Local Ownership and Empowerment

Local Ownership and Empowerment

This blog post was co-written with Morsi Mansour. Joan and Morsi are leadership development specialists in MSH’s Center for Leadership and Management.

Students in Uganda participate in a leadership development program during their pre-service medical training.

How can we empower the front-line of health care managers and service providers in the developing world?

As the Leadership, Management and Sustainability Program completes five years, it is an important moment to sum up what we have learned about sustainability and to reflect on how local ownership of health improvement programs supports sustainability of health results.

To explore this question of local ownership, we ask participants in leadership programs to reflect on how they are approaching development work. There are two models of development, each providing important contributions: the Expert Model and the Empowerment Model. While both are valid, it is important to know which model to use when doing development work.

The Expert Model is useful when someone, either outside or inside a difficult situation, already knows the solution to the problem. That person can fix the problem by transferring his or her knowledge to others involved in the situation to solve the problem. The goal is to fix a problem for which there is a known solution---closing the gap between what is known and done.

The Empowerment Model is useful when the solution to the problem is complex and requires adaptation of thinking and behavior. A result can only be achieved by empowering those involved to create a vision of a better future and participate in a process of designing actions that lead towards that vision.

We understand that people are able to change their behavior when they can envision a better future that they are committed to, participate in the analysis of the obstacles, and take part in planning activities to achieve results. This enables sustainable change in a way that cannot be achieved by telling simply people behaviors they should adopt.

When considering the two approaches to development it is important to be clear about the kind of situation you are facing. Often problems that appear to require only an Expert Model, like installing an effective drug supply chain in a national ministry of health, turn out to be complex in the number of stakeholders and the adaptation of thinking and behavior that must occur.

The Empowerment Model asks: who will set the goals and analyze the conditions, who does the planning and sets the indicators, who supervises the activities, who monitors the progress, and finally, who is responsible and takes credit for the results? In short---how is local ownership developed and supported?

Leadership and management development programs use an Empowerment Model of development. They enable health managers and service providers on the front line---including primary care physicians, nurses, and outreach workers---to create a compelling shared vision of the future they want to create. When health providers learn how to align and mobilize their teams and stakeholders to fully utilize local resources to face their challenges and achieve desired results, they build a climate and processes for sustainable performance improvement.

When local leaders see that an empowering process produces results, and can be easily transferred using their own resources, they find inspiration and support in situations that were previously filled with despair.

When technical assistance is seen as a resource, but not the source, of improved health, local leaders are free to be that source---to choose, use, 'own,' and sustain necessary improvements in health care for their communities.

To support locally-owned processes, we recommend the following:

  • Empower front-line managers and their teams with leading and managing practices and a simple process for improving service results that is based on their shared vision of the health outcomes they want to achieve.
  • Ensure that program materials, processes, and tools are simple and easy to adapt and contribute to measurable results that people care about.
  • Support managers and their teams in playing the lead role in facilitating, adapting, and sustaining health improvement programs.
  • Provide constructive feedback and support throughout the process to enable people to succeed in achieving the desired results.