---
title: "Self-perceived competencies of South African Master of Public Health graduates"
id: "plos-one-15-self-perceived-competencies-of-master-of-public-health-graduates-and"
canonical_url: "https://medichelpline.com/clinical-feed/plos-one-15-self-perceived-competencies-of-master-of-public-health-graduates-and"
content_type: "clinical_feed_article"
specialty: "General"
source_name: "PLOS ONE (Medicine)"
source_url: "https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360789"
published_at: "2026-10-16T14:00:00.000Z"
evidence_level: "Journal Feed"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Self-perceived competencies of South African Master of Public Health graduates
## Provenance & Clinical Metadata
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- **Specialty:** [General](https://medichelpline.com/clinical-feed/general.md)
- **Primary Source:** PLOS ONE (Medicine)
- **Source URL:** [Original Journal Publication](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0360789)
- **Published At:** 2026-10-16T14:00:00.000Z
- **Evidence Rating:** Journal Feed
## Executive GIST (TL;DR)
- A cross-sectional online survey assessed self-perceived competencies of 221 alumni who graduated with a **Master of Public Health (MPH)** between 2012 and 2016 from eight South African universities. - The instrument evaluated 58 competencies across 11 domains, scored through three lenses: applicability at work, whether the competency was obtained via the **MPH**, and confidence in applying the competency. - More than 80% of respondents reported needing competencies across all 11 domains in their work; alumni generally reported acquiring these from their MPH and expressed confidence in using them. - However, roughly 20% reported low confidence in **crisis management**; 13% were not confident in **health promotion** tasks. - Approximately 30% said their **MPH** did not provide adequate training in **crisis management** or **leadership** skills. - The survey found missing data increased through the questionnaire (25% attrition within the competencies section), but Little’s MCAR test indicated missingness was random. The team therefore analyzed completed items without imputation. - Respondents recommended more experiential learning, structured mentorship, expanded practical/problem-solving training, and faculty advocacy to support graduate employment. - The study authors note absence of nationally agreed core competencies for MPH programs in South Africa; findings are presented as a first step to inform program reviews and potential standard-setting, with emphasis on strengthening **monitoring and evaluation**, leadership and crisis management training. - Data are not publicly available due to confidentiality commitments to participants; the South African Medical Research Council funded the work. - The source article reports the study methods, scores, and internal reliability checks (Cronbach’s alpha for most domains 0.72–0.95) and details statistical handling but does not provide national competency thresholds or longitudinal outcome data.
## Clinical Analysis & Structured Key Points
Self-perceived competencies of Master of Public Health graduates and recommendations for programs in South Africa | PLOS One Browse Subject Areas ? Click through the PLOS taxonomy to find articles in your field. For more information about PLOS Subject Areas, click here . Article Authors Metrics Comments Media Coverage Reader Comments Figures Figures Abstract The Master of Public Health (MPH) degree is a key qualification for public health practice in low- and middle-income countries. Graduates entering practice should possess a range of competencies to address complex health issues in managerial, technical or research positions. As competencies of graduates exiting South African MPH programs are unknown, a consortium of academics from South African universities conducted an on-line survey of alumni exiting between 2012−2016, to determine their self-reported public health competencies and their recommendations for improving academic programs. Competencies were explored in 11 domains, through three lenses – their reported usefulness at work; perceptions whether they were obtained through MPH programs; and graduates’ confidence in their application. Over 80% of this cohort of 221 graduates, mostly in their mid-30’s, largely from South Africa and sub-Saharan Africa, needed the competencies in all 11 domains at work, which were felt to be largely obtained from the MPH, and most were confident using them. However, one fifth were not confident in crisis management and 13% were not confident in health promotion. On average 30% reported they did not obtain either crisis management or leadership skills from the MPH. Respondents recommended changes to course content and organization included more experiential learning, mentorship and faculty advocacy for graduate employment. In the absence of country-wide governance for public health education, the study is a first step towards developing core-competencies for South African programs. Findings can be factored into MPH program reviews with attention given to enhancing leadership, crisis management and monitoring and evaluation training into existing courses. Additionally, more experiential learning could fill identified gaps in problem-solving and project management skills. Producing a ‘fit for purpose’ public health workforce requires alignment of education objectives with health workforce systems in country contexts to ensure a seamless transition between learning and working. Citation: Zweigenthal V, Christofides N, Dlungwane T, Matlala SF, Mokgatle MM, Opare A, et al. (2026) Self-perceived competencies of Master of Public Health graduates and recommendations for programs in South Africa. PLoS One 21(10): e0360789. https://doi.org/10.1371/journal.pone.0360789 Editor: Takele Gezahegn Demie, SPHMMC: St Paul’s Hospital Millennium Medical College, ETHIOPIA Received: November 13, 2025; Accepted: October 1, 2026; Published: October 16, 2026 Copyright: © 2026 Zweigenthal et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: We assured respondents that all information provided will only be used for the purpose of the study. Consequently, no dataset can be made available. This was discussed with the Ethics Committee at the University of Cape Town. They pronounced that making the data available violates our undertaking as it undermines the trust between the researchers and study participants. Funding: This study would not have been possible without the support of the South African Medical Research Council which awarded a self-initiated grant for the conduct of the study. Laetitia Rispel holds a Research Chair as part of the South African Research Chair Initiative (SARChI) funded by the National Research Foundation (Grant # 102219). The views expressed in this study are those of the authors. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Competing interests: nil. Introduction A skilled health workforce is required to embed public health functions in countries’ health systems, facilitating initiatives to keep populations healthy [ 1 ] and improving their health status [ 2 ]. This workforce also contributes to clinical health service delivery, necessary for realizing the health related Sustainable Development Goals (SDGs) and universal health coverage [ 3 ]. As the World Health Organization (WHO) notes, core public health personnel collaborate with health care workers and professionals allied to human health (such as engineers), to deliver essential public health functions (EPHFs). Despite this, core public health personnel has been neglected in many countries’ health systems [ 4 ] in part due to the focus on clinical service delivery [ 5 ], the diversity of public health [ 6 ] and its invisiblity [ 7 ]. Ironically, public health becomes visible during disasters or health crises that are preventable or unexpected such as the COVID-19 pandemic [ 8 ]. The pandemic highlighted public health, its workforce, and the need for resilient health systems [ 9 , 10 ]. In Africa, the COVID-19 pandemic exposed how gaps in public health expertise resulted in inadequacies in surveillance, outbreak management and communication [ 11 ]. Consequently, the WHO embarked on a public health project that defines EPHFs, competencies needed for these functions and roadmap that serves to measure countrywide capacity [ 3 ]. In low- and middle-income countries (LMICs), public health training has focused on Master of Public Health (MPH) as the main qualification for public health practice, reflected in an increasing number of institutions that offer MPHs and a growing numbers of graduates [ 12 ]. Competency-based education is an approach that aims to ensure that graduates exit educational programs with measurable outcomes in knowledge, behavior, skills as well as attitudes [ 13 ]. The focus is on graduates’ ability to mobilize skills and qualities to successfully perform in particular contexts [ 14 ]. The MPH degree, introduced by several universities in South Africa over the last three decades [ 15 ], has no nationally agreed upon set of competencies. Universities determine the content of course work, which is accredited and quality assured by mandated educational authorities [ 16 ]. In addition to teaching traditional public health disciplines, there has been a proliferation of MPH tracks in specialist areas such as rural health, maternal and child health, environmental health and social behavioral communication, in response to the growth and breadth of public health and the diverse research and expertise of course coordinators or educators. However, there are knowledge gaps on specific competencies attained across the various MPH programs in South African and whether graduates share a common core skill set upon completion. While a previous study of University of KwaZulu-Natal (UKZN) MPH graduates reported that they had acquired skills in report writing, critical analysis, research, leadership, and management [ 17 ], there is limited educational research that examined the competencies of alumni of South Africa’s MPH programs. Consequently, a consortium of public health academics from eight South African universities that graduated MPH students between 2012 and 2016 conceptualized an overarching mixed methods study to describe the socio-demographic characteristics of graduates, their career paths, competencies, leadership skills and impacts at work and in society. Their demographic characteristics, career trajectories, perceived competencies, leadership skills and perceived impacts as well as recommendations about MPH graduates’ roles are reported elsewhere [ 18 , 19 ]. This paper reports on graduates’ perceptions about selected public health competencies through three lenses: their usefulness at work, the extent to which these were obtained from the MPH; their confidence in applying them; and their recommendations to improve MPH programs In South Africa. Methods This was a descriptive, cross-sectional, collaborative study among all eight South African university public health departments that graduated MPH students between 2012 and 2016. Universities that participated in the collaborative study were Sefako Makgatho Health Sciences University (SMU), the University of Cape Town (UCT), UKZN, University of Limpopo (UL), University of Pretoria (UP), University of Venda (Univen), University of the Western Cape (UWC), and the University of the Witwatersrand (Wits). During the study focus period, SMU and UL were combined as one university that taught the same curriculum at two campuses in two different towns. Hence, we merged the results from these alumni. Universities with newer or inactive programs were excluded. Each university developed a list of eligible alumni and their contact details. Recruitment into the study was delayed by the COVID-19 pandemic, and the on-line survey was undertaken from 2022 until 2023. Consequently, alumni had between six and eleven years post-graduation experience which allowed for substantial work experience and reflection on their competencies. The survey consisted of closed-end statements using Likert scales and open-ended questions, allowing for free comment. Development of the competency tool Prior to conceptualization of the study, our consortium members held informal discussions on MPH programs at the 2015 and 2016 annual conferences of the Public Health Association of South Africa. In 2018, when the study was conceptualized, we adapted Zwanikken et al .’s 2014 approach [ 20 ] which had included one South African university to develop our competency framework. Their validated instrument for LMIC settings is based on the literature, modified Delphi panels among experts and alumni, which yielded a high degree of consensus, suggesting that their set of competencies has content validity and could be used to design and evaluate MPH programs. Although Zwanikken et al. acknowledged the US Linkages framework, they gave greater prominence to those public health competencies that incorporated the complexity and context of LMICs. Additionally, Zwanikken et al., combined a review of the stated competencies of their six institutions, consensus building and validation of their tool focusing on self-perceived competence to arrive at seven competency categories [ 21 ]. Our tool built on Zwanikken et al .’s tool, and added questions derived from previous questionnaires used in MPH alumni studies in South Africa [ 17 , 22 ], and the experiential knowledge and curricula of investigators from the eight participating institutions. We also considered traditional public health curricula which have been organized around five core disciplines: biostatistics, epidemiology, environmental health, health policy and management, and social and behavioral sciences [ 23 ]. The tool was piloted among MPH graduates participating in our qualitative study and with MPH alumni from all eight institutions who were not part of the cohort of interest to determine face validity. Following the pilot, competencies in project management, financial literacy and managing crises were added to the tool. The final self-administered questionnaire (SAQ) was housed in and administered through REDCap (Research Electronic Data Capture v 13.1.37), a secure web application for managing online surveys and databases [ 24 ]. The SAQ included items about graduates’ demographics, educational backgrounds, career paths and recommendations for graduate roles in the light of COVID-19. Their demographics, educational backgrounds, career paths, leadership skills and perceived impact at work and in society are reported elsewhere [ 18 , 19 ]. The final SAQ examined 58 self-perceived competencies in 11 domains: 1) Public health sciences, 2) Health promotion, 3) Monitoring and evaluation (M&E), 4) Health policy, 5) Communication, 6) Context sensitivity, 7) Community and intersectoral skills, 8) Planning and management, 9) Crisis management, 10) Academic, and 11) Leadership. M&E became a separate domain as analysis of data from routine service delivery is the foundation of core public health work in the public sector in the South African setting. The ability to manage crises emerged as an important domain following the COVID-19 pandemic. As detailed in Table 1 , each domain had between two and seven statements and Zwanniken et al .’s categories are indicated. Download: PNG larger image TIFF original image Table 1. The eleven competency domains with their specific activities. https://doi.org/10.1371/journal.pone.0360789.t001 We use three lenses to assess self-reported competencies of MPH graduates – the applicability to their work settings; whether competencies were attained or acquired from the MPH; and respondents’ confidence in applying or using competencies in practice. Each lens was scored using a tailored four-item Likert score. Applicability was scored from: 1 = not applicable to 4 = very applicable; Acquisition from MPH: 1 = not from MPH to 4 = MPH enabled substantially; and confidence from: 1 = not confident to 4 = very confident. The wording of the SAQ is shown in S1 File , the questionnaire. The scores were recoded, to yield a maximum of 3 for each item, giving a minimum score of 0 and a maximum of 21 for domains with 7 items. The Likert recoded scoring system for each competency domain is detailed in S1 File . Their recommendations for improving MPH courses were elicited through a Likert scale rating the desirability of three items – practical experience, problem solving skills and mentorship, as well as through an open-ended question. The scale ranged from 1–5: 1 = strongly disagree; 2 = disagree; 3=neither disagree nor agree; 4 = agree; 5 = strongly disagree. Data collection and response rate The recruitment of respondents is detailed elsewhere [ 18 ]. Following ethics approval from all participating universities, we attempted to contact 710 eligible graduates (2012–2016) from all eight universities, regardless of nationality and country of work. For five universities, graduates were emailed through REDCap, inviting participation, and this enabled tracking of non-responders. As three universities’ academic departments were not permitted to divulge identifiers of their graduates, those alumni were invited by academics or university administrators through emails which contained a link to the on-line survey. Recruitment for all institutions commenced on 04/05/2022 and closed on 10/08/2023, except for UWC which started after 18/05/2022. As graduation and up-to-date contact details varied by institution, there was uncertainty as to when some graduated and if eligible graduates were successfully contacted (see figure in S2 File ). The denominator for response rates was determined by counting those that we attempted to contact by email (n = 658), short messaging service or by phone. Those invited needed to complete the online consent form before completing the questionnaire, by clicking ‘yes’ or ‘no’. In the case of the latter, the survey terminated immediately. Respondents did not have to complete the questionnaire in one sitting and could return it using a unique link. Patterns in missing competency survey data were explored. Reviewing the data revealed that the frequency of missing data increased as the questionnaire proceeded, as depicted in Fig 1 , from 167 responses at the beginning of the competencies section to 125 at the end, signifying attrition of 25%. Fig 1 shows that the extent of missing data was relatively consistent across each lens and domain, indicating comparable levels of questionnaire completeness within each domain. Missingness was, therefore, highly correlated across lenses for all competencies and domains. We determined that missing data were not related to hidden patterns or variables using Little’s Missing Completely At Random (MCAR) test by testing one lens for all 58 competencies in the 11 domains, which was not significant (p = 0.74). This “means that the missing data was a random sample of the complete data”, and could be considered ignorable [ 25 ]. Consequently, missing responses were not imputed, and likelihood-based methods were not used to generate values for the missing data. Scores were therefore calculated only for completed items, with the sample size reported for each variable analyzed. Download: PNG larger image TIFF original image Fig 1. Median missingness of data by competency domain. https://doi.org/10.1371/journal.pone.0360789.g001 Data storage and analysis The REDCap application enabled encrypted data storage. No identifiers were captured, and the anonymized dataset was analyzed using STATA 13. Data was cleaned by removing respondents who graduated before 2012 and those graduating after 2017. We combined the responses of SMU and UL graduates as they were one institution from 2005 until April 2015. Quantitative data analysis Descriptive analyses were undertaken for variables derived from closed-ended questions. Summary statistics were calculated for variables, including competency scores, with appropriate measures of central tendency for normal and non-normally distributed data, and 95% confidence intervals (CI) for proportions. T-tests and χ-squared tests compared means and proportions between groups. As the Likert scores were essentially ordinal, competency scores for each respondent were calculated for each item in the 11 competency domains and totaled. All items were weighed equally. Totals were calculated for all three lenses – their applicability to work, extent they were perceived to be obtained from MPH and graduates’ confidence in their use. Shapiro-Wilk tests were performed on all composite competency data – the 11 domains through the three lenses, which demonstrated that 31 of the 33 variables were not normally distributed (p 0.9 indicating excellent consistency [ 28 ]. A low number of questions can yield a low value of alpha, such as was the case for community and intersectoral competence [ 29 ]. Recommendations to improve the MPH program, ascertained through three closed ended questions, used Likert scales – of strongly disagree = 1; disagree = 2; equivocal = 3; A
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