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Empowering Leaders Throughout Mozambique's Health Sector
The Mozambican Ministry of Health (MOH) used a new approach to improve service
delivery over the past two yearsgiving workers at all levels of the health
sector a chance to offer solutions to issues ranging from budget details to
equipment sterilization. Though such issues don't usually inspire an outpouring
of enthusiasm or creativity from employees, MOH managers have recently seen
just such a response from their staff.
The MOH approach has been shaped by a management and leadership
process called MOSTambique, which was rolled out as a part of a program that
MOH staff refer to broadly as "REPARE" (REalistic, REsponsible, PArticipatory).
MOSTambique has a history of success in the countrythe process was first
introduced by Management Sciences for Health (MSH) several years ago under
the USAID-funded Family Planning Management Development Project (1995-2000).
The Mozambican MOH has built on that initial experience with MSH and MOSTambique
under the USAID-funded Management and Leadership for Health Sector Support
Program (M&L/HSS, 2003-2005).
"This Management and Leadership Program has brought about a change here.
Not by introducing new technical skills or funding, but by helping us to
look objectively at our behavior and creating an open environment to discuss
our goals and problems."
-Staff Member from the Central Ministry of Health in Mozambique
At the final presentation of the MOSTambique team workplans for
the Department of Finance at the Ministry of Health, one program participant
stood shyly at the front of the room, waiting for her colleagues' attention.
Judite Mutemba had explained earlier that afternoon, "Lots of people work with
numbers all day, but to know the why of those numbers is what will keep someone
working." For Judite and her accounting group, the final product of the MOSTambique
process is a new budget and workplan for the central ministry. She said that
at the end of MOSTambique, the budget number that her group produced actually
made her proud. Judite pointed at the spreadsheet cell containing the total
budget allocation for the central ministry for the year. "I look at this and
think, that is me, I put that number there!"
Judite's enthusiasm was echoed by her peers. Fellow accounting
staff said that the new management and leadership techniques introduced through
the MOSTambique process had provided the opportunity to express their ideas
and feel responsible for group accomplishments; many said plainly that MOST
had changed the way they thought about their jobs. MOSTambique is a process
that brings together all staff, from department directors to the cleaning crew,
to identify organizational problems and devise solutions. The MOSTambique process
helps health sector groups develop sound business practices and incorporates
the principle that teamwork and good communication create organizational efficiency.
Because MOST is based on staff participation, the process develops leaders
at all levels; under MOST, all staff contribute uniquely to team goals. MOSTambique
helps teams answer the questions: What are our goals? What is impeding our
progress toward achieving those goals? How will we work as a team to reach
our objectives? Health sector efficiency is especially important for a country
like Mozambique, where the MOH must create health policy with very limited
resources and a lack of trained health professionals. The MOH staff in the
capital city of Maputo report that MOSTambique has prompted new communication
among managers and employees. Most importantly, program participants from all
levels say that the MOSTambique process has inspired the staff at the central
ministry to a new sense of individual commitment to Mozambique's health issues.
This process, they say, has prompted them to evaluate how their actions have
a direct impact on client services.
Judite was personally so inspired by MOSTambique that her enthusiasm
found a creative outlet. As she stood in front of the assembled group at the
final meeting, she began to sing the song she had prepared about the MOSTambique
experience, entitled 'Hymn of the Financial Department.' She started, "The
financial team is here / to be leaders in managing / the resources that improve
/ the health of Mozambicans!"
The Portuguese tune was catchy, and Judite built up steam as
she sang. By the time she hit the last stanza, she was swaying and waving her
arms. She finished to a burst of applause from her surprised colleagues and
impressed program facilitators from the Mozambican MOH and MSH, all of whom
requested copies of the song. Several in the audience became Judite's backup
singers at subsequent performances of the tune.
Imutemba, one member of the maintenance crew that manages facilities
for Judite's department, described his participation in the MOSTambique process. "Our
work before was very structuredpeople were used to following orders, and
not accustomed at all to analyzing their tasks or identifying weaknesses, especially
not asking for help." With MOSTambique, staff from various departments within
the MOH were asked to evaluate their work climate and name their greatest challenges.
Program participants said that the process was an uphill battle at first, especially
for many managers, who were not used to such a participatory process. Months
after the MOSTambique process began, one manager from the central ministry
admitted, "The idea of more than one leader was not appealing to me when we
first began to work with MSH and the Management and Leadership Program. Certainly
we had no history of open communication here." She glanced up sheepishly. "I
thought, What is the use of this? We need strong leaders to guide us, not a
lot of competing ideas. But after participating here, I have learned that it
is quite important to stop and listen to people, to make sure that everyone
knows where the department is headed and why." At this point the manager grinned, "I
was an autocrat!"
"The MOSTambique process helped us to gather opinions from
those that were each doing a little piece of the work here at the Central
Ministry of Health. We have gathered our ideas and focused on group goals,
each person has contributed and sees his value within our work."
-Manager from the Central Ministry of Health in Mozambique
Managers at the Central Ministry report that they became convinced
of the usefulness of MOSTambique's participatory approach to management challenges
once they began to hear from their staff about how to improve the ministry's
performance. "We began to see that solutions to our problems lived inside the
minds of our employees herethis leadership program and the MOSTambique process
helped us access those solutions and fit them all together," explained one
manager. "This program has not solved all of our problems, clearly we still
have to achieve that. But it has helped us create a process that has made our
business better," said another manager from the Department of Administration
at the MOH. "We are now strategic in our approach to the country's health problems,
and each staff member here has helped create our plans to make the Ministry
run better and be responsive to national health needs."
"I learned that everyone in the directorate has the capability to plan.
We didn't need a group of experts to plan for us; we simply needed support
to be able to face our challenges."
-Staff Member from the Central Ministry of Health in Mozambique
MOST - Management and Organizational Sustainability Tool
MOST is a structured, participatory process that allows organizations to assess
their own management performance, develop a concrete action plan for improvement,
and carry out their plan. Management Sciences for Health developed MOST after
years of experience helping public- and private-sector organizations manage
their programs to provide high-quality services under complex and changing
conditions. MSH has successfully implemented MOST in many countries under the
USAID-funded Management and Leadership Program (2000-2005) and the earlier
FPMD II Program (1995-2000).
For more information about Management Sciences for Health,
please visit: www.msh.org.
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