Oxford graduates' perceptions of a global health master's degree: a case study

Career Paths of Public Health Medicine Specialists in South Africa

Public health (PH) skills are core to building responsive and appropriate health systems, and PH personnel including medical specialists are embedded in many countries' health systems. In South Africa, the medical specialty in PH, Public Health Medicine (PHM), has existed for over 40 years. Four years of accredited training plus success in a single national exit exam allows specialist registration with the Health Professions Council of South Africa (HPCSA). However, there are few posts designated specifically for PHM specialists in SA's health system. In view of uncertain roles, this research was designed to determine specialists' career paths, their work, job satisfaction, and perspectives on the future of the specialty. We combined three databases to generate the study population and invited all specialists to participate in an online or hard-copy survey. We found that in 2010, PHM was a small specialty of less 200 physicians. Of the 151 contactable, eligible physicians, 55.6% completed the questionnaire. Participants represented an aging group (median age = 49) of specialists and recent graduates were increasingly women. They largely worked in academic institutions (as managers, teachers, and researchers) and in the public sector health system; were motivated by a sense of social justice and their training was formative, exposing them to work settings which they later entered; were largely highly satisfied at work, but many worked in non-specialist positions. Indeed, one fifth had not registered with the HPCSA as specialists. They were concerned about the specialty's poor visibility and identity, but did not see other PH professionals as a threat. They believed that the specialty should refine its competencies, demonstrate its value and advocate for service positions at all levels of the public sector health service. PHM has a contribution to make—reorienting services to protect communities, preventing ill health, analyzing disease burdens locally, identifying innovations in a resource-constrained health service, largely preoccupied with curative care services.

The potential of an online educational platform to contribute to achieving sustainable development goals: a mixed-methods evaluation of the Peoples-uni online platform

BACKGROUND

This paper reports on an online platform, People's Open Access Education Initiative (Peoples-uni), as a means of enhancing access to master's level public health education for health professionals. Peoples-uni seeks to improve population health in low- and middle-income countries by building public health capacity through e-learning at very low cost. We report here an evaluation of the Peoples-uni programme, conducted within the context of Sustainable Development Goal 4, which seeks to "ensure inclusive and quality education for all and promote lifelong learning" by 2030. The evaluation seeks to address the following three questions: (1) Did Peoples-uni meet its intended goals? (2) What were the different types of impacts that students experienced? (3) What suggestions for future changes in Peoples-uni did students recommend?

METHODS

A mixed methods evaluation consisted of two parts, namely an online survey and a telephone interview. A total of 119 master's level graduates were invited to participate; responses were obtained from 71 of those invited, giving a response rate of 60%. Respondents were spread across 31 countries. Interviews were conducted with 18 respondents.

RESULTS

There was strong evidence that Peoples-uni had achieved its stated goals. Potential impacts on students included knowledge to enhance practice and appreciation of context, enhanced research capacity through knowledge of public health, critical thinking and evidence-based programming, and empowerment of students about the potential of education as a means of improving their lives. Accreditation through future partnerships with local universities was recommended by students.

CONCLUSIONS

Peoples-uni has been able to deliver a credible public health master's level educational programme, with positive impacts on the students who graduated. Challenges are to find a way to accredit the programme to ensure its sustainability and to see how to take full advantage of the current, and future, graduates to turn this from an education programme into a capacity-building programme with real impact.

Public Health Activist Skills Pyramid: A Model for Implementing Health in All Policies

Affecting public health for society requires various competencies. In fact, the prerequisite for the implementation of health in all policies should be effectiveness of public health activists (PHAs) in these competencies. This study aims to determine the competencies of the activists in public health. The present qualitative study reviewed the literature and adopted qualitative methods like content analysis, stakeholder interviews, and conducted focus group discussions with related experts. In each stage, the required competencies were extracted through drawing the main action processes of a PHA. Thereafter, the authors reached an ultimately best-suited working model by classifying and approving extracted competencies. The competencies comprise a pyramid set of three main categories of basic, specialized/professional, and individual updating competencies. Personal management, communication, teamwork, project management, ability to apply principles and concepts of public health, anatomy, physiology, and pathology in the organizations of the society should be included in the basic category. Specialized skills should include ability to plan, public participation, intersectoral collaboration, social marketing, working with the media/media friendly attitude, advocacy, research management and knowledge translation, evaluation of health programs, network establishment and management, deployment and institutionalization, operational research, empowerment and consultation, and protocol and service pack design. Last but not least, individual updating is defined as being informed of the latest scientific articles and reports about health and its situation in different countries as well as determinants that affect health. Implementation of this pyramid requires design and establishment of specific centers for transferring effective public health competencies. This pyramid has also functional use for the revision of educational curriculums in all health study fields. Moreover, it is helpful in designing virtual health education courses and the update of employees in entire parts of society pertaining to the health sector.

'Why do an MPH?' Motivations and intentions of physicians undertaking postgraduate public health training at the University of Cape Town

Background

Public health (PH) approaches underpin the management and transformation of health systems in low- and middle-income countries. Despite the Master of Public Health (MPH) rarely being a prerequisite for health service employment in South Africa, many physicians pursue MPH qualifications.

Objectives

This study identifies their motivations and career intentions and explored MPH programme strengths and gaps in under- and post-graduate PH training.

Design

A cross-sectional study using an online questionnaire was completed by physicians graduating with an MPH between 2000 and 2009 and those enrolled in the programme in 2010 at the University of Cape Town.

Results

Nearly a quarter of MPH students were physicians. Of the 65 contactable physicians, 48% responded. They were mid-career physicians who wished to obtain research training (55%), who wished to gain broader perspectives on health (32%), and who used the MPH to advance careers (90%) as researchers, policy-makers, or managers. The MPH widened professional opportunities, with 62% changing jobs. They believed that inadequate undergraduate exposure should be remedied by applying PH approaches to clinical problems in community settings, which would increase the attractiveness of postgraduate PH training.

Conclusions

The MPH allows physicians to transition from pure clinical to research, policy and/or management work, preparing them to innovate changes for effective health systems, responsive to the health needs of populations. Limited local job options and incentives are important constraining factors. Advocacy for positions requiring qualifications and benchmarking exit competencies of programmes nationally may promote enrolment.

Entry characteristics and performance in a Masters module in Tropical Medicine: a 5-year analysis

OBJECTIVES

Postgraduate courses can contribute to better-qualified personnel in resource-limited settings. We aimed to identify how entry characteristics of applicants predict performance in order to provide support measures early.

METHODS

We describe demographic data and end-of-module examination marks of medical doctors who enrolled in a first semester module of two one-year MSc programmes between 2010 and 2014. We used t-tests and one-way anova to compare, and post hoc tests to locate differences of mean marks between categories of entry characteristics in univariate analysis. After exclusion of collinear variables, multiple regression examined the effect of several characteristics in multivariable analysis.

RESULTS

Eighty-nine students (47% male) with a mean age of 32 (SD 6.4) years who received their medical degree in the UK (19%), other European (22%), African (35%) or other countries (24%) attended the 3-months module. Their mean mark was 69.1% (SD 10.9). Medical graduates from UK universities achieved significantly higher mean marks than graduates from other countries. Students' age was significantly negatively correlated with the module mark. In multiple linear regression, place of medical degree (β = -0.44, P < 0.001) and time since graduation (β = -0.28, P = 0.007) were strongest predictors of performance, explaining 32% of the variation of mean marks.

CONCLUSION

Students' performance substantially differs based on their entry criteria in this 1st semester module. Non-UK graduates and mature students might benefit from early support.

Outcome and impact of Master of Public Health programs across six countries: education for change

BACKGROUND

The human resources for health crisis has highlighted the need for high-level public health education to add specific capacities to the workforce. Recently, it was questioned whether Master of Public Health (MPH) training prepared graduates with competencies relevant to low- and middle-income countries (LMICs). This study aims to examine the influence of the MPH programs geared towards LMICs offered in Vietnam, China, South Africa, Mexico, Sudan, and the Netherlands on graduates' careers, application of acquired competencies, performance at the workplace, and their professional contribution to society.

METHODS

A self-administered questionnaire was sent to graduates from six MPH programs. Frequency distributions of the answers were calculated, and a bivariate analysis and logistic regression of certain variables was performed.

RESULTS

The response rate was 37.5%. Graduates reported change in leadership (69%), in technical position (69%), acquiring new responsibilities (80%), and increased remuneration (63%); they asserted that MPH programs contributed significantly to this. Graduates' attribution of their application of 7 key competencies 'substantially to the MPH program' ranged from 33% to 48%. Of the 26 impact variables, graduates attributed the effect they had on their workplace substantially to the MPH program; the highest rated variable ranged from 31% to 73% and the lowest ranged from 9% to 43%. Of the 10 impact variables on society, graduates attributed the effect they had on society substantially to the MPH program; for the highest rated variable (13% to 71%); for the lowest rated variable (4% to 42%). Candidates' attribution of their application of acquired competencies as well as their impact at the workplace varied significantly according to institution of study and educational background.

CONCLUSIONS

This study concludes that these MPH programs contribute to improving graduates' careers and to building leadership in public health. The MPH programs contribute to graduates' application of competencies. MPH programs contribute substantially towards impact variables on the workplace, such as development of research proposals and reporting on population health needs, and less substantially to their impact on society, such as contributing equitable access to quality services. Differences reported between MPH programs merit further study. The results can be used for curriculum reform.

Validation of public health competencies and impact variables for low- and middle-income countries

BACKGROUND

The number of Master of Public Health (MPH) programmes in low- and middle-income countries (LMICs) is increasing, but questions have been raised regarding the relevance of their outcomes and impacts on context. Although processes for validating public health competencies have taken place in recent years in many high-income countries, validation in LMICs is needed. Furthermore, impact variables of MPH programmes in the workplace and in society have not been developed.

METHOD

A set of public health competencies and impact variables in the workplace and in society was designed using the competencies and learning objectives of six participating institutions offering MPH programmes in or for LMICs, and the set of competencies of the Council on Linkages Between Academia and Public Health Practice as a reference. The resulting competencies and impact variables differ from those of the Council on Linkages in scope and emphasis on social determinants of health, context specificity and intersectoral competencies. A modified Delphi method was used in this study to validate the public health competencies and impact variables; experts and MPH alumni from China, Vietnam, South Africa, Sudan, Mexico and the Netherlands reviewed them and made recommendations.

RESULTS

The competencies and variables were validated across two Delphi rounds, first with public health experts (N = 31) from the six countries, then with MPH alumni (N = 30). After the first expert round, competencies and impact variables were refined based on the quantitative results and qualitative comments. Both rounds showed high consensus, more so for the competencies than the impact variables. The response rate was 100%.

CONCLUSION

This is the first time that public health competencies have been validated in LMICs across continents. It is also the first time that impact variables of MPH programmes have been proposed and validated in LMICs across continents. The high degree of consensus between experts and alumni suggests that these public health competencies and impact variables can be used to design and evaluate MPH programmes, as well as for individual and team assessment and continuous professional development in LMICs.

A systematic review of outcome and impact of master's in health and health care

BACKGROUND

The 'human resources for health' crisis has highlighted the need for more health (care) professionals and led to an increased interest in health professional education, including master's degree programmes. The number of these programmes in low- and middle-income countries (LMIC) is increasing, but questions have been raised regarding their relevance, outcome and impact. We conducted a systematic review to evaluate the outcomes and impact of health-related master's degree programmes.

METHODS

We searched the databases Scopus, Pubmed, Embase, CINAHL, ERIC, Psychinfo and Cochrane (1999 - November 2011) and selected websites. All papers describing outcomes and impact of health-related Master programmes were included. Three reviewers, two for each article, extracted data independently. The articles were categorised by type of programme, country, defined outcomes and impact, study methods used and level of evidence, and classified according to outcomes: competencies used in practice, graduates' career progression and impact on graduates' workplaces and sector/society.

RESULTS

Of the 33 articles included in the review, most originated from the US and the UK, and only one from a low-income country. The programmes studied were in public health (8), nursing (8), physiotherapy (5), family practice (4) and other topics (8). Outcomes were defined in less than one third of the articles, and impact was not defined at all. Outcomes and impact were measured by self-reported alumni surveys and qualitative methods. Most articles reported that competencies learned during the programme were applied in the workplace and alumni reported career progression or specific job changes. Some articles reported difficulties in using newly gained competencies in the workplace. There was limited evidence of impact on the workplace. Only two articles reported impact on the sector. Most studies described learning approaches, but very few described a mechanism to ensure outcome and impact of the programme.

CONCLUSIONS

Evidence suggests that graduates apply newly learned competencies in the field and that they progress in their career. There is a paucity of well-designed studies assessing the outcomes and impact of health-related master's degree programmes in low- and middle-income countries. Studies of such programmes should consider the context and define outcomes and impact.

Fifteen years of the tropEd Masters in International Health programme: what has it delivered? Results of an alumni survey of masters students in international health

OBJECTIVES

In 2010-2011, recent graduates (2008 or earlier) of the Masters in International Health (MIH) (as offered by over 30 universities and institutions collaborating in the tropEd network) were surveyed. We aimed to examine whether the competencies gained proved appropriate for alumni's current positions and to develop the programme according to alumni's needs.

METHODS

An online questionnaire was sent to 327 alumni. One hundred and seventy-seven responded and 99 met the inclusion criteria. We calculated frequency distributions of the answers and performed a bivariate analysis of certain variables.

RESULTS

Alumni feel confident in all areas covered by the MIH. Most competencies acquired are perceived as essential or very relevant to their current position. Many respondents (77%) changed jobs after graduation, mostly from curative care to public health. More African and Asian alumni work in their country of origin (66% and 63%, respectively) than alumni from other continents (42%). The respondents had mostly worked at a national or provincial level, but after graduating mostly worked at international or national level. Alumni said that the network's mobility and flexibility had important advantages and disadvantages.

CONCLUSIONS

This is the first alumni survey of the MIH programme offered through the international network tropEd. The results suggest that competencies gained by graduates are relevant for their current careers. We recommend offering better guidance to students planning modules and to improve administration.

Placements in global health masters' programmes: what is the student experience?

BACKGROUND

Global health training is increasingly part of public health training in high-income countries, with placements as key components. We sought preliminary evidence of student placement experiences and learning through masters' programmes at the universities of Oxford and Toronto.

METHODS

In a mixed-methods design, we drew on existing programme records, student feedback surveys (Oxford only) and semi-structured interviews with graduates.

RESULTS

Students participated in practice, informed policy and conducted research across a wide variety of topics, and with a range of different tasks, mostly overseas. Building on existing collaboration- or partnership-facilitated placement setup. Clear communication and face-to-face time with organizational representatives or on-site supervisors helped clarify placement objectives. Flexibility on students' and supervisors' part enabled students to take advantage of urgent public health activities for learning. Students valued the opportunity to make cross-country comparisons, to see first-hand the role of international organizations and to learn concrete skills in project design, questionnaire formulation, qualitative and quantitative analysis and writing up.

CONCLUSIONS

Placements were valuable to public health professionals in training. We encourage other programmes to share placement experience of their students, field supervisors and host organizations.