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Hot Topic - Workforce development
Promoting optimal nutrition is the central focus of public health nutrition (PHN) as a discipline. While some progress has been made internationally in addressing undernutrition, progress has been too slow to achieve the Millennium Development Goals(1,2). Overnutrition, as expressed by rates of overweight and obesity, is rising in most countries(3), with many low- and middle-income countries now suffering a double burden. Many countries have responded by developing policies and action plans that are aimed at addressing these major nutrition problems(4), but they usually ignore issues relating to capacity to implement and the determinants of capacity such as workforce development(5). As a consequence, many nutrition policies and plans are not being effectively implemented(6). Building strategic and operational capacity is recognised as a critical determinant of the effectiveness of local, national and international nutrition systems in delivering optimal nutrition outcomes for populations(2,7). As both forms of capacity are dependent on purposive and multi-strategy investments in workforce development at all levels in the system, workforce development remains an outstanding and often neglected challenge in our discipline area. Workforce capacity deficits in PHN are a universal problem, even in rich economies with well-developed health systems(5,7-9). The key determinants of workforce capacity that are consistent internationally are summarised in Table 1.
Table 1
Determinants of public health nutrition (PHN) workforce capacity(5-9,17)
Workforce preparation | Inadequate and/or non-specific training, reliance on clinically trained practitioners |
Practice improvement and learning systems | Workforce practices do not reflect required work, limited targeting of interventions to most needy groups, strategy utilisation more aligned to clinical practice, limited environmental change strategy use, limited workforce mentoring, barriers to continuing competency development |
Human resource infrastructure | Small workforces relative to need, limited specialisation in PHN, high staff turnover, over-reliance on overworked health generalists |
Organisation and policy environment | Inadequate resource allocation to support action, leadership limited to rhetoric, absence of systematic and strategic workforce development, workforce disorganisation |
Intelligence access and use | Suboptimal access to PHN intelligence, under-developed workforce... |