A consortium of eight South African public health departments surveyed 221 alumni who completed an MPH between 2012 and 2016 to map self-perceived competency coverage and readiness for practice. The cohort, mainly in their mid-30s and drawn from South Africa and sub-Saharan Africa, reported that competencies across 11 domains were relevant to their work: over 80% indicated that they needed these skills on the job. The investigators assessed 58 discrete competencies organized into domains including monitoring and evaluation, health promotion, policy, communication, community and intersectoral work, planning and management, academic skills, and leadership. The tool was adapted from validated instruments for LMIC settings and piloted among alumni prior to rollout.
Respondents generally felt their MPH programs had equipped them with the necessary skills and expressed confidence in applying most competencies. Median domain scores were converted into percentage metrics for interpretability, and internal consistency checks showed most domains had Cronbach alpha values between 0.72 and 0.95, indicating acceptable to excellent reliability for the composite measures used in the survey.
The team used three lenses to evaluate each competency: applicability to work, perceived acquisition from the MPH, and confidence in application. Each lens used a Likert-style scoring system which was recoded to permit per-domain summation and conversion to percentage scores for comparability. Data collection occurred between May 2022 and August 2023 via REDCap, and analysis used completed items only after determining that missing data were Missing Completely At Random.
Scores showed a consistent pattern: many competencies were reported as both relevant to practice and as having been substantially enabled by the MPH. Confidence in applying these skills tended to mirror perceived acquisition and workplace relevance; Spearman correlations across the three lenses were calculated by the study team to examine these relationships. The investigators did not impute missing responses and reported sample sizes for each calculated metric.
Despite generally positive self-assessments, the survey identified persistent gaps. About one fifth of respondents reported not being confident in crisis management, and 13% reported not feeling confident in health promotion. On average, roughly 30% of graduates indicated they did not obtain adequate crisis management or leadership training from their MPH programs. The emergence of crisis management as a separate domain reflected lessons from the COVID-19 pandemic; the authors explicitly added it to the competency set after piloting the questionnaire.
These gaps were not uniformly distributed across domains; community and intersectoral competencies—comprised of fewer items—produced lower Cronbach alpha values, which the authors attributed to the domain’s limited item count rather than poor measurement per se. The study does not provide objective performance data or employer assessments to triangulate self-reports, and it does not report specific curricula, module hours, or pedagogical methods from participating programs.
Alumni provided concrete suggestions to address perceived shortfalls. Practical experiential learning ranked highly among recommended reforms; respondents favored more workplace attachments, hands-on projects, and applied problem-solving approaches within course structures. Mentorship—formalized and ongoing—was proposed to support the transition from study to employment and to strengthen professional advocacy for graduate hiring.
Graduates also recommended enhanced content in monitoring and evaluation, project and financial management, and structured leadership development. The study team asked respondents to rate the desirability of adding practical experience, problem-solving skills, and mentorship using Likert scales, and open-text responses reinforced the call for more applied learning and faculty involvement in bridging students to employment opportunities.
The collaborative design, inclusion of eight universities, and use of a validated LMIC-focused framework adapted for South Africa are strengths. The alumni had 6–11 years of post-graduation experience at the time of survey, allowing reflection on workplace relevance. Data storage and analysis used REDCap and STATA; the investigators reported standard descriptive and non-parametric analyses appropriate for ordinal data.
Limitations are explicit in the source. Recruitment methods varied by institution because of differing access to alumni identifiers; response denominator was set at 658 attempted contacts, and item-level attrition rose through the competencies section (about 25% loss). The authors tested missingness and concluded it was random, but they did not impute missing items. The study relies on self-reported perceptions without employer validation or objective competency testing, and the questionnaire did not capture detailed curricular hours or pedagogical sequences—information the source did not report.
The authors framed the study as a foundational step toward establishing nationally aligned core competencies for South African MPH programs. They recommend that program reviews consider strengthening leadership, crisis management, and monitoring and evaluation training, and expand experiential learning and mentorship to better align education outputs with workplace requirements. The source did not report regulatory timelines, nor did it provide national competency benchmarks; these remain open questions for policymakers and educators.