2017 Western Africa Management Development Institute (MDI) Training

  1. Please read the instructions below before you begin filling out the Application Form

    Please note that the form has several different fields to fill spread over 7 pages. It is an intensive process and the MDI program organisers propose that you complete the application as a team (2-4 people).

    Before you start filling in this application make sure you have the following information:

     

    1. Primary Health Priority (in your Country/County or Institution)

    a. Examples: (Communicable or Non-communicable) Disease prevention & control; Maternal & Child Health; HIV/AIDS and STI; Tuberculosis; Expanded program on immunization etc

    2. Organization Information

    a. Physical and Postal Address, Email Address, website

     

    b. Telephone, Fax 

     

    c. Number of patients/clients served per year; 
    Number of sites, clinical staff, admin staff, and other staff;

     

    d. Which sector is your organization: Govt, NGO, Private?

     

    e. Organization Type: Local Non-Government, National Non-Government, International Non-Government, Faith-Based, Community-Based, Educational Institution, Local Health System, Regional Health System, National Health System, Governmental Institution, Hospital, Other (please specify)

    3. Team Members' information

    a. Personal Information: Name, Email, Phone, Postal Address, Gender

     

    b. Role in Addressing Health Priority

     

    c. Have you ever applied to MDI before?

     

    d. Education: Highest level of education attained; 
    Name of Institutions attended, years attended, name of degree or certificates received.

     

    e. Professional Development: List any management or leadership training you have attended within the last 3 years (e.g., conferences and seminars) relating to your work as a health care executive

     

    f. Employment History: Total number of years worked; List other positions held in the health care industry – Position/Title, Company/Organization, Number of Years

     

    g. Leadership Involvement: List any community and/or health care organization(s) in which you are involved in a leadership capacity, including the scope and length of time of your participation. Note: A minimum of 3 – 5 years leadership involvement is required;
    Name of Organization;
    Dates of Participation;
    Leadership Role / Title.

     

    h. Choose one organization and describe, in detail, your leadership role.

    Repeat for EACH Team Member / Applicant

    4. Statements

    a. Team to Jointly Respond: What are the major health care needs, challenges and priorities facing your nation, region or community? What is your entity, department, organization, team or partnership doing, or else are planning to do, to respond to these challenges and to attend to these health priorities?

     

    b. EACH Team member to Respond: Describe your personal role and responsibilities in confronting these challenges.

     

    c. EACH Team member to Respond: What do you anticipate as being the benefits to your management team from participating in the Management Development Institute? What do you, as a member of the team that is attending, expect to gain?

     

    5. Commitment

    a. Commitment Letter from Organization: Upload (Scanned and in PDF) a letter of recommendation from your organization will be included along with the team's program application.

     

    b. Commitment Form: Download the Commitment Form. Print, complete and upload the signed form.

  1. Management Development Institute (MDI) Program
    A Management Development Training for Managers and Leaders of Health Care Organizations

    GIMPA, ACCRA, GHANA PROGRAM:
    14-23 October 2017
    Application Deadline: 30 September 2017

    Multi-Person Team

    You are expected to attend the program as a member of a team consisting of two to four individuals that are employed by the same organization or else that are collaborating across organizations and focused on the same national or regional health priority.

    Titles of team members might be Director, Project Manager, Program Manager, Executive Director, Program Coordinator, Public Health Coordinator, Regional Coordinator, Chief Medical Officer, Chief Nurse, Medical Superintendent, Country/County Coordinator, Head of Finance/Administration or comparable titles. All team members must commit to the full program, complete the Applicant Information pages, jointly respond to the Statements on Section V and VI, and sign the Commitments section on section VII and VIII.

    Special Program Feature - Community Healthcare Improvement Project (CHIP)

    The Community Healthcare Improvement Project (CHIP) is the practical application or experiential component of the program, allowing the participants to immediately translate the MDI curriculum to improve performance in their own health systems. As part of the application process, participants identify specific initiatives — aligned with national health priorities — that they intend to undertake as part of their CHIP.

    Before finalizing this application, participant teams and their superiors should discuss and identify two potential healthcare improvement projects that are relevant to their roles and organizations. During the residential portion of the program, one of these projects will be further developed as the CHIP. Each team's CHIP should be aligned with the roles and responsibilities of the team members, and should have the support of their superiors and/or their organization's senior leadership. It is expected that program participants will implement the CHIP as part of their work responsibilities after completing the program, and will secure the resources (including time) necessary to do so. Our objective is to ensure that MDI participants and their superiors will implement and evaluate CHIPs in the context of their healthcare service delivery programs that lead to better health outcomes, and which may serve as models for other organizations.

    NOTE: Fields marked with (*) are mandatory

  2.  

    I. Primary Health Priority

  3. List Primary National or Regional Health Priority (to be addressed in MDI program):(*)
    Invalid Input
  4.    (Examples include, but not limited to: Disease prevention & control; Maternal & Child Health; HIV/AIDS and STI; Tuberculosis; Expanded program on Immunisation; Communicable Disease Prevention Control; Malaria Control; Health Systems Support; Health Promotion; Family and Reproductive Health; Child and Adolescent Health)

  5.  

    II. Organization(s) Information

  6. Primary Organization Name:(*)
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  7. Secondary Organization Name
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    (if more than one organization is applying)
  8. Primary Organization Physical Address:(*)
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  9. Postal Address/Postal Code
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  10. City and Country(*)
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  11. Organization Telephone:(*)
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    (Add Country Code)
  12. Fax:
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  13. Web Site(s):
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  14. Organization E-mail address(*)
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  15.  

    III. Scope of Organization

  16. Number of Patients/Clients Served per Year:(*)
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    (unduplicated)
  17. Number of Sites:(*)
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  18. Number of Clinical Staff(*)
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  19. Number of Administrative Staff(*)
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  20. Number of Other Staff(*)
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  21. Sector(*)


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  23. Organization Type(*)
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  24. Other (Organization Type)
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  1. Please Fill Out for EACH Team Member Applying. At Least One Team Member Should be of Senior Level.


    All members of a team must fill out the applicant information section

  2.  

    IV.1 Applicant Information - This Section is for the First Person of the Team

  3. Name(*)
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  4. Organization Name(*)
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    (if more than one organization is applying)
  5. Position(*)
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  6. No. of Years in Current Position(*)
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  7. Role in Addressing Health Priority listed in Section I:(*)
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  8. Postal Address/Postal Code:
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  9. City and Country:(*)
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  10. Telephone:(*)
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    (Add Country Code)
  11. Fax:
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  12. E-mail Address(*)
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  13. Gender(*)
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  15. Have you previously applied for MDI?
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  16. If Yes Which Year
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  17. Educational Background

  18. Highest level of education attained(*)
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  19. Please list schools attended, beginning with most recent.
  20. Name of Instutution(*)
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  21. Number of years attended(*)
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  22. Degree or certificate received (if any)(*)
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  23. _________________________________________________
  24. Name of Instutution
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  25. Number of years attended
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  26. Degree or certificate received (if any)
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  27. _________________________________________________
  28. Name of Instutution
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  29. Number of years attended
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  30. Degree or certificate received (if any)
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  31. _________________________________________________

  32. Professional Development:

    Please list any management or leadership training you have attended within the last 3 years (e.g., conferences and seminars) relating to your work as a health care executive
  33. .(*)
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  34. Employment History

  35. Total number of years worked(*)
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  36. Please list other positions held in the health care industry.
  37. Position/Title(*)
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  38. Company/Organization(*)
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  39. Number of Years(*)
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  40. _________________________________________________
  41. Position/Title
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  42. Company/Organization
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  43. Number of Years
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  44. _________________________________________________
  45. Position/Title
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  46. Company/Organization
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  47. Number of Years
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  48. _________________________________________________

  49. Leadership Involvement:

    Please list any community and/or health care organization(s) in which you are involved in a leadership capacity, including the scope and length of time of your participation. Note: A minimum of 3 – 5 years leadership involvement is required.
  50. Name of Organization(*)
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  51. Dates of Participation(*)
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  52. Leadership Role/Title(*)
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  53. _________________________________________________
  54. Name of Organization
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  55. Dates of Participation
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  56. Leadership Role/Title
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  57. _________________________________________________
  58. Name of Organization
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  59. Dates of Participation
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  60. Leadership Role/Title
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  61. _________________________________________________
  62. Choose one organization and describe, in detail, your leadership role:
  63. .(*)
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  1.  

    IV.2. Applicant Information - This Section is for the Second Person of the Team

  2. Name(*)
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  3. Organization Name(*)
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    (if more than one organization is applying)
  4. Position(*)
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  5. No. of Years in Current Position(*)
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  6. Role in Addressing Health Priority listed in Section I:(*)
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  7. Postal Address/Postal Code:
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  8. City, Country:(*)
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  9. Telephone:(*)
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    Add Country Code
  10. Fax:
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  11. E-mail Address(*)
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  12. Gender(*)
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  14. Have you previously applied for MDI?(*)
    Invalid Input
  15. If Yes Which Year
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  16. Educational Background

  17. Highest level of education attained(*)
    Invalid Input
  18. Please list schools attended, beginning with most recent.
  19. Name of Instutution(*)
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  20. Number of years attended(*)
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  21. Degree or certificate received (if any)(*)
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  22. _________________________________________________
  23. Name of Instutution
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  24. Number of years attended
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  25. Degree or certificate received (if any)
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  26. _________________________________________________
  27. Name of Instutution
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  28. Number of years attended
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  29. Degree or certificate received (if any)
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  30. _________________________________________________

  31. Professional Development:

    Please list any management or leadership training you have attended within the last 3 years (e.g., conferences and seminars) relating to your work as a health care executive
  32. .
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  33. Employment History

  34. Total number of years worked
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  35. Please list other positions held in the health care industry.
  36. Position/Title
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  37. Company/Organization
    Invalid Input
  38. Number of Years
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  39. _________________________________________________
  40. Position/Title
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  41. Company/Organization
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  42. Number of Years
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  43. _________________________________________________
  44. Position/Title
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  45. Company/Organization
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  46. Number of Years
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  47. _________________________________________________

  48. Leadership Involvement:

    Please list any community and/or health care organization(s) in which you are involved in a leadership capacity, including the scope and length of time of your participation. Note: A minimum of 3-5 years leadership involvement is required.
  49. Name of Organization
    Invalid Input
  50. Dates of Participation
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  51. Leadership Role/Title
    Invalid Input
  52. _________________________________________________
  53. Name of Organization
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  54. Dates of Participation
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  55. Leadership Role/Title
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  56. _________________________________________________
  57. Name of Organization
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  58. Dates of Participation
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  59. Leadership Role/Title
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  60. _________________________________________________
  61. Choose one organization and describe, in detail, your leadership role:
  62. .
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  1.  

    IV.3 Applicant Information - This Section is for the Third Person of the Team

  2. Name
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  3. Organization Name
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    (if more than one organization is applying)
  4. Position
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  5. No. of Years in Current Position
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  6. Role in Addressing Health Priority listed in Section I:
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  7. Mailing Address
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  8. Postal Address/Postal Code:
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  9. City, Country:
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  10. Telephone:
    Invalid Input
    Add Country Code
  11. Fax:
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  12. E-mail Address
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  13. Gender
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  15. Have you previously applied for MDI?
    Invalid Input
  16. If Yes Which Year
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  17. Educational Background

  18. Highest level of education attained
    Invalid Input
  19. Please list schools attended, beginning with most recent.
  20. Name of Instutution
    Invalid Input
  21. Number of years attended
    Invalid Input
  22. Degree or certificate received (if any)
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  23. _________________________________________________
  24. Name of Instutution
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  25. Number of years attended
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  26. Degree or certificate received (if any)
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  27. _________________________________________________
  28. Name of Instutution
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  29. Number of years attended
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  30. Degree or certificate received (if any)
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  31. _________________________________________________

  32. Professional Development:

    Please list any management or leadership training you have attended within the last 3 years (e.g., conferences and seminars) relating to your work as a health care executive
  33. .
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  34. Employment History

  35. Total number of years worked
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  36. Please list other positions held in the health care industry.
  37. Position/Title
    Invalid Input
  38. Company/Organization
    Invalid Input
  39. Number of Years
    Invalid Input
  40. _________________________________________________
  41. Position/Title
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  42. Company/Organization
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  43. Number of Years
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  44. _________________________________________________
  45. Position/Title
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  46. Company/Organization
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  47. Number of Years
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  48. _________________________________________________

  49. Leadership Involvement:

    Please list any community and/or health care organization(s) in which you are involved in a leadership capacity, including the scope and length of time of your participation. Note: A minimum of 3-5 years leadership involvement is required.
  50. Name of Organization
    Invalid Input
  51. Dates of Participation
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  52. Leadership Role/Title
    Invalid Input
  53. _________________________________________________
  54. Name of Organization
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  55. Dates of Participation
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  56. Leadership Role/Title
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  57. _________________________________________________
  58. Name of Organization
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  59. Dates of Participation
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  60. Leadership Role/Title
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  61. _________________________________________________
  62. Choose one organization and describe, in detail, your leadership role:
  63. .
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  1.  

    IV.4 Applicant Information - This Section is for the Fourth Person of the Team

  2. Name
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  3. Organization Name
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    (if more than one organization is applying)
  4. Position
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  5. No. of Years in Current Position
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  6. Role in Addressing Health Priority listed in Section I:
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  7. Mailing Address
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  8. Postal Address/Postal Code:
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  9. City, Country:
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  10. Telephone:
    Invalid Input
    Add Country Code
  11. Fax:
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  12. E-mail Address
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  13. Gender
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  15. Have you previously applied for MDI?
    Invalid Input
  16. If Yes Which Year
    Invalid Input

  17. Educational Background

  18. Highest level of education attained
    Invalid Input
  19. Please list schools attended, beginning with most recent.
  20. Name of Instutution
    Invalid Input
  21. Number of years attended
    Invalid Input
  22. Degree or certificate received (if any)
    Invalid Input
  23. _________________________________________________
  24. Name of Instutution
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  25. Number of years attended
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  26. Degree or certificate received (if any)
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  27. _________________________________________________
  28. Name of Instutution
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  29. Number of years attended
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  30. Degree or certificate received (if any)
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  31. _________________________________________________

  32. Professional Development:

    Please list any management or leadership training you have attended within the last 3 years (e.g., conferences and seminars) relating to your work as a health care executive
  33. .
    Invalid Input

  34. Employment History

  35. Total number of years worked
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  36. Please list other positions held in the health care industry.
  37. Position/Title
    Invalid Input
  38. Company/Organization
    Invalid Input
  39. Number of Years
    Invalid Input
  40. _________________________________________________
  41. Position/Title
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  42. Company/Organization
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  43. Number of Years
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  44. _________________________________________________
  45. Position/Title
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  46. Company/Organization
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  47. Number of Years
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  48. _________________________________________________

  49. Leadership Involvement:

    Please list any community and/or health care organization(s) in which you are involved in a leadership capacity, including the scope and length of time of your participation. Note: A minimum of 3-5 years leadership involvement is required.
  50. Name of Organization
    Invalid Input
  51. Dates of Participation
    Invalid Input
  52. Leadership Role/Title
    Invalid Input
  53. _________________________________________________
  54. Name of Organization
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  55. Dates of Participation
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  56. Leadership Role/Title
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  57. _________________________________________________
  58. Name of Organization
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  59. Dates of Participation
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  60. Leadership Role/Title
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  61. _________________________________________________
  62. Choose one organization and describe, in detail, your leadership role:
  63. .
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  1.  

    V. Statements

    Please respond to the following questions. Limit each response to one page

  2. 1. Team to Jointly Respond

    What are the major health care needs, challenges and priorities facing your nation, region or community? What is your entity, department, organization, team or partnership doing, or else are planning to do, to respond to these challenges and to attend to these health priorities?
  3. .(*)
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  4. 2. Each Individual to Respond

    Please describe your personal role and responsibilities in confronting these challenges.
  5. Applicant 1(*)
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  6. Applicant 2(*)
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  7. Applicant 3
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  8. Applicant 4
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  9. 3. Each Individual to Respond

    What do you anticipate as being the benefits to your management team from participating in the Management Development Institute? What do you, as a member of the team that is attending, expect to gain?.
  10. Applicant 1(*)
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  11. Applicant 2(*)
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  12. Applicant 3
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  13. Applicant 4
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  1.  

    V.I Commitment Letter from Organization

  2. Upload (Scanned and in PDF) a letter of recommendation from your organization will be included along with the team’s program application.

  4. Upload in PDF
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  5.  

    VII. Commitment Form

  6. Download the Commitment Form by clicking on the image below: Print, complete and upload the signed form.

    Download Commitement Form

  7. Upload Form in PDF
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  8. For questions, please contact:   

    Prof Antony Sallar
    Western Africa MDI Regional Director
    Contact email: [email protected]

    Telephone: (+233) 54 315 4128
  9. Submit