative study was conducted in 2012–13, using in-depth interviews with thematic analysis, which elicited perspectives of 31 key stakeholders nationally reflecting diverse employer and institutional backgrounds. While some were surprised by the absence of PH professionals in SA’s health system, most agreed the reason was due to factors internal to the profession, such as its low profile and uncertain identity. External factors such as legislation and political preferences for health managers impacted on the employment of PH professionals. However, given the competencies required to implement an ambitious restructuring of the health sector, all believed that PH and PHM personnel were vital. In view of the health system’s dominant curative orientation, embedding PH personnel in the services should ensure that health protection, promotion and prevention strategies will inform health priorities. This study, the first known from a low and middle-income country, contributes to the international literature about the identity and roles of PHM physicians, who are versatile professionals with broad skills-sets. In SA, through consultation with health sector employers about potential roles, curricular redesign and trainee recruitment, PHM can graduate fit-for-purpose specialists to work in a range of institutions to address health system reform.

Health managers and community representatives’ views of a system-wide intervention to strengthen public healthcare in the Free State, South Africa

“…Despite the fact the public health system has been transformed into an integrated, comprehensive national service, failures in leadership, stewardship and management have led to inadequate implementation of good policies 19 . It is generally accepted that public health services in South Africa are not always of sufficient quality to be effective 20. External factors such as political preferences for the appointment of public health managers (HMs) have been reported to influence the employment of public health professionals 21 . Resulting management skill deficits have a detrimental effect on the quality of public health services.…”

“…It is generally accepted that public health services in South Africa are not always of sufficient quality to be effective 20 . External factors such as political preferences for the appointment of public health managers (HMs) have been reported to influence the employment of public health professionals 21 . Resulting management skill deficits have a detrimental effect on the quality of public health services.…”

Perspectives on the Doctor of Public Health (DrPH) education among students and alumni in the United States: a cross-sectional national online survey

“…Additionally, it is essential to note that the focus of this study is on DrPH programs in the United States, given the direct applicability and jurisdiction of CEPH. However, the challenge of standardizing public health practice and leadership is global, with similar discourse [ 25 ] taking place in South Africa [ 26 – 28 ], India [ 29 ], China [ 30 ], Korea [ 31 ], Southeast Asia [ 32 ], Ethiopia [ 33 ], and Pan Africa [ 25 ]. Many identity-defining efforts have been made by other accreditation agencies, such as the United Kingdom Public Health Register [ 34 ], the Board Certified in Public Health (CPH) [ 35 ], the National Consortium for Public Health Workforce Development [ 36 ], and the Council on Linkages Between Academia and Public Health Practice [ 37 ].…”

“…Globally, endeavors have been made to incorporate the viewpoints of public health leaders in the development of education and healthcare systems. For instance, a qualitative study conducted in South Africa’s health system revealed that public health stakeholders perceived the public health profession to have a low standing due to an unclear identity [ 26 , 27 ]. In order to enhance the field, Zweigenthal et al (2018 & 2019) advocated for a curriculum redesign to improve recruitment efforts [ 26 , 27 ].…”

“…For instance, a qualitative study conducted in South Africa’s health system revealed that public health stakeholders perceived the public health profession to have a low standing due to an unclear identity [ 26 , 27 ]. In order to enhance the field, Zweigenthal et al (2018 & 2019) advocated for a curriculum redesign to improve recruitment efforts [ 26 , 27 ]. In China, the significance of DrPH training has been acknowledged as a means to address complex problems and challenges [ 30 ].…”