Giving and receiving feedback is core to learning in TGLF’s programmes. A community volunteer’s analysis is judged alongside a district medical officer’s without either knowing whose it is. On 6 August 2026, at Teach to Reach 16, the Foundation’s gathering of health workers from more than fifty countries, one Ghanaian volunteer described what that did to his standing rather than his knowledge, and TGLF released a leadership framework drawn from more than 1,300 practitioners. Second article from that day, this is the one about credentials: who gets counted as a leader, and whether a document can validate work that appears in no job description. It also records the limits the framework sets on itself.
Joshua Kofi Nnanchom introduced himself by explaining what he did not have.
“My case is that I am just a mere volunteer. Unfortunately I could not get a chance to enrol into any institution to learn professional health courses.”
He is a community health volunteer in Ghana.
He had just completed a peer learning course on malaria alongside doctors, district medical officers, and national advisers, and the thing he wanted to report was not something he had learned.
It was something he had become.
“Now I can speak in public confidently, because the main aspect of the programme was also done anonymously. So that aspect has boosted my confidence level, because I see myself as a mentor now.”
Then he explained why the anonymity mattered.
“I get the opportunity to interact with the diaspora and then people from different regions. And in fact, it was so amazing to me, because as I stated earlier, a person without any good background from the health aspect, and now I am able to interact with health expertise.”
In a course where work is reviewed by peers who cannot see your credentials, a volunteer’s analysis is judged as analysis.
That is the argument the TGLF Leadership framework, released at the same session, is trying to turn into deliberate practice.
A framework that opens on a complaint
Most leadership frameworks in global health begin with an aspiration.
This one begins with the working week.
“You have more to do this week than the week has hours. The list gets longer.”
Only then does it name its subject.
“You have plans, but this is about making the plans happen. And making them work for the community.”
It descends from an open-source Manifesto drafted in 2023 with voluntary responses from more than 1,300 people who work for health, reviewed that September by 390 health leaders, predominantly ministry of health staff from districts and facilities.
The record notes who was not in that room.
“No international consultants, global health agencies, or donors were present.”
The Manifesto recorded a specific grievance about how knowledge is ranked.
“Many of us point to the inequities in global health knowledge, which prioritises global knowledge over context-based expertise. We respect and enjoy hearing from global experts, but many of us suggest that talking to peers with day-to-day field experience is often of more relevance to us.”
The transmission is traceable
Nine domains name what health workers do.
Three levels describe how far each behaviour has grown, from Practitioner, who keeps the service running, to Collaborator, who adapts to local conditions and shares with peers, to Strategist, who mentors, mobilises resources, and turns local success into something others can use.
In at least one place, the line from 2023 to 2026 is almost verbatim.
Asked in the Manifesto what he does to strengthen preventive medicine, a contributor named Edwin Simple answered:
“Increase communication to strengthen the linkage between public health and clinical medicine, and also the use of innovative strategies to increase adherence and access.”
The framework’s ninth domain now lists, as a level two behaviour, increasing communication to link public health with clinical medicine and implementing innovative strategies to increase adherence and access to services.
A sentence typed by a practitioner is a competency descriptor three years later.
The most consequential design choice concerns the bottom rung.
Review cycles corrected the descriptors “so that the lowest level described a genuine starting state rather than absence of the competency.”
Level one is not a deficit.
It is competent daily work under standard conditions, which is what most health workers are doing most of the time.
What a leader is, and how do you become one?
Ninety minutes in, Reda Sadki asked three questions.
What is a leader?
What does it take to be one?
Are you one?
Almost nobody described authority.
Ahmed Ejaeidi described “the person guiding a group of people towards a noble goal.”
Rabiu Yau described “a person who tries to understand the people’s perception, problem, and provide contextual solution.”
Gédéon Uwizeyimana, in Burundi, gave the shortest version: “someone who can guide a team with knowledge and humility.”
Abel Draiva, in Mozambique, wrote of someone “able to influence others for change to be taken with responsibility and care.”
Emmanuel Dare, at national level in Nigeria, described leadership as a distribution problem.
“A leader is the person that knows he or she is not alone on a particular task.”
Separately he added:
“A leader must listen to members’ suggestions and reason together for the best solution.”
Acha Achi, at regional level in Cameroon, produced the answer that maps most closely onto the framework’s third level.
A leader leads “without necessarily using force or coercion but being persuasive and exemplary,” which requires “understanding of the people you lead, commitment to the course, accountability, transparency to the people you lead and key stakeholders.”
Amanda Gbarmo Ndorbor, at community level in Liberia, answered the third question by describing her own week.
“I guide, share knowledge and skills, and mentor others with respect as I listen to learn. All of which makes me a leader.”
MLS Abdul Elladan, at a health facility in Niger, answered all three, and Charlotte Mbuh read his answer out.
A leader “inspires, guides, and supports others to achieve a common goal through positive actions and integrity.”
It takes “honesty, responsibility, good communication, empathy, confidence, and a willingness to serve others.”
And: “Yes. I believe I am a leader because I take initiative, support others, and lead by example in my work and community.”
Dr. Buhari Shehu, at region level in Nigeria, answered in three words.
“Yes, I am a leader.”
The shift
Usman Muhammad Tukur, at regional level in Nigeria, took the microphone after the framework appeared, and his reason for wanting it was practical rather than aspirational.
“When you learn and you want to communicate to somebody, you have to have a leadership style. You have to have a leadership quality that will allow you to lead by example, that allows you to deal with a lot of people in the community.”
Mbuh answered with a claim about ownership.
“All of that comes from you, from you and all the other scholars that make up the TGLF network. We are just glad we are able to put it together and give it back to the community.”
Kingsley Nignere, at district level in Ghana, typed the reply.
“Giving it back to the community is a great sustainability strategy.”
Nignere had also responded to the Manifesto draft in 2023, where he wrote that “transparency always brings about trust.”
Three years separate the two sentences.
Why is leadership invisible when it is undeniably critical to health outcomes?
Of everything in the framework, one line carries the most weight, and it sits in the guidance for health workers rather than in the competency tables.
The purpose is “to validate your existing invisible work and map your professional growth.”
The malaria cohort that finished the same week showed exactly what is invisible.
Nearly half its participants described negotiating with informal medicine sellers on their own time, work the synthesis records as receiving “no funding, no tools, and no recognition.”
Mortimer Papy Mohele Bosalo met a pharmacy team “in the back room of the pharmacy after the busy hours” because two children had arrived in shock.
Adrienne Vanessa Kouatchouang phoned a head nurse directly and found the stockout that a falling case count had concealed.
None of that appears in their job descriptions.
The framework’s proposal to ministries is to change that: move performance management to recognize that technical knowledge is necessary but insufficient, and add adaptive measures such as the ability to resolve community refusal.
TGLF’s research indicates that the main barriers to workforce development may in fact depend on such a shift.
Its proposal to employers is to interview for level two resource mobilization competencies, on the argument that someone who can find local solutions is often more valuable in a crisis than someone with high theoretical knowledge and low adaptive capacity.
Its proposal to individuals is the simplest.
Open the guide.
Read the nine domain names.
Circle the one that sounds most like your week.
Write one sentence about a real thing you did last month that fits it.
“That is the whole task for this week.”
What are the limits of TGLF’s leadership framework?
The document declines to oversell itself.
Contributors were self-selected rather than probability-sampled, “so the evidence base supports identification of the range of relevant competencies rather than population-level prevalence estimates.”
It “presents itself as a structured synthesis of frontline practice rather than a statistical model.”
Formal psychometric validation, including field testing of the behavioural indicators and inter-rater reliability, “is identified as one appropriate next step.”
That is a usable instrument for self-assessment and career mapping, released as a draft for community review, with a certification attached.
It is not yet a measurement tool, and it says so before anyone else can.
What it cannot do is pay Nnanchom.
He is still a volunteer in Ghana.
What changed in August is that there is now a page naming the work he has been doing, and a word he used himself, unprompted, in front of several hundred colleagues.
Mentor.