IDENTIFICATION, TOOL DEVELOPMENT AND VALIDATION, AND ASSESSMENT OF CORE COMPETENCIES OF PUBLIC HEALTH PROFESSIONALS IN UTTAR PRADESH, INDIA

Core competencies are the key knowledge, skills, abilities, and attitudes that the health workforce should possess to effectively deliver essential public health services like epidemiological surveillance, situation assessments, and health promotion. Despite widespread recognition of the importance of core competencies, including by the World Health Organization, many low- and middle-income countries (LMICs) continue to face challenges in ensuring their public health workforce has the appropriate and adequate competencies. Contributing to this challenge are the absences of (i) agreed sets of core competencies, (ii) validated and reliable instruments to measure these competencies in these settings, and (iii) assessment of the factors such as self-assessed competencies and demographic variables that are associated with high competencies. This dissertation addresses these three research needs in Uttar Pradesh (UP), India’s most populous state with almost 230 million people, and some of the nation’s poorest health outcomes. The dissertation has three distinct but interlinked papers, each with their unique aims, methods, and results. The aim of Paper 1 was to identify a recommended set of core competencies for public health professionals in supervisory and program management roles in UP state. We used a multi-step, interactive Delphi technique to develop an agreed set of public health competencies for the state. Paper 2 aimed to develop and validate a reliable set of items that form a self-assessment tool to evaluate core public health competencies. It used a cross-sectional survey—adapted from the consensus focused Delphi technique (Paper 1)—to collect data from mid-level and senior health professionals in the state. We used an Exploratory Factor Analysis (EFA) as the primary statistical technique that utilized the Principal Component Analysis (PCA) method for factor extraction. Paper 3 explored the association of individual-level variables, including self-assessed competencies and demographic characteristics of health professionals, with performance on an objective core competency test. We relied on multiple linear regression to understand these associations. Paper 1 produced a consensus set of 40 core competencies in public health across eight public health 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. Paper 2 generated a 37 validated and reliable set of items that form the core public health competency (COPHEC) tool. Paper 3 found the seniority of public health professionals to be significantly associated with objectively measured competencies. Self-assessed competencies had a weak positive correlation with objectively assessed competencies. Paper 3 also discovered generally low competency scores for all respondents, and it found that mid-level professionals had lower objective measurement scores compared to senior health professionals, but higher self-assessment scores, perhaps indicating a cognitive bias. To our knowledge, this study presents a novel attempt to develop a framework and measurement tool for core competencies for practicing public health professionals in UP or elsewhere in India. The framework and tool can be used to review current training practices, assess competencies of public health professionals, and inform workforce development efforts such as the generation of competency-based job descriptions for recruitment and performance management in UP or other resource-poor settings globally. The significant association of seniority (and not the other variables such as the duration on a job) with objectively measured competency indicates that responsibilities may matter more in ensuring higher competency than time on the seat. Low scores in the objective test indicate significant gaps in competencies to perform public health functions, and opportunities to deploy measures like competency-based training to address these gaps. Given the low correlation between self-assessment and objective measurement, we recommend the administration of the COPHEC tool to be accompanied by objective measurement questions. Future research should test strategies to reduce cognitive bias by providing poor performers appropriate training, showing what good performance looks like, and providing meaningful feedback to strengthen competencies