Advocacy and policy leadership training for primary care: a global environmental scan of competency frameworks, interventions, and strategic priorities

Abstract

Primary health care (PHC) strengthening globally is catalysed by family physicians and primary care professionals equipped with integrated advocacy, policy leadership, and governance competencies. Yet training in these domains remains fragmented and inconsistent across both high-income countries (HICs) and low- and middle-income countries (LMICs), limiting primary care providers’ capacity to influence health systems, advance equity, and engage in the policy processes essential to PHC system strengthening and universal health coverage (UHC). International academic partnerships aimed at PHC transformation require a shared, rigorous evidence base to inform collaborative curriculum co-design across contexts. An environmental scan of global evidence was conducted in December 2025 to map advocacy and policy leadership frameworks, competencies, and educational interventions for primary care professionals. A scoping search of PubMed, Scopus, ERIC, and Google Scholar, supplemented by grey literature, identified 176 potentially relevant papers (1976–2025). After title, abstract, and full-text screening, 20 core sources published between 2004 and 2024 were selected for detailed structured extraction using a standardized 32-field template across three analytical lenses: conceptual frameworks, competency definitions, and educational interventions. Thematic synthesis was organized around seven major themes aligned with PHC system-strengthening priorities. Four foundational competency frameworks were identified: the CanMEDS Health Advocate role; the South African District Health System Family Physician Leadership and Governance Framework; the Turkish Family Medicine Health Advocacy Competency Set (derived through Delphi consensus); and Kuehne et al.'s PHC Provider Advocacy Framework. All four converge on six core competency domains: health policy literacy, communication, community engagement, equity focus, leadership and governance, and interprofessional collaboration. Educational interventions ranged from brief didactic sessions (approximately 10% of programs) to longitudinal, experiential curricula (approximately 40%). Evidence for effectiveness was strongest at the learner-level improved knowledge and attitudes documented across 75% of postgraduate programs, but evidence for sustained behavioural change and organizational or policy-level system impacts was sparse, particularly in Low- and Middle-Income Countries (LMIC) settings. The evidence base was predominantly High-Income country (HIC)-focused (55%), with only three sources explicitly developing LMIC-adapted frameworks. Major gaps include the near-absence of evaluated LMIC-specific postgraduate curricula, virtually no studies linking training to health system policy changes, and limited attention to advocacy ethics and safety in politically constrained environments. The global evidence base supports competency-based, longitudinal, and experiential approaches to advocacy and policy leadership training for primary care but is critically underdeveloped for LMIC and district health system contexts. Eight strategic priorities are proposed and centered on: designing context-adapted curricula within international collaborative frameworks; establishing academic networks for mentorship and resource sharing; conducting rigorous longitudinal outcome studies; and integrating advocacy and policy literacy into accreditation standards globally. These priorities are framed as the evidence-informed foundation for reciprocal North–South and South–South academic partnerships to advance PHC transformation, health equity, and UHC.