Competence framework for Public Health professionals in the Peoples-uni.org Dick Heller Peoples Open Access Education Initiative

Background Peoples-uni.org plans to offer problem and competence based educational context around open source materials on the Internet to assist in Public Health capacity building for developing countries. This report examines published Public Health professional competencies for relevance to this mission. –Comparing published competences –Mapping against one of the course modules in the Peoples-uni

Educational framework Identify a number of important Public Health problems (such as maternal mortality); Assess the most pressing educational need (such as for masters or certificate level competence for midwives, doctors or others); Identify the competences required to met the need; Find on-line resources available to meet these competences; Develop a set of focussed discussion topics that will help students to collaboratively learn to meet the required competencies with the assistance of group facilitators; Assess and accredit the learned competencies. In addition, consistent with the Web 2.0 philosophy, revise the resources as they are used, to ensure local relevance, to replace materials in future iterations.

Search A search was conducted through MEDLINE (terms Public Health and Competencies; developing countries and competencies) and various Internet search engines with secondary searching. A number of competence descriptions were identified.

Competencies or competences defined by various individual courses or universities were not examined further, but those produced by national, regional or international bodies were explored. We then attempted to apply the competencies to the education being planned through the Peoples-uni, which starts with a Public Health problem

example Child mortality for an Indian audience Map our competences against one of the published competency sets (from the Canadian Public Health Agency)

Findings (1) The majority of identified competencies for Public Health came from developed countries, although the Pan American Health Organisation and two Asian sources were identified. Most were the results of the deliberations of committees or of group discussions at conferences. Some were the results of Delphi surveys.

Findings (2) four lists of competencies from four different countries each have published specific ‘sub- competencies’ as well as the general domains or areas each represent the viewpoint of the public health service provider

Authors of competence lists NSW Australia Department of Health Public Health Agency of Canada US Council on Linkages between Academia and Public Health Practice UK (Faculty of Public Health, 2007)

Variation number of areas/domains varies from 7 to 11 number of specific competencies varies from 167 (UK Faculty of Public Health) to 44 (Public Health Agency of Canada) difference between functions and competencies is frequently blurred in both the competencies described and the discussion

Deficiencies of published lists In our educational framework, we identify the public health problem (in this example child mortality) and the educational need (for graduate health professionals who require Masters level competence) Matching the published competencies with those required to deal with practical understanding of, and solutions for, the burden of child mortality in developing countries, we find major limitations

Deficiencies of published lists Published competencies have large gaps and inappropriate emphases. The gaps are in the areas of basic public health discipline of epidemiology and in the skills of assessing the evidence base, and there is excessive focus on details of policy implementation. We have identified five relevant competences, which map against some of those published elsewhere in outline but not in detail.

Summary of findings The majority of published Public Health competences are designed for non-developing country settings. There is confusion between competence and function in some of the publications. There are differences between the various competency lists in content, both range and depth. When the educational process is planned to start with a Public Health problem (such as child mortality), rather than with a curriculum content area (such as epidemiology), deficiencies in published competencies are readily apparent.

Competences for new programme Revised lists of competences are therefore necessary in an educational programme such as the Peoples-uni, and this may also be the case for other programmes. In order for a new programme to maintain credibility, however, it is important to ensure that mapping against published competencies is carried out.

Our suggestion for competence framework (1) Identify the problem-specific area for which the competence is required. Identify the level at which these competences should be achieved, depending on the professional target group for the education. Identify, for starting purposes, apparently relevant published competence requirements for Public Health practitioners. For each ‘problem’ in the problem based course, determine competence parameters of relevance for the setting and level at which Public Health is to be practiced by the students, and map these against the published competencies.

Our suggestion for competence framework (2) Aggregate the competences across each of the ‘problems’ for the whole course, to produce a set of relevant competences for the target professional group, and ensure that over the extent of a whole course (certificate, diploma, masters) an appropriate range of competence requirements have been met. Where differences are seen between these and published competences, determine that large gaps in competences are not being seen, to allow credibility of the education to be maintained. Adopt a strategy so that this process is replicated for each setting in which the education is to be delivered, to ensure local relevance.

Future needs Various organisations have identified more specific competencies, for example for Public Health practitioners focussing on surveillance or for chronic disease management. New competence descriptions will be required as priorities and new areas develop, such as informatics, SARS, disaster management and bioterrorism preparedness.

Peoples-uni.org is still very much under development. All suggestions, contributions and collaboration would be much welcomed. Please contact ¡Muchas Gracias!