Identifying competencies of primary health care teams in Bhavnagar district, Gujarat

Primary healthcare (PHC) services provided by multi-disciplinary teams is essential for delivering comprehensive, integrated health services. PHC policies in many low- and middle-income countries emphasize team-based approaches. While competencies (knowledge, skills, and attitudes) of specific health worker cadres have been identified, collective competencies of PHC teams have not been examined. Knowing these competencies will inform development of capacity building initiatives to strengthen PHC team functioning and performance. This study presents findings from an exercise to identify key competencies of PHC teams in Bhavnagar district, Gujarat, India. Team competencies were derived through a multi-step process. We searched the literature to develop an initial list of PHC team functions. We held consultations with technical experts and PHC team members where participants reviewed, edited, and developed a list of PHC team functions and identified corresponding knowledge, skills, and attitudes the PHC team must possess. Participant responses were analyzed and PHC team competencies clustered thematically. PHC team functions comprised taskwork and teamwork activities at community and facility levels. PHC team members viewed their functions through a cadre-specific lens. Identified team competencies were clustered under six themes: technical and clinical, which included use of data and digital tools and ability to implement clinical and technical protocols; communication; shared leadership and accountability; problem-solving; conflict management; and team values. While recognizing the importance of technical and clinical competencies, participants prioritized the "softer" competencies. Findings of this study suggest the importance of training PHC team members on competencies beyond the technical and clinical competencies, that strengthen ways in which teams work together. Further, teams should be trained as a unit to reinforce these competencies. The study also suggests a need for policy and organizational reforms to support team-based care. Strengthening PHC team competencies can enable the team to perform its functions better, contributing to improved service delivery.