Since 2001, the Management and Leadership Program (M&L) has been working in partnership with public and private organizations to improve health care in Nicaragua. Our technical assistance has involved close coordination with the USAID mission and with nongovernmental organizations (NGOs) including Nicasalud (the Nicaragua NGO Health Network), Profamilia, and the Prosalud Project, the former USAID bilateral program. The Ministry of Health, the Social Security Institute, the Ministry of the Family and the Ministry of Education are among M&L’s client organizations. The Harvard School of Public Health supports components of the project.

• leadership development;
   
• improved management effectiveness;
   
• scale-up of proven health care and educational approaches;
   
• financial management;
   
• regulatory and social sector reform;
   
• community health and leadership;
   
• support for Profamilia, a provider of family planning/reproductive health care.

Leadership development of health managers at the central, regional, municipal levels
Leadership development in Nicaragua fits into an overall effort to reform and modernize the nation’s health care system at every level. In 2003, 50 high level managers, including the heads of every department and the secretary general, completed the M&L leadership development program. The Minister of Health, Dr. Jose Antonio Alvarado, who attended several leadership development sessions, presented a letter congratulating the M&L team on its success in training municipalities to improve health services.

Members of this top management team reported that the skills they acquired in the leadership development program enabled them to more effectively face challenges. For example, they immediately applied their new knowledge to address the real-life challenge of developing and gaining approval for a new National Health Plan. The director of Human Resource Management used the method learned in the negotiation workshop to come to agreement about new regulations with the health workers union. These leaders—typically operating in crisis mode, divided into factions, and subject to the political winds—said they had coalesced as a group, improved communication, and matured, a development that participants considered one of the most significant achievements of the program.

More than 1,700 officials and staff from eight of the 17 regions of the country have also completed M&L’s leadership development program; 114 MOH staff have been trained as facilitators to deliver the program; the program was accepted by the MOH as the official leadership development training curriculum throughout the country in 2004.

At the local level, health managers have applied the leadership development curriculum to develop action plans to improve organizational climate in order to raise staff motivation and performance. A positive organizational climate is expected to have a positive impact on health services quality and utilization. Some municipalities reported increases in family planning coverage and immunizations that they attributed to better team work and a common shared vision. Client satisfaction at health centers went up. And the majority of municipalities that participated in M&L leadership development programs improved their overall organizational climate as measured by the survey of organizational climate developed by the Pan American Health Organization (PAHO).

National scale-up of fully functional service delivery points (FFSDP)
M&L is helping Nicaragua go nation-wide with proven health care delivery concepts and tools. Fully functional service delivery points ( FFSDP) is an approach pioneered by MSH that improves the quality of health care by ensuring that essential services are available at the point of client-provider interaction (service delivery point). M&L supported the institutional adaptation and nation-wide application of key FFSDP approaches developed under the MSH Prosalud Project.

Financial management of key institutions
M&L is providing support to strengthen the financial management of key Nicaragua institutions, including the Ministry of Health, National Social Security Institute (INSS), and the Nicaragua Health NGO Network (Nicasalud). This support has involved working with departmental health teams to develop budgets and improve internal financial controls; assisting the INSS in costing out services delivered to insured clients; developing business planning expertise among the staff of six NGOs in the Nicasalud NGO network; and developing mechanisms for the efficient and equitable distribution of resources within regions.

Regulatory and social sector reform
M&L has helped the Ministry of Health in the development of a number of elements of health reform—a new service delivery model, an approach to re-engineering of systems, the evaluation of current health policies, and the development of the national health plan. M&L is also assisting the MOH and the Ministry of the Family in reviewing their regulatory frameworks and developing a plans to strengthen them in preparation for increased private sector participation.

Community health and leadership
M&L is providing support to improve the leadership capabilities of community leaders, representatives from mayors’ offices, religious leaders, and local NGOs in isolated rural regions, with the aim of strengthening social capital. Community distribution of contraceptives, which was initiated in a few communities under the guidance of Prosalud, became a national norm when it was approved by the Minister of Health in January of 2004.

Support for family planning and reproductive health
M&L has been providing technical assistance to Profamilia, Nicaragua’s affiliate of the International Planned Parenthood Federation (IPPF). With M&L support, Profamilia re-engineered its administration, financial and information systems; strengthened prognostic models for its 17 health clinics; and addressed the critical management issue of leadership transition.