Navigating Devolved Health Systems

Joseph Gates

Project Associate

"Passport to Leadership" stamp. Click to return to the Passport to Leadership page.

When projects draw to a close, it is important not only to reflect on achievements, but also to look forward and ask the hard questions—what have we learned, what problems remain, and how can we sustain our project’s legacy?

On March 2, 2017, the USAID-funded Leadership, Management, and Goverance (LMG) Project convened members of academia, the donor community, implementing organizations, and representatives of regional ministries of health for the first of two end-of-project events at the Crowne Plaza hotel in Nairobi, Kenya, to do precisely that.  The event, Passport to Leadership: Navigating Devolved Health Systems, featured presentations by stakeholders who worked with the LMG Project and its predecessor, the Leadership, Management, and Sustainability Project, to build capacity and improve health service delivery, specifically across decentralized health systems.

Megan Kearns, LMG Project Director, addresses the audience at Nairobi event.

Megan Kearns, LMG Project Director, addresses the audience at Nairobi event. (Photo: Joe Gates)

Lightning Talks

The event kicked off with a series of inspiring Lightning Talks. Speakers took just five minutes each to share their experiences embracing leadership, management, and governance principles to deliver dramatic results for their organizations.

Robinah Nambooze from Reproductive Health Uganda (RHU), for example, related how applying the Leadership Development Program Plus to RHU’s Iganga Branch health facility team improved teamwork and led to a 33% increase in the average number of clients receiving SRH services.

Lizzie Kiama, the Director for Disability Inclusion at This-Ability Consulting presented on the Women’s Institute for Leadership and Disability—which has reached 200 women with disabilities from 80 countries thanks in part to a Training of Trainers course developed with LMG Project support. Her passionate presentation emphasized the breadth of the LMG Project’s work and reminded everyone that inclusive health systems are strong health systems.

The lightning talks acquainted the uninitiated in the audience with the nature of the LMG Project’s work and informed the discussions that followed.

Evidence, Responsiveness, and Accountability

From there, the event split into two concurrent breakout sessions on diverging topics—evidence, and responsiveness and accountability. In the Evidence Track, participants discussed the intuitive understanding we have of the   power of leadership, management, and governance interventions to improve service delivery, while recognizing the gap in research and evidence to show how this happens.  This dynamic was captured by LMG Project’s M&E manager, Monita Baba Djara’s presentation on the LMG Project’s study in Cameroon, which assessed the added value of a leadership development program on post-partum family planning clinical training.

“How do you measure alignment, buy-in, etc.…they are like smoke, difficult to touch and hold,” one participant vividly summed up. The LMG Project has accomplished much, but these discussions made clear that building the evidence base requires continued effort and investment.

Discussions during the Accountability and Responsiveness track provided examples showing that investing in leadership, management, and governance yielded results. Yvan Sidler of the International Committee of the Red Cross’ MoveAbility Foundation (formerly the Special Fund for the Disabled) described his organization’s use of the Essential Management Package, Senior Leadership Program, and Coaching and Communication Workshops to achieve truly “transformational” results and increase access to rehabilitation services across sectors. Embracing LMG Project tools—and in particular the Challenge Model—leads to stronger teams, organizations, and ultimately health systems, Lakachew Walie, from the International Planned Parenthood Federation’s Africa Region Office, insisted. This theme was echoed by other presenters during the session.

But what will come of these investments after the project closes?  Will the achievements to date be sustained?

Getinet Kaba, a trainer with the LMG/Ethiopia Project shared an example of one such lasting achievement. The LMG/Ethiopia Project partnered with the Ethiopian government to integrate key leadership, management, and governance principles into pre-service health worker training offered at public Ethiopian medical universities. In all, 150 university staff were trained to deliver the course content and 2,615 medical students so far have taken the health system management course. This curriculum has been officially incorporated into all training at 13 universities and health colleges, so as new graduates go through the programs, they will all receive the foundational skills they need to effectively lead and manage health programs.

Leadership, management, and governance competencies were also incorporated into the national licensure exams, and four universities have even developed leadership, management, and governance curriculums for post-graduate programs. Moreover, four regional states have joint plans with universities and health science colleges to sustain and cascade the LMG courses on their own.

Persistent Challenges, Lasting Solutions

Ummuro Adano, a Principal Technical Advisor for Management Sciences for Health, led a concluding session to sum up the day’s main points. Although the LMG Project is ending, many of the challenges facing decentralized health systems will persist, and key L+M+G principles such as engaging stakeholders, embracing inclusiveness, identifying root causes, and planning for sustainability can continue to be used by Project stakeholders to promote the strength of health systems into the future.

Hopefully the trove of tools, resources, and lessons learned that the LMG Project will leave behind can empower those who continue this important work to build on the Project’s achievements.