Human resources in health care system in sub-Saharan Africa are generally picturing a lack of adequacy between expected skills from the professionals and health care needs expressed by the populations. It is, however, possible to analyse these various lacks of adequacy related to human resource management and their determinants to enhance the effectiveness of the health care system. From two projects focused on nurse professionals within the health care system in Central Africa, we present an analytic grid for adequacy levels looking into the following aspects:-adequacy between skills-based profiles for health system professionals, quality of care and service delivery (health care system /medical standards), needs and expectations from the populations, -adequacy between allocation of health system professionals, quality of care and services delivered (health care system /medical standards), needs and expectations from the populations, -adequacy between human resource management within health care system and medical standards, -adequacy between human resource management within education/teaching/training and needs from health care system and education sectors, -adequacy between basic and on-going education and realities of tasks expected and implemented by different categories of professionals within the health care system body, -adequacy between intentions for initial and on-going trainings and teaching programs in health sciences for trainers (teachers/supervisors/health care system professionals/ directors (teaching managers) of schools...).This tool is necessary for decision-makers as well as for health care system professionals who share common objectives for changes at each level of intervention within the health system. Setting this adequacy implies interdisciplinary and participative approaches for concerned actors in order to provide an overall vision of a more broaden system than health district, small island with self-rationality, and in which they operate.

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Mieux gérer la cohérence pour renforcer les ressources humaines en santé : paradigmes et méthodes pour une intégration efficace des pratiques professionnelles et communautaires en formationBetter managing coherence to strengthen health-related human resources: paradigms and methods for an effective integration of professional and community training practices Les fils conducteurs sont à la fois dans le paradigme du socioconstructivisme en formation et dans celui de la promotion de la santé en ce qui concerne les finalités attendues de ces travaux. Exégèse : Le thème abordé vise à argumenter et à illustrer la légitimité et la fé-condité de l'approche par compétences dans le cadre de la formation des professionnels de santé, en montrant qu'il ne s'agit pas seulement d'un cadre conceptuel opérationnalisable en termes d'ingénierie des dispositifs pédagogiques mais aussi d'un outil puissant au service des processus de changements nécessaires au regard de l'exigence de responsabilité sociale qui s'applique aux institutions de formation et à la nécessité pour celles-ci d'apporter des réponses adéquates et viables au problème de la gestion des ressources humaines en santé. Keywords:Management of human resources; referential of competencies; professionalization; social responsibility; training Abstract -Context and issues:The question of human resources in the area of health is a difficult one. Accordingly, conceptual frameworks and tools are needed to make sense of reality and determine one's action. Objectives: The integrated competence method is a way to tackle the relevance of health-related training curriculum and change. The pedagogical approach is based on a methodological (step-by-step) guide. As a result, experienced readers should be able to take ownership of the approach while considering complementary literature. The expected results of the work are linked to the paradigm of developing socioconstructivism and health promotion. Interpretation: The study aims to make a case for and illustrate the legitimacy and richness of the competence approach in training health professionals. It demonstrates that it is not only an operationalizable conceptual framework in terms of engineering pedagogical plans but also a powerful tool that helps move change processes forward with respect to the social responsibility of training institutions and the need for them to offer adequate and viable responses to the problem of the management of human health resources. Problématique, contexte et objectif

This article describes the results of a participatory process aiming to design and develop a referential of competencies for nurses to be used in secondary professional training within the context of the global South, and more specifically in the Democratic Republic of Congo (DRC). Priority focus is given to the presentation of the final validated product. The competencies' referential is accompanied by a training referential as a pre-requisite guide, which outlines the course of study. Only the referential of competencies is described in this article. The result documents, in the first instance, the shape which this referential of competencies takes in reality, from which a school nurse can be brought to mobilise while practicing his/her profession. The referential's basis and presentation is founded on four key skill sets as a starting point. Each of the four key skills were further broken down and divided according to levels of competencies and minimal criteria for perfecting these skills per year of study. The presentation of the referential of competencies ends by regrouping "families of situations" for each year as well as with an adapted glossary. The discussion focuses on the results of the referential of competencies in its context but also on the use which should be made of this tool within the framework of the implementation of the education and training reform for nurses in DRC. Another point is the interest of this approach by skills for various types of professional training in the health sciences.