Abstract
BackgroundEnsuring the current public health workforce has appropriate competencies to fulfill essential public health functions is challenging in many low- and middle-income countries. The absence of an agreed set of core competencies to provide a basis for developing and assessing knowledge, skills, abilities, and attitudes contributes to this challenge. This study aims to identify the requisite core competencies for practicing health professionals in mid-level supervisory and program management roles to effectively perform their public health responsibilities in the resource-poor setting of Uttar Pradesh (UP), India.MethodsWe used a multi-step, interactive Delphi technique to develop an agreed set of public health competencies. A narrative review of core competency frameworks and key informant interviews with human resources for health experts in India were conducted to prepare an initial list of 40 competency statements in eight domains. We then organized a day-long workshop with 22 Indian public health experts and government officials, who added to and modified the initial list. A revised list of 54 competency statements was rated on a 5-point Likert scale. Aggregate statement scores were shared with the participants, who discussed the findings. Finally, the revised list was returned to participants for an additional round of ratings. The Wilcoxon matched-pairs signed-rank test was used to identify stability between steps, and consensus was defined using the percent agreement criterion.ResultsStability between the first and second Delphi scoring steps was reached in 46 of the 54 statements. By the end of the second Delphi scoring step, consensus was reached on 48 competency statements across eight domains: public health sciences, assessment and analysis, policy and program management, financial management and budgeting, partnerships and collaboration, social and cultural determinants, communication, and leadership.ConclusionsThis study produced a consensus set of core competencies and domains in public health that can be used to assess competencies of public health professionals and revise or develop new training programs to address desired competencies. Findings can also be used to support workforce development by informing competency-based job descriptions for recruitment and performance management in the Indian context, and potentially can be adapted for use in resource-poor settings globally.
Highlights
Ensuring the current public health workforce has appropriate competencies to fulfill essential public health functions is challenging in many low- and middle-income countries
We used the Delphi technique because of its various advantages including anonymity between participants— which minimizes group discussion biases; iteration with controlled feedback of group opinion—achieved through the use of successive questionnaires allowing participants to amend their views if they want; statistical aggregation of group response—which is shared with the participants, enabling them to see where their opinions lie relative to the group response; and expert input—ensuring that the participants are experts adequately informed in the topic [38]
Findings from the narrative review: international scenario of core competencies for public health professionals Based on the narrative review, we found similarities in domains and competencies across various core competency frameworks, as well as differences in their emphasis
Summary
Ensuring the current public health workforce has appropriate competencies to fulfill essential public health functions is challenging in many low- and middle-income countries. This study aims to identify the requisite core competencies for practicing health professionals in mid-level supervisory and program management roles to effectively perform their public health responsibilities in the resource-poor setting of Uttar Pradesh (UP), India. A strong health system relies on health workers who are competent to provide quality health services that are effective, efficient, integrated, people-centered, safe, and timely [5]. Many resource-poor settings struggle to ensure the health workforce has the appropriate public health competencies needed to effectively perform these and other public health functions [8, 9]. In many low-resource settings, funding for training of public health professionals is inadequate; little attention is paid to the health needs of the population during professional training; educational curricula remain outdated; public health training is conducted mostly by medical colleges, which offer narrow perspectives about population-health and restrict access to public health training for nonclinical students; and there is, overall, under-investment and poor governance of the health sector, which may aggravate these challenges [8, 10,11,12,13]
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