Developing a competency-based framework for global health leadership: Integrating clinical practice, behavioral science, and public health training

Global health leadership has become increasingly vital in navigating the complex intersection of clinical care, behavioral science, and population-level health management. The challenges of emerging infectious diseases, global inequities, and health systems fragility have amplified the demand for a new generation of leaders who possess interdisciplinary competencies that transcend traditional biomedical boundaries. Yet, leadership training in global health remains fragmented, often privileging clinical or administrative expertise while neglecting behavioral and systemic dimensions essential for effective collaboration, decision-making, and policy translation. This original research article develops and validates a competency-based framework for global health leadership that integrates clinical practice, behavioral science, and public health training. The study employed a sequential mixed methods design involving (1) a systematic review of global health leadership competencies across 62 academic and institutional training programs, (2) Delphi panel consultation with 24 international experts representing clinical, behavioral, and public health domains, and (3) validation through a cross-sectional survey of 412 participants from low-, middle-, and high-income countries engaged in global health practice or training. Quantitative analysis employed exploratory factor analysis (EFA) to identify core competency domains, while qualitative data from panel discussions and open-ended survey responses were analyzed thematically to contextualize domain interrelations and application pathways. The study identified six essential competency domains: systems thinking and policy integration, behavioral adaptability and cross-cultural communication, evidence-based clinical decision-making, ethical global governance, collaborative leadership and mentorship, and equity-driven innovation. Validation testing demonstrated strong construct reliability (Cronbach’s ? = 0.89) and high inter-domain correlation, confirming internal coherence and cross-disciplinary relevance. Qualitative insights emphasized the importance of experiential learning, mentorship continuity, and contextual adaptability in leadership formation. The resulting framework offers an integrated blueprint for reorienting global health education toward holistic, practice-oriented leadership development. It provides actionable guidance for universities, health ministries, and global health organizations seeking to align leadership capacity building with the complex realities of 21st-century health governance. By bridging clinical, behavioral, and public health domains, this framework lays the foundation for a more resilient, equitable, and collaborative global health workforce. Keywords: Global Health Leadership, Competency-Based Education, Behavioral Science, Clinical Practice, Public Health Training, Interdisciplinary Framework, Systems Thinking.