Validation of public health competencies and impact variables for low- and middle-income countries

Responsive public health doctoral education: experiences and reflections from a School of Public Health in South Africa

Institutional capacity for doctoral training is key to addressing the complex challenges facing the global south. In the context of the need for skilled knowledge workers in health systems and growing demand for doctoral places, we reflect on the evolution of a public health doctoral programme in a South African School of Public Health. Through this case, we aim to contribute to wider debates on the form and content of emerging public health doctoral programmes in South Africa and the African continent. Drawing on a multi-level framework of 'curriculum responsiveness' we consider responsive public health doctoral education as simultaneously engaging macro-social, institutional/cultural, disciplinary and individual learning imperatives. We assess the responsiveness of the doctoral programme against these elements, describing the growth, institutional context and systems and pedagogical strategies introduced over the last decade, and areas for further development. We conclude by proposing the multi-level capacities required for responsive public health doctoral education. We highlight the need for diversified curricula (including professional doctorates) that support a wider set of graduate attributes and career trajectories beyond academia, greater investment in doctoral infrastructures within higher education institutions, and disciplinary practices and pedagogies that centre epistemic access and justice.

Identifying core global mental health professional competencies: A multi-sectoral perspective

Concerned with sustainably alleviating mental distress and promoting the right to health worldwide, global mental health (GMH) is practised across various contexts spanning the humanitarian-development-peace nexus. The inherently intersectoral and multidisciplinary nature of GMH calls for competency frameworks and training programmes that embody diversity, decolonisation and multiprofessionalism. Existing competency frameworks have failed to capture the multi-sectoral, inter-professional nature of contemporary GMH practice. In response to these needs, a qualitative content analysis of relevant job advertisements was conducted to distil a comprehensive set of professional competencies in contemporary GMH practice. Approximately 200 distinct skills and competencies were extracted from 70 job advertisements and organised into four meta-dimensions: 'skills', 'sector', 'self' and 'subject'. The first known systematic attempt at a multi-sectoral GMH competency framework, it offers a springboard for exploring vital yet overlooked professional competencies such as resilience, self-reflection, political skills and entrepreneurialism. On this basis, recommendations for building a competent, agile and effective GMH workforce with diversified and future-proof skillsets are proposed. The framework can also inform inter-professional training and curriculum design, and capacity-building initiatives aimed at early-career professional development, particularly in low- and middle-income settings.

Developing public health competency statements and frameworks: a scoping review and thematic analysis of approaches

Competencies ensure public health students and professionals have the necessary knowledge, skills, values, and behaviours to do their jobs effectively. Public health is a dynamic and complex field requiring robust competency statements and frameworks that are regularly renewed. Many countries have public health competencies, but there has been no evidence synthesis on how these are developed. Our research aim was to synthesize the extent and nature of the literature on approaches and best practices for competencies statement and framework development in the context of public health, including identifying the relevant literature on approaches for developing competency statements and frameworks for public health students and professionals using a scoping review; and, synthesizing and describing approaches and best practices for developing public health competency statements and frameworks using a thematic analysis of the literature identified by the scoping review. We conducted a scoping review and thematic analysis of the academic and grey literature to synthesize and describe approaches and best practices for developing public health competency statements and frameworks. A systematic search of six databases uncovered 13 articles for inclusion. To scope the literature, articles were assessed for characteristics including study aim, design, methods, key results, gaps, and future research recommendations. Most included articles were peer-reviewed journal articles, used qualitative or mixed method design, and were focused on general, rather than specialist, public health practitioners. Thematic analysis resulted in the generation of six analytical themes that describe the multi-method approaches utilized in developing competency statements and frameworks including literature reviews, expert consultation, and consensus-building. There was variability in the transparency of competency framework development, with challenges balancing foundational and discipline-specific competencies. Governance, and intersectoral and interdisciplinary competency, are needed to address complex public health issues. Understanding approaches and best practices for competency statement and framework development will support future evidence-informed iterations of public health competencies.

Adaptation of the CUGH global health competency framework in the Chinese context: a mixed-methods study

BACKGROUND

In 2014, the Consortium of Universities for Global Health (CUGH) developed a global health competency framework and called for its validation. Given China's increasing engagement in global health over the past decade, there is a need for a tailored competency framework to enhance the capacity of its workforce. This study aimed to localize the CUGH global health framework within the Chinese context, offering guidance to public health professionals in China to bolster their capabilities for international endeavors.

METHODS

Employing a modified Delphi consultation approach, this study adapted the CUGH global health competency framework through three consultation rounds and a panel discussion. A questionnaire employing a five-point Likert scale was developed to gather opinions from 37 experts on the significance and feasibility of each competency within the Chinese setting. Profiling information, judgment criteria, and familiarity with each competency were collected to assess experts' authority levels. Furthermore, a priority survey was administered to 51 experts to identify key competencies and provide recommendations for bolstering the capabilities of China's public health professionals. Data analysis was performed using Microsoft Excel.

RESULTS

The adapted framework comprises 10 domains and 37 competencies including: 1. Global Burden of Disease; 2. Social-economic, Environmental and Behavioral Determinants of Health; 3. The Impact of Globalization on Population Health, Health Systems, and Healthcare; 4. Major Global health initiatives and efforts; 5. Ethics, Health Equity and Social Justice; 6. Sociocultural, Political Awareness and Policy Promotion; 7. Personal Competencies and Professional Practice; 8. Capacity strengthening; 9. Collaboration, Partnering and Communication; 10. Programme Management. The priority survey underscored Domain 9, 10, and 4 as the foremost concern for Chinese public health professionals, urging active learning, critical thinking, open communication, experiential learning, and case-based studies. Institutions were advised to enhance their capacity, foster partnerships, and discern China's distinct role in the global health arena.

CONCLUSIONS

This study adapted the CUGH framework within the Chinese context, evaluating the significance and feasibility of each competency. The adapted framework can serve as a tool for developing global health curricula and delineating roles for Chinese public health professionals. To ensure contextual compatibility, testing of the framework with diverse public health professionals is recommended, enabling precise refinement of competencies based on empirical results.

The Governance of Core Competencies for Public Health: A Rapid Review of the Literature

Core competencies for public health (CCPH) define the knowledge, skills, and attitudes required of a public health workforce. Although numerous sets of CCPH have been established, few studies have systematically examined the governance of competency development, review, and monitoring, which is critical to their implementation and impact. This rapid review included 42 articles. The findings identified examples of collaboration and community engagement in governing activities (e.g., using the Delphi method to develop CCPH) and different ways of approaching CCPH review and revision (e.g., every 3 years). Insights on monitoring and resource management were scarce. Preliminary lessons emerging from the findings point towards the need for systems, structures, and processes that support ongoing reviews, revisions, and monitoring of CCPH.

Understanding the need for developing a structured competency-based curriculum for health policy and programs among community medicine postgraduates: A grounded theory approach

Introduction

Many plans and policy changes about health outcomes have evolved, but none of them have ever given a definite shape to the postgraduate (PG) curriculum so as to make it more intensive and integrative, which needs to be so structured and tailored that it is more patient, community centric, and less knowledge based.

Objectives

The objective of this study was to identify the gap in existing curriculum in learning of health policy and program among PGs of community medicine and recommend a structured model for the same.

Materials and Methods

A qualitative study (grounded theory approach) with all PGs of community medicine in one teaching institute in South India (8 PG students) was taken up.

Results

PGs felt that they never had any day-to-day update. They wanted to understand the working pattern and ground reality of policy and program which was unavailable to them. People who came to postgraduation after being medical officers felt that the monitoring and evaluation done by inexperienced MD Community Medicine students was never accepted by state public health because they did not understand the implementation problems and so could not rightly critically evaluate the programmatic challenges.

Conclusion

With the shift in medical education patterns and expectations of residents, it becomes important to justify the need of developing a structured based curriculum, more so for policy and programs, which will make them capable enough by polishing their managerial and financial skill set. The evaluation technique should focus more on practical aspects on field instead of their theory examination.

Key factors influencing public health students and curricula in India: Recommendations from a mixed methods analysis

BACKGROUND

Building on a distinguished history of community medicine training, public health programs have been expanding in India in recent years. The COVID-19 pandemic has brought additional attention to the importance of public health programs and the need for a strong workforce. This paper aims to assess the current capacity for public health education and training in India and provide recommendations for improved approaches to meet current and future public health needs.

METHODS

We conducted a desk review of public health training programs via extensive internet searches, literature reviews, and expert faculty consultations. Among those programs, we purposively selected faculty members to participate in in-depth interviews. We developed summary statistics based on the desk review. For qualitative analysis, we utilized a combination of deductive and inductive coding to identify key themes and systematically reviewed the strengths and weaknesses of each theme.

RESULTS

The desk review captured 59 institutions offering public health training across India. The majority of training programs were graduate level degrees including Master of Public Health and Master of Science degrees. Key factors impacting these programs included collaborations, mentorship, curriculum standardization, tuition and funding, and student demand for public health education and careers. Collaborations and mentorship were highly valued but varied in quality across institutions. Curricula lacked standardization but also contained substantial flexibility and innovation as a result. Public sector programs were perceived to be affordable though fees and stipends varied across institutions. Further development of career opportunities in public health is needed.

CONCLUSION

Public health education and training in India have a strong foothold. There are numerous opportunities for continued expansion and strengthening of this field, to support a robust multi-disciplinary public health workforce that will contribute towards achieving the sustainable development goals.

Assessing self-reported core competencies of public health practitioners in Lebanon using the WHO-ASPHER validated scale: a pilot study

BACKGROUND

The World Health Organization and the Association of Schools of Public Health in the European Region recommend the self-assessment of public health core competencies to strengthen the proficiency of the public health workforce and prepare them for future challenges. A framework for these competencies is lacking and highly needed in Lebanon. This study aims to validate the WHO-ASPHER self-declared scale and evaluate the perceived competency level of the different categories of Lebanese public health practitioners.

METHODS

This population-based cross-sectional study conducted online between July and September 2021 involved 66 public health practitioners who graduated from different universities in Lebanon. Data were collected using the snowball technique via a self-report questionnaire that assessed public health proficiency, categorized into 1) content and context, 2) relationship and interactions, and 3) performance and achievements. The rotated component matrix technique was used to test the construct validity of the scales. Bivariate and multivariate analyses were performed after ensuring the adequacy of the models. Significance was set at a p-value < 0.05.

RESULTS

The factor analysis for scale domains showed that the Barlett test sphericity was significant (p < 0.001), high loadings of items on factors, and Cronbach's alpha values of more than 0.9 in all three categories, showing an appropriate scale validity and reliability. The perceived level of competencies was significantly different between public health professionals and other health professionals with public health activities. All respondents scored low in most public health categories, mainly science and practice.

CONCLUSION

Data findings showed variability of self-declared gaps in knowledge and proficiency, suggesting the need to review the national public health education programs. Our study offers a valuable tool for academia and public health professionals to self-assess the level of public health proficiency and guide continuous education needs for professional development.

Implementation of global health competencies: A scoping review on target audiences, levels, and pedagogy and assessment strategies

BACKGROUND

As the field of global health expands, the recognition of structured training for field-based public health professionals has grown. Substantial effort has gone towards defining competency domains for public health professionals working globally. However, there is limited literature on how to implement competency-based training into learning curricula and evaluation strategies.

OBJECTIVES

This scoping review seeks to collate the current status, degree of consensus, and best practices, as well as gaps and areas of divergence, related to the implementation of competencies in global health curricula. Specifically, we sought to examine (i) the target audience, (ii) the levels or milestones, and (iii) the pedagogy and assessment approaches.

SOURCES OF EVIDENCE

A review of the published and grey literature was completed to identify published and grey literature sources that presented information on how to implement or support global health and public health competency-based education programs. In particular, we sought to capture any attempts to assign levels or milestones, any evaluation strategies, and the different pedagogical approaches.

RESULTS

Out of 68 documents reviewed, 21 documents were included which contained data related to the implementation of competency-based training programs; of these, 18 were peer-reviewed and three were from the grey literature. Most of the sources focused on post-graduate public health students, professional trainees pursuing continuing education training, and clinical and allied health professionals working in global health. Two approaches were identified to defining skill level or milestones, namely: (i) defining levels of increasing ability or (ii) changing roles across career stages. Pedagogical approaches featured field experience, direct engagement, group work, and self-reflection. Assessment approaches included self-assessment surveys, evaluations by peers and supervisors, and mixed methods assessments.

CONCLUSIONS

The implementation of global health competencies needs to respond to the needs of specific agencies or particular groups of learners. A milestones approach may aide these efforts while also support monitoring and evaluation. Further development is needed to understand how to assess competencies in a consistent and relevant manner.

Evaluation of the UK Public Health Skills and Knowledge Framework (PHSKF): implications for international competency frameworks

Background

The value of competency frameworks for developing the public health workforce is widely acknowledged internationally. However, there is a lack of formal evaluations of such frameworks. In the UK, the Public Health Skills and Knowledge Framework (PHSKF) is a key tool for the public health workforce across the UK, and this study presents the evaluation of the PHSKF 2016 version, with the aim of reflecting on implications for international public health competency frameworks.

Methods

A sequential explanatory design was employed. An online survey (n = 298) was completed with stakeholders across the four UK nations and different sectors. This was followed by 18 telephone interviews with stakeholders and survey completers. Quantitative results were analysed descriptively; qualitative transcripts were analysed with thematic analysis.

Results

Most respondents had used the PHSKF occasionally or rarely, and most users found it useful (87%) and easy to use (82%). Main purposes of use included team/workforce development (e.g. setting of standards) and professional development (e.g. identify professional development opportunities). Some positive experiences emerged of uses of the PHSKF to support organisational redevelopments. However, 23% of respondents had never used the framework. Areas for improvement included greater clarity on purpose and audience, the need for more support from employers and for clear career progression opportunities, and stronger links with other competency frameworks.

Conclusions

The development of a digital version of the PHSKF, together with improving buy-in from the workforce and employers could make an important contribution towards UK public health workforce development. Further evaluation and shared learning internationally of the implementation of public health competency frameworks would support global public health workforce development.

Community-based education in the Institute of Medicine, Tribhuvan University, Nepal: a qualitative assessment

Background: Community-based education (CBE) involves learning activities that take place in a community setting. CBE is now recognized as an important addition to medical education, because the skills of graduates are needed more in communities than in urban and tertiary hospitals. The goal of CBE is to help the students understand social dynamics of health promotion and disease prevention and to impart a sense of social justice and cultural humility. Since its establishment in 1972, the Institute of Medicine (IOM) has provided community-based education in the medical and public health programs. Purpose: The objective of this study was to assess the organization and implementation of CBE in the IOM. This study also aimed to make recommendations based on the perspectives of students, faculty, education managers and administrative staff. Methods: The methods employed in this study were descriptive and exploratory using primary as well as secondary data collection. Primary data were collected using a qualitative approach - five focus group discussions with the students of Bachelor of Medicine and Bachelor of Surgery and Bachelor of Public Health programs, and 13 interviews with faculty members, field coordinators, administrative staff and office-bearers of the IOM. Additionally, observation of the infrastructure for implementing CBE activities was conducted. Secondary data were collected from the field reports of the students. The results were grouped into the following themes - organization of CBE, implementation of CBE and beneficiary perspectives. Results: The CBE has remained an important component of the undergraduate medical and public health curricula of the IOM since its establishment in 1972. The students and faculty members emphasized the importance of CBE in medical and public health education. The IOM has achieved the curricular objectives of the CBE by developing relevant guidelines and regularly conducting orientations and field activities. Conclusions: The organization and implementation of the CBE need to be made more effective and efficient by simplifying the administrative and financial procedures, specifying teaching communities, acknowledging the support of community and stakeholders, increasing the service components in students' field practice, and engaging the communities in planning, implementation and evaluation of CBE.

Motivations of South African physicians specialising in public health

Background: South African physicians can specialise in public health through a four-year ‘registrar’ programme. Despite national health policies that seemingly value public health (PH) approaches, the Public Health Medicine (PHM) speciality is largely invisible in the health services. Nevertheless, many physicians enrol for specialist training.

Objectives: This study investigated physicians’ motivations for specialising in PHM, their intended career paths, perceptions of training, and perspectives about the future of the speciality.

Methods: Focus groups and in-depth interviews were conducted with specialists-in-training and newly qualified specialists, and thematic analysis of transcripts was performed.

Results: Motivations, often driven by difficult experiences as young physicians in poorly resourced clinical settings, stemmed from a commitment to improving communities’ health and desire to impact on perceived failing health systems. Rather than ‘exiting’ the South African health service, selecting PHM specialist training enacted participants’ ‘loyalty’ to population health. Participants anticipated carving out their own careers due to an absence of public sector career paths. They believed specialists’ contribution centred on providing ‘public health intelligence’ – finding and interpreting information; supporting services through management and leadership; and inputting into policymaking and planning.

Conclusions: Competencies of PHM specialists should be refined to inform and improve management of this scarce human resource for health. This is particularly important given the proposed major health reforms towards universal health coverage in South Africa presently. In addition, findings highlight the importance of physicians’ early work experiences where avenues for expressing ‘voice’, mediated by ‘loyalty’, could be utilised to improve public sector health systems.

Master of Public Health programmes in South Africa: issues and challenges

BACKGROUND

The demand for highly skilled public health personnel in low- and middle-income countries has been recognised globally. In South Africa, the need to train more public health professionals has been acknowledged. The Human Resource for Health (HRH) Strategy for South Africa includes the establishment of public health units at district and provincial levels. Programmes such as Master of Public Health (MPH) programmes are viewed as essential contributors in equipping health practitioners with adequate public health skills to meet the demands of the health care system. All MPH programmes have been instituted independently; there is no systematic information or comparison of programmes and requirements across institutions. This study aims to establish a baseline on MPH programmes in South Africa in terms of programme characteristics, curriculum, teaching workforce and graduate output.

METHODS

A mixed method design was implemented. A document analysis and cross-sectional descriptive survey, comprising both quantitative and qualitative data collection, by means of questionnaires, of all MPH programmes active in 2014 was conducted. The MPH programme coordinators of the 10 active programmes were invited to participate in the study via email. Numeric data were summarized in frequency distribution tables. Non-numeric data was captured, collated into one file and thematically analysed.

RESULTS

A total of eight MPH programmes responded to the questionnaire. Most programmes are affiliated to medical schools and provide a wide range of specialisations. The MPH programmes are run by individual universities and tend to have their own quality assurance, validation and assessment procedures with minimal external scrutiny. National core competencies for MPH programmes have not been determined. All programmes are battling to provide an appropriate supply of well-trained public health professionals as a result of drop-out, low throughput and delayed time to completion.

CONCLUSION

The MPH programmes have consistently graduated MPH candidates, although the numbers differ by institution. The increasing number of enrolments coupled by insufficient teaching personnel and low graduate output are key challenges impacting on the production of public health professionals. Collaboration amongst the MPH programmes, standardization, quality assurance and benchmarking needs considerable attention.

'Why do an MPH?' Motivations and intentions of physicians undertaking postgraduate public health training at the University of Cape Town

Background

Public health (PH) approaches underpin the management and transformation of health systems in low- and middle-income countries. Despite the Master of Public Health (MPH) rarely being a prerequisite for health service employment in South Africa, many physicians pursue MPH qualifications.

Objectives

This study identifies their motivations and career intentions and explored MPH programme strengths and gaps in under- and post-graduate PH training.

Design

A cross-sectional study using an online questionnaire was completed by physicians graduating with an MPH between 2000 and 2009 and those enrolled in the programme in 2010 at the University of Cape Town.

Results

Nearly a quarter of MPH students were physicians. Of the 65 contactable physicians, 48% responded. They were mid-career physicians who wished to obtain research training (55%), who wished to gain broader perspectives on health (32%), and who used the MPH to advance careers (90%) as researchers, policy-makers, or managers. The MPH widened professional opportunities, with 62% changing jobs. They believed that inadequate undergraduate exposure should be remedied by applying PH approaches to clinical problems in community settings, which would increase the attractiveness of postgraduate PH training.

Conclusions

The MPH allows physicians to transition from pure clinical to research, policy and/or management work, preparing them to innovate changes for effective health systems, responsive to the health needs of populations. Limited local job options and incentives are important constraining factors. Advocacy for positions requiring qualifications and benchmarking exit competencies of programmes nationally may promote enrolment.

Schools of public health in low and middle-income countries: an imperative investment for improving the health of populations?

BACKGROUND

Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005-2008) strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges.

MAIN TEXT

The challenges faced by LMICs include rapid urbanization, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs).

CONCLUSION

SPHs in LMICs can contribute to overcoming several public health challenges being faced by LMICs, including achieving SDGs. Most importantly they can develop cadres of competent and well-motivated public health professionals: educators, practitioners and researchers who ask questions that address fundamental health determinants, seek solutions as agents of change within their mandates, provide specific services and serve as advocates for multilevel partnerships. Funding support, human resources, and agency are unfortunately often limited or curtailed in LMICs, and this requires constructive collaboration between LMICs and counterpart institutions from high income countries.

Impact of MPH programs: contributing to health system strengthening in low- and middle-income countries?

BACKGROUND

The "health workforce" crisis has led to an increased interest in health professional education, including MPH programs. Recently, it was questioned whether training of mid- to higher level cadres in public health prepared graduates with competencies to strengthen health systems in low- and middle-income countries. Measuring educational impact has been notoriously difficult; therefore, innovative methods for measuring the outcome and impact of MPH programs were sought. Impact was conceptualized as "impact on workplace" and "impact on society," which entailed studying how these competencies were enacted and to what effect within the context of the graduates' workplaces, as well as on societal health.

METHODS

This is part of a larger six-country mixed method study; in this paper, the focus is on the qualitative findings of two English language programs, one a distance MPH program offered from South Africa, the other a residential program in the Netherlands. Both offer MPH training to students from a diversity of countries. In-depth interviews were conducted with 10 graduates (per program), working in low- and middle-income health systems, their peers, and their supervisors.

RESULTS

Impact on the workplace was reported as considerable by graduates and peers as well as supervisors and included changes in management and leadership: promotion to a leadership position as well as expanded or revitalized management roles were reported by many participants. The development of leadership capacity was highly valued amongst many graduates, and this capacity was cited by a number of supervisors and peers. Wider impact in the workplace took the form of introducing workplace innovations such as setting up an AIDS and addiction research center and research involvement; teaching and training, advocacy, and community engagement were other ways in which graduates' influence reached a wider target grouping. Beyond the workplace, an intersectoral approach, national reach through policy advisory roles to Ministries of Health, policy development, and capacity building, was reported. Work conditions and context influenced conduciveness for innovation and the extent to which graduates were able to have effect. Self-selection of graduates and their role in selecting peers and supervisors may have resulted in some bias, some graduates could not be traced, and social acceptability bias may have influenced findings.

CONCLUSIONS

There was considerable impact at many levels; graduates were perceived to be able to contribute significantly to their workplaces and often had influence at the national level. Much of the impact described was in line with public health educational aims. The qualitative method study revealed more in-depth understanding of graduates' impact as well as their career pathways.

An exploratory study of the need for curriculum review of Master of Public Health Degree at a Rural-based University in South Africa

Background

Master of Public Health (MPH) training programmes were developed worldwide in response to the crisis in human resources for health.

Aim

To determine whether the MPH programme at the selected rural-based university in South Africa enabled students to achieve the MPH core competencies relevant for Lower Middle Income Countries.

Setting

The study was carried out at a rural-based University in South Africa. The target population was the 2011 first-year cohort of MPH students who by the beginning of 2014 had just completed their coursework.

Methodology

A quantitative cross-sectional descriptive research design was adapted. Eighty-five students were randomly selected to participate in the study. A structured questionnaire comprising seven competency clusters was developed. The selected students completed a self-administered questionnaire. Only those students who signed consent forms participated in this study. The questionnaire was tested for construct validity and reliability using 10 students with similar characteristics to those sampled for the study. Microsoft Excel software was used to analyse the data descriptively in terms of frequency and percentages.

Results

The students were confident of their competencies regarding public health science skills. Amongst these were analytical assessment, communication, community and inter-sectorial competencies as well as ethics. However, the students lacked confidence in context-sensitive issues, planning and management, research and development, and leadership competencies. Yet the latter is the backbone of public health practice.

Conclusion and recommendation

There is a need for revamping public health curricula. In this respect, a follow-up study that builds a deeper understanding of the subject is needed.

Development of the competency scale for primary care managers in Thailand: Scale development

BACKGROUND

The complexity of the primary care system requires a competent manager to achieve high-quality healthcare. The existing literature in the field yields little evidence of the tools to assess the competency of primary care administrators. This study aimed to develop and examine the psychometric properties of the competency scale for primary care managers in Thailand.

METHODS

The scale was developed using in-depth interviews and focus group discussions among policy makers, managers, practitioners, village health volunteers, and clients. The specific dimensions were extracted from 35 participants. 123 items were generated from the evidence and qualitative data. Content validity was established through the evaluation of seven experts and the original 123 items were reduced to 84 items. The pilot testing was conducted on a simple random sample of 487 primary care managers. Item analysis, reliability testing, and exploratory factor analysis were applied to establish the scale's reliability and construct validity.

RESULTS

Exploratory factor analysis identified nine dimensions with 48 items using a five-point Likert scale. Each dimension accounted for greater than 58.61% of the total variance. The scale had strong content validity (Indices = 0.85). Each dimension of Cronbach's alpha ranged from 0.70 to 0.88.

CONCLUSIONS

Based on these analyses, this instrument demonstrated sound psychometric properties and therefore is considered an effective tool for assessment of the primary care manager competencies. The results can be used to improve competency requirements of primary care managers, with implications for health service management workforce development.

Developing core competencies for monitoring and evaluation tracks in South Asian MPH programs

BACKGROUND

Monitoring and evaluation (M&E) provides vital information for decision-making and its structures, systems and processes are expected to be integrated throughout the life-cycle of public health programs. The acquisition of these skills should be developed in a structured manner and needs educational systems to identify core competencies in M&E teaching. This article presents our work on harmonizing M&E competencies for Masters level programs in the South Asian context and undertaking the global review of M&E track/ concentration offered in various Masters of Public Health (MPH) programs.

METHODS

Through an online search and snow-balling, we mapped institutions offering M&E tracks/ concentrations in Masters of Public Health (MPH) programs globally. We obtained detailed information about their M&E curriculum from university websites and brochures. The data on curricular contents was extracted and compiled. We analyzed the curricular contents using the framework for core competencies developed by the Association of Schools of Public Health (ASPH); and the Miller's triangle. This data was then used to inform a consultative exercise aimed at identifying core competencies for an M&E track/ concentration in MPH programs in the South Asian context.

RESULTS

Our curricular review of M&E content within MPH programs globally showed that different domains or broad topic areas relating to M&E are covered differently across the programs. The quantitative sciences (Biostatistics and Epidemiology) and Health Policy and Management are covered in much greater depth than the other two domains (Social & Behavioral Sciences and Environmental Health Sciences). The identification of core competencies for an M&E track/ concentration in the South Asian context was undertaken through a consultative group exercise involving representation from 11 institutions across Bangladesh, India, Nepal and Sri Lanka. During the consultation, the group engaged in a focused discussion to reach consensus on a set of 15 core competencies for an M&E track in South Asian MPH programs.

CONCLUSION

This work presents an opportunity for institutions to identify and re-examine their M&E competencies as a part of their specialized tracks within MPH programs. Our curricular analysis approach has the potential for adaptation and further use in curriculum analysis across different academic specialties.

Defining and Developing a Global Public Health Course for Public Health Graduates

Global public health is increasingly being seen as a speciality field within the university education of public health. However, the exact meaning of global public health is still unclear, resulting in varied curricula and teaching units among universities. The contextual differences between high- and low- and middle-income countries, and the process of globalization need to be taken into account while developing any global public health course. Global public health and public health are not separable and global public health often appears as an extension of public health in the era of globalization and interdependence. Though global public health is readily understood as health of global population, it is mainly practiced as health problems and their solutions set within low- and middle-income countries. Additional specialist competencies relevant to the context of low- and middle-income countries are needed to work in this field. Although there can be a long list of competencies relevant to this broad topic, available literature suggests that knowledge and skills related with ethics and vulnerable groups/issues; globalization and its impact on health; disease burden; culture, society, and politics; and management are important.

The effect of using different competence frameworks to audit the content of a masters program in public health

Objectives

(1) To quantify the effect of using different public health competence frameworks to audit the curriculum of an online distance learning MPH program, and (2) to measure variation in the outcomes of the audit depending on which competence framework is used.

Study Design

Retrospective audit.

Methods

We compared the teaching content of an online distance learning MPH program against each competence listed in different public health competence frameworks relevant to an MPH. We then compared the number of competences covered in each module in the program’s teaching curriculum and in the program overall, for each of the competence frameworks used in this audit.

Results

A comprehensive search of the literature identified two competence frameworks specific to MPH programs and two for public health professional/specialty training. The number of individual competences in each framework were 32 for the taught aspects of the UK Faculty of Public Health Specialist Training Program, 117 for the American Association of Public Health, 282 for the exam curriculum of the UK Faculty of Public Health Part A exam, and 393 for the European Core Competencies for MPH Education. This gave a total of 824 competences included in the audit. Overall, the online MPH program covered 88–96% of the competences depending on the specific framework used. This fell when the audit focused on just the three mandatory modules in the program, and the variation between the different competence frameworks was much larger.

Conclusion

Using different competence frameworks to audit the curriculum of an MPH program can give different indications of its quality, especially as it fails to capture teaching considered to be relevant, yet not included in an existing competence framework. The strengths and weaknesses of using competence frameworks to audit the content of an MPH program have largely been ignored. These debates are vital given that external organizations responsible for accreditation specify a particular competence framework to be used. Our study found that each of four different competence frameworks suggested different levels of quality in our teaching program, at least in terms of the competences included in the curriculum. Relying on just one established framework missed some aspects of the curriculum included in other frameworks used in this study. Conversely, each framework included items not covered by the others. Thus, levels of agreement with the content of our MPH and established areas of competence were, in part, dependent on the competence framework used to compare its’ content. While not entirely a surprising finding, this study makes an important point and makes explicit the challenges of selecting an appropriate competence framework to inform MPH programs, and especially one which recruits students from around the world.

Outcome and impact of Master of Public Health programs across six countries: education for change

BACKGROUND

The human resources for health crisis has highlighted the need for high-level public health education to add specific capacities to the workforce. Recently, it was questioned whether Master of Public Health (MPH) training prepared graduates with competencies relevant to low- and middle-income countries (LMICs). This study aims to examine the influence of the MPH programs geared towards LMICs offered in Vietnam, China, South Africa, Mexico, Sudan, and the Netherlands on graduates' careers, application of acquired competencies, performance at the workplace, and their professional contribution to society.

METHODS

A self-administered questionnaire was sent to graduates from six MPH programs. Frequency distributions of the answers were calculated, and a bivariate analysis and logistic regression of certain variables was performed.

RESULTS

The response rate was 37.5%. Graduates reported change in leadership (69%), in technical position (69%), acquiring new responsibilities (80%), and increased remuneration (63%); they asserted that MPH programs contributed significantly to this. Graduates' attribution of their application of 7 key competencies 'substantially to the MPH program' ranged from 33% to 48%. Of the 26 impact variables, graduates attributed the effect they had on their workplace substantially to the MPH program; the highest rated variable ranged from 31% to 73% and the lowest ranged from 9% to 43%. Of the 10 impact variables on society, graduates attributed the effect they had on society substantially to the MPH program; for the highest rated variable (13% to 71%); for the lowest rated variable (4% to 42%). Candidates' attribution of their application of acquired competencies as well as their impact at the workplace varied significantly according to institution of study and educational background.

CONCLUSIONS

This study concludes that these MPH programs contribute to improving graduates' careers and to building leadership in public health. The MPH programs contribute to graduates' application of competencies. MPH programs contribute substantially towards impact variables on the workplace, such as development of research proposals and reporting on population health needs, and less substantially to their impact on society, such as contributing equitable access to quality services. Differences reported between MPH programs merit further study. The results can be used for curriculum reform.

Public health education in South Asia: a basis for structuring a master degree course

Countries in South Asian Association for Regional Cooperation (SAARC) lack enough public health workforces to address their poor public health situation. Recently, there have been efforts to develop capacity building in public health in these countries by producing competent public health workforce through public health institutes and schools. Considering the wide nature of public health, the public health education and curricula should be linked with skills, knowledge, and competencies needed for public health practice and professionalism. The 3 domains of public health practice and the 10 essential public health services provide an operational framework to explore this link between public health practice and public health education. This framework incorporates five core areas of public health education. A master degree course in public health can be structured by incorporating these core areas as basic and reinforcing one of these areas as an elective followed by a dissertation work.