Multilevel leadership

Another positive example of health professional schools engaging system-wide with health managers at the national level and affecting the municipal, district, and regional levels involves the Bangladesh National Institute of Population Research and Training (NIPORT). The example illustrates the potential benefit of making academic training and research relevant in achieving national health objectives. The Bangladesh NIPORT experience reflects a shift from traditional centralized planning and management to one more responsive to solutions that fit institutional needs and engage stakeholders in the process.

NIPORT, comprising a central national institute and 12 regional family welfare visitor training institutes across the country, introduced multiple innovative elements (Afroza 2012; Banglapedia 2012; World Bank 2011) supported by German technical and financial assistance, including:

  1. Emphasis on local recruitment of NIPORT students at the village level, with student selection led and endorsed by village committees
  2. Internships for NIPORT students at the originating district level
  3. Upon graduation from NIPORT, government posting to the originating district (and, preferably, the same village or municipality)
  4. Annual refresher training at NIPORT and the regional institutes
  5. Gradual promotion and selection of posted alumni into the NIPORT system, first as junior faculty and then as more senior faculty over the years
  6. Selection of regular NIPORT faculty from best-performing alumni
  7. Involvement of faculty in the village- and district-level selection of subsequent student candidates, completing the full cycle of a mutual and two-way process of direct involvement of training and research with clinical and policy-making practice at the local, municipal, district, and regional levels.

The NIPORT system contributed upward to broader government thinking in that the central government diminished direct public sector community and district involvement in population research, recruitment, and training, with a preference for having rural nongovernmental programs (such as BRAC and Grameen Bank) take on responsibilities at the local level while retaining NIPORT at the national level (Afroza 2012; Huda 2010; Hulme 2008; Smillie 2009). It contributed downward by providing local institutions with advice, support, and the training of personnel more likely to respond to their needs.

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