Designing a leadership and management training curriculum for undergraduate health professions students: Lessons from the University of Sierra Leone.

Leadership by health professionals is key in any health system, but health leadership training programmes are varied in their conceptualisation, learning objectives, and design. This paper describes an undergraduate leadership and management module for health students at the University of Sierra Leone and provides lessons from the design process. Our methods included an initial scoping review and qualitative study, followed by a co-design process of 10 workshops and 17 consultation meetings. The result was a curriculum with learning outcomes emphasising leadership identity, proactiveness, management of people and of change, and the formation of peer relationships. Learning methods included group teaching, team quality improvement projects, mentoring, and reflective practice. Lessons from the design process included the importance of support from university leadership and extensive consultation. Virtual workshops enabled broader participation but limited relationship building. Integrating doctoral research into the process facilitated inclusion of evidence and theory but risked reducing ownership by faculty. The importance of interprofessionalism and management skills in leadership training emerged during the process, illustrating the effectiveness of a co-design approach. Our programme is broadly aligned with other health leadership frameworks and is distinctive due to its undergraduate focus, offering insights for leadership training design in other settings.

Re-Envisioning Global Health Competencies for the African Region Aligned with Local Health Needs and Resources.

Background: While many Global Health programs aim to address health inequalities within and between HICs and low- and middle-income countries (LMICs) there is a need to establish new Global Health academic programs within the growing trend towards 'internationalization of higher education'. Objective: This study was undertaken to re-envision Global Health competencies for the African region context with respect to the local health needs and availability of resources. Methods: This study was undertaken over a period of four years from 2017 till 2020. A three-pronged strategy was undertaken to scan, scope, distil and develop a set of Global Health domains and competencies for the African region. Strategy 1 encompassed an environmental scan of Global Health competencies (2017-2019), and a literature review (2017-2020); strategy 2 comprised a scoping of education programs in Global Health (2018-2019); and strategy 3 involved an interest-group discussion in a face-to-face conference. Findings: Seven core and four cross-cutting global health competency statements were developed for the African region. The core competency statements included following domains: global health systems and international relations; global evidence ecosystem; role of international organizations; universal health issues; intellectual property rights; responses to issues affecting different at-risk groups; local, national, and international policy and economic context affecting global health. The four cross-cutting competency statements included following domains: digital and academic literacies; quantitative and qualitative research; policy and funding allocation resources; ethical conduct of global health practice and research global health. Conclusion: There is a need to enable higher education institutions (HEIs) from the Global South to offer global health qualifications with a set of competencies that better approximate solutions to contextualised problems - not only to students from the Global South but also from the Global North. The global health competencies developed in this research study will enable African HEIs to offer global health education in a more pragmatic manner.

To bend without breaking: a qualitative study on leadership by doctors in Sierra Leone.

Strong leadership capabilities are essential for effective health services, yet definitions of leadership remain contested. Despite the acknowledged contextual specificity of leadership styles, most leadership theories draw heavily from Western conceptualizations. This cultural bias may attenuate the effectiveness of programmes intended to transform healthcare practice in Sub-Saharan Africa, where few empirical studies on health leadership have been conducted. This paper examines how effective leadership by doctors was perceived by stakeholders in one particular context, Sierra Leone. Drawing together extensive experience of in-country healthcare provision with a series of in-depth interviews with 27 Sierra Leonean doctors, we extended a grounded-theory approach to come to grips with the reach and relevance of contemporary leadership models in capturing the local experiences and relevance of leadership. We found that participants conceptualized leadership according to established leadership models, such as transformational and relational theories. However, participants also pointed to distinctive challenges attendant to healthcare provision in Sierra Leone that required specific leadership capabilities. Context-specific factors included health system breakdown, politicization in the health sector and lack of accountability, placing importance on skills such as persistence, role modelling and taking initiative. Participants also described pressure to behave in ways they deemed antithetical to their personal and professional values and also necessary in order to continue a career in the public sector. The challenge of navigating such ethical dilemmas was a defining feature of leadership in Sierra Leone. Our research demonstrates that while international leadership models were relevant in this context, there is strong emphasis on contingent or situational leadership theories. We further contribute to policy and practice by informing design of leadership development programmes and the establishment of a more enabling environment for medical leadership by governments and international donors.

Interventions to strengthen the leadership capabilities of health professionals in Sub-Saharan Africa: a scoping review.

Leadership is a critical component of a health system and may be particularly important in Sub-Saharan Africa, where clinicians take on significant management responsibilities. However, there has been little investment in strengthening leadership in this context, and evidence is limited on what leadership capabilities are most important or how effective different leadership development models are. This scoping review design used Arksey and O'Malley's approach of identifying the question and relevant studies, selection, charting of data, summarizing of results and consultation. A comprehensive search strategy was used that included published and unpublished primary studies and reviews. Seven databases were searched, and papers written in English and French between 1979 and 2019 were included. Potential sources were screened against inclusion and exclusion criteria. Data were grouped into common categories and summarized in tables; categories included conceptual approach to leadership; design of intervention; evaluation method; evidence of effectiveness; and implementation lessons. The findings were then analysed in the context of the review question and objectives. Twenty-eight studies were included in the review out of a total of 495 that were initially identified. The studies covered 23 of the 46 countries in Sub-Saharan Africa. The leadership development programmes (LDPs) described were diverse in their design. No consistency was found in the conceptual approaches they adopted. The evaluation methods were also heterogeneous and often of poor quality. The review showed how rapidly leadership has emerged as a topic of interest in health care in Sub-Saharan Africa. Further research on this subject is needed, in particular in strengthening the conceptual and competency frameworks for leadership in this context, which would also inform better evaluation. Our findings support the need for LDPs to be accredited, better integrated into existing systems and to put greater emphasis on institutionalization and financial sustainability from their early development.