The following research question guided the review: What is the current landscape of health diplomacy education, including curricula, training approaches, learning outcomes, competencies, and evaluation methods available globally across peer-reviewed literature?

The research team conducted a systematic search to identify studies on health diplomacy education, with eligibility criteria defined a priori to ensure consistency and transparency in study selection. Inclusion criteria were broad and encompassed peer-reviewed articles, conference papers, reports, policy documents, and relevant gray literature. Studies were eligible if they described curricula, training modules, workshops, or structured skill-development programs in health diplomacy or global health diplomacy. The team also included publications that focused on competencies, training frameworks, or evaluation of health diplomacy programs. To ensure contemporary relevance, the team only included studies published between 2015 and 2025, and included documents only published in English. Exclusion criteria applied to articles that were unrelated to education or training in health diplomacy, as well as purely theoretical or conceptual papers that did not reference specific curricula, training, or skill-development activities.

The information sources for this review included two main electronic databases: PubMed, to capture peer-reviewed biomedical and health-related literature, and Google, to ensure coverage of gray literature, policy reports, and less traditional academic outputs (e.g., conference proceedings, institutional reports, and training manuals). The team searched the PubMed database using separate targeted searches for each component (e.g., “global health diplomacy AND curriculum,” “public health diplomacy AND training”), as shown in Supplementary Table S1. This approach was adopted to improve the specificity of results after an initial combined search yielded a large number of irrelevant records due to the broad and interdisciplinary use of these terms.

The research team imported the retrieved citations into a reference management software (Zotero). The search returned n = 953 records. After checking for duplicates (n = 804) a total of 149 documents were included for titles and abstracts screening. Two reviewers (NJ and AJ) independently screened (n = 149) abstracts. A total of 144 records were excluded after screening titles and abstracts for relevance, leaving five articles for full-text review and inclusion. To ensure comprehensive coverage, we also conducted a hand search through Google, which identified three additional relevant studies that met the eligibility criteria. A total of eight studies were included in this scoping review. Any discrepancies were resolved through consensus. The PRISMA flow diagram (Figure 1) reflects the study selection process.

The team developed a standardized data charting form in excel to ensure consistency in extracting and organizing information from the included studies. The charting process captured key characteristics (Table 1) of each publication, including author, year of publication, country, and type of document. The form recorded details of the training initiative, such as the type of initiative (e.g., curriculum, training program, workshop, short course, or academic program), the target audience (students, professionals, diplomats, or health workers), and the duration and delivery mode of the intervention. We extracted information on the pedagogical methods employed (such as simulation, problem-based learning, or peer-to-peer approaches), alongside the competencies and skills addressed, including domains such as negotiation, policy analysis, and cross-cultural communication. Finally, the charting process documented the evaluation methods used in each study and the reported outcomes, providing a comprehensive framework for mapping and synthesizing evidence across diverse training initiatives.

We synthesized the extracted data using a combination of descriptive statistics and narrative synthesis. We calculated frequencies and distributions to provide an overview of the types of initiatives, delivery modes, learning outcomes and competencies reported across the included studies. We mapped training initiatives according to their geographic regions, target audiences, and skill domains, allowing us to identify patterns and contextual variations in health diplomacy education. In addition, we conducted a qualitative thematic analysis to identify key gaps and recurring insights across the literature. To enhance clarity and accessibility, we presented the findings using tables and charts that visually summarized the distribution of initiatives and highlighted emerging trends.

Most initiatives originated from the United States (n = 3), followed by Europe (n = 2), South Asia (n = 2), and the Middle East (n = 1). The overall landscape reflects the dominance of Global North institutions in defining and advancing global health diplomacy (GHD) education.

The training initiatives identified in this review catered to a wide spectrum of learners, reflecting the diverse skill demands in health diplomacy.

Students represented a major target group, with three studies focusing on undergraduate, graduate, or postgraduate learners. Examples include the American Mock WHO Conference (6), where students practice negotiation and diplomacy through simulated World Health Assembly sessions, and the epidemic simulation activity at the University of South Florida (8), which introduced MPH students to crisis negotiation and communication in a classroom setting. Additionally, Millar et al. (7) described a semester-long postgraduate program in Global Health Leadership at the University of Birmingham Dubai, aimed at embedding diplomacy and systems thinking within formal academic curricula.

Professionals and practitioners were the focus of another four studies, emphasizing the training of diplomats and health attachés and senior officials in active practice of health diplomacy. Brown et al. (11) highlighted the need for structured career pathways and mentorship for health attachés, while Rosenbaum et al. (12) examined capacity-building and network development among experienced global health diplomats across 23 countries. Pattanshetty et al. (13) mapped existing health diplomacy curricula, many of which targeted professional learners seeking to expand expertise in governance, negotiation, and international policy. Similarly, Shaikh et al. (14) reported on a capacity-building workshop in Pakistan, which trained mid- and senior-level officials, diplomats, and professionals from multiple sectors through a contextualized curriculum that included negotiation, governance, and cross-sectoral collaboration.

Finally, we identified mixed audiences addressed by multiple adaptable frameworks. The Global Health Diplomacy Network’s Training Framework (2025) was designed to be flexible, allowing institutions to tailor training for both students and practicing professionals (15). This adaptability highlights the recognition that GHD requires collaboration across experience levels, blending fresh academic perspectives with practitioner expertise (see Table 2).

The initiatives identified in this review varied considerably in both their format and duration, ranging from short, intensive experiences, to career-long professional development pathways.

Short-term training opportunities were the most common, providing concentrated exposure to GHD skills within highly interactive learning environments. Examples included single classroom simulations, such as the COVID-19 epidemic scenario developed by Ortiz et al. (8), which introduced students to negotiation and crisis response skills within the span of a single academic session. Similarly, the American Mock World Health Organization (AMWHO) described by Lei et al. (6) offered an immersive three-day conference where student delegates engaged in role-play simulations of a session of the World Health Assembly. In South Asia, Shaikh et al. (14) reported on a multi-day national training workshop in Pakistan, which trained mid- and senior-level officials from across sectors using lectures, case studies, panel discussions, and group work. These short-term models emphasized experiential and participatory learning, providing both students and professionals with opportunities to practice diplomacy and negotiation in condensed but contextually rich formats.

At the other end of the spectrum, we identified medium- to long-term initiatives, notably the Global Health System Leadership program delivered at the University of Birmingham Dubai (7). This degree-based curriculum extended over a semester or more and was embedded within broader postgraduate education. Unlike short simulations, these longer programs sought to integrate global health diplomacy into a more comprehensive leadership framework, blending coursework with reflexive and decolonial pedagogical approaches (7). In addition to structured academic offerings, some initiatives were designed as flexible frameworks rather than time-bound courses. The Global Health Diplomacy Network’s (GHDIN) Training Framework (2025) exemplifies this category, providing a competency-based model that institutions and organizations can adapt to their own contexts. Such frameworks allow for modular learning and are not tied to fixed timelines, offering adaptability across professional and educational settings (15).

Finally, we identified career-long training initiatives identified in the form of professional pathways for health attachés (11). Unlike discrete courses or programs, these initiatives emphasized continuous learning through on-the-job experiences, mentorship, and reflective practice (11). This approach recognizes that global health diplomacy is a competency based professional pursuit, with some skills requiring significant investments of time for practitioners to develop, refine and strengthen skills throughout their diplomatic careers.

These findings illustrate a spectrum of training opportunities (ranging from short, intensive simulations, to ongoing professional development) reflecting the diverse needs of students, professionals, and career diplomats in the evolving field of global health diplomacy.

Across the included studies, the delivery of training initiatives was predominantly delivered in-person, particularly in student-centered simulations and professional development programs. Conferences such as the American Mock WHO (6) and classroom-based activities like the COVID-19 epidemic simulation (8) relied heavily on face-to-face interaction to recreate authentic negotiation and decision-making environments. However, some programs adopted blended or adaptable models, particularly within academic institutions and international frameworks, which allowed for tailoring to diverse audiences and contexts (7, 15).

In terms of pedagogy, simulation-based experiential learning emerged as a cornerstone approach. The AMWHO model engaged students through mock World Health Assembly debates, role-play, and resolution drafting to build practical skills in diplomacy and negotiation (6). Similarly, the epidemic simulation exercise emphasized scenario-based crisis response, requiring students to apply knowledge in real-time decision-making environments (8).

Beyond simulations, several initiatives incorporated competency-based and problem-based learning approaches. For instance, the COVID-19 epidemic simulation was explicitly grounded in problem-based learning and Bloom’s taxonomy, ensuring that students progressed from knowledge acquisition to applied critical thinking (8). Likewise, the GHDIN framework emphasized competency mapping and measurable learning outcomes to guide training design (15). The Pakistan workshop also used case studies and panel-led discussions, offering applied learning opportunities while contextualizing global diplomacy concepts within national and regional realities (14).

Professional training and community-of-practice initiatives further highlighted the importance of peer-to-peer and intergenerational knowledge exchange. Rosenbaum et al. (12) found that seasoned diplomats and practitioners valued mentorship, reflective practice, and tacit knowledge transfer as critical mechanisms for building sustainable capacity in global health diplomacy. Similarly, Brown et al. (11) emphasized the role of mentorship and structured career pathways for health attachés, underscoring that learning in this domain extends beyond classrooms into long-term professional practice. Academic programs at international branch campuses, such as the Global Health System Leadership course at the University of Birmingham Dubai have adopted formal coursework combined with reflexive and decolonial pedagogies (7). These approaches recognized the importance of critically examining power dynamics, encouraging students to reflect on global–local intersections in health diplomacy, and equipping them with contextually relevant leadership skills.

These delivery modes and pedagogical strategies highlight a spectrum of approaches, from immersive simulations and national workshops to reflexive academic curricula, all aimed at equipping learners with the knowledge and competencies necessary for effective global health diplomacy.

Across the reviewed initiatives, negotiation and diplomacy skills were the most consistently addressed, appearing in all eight studies. Whether through structured simulations, such as the American Mock WHO (6), problem-based epidemic scenarios (8), national-level training like the Pakistan capacity-building workshop (14) or professional practice among health attachés (11), the centrality of negotiation reflects a core role that diplomacy plays in global health. Institutional frameworks, including the GHDIN competencies, further reinforce diplomacy as a foundational skill for both students and practitioners (15).

We identified cross-cultural communication and leadership emphasized in six initiatives, recognizing that effective diplomacy requires navigating diverse cultural contexts while also demonstrating leadership capacity. The profession of Health attachés underscored the importance of intercultural skills for advancing negotiations across borders (11), while frameworks such as the GHDIN guidance (15) highlighted coalition-building and leadership as key competencies. Similarly, the University of Birmingham Dubai program incorporated leadership and reflexive practice as central learning outcomes (7). The Pakistan workshop also emphasized cross-sectoral collaboration and governance, underscoring the importance of intercultural and interprofessional dialogue for advancing health diplomacy in complex national and regional contexts (14) (see Table 3).

Policy analysis and governance knowledge featured in four studies, particularly in training programs aimed at equipping professionals with the ability to understand and influence health policy structures. Curriculum mapping exercises revealed a strong emphasis on governance and systems knowledge (13), while the GHDIN framework provided structured pathways to connect governance with negotiation (15). Professional networks and academic programs also underscored the importance of linking policy analysis to leadership (7, 12).

We also found crisis management and emergency response competencies in three initiatives, reflecting a focus on case studies that identified lessons learned from health crises such as COVID-19 and Ebola. The epidemic simulation directly targeted students’ ability to negotiate and communicate during outbreak response scenarios (8), while health attachés highlighted the importance of crisis preparedness in diplomatic practice (11). Mapping studies also identified crisis management as a recurring but underdeveloped domain (13).

Advocacy, coalition-building, and systems thinking appeared in three initiatives, reflecting a growing recognition of the need for collaborative approaches to global health. The GHDIN framework explicitly outlined coalition-building as a core competency (15), while communities of practice emphasized advocacy through networks and tacit knowledge sharing (12). Academic programs such as the Global Health Leadership course integrated systems thinking and critical inquiry into their curricula, aiming to build leaders capable of navigating complex intersectoral challenges (7).

These findings illustrate that while negotiation remains a central skill domain across all initiatives, there is increasing attention to leadership, cross-cultural competence, and systems-level approaches that broaden the scope of global health diplomacy training.

Evaluation approaches across the identified initiatives were diverse but limited to short-term, self-reported outcomes, reflecting a gap in long-term impact assessments. Several studies relied on post-activity surveys to measure participant satisfaction and perceived learning. For instance, the American Mock WHO simulation reported very high approval, with 90%–98% of participants rating the experience as good or better, and many indicating that it influenced their career trajectories (6). Similarly, other student-centered workshops and conferences used structured surveys to capture immediate feedback, with participants consistently reporting improvements in diplomacy, negotiation, and communication skills. A smaller number of initiatives employed pre- and post-designs to assess changes in identified skills. The COVID-19 epidemic simulation conducted among MPH students demonstrated significant self-reported gains in understanding diplomacy, negotiation, and public health emergency response, with statistical improvements confirmed through mixed-methods evaluation (8). These findings highlight the potential of scenario-based, problem-centered learning to produce measurable short-term outcomes in student populations.

Among professional audiences, qualitative interviews with health attachés and practitioners provided rich insights into training needs and skill development gaps. Brown et al. (11) emphasized that while attachés recognized the importance of diplomacy, negotiation, and cross-cultural competence, they also identified the absence of structured career pathways, mentorship opportunities, and defined competency mastery levels. These perspectives underscored the necessity of moving beyond ad hoc learning toward more systematic professional development in global health diplomacy. Likewise, Rosenbaum et al. (12) reported that communities of practice valued mentorship and peer learning but noted challenges in knowledge transfer and leadership development. In the Pakistan capacity-building workshop, Shaikh et al. (14) reported participant feedback that indicated improved understanding of global health diplomacy concepts, stronger appreciation of foreign policy linkages, and enhanced confidence in cross-sectoral collaboration. However, similar to other initiatives targeting senior officials, no formal pre- and post-assessment was conducted, reflecting a common limitation in evaluating professional training programs.

Some initiatives, particularly framework-driven approaches, have not report empirical evaluation results at all. The GHDIN competency framework (2025) provided structured benchmarks and guidance for institutions, but lacked outcome-based assessment of effectiveness (15). Similarly, curriculum mapping studies synthesized program content, but did not track learner outcomes (13).

The evaluations demonstrate strong short-term evidence of learner satisfaction and self-reported skill development, but highlight a need for rigorous, longitudinal assessments translates into sustained institutional strengthening or improved diplomatic outcomes in global health. Further, learning institutions are encouraged to adopt the competency-based education approach, which aligns learning inputs and outcomes to learner measurement and into labor market recruitment, performance assessment and career advancement.

Despite these gaps, we observed several important insights across the initiatives.

First, communities of practice emerged as vital to sustaining GHD capacity. Professional networks, mentorship, and tacit knowledge-sharing are consistently highlighted as mechanisms that complemented formal training. For example, Rosenbaum et al. (12) underscored the importance of peer-to-peer knowledge exchange in strengthening diplomatic skills, while Brown et al. (11) emphasized mentorship and on-the-job learning as critical for health attachés.

Second, there was a strong call for decolonization of curricula, and yet few if any emphasized the interface between local culture and politics on global health strategy and action. Training initiatives situated in the Middle East have demonstrated the importance of reflexive and context-sensitive pedagogies that acknowledge and address colonial legacies in global health education (7). This insight reflects a broader push for curricula that are more inclusive, locally relevant, and critically engaged with power dynamics in global health.

Finally, the review identified the importance of career pathways in maturing GHD as a professional discipline. Health attachés highlighted the lack of structured career progression, competency mastery frameworks, and mentorship opportunities to support sustained professional development (11). Without clear pathways, training risks being episodic rather than contributing to long-term institutional and career-level capacity building, needed to bring about global health action.

These insights underscore the need for global health diplomacy training that extends beyond short-term skill acquisition to encompass sustained professional networks, decolonial approaches to curriculum design, and structured career pathways (see Table 4).

The findings of this review demonstrate that training initiatives in global health diplomacy (GHD) are integral to the broader practice of public health diplomacy (PHD), which operates at the interface of health and international relations. Public health diplomacy is defined as a multidisciplinary field that equips practitioners to communicate, facilitate, negotiate, and build consensus using systems thinking and evidence-based, community-informed approaches. It is grounded in equity-focused and human-centered values, with the ultimate goal of improving health and well-being for all (16). The emphasis on competencies such as negotiation, cross-cultural communication, leadership, and crisis management reflects the practical skills required for Public Health Diplomacy practitioners, applicable to both the domestic and global roles, who must navigate complex multilateral environments with often competing interests. Initiatives like the American Mock WHO simulation (6) and epidemic response exercises (8) replicate the decision-making contexts in which health and foreign policy intersect, preparing students to apply diplomacy in real-world crises. Similarly, professional training needs identified by health attachés underscore that PHD extends beyond technical knowledge, requiring structured mentorship, tacit knowledge exchange, and career-long development to support practitioners in influencing health policy and program outcomes at global and national levels (11).

At the same time, the gaps and insights identified across the reviewed initiatives reveal challenges and opportunities for strengthening public health diplomacy. The dominance of Global North institutions in shaping curricula reflects ongoing power asymmetries in global health education (13), while limited evaluation methods and fragmented program designs hinder the establishment of shared standards. Yet, several promising directions emerge: the importance of communities of practice in sustaining capacity (12), the call for decolonizing curricula to better reflect diverse contexts and histories (7), and the need for structured career pathways to institutionalize GHD as a professional discipline (11). Together, these insights suggest that effective training is not only about equipping individuals with discrete skills but also about transforming institutions and systems to strengthen the practice of public health diplomacy in an interconnected and inequitable world.

This review has several notable strengths. By systematically mapping curricula, training approaches, and competency domains, it provides a comprehensive overview of the emerging field of health diplomacy education. The inclusion of diverse sources, spanning student-focused simulations, academic degree programs, professional development pathways, and competency frameworks, enabled a broad synthesis that captures both the diversity and commonalities across these initiatives. The review also highlights cross-cutting competencies, pedagogical innovations, and structural gaps, offering a foundation for future curriculum design and policy development. Importantly, by linking findings explicitly to the broader concept of public health diplomacy, this review contributes to bridging the gap between training initiatives and their implications for practice and governance. The review brings to light that GHD training does not generally emphasize the applicability of diplomacy skills to local/domestic consensus building, policy making, strategy building and implementation.

However, several limitations must be acknowledged. First, the review was limited to available published literature, which may exclude relevant but unpublished training initiatives. For example, several health diplomacy focused programs and educational offerings were not included in our analysis due to our focus on GHD education and training that were discussed or evaluated in the literature. Second, heterogeneity in study designs, evaluation methods, and reporting limited the ability to conduct comparative analysis or meta-synthesis. Many initiatives relied on descriptive accounts or short-term self-reported outcomes, making it difficult to assess long-term effectiveness. Third, the review did not include quantitative meta-analysis due to the absence of standardized evaluation metrics across studies. Finally, while the scoping methodology enabled a broad mapping of the field, it does not allow for detailed assessment of intervention effectiveness, which would require future systematic reviews with more stringent inclusion criteria.

Based on the findings of this review, this research draws several recommendations to strengthen health diplomacy education and, by extension, the practice of public health diplomacy. First, there is a need to institutionalize competency-based frameworks that standardize key skills such as negotiation, leadership, and cross-cultural communication while allowing flexibility for local adaptation. Second, programs should prioritize longitudinal evaluation strategies that go beyond short-term surveys to assess the retention of competencies, their application in practice, and their influence on career trajectories and institutional capacity, as well as assess impact on public health programs and initiatives. Third, training should be embedded within communities of practice and mentorship structures, recognizing that diplomatic competencies are refined over time through networks, peer exchange, and lived professional experience. Finally, the decolonization of curricula should be an explicit objective, particularly in international branch campuses and global partnerships, to ensure that pedagogy is reflexive, inclusive, and contextually relevant.