An Interdisciplinary Approach to Developing Strategic Leadership
in the Healthcare Workforce of the Future
A Panel Discussion
At the 38th Annual International Conference on Global Health
The theme of the Global Health Council annual conference was on non-communicable diseases (NCDs) with a large focus on health system strengthening (HSS). A major component of addressing both of these challenges to public health is human resources for health (HRH). With many of the Millennium Development Goals (MDGs) and targets set by public health organizations focused on specific diseases or campaigns, often the means through which interventions are delivered is overlooked. As Dr. Peter Ngatia, Director of Capacity Building at AMREF, stated, “You can have all the vaccines in the world, but they are useless if you don’t have the health workers to deliver them.”
Other than the need for more health workers itself, there are many challenges for those already on the frontlines. In a discussion moderated by Lisa Meadowcroft, Executive Director of AMREF USA, panelists discussed how leadership and management training for health workers improve healthcare delivery. The panel consisted of Michal J. Bzdak, Director of Corporate Contributions - Johnson and Johnson, Joseph Dwyer, Director of the Leadership and Management Science Program - Management Sciences for Health (MSH), Peter Ngatia, Director of Capacity Building - AMREF, and Professor Henry Mosley, Bloomberg School of Public Health - Johns Hopkins University.
In opening remarks, Lisa Meadowcroft emphasized the challenges that health workers face, particularly in rural settings. Doctors sent to rural areas need to cope with supply shortages, and a lack of access to many of the technologies and tools used in training. They do not just serve as surgeons and see patients—they must also manage the staff and facility. She added that relatively low wages with no financial incentives for rural healthcare workers often creates low morale which sometimes results in these workers leaving the rural areas where they are so much needed to go to other countries, or leaving the health workforce altogether. Additionally, the realities of practicing medicine and managing health facilities are not addressed in current medical school curricula in Africa. In order to perform effectively as healthcare providers, doctors must be trained in leadership and management (L&M) techniques.
Professor Mosley explained that the type of L&M training needed has changed. The old approach, where the curricula was based on doctors working in large hospitals has been reworked so that it can fit the needs of leadership at the community level as well. He mentioned The Strategic Action and Reflection Guide (STARGuide). Developed by the Gates Institute and Johns Hopkins, STARGuide is a learning model which is easily adjusted to the needs of the situation. It helps leaders and managers to better share information, best practices and to involve more voices into their planning. The leadership program model has now been enacted in 26 universities, with the training programs replicated over 400 times. These L&M programs are designed to provide hands-on learning.
“People in health are calling for L&M help,” Mr. Dwyer declared. MSH focuses their programs on learning over time and gaining management experience by leading at all levels. With practical and accessible tools, leadership and management can be taught, and facilities and service delivery improved. As a result of one of their L&M programs for health workers in a hospital in Swaziland, the hospital went from receiving bad press about their service inefficiencies to being rated ‘best hospital in Swaziland’.
As Mr. Bzdak emphasized, the efficiency and motivation of HRH is essential to strengthening health systems. Elevating healthcare workers in their field through skill development allows for empowerment. Communication between healthcare providers can ensure that best practices are shared, and that the workers are as effective and efficient as possible.
In order to ensure sustainability of HRH, L&M training must be available at medical schools and integrated into undergraduate curricula. However, until that is accomplished, programs providing L&M training after graduation are still essential. Dr. Ngatia discussed the Management Development Institute (MDI) as an example of current, hands-on learning practices. The leadership techniques and programs being taught are culturally sensitive and team-centered. Faculty from UCLA, in collaboration with local schools, develop a curriculum aligned with the priorities of the students in training. After six days of training, MDI culminates in the creation of a community health improvement plan. The graduates remain in contact with MDI faculty after training to ensure constant dialogue and support for those out in the field. Since 2006, there have been 536 graduates from 27 countries, and all graduates have developed plans to take back to their clinics. MDI currently operates as a joint program between AMREF, Johnson & Johnson, and UCLA.
Through their L&M work, AMREF, Johnson & Johnson, MSH, and Johns Hopkins University are providing essential training that helps strengthen healthcare systems, and empower health workers. All of these programs provide a model for replication throughout the developing world to create a more efficient and effective health workforce, and allow for a healthier future.