Master of Philosophy in Community Paediatrics

Purpose

The purpose of the Master of Philosophy in Community Paediatrics is to strengthen child health services and programmes and improve the health outcomes for children by providing doctors sub-specialising in Community Paediatrics with specialised knowledge, understanding and skills.

The qualification will target paediatricians who want to sub-specialise in community paediatrics and will work for two years at an accredited training site attached to the institution.

The qualification will

• Deepen and advance, using an evidence-based and experiential approach, specialised knowledge, understanding and skills in community and general paediatrics of paediatricians working at primary and secondary levels of care.
• Educate and train those undertaking the sub-speciality in health systems research so that they can critically evaluate and contribute to knowledge on community paediatrics at an advanced level.
• Contribute to the knowledge base of a future sub-specialty in community and general paediatrics.

Rationale

In South Africa, the need for a child public health focus is underpinned by an under-five mortality (U5MR) currently estimated at 32 per 1000 live births. Considerable work must be done to reach the third Sustainable Development Goal (SDG) and the U5MR target of <25 per 1000 live births by 2030. Common preventable conditions such as neonatal problems, diarrhoea, pneumonia, malnutrition, and HIV/AIDS are the main contributors to under-five deaths. The main causes of child mortality cover other conditions which are pervasive within communities and impact the quality of life of children, including hunger and food insecurity, chronic disease, disability, child abuse, domestic violence, mental health problems, teen pregnancy, substance abuse and crime.

A previous survey of paediatricians working at regional hospitals with responsibility for child health services within their catchment area indicated that while they had acquired the necessary clinical skills during their training, there were several gaps in their knowledge which limited the impact of their work at the primary level of care. These included knowledge and skills in teaching and training, health management, policy development, clinical governance, and management of chronic or long-term child health conditions. The qualification intends to address the gap in clinical skills and knowledge.

The purpose of the qualification is to strengthen and improve the delivery of child health services within the various districts in the country. The qualification was designed to meet the training needs and skills of paediatricians working at regional and district levels who want to subspecialise. The qualification is aligned with the role and functions of the district paediatricians who are part of the District Clinical Specialist Teams (DCSTs) as outlined in the Ministerial Task Team Report of 2011. The core functions of the DCTS are to improve clinical governance to address the poor quality of healthcare, clinical training, communication, monitoring and evaluation and the health outcomes for mothers, newborns, and children in the district. The DCSTs are one of the maternal and child health streams and a core component of the National Department of Health's re-engineering of primary health care strategy.

Driving this poor state of health are the social and environmental conditions that children are exposed to; currently, 60% live in income-poor households, 30% do not have access to piped water at home, 20% do not have access to sanitation and 18% live in overcrowded households. To ensure that children do not only survive but also thrive within an enabling environment, a shift is required in the training of paediatricians and other healthcare cadres working at the district and regional levels. This includes not only training that ensures the acquisition of clinical skills but also knowledge and skills in child public health. The qualification is intended to address the poor quality of healthcare in hospitals.

The American Academy of Paediatrics (AAP) defines community paediatrics as having a perspective that focuses on all children in a community, rather than an individual child and considers the influence of social determinants on the health and functioning of children. The AAP integrates clinical practice with the principles of public health to promote the health of children within the context of the family and community, and links community partners to advocate for quality and equitable services for children.

Currently, community paediatricians and those working in general and community paediatrics make up more than 20% of the paediatric workforce. The community paediatrician works in secondary care and caring for vulnerable families; diagnosing and managing neurodevelopmental and long-term health conditions; and child public health. The model has seen improvements in child health although these gains are being challenged by increasing rates of poverty, inequity, and non-communicable disease. The European Confederation of Primary Care Paediatricians which embodies 20 000 paediatricians from 20 different countries, has developed a curriculum and training programme for primary care paediatricians working in community paediatrics. The development of the qualification incorporated in the curriculum the competencies and knowledge required by the community paediatrics. The qualification was approved by the Health Professions Council of South Africa (HPCSA) for learners wanting to specialise in the field.

Globally, 90% of children live in low- and middle-income countries (LMIC) and are affected by infectious diseases, malnutrition, an increase in chronic disease, injuries, mental health problems and environmental health issues. Although the number of childhood deaths has been reduced by half, in children under five years, 5.4 million die every year and 43% fail to reach their developmental potential because of poverty and poor nutrition. One of the worst affected regions is Sub-Saharan Africa where the under-five mortality is estimated to be more than 13 times higher than in developed countries (83.1 vs 5.8 per 1000 live births).

There is a call for paediatricians to work domestically and internationally to improve the health of children globally through cohesive and integrated education and training of the global paediatric workforce. Paediatricians have been earmarked to take on a leadership role in advancing training in child and adolescent health and in ensuring linkages with obstetricians, midwives, and primary care nurses in reducing stillbirths and neonatal deaths. Intersectoral connections need to be forged with education and social services to ensure that the developmental and health needs of school children are met and that vulnerable children are safeguarded. The qualification is structured such that Advocacy and Children's Rights, Child Health Policies and Programmes, Optimising Care for Long-term Health Conditions and Health Management and Leadership are included in the coursework.

Recognition of Prior Learning (RPL)

The institution has an approved Recognition of Prior Learning (RPL) policy applicable to equivalent qualifications for admission into the qualification. RPL will be applied to accommodate applicants who qualify. RPL thus provides alternative access and admission to qualifications, as well as advancement within qualifications.

RPL for access

• Learners who do not meet the minimum entrance requirements or the required qualification that is at the same NQF level as the qualification required for admission may be considered for admission through RPL.
• To be considered for admission in the qualification based on RPL, applicants should provide evidence in the form of a portfolio that demonstrates that they have acquired the relevant knowledge, skills, and competencies through formal, non-formal and/or informal learning to cope with the qualification expectations.

Entry Requirements

The minimum entry requirement for this qualification is

• Postgraduate Diploma in Community and General Paediatrics, NQF Level 8.

Or

• Postgraduate Diploma in Clinical Developmental Paediatrics, NQF Level 8.

Or

• Postgraduate Diploma in Child Health, NQF Level 8.

Or

• Honours degree, Level 8 in a cognate field

And

• Registration as a specialist paediatrician with the Health Professions Council of South Africa (HPCSA).

This qualification consists of the following compulsory modules at NQF Level 9 totalling 180 Credits.

Compulsory modules, Level 9, 180 Credits

• Coursework, 90 Credits.
• Learning Portfolio, 45 Credits.
• Research Project, 45. Credits.

1. Demonstrate a critical understanding and knowledge of epidemiological concepts relating to community paediatrics or child public health.
2. Demonstrate command of and the ability to design, select and apply appropriate key statistical concepts and creative methods, techniques, processes, or technologies to complex practical and theoretical problems.
3. Demonstrate specialised knowledge and the application of evidence-based practice.
4. Demonstrate the ability to use a wide range of specialised skills in identifying, conceptualising, designing, and implementing methods of enquiry to address complex and challenging problems within the Community Paediatrics health systems research.
5. Demonstrate specialised knowledge and the application of health promotion concepts.
6. Demonstrate the ability to implement the priority of child interventions at an appropriate level based on the hierarchical relations and address the intended and unintended consequences of interventions within the system.
7. Demonstrate specialised knowledge and interpretation of child health policies and programmes.
8. Demonstrate the ability to use a range of advanced and specialised advocating and communication skills for children and discourses appropriate to the community Paediatrics practice and make autonomous ethical decisions which affect knowledge production.
9. Demonstrate specialised knowledge and skills in health management and leadership.
10. Demonstrate specialised knowledge of health information systems.
11. Demonstrate a specialised understanding of adult education principles and facilitation skills.
12. Demonstrate an ability to operate independently and take full responsibility for managing learning tasks, engage in self-evaluation and learn independently for continuing professional development.
13. Demonstrate a capacity to take full responsibility for managing learning tasks, to engage in self-evaluation and to learn independently for continuing professional development.

Associated Assessment Criteria for Exit Level Outcome 1

• Explore approaches to the epidemiology and classification of long-term health conditions and paradigms for continuing care over time.
• Apply the key principles of epidemiology: concepts, disease causation, study design, measuring disease and diagnostic tests.
• Develop and implement the guidelines for long-term care and configure health services optimally for long-term health conditions such as child allergy, disabilities, HIV/AIDS, TB and child and adolescent mental health conditions at the primary and secondary levels of care.

Associated Assessment Criteria for Exit Level Outcome 2

• Interpret key biostatistical concepts including types of data, measures of spread and central tendency; hypothesis testing, probability values and confidence intervals; and statistical tests.
• Apply biostatistical concepts when covering the relevant epidemiological units using published research.
• Interpret and apply statistical concepts to published research and present data in an appropriate format.

Associated Assessment Criteria for Exit Level Outcome 3

• Find and critically evaluate reliable sources of evidence, correctly interpret and apply them to specific practice settings for children with long-term conditions e.g., child abuse, disability, HIV etc. and the development of clinical guidelines.
• Critically appraise systematic reviews.
• Synthesize, transfer, and use evidence in the implementation of practical paediatric nursing work.
• Independently examine and assess a patient's need for care, start treatment, and monitor acute and chronic health issues.
• Promote interaction, communication, and networks, through strong leadership, feedback, monitoring, and evaluation and through an open organizational culture which supports learning and values.

Associated Assessment Criteria for Exit Level Outcome 4

• Apply the concept of health systems research at different levels of the health system; methods in health system research; data collection, analysis, and interpretation.
• Critically examine different health promotion approaches and strategies linked to child health programmes at the district and regional levels.
• Discuss an approach appropriate for the implementation and support of child health policies in addressing the priority conditions affecting children at the district level.

Associated Assessment Criteria for Exit Level Outcome 5

• Monitor and apply the health promotion concepts and health promotion approaches within the child health context.
• Identify an important health promotion issue within the district or subdistrict.
• Develop and implement the health promotion strategy and materials in collaboration with staff to address the issue at a local Community Health Clinic or Clinic.

Associated Assessment Criteria for Exit Level Outcome 6

• Identify and rank priority interventions appropriate for the implementation at the primary and secondary levels.
• Make significant contributions to team efforts in planning and implementing the interventions.
• Assess, diagnose, manage and follow-up children with a disability, developmental or behavioural disorder or in need of palliative care.

Associated Assessment Criteria for Exit Level Outcome 7

• Interpret the child health policies and programmes and analyse the pattern of child morbidity and mortality locally and globally.
• Critically interrogate child health policies, programmes and national health policies and assess their implications for child health, and the challenges in child health policy implementation.
• Interpret and critically evaluate current global and local child health policies and legislation.

Associated Assessment Criteria for Exit Level Outcome 8

• Apply comprehensive and specialised knowledge of children's rights to advocate for the realisation of children's rights.
• Explore and apply the ethical principles and legislation guiding the provision of child health care.
• Develop an advocacy strategy relating to specific aspects of child health.
• Develop an advocacy plan and materials on a child health issue for implementation in the district.

Associated Assessment Criteria for Exit Level Outcome 9

• Apply management and leadership skills to the health system, health management and leadership practices.
• Manage change and apply human resource management and financial management. to child public health.
• Undertake a quality improvement project which focuses on the organisation of services and support systems at the different levels of care.
• Implement a small win as part of a broader project in the health system.
• Identify a child health service challenge at the district level and convene a meeting of key members of a multidisciplinary team.

Associated Assessment Criteria for Exit Level Outcome 10

• Evaluate the different health information systems, health indicators, and quality improvement in healthcare.
• Monitor and evaluate the Community Healthcare Programmes.
• Select, analyse, and interpret health information.
• Use health information and clinical audits to improve child health services and programmes.
• Undertake a situation analysis of key health status and service delivery indicators within the district.
• Present and discuss the situation analysis at a meeting with key stakeholders. Include a plan on how to improve at least two child health indicators.

Associated Assessment Criteria for Exit Level Outcome 11

• Apply communication skills, communication theories and intercultural communication.
• Effectively apply verbal and written communication skills in small and large groups.
• Present, write and publish health information relevant to own work.

Associated Assessment Criteria for Exit Level Outcome 12

• Apply adult education principles to in-service training of health personnel, including doctors and nurses.
• Apply facilitation skills, active teaching and learning methods and the main principles of feedback and assessment.
• Train those undertaking the subspecialty in health systems research and contribute to knowledge and research within community paediatrics at an advanced level.
• Participate in academic clinical ward rounds and academic meetings and contribute to discussions and clinical presentations.
• Observe and supervise learner's consultations with consultants.

Associated Assessment Criteria for Exit Level Outcome 13

• Take full responsibility for managing learning tasks, engage in self-evaluation and learn independently for continuing professional development.
• Develop a structured learning plan and identify goals and actions on key experiential activities in health management and leadership; health promotion and evidence-based policies; health information systems; communication, education, and training; and advocacy.
• Reflect on and document the strengths and areas for improvement and progress.

INTEGRATED ASSESSMENT

The qualification is comprehensively assessed at the exit level. Assessment is both formative and summative.

Formative Assessment

The formative assessment of the coursework will involve unit submissions, attendance, and participation in face-to-face sessions and online forums, discussions, and chat sessions. Formative assessment will include feedback on the unit submissions which will contribute to 20% of the course assessment mark.

Summative Assessment

The summative assessments will include the assignments and a written examination. Assessment of the portfolio of learning will be a summative assessment of the learning activities. The research component will include a professional master's project technical report. Summative assessment will contribute to 80% of the assessment mark and include the assignment marks and two 3-hour examination papers.