Closing the Gap between the Leadership and Management Demands of Public Health Systems and how Stude

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Closing the Gap between the Leadership and
Management Demands of Public Health Systems and
how Students are Prepared to Face Them
Joseph Dwyer Management Sciences for Health
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Why Invest in SPH Roles Leadership Mgmt?

• There are millions of needless deaths each year
• YET
• Technically and medically, we know what to do to
• Billions of dollars are now available for
  healthcare

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Binding Constraint using whats known

• A binding constraint in applying what is known,
  is lack of effective management for achieving the
  MDGs in Health.
• 
  WHO Working Paper 8

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The Need Student Voices- UNAN, Nicaragua

• When we graduate, we will be sent to a health
  post.
• I think the biggest challenge will be how to
  manage the people and the resources.
• I have never managed anything, therefore I do
  not know how to manage, and I could commit
  errors.

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Voice from A Current Health Manager

• I remember I was appointed a District Medical
  Officer in 1993, straight from a surgery ward as
  a medical officer, and within a week I had to
  manage an entire district It was a totally
  different world. I learned more by accident
• Dr. Willis Akwahle, Director of the Malaria
  Control Program, Kenya

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Challenges for Health Managers - examples
Management of funding streams
Ambiguity of health sector reform
Pressure for rapid scale up
Shifting from input-focus to results-focus
Reducing corruption and misuse of funds
Resource constraints
Gaps in quality and access
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Skills they say they need - examples
Time management
Team work and decision making
Resource management (human financial)
Monitoring and evaluation (owning the data)
Results focus - quality client satisfaction
Forming partnerships
Motivating staff
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Perceived Level of Preparedness on Being Asked to
Manage - Kenya Assessment Apr June 08
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The Need Student Voices- MUHAS, Tanzania

• The problem is how we are taught about
  management. We learn by copying and pasting. Not
  really hands-on.
• We have to go there to see how they do things.
• Then we can talk about it with staff and see
  what can be improved.

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What is being done - State of Ceara, Brazil

• School of Public Health Leads Shifts from
• Accidentally trained to intentionally developed
• Patronage to merit
• Activity driven to results-focused
• Passive and unmotivated to active and committed
  staff

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Leadership Management Make a Difference

• Increase from 50 to 80 of women enrolled in
  prenatal programs
• IMR declined from 26/1000 to 11/1000
• From 2001 2005 Ceara

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Makerere Faculty of Medicine

• Medical students are required to complete
  practical, field-based training in leadership and
  management

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Pre-Service Education in Nicaragua

• Universidad Nacional Autonoma de Nicaragua (UNAN)
  
• Centro de Investigaciones y Estudios de la Salud
  (CIES)
• 7 module leadership and management curriculum for
  fifth year medical students
• 175 students 3 faculty using the new curriculum

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Lessons Learned from Nicaragua

• Curriculum development works best when done in
  teams using action-based approaches with
  participation,
• It is possible to introduce a Management and
  Leadership course into a traditional academic
  school curriculum
• They can also institutionalize this, and scale it
  up in a sustainable manner.
• (UNAN evaluation 2009).

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Student Focus Groups

• Students want more preparation in leadership and
  management and they want this preparation to be
  practical and action oriented
• Faculty champion is needed
• Internet access is often challenging- need to
  reach out through various means, including print

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Intense Interest and Synergy between Countries

• Makerere School of Public Health in Uganda and
  Muhimbili School of Public Health in Tanzania
  developed short course.
• Pre service and in service training of health
  managers and public health professionals
• Supported by LIPHEA with MSH input

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Health Ministers Resolution Role of PHA, SPH

• Members develop nationally owned L M programs
• Institutionalize induction and orientation
  programmes for all health managers
• ECSA Work with member States to develop training
  programs in L M - toward continuous career
  development
• Explore credentialing of health leaders/managers
  via partnerships with training institutions.

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Preparing the next generation

• If we do not prepare public health students for
  the realities they will face after graduation, we
  are like the little Dutch boy holding back the
  crisis by sticking our fingers in the dike.

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Are Leadership and Management the Same?

• Leading and Managing - Enabling teams to set
  direction, face challenges and achieve results
•  
• Leading Mobilizing others to envision and
  realize a better future
•  
• Managing - Planning and using resources
  efficiently to produce intended results
•  

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Proven Action-Learning Pathways Exist
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The Need Student Voices- UNAN, Nicaragua

• When we finish school and go for our social
  service for two years, we will be sent as doctors
  to health posts. We will not only be doctors but
  also managers.
• We will have to make HR and financial decisions.
  It will just be us with a nurse or two. There
  may not even be telephones, so we will have to
  make decisions.

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L/M by Design on LeaderNet
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Faculty Voice

• The many projects generated by new funding
  opportunities, e.g., the Global Fund, are
  exposing weaknesses in existing systems, from
  monitoring and evaluation to internal controls.
  We need leadership and management development if
  the full benefits of these initiatives are to be
  achieved.
• Dr. Samuel Luboga,
• Was Deputy Dean of Makerere University in Uganda

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Get on the map!