Online discussion transcript:

Gerald Kimber White: Hello and salaam!

Welcome to the interactive chat discussion of today's Seeds of Success premiere.

I will be your moderator for the discussion and for the next 30 minutes, you will be able to ask questions of health care staff that appeared in "Seeds of Success" and of those responsible for the success of the Leadership Development Program in Aswan, Egypt.

Our panelists today include:

• Dr. Morsy Mansour - Founder of the Leadership Development Program in Aswan, Egypt
  
  
• Dr. Joan Galer - Team Leader, Leadership Development, LMS
  
  
• Dr. Abdo El Swasy - Consultant of Obstetrics & Gynecology, Kom Ombo Central Hospital
  
  
• Dr. Mohamed Sorour, Director of Family Planning, Aswan Governorate
  
  
• Dr. Angreed Edward Bolis - Director, Maternal and Child Health Center, Kom Ombo
  
  
• Jasmin Boshra Abdollah - Nurse, Maternal and Child Health Center, Kom Ombo

At this time, I would like to invite you to post your questions for our panelists.

Peter Braitsch: Great job, everyone!  Do you have a plan to extend leadership development to other governorates?

Joan Galer: Hello everybody from Joan.  We are waiting to hear from Dr. Abdo and Dr. Morsy about plans to extend this program. Let me thank all who helped to make this program a success -- too many mention here. But so many people who contributed to its success.

We also want to hear other people's comments about the video. What did you think?

Morsy Mansour: Yes, we already transferred the program through other CAs to many Governorates in Egypt, Now the MOH is trying to transfer it by the Ministry's resources.

Jean François Saint Sauveur: What motivated you to start such a program in Aswan?

Joan Galer: Again, I will let Dr. Abdo and Dr. Morsy answer this question (they are conferring now in Arabic about the answer!)

What I know is that they had tried many programs in the past, and still something was missing from the health system - they say there was a "missing piece".  This piece turned about to be leadership which can empower the commitment of all in the system.

Abdo Alswasy: The main motivation that there is a lack in management skills at a district's level. And there were many health challenges.

Morsy Mansour: This was the missed piece in the Health system, there are a lot of challenges and lack of managers who can lead the teams in the frontline to produce results.

Jean François Saint Sauveur: The video was very good and we congratulate the team for sharing their experience.  Which types of incentives did you use to get the staff involved at the beginning?

Joan Galer: The incentives were few in the beginning. There were workshops and team meetings that were sponsored by MSH and the MOHP. But after the initial pilot, all funding ended and the participants chose to continue the program.  Their challenge in the beginning of the self-funded program was how to involve people when there were no incentives other than their own commitment to produce results.  Dr. Abdo and his team were committed to see them through this initial challenge.  Their success is measured by 185 health facility teams and 35 facilitators, all who did this without any "incentives" other than internal motivation.

Morsy Mansour: We promised them that they can make a difference. We trusted them and we valued them.

Abdo Alswasy: No incentives, i.e., no monetary support. But there was a spiritual support of course and that motivated us.

Mubarak Shah: Dear Facilitators of the ASWAN LMS programme. I am very much pleased with the results you indicated in your programme. Can you tell me what was the key criteria for selection of the first group of facilitators of the LMS programme in ASWAN?  thanks Dr.Mubarak from Afghanistan.

Joan Galer: The first group of facilitators came from the most active participants in the original program. They chose themselves! But after that, when they launched the program on their own, they found a way to identify the most active participants to be future facilitators.  These included doctors, nurses, lab technicians and outreach workers.  All who showed a commitment to sharing and teaching leadership were involved.

Stephen Redding: In many countries we work in, leadership is hampered by underinvestment in the health system.  This results in poorly paid health workers who link motivation to adequate pay.  Is this an issue in Aswan?  If so, how do you overcome it?

Joan Galer: We know that people need to be paid adequately. This is a basic human need. But we are often faced with situations where there is a lack of motivation, due to other factors, including poor management and leadership.  What we have discovered in Aswan is the amount of human potential there is in the system when it is untapped by good leadership.  The resources we found in Aswan were the human resource of commitment, innovation, creativity and love of their community. These resources enabled the health indicators to improve. The people were enabled to improve the systems and learn to advocate for the unmet needs.

Abdo Alswasy: Let people see the success and the achievements by themselves, and this was the most leading principle in our work. We made the adobe that success by themselves.

Morsy Mansour: This program creates the commitment among the participants, the challenge Model, starting by the shared dream and moving step by step to work on their own challenge is the cause main cause for the commitment for better results.

Mubarak Shah: What were the main factors that kept the health care staff committed?

Joan Galer: This is an excellent question. What enables commitment - this is the overall question that leadership addresses! And one that must be answered by all who want to achieve results in difficult conditions.  We have learned that when people are led well, that is they are involved in identifying their own challenges and focusing to achieve a measurable result... when they are aligned and mobilized, and inspired to keep going - then they can become committed.  This is the core of the leadership program.

Abdo Alswasy: We think that people were lacking something that they found in the leadership programme"from Dr. Angred"

Morsy Mansour: That they own the challenge and they work together to find ways, using the M&L practices

Jean François Saint Sauveur: So there was a commitment from the director and openness to have a management style and a structure that would make time for the team meeting and value their inputs. How important do you think the leadership of the manager of the facility is in the first moments? Can you see the difference in facilities with not so much support from management?

Joan Galer: Our view of leadership is that it must come from all levels in order to create an effective organization.  Of course we need leadership at the top, but the program focused on all levels, and sometimes, even when the top doesn't see yet the need, the lower levels can show improved results and commitment. We know that in Aswan it was the district level that led this effort in the beginning. I will let Dr. Abdo comment on the facility level.

Morsy Mansour: The difference is the shifts from the individual work to the team work, from the scattered activities without clear direction and purpose to focusing on results.

Abdo Alswasy: Managerial support is very important, but still low level training of leadership get results that motivate a higher level directors to support the program.

Gerald Kimber White: We are coming to the end of our 30 minutes, but we still have many questions that have been sent in.  As such, we are going to extend our discussion an additional 30 minutes.

If you have to leave the discussion at this time, however, we thank you for your time with us and ask that you please take a moment to click on and respond to our brief survey in the upper right hand side of the chat window to let us know about your experience at today's premiere.

And now, back to our discussion.

Lo Bro: It is exciting to see the amazing progress you have made in Aswan. Watching the film, I wondered if there was resistance to teaching leadership skills to women. Their work is obviously now making a big difference!

Joan Galer: This is a good question. There was no resistance to teaching leadership skills to women.  In fact there was a concern in the MOHP that women health workers begin to speak up.  And did they ever! At the beginning of the program mainly men spoke, by the end, women were leading the teams and the facilities and making the presentations. It was a big shift in gender equality.

Abdo Alswasy: I had no resistance in teaching women on LDP.

Morsy Mansour: Female nurses were important part of the teams and they get empowered by this LDP. There was no resistance at all from the beginning.

Mubarak Shah: What are the key success factors to the people that encouraged them to adopt and use the services and participate in the programme?

Joan Galer: The key success factors were a set of principles, focused on trusting and empowering the people, and not coming in as an expert.  The principles include learning leadership over time, focusing on real health results, and encouraging participation of all in the design and implementation of the program. It works when it is owned by the people who are most affected. It works when outsiders get out of it and empower the people to lead it themselves.

Jean François Saint Sauveur: How is the community's (users) reaction to these leadership changes? Has there been any assessment of their satisfaction?

Abdo Alswasy: We made a questionnaire before and after LDP about client's satisfaction. We found a great difference in the answers in the second questionnaire "Dr. Angreed".

Morsy Mansour: We did client exit interview as pre and post. The results were great improvement in the client service provider relationship, and more satisfaction regarding the service provision.

Mubarak Shah: I liked the statement made by Ms. Galer. We need to bring women in front. I think if we create suitable opportunity for women to participate, they will increase their effort for success and will benefit from the programme. The question is how the ASWAN project was able to get the confidence of the families of women?

Joan Galer: Mubarak Shah, our dear friend from Afghanistan, we are happy to have you in this conversation, as we know you are committed to your people there.  Dr. Abdo is preparing his answer now.

Abdo Alswasy: These women were basically health workers. They liked to be with their leaders and we found a great help from there families to share with the activities of LDP.

Joan Galer: Mubarak Shah, we are so happy to have you join us from Afghanistan, where we know you and your colleagues are working so hard to for the health of the people there. We will let Dr. Abdo answer this question. I have observed that families support the women when they find out how important their role is in the communities and their health care.

Jean François Saint Sauveur: Were people afraid of setting "difficult" challenges or they felt no fear in setting challenges because they knew they would have support from their colleagues?

Abdo Alswasy: The challenge is a challenge. But of course the support from our colleagues made it more easy to handle these challenges.

Joan Galer: That's a good question. We found that being in a team really helped people to set and face challenges. And, that over time people were able to take on increasingly difficult challenges. For example, now they are taking on decreasing maternal mortality across the governorate by 30%.  At first they took on increasing the family planning coverage, but they  began to see how this added up to big results.

Morsy Mansour: They faced the challenge as a team, they get support from their managers and their colleagues, and feedback from their clients, supervisors and from other teams.

Jean François Saint Sauveur: I agree with the learning leadership part, but the problems with civil servants is not limited to the leadership factor, in developing countries, we know that there are other factors like work security, fair renumeration, bad management style, etc. that can keep staff from performing efficiently...

Joan Galer: Bad management style is part of leadership. Work security and fair renumeration are often issues that are out of the sphere of control of most people.  What can we work on? What can we do?  All of these systemic issues need to be worked, but we have found that committed people are key to all of these challenges.

Mubarak Shah: Despite the success of the LMS programme, I am still wondering how we can be successful in a resource constrained situation?  Can you provide 2-3 key success factors in that situation?

Joan Galer: I will let Dr. Abdo and Dr. Morsy address this, as they have spent their entire careers in these situations. What are the key factors ?

Abdo Alswasy: First, depend on local trainer. Second, depend on your own resources. Thirdly, start with real challenges. Fourth, team work.

Morsy Mansour: As we mentioned that committed people always find ways to achieve their desired result. They can overcome the obstacles in the way. They cam mobilize the needed resources around them and in the community.

Joan Galer: Wow, good answer. Local trainers, depend on their own resources, start with real challenges, teamwork.  I can only echo this exact list.

Kristina Kennedy: In the video you mentioned that Afghanistan was involved in the LDP.  What are they doing and have they seen any results yet?

Joan Galer: I think this is a question that our Afghan colleagues, Dr. Mubarak, and Dr. Ali will need to answer. We have seen them boldly begin a leadership program, using only the resources at hand and spread it to 7 provinces.  They are already beginning to see results from this in the health indicators.  We are proud of them, and will do everything we can to support them now and in the future.

Mubarak Shah: What was the role of religious values in inspiring the people for serving the poor and who initially took the lead in introducing religious values in the programme?   In our country it is better to involve a religious leader to inspire others on religious basis for support.

Abdo Alswasy: We already involved religious men with us especially in matters like family planning "Dr. Angreed"

Abdul Ali Waris: We piloted the LDP in Afghanistan and believe it or not our front line Health Worker achieved the result higher than they set.

Morsy Mansour: Yes Dr. Mubarak, I did that, I linked the M&L principles and values to our Islamic Values and to the practices of the greatest leader in the world "Mohamed(s)".

Mubarak Shah: In the provinces where we introduce the LMS programme we had seen good results. Significant increase in the level of immunization of children and women, increase in the number of women participating in the MCH services and better response of MOPH team at provincial level to the immediate challenges of coordination of efforts with stake holders. We do have figures that could be provided to show results and that can be provided later.

Morsy Mansour: We should enroll them as  stockholders, we need their support and we need them to work with us to achieve our goals.

Abdo Alswasy: Great, go on you will get a great achievement.

Gerald Kimber White: We need to end this wonderful discussion and let our panelists go home/get back to improving health care!

We appreciate everyone's questions and thank our panelists for taking the time to respond so thoughtfully.

Do our panelists have any last comments they would like to make?

We apologize that several of you have posted questions that we haven't had time to answer.  Your questions will be forwarded to the panelists and their responses will be posted with the questions on the LMS Aswan video Web site as they are ready.

If you have any questions that you did not have a chance to post during today's discussion, please e-mail them to LDP@msh.org and the appropriate panelist(s) will respond to you.

As you are leaving today, please take a moment to click on and respond to our brief survey in the upper right hand side of the chat window to let us know about your experience at today's premiere.  This will enable us to make our next premiere even better!

The survey is the "Evaluation" link in the upper right.

Joan Galer: We want to thank all for participating. But mostly we want to thank the people of Aswan and Afghanistan, and other places, who are so committed and who are working so hard to deliver quality health services to their people.  They do this from deep love.  While we appreciate this technology and its ability to communicate this message more broadly, we remember that everyday people are working in under resourced health facilities, providing the best possible services to their clients, in the most difficult of conditions. For this we are thankful, for this we are grateful for this we owe all of our acknowledgement.  Please, Dr. Abdo and Dr. Morsy pass on all of our acknowledgements to the people involved. Send them our love and our thanks.

Gerald Kimber White: Thank you, Joan, and thank you everyone.  Have a nice day.

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