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.

Objective: To describe the methodological steps of developing an integrated reference guide for competences according to the profile of the healthcare professionals concerned. Design: Human resources in healthcare represent a complex issue, which needs conceptual and methodological frameworks and tools to help one understand reality and the limits of one's acts. Setting: This study uses results from four contexts (Belgium/Europe, Democratic Republic of Congo, Rwanda and Senegal) in which integrated reference guides for competences for healthcare professionals have been developed. Method: Priority was given to the writing of curricula (initial training) or of training plans (continuous training) more effective in terms of professionalization and more adequate to populations' needs. Results: Pedagogical approach is presented as some (step-by-step) methodological guidance which will help one to get acquainted with this approach. This analysis questions the whole issue of healthcare training institutions' social responsibility. Conclusion: The products obtained (ie reference guides for competences) are only the visible part of the results of the far more fundamental change process that is the real reinforcement of competences and capacities of healthcare professionals in organizations aiming at better managing their resources, among which are human resources in healthcare.

Background: The problem of training human resources in health is a real concern in public health in Central Africa. What can be changed in order to train more competent health professionals? This is of utmost importance in primary health care.

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