Health professionals’ competence for the provision of quality primary health care in Amhara region, Ethiopia

Gebeyehu Tsega; Mirkuzie Woldie; Gizachew Yismaw; Getu Degu

doi:10.1371/journal.pone.0315415

Peer Review History

Original SubmissionMay 22, 2024
22 May 2024 Author Response https://doi.org/10.1371/journal.pone.0315415.r001
5 Nov 2024 Decision Letter - Mulu Tiruneh, Editor PONE-D-24-20430Health professionals’ competence for the provision of quality primary health care in Amhara region, EthiopiaPLOS ONE Dear Dr. Nebeb, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Dec 20 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: No Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Author should explain more convincingly the sample technique. Apart from this, another limitation with the competency assessment technique. Competency assessment relying upon the self reported questionnaire can only satisy the Knowledge component of competency, in that case what about attitude and skills. Reviewer #2: The article is based on the World Health Organisation's (WHO) Global Competency Framework for Universal Health Coverage (GCUHC), and the research is closely related to international topics, which to some extent reflects the current issues facing health system challenges. The article explores the primary health care capacity of health professionals in Amhara Region, Ethiopia. A mixed-methods research design was used, including both quantitative and qualitative data, and the methods of data collection and analysis, including logistic regression modelling and thematic analysis, as well as audio-recording and cross-checking were described in detail to increase the credibility of the findings. The article's findings show that only 14 per cent of health professionals consider themselves to have all competency areas, revealing important gaps in professional competence. The article's results point to the fact that primary health care competencies are strongly associated with factors such as educational status, training, taking licensure/competency certificate exams, and monthly salary, findings that are critical for developing strategies for improvement. The article also suggests that this study addresses contemporary emerging competency issues, that there was a lack of self-perception on the part of the respondents, and that the results may not be accurate. Recommendations: Firstly, for the qualitative data sample of 12 technical professionals, the authors need to be mindful of whether more detailed information is provided on the qualitative data collection and analysis methods, including semi-structured questions for the interviews and specific steps for data analysis. Secondly, the study relied on health professionals' self-assessments to measure competence, which may be subject to social desirability bias, and participants may have overestimated or underestimated their competence. It is recommended to add a third-party perspective to the assessment results. Third, the results of the article showed that only 14% of health professionals considered themselves to have all competency domains, and the results section should discuss the specific scores and distribution of each competency domain in more detail. Fourth, the discussion section suggests listing the consistency and discrepancy of the results with global and regional health policies. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #1: Yes: Sanjeev Kumar Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". 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Revision 1
11 Nov 2024 Author Response Dear Editor and Reviewers, Thank you so much for your kind words and valuable comments, as well as the opportunity to revise the manuscript. Your feedback has greatly improved our work. We have revised the manuscript according to your suggestions and recommendations. Reviewer #1: Author should explain more convincingly the sample technique. Apart from this, another limitation with the competency assessment technique. Competency assessment relying upon the self reported questionnaire can only satisy the Knowledge component of competency, in that case what about attitude and skills. Response: Thank you for your kind words and insightful comment. The sampling technique is described in lines 166-173. The competence of health professionals was measured using 30 competency statements that integrated knowledge, attitude, and skill components. This method aimed to assess the health professionals' perceptions of their performance on each competency described in the global competency framework for universal health coverage (WHO, 2022). Understanding their perceptions can inform policies to address competency gaps. They rated their competence and identified gaps in each statement, indicating a need for training. In the global competency framework for universal health coverage, "competent" refers to an individual’s ability to perform designated practice activities to a defined standard, which means possessing the requisite competencies. Competencies are defined as the abilities to integrate knowledge, skills, and attitudes in performing tasks in a given context (WHO,2022). Health professionals were asked whether they performed each competency statement by integrating these three components, not just knowledge. Moreover, this limitation is described in the discussion section of the manuscript, in lines 429-431. Reviewer #2: The article is based on the World Health Organisation's (WHO) Global Competency Framework for Universal Health Coverage (GCUHC), and the research is closely related to international topics, which to some extent reflects the current issues facing health system challenges. The article explores the primary health care capacity of health professionals in Amhara Region, Ethiopia. A mixed-methods research design was used, including both quantitative and qualitative data, and the methods of data collection and analysis, including logistic regression modelling and thematic analysis, as well as audio-recording and cross-checking were described in detail to increase the credibility of the findings. The article's findings show that only 14 per cent of health professionals consider themselves to have all competency areas, revealing important gaps in professional competence. The article's results point to the fact that primary health care competencies are strongly associated with factors such as educational status, training, taking licensure/competency certificate exams, and monthly salary, findings that are critical for developing strategies for improvement. The article also suggests that this study addresses contemporary emerging competency issues, that there was a lack of self-perception on the part of the respondents, and that the results may not be accurate. Response: Thank you for your kind words and insightful comments. The focus is to examine health professionals' perceptions through self-rating of each competency statement/item, allowing us to hear their voices on these competencies. This self-assessment is substantiated by a qualitative exploration of their competence. Recommendations: Firstly, for the qualitative data sample of 12 technical professionals, the authors need to be mindful of whether more detailed information is provided on the qualitative data collection and analysis methods, including semi-structured questions for the interviews and specific steps for data analysis. Response: Thank you for your kind words and insightful comments. We have made revisions based on your comments, as indicated in lines 225-230 and 265-272 of the revised manuscript. Secondly, the study relied on health professionals' self-assessments to measure competence, which may be subject to social desirability bias, and participants may have overestimated or underestimated their competence. It is recommended to add a third-party perspective to the assessment results. Thank you for your kind words and insightful comments. To address the risk of social desirability bias, we used a self-administered questionnaire in line 222, allowing respondents to rate their competence at their convenience. Additionally, the quantitative data is supported by a qualitative exploration of their competence. By recogning this, we have included this as a limitation in the discussion section of the revised manuscript, as indicated in line 429-431. Furthermore, perspectives from service users, development partners, and health managers are included in another paper as part of a Ph.D. research project. Together, these papers will provide a holistic view of health professionals' competence. Third, the results of the article showed that only 14% of health professionals considered themselves to have all competency domains, and the results section should discuss the specific scores and distribution of each competency domain in more detail. Response: Thank you for your kind words and insightful comments. We have revised as per the comments as indicted in lines 313-317 in the revised version along with Table 2. Fourth, the discussion section suggests listing the consistency and discrepancy of the results with global and regional health policies. Response: Thank you for your kind words and insightful comments. We discussed the findings in relation to Universal Health Coverage and the philosophy of primary health care, which are local, regional, and global health policies, in lines 382-383 and 424-426 of the revised version. Attachments Attachment Submitted filename: Response letter.docx https://doi.org/10.1371/journal.pone.0315415.r003
26 Nov 2024 Decision Letter - Mulu Tiruneh, Editor Health professionals’ competence for the provision of quality primary health care in Amhara region, Ethiopia PONE-D-24-20430R1 Dear Dr. Nebeb, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. 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If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: I Don't Know Reviewer #2: (No Response) ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The author has adequately addressed the comments. However, i am not in position to comment on statistical analysis. Reviewer #2: The author has already answered the previous question and there are no more questions.No other advice for this author. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #1: Yes: Sanjeev Kumar Reviewer #2: No ******** https://doi.org/10.1371/journal.pone.0315415.r004
Formally Accepted
Acceptance Letter - Mulu Tiruneh, Editor PONE-D-24-20430R1 PLOS ONE Dear Dr. Tsega, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Mr. Mulu Tiruneh Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0315415.r005

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