An exploratory study on transformational leadership competencies in global health.

Background: PhD programs typically emphasize scientific competencies but may insufficiently prepare graduates to lead complex global health challenges. Persistent inequities, weak governance and emerging threats to global peace demand leaders who can critically assess systems, respond to local needs, and foster equitable, sustainable change. Such leadership requires reflexivity, humility, and collaborative learning. This study explores how PhD graduates across world regions perceive transformational leadership competencies and compares competencies developed during PhD training with those relevant in their current workplace. Methodology/findings: Using an expert-validated survey based on a previously published competency framework and Delphi-derived behavioral descriptors (CROSS-guided; internationally piloted), we surveyed 618 graduates from Swiss TPH, CARTA, SSPH+, and CAPHRI; 71 graduates from 27 countries responded (response rate 11.5%). Median age was 45 years (IQR 41-51), 49% were women; median time since graduation was 6 years (IQR 3-9.5). One third completed their PhD in Africa and two thirds in Europe. Most worked in education (53.5%) or health care (10%), with others in NGOs, government, or international organizations. Competencies were rated highly relevant in the workplace (means 5.58-6.23, 1-7 scale). However, mean ratings (5.29-5.97) suggest that PhD training contributed less to competency development than the level relevant in the current workplace. Graduates from low- and middle-income countries reported better alignment between training and workplace relevance than those from high-income countries. Remaining in one location during the PhD was associated with higher perceived development. There was no evidence for gender effects. Conclusions/significance: Transformational leadership competencies are highly valued in the workplace but not consistently developed through PhD training, particularly in high-income countries. Programs with formally structured leadership-related educational components and dedicated pedagogical approaches were associated with higher levels of self-reported competency development. These findings should be interpreted cautiously given the low response rate and reliance on self-reported data. Future research is needed to determine curricular elements that contribute to leadership competency development. A transformational leadership lens may provide a useful framework for strengthening doctoral education in global health while incorporating lessons from low-income settings.