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Title: Netherlands Course on Global Health and Tropical Medicine
Country: Netherlands
Institution: The Netherlands - Royal Tropical Institute (KIT), Amsterdam
Course coordinator: Maaike Flinkenflögel
Fernando Maldonado
Date start: 2023-03-06
Date end: 2023-06-09
About duration and dates: 14 weeks full time study, including 1 examination/ graduation week. 08/03/2021 until 11/06/2021 13/09/2021 until 17/12/2021 The course runs twice a year (once in spring and once in autumn)
Classification: core course
Mode of delivery: Blended-learning
Course location: KIT Royal Tropical Institute, Amsterdam
PO Box 95001, Amsterdam, The Netherlands.
Tel: +31-20-5688256 / Website:
ECTS credit points: 20 ECTS credits
SIT: SIT: 600 hours (~ 43 hours per week)
- Contact time: on average 4 days a week, 6 hrs per day (approximately 280 hrs total, excluding opening, open book exam, closing ceremony (~ 10 hours))
- Other: Self-study, preparation and not facilitated group work: on average one full day per week and several hours during class days (approximately 320 hrs total)
Language: English
Description: By the end of the core course, students should be able to:

1. critically reflect on the collection, analysis and appraisal of qualitative and quantitative data relevant for the improvement of health and health care equity.
2. identify and analyse interrelated determinants of health and major health concerns of populations in a trans-disciplinary perspective in low- and middle-income settings and on global level
3. propose sustainable improvements of health systems addressing inequities and considering diverse intercultural settings as well as social, legal and ethical responsibilities.
4. describe the role, decision-making process and impact of global health policy actors
5. collaborate and clearly communicate in a multi-disciplinary and multi-cultural setting
Focus or specific features:
The course is directed at health professionals (physicians, nurses, midwives, etc.) and aims to be at the cutting edge of clinical and global health. KIT’s approach puts emphasis on the practical application of knowledge and skills using expertise from students and facilitators. Facilitators are active in the field and have up to date knowledge of situations encountered. Therefore we can offer and up-to-date approach to complex global health issues.

Both the facilitators and the students are from various disciplines and countries. This results in a vivid exchange of experiences/ viewpoints/ knowledge. The classroom sessions are highly interactive to facilitate this exchange.

The advisory board of the course consists of the KIT coordination team, representatives of the University Hospital of Amsterdam (UvA), representatives of the CIGT (concilium internationale geneeskunde en Tropengeneeskunde (; representatives of international NGO’s, representatives of the VU University Amsterdam and student representatives who meet once a year.
Assessment Procedures: The assessment of the course consists of four assessments. The student needs to pass all examinations to successfully complete the course.

1. one written assignment – 50%. A 2500 word paper analyzing social determinants of a health problem in a country of choice. Students receive one group tutoring session and one personal tutoring session. The essay is reviewed by 2 assessors who provide detailed feedback.
2. one three hour, open book exam – 50%. The open book exam covers a representation of the subjects taught during the course. Student can have their laptops (offline) with all course materials during the exam. In consultation with the tutor and with facilitators the coordinators prepare a suitable test to assess the compre¬hensive knowledge and the problem-solving capacity of the candidates; A data base is available as a source for suitable questions. Students get a mock exam to test themselves. All exams are double marked. On student request (when fail), the student can get a personal oral review of the exam.
3. Students are requested to keep a portfolio with documents showing their reflection on their learning process. The assessment of the final reflective commentary of the portfolio is pass/fail . Students receive a reflection from the tutor/ coordinator on their portfolio.
4. Students have to give a presentation, which is peer-assessed. The assessment of the presentation is pass/fail. General feedback to the whole group is given.

Papers and exams with open-ended questions are always marked by two examiners, who mark the assignments individually and independently.

If a student fails, (s)he can resit the open book exam or hand-in the SDH paper on a specified date within 4 weeks of the end of the course.

Examples of exams and guidelines for the writing are enclosed in annex 1.

See table 1. The course in KIT consists of the following five modules:

- Introduction Module (0.5 ECTS)
- Determinants of Health (3.5 ECTS)
- Health Needs and Responses (7.5 ECTS)
- Basic Research Methods (2.5 ECTS)
- Health Systems (6 ECTS)

The modules ‘Determinants of Health’ and ‘Basic Research Methods’ combined cover the content of the category ‘Concepts and Research Methods’ as used by tropEd (Table 2).

Below the content of each of the modules is described in detail.

Introduction module
This module has the aim to help students develop learning and communication skills that will be necessary in their daily practice and for further personal studying.
By definition the MIH is international: how to communicate with fellow students will be a first opportunity in the intercultural communication skills that they will need as health professionals in Low and Middle Income Countries. In dealing with the local population, with refugees or with donor agencies graduates of International Health will need to operate in a multicultural environment in which they will have to explain their actions, to lobby or to give well formulated instructions. The sessions on intercultural communication and presentation skills aim to raise the awareness of cultural issues in communication and to prepare students to the rest of their study; to their work and to further self-study.
The module will provide the students with several sessions on learning styles and self-reflection, the use of search tools, scientific writing (including plagiarism and referencing). These sessions will be the departing point of a continuous process though the NTC aimed to provide student with tools for academic writing, presentation skills and professional development. The follow-up of the process will be done during assignments and using a system of personal portfolios.

Determinants of Health
Health is highly valued in all societies, though cultures differ in perceptions of causes of health and ill health, and in the action they take to promote or restore health. There is also agreement on the broad categories of factors that influence health. If we analyse the environmental factors that influence health it becomes clear that each of these factors is not only separately related to health, but that they mutually influence each other. Poverty has a clear influence on the health of women and men but ill health also affects the wealth of individuals and families. Gender and age have an impact on the health of individuals and families. While some aspects of the demographic transition have obvious impacts on health, others have more subtle but none the less important health consequences. Moreover, the recent acceleration in population movements within countries and across borders can have dire consequences for the health of displaced population and sometimes that of the recipient population. Changes in the physical environment may not only influence the economy of the country and of individuals; they may also have political consequences, and cause changes in the value attached to the health of individuals, in (health) policy and budget allocations, and therefore in the functioning of the health services. In fact, all factors are mutually related, but in each country the strength and direction of the influences may differ. Many connections may also still be unknown, and some may be so sensitive (e.g. influence of pollution due to industrial 'development' on health) that research into this field is not encouraged by policymakers, or that no action is taken on research findings which would require action in favour of health of large population groups. Policy makers, clinicians and managers therefore need to be conscious of the various factors, which influence health. Finally, all the above mentioned determinants are themselves influenced by the present processes that are intensifying human interactions at all level, i.e. globalisation: determinants of health are not fixed, they evolve and with them, their impact on health.

Health Needs and Responses
This module aims to analyse key issues regarding diagnosis and treatment of the most important diseases and health problems occurring in LMIC.
The module consists of three main components: care for adults, care for children, and sexual and reproductive health.
Infectious diseases like HIV/ AIDS, malaria, tuberculosis, hepatitis B and C, leprosy will be covered, but also attention will be paid to often neglected but important health problems like dermatological, ophthalmologic and gastro-intestinal problems (including bowel parasites). On HIV/AIDS we discuss ARV’s, opportunistic infections. HIV/ AIDS diagnosis, treatment and prevention is covered and advice on Post Exposure Prophylaxis for the professional health worker is provided. Differential diagnosis and different forms of malaria, treatment and relation to resistance patterns are covered. Best practices and new developments in recognition, diagnosis (genExpert) and treatment of tuberculosis are highlighted, including the DOTS strategy.
The burden of non-communicable diseases (NCD’s) in LMIC is rapidly increasing. Also mental health problems are often underestimated in low-income countries. This course will address burden and management of NCD’s in a resource limited setting.
Knowledge of the work in the laboratory and developments of bedside tests is highly relevant. Two practical instruction classes in the laboratory are planned in this course.
A large proportion of the patients in resource poor countries are children, therefore a number of classes are devoted to this target group. The application, use and stimulation of the IMCI approach, ETAT, as well as EPI will be practised.
Maternal health is an essential component of this module, looking at the determinants of maternal and perinatal morbidity and mortality and effective clinical and public health interventions. As the focus from population control has changed towards sexual health and individual rights, fertility regulation issues and the societal influence on individual reproductive decision-making process is the subject of a session in this module. Sexual transmitted infections, prevention and their relationship with the HIV/AIDS epidemic are dealt with.
Mental health and palliative care are essential aspects of health needs in LMIC, even though this is often overseen. In this course we pay special attention to these two components of care.

Basic Research Methods
Health professionals needs to use evidence: to describe and analyse the many determinants and/or risk factors of health, to analyse the factors that impact on health seeking behaviour, and to evaluate the impact and the perception by the people of different interventions. They need to understand, critically appraise and be able to apply a range of research approaches and methods, both quantitative and qualitative. They should also be able to generate evidence from their own work. Finally they should be able to apply the evidence to the context they are working in.
The complementary nature of qualitative and quantitative approaches for the planning, development and evaluation of specific interventions and health promotion strategies will be stressed.
As both epidemiology and statistics are basic knowledge systems to interpret evidence. The statistics part of the module will emphasise the interpretation of statistical tests, confidence intervals, p-values, etc.
The emphasis in qualitative and participatory research is on generating knowledge to inform decisions and interventions. Involvement of patients, community groups, grassroots workers and managers help to identify local needs and priorities and places health issues in the context of people's lives, thus giving direction to health programme development and service provision.
An introduction to medical anthropology and sociology will help to explain health, illness and health care from a socio-cultural perspective, which is of crucial importance to interpret health- and health care seeking behaviour.

Health Systems
Health systems in countries all over the world are facing different kind of challenges in order to meet the ever increasing needs and demands of their citizens. Demographic changes, technological developments, a more conscious and assertive demand for quality care compete with requirements of reaching or maintaining universal access and containing costs. This module starts therefore with an introduction on how health systems are defined, their goals, functions and main actors. Basic health economic concepts are explained in order to understand how health systems are financed (through user fees, insurance systems, taxes, or donor funding), how providers of services are paid (fees, salaries, contracting) and how market failures in health influence the choice for public and/or private provision of services. Health economics also provides basic tools for priority setting and resource allocation in the planning process. A short introduction to health promotion and disease prevention links this module to the one on determinants of health, as health systems enclose ‘all activities, whose primary purpose is to promote, restore, improve or maintain health’ (WHR 2000).
The emphasis in this module is on the practical implementation of health programmes and the organisation of health care at district level. This district level is situated at the crossroads of national health systems and -policies and the community: the community as consumer, target group and partner in health care. In order to make efficient use of the scarce resources available to the health sector, the sector has to be well organised at this operational level. Roles of community initiatives, health centres and hospitals as well as NGO’s and private providers are discussed, and attention is drawn to the importance of other sectors in relation to health.
Working within the health system health, professionals deal with a number of management issues. Management in district health systems includes the management of resources, drugs, personnel, and information. Therefore resource management, elements of bookkeeping and the use of management information systems are important topics. Management of human resources entails aspects of training and continuous education, performance management and motivation, as well as supervision. Basic skills for the management of projects, as well as in communication and managing oneself are part of this module. Monitoring of quality of care and quality improvement is highlighted. Attention will be paid to the management of drugs, including the drug supply cycle and the rational use of drugs.
National and international policies and initiatives and different health sector reform strategies are discussed in relation to what they imply for equity, efficiency and effective coverage of priority health programmes and their implementation at the district level. What are the implications of decentralization policies, strongly vertically and top-down organised programmes or brain drain and human resources motivation issues on the day to day running of a district health systems? How communities are involved in planning for their health and how are providers and managers held accountable for their performance? Due consideration is given to the specific situation of health care delivery in emergency situations, health issues around migration and the influence that migrants/ refugees may have on resident populations.
Throughout the module, attention is paid to a pro-poor approach and gender implications of health policies.

There are generally two sessions a day. A session consists of two or three hours including a coffee/tea break. The morning session is from 9 or 10am to 12am and the afternoon session runds from 1pm to 3 or 4pm.

The sessions provided in different ways:
1. Face-to-Face session (F2F): These sessions will be conducted plenary face-to-face at KIT Amsterdam.
2. Zoom session: Zoom sessions are virtual (online) classes conducted via the Zoom video conferencing platform.
3. Flipped session: Flipped classes are a hybrid between self-learning and face-to-face interaction. For the self-learning part facilitators will share in advance a narrated Power Point presentation or a video explaining the core concepts of the session. For the F2F part facilitators will meet twice with half of the group. During this meeting the facilitator will explain concepts that are difficult to explain in a video; answer questions about the information on the video; and/or do exercises with the students.
4. Flipped Zoom session: For these sessions, all students will have an opportunity to discuss any question related to the flipped session and this will be done online via Zoom video conferencing.

Reading material is prepared and distributed beforehand via the Virtual Ground (see attachment 2). Laptops and/or tablets are required.

On average 1 day a week is kept free from sessions for self-learning. Sessions usually consist of an introductory presentation combined with other teaching methods as described below and finally a reflection on how the session relates to global health and the final take home messages.

The content of the course is oriented as much as possible to the working situation of the participants. Participants have intensive contacts with highly qualified staff who are active in the field. Methods are varied and include interactive lectures, discussions, group work, case studies, exercises, health games, self-reflection, giving feedback to others and self-study. Simulations and role plays are used to familiarize participants with problem-solving in cross-cultural management and planning. Some sessions are provided as a flipped classroom. Two days of the course training is provided in the laboratory.
Prerequisites for the program are:
• Bachelor’s degree, or equivalent academic training in medicine or any paramedical science
• Two years of relevant work experience, incl. work experience in low and middle income settings
• Proven proficiency in spoken and written English. The minimum scores required: TOEFL 5.5 or IELTS 6.0.
• Computer literacy is expected

Applications are assessed in an online application system.
Maximum number of students: 30
first-come, first-served basis
Course fee 2023: EUR 7.200
This fee does not include living expenses, transportation costs, insurance or any other incidental costs.
There are no special scholarships for the core course/NTC.

When the NTC is done as part of the full-time MIH program, KIT offers a scholarship for students from LMIC. (

Suggestions for financial support can be found on our website or
Major changes since initial accreditation:
In September 2016 the course coordination was changed: Fernando Maldonado and Maaike Flinkenflögel have since coordinated the program. A course tutor takes care of the daily business of the program and is the link between the students and the course coordination. The tutor usually stays one or two courses and usually is a graduate of the MIH or MPH master programme at KIT.

The course is paperless and everything happens in the KIT Virtual Grounds platform.

We are presently working on the guidelines for copyright to make sure that material used in our courses and in the Powerpoint presentations of the facilitators are open source. We provide links and not the actual documents.

The program used to have some sessions that were optional for MIH students (mainly in the health needs and responses module), presently all classes are obligatory for all students to decrease confusion between students.

We have combined some of the HIV/AIDS sessions with less facilitators to decrease overlap between classes. We have added some hours for qualitative research as there was a strong need. An extra session on migrant health has been added due to the importance of the subject in international health.

An optional session to guide students with their self-reflection portfolio halfway in the course has been added on suggestion of the students.

Optional lunch sessions are offered on topics requested by students, by international NGO’s in Amsterdam or when a visitor at KIT has a interesting subject to discuss.

Each of the sessions is separately evaluated by the students online. An analysis of these evaluations is shared with the facilitators and when we see a need for specific improvement we communicate with the facilitator to improve the session for the following course.
Student evaluation:
Each of the sessions is separately and anonymously evaluated by the students in the Virtual Ground platform. The tutor and course coordinators review these evaluations and this is shared with the facilitators. Twice during the course the tutor and course coordinators sit together with the students to evaluate to course. The analysis of the individual sessions is discussed (the outliers) and a general evaluation is done in an interactive discussion. Students share their positive and negative impressions of practical issues and course content and based on this improvements are made where possible.

Evaluations and changes made based on the last NTC (2017-2), from the official report:

In response to the evaluation of NTC 2017-2 the following changes were made:
• KIT Virtual Grounds was used for the third time. Session evaluations were introduced using Virtual Grounds. The student could fill them in using their laptop or phone A continues effort is made to further increase the usage of Virtual Grounds (using wiki, homework assignments, handing in assignments etc). The general perception from the class was again positive and some new adjustments were made.
• New facilitators were identified for the several sessions. Sessions outlines and presentations were reviewed. The class reacted positively to the changes made. More details can be found in the mid and final evaluation
• Facilitators were again asked to make objectives for the required reading so students would know what to take out from it and they were reminded to integrate it in their lessons.
• Group assignments were reviewed, one reading article was updated.
• No optional sessions this time; In 2017-2, most students chose to attend all sessions. So this time the management team decided to make all sessions obligatory.
• Reading materials were reviewed and facilitators were reminded to update them and limit them to maximum of 30 pages per session
• Deadlines for the assignments were revised to make sure they are not so close or overlapping
• The topics for the SDH paper were available earlier on the online platform
• The Mock Exam was published also earlier as some students suggested from previous course
• Objectives in the topic sheets / presentation not matching.
• No comments were made on the handing out of assignments.
• The online evaluation was made easier by removing the date and facilitator names, also making the comments optional.
• The GDPR new rules of privacy are being reviewed all over KIT including the online platform
• The Migrant Health session objectives and content were reviewed and discussed with the facilitator
• The scientific writing and the library search techniques sessions were reviewed and made more interactive with more exercises

4.3 Evaluation of learning methods and learning arrangements
Most students were very positive on the learning arrangements and opportunities to receive and provide feedback. The following comments were made:
• Students gave very positive comments about the structure and organization of the course
• Some students considered it is very difficult what the course expect from students. Sometimes it is vague and not tangible. The objectives sometimes are very broad.
• MIH students saw the NTC as too clinical, while AIGT doctors consider it too public health related
• As suggested by students from the previous run some classes especially those related to the SDH paper topics were reordered
• Aid Architecture self-study session was not well perceived; The session was complicated to study on your own. An optional face to face session was added towards the end of the course to help the students go through the material
• The community session was done outdoors in the Oosterpark
• One session was organized as a join session along with the ICHD master students. The students found it challenging, as the other master students were towards the end of their one year full time course and there were apparent difference in the level of knowledge.
• AMC library, slow connection, not reliable website

Recommendations from the students during the oral midterm evaluation
• Focus of most of the sessions is too much on Africa!
• Repetition of malaria and SDG’s.
• Class room is a bit noisy: due to construction work and busy road outside the windows can’t be open. Also vacuum cleaning during class is disturbing: ask Master Cleaners not to do this during class hours.
• different ways of teaching, especially from the internal KIT teachers (modern ways) makes it more fun!
• AMC library needs to be checked once more.

Recommendations from the students during the oral end evaluation:
• The internet connection was not good, especially while playing videos
• Missing presentations on the virtual grounds
• The demography and the Aid Architecture sessions would be better face to face. The flipped class and self study can be kept for other classes, for example the library search and the scientific writing.
Lessons learned:
Recent lessons learned and improvements made based on evaluations from students and facilitators.
- Preparation material is interesting but for some sessions it was far too much according to students  the tutor reviewed all material and when more than 30 pages of reading material the facilitators were requested to reduce.
- Facilitators usually share personal experiences and the focus is strongly on Africa. Some students who are from other parts of the world have requested to have some more focus outside of Africa  we shared this general feedback with the facilitators and asked them to include not only African examples, but also other LMIC.
- The group following the program can be divided into 3 parts; international students who take the NTC as the core course for the MIH. Dutch students who take the NTC as the theoretical part of their training as an AIGT (physician in global health and tropical medicine) and the third group of international students who take the NTC as a separate course. The expectations of the course and the experiences of these people are quite different, which is positive for discussions, sharing of experiences and group work. But the different groups also have different expectations and needs (in general the Dutch group has a strong demand for increasing their knowledge on tropical diseases, while the international group of students has a stronger demand for health systems, management and research).  we are making sure the balance is good between the student groups and the material we offer.
tropEd accreditation:
Accredited in 2004 in Madrid. Re-accredited in 2009 in London, in 2014 in Umea in 2019 in Lisbon.
This accreditation is valid until January 2024.
Email Address:
Date Of Record Creation: 2011-06-07 17:26:56 (W3C-DTF)
Date Of Record Release: 2011-06-07 17:35:30 (W3C-DTF)
Date Record Checked: 2021-03-18 (W3C-DTF)
Date Last Modified: 2023-01-04 20:49:14 (W3C-DTF)

Fifteen years of the tropEd Masters in International Health programme: what has it delivered? Results of an alumni survey of masters students in international health

L. Gerstel1, P. A. C. Zwanikken1, A. Hoffman2, C. Diederichs3, M. Borchert3 and B. Peterhans2

1 Royal Tropical Institute, Amsterdam, The Netherlands
2 Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
3 Institute of Tropical Medicine and International Health, Charite – Universit€atsmedizin Berlin, Berlin, Germany