Success Story: Sustainable Integration of Pre-service Curricula in Health Leadership and Management

By: Sasha Grenier, MPH and Reshma Trasi, MBBS, MHA, MPH

A rapid assessment of integration of L+M curricula carried out by the Leadership, Management and Sustainability (LMS) predecessor project shows promise with regard to sustainability, and is helping to guide similar efforts by the LMG project.


Universities in low- and middle-income countries (LMICs) are developing health professionals that are trained to deliver health services in resource-poor settings. Many of these universities have recognized that leadership and management (L+M) competencies among health professionals can create a stronger, more effective and efficient public health response. While some universities have specific departments on health management, others have chosen to design and incorporate leadership- and management-related content into their existing pre-service curriculum.[1]

Was Incorporation of L+M into Pre-Service Curricula Sustainable?

The short answer is a resounding “yes,” and this article will explain the success of these sustainable interventions.

Was incorporation of leadership and management into pre-service curricula of universities in low-and-middle-income countries sustainable?

The short answer is a resounding “YES.”

The USAID-funded Leadership, Management, and Sustainability (LMS) Project (2006-2010) supported the integration of pre-service leadership and management (L+M) content into medical, nursing, and public health universities as well as training institutions in several LMICs. The pre-service content teaches students team-based problem solving. Teams of students learn to identify health challenges within their sphere of influence, lead teams to focus on priority areas for intervention, align and mobilize resources, and inspire people to produce results. LMS staff and consultants tailored the L+M curriculum to suit the needs of faculty and trainers in these institutions and worked with them to integrate the content into the existing curriculum.

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In August 2012, the LMG project undertook a rapid assessment to see if and where the pre-service L+M content incorporated during the LMS project was still being used.  We developed a  brief survey questionnaire to learn which L+M content is still being delivered, how many students are being trained using the L+M curriculum, if plans for scale-up have been completed or developed, and what barriers the universities face in scaling up the content. The questionnaire was sent using Survey Monkey to 25 respondents from 12 universities, schools, and colleges across 6 countries where LMS had worked. Twelve Universities or training institutions from Kenya, Uganda, Egypt, Nicaragua, Guatemala, and Ghana responded to the questionnaire.

Summary of Results

Most popular content

Most of the institutions or schools who had originally used specific L+M curricula are still using these, on average, 1.4 years after LMS and USAID support has ceased. Content on Eight Leading and Managing Practices and the Leadership and Management Competencies of Health Managers were the most prominently sustained components, followed by the Leadership Development Program (LDP) and the Challenge Model. The least utilized strategy was Experiential and Action-based Learning, although still reported to be used by eight of the surveyed institutions.

The modules that are still being used by all the Universities are Organizational Performance and/or the Important and Urgent MatrixManaging Health Information Systems and Data Use, Managing Change, Optimizing Individual Performance, and Systematic Approach and Health Systems. When asked for reasons for the continued delivery of these specific modules, participants explained that those modules were the most relevant, practical, and they satisfied graduation and competency requirements. Another respondent explained that the modules were the “core ingredients for the achievement of results.

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Scaling Up Is Taking Place

The assessment also inquired about whether the L+M content had been subsequently rolled out or scaled up to other institutions, universities, colleges, units, departments, or schools without the support of LMS or USAID.  About half of the institutions surveyed reported that they had already completed scaling-up the content to other schools and training colleges. The other half reported that they were planning scale-up.

Many respondents shared similar challenges related to scale-up. Lack of financial resources was the largest perceived barrier to scaling up integration to other schools and/or universities. One respondent emphasized that “We want to train health workers in the region, but lack resources.” Other common responses included the lack of trained faculty to teach the L+M related content and the time limitations of faculty to teach L+M content.

Despite these challenges, 104 staff has been trained across the 12 responding universities and training institutions to teach students the L+M curriculum. Each year, across the responding universities and training institutions, 3,660 students continue to be trained using this content. Since the end of LMS, approximately 4,500 students have been equipped with leadership and management competencies and team-based problem solving skills.

A promising strategy

Pre-service training provides a valuable opportunity for developing the leadership and management competencies of future public health leaders.  The content supported by the LMS project aimed to provide students with the essential skills and tools needed for playing a leadership role in their health system. Years later, most of the strategies, content, and/or modules are still being delivered to students and faculty.

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The Leadership, Management, and Governance (LMG) project continues to build on these gains.  Having just begun its second year, the LMG project has developed an expanded and customizable pre-service curriculum for supporting educational institutions in LMICs.  This generalized curriculum will be adapted for use in LMG’s planned professionalization activities in diverse health cadres and in a range of training programs.

Integration of pre-service curriculum remains an essential—and sustainable—part of the LMG project’s overall strategy to professionalize health services management by developing a cadre of current and future health professionals who are able to lead, manage and govern health systems in low- and middle-income countries around the world.

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[1]  Pre-service curricula includes professional competency, diploma, certificate, degree, or technical programs or courses, in undergraduate, graduate schools and Universities, medical schools, nursing schools and management institutions that prepares students for careers in the health services field.

Sasha Grenier, MPH, is a Project Specialist for the Leadership, Management and Governance Project.

Reshma Trasi, MBBS, MHA, MPH, is the Monitoring, Evaluation, and Research (MER) Team Director for the Leadership, Management, and Governance Project.

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