Competency mapping of medical officers in charge in Kerala’s family health centers: exploring possibilities and challenges

Background: Kerala’s Aardram Mission transformed Primary Health Centres into Family Health Centres (FHCs) to deliver comprehensive primary care. Medical officers in charge (MOICs) are pivotal as clinical leaders and administrators, yet their specific competency requirements in this model remain underexplored. This study, part of a larger competency-mapping initiative by the State Health Systems Resource Centre–Kerala, aimed to identify the roles, responsibilities, and competencies of MOICs to inform targeted capacity-building. Methods: Competencies were mapped through consultations with health system experts and review of government orders and service delivery frameworks. Using these, in-depth interview guides and observation checklists were developed. Twenty-nine MOICs from randomly selected FHCs across six districts, representing diverse geographic and service contexts, were interviewed. Transcripts were deductively coded against the WHO–ASPHER Competency Framework for the Public Health Workforce in the European Region. Results: MOICs demonstrated strong competencies in clinical care, disease surveillance, health promotion, and community engagement. They effectively collaborated with local self-governments and other departments, led disaster and outbreak responses, and managed human, financial, and material resources. However, challenges included staff shortages, infrastructure gaps, inconsistent community participation, and limited training in managerial, financial, and administrative skills. Performance appraisal practices were inconsistent, and disaster preparedness knowledge varied. Technology use was growing but constrained by connectivity and equipment gaps. Conclusion: MOICs in Kerala’s FHCs fulfill multifaceted roles spanning clinical service, leadership, public health, and resource management. Strengthening targeted training particularly in administration, financial management, and disaster preparedness-along with systemic support for staffing and infrastructure, can enhance their capacity to deliver comprehensive primary care.