National Public Health Institutions

by

Courtenay M. Dusenbury, Jeffrey P. Koplan

• LAST REVIEWED: 27 March 2014
• LAST MODIFIED: 27 March 2014
• DOI: 10.1093/obo/9780199756797-0085

Introduction

More than eighty-five countries around the world have established national public health institutes (NPHIs) to coordinate and lead their public health systems. Some, such as the US Centers for Disease Control and Prevention (CDC), the Dutch National Institute for Public Health and the Environment, the South African National Institute for Communicable Diseases, the Brazilian Oswaldo Cruz Foundation (FIOCRUZ), and China’s Center for Disease Control and Prevention, have developed over time, whereas others, such as the institutes in Canada and the United Kingdom, were created in response to recent global public health threats such as severe acute respiratory syndrome (SARS) and bovine spongiform encephalopathy. NPHIs range from those with a focus only on infectious diseases to those with a comprehensive mandate to lead national efforts for prevention and control of both infectious and noncommunicable disease threats. The International Association of National Public Health Institutes (IANPHI) was envisioned in 2001 and chartered in 2006 to link and catalyze the capacity of NPHIs around the world through a robust international professional and scientific network. IANPHI works closely with the World Health Organization (WHO), with which it has a formal partnership agreement. Its activities are supported by the Bill and Melinda Gates Foundation, the Rockefeller Foundation, member dues and peer assistance, bilateral cooperative agreements, and private-sector partnerships. IANPHI’s members represent close to 90 percent of the world’s population and include, among others, the NPHIs of India, Ethiopia, Bangladesh, Rwanda, Kenya, Nigeria, Mexico, El Salvador, Myanmar, Afghanistan, Sudan, Peru, Russian Federation, Tanzania, Angola, Brazil, China, Cote d’Ivoire, Ghana, Thailand, Uganda, Cambodia, and Vietnam. IANPHI’s three objectives include supporting a robust scientific community of NPHI directors (through an annual meeting, a list-serv, and other activities); developing policies that inform decision making on public health systems strengthening (including an NPHI framework, NPHI-to-NPHI evaluation guidance, and a NPHI toolkit); and investing in projects that strengthen public health systems in low-resource countries through creation and enhancement of NPHIs. IANPHI helps the world’s NPHIs by advocating for strong and well-supported NPHIs. The authors wish to thank Allison Greenspan, MPH, for her assistance in formatting this article.

Introductory Works

NPHIs vary in scope and size, from fledgling institutes focusing only on infectious diseases to those with comprehensive responsibility for research, programs, and policy for almost all public health issues and threats. Their scope and functions were defined by IANPHI in its 2007 Framework for the Creation and Development of National Public Health Institutes (see International Association of National Public Health Institutes 2007, cited under Best Practice Guidelines). NPHIs have a national scope of influence and recognition and focus on the major public health problems affecting the country. NPHIs use scientific evidence as the basis for policy implementation and resource allocation and are accountable to national governments and the public. Their key functions—including disease surveillance, detection, and monitoring; outbreak investigation and control; health information analysis for policy development; operational research; training; health promotion and health education; and laboratory science—are particularly critical in low-resource nations. Several works, including Frieden and Koplan 2010, outline the importance of creating NPHIs to give countries (a) a focal point for developing and strengthening their national public health systems; (b) increased technical capacity to better respond to major causes of disease, death, and disability; and (c) the skills to deliver public health programs for HIV/AIDS, tuberculosis, malaria, vaccine-preventable diseases, emerging diseases, and chronic conditions. Leaders of European NPHIs outline the purpose and scope of their institutions and perspectives for the future in International Association of National Public Health Institutes/Europe 2011. Frenk and Gonzalez-Block 2008 notes that NPHIs can foster national long-term strategic plans for an evidence-based, sustainable system that addresses major public health challenges, as well as more organized and efficient use of existing resources and a plan to fill gaps moving forward, including leveraging vertical resources from the donor community around a central national strategy. Rodier, et al. 2007 asserts that NPHIs provide a strategic approach not only to meeting the requirements of the International Health Regulations and national and regional regulations but also to responding decisively to public health threats (e.g., avian influenza, SARS) and opportunities. Koplan, et al. 2005 and Jousilahti 2006 outline the important functions of NPHIs as well as their key role in public health training and as a career home for a cadre of locally educated public health experts: the workforce needed to prevent and control disease outbreaks and improve health outcomes. Committee on the US Commitment to Global Health 2009 outlines the importance of NPHIs, including their role in evidence-informed policy development and public health program execution as well as their contributions to improving the public’s health. Pierre-Louis, et al. 2012 calls NPHIs a key component of global health strategies and states that the World Bank will make NPHI creation a pillar of its global development efforts. The World Health Organization 2013 notes in its Global Action Plan that strong national capacity is crucial to supporting international goals and calls for the establishment of NPHIs to strengthen public health systems.

• Committee on the US Commitment to Global Health, Institute of Medicine. 2009. Invest in people, institutions, and capacity building with global partners. In The U.S. commitment to global health: Recommendations for the new administration, 107–129. Washington, DC: National Academies Press.

  This report cites the importance of NPHIs to strong national public health capacity, noting that “[c]oordinating core public health functions through an NPHI can result in a more efficient use of resources, improved delivery of public health services, and increased capacity to respond decisively to public health threats and opportunities” (p. 112).

• Frenk, J., and M. A. Gonzalez-Block. 2008. Institutional development for public health: Learning the lessons, renewing the commitment. Journal of Public Health Policy 29:449–458.

  DOI: 10.1057/jphp.2008.35

  Using the development of Mexico’s National Institute of Public Health as an example, the authors discuss the importance of NPHIs in solving complex public health challenges and boosting national capacity in resource allocation and policy development. NPHIs strengthen national research capacity in low-resource nations and counter the silos of vertical programs. The IANPHI and National Institute of Public Health have worked to build capacity in Mesoamerica.

• Frieden, T., and J. Koplan. 2010. Stronger national public health institutes for global health. Lancet 376:1721–1722.

  DOI: 10.1016/S0140-6736(10)62007-7

  This commentary describes the core functions of NPHIs, based on the IANPHI Framework (see International Association of National Public Health Institutes 2007, cited under Best Practice Guidelines) and notes that effective public health response requires a multidisciplinary effort (encouraged by NPHIs), with scientific credibility and independence from political interference. The authors call on developing countries to increase the resources to and authority of NPHIs.

• Heymann, D. L. 2008. NPHIs as focal points for leadership in prevention and control of infectious diseases. Journal of Public Health Policy 29:374–376.

  DOI: 10.1057/jphp.2008.19

  WHO Deputy Director David Heymann outlines the role of NPHIs as governmental focal points for science-based public health policy and resource allocation. Citing efforts to combat specific infectious diseases such as SARS, HIV-AIDS, malaria, and tuberculosis, he posits that the infrastructure from these disease-specific investments can become the keystone of the national, coordinated public health infrastructure necessary to comply with the International Health Regulations.

• International Association of National Public Health Institutes/Europe. 2011. National public health institutes: European perspective. Report 40/2011. Helsinki: National Institute for Health and Welfare.

  Directors of NPHIs from European countries share their perspectives on the functions, scope, and importance of NPHIs.

• Jousilahti, P. 2006. Improving the world’s health: The role of national public health institutes. Central European Journal of Public Health 14:3–5.

  This article summarizes the importance of NPHIs in fostering and sustaining a competent public health workforce. NPHIs, because they are primarily scientific organizations, are not subject to political changes and can provide a stable base for national expertise. They also encourage collaboration within and between nations on public health challenges.

• Koplan, J. P., P. Puska, P. Jousilahti, K. Cahill, J. Huttunen, and NPHI partners. 2005. Improving the world’s health through national public health institutes. Bulletin of the World Health Organization 83.2: 154–157.

  This article lays out the functions of NPHIs, including research, monitoring and surveillance, infectious disease control, noncommunicable disease control, emergency preparedness, diagnostic services, health promotion and health education, and training. It further outlines the main activities of IANPHI, which include training, collaborative research, and benchmarking.

• Pierre-Louis, A. M., S. El-Saharty, A. Stanciole, et al. 2012. Connecting sectors and systems for health results. Washington, DC: World Bank.

  The World Bank team notes that “experience has shown that achieving and sustaining positive impact in public health is best served by a national organization which can help ensure a strong and coordinated focus on public health to assist the government in its stewardship role” (p. 21). As a key pillar of its work, the Bank will be “supporting client countries’ capacity to perform the essential public health functions, supported in this effort by the establishment of NPHIs, or similar institutions adapted to local contexts” (p. 31).

• Rodier, G., A. L. Greenspan, J. M. Hughes, and D. L. Heymann. 2007. Global public health security. Emerging Infectious Diseases 13:1447–1452.

  Given the complexity of modern-day disease transmission, including newly emerging infections, the need for cross-border collaboration, strong and well-linked surveillance capacity, and outbreak investigation expertise, NPHIs and IANPHI will play a major role in ensuring that countries are ready for the International Health Regulations.

• World Health Organization. 2013. Global action plan for the prevention and control of NCDs 2013–2020. Geneva, Switzerland: World Health Organization.

  The WHO resolution calls for the strengthening of capacity and innovation through such measures as the establishment of NPHIs (p. 38).