Health Worker Leadership Improves Service Delivery in Ghana and Uganda

This article originally appeared in the April 2015 newsletter, “Broadly Supporting Health Workers”

By Sasha Grenier, Senior Technical Officer, MSH and Katie Martin, Project Associate, MSH

Lack of management preparation is a binding constraint to meeting the Millennium Development Goals (MDGs), and WHO lists leadership and governance as one of the six interrelated health systems building blocks.[1] Evidence has shown that equipping health workers at all levels with leadership, management, and governance skills produces positive changes in health-service delivery outcomes.[2]

The Leadership Development Program Plus (LDP+) allows professionals at all levels of the health system to learn and practice leadership, management, and governance skills. The hands-on program guides teams of health workers in a variety of levels and positions to implement improvement projects over a period of five to eight months. Teams develop a shared vision, analyze what stands in the way of progress, think collaboratively and creatively, and develop innovative solutions to overcome their specific health service delivery challenges. Participants have reported greater self- confidence and improved health service delivery.

Via the partnership between the Leadership, Management & Governance (LMG) Project and the International Planned Parenthood Federation (IPPF), six teams from Reproductive Health Uganda (RHU) and three teams from Planned Parenthood Association of Ghana (PPAG) completed the LDP+ in 2014. All nine teams implemented performance improvement action plans directed at improving the quality of and access to family planning, reproductive health and rights, and STI-related services.

Engaging Youth in Uganda

In Uganda, 12 teams from RHU embarked on the six-month LDP+ performance improvement process in March 2014. All teams focused on reaching underserved populations, including sex workers, rural populations, and youth. After being coached and supported by LDP+ facilitators to scan their environments, mobilize stakeholders, focus on a health issue, plan for actions, implement, and monitor and evaluate, teams of health workers in six clinics surpassed their program objectives. By developing custom solutions to their context-specific challenges, the six clinics increased access to services for an additional 50,608 youth and adults over six months.

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The team from Mbarara, a sexual and reproductive health (SRH) clinic in Southwestern Uganda, found that the lack of collaboration among the youth center, the community, and the clinic was detrimental to service delivery. A member of the team, Chrispaul Abaho explained, “Everyone was working separately. The youth would come to the youth center to access recreational activities, but would not come for health services.”

To address these issues, the team decided to include youth from the community in their weekly meetings and launch monthly health education talks at the youth center. Abaho noted, “We began to plan jointly for both the youth center and the clinic at the same time. We would now collaborate with each other.”

Rita Murungi, a young woman from the community who attended one of the monthly health education talks and was able to talk to a nurse privately, explained how this was transformational for her. “It’s not that I didn’t know where to go for services, but I was scared of whom to talk to and how to explain everything,” she said, “But now, I am using a three-month injection for family planning to avoid unwanted pregnancies.”

Donanta Muhureze, a health worker at RHU, summarized how this has affected the community’s access to the clinic. “This has not only improved youth participation in addressing their own needs, but also contributed to the client load for the clinic because many now freely visit the clinic for services.”

Reaching the Underserved in Ghana

Three teams of health workers from PPAG completed the LDP+ process, led by local facilitators and coaches. These teams looked at health challenges in their communities and used leadership and management skills to identify and implement solutions. In less than six months, the three teams, from three regions in Ghana, reached an additional 15,096 youth and adults with sexual and reproductive health services and education over six months.

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In order to remove barriers in accessing family planning and SRH services in Ghana’s Northern Zone, the team of health workers from Jisonayili Young and Wise Center implemented multiple strategies. First, they improved relationships with stakeholders, reaching out to religious leaders to encourage family planning acceptance in the community and collaborating with youth groups to tailor services and messages for young people. They addressed the community’s need for confidentiality by adding a new private entrance to the clinic. To face challenges with staff workload, the team developed a new partnership with Ghana Health Service to relieve staff shortages.

Overall, the nine teams of health workers who implemented the LDP+ in Ghana and Uganda all improved performance and service delivery, as evidenced by reaching their health indicator targets. Teams learned key leadership, management, and governance skills that will sustainably improve their performance, and they applied these new skills to bring about changes in their communities, reaching youth and underserved populations with essential family planning and SRH services. With this new skillset, LDP+ participants have dedicated themselves to continuing to use the program’s approaches to continuously improve their own performance, leading to better health in their communities.

[1] World Health Organization: Countdown to 2015 decade report (2000–2010): Taking stock of maternal, newborn and child survival. Geneva: WHO; 2010

[2] Seims, La Rue K., et al. “Strengthening management and leadership practices to increase health-service delivery in Kenya: an evidence-based approach”

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