TABLE 1.

Responsive Feedback Mechanism Stepwise Design for NPHCDA Leadership Development Academy

Focus and Description	Data Collected, Data Collection Tools, and Period of Collection	Stakeholders Involved	Meeting Fora to Discuss Data Findings and Objective Frequency
Program design
Align on: Capacity-building support Defining the scope of capacity-building Plan to deploy the LDA	Baseline assessment result; Baseline assessment forms; 3 months	Executive director, departmental directors, TSU, supporting partners	Kick-off meeting and then held weekly until program commencement To align on the need for capacity development and plan to build and sustain staff capacity
RF incorporation: Held multiple iterative sessions with the leadership of the NPHCDA and partner organizations to elicit feedback on the capacity-building design before rollout. Feedback from key stakeholders was reflected in the design by using baseline assessment results and interviews to screen and select enrollees to ensure commitment as opposed to the use of the civil service quota system. Initial program design allocated to span for 12 months but reduced to 6 months based on feedback from the NPCHDA leadership to ensure that staff do not lose focus of their assigned job functions at the agency.
Implementation (by learning approaches)
In-class session: Ensure trainees acquire the requisite knowledge to develop the focus skills of the LDA Interactive lectures Demonstrations Individual and group exercises	Pre- and post-assessment results; Baseline assessment evaluation form, in-class session assessment form, course delivery feedback form; 4 weeks (in 2 waves of 2 weeks each, where the second wave commences after the first wave of external rotation)	TSU, steering committee, enrollees	Program review meetings Held once To review assessment results, identification of trainees' strengths and weaknesses to inform area of support from the other learning approaches
External rotation: Provide firsthand experience of different work cultures and the opportunity to apply knowledge gained and develop skills	Logbook, supervisor's ratings; Logbook, performance appraisal, check-in visit feedback form; 12 weeks (in 2 waves of 6 weeks each that commences after each in-class session)	TSU, externship supervisors from partner organizations	Program review meetings held bi-weekly To review trainee's performance
Mentorship: One-on-one sessions with an experienced professional to support the trainees to own their personal and professional leadership growth and development	Midpoint evaluation tracker, mentee feedback form, mentor feedback form; 20 weeks (runs concurently with the external rotation and e-learning)	TSU, mentors, steering committee	Program review meetings held monthly To review trainee's activities towards achieving a personal development plan. To review implementation of mentor-prescribed activities
E-learning: Expose trainee to carefully curated PHC content across multiple learning platforms to facilitate continuous learning	Certificates of course completion Feedback forms, weekly check-in calls tracker; 10 weeks (runs concurrently with the external rotation)	TSU, steering committee	Program review meetings held weekly To review the status of completion of e-courses
Capstone project: Apply all the knowledge and exhibit skills gained from the other learning approaches to plan and deliver technical assistance requests from SPHCBs	Performance evaluation form; 13 weeks (commences after the first wave of external rotation and runs until the end of the LDA)	TSU, partners, steering committee, secretariats, division directors, SPHCB	Program review meetings held biweekly To review implementation of capstone project; challenges and lessons learned
Learning tour: Expose enrollees to successfully executed interventions outside Nigeria through discussions, site visits, and interviews along the health building blocks that are directly applicable to Nigeria's PHC priorities	Learning tour report; 1 week	Executive director, directors of divisions, TSU, Ministry of Health representatives, steering committee, supporting partners, other country's program directors	Senior management meetings and program review meetings Held once To review program design, implementation, and results
RF incorporation: Incorporated feedback from the enrollees, supervisors, and steering committee on the need for an objective evaluation of the external rotation. Introduced a logbook and performance appraisal forms after the first wave of the first cohort. Reviewed enrollees' feedback forms that revealed that some partner organizations did not offer an enabling environment (workspace and work assignments) for the enrollees to enable them to accomplish their milestones. As a result, postings were made based on the partner organization's ability and willingness to do so. Observed a mismatch of enrollees to partner organizations based on the skills they need to acquire and made appropriate changes after receiving feedback from the enrollees and alignment with the steering committee. To sustain learning enthusiasm, integrated cocurricular activities, such as picnics and weekend aerobic sessions, in the second wave of the in-class session based on enrollees' feedback.
Review
End of cohort review: Assess LDA enrollees on their view of the learning approaches for course correction and improvement	LDA assessment result, LDA report; LDA assessment form, post-LDA assessment form; 4 weeks	Executive director, division directors, TSU, steering committee, supporting partners	Senior management meetings, program review meetings Held once To review program design, implementation, and results
RF incorporation: Made modifications to the curriculum during the first cohort review. Deprioritized vision and strategic thinking courses based on enrollees' feedback that the skill could not be applied within the agency. Introduced a time management course to increase enrollees' work productivity. These changes were reviewed and approved by the steering committee. Removed learning tour from the learning strategy because it contributed very little to the skill or knowledge growth of the enrollees.

Abbreviations: LDA, leadership development academy; NPHCDA, National Primary Health Care Development Agency; PHC, primary health care; SPHCB, state primary health care board; TSU, technical support unit.