title: Global health leadership training in resource-limited settings: a collaborative approach by academic institutions and local health care programs in Uganda.
abstract: BACKGROUND
  Due to a limited health workforce, many health care providers in Africa must take on health leadership roles with minimal formal training in leadership. Hence, the need to equip health care providers with practical skills required to lead high-impact health care programs. In Uganda, the Afya Bora Global Health Leadership Fellowship is implemented through the Makerere University College of Health Sciences (MakCHS) and her partner institutions. Lessons learned from the program, presented in this paper, may guide development of in-service training opportunities to enhance leadership skills of health workers in resource-limited settings.
  
  
  METHODS
  The Afya Bora Consortium, a consortium of four African and four U.S. academic institutions, offers 1-year global health leadership-training opportunities for nurses and doctors. Applications are received and vetted internationally by members of the consortium institutions in Botswana, Kenya, Tanzania, Uganda, and the USA. Fellows have 3 months of didactic modules and 9 months of mentored field attachment with 80% time dedicated to fellowship activities. Fellows' projects and experiences, documented during weekly mentor-fellow meetings and monthly mentoring team meetings, were compiled and analyzed manually using pre-determined themes to assess the effect of the program on fellows' daily leadership opportunities.
  
  
  RESULTS
  Between January 2011 and January 2015, 15 Ugandan fellows (nine doctors and six nurses) participated in the program. Each fellow received 8 weeks of didactic modules held at one of the African partner institutions and three online modules to enhance fellows' foundation in leadership, communication, monitoring and evaluation, health informatics, research methodology, grant writing, implementation science, and responsible conduct of research. In addition, fellows embarked on innovative projects that covered a wide spectrum of global health challenges including critical analysis of policy formulation and review processes, bottlenecks in implementation of national HIV early infant diagnosis and prevention of mother-to-child HIV-transmission programs, and use of routine laboratory data about antibiotic resistance to guide updates of essential drug lists.
  
  
  CONCLUSIONS
  In-service leadership training was feasible, with ensured protected time for fellows to generate evidence-based solutions to challenges within their work environment. With structured mentorship, collaborative activities at academic institutions and local health care programs equipped health care providers with leadership skills.
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda. dnakanjako@gmail.com.|Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda. dnakanjako@gmail.com.
authors.forename: Damalie
authors.initials: D
authors.lastname: Nakanjako
authors.affiliation: Ministry of Health, AIDS Control Program, Kampala, Uganda.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Namagala
authors.affiliation: Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Aggrey
authors.initials: A
authors.lastname: Semeere
authors.affiliation: Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Joanitor
authors.initials: J
authors.lastname: Kigozi
authors.affiliation: Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sempa
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
authors.forename: John Bosco
authors.initials: JB
authors.lastname: Ddamulira
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
authors.forename: Achilles
authors.initials: A
authors.lastname: Katamba
authors.affiliation: Medical Research Council/Uganda Virus Research Institute, Entebbe, Uganda.
authors.forename: Sam
authors.initials: S
authors.lastname: Biraro
authors.affiliation: Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Sarah
authors.initials: S
authors.lastname: Naikoba
authors.affiliation: University of Botswana, Gaberone, Botswana.
authors.forename: Yohana
authors.initials: Y
authors.lastname: Mashalla
authors.affiliation: Departments of Medicine, Global Health and Epidemiology, University of Washington, Seattle, WA, USA.
authors.forename: Carey
authors.initials: C
authors.lastname: Farquhar
authors.affiliation: Department of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda.
authors.forename: Nelson
authors.initials: N
authors.lastname: Sewankambo
mesh_terms: D003299:Cooperative Behavior; D003479:Curriculum; D003695:Delivery of Health Care; D004493:Education / Q000592:standards*; D005257:Fellowships and Scholarships; D014943:Global Health; D006282:Health Personnel / Q000193:education*; D006295:Health Resources; D006296:Health Services; D006801:Humans; D007391:International Cooperation; D007857:Leadership; D009726:Nurses; D010820:Physicians; D015397:Program Evaluation; D014454:Uganda; D014495:Universities