SPECIAL COLLECTION: CAPACITY BUILDING FOR GLOBAL HEALTH LEADERSHIP TRAINING EXPERT CONSENSUS DOCUMENT CORRESPONDING AUTHOR: Meike Schleiff 615 N Wolfe St. Rm E8638, Baltimore, MD, 21205, US [email protected] TO CITE THIS ARTICLE: Schleiff MJ, Mburugu PM, Cape J, Mwenesi R, Sirili N, Tackett S, Urassa DP, Hansoti B, Mashalla Y. Training Curriculum, Skills, and Competencies for Global Health Leaders: Good Practices and Lessons Learned. Annals of Global Health. 2021; 87(1): 64, 1–16. DOI: https://doi. org/10.5334/aogh.3212 ABSTRACT Objectives: This paper aims to depict unique perspectives and to compare and contrast three leadership programs for global health in order to enable other training institutions to design impactful curricula. Methods: We purposively selected three global health training programs. We used a six-step curriculum development framework to systematically compare the curriculum process across programs and to identify best practices and factors contributing to the impact of each of these programs. Findings: All three fellowship programs undertook an intentional and in-depth approach to curriculum development. Each identified competencies related to leadership and technical skills. Each defined goals, though the goals differed to align with the desired impact of the program, ranging from improving the impact of HIV programming, supporting stronger global health program implementation, and supporting the next generation of global health leaders. All programs implemented the curriculum through an onboarding phase, a delivery of core content in different formats, and a wrap-up or endline phase. During implementation, each program also utilized networking and mentoring to enhance connections and to support application of learning in work roles. Programs faced overlapping challenges and opportunities including funding, strengthening partnerships, and finding ways to engage and support alumni. Conclusions: Local ownership of programs is critical, including tailoring curricula to the needs of specific contexts. Strong partnerships and resources are needed to ensure program sustainability and impact. MEIKE J. SCHLEIFF PATRICK MWIRIGI MBURUGU JOHN CAPE RAMA MWENESI NATHANAEL SIRILI SEAN TACKETT DAVID P. URASSA BHAKTI HANSOTI YOHANA MASHALLA *Author affiliations can be found in the back matter of this article Training Curriculum, Skills, and Competencies for Global Health Leaders: Good Practices and Lessons Learned
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SPECIAL COLLECTION:
CAPACITY BUILDING
FOR GLOBAL HEALTH
LEADERSHIP TRAINING
EXPERT CONSENSUS
DOCUMENT
CORRESPONDING AUTHOR: Meike Schleiff
615 N Wolfe St. Rm E8638, Baltimore, MD, 21205, US
TO CITE THIS ARTICLE: Schleiff MJ, Mburugu PM, Cape J, Mwenesi R, Sirili N, Tackett S, Urassa DP, Hansoti B, Mashalla Y. Training Curriculum, Skills,and Competencies for GlobalHealth Leaders: Good Practices and Lessons Learned. Annals of Global Health. 2021; 87(1): 64, 1–16. DOI: https://doi.org/10.5334/aogh.3212
ABSTRACTObjectives: This paper aims to depict unique perspectives and to compare and contrast three leadership programs for global health in order to enable other training institutions to design impactful curricula.
Methods: We purposively selected three global health training programs. We used a six-step curriculum development framework to systematically compare the curriculum process across programs and to identify best practices and factors contributing to the impact of each of these programs.
Findings: All three fellowship programs undertook an intentional and in-depth approach to curriculum development. Each identified competencies related to leadership and technical skills. Each defined goals, though the goals differed to align with the desired impact of the program, ranging from improving the impact of HIV programming, supporting stronger global health program implementation, and supporting the next generation of global health leaders. All programs implemented the curriculum through an onboarding phase, a delivery of core content in different formats, and a wrap-up or endline phase. During implementation, each program also utilized networking and mentoring to enhance connections and to support application of learning in work roles. Programs faced overlapping challenges and opportunities including funding, strengthening partnerships, and finding ways to engage and support alumni.
Conclusions: Local ownership of programs is critical, including tailoring curricula to the needs of specific contexts. Strong partnerships and resources are needed to ensure program sustainability and impact.
MEIKE J. SCHLEIFF
PATRICK MWIRIGI MBURUGU
JOHN CAPE
RAMA MWENESI
NATHANAEL SIRILI
SEAN TACKETT
DAVID P. URASSA
BHAKTI HANSOTI
YOHANA MASHALLA
*Author affiliations can be found in the back matter of this article
Training Curriculum, Skills, and Competencies for Global Health Leaders: Good Practices and Lessons Learned
2Schleiff et al. Annals of Global Health DOI: 10.5334/aogh.3212
BACKGROUNDGlobal health has been defined as “the area of study, research and practice that places a priority on improving health and achieving equity in health for all people worldwide” [1, 2]. The goal of global health is worldwide health improvement, reduction of disparities, and protection against global threats [3]. In recent years, the field of global health has experienced exponential growth with significant investments and new partnerships between entities in high-income countries (HIC) and low- and middle-income countries (LMIC) [4]. The changing landscape of global health has also spurred the need to champion an increased emphasis on interprofessional approaches to health service delivery and the cultivation of leadership skills to build local leadership capacity [5].
A number of groups have been developing guidance and programs to effectively build needed leadership capacity at country and local levels. There has also been a broad shift towards competency-based education, which means focusing on applying and assessing skills and knowledge rather tracking learning by time spent in a classroom [6]. Multiple competency frameworks for global health and public health have been developed [7–9]. For example, the Consortium for Global Health (CUGH) developed interprofessional competencies for global health that can be adopted as guidelines when developing training curricula with different scopes and available resources [8]. The process of developing global health competencies and curricula is often insufficiently inclusive of input from host country health professionals and furthermore fails to take adequate account of local health contexts. In addition, the methods applied and resources available for meaningfully assessing global health curricula are frequently inadequate [10, 11].
In its basic format, “curriculum” refers to the lessons and academic content taught in a school or in a specific course or program [12, 13]. There are several ways that curricula can be focused and organized, including 1) subject-centered, 2) learner-centered, and 3) problem-centered design. For the purposes of this paper, we take a learner-centered approach. Learner-centered teaching posits that faculty members should focus their efforts on what students need to learn, tailoring learning to the priorities of specific target audiences [14].
In order to bridge current global health leadership training gaps, several global health training programs have developed competency-based curricula targeting different groups of health professionals. One such program is the Afya Bora Consortium Fellowship, established in response to a “Call For Action” in improving leadership in global health programs. This program is targeted towards senior health professionals (having more than five years professional experience) from across the fields of medicine, nursing, and public health, to fill gaps in leadership and management of HIV/AIDS programs [15]. Sustaining Technical and Analytic Resources (STAR) is a program established in response to the recognition by USAID that more explicit emphasis is needed on capacity strengthening and leadership development for leading technical professionals, as well as the teams and organizations they work, which are the target audiences for STAR. The program aims to develop the next cadre of global health technical professionals by bolstering traditional
KEY TAKEAWAYS
• Global health competencies and curricula should be linked to local health system needs and contexts where learners are working.
• Emphasizing both individualistic and collectivist approaches to learning is important in engaging and supporting diverse global health learners.
• Emphasizing mentorship and opportunities to apply learning in contexts where learners are working is important in order to provide support to learners as they work to integrate what they are learning into their professional roles and activities.
• Partnerships and resources—including donor support—are essential to implement and sustain robust leadership curricula and to provide opportunities for experiential and didactic learning.
3Schleiff et al. Annals of Global Health DOI: 10.5334/aogh.3212
work-based fellowships with dedicated time for leadership development, focused learning activities, and linkages to academic resources [16]. Global Health Corps (GHC) was established to foster a diverse, highly skilled, and tightly-networked community of leaders who work together across disciplines in order to strengthen health systems and targets young and diverse global health professionals. GHC’s unique co-fellow model matches two fellows—one national and one international fellow—with health organizations for a 13-month fellowship. During this fellowship, they receive substantial leadership and management training, coaching, and technical mentorship.
Development of leadership capacity with comprehensive skills to navigate the challenging health care systems in LMIC and HIC has resulted in several innovations in global health leadership training that have incorporated input from host countries and have been suited for local contexts. However, there is a limited understanding of the unique features, successes, and challenges of such programs.
OBJECTIVEThis paper aims to depict unique perspectives from representatives to compare and contrast three leadership programs for global health in order to enable other training institutions to design impactful curricula.
METHODSWe purposively selected a set of three global health leadership training programs (The Afya Bora Consortium Fellowship in Global Health Leadership, The Sustaining Technical and Analytic Resources (STAR) Project, and Global Health Corps (GHC)). We aimed to illustrate a range of educational models for which we have extensive first-hand experience. All of the programs had the following criteria in common:
• The program must not be solely clinically focused and must aim to train professionals to lead and manage public health programming around the world.
• The program must include an explicit emphasis on leadership development.
• The program must include a focus on LMIC-based participants and on strengthening capacity for leadership in LMICs, particularly across the African continent.
• The program must not rely solely or predominantly on bringing participants to the US or Europe for study and work opportunities, but rather aim to reach and support them in gaining skills and expertise within the context they are working in around the world.
• The program has been in operation long enough to have evidence and experience available.
FRAMEWORK FOR COMPARING PROGRAMS
We adapted a six-step curriculum development process [13] to inform our framework for comparing the selected training programs. This curriculum development process, described in Figure 1, begins with problem identification and a general needs assessment (top) and follows an iterative cycle of planning, implementation, and evaluation; the process was developed for medical education programs but has been used widely across the Johns Hopkins University, as well as with other training programs for other sectors.
DATA ANALYSIS AND SYNTHESIS
Data on the programs’ curricula development procedures, target population, structure, implementation—including delivery mode, assessment, monitoring and evaluation procedures, expected outcome, and impact—were collected and reviewed. Trustworthiness and consistency of data presentation was achieved through regular reviews and discussion among team members and members of the program working groups. A comparative analysis of the training programs was made to elucidate key outcomes of each program.
4Schleiff et al. Annals of Global Health DOI: 10.5334/aogh.3212
FINDINGSDESCRIPTIONS AND COMPARISON OF GLOBAL HEALTH LEADERSHIP TRAINING PROGRAMS
The following program descriptions provide an overview of each program’s genesis and aims, including how each was adapted to the needs of its particular target audience.
1. The Afya Bora Consortium Fellowship in Global Health Leadership
In 2011, the Afya Bora Consortium, comprising nine academic medical institutions (five in Africa and four in the United States) started implementing an interprofessional global health leadership training program for participants from across Africa and the US. The overarching goal was to fill in the gaps in leadership for the HIV/AIDS programs [15]. The fellowship program is uniquely designed to ensure trainees acquire leadership skills that are not part of traditional medical, nursing, and public health curricula. The program imparts technical expertise in planning, designing, implementing, monitoring, and evaluating health interventions projects and organizational strategies to prepare participants for positions in governmental, non-governmental, clinical, and academic health institutions [17]. To date, Afya Bora has trained 146 health professionals. Among the fellows, 52% are doctors, 44% are nurses, and 4% are public health professionals. The strength of the Afya Bora Consortium fellowship lies in the diversity of its curricula and the fact that it is aligned with leadership gaps in LMIC in Africa, the interprofessional nature of recruited fellows, the north-south and south-south collaboration, module delivery, mentorship, and networking.
2. The Sustaining Technical and Analytic Resources (STAR) Project
STAR was established to build on several decades of experience managing fellowships at USAID, via the well-established Global Health Fellows Program (GHFP). The impetus for establishing STAR was a move to transition from technical assistance only to capacity strengthening and leadership development—especially within LMIC settings. STAR fellows can have from 2 to 15+ years of professional experience; 50% are based abroad, and a significant portion boast advanced degrees. STAR aims to develop the next cadre of global health technical professionals by bolstering traditional work-based fellowships with dedicated time for leadership development, focused
Figure 1 Six-Step Curriculum Development Framework.
5Schleiff et al. Annals of Global Health DOI: 10.5334/aogh.3212
learning activities, and linkages to academic resources. As such, the STAR learning developed a high impact individualized learning curriculum that incorporates principles of deliberate practice and competency-based training to support learning and capacity development across a wide breadth and depth of participants. The goals of the STAR learning program are as follows:
a) Enable highly skilled public health workers to fulfill technical roles in local global/public health programming
b) Train fellows that can perform at practicing level, or higher, across all eight core competencies
c) Help fellows develop skills and strategies for knowledge sharing
STAR is designed to respond to the challenges of lack of protected time available for learning, especially for senior professionals, as well as lack of resources dedicated to leadership training in global health.
3. Global Health Corps (GHC)
Since its founding in 2009, GHC has recruited and trained over 1,000 young leaders committed to transforming health systems and placed them with more than 150 global health organizations in the USA and east and southern Africa, including Ministries of Health, NGOs, and grassroots organizations. This paid fellowship program matches the capacity needs of partner organizations with talented individuals seeking to build careers in global health. GHC complements fellows’ work experience with a robust curriculum and coaching focused on leadership and management skills. The curriculum is built around four pillars—systems thinking, design thinking, authentic leadership, and collective leadership—and is designed to complement the technical learning fellows acquire through their workplace. GHC’s co-fellow model and cohort-based learning ensures that fellows can engage with unique and diverse perspectives and also develop a rich network of peers across disciplines, geographies, and backgrounds. Beyond the fellowship year, GHC alumni continue to receive training, seed funding, coaching, and networking support.
COMPARISON ACROSS GLOBAL HEALTH LEADERSHIP PROGRAM CURRICULUM DESIGN AND COMPETENCIES
In order to facilitate comparisons across the three programs we describe in this paper, we developed a matrix following the curriculum development process in order to compare and contrast each global health leadership program (Table 1).
Steps 1 and 2: Problem Identification and Needs Assessment
The programs described in this paper vary in number of years of implementation, target population, number of participants trained to date, and program model. However, each of the programs were established to address a similar problem: a lack of highly skilled and diverse leaders in LMICs with the leadership and management skills and networks required to address complex global health challenges.
Programs identified that local candidates and candidates from historically marginalized populations were underrepresented in leadership positions due to various barriers, including lack of access to referral networks, underinvestment in recruiting a diverse candidate pool, lack of access to professional training and accreditation, and lack of opportunity for continuous learning and professional development. Furthermore, existing education programs tended to focus on clinical or technical skills and were mostly based in high-income contexts, limiting access to candidates who lacked the time, resources, and ability for travel to these locations. Each program recognized that building a strong and diverse talent pipeline in LMICs would require establishing strategic partnerships and increasing donor investments in locally based leadership training. Additionally, each program recognized the need to expand opportunities to a broad cross-section of leaders, including clinical workers, NGO workers, public sector actors, and young professionals from diverse backgrounds.
(Con
td.)
CUR
RIC
ULU
M S
TEP
AFY
A B
OR
AST
AR
PR
OJE
CTG
LOB
AL
HEA
LTH
CO
RPS
Initi
al m
atric
ulat
ion
2011
2017
2009
Mai
n co
llabo
rato
rsA
fric
an P
artn
ers:
Uni
vers
ity o
f Nai
robi
- Ke
nya
Muh
imbi
li U
nive
rsity
-Tan
zani
a
Uni
vers
ity o
f Bot
swan
a- B
otsw
ana
Mak
erer
e U
nive
rsity
-Uga
nda
Uni
vers
ity o
f Bue
a-Ca
mer
oon
US
part
ners
Uni
vers
ity o
f Was
hing
ton
Seat
tle
Uni
vers
ity o
f Pen
nsyl
vani
a
John
Hop
kins
Uni
vers
ity
Uni
vers
ity o
f Cal
iforn
ia S
an F
ranc
isco
Publ
ic H
ealt
h In
stitu
te (P
HI)
John
s H
opki
ns S
choo
l of P
ublic
Hea
lth
(JH
SPH
)
Cons
ortiu
m o
f Uni
vers
ities
for G
loba
l Hea
lth
(CU
GH
)
Uni
vers
ity o
f Cal
iforn
ia S
an F
ranc
isco
(UCS
F).
150+
par
tner
org
aniz
atio
ns in
clud
ing
Min
istr
ies
of H
ealt
h, I
NG
Os,
and
gra
ssro
ots
orga
niza
tions
ac
ross
the
USA
, Eas
t an
d So
uthe
rn A
fric
a
Tota
l enr
ollm
ent
to d
ate
189
(162
alu
mni
, 27
curr
ent
fello
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115
(69
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ws,
46
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rns)
1,02
8 al
umni
Prog
ram
dur
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nO
ne y
ear f
ello
wsh
ip.
Two
year
s fo
r fel
low
s an
d 3–
12 m
onth
s fo
r in
tern
s.13
mon
ths
fello
wsh
ip; c
aree
r-lo
ng s
uppo
rt fo
r al
umni
.
Step
s 1
and
2: P
robl
em
Iden
tifi
cati
on a
nd
Nee
ds A
sses
smen
t
Prob
lem
sta
tem
ent
Lack
of h
ealt
h pr
ofes
sion
als
with
lead
ersh
ip
and
man
agem
ent
skill
s to
man
age
HIV
/AID
S pr
ogra
ms.
Lack
of h
ighl
y sk
illed
pub
lic h
ealt
h w
orke
rs t
o fu
lfill
tech
nica
l rol
es in
loca
l (LM
IC fo
cuse
d)
glob
al/p
ublic
hea
lth
prog
ram
min
g.
Lack
of d
iver
se le
ader
s in
non
-clin
ical
pub
lic
heal
th ro
les
Lack
of i
ndiv
idua
ls w
ith t
he le
ader
ship
ski
lls,
man
agem
ent
skill
s, a
nd p
rofe
ssio
nal n
etw
ork
nece
ssar
y fo
r sys
tem
s ch
ange
.
Curr
ent
appr
oach
(sta
tus
quo
for l
eade
rshi
p an
d m
anag
emen
t in
glo
bal
heal
th p
rogr
amm
ing)
Prac
titi
oner
per
spec
tive
Ther
e is
an
incr
easi
ng n
eed
for h
ealt
h pr
ofes
sion
als
trai
ned
to fi
ll in
the
gap
s in
le
ader
ship
and
man
agem
ent
for t
he g
row
ing
num
ber o
f hea
lth-
rela
ted
prog
ram
s in
Afr
ica.
M
ost
ofte
n th
ese
posi
tions
are
fille
d by
ex
patr
iate
s du
e to
lack
of e
xper
tise
amon
g lo
cal h
ealt
h ca
re p
rofe
ssio
nals
.
Educ
atio
n pe
rspe
ctiv
e
Maj
ority
of t
rain
ing
prog
ram
s in
Afr
ica
focu
s m
ore
on c
linic
al s
kills
as
oppo
sed
to in
culc
atin
g le
ader
ship
ski
lls in
the
ir tr
aine
es. T
his
has
led
to
wel
l-tr
aine
d cl
inic
ians
abl
e to
man
age
patie
nt
illne
sses
but
una
ble
to d
evel
op a
nd ru
n he
alth
pr
ogra
ms.
Fin
ding
lead
ersh
ip a
nd m
anag
emen
t tr
aini
ng o
ppor
tuni
ties
is le
ft u
p to
indi
vidu
als;
m
any
mus
t tr
avel
abr
oad,
whi
ch c
reat
es
ineq
uitie
s by
lim
iting
tra
inin
g fo
r tho
se w
ith
mea
ns t
o tr
avel
.
Prac
titi
oner
per
spec
tive
US
resi
dent
s of
ten
fill t
echn
ical
lead
ersh
ip ro
les
for U
SAID
pro
gram
s. P
rofe
ssio
nals
focu
s on
in
divi
dual
adv
ance
men
t an
d te
chni
cal s
kills
; on
goin
g ed
ucat
ion
is o
ften
not
pla
nned
and
re
lies
on a
ppre
ntic
eshi
p.
Educ
atio
n pe
rspe
ctiv
e
USA
ID h
as in
vest
ed in
inte
rnal
tra
inin
g m
odul
es
avai
labl
e to
the
ir em
ploy
ees.
HIC
-bas
ed
grad
uate
pro
gram
s ar
e cl
assr
oom
-bas
ed a
nd
mis
alig
ned
with
prio
ritie
s of
pra
ctiti
oner
s.
Onl
ine
optio
ns a
re e
xpan
ding
but
requ
ire t
ime
and
inte
rnet
acc
ess
and
are
limite
d in
the
ir in
tera
ctiv
ity, a
sses
smen
t, a
nd e
valu
atio
n op
tions
.
Prac
titi
oner
per
spec
tive
Non
-clin
ical
hea
lthc
are
wor
kers
add
ress
crit
ical
ca
paci
ty g
aps
in p
ublic
hea
lth
orga
niza
tions
. U
nder
inve
stm
ent
in t
he re
crui
tmen
t, re
tent
ion,
an
d tr
aini
ng o
f div
erse
non
-clin
ical
hea
lth
wor
kers
resu
lts
in w
eak
and
vuln
erab
le h
ealt
h sy
stem
s.
Educ
atio
n pe
rspe
ctiv
e
Man
y tr
aini
ng a
nd e
duca
tion
prog
ram
s ov
erva
lue
tech
nica
l ski
lls a
nd n
egle
ct t
he
impo
rtan
ce o
f lea
ders
hip
and
man
agem
ent
skill
s-bu
ildin
g fo
r ach
ievi
ng g
loba
l hea
lth
outc
omes
. Pra
ctiti
oner
s ar
e th
eref
ore
unpr
epar
ed t
o re
spon
d or
ada
pt t
o th
e ch
alle
nges
and
sys
tem
s le
ader
ship
requ
ired
to
tran
sfor
m c
ompl
ex h
ealt
h sy
stem
s.
Tabl
e 1
Com
para
tive
Ana
lysi
s of
Glo
bal P
ublic
Hea
lth
Lead
ersh
ip P
rogr
am C
urric
ular
App
roac
hes.
CUR
RIC
ULU
M S
TEP
AFY
A B
OR
AST
AR
PR
OJE
CTG
LOB
AL
HEA
LTH
CO
RPS
Idea
l app
roac
h (w
hat
our
prog
ram
s ar
e al
igne
d to
co
ntrib
ute
tow
ards
)
Prac
titi
oner
per
spec
tive
Lead
ersh
ip a
nd m
anag
emen
t tr
aini
ng c
apac
ity
for h
ealt
h pr
ofes
sion
als
in A
fric
a ca
n be
en
hanc
ed t
hrou
gh c
olla
bora
tions
am
ong
loca
l go
vern
men
ts a
nd im
plem
entin
g pa
rtne
rs.
Educ
atio
n pe
rspe
ctiv
e
Lead
ersh
ip a
nd m
anag
emen
t m
odul
es t
ailo
red
to h
ealt
h sy
stem
s sh
ould
be
inte
grat
ed t
o ex
istin
g he
alth
-rel
ated
cur
ricul
a. T
he m
ode
of t
rain
ing
shou
ld e
mph
asiz
e pr
actic
al/
atta
chm
ents
to
enab
le a
cqui
sitio
n of
ski
lls a
nd
expe
rienc
es in
org
aniz
atio
ns t
hat
also
hav
e an
im
med
iate
impa
ct.
Prac
titi
oner
per
spec
tive
USA
ID a
nd o
ther
lead
ing
inte
rnat
iona
l de
velo
pmen
t ag
enci
es a
roun
d th
e w
orld
sho
uld
prov
ide
ince
ntiv
es t
o in
vest
and
sha
re re
sour
ces
with
col
leag
ues.
Pra
ctiti
oner
s sh
ould
acc
ess
trai
ning
tha
t w
ill im
prov
e th
eir p
erfo
rman
ce
and
part
icul
ar w
ork
expe
ctat
ions
whi
le s
ervi
ng
as t
echn
ical
lead
s an
d pa
rtne
ring
with
hos
t co
untr
y go
vern
men
ts.
Educ
atio
n pe
rspe
ctiv
e
Rele
vant
edu
catio
nal o
ppor
tuni
ties
shou
ld
be a
vaila
ble
broa
dly
to th
e gl
obal
hea
lth
wor
kfor
ce. T
eam
s an
d or
gani
zatio
ns s
houl
d th
ink
syst
emat
ical
ly a
bout
sup
port
ing
ongo
ing
lear
ning
. Le
arni
ng s
houl
d be
targ
eted
tow
ards
the
need
s of
indi
vidu
als
and
the
prog
ram
s th
ey s
uppo
rt.
Prac
titi
oner
per
spec
tive
Glo
bal h
ealt
h or
gani
zatio
ns s
houl
d ha
ve
acce
ss t
o a
relia
ble
tale
nt p
ipel
ine
of d
iver
se,
non-
clin
ical
sta
ff w
ho h
ave
the
lead
ersh
ip a
nd
man
agem
ent
skill
sets
to
succ
essf
ully
lead
co
mpl
ex in
itiat
ives
.
Educ
atio
n pe
rspe
ctiv
e
Lead
ers
shou
ld b
e pr
epar
ed w
ith t
he le
ader
ship
an
d m
anag
emen
t sk
illse
ts t
o su
cces
sful
ly
navi
gate
and
lead
com
plex
cha
nge.
Lea
ders
hip
and
man
agem
ent
acum
en a
re c
onsi
dere
d as
es
sent
ial a
s te
chni
cal s
kills
ets.
Targ
et le
arne
rsD
octo
rs, n
urse
s, a
nd p
ublic
hea
lth
prof
essi
onal
s dr
awn
from
Min
istr
y of
Hea
lth,
N
on-G
over
nmen
t O
rgan
izat
ions
(NG
O),
Aca
dem
ic H
ealt
h In
stitu
tions
.
USA
ID, M
inis
trie
s of
Hea
lth,
and
NG
O m
anag
ers
and
tech
nica
l lea
ds fo
cuse
d on
pub
lic h
ealt
h pr
ogra
ms.
Youn
g pr
ofes
sion
als
(age
s 22
-30)
from
div
erse
na
tiona
l, ra
cial
, eth
nic,
and
pro
fess
iona
l ba
ckgr
ound
s.
Step
3: G
oals
and
ob
ject
ives
Ove
rall
goal
s of
the
cu
rric
ulum
1. T
rain
Afr
ican
hea
lth
prof
essi
onal
s in
ev
iden
ce-b
ased
lead
ersh
ip t
o im
plem
ent
succ
essf
ul H
IV-r
elat
ed a
nd o
ther
pub
lic
heal
th p
rogr
ams.
2. I
mpr
ove
HIV
pre
vent
ion,
car
e an
d tr
eatm
ent
thro
ugh
site
-lev
el p
rogr
ams
and
proj
ects
th
at a
re p
art
of t
he fe
llow
ship
tra
inin
g ex
perie
nce.
3. S
uppo
rt c
olla
bora
tions
and
net
wor
king
am
ong
curr
ent
fello
ws,
alu
mni
, and
men
tors
to
impr
ove
the
qual
ity, e
ffici
ency
, and
im
pact
of H
IV s
ervi
ces
loca
lly, n
atio
nally
, an
d re
gion
ally
.
1. E
nabl
e hi
ghly
ski
lled
publ
ic h
ealt
h w
orke
rs
to fu
lfill
tech
nica
l rol
es in
loca
l glo
bal/p
ublic
he
alth
pro
gram
min
g
2. F
ello
ws
can
perf
orm
at
prac
ticin
g le
vel,
or
high
er, a
cros
s al
l eig
ht c
ore
com
pete
ncie
s
3. F
ello
ws
will
dev
elop
ski
lls a
nd s
trat
egie
s fo
r kn
owle
dge
shar
ing.
Fello
ws
are
equi
pped
to
be e
ffec
tive
lead
ers
who
exc
el in
the
ir ca
reer
s, c
olla
bora
te w
ith e
ach
othe
r, an
d in
fluen
ce t
he fi
eld
of g
loba
l hea
lth.
Com
pete
ncy
dom
ains
• L
eade
rshi
p at
trib
utes
• Pro
blem
sol
ving
ski
lls
• Int
erpr
ofes
sion
al c
omm
unic
atio
n: b
oth
verb
al
and
oral
• Acc
ount
abili
ty a
nd m
anag
emen
t of
hea
lth
prog
ram
s, u
se o
f dat
a to
gui
de, i
mpr
ove,
and
ad
voca
te fo
r pro
gram
s, e
thic
al c
ondu
ct, a
nd
rese
arch
with
hum
an s
ubje
cts
• Eff
ectiv
e w
ritin
g/pr
opos
al w
ritin
g
• Dev
elop
men
t pr
actic
e
• Com
mun
icat
ions
• Cro
ss-c
ultu
ral p
ract
ice
• Cap
acity
str
engt
heni
ng
• Glo
bal b
urde
n of
dis
ease
• Equ
ity
• Eth
ics
• Gen
der
Lead
ersh
ip a
nd m
anag
emen
t sk
ills
are
addr
esse
d in
four
are
as:
• sys
tem
s th
inki
ng
• des
ign
thin
king
• aut
hent
ic le
ader
ship
• col
lect
ive
lead
ersh
ip
Tech
nica
l ski
lls a
re d
evel
oped
thr
ough
w
orkp
lace
lear
ning
and
sup
plem
enta
ry
prog
ram
min
g.
(Con
td.)
CUR
RIC
ULU
M S
TEP
AFY
A B
OR
AST
AR
PR
OJE
CTG
LOB
AL
HEA
LTH
CO
RPS
• Tra
nsla
tion
of re
sear
ch fi
ndin
gs t
o pr
actic
e,
effe
ctiv
e pr
ojec
t m
anag
emen
t, p
rinci
ples
and
to
ols
of h
uman
reso
urce
man
agem
ent
• Hea
lth
polic
y
• Bud
get
man
agem
ent
Step
4: E
duca
tion
al
Stra
tegi
es
Educ
atio
nal s
trat
egie
s an
d pe
dago
gica
l app
roac
hes
One
yea
r fel
low
ship
tha
t in
clud
es in
tera
ctiv
e di
dact
ic s
essi
ons
for e
ight
wee
ks a
nd t
wo
4.5
mon
ths
atta
chm
ent
site
rota
tions
(men
tore
d pr
ojec
t or
ient
ed ro
tatio
ns)
Fello
wsh
ip m
eeti
ngs
The
fello
ws
atte
nd t
hree
fello
wsh
ip m
eetin
g th
at in
clud
e or
ient
atio
n, m
id-f
ello
wsh
ip a
nd
final
mee
tings
. Dur
ing
the
mee
ting,
ple
nary
pr
esen
tatio
ns a
re m
ade
on c
urre
nt is
sues
in
Glo
bal H
ealt
h by
gue
st s
peak
ers,
net
wor
king
w
ith m
ento
rs a
nd a
lum
ni a
nd fe
llow
s m
ake
pres
enta
tions
on
thei
r pro
ject
s.
Did
acti
c se
ssio
ns
Fello
ws
unde
rgo
face
-to-
face
lect
ures
, cas
e st
udie
s, a
nd d
iscu
ssio
ns in
inte
rpro
fess
iona
l te
ams.
Att
achm
ent
site
pla
cem
ents
Thes
e pr
ovid
e pr
actic
al s
kills
and
off
er a
ch
ance
to
impl
emen
t m
ater
ials
lear
nt fr
om
dida
ctic
ses
sion
s. D
urin
g th
e pl
acem
ent
the
fello
ws
are
supe
rvis
ed b
y si
te m
ento
rs.
Indi
vidu
al fe
llow
s ar
e ex
pect
ed t
o un
dert
ake
a pr
ojec
t th
at b
enefi
ts t
he o
rgan
isat
ion
durin
g th
e pl
acem
ent
unde
r the
gui
danc
e of
men
tors
.
Alu
mni
eng
agem
ent
The
prog
ram
off
ers
com
petit
ive
supp
ort
for a
ca
reer
dev
elop
men
t pr
ojec
t an
d at
tend
ance
of
net
wor
king
foru
ms,
incl
udin
g fe
llow
ship
m
eetin
gs a
nd c
onfe
renc
es.
Two-
year
fello
wsh
ip a
nd t
hree
-mon
th t
o on
e-ye
ar in
tern
ship
s.
ILP
Dev
elop
men
t of
indi
vidu
aliz
ed le
arni
ng p
lans
(I
LP) f
or e
ach
part
icip
ant
at t
he o
utse
t of
the
fe
llow
ship
, whi
ch is
mon
itore
d an
d re
vise
d as
ne
eded
thr
ough
out.
Thi
s pl
an h
elps
par
ticip
ants
or
gani
ze a
nd a
ntic
ipat
e le
arni
ng n
eeds
and
de
velo
p a
holis
tic a
nd c
oher
ent
pack
age
of
lear
ning
ove
r the
cou
rse
of t
he p
rogr
am.
Del
iber
ate
Prac
tice
A d
elib
erat
e pr
actic
e ap
proa
ch is
util
ized
link
ing
lear
ning
with
wor
k pe
rfor
man
ce.
Hyb
rid
Men
tors
hip
A h
ybrid
men
tors
hip
mod
el w
as d
evel
oped
and
is
util
ized
with
pee
r men
tors
hip
grou
ps t
hat
focu
s on
cor
e co
mpe
tenc
ies
and
need
-driv
en
sess
ions
on
topi
cs in
form
ed b
y th
e pr
iorit
ies
of e
ach
part
icul
ar g
roup
as
wel
l as
gene
ral
publ
ic h
ealt
h ch
alle
nges
, suc
h as
the
CO
IVD
-19
resp
onse
. In
addi
tion,
indi
vidu
al t
echn
ical
m
ento
rs a
re a
ssig
ned
as re
ques
ted.
Expe
rien
tial
Lea
rnin
g
Paid
13-
mon
th fe
llow
ship
with
pla
cem
ent
orga
niza
tions
wor
king
on
the
fron
tlin
es o
f glo
bal
heal
th in
Mal
awi,
Rwan
da, U
gand
a an
d Za
mbi
a.
Co-F
ello
w M
odel
We
plac
e fe
llow
s in
pai
rs—
one
natio
nal a
nd o
ne
inte
rnat
iona
l fel
low
—w
ithin
eac
h or
gani
zatio
n,
to p
rom
ote
cros
s-cu
ltur
al le
arni
ng a
nd
colla
bora
tion.
Trai
ning
and
Com
mun
ity
Build
ing
Fello
ws
mee
t re
gula
rly w
ith t
heir
coho
rt fo
r w
orks
hops
and
com
mun
ity b
uild
ing
activ
ities
.
Prof
essi
onal
Dev
elop
men
t Fu
nd
Fello
ws
can
appl
y fu
ndin
g to
pur
sue
indi
vidu
al
lear
ning
opp
ortu
nitie
s.
Men
tors
hip/
Coac
hing
Prov
ided
by
staf
f, ad
viso
rs, a
lum
ni, a
nd
supe
rvis
ors.
Care
er-l
ong
Supp
ort
Fello
ws
join
an
alum
ni c
omm
unity
and
acc
ess
ongo
ing
supp
ort
as t
hey
adva
nce
in t
heir
care
ers,
col
labo
rate
with
eac
h ot
her,
and
influ
ence
the
fiel
d of
glo
bal h
ealt
h.
Step
5:
Impl
emen
tati
onCo
re C
urri
culu
m
Cons
ists
of e
ight
one
-wee
k di
dact
ic m
odul
es
and
two
wor
ksho
ps (o
ne t
o tw
o da
ys e
ach)
an
d fo
ur d
ista
nce
lear
ning
mod
ules
Del
iver
y: B
ased
on
case
stu
dies
, Pro
blem
ba
sed
lear
ning
app
roac
h, G
roup
wor
k an
d pr
esen
tatio
ns w
ith m
inim
al p
ower
-poi
nt
lect
ures
Onb
oard
ing
Part
icip
ant
onbo
ardi
ng in
clud
es a
goa
ls
deve
lopm
ent
activ
ity, a
bas
elin
e co
mpe
tenc
y as
sess
men
t, a
nd t
he d
evel
opm
ent
of a
n IL
P.
Each
ILP
refle
cts
wor
k-re
late
d go
als
as w
ell a
s lo
nger
-ter
m c
aree
r goa
ls in
a s
et o
f spe
cific
and
in
divi
dual
ized
lear
ning
obj
ectiv
es. T
he I
LP is
a
cont
ract
bet
wee
n th
e pa
rtic
ipan
t, t
heir
onsi
te
man
ager
at
USA
ID, a
nd S
TAR
for t
ime
and
Recr
uitm
ent
and
Plac
emen
t
We
recr
uit
and
plac
e a
dive
rse
pool
of t
alen
ted
youn
g pr
ofes
sion
als
on t
he fr
ont
lines
of g
loba
l he
alth
. Our
lead
ers
fill c
ritic
al g
aps
with
in o
ur
com
petit
ivel
y se
lect
ed p
artn
er o
rgan
izat
ions
, ho
ning
the
ski
lls n
eede
d to
tra
nsfo
rm h
ealt
h sy
stem
s th
roug
hout
the
ir ca
reer
s.
(Con
td.)
CUR
RIC
ULU
M S
TEP
AFY
A B
OR
AST
AR
PR
OJE
CTG
LOB
AL
HEA
LTH
CO
RPS
Att
achm
ent
site
rot
atio
ns
Act
as
area
s fo
r exp
erie
ntia
l lea
rnin
g,
site
s lo
cate
d in
Afr
ican
par
tner
cou
ntrie
s in
clud
ing
Gov
ernm
ent
faci
litie
s (M
OH
), N
GO
s,
Inte
rnat
iona
l Hea
lth
orga
niza
tions
—CD
C,
USA
ID.
Post
fel
low
ship
net
wor
king
This
is t
hrou
gh p
rovi
sion
of n
etw
orki
ng
plat
form
s an
d su
ppor
t of
ong
oing
car
eer
activ
ities
budg
et a
lloca
tion
for t
he p
artic
ipan
t to
dev
ote
to le
arni
ng.
Prog
ram
per
iod
Onc
e on
boar
ding
is c
ompl
eted
, par
ticip
ants
em
bark
on
thei
r job
s an
d co
mpl
ete
the
activ
ities
laid
out
in t
heir
ILP.
The
STA
R le
arni
ng
team
als
o en
gage
s th
em in
gro
up m
ento
rshi
p gr
oups
and
oth
er p
rogr
am-w
ide
oppo
rtun
ities
. Ea
ch p
artic
ipan
t ha
s ch
eck-
ins
ever
y si
x m
onth
s to
mon
itor p
rogr
ess
and
to c
ours
e-co
rrec
t as
ne
eded
.
Prog
ram
wra
p-up
Each
par
ticip
ant
com
plet
es a
n ev
alua
tion
of
the
lear
ning
exp
erie
nce
as w
ell a
s on
eac
h sp
ecifi
c ac
tivity
tha
t th
ey c
ompl
eted
. The
y al
so
com
plet
e an
end
line
com
pete
ncy
asse
ssm
ent
to d
emon
stra
te c
hang
es in
ski
lls a
nd
know
ledg
e, p
artic
ular
ly a
cros
s th
e ei
ght
core
co
mpe
tenc
ies.
Lead
ersh
ip P
rogr
amm
ing
We
desi
gn a
nd im
plem
ent
a tr
ansf
orm
ativ
e,
robu
st le
ader
ship
dev
elop
men
t cu
rric
ulum
.
Com
mun
ity
Build
ing
We
build
a t
ight
-kni
t co
mm
unity
to
harn
ess
the
pow
er o
f col
lect
ive
lead
ersh
ip. T
hrou
gh
sum
mits
, tra
inin
gs, a
n on
line
port
al, a
nd
regi
onal
cha
pter
s, o
ur le
ader
s co
llabo
rate
ac
ross
bor
ders
and
bou
ndar
ies,
am
plify
ing
thei
r im
pact
and
influ
ence
.
Step
6: E
valu
atio
n an
d Im
pact
Ass
essm
ent
and
eval
uatio
n ap
proa
chFe
edba
ck b
y fe
llow
s on
all
mod
ules
Att
achm
ent
site
s: C
ompl
etio
n of
bi-
wee
kly
jour
nal d
escr
ibin
g ex
perie
nces
Wee
kly
mee
ting
with
site
men
tors
Mon
thly
mee
tings
with
prim
ary
men
tors
and
pe
er re
view
s by
fello
ws
Com
plet
ion
of e
valu
atio
ns b
y m
ento
rs a
nd
Men
tees
Fina
l eva
luat
ion:
Fin
al re
port
Post
fello
wsh
ip: B
iann
ual s
urve
ys fo
r alu
mni
—tr
ack
care
er p
rogr
essi
on/lo
ng t
erm
impa
ct.
Feed
back
from
fello
ws
and
eval
uato
rs u
sed
to
impr
ove
curr
icul
a
Eval
uatio
n of
the
pro
gram
was
driv
en b
y th
e de
velo
pmen
t of
a t
heor
y of
cha
nge
and
asso
ciat
ed m
etric
s to
mea
sure
impa
ct.
Base
line
asse
ssm
ent
of p
artic
ipan
t co
mpe
tenc
e an
d ca
reer
goa
ls w
as c
ondu
cted
for e
ach
part
icip
ant.
Regu
larly
mon
itorin
g of
lear
ning
pro
gres
s w
as
unde
rtak
en o
n an
ann
ual b
asis
as
wel
l as
less
fo
rmal
ly b
y pr
ojec
t st
aff.
An
endl
ine
asse
ssm
ent
of im
pact
at
indi
vidu
al
and
team
leve
ls w
as a
lso
cond
ucte
d.
Cond
ucte
d fo
rmal
impa
ct e
valu
atio
n in
201
8 in
pa
rtne
rshi
p w
ith D
r. A
my
Lock
woo
d (U
nive
rsity
of
Cal
iforn
ia, S
an F
ranc
isco
). Th
ese
findi
ngs
info
rmed
a n
ew T
heor
y of
Im
pact
and
a s
yste
m
of im
pact
met
rics
that
mea
sure
how
GH
C im
pact
s ou
r fel
low
s an
d ho
w o
ur re
sult
s lin
k to
pr
ogre
ss in
glo
bal h
ealt
h.
Feed
back
col
lect
ed t
hrou
gh re
gula
r sur
veys
, in
divi
dual
che
ck-i
ns, a
nd g
roup
ses
sion
s
Impa
ct a
chie
ved
Post
fello
wsh
ip a
lum
ni s
urve
ys a
re c
ondu
cted
th
at c
over
the
follo
win
g to
pics
:
• Car
eer
deve
lopm
ent
• Im
prov
emen
t in
per
form
ance
• Pro
fess
iona
l net
wor
king
• Pub
licat
ions
The
Afy
a Bo
ra C
onso
rtiu
m h
as s
een
posi
tive
chan
ges
acro
ss t
hese
indi
cato
rs a
nd h
as
publ
ishe
d m
ore
deta
iled
findi
ngs
else
whe
re.
Ove
r the
tw
o ye
ars
sinc
e ST
AR
has
activ
ely
been
wor
king
with
par
ticip
ants
, a n
umbe
r of
resu
lts
have
bee
n ac
hiev
ed. I
n ad
ditio
n to
on
boar
ding
par
ticip
ants
on
a ro
lling
bas
is, w
e ha
ve e
stab
lishe
d a
lear
ning
act
iviti
es d
atab
ase
from
whi
ch t
o dr
aw a
ctiv
ities
for p
artic
ipan
ts a
t di
ffer
ent
leve
ls a
cros
s th
e co
re c
ompe
tenc
ies
as w
ell a
s fo
r spe
cific
tec
hnic
al a
nd c
onte
nt
area
s. W
e ha
ve a
lso
mon
itore
d le
arni
ng p
lans
an
d id
entifi
ed g
aps
in a
vaila
ble
activ
ities
. In
resp
onse
to
seve
ral g
aps,
in p
artic
ular
rela
ted
to p
ublic
hea
lth
ethi
cs a
nd g
ende
r equ
ity, w
e
GH
C id
enti
fies
and
sup
port
s a
dive
rse
com
mun
ity
of e
ffec
tive
lead
ers…
• 68%
of a
lum
ni a
re fe
mal
e, 4
3% a
re A
fric
an
natio
nals
• 99%
of a
lum
ni a
ttrib
ute
thei
r pro
fess
iona
l ac
hiev
emen
ts in
par
t to
the
ir in
volv
emen
t w
ith G
HC
(Con
td.)
CUR
RIC
ULU
M S
TEP
AFY
A B
OR
AST
AR
PR
OJE
CTG
LOB
AL
HEA
LTH
CO
RPS
have
dev
elop
ed t
ailo
red
mod
ules
for S
TAR
part
icip
ants
. Mor
e da
ta o
n th
e im
pact
of t
he
prog
ram
is fo
rthc
omin
g as
we
begi
n to
hav
e pa
rtic
ipan
ts c
ompl
ete
the
prog
ram
and
shi
ft
furt
her a
tten
tion
tow
ards
mon
itorin
g an
d ev
alua
tion.
who
exc
el in
the
ir c
aree
rs…
• 82%
of a
lum
ni re
mai
n in
the
fiel
ds o
f glo
bal
heal
th o
r hum
an d
evel
opm
ent
• 35%
of o
ur fi
rst
coho
rt h
old
seni
or-l
evel
po
sitio
ns
colla
bora
te w
ith
each
oth
er…
• 61%
of a
lum
ni h
ave
colla
bora
ted
with
an
othe
r alu
mnu
s/a
in t
he p
ast
year
and
infl
uenc
e th
e fi
eld
of g
loba
l hea
lth.
• 70%
of a
lum
ni h
ave
spok
en p
ublic
ly,
publ
ishe
d w
ritin
g, o
r par
ticip
ated
in
advo
cacy
eff
orts
in t
he p
ast
year
Scal
abili
ty/S
usta
inab
ility
The
mai
n ch
alle
nge
in s
usta
inab
ility
has
bee
n fu
ndin
g.
Trai
ning
of f
ello
ws
in t
heir
hom
e co
untr
y/lo
cal
orga
niza
tions
incr
ease
s re
tent
ion
and
ensu
res
sust
aina
bilit
y.
Sust
aina
bilit
y of
lear
ning
bud
gets
is a
cha
lleng
e.
Lear
ners
stil
l str
uggl
e to
pro
tect
tim
e fo
r le
arni
ng, e
ven
whe
n it
is p
art
of t
heir
cont
ract
s.
The
lear
ning
act
iviti
es d
atab
ase
requ
ires
regu
lar
upda
tes
in o
rder
to
rem
ain
curr
ent,
whi
ch is
la
bor-
inte
nsiv
e.
Look
ing
ahea
d, S
TAR
is a
imin
g to
iden
tify
mor
e w
ays
to a
lign
with
USA
ID p
riorit
ies
and
enga
ge
key
part
ners
in s
usta
inab
le w
ays.
Part
ner o
rgan
izat
ions
con
tinue
to
exhi
bit
high
de
man
d fo
r fel
low
s as
a p
rove
n ta
lent
pip
elin
e.
GH
C’s
path
way
s to
sca
le in
clud
e le
vera
ging
st
rate
gic
part
ners
hips
for:
wor
k pl
acem
ents
, tr
aini
ng, t
houg
ht le
ader
ship
, net
wor
king
and
se
ed fu
ndin
g fo
r alu
mni
initi
ativ
es.
Less
ons
lear
ned
It is
pos
sibl
e to
impl
emen
t a
lead
ersh
ip
fello
wsh
ip fo
r hea
lth
prof
essi
onal
s th
at h
as
impa
ct in
impr
ovin
g he
alth
sys
tem
s in
Afr
ica.
Colla
bora
tion
with
gov
ernm
ent
and
loca
l pa
rtne
rs is
key
in s
ucce
ss
The
nort
h to
sou
th c
olla
bora
tions
/net
wor
king
ar
e im
port
ant
in in
crea
sing
div
ersi
ty a
nd
open
ing
up o
ppor
tuni
ties
post
fello
wsh
ip
Buy-
in a
nd s
uppo
rt fr
om p
artn
ers
and
fund
ers
is c
ritic
al fo
r equ
itabi
lity
and
succ
ess
of s
uch
prog
ram
s. S
tron
g co
mm
unic
atio
n lin
ks b
etw
een
lear
ning
tea
ms
and
othe
r sup
ervi
sors
can
hel
p m
itiga
te c
halle
nges
.
Valu
e of
str
ateg
ic p
artn
ersh
ips
Fund
er s
trat
egy—
com
plem
enta
ry t
o ot
her
glob
al h
ealt
h ef
fort
s
Alu
mni
inve
stm
ent
(net
wor
k)
11Schleiff et al. Annals of Global Health DOI: 10.5334/aogh.3212
The difference in target learners between the programs is the primary driver for the variance in curriculum design: Afya Bora Consortium fellowship focuses on clinical and public health professionals. The STAR project promotes public health managers and technical program leaders. Global Health Corps invests in professionals from interprofessional backgrounds at the early stages of their global health career.
After identifying the target learners, each program reviewed the current approach to recruiting and training leaders in LMICs and then identified opportunities for improvement. The success of this assessment and, ultimately, the implementation of each program depended on close collaboration with strategic partners. At the outset, each program described in this paper engaged a set of key local and global collaborators, including public health organizations, government ministries, donors, and academic partners.
Step 3: Goals and Objectives
In step three of the curriculum development process, each program identified objectives for the curriculum, which included expansion of capacity for leadership in LMICs, improvement in work performance and functioning of key public health programs such as HIV, and setting leaders up to become mentors, partners, and contributors to continued knowledge sharing for the field. The main competencies that each program included were essential leadership and management skills, such as communication, strategic partnerships, cross-cultural collaboration, understanding research processes, and evidence generation and use.
The degree of technical capacity development varied between programs. As an example, Global Health Corps emphasizes developing leadership and management skills; technical skills building occurs through on-the-job training, as their cohort of fellows is interdisciplinary and require a broad set of technical tools. Afya Bora Consortium and STAR utilize similar approaches as well, though the balance of leadership versus technical skills differed across programs.
Step 4: Educational Strategies
Each program implemented educational strategies to meet the unique needs and requirements of their target learners. Afya Bora Consortium organized around a cohort model, working with a set of participants to complete the core curriculum and to engage in placements or rotations to gain applied experience and skills. STAR utilized an individualized approach to tailor and source appropriate content for each participant’s level and skill needs and also embedded a peer mentorship model to encourage knowledge sharing among participants around core competencies as well as topics of interest to the participants. GHC is a hybrid of these approaches, leveraging a cohort model while also providing coaching and funding so that learners can address individualized skill gaps.
In addition to skills development, all three programs focus on network building. GHC does this not only to support their target learners who are in the early career stage, but also to improve collaboration across global health programs. In addition to utilizing a cohort model, GHC places fellows in pairs—one national and one international fellow—within each organization in order to promote cross-cultural learning and collaboration. STAR emphasizes a peer-to-peer mentorship to harness the extensive experience of many of the fellows and to facilitate collaboration across USAID programs. GHC and Afya Bora Consortium also continue to invest significantly in the alumni of their programs, fostering a community of continuous learning and support.
Step 5: Implementation
All three programs included recruitment and an onboarding or orientation process. Afya Bora Consortium and GHC followed a shared schedule of core curriculum. At the end, participants had an exit process or wrap-up phase. Afya Bora and GHC also included ongoing networking and community-building approaches to engage with and support participants after they completed the program. Implementation varied across programs based on the primary educational strategies (e.g., individualized, cohort, hybrid).
12Schleiff et al. Annals of Global Health DOI: 10.5334/aogh.3212
Step 6: Evaluation and Impact
Finally, each program included an evaluation approach under step six of the curriculum development process. Afya Bora Consortium, STAR, and GHC all developed a theory of change to assess impact. Participant feedback was solicited throughout the participants’ engagement with all three programs, including feedback on specific aspects of the curriculum, as well as an endline reflection on the programs as a whole. Efforts to continue to track longer-term impact and feedback from alumni of these programs also occurs in all three programs. The kinds of impact that the programs aim to achieve include career advancement for participants, improvements in their job performance, networking, and products, such as publications reports and other impacts that they have on the field of global health. Sustainability of all programs is a challenge due to funding. However, changes in pedagogy to support participants learning in-country and applying learning in their own contexts has supported demand, retention, and support for these programs, particularly Afya Bora Consortium and GHC.
Each program has lessons learned, some of which will be explored further in the following section. Some key lessons are that strengthening leadership of a diverse global health workforce is possible. In addition, strong and functional partnerships are essential. Engaging with supervisors and other key stakeholders can help key individuals to whom participants are accountable to understand the value of these programs. Finally, maintaining an alumni network and generally supporting participant engagement with each other is a central factor for success.
REFLECTIONS FROM PRACTICEWe reflect on some of the solutions and innovations that have been developed by the programs to meet the needs of the leadership programs outlined above.
CONTEXTUAL FACTORS
Despite different start years and a variety of partners and specific motivations, each of the three programs in this paper aimed to address a similar problem: the lack of appropriately trained local public health professionals to lead and manage health programs in LMICs. The status quo for fulfilling these functions has been a tendency to bring in external experts and to focus on clinical training ahead of public health training for the skilled workers who are trained in LMICs. There has also been a lack of concerted effort to ensure that these leaders contribute to sustainable change—by addressing both challenges related to isolation and burnout, and lack of incentives and support for these workers to build skills and to share knowledge among their teams and within the organizations where they work. In parallel, as the problems faced by health systems around the world continue to become more numerous and complex (e.g., communicable and non-communicable diseases, climate change, rising inequities, and outbreaks, such as Ebola and COVID-19), many have raised the concern that current models for managing these challenges are too fragmented, inefficient, and untenable [18–21]. Against this backdrop, the audacious vision to support capacity strengthening through partnerships, networking, mentorship, and an explicit focus on leadership and management skills needed for the local context has gained traction among donors and host institutions.
To meet these challenges, programs have developed tailor-made curricula for the program and/or for each participant, with a focus on mentorship and coaching, and greater emphasis of the curricula to support transition to practice as opposed to an emphasis on technical knowledge acquisition. These programs focus on supporting individuals who are already dedicated to pursuing leadership roles in global health and supporting them to grow and become continually more effective.
INNOVATIONS
All three programs are different from global health fellowships that focus on HIC settings and learners in that Afya Bora Consortium fellows are trained in their home countries in sub-Saharan Africa, STAR participants work on global programs or are based in the countries where they work,
13Schleiff et al. Annals of Global Health DOI: 10.5334/aogh.3212
and GHC participants are based in countries where they are working as well. This is aimed at ensuring the trainees identify health systems gaps unique to these settings and assures retention of health professionals in sub-Saharan Africa and other LMICs after training. Despite the programs being offered in sub-Saharan Africa, recruited fellows are drawn from both LMIC and HIC. This innovative approach ensures diversity of fellows, increasing learning and networking opportunities and south-to-south collaborations. The long-term goal for all three programs in their own unique ways is that alumni of these programs will be able to be strong global health leaders working in diverse contexts and roles who can serve as mentors, guides, and future instructors or faculty for subsequent generations of global health leaders. All programs also target an interprofessional set of health professionals. This allows for discussion across different cadres of health professionals and promotes the sharing of both knowledge and perspectives.
CHALLENGES AND LIMITATIONS FOR EQUITY, SUSTAINABILITY, AND SCALABILITY
While overall the innovative curricula proposed have been well received and enjoyed by senior professionals, the implementations of these curricula have presented unique challenges. For example, implementing the individualized learning plans for STAR participants has been a labor-intensive process. It has also not been easy to identify the exact kind of learning activities (right timing, location, cost, etc.) that are appropriate for each participant. Due to project priorities and budget limitations, sustaining and ensuring equity of learning budgets has been a challenge. Given the breadth and depth of cadres of global health professionals that would benefit from learner-centered leadership training, a tailored learning delivery model that meets the needs of the learner is highly recommended. Such a model is best supported by tracking learning needs against competency gaps, which can either be knowledge or skills focused. Many of the learners in these programs continued with full-time work while engaging in an “executive-type” leadership program. Thus, an effective curriculum design needs to incorporate flexibility, a range of learning opportunities, and multi-modes of delivery. However, such an approach is challenged by being resource intensive and by the high likelihood of participant drop-off and difficulties in capturing achievement of learning objectives.
The Afya Bora Consortium fellowship curricula has been designed to accommodate working health professionals, covering a wide variety of required content within a period of one year. Despite the period of the fellowship being short, fellows have been faced with difficulties of getting protected leave from employers to pursue activities for the fellowship. This has ended up limiting some fellows who have wished to complete the curriculum. The other major limitation of the fellowship is funding, and this has affected sustainability.
GHC’s fellowship is composed of participants with varying levels of educational attainment and professional experience, from diverse national, racial, and ethnic backgrounds. Furthermore, fellows work across disciplines in diverse settings during the fellowship year with varying frequency and quality of supervision and support. Designing a cohort-based experiential learning curriculum that responds to the unique needs and abilities of fellows has been a labor and resource-intensive process. GHC has relied on dialogic methods (e.g., case studies, applied learning, small group discussions) over didactic ones in order to engage such a diverse cohort. Staff have also relied on fellow and alumni-designed workshops and resources to supplement the core curriculum and to access new tools and bodies of research. Additionally, it has been important to integrate individualized approaches to meet individual learning needs, such as coaching and mentoring, asynchronous learning (e.g., online learning courses), and access to funds for advanced learning opportunities. Finally, GHC has also found it important to invest in the experiential portion of the fellowship—specifically, the work placements—by sharing resources and investing in the management capacity of fellows’ supervisors. It has, however, been challenging to convene supervisors with regularity. Furthermore, supervisor transitions at partner organizations limit the effectiveness of this intervention.
14Schleiff et al. Annals of Global Health DOI: 10.5334/aogh.3212
SUMMARY OF RECOMMENDATIONS
Several approaches are needed in order to strengthen global health curricula and competency frameworks. First, the focus of global health competencies and curricula should be unambiguously linked to local health system needs. This further means ensuring that program leaders and implementors understand the context in which the program and its participants will be operating. Second, emphasizing both individualistic and collectivist approaches to learning is important in engaging and supporting diverse learners. Finally, it is important to emphasize mentorship and opportunities to apply learning in contexts where learners are working in order to provide necessary support to learners and to ensure that learning is integrated into their professional roles.
CONCLUSIONSThere is a need to shift ownership of programs towards local leaders who are currently living and working in settings where the most pressing global health challenges occur. To achieve this goal, curricula need to be tailored to the learner and the context. Strong partnerships and resources—including donor support—are essential to implement and sustain a robust curriculum that addresses core skills for effective leadership and that provides opportunities for experiential and more traditional didactic learning.
FUNDING INFORMATIONThis work was supported by 1) Afya Bora Consortium fellowship, which is funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through funding to the University of Washington’s International AIDS Education and Training Center (IAETC) under cooperative agreement U91 HA06801 from the Health Resources and Services Administration (HRSA) Global HIV/AIDS Bureau and (2) the STAR project funded through Cooperative Agreement No. 7200AA18CA00001 by the United States Agency for International Development (USAID).
The views presented here do not necessarily reflect the views of these funding agencies.
COMPETING INTERESTSThe authors have no competing interests to declare.
AUTHOR CONTRIBUTIONSAll article authors had access to the data and a role in writing the manuscript.
AUTHOR AFFILIATIONSMeike J. Schleiff, DrPH, MSPH orcid.org/0000-0001-6492-3718 Johns Hopkins School of Public Health; STAR
Patrick Mwirigi Mburugu, MD orcid.org/0000-0001-7635-5236 Jomo Kenyatta University of Agriculture and Technology, School Of Medicine; Afya Bora Consortium
John Cape, BA orcid.org/0000-0002-1504-6955Global Health Corps
Rama Mwenesi, MSE orcid.org/0000-0001-9969-453X University of Michigan School of Nursing
Nathanael Sirili, MD, PhD orcid.org/0000-0001-5205-624X School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Tanzania; Afya Bora Consortium
Sean Tackett, MD, MPH orcid.org/0000-0001-5369-7225 Johns Hopkins Bayview Medical Center
David P. Urassa, MD, PhD orcid.org/0000-0002-0970-0826 School of Public Health, Muhimbili University of Health and Allied Sciences, Tanzania; Afya Bora Consortium
15Schleiff et al. Annals of Global Health DOI: 10.5334/aogh.3212
Bhakti Hansoti, MD, PhD orcid.org/0000-0003-0188-9764 Johns Hopkins School of Medicine; STAR
Yohana Mashalla, MD, PhD orcid.org/0000-0003-2031-3672 School of Health Sciences, University of Botswana, Gaborone, Botswana; Afya Bora Consortium
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16Schleiff et al. Annals of Global Health DOI: 10.5334/aogh.3212
TO CITE THIS ARTICLE: Schleiff MJ, Mburugu PM, Cape J, Mwenesi R, Sirili N, Tackett S, Urassa DP, Hansoti B, Mashalla Y. Training Curriculum, Skills, and Competencies for Global Health Leaders: Good Practices and Lessons Learned. Annals of Global Health. 2021; 87(1): 64, 1–16. DOI: https://doi.org/10.5334/aogh.3212
Published: 12 July 2021
COPYRIGHT: © 2021 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.
Annals of Global Health is a peer-reviewed open access journal published by Ubiquity Press.
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