Essential Public Health Functions

Public health is, therefore concerned with carrying out activities that address the determinants of health, protect a population's health and reduce burden of diseases of public health importance with the aim of improving the health and quality of life of populations and achieving a reduction of health inequalities. This wide scope of public health indicates that a population-wide perspective, stewardship of the health sector, a multidisciplinary workforce and a multi-sectoral approach should be the core features of public health.

Public health is, therefore concerned with carrying out activities that address the determinants of health, protect a population's health and reduce burden of diseases of public health importance with the aim of improving the health and quality of life of populations and achieving a reduction of health inequalities. This wide scope of public health indicates that a population-wide perspective, stewardship of the health sector, a multidisciplinary workforce and a multi-sectoral approach should be the core features of public health.
Essential Public Health Functions (EPHF) are a set of actions or interventions that should be carried out specifically to achieve the central objective of protecting and improving the health of populations. Essential in this context is to denote fundamental, indispensable requirements to meet public health goals. It also indicates that it is the responsibility of the government of a coumry to ensure that these interventions are implemented.
EPHF were initially described by Yach (2) as a set of fundamental activities that address the determinants of health, protect a population's health, and treat disease. He described these public health functions as representing public goods and that the governmenlS would need to ensure the provision of these essential functions, but would not necessarily have to implement and finance them. It is a social obligation for which the government through its nati. onal health authorities has an important role to play.
In many countries, especially in our region, public health systems are either not functioning optimally or are in a state of decline due tO lack of With the need to improve public health services, defining EPHF was considered important as a means of focusing on public health services. It was noted that EPHF could also act as a framework for measuring the performance of nations, health departments and public health personnel in effectively delivering those functions with a view to improving the public health performance. Furthermore, defining such EPHF provide guidance in developing a framework for capacity building of public health personnel at all levels.
In recent years, several studies have focused their attention on defining EPHF. These include a study by the Pan American Health Organization (PAHO) (3), a study conducted by Centre . for Disease Control (CDC), Atlanta (4), the WHO Delphi Study (5), a three country sn1dy in the WHO -Western Pacific Region (WPR) (6) and the most recent, the three country study in the South East Asia Region (SEAR) (7) which included Sri Lanka.
All these studies have focused on defining essential public health functions. However, rhere have been differences in the conceptual models that have been adopted by different groups.
The conceprnal model adopted in the EPHF study in the Western Pacific Region, has been considered as a subset of interventions based on homogeneity of tasks required to be done (6). Each function includes several tasks and each task, several practices. Furthermore, each practice will produce certain outputs that cake the form of programmes or services. In this context a function is defined as the mode of activity by which a thing fulfils its purpose. A practice is a repeated exercise in an activity requiring the development of skill while a service is the act of helping or doing work for another or a community. Each programme or service will produce outcomes that can be measured using appropriate indicators. The analysis of tasks and practices in a particular setting could ind.icate the competencies needed by the public health workforce.
The srndy conducted in three of the countries of the WHO, South East Asia Region adopted the above conceptual model by the study in the Western Pacific Region. Sri Lanka, Thailand and

Volume 11, No.2, December 2006
in Bangladesh were the counnies included (7). The Rapid Assessment Technique was used to gather information. Literature revi. ew on exisring situation, key infonnant interviews among key public health personnel, survey among public health workforce, a community based survey, assessment of public health facilities and a SWOT analysis were the components that were included • in rhe Rapid Asses�menr method that was adopted.
Given below are the EPHF rhar were identified along with the expected outcome in the latest study in SEAR. The tasks idenrified for each of the functions are also described.
Health status monitoring and analysis Outcomes of chis function are the measurement, monitoring and analysis of changes in health status, including quality of life and heahh inequalities and che acute and chronic disease burden. This funccion results in confidence that s;,feguards exist for rhe protection of the public's heahh and provides early warning of emerging problems.
The tasks identified for this function were assessing health status for the relevant geographical areas and specific high risk groups, analysing trends in health, analysing barriers in access co services, identifying threats to health and managing health informacion.
Epidemiological surveillance and disease prevention and control The outcomes of this function contributes to improving health status and the quality of life, reducing health inequalicies, safeguarding the public's heahh and reducing the burden of disease.
Conducting disease and outbreak surveillance of boch communicable and non-communicable disease and associated risk factors, conducting surveillance of environmental hazards.
investigating and controlling disease ourbrenks , undertaking case finding, diagnosis and treatment of diseases of notifiable diseases, responding rapidly to control outbreaks and emerging heahh problems or risks and implementing mechanisms to improve surveillance systems and disease prevencion and concrol were rhe tasks idenci fied under this funcrion.

Development of policies and planning in public health
The outcomes of chis function arc the development of policies and planning for the i111proveme111 of health status and quality of life, reducing health inequalities, safeguarding the public's heallh and reducing rhe burden of disease.

Journal of the Com1111111ity physicians of Sri Lanka
Developing policy and kgislation for public health, developing plans to promote and prorecr public health, reviewing and updating regulatory frameworks and policy, _ advocacy for public health perspectives in health services planning, developing and tracking target5 and evaluating policy were identified as rasks to be performed to ensure development of policies and planning in public health.

Strategic management of health systems and services for population health gain
The ouccomes of this function co111ribu1es to implemenrarion of strategies to improve health scatus ,md quality of life, reducing heahh inequalities, safeguarding the public's health and reducing the burden of disease. The tnsks identified for this function were promoting and evaluating acces5 by all citizens to che health services they need. promoting multi sectoral collaboracion for interagency working , facilitating services ro vulnerable groups e.g .. disabled, youch, mentally dise,ised, advocacy on priorities of publicly funded health service� using evidence to assess che healih technology and interventions, managing public health services to address public health problems and preparing for disaster and emergency response by the health system.

Regulation and enforcement to protect public health
The outcomes of this function c<mtribuce to the development and compliance with regulacion chat improves health status and qualicy of life, reduces health inequalities, safeguards rhe public';; health and reduces the burden of disease. Implementing Jaws and regulncions in public health, enforcing regulations. promoting compliance, reviewing, developing and updating regulations in public health were the tasks identified under chis funCLion.

Human resource development in public health
The omcomes of this function provide the workforce to improve health scatus and the quality of life, reduce health inequalities, safeguard the public's health and reduce the burden of disease. The tasks idemified for this function were maincaining an inventory of the human resource base including the profes�ional skills and cliscribution, projecting workforce requirements in terms of quantity and quality, ensuring an aclequare human resource base for public healih activities, ensuring workers arc adequately educated and trnined with demonstrable certification and re,cenirication, coordinating between stakeholder� in the design and delivery of tra111111g programmes, promoting continuing professional educa\ion. monitoring and evaluating

Health promotion, social participation and empowerment.
The ouccomes of this function make communities healthier by advocating for health and empowering citizens through access to relevant, high quality and effective information.
Creating supportive environments to promote healthy choices, advocating for health by building coalitions, working inter-sectorally in health promotion programmes. empowering communities and citizens to change lifestyles and playing an active role in changing community behaviour change, facilitating and convening partnerships among groups to promote health, communicating through social marketing and media communications, providing accessible health info1mation resources at comn1unity levels were the tasks identified under this function.
Ensuring quality of public health services The outcomes of this function ensure the quality of public hea.lth services to improve health status and quality of life, reduce health inequalities, safeguard the public's health and reduce che burden of dise;ise. Developing appropriate standards for quality and monitoring and designing improvements in quality were the tasks identified for this function.

Public health and health systems research
The outcomes of this function contribute to innovative ways 10 improve health s1a1us and quality of life, reduce health inequalities, safeguard the public's health and reduce the burden of disease. Tasks that were included in this functions were developing a research agenda, identifying funqing, ensuring appropriate ethical safeguards, encouraging participation between public health agencies, workers and organizations in the research agenda and programmes and developing research programmes to solve the identified problem.

Disaster and emergency preparedness and response
The outcomes of this function contribute to effective management of disaster to improve health stacus and quality of life, reduce health inequalities, safeguard the public's health and reduce the burden of disease. Preparing disaster management plan, identifying priority threats and situations for the country, trying responses 10 priorities in plan, planning activities to address (resource and skill) gaps in plan, ensuring adequate supporl facilicies for re. sponse e.g., quarantine facilities, ensuring supplies for prevention of the spread of disease

Journal of the Community physicians of Sri La11kt1
e.g., drug prophylaxis supplies, ensuring effective disease and outbreak surveillance and investigation and ensuring effective communicalion infrastructure and pathways were the tasks that included in the function of disaster and emergency preparedness and response It is expected that this study and follow-up would result in much-needed sensitisacion to public health among policy-makers and the workforce. It would also enable che identification of gaps and sho11comings in the workforce and services provided and assist io developing institutional capacities and designing necessary i111erve111ions. The identified casks for each of these EPHF in a particular selling indicates the competencies needed by the public health workforce. Therefore. competency assessment based on EPHF is expected 10 act as the basis for capacity-building in both pre-service and in-service seuings. Funhermore ic will be useful in highlighting the importance of EPHF and the urgem need for suppon both From governments and funding agencies. Effectiveness of this approach in improving public health services needs to be evaluaced.