A Closer Look: The Leadership, Management, and Governance Certificate Course for Midwifery Managers

Katie Martin

Senior Project Associate

Imagine yourself as a young pregnant woman in rural southern Tanzania. Your rural district council doesn’t have a hospital, and neither do the councils that surround your community. As you go into labor, you pack for the agonizing four-hour drive on bumpy roads to the nearest regional hospital to give birth. Once you arrive, it becomes apparent very quickly that the staff is overworked.

Unfortunately, this scenario is based in reality. Sophia Abdallah Mchinjita, a recent midwife trainee under the Leadership, Management, and Governance Certificate Course for Midwifery Managers, faces these very challenges in her workplace. When the Tanzanian Ministry of Health nominated her to participate in this certificate course, she didn’t know what to expect.

“I had no prior training in L+M+G (leadership, management, and governance skills), but after the trainers came I was very impressed and motivated. I was not initially aware of what L+M+G was, but it immediately started to help me in my work environment.” –Sophia Abdallah Mchinjita

Sophia used the experiential learning and action-focused course curriculum to address the pressing issue of human resources staffing shortages in her clinic. After learning critical leadership, management, and governance skills, she developed an action plan with other midwives at her workplace. 

“We only have one regional hospital and our rural district councils don’t have any hospitals. It can take 1-4 hours to access the regional hospital, depending on where you live. [As a result,] the number of deliveries per month in my clinic is 350-500. However, we only have 40 midwives working. We recognized this as a difficulty, so we met to make a new HR plan. Instead of having 3 daily shifts, we now have 2 daily shifts to increase the number of midwives who are available.” –Sophia Abdallah Mchinjita

Sophia is not alone in her efforts to use L+M+G skills to identify and solve clinical workplace challenges. Management Sciences for Health and Amref Health Africa, united under USAID’s Leadership, Management, and Governance (LMG) Project, piloted the certificate course to 48 midwives from Ethiopia, Kenya, Malawi, Tanzania, and Uganda during the past year. Course delivery consists of five days of in-person training, followed by a six-month action plan implementation period.

To share lessons learned about the initial completion of the face-to-face course delivery, the LMG project, in close partnership with Amref Health Africa, hosted a stakeholder roundtable on July 10, 2014, in Nairobi, Kenya. Course trainers from each country selected a top-performing midwife trainee to serve as a panelist at the stakeholder roundtable, in order to share lessons learned for scale-up in Francophone Africa and ideas for a virtual graduate network. Additionally, each trainee was interviewed upon arrival to learn about course challenges, connections to service delivery improvement, and implementation of their action plans. It was during this time that LMG staff was able to interview Sophia and her fellow midwife nominees about their workplace challenges and action plans. Preliminary data from this event showed a broad array of MNCH areas that midwives are now working to address during their implementation phase. 

Investing in leadership and organizational development activities has long been a priority of Management Sciences for Health and the LMG project, who have long recognized that building the capacity of health leaders and managers not only improves the organizational strength and resilience of health systems; it can have a profound impact on the quality of care delivered to the world’s poorest and most vulnerable communities. Despite a broad array of literature and experience to back up this claim, it is often difficult for the outside observer to discern the clear connection between leadership development and health outcomes. Yet leadership development lies at the very core of any successful development approach. A clear connection to maternal, neonatal, and child health (MNCH) outcomes can be clearly seen given the preliminary data from the L+M+G for Midwifery Managers certificate course. In time, we expect that Sophia will see a significant service delivery impact from her team’s use of L+M+G practices.