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Using a Community Based Participatory Research Approach to Create a Competency Based Health Systems Strengthening Curriculum in a Developing Country

Abstract

Achieving a targeted, competency-based curriculum through an international partnership focusing on health systems strengthening is a challenge. Guided by community-based participatory research (CBPR) principles, researchers from Saint Louis University's College for Public Health and Social Justice (SLU) Department of Health Management and Policy joined an international effort to develop a hospital-based leadership and governance curriculum in a sub-Saharan low-to middle-income country (LMIC). This qualitative case study provides insight for (a) working with international partners to develop a health systems strengthening competency-based framework, (b) enhancing healthcare leaders' ability to engage stakeholders in efforts to improve community capacity in delivering health services, and (c) analyzing a CBPR approach in developing a health systems strengthening competency framework. Results indicate that a tailored, culturally relevant CBPR approach for developing a competency-based curriculum in a LMIC country is possible despite challenges. In particular, the CBPR approach provides a way to incorporate culturally relevant issues unique to the healthcare environment and context when developing a competency-based curriculum, while honoring all part-ners' viewpoints. The CBPR approach builds a foundation of trust among all partners, including research partners, which is critical for a true collaborative engagement among all partners.
Community-based participatory research in a developing country 121
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122 The Journal of Health Administration Education Winter 2016
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

  

   







  
           
    
   



   



 


    


Community-based participatory research in a developing country 123

Community-Based Participatory Research Approach (CBPR)



           





 

 





 

  





Health Systems Strengthening (HSS)




         

      



124 The Journal of Health Administration Education Winter 2016



 








The Link between Competency-Based Education and HSS









 
 





         
     

      
  



   

Community-based participatory research in a developing country 125
       
   

 




  



          



Using CBPR to Develop a Competency Framework to address HSS

    









          

        
   





126 The Journal of Health Administration Education Winter 2016

Feasibility and use of a CBPR approach to develop a targeted competency-based cur-
riculum for health care leaders in a LMIC within sub-Saharan Africa

  

















  

Data Collection
    
   
n
n
  
n
  






Community-based participatory research in a developing country 127
 





n

 


Developing the competency framework

       
 

     




 



 


 

 
          

 
   

128 The Journal of Health Administration Education Winter 2016

        


Competency identication and the curriculum framework
  


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

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

 
        

  
          
   


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


   

  



  




Community-based participatory research in a developing country 129



 






   


Analyzing insights from using a CBPR approach to develop a competency framework









Feasibility of developing a targeted competency-based curriculum to support health
systems strengthening through an international partnership focused on enhancing
in-country leaders’ ability to improve capacity for delivering health services
   
         



   



 
130 The Journal of Health Administration Education Winter 2016







A CBPR approach to developing a targeted competency-based curriculum for health
care leaders in a LMIC within sub-Saharan Africa








     





 







Analyzing insights from using a CBPR approach to develop a competency framework




        
Community-based participatory research in a developing country 131



  


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
132 The Journal of Health Administration Education Winter 2016

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   



 


   


Feasibility of developing a targeted competency-based curriculum to support health
systems strengthening through an international partnership







          




    

A community-based participatory research approach used to develop a competency-
based curriculum for health care leaders in a LMIC within sub-Saharan Africa





Community-based participatory research in a developing country 133



        
   



  
    

 

Analyzing insights from using a CBPR approach to develop a competency framework
designed to empower international partners


         
  
   







  

 





 

134 The Journal of Health Administration Education Winter 2016
 



   


 
   


    

Discussion summary points
 


          
 



 
    







          






Community-based participatory research in a developing country 135
 






   



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
          
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 
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 
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
 
        
        


136 The Journal of Health Administration Education Winter 2016


 
 Annual Review of Public Health, 26

Education, 118

 Journal of Public
Health Management and Practice, 9

 
 Participatory research in health: Issues and experiences
 
Social Science
& Medicine, 41
Qualitative inquiry & research design: Choosing among
ve approaches

 
 The Lancet,
376

 Voices of change:
Participatory research in the United States and Canada
 

 Study of participatory research in health
promotion: Review and recommendations for the development of
participatory research in health promotion in Canada
 
Community-based participatory research in a developing country 137

 
 
 Health Education & Behavior, 21

 
 Annual Review of Public Health, 19

 Journal of Urban Health, 82
Community based participatory research
for health
Community-based participatory research
for health: From process to outcomes
Human Resource
Management, 39

 
 Journal of Public Health Management and Practice, 9

 Health Policy and
Planning, 27

 
 

 Community-based participatory research:
Assessing the evidence
 
Everybody’s business: Strengthening health
systems to improve health outcomes: WHO’s frmaework for action. 
 
138 The Journal of Health Administration Education Winter 2016

   



 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 

 
 
 
 
 
Community-based participatory research in a developing country 139

 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 
 
 
140 The Journal of Health Administration Education Winter 2016
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 
 
 
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 
 
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 
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 
 
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 
 
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... Such a change is more than a paper exercise of upgrading a written curriculum. It involves multiple aligned activities including: understanding differences between traditional curricula and CBCs; aligning developments with global standards in nursing education; basing learning on best practices in known educational theories; embedding culturally relevant models of care; supporting faculty development; and building partnerships for effective clinical learning environments (44). As highlighted, it is important to ensure alignment of new curricula with global standards while reflecting local culture, context and population health needs (37). ...
... CBE demands movement away from teaching dominated by lectures, Power-Point presentations and didactic instruction. Changes in clinical instruction are essential with the requirement to move from time-based didactic strategies to focus on the acquisition of skills and competencies and achievement of clear learning outcomes (44,57,58). Therefore, success is dependent on parallel investments in faculty development focused on new pedagogical approaches. ...
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Nursing in Egypt has evolved over recent decades. Development has accelerated following recent government recognition of the contribution nurses make to healthcare access, quality and delivery. A vision to enhance nursing capacity resulted in a recent mandate requiring all nursing curricula to be competency based. Concurrently, the Educational Development Fund of the Egyptian Cabinet of Ministers drafted a nursing educational plan including a strategy to develop and implement a contextually congruent educational model with proven success comparable to international standards. This report discusses the 4-year curriculum development project designed to upgrade the current technical-level nursing curriculum to a consistent competency-based model. The competency-based educational model will be trialled in 3 technical institutes before nationwide rollout and implementation. Details of the project plan are described, including an overview of curriculum development considerations. This report provides insights for policy-makers and educators embarking on similar health workforce reform and capacity development initiatives. Copyright © World Health Organization (WHO) 2018. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).
... Participatory curriculum development has not been widely adopted outside of these fields. However, it has been used to some degree to develop training curriculums in a variety of other disciplines, including: adult second-language literacy (Auerbach 1992), higher education (Gubo et al. 2008;Alexander and Hjortsø 2019), healthcare leadership (Wilson et al. 2016) and the training of midwives (Sidebotham et al. 2017) and disability paraeducators (Parker et al. 2017). The current study builds on previous research by integrating the unique knowledge of disabled people to develop curriculums supportive of their needs, as informed by their experiences. ...
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The importance of a well-prepared public health workforce is widely recognized and appreciated. Strategies for enhancing workforce capacity and competency have been discussed by agencies, associations, committees, and expert panels since the landmark 1988 Institute of Medicine report. The need to foster the development of incentives for lifelong learning and career growth is of current interest to national public health associations and federal agencies. The fact that the public health workforce is not a single profession, but rather a fabric of many professions dedicated to a common endeavor, creates challenges to any singular approach. This article explores the relationships among competency, certification, and accreditation and summarizes the expert panel dialogue on workforce development incentives, specifically regarding certification and credentialing. The authors challenge public health leaders to become actively involved in framing the issues so the best possible strategies can be developed. The importance of a well-prepared public health workforce is widely recognized and appreciated. Strategies for enhancing workforce capacity and competency have been discussed by agencies, associations, committees, and expert panels1,2 since the landmark 1988 Institute of Medicine (IOM) report The Future of Public Health.3 The need to foster the development of incentives for lifelong learning and career growth is of current interest to national public health associations and federal agencies. Healthy People 20104 includes three workforce infrastructure objectives that are presented in Table 1.