A Critical Review of Professional Identity, Competency Frameworks and Workforce Management in the Health Promotion Workforce
Keywords:
Health promotion workforce; professional identity; competency frameworks; community health workers; workforce management; sociology of professionsAbstract
Health promotion is studied intensively as a set of interventions and scarcely at all as a form of work. This critical
review reconstitutes the people who deliver health promotion as an occupational category and asks what is known about their
professional identity, competencies, remuneration, supervision and retention. Drawing on 94 sources spanning health
promotion competency and accreditation scholarship, community health worker research in low- and middle-income
countries, and the sociology of professions, it argues that the field studies two workforces, a small, credentialed specialist
cadre in high-income Anglophone systems and a large, largely unpaid and majority-female frontline cadre in the Global
South, never analysed together although they perform overlapping work. Four findings follow. First, sixteen years of
competency framework development has produced frameworks but almost no evaluation, and the field's own scoping review
found only two instances of evaluation across thirty-nine sources. Second, a European framework was relabelled global in
2016 without re-derivation, while the corresponding low- and middle-income scoping study was published as a report rather
than in the peer-reviewed record. Third, nobody can count this workforce; Nigeria's own health promotion policy mandates
a census of health promotion officers that remains unpublished. Fourth, where the workforce is counted it is frequently unpaid,
with fifty-nine per cent of unsalaried community health worker cadres meeting published criteria for labour exploitation
against ten per cent of salaried ones. The review argues that competency frameworks constitute professionalism imposed
from above without occupational control, proposes an occupational viability framework organised around enumeration,
jurisdiction, compensation and voice, and sets out a research agenda prioritising enumeration studies and African evidence.
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