Van der Berg-Cloete, S.E. (Sophy)Tosh, Cheryl A.Buch, Eric2026-01-272026-01-272025-09Van der Berg-Cloete, S., Tosh, C.A. & Buch, E. 2025, 'External factors affecting the efficacy of the Albertina Sisulu executive leadership programme in health fellowship in South Africa : a 360° qualitative assessment', African Journal of Health Professions Education, vol. 17, no. 3, pp. 137-141. https://doi.org/10.7196/AJHPE.2025. v17i3.2517.2078-5127 (online)10.7196/AJHPE.2025. v17i3.2517http://hdl.handle.net/2263/107620BACKGROUND : In South Africa (SA), concerns have been expressed that the leadership is not ready for the implementation of National Health Insurance (NHI). The health minister has therefore advocated leadership development and training to equip leaders with the skills to perform optimally. The Albertina Sisulu Executive Leadership Programme in Health (ASELPH) Fellowship, a postgraduate qualification offered in SA, was developed for this purpose and was proven to improve the leadership skills of executive leaders. OBJECTIVES : To identify the various factors influencing the efficacy of the ASELPH Fellowship. Methods. A quasi-experimental study design was used to determine the factors affecting the ASELPH Fellowship. Data were collected from healthcare leaders (n=42) by means of a questionnaire before and after training. It included post-training and retrospective assessments from their assessors and their module daily assessments and reflective essays. Descriptive analysis and thematic content analysis were used for the qualitative reflections. The perceptions of participants, including students and assessors, regarding external barriers to implementing their newfound skills and competencies were assessed. RESULTS : Participants found it difficult to implement their training owing to a lack of leadership skills and knowledge, shortage of human and financial resources, political pressure, poor governance and policy implementation. Despite these barriers, participants who attended the course were still able to improve their leadership skills and performance in the workplace. CONCLUSION : Leadership training and development programmes such as the ASELPH Fellowship bode well for the future implementation of public health because much-needed leadership skills are injected into the currently beleaguered public health systemen© 2025 The Author(s). This work is licensed under the Creative Commons Attribution License.National Health Insurance (NHI)LeadersTrainingSouth Africa (SA)Article