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 years—giving 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 country—the 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 structured—people 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 here—this 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

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