Starting from Zero: Dr. Ihsanullah Shahir on Leadership and Management in Afghanistan
Dr. Ihsanullah Shahir, Director General of Human Resources within Afghanistan’s Ministry of Public Health, began work as a young doctor in mountainous Bamyan province during what he calls “an emergency situation during the war.” In 2004, Shahir became the Provincial Health Director in Bamyan Province.
I had limited knowledge, but I got help from colleagues. We established everything from zero.
Shahir and his colleagues worked to ensure coverage of the Basic Package of Health Services. The following year, he went on a study tour to Egypt through MSH’s US Agency for International Development (USAID)-funded Rural Expansion of Afghanistan Community-Based Health Care Program (REACH) Project, where he saw how an effective leadership program had been implemented.
We learned a lot about leadership and management, which was still a new concept in Afghanistan. I learned how to use my capacity as a strong and creative thinker, exploring opportunities in the environment. When I came back to Bamyan, I was a totally different person mentally, but I had to decide how to face the challenges from the war.
Shahir applied the leadership and management practices he had learned once he was back in Bamyan province: He worked with local leaders to find local solutions.
There were a lot of challenges regarding accountability, paper processes, even hygiene, and noise. We brought a lot of changes. We established a Leadership and Management Directorate here.
The LMG/Afghanistan team [Leadership, Management and Governance Project/Afghanistan] is working very closely with us on leadership, management, and governance training as part of the orientation package we developed for new people coming into the system.
We’ve also conducted a lot of training for hospitals—how to enable people to think differently, face their challenges, and find a way.
One such training was the Leadership Development Program (LDP), which helps organizations develop managers who lead, with a vision of a better future. Increasing leadership and management skills enhances the performance of Afghanistan’s health system to save lives and improve the health status of the population. For example, a regional maternity center in Herat used tools they had learned in the LDP to increase their compliance with infection prevention standards. Within one year, the regional maternity center was able to increase their compliance score from 5 percent to 58 percent.
Shahir recommends that leadership and management training be incorporated into pre-service educational curricula, as part of private sector training for nurses and midwives, as part of post-graduate work for health specialists, and as part of in-service training to strengthen health management as well as health service provision.
Shahir also cites the development of the Management and Leadership Development Department (MLDD) within the Ministry as a good step towards the institutionalization of leadership and management practices.
Leadership and management practices have been applied to middle management within the Ministry of Health, and at the highest levels through the Senior Leadership Program by Johns Hopkins [through LMG/Afghanistan]. That means awareness has spread, and that’s a good phase. Now we need a master plan for the future to develop leadership, management, and governance at the national level.
As a health professional, I am committed to working in this area. We will be the player on the ground. We can take these practical steps, and MSH can help us.
USAID's Leadership, Management & Governance (LMG) Project is led by Management Sciences for Health (MSH) with a consortium of partners. More information on the work LMG is doing in Afghanistan can be found in the project’s program brief, Rebuilding the Health Sector in Afghanistan: Professionalizing Leadership and Management as a Pillar of the Health System.