Is health systems governance interesting to medical and nursing students?

Katie Martin

Senior Project Associate

Lourdes de la Peza

Principal Technical Advisor on Management and Leadership

How can we engage health education students in governance matters if they think governance is just about politics?

Ethiopian faculty from different universities that participated in the governance workshop. Picture from Getinet Kaba Chali

This is one of the challenges that faculty from a variety of Ethiopian universities expressed after the first roll-out of the new standardized Ethiopian Leadership, Management and Governance (L+M+G) curriculum.

Strong governance has been heralded as the “great enabler” when it comes to achieving strong health systems. However, the public health community recognizes that governance is not a practice that should only be relegated to parliamentarians.  Service delivery professionals must be equipped with a broad array of governance practices in order to thrive in their critical roles.

Recognizing this need, the USAID-funded Leadership, Management, and Governance (LMG) Project in Ethiopia has developed close partnerships with the Ministry of Health and training institutions to integrate leadership, management, and governance (L+M+G) practices into a standardized pre-service curriculum.

During the initial integration workshop, faculty expressed that in most cases, the curriculum’s modules devoted to governance were not even being covered during course delivery. Three main reasons were at play:

  • Insufficient time for delivery
  • Low faculty comfort levels with governance concepts; and
  • Instructor difficulty in properly communicating the interdependence between L+M+G concepts

In light of these challenges, I was invited to deliver a “Training of Trainers”, or TOT, on basic principles of governance in the health sector, including how to deliver governance content using adult learning and participatory approaches.

During the TOT, a variety of delivery methods were used to teach each governance practices: group discussions, panel-style interviews, team brainstorming using note cards, debates, storytelling, role playing, case studies, etc. This broad array of teaching methodologies was successful not only in engaging participants, but also in demonstrating the many ways in which the instructors could similarly deliver governance content to their own students.

Role-playing discussion from different constituencies in a HIV program during the workshop. Getinet Kaba Chali pictureOn the TOT’s fourth day, participants designed and delivered a 45-minute session related to one of the four governance practices and gender. After they each delivered their session to the broader group, they received feedback from the other participants and myself.

The results were astounding. Each team was able to confidently explain governance concepts in an accessible way by using participatory methods. Three groups even developed new teaching methodologies that vastly improved on the ones I proposed as their instructor.

It is critical to note that utilizing participatory and experiential learning approaches represents a significant cultural shift in these academic institutions, which are used to primarily teaching via a lecture-based method. As a result, the TOT participants were very enthusiastic to begin introducing governance concepts into their teaching using participatory methods. However, they are still in the preliminary stages of integration and will require continued practice and institutional support.

There are other challenges to be address. First, it is likely that other Ethiopian faculty  may be experiencing similar difficulties in using participatory methodologies to deliver other components of the standardized leadership and management curriculum. In order to assess this initiative’s impact, it will therefore be critical not only measure the quantity of universities or faculty that are integrating L+M+G concepts into their curricula, but the quality of the delivery as well.

Secondly, TOT participants expressed that many universities don’t have the proper infrastructure, strategies, or resources conducive to the use of participatory teaching methodologies. There is a demand to work with universities to create an enabling environment for the faculty to deliver L+M+G content with participatory and experiential learning approaches.

It is certain that there is still a great deal of work to be done in order to ensure that all pre-service health students are equipped with the proper skills to confidently navigate their future careers. With the help of more targeted, intentional training, we expect to see great results from Ethiopia in the coming years.