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Public Health Specialty Pathway

Understanding the journey to Public Health career - Dr F. Makama (Experience-based article originally posted in FB group).


Sections:

  • The recruitment process: Direct route, IMG route, ST3 route, Portfolio route.

  • Apply from outside the UK: Does Shortage Occupation List matter?

  • Already in the UK, what now?

  • Appying using working experience in the UK, including volunteering.

  • Building your CV using accreditation and CPDs

  • Available Certficate Programs

  • Does language proficiency matter?

  • DFPH (Diplomate, Faculty of Public Health)


 

THE RECRUITMENT PROCESS

In public health, there are those who go into it as a profession and leave it as that. Then there are those who actually BUILD A CAREER in it, growing to the specialist (or consultant level). As for the latter (having a career in it), there are two routes in reaching that aim and they are:

1. The Doctor’s training route

2. The portfolio route.


As an IMG, you come to the UK via the PLAB route and do your FY2 experience. When the public health training opening comes around, you register for it. You should know that you’ll pass through 3 stages of the screening exercise:

1. Submission of CV (or registration)

2. If long-listed, you’ll write an exam

3. If passed (2), you will go for 8 stations (OSCE-like)


This route has proven almost impossible for IMGs because of steps (2) and (3). No bank questions to the exams and it is mostly questions from the community medicine undergraduate study syllabus of the UK. So, if one did not train in the UK, that is an automatic failure already, since there are no bank questions to reset the brain to what may be required. The stage (3) will have stations where a candidate speaks about their journals published, the conferences they have attended and if they presented, what type of presentation? - This could be Masters class presentation or poster presentation; your motivation or drive for training in Public Health, your CPDs (Continuous Professional Developments) etc. The candidates trained in the UK are better equipped for these situations right from their undergraduate study days and since anything UK (from experience to achievements) beats outside the UK (in points), IMGs also find it very difficult to scale through their British counterparts. No wonder the popular sentiments “Public health in the UK is not for foreigners.” As much as this isn’t theoretically true, it seems so, practically.


Then, there is the ST3 route, where you enter straight into specialist training year 3. You didn’t know about this right? YEAH IT EXISTS!! It is a possible route, but it is yet another difficult path for an IMG, very very difficult.


The portfolio route on the other hand is simply working with organizations and Public Health recognized institutions for years and while doing so, fine tuning your experience so as to be marked fit for you to become a specialist (or consultant). So, let’s say I am working with 'Save the Children', then I moved to 'British Heart Foundation', while working with these two organizations, I will ensure that I have my MPH, sit for, and pass the membership exams, MFPH (Member Faculty of Public Health), I have met the requirement of being paid at at least Band 6 (which is about 35,000 pounds per year) for at least 24 months in my years of experience, attend conferences and also try participating in presentations, do CPDs and but not mandatory, publish journals. After 60 months of working experience, I can then submit my papers and CV to the UKPHR (United Kingdom public health registry) to be approved as a specialist. THIS IS THE PORTFOLIO ROUTE. But again, getting a job from outside the UK and being given CoS to come to the UK to work is practically impossible, since it is not in the Shortage Occupational List.


WHAT WILL BE THE DIFFERENCE NOW, AFTER BEING DRAFTED INTO THE SHORTAGE OCCUPATIONAL LIST? 1. There MAY be leniency in the nearest future in the steps towards public health training. There could be drastic changes in the steps (2) and (3) of the registration for training in Public Health. I am not saying this will happen for sure, but from the sample questions sent to me by one of us here whom has been long-listed for the exams, I do not only have hope, I am indeed so happy that these changes will MOST LIKELY come.


2. The ST3 route will be brought to life and its difficulty level, massively reduced for IMGs to take advantage of. All applicants for recruitment to public health specialty training at ST3 level will be required to have passed the FPH Diplomate examination within the last seven years at the time of appointment (the date at which the post commences) and have demonstrated essential phase 1 learning outcomes (which is learnt from your MPH, hence MPH required). For individuals applying for public health specialty training leading to a CCT in public health medicine evidence of achievement of CT/ST1 & CT/ST2 competences in any medical specialty or ST1 & ST2 competences in general practice is required by the commencement of the ST3 training post in public health (in order words, you should have passed a professional membership exams in another specialty in Medicine- MRCS, MRCGP, MRCP, MRCPsych, MRCOG, MRCPaed etc and meet some of their other requirements such as, for example BSS, ATLS, a surgical taster week and training in teaching-there are free courses online from the open universities here in the UK if using the MRCS route to go into ST3 in Public Health). Public health phase 1 learning outcomes (ST1 and ST2) can be demonstrated as transferable competence during or after satisfactory completion of the first two years of these post foundation training programmes. So, in a simple language, if you want to jump to ST3 in Public health training, get GMC registration, have your MPH, pass the two steps of MFPH, have 1 more membership with its corresponding requirements and BOOM! You are there!


3. The portfolio route will also be a bit easier. You can enter the country, do your MPH and Ph.D and this will enable you join any population based organization as approved by the Public Health of England and then up you go. OR, do your MPH, write the step1 (DFPH) or/and step 2 (MFPH) of the MFPH exam. Pass it and get yourself a job in any population base organization. Then try your best to meet other eligibility criteria on your way up to becoming a specialist. Also, with just MPH alone, look for “not much paying” jobs, but in public health and begin to amass your public health experience from there.


4. Specialists or consultants in Public Health from outside the UK can now enter the UK with a CoS to work as public health managers. This was not the case before 1st of December 2020. So, the eligibility is simple: have many years of experience (I’d say at least 7 years, to have a competitive advantage), acquire a professional qualification (Consultants) and if not a consultant, acquire a Ph.D. You should have gone for at least 4 international conferences (with such an experience) and if you participated by giving presentations (master class or poster), you have a GREAT, GREAT, GREAT competitive advantage. You should also have numerous certificates to show for your CPD. Then minor eligibility criteria which will boost your chances are: (i) more professional qualifications (member of any of the post graduate colleges in any of the medical specialty besides Public health, (ii) journals published online, (iii) teaching experience in Public health and (iv) leadership and management skills. If you meet these eligibility criteria, send me a DM let’s talk more.

5. But more interestingly is the fact that with your MPH and some experience (volunteering especially) you can get “not-so-good” paying jobs that can boost your public health experience (we will discuss this later).


I AM ALREADY IN THE UK, SO WHAT NOW?

I have already settled the matter on those coming from outside the UK and what they need to do. As for those, already in the UK who are interested in Public health, what next? The popular question I get is “I am a GP (or Psychiatrist) in training and I wish to work in Public health later in my career, how can I go about it? With the latest development, Public Health definitely needs you and your experience.


So, the answer is simple: acquire your MPH (be it full time or part time, it doesn’t matter). Do CPDs in public health, get some working experience in Public health and try your best to attend at least 1 public health conference in a year. If you wish to delve into public health in 3 years’ time from now, just imagine what you should have achieved by then.


WORKING EXPERIENCE IN PUBLIC HEALTH

This is one of (if not) the biggest issue and from the flood of questions asked, one could see the concern. The popular concern is already having an MPH, living here in the UK and still yet to find “working experience.” I AM SHOCKED! There are tonnes and tonnes of opportunities to acquire the needed work experience in Public Health. I would recommend downloading the ADZUNA APP! Why Adzuna? Adzuna uses a systematic search algorithm by sending its crawlers across most UK Giant Job sites and present the jobs from these sites to you, as they correspond to the keywords you used to search for the jobs. Job site giants like totaljobs, indeed, Reed.co.uk, wikijobs, techradar, unicorn Hunt, Monster, Universal Jobmaster, Gumtree, Seek Limited, Career One etc. Adzuna brings latest job vacancies to your phone screen from all these sites. So, Adzuna is like the “google” of Job sites. Though, NHS Jobs and LinkedIn seem not to be searched by it. So, always use Adzuna EVERYDAY to seek for jobs.


So, what is my point exactly? Search, search, search! Search in the morning, search in the evening, every day until you get what you want. Again, do not search only one key word and go back and relax, NO! I have sent someone a Job vacancy by using the keyword “population” on the search tab. So, diversify your keywords such as:

1. Public health

2. Public health administrator

3. Public health assistant

4. Public health manager

5. Population

6. Population health

7. Gender health

8. Child health

9. Research

10. Cancer research


I once shared a link of the 160 population based organizations recognized by the Public Health of England. You can be picking them one after the other and searching for jobs, for Example: you can use “save the children” “British Heart Foundation”, “Red Cross”, etc as your search Keywords. Also use google and repeat the same strategy above, google crawlers will take note of your search and bring some of these job vacancies to your screen unsolicited. From facebook to instagram and to a normal internet tab, the cookies of these sites will be at work and you will be getting job vacancies even without asking.


But if this one pass your power, then VOLUNTEER! It is good to volunteer for the NHS as this COVID-19 is being tackled. It will be an excellent job experience and will never be ignored. No matter how busy you are, you can always spare 4 hours every week for volunteering. Again, most of the 160 population based organizations I have so made noise about, give room for Volunteering and as a medical Doctor, they will give you an open arms without hesitation. Just be upfront and sincere with them. Write to them, then meet them in person and be honest with your intentions. Let them know you are using this opportunity to garner some experience in Public Health, hence you will want a flexible routine that you can engage in. THEY WILL HAPPILY OBLIGE. So, here are a few:

1. Royal Voluntary Service: https://www.royalvoluntaryservice.org.uk/

They are numerous….Search, search, search!


CPDs (CONTINUOUS PROFESSIONAL DEVELOPMENTS)

Public Health and CPDs go hand in hand and when it comes to recruitment, CPDs are looked out for. There are plenty of such courses online, some are to be paid for, some are free, while others are free except the certificate which should be paid for. I have a recommendation for you which is:

GLOBAL HEALTH eLEARNING CENTRE organized by the John’s Hopkins Bloomberg School of Public Health and the USAID. It is like a University of Public Health Online. There are 103 short courses (91, when I did most of mine) and these 103 short courses are grouped into 17 Certificate programs. For instance: Antenatal care is a short course that will fetch you 1 certificate. “Diarrheal diseases” is another short course that will fetch you another certificate. But when you go ahead to add these other short courses: Emergency Obstetric and Newborn care, Essential steps for improving Newborn survival, Immunization Essentials Mother-to-Child transmission of HIV, Newborn Sepsis, Nutrition (An introduction) and Pneumonia, you will end up accomplishing a major certificate program called CHILD SURVIVAL. So, 9 certificates for the 9 short courses, plus 1 extra certificate for the certificate program, making it 10. (A sample of these 2 separate certificates has been attached to this post below.


CERTIFICATE PROGRAMS

1. CHILD SURVIVAL: Antenatal care, Diarrheal diseass, Emergency Obstetrics and Newborn care, Essential steps for improving Newborn Survival, Immunization Essentials, Mother-to-Child transmission of HIV, Newborn sepsis, Nutrition (An introduction) & Pneumonia.


2. CROSS-CUTTING: Bureau of Global Health Environmental Management process Timing, Gender and sexual and Reproductive Health 101, Health communication for managers, Human Resources for Health (HRH) Basics, Improving Health Care Quality, Knowledge Management (KM) in Global Health Programs, Logistics for Health Commodities, M&E Fundamentals, mHealth Basics: Introduction to Mobile Technology for Health, Nutrition (An introduction), Population, Health and Environment, Protecting Life in Global Health Assistance and Statutory Abortion Restrictions and Social Media for Health and Development.

3. EARLY CHILDHOOD DEVELOPMENT: Introduction to Early Childhood Development, Integrated Early Childhood Development Programming for Young vulnerable Children, Improving the Lives of Young Vulnerable children and their caregivers, Special Considerations for Highly vulnerable Children and their caregivers, Creating an Enabling Environment for Young vulnerable Children and their caregivers, M&E of Holistic ECD programs.


4. FAMILY PLANNING METHODS: Family Planning 101 Hormonal methods of contraception, IUD, LA/PMs-A Smart FP/RH program Investment, Standard Days Method ®


5. FAMILY PLANNING PROGRAMMING: Community-Based Family Planning, Family Planning 101, Family Planning and HIV Service Integration Family Planning counseling, Family planning programming-Elements of Success, Gender and Sexual and Reproductive Health 101, Healthy Timing and Spacing of Pregnancy (HTSP), LA/PMs-A Smart FP/RH program investment, Logistics for Health Commodities, Postpartum Family Planning, Promising Programmatic Approaches for Adolescent and Youth Sexual and Reproductive Health (AYSRH), protecting Life in Global Health Assistance and statutory Abortion Restrictions, Social Franchising for Health, US Abortion and FP requirements-2017, and Youth Sexual and Reproductive Health.


6. GENDER AND HEALTH: Female Genital Mutilation/Cutting (FGM/C), Gender and Health Systems Strengthening, Gender and Sexual Reproductive Health 101, Gender M&E.


7. GOVERNANCE AND HEALTH: Governance and Health, Key practices of good Governance, Infrastructure for Good Governance, Good Governance in the Management of Medicines


8. HEALTH SYSTEMS: Antimicrobial Resistance (Part 1), Antimicrobial resistance (part 2), Fostering change in Health Services, Gender and Health Systems strengthening, Health Workforce productivity: An approach for measurement, Analysis, and improvement Human resources for Health (HRH) Basics, Improving Health Care Quality, Knowledge Management (KM) in Global Health Programs, Logistics for Health Commodities, mHealth Basics: Introduction to Mobile Technology for Health.


9. HIV/AIDS: Designing HIV prevention programs for key populations, Family planning and HIV Service integration HIV/AIDS Legal and Policy Requirements, HIV/AIDS Surveillance, HIV Basic Biology Epidemiology and prevention, HIV stigma and Discrimination, Male circumcision: Policy & Programming, M&E Frameworks for HIV/AIDS programs M&E Guidelines for Sex workers, Men who have sex with Men, & Transgender populations- National Level, M7E Guidelines for Sex Workers, Men who have sex with men & Transgender Populations-Service Delivery Level, Mother-to-child transmission of HIV.

10. IMPACT EVALUATION OF HEALTH COMMUNICATION PROGRAMS: Introduction to Impact evauation of Health Communication programs preparing Data for Impact Analysis, basic and advanced Impact Analysis.


11. INFECTIOUS DISEASES: Antimicrobial Resistance (Part 1), Antimicrobial resistance (Part 2), HIV Basic Biology, epidemiology and prevention, Mother-to-child transmission of HIV, Tuberculosis-Advanced concepts, Tuberculosis Basics, Malaria in Pregnancy, Malaria.


12. MATERNAL HEALTH: Antenatal care, Emergency Obstetric and Newborn care, Family planning 101, Healthy Timing and Spacing of Pregnancy (HTSP), Malaria in Pregnancy, Mother-to-Child transmission of HIV, Nutrition (An introduction), Postpartum care, Postpartum Family planning preventing postpartum Hemorrhage.


13. MONITORING AND EVALUATION: Data Quality, Data use for program Managers, Demographic and Health surveys: Data use, Economic Evaluation Basics, Gender M&E, Geographic Approaches to Global Health, GIS techniques for M&E of HIV/AIDS and related programs, HIV/AIDS surveillance, M&E Frameworks for HIV/AIDS programs, M&E Fundamentals, M&E Guidelines for sex Workers, Men who have sex with Men, & transgender populations-Service Delivery Level and Mortality Surveillance methods & strategies.


14. NEONATAL HEALTH: Diarrheal Disease, Emergency Obstetric ad Newborn Care, Essential Steps for improving Newborns survival, Healthy Timing and Spacing of Pregnancy (HTSP), Immunization Essentials, Newborn Sepsis, Nutrition (An introduction), Pneumonia.


15. ORGANIZATIONAL CHANGE AND KNOWLEDGE: Data Visualization- An introduction, dependency to partnership: It’s about change dependency to partnership: leading, managing change, Fostering change in Health services, Journal Manuscript Development for Global Health, Knowledge Management (KM) in Global Health Programs, Online Communities of Practice (CoPs) for Global Health & Social Media for Health and Development.


16. PRIVATE SECTOR APPROACHES: Commercial private Health sector Basics, Contracting for family planning and Reproductive Health Services, Healthy Businesses, social Franchising for Health, Social Marketing for Health, Total Market Approach, A total Market Approach to Family Planning Services.


17. REPRODUCTIVE HEALTH ISSUES: Cervical cancer prevention (Low-Resource settings) Female Genital Mutilation/Cutting (FGM/C), Malaria in pregnancy, Promising Programmatic Approaches for Adolescent and Youth Sexual and reproductive Health (AYSRH); Youth Sexual and Reproductive Health.

The essence of these categorizations is to go for your specialty or, if you have a target organization you are planning to work for in the future, then you can go for whatever category that may suit the mission and vision of that organization. Take for instance, Society of Family Health or (in Nigeria for instance) Achieving Health Nigeria Initiative (AHNI); these organizations focus more on reproduction and maternal health. So, one who is planning to work in these areas can go for certificate programs such as: Family planning methods, family planning programming, Gender & Health, Maternal Health & reproductive health issues. If for instance, you are going for CARITAS International which is all about HIV/AIDS, then go for certificate programs such as HIV/AIDS, Infectious diseases & Maternal health. As for UNICEF and its likes, go for Child survival, Early childhood development, Neonatal health and Maternal health. If you want to Bam-Bam with the big boys such as WHO, UNICEF, Departments of Health with UN or EU; Medical Director of NHS etc, try to do the following:

a. Governance and Health

b. Health Systems

c. Impact Evaluation of Health Communication programs, and

d. Organizational change and Knowledge.



DOES LANGUAGE PROFICIENCY MATTER?

Don’t forget proficiency in 2 world languages is not a mandatory but essential criterion of eligibility. The world languages are: Arabic, English, French, Mandarin (Chinese), Russian and Spanish. Most international Organizations within Europe acknowledge German, Italian and Portuguese as world languages also. As 9ja wey we be, we already know one, English, so one more is essential but don’t let this trouble you, especially if the opportunity you seek with these big boys is still within the UK. British people value their English pass anything for this life, hence, you are safe.


If you want to be a research associate in public health (life myself) or go into Epidemiology or have a significant role to play in Epidemiology, do the Monitoring and Evaluation Certificate program and if you are thinking of any regulatory body in public health, do the “private sector approaches” certificate program. The “Cross-cutting” certificate program includes short courses that cut across all spheres of Public health. It’ll be a good advantage if that is added to the line of certificate programs you may want to do. Hence, irrespective of specialty or organization you are planning for, add “Cross-Cutting” to your list of certificate programs to acquire. Finally all specialists or trainees in any field of medicine have one or two certificate programs here, but if you think there is no certificate program here that suits your area of specialization, just go for the “Cross-Cutting” certificate program. Between 2014 and 2017, I amassed the 17 certificate programs and 91 certificates on the short courses. So yes, you can do it. One short course achieved every month will be a good start. There may be some changes currently, but it will surely not be too different from what is presented here.


DFPH (DIPLOMATE, FACULTY OF PUBLIC HEALTH)

The DFPH is the part 1 of the MFPH examination, which is officially the membership exams of Public health, here in the UK. It is very difficult to pass and there is no question bank available (typical of Public health, here in the UK). Even with MPH done in the UK, the guarantee of passing is still not there. Since they repeat questions, the Q-Bank is hidden to the public and in fact, there is a warning on the website that if there is any possibility of exam question circulation, the questions would be completely changed.


This has proven to be so discouraging to so many intending public health experts that are currently outside the UK. Most who contacted me already have their MPH with some experience and they cannot afford to begin another MPH program again, just to pass the DFPH examination, even if they choose to, there is no guarantee at all.

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