Leadership Can Be Learned: A Conversation with Xavier Alterescu on MSH's Approach to Leadership Development

Xavier Alterescu, LLM, MIB, PhD (ABD). {Photo credit: MSH.}Photo credit: MSH.

Inspired leadership, sound management and transparent governance are critical components of any organization facing complex challenges and pressure to produce sustainable results. These three components are especially important to health service organizations and their managers, leaders and governors.

MSH spoke with Xavier Alterescu, LLM, MIB, PhD (ABD), deputy director of the USAID-funded Leadership, Management and Governance (LMG) Project, on MSH's approach to building leaders for improving health.

Can you provide background on MSH's role with leadership development for health?

MSH has been contributing to this field for over 25 years. In the early 1990’s, MSH, through its Center for Leadership and Management (CLM), started addressing leadership as a fundamental building block of the health system through the USAID-funded Management and Leadership (M&L) Project, and later through the Leadership, Management, and Sustainability (LMS) Project. We are now including governance as a priority, through LMG. So, as you can see, the focus on leadership development, and what goes with that, evolves over time.

What is MSH's approach to building leadership in the health sector?

Leadership can be learned. MSH’s approach links leadership, management, and governance of public and civil society organizations, as well as public/private partnerships, to achieve sustainability of accessible, quality health services and programs. We build leaders for better health.

MSH also applies a specific approach to leadership development that focuses on developing collective leaders through action learning. It's not about a notion of charismatic, personal leadership. We help promote practices that can be applied for building collective leadership, and leadership for results. Team leadership is developed through action (or experiential) learning. You could think of it in contrast to competency-based learning: action learning is about practical learning, versus academic learning.

Our model of leadership encompasses four practices: scanning, focusing, mobilizing, and inspiring, through which individuals and teams can enhance their capacity to recognize trends and opportunities in the environment, as well as stakeholders’ needs and priorities and the risks that affect their organization; create a common vision of a desired future, identify critical challenges; and determine key priorities for action; facilitate teamwork and unite stakeholders around an inspiring vision; and, last but not least; provide support, inspire trust, and be an example of innovation and learning.

We've developed a set of flagship tools that help build on this model of leadership. The Leadership Development Program, or LDP, has been one of MSH's flagship programs. We also use a Virtual Leadership Development Program (VLDP) that enables the program to occur over the internet. Now, MSH and partners are developing "LDP Plus", which renews and enhances the importance of gender, governance, and monitoring & evaluation.

We are also currently piloting a Senior Leadership Program (SLP) which is a 12-month program provided in partnership with Yale University, with country ownership in mind, The SLP equips senior decision-makers to develop effective governance practices, strategic problem solving and team facilitation and mentoring techniques, to help them face their health system challenges. In building collective leadership, we help people strengthen their capacity to align their teams and stakeholders around identified goals and we help build people's capacity to inspire!

What is next on the horizon for the field of leadership?

I see three exciting aspects of building leadership for health going forward: gender, governance at the lower levels of the health system, and building organizational capacity for networking.

The first aspect for moving forward is building the role of women leaders and governors, from villages to parliaments. Women are approximately half of the global population, and gender is central to the US government’s Global Health Initiative principles, so focusing on gender is key to future leadership work. One very effective strategy to promote the empowerment of women in the health system and in society at large can be the development of and support to specific coaching and mentoring programs and networks for women as decision-makers at all levels.

The second key is governance at the decentralized level. Multi-stakeholder engagement and decision-making at the community, district or provincial levels is a very current and real challenge for health systems. Improving leadership, management, and governance requires putting mechanisms in place that make decentralization effective, accountable, & successful. Provincial level decentralization involves health authorities, community organizations, civil society organizations---the whole network with shared interest. 

The new frontier here is the enhancement of the capacity to ensure appropriate participation of key stakeholders, including marginalized voices, by giving them a place in formal decision-making structures, by providing effective and reliable conflict resolution mechanisms, and helping build consensus on achieving a shared direction. This requires the development of the capacity to establish governing bodies (such as committees, councils, or boards) and mechanisms for joint action at whole-of-government and whole-of-society levels.

Third, while it's not new, per se, networking at the organizational level is another key to the future. While strengthening the capacity to lead, how do you ensure that organizations can manage their networks? That is the leadership of networks. MSH can build on its unique experience in leadership development to increase its organizational capacity to leverage networks through a systematized approach.

Can you say more about this capacity building of networks or give an example?

Among other examples, MSH has been helping through the USAID-funded MEASURE Evaluation Project, to pilot a Network Development Program (NDP) for organizations providing family planning, reproductive health (FP/RH) and HIV/AIDS services in a district of Addis Ababa, Ethiopia. This experience has clearly outlined the need to "think differently" when it comes to network development. Organizational networks require a different approach and a different kind of leadership.

A network leader has to push people beyond comfort zones. You have to see yourself as a leader in learning. The most important resource is not money, its information & knowledge. So, for example, in Ethiopia, where MEASURE Evaluation has piloted the NDP, the facilitators always needed to be aware of the external environment, seeking ways to adapt accordingly. I have mentioned that the four practices of leadership are: scanning, focusing, mobilizing, and inspiring. One key for a network leader is being able to mobilize all network members. You need to be able to identify the power source and mobilize it. You also need to have the capacity to foster trust.

Over six months, we guided participants through a lot of trust-building exercises and we constantly and regularly reinforced this aspect through games and role plays. Only once you have achieved a minimum level of trust and information exchanged between members, inside and outside of the formal NDP sessions, can you really start focusing on actual challenges facing the network.

In the case of the NDP in Ethiopia, the challenge was to foster the integration of FP/RH and HIV/AIDS at the district level, and an initial desired measurable result was the increase of the referral density between network members by 50% in 6 months. The results of this approach have been measured (the desired increase in the referral density was achieved) by the University of North Carolina through an Organizational Network Analysis and will be available soon.

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