Abstract

Background

     Strengthening leadership and management competencies among national Expanded Programme on Immunization (EPI) teams will be critical to achieving global immunization targets and other sustainable developmental goals. However, there is little empirical evidence of the effectiveness of investments in leadership and management capacity in the context of national EPI programs. Therefore, we sought to evaluate the EPI Leadership and Management Programme (EPI LAMP), a nine-month certificate program for EPI teams in national Ministries of Health from Gavi priority countries in Anglophone and Francophone Africa and Asia.

Methods

     We used a mixed-methods longitudinal evaluation to describe EPI LAMP at four levels: (1) participant response to the training experience based on program administration records and satisfaction surveys; (2) change in management and leadership skill based on competency surveys and exit interviews; (3) change in behavior in the workplace based on exit interviews; and (4) impact of the training on EPI program performance based on the results of each delegate’s leadership project.

Results

     In the first three cohorts, the programme engaged 16 countries (63 participants) and achieved an 86% graduation rate (54 alumni). Participants demonstrated significant improvement in management and leadership competencies across eight domains with the largest improvement observed in the domain of governance and leadership. Women showed greater increases than men, especially in the domains of Operations Management and Political Advocacy and Dialogue. We observed no difference in the gains made by French-speaking delegates compared to English-speaking participants. Breakthrough projects developed by each team improved EPI program performance, as measured by metrics specific to each project.

Discussion

     Our results show that team-based leadership programs can foster improvements in management practice, collaboration, and problem-solving, and that engagement the broader policy and organizational context is needed to foster the systems thinking capacity required to address complex challenges and improve system performance.

Introduction

     Immunization is one of the most cost-effective investments in global health [1], and reaching every child with immunization is the major strategic goal of Gavi, the Vaccine Alliance. Despite significant increase in vaccination coverage in low- and middle-income countries (LMICs), 14 million children were not reached by routine immunization in 2019 [2]. EPI programs must adapt and evolve to address complexities such as reaching zero- dose children, reaching children in conflict settings and other humanitarian crises, managing an increasingly complex portfolio of routine immunizations, overcoming weaknesses in primary health care systems, and, more recently, ensuring continuity of services in light of COVID-19. Strengthening leadership and management competencies [3], [4] among national EPI teams will be critical to achieving global immunization targets and other sustainable development goals [5], [6], [7].

     In response, Gavi has developed a small but strategic portfolio of investments in leadership and management to support EPI program performance. Drawing on literature from primary health systems strengthening more broadly, leadership and management is associated with better health systems performance in LMIC settings [8], and can be improved through practical approaches to education and mentorship for healthcare professionals at all levels of the health system [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19]. Leadership and management trainings conducted at the facility level have been linked with the reduction of wait times and patient crowdedness in hospitals in Egypt [13] and the increase in the number of women receiving counseling during antenatal care in Cameroon [14]. At the district level, a number of studies [8], [15], [16], [17], [18], [19] reported the impact of management and leadership training on primary care system performance. However, there is little empirical evidence of the effectiveness of investments in leadership and management capacity in the context of national EPI programs.

Conclusion

     Strengthening leadership and management competencies among national EPI teams will be critical to achieving global immunization targets and other sustainable developmental goals, and can be significantly improved through participation in a team-based program customized to meet the needs of immunization professionals across Gavi-eligible countries. Programs that foster development of a cross-country learning community, engage multiple levels of hierarchy, and equip teams to address complex adaptive challenges are likely to be superior to brief training programs focused on individual participants. The results of this study may be useful to educators, practitioners, and government officials seeking to strengthen EPI programme performance, as well as policymakers and global partners seeking to invest in evidence-based management and leadership development models.