Building public health leadership capacity in LMICs: lessons from global initiatives for training innovation

Abstract

Background: Leadership development is an important part of strengthening Human Resources for Health (HRH) and navigating the complex, dynamic, and interdependent nature of health systems in low- and middle-income countries (LMICs). These health systems are frequently characterized by uncertainty, resource limitations, and fragmented service delivery, necessitating contextually grounded and adaptive leadership on all levels. Despite this, conventional public health staff training programs in LMICs often overlook leadership competencies and fail to incorporate learner-centric, affective, and experiential learning methods. The objective of this review was to synthesise evidence from leadership development initiatives implemented in LMICs to identify common success factors, gaps, and contextual adaptations, and to propose a strategic framework for strengthening leadership capacity among human resources for health (HRH) especially for LMICs. Methods: This study employed a qualitative thematic synthesis of nine leadership development initiatives implemented across LMICs between 2000 and 2022. Initiatives were selected based on defined inclusion criteria: targeting HRH, reporting contextual adaptation, and including participatory or applied pedagogies. Braun and Clarke’s six-step framework for thematic analysis was applied to extract and synthesize key findings from the selected case studies. Results: Four major crosscutting themes emerged from the synthesis: (1) contextual relevance and local ownership; (2) adaptive and participatory pedagogies; (3) multilevel stakeholder engagement; and (4) progressive skill development and reflective practice. Based on these findings, we propose a comprehensive strategic approach to leadership development that integrates adult learning theories, blended instructional designs, and adaptive training ecosystems. Emphasis is placed on co-design with stakeholders, including policymakers, healthcare providers, academic institutions, and communities, to ensure relevance and sustainability. Discussion: Aligning global standards with local contexts, this approach positions leadership development as a central driver for the strengthening of health systems. The paper offers practical
recommendations for health system leaders, training institutions, and global health policymakers committed to building resilient and inclusive HRH leadership in LMICs. Drawing on thematic insights from nine leadership initiatives, the study emphasizes the importance of participatory
teaching-learning methods, stakeholder engagement, and adaptive training ecosystems.