Public health cadre development using competency based approach

Public health cadre development, using competency based approach in the State Health system, Odisha, India Prof. Sushma Acquilla, Project Director & the Odisha Team Leena Inamdar, Catherine Hannaway, Bharat Sibal, Ankush Mittal, Anjali Pai, Gurpreet Rai, Himanshu Negandhi,

Overview of Session • Background to the project • Scoping study and Road map for Public Health cadre Implementation in Odisha • Training needs assessment • Training the Trainers Program • Leadership Development program • Way forward for India SIG

Background to Odisha (India) project • There is no defined PH structure or cadre in State based health service • Yet India has health inequality and associated public health challenges • Government of Odisha (Go. O) agreed to develop a Public Health Cadre • Need development of a trained and effective public health workforce • A scoping study carried out at the start • Roadmap for implementation of public health cadre • Go. O needed technical assistance for implementation of PH Cadre • Go. O partnered with the UK Faculty of Public Health through an international Mo. U • Financial support from Df. ID, India

Odisha Project Delivery Team • Project Director: Sushma Acquilla (FPH) • Needs assessment Team: Sushma Acquilla, Bharat Sibal, Ankush Mittal, Gurpreet Rai, (FPH) Himanshu Negandhi (PHFI/IIPH) • Training the Trainer Program Team: Sushma Acquilla, Bharat Sibal, Anjali Pai • Leadership Development Program & delivery Team Sushma Acquilla, Catherine Hannaway, Leena Inamdar • Developing Curriculum for MPH for India Sushma Acquilla & Suzanna Mathews

Scoping visit /activities in Odisha and MP • Carried out during 3 personal trips in 2014/15 by Sushma Acquilla with a report to Go. O and Df. ID India • Although the Government agreement in place, No public health cadre structure was available • Overlap between public health and primary care role • Lack of leadership or management capability amongst senior public health professionals • Lack of direction and clarity of role for the State Institute for training • Lack of defined training, job description or promotion structure • Medical leadership with no appropriate delegation • Lack of clarity on individual role

Training Needs Assessment Aim • To conduct a survey of functions and training needs assessment of practitioners in the State of Odisha, in order to assess and further develop competencies for the generic public health programmes. Objectives • To complete a training needs analysis report of the public health functions delivered in the current State health system for the government of Odisha. • To provide recommendations to the State on the structure and competency framework for the public health cadre for Odisha. • To provide recommendation, develop and deliver training programs to public health professionals in order to help implementation of Public health Cadre.

Training Needs Assessment Methods Time period: 1 week (Feb 2016) We performed semi-structured interviews with 29 responders at various levels of the state health system in Odisha in health centres of Puri, Kurdha and Bhubaneshwar. We identified the principal clinical and public health functions being performed at each level and identified any training provided/training gaps at each level Main questions 1. What are your functions/responsibilities? 2. What training have you received in order to perform these functions? 3. What training would be useful for you to perform better in your current role. Analysis Mapping of functions against training received in order to identify training needs , with a focus on public health functions/training needs)

Training Needs Assessment Results of Public Health Training Needs Assessment Key training needs identified: 1. ‘Train the trainer’ training 2. Leadership training 3. Health Economics/Financial Management 4. Partnership/Team working • Training gaps were identified across all public health functions being performed at each operational level • There is a need for a formal public health cadre in Odisha, with a set of integrated public health competencies

Train the Trainer workshop Aim To train health professionals in the state of Odisha, India to become effective public health trainers Objectives • To provide an overview of public health system in the United Kingdom and comparative links to Odisha, India • To understand theoretical basis of learning and teaching methods and models • To demonstrate how techniques learnt can be implemented in practice • To provide opportunities to discuss and learn from each other

Train the Trainer 2 Training Content and Delivery • Two training workshops held : 2. 5 days each • In July 2016: SIHFW, Bhubaneshwar, India • 43 senior clinical and public health officers at the Department of Health and Family Welfare, Bhubaneshwar, Odisha attended • Resource material from the NHS Education for Scotland, Train the Trainer toolkit • Training material was adapted to the Indian public health context • Training methods: power point presentation, flip charts, case studies, group work • Handouts and training material were shared with participants

Train the Trainer Outcome and Key Achievements • 39 participants completed full workshop • 89% said expectations were well met • Facilitators were rated very good (87%) or good (13%) • 67% said the materials provided were good • Overall training evaluated ‘very good’, particularly day 2 (74%) • Facilitative style of teaching, adaptability to local context and interactive elements were highly commended • Potential future ‘trainers’ identified among participants for the sustainability of the program

Public Health Leadership Training Aim • To develop leadership skills of middle to senior level in public health roles in Odisha and build a cadre of strong public health leaders across Odisha • Objectives • To develop leadership skills and competencies for senior public health officials in Odisha • To develop understanding of role of middle to senior level public health leaders in whole system leadership across Odisha • To recognise own style of leadership, management and impact on others • To develop systems leadership by strong multi-disciplinary and cross-sectoral working • To develop a network of public health leaders for addressing health inequity in Odisha

Public Health Leadership Training • • Delivered by UK FPH and PHE team with State support in March 2017 Aimed at senior to mid-level public health staff in the State Training programme developed in consultation with State Conducted over 5 days in interactive way in SIHFW, Bhubaneshwar • Three core elements of leadership: • An introduction to Public Health leadership • Understanding self as a Public Health leader and working with others • Leading others in complex systems, teams and partnerships

Public Health Leadership Training Key achievements • Addressed a key gap in leadership development • 17 mid to senior public health professionals trained • Evaluated highly by participants • Enabled participants to do self-assessment of leadership skills and identify areas for self-improvement

Lessons Learnt • Project should have detailed and adequate funding for the delivery • Need a fully committed project director/ Officer • Have an effective and influential local coordinator along with direct connection with the Government officers • Time scale for delivery should be fixed with 1 -2 months notice to allow recruitment of appropriate team • Whilst it is important to be able to offer opportunity of experience to wider group, selected individuals need to be available and committed for the delivery of appropriate section

Next step for India & related country SIG • Create a competency based curriculum for public health training in India using Odisha experience, adapted to local needs • Support further training in management, leadership, and trainer development to current and future public health leaders in Odisha • Facilitate the development of an electronic training platform to track public health training and support continuing professional development • Work with central government to develop Masters in Public Health curriculum for India for approval by Government ministry. • Continue the link with the Central and State government to implement Public Health Cadre in the States of India. • Facilitate the development of public health laboratories in Odisha