This article describes the main operational functions of public health (EPHO), as well as the main directions of their activities. EPHOs are a standardized self-assessment approach whose main purpose is to strengthen and develop the public health potential. In addition, the results of international and domestic self-assessment of the implementation of the operational functions of public health are presented, during which it was revealed that the assessment of the implementation of the EPHOs allows us to demonstrate an objective picture of the state of public health both at the country level and at the regional level.
Introduction. Public health is defined as «the science and art of improving health, preventing disease and prolonging life through the organized efforts of the whole society» [1, 2]. The UK Department of Public Health divides public health into the following 3 main areas:
- - improved health (including lifestyle, health inequalities and wider social determinants of health)
- - health (including research and control of infectious diseases, environmental hazards and emergency preparedness)
- - improving the quality of services (including evidence-based screening, patient self-management of their illness on a evidencebased basis, integrated care delivery routes, service planning, cost-effectiveness, audit and evaluation) .
Undoubtedly, only integrated actions in the above areas will lead to ensuring the effectiveness of public health services for all population groups.
In the context of the development of modern society and health care, where changes are permanent, the public health service has a difficult task - adapting health services to these changes.
In 2012, the European Regional Committee of the World Health Organization developed and approved the European action plan for the development of the potential of public health services, as the main element of the implementation of the regional program and strategy in the field of health and wellbeing “Health 2020” [4, 5].
In this regard, ten revised EPHOs were presented, which all public health systems should strive to implement. The operational functions were developed based on the results of the work of the Pan American Health Organization (PAHO) and its health indicators developed by the Public Health in the Americas initiative. The aim of this work is to analyze the results of self-assessment of the operational functions of public health.
Materials and methods. To write this work, a descriptive method and a method of expert assessments were used. A search was carried out for international and domestic sources, as well as official regulatory documents in the following databases: Scopus, Web Of Science, Pubmed, online. zakon.kz, scientific electronic libraries KIBERLENINKA, eLIBRARY.RU. A total of 40 sources were analyzed.
Main part. The main operational functions of public health is a standardized approach to self-assessment, the main purpose of which is to strengthen and develop the potential of public health. It should be noted that EPHOs are constantly evolving and should be regularly updated to reflect current assessments, new problems and communication technologies, including social networks 
According to Figure 1, the operational functions of public health can be divided into 2 groups (basic and facilitating EPHOs). The core functions include 5 traditional functions, such as surveillance, disease prevention and health protection. Contributing functions include the so-called «strategic» EPHOs (strategic leadership, human resources, financing, outreach, research).
The main activities of epho.
1. Epidemic surveillance and assessment of the state of health and wellbeing of the population. This function is aimed at the creation and high-quality operation of surveillance systems, the main purpose of which is to monitor the frequency and prevalence of diseases, as well as to control public health indicators
- Monitoring and response to health hazards and emergency situations. The main objective of the EPHO 2 is preparedness for emergency management, including the development of suitable action plans; development of systems for data collection, control and prevention of morbidity and the application of a comprehensive approach, which involves joining forces and cooperation with various bodies involved in the management process.
- Health protection, including ensuring the safety of the environment, labor, food, etc. This function includes monitoring, identifying and predicting the priority of biological, chemical and physical threats to health at work and in the environment; application of risk assessment methods and tools for measuring environmental health risks.
- Disease prevention, including early detection of health problems. Disease prevention is one of the main elements of public health development. The purpose of this operational function is to eliminate such problems as insufficient implementation of vaccination, screening and clinical examination programs.
- Health promotion, including impact on social determinants and reduction of health inequalities. EPHO 5 includes activities to improve the health promotion process by influencing the determinants of both infectious and noncommunicable diseases and includes activities such as promoting lifestyle changes, habits and environmental conditions in order to develop a “health culture” among all population groups.
- Providing strategic leadership for health and well-being. The EPHO for the implementation of strategic leadership is cross - cutting, as it is present in each of the operational functions and areas of activity. For the implementation of this function, an integral part is issues such as leadership, management, planning, implementation, monitoring and evaluation. In addition, over the past decade, the importance of assessing the impact of international changes in health on the health status of a country's population has grown.
Quality assurance is associated with the development of standards to ensure the quality of individual and collective medical services in terms of disease prevention and health promotion, as well as the evaluation of these services based on these standards.
- Provision of a sufficient number of qualified public health personnel. The public health workforce potential and its development are a fundamental component of the provision and implementation of public health services and activities. This public health function includes the education, training, development and evaluation of personnel in order to effectively address priority public health problems and to properly evaluate public health measures.
- Providing sustainable organizational structures and financing. EPHO 8 addresses the relevance of the core organizational structures needed to implement EPHOs and the coordination mechanisms that link them. It also covers the systematization and adequacy of funding structures that ensure that all EPHOs are implemented. As part of this function, the proper organization of the work of institutions of the entire health system is considered, in addition, a separate section is devoted to financing in the field of public health.
- Advocacy, communication and social mobilization for health. Outreach is one of the fundamental methods of improving medical literacy and health indicators, both for individuals and all population groups. This function is interdisciplinary, as it includes joint activities with areas such as journalism, education, etc.
- Promoting the development of public health research for the scientific justification of policies and practices. Scientific research in the field of public health is at a stage of intensive development, however, scientific research on the impact on broader determinants of health, disease prevention and improving the well-being of the population is not enough. In addition, there are problems introducing a significant part of the research results at the state level.
This function is aimed at developingand imple menting new research methods, innovative technologies and solutions in the field of public health, conducting research with the aim of increasing the knowledge base in support of evidence-based policy formulation at all levels
The operational functions of public health are centered around three main areas of service delivery: health protection, disease prevention and health promotion. They are supported by reliable analytical activities and enhanced by functions that facilitate the provision of services [7, 8, 9, 10, 11].
Self-assessment of the main operational functions of public health. In
2012, a self-assessment of the operational core public health functions was conducted among countries in the European Region. 43 of 51 countries included in the WHO European Region were covered. Based on the information provided on the self-assessment of public health services, general estimates were obtained of the estimated percentage of countries in which some activities related to each EPHO are carried out. The EPHO selfassessment tool developed by WHO / Europe provides a unified approach for countries in the European Region, allowing for the development of more integrated and coherent public health policies .
Based on the data presented in Fig. 2, it can be argued that EPHOs 1,2,3,5 (surveillance; monitoring of health risks; health promotion; disease prevention) are most effectively implemented in the European Region.
Systemic EPHOs are less developed, especially the provision of public health personnel and organizational structures,
financing. Outreach and communication were not considered in this assessment. The assessment found that countries in the European Region were less prepared to tackle the vast epidemics of noncommunicable diseases, and especially to overcome inequalities and impact on broader determinants of health, which affect the incidence of NCDs and other health outcomes.
Наука о жизни и здоровье №1, 2020
The results of the assessment of the implementation of EPHOs among the CIS countries showed that the CIS countries are strong in the field of services related to public health and well-being surveillance; monitoring and responding to hazards in emergency situations; and protecting health, including ensuring the safety of the environment. The most poorly implemented are the operational functions related to providing strategic leadership, competent personnel, ensuring sustainable organizational structures, and financing.
In general, it can be noted that the EP countries have greater potential in the implementation of EPHOs in comparison with the CIS countries. Among the main recommendations of the WHO presented in the report were the strengthening of traditional EPHOs 1-5, which is impossible without the development of strategic leadership and advocacy (EPHOs 6 and 9).
The Republic of Kazakhstan also implements the basic operational functions of public health. The EPHO self-assessment, which was conducted under the leadership of the Ministry of Health of the Republic of Kazakhstan (MH RK), became a huge step for the development of public health.
The self-assessment process for the implementation of the 10 core operational functions of public health (EPHOs) specified in the WHO European Action Plan for Strengthening Public Health Capacities and Services was conducted from April to September 2016. The main problems that were identified as a result of self-assessment:
- EPHO 1 - it is necessary to refine information systems and introduce a system for the epidemiological surveillance of noncommunicable diseases (NCDs) according to the methodology of the WHO phased approach to surveillance (STEPS).
- EPHO 2 - lack of a national emergency response plan.
- EPHO 3 - insufficient control and monitoring of food products at each stage of production, insufficient funding.
- EPHO 4 - further development of programs for the protection of sexual, reproductive and mental health is necessary.
- EPHO 5 - low level of employers' interest in the health of staff, low quality of tertiary prevention (rehabilitation).
- EPHO 6 - imperfect methods of strategic leadership, insufficient information on migrants.
- EPHO 7 - lack of a unified register of healthcare personnel, lack of professional standards, problems in managing healthcare personnel, lack of systematic research.
- EPHO 8 - absence of the Ministry of Environmental Protection and coordination of environmental services
- EPHO 9 - low level of health managers about outreach technologies.
- EPHO 10 - insufficient number of joint research between the health sector and others, lack of a unified research strategy in public health .
An analysis of the results of the selfassessment of 10 EPHOs made it possible to give an objective assessment of the situation for 2016 and to determine the main directions for improving Public Health. At present, the right course for the development of public health in the Republic of Kazakhstan has been selected. The development of public health is the first priority area of health development in the Republic of Kazakhstan, which is reflected in the State Health Development Program “Densaulyk” for 2016-2019 [14, 15].
As part of this program, a public health service (POP) reform has been carried out in Kazakhstan, a National Public Health Center has been established, and the structure of the Public Health Committee of the Ministry of Health of the Republic of Kazakhstan has been revised. The next step to achieve the implementation of the basic operational functions of public health is the approval of the Guidelines for the development of primary health care in the Republic of Kazakhstan for 2018-2022. within the framework of the implementation of the 80th step of the Program of the President of the Republic of Kazakhstan “Plan of the nation - 100 concrete steps”.
Within the framework of this program, out of 10 operational functions, 50% are implemented at the level of primary health care.
- health promotion, including impact on social determinants and reduction of health inequalities
- disease prevention, including early detection of health problems
- ensuring the public health sector with a sufficient number of qualified personnel
- ensuring sustainable organizational structures and financing
- outreach (advocacy), communication and social mobilization for health [16.17].
Based on the main directions of each main operational function of public health, considerable work has been done at the moment for the full implementation of the EPHOs. Professional standards have been developed and are being implemented, an observatory of human resources has been created, and managers are regularly trained at all levels of the healthcare system in strategic management. In order to develop scientific research in the field of healthcare, a system of grant financing for young scientists, a targeted funding program, and research and development work have been introduced.
Conclusion. In general, an analysis of published sources showed that continuous work is underway to improve PHSs in order to achieve the comprehensive and continuous implementation of EPHOs at the levels of the health system. An assessment of the operational functions of public health makes it possible to demonstrate an objective picture of the state of public health both at the country level and at the regional level. Function assessment tools cover all levels of activity of public health professionals and are a universal analytical tool, as a result, the final results of the analysis of the EPHO implementation are fundamental data for the purpose of improving the public health service.
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