Sir: We welcome the March issue letter from fellow Association members Claudio Schuftan and Urban Jonsson(1). This responds to our February WN contribution outlining a competency framework for public health nutrition workforce development (2).

A fully competent workforce is essential to improve global health. Policy reviews conducted by the World Health Organization(3), and by REACH (the UN ending child hunger and undernutrition initiative) (4), emphasise that a lack of a competent and well trained workforce impedes the effective delivery of policy goals.

These reviews, and our own personal experiences working in many different countries over many years, also show that responsibility for nutrition programmes needs attention at the highest level. A functioning system and structure is a pre-requisite of effective policies.

Yes, we agree that any comprehensive competencies framework needs to emphasise nutrition as a human right, and also needs to ensure that policies are implemented on the ground. The issues are similar in countries in the North and in the South. Some of the imperatives are indeed more urgent in the South. Our commentary did not include the comprehensive competency list in our draft report. This is linked here, and also is now posted on the Association website, under 'Professional affairs'. It explicitly identifies knowledge of the political, social, economic and environmental determinants of nutrition and health also as pre-requisites of effective practice.

In a recent report Olivier De Schutter, the UN Rapporteur on the Right to Food, details an agenda that highlights the indissociability of the two dimensions of this right (5). These are freedom from hunger, and access to adequate food. Policies cannot be separated from techniques, and techniques are essential to achieve political ends. Yes, a workforce that ignores issues such as inequity, that lacks dynamic leadership, and that does not recognise actual limitations and possibilities, can only increase the likelihood of political decisions that ignore the underlying and basic drivers of nutrition insecurity and malnutrition.

Perhaps our key objective may have been misread or misinterpreted, so here is some clarification.

We assert that a competency framework that codifies assessable knowledge, skills and attitudes, is needed to inform public health nutrition workforce development and ongoing professionalisation.

Frameworks for workforce development such as competency standards are by their nature reductionist and technical. We argue that the approach we take is holistic, in the context of the broader literature. Workforce preparation needs to be informed by scholarship and debate. Attention to the practical task of workforce development is important. We need to codify what knowledge, skills and attitudes students and practitioners need to be able to apply in practice to be effective, in a diverse range of practice contexts.

The existing competency framework we describe is indeed work in progress. It needs to evolve alongside the changing demands of practice in this field, broader international professional discourse, and findings from further scholarship.

This discussion is fundamental to the professionalisation of the Association. Our challenge is to make the whole system work better. All of us in public health nutrition need to press for political systems that work well and take important issues seriously. This requires a complex mix of competencies. When government ministers look for guidance as to what should be done, they need to look to our members and other well trained staff to ensure that necessary technical work is done properly.

The development of this workforce capacity requires more than training by means of short courses, university degrees and workshops. It requires a system for workforce development that integrates preparation with planning, continuing professional development support, and quality assurance. One key area of building capacity is how we work with others to strengthen the wider workforce. The more day-to-day work of delivering public health services will be done by many different people. They all need to be supported and enabled to work effectively. They all need guidance on best practice, to give them the best chance of working appropriately with and for their community. A key responsibility of professional public health nutritionists is to support this wider workforce, and to train, support and integrate them.

Public health nutrition is our business and our responsibility. We need to make sure that it works well, and when it doesn't, we need to know how and to be able to fix it. We need to collaborate and work collectively with many different groups and organisations, but the sign of a mature profession is that the buck stops with us. We need to agree and enact competencies, in order to fulfil our roles and responsibilities appropriately. If we don't do this, who will?

We are grateful to our colleagues for challenging us to be clearer. We would like to hear other views as well. This whole area is crucial, and we have a narrow window of opportunity. We must sort this out now!

Please cite as: Hughes R, Shrimpton R, Recine E, Margetts B. Competence: what for, and why. [Letter] World Nutrition, April 2012,3, 4: 164-167. Obtainable at www.wphna.org

References

1. Schuftan C. Jonsson U. Competence: for what, and so what? [Letter] World Nutrition, March 2012, 3, 3,: 81-84. Obtainable at www.wphna.org
2. Hughes R, Shrimpton R, Recine E, Margetts B. Empowering our profession. [Commentary] World Nutrition, February 2012; 3, 2, 33-56. Obtainable at www.wphna.org
3. World Health Organization. A Review of Nutrition Policies: Draft report. December 2010. http://www.who.int/nutrition/EB128_18_Backgroundpaper1_ A_review_of_nutritionpolicies.pdf.
4. REACH. Accelerating the Scale-Up of Food and Nutrition Actions. July 2010-June 2011. Rome: REACH, 2011.
5. UN Human Rights Council. Promotion and protection of all human rights, civil, political, economic, social and cultural rights, including the right to development. Report submitted by the Special Rapporteur on the right to food. Human Rights Council, 19th session, agenda item 3, December 2011.