Building skills for multisectoral action among PHC practitioners

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regions often have limited access to comprehensive, quality health care. Indeed, several European countries, as well as Brazil, China, Colombia, and Turkey, use metrics or indexes to define lagging areas that include health and healthy living and aging.

Not surprisingly, these same countries emphasize community- or peoplecentered health care, with PHC at the center. Their different approaches all highlight the importance of integration across sectors and levels of care, communications strategies, stakeholder engagement, and continuous performance monitoring. All have undertaken or are considering regulatory reforms and workforce measures to facilitate the introduction of multidisciplinary teams (Somanathan, Finkel, and Arur 2019; Sumer, Shear, and Yener 2019; World Bank and WHO 2019a).

Training in advocacy, communication, and resource generation for multisectoral action

Chapter 3 identifies proper undergraduate, graduate, and in-service training as essential to building health workers’ skills and competencies for multisectoral engagement (Rechel 2020). PHC professionals need to expand their skills in preparation for a range of newer interdisciplinary roles across the care spectrum—from health promotion, disease prevention, and management of chronic diseases to palliation and social care. Equally important for PHC professionals is acquiring leadership/stewardship, management, and communication skills to be able to confidently advocate for healthier living in the communities they serve. Such advocacy has many facets. It can include reaching out to local practitioners in other sectors whose activities influence health outcomes in the community and with whom opportunities for productive intersectoral partnerships may exist. It also involves sustained dialogue with communities themselves, to strengthen health literacy, encourage healthy lifestyle choices, and promote greater community agency and self-reliance in health, often across diverse socio-cultural contexts.

Achieving this is easier said than done, in a context of rapidly shifting disease burdens and demographics, as well as technological change and evolving social expectations that challenge health professionals’ traditional status in many settings. Policy makers may encounter substantial opposition to

reforms of curriculum and pedagogy in undergraduate medical training, especially if the reforms propose to expand already-packed academic programs with new material, such as management or advocacy skills that may be perceived as peripheral to many future physicians’ career plans. As countries weigh possible changes to health worker education and training, factors such as the chronic shortages of properly trained health workers, the difficulty of deploying them to underserved areas, the migration of health professionals within and across national borders, and the long delays in recouping public investment in the training of health professionals must also be considered.

Recognizing these challenges, there are at least three ways in which countries can address the shortage of skills and competencies in multisectoral engagement. + First, in the shorter run, countries can leverage the continuous on-thejob learning that is already part of many PHC professionals’ routine experience, especially in LMICs. Conscientious PHC practitioners, whether CHWs or PHC doctors and nurses, already participate in such learning as an integral part of their polyvalent vocation (UN 2019).

Indeed, PHC professionals themselves increasingly perceive advocacy and communication skills as a key competency in daily PHC practice, as well as a foundation for more ambitious multisectoral engagement at the program-design and policy levels. Action to reinforce their capacities could include not only short-term on-the-job training but also “embedded

PHC research” (AlKhaldi, Meghari, and Ahmed 2020) to systematically document local health and health care needs and preferences, as well as the broader socio-cultural and economic determinants of health. Frontline PHC workers will be most motivated to build such competencies when they can apply them in the day-to-day practice of their jobs and be recognized and rewarded for doing so.

+ A second, longer-run agenda, is to instill flexibility in existing undergraduate and graduate training courses to encourage the pursuit of joint degrees in areas like business administration (MBA), health or medical administration (MHA, MA), or public health (MPH). The United States has seen a recent very rapid increase in joint degree programs linking an MD degree with a PhD, MPH, or MA qualification. The number of MD/MBA programs in the United States alone now exceeds 60, including online training; many of them have started since 2000 (Viswanathan 2014).16 Similar dual programs are also becoming more common in Canada (Canadian-universities.net 2021). While many of these programs are more attuned to the business side of health care in high-income settings, some prepare students for other vocations, including community-based

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