UNDERSTANDING PUBLIC HEALTH PROFESSIONALS: THEIR ROLES, SIGNIFICANCE, AND CHALLENGES
Abstract
The dramatic progress in public health throughout the 20th century, including the extension of life expectancy, enhancement of quality of life, and significant reductions in infant and child mortality rates, as well as the successful reduction and eradication of some infectious diseases, could not have been achieved without public health professionals responsible for the management, coordination, and provision of essential public health services. Public health systems in countries around the world, including the Republic of Serbia, are "chronically" underinvested, and face difficulties in ensuring an adequate number and appropriate distribution of qualified public health workers. Numerous challenges related to the public health workforce can be classified into several groups: social (aging workers, the profession’s lack of appeal, diminished morale and motivation, retention challenges); technological (the diverse array of education and training options, scarce opportunities for professional development); economic (insufficient financing and low salaries); environmental (antibiotic resistance, pollution, food safety, climate change, urbanization); political (lack of prominence on the agendas of political leaders, lack of legal frameworks for workforce development); and legal and ethical (absence of a well-defined ethical framework in public health). To deliver high-quality public health services, mitigate health disparities, and effectively tackle emerging health crises, enhancing the capabilities of a skilled and competent workforce is imperative. This involves gaining a comprehensive understanding of the interests and needs of public health professionals, implementing strategic succession planning, optimizing recruitment and retention of workers, and ensuring more efficient use of resources. A thorough examination of public health personnel management, together with the development of strategic and operational personnel policies within the healthcare system of the Republic of Serbia, is necessary for effectively addressing the demands posed by crises such as the outbreak of a novel infectious disease pandemic.
References
Babić M, Bjegović Mikanović V, Vuković D i sar. Literatura. In: Simić S, editor. Socijalna medicina. Udžbenik za studente medicine. Beograd: Medicinski fakultet Beograd; 2012.
Azari R, Borisch B. What is public health? a scoping review. Arch Public Health, 2023. 81; 86. https://doi.org/10.1186/s13690-023-01091-6.
Acheson D. Public health in England. The report of the committee of inquiry into the future development of the public health function. London: HMSO; 1988.
Bjegovic Mikanovic V, Czabanowska K, Flahault A et al. Addressing needs in the public health workforce in Europe. Copenhagen: World Health Organization; 2014. http://dx.doi.org/10.13140/2.1.2707.0407.
Rotem A, Walters J, Dewdney J. The public health workforce education and training study. Aust J Public Health. 1995; 19(5):437-8. doi: 10.1111/j.1753-6405.1995.tb00404.x.
Beaglehole R, Dal Poz М. Public health workforce: challenges and policy issues. Human Resources for Health. 2003; 1(1):4.
Institute of Medicine (IOM). Shaping the Future: Who will keep the public healthy? Educating public health professionals for the 21st century. 2002.
Whitfield M. Public health job market. In Employment in Public Health in Europe [Zatrudnienie w Zdrowiu Publicznym w Europie]. K. Czabanowska and C. W lodarczyk, Eds. Kraków, Jagiellonian University Press. 2004.
WHO Regional Office for Europe. European Action Plan for Strengthening Public Health Capacities and Services. Copenhagen: WHO Regional Office for Europe, 2012. Dostupno na: http://www.euro.who.int/en/health-topics/Health-systems/public-health-services/publications/2012/european-action-plan-for-strengthening-public-health-capacities-and-services.
National workforce capacity to implement the essential public health functions including a focus on emergency preparedness and response: action plan (2022–2024) for aligning WHO and partner contributions. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.
Watts RD, Bowles DC, Ryan E et al. No Two Workforces Are the Same: A Systematic Review of Enumerations and Definitions of Public Health Workforces. Front. Public Health. 2020; 8:588092. doi: 10.3389/fpubh.2020.588092.
Zhang Y, McDarby G, Seifeldin R et al. Towards applying the essential public health functions for building health systems resilience: A renewed list and key enablers for operationalization. Front. Public Health, 2023; 10:1107192. doi: 10.3389/fpubh.2022.1107192.
Institute of Medicine (IOM). The Future of Public Health. Washington, DC: National Academy Press; 1988.
CDC. The Essential Public Health Services. Dostupno na: https://www.cdc.gov/publichealthgateway/publichealthservices/originalessentialhealthservices.html.
WHO. Essential Public Health Functions: Results of the International Delphi Study. World Health Statistics. 1998; 51.
Essential public health functions, health systems and health security: developing conceptual clarity and a WHO roadmap for action. Geneva: World Health Organization; 2018. Licence: CC BY-NC-SA 3.0 IGO.
World Health Organization. Regional Office for Europe. Self-assessment tool for the evaluation of essential public health operations in the WHO European Region. World Health Organization. Regional Office for Europe; 2015. Dostupno na: https://apps.who.int/iris/handle/10665/344398.
World Health Organization. Regional Office for Europe. Health 2020: a European policy framework and strategy for the 21st century. World Health Organization. Regional Office for Europe; 2013. Dostupno na: https://apps.who.int/iris/handle/10665/326386.
Regional Committee for Europe, 62nd session. Sixty-second Regional Committee for Europe: Malta, 10–13 September 2012: report of the sixty-second session of the WHO Regional Committee for Europe. World Health Organization. Regional Office for Europe; 2012. Dostupno na: https://apps.who.int/iris/handle/10665/336532.
WHA69.1 Strengthening essential public health functions in support of the achievement of universal health coverage. Geneva: World Health Organization; 2016. Dostupno na: https://apps.who.int/iris/handle/10665/252781
21st century health challenges: can the essential public health functions make a difference? Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.
National workforce capacity to implement the essential public health functions including a focus on emergency preparedness and response: roadmap for aligning WHO and partner contributions. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.
The European Health Report 2021. Taking stock of the health-related Sustainable Development Goals in the COVID-19 era with a focus on leaving no one behind. Copenhagen: WHO Regional Office for Europe; 2022. Licence: CC BY-NC-SA 3.0 IGO.
WHO Regional Office for Europe. Tuberculosis in the WHO European Region - Factsheet [website]. Copenhagen: WHO Regional Office for Europe; 2021. Dostupno na: https://iris.who.int/bitstream/handle/10665/340277/WHO-EURO-2021-1980-41731-57122-eng.pdf?sequence=1.
Rome Declaration. European Union; 2021. Dostupno na: https://global-health-summit.europa.eu/rome-declaration_en.
G20 Italia. Declaration of G20 Health Ministers; 2021. Dostupno na: https://www.g20.org/wpcontent/uploads/2021/09/G20_Italia_2021_Health_Declaration_final_05092021_OFFICIAL.pdf.
Yeager VA, Wisniewski JW, Amos K, Bialek R. Why Do People Work in Public Health? Exploring Recruitment and Retention Among Public Health Workers. J Public Health Management Practice. 2016;00(00):1–8.
Roadmap to professionalizing the public health workforce in the European Region. Copenhagen: WHO Regional Office for Europe; 2022. Licence: CC BY-NC-SA 3.0 IGO.
Bjegovic-Mikanovic V, Santric-Milicevic M, Cichowska A et al. Sustaining success: aligning the public health workforce in South-Eastern Europe with strategic public health priorities. Int J Public Health. 2018; 63(5):651-662. doi: 10.1007/s00038-018-1105-7.
WHO Regional Office for Europe. WHO-ASPHER Competency Framework for the Public Health Workforce in the European Region [website]. Copenhagen: WHO Regional Office for Europe; 2020. Dostupno na: https://www.euro.who.int/en/health-topics/Health-systems/public-health-services/publications/2020/who-aspher-competency-framework-for-the-public-health-workforce-in-the-european-region-2020.
World Health Organization. Regional Office for Europe, European Observatory on Health Systems and Policies, Bjegovic-Mikanovic, Vesna, Vasic, Milena, Vukovic, Dejana. et al. 2019. Serbia: health system review. World Health Organization. Regional Office for Europe.
Zakon o zdravstvenoj zaštiti. "Službeni glasnik RS", br. 25/2019 i 92/2023.
Zakon o javnom zdravlju. "Službeni glasnik RS", br. 15/2016.
Zakon o zdravstvenom osiguranju. "Službeni glasnik RS", br. 25/2019 i 92/2023.
Uredba o planu mreže zdravstvenih ustanova. "Službeni glasnik RS", br. 5/2020, 11/2020, 52/2020, 88/2020, 62/2021, 69/2021, 74/2021, 95/2021, 43/2023, 58/2023, 87/2023 i 103/2023.
Pravilnik o specijalizacijama i užim specijalizacijama zdravstvenih radnika i zdravstvenih saradnika. "Službeni glasnik RS", br. 10/2013, 91/2013, 113/2013, 109/2014, 53/2018, 17/202, 77/2022, 6/2023 i 93/2023.
Pravilnik o bližim uslovima za obavljanje zdravstvene delatnosti u zdravstvenim ustanovama i drugim oblicima zdravstvene službe. "Službeni glasnik RS", br. 43/2006, 112/2009, 50/2010, 79/2011, 10/2012, 119/2012, 22/2013, 16/2018, 18/2022 i 20/2023.
Institut za javno zdravlje Srbije „Dr. Milan Jovanović- Batut“. Zdravstveno-statistički godišnjak Republike Srbije 2022. Beograd: Institut za javno zdravlje Srbije „Dr. Milan Jovanović- Batut“; 2023.
Republika Srbija. Republički zavod za statistiku. Izveštaj o napretku u ostvarivanju ciljeva održivog razvoja do 2030. godine u Republici Srbiji. Izveštaj za 2022. godinu. Beograd: Republički zavod za statistiku; 2023.
Republički zavod za statistiku i UNICEF. Istraživanje višestrukih pokazatelja položaja žena i dece u Srbiji i Istraživanje višestrukih pokazatelja položaja žena i dece u romskim naseljima u Srbiji, 2019, Izveštaj o nalazima istraživanja. Beograd, Srbija: Republički zavod za statistiku i UNICEF.
Republički zavod za statistiku. Становништво - Процене становништва. Beograd: Republički zavod za statistiku; 2023. Dostupno na: https://publikacije.stat.gov.rs/G2023/Html/G20231179.html.
Program unapređenja kontrole raka u Republici Srbiji za period 2020-2022. godine. "Službeni glasnik RS", br. 105/2020.
Marić N, Lazarević Lj, Knežević G i sar. Psihijatrijski poremećaji, distres i pandemija KOVID- 19 u Srbiji: Rezultati na nacionalno reprezentativnom uzorku. Beograd: Institut za mentalno zdravlje; 2022. Dostupno na: https://cov2soul.rs/o-projektu/#dearflip-df_100483/21/.
Republika Srbija. Ministarstvo zdravlja Republike Srbije. Republički zavod za statistiku. Institut za javno zdravlje Srbije „Dr. Milan Jovanović- Batut“. Istraživanje zdravlja stanovništva Srbije 2019. godine. Beograd: 2021.
Institut za javno zdravlje Srbije „Dr. Milan Jovanović- Batut“. Izveštaj o sprovedenoj imunizaciji na teritoriji Republike Srbije u 2022. godini. Beograd: Institut za javno zdravlje Srbije „Dr. Milan Jovanović- Batut“; 2023.
Institut za javno zdravlje Srbije „Dr. Milan Jovanović- Batut“. Zdravstveno-statistički godišnjak Republike Srbije 2021. Beograd: Institut za javno zdravlje Srbije „Dr. Milan Jovanović- Batut“; 2022.
Strategija javnog zdravlja u Republici Srbiji 2018–2026. godine. "Službeni glasnik RS", br. 61/2018.
Santric- Milicevic M, Vasic M, Edwards M et al. Strengthening the public health workforce: An estimation of the long-term requirements for public health specialists in Serbia. Health Policy, 2018; 122:674–680. https://doi.org/10.1016/j.healthpol.2018.03.012.
Tripkovic K, Santric- Milicevic M, Miladinovic- Mandic M et al. Implementation of theWorkload Indicators of Staffing Need (WISN) method in determining staff requirements in public health laboratories in Serbia. Disaster Med. Public Health Prep, 2020; 1–9. https://doi.org/10.1017/dmp.2020.133.
Tripković K. Ispitivanje faktora povezanih sa namerom javnozdravstvenih radnika u Republici Srbiji da promene posao. Doktorska disertacija. Medicinski fakultet Univerziteta u Beogradu, 2023.
Institut za javno zdravlje Srbije „Dr Milan Jovanović- Batut“. Nacionalni zdravstveni račun. Dostupno na: https://www.batut.org.rs/index.php?category_id=50.
Program rada SZO za Evropu u periodu 2020–2025. godine „Udružena akcija za bolje zdravlje u Evropi” Kopenhagen: Regionalna kancelarija SZO za Evropu; 2021. god., Licenca: CC BY-NC-SA 3.0 IGO.
