Search strategy

A search strategy for the peer-reviewed literature was developed in consultation with a Johns Hopkins Bloomberg School of Public Health (JHSPH) informationist around three core concepts: (1) leadership resource, training, and/or intervention; (2) an explicit focus on women; and (3) global health. The search was conducted on October 28, 2021, in five databases (PubMed, Embase, SCOPUS, ERIC, and Business Source Ultimate) to capture literature in the global health and business and management sectors. We did not restrict articles by publication date or language.

We also conducted an iterative review of references cited in the peer-reviewed literature to identify possibly eligible gray literature resources. Then, we searched websites of relevant organizations using the specified search terms “women global leadership program” and “women global leadership initiative.”

Study selection and eligibility criteria

A total of 2,691 references were identified and imported to Endnote for deduplication. Of these 253 duplicated articles were removed; the remaining articles (n = 2,438) were imported to Covidence, an online tool to support systematic review management, for title and abstract screening [15].

Two independent reviewers screened the titles and abstracts before completing full-text reviews for sources short-listed by at least one reviewer. Any conflicts were resolved by a third independent reviewer. Articles were included if they described a leadership resource, tool, or intervention; had a focus on women; and were explicitly related to global health or a global health issue. Global health work is a broad concept, and we landed on the definition of global health work as efforts attempting to improve the health of any population globally [16]. Articles were excluded if they did not address all three concepts and if no full text was available.

The gray literature resources were screened by one reviewer, and those that were thoroughly described by peer-review articles or did not satisfy the eligibility criteria were excluded. Screening results were verified by another experienced reviewer.

Data charting and analysis

We developed and pilot-tested a standardized data extraction form in Microsoft Excel. Teams of two independent reviewers extracted data from each article, and conflicts were resolved by a third reviewer. The extracted data were organized into key variables that included the article’s key research questions, objectives, and sources of funding. We captured information about the leadership resources, tools, and interventions, including global health focus areas, geographic location, length of resource, advertisement of resource, target audience, form of the resource, payment information, presence of mentorship, group networking, or networking, presence of training and incorporated topics, target audiences, and any associated evaluation data, if available. Data were reviewed for discrepancies or missing data. For example, data coded as “N/A” were examined in further detail to determine whether the information for a particular variable was truly unavailable or should be coded as “no” or another category.

We synthesized the data in both narrative and tabular formats and selected appropriate variables in the final dataset to be transformed from full-text character-type data into categorical data types with unique levels. Finally, we discussed the categorical coding for each of the questions after the initial full-text extractions to create more informative variable levels.

We used RStudio to generate summary tables of the cleaned data set, including the gray literature and peer-reviewed articles. Relevant R packages used include the readr package to read in the exported dataset into RStudio and the flextable package to create the descriptive tables.

Description of resources

The resources included conferences (n = 4, 12.90%) [17, 18, 19, 20]; supplemental resource to a conference (n = 1, 3.23%) [21]; a certificate program (n = 1, 3.23%) [22]; coursework (n = 2, 6.45%) [23, 24, 25]; stand-alone documents (n = 8, 25.81%) [8, 25, 26, 27, 28, 29, 30, 31]; single-focus programs (n = 1, 3.23%); and multicomponent programs (n = 14, 45.16%). Most resources (n = 20, 64.52%) did not have a specific global health focus area. Ten resources (32.23%) identified women first authors [3, 8, 9, 27, 30, 31, 32, 33, 34, 35], and of those, nine (29.03%) were also affiliated with institutions in high-income countries [3, 8, 9, 27, 30, 31, 32, 33, 34, 35]. As far as time commitments are concerned, most resources were not time bound (n = 18, 58.06%). Those with specific time commitments ranged from less than one week (n = 3, 9.68%) to more than one year (n = 3, 9.68%) (Table 1).

Conferences included the Women’s Federation for World Peace International First Ladies and Emerging Leaders: The Journey of 1325 & Women’s Leadership Conference [17]; the Women Leaders in Global Health conference organized by WomenLift Health [18]; the Gender Summit annual conference coordinated as part of a European Commission Project, genSET [19]; and the Women Deliver conference [20].

The one certificate program was based in Rutgers University’s Department of Women’s and Gender Studies, in collaboration with the Institute for Women’s Leadership and the National Nurses United. It offers a certificate in women’s global health leadership to individuals who complete the program [22].

Other coursework included the Essential Skills for Women’s Leadership in Global Health course, based in the JHSPH, which covered a range of topics, including understanding barriers, fostering solutions, and creating strategies for individuals and institutions to promote women’s leadership [23]. In addition, members of the Women Deliver Young Leaders Program can take online courses on topics such as gender equality and sustainable development, grant proposals and financial stewardship, and sexual and reproductive health and rights. Participants can further learn advocacy and project management through the Women Deliver’s Digital University [24].

We found one single-focus program called the Alliance-HSG Publication Mentorship Program, a six-month program for women working on health policy and systems research (HPSR) [9], but most resources (n = 14, 45.16%) featured multiple components [30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44].

Examples of multicomponent resources include Emerging Women Leaders in Global Health, based out of the Johns Hopkins University Center for Global Health [31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43]; Women in Global Health [44]; WomenLift Health: The Leadership Journey [31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43],; the TDR’s Women in Science Fellowship [38]; the Harvard LEAD Fellowship [39]; Building Interdisciplinary Research Careers in Women’s Health [40]; the Global Women’s Leadership Project [41]; the United Nations’ Ahfad University for Women [42]; the Moremi Initiative [43]; the Female Global Scholars Program [32]; the World Academy for the Future of Women [33]; the Higher Institute for Growth in Health Research for Women (HIGHER Women) consortium [34]; and the Malawi-Penn Women for Women’s Health project [35]. See the supplementary material for detailed descriptions of each resource.

Common resource components

While the formats, structures, and contents of the resources varied widely, networking and mentorship emerged as common components of these resources.

Targeting

Over half of the resources did not have a target audience (n = 17, 54.84%); nine (29.03%) targeted early career professionals (5 years of experience or less), eight (25.81%) targeted midcareer professionals (5–10 years of experience), five (16.13%) targeted late career professionals, and one (3.23%) was inclusive of all experience levels. Most targeted women specifically (n = 20, 64.52%), and roughly half (n = 15, 48.39%) targeted people in specific geographic locations. Six of those with geographic target audiences were only available to participants from low- and middle-income countries (LMICs). Most (n = 20, 64.52%) did not focus on a specific global health topic area.

Program funding and costs to participate

Most resources (n = 27, 87.00%) were free to users; however, four (12.91%) required payment for subscription or participation. One resource published its cost on a sliding scale of US$500–$800, while the other three did not indicate the specific costs to participants.

The resources were funded by the nongovernmental organizations (NGOs) implementing the resource (n = 9, 29.03), by public academic organizations (n = 8, 25.81), or by unspecified sources (n = 7, 22.58). Other sources of funding include nonprofit organizations (n = 5, 16.13%), for-profit organizations (n = 3, 9.68%), government (n = 2, 6.45%), private academic organizations (n = 1, 3.23%), or another source (n = 2, 6.45%).

Assessment/evaluation

Of the six resources (19.35%) that reported an evaluation, three (9.68%) conducted an evaluation outside of qualitative testimonials. Of those, the captured metrics centered around the number or percentage of participants who had a career-advancing opportunity after using the resource. Examples of career-advancing opportunities included 40% of participants enrolling into graduate school [33], 6 participants receiving academic promotions [32], 8 members participating in internships [33], 11 participants presenting at conferences [32], and 41 participants writing publications [32]. One of the resources (3.23%) used an individual interview evaluation design [32], while the other two resources (6.45%) used a survey format [27, 33]. Two of the resources (6.45%) mentioned an evaluation that was not published yet [23, 27].

Two resources (6.45%) used qualitative testimonials to highlight how participants have benefited from participating in the intervention [3, 34]. Relevant outcomes recorded from the testimonials from the GROW model include economic resources and career advancement. Two graduates reported outcomes of presenting at conferences and publication of their proposals, and three graduates cited acceptance of tenure-track offers, securing a job postgraduation, and an improvement as a qualitative and quantitative researcher [3]. One resource (3.23%) used qualitative feedback from an evaluation of a program’s workshop and reported three outcomes of value: applying to a PhD program, acceptance into a fellowship, and presenting or participating in international conferences [34].

Mentorship and networking

Among the variability, however, mentorship and networking were two components that were commonly offered by the resources. This was not surprising, as mentorship and networking are important for career growth [45]. Currently, there are opportunities for women such as the annual conference held by WomenLift Health, which convenes established and emerging women leaders from around the world and across various sectors [18]. Another organization with global reach, Women in Global Health [46], is the largest network of women and allies working to confront the issues of power and privilege for gender equity in health [44]. Providing opportunities for women in global health to convene, learn, and inspire one another is one way to establish networks and mentorship and to develop a consortium of tools, support, and other means by which women can effectively progress and succeed in leadership roles.

Targeting

Our review found that many programs for women leaders in global health were broad in scope, were not specifically targeted to a particular group of women and their needs, or did not specify an intended audience. Providing effective and acceptable programming for different populations requires acknowledging and understanding their different needs. Programs should be designed and targeted to meet the needs and desired ways of engaging specific audiences. An important early step in developing programming should be to clarify the target audience(s). Establishing a clear understanding of the target audience informs subsequent decisions about the program’s design, scope, objectives, and format [47]. This can allow for more sensitive consideration of different groups’ needs.

Needs assessments

In our review we found that needs assessments were scarce. The EDGE program was one that documented findings from a working group that asked emerging women leaders in global health for an assessment of their needs for developing leadership skills [48]. Thoughtful and thorough assessments of leadership resources and interventions must occur more frequently to engage end users in designing programming that may affect them and to better design and deliver programs that will successfully empower women to learn and take on leadership roles in global health. Stakeholders affected by decisions, programs, and policies should be involved in and able to influence the planning, conduct, dissemination, uptake, and evaluation of programming and research [49]. Stakeholder engagement throughout the course of development, implementation, and evaluation of educational and leadership programs is necessary to ensure relevance, acceptability, and feasibility; to make sure that equity and human rights issues are taken into consideration; and to support successful outcomes and improved ongoing implementation of skills and concepts learned [50].

Women in the global health field, as constituents of these programs, must be engaged at all stages of program planning, design, and evaluation. The voices of women who will participate in the programming must be heard in a way that gives them more than token involvement; they want a meaningful sense of shared ownership in the process. End user engagement improves the relevance, transparency, and usefulness of programs, and there is also an ethical obligation to engage end users in activities that may affect them [51].

Equity

It is important to note that in our review of the literature, we found that only 10 resources (32.23%) were written by women first authors. This is ironic, given that the articles were all related to women’s global health leadership. Additionally, when the first author’s location was specified, he or she was overwhelmingly from a high-income country; this was often the case even when the programs were targeting women from LMICs.

A paternalistic approach, where an outside force solely designs and offers leadership development programs, contributes to systemic inequities perpetuated by gender-based barriers stemming from organizational constraints and culture [7]. These are many of the same reasons women, especially women from LMICs, lack leadership opportunities to begin with [52]. At all stages of program planning, implementation, evaluation, and documentation, it is important to develop clear, aligned, and equitable expectations and goals with the input of constituents.

Evaluation

Our review also found a lack of consistent and meaningful evaluation of enacted programming. This makes it difficult to know what resources are effective and for whom. Evaluation provides an opportunity to assess the value of a given program for the participants and determines how well it met the intended objectives. A carefully targeted evaluation process that considers the outcomes women themselves identify as most meaningful to them provides valuable feedback for shaping future programming, making improvements, and ensuring that efforts match needs [53]. This process is crucial for targeting programs to constituent-identified needs, sustainability, and scalability. Conducting an appropriate and rigorous evaluation also contributes to keeping those who design and deliver programs accountable to the participants they serve, the funding agency supporting the project, and the greater goals of global health [53].

Funding

In our review, we found that the documented resources were mostly funded by NGOs who were implementing interventions (n = 9, 29.03%), public academic organizations (n = 8, 25.81%), or unspecified sources (n = 7, 22.58%). Interestingly, only 3.23% (n = 1) were funded by private academic organizations, 6.45% (n = 2) were funded by the government, and 9.68% (n = 3) were funded by for-profit organizations, entities that would be expected to have more disposable funds. It is time that government, private institutions, and for-profit entities substantially invested in developing and maintaining women leaders in global health.

Even though most of the students pursuing studies in global health are women, the number of women in the field tends to decrease as they advance in their careers [54, 55]. This may be due to the fact that women experience particular barriers to reaching leadership positions in global health, such as balancing work and home, gender bias, and lack of mentorship. Women in LMICs face additional barriers, including lack of opportunities, safety concerns, and financial constraints, more often than their counterparts in high-income countries (HIC) [27]. As such, funding opportunities like career development scholarships and grants to cultivate women leaders, especially in LMICs, is vital. Addressing these economic barriers will require strategic approaches backed by monetary resources to preserve and develop women in the field for advancement into leadership roles.

Sustainability

In our search, we did not find much documentation about the sustainability of the resources and programs, regarding either sustained funding or the ability for women to maintain participation in global health leadership opportunities. The resources reviewed may have had sustainability strategies, but they were not included in the articles.

Steady and specific funding is key to making women’s leadership programs sustainable. For example, the National Institutes of Health (NIH) Fogarty International Center dedicates funding for research in global health specifically targeted at women [56]. Now, women make up about 33% of the leadership of NIH institutes and centers (women lead 9 out of 27 centers). The Bill & Melinda Gates Foundation has been supporting the WomenLift Health organization in scaling up interventions to support women’s leadership in health, starting in Africa and India [57]. For sustainability, these WomenLift programs are being held in collaboration with local partners in the countries where these are conducted. One of WomenLift Health’s global leadership programs is a yearlong, fully funded leadership experience aimed at increasing the confidence, networks, and understanding of barriers against developing women leaders as well as providing peer, mentor, and coaching support for midcareer women [37]. However, it is not clear whether any evaluations of these programs have been conducted.

Further, for resources and programs to be sustainable for women to participate in, due to barriers that women face regarding work-life balance, funding opportunities should accommodate adequate protected time away from work/training responsibilities, with flexible schedules for maternity leave and caregiving responsibilities [54].

Strengths and limitations

This scoping review is subject to certain limitations. Since the research question was focused on assessing the availability of resources for women leaders in global health, one limitation is the very nature of variability in the programs publicly available. Most programs and resources may not be well documented in published peer-reviewed papers and gray literature or may not have been available in English. Relevant resources may exist beyond the scope of public online search, as formal and informal opportunities may exist within private social networks that would not be identified in our review.

Since the methods of the gray literature search were defined by the specified Google search terms, another limitation is that the team of reviewers did not screen every item from the search results due to the incredible volume of search results. In addition, the relevancy of resources presented by Google could vary based on the reviewer’s location or language, for example.

Although there was a large team of reviewers working on full-text reviews and extraction of gray literature items, there may be some variability in the comprehension of the extraction criteria, which can reduce the reliability of the results.

While there may be some variation in the results due to a diverse team of reviewers, the extraction method was piloted, and third reviewers were used to build consensus on the results. Furthermore, the results from the scoping review were found using broad and publicly available search methods, which ensures the accessibility of finding information about the resources.