Tim Stephens
The arena of public health is changing as more agencies are being given, and are taking, responsibility for traditional public health services. The challenges of managed care, changes and reductions in Medicaid, and the privatization of health departments are all examples. Supporting and managing these changes, while still providing for the health needs of a population that has some of the highest rates of sexually-transmitted diseases in the nation, second highest infant mortality rate and other major health drains on its economy, requires new and innovative practices.
The Department of Environment, Health and Natural Resources (DEHNR), county health departments and the UNC School of Public Health (SPH) have joined into a partnership to establish the Public Health Training & Information Network (PHTIN) using the NCIH as a backbone. Six sites are operational at the start of 1996:
The NCIH may provide one mechanism for an innovative partnership to support the changing public health system, based on initial evaluation. The NCIH can provide the space in which the skills and practices of the public health workforce can be upgraded and improved. Moreover, initial analysis suggests the PHTIN, and by extension the NCIH, will provide a cost-effective way to reinvent the public health system in North Carolina.
Since 1990 the SPH has provided training via the existing video networks in North Carolina (NCREN, Vision Carolina, etc.). Growth in this activity has been steady: 300 people were trained the first year in four courses; 1,500 in 15 courses last year. This experience has produced a cadre of trainers and support staff ready to seize the opportunity of a network devoted to the purposes of public health.The experience of the SPH illustrates increased access to training and information through use of electronic highways. Examination of participation patterns at the county level shows a more even distribution of participation in electronically delivered training courses. This pattern is most marked at the geographic peripheries of the state, the very places with the fewest existing educational resources. (See attached maps and discussion.)
Up to this point, programming has had to be worked around the schedules and priorities of institutional partners such as MCNC, the universities, hospitals and community colleges, rather than the needs of the public health system. The PHTIN and NCIH can change this dynamic, if the NCIH’S promise of bandwidth on demand can be delivered.The experience thus far provides the initial statistical basis for judging the NCIH cost equation, as well as preliminary management practices for successful completion of the goals. A database to track the educational, training needs, and attainments of the workforce is under design. The information will be used by the public health system to deliver courses in a time-efficient manner based upon need. The database provides information when a critical number of the workforce is in need of a particular training, and will give a clear picture of the changes in the educational level of the workforce over time.
Cost comparisons of courses delivered in traditional meeting spaces with distance delivery show that an average savings per person of $35/day were realized by the distance education strategy, in addition to 1.5 hours of time on the job through reduced travel due to greater accessibility of the training. During the first full year of the PHTIN 10,000 people are expected to use the network for training, for policy meetings, to receive emergency updates, and for technical assistance. (This number is projected from the 1,500 people who used the network in the first 2 months of the network’s existence.)
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