Enhancing Security Cooperation: Achieving and Sustaining Change Through Health Train-the-Trainer Capacity Building Initiatives
Open AccessBackground: One way the U.S. Department of Defense (DOD) works to achieve national security is through security cooperation, by way of building and enhancing partner nation capacity. The DOD leads several health-related security cooperation training efforts to improve the capacity and capability of partner nations. Despite the rationale and significant resources devoted by the U.S. government, the outcomes of change and how to best achieve and sustain these initiatives are still uncertain. The purpose of this research was to evaluate change outcomes of a health-related security cooperation train-the-trainer (T3) initiative and to better understand in practice the factors, including facilitators and barriers, to best achieve and sustain change across multiple countries and levels through T3 approaches.Methods: The study applied a mixed method explanatory sequential design to explore training outcomes of a specific health-related security cooperation training initiative. The DOD employed a T3 model in Ghana, Rwanda, Senegal, and Uganda to support the African Peacekeeping Rapid Response Partnership program. U.S. instructors trained 192 peacekeepers through 11 training iterations between December 2016 and March 2020. Quantitatively, three hypotheses were tested using nonparametric statistical analysis. Qualitative analysis of documents was used to inform and contextually understand the quantitative results. The study also included a systematic review of health-related T3 interventions instructed in various settings globally. The systematic review included peer-reviewed and grey literature from six databases. Inclusion items focused on health-related T3 programs that were at least one year in duration, consisting of at least two time points, assessing change including sustainability at the individual, organizational, or institutional levels, and involving training initiated by one country and received by another.Results: Quantitative and qualitative results indicated improved short-term public health knowledge and upskill among partner nation participants. There was the beginning of a cascade effect of the partner nations’ ability to autonomously teach tasks and skills to their military to sustain the initiative. Differences in achieving and maintaining change outcomes were related to student characteristics, the training course, and the partner nation. For the systematic review, 22 studies met the inclusion criteria. The T3 training spanned all geographical regions, but interventions were most prevalent in sub-Saharan Africa (46%). Nearly all studies (68%) quantitatively examined change at the individual level (95%), but some studies also explored change at the organizational (77%) and institutional (23%) levels. All but two studies demonstrated change effect at their respective levels. Implementation and Nurture/Development were the two salient factors in achieving and sustaining change. The greatest hindrances involved Resources and Context.Discussion: This research serves as the first published study to empirically examine health-related security cooperation T3 initiative change outcomes. This study is an essential building block to empirically evaluate and capture change outcomes from security cooperation capacity-building training initiatives. The findings and recommendations inform security cooperation policy and associated investments. Part of this research also serves as the first systematic review to explore antecedents, including barriers, that influence achieving and sustaining change through health-related T3 interventions in low- and middle-income countries. This review is an essential step in understanding how to implement T3 practices to best shape and maintain change. These findings and recommendations can inform training and capacity-building investments, improve existing T3 initiatives, and steer planning for future approaches.
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