PUBLIC HEALTH WORKFORCE DEVELOPMENT SURVEY 2012

PUBLIC HEALTH

WORKFORCE

DEVELOPMENT SURVEY

2012

HEAD STRATEGIC

THE MINISTRY OF HEALTH

Revised July 2013

Authors:

Dr Allan Wyllie

Jo Howearth

CONTENTS

5 WHAT IS THE RESPONSE TO THE PROPOSED CERTIFICATE IN PUBLIC HEALTH? ... 18

6 WHO ARE WE? ... 30

7 WHAT ARE THE MOST IMPORTANT WORKFORCE ISSUES? ... 34

8 HOW ARE WE DOING? EXPERIENCE, RECRUITMENT AND RETENTION ... 39

9 HOW ARE WE DOING? QUALIFICATIONS AND TRAINING ... 46

LIST OF GRAPHS

Graph 1: Recruitment difficulty – Māori and Pacific dedicated positions ... 41

Graph 2: Recruitment difficulty – non-dedicated positions ... 42

Graph 3: Retention difficulty – Māori and Pacific dedicated positions ... 43

Graph 4: Retention difficulty – non-dedicated positions... 44

LIST OF TABLES Table 1: Number in target audience and number attending ... 6

Table 2: Workforce issues ... 7

Table 3: Public health qualifications: Overview ... 10

Table 4: Type of organisation ... 16

Table 5: Knowledge of Certificate in Public Health ... 18

Table 6: How well delivery meets needs ... 19

Table 7: Key to successful programme for organisation ... 20

Table 8: Key to successful programme for staff ... 21

Table 9: Knowledge/skills want graduates to obtain ... 22

Table 10: Number in target audience and numbers attending course ... 23

Table 11: Proportions attending ... 24

Table 12: Proportion of target audience in each discipline ... 24

Table 13: Proportion of those attending over first 3 years in each discipline ... 25

Table 14: Barriers/risks that need to be addressed ... 26

Table 15: How feel about strong Māori focus and some Pacific focus ... 27

Table 16: What they can do to integrate course learnings into workplace ... 27

Table 17: How well having all staff with public health qualifications fits with workforce devel opment planning ... 28

Table 18: What support would require to meet Ministry's aspirational targets ... 29

Table 19: Discipline working in ... 31

Table 20: Dedicated role ... 31

Table 21: Ethnicity ... 32

Table 22: Age ... 32

Table 23: Age by discipline ... 33

Table 24: Workforce issues ... 34

Table 25: Top three workforce issues ... 35

Table 26: Years in public health, by discipline ... 39

Table 27: Years in public health, by ethnicity ... 39

Table 28: Employment status... 40

Table 29: Vacancies ... 45

Table 30: Workforce planning ... 46

Table 31: Public health qualifications: Overview ... 47

Table 32: Public health qualifications: highest completed ... 48

Table 33: Public health qualifications: currently studying ... 49

Table 34: Public health qualifications: intend beginning in next 3 years ... 49

Table 35: Highest qualification completed by discipline working in ... 51

Table 36: Public health qualifications by regulated versus unregulated professions ... 52

Table 37: Highest qualification completed by ethnicity ... 53

Table 38: Proportion with degrees ... 54

Table 39: Proportion with degrees, by discipline working in ... 54

Table 40: Proportion with degrees, by ethnicity ... 54

Table 41: Key to successful programme for organisation ... 55

Table 42: Key to successful programme for staff ... 56

Table 43: Anything else want staff to learn on course ... 57

Table 44: Barriers/risks that need to be addressed ... 58

Table 45: Barriers/risks that need to be addressed ... 59

Table 46: How feel about strong Māori focus and some Pacific focus ... 60

Table 47: What they can do to integrate course learnings into workplace ... 61

Table 48: How well having all staff with public health qualifications fits with workforce development planning ... 62

ACKNOWLEDGEMENTS

We wish to thank all those who participated in this research, particularly the person in each organisation who was responsible for organising the collection and collating of data from each public health staff member in their organisation.

1

SUMMARY

INTRODUCTION

 The research objectives were:

 To provide an update on the qualifications currently held by the public health workforce  To provide information to inform on-going workforce planning

 To obtain feedback on the planned Certificate in Public Health course and how it can best meet organisational and staff needs

 To identify enablers and barriers to uptake of the new course

 To assess the near future demand for public health qualifications, including the Certificate in Public Health

 To assist the Ministry to estimate in provider contracts the numbers of staff that must hold public health qualifications within specified time frames

 To provide an update on the main workforce issues facing public health organisations and strategies for dealing with these

 The planned New Zealand Certificate in Public Health fulfils the Ministry of Health's aim to make a generic, undergraduate level 5 public health qualification widely available for the public health and primary health workforces.

 Thirty-two organisations were invited to complete a self-completion survey and a phone interview. There were 27 organisations that completed the self-completion and 28 that completed the phone interview.

 The sample included all 12 PHUs (Public Health Units). The NGOs were selected by Head Strategic with the aim of providing a representative mix in terms of Māori (5 participated), Pacific (5) and other public health providers (6).

 Given only 16 of the 203 NGOs were included, their data needs to be interpreted with some caution.

 Within the self-completion survey, some key information was collected about each public health staff member within the organisation, providing a sample of 883 individuals.

 The data collection took place between 8 February and 29 March, 2012.

 This report was originally published in June 2012, but has now had data relating to the Certificate in Public Health corrected with revisions to the data regarding public health qualifications .

WHAT IS THE RESPONSE TO THE PLANNED CERTIFICATE IN PUBLIC

HEALTH?

 63% of the managers knew either only ‘a little’ (52%) or ‘nothing’ (11%) about the planned course. A third knew ‘a moderate amount’ and 4% ‘a lot’.

 The concept of block courses had a good level of appeal, but there was some concern that the proposed four day duration of the block courses was too long. Some noted a preference for four block courses of two days. However, there was also some concern with the cost of travel, which the organisations would mostly have to cover (see page 18).

 The key ingredient to making it a successful programme was that it needed to be relevant to the work the organisation and staff are undertaking (see page 19).

 The different components of the proposed content of the course generally all received high levels of support from managers (see page 21).

 Table 1 below shows that, of the organisations which provided data, the mean (average) number of staff who they thought were in the target audience for this course was 14.9 among PHUs and 9.6

 The same table also shows the estimated number they would support to attend over the first three years in total. The mean for PHUs was 7.6 and for NGOs it was 8.1.

 NGOs would expect to have 58% of their workforce attend the course in the first three years, while for PHUs it would be just 9%. However, because of the much greater size of the PHUs, the actual numbers attending per organisation would be reasonably similar for PHUs and NGOs. Despite this level of similarity, the NGOs would account for the vast majority of those attending the course, because of the much greater number of NGOs in the country.

 These findings are at least in part a reflection of the level of qualifications currently held by staff in PHUs versus NGOs.

 Using relatively conservative assumptions, it has been estimated that there might be approximately 200 per year attending in the first three years, assuming demand could be met.

 The biggest group likely to attend the course would be health promoters/ educators (accounting for 48% of the PHU staff attending and 58% for the NGOs).

Table 1: Number in target audience and number attending

NUMBER IN TARGET AUDIENCE

Public

Health Unit NGO

Mean

14.9

9.6

ATTENDING OVER 3 YEARS

Mean

7.6

8.1

 Monetary restraints were seen as the biggest potential barrier to supporting staff to attend (see page 25).

 The responses were generally positive to the concept of having a strong Māori focus and to a lesser degree a Pacific focus in the course material. However, some PHUs in particular noted they had few Pacific peoples in their region. Some also noted the need for the course to adapt to the changing population, which included Asian and refugees (see page 26).

 The main suggestion for ways in which managers could ensure that what staff learn on the course is successfully integrated into their workplace, was having the staff share their knowledge with other staff, followed by ensuring there are opportunities provided for the staff to put into practice what they have learnt on the course (see page 27).

 There was a mixed response to the concept of the Ministry preferring everyone employed in public health to hold a public health qualification. Some were totally in agreement, while others felt the important thing was that staff had qualifications which were relevant to their area of work and there should be flexibility around qualifications (see page 28).

WHO ARE WE?

 The 12 PHUs had an average of 81 staff positions, which was an increase from 68 in 2004.

 The 15 NGOs which provided data had an average of 16 staff postions, but the larger NGOs were included in the survey (the average size in 2004 among 171 NGOs was 10).

 The following profile data was based on 879 staff who answered this section, of whom 672 (76%) were from PHUs and 207 from NGOs.

 20% of those who specified their ethnicity were Māori (n=167), 9% Pacific (n=73) and 7% Asian (n=55)2_.

 76% were female.

 Staff in NGOs were predominantly health promotion/education (56%) and management/advisory (20%), while PHUs had a much greater spread of disciplines, reflecting the broader focus of their work (see page 30).

 Forty percent were aged 50 years and over and a total of 69% were aged 40 years and over. Just 10% were aged under 30 years.

 Compared with a previous 2004 survey, the proportion aged 50 years and over had increased from 29% to 39%.

WHAT ARE THE MOST IMPORTANT WORKFORCE ISSUES?

 Table 2 below shows funding was the most mentioned issue, both currently (93%) and over the next five years (92%).

 Staff performance was seen to be more of an issue now (30% mentioned it in their top 3), than in the next five years (15%). Conversely, staff recruitment and retention were expected to be more important issues in the next five years than they are now.

 More workforce training was a much greater issue for NGOs (47% vs 8% for PHUs). Workloads/burnout were also more of an issue for NGOs (53% vs 33% for PHUs for current issues), as was staff performance (40% vs 17%). Meeting Ministry requirements was more of an issue for PHUs (42% vs 27%).

Table 2: Workforce issues

TOP 3 WORKFORCE ISSUES

TOTAL SAMPLE (27)

Currently Next 5 years

% %

Level of funding/ funding cuts/ obtaining more funding 93 92

Workloads/ burn out 44 42

Meeting Ministry requirements/ relationship with Ministry 33 35

Need for more training for the workforce 30 31

Staff performance 30 15

Staff retention 19 31

Lack of skilled staff available/ recruitment problems 15 31

 When asked to discuss any issues managers had with regard to meeting Ministry requirements and the relationship with the Ministry, the most common responses related to financial issues. A number of managers also talked about the reduced level of contact and reduced quality of relationships with the Ministry (see page 35).

 The concerns with staff workload and burnout related in large part to the cost-cutting. Some felt they were still trying to deliver the same level of service, but with fewer staff, as they were aware of the amount of work that needed to be done (see page 36).

 The main staff training issue again related to the lack of funding, and its impact on the ability to fund staff training (see page 36).

 Almost half the PHUs mentioned issues relating to recruitment for Maori specific roles, while none of the NGOs did. This was linked to there being a limited pool of Maori in the workforce (see page

 When asked to suggest their top five strategies for managing the current workforce issues, most PHUs and some of the NGOs mentioned workforce development planning. This included looking at both internal needs, including staff needs and external needs (see page 37).

 There were 83% of the PHUs and 75% of the NGOs who said their organisations had had reductions in public health services contracted for by the Ministry in the previous three years. Effect of these reductions are noted on page 38.

HOW ARE WE DOING? EXPERIENCE, RECRUITMENT AND RETENTION

38% having worked less than five years.

 Just under two thirds (65%) were working full-time.

 Managers rated the difficulty of recruiting and retaining staff in a range of positions. With almost all the dedicated Māori and Pacific roles, higher proportions of managers reported recruiting

difficulties compared with those reporting no difficulties. The exceptions were Maori and Pacific community workers, where recruitment was more likely to be never difficult (see page 40).

 The following positions are rated from highest down, in terms of reported levels of recruitment difficulty compared with there never being difficulties. 3

 Portfolio managers

 Public health dieticians/nutritionists  Health protection officers

 Public health registrars

 Researchers/ evaluators/ analysts  Medical officers of health

 Public health programme co-ordinators  Health promotion workers/ advisors  Managers

 Epidemiologists  Policy analysts

 Public health physicians  Public health nurses

 Compared with 2004, in 2012 it had got less difficult to recruit for 4_:

 Māori health promotion workers/ advisors  Medical officers of health

 Public health physicians  Policy analysts

 Public health nurses

 In 2012 it had got more difficult to recruit for:  Māori advisors

 Public health registrars  Public health dieticians

 The non-dedicated positions for which there were more difficulties with retention compared with no difficulties are listed below, with the highest difficulty first:

The percentage reporting that there were at least sometimes difficulties was divided by the percentage saying there were never difficulties, to give a ratio.

4

 Public health dieticians/ nutritionists  Public health programme co-ordinators  Health promotion workers/ advisors  Public health nurses

 Health protection officers

 Researchers/ evaluators/ analysts

 The fact that the above list is much shorter than that for recruitment, shows that there were fewer issues with retention than there were with recruitment (see page 43).

 Compared with 2004, in 2012 there were no positions where it had got less difficult to retain staff. It had got more difficult to retain:

 Managers

 Researchers/evaluators/analysts  Health promotion workers/advisors  Public health nurses

HOW ARE WE DOING? QUALIFICATIONS AND TRAINING

 Almost all the organisations reported using “a workforce development plan to direct internal workforce development activities”.

 There were 83% of the PHUs, but just 31% of the NGOs, that made any use of Te Uru Kahikatea, the Ministry of Health Public Health Workforce Development Plan, to structure their workforce.

 As shown in Table 3 below, there were 29% who reported currently having a public health qualification, but there were another 9% who did not answer, which might mean they did not have any public health qualifications, or they may not have answered for some other reason (some of this information may have been supplied by other staff members who may not have known the person’s qualifications).

 There were 22% who held a graduate or higher public health qualification, while 9% held a non-graduate qualification as their highest public health qualification.

 There were 8% with a Diploma in Public Health and another 6% with a Master of Public Health.

 Comparisons of the PHU sample with 2004 showed that the proportion of staff holding a Master of Public Health had increased from 3% to 8%, a Diploma in Public Health from 4% to 10% and a Certificate in Health Promotion from 10% to 14%.

 Staff in PHUs were more likely to currently hold a public health degree (28% vs 5% for NGOs).

 Public health degrees were more prevalent among those in: medicine (61%), health protection (52%), and analysis/ policy analysis (46%).

 Asian people were the most likely to currently have a public health degree (47%), Pacific peoples were notably low (8%), while Māori (16%) did not differ significantly from the total sample (22%).

 There were 10% who were currently studying for a public health qualification, although another 14% did not answer.

 There were 16% who intended to begin studying for a public health qualification in the next three years, with another 14% not answering.

 There were 37% of the public health workforce who had a degree but did not have a public health degree5_{, giving a total of 59% with a degree.}

 There were another 3% who currently had no degree but were studying for one (either public health or non-public health).

Table 3: Public health qualifications: Overview

PUBLIC HEALTH QUALIFICATIONS: OVERVIEW

TOTAL SAMPLE (883)

%

Highest

completed studying for Currently

Intend beginning next 3 years

Any Public Health Qualification 29 10 16

Any Graduate/Post-grad Public Health

Qualification 22 6 9

Master of Public Health (MPH) 6 2 4

Diploma in Public Health (DPH) 8 3 4

Post graduate Certificate in Public Health 1 1 1

Graduate Diploma Environmental Health 3 * 0

BHS (Health Promotion) 1 1 1

BHS/ BSc (Environmental or Health Protection) 1 * *

Other Graduate/ Post-grad Public Health

Qualification 1 * *

Any Other Public Health Qualification 6 4 7

Diploma in Health Promotion 1 2 3

Certificate in Health Promotion 3 1 1

Certificate in Public Health (undergrad) NA NA 3

Other Public Health Qualification 2 1 0

None 62 76 70

Not answered 9 14 14

NA = Not available; * denotes less than 1%, but not zero

2

DISCUSSION

HIGH LEVEL OF DEMAND FOR CERTIFICATE IN PUBLIC HEALTH

The planned Certificate in Public Health is clearly meeting a need within the NGOs, with them typically expecting to 58% of their workforce to the course in the first three years. While PHUs only intend to send nine percent of their workforce, this is a similar number of staff per organisation as for the NGOs.

To estimate the number of staff likely to attend there was a need to estimate the average size of the NGOs, as only 16 were included in the survey. The Ministry have estimated this at 9.7, which is similar to the 9.6 reported in the 2004 survey. In the research the NGOs were planning to send 58% of their public health staff to the course over the first three years. Based on an average NGO size of 9.7 this equates with 5.6 staff attending over the first 3 years. There are currently 203 NGOs contracted to provide public health services, so the 5.6 staff per NGO represents 1137 staff. With the average of 7.6 from the 12 PHUs, this represents 91 staff from them, giving a total of 1228.

With these types of measures, persons always overstate what eventuates as actual behaviour. This is compounded in this survey, because the managers were encouraged to specify aspirational targets. Also the managers reported the numbers they would support to attend, and it might be that some of their staff might not want to attend or might be unable to attend. Obviously the economic climate and funding available for training within the organisations will have some impact on final numbers. There is also a need to take into account that the NGO data was based on only 13 organisations who provided data for this set of questions. Therefore it is appropriate to take a conservative stance when estimating the numbers who are likely to attend in reality. If half of the intended numbers were achieved, this would equate with just over 600 persons over the three year period, averaging 200 per year. This would seem to be a reasonable number to aim for in terms of contracting for the service delivery.

Having a spread of locations for the course will assist in participation rates. Obviously having a course in Auckland would be advantageous, assuming a good proportion of the providers will be closer to Auckland than either Wellington or Christchurch.

There will obviously have to be a lot more awareness built up prior to the course being introduced. Any increases in awareness may contribute to an increased demand for the course, beyond that stated in the survey.

The four day block courses were thought to be a barrier for some, so perhaps the course could be offered in two configurations, one with fewer longer block courses (e.g. four days) and one with a greater number of shorter block courses (e.g. two days).

MIXED RESPONSE TO ALL STAFF HAVING PUBLIC HEALTH

QUALIFICATION

The concept of having all public staff with a public health qualification met with a mixed response, so the Ministry will have to consider how to more effectively communicate the benefits, if this concept is to be implemented.

IMPACT OF ECONOMIC CLIMATE

Clearly the economic climate and the need for cost-cutting is having a marked impact on the public health workforce, with most of the organisations having had reductions in their contracted services. As well as funding issues being clearly the number one workforce issue, monetary concerns were to the fore for several other workforce issues as well.

3

INTRODUCTION

This project was commissioned by Head Strategic, on behalf of the Ministry of Health. Head Strategic and the Ministry have been engaged in public health workforce development for a number of years. The earlier work was informed by research undertaken by Phoenix Research in 2003/04. The Ministry and Head Strategic have also undertaken a lot of consultation with the public health sector. To meet an identified need, it is proposed to introduce a Certificate in Public Health course. This research was undertaken in part to inform the planning for that course, but also to meet a number of other objectives, as outlined below.

RESEARCH OBJECTIVES

The objectives were:

 To provide an update on the qualifications currently held by the public health workforce

 To provide information to inform on-going workforce planning

 To obtain feedback on the planned Certificate in Public Health course and how it can best meet organisational and staff needs

 To identify enablers and barriers to uptake of the new course

 To assess the near future demand for public health qualifications, including the Certificate in Public Health

 To assist the Ministry to estimate in provider contracts the numbers of staff that must hold public health qualifications within specified time frames

 To provide an update on the main workforce issues facing public health organisations and strategies for dealing with these

THE CERTIFICATE IN PUBLIC HEALTH

The following information was provided to research participants, as part of the self-completion questionnaire:

What is it?

The New Zealand Certificate in Public Health (the Certificate) fulfils the Ministry of Health's aim to make a generic, undergraduate level 5 public health qualification widely available for the public health and primary health workforces. The Certificate is currently being registered on the New Zealand Qualifications Framework with the aim that it will be offered in 2014.

Why is it needed?

The public health workforce draws from a rich and diverse pool of different disciplines. Many working in public health have come from grassroots community leadership roles while others have come from clinical health and other careers. As a result many in the public health workforce do not hold qualifications in public health.

everybody in the public health workforce to hold public health qualifications, and in the medium term this is likely to be reflected in contractual obligations for Ministry funded public health providers. The Certificate in Public Health (Level 5) is designed to be the first step on the qualification staircase; providing an accessible qualification that can be achieved through part-time study over one year. The only pre-requisite is an adequate level of English language skills. Over time it is envisaged that the Certificate will become the baseline qualification held by the non-regulated public health workforce, provide a recruitment pool for the regulated workforce, and increase the sector's effectiveness in improving the health of communities.

Who is it for?

The Certificate is intended for anyone who has a need for baseline knowledge and skills in public health :

 People working in public health who hold tertiary qualifications in fields other than public health, as a briefer alternative to postgraduate public health qualifications

 People working in public health who do not hold tertiary qualifications

 People from the primary health sector who need or want public health skills and knowledge

It may also offer an appropriate educational entry point for immigrants to New Zealand whose jobs require competencies that relate to the New Zealand public health sector.

What value will it deliver?

Graduates will demonstrate the baseline knowledge, skills and attributes required of a public health practitioner, capable of working both independently and in a collaborative manner to analyse, communicate, plan, and implement public health initiatives to improve population health outcomes and address health inequalities for Māori, Pasifika and other specific population groups. If you have staff whom lack some of these baseline knowledge and skills, they should be considered for the course. For more information see http://www.publichealthworkforce.org.nz/Certificate-in-Public-Health-Practice-_196.aspx.

How has it come about?

The Certificate is based on the generic public health competencies (GPHCs) which were developed by the Public Health Association and sector stakeholders in 2007.

The Ministry of Health has been working with Careerforce (an Industry Training Organisation) to turn the GPHCs into an undergraduate qualification. A multi-disciplinary panel of public health practitioners have guided the qualification development to ensure relevance and practicality of learning outcomes. A sector consultation provided important advice on the use, access and delivery of the Certificate.

What will it entail for participants and employers?

It is anticipated that the Certificate will be a 60 credit part-time one-year course delivered mainly through distance learning with up to 8 days of face to face block courses.

Fees grants will be available for those working in public health roles. Public health providers need to cover travel and accommodation costs to attend block courses. Limited travel and accommodation scholarships will be available for circumstances of hardship.

4

RESEARCH METHODS

Thirty-two organisations were invited to complete a self-completion survey and a phone interview. There were 27 organisations that completed the self-completion and 28 that completed the phone interview.

The sample included all twelve PHUs (public health units). The other organisations (all referred to as NGOs for the purposes of reporting) were selected by Head Strategic with the aim of providing a representative mix in terms of Māori, Pacific and other public health providers. Table 4 shows the numbers contacted and the numbers completing each part.

Within the self-completion survey, some key information was collected about each public health staff member within the organisation, providing a sample of 883 individuals. This required someone in the organisation managing the collection and collation of this data. In addition to the main self-completion survey, on which all the collated data from individuals was recorded (one line per person), Phoenix Research supplied a self-completion survey which could be sent to each staff member to complete and send back to the person in their organisation who was collating the data. This was a large task to request of each organisation and in acknowledgement of this a koha was offered, which not all chose to accept. From the researcher’s perspective, this process worked very well, with a high level of completion within a limited time frame. Of the 27 organisations that did the rest of the self-completion questionnaire, only one did not complete the section on the individuals. Of the others, one or two organisations had a small proportion of staff not recorded, but most provided data for all of them.

Table 4: Type of organisation

TYPE OF

ORGANISATION _participate Invited to

Completed organisation part of self-completion survey Completed individual part of self-completion survey Completed phone interview (n= (n= (n= (n= PHU 12 12 12 12 Māori Provider 7 5 5 5 Pacific provider 6 4 3 5 NGO 7 6 6 6 Total 32 27 26 28

In most cases the main part of the self-completion survey and the phone interview were completed by the manager of the public health team in the organisation.

The self-completion and phone interviews were piloted with three organisations (PHU, Māori and NGO), to check they were working as intended. Two Pacific providers were invited to be part of the pilot but one declined to do the survey and the other was not able to complete it in time for the pilot. Following this piloting, more detail was provided in the self-completion questionnaire about the Certificate in Public Health course. The pilot interviews were included in the final data set.

The phone interviews were undertaken by Phoenix researchers, with all but one being undertaken by Māori researcher Jo Howearth. The average interview duration was approximately one hour.

NOTES ON ANALYSIS AND REPORTING

The phone interview was mostly open-ended questions. The comments made were noted down by the researcher and these were then coded into categories for the analysis.

For most of the data, there is reporting for the PHUs, with the NGOs grouped together. The numbers of Māori and Pacific organisations was not sufficient to report on these separately and are included as part of the NGO grouping. As all PHUs were included, this data should be near to 100% accurate. However for the other 16 organisations, they were a small sub-sample of the 203 NGO public health organisations. With the sample size of 16, their data needs to be interpreted with some caution. The data on individual public health staff was based on all staff for which organisations supplied data, so the sample size was sufficient to readily allow comparisons between sub-groups. For this reason significance testing was undertaken. In the tables ↑ denotes a figure for a sub-group which was significantly higher than the total sample, and ↓ denotes a significantly lower figure.

For the tables based on the phone survey, the main mentions are often included in the main part of the report, but the fuller list of mentions are also included in Appendix A. The Tables in Appendix A do not include the many responses mentioned by just one person.

5

WHAT IS THE RESPONSE TO THE PROPOSED

CERTIFICATE IN PUBLIC HEALTH?

KNOWLEDGE OF THE COURSE

In the self-completion survey there was a full page description of the Certificate in Public Health, using the wording provided in the Introduction section of this report. The managers were asked to rate how much they knew about the Certificate in Public Health prior to receiving the questionnaire. As shown in Table 5, 63% knew either only a little (52%) or nothing (11%). Levels of knowledge were similar in both PHUs and NGOs.

The figures in this and the following tables are percentages, so that comparisons can be made between PHUs and NGOs. However, it should be noted that one person represents 8% for the PHUs and for the NGOs they represent 6%, so differences need to be large to be worthy of note. Because the numbers interviewed were so small, no significance testing has been undertaken on these tables based on the organisations.

Table 5: Knowledge of Certificate in Public Health

KNOWLEDGE OF CERTIFICATE IN PUBLIC HEALTH Total sample Public

Health Unit NGO

(27) (12) (15) % % % A lot (4) 4 0 7 A moderate amount (3) 33 33 33 A little (2) 52 58 47 Nothing (1) 11 8 13 Don't know 0 0 0 Average 2.3 2.3 2.3

HOW WELL PROPOSED DELIVERY MEETS NEEDS

In the telephone interviews, managers were asked a series of questions relating to the planned Certificate in Public Health. The first question asked, “As noted in the information supplied about the Certificate in Public Health, it is proposed that the course operate as distance learning with up to 8 days of block courses. While the location and number of block courses will be determined in consultation with selected providers, for the purposes of this discussion assume there are two block courses each of four days and they are available in Auckland, Wellington and Christchurch. How well will this method of delivery meet the needs of your organisation and its staff?” They had previously been told in the self-completion questionnaire that, “Fees grants will be available for those working in public health roles. Public health providers need to cover travel and accommodation costs to attend block courses. Limited travel and accommodation scholarships will be available for circumstances of hardship.”

The most frequently mentioned responses are showing in Table 6. The concept of block courses had a good level of appeal, but there was some concern that the proposed four day duration of the block courses was too long. Some noted a preference for four block courses of two days. However, there

was also some concern with the cost of travel, which the organisations would mostly have to cover, so having more block courses would add to that barrier. In relation to the travel costs issues, some noted that they worked in one of the areas where it was proposed there be courses.

Table 6: How well delivery meets needs

HOW WELL DELIVERY MEETS NEEDS

Total sample

Public

Health Unit NGO

(28) (12) (16)

% % %

Block good – over and done with/ less time off work in terms of

maintaining staff capacity/ staff can organise their families 36 42 31

Will work well/ fine/ fantastic 21 25 19

Length of block courses too long/ people have family/ community

commitments 21 25 19

Expensive travel costs for organisation – restricts how many can

go 18 33 6

Live, work in Auckland/ Wellington/ Christchurch – will cut down

on expenses 11 17 6

4 x 2 days ideal 11 17 6

KEYS TO MAKING IT A SUCCESSFUL PROGRAMME

Table 7 shows what managers considered to be the key ingredients to making it a successful programme for their organisation. The key thing was that the programme needed to be relevant to the work the organisation and staff undertake. Along a somewhat similar theme, there was some specific mention of the need for it to able to be put into practice back in the workplace. Locality was again mentioned as important.

The kaupapa Māori focus that the course intends to have was also noted as a key to the success of the programme by some managers.

The health promotion component was also seen as key, which was consistent with the findings of a separate question, that identified health promoters were the largest discipline who were likely to attend the course.

There were a wide range of other things noted by just a few managers and these are included in a more detailed table in Appendix A, Table 41.

When the managers were asked what would make it a successful programme for their staff, there were similar types of comments as for the organisation. One comment with more focus for the staff was that they would be concerned as to whether it would be enough of a qualification to provide what was needed in their role. In conjunction with this, it was noted that staff are cautious about investing their time. Associated with this was having the qualification recognised as valid and credible in other areas such as local government, and having it NZQA approved. These concerns were only mentioned by PHU managers. The responses to this question are included in Appendix A, Table 42.

Table 7: Key to successful programme for organisation

KEY TO SUCCESSFUL PROGRAMME FOR ORGANISATION

Total sample

Public

Health Unit NGO

(28) (12) (16)

% % %

Relevance of course to work – meets the needs of contract models and approaches we use/ work plans/ objectives of organisation/ course content relevant to their work/ ensure programme is broad

enough to what we think our staff will benefit from 54 75 38

Locality – great to be nearer to home – make better use of time –

lose a day/ local would be good/ accessible location 21 25 19

Needs to have strong practical information – can apply back to

practice 14 17 12

Kaupapa Māori focus/ ensuring kaupapa Māori focus in programmes

and delivery/ components Te Pae Mahutonga 11 8 12

Does it align with health promotion training delivered – how does it build on that?/ health promotion component/ all aspects of health

Table 8: Key to successful programme for staff

KEY TO SUCCESSFUL PROGRAMME FOR STAFF

Total sample

Public

Health Unit NGO

(28) (12) (16)

% % %

Relevance of course to work – meets the needs of contract models and approaches we use/ work plans/ objectives of organisation/ course content relevant to their work/ ensure programme is broad

enough to what we think our staff will benefit 39 50 31

Kaupapa Māori focus/ ensuring kaupapa Māori focus in programmes

and delivery/ components Te Pae Mahutonga 14 8 19

Needs to have strong practical information – can apply back to

practice 14 25 6

Will this be enough of a qualification for staff to meet what is needed

for their role?/ staff cautious in investing time 11 25 0

Does it align with health promotion training delivered – how does it build on that?/ health promotion component/ all aspects of health

promotion 11 0 19

Opportunity to learn and network outside of their own team 11 17 6

Having it recognised as a valid qualification in other areas e.g. useful to local government/ NZQA approved/ will certificate have standing?/

credibility is key issue 11 25 0

Not too high-powered/ technical/ cover basics/ pitched at the right

level 11 8 12

Need facilitator who makes people want to learn/ really engages

people/ create learning environment 11 17 6

KNOWLEDGE/SKILLS WANT GRADUATES TO OBTAIN

The information in Table 9 was collected from managers as part of the self-completion survey. They were asked to rate how important each knowledge and skill set listed in the table was, in terms of what they wanted the graduates to obtain from the course. The question had a rating scale from 0 ‘Not important’ to 5 ‘Extremely important’. The percentages shown in the table are those who gave a rating of 4 or 5. The items are listed in the order in which they were asked.

Most PHU managers gave all the items a high rating. There was more variation among managers from NGOs. They placed somewhat lower emphasis on:

 ‘Can describe the health and disability sector in New Zealand and explain the public health sector’s role in promoting and protecting public health’

 ‘Can assess the impact and influence of the Treaty of Waitangi on Māori and public health; and analyse public health issues from a Treaty of Waitangi perspective’

 ‘Can demonstrate how the range of approaches used by public health disciplines can improve health outcomes’

Table 9: Knowledge/skills want graduates to obtain

KNOWLEDGE/ SKILLS WANT GRADUATES TO OBTAIN

Total sample

Public

Health Unit NGO

(27) (12) (15)

% % %

Can describe the health and disability sector in New Zealand and explain the public health sector’s role in promoting and protecting

public health 74 83 67

Can define the social, cultural and economic determinants of health

in New Zealand; and analyse health inequalities 78 75 80

Can assess the impact and influence of the Treaty of Waitangi on Māori and public health; and analyse public health issues from a

Treaty of Waitangi perspective 74 92 60

Can demonstrate how the range of approaches used by public health

disciplines can improve health outcomes 78 92 67

Contributes effectively to community health development in a public

health context 81 83 80

Uses research and evaluation effectively to improve own public

health practice 85 75 93

Builds and maintain relationships with Māori , Pacific and/or other peoples in New Zealand, using culturally appropriate processes and

protocols 96 100 93

Be a creative problem solver, and apply ethics to professional

practice 93 83 100

DEMAND FOR THE COURSE

The first part of Table 10 shows that, of the 24 organisations which answered this question, the mean number of staff who they thought were in the target audience for this course was 14.9 for PHUs and 9.6 for NGOs. Managers were asked to provide numbers that they would aspire to achieving, rather than what would be an easy target.

The same table also shows the estimated number they would support to attend in each of the three years and then the three year total. The mean for the three year total was 8.1 for NGOs and 7.6 for PHUs.

The answers to this part of the questionnaire often had a number of missing values. For the analysis purposes it has been assumed that if someone gave an answer somewhere in the target audience column, then the blanks were zero values rather than them having chosen not to answer. There were three cases where there were no values in any part of the target audience column, so these organisations were left out of the analyses. A similar approach was used for the columns where they identified the number they would support each year, as reported in the following section.

Table 10: Number in target audience and numbers attending course NUMBER IN TARGET AUDIENCE Total sample Public

Health Unit NGO

(n=

24

9

15

11.6

14.9

9.6

22

9

13

3.2

3.2

3.2

22

9

13

2.6

2.3

2.8

22

9

13

2

2

2

22

9

13

7.9

7.6

8.1

The sample size (n=, is shown for each part of the table because the numbers varied a little depending on the level of data supplied.

While the previous table provided the actual numbers, it is also useful to consider these as a percentage of the total public health workforce. Table 11 shows that for PHUs the managers thought that just 19% of their workforce would be in the target audience for the Certificate. However managers in the NGOs thought 62% of their workforce would be in the target audience.

The second set of data in Table 11 shows that PHUs would expect to support half (51%) of those in the target audience to attend the course some time in the first three years. In contrast the managers in the NGOs expected to support almost all of their target audience staff to attend over the three years (83%).

The final set of data in the table shows that PHUs would expect to have just 9% of their workforce attend the course in the first three years, while for NGOs it would be 58%.

These findings are at least in part a reflection of the level of qualifications currently held by staff in PHUs versus NGOs (see Page 46 for more detail).

Table 11: Proportions attending TARGET AS A % OF THE WORKFORCE Total sample Public

Health Unit NGO

(n=

24

9

15

Mean

45.8

18.8

62.0

ATTENDING OVER 3 YEARS AS % OF TARGET

(n=

21

8

13

Mean

70.8

51.2

82.9

ATTENDING OVER 3 YEARS AS % OF WORKFORCE

(n=

22

9

13

Mean

37.6

8.5

57.8

Table 12 shows that health promotion/education accounted for the largest proportion of the staff that managers thought would be in the target audience for the course (62% for NGOs and 30% for PHUs). Among PHUs, public health nurses were the second largest group (28%), followed by ‘Other’, which would be any discipline not included in the categories shown in the table.

Table 12: Proportion of target audience in each discipline

PROPORTION OF TARGET AUDIENCE IN EACH DISCIPLINE

Total sample

Public

Health Unit NGO

(23) (9) (14)

% % %

Public health programme co-ordinator 6 1 10

Health promotion/education 46 30 62

Community health work 4 1 8

Health protection 7 13 1

Public health nurse 15 28 2

Management/advisory 6 1 11

Other 16 26 6

Table 13 is based on the data for how many staff the managers would support to attend the Certificate programme over the first three years. There were 19 of the managers who provided some data in answer to this question. This table shows that health promotion/education staff accounted for 48% of the PHU staff likely to be attending and 58% for the NGOs. Public health nurses accounted for 22% of PHU staff attending.

Table 13: Proportion of those attending over first 3 years in each discipline

PROPORTION OF THOSE

ATTENDING OVER FIRST 3 YEARS IN EACH DISCIPLINE

Total sample

Public

Health Unit NGO

(19) (8) (11)

% % %

Public Health programme co-ordinator 8 4 12

Health promotion/ education 55 48 58

Community health work 6 0 9

Health protection 6 12 1

Public health nurse 10 22 3

Management/ advisory 8 1 12

Other 7 13 5

IMPACT OF HAVING TO TRAVEL FURTHER FOR COURSE

The estimates of numbers of staff that they would support to attend the course were based on the block courses being in Auckland, Wellington and Christchurch. In the phone interview they were asked if the course was only available in Auckland/Wellington [they were asked about the option farthest from them], would this make any difference to the numbers they would support to attend. If they said it would, the interviewer sought to obtain an estimate of the likely percentage reduction in numbers attending. There were 11% who said it would make no difference, 43% gave some level of reduction and 48% did not provide any percentage reduction. The percentage reductions mentioned were: 20% (1 person), 25% (2 persons), 50% (5 persons), 80% (1 person), 90% (2 persons) and one person said they would not send anyone if it was out of town (i.e. 100% reduction).

In terms of other responses to this question, a quarter mentioned cost issues, particularly in the current environment. There were two who said they would not send staff to Christchurch, and all the other comments were mentioned by just one person.

BARRIERS/RISKS THAT NEED TO BE ADDRESSED

Managers were asked in the phone interview what possible barriers or risks needed to be addressed before their organisation could feel it was able to fully support this programme. As shown in Table 14, monetary restraints were seen as the biggest potential barrier. Once again, relevance to their work was also mentioned. The time involved was also noted, as was the fact that there are competing priorities for their time. There was also some mention that it was not an appropriate course for some staff, in terms of their existing qualifications already being at a higher level. A fuller set of responses, with the more minor mentions included, is included as Table 44 in Appendix A. When asked what barriers/risks needed to be addressed before there was full support from staff, 25% of managers mentioned the need for staff to see the relevance of it to their roles and being an extension of what they have already learnt. No other risks/barriers were mentioned by more than one person.

Table 14: Barriers/risks that need to be addressed

BARRIERS/RISKS THAT NEED TO BE ADDRESSED

Total sample

Public

Health Unit NGO

(28) (12) (16)

% % %

Monetary restraints/ budget/ funding/ small organisation no funding

increase for long time/ stop cutting funding 61 67 56

Relevance to their roles – extension of what they've learnt/ alignment in terms of content of course/ must be applicable, have cultural content in training/ what we do and not just top-level theory/

of value to staff, practicality issue 25 25 25

Time – family commitments/ arranging childcare/ working full-time/

managing workload 18 25 12

If staff didn’t have a set of learning and development linked into their

pathway 11 25 0

Competing priorities/ prioritise the need for professional

development 11 8 12

Course is of a quality standard – is at a level for someone with few qualifications through to someone who has practical knowledge of

public health and health promotion 11 8 12

ADDRESSING BARRIERS/RISKS

When asked how the barriers/risks for the organisation might be best addressed, two mentioned the need to be notified early, so they can be included in the budget. Nothing else was mentioned by more than one person.

There were only single response comments for how these barriers/risks with staff might be addressed.

RESPONSE TO STRONG FOCUS ON MAORI AND, TO LESSER EXTENT,

PACIFIC

Managers were advised that, “With the course material for the Certificate in Public Health, it is proposed that there will be a strong Maori focus, and to a lesser degree a Pacific focus.” The responses were generally positive, but some PHUs in particular noted they had few Pacific peoples in their region. Some also noted the need for the course to adapt to the changing population, which included Asian and refugees.

Table 15: How feel about strong Māori focus and some Pacific focus

HOW FEEL ABOUT STRONG MĀORI FOCUS AND SOME PACIFIC FOCUS

Total sample

Public

Health Unit NGO

(28) (12) (16)

% % %

Supportive comments

Positive, as there is a strong Māori population in our region/ the main

communities we work with and deliver to 18 33 6

Pacific needs focus/ needs to be there/ needs to have Pacific

content/ understand Pacific world 18 25 12

Is good, as have a good number of Māori staff here 11 25 0

Hundred percent support Māori/ Māori focus 11 8 12

Pacific community growing – need to address 11 8 12

Neutral comments

Not many Pacific in this region/ not an issue for us 18 42 0

Courses need to be able to adapt to changing population – Asian,

refugee 14 25 6

More Pacific in Auckland than registered Māori/ larger focus on

Pacific in Auckland – much lower demographics in health 11 8 12

WHAT CAN DO TO INTEGRATE COURSE LEARNINGS INTO

WORKPLACE

Table 16 shows the main ways which managers felt they could make sure what staff learn on the course is successfully integrated into their workplace. Having the staff share their knowledge with other staff was the most mentioned, followed by ensuring there are opportunities provided for the staff to put into practice what they have learnt on the course.

Table 16: What they can do to integrate course learnings into workplace

WHAT THEY CAN DO TO INTEGRATE COURSE LEARNINGS INTO WORKPLACE

Total sample

Public

Health Unit NGO

(28) (12) (16)

% % %

Feedback to others what is learnt – nice to re-energise team/

everything new you learn integrate back/ share knowledge with other

staff 46 50 44

Identify where in their roles they can take learnings on board/ embed

the knowledge in terms of practice 29 25 31

Performance appraisal process identifies whether staff have got

value from the course and are using it in their work 18 33 6

Having opportunity as manager to sight course content and assessment criteria or obligations – will sit down with staff member and chat, agree on some learning objectives – topics manager will

RESPONSE TO CONCEPT OF ALL PUBLIC HEALTH STAFF HOLDING

PUBLIC HEALTH QUALIFICATIONS

Managers were asked, “The Ministry would like everyone employed in public health to hold public health qualifications. How well does this fit with your workforce development planning?” As shown in Table 17, there was a mixed response to this concept. Some were totally in agreement, while others felt the important thing was that staff had qualifications which were relevant to their area of work and there should be flexibility around qualifications.

Table 17: How well having all staff with public health qualifications fits with workforce development planning

HOW WELL HAVING ALL STAFF WITH PUBLIC HEALTH QUALIFICATIONS FITS WITH WORKFORCE DEVELOPMENT PLANNING

Total sample

Public

Health Unit NGO

(28) (12) (16)

% % %

Need to have relevant qualifications for their area of work/ if useful to

their work 29 17 38

Absolutely agree/ totally support/ good idea 18 25 12

Not a focus for our organisation for everyone to have public health qualifications – focus on Ministry of Health leadership training course/

health qualifications 14 0 25

Fits with some of our workforce planning/ starting to review workforce development now/ going into new planning stage – good opportunity

moving forward to build that in 14 17 12

Barrier – money to finance learning 14 17 12

Nice goal but doubt could be achieved/ public health so broad 11 0 19

Need competent workforce – not necessarily qualifications 11 8 12

Public health should allow flexibility around qualifications – have an MBA but not a degree in public health/ university degree minimum

when employing 11 8 12

Don't expect all staff to have public health qualifications – admin

staff/ public health nurses, advisors, health protection officers, etc 11 17 6

Professionalise workforce – do need to make sure qualifications are

SUPPORT REQUIRED TO REACH MINISTRY’S ASPIRATIONAL GOALS

The question asked, “In the medium term the Ministry is considering setting aspirational targets for each provider organisation in terms of the numbers of staff required to undertake public health qualifications. What support would your organisation require to achieve this?” The main responses all related to funding. This included funding to support the staff getting qualified, and more specific mentions of funding course-related costs and funding back-filling when staff are away at the courses. Other less frequently mentioned comments are in Table 49 in Appendix A.

Table 18: What support would require to meet Ministry's aspirational targets

WHAT SUPPORT WOULD REQUIRE TO MEET MINISTRY'S ASPIRATIONAL TARGETS

Total sample

Public

Health Unit NGO

(28) (12) (16)

% % %

Financial support – give us workforce funding for staff to get qualified 54 58 50

Funding for course-related costs – travel/accommodation grants 18 17 19

6

WHO ARE WE?

SIZE OF WORKFORCE

The 12 PHUs reported having 934 current public health staff, an average of 77.8. They also had 43 vacancies, taking their public health workforce size to 977, an average of 81.4. The numbers of current public health staff in the PHUs ranged from 23 to 180. The median6 _{number was 60.}

The 15 NGOs which provided data had 230 public health staff, an average of 15.3. They also had 6 vacancies, taking their public health workforce size to 236, an average of 15.7. The numbers of current public health staff in the PHUs ranged from 3 to 40. The median number was 10.

When compared with 2004, the mean number of PHU staff had increased from 68 to 81. A much higher proportion of NGOs were included in the more extensive study undertaken in 2004 (171 compared with 16 in the current survey). The mean number of staff in the NGOs in 2004 was 9.6. The much higher level of 15.7 for the current survey reflected the sample being more focussed on the larger organisations.

DATA REPORTED

The data for the remainder of this chapter comes from the details that each organisation provided for each of their staff. There were 879 staff reported on, with 672 (76%) from PHUs and 207 from NGOs. Within PHUs there were 72% reported on, while among NGOs there were 90% reported on. The data in the tables which follow are based on those who responded, so the base numbers vary, especially for the ethnicity question.

Because of the larger sample numbers, it has been possible to conduct significance testing, for comparisons between the PHU and NGO responses. An upward arrow (↑) denotes a significantly higher value for NGO compared with PHUs, while a downward arrow (↓) denotes a significantly lower value.

DISCIPLINE WORKING IN

It can be seen in Table 19 that the staff in NGOs were predominantly health promotion/education (56%) and management/advisory (20%), while PHUs had a much greater spread of disciplines, reflecting the broader focus of their work.

Where possible, comparisons have been made with the same organisations in 2004, but there the data came from staff self-completion surveys, so there were fewer staff who responded. The Total Sample results were reasonably similar between the two surveys.

The median is the value which the middle person is at, after ranking from lowest to highest values. Medians are often used as a better indicator than means, because means can be affected by a few extreme values.

Table 19: Discipline working in

DISCIPLINE WORKING IN

Total sample

Public

Health Unit NGO

(879) (672) (207)

% % %

Public health programme coordinator 8 7 9

Health promotion/education 36 30 56↑

Community health work 3 1 10↑

Health protection 15 19 3↓

Medicine 5 6 1↓

Analysis/policy analysis 5 5 2

Management/Advisory 13 10 20↑

Public health nurse 10 12 2↓

Support worker 16 17 14

NGO 4 4 4

↑ denotes NGO is significantly higher than the PHU sample, and ↓ denotes a significantly lower figure

DEDICATED MAORI AND PACIFIC ROLES

In the NGOs, 17% said they worked in a dedicated Māori role and 18% in a dedicated Pacific role (Table 20). To provide some context to these findings, there were 13% of the NGOs which were Maori and 11% which were Pacific, although obviously dedicated roles can exist in organisations which are not Māori or Pacific providers. There were very few dedicated roles in PHUs.

Table 20: Dedicated role

DEDICATED ROLE

Total sample

Public

Health Unit NGO

(865) (662) (203)

% % %

Dedicated Maori role 6 2 17↑

Dedicated Pacific role 5 1 18↑

Neither 89 97 65↓

ETHNICITY

Persons were asked to code all ethnic groups that applied to them, which is why the columns in Table 21 totals more than 100%. Māori and Pacific persons were both better represented in the NGOs than PHUs, which was consistent with the NGOs including Māori and Pacific providers.

Table 21: Ethnicity

ETHNICITY

Total sample

Public

Health Unit NGO

(829) (622) (207) % % % Maori 20 18 27↑ Pacific 9 4 24↑ Asian 7 7 6 NZ European/Pakeha 60 66 45↓ Other 11 12 6↓

GENDER

Just over three quarter of the staff were female (76%) and this level was the same for both PHUs and NGOs. This was similar to 2004.

AGE

Forty percent were aged 50 years and over and a total of 69% were aged 40 years and over (Table 22). Just 10% were aged under 30 years. The age profile was similar in PHUs and NGOs.

Compared with 2004, the proportion aged 50 years and over had increased from 29% to 39%7_.

Table 22: Age

AGE

Total sample

Public

Health Unit NGO

(825) (617) (208) % % % Under 30 years 10 11 8 30 to 39 years 22 20 25 40 to 49 years 29 28 30 50 to 59 years 28 29 26 60 years or over 12 12 11

Table 23 shows how age varied by discipline. Health promotion/education staff tended to be a little younger (40% aged under 40 years vs 31% for the Total Sample). Those in management/advisory were more likely than others to be aged 40 to 49 years (39% vs 29%), while public health nurses were more likely to be aged 50 to 59 year (41% vs 28%). In this table, and any others with more than just two groups being compared, the significance testing is for the difference between the group with the upward or downward arrow and the Total Sample.

The 39% differs from the 40% in Table 22 because some organizations in the current survey did have data for 2004 and were excluded from the comparisons.

Table 23: Age by discipline AGE: 2012 DISCIPLINE WORKING IN Total sample Public Health Pro-gramme co-ordinator Health Pro-motion/ education Comm-unity health work Health pro-tection Medi-cine Analysis/ policy analysis Manage-ment/ advisory Public health nurse Support worker (823) (66) (307) (30) (126) (39) (39) (108) (73) (120) % % % % % % % % % % Under 30 years 10 11 13 0 10 3 15 2↓ 1↓ 14 30 to 39 years 21 32 27↑ 7 16 13 31 16 11↓ 22 40 to 49 years 29 24 24 30 35 38 36 39↑ 36 22 50 to 59 years 28 29 26 43 26 33 15 30 41↑ 27 60 years or over 12 5 10 20 13 13 3 14 11 15

7

WHAT ARE THE MOST IMPORTANT

WORKFORCE ISSUES?

In the self-completion survey managers were presented with the list of workforce issues shown in Table 24 and asked to rate the top five from one to five. This table has PHU and NGOs combined. ‘Level of funding/ funding cuts/ obtaining more funding’ was the number one issue, both now and in the next five years.8 _{‘Workloads/burnout’ was the next most mentioned in the top three, for both now}

and in the next five years. ‘Meeting Ministry requirements/ relationship with the Ministry’ was one of a group of three items with around a third rating them in their top three for current issues. The other two were the ‘Need for more training for the workforce’ and ‘Staff performance’.

‘Staff performance’ was seen to be more of an issue now (30% mentioned it in their top 3), than in the next five years (15%). Conversely, ‘Staff recruitment’ and ‘Staff retention’ were expected to be more important issues in the next five years than they are now.

The questionnaire allowed managers to write down other workforce issues, apart from those listed. Two managers in PHUs (7%) mentioned cultural competency in their top three current issues.

Table 24: Workforce issues

WORKFORCE ISSUES

TOTAL SAMPLE (27)

CURRENTLY NEXT 5 YEARS

Most important Top 2 Top 3 Most important Top 2 Top 3 % % % % % %

Level of funding/ funding cuts/ obtaining

more funding 74 85 93 88 92 92

Workloads/ burn out 7 26 44 4 27 42

Meeting Ministry requirements/

relationship with Ministry 0 22 33 0 27 35

Need for more training for the workforce 4 19 30 0 15 31

Staff performance 0 4 30 0 4 15

Staff retention 0 4 19 0 4 31

Lack of skilled staff available/

recruitment problems 15 15 15 8 15 31

Table 25 shows the data for PHUs and NGOs. ‘More workforce training’ was a much greater issue for NGOs (47% vs 8% for PHUs for current issues). ‘Workloads/burnout’ were also more of an issue for NGOs (53% vs 33% for PHUs), as was ‘Staff performance’ (40% vs 17%). ‘Meeting Ministry requirements’ was more of an issue for PHUs (42% vs 27%).

Although the items in the list were based on the most mentioned in 2004, this earlier survey asked the question unprompted (i.e. they were not shown the list of items), so it is not valid to make comparisons.