Guidance

Health: Technical Competency Framework, May 2024 (for posts and internal processes advertised from 7 May 2024)

Updated 23 May 2024

About the FCDO advisory cadres

World-leading technical and analytical capability is central to FCDO’s mission to be a force for good in the world. FCDO Advisers embody these capabilities, playing a key role in the delivery of the UK’s international objectives and development impact in particular.

Advisors have a central role in the design, implementation, appraisal, and evaluation of international development programmes; in the development and implementation of foreign and development policy; and in diplomacy and international partnerships. They play an expert role in inter-disciplinary thinking and thought leadership, linking programmes and bringing deep expertise to maximise impact. They have strong links with specialist networks, research organisations, and professional bodies in the UK and globally.

Advisers are accredited to one or more of 13 Advisory Cadres. These are professional bodies within FCDO and cover: Climate and Environment, Conflict, Economics, Education, Evaluation, Governance, Health, Humanitarian, Infrastructure, Livelihoods, Private Sector Development, Social Development, and Statistics. The Economics, Statistics, and Evaluation Cadres are linked to government-wide advisory services. Each Cadre has a Head of Profession (HoP), who is responsible for ensuring that professional standards are maintained both within the Cadre and for those wishing to join. The HoP provides thought leadership, quality assurance, and supports continuous professional development.

Adviser capabilities

Advisers have certain capabilities in common. These include but are not limited to the following:

• expertise and thought leadership in international policy and investment, applicable across a range of themes and geographies, including a specific focus on development impact
• use of evidence to inform policy and programming including the use of political economy analysis
• knowledge of data relevant to operating sector and context, and application of professional expertise in interpretation and analysis of this in support of intended outcomes
• international influence and diplomacy, thinking and working politically and cooperatively, and through appropriate challenge, to shape norms and approaches
• brokering partnerships with governments, civil society, the private sector, multilaterals, research organisations and professional bodies in the UK and globally
• delivering value for money by applying key technical, economic and commercial concepts
• safeguarding to ensure the UK does-no-harm by integrating gender equality, child protection, disability inclusion, preventing sexual exploitation and abuse, and sexual harassment
• tackling climate change and restoring nature, ensuring that programmes are aligned with the Paris agreement on climate change and UK commitments on nature
• appreciating contextual differences, including in fragile and conflict affected contexts, and be able to respond appropriately
• embodying Civil Service behaviours in applying, communicating, influencing, and leading technical and evidence-informed processes and engagement
• systems thinking, recognising inter-linkages, real-world dynamics, and complexity to help design effective policies and interventions
• innovation and digital development skills, proactive in exploring and validating innovative approaches, technology solutions and creative ways to address the world’s challenges.
• capacity to design and deliver programmes compliant with FCDO policies (Public Sector Duty, safeguarding measures) and appropriate for the context including fragile and conflict affected environments

1. FCDO and global health

The FCDO’s global health agenda is shaped by the UK’s policies: the Integrated Review Refresh 2023, the 2023 White Paper: International development in a contested world: ending extreme poverty and tackling climate change and the Global Health Framework: working together towards a healthier world 2023 (GHF).

As set out in the GHF, the FCDO contributes to:

1. strengthening global health security and prevention, preparedness and response to disease outbreaks

2. strengthening global health architecture

3. ending the preventable deaths of mothers, babies and children through strengthening health systems, accelerating progress to universal sexual reproductive health and rights, strengthening food, water, sanitation and wider environmental systems, and addressing social and commercial determinants of health, and the impact of climate change

4. advancing global health science, innovation and technology.

Collectively, the FCDO’s work on global health contributes to the advancement of multiple Sustainable Development Goals (SDGs) – in particular, SDG 3 – ‘ensure healthy lives and promote well-being for all at all ages’. Whilst impacting on health across the globe, FCDO has a focus on improving health outcomes in low- and lower-middle income countries (LIC/LMICs) and for the poorest and most vulnerable across the geographies in which we work.

The FCDO delivers on a range of global public goods for health, for example engagement and finance for developing new vaccines, diagnostics and therapeutics and other innovations, and research and evidence generation to tackle major health challenges including climate change impacts, conflict, emerging infectious diseases, food security, and implications of the rollback on rights. FCDO informs and shapes global health policy on many issues, for example sexual and reproductive health and rights, climate and health, One Health approaches, and epidemic and pandemic preparedness. FCDO contributes to health gains for the poorest in LIC/LMICs through its support to the major global health initiatives and through in country programmes in support of national health systems complemented with targeted high-impact interventions.  A large number of health programmes are in fragile and conflict affected states, with strong links to humanitarian programming.

FCDO’s global health agenda contributes HMG’s global health objectives as set forth in the GHF and as such FCDO collaborates strongly with other HM government departments.

2. The health cadre

The health cadre is a medium-sized cadre; with over 55 accredited health advisers. The cadre sits within a wider community, called the health network, of over 200 members, who collectively deliver the agenda.

Health advisers provide the high-quality technical expertise required to deliver the FCDO’s health ambitious health agenda. Health advisers work in-country where they influence national development agendas and support delivery of FCDO campaign goals. Health advisers also work at regional and global levels shaping global health policies and institutions, leading relationships with international and regional partners, and in commissioning and managing the production of global public goods.

Health advisers work with:

• national governments, academics, civil society and other stakeholders to advance national health gains focusing on the poorest, and tailor FCDO’s health interventions to the development aspirations of partner countries, and building equitable country-led partnerships in ways consistent with UK and international commitments and ambitions
• other UK government departments such as the Department of Health and Social Care
• global and UK public health institutions and research organisations

Section 4 depicts the 3 levels of expertise amongst advisers: practitioner, expert and senior expert.

3. Health technical competencies

Health advisers, as with other advisers, deploy their inter-disciplinary thinking and ‘brokering’ skills, their high-quality, evidence-based strategic analysis and advice, and their appreciation of all available UK levers. These include development policy and ODA programme interventions; use of diplomatic networks and relationships; collaborating and influencing across FCDO and HMG; and facilitating bilateral, regional, and multilateral agreements and negotiations.

The health cadre has 5 technical competencies. In addition to these, some advisers hold in-depth/specialist skills of a topic within one or more competencies, for example eg deep experience of public health responses to conflict situations, and/or humanitarian settings, addressing climate change impact on health, health systems and the health sector’s response, advancing demographic transition through health and rights interventions, and One Health approaches.  

The 5 technical competencies are based on a knowledge and application of public health. The health conditions therein cover: (1) communicable disease including infectious diseases (prevention, preparedness, surveillance, detection, outbreak response and methods of control (2) reproductive, maternal, newborn, child and adolescent health (3) nutrition (4) population dynamics and demography and (5) non communicable diseases.

Across the health competencies, addressing health inequalities, including poverty and gender issues, and underlying factors such as power imbalances and social norms is fundamental. Across the competencies, an understanding of the political, social and geopolitical dynamics related to each is critical.

Competency H1: Health systems development

Knowledge – advisers conversant in the dynamics of a health system:

• health services: packages of essential ‘best buy’ services, including primary and secondary health care and public health, and delivery systems
• leadership and governance: political economy shaping national health systems, relationship between state and non-state actors, accountability structures and procurement policies.  Appreciation of Regulatory policies and systems:  those that govern the health sector and those that govern the macro state structure that the health sector operates within
• health financing: (1) strategies for financial risk protection for the poor (2) strategies to improve economy, efficiency, effectiveness, sustainability, and equity (3) health budgets and value for money application to health outcomes and poverty reduction (4) sources of non-health funding that impact on health status (eg multilateral fund and climate funds)
• health information systems: national and global information systems, including mechanisms for analysing and communicating health data, digital for decision-making and to demonstrate results and value for money
• health workforce: human resources policies, planning and management and health workforce migration
• access to essential medicines and products: markets for products, market shaping approaches including diversification of supply with LMICs, research and development of new technologies, including LICs and LMICs partnerships for research and innovation, and promotion of equitable access and responsible use.

Universal health coverage: conceptually and how quality equitable care is advanced.

The dynamics across the range of global health systems: from LICs to LMICs to High Income Countries.

Health systems in protracted crises, fragile and conflicted affected states: understanding of political, economic, and social implications of differing contexts in the humanitarian-development-peace nexus and the impact these have on health systems.

Fundamentals of the UK’s health system.

International public health legislation (such as International Health Regulations) and global health treaties and ‘soft’ law instruments law (many under the auspices of the WHO) and governance.

Practice areas – advisers use the knowledge to:

• advance tackling stigma and discrimination and promote inclusive systems
• address social norms and the political economy to shape the health systems and health markets, and influence decision-making on sector priorities and resource allocation
• advise on evidence-based strategies for effective state and non-state systems
• ability to influence public sector reforms (such as decentralisation, anticorruption, and accountability), to improve the performance of health systems
• support partner country governments and their stakeholders to develop and deliver a package of priority cost-effective quality service for care and prevention which are affordable and accessible to all
• advance health systems response to climate change towards more resilient sustainable and low carbon systems (based on a systematic analysis of a health system’s vulnerability to climate change and greenhouse gas emissions) whilst also maximising health outcomes from action on climate change
• adapt health systems to a variety of contexts in particular systems to deliver health care in protracted crises and fragile and conflict affected states
• advise on range of relationships between state and non-state systems or providers
• critically appraise health systems and advance their cost effectiveness, impact on health and health inequalities
• ability to steer effective multi sectoral collaboration

Competency H2: Health architecture and health diplomacy

Knowledge – advisers conversant in:

• Global Health Architecture: (1) the mandate, structure, policy and approach of key global health multilaterals, IFIs, UN  and global health initiatives including World Bank, WHO and other UN agencies, GFATM, GFF, Gavi, and the Quadripartite (2) the mandate, structure, policy and approach of major bilateral agencies, non-traditional donors and foundations; (3) roles played in global health by research organisations, academia, civil society and the private sector, including pharma and other health industries (4) the structure, role and influence of G7, G20 (5) new public health institutions of regional influence and (6) humanitarian organisations and (7) advocacy agencies

• Overseas Development Aid: (1) ODA globally (2) UK ODA legislation and policy

• UK’s contribution to the global health eco-system: (1) HMG wide global health engagement (2) role and scope of UK leading CSOs and professional organisations and (3) role and scope of leading UK academic institutions

• appreciation of global health diplomacy: appreciation of the dimensions and aims of global health diplomacy and the role of geopolitics on health diplomacy at country, regional and global levels.

Practice areas – advisers use the knowledge to:

• work with partners in countries to advance complementarity and coherence of multilateral, bilateral and UK’s Centrally Managed Programmes
• influence the totality of the UK’s sphere of engagement in health using development and diplomacy channels to impact on health policy and strategic delivery of global public goods
• recognise, and interpret, health threats and engage in, and influence, the global, regional or national response, and advocate for prevention and preparedness at all levels
• shape the global health architecture to maximise its coherence, value for money and impact for public health especially the poorest
• effectively engage with UK expertise in science, technology and public health partnerships globally, including OGDs and HMG agencies, such as the UKHSA

Competency H3: Health security

Knowledge – advisers conversant in:

• the links between health systems strengthening, UHC and global health security
• key threats to health security, including novel pathogens, the increase or spread of existing infectious diseases or disease vectors, and antimicrobial resistance
• the interdependent nature of the health of humans, animals, plants and ecosystems and the factors within and outside of the health sector contributing to major threats to health security, such as population growth, urbanisation, climate change and the misuse of antimicrobials
• the One Health approach
• knowledge of related international public health legislation and aspects of the global architecture of relevance to health security, including the Quadripartite
• key approaches to surveillance, including cross-sectoral surveillance, to support the detection, response to and monitoring of emerging health threats
• antimicrobial resistance

Practice areas – advisers use the knowledge to:

• advance implementation of the IHRs and strengthening of IHR core capacities.
• supporting improved communication, coordination and collaboration between the human health, animal health and environment sectors on key health security issues such as zoonotic diseases and AMR
• Influence the development, financing, implementation and monitoring of National Action Plans for Health Security
• engage across relevant sectors, including environment, climate, agriculture and food systems, to support improved health security through the One Health approach
• advocate for a One Health approach to health security at country level, and support the development and implementation of One Health governance mechanisms
• Addressing AMR at country, regional and global level

Competency H4: The wider determinants of health and health improvement

Knowledge – advisers conversant in: 

• wider determinants of health: the impact of (1) macroeconomics (2) social determinants including gender equality and inclusion and diversity (3) education - quality and quantity (4) political and governance systems (5) food safety and systems (6) environmental determinants; air quality, land quality and usage, urbanisation and housing (7) climate change and the health co-benefits of action on climate change, (8) the interdependent nature of the health of humans, animals, plants and ecosystems and the importance of the One Health approach to address this (9) nutrition -  the causes, scale and trends of malnutrition and range of interventions within, and beyond, the health sector and (10) the commercial determinants of health

• leaving no-one behind: strategies to strengthen pro-poor and equitable policy, financing, and implementation based on analysis of socio-cultural contexts, power imbalances between different groups and their effect / impact on safeguarding concerns within health systems / health sector and interventions or approaches to address such concerns

Practice areas – advisers use the knowledge to:

• advance health gains by influencing national development plans
• use relevant social sciences and behavioural research to develop and implement interventions including for systems strengthening and behaviour change to shift social norms
• advance the health arguments for more ambitious national and global action on climate mitigation and adaptation
• engage with multisectoral partners to maximise health co-benefits of action on climate change, and to motivate higher ambition on climate change through utilization of the health arguments
• engage across relevant sectors, including environment, climate, agriculture and food systems, to support the delivery of health co-benefits through the One Health approach.
• ensure equity and inclusion principles and understanding of all health determinants integrated into programme design and implementation
• promote analysis and understanding of commercial determinants in context of wider UK objectives
• advise on policy and programmes in all the determinants listed above (for example design nutrition-specific and nutrition-sensitive actions, and multi-sector approaches to prevent and treat (all forms of) malnutrition)

Competency H5: Evidence, innovation and evaluation

Knowledge – advisers conversant in:  

• research skills: (1) statistical methods (2) approaches to assess health needs and (3) critical appraisal of research and (4) designing and appraising evaluations of programmes.
• appreciation of health economic tools and approaches
• appreciation of digital and AI  improve the reach and value for money of health interventions and aware of risks
• appreciation of epidemiology

Practice areas – advisers can use the knowledge to:

• contribute effectively to the development of FCDO’s research priorities
• ability to use evidence and learning from monitoring, evaluation and research into policy and programmes
• ability to oversee and support the design of rigorous evaluations of programmes including building impact evaluations into programme design where appropriate.
• ability to work credibly with other actors (nationally and internationally) to identify research gaps and contributing strategically to national and international evidence base through responsive and timely interventions
• ability to determine how appropriate digital technologies can be integrated into programmes
• advance the scale and effectiveness of global goods for health, including take-up and use of data and evidence
• influence global, regional and national policy development combining knowledge with evidence and political economy analysis
• assess and communicate the potential impact of new evidence at country or global level
• ability to address equity considerations in interventions and apply a rights-based approach to policy and programming
• advise on the value for money of interventions intended to improve the health of populations

4. Levels of expertise

Advisers are not expected to have equal knowledge and practice experience in all competencies but are expected to provide evidence of knowledge and demonstrate either direct or transferable practice and experience across all 5 competencies.

There are 3 levels of competency held by advisers in the cadre:

Practitioner

• strong and confident day to day application of capability in common or standard situations but may need to seek expert support on more complex issues
• holds relevant experience^{[footnote 1]} and may be augmented by a formal qualification of direct relevance such as a master’s in public health (or similar qualification) or significant self-directed study
• minimum level required in order to be a member of the Cadre

Expert

• recognised for technical knowledge and skills, underpinned by extensive experience applying it in practice on complex issues at national and global level
• the health systems competency should be based on sufficient experience in a LICs or LMIC
• holds significant relevant experience^{[footnote 1]} and likely to be augmented by a formal qualification of direct relevance such as a Masters in Public Health (or similar qualification) or significant self-directed study
• able to develop the capability of practitioner level advisers and others in the FCDO health network

Senior expert

• recognised for deep specialist within a competency or high quality skills across all competencies, underpinned by extensive experience in practice in complex contexts
• the health systems competency should be based on sufficient experience in a LIC or LMIC
• holds very significant relevant experience^{[footnote 1]} and likely to be augmented by 1 or more formal qualifications of direct relevance such as a Masters in Public Health (or similar qualification) or significant self-directed study
• evidence of effective strategic leadership, organisational and management skills
• ability to provide thought leadership – drive a policy from conceptualisation to delivery, based on mature strategic and communication skills demonstrated in complex contexts
• ability to develop the capability of expert level advisers and others in the FCDO health network

1. relevant experience is defined as significant work experience in most of the competencies ↩ ↩² ↩³