| FEATURES | AFYA BORA GHL PROGRAM | STAR GH FELLOWSHIP PROGRAM |
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| Evolution of the Program | Brain drain occurred when African professionals received formal advanced degrees in US, Europe and Australia and did not return back to their home countries. Leadership taught in the formal medical and nursing curricula were not adequate. Many health and HIV organizations in Africa relied on Expatriates to fill the positions because of a lack of training to manage such programs within the country. In 2009, 100 African and US leaders met in Nairobi, Kenya to define the original intent of a Global Health Leadership Training. Major issue identified was that while many clinicians were highly skilled professionals, most lacked leadership skills and experiences to manage regional or national health programs. Formation of working group to develop curriculum with equal representation of African and US members. Identification of attachment sites with capacity to mentor fellows in Botswana, Kenya Uganda and Tanzania was carried out by the working group. Development of a selection (matching) process of fellows from initially Uganda, Kenya, Tanzania and Botswana through the local national universities. A six months project pilot in 2010 was conducted to understand and improve the implementation processes, test the learning content, and shape the outcomes expectations.
| Evolved from a 23-year legacy of global health fellowship programs funded by USAID, which aimed to provide opportunities for Americans and US permanent residents to work in technical positions within USAID. Established as five-year cooperative agreements that begun with the Population Leadership Program (PLP), which then evolved to Global Health Fellows Program I and then Global Health Fellows II. Each subsequent program continued to refine approaches and track records to recruiting and supporting diverse fellows and interns, while expanding its strategies to include a wider range of highly qualified talent across the global health pipeline as well as and placement sites. In 2018, under the USAID Forward initiative during a period that focused heavily on the journey to self-reliance, USAID’s vision, reflected in the STAR Program emphasized two major themes: (1) preparing diverse US (United States) and developing country GH professionals to innovate lasting solutions, based on deep mastery of program implementation, research and analytic skills that are honed during field experience and; (2) fostering effective, empowered, sustainable collaborations among US and LMIC academia, and other relevant groups. STAR aims to strengthen the capacity of global health professionals, organizations, and companies to implement stronger programs, achieve better results, and make a bigger impact in the global health field. Position based opportunities are available on a rolling basis to qualified candidates globally. Due to the diversity of participants, their technical skills and geographic placements and the unique reality of rolling admissions, a cohort model was not feasible thus, the fellowship developed tailored individual learning opportunities for both the participants and the host organizations. Developed STAR competencies and milestones framework and associated tools to standardize the core skills required of GH professionals and help individuals identify their need, leverage resources to address learning gaps, and track milestones using a common approach.
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| Target Population | Nurses, physicians, public health professionals, pharmacists, ethicists, and lawyers. | STAR targets diverse early career to senior global public health professionals from the US and from low- and middle-income countries. |
| Salient Activities | Attend three in-person didactic training meetings and complete online modules. Be attached at a national training site to be engaged in leadership activities through team mentorship. Participate in meetings with primary and site mentors and joint meetings. Complete M&E activities and logbook on a regular basis. Planned orientation, mid fellowship and final meeting held to enable familiarisation of participants to the program, sharing and presentations of projects conducted by fellows for constructive feedback. Complete required report at the end of the program and present at each meeting. Communicate regularly with site and national mentor.
| Work-based fellowship at USAID, Ministry of Health or NGO Performance Management support Protected time for individualized, deliberate/targeted learning opportunities (10% -4 hours/week) Individualized Learning plan with learning objectives and relevant learning activities Mentorship and coaching (both one-on-one and group) Peer-to-peer learning and network building
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| Competencies/Core Content | Twelve training modules (leadership, communication, monitoring and evaluation, responsible conduct of research, research methods, project management, implementation science, HR/budgeting, grant/manuscript writing, health informatics, policy governance and 57 competencies are listed related to 11 modules. At least 70% achievement is expected and the Logbook has to be submitted at the Mid- and final meeting to the M&E coordinator.
Experiential leadership learning occurred during the attachment site periods where fellows learned from real-world leadership experiences. | Eight core skills-based competency domains (development practice, communication and interpersonal effectiveness, cross-cultural practice, capacity strengthening, global burden of disease, ethics, health equity and social justice, and gender equity). There also are twenty+ elective technical and content-based competencies that are relevant depending on the job description and learning objectives of the participant. For each competency domain, milestones defined across five levels (inquiring, understanding, practicing, leading and advancing) and a set of measurable targets for continued advancement of knowledge, attitudes, and skills, which will enable tracking and assessment of learning for all participants. |
| Key Operational Issues | Finding accommodations for the fellows during the meetings. Transportation for the fellows and assuring that every fellow had a workable computer. Using university facilities to house the meetings. Online learning with slow broadband connections. Assuring safety of fellows during public unrest at the sites and during the meetings. To organize travel for such a diverse group of people three times a year is a major challenge.
| Balancing meeting the needs of the fellow, the host organization and funder (in most cases, host and funder is the same). Managing a global staffing sub-contractor to hire and be legally responsible for internationally placed local and third country national fellows. Individualized learning model is both time and labour intensive and participants have varying needs from academic to applied technical. Delays to on boarding of fellows due to security clearance and working visas.
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| Key Challenges | Initial training was conceptualized as a two-year training but was not realistic and scaled back to a one-year program. Decentralized fund distribution was challenging and caused delays in payments to the fellows. Financial management mostly through University of Washington for a majority of the program. Ensuring that the modules had an African and an American instructor to teach the content. Validating the content with the fellows in terms of relevance and usability. Funders were slow to send the funding which made it necessary the University of Washington helped bridge the funding at times. The governments of Botswana, Uganda, Kenya and Tanzania did not begin as initially conceptualized to fund portions of the program and expand the scope of the project. Focus on HIV-related issues limited the scope of the training program initially. Some fellows could not be released 100% so requirements of the fellowship had to be modified. E.g. From fulltime to part time.
| Navigating a balancing act-managing the function of a staffing mechanism with the ethos of a fellowship Adapting to the complex reality of being a US-based organization with fellows placed and employed locally in multiple countries but without local established registration. This challenge required contracting a global staffing sub-contractor. STAR recruitment team does not make final fellow selection, decision is done jointly with host organization hiring team thus recruitment team composition and selection determinations are different for each fellow. This makes it difficult to plan learning until they are on-board. One of the reasons STAR designed individualised learning model. Cannot physically bring fellows together due to geographic vastness of their placements, thus restricted to virtual learning programming Measuring achievement of the competency milestones-currently have guided questionnaire that guides staff in placing fellows for the baseline and the mid-line is self-report.
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| Key Successes | Successful training of 179 fellows and placements in Cameroon, Kenia, Botswana, Tanzania, China, and Uganda. High level of satisfaction with the program and high level of career advancements due to the program. Major impact in implementation of national health programs, education, and leadership.
| Successful placements of over 79 Fellows and approximately 55 Interns in 20+ countries and Washington, DC. High level of satisfaction among Fellows and Interns about their placements and learning opportunities. High level of satisfaction among hiring managers and onsite managers at hosting organizations with the Fellows and Interns they received.
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| Key Recommendations | The curriculum content is highly relevant and has been found effective and applicable. Fostering South-South collaborations has established a network of highly collaborative interprofessional global health leaders that have impacted the planning, delivery, and implementation of much improved healthcare. Research is needed to determine the gaps in training after they have been multiple years in their leadership roles. The demand far outstripped the supply of fellowship positions and more such leadership models are needed to help the human infrastructure of global health leaders. Political support from within the countries is needed to recognize the benefits of better trained global health leaders and eliminate the gender inequity in many African countries. Nurses need an expanded scope of advanced practice to fully assume leadership positions in most African countries.
| For nascent fellowship programs, be clear about your objectives; identify the purpose, the gap it is filling and then stick to it as closely as possible within the parameters of the of funders. Establish a good and solid source of funding from an independent source that fully covers project start up, as well as operating costs of the fellowship program. This will ensure more control towards achieving objectives. Balancing the needs of the fellow and the host organization (and the funder)- Our process is designed to meet the needs of the funder (host organization) first, which sometimes can dilute the ability to deliver upon objectives of the fellowship. Employ cohort model where possible- Easier to administer, promotes peer to peer collaboration for fellows and allows for consistent delivery of high-quality core learning content.
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