On March 26, 2009, the Global Health Council held a Partners Forum entitled, Health Leadership and Management by Design — Not Default. Effective leadership and skilled management in the health sector are essential to improve health outcomes and sustain improvements. Health systems are now on everyone’s mind, but actually what to do to improve health systems is unclear.
- Dr. Delanyo Dovlo, World Health Organization (WHO)
- Dr. Harrison Kiambati, Kenya Ministry of Medical Services
- Dr. Rebecca Weintraub, Harvard Global Health Delivery
- Mr. Joseph Dwyer, Management Sciences for Health (MSH)
Moderator: Dr. Susan Higman, Director of Research & Analysis, Global Health Council
This discussion focused on critical issues surrounding leadership and management in health, country studies by WHO and Kenya’s National Health Leadership and Management Strategy. The discussion highlighted findings from Kenya’s Leadership and Management Assessment, MSH Worldwide surveys and work from Harvard’s Global Health Delivery Program as well as recommendations for policy changes.
The speakers were asked to address the following three questions:
- What are the critical issues related to health leadership and management?
- What experiences or findings do you have in relation to this issue?
- What recommendations would you make for policy change?
Dr. Devlo highlighted the lack of emphasis on management and the need for reform. He also identified two policy recommendations.
- Managers are not seen as a category, the way that practitioners are.
- It is unclear what training is effective.
- Support systems are not integral to the health system, but rather are fragmented (often through disease-specific programs).
- Management is often influenced by the political environment and there may be little accountability.
- Some aspects of management may work in a given setting, but others do not and there is not a clear understanding of why.
- There are few well-established mechanisms for measuring management performance.
- Recommendation 1: The management strategy needs to be articulated as part of the national plan.
- Recommendation 2: Managers need to be recognized as key players in the health system; management needs to be recognized as an integral component of the health system.
Dr. Kiambati discussed how the recent trends in decreased maternal mortality in Kenya led to an assessment of which parts of the system worked well and which elements are weak.
- Leadership and management are often forgotten in putting together health systems plans, particularly when the approach highlights individual components.
- Most leaders in clinical medicine are expected to be managers — thus, losing a physician and gaining an untrained manager.
- Training is needed prior to entering the job market.
- There is a “critical mass” of trained managers needed to move the institution to a better future, but this may be too expensive to be sustainable in some institutions.
- Recommendation 1: Medical training institutions at all levels need to incorporate leadership and management training.
- Recommendation 2: Efforts are needed to get the Ministers of Health to incorporate leadership and management training in their plans.
Dr. Weintraub focused on the role of academia.
- Training does not prepare people for the scope and breadth of management work.
- The process needs to look at multiple levels — from interviews with high level officials to following what happens when the first $1 hits the clinic.
- Supply chain systems need to be considered and are often left out of the equation; better evaluation and management are critical.
- Recommendation 1: There is a need for better performance metrics to see how best to intervene in a system and for coordination between the number and type of form per patient for each institution.
- Recommendation 2: Global health needs to look at how other industries have approached and assessed leadership and management issues.
Mr. Dwyer raised several issues related to the operation of health systems.
- With more money pouring into health systems, how can we best ues the money?
- There is wide agreement that most health systems are broken — or, alternatively, have not been established.
- The default approach is to develop ad hoc systems rather than systematic systems.
- Who are the people that make health systems work? Do they have what they need?
- Myth 1: Those in management positions want to do this — actually, most are drafted into these positions.
- Myth 2: Doctors and nurses are automatically good managers — actually some are and some are not; all need training.
- Myth 3: Health systems are mechanical things that can be fixed — actually, health systems are complex and are composed of individuals with strengths and weakness.
- Recommendation 1: We need to fill management positions with people who are interested in serving in those roles.
- Recommendation 2: We need to support pre-clinical management training, including mentorship programs.
- Recommendation 3: We need to adopt policies to engage non-clinical staff in management activities and roles.
- Recommendation 4: We need to more visibly demonstrate support for the cadre of managers.