The study was conducted as a mixed-methods investigation with public health stakeholders in the UAE between November 2024 and February 2025. The published analysis concentrates on the qualitative strand of the data, which came from two complementary sources: open-ended responses in an online survey completed by 19 participants, and semi-structured interviews with 12 senior decision-makers. Rather than treating these datasets separately, the researchers integrated the survey’s free-text answers with the interview transcripts and analysed them thematically as a single dataset, a technique that strengthens the depth of interpretation when participant numbers are small. The authors are explicit that the findings describe this bounded group of experts in depth rather than producing generalisable estimates for the entire workforce.

Two established frameworks anchored the analysis. The first is the WHO–ASPHER Competency Framework, developed by the World Health Organization together with the Association of Schools of Public Health in the European Region, which defines the knowledge, skills and behaviours that a modern public health professional should command, from epidemiology and health protection to leadership, ethics and communication. The second is the WHO Health System Building Blocks Framework, which decomposes a health system into six core components: service delivery, the health workforce, health information systems, access to essential medicines, financing, and governance. By reading stakeholder testimony through both lenses simultaneously, the team could connect individual-level skill gaps to system-level structural weaknesses, a technical move that distinguishes this study from simpler workforce surveys.

The thematic analysis surfaced six overarching themes: fragmented governance, competency and training gaps, misalignment between curriculum and practice, Emiratization and career barriers, lessons drawn from COVID-19, and the need for a unified national strategy. Each theme represents a distinct failure mode, but the researchers emphasise that they are interlocking. Fragmented governance, for example, is not merely an administrative inconvenience; it fragments workforce planning itself, so that different institutions train, credential and deploy public health staff against different assumptions. When governance is disjointed, competency frameworks lose their anchoring function, because no single body is responsible for defining what a public health professional in the country should be able to do.

Among the most consequential findings is the limited awareness and use of competency frameworks among stakeholders. International frameworks such as WHO–ASPHER exist precisely to give workforce planners a common vocabulary: they specify the domains in which practitioners must be proficient and allow education providers to design curricula that map onto real occupational requirements. If practising managers and policymakers are largely unaware of these tools, the link between training and employment breaks down. The study found exactly this weak alignment between education and practice, with academic programmes not consistently reflecting the competencies that public health roles in Abu Dhabi actually demand. Graduates may therefore enter the workforce with credentials that employers do not fully recognise, and employers may struggle to articulate the skills they need in a form that educators can act upon.

The question of Emiratization, the national policy of increasing Emirati participation in the workforce, emerged as a theme with particular technical and social complexity. Stakeholders reported limited Emiratization in public health roles specifically, alongside career barriers that discourage nationals from entering or remaining in the field. Public health occupies an awkward position in many health labour markets: it is neither clinical medicine, with its clear prestige and licensure pathways, nor administration, with its conventional civil-service ladders. Without defined career structures, competency-based promotion criteria and visible professional identity, the field struggles to attract and retain national talent. The study suggests that workforce reform cannot be separated from career-pathway design; training pipelines only function when there is a destination at the end of them.

The COVID-19 pandemic functions as both backdrop and catalyst throughout the findings. The authors note that reforming the public health workforce in Abu Dhabi and across the UAE became increasingly urgent during and after the pandemic, alongside wider pressures from evolving public health challenges and health-system transformation. Pandemics are, in effect, unrequested stress tests of workforce planning. They expose shortfalls in surveillance capacity, outbreak investigation, risk communication and health information systems, and they reveal whether governance structures can coordinate across emirates and federal institutions at speed. The stakeholders in this study treated the pandemic experience as a source of concrete lessons about where the UAE’s public health machinery performed well and where structural fragilities appeared, and the researchers folded those lessons directly into their thematic framework.

Governance and policy, together with education and training, were the concerns most consistently raised across both data sources, the survey’s open-ended items and the interviews. That convergence matters methodologically. When two independent modes of data collection, one written and asynchronous, the other conversational and probing, produce the same priority concerns, the risk that findings are artefacts of a single instrument diminishes. The institutional landscape that stakeholders described involves multiple actors, including the Department of Health, the Abu Dhabi Public Health Centre, and the Ministry of Health and Prevention, operating across federal and emirate-level jurisdictions. Fragmentation across these governance structures, the study reports, impedes coherent workforce planning and dilutes accountability for implementing reform.

The study’s conclusions translate these findings into a reform agenda with clearly specified components. The authors argue that public health workforce reform in Abu Dhabi requires a coordinated cross-sector response that aligns competencies, curricula, regulation and career pathways, while strengthening governance, integration and long-term sustainability. In practical terms, that means adopting a national competency framework as the reference standard for job descriptions, accreditation and continuing professional development; redesigning academic curricula so that they map onto that framework; establishing regulatory recognition of public health as a distinct professional discipline; and building career ladders that make the field attractive to Emirati graduates. Each element reinforces the others, which is why the researchers frame the agenda as systemic rather than piecemeal.

The research also carries significance beyond the Gulf. Many health systems, in high-income and middle-income countries alike, confront the same triad of weak workforce data, unclear competency standards and fragmented governance, and the World Health Organization has repeatedly identified health workforce strengthening as one of the binding constraints on universal health coverage and pandemic preparedness. By applying internationally recognised frameworks to a specific national context and publishing the results open access, the team has produced a template that other countries in the Gulf Cooperation Council and beyond can adapt. The study was supported by a research grant from United Arab Emirates University and approved by the university’s Institutional Review Board, with informed consent obtained from all participants. Its authors, spanning institutions in the UAE, Portugal, the Netherlands, Poland and the Czech Republic, present the work as a pathway toward evidence-based policy, and the evidence they have assembled suggests that the pathway runs directly through the people who make public health happen.

Subject of Research: Public health workforce reform and competency-based workforce planning in Abu Dhabi and the United Arab Emirates

Article Title: Public health workforce reform in Abu Dhabi: a pathway to evidence-based policy and global standards alignment

Article References: Al Qadiri, T., Elbarazi, I., Elkonaisi, I., Paulo, M. S., Sheek-Hussein, M., Koornneef, E., Czabanowska, K., & Grivna, M. (2026). Public health workforce reform in Abu Dhabi: a pathway to evidence-based policy and global standards alignment. BMC Medical Education. https://doi.org/10.1186/s12909-026-10518-x

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10518-x

Keywords: public health workforce, Abu Dhabi, United Arab Emirates, WHO-ASPHER Competency Framework, health workforce planning, competency frameworks, medical education, health policy, Emiratization, COVID-19, governance, BMC Medical Education

The scale of the problem the review addresses is considerable. Despite repeated calls for a programmatic approach to remediation, practices across training programs remain highly variable, and up to half of relevant institutions have no written remediation policy at all. The reasons for this institutional reluctance are revealing. Many training bodies avoid documenting remediation policies because they fear legal challenges from trainees, which helps explain why reforms have historically focused on due process rather than educational principles. The evidence base itself has been thin, with limited outcome data proving the benefits of specific interventions, and most proposed frameworks resting on commentary and literature reviews rather than empirical testing.

Led by Kathryn McLeod, a surgeon and researcher affiliated with University Hospital Geelong, Deakin University, and the University of Melbourne, the team chose a narrative review format precisely because the existing data were so diverse and methodologically inconsistent that meaningful statistical comparison was impossible. Working with a specialist research librarian, they searched Medline, Embase, PubMed, and Google Scholar in July 2025, using a combination of MeSH and natural language terms, supplemented by hand searching of reference lists. From 519 papers screened, 54 made the final analysis: 28 commentaries, 12 reviews, 7 survey studies, 3 qualitative studies, 2 case studies or series, and 2 retrospective cohort studies. The team analyzed the material using reflexive thematic analysis, iteratively building a codebook of components and re-reading earlier papers as new codes emerged, until consensus was reached on definitions and their consistent application.

The seventeen components the researchers identified fall into three overarching phases: assess and support, plan and implement, and evaluate and follow-up. Crucially, the authors stress that these phases are not discrete boxes on a checklist but an iterative, dynamic cycle. Elements of assessment and support often persist throughout the entire process, planning evolves in response to ongoing trainee development, and evaluation is not a terminal stage but a continuous loop that feeds back into earlier stages of assessment and intervention. This temporal framing reflects a growing recognition in medical education that remediation is not an event but a sustained relationship between a struggling learner and a responsive system.

The first phase begins with what the authors call ensuring an accurate diagnosis of underperformance, a step they describe as critical because it underpins the success of everything that follows. Without a clear understanding of why a trainee is struggling, remediation risks being misaligned with the actual cause. The recommended approach involves mapping performance against established competency frameworks such as CanMEDS or the standards of the General Medical Council, sampling assessment data from multiple sources including workplace-based assessments, logbooks, and supervisor reports, and convening round-table discussions with supervisors, trainers, and program directors. These multi-perspective discussions reduce the risk of bias and enable earlier identification, since many trainers are more willing to voice concerns verbally to a program director than to issue formal documentation at a lower threshold.

Equally important in the first phase is the human dimension. Many trainees are not fully aware they are underperforming, or they underestimate the severity and scope of their difficulties, so clear, honest, specific feedback illustrated with concrete examples is essential. The review emphasizes empathetic, two-way feedback conversations that focus on behaviors rather than personal traits, noting that constructive, actionable feedback can increase motivation, restore confidence, and foster a growth mindset. Trainees report feeling unheard when feedback is delivered at them rather than with them, and if a trainee disagrees with the description of their underperformance, the designated intervention will usually fail. The reviewers also urge programs to look beneath the surface: mental health conditions such as depression, anxiety, and burnout, disabilities including dyslexia and ADHD, and external stressors like addiction, financial problems, and bereavement can all impair performance, and professionalism is the competency most commonly affected among trainees with mental health conditions. Systemic causes, too, deserve scrutiny, since inadequate supervision, excessive workload, and poor organizational culture may drive difficulties that are too often framed as individual failings.

The second phase, plan and implement, shifts from understanding to action. The review recommends involving remediation and educational experts, noting that supervisors may lack the time and skills to manage underperformance appropriately and that centralized remediation programs have demonstrated better outcomes than individual training programs. Team-based approaches and communities of surgical educators supporting supervisors have been successfully implemented at institutional, regional, and national levels. Individualized remediation plans, developed collaboratively between trainees and educators wherever possible, build trust, encourage self-reflection, and foster shared responsibility, although plans created solely by experts may be necessary when a trainee lacks insight or when the process must begin urgently. Clear documentation is vital: plans should state the reasons for remediation, the steps to be taken, desired outcomes, time frames, and the consequences of failing to remediate, and should be distributed to all relevant parties including the trainee. Teaching goal setting, self-monitoring, and self-regulation rounds out this phase, fostering learner autonomy and sustained improvement, potentially supported by a mastery approach in which trainees achieve defined proficiencies before progressing to more complex material.

The third phase tackles the awkward realities of follow-up. Regular monitoring and reassessment allow early identification of ongoing barriers and timely adjustments, while improving transparency through honest discussions about progress. The reviewers highlight the delicate task of feeding forward: performance issues can persist despite successful short-term remediation, so sharing pertinent information with new supervisors, with the trainee’s knowledge and only with those who have a legitimate need to know, reduces the risk of recurrence without breeding prejudgment. Perhaps the most structurally significant recommendation is to separate those conducting remediation from those judging it. An effective educational alliance depends on trust and emotional support, which becomes impossible if the supervisor also holds progression decisions. Remediation is best delivered by educational experts, while outcome decisions rest with independent panels evaluating evidence against standards. The review also notes that decisions to terminate training are often overturned not because the decision was wrong but because due process was not followed, underscoring the need for well-defined, transparent policies with thorough documentation.

Two further components carry particular emotional weight. The authors call for actively destigmatizing remediation, recommending that programs flag the possible need for additional support during orientation, before any problem is apparent, and that institutions abandon labels like problem resident or difficult resident in favor of constructive language such as performance improvement plan or individual learning program. And when remediation fails despite everyone’s best efforts, the review insists on compassionate exit pathways: trainees who cannot meet required standards often feel guilt, loss of confidence, and fear of further decision-making, and they should receive career counseling, networking support, recognition of prior learning, and emotional help to transition into alternative paths better aligned with their strengths.

The authors are candid about the limitations of their work. Narrative reviews lack the rigor of systematic reviews, and with 28 of the 54 included papers being opinion pieces lacking evidence-based outcomes, they could not comment definitively on the effectiveness of specific components. The framework should therefore be read as a literature-informed synthesis of current thinking rather than a validated protocol, and the team highlights the need for further empirical research on the efficacy and optimal design of each component. Still, the value of the synthesis lies in its comprehensiveness and its practical orientation. By naming seventeen interlocking components and showing how they connect across three dynamic phases, the review gives institutions a concrete starting point for building frameworks that are transparent, grounded in sound educational theory, and adaptable to local contexts. With growing calls for standardization and half of institutions still operating without written policies, the message to the medical education community is unambiguous: remediation should no longer be improvised, and the blueprint for doing it properly now exists.

Subject of Research: Components of remediation frameworks for underperforming postgraduate medical trainees

Article Title: Components of postgraduate remediation frameworks: a narrative review

Article References: McLeod, K., Woodward-Kron, R., Rashid, P., & Nestel, D. (2026). Components of postgraduate remediation frameworks: a narrative review. Global Surgical Education – Journal of the Association for Surgical Education, 5(1), Article 132. https://doi.org/10.1007/s44186-026-00536-0

Image Credits: AI Generated

DOI: 10.1007/s44186-026-00536-0

Keywords: medical education, remediation, postgraduate training, surgical education, underperformance, feedback, trainee support, due process, individualized learning plans, narrative review, competency frameworks, mental health

The timing of the intervention is significant. The commentary forms part of a series of contributions to the 2026 UN Water Conference, supported by the United Nations University Institute for Water, Environment and Health as part of the UN-Water initiative to embed evidence-based policymaking in the water sector. As governments gather to negotiate responses to escalating water crises, Ong and Tortajada make the case that workforce transformation deserves the same political attention as pipes and plants. The authors acknowledge funding support from PUB, Singapore’s national water agency, an organisation frequently cited as a global benchmark for integrated water management and one that has invested heavily in developing specialised talent.

The pressures bearing down on urban water systems are well documented. Climate change is intensifying both floods and droughts, forcing utilities to manage extremes that legacy systems were never designed to withstand. Ageing infrastructure — much of it buried beneath city streets for half a century or more — is failing at rising rates, with pipe bursts, sewer overflows and treatment plant breakdowns imposing growing costs on operators and communities. Urban expansion adds another layer of stress, as informal settlements and fast-growing peri-urban districts often develop faster than formal water networks can reach them. Meanwhile, technological change is rewriting the skills profile of the sector entirely, as digitalisation, automation, remote sensing and artificial intelligence enter control rooms that were once run on manual gauges and experience-based judgement.

Each of these pressures translates into a human challenge. Consider the demographic problem first. Across many developed economies, the water workforce is ageing faster than the broader labour market, and retirements are outpacing recruitment. Studies cited in the commentary, including analysis by Brookings on renewing the water workforce in the United States, describe a widening pipeline gap: fewer young people enter water-related trades and professions than the sector needs to replace those leaving. The United States Environmental Protection Agency has repeatedly highlighted this workforce constraint alongside its funding programmes, including the water infrastructure investments announced under the bipartisan infrastructure law, which explicitly call for prioritising underserved communities. Money, the argument goes, cannot buy competence; somewhere between the appropriation of funds and the delivery of a resilient system stands a technician who must be trained, certified and retained.

The technological dimension of the workforce problem is equally consequential. Research published in Environmental Science & Technology by Garrido-Baserba and colleagues has examined how the digitalisation of wastewater operations changes decision-making in utilities, introducing data-driven control strategies that demand new competencies. The commentary extends this analysis to cybersecurity, an increasingly urgent concern as water and sewer infrastructure becomes networked. Work from Kompetenzzentrum Wasser Berlin on the future evolution of water infrastructure and associated cyber risks, together with industry analyses from GHD on overcoming vulnerabilities in critical water infrastructure, illustrates how digital transformation creates exposure that only a skilled, security-aware workforce can manage. A treatment plant that can be operated remotely can also, in principle, be attacked remotely — and the first line of defence is not software but the human expertise layered around it.

Different jurisdictions are already experimenting with different workforce models, and the commentary draws together these scattered examples into a coherent agenda. In the United States, the EPA maintains dedicated resources on the water infrastructure sector workforce, framing workforce development as integral to infrastructure sustainability. In Australia, the New South Wales Department of Climate Change, Energy, the Environment and Water has published a water industry traineeship guide designed to create structured entry pathways into the sector. New Zealand has gone further with a national competency framework maintained by Water New Zealand, which sets out the skills and standards expected of water professionals across the industry. In the United Kingdom, the sector skills body Energy & Utility Skills published a workforce renewal and skills strategy in 2020 anticipating demographic decline and skills shortages across energy and water utilities, while case studies such as Thames Water’s diversity and inclusion programme demonstrate attempts to widen the recruitment base.

Singapore offers perhaps the most comprehensive illustration of what deliberate workforce transformation looks like. PUB’s long-running innovation series documents how the city-state has paired infrastructure investment with sustained research and development capacity, cultivating in-house expertise in membrane technology, water reuse and integrated catchment management. The lesson, Ong and Tortajada suggest, is that technology adoption and workforce development are not parallel tracks but a single system: advanced treatment processes only deliver value when engineers understand them, operators can run them and managers can plan around them. UNESCO’s 2016 World Water Development Report, subtitled Water and Jobs, made a related macro-level argument nearly a decade ago — that water and employment are mutually reinforcing — but the commentary argues that this insight has still not been translated into routine workforce planning within urban utilities.

The health dimension of the workforce question also deserves emphasis. Research from New Zealand, published in the New Zealand Medical Journal by Chambers and colleagues, has examined drinking-water quality outcomes in ways that ultimately trace back to the competence of those operating supplies. When treatment fails, the public health consequences can be immediate and severe, as outbreaks of waterborne disease in various countries have demonstrated. This elevates workforce capability from a sectoral concern to a matter of public safety, comparable to aviation safety culture or medical training standards. Yet the water sector rarely enjoys the professional visibility of those industries, and the commentary argues that raising the status, pay and career prospects of water workers is therefore not merely an employment issue but a structural investment in public health and trust.

What, concretely, would a transformed urban water workforce look like? Drawing on the evidence assembled in the commentary, several elements emerge. Utilities and governments would treat workforce planning as a core function, mapping future skill needs against climate scenarios and digital roadmaps rather than filling vacancies reactively. Education and training pipelines would be formalised through apprenticeships, traineeships and competency frameworks of the kind already piloted in Australia, New Zealand and the United Kingdom. Recruitment would broaden beyond traditional engineering cohorts to include data scientists, cyber specialists and community engagement professionals, alongside deliberate efforts to diversify the workforce and include underrepresented groups. Retention would be addressed through career progression, fair compensation and professional recognition, countering the attrition that drains experienced operators into other industries. And international cooperation — the spirit of the 2026 UN Water Conference process — would help transfer these models to cities in lower-income countries, where workforce gaps are often most acute and where urbanisation is fastest.

The broader message of the commentary is one of reframing. Water security is usually measured in cubic metres, infrastructure asset registers and investment sums. Ong and Tortajada ask policymakers to add a different metric: does the city have enough people with the right skills to design, build, operate, secure and adapt its water systems under conditions of accelerating change? Their answer, informed by evidence spanning the United States, Europe, Australia, New Zealand and Singapore, is that most cities do not — and that this human deficit is quietly undermining decades of infrastructure investment. If the urban century is to be water-secure, they conclude, the transformation of the urban water workforce is not an optional complement to infrastructure spending but its essential foundation. The pipes, in other words, are only as resilient as the people who run them, and the time to invest in those people is now.

Subject of Research: The role of workforce transformation in supporting urban water security.

Article Title: Transforming the urban water workforce will support water security

Article References: Ong, C., & Tortajada, C. (2026). Transforming the urban water workforce will support water security. Nature Water. https://doi.org/10.1038/s44221-026-00708-8

Image Credits: AI Generated

DOI: 10.1038/s44221-026-00708-8

Keywords: urban water workforce, water security, water infrastructure, climate change, digitalisation, cybersecurity, workforce training, competency frameworks, urban water management, Nature Water, UN Water Conference, water utilities