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A capacity mapping approach to public health training resources - Practice Articles

Public Health Reports - January 1, 2002

The Future of Public Health, (1) The Public Health Workforce: An Agenda for the 21st Century, (2) the Healthy People 2010 Objectives, (3) and the report of the Taskforce on Public Health Workforce Development (4) have all recognized an unmet need for public health workforce training. The need is daunting, considering the large number of untrained public health workers (5) and the limited federal funding now available for training.

Consider that the tuition for a single MPH student can easily cost $25,000, with additional salary and opportunity costs when the student is provided with work release time from a public health agency. Compare that to recent federal funding for public health training centers (the Health Research and Service Administration's Public Health Training Centers and the Centers for Public Health Preparedness) in fiscal year 2001 of less than $10 million, or enough to educate just 400 MPH students if used for tuition only.

The training resources of individual local and state health agencies are one source of workforce development training to be considered, but the distribution and availability of these resources does not match the greatest needs for them. Common sense, anecdotal examples, and practical experience support the premise that those, agencies that serve in economically depressed areas with the greatest competing needs are the most likely to need staff training and the least likely to have the necessary resources.

Capacity mapping, as described here, addresses the mismatch between needs and available resources? In this article, we describe a capacity mapping approach that can be used by local health departments. We discuss the development of two inventories of public health workforce training resources that we used to construct a model public health workforce training capacity map. Finally, we discuss some of the challenges of a capacity mapping approach when applied to public health agencies, given their characteristic financial, legal, and structural constraints.

CAPACITY MAPPING

Capacity mapping is a strategy to find untapped and unrecognized resources for the purpose of rebuilding a community from the inside out. Instead of looking at a community solely from the perspective of its many problems (such as crime, domestic violence, alcoholism, illiteracy, or lead paint), capacity mapping identifies and maps resources available to a community. These include individual capacities, personal income, the potential contributions of labeled people (developmentally delayed, mentally ill, disabled, elderly, and so on), and individual local businesses and organizations.

McKnight and Kretzmann (6) describe three possible types of resources or building blocks with which to construct a capacity map. Primary building blocks are assets and capacities located within and under the control of the community. Secondary building blocks are assets located within the community but largely controlled by outsiders. Finally, potential building blocks are resources originating outside the community and controlled by outsiders. Resource inventories at both the individual and community levels are used to identify the building blocks, which are then used to produce the capacity map.

CAPACITY MAPPING FOR PUBLIC HEALTH WORKFORCE DEVELOPMENT

As part of the Northeast Regional Public Health Training Project (NERPHT), we assessed the training needs of public health agency workers in six Northeastern states and then used capacity mapping to identify training resources matched to these needs. (7) We recognized that, even with federal funding, resources would be insufficient to meet the needs of large numbers of workers. Rather than develop all training programs from scratch, we developed two inventories of practical resources that could be used to train entry- and mid-level public health workers. One was an institutional inventory and the second was an inventory of individual courses. The geographic scope of the inventories was initially limited to resources for public health workers in the Northeast; it was later broadened to include resources for public health nurses nationally. Since the training needs of the professions overlapped substantially, we used the same inventory questionnaires for both and combined the results to construct a capacity map for workforce development.

We described training needs in terms of "competencies," as developed by the Faculty/Agency Forum, (8) a predecessor to the Council on Linkages between Academia and Public Health, and as suggested by the NERPHT advisors and a prior needs assessment for public health nurses. (9,10) The complete list (Figure 1) included competencies in the following general areas: Orientation to Public Health, Analytic Skills, Basic Public Health Sciences, Communication/Cultural Skills, Policy Development/Program Planning Skills, Financial Planning and Management Skills, and Computer Skills.

Inventory One--training and development institutions

We looked beyond traditional public health educational institutions to find as many resources as possible because many of the competencies are not specific to public health; they can be taught by non-public health institutions or delivered anywhere by distance-learning technology such as satellite transmission and interactive television (ITV).

Using Peterson's Guides to Distance Learning and Nursing Programs, (11,12) we developed a database of 462 institutions that could deliver competency-related programs to our Northeast region or to the national public health nursing community. Another 284 institutions were identified by the project's regional and national advisory committees through exhibits at the American Public Health Association (APHA) 1998 Annual Meeting, the Training Expo-Lit catalog, and membership lists of the Nursing Organization Liaison Forum and the Association of State and Territorial Health Officers (ASTHO). An additional eight institutions were identified by members of two list-servs (APHA state affiliates and APHA Health Services Administration Section) who responded to our call for information. Schools of public health were not specifically targeted since information about them was already readily available to us and could be added to the capacity map without incurring the time and cost of the inventory process.

From December 1998 to July 1999 we mailed each of the 746 institutions a letter asking them to fill out a questionnaire if they had or were planning non-degree training or distance learning programs. The survey (13) was designed to determine whether an institution could contribute to public health training either by providing local access to distance learning resources (such as through satellite downlinks or ITV facilities), by offering local continuing education training, or by originating distance training in any of the competencies.

A high response rate was neither expected nor obtained since no funding was available for incentives and many of the institutions had no prior identification with public health and/or with the Northeast. Still, 191 institutions reported relevant public health training and/or distance learning resources. We received completed questionnaires from colleges and universities (136), health-related training programs and institutes (22), state health departments (17), professional organizations (10), and others (6). These 191 institutions reported a variety of distance learning technological capacities including video conferencing (61%), satellite downlink (50%), satellite transmission (26%), Internet audio broadcast (35%), and Internet video broadcast (33%). The list of institutions sorted by state, including their answers to relevant questions, are listed at http://www.cphp.pitt.edu/training/sectiona.html. (14)

This survey also identified the areas of competency training offered by these institutions, as shown in Table 1. Of the 191 institutions, 126 currently offered nondegree training programs in at least one of the competency domains, and 101 planned distance training or brief (less than one week) on-site courses for the upcoming year (through June 2000) in one or more domains.

Inventory Two--training and development modules

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