Through the curricular review, we identified 21 programs offering an M&E track/ concentration as part of their postgraduate educational program. The list of the institutions is depicted in Table 2 below.

Table 2 List of institutions offering M&E track/ concentration as a part of their educational program globally Full size table

We included 19 programs which offered detailed information permitting a curricular review. The results of the frequency and depth of the domains have been depicted in Fig. 2 below, where the five core ASPH domains are depicted as circles. The thickness of the boundary for each circle represents the frequency of inclusion of each domain within the curricula of the included institutes. It is evident from the figure that majority of the curricula of M&E tracks/ concentrations currently include Biostatistics. This is closely followed by the Health Policy and Management domain. The Environmental Health Sciences domain has the lowest representation in M&E tracks/ concentrations.

Fig. 2 Global situation: Curricular content and depth across M&E tracks/ concentrations Full size image

The area of each circle represents the depth of inclusion of the curricular content in that domain. As Fig. 2 suggests, both Biostatistics and the Health Policy and Management domains are covered in much greater depth across M&E tracks/ concentrations globally as compared to the other domains. The Environmental Health Sciences domain is covered with the least depth among these five core domains.

Figure 2 represents the depth of each domain that currently exists in M&E tracks/concentrations. Whether this current admixture of the level of domains is an appropriate mix or what is an appropriate mix was not a direct output of the current activity.

The list of core competency statements for M&E tracks/concentrations that were agreed upon by the group is as follows:

1. Ability to develop/use M&E tools with special reference to National Health Programs 2. Ability to develop and design framework and link the indicators with frameworks 3. Ability to identify the sources of data, collect, manage, analyze and interpret data 4. Ability to assess and maintain quality of data 5. Ability to comprehend M&E concepts and importance of M&E & differentiate between M&E 6. Ability to identify, develop and evaluate indicators 7. Ability to identify and engage stakeholders at all levels 8. Ability to identify evaluation designs and conduct an evaluation 9. Ability to write reports, communicate & disseminate M&E information 10. Ability to manage and lead the M&E team 11. Ability to critically appraise the M&E system 12. Ability to identify appropriate principles and guidelines to ensure ethical conduct of M&E 13. Ability to use M & E data to support decision making, advocacy and other purposes 14. Ability to design M&E systems in terms of social (social stratification), economic, and cultural context 15. Ability to develop and implement a M&E Plan

The competency-driven approach towards public health education is suggested as an indispensable component of public health education [10, 11]. It addresses the supply-side of the health systems and works towards creating the right balance of skill-sets among future public health professionals.

According to Le Boterf as reported in Brahimi [12] “the concept of competency has to be consistent with the changing contexts and situations in the workplace.” Since developing countries differ from developed countries in their public health challenges, there are differences in healthcare delivery and the competencies that are expected of these graduates. There are concerns about whether existing programs in low and middle-income countries (LMIC) equip public health alumni to be effective, and whether the taught competencies from these programs are relevant to their contexts [13]. The multidisciplinary learnings of public health bring together people with diverse professional qualifications who have to rely on each other for their day-to-day functioning. These public health professionals should have the ability to understand the problem, while possessing an ability to identify and implement efficient solutions. This multidisciplinary approach towards addressing public health concerns demands complex skills among public health professionals. Competency frameworks are the building blocks that help structure training programs that lead to the acquisition of relevant skills.

These competency frameworks should be designed while remembering that a properly designed MPH degree is expected to be intellectually challenging, with emphasis on active, student-centered learning, problem solving and acquisition of essential public health practice skills [14]. The development of competency frameworks [15–17] is ideally guided by sound research and consultation, is evidence-informed and yet flexible enough to be adopted across diverse institutional settings. Competency frameworks are however scarcely documented for public health programs in developing countries. There have been limited efforts in the South Asian context to develop public health competencies for under-graduate and post-graduate public health education.

The program contents in M&E tracks/ concentrations would be expected to show variability in the reported curricula. This variability could represent an actual difference in the curricular contents between the programs; or a poor reporting of what actually gets covered as a part of the teaching. While the latter continues to remain a limitation of our work, we addressed the issue of accurately reporting the curricular contents against a standard framework. The group chose to proceed with the ASPH core competency model for MPH programs [15] as a standard reference against which we judged the curricular contents included within an M&E track/ concentration. The ASPH core competency model is universally recognized, widely adhered to and has been developed through a rigorous methodology.

The inclusion of a particular topic within the curricular contents of a specific academic program was an area of potential subjective variations in its analysis.

Our curricular review showed that different domains of the framework are covered differently across the programs. The quantitative sciences (Biostatistics and Epidemiology) and Health Policy and Management are covered in much greater depth than the other two domains (Social & Behavioral Sciences and Environmental Health Sciences). This is attributable to the greater ‘hands-on doing’ exercises and working on real-time datasets that gets reflected in the quantitative sciences, particularly Biostatistics. This has resulted in the quantitative sciences getting a higher score in the depth of coverage along with health systems. The M&E track/ concentration had a higher frequency of inclusion of these three domains when compared to the Social & Behavioral Sciences and Environmental Health Sciences as is evident by the thickness of the circle boundaries.

The structure and duration of an ideal M&E track/ concentration for a country or a region could vary considerably depending on the needs and structure of the health system, the health system priorities and the ability of health professional educational systems to respond to these priorities. Although our work drew upon the experiences of several senior experts, there is scope for further fine-tuning once there is some experience in delivering these competencies through an academic program.

The limitations of our work include the presence of subjectivity in assessing the curriculum. We partly addressed it through independent review of the curriculum by multiple team members. Inconsistencies or differences in results were discussed and addressed. We looked only at the core ASPH MPH competency domains, with a consequent difficulty in classification of curricular contents completely within one specific domain. This work is based on what is documented while in an ideal scenario, we would have wanted to witness what is carried out or delivered as a part of the academic experience. An M&E track/ concentration is housed within an MPH program and it is difficult to judge the merit of a track through examining a track alone. Several deficiencies within a track could have been addressed through other core or elective teachings across the program.