Decentralization and Demand for Improved Services Underscore the Urgent Need for Leadership and Management Capacity
What Was the Program?
The Challenge. The Government of Nepal (GON) is committed to political reform. It is decentralizing authority in the development sector to the district level on a pilot basis in 12 of 75 of the country’s districts. To successfully meet these goals, effective leadership and management are critical for staff to carry out their new roles and responsibilities at the district level. The Results-Oriented Leadership Development Program (ROLDP) has begun to build this capacity.
The Intervention. Based on proven leadership and management development approaches implemented by MSH, ROLDP was conducted by the National Health Training Centre (NHTC) of the Ministry of Health and Population (MOHP) with technical assistance from the Leadership, Management and Sustainability (LMS) Program/Nepal, Adventist Development and Relief Agency (ADRA)/Nepal, and the Institute of Cultural Affairs (ICA)/Nepal in three districts — Banke, Jhapa, and Rupandehi. The Program began in April 2006 with a Leadership Dialogue involving national level stakeholders from the GON, USAID, and other donors. This was followed by four workshops and supplementary coaching visits in each of the three pilot districts until December, 2006. ROLDP engaged a broad cross-section of government and NGO staff at the district level, including managers from health, water, sanitation, women in development, education, and local government councils. A total of 31 teams from district government offices and NGOs participated. During the four workshops and follow-up coaching visits, the teams worked with facilitators to identify and develop short-term projects that addressed real-life challenges they faced in their daily work environments. The teams were led through a process of forming a vision for their projects, defining their challenges, developing commitment within their teams and their larger organizations to carry out prioritized action plans, and implement the action plans to achieve desired results over a period of 7 months through December 2006. To build sustainability and scale-up following the end of LMS assistance, ROLDP trained, mentored and supported a cadre of local facilitators to conduct the workshops and provide coaching. Of the original 31 teams, three organizations (two government and one NGO) dropped out of the program before the workshops were completed.
What Did the Program Achieve?
Appropriateness, Acceptability, and Effectiveness of ROLDP. Teams that participated in the Evaluation Workshops were very receptive to ROLDP. They reported that the Program differed from other leadership and management programs in its use of training materials, facilitation methods, discussions on ways to identify problems, identifying challenges, and finding solutions. They rated the following aspects of the program highly: materials and tools; facilitation methods; participatory approach, coaching and follow-up; ROLDP’s use of practical, real-life examples; and facilitator feedback which helped teams achieve their desired results. Participants noted that the duration of the workshops was short, with too many subjects covered in too little time. Some experienced language difficulties (English words and phrases were not understood by all participants) and case studies used should be from Nepal. Some participants experienced difficulty participating fully in the workshops due to their normal work, and enrolled participants who were not present at the first and second workshops had difficulty understanding and participating in the succeeding two workshops. Finally, participants recommended that the period of implementation of actions plans should be for one year.
“ROLDP gave me the insight and skills needed to implement a program.”
—Participant from the Women’s Development Office, Jhapa
Application and Use of Leadership and Management Concepts, Tools, and Skills. Participants had good recollection of ROLDP concepts, principles, and tools including: root cause analysis, stakeholder analysis, giving feedback, and the eight practices of leading and managing. More than 80% of participants in the Evaluation Workshops could remember more than five leadership and management concepts. Participants are continuing to apply what they learned at work and in their personal lives. For example, when developing and implementing work plans, to improve work office environment, to better scan, focus and plan, to conduct results-oriented meetings, and to measure results more effectively.
Results Achieved and Benefits. Participants reported positive changes in their work environments, with staff beginning to “perceive themselves as their own leaders, respecting their own work and the contributions of their colleagues.” Reporting and communication skills have greatly improved as evidenced by the quality of project reports submitted to the evaluator and participant interactions during the Evaluation Workshops. The evaluator also found that “Teams are better equipped to deal with challenges and prioritize actions.”
There was a marked change in the work environment in teams’ respective home organizations. Scores from the reapplication of the WCA improved. For example, the WCA score of UNESCO Club in Banke district rose from 3.92 to 4.33. Nearly all interviewees said that they are more committed and better equipped to lead and achieve results. Almost all (>90%) of the teams that participated in the Evaluation Workshops achieved the desirable results of their projects within the seven-month time frame for implementation.
Examples of Results Achieved (April – December 2006)
Scale-up and Sustainability Potential. Participants felt that ROLDP supports decentralization by empowering the grassroots level with leadership and management skills. They recommended that ROLDP be replicated in other districts and continue to include health and non-health sectors, VDCs, and schools. They felt that ROLDP helps improve the quality of services, identify resources, and develop a team spirit.
Since the pilot phase was completed, ROLDP has already been replicated independent of LMS. For example, UNESCO Club/Banke and NAMUNA of Rupandehi have used leadership and management concepts to conduct trainings at the community level. ADRA/Nepal has used ROLDP concepts in its trainings and proposed ROLDP in project bids.
At the request of the NHTC, key findings of the evaluation were summarized in a bilingual booklet. Results of the evaluation were presented at a Dissemination Seminar for GON officials and other key stakeholders organized by the NHTC with assistance from USAID/Nepal, LMS, ADRA/Nepal, and ICA/Nepal on 22 March 2007.
What Was the Purpose of the Evaluation?
The NHTC requested an external evaluation to determine if pilot ROLDP activities had achieved concrete results, to formulate recommendations for replication of the Program in additional districts, and to help it decide whether ROLDP should be integrated into the national health system’s decentralization plan. The evaluation addressed: the appropriateness and acceptability of ROLDP for the participants; effectiveness of the program methodology and delivery; participants’ use of leadership and management concepts and tools; results achieved by the teams and benefits of the program; and potential for scale-up and sustainability.
Methodology: The NHTC formed an Evaluation Steering Committee to provide guidance for the evaluation. Committee members included the NHTC Director and other NHTC staff as well as representatives from NHTC, MOHP, LMS, ADRA/Nepal, and the Nepal Family Health Program (NFHP), the USAID bilateral. The external evaluator reviewed program documents and participant evaluations of the workshops, and then developed guidelines and tools for conducting the evaluation: criteria for participant selection; questionnaires for group interviews and interviews with chiefs of home organizations in districts; and a checklist for field observations. All materials were approved by the Evaluation Steering Committee. The evaluator organized one-day Evaluation Workshops in each district. A total of 43 participants from 18 of the 28 teams completed the questionnaire, and then presented their achievements, success stories, best practices, lessons learned, and the impact of ROLDP on their work and lives. Each Evaluation Workshop became an opportunity for teams to continue to learn from one another. Following each workshop, the evaluator interviewed nine of the home office chiefs. The evaluator also reviewed pre- and post- results of the administration of MSH’s Work Climate Assessment (WCA) tool.
Limitations of the evaluation cited by the evaluator included: the exercise was conducted in March 2007 not long after the end of ROLDP; and baseline and/or current results data were not available for review from 3 of the 28 teams that completed the program.
Current status of ROLDP. With assistance from LMS in developing training modules, ROLDP has been integrated into the new decentralization training program offered by the NHTC. A Training of Trainers for regional trainers was conducted in March 2007 in two new districts to pilot test the curriculum at district and health facility levels. LMS, ADRA and ICA are collaborating with the NHTC in the delivery of the program. Following the conclusion of this pilot test the NHTC intends to scale up the decentralization “hand-over” training approaches to maximize sustainability at the local levels. LMS pilot activities and curriculum development will serve as a foundation for these mainstreaming and scale-up activities.