Schools of public health in low and middle-income countries: an imperative investment for improving the health of populations?
Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005-2008) strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges.



The challenges faced by LMICs include rapid urbanization, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs).



SPHs in LMICs can contribute to overcoming several public health challenges being faced by LMICs, including achieving SDGs. Most importantly they can develop cadres of competent and well-motivated public health professionals: educators, practitioners and researchers who ask questions that address fundamental health determinants, seek solutions as agents of change within their mandates, provide specific services and serve as advocates for multilevel partnerships. Funding support, human resources, and agency are unfortunately often limited or curtailed in LMICs, and this requires constructive collaboration between LMICs and counterpart institutions from high income countries.
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. fauziah.rabbani@aku.edu.
Fauziah
F
Rabbani
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Leah
L
Shipton
Pacific Health & Development Sciences Inc., Victoria, Canada.
Franklin
F
White
Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
Iman
I
Nuwayhid
Division Public Health Medicine, School of Public Health and Family Medicine University of Cape Town, Cape Town, South Africa.
Leslie
L
London
Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland.
Abdul
A
Ghaffar
Hanoi School of Public Health, Giang Vo, Ba Dinh, Hanoi, Vietnam.
Bui Thi Thu
BT
Ha
Depts LIME & PHS, Karolinska Institutet Stockholm, Stockholm, Sweden.
Göran
G
Tomson
Department of Prevention and Community Health, George Washington University School of Public Health and Health Services, Washington, USA.
Rajiv
R
Rimal
School of Health Policy and Management, York University, Toronto, Ontario, Canada.
Anwar
A
Islam
Department of Global Health & Sustainable Development, School of Public Health-Tehran University of Medical Sciences, Tehran, Iran.
Amirhossein
A
Takian
JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong.
Samuel
S
Wong
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Shehla
S
Zaidi
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Kausar
K
Khan
School of Nursing & Midwifery and Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Rozina
R
Karmaliani
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Imran Naeem
IN
Abbasi
Medical College, Aga Khan University, Karachi, Pakistan.
Farhat
F
Abbas
D003299:Cooperative Behavior; D003906:Developing Countries; D000069576:Health Equity / Q000458:organization & administration; D006295:Health Resources; D006801:Humans; D011203:Poverty; D011320:Primary Health Care / Q000458:organization & administration; D011634:Public Health / Q000379:methods*; D012581:Schools, Public Health; D019472:Universal Health Insurance / Q000458:organization & administration
Collaboration; Health research; Healthcare; Low and middle income countries; Partnerships; Policy development; Public health education; Schools of public health; Social determinants of health; Universal health coverage