In the global context, the development of global health competencies has been a dynamic area of research and practice since the 2000s. Plenty of studies have emerged, employing various methodologies such as literature reviews, interviews, surveys, and the review of academic programs tailored for medical, nursing, or global health students [19,20,21,22,23,24,25,26,27,28,29]. Notably, a substantial portion of these initiatives originated from high-income countries like the United States, the United Kingdom, Canada, and Australia, where the concept of global health first took root. However, it is worth highlighting the predominance of this trend and the associated geographic bias towards high-income countries. Recognizing this disparity, some researchers have called for the validation and adaptation of these competencies in Asian countries [30]. In China, efforts to introduce global health education began with the proposal of course modules for undergraduate programs, marking the launch of global health programs in universities as early as 2011 [31,32,33]. Despite these commendable initiatives, a critical gap persisted—the absence of a competency framework designed specifically for professionals already established in their careers who aspire to gain global health experience. As China continues to play an increasingly prominent role in global health initiatives, the adapted competency framework serves as a valuable resource, aligning training programs with the specific needs and challenges encountered by Chinese professionals engaged in global health endeavors.

What’s new in this framework

Comparing with the original CUGH framework (see Additional file 10 for comparison), the adapted framework introduces several adjustments. These changes include:

Enhanced analytical proficiency: Addition of competencies related to analyzing key global health issues, understanding intellectual property systems in health technology development, and applying historical insights to contemporary global health challenges (competency 1.3, 3.3, 4.4).

Expanded global health governance and policy acumen: Enrichment of competencies covering roles and relationships among global health actors, China's roles and policies, political awareness, and the ability to navigate complex policy environments (competency 6.1, 6.2, 6.3, 6.4).

Improved effective communication and emotional intelligence: Inclusion of competencies emphasizing effective communication skills, cross-cultural competence, emotion management, psychological endurance, and conflict resolution abilities (competency 7.1, 7.2).

The Chinese Delphi panel largely agrees with the CUGH framework, highlighting its well-developed nature. However, this adapted framework offers distinct value by adapting the competencies to a different setting, reducing potential biases that may arise from the original development process, which primarily involved US-based panelists. This adaptation recognizes the unique needs and challenges faced by the Chinese workforce in global health. For instance, the inclusion of competency 7.1, which focuses on effective communication in the official language of the target context, addresses a language barrier that may not be as relevant for a US-based workforce. Additionally, competencies in domain 6 underscore the importance of understanding the political, social, cultural, and policy aspects of both China and recipient countries. These competencies empower the workforce to navigate diverse global contexts and contribute effectively.

Core debates among the Delphi experts

Throughout the Delphi process, several key debates emerged among the experts, reflecting important considerations in the development of competency frameworks for global health professionals:

One central debate revolved around the feasibility of individuals possessing all the competencies outlined in the framework. Some experts raised the concern that it might be unrealistic for a single professional to possess every competency listed. The recognition that not all competencies will be equally relevant to every individual or program led to reflections on the current status of China's public health professionals. It also highlighted the need for further analysis to tailor the competencies for different levels of professionals and those with diverse scientific backgrounds. This debate underscores the importance of adaptability and context specificity in competency development.

Another significant debate revolved around how to effectively assess the competencies outlined in the framework. Assessing competencies has long been a challenge in competency-based education [34]. The experts reached a consensus that qualitative methods could be employed, despite the inherent difficulties. This includes approaches such as self-assessment, allowing learners to evaluate their own work after receiving proper guidance to enhance the validity and reliability of assessments. Additionally, involving a third party, such as a co-worker working alongside the learner, was suggested as a means to assess competencies [35]. These discussions reflect the ongoing exploration of innovative assessment methods in competency-based education.

The experts also grappled with the challenge of avoiding overlaps among competencies. They recognized that certain overlaps were inevitable, as each competency may have specific emphases under different domains. However, to enhance clarity and coherence within the framework, efforts were made to minimize overlaps. This was achieved by merging closely related competencies into broader domains that could encompass both competencies. This debate highlights the need for precision and conciseness in competency frameworks while acknowledging the interconnected nature of competencies in practice.

Bottlenecks of China’s public health professionals

China's public health professionals face several bottlenecks and challenges, which have been highlighted through the Delphi consultation process and other research. One major bottleneck is lacking of international experience and the limited exposure of Chinese global health workers to foreign cultures. This lack of exposure makes it challenging for these professionals to fully adapt, both physically and intellectually, to the localities where they work. The global nature of health work often requires individuals to operate effectively in diverse and unfamiliar cultural contexts. Without adequate exposure and cross-cultural training, Chinese public health professionals may struggle to navigate these challenges effectively. Language barriers and communication gaps with international co-workers are another obstacle associate with the lacking of international experience. Effective communication is essential in global health collaboration, as it facilitates the exchange of knowledge, ideas, and best practices. When language becomes a barrier, it can impede teamwork, hinder information sharing, and limit the impact of global health initiatives. Similar challenges have been reported among China's Overseas Medical Teams, which have been providing health assistance in African countries for over 60 years [36]. These medical teams have encountered language barriers and difficulties adapting to local contexts [37]. These challenges can impact the effectiveness of medical missions and require strategies for mitigation.

Suggested steps for institutions and individuals intend to use the framework

For institutions and individuals intending to use the framework, here are recommended steps to integrate and apply the competencies:

For Institutions: (1) Begin by reviewing the institution's existing curricula in the context of the competency framework. Identify areas where the current curriculum aligns with the competencies and where there are gaps. (2) Re-design training modules to ensure that the competency priorities are adequately addressed within the curriculum. Adjust the distribution of time and resources to reflect the importance of each competency. (3) Map out the available teaching, learning, and field practice resources. Consider introducing e-learning and online resources, promote interdisciplinary co-teaching [38], and establish connections with international institutions to share educational materials and resources [39]. (4) Engage faculty members in harmonizing the resources and reconfirming the study objectives and outcomes of each module. Ensure that the faculty is aligned with the competency-based approach. (5) Innovate teaching methods by introducing interactive activities and novel teaching approaches that encourage critical thinking and open communication. Examples include case-based studies, group discussions, thematic seminars, and flipped classroom techniques. (6) Offer field practice opportunities to expose trainees to international contexts. Practical experience in global health settings can enhance the application of competencies in real-world scenarios. (7) Continuously test, evaluate, and modify the training program to ensure that it effectively aligns with the competency framework. Gather feedback from students, faculty, and experts to make necessary improvements.

For Individuals: (1) Gain hands-on experience by working in developing or low-income countries. Practical experience is invaluable for understanding global health challenges and solutions. (2) Develop critical thinking skills by analyzing global health problems and potential solutions. Consider the effectiveness of interventions and explore alternative approaches. (3) Identify and gather data from internationally available sources, such as the World Health Organization. Utilize global health datasets to inform the understanding of health patterns and determinants. (4) Characterize local, regional, and global patterns of health and disease, focusing on socio-cultural and environmental determinants. Understand the complex interplay of factors influencing health outcomes. (5) Develop appropriate global health interventions and evaluate their impact. This process will help individuals become familiar with major global health initiatives and enhance the capacity to analyze and interpret information for policy and program decision-making.

This study has several limitations. First, the study focused exclusively on public health professionals engaged in global health activities in China. Medical workers involved in global missions were not included in the targeted population. This limitation may restrict the applicability of the framework to a broader range of healthcare professionals. Second, the accuracy of the English-to-Chinese translation of the competencies may impact how well the experts comprehend the framework. Variations in translation can introduce subtle differences in interpretation, potentially affecting the results and applicability of the competencies.