Flying Halfway Around the World and Creating a Real Fundamental Change

Lourdes de la Peza

Principal Technical Advisor on Management and Leadership

Are you still traveling? Aren’t you tired? Don´t you ever suffer from jetlag? These are the questions my friends continuously ask me. And the answer is yes and no. Yes, I continuously travel like mad and no, I don´t suffer from jetlag. I love being in the field, shoulder to shoulder working with doctors, nurses and community health workers that help make a difference in the lives of many people in Africa. This is what makes me happy and keeps me going. What makes the work I do and travel I endure (32 hour flights, sometimes) so rewarding, is making a connection to the people I work with.

On my most recent trip to Nigeria, I traveled 32 hours from Mexico to Abuja, stayed five days, working constantly, and returned for another long set of flights back home. But it was worth it, as this was the last meeting of the Leadership Development Program Plus or LDP+, and I am very impressed with their results.

Participants at a LDP+ training in Nigeria.

All of the teams that participated successfully completed the program. They were assigned a particular challenge and then had to develop an action plan to achieve a measurable result. 9 out of the 10 teams had significant improvements within the first six months of the program ending. Some of their achievements were:

  • Old Kutunku and Anwan-do Health centers increase the number of Ante Natal Care (ANC) attendees per month from 17 to 61 and from 27 to 47
  • Gwako increase the percentage of women on ANC that deliver at the facility from 18% to 42%
  • Gwako, Zuba and Yimi Health Centers and Township clinic increase the number of partners of HIV positive pregnant women attending ANC, that are counseled and tested in percentages from 20  to 100%
  • Township Clinic increase the percentage of pregnant women who tested HIV positive and are on ART (Retrovirals treatment) from 89% to 100% 

In August 2012, I facilitated another LDP+ training with a group of skilled facilitators from Management Sciences for Health’s Plan Health Nigeria project. After the success of that first training we coordinated with the Ministry of Health at the Federal Capital Territory to launch the program in Gwagwalada Council. Gwagwalada is one of the five Local Government Area Councils of the Federal Capital Territory of Nigeria.

A follow on meeting in October with key leaders from the Gwagwalada Area Council, members of two NGOs and a community leader was organized to engage them as leaders of the program and become the oversight team. During that meeting, the oversight team selected Prevention of Mother to Child Transmition of HIV (PMTCT) services as a priority measure that the program should work towards and the five main indicators that would need improvement. They also selected ten primary health facilities within Gwagwalada Area Council that were offering PMTCT services to participate in the program.

PMTCT indicators selected for the LDP+ teams

  • Number of new Ante Natal Care (ANC) clients
  • Number of pregnant women HIV tested, counseled and received results
  • Number of pregnant women who tested HIV positive
  • Number of HIV positive women started on ARV prophylaxis – triple regimen
  • Total deliveries at facility booked and un-booked

During a five day workshop in October, the participants learned how to apply leadership and management practices to face challenges and achieve results. Participants worked in teams using the challenge model to develop a vision, define a measurable result, analyze the root causes of their challenge, and develop an action plan to implement proven interventions to address the challenge.

The teams developed a unique challenge that they hoped to address and solve: “Every woman in Gwagwalada Council should have access to high quality PMTCT services, to ensure all babies are born HIV free” . With that vision in mind, they analyzed what were the main challenges to increase the uptake of PMTCT services by pregnant women. They found that the main obstacles were women and their partners were not coming to Ante Natal Care (ANC) and thus were not being tested because of lack of awareness of the importance of ANC and PMTCT, staff attitude, cost of services and community stigmatization.

In February 2013, I came back with my partners from Plan Health to visit the Gwagwalada Council and had a meeting with the oversight team. We were so pleased to discover how engaged and committed they were. Without any much oversight or communication from me or from the facilitators, they were monitoring the facilities, visiting them and helping them to engage the rest of the facility members that didn´t participate in the training and also organizing meetings with the community leaders to support the PMTCT services.

A challenge overview at a LDP+ training in Nigeria.

The following two days we had a Sharing Learning Session with the 10 facilities. During the session each facility presented their results from November to January and learned what the best practices are for increasing PMTCT services.

They were visiting community and religious leaders to invite them to promote PMTCT and some of them were encouraging men to join their wives to go to the clinic.

They invited HIV positive women, who had delivered a healthy baby, to be “mentor mothers” to other pregnant women facing similar situations. They also worked with traditional birth attendants and community health workers to sensitize the community and to help identify at-risk pregnant women and bring them to the health clinics.

We were surprise with the speed the teams had implemented so many activities, with one of their biggest obstacles being staff performance, they stated, “We worked as a team, give everybody the chance to talk, being respectful of each other opinion and organizing the work plan together”.

Many were impressed with the enhanced performance of their staff, Umar London from Gwako Community remarked, “Is it that you have increased the salary of the clinic staff? Because they are now very committed to work, they are at work early and they remain till closing hours”.

On the last day of my visit, I and my partners from Plan Health, had an evaluation meeting with the oversight team. They were so satisfied with the results that would continue with the program with their own resources with eight new health facilities in Gwagwalada Area Council. They would also invite people from other area councils to the ceremony of certificates to advocate for extending the program to other area councils.

On my way out of Nigeria, it was 4 P.M. and I was rushing to the airport for my last flight back home. Though I was tired and knowing how exhausted I would be once I was home, I was floating on the success of the program and how much good we had done in such a short time.

Lourdes De la Peza is the Principal Technical Advisor on Management and Leadership for the Leadership, Management & Governance (LMG) Project.

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This is live indicator of what a committed group of people can achieve in terms of results. It's a testimony that improvement in the application of every day leadership and management practices can lead to improvement in health services delivery and uptake. What the ever dogged and hard working Lourdes may not have added is that these people received no extra stipends or incentives to achieve these results. Thumbs up to the entire team.

Thanks for sharing your thoughts. I truly appreciate your efforts and I am waiting for your next write ups thanks once again.

<a href="http://www.imarksweb.org">Traviz</a>
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