Celebrating a Strengthened Decentralized Health System in Côte d’Ivoire

Cherie Black

Global Health Editor

The success stories and positive results kept coming, one after the other. As a standing-room only crowd nodded in approval and gave rousing applause after each presentation, health teams from regions across Côte d’Ivoire presented visual and verbal accounts of improved outcomes and increased preparedness to prevent and respond to major health crises, which, as one physician shared, meant his tiniest patients now have a better chance of survival.

Rose N’Guessan, LMG/Côte d’Ivoire Project Deputy Director, presents results from the LDP+. (Photo: Cherie Black/MSH)
Rose N’Guessan, LMG/Côte d’Ivoire Project Deputy Director, presents results from the LDP+. (Photo: Cherie Black/MSH)

They joined other Ivorian regional and district health authorities, government staff, and US Embassy Chargé d’Affaires to Côte d’Ivoire, Andrew Haviland, at a high-profile ceremony in Abidjan on July 20, at Sofitel’s Hotel d’Ivoire, to celebrate improvements in the country’s health system, which had been damaged by decades of economic and political instability and threatened by the 2015 Ebola outbreak in neighboring countries.

As part of a strategy to strengthen Côte d’Ivoire’s health system, the Ministry of Health and Public Hygiene (MSHP), in its National Health Development Plan 2012-2015, decentralized decision-making and management to health regions and districts. This meant important health decisions were made closer to the communities and people they impacted.

To support this decentralization process, in 2013, the US Agency for International Development’s Leadership, Management, and Governance (LMG) Project, led by Management Sciences for Health (MSH), launched a leadership, management, and governance (L+M+G) decentralization approach to strengthen capacity at the regional, district, and hospital level in the health regions of Indénié-Djuablin and N’Zi-Iffou-Moronou. The model relied on a work-based capacity building program focused on action and targeting health care system managers and directors. It also included capacity building of leaders in administrative management through specialized training and mentoring. In both regions, the LMG Project organized improvement teams that participated in the LMG Project’s intensive Leadership Development Program Plus (LDP+) with a specific focus on improved HIV and AIDS treatment and response.

Teams learned how to create a common vision, define the current situation in their community, identify obstacles and root causes, and develop a desired measurable result they could achieve through targeted, concrete actions. After participating in the LDP+, health staff saw considerable results: significantly more women went to clinics for antenatal exams and to deliver their babies, and more people living with HIV continued their life-saving antiretroviral treatment 12 months after starting it.

“I appreciate that we see the importance of this aspect of developing capacity,” said Haviland during a break between success stories and presentations. “We couldn't do any of this unless the government of Côte d’Ivoire really wanted to improve the health of this country and the health and well-being of its people. It’s important to stop and see where we have arrived, what we have accomplished, because you always see challenges ahead of you--the work is never done. It's good to take a moment to say yes, we did a great job.”

A stand showcases results from the Cavally-Guémon region. (Photo: Cherie Black/MSH)
A stand showcases results from the Cavally-Guémon region. (Photo: Cherie Black/MSH)

Building upon the success of the pilot decentralization project, and in response to the weaknesses highlighted by the region’s Ebola epidemic, in 2015, USAID provided funding for the LMG Project to implement this decentralization approach in three new regions: Cavally-Guémon, Kabadougou-Bafing-Folon, and Tonkpi. In the new regions, improvement teams tackled challenges related to epidemic preparedness and response, requiring them to confront workplace challenges and commit to working together and communicating better.

“My vision is that the hospital should not be a place where people go to die, but a place where they feel confident and rejuvenated when they leave,” said Dr. Kouamé Kouadio, head of the pediatric department at the Yamoussoukro Regional Hospital Center. “But how can we share this vision with a climate of mistrust at the workplace? After our involvement in the Leadership Development Program, my colleagues and I succeeded in moving from vision to action, and we saved more children’s lives by strengthening our team solidarity and communication.”

Throughout the day, health officials described how the LMG Project’s LDP+ resulted in detailed epidemic prevention and response plans, and a program to systematically collect and analyze data on maternal and child mortality, HIV, tuberculosis, and malaria. Community leaders, members, and traditional healers are also more actively reporting instances of diseases to the local health authorities, and are referring people with suspected diseases to health clinics.

“I'm really excited by the aspect of the decentralization of this [approach]” Haviland said. “There's always a lot of work to do, and the next steps are to continue to improve management and push even harder so people in the regions feel empowered to insist on good health care, and good performance gets rewarded.”