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.

SDT materials are available in English, French, Portuguese, and Spanish.

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.

Our forms resource table contains downloads of all Discussion Guides in English, French, Portuguese, and Spanish.

The SDT was first disseminated in 2017. If desired,  you can view the original website and the associated documents, which includes the option to download the previous versions of including the Discussion Guides..

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 six domains are described in the "Domain Definitions" document.

Use our "Choosing a Discussion Guide" document for ideas about how to select the that best fits your needs. If you wish to obtain an editable Word version of a Discussion Guide, please contact info@ianphi.org.

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.

See also:

Staged Development Tool Case Study: Colombia Instituto de Salud: Implementation and Outcomes

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. An adapted version of the SDT is a component of the Noncommunicable Diseases Capacity Assessment and Planning (N-CAP) Process. View more details about the Noncommunicable Diseases Capacity Assessment and Planning Process.

Forms to Capture SDT Discussions

Two fillable forms have been developed for use with the SDT: the Assessment Form and the Next Steps Form. These are most often used as part of an SDT workshop, but they may also be helpful for capturing ideas during less formal conversations based on the Discussion Guides.

SDT Assessment Form

The 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, contact IANPHI at info@ianphi.org or contact the U.S. CDC's NPHI Program at nphisdt@cdc.gov.