Staged Development Tool

National Public Health Institutes (NPHIs) sometimes struggle to deﬁne the most critical next steps that will improve capacity for core public health functions and eﬀective and eﬃcient internal operations. To ﬁll this gap, the U.S. Centers for Disease Control and Prevention (CDC) and the International Association of National Public Health Institutes (IANPHI), in consultation with a group of NPHI leaders from around the world, developed the Staged Development Tool (SDT). The tool helps NPHIs assess their current capacities and plan for how to move to a higher level of functioning. With minor adaptations, the SDT can also be used by Ministries of Health or other organizations.

Please note that the Staged Development Tool (SDT) materials are currently available in English. Versions in French, Portuguese, and Spanish will be available soon.

What is the Staged Development Tool?

The SDT includes 20 Discussion Guides that are based on a maturity model – the idea that for a given topic, NPHIs exhibit different levels of maturity. The SDT Developmental Stages range from Basic to Leading Edge.

By providing detailed examples of what these stages “look like,” Discussion Guides facilitate conversations that help participants clarify their NPHI’s current and desired stages and plan for how to achieve their desired stage. You can find more details about the SDT materials and use in the downloadable PowerPoint.

SDT Discussion Guides

SDT Discussion Guides are organized into two categories, internal-facing and external-facing. Internal-facing Discussion Guides relate to NPHI internal operations, including such topics as leadership and management, financial management, and health and safety of NPHI staff. These describe the ways the organization supports the NPHI to conduct its external-facing functions.

External-facing Discussion Guides often overlap with core public health functions, as described in the “IANPHI Framework for NPHI Development” and other internationally recognized documents. They include activities designed to impact or engage people and organizations outside of the NPHI. These include functions, such as surveillance, public health research, and emergency response.

Each of the Discussion Guides has the same structure: four Developmental Stages (Basic, Developing, Advanced, and Leading Edge), and six domains per stage (Strategic Direction, Systems, Resources, Quality, Engagement, and Impact). The definitions for the six domains are available here.

Information about each of the Discussion Guides can be found here. Click on any of the Discussion Guide names in the table below to view or download the PDF for that Discussion Guide. If you wish to obtain an editable Word version, please contact info@ianphi.org.

Internal Facing	External Facing
1. Organizational Leadership and Management	9. Population Health Status
2. Human Resources (HR) Management	10. Health Communication and Promotion
3. Financial Management	11. Laboratory Systems
4. Information Technology (IT) and Management of Organizational Information	12. Surveillance
5. Health and Safety	13. Emergency Preparedness and Response (EPR)
6. Laboratory Safety	14. Data-to-Action
7. Internal Communication	15. Public Health Workforce (WF) Development
8. External Communication About the NPHI and Its Activities	16. Public Health Research
	17. Multisectoral Collaboration
	18. Linkages with Subnational Public Health
	19. Non communicable Diseases
	20. Generic Discussion Guide

The SDT was first disseminated in 2017. The original website and the associated documents, such as the Discussion Guides, were updated in 2023. The original 30 Discussion Guides that were previously available on this website and the “Definitions and Notes” can be accessed by clicking here.

Using the Discussion Guides

The complete SDT process involves a workshop using one or more Discussion Guides, usually led by a facilitator and recorder team trained in using the SDT. The goal of the workshop is to produce a roadmap for building capacity and increasing impact in areas the NPHI considers a priority. The Discussion Guides can also be used in other ways. For example, some groups have used them in more informal settings, such as staff meetings, to identify gaps and ways to address them.

Use of the Staged Development Tool for Assessing, Planning, and Measuring Progress in the Development of National Public Health Institutes, published in Health Security, Volume: 16, Issue S1: November 27, 2018

SDT Workshops

SDT workshops are facilitated sessions designed to be used by established NPHIs or during the development of an NPHI if it is clear what groups and which people will comprise the NPHI. The workshops can be either in-person, virtual, or hybrid. The number of Discussion Guides covered depends on factors such as the purpose of the workshop (more Discussion Guides would be used for overall strategic planning than to address a specific topic) and logistics. U.S. CDC and IANPHI staff can help an NPHI plan a workshop.

An SDT workshop involves three steps:

Step 1: Assess

NPHIs use Discussion Guides that are most relevant to them to assess their current and desired stages and the reasons they have not reached the desired stage. By providing examples of what the four maturity stages look like, Discussion Guides provide a basis for in-depth conversations.

Step 2: Prioritize

The next step is to select the highest priorities for planning. During the discussion of priorities, the facilitator probes participants to ensure that the priorities and plans will address the underlying issues/reasons inhibiting progress.

Step 3: Plan

Once the NPHI has identified its priorities, planning can begin. Detailed plans, including who will be responsible and when the work should be done, get recorded. In addition, the participants discuss easy wins – activities that can be accomplished easily and will be impactful.

Other Ways to Use the Discussion Guides and the SDT

NPHIs or parts of NPHIs at any stage of development can use Discussion Guides to prompt discussions about the current and desired status and ways to move forward. For example, the director of an NPHI or a division or unit in the NPHI could devote a staff meeting to review a Discussion Guide relevant to an area the group would like to improve. During a reorganization that brings together research groups that have previously been separate, the Discussion Guide on Research could be used to explore concerns and opportunities related to the upcoming change.

A modified SDT process has been used in peer-to-peer workshops, in which countries took turns being facilitators and participants. A modified version of the SDT is a component of the Noncommunicable Diseases Capacity Assessment and Planning (N-CAP) Process. Details on this are available at https://www.tephinet.org/noncommunicable-diseases-capacity-assessment-and-planning-process.

Forms to Capture SDT Discussions

SDT Assessment Form

The SDT Assessment Form is used to capture the key points from discussion during the Assessment Step. It includes spaces to record current and desired scores and reasons why those scores were selected. It includes ideas about the underlying reasons the NPHI has not yet achieved the desired stage or score.

SDT Next Steps Form

The Next Steps Form is used to clarify set priorities and record the next steps for the NPHI to move to a higher stage. It has space to identify who is responsible for carrying out the next steps, and what the timeframe is for accomplishing them.

If you have any comments or questions, you can contact IANPHI at info@ianphi.org or contact the U.S. CDC's NPHI Program at nphisdt@cdc.gov.