leadership & management

Strong, well-functioning health systems need strong leadership, management, and governance. Over the next couple of weeks, leading up to conversations that MSH is hosting at the Global Symposium on Health Systems Research next month in Vancouver, we will be sharing stories and insights about the role of leadership, management and governance in health systems strengthening. This is the second in a series of four blog posts on this topic. See part one.

Linvell Nkhoma is a midwife manager at Mitundu Community Hospital in northern Lilongwe, Malawi. She lives on the hospital premises so she can be on call 24 hours a day for emergencies or complicated cases that less experienced midwives don't know how to manage.

"We have limited space, only three delivery beds for 400 deliveries a month," Linvell said.

Linvell and her colleagues were concerned about overcrowding, and more importantly, the high rates at which mothers and babies were dying during deliveries.

Ezekiel Kyasesa is a village health team coordinator and supervisor in Kasese District, western Uganda. He supports 11 villages, 90 parishes, and 2 health centers.

Ezekiel has been working in community health for a few years, but only on a small scale. A year ago, he was selected to attend a training provided by STRIDES for Family Health to learn new family planning, child survival, and reproductive health information and the skills to become a village health team member. He was then nominated by his peers to become the coordinator and supervisor.

Now Ezekiel is educated and has the skills to go out to the communities and talk to people about the benefits of going to the health center for a range of services. The village health teams are a crucial link to sharing knowledge and information between the clinics and the communities.

Ezekiel and his village health team visit 10 households two days each week (20 visits per team member each week). He explained that they discuss with the mothers --- the key person to a healthy family --- four topics:

The Kasese district in western Uganda is nestled between two national parks. Located hours from the capital city, Kampala, the region attracts tourists to view gorillas and mountain birds.

During my recent trip to Uganda, I met with Dr. Yusuf Baseka, the district health officer of Kasese, who described the health challenges his district faces, and his hopes for the future.

Although the national parks are beautiful and bring a much needed economic boost to the area, they also offer a challenge, Dr. Baseka explained.  The population growth and fertility rate of the district are very high. With the two national parks, there is no land for expansion. The town of Kasese is rapidly becoming a slum with unsanitary conditions that are difficult to address.

Another challenge in his district is that children are not going to or staying in school. They are leaving secondary school early and engaging in risky sexual behaviors. He explains, “We’ve seen a dramatic increase in young mothers, under 18 years, some as young as 12.” Their pregnancies offer unique challenges for the health system to address.

Earlier this year, USAID supported the launch of the Leading High-Performing Healthcare Organizations program (LeHHO) for senior health leaders in Kenya. Offered at Nairobi’s Strathmore Business School, the program is the result of a successful partnership between Strathmore and USAID’s Leadership, Management and Sustainability (LMS) project in Kenya.

Strong leadership, governance, and management are the cornerstones of successful global, national, and local efforts to save lives and achieve the  maximum impact from health investments. Yet effective leadership, management, and governance skills and practices too often are the vital missing elements in public, civil society and even private health organizations. Fortunately, these skills can be developed. They are best developed working in teams, in one’s own setting, over time, while facing real challenges.

With our partners, MSH works to build capacity at all levels within public and private organizations to improve leadership and management practices. Improved capacity ensures sound governance policies, creates a work climate that supports staff motivation, increases flexibility, and realigns staff to focus on common, achievable objectives.

News from the HIV Capacity Building Partners Summit in Nairobi, Kenya

On the second day of the first ever Regional HIV Capacity Building Partners Summit in Nairobi, Kenya, one of the key issues that continued to dominate the conversations in various sessions was sustainability.

Many speakers noted that despite a mild increase in organizational capacity building efforts by donors, governments, and nongovernmental organizations in the Eastern and Southern Africa region, the documentation and dissemination of these efforts and their effects on HIV & AIDS programs and other health programs and systems remains limited. Apparently, several factors have contributed to this situation.

First, the group noted that evaluative research for questions of program sustainability were primarily based on the objectives, work plans, timeframes and measures of sustainability that had been developed by individual projects. In most cases, these projects were donor funded and had their own agenda and hence did not take an organizational-wide approach in their approach to measuring sustainability. They just focused on the project deliverables.

Simi Grewal is the Program Coordinator for Health Systems Strengthening and Results Management at MSH. She worked as a fellow in Egypt from January 16-February 5.

Introduction

by Joan Bragar Mansour, ED.D, leadership development specialist at MSH.

Dr. Morsi Mansour is an Egyptian surgeon and Leadership Development Specialist for MSH who teaches leadership to health professionals and develops leadership facilitators around the world. He was in Tahrir Square for two weeks during the uprising in Egypt and shares his experience below.

In Egypt, there has been a Leadership Development Program since 2002. Using their own local resources, health workers unified in over 184 health units across the Aswan governorate in Egypt focused on reducing maternal mortality and succeeded in reducing it from 85/100,000 to 35/100,000 in two years.

Prior to January 12, 2010, Management Sciences for Health’s Leadership, Management and Sustainability Program was working with Haiti’s Ministry of Public Health and Population to build capacity in several areas:  family planning and reproductive health; commodity management and security; coordinating HIV & AIDS awareness and community mobilization activities; and leadership development.

But after the terrible earthquake of one year ago, we who normally promote leadership in the health sector were faced with our own leadership challenges:  how to continue to lead and manage our program effectively during an ongoing crisis, and most importantly, how to ensure continued help to those who rely on LMS support. Our immediate priority:  dealing with the collapse and destruction of our office.  For months, we worked out of large tent constructed next to the LMS warehouse, a reminder everyday that many of those we were serving had been forced to move into temporary shelters.  

In Aswan, Egypt’s sunniest southern city located about one and a half hours by plane from Cairo, the Nile is at its most striking. Tropical plants grow along the edges of the flowing river, and the amber desert and granite rocks surround orchards of palm trees.

I was honored to be present in Aswan during one of Management Sciences for Health’s most important events; the results presentation of the Leadership Development Program (LDP), funded by the US Agency for International Development (USAID) as part of the Improving the Performance of Nurses in Upper Egypt (IPN) project in the Aswan governorate.