Montira Inkochasan / Thitikorn Trayaporn /
Marc Van der Putten

Public health professionals in an evolving system and its environment are facing increasing challenges in their work to meet the needs of communities. This is especially true in Thailand because of the economic growth in recent decades and the priority given to health systems reform. In anticipation of response to the needs, especially to support the need for human resource development in rural Thailand, a part-time international Master of Public Health Program, the Learning @ the Workplace Program (the program) was developed in 1996 by the College of Public Health (the College), Chulalongkorn University in Thailand. This paper describes this step in the needs assessment in which professional perspectives were explored in terms of the program’s target group among professionals, specific learning needs and programmatic requirements. The authors work at the College of Public Health, Chulalongkorn University, Thailand.

Public Health Education in Rural Thailand: Professional Perspectives on the ‘Learning @ the Workplace’ Program

Introduction

The program aims to create a new type of public health professional who would be knowledgeable, with broad critical thinking skills and with sufficient discipline depth, to meet the new challenges in public health.1

The program can be described as a form of experiential education in which students engage in activities that address health systems and community needs. Moreover, its structured learning experiences are designed to promote group learning and development. Reflective approaches and mutual gains among key stakeholders, such as health authorities, the community and students, are key concepts of the program.

The program finds legitimacy in Kolb’s experiential learning model2 because it assumes that significant and important learning takes place by an integrated combination of abstract conceptualization (learning) and concrete experience (the workplace) linked with reflection on the entire learning experience.

Because of the emphases within Thailand’s 9th National Health Development Plan (2002-2006),3 the College embarked on a review of the objectives of its program. The initial step of this review was based on a broad-based needs assessment to contribute to curriculum development for the postgraduate professional development program in public health.

Method

Six Focus Group Discussions were conducted; one group with Provincial Chief Medical Officers and five groups with past and present students from all implementation sites of the program. Each group consisted of 6 to 8 participants who were purposively selected.

A moderator and an observer, using a discussion protocol, conducted the focus group discussions, which lasted approximately two hours each and were audio-recorded.

Data analysis was facilitated by the use of a code-book, a logbook, transcripts, inter-analyst comparisons and Ethnograph software.4

Findings

I. Target Groups

The program is seen as a postgraduate program in public health that targets students in rural areas, from provincial health offices up to health centers at the sub-district level. Participants pointed out that the target groups have 3 foci: educational background, job responsibilities and functional levels within the provincial health system.

(a) Educational Background

Participants referred to two specific groups within the provincial health system, namely those with a medical or para-medical background and those with a non-medical background. Participants expressed the view that a postgraduate program in public health should not exclude applicants with a non-health related bachelor’s degree.

In addition, participants pointed to the importance of clear criteria in selecting students in terms of target group characteristics and pre-requisites including language skills and professional experience.

(b) Job Responsibilities

There were different opinions among participants on target groups in terms of job responsibilities. Several participants pointed out that staff members involved in instruction, training and education would be preferred target groups. However, an underlying assumption here is that the human resource pool as well as responsibility domains are occasionally shifted within the provincial health system. As a result, the staff members of all levels should be encouraged to further their studies.

In conclusion, there were two different viewpoints among participants: (1) a total human resource pool perspective across responsibilities within the provincial health system and (2) a more selective perspective focusing on instructors and educators within the province for direct benefit to the provincial health office. The discussion turned then to functional levels within the health system, which was helpful in developing further insights.

(c) Functional Levels

Within the context of the needs assessment, functional levels in the provincial health system in Thailand can be generally classified into provincial, district and sub-district levels. There was more agreement between participants on functional level perspectives. The majority of participants expressed the view that the program should be accessible for all levels within the provincial health system up to health centers at the sub-district level.

However, in identifying target groups, personal motivation, ability to manage time for study and capability seemed to be as important as educational background, professional responsibilities or functional levels.

II. Learning Needs

Learning needs may vary from group to group based on present or future responsibilities and functional levels. Also provincial goals are important factors that affect learning needs, and these development goals may vary among provinces.

The Provincial Chief Medical Officers raised the following learning needs as important for the targeted provincial human resource pool: situation analysis, development of interventions, monitoring and evaluation skills and developing a lifelong learning attitude.

For student participants, continuous learning as well as applying knowledge to professional settings were seen as important. Most of the participants expressed learning needs related to themselves such as qualitative and quantitative research methodology, program evaluation and strategic planning. Some students pointed out that they wanted to develop more management and applied research skills, while several were concerned with proposal and report writing skills.
A weakness among human resources in insight into social aspects and determinants of public health was recognized. Further there was the need to improve communication skills.

III. Programmatic Requirements

Participants’ perspectives on programmatic aspects can be grouped into the following categories.

(a) Educational Approach

Participants placed value in problem-based, student-centered and health systems-oriented learning. The approach of utilizing the students’ work situation and the community for learning, as well as the opportunity to study at their workplace, seemed to be important program aspects.

(b) Program Design

Most Provincial Chief Medical Officers identified that the main purpose for them to collaborate with the program was to link health systems reform with human resource development in their provinces.

All students considered the specific design ‘study while working’ to be the program’s strongest characteristic. The fact that they do not have to take leave for study was important to them. However, at the same time, concerns were expressed about collaboration and approval of local employers and provincial health authorities.

(c) Student Selection

The program, which uses English as the medium in rural Thailand, excludes several candidate applicants and, therefore, gives advantages to those having English proficiency. In addition, the language problem is considered to hinder learning. As a result, students called for clear and consistent selection criteria and standards.

(d) Academic Level

The discussions on eventual multiple options in academic levels lead to the conclusion that certificate courses in public health are less attractive. A postgraduate diploma could address certain needs, but with the condition that credits should be transferable if students decide to continue to take up a Master’s degree. Therefore, a Master’s degree in public health is considered to yield the highest motivation among professionals. An important point made by students was that the College should consider its potential, readiness and performance before extending options.

(e) Implementation Site

The majority of Provincial Chief Medical Officers preferred implementation of the program at the provincial level because integration of learning and work would be more feasible and more beneficial for group learning.

Students seemed to prefer implementation at the regional level because exchange of experience among students was seen as positive. On the other hand, from the managerial point of view, regional program implementation was seen as a disadvantage, especially in terms of coordination, distance and travel time for students.

Discussion and Conclusions

The authors acknowledge that the interaction of participants with one another and with the moderator might have undesirable effects. However, the moderator was professionally not involved in the program and she was sufficiently experienced to deal with group dynamics.

Based on the purposive sample strategy and the nature of this study, results represent perceptions of the participants only and cannot be generalized to a larger group of public health professionals.

Findings support the conclusion that target-groups for the program should be local public health professionals with medical or para-medical and non-medical backgrounds in education, mainly responsible for instruction, training and education, and may work at any level within the provincial health system.

Perceived learning needs concentrate on strategic and operational management skills including monitoring and evaluation, applied qualitative and quantitative research and the development of a lifelong learning attitude.

The participants believe that the application of core skills in public health, through a problem-based approach in teaching and learning, can address local issues and priorities.

Regarding programmatic requirements, the participants preferred the current educational approach, program design and academic level provided, but they proposed that the College consider student selection and program implementation site.

The outcomes of these focus groups provide more in-depth understanding of professional perspectives and will complement other methods used in the needs assessment to support curriculum development efforts for the program.

Notes

1 Sitthi-amorn, C. (1993) Proceedings of the international consultative workshop: attributes and threshold capacities of public health graduates: College of Public Health, Chulalongkorn University. Bangkok: CPH, Chulalongkorn University, ISBN 974-7571-33-1

2 Kolb, D. (1984) Experiential Learning. New Jersey: Prentice Hall Inc.

3 Ministry of Public Health Thailand. (2001). Ministry of Public Health and the 9th National Health Development Plan in Thailand. Bangkok: MOPH Bureau of Health Policy & Planning.

4 Seidel, J. (1998) Ethnograph V. 5.0: A User’s Guide. London: Sage Publications Software, Inc.