Designing a Standardized and Sustainable Training Framework for Healthcare Workforce Capacity Building in Punjab,...

Background: A well-trained healthcare workforce is crucial for effective health service delivery and policy implementation. Despite the Primary and Secondary Healthcare Department's (P&SHD) efforts to improve physical infrastructure, critical gaps persist in the training system. This study aims to develop a standardized, effective, and sustainable training framework for healthcare professionals. Methods: The study was conducted from September 2024 to July 2025 using a convergent mixed-methods design. Responses were received from 26 DHDCs, representing an 83.9% response rate, with the DHDC serving as the unit of analysis. The qualitative component included 33 focus group discussions involving 270 participants, as well as 20 key informant interviews. Findings informed the development of the training framework using Kern's six-step approach and the Hennessy-Hicks Training Needs Analysis Model. Results: Of the reporting DHDCs, 96.2% had a dedicated training hall, 96.2% reported internet access, and 80.8% employed information and communication technology in training delivery. In contrast, institutional and governance capacity was markedly weaker: 16 of 26 centers lacked a documented definition of roles and responsibilities. Qualitative findings further revealed that trainings were frequently not needs-based, participant selection was perceived as influenced by favoritism and political considerations, standardized curricula and trainer criteria were absent, and evaluation was limited to attendance and satisfaction metrics. Thus, physical capacity and system functionality diverged substantially: the binding constraints were governance, coordination, staffing continuity, and financing rather than infrastructure. Conclusions: This study underscores the critical need for a standardized, sustainable training framework to strengthen the capacity and performance of healthcare providers.