On April 6, 2017, the USAID-funded Leadership, Management, and Governance (LMG) Project organized Passport to Leadership: Unlocking the potential of individuals, teams, and nations – an end-of-project event celebrating achievements and lessons learned across more than 90 countries, in Washington, DC. The event was designed and facilitated to be a catalytic learning experience, similar to LMG Project workshops facilitated in our activities, with an interactive and engaging format to encourage learning.
Shyami de Silva, Deputy Director for the USAID Office of Population and Reproductive Health (PRH), shared opening remarks to kick-off the event. She highlighted the critical role leadership, management, and governance capacity plays in promoting health system resilience and responsiveness. In particular, she focused on two examples:
In Cameroon, the LMG Project partnered with the USAID-funded Evidence to Action Project to conduct a research study on the added value of a leadership development program combined with clinical training to improve postpartum family planning service delivery. The study’s findings indicate that building health workers’ leadership and management capacity improves their ability to address challenges to service delivery.
De Silva also showcased the LMG Project’s contributions to Ethiopia’s health system by helping the Federal Ministry of Health (FMOH) to institutionalize pre- and in-service health management training and promote the inclusion of women at all levels.
Megan Kearns provides opening remarks at the LMG Project’s Washington, DC, end-of-project event on April 6, 2017. (Photo: MSH)
Megan Kearns – the LMG Project Director – provided an overview of the project, its achievements, and its refreshed approach that incorporates what has been learned over the life of the project. The approach makes the link between interventions and intended outcomes and provided a framework for understanding of the LMG Project’s work as participants engaged in the day’s sessions.
Local Ownership and Sustainability
Reena Shukla – LMG Project Agreement Officer Representative and a Health Officer in the USAID Maternal, Child Health, and Nutrition Office – moderated a discussion of the LMG Project’s broad mandate to build capacity, ensure equitable access, and strengthen health systems; which, she noted, all contribute to sustaining and scaling high quality health services.
Cara Thanassi – a Senior Human Rights Advisor in the Empowerment and Inclusion Division of USAID’s Center of Excellence on Democracy, Human Rights, and Governance – pointed out that local demand is essential for impact, sustainability, and ownership; however, these three variables are often not only the “hardest nuts to crack,” but also difficult to measure.
But Joseph Dwyer, a consultant for Management Sciences for Health (MSH) and the LMG Project, framed some of these difficulties a different way. “People are really good at solving problems,” Dwyer said, “When we fail consistently; it is usually because we are trying to solve the wrong problems.” Instead, he says that emphasis should be placed on identifying and addressing the underlying issues that undermine effective service delivery. Build on health workers’ clinical training by developing their leadership and management skills and they will be able to better maneuver challenges in the health system.
Closing the discussion, Ummuro Adano, a Principal Technical Advisor with MSH, shared examples from Kenya where people who completed the LMG Project’s leadership development program were able to influence how the local health system and its health clinics were run. Oftentimes, money is not the problem, it is how leaders prioritize and use resources. Adano wished to impress upon event attendees five questions, which, he said, “everyone brings to work every day:”
- Am I being treated fairly?
- Do I know what I am supposed to do?
- How do I know how well I am doing?
- Who cares? Will I be missed if I go?
- Do I have a future in this organization?
According to Adano, whether or not an organization has a culture of clear expectations and rewards in place to answer these questions on a daily basis dictates its capacity to sustainably deliver services.
After the early morning sessions framed some of the high-level challenges, attendees participated in a solutions marketplace where they could choose to learn about specific tools, programs, and solutions to challenges. The marketplace’s 11 presentations were divided into three implementation themes that reflected some of the common or recurring challenges that LMG Project teams have witnessed over the past six years.
After a short lunch, attendees organized into fishbowls – facilitated small group discussions surrounded by a larger group of observers – to discuss leadership, management, and governance across six pre-assigned themes:
- From Intuition to Evidence
- Healthy Communities: Holding each other accountable for good health
- Inclusion Matters: Making sure no one is left behind on the road to universal health
- Navigating Decentralized Health Systems (two groups: English and French)
- Quality of Care: A luxury good?
Each group was facilitated by a “lead fish,” who led the group through a set of questions to enrich the conversation. At the end, groups were asked “If you were given $10M, what strategic investment would you make to advance [your topic area]?”
Attendees prepare to participate in the solutions marketplace session at the LMG Project’s Washington, DC, end-of-project event on April 6, 2017. (Photo: MSH)
One theme that emerged for working at the decentralized level was the importance of inter-sectoral and integrated engagement. At local levels, they would also invest in providing this training for health workers at all levels of the health system and in incorporating leadership, management and governance in existing pre-service and in-service training institutions.
Groups discussing evidence, accountability, inclusion, and quality of care all emphasized the importance of investing in deliberate stakeholder engagement to understand needs and create programs that are valuable to all. In particular, the inclusion group proposed inviting decision makers to spend a week in the shoes of a disabled person as a way to understand their challenges to accessing care. Only after this experience would it be appropriate to then bring together stakeholders to discuss how to invest the $10m. The quality of care group would invest in “paying” for quality through performance-based incentives, with the community holding the care providers accountable for what they had to achieve.
Spotlight on Health Systems
Temi Ifafore-Calfee, a Technical Advisor to the LMG Project in USAID’s PRH Office, moderated the afternoon’s talk-show-style plenary with discussants reflecting perspectives on the LMG Project’s activities from every level of the health system.
Rose-Ann Foster-Vaughan, an Administration Project Officer for the Barbados Council for the Disabled, shared her individual perspective on the impact of Mobility International USA’s Women’s Institute on Leadership and Disability (WILD) and its ability to empower women with disabilities. Reflecting on her WILD training of trainers’ program experience, she said that WILD women “went away stronger than they came… they were given a voice and ability to advocate for themselves.”
Organizations and institutions are important actors in health systems too. Michael Kabugo – the Chief of Party for the THALAS Project at the Joint Clinical Research Centre (JCRC), a Ugandan HIV and AIDS service delivery, research, and training institution – discussed the LMG Project’s partnership with JCRC by sharing their journey to sustainable organizational improvements. After an external assessment identified 72 recommendations, JCRC worked with the LMG Project to update its information and communications technologies and strengthen management systems across the organization. With these improvements, Michael said, JCRC was able to reduce patient average waiting times from five or more hours down to 20 minutes and received a positive recent audit from USAID.
Scaling improvements in leadership, management, and governance capacity to the national level can be challenging, but Jemal Mohammed, the LMG/Ethiopia Project Director, shared how they partnered with the FMOH to institutionalize these practices within pre- and in-service training curricula. This close partnership helped foster the Ministry’s ownership of the program, demonstrated by the FMOH starting to roll out training to regions where USAID does not work.
Miguel Fernandes – the Physical Rehabilitation Project Manager for the International Committee of the Red Cross (ICRC) – detailed the LMG Project’s regional impact on ICRC teams from physical rehabilitation centers. In particular, he discussed the effectiveness of the LMG Project’s support over the long-term for leadership, management, and governance capacity improvements, and mentioned that some countries now have “really good results,” like Ethiopia, Madagascar, and Myanmar.
Finally, Kate Baye shared her perspective on the LMG Project’s long-term technical assistance at the global level, working with the International Youth Alliance for Family Planning (IYAFP), an all-volunteer, global network of young activists that was launched at the International Conference for Family Planning in 2013. With the LMG Project’s support, IYAFP formalized its management and governance structures and submitted an application for formal registration as a non-profit legal entity. If approved, this status would be a big boost for IYAFP, allowing them to mobilize additional resources and implement new activities.
Unlocking the Potential
Although the LMG Project ends in September 2017, many of the challenges that health systems and workers face will not. Individuals, organizations, and systems will continue to grapple with everyday barriers that hinder service delivery and negatively impact health, if they approach these challenges with a different mindset and use the appropriate tools and approaches to effect change, they can unlock their potential to overcome barriers in the health system.