Promoting the Value of Health Manager Professional Associations in Low- And Middle-Income Countries (LMICs)

A Clear Need

As health systems in low- and middle-income countries continue to grow and to provide for an increasing range of health services—from preventive care to more complex clinical treatments and management of infectious and chronic diseases—the critical role of health managers becomes more evident. Ensuring a strong skillset for those who go into health management rather than classic health careers (e.g. nursing, medicine), is still a new idea in many places. However experience has demonstrated the need to build a cadre of health professionals whose primary responsibility is to lead, manage and govern the health sector.[1]

Whatever the career, it is essential that health professionals are well trained and are supported to embrace continuous learning as part of the pursuit of high quality clinical care, and to promote good patient experiences. Health professional associations can be key resources to encourage and enable this life-long learning. Health professional associations are “organization[s] of practitioners who judge one another as professionally competent and who have banded together to perform social functions which they cannot perform in their separate capacity as individuals.”[2] In addition to bringing like-minded health professionals together, they also:

Represent the interests of and serving as the public voice of the profession at the national and international levels
Guide terms and conditions of employment
Maintain and enforce training and practice standards as well as ethical approaches in professional practice
Influence national and local health policy development to improve health care standards
Ensure equitable access to high-quality, cost-effective services
Advocate for enhanced knowledge, employment support and professionalism across the professions of health management, medical, nursing and allied health workers

As summarized in the USAID-funded CapacityPlus Project’s Technical Brief on strengthening health professional organizations:

“Professional associations for health care workers can promote high standards of practice, advocate for the needs of both consumers and providers, form networks with other professional associations and liaise with legislative and regulatory bodies.”

Strengthening professional associations is one strategy for addressing global human resources for health (HRH) issues such as out-migration and the lack of an adequate supply of well-trained professionals.[3]

While the utility of health professional associations has been widely recognized as evidenced by the formation of medical and nurses’ associations in countries around the world, similar acknowledgement of the need for and the potential utility of such associations for health managers has not occurred. Health Manager Associations could be helpful avenues to the further professionalization of leadership and management within the health system through their ability to organize around and promote the strengthening of health management as a profession.

Health Management is not always seen as a separate profession; in the eManager entitled, “Paving the Way toward Professionalizing Leadership and Management in Healthcare,” the challenges are noted:

Standards related to management and leadership competencies rarely exist
There are rarely clear requirements for the licensing or certification of those who lead and manage health care services (Egger and Ollier 2007)
No clear career path for professional health managers exists in most developing countries
Medical and nursing professional associations rarely include a focus on health leadership and management advocacy or continuing educationinleadership and management
Young people rarely envision health management as a potential career path
Surveys of people who lead and manage health care services in developing countries tell us that these roles are not valued, whereas the roles of medical specialists are (MSH 2008)

Imperatives for Modern Health Professional Associations

Modern health professional associations seek to enhance the competencies of their members through academic and practice-focused learning opportunities. They also seek to promote the interests of association members and set and enforce quality standards. Achieving these objectives requires a stable, health professional organization that is led by an experienced governing board comprised of representatives from its member professionals, and a staff that can carry out core functions for the long term vitality of the association.

Governing bodies of health professional associations (HPAs) must help their professional associations ensure sustainability by working with staff and members to:

Create strategic plans
Implement association programming
Implement sound governance and human resources practices
Communicate effectively with their members
Develop reliable sources of revenue

Sample considerations in these important arenas of focus are:

Strategic Planning

A strategic plan guides an association toward its desired mission and vision. With a strategic plan, the association’s governing body and staff can develop annual work plans that detail what actions the association will take to achieve its desired results, and to identify the resources needed to carry them out. Flexible work plans allow associations to respond to emerging opportunities. Ongoing needs assessment, outreach, and two-way communication with members ensure that the association is responsive to their priorities and needs.

Professional associations for health managers should develop and implement systematic methods to assess the need for and the effectiveness of its activities, and to develop and implement strategic plans that will lead to long-term association viability. A sample assessment tool that can be used for this purpose can be found in the appendix.

Association Programming

Advocacy, information exchange, networking, and professional development are among common activities and services that are provided, as part of their programming, by health professional associations to promote the vitality of members and the profession at large.

Advocacy
Health professional associations, including health manager associations, serve as advocates for the health of populations and communities, as well as for the professional interests of their members. Associations can research issues relevant to their profession, develop a related legislative agenda, formulate policy positions on issues of concern to members and the general public, and lobby the government for passage of related laws and regulations.

Information Exchange
Associations provide a forum for information exchange among members and their stakeholders, as well as with ministries of health and civil society organizations. As clearinghouses for the collection and dissemination of best practices in the professional area, associations can enable practitioners to learn about innovative approaches that their colleagues in other disciplines, nations and communities are using to solve local problems. Health professionals can access this information and adapt and replicate approaches that have worked elsewhere as a way of improving their effectiveness in their field.

Networking
Associations can play an important role in creating opportunities for health professionals to network and to discuss creative solutions to challenges they have faced. Associations help identify the issues of greatest interest and concern to their members and organize conferences and workshops on these topics. These forums can be venues for sharing best practices and providing recognition for high quality of practice or innovation in the field. Strong associations also recognize that they are part of the global/world community, and many are involved in education and scientific exchange beyond their local community and national borders.

Professional Development
Associations support training workshops, certification programs, self-study materials, and faculty exchange programs that help their members enhance their knowledge and skills. As noted under advocacy above, associations also serve as centers for research, which allows them to provide professional development programs based on the findings of the research or the innovations that are identified.

Governance and Human Resource Management

Health professional associations are strongest when they are governed by respected leaders from within the membership who are organized into a governing body that is affective at four critical governance practices[4]:

1. Cultivate accountability: Foster a facilitative decision-making environment based on systems and structures that support transparency and accountability

2. Engage Stakeholders: Identify, engage and collaborate with diverse stakeholders representing the full spectrum of interested parties

3. Set shared direction: Develop a collective vision of the ‘ideal state’ and a process for designing an action plan, with measurable goals, for reaching it

4. Steward resources: Steward resources responsibly and build capacity and processes for this within the body

Associations need strong and effective executive staff to lead their efforts so that they can be active in advocacy for the health profession within the community or nation, or internationally. Associations must manage their own staff following good human resource practices to ensure that they make the most effective use of limited budgets and maximize membership dues. Excellent human resource management can focus on ensuring that associations have documented and accurate personnel procedures, job descriptions, and office procedures. Employees and member volunteers should also benefit from opportunities for their own professional development.

Member Communication

Member communication and participation are essential to well-functioning health professional associations. A membership organization that is driven only by its board and staff without getting input from a wide range of members is missing crucial information to inform the use of the association’s resources. Two-way communication between association staff and members should take place regularly via different channels (newsletters, listserve, web portal, webinars, journals), and members should be allowed opportunities to provide input through mechanisms such as task forces and committees. To promote good communication and engage stakeholders, well-planned and executed regular meetings are crucial. Annual award programs are additional venues for communication, recognizing excellence and innovation in the respective field and providing opportunities for members to share their experiences.

Developing reliable sources of revenue

To be effective, associations must have well-developed, stable sources of revenue from member dues and other sources such as research grants, contracts for services with government or private health services organizations, international donor support, and fees from professional development programs. The association must consider the desired membership structure and create a dues structure that all members consider equitable.

To create this structure, associations should decide:

Whether to have both individual and institutional members
Whether to limit membership to those working in the public sector or to include those working for NGOs and the private sector
How to structure membership fees to cover operational and programmatic costs.

To Learn More:

There are many resources available to help guide leaders of health professional associations. These are among the best globally:

Policies for Health Services Manager Associations: American College of Healthcare Executives www.ache.org; http://www.ache.org/policy/policy.cfm

Toolkit: “Strengthening Organizational Capacity of Health Professional Associations” FIGO: http://figo-toolkit.org/

Professionalism in Pediatrics: Statement of Principles: http://pediatrics.aappublications.org/content/120/4/895.full