Bridging the gap between competency frameworks and practice: evidence from Lithuania

Background

Competency-based workforce development is a priority for public health systems, and the ASPHER framework defines core competencies for public health specialists in Europe. In Lithuania, specialist functions are decentralized across multiple legal acts, making it unclear how competencies acquired during studies are applied in practice and how they align with international recommendations.

Methods

A conceptual and policy analysis assessed the ASPHER framework’s relationship with the Lithuanian public health system, reviewing legislation, regulatory documents, and study programs. A cross-sectional online survey was conducted among 200 non-managerial public health specialists, who self-assessed their proficiency in ASPHER competencies.

Results

ASPHER competencies are reflected in national education standards, but professional functions are dispersed across regulatory documents, creating role ambiguity. Respondents reported having 56.6% of competencies fully, 34.7% partially, and 8.7% not at all; only 37% were acquired during studies vs 63% in practice. Largest gaps concerned health policy participation (24.5%), socio-political determinants (27.0%), One Health (30.5%), and crisis communication (32.2%); the strongest were ethics (96.0%), knowledge sharing (87.9%), and data analysis (85.5%). Competency levels did not differ significantly by education, experience, workplace, or region (p > 0.05), suggesting systemic gaps across the workforce.

Conclusions

Formal alignment with international competency frameworks does not ensure coherent implementation. The Lithuanian case highlights the need to strengthen mechanisms for competency evaluation, postgraduate training, and continuous professional development. Defining a clearer national concept of the public health profession may be essential to advancing competency-based workforce development with implications for strengthening the public health workforce in Europe.

Key messages

• The role of public health specialists in Lithuania is unclear and fragmented, despite their inherently interdisciplinary position and potential to act as a strategic core of the health system.

• In the context of One Health challenges, strengthening their role and competencies is essential for effective system-wide responses.