NSW Public Health Training Program: 35 years of strengthening public health systems and practice in an Australian setting

Introduction

The public health workforce is central to promoting and protecting the health of individuals, communities, and populations, and to creating environments that support healthy living and wellbeing. The COVID-19 pandemic reinforced the importance of a multidisciplinary and multisectoral public health workforce in effective emergency response and highlighted the need for ongoing investment in public health training.^1,2

The New South Wales (NSW) Department of Health (now Ministry of Health) initiated the NSW Public Health Training Program in 1989 as part of a package of measures aimed at enhancing public health capacity in NSW. This initial investment began with six public health medicine registrars completing 3 years of training placements and short courses in epidemiology and public health.³ The program was expanded to include non-medical trainees from 1991. Originally modelled on the US Centers for Disease Control and Prevention Epidemic Intelligence Service, the program has evolved in line with changing public health workforce needs.^4–6 Other states have offered similar programs;^7,8 however, the NSW Public Health Training Program is Australia’s longest-running multidisciplinary public health training program.^1,7 Strong support from senior NSW Health leaders has enabled the program to endure and flourish despite the dynamic public health landscape and challenges associated with operating in a government setting.

This paper describes the program’s history, key outcomes, and contribution to building public health capacity in NSW.

Methods and results

The authors used a mixed methods design that included analysis of administrative data from a dedicated database and review of program documentation. Unless stated, data are reported from January 1990 (when the first trainees commenced) to December 2023.

Program overview

The NSW Public Health Training Program is a 3-year workplace training program for people with a postgraduate public health qualification and 3 years of health-related experience. Trainees complete supervised work placements that are aligned with the strategic and operational priorities of NSW Health. The program also plays a key role in providing public health surge capacity for NSW Health.

Since 1994, the program has used a competency framework to guide workplace learning.¹⁰ Early versions focused on epidemiology and communicable diseases; however, the framework was later expanded to include health economics, health promotion, management, evaluation, and policy. The program and its competency framework are regularly reviewed to ensure they are effective and aligned with health system priorities and reflect contemporary public health practice.¹⁰

The program has been associated with three different credentialing bodies. Throughout its 35-year history, it has been recognised towards medical graduates’ attainment of Fellowship of the Australasian Faculty of Public Health Medicine (AFPHM). From 1994 to 2006 it was accredited by the NSW Vocational Education and Training Accreditation Board as a Graduate Diploma of Applied Epidemiology.¹⁰ From 2009 to 2013 it was delivered in partnership with the University of NSW as a Professional Doctorate in Public Health.¹¹

Fig. 1 provides an overview of key changes to the program over time.

Fig. 1.

Timeline of key developments, NSW Public Health Training Program 1989–2023.

The program has supported 223 trainees, including 9 Aboriginal and/or Torres Strait Islander people. Ninety-seven (43.5%) were registered health practitioners, including 52 medical practitioners, 22 nurses/midwives, 12 physiotherapists, and 11 people from other health professions. Immediately before enrolment, 126 trainees (56.5%) worked in government, including 97 (43.5%) NSW Health employees. Thirty-six (16.1%) worked in academic or research organisations, 31 (13.9%) worked for non-profit organisations, 19 (8.5%) were in the private sector, and 7 (3.1%) were full-time students. Data are not available for 4 (1.8%) people. The most common pre-enrolment occupations were project officer or manager (n = 56, 25.1%), physician (n = 39, 17.5%), and researcher (n = 39, 17.5%).

Completions and qualifications

The program has produced 142 graduates, led to 84 postgraduate qualifications, and supported 39 medical graduates to gain AFPHM Fellowship. Fifty-six people (28.3%) left the program early (Fig. 2).

Fig. 2.

Completions and qualifications, NSW Public Health Training Program 1990–2023. Source: NSW population health training programs database.

Discussion

People with public health qualifications represent only a subset of those who work in public health.²² Although these qualifications provide good preparation,²² public health professionals with skills-based training are better equipped than those without to respond to public health emergencies.¹ Further, the World Health Organization recognises that targeted competency-based learning is essential for an appropriately skilled public health workforce.²

As one of the few skills-based training pathways for non-medical public health professionals in Australia, the NSW Public Health Training Program has played an important and unique part in building public health capacity and developing the public health workforce. It has done this by producing highly skilled, work-ready graduates; promoting evidence-based practice; supporting key population health programs, policies and solutions; and providing critical surge capacity.

Employment outcomes for graduates and early exits are similar. The program’s 198 alumni meaningfully contribute to the NSW health system, filling critical roles including public health physicians, medical advisors, epidemiologists, policy analysts, and other key contributors to public health action. Importantly, alumni regularly assume leadership roles. Some move directly into leadership roles; however, many more assume leadership roles throughout their careers. The program’s contribution to system leadership was illustrated during the COVID-19 response, with 30 alumni filling executive roles.

The program has made a significant contribution to evidence-based practice, with 17 graduates achieving research degrees and trainees publishing more than 600 peer-reviewed publications. Publishing is an important platform for sharing discoveries, insights, and best practices, and these papers often form the basis for new evidence-based policies and interventions. Importantly, publishing enables trainees to develop research skills, potentially making them more likely to engage in research activities, contribute to new methodologies, and generate evidence to inform future practice and policy.²⁴

Trainees have contributed to key population health programs and initiatives across many priority policy areas. They have supported a wide range of public health responses to events including cancer clusters, environmental hazards, pandemics, disease outbreaks, infection control breaches, and mass gatherings.

One of the program’s strengths is its responsiveness to the changing public health landscape. For example, specialist streams have addressed emerging issues and filled short-term gaps in the public health workforce, and work placements are tailored to address emerging priorities. At times this adaptability has led to differing perceptions about the program’s purpose, for example some see it as an epidemiology training program and others view it as a leadership program. However, the program’s fundamental strength continues to be producing multidisciplinary graduates with generalist, well-rounded public health experience.

Although the program is widely recognised as successful, running a postgraduate training program in a government setting is not without its challenges. Fig. 3 outlines key barriers the program has encountered over its 35-year history and enablers that have helped to address them.

Fig. 3.

Barriers and enablers, NSW Public Health Training Program.

Although the program is sustainable and institutionalised, several challenges remain. For example, priority-driven work placements can limit the scope for trainees to pursue areas of interest or for training to be tailored to individual needs. Since rural placements became optional, fewer trainees have gained rural experience, affecting the program’s ability to support rural public health workforce development.

The program no longer offers a qualification pathway for non-medical trainees. Its early vocational sector accreditation was discontinued as its scope expanded. It was later briefly offered as a professional doctorate, which enhanced academic rigour and research activity but ultimately detracted from trainees’ ability to focus on immediate health system priorities. The lack of formal recognition for the non-medical public health workforce is recognised as a global issue.²

Attracting Aboriginal and Torres Strait Islander people to the program has also been a challenge, with only nine enrolling since 1990. It is important to note that in parallel, NSW Health has successfully established an Aboriginal Population Health Training Initiative, which has supported the development of nearly 50 Aboriginal and Torres Strait Islander public health professionals since 2011.²⁵ The initiative is more tailored to the needs of Aboriginal and Torres Strait Islander people and communities, using a person-centred approach and training-in-place model to support trainees to work and study in environments that are most conducive to their learning.²⁵

Recommendations

This study coupled with observations from many years of stewardship has highlighted several factors fundamental to the program’s success and of broader relevance to workplace training programs. In particular:

Limitations

This study used administrative data from a dedicated program database supported by a review of program documentation. Including trainees’ experiences would have strengthened the study; however, it comprehensively describes Australia’s longest-running public health training program and will make an important contribution to understanding efforts to build public health capacity.

Conclusion

The NSW Public Health Training Program has been critical to building public health workforce capacity in NSW, has contributed to improvements in public health outcomes, and has promoted research and innovation. The program’s emergency response capacity and responsiveness to the changing public health landscape have ensured that it continues to be contemporary and relevant; however, its fundamental strength continues to be producing generalist, well-rounded public health professionals.