Porto workshop members. From left, Barrie Margetts, David Sanders, Emorn
Wasanwisut, Geoff Marks, John Mason, Roger Hughes, Roger Shrimpton

Barrie Margetts writes: The Association is now ready to build our own capacity, and also that of health professionals whose work involves nutrition, throughout the world, and most of all in less resourced regions and countries. This is our pledge, at the beginning of this year. Association members have already done a substantial amount of preliminary work, led by professional affairs secretary Roger Hughes (next to right, above), now joined by John Mason and Roger Shrimpton (flanking him, above). Some of this work in progress was presented at a special tw-day pre-congress workshop at Porto on 22-23 September. A report follows. The workshop’s tasks included agreement on work to be progressed, published and actioned in 2011.

The Porto workshop

Roger Shrimpton reports. We held this workshop before the Porto congress, as part of our professional affairs work. One of the responsibilities of the professional affairs team is to convene expert groups to carry out tasks such as this. Thus we brought together professionals with relevant experience from different parts of the world and from a range of settings. Our purpose was to identify areas where the Association could provide leadership.

The Porto workshop participants were Barrie Margetts (facilitator), Roger Hughes, John Mason, David Sanders, Sonia Khan, Edna Possolo, Pak Minarto, Elisabetta Recine, Janine Coutinho, Patricia Gentil, Ana Beatriz Vasconcelos, Geoff Marks, Emorn Wasantwisut, and myself. Apologies to those not pictured above.

Purpose and method

The overall objective of the workshop was to reach a common understanding of the competencies required by professionals to build capacity at national, provincial and district levels. ‘Competencies’ here means the knowledge, skills and attitudes required effectively to perform in practice. The capacity to be created is primarily to accelerate reduction of maternal and child undernutrition. But the double burden of chronic diseases superimposed on undernutrition now weighs on most lower-income countries, and requires professionals equipped to deal with this reality.

The workshop involved case study presentations by country representatives, followed by presentations outlining rationale, conceptual issues and strategy initiatives related to capacity building, particularly in the context of Association activity, and next steps that we should take.

Brazil. Ana Beatriz Vasconcelos presented the Brazilian experience, including the revision of the national food and nutrition policy after ten years, which emphasises nutrition in primary health care, the strengthening of procedures for professional qualification, and the ongoing work of strengthening in-service training and support.

Indonesia. Pak Minarto described the situation of capacity building for nutrition manpower in Indonesia, including a roadmap for its further development.

Mozambique. Sonia Khan and Edna Possolo presented the strengths and weaknesses of the current health system human resources for nutrition in Mozambique, and outlined challenges to be faced.

Australia. Roger Hughes presented Australian experience, and then summarised the Association’s professional affairs team’s work to date in developing international competency standards, and also a certification system for practitioners.

Ethopia. John Mason described the scale of the work needed, using Ethiopia as an example. He then also described the potential role of the projected Public Nutrition Virtual University, including curriculum requirements.

South Africa. David Sanders described some of the challenges as well as ongoing efforts in Africa, including experience gained with distance learning through his own school of public health of the University of the Western Cape in South Africa.

Decisions

The workshop concluded with a number of key decisions:

• A comprehensive approach to capacity building is required. This needs to recognise the importance of workforce development, and also leadership development, academic institutional strengthening, organisational development and partnerships
• There is merit in developing international competency standards specific to public health nutrition workforce development that recognise different workforce tiers (frontline, manager, specialist) and different practice contexts (under- and overnutrition).
• There is considerable overlap in the competencies needed by a public health nutritionist in dealing with over- or undernutrition. A core set of competencies are equally valid in either setting, with different emphases depending on the context.
• There is a need for strategic thinking and ongoing dialogue on the process and strategies required to assist capacity development. The role of the Association as a global standard setting body is of critical importance.
• The proposed Public Nutrition Virtual University is a very promising idea. The curriculum it uses would benefit from being linked to and informed by the competency development work.

Discussion papers

It was also agreed that discussion papers be developed by the workshop participants for submission to World Nutrition or Public Health Nutrition. The purposes of these papers include

• To agree the policy and programme basis for accelerating the reduction of maternal and child undernutrition in countries most affected, while recognising the coexistence with overnutrition.
• To agree the competencies required at different levels in the health system, and to define curricular requirements (including content, learning, teaching and assessment strategies) required for competence at each level.
• To recommend to the Association the next steps, including how we should support the development of required capacity across the many countries that are most affected by maternal and child undernutrition

Competency standards

Roger Hughes, Elisabetta Recine and I are now preparing a paper outlining the competency standards and curriculum requirements for public health nutrition, drawing on existing research and national competency standards. A draft has been out for consultation, and a final draft is now ready. The paper will be finished and submitted for publication in World Nutrition in the first half of this year.

Capacity building process and strategy

John Mason, David Sanders and Geoff Marks are now preparing a paper on strategies and processes, including the proposed Public Nutrition Virtual University. Topics suggested included: examples of courses needed and possible sources; technology for instruction and mentoring; pedagogic methods; development of websites and interactive mechanisms; faculty and professional exchanges; certification; leadership development. From this an advocacy paper describing the imperatives and issues concerning global capacity building is also planned.

Barrie Margetts adds: This work is now a top agenda item for the Association Council, of which Roger Hughes and Roger Shrimpton are members. At our February meeting we will agree concrete plans for the whole of 2011. Watch this e-space. We are also well aware that paper agreements are necessary as a preliminary to action, and we will be reporting on example of best practice also during this year.