Strong Women Leaders Build Strong Health Systems

Strong Women Leaders Build Strong Health Systems

Mary Ngari, Permanent Secretary of Kenya’s Ministry of Medical Services, addresses conference attendees on the first day. {Photo credit: MSH.}Photo credit: MSH.

In my 35 years working in international health, I've attended hundreds of conferences. Conferences are opportunities to exchange ideas and form connections. They’re often fascinating. But once in a while a conference itself can be a pivotal moment. A great example was last year’s International AIDS Conference, the first held in the United States after President Obama finally lifted the longstanding travel ban against foreigners living with HIV.

And recently, people around MSH, and throughout the Kenya health community, have been talking about Kenya’s First National Conference on Health Leadership, Management and Governance. The conference, held in early February, demonstrated the long-term vision of the Kenyans who are running the health system. These leaders understand the value of training health systems managers to improve the quality of service delivery.

The conference got great coverage in Kenya’s Daily Nation. An article highlighted Dr. Anisa Omar, a provincial health director who has received training through a leadership project in Kenya funded by USAID and implemented by MSH. Dr. Omar isn't just a great example of a dedicated health leader, but of a prominent female health leader in Kenya. Recognizing and empowering women health leaders is an MSH priority.

Soon after this successful conference, I discussed these topics with Sylvia Vriesendorp, MSH’s technical lead on leadership.

Jonathan Quick: Sylvia, I've been excited to hear about Kenya’s recent conference on Health Leadership, Management and Governance. A conference like this one would have been unthinkable 20 years ago. It wasn't just outside consultants and development staff. It was a cross-section of the Kenyan health system. About half of the audience was from health centers across the country. And most of the speakers were senior government officials. They were talking about how they want their health system to run. That’s a great sign of country ownership.

Sylvia Vriesendorp: That’s right. They were talking about improving access to leadership and management training for health officials. Doctors come out of medical school thinking their job is just diagnosing and curing people, but many get assigned to manage health facilities and lead teams of health professionals. There will be older nurses and midwives in the facility who've been there 20 years, and this brand-new young doctor is supposed to manage them. Nothing in their medical training prepared them for that. They need help, and many have asked us for it.

JQ: At the conference they announced the establishment of the Kenya Institute of Health Systems Management. What a great idea. It’ll provide the training you’re talking about, and it doesn't rely on a single source of funding or support. Once it’s in place, the funding can come from everywhere. That’s sustainable development. And it’s not just embedded in the Ministry of Health or a big city like Nairobi— they've partnered to use facilities spread out across the country. I noticed there were a number of women speakers at the conference, but I understand that in general, there’s a gender disparity among health systems managers in Kenya.

SV: There are women in top-level positions, so the glass ceiling is broken here and there. But, it’s mostly doctors who end up running facilities and district-level systems. There’s this assumption that doctors can do it better. And while there are more and more women physicians, the profession is still predominantly male in Kenya, as in many countries. So it’s mostly men who get into those leadership positions and have the chance to move up. Closing this gap is important to the long-term success of the system. There may be system-wide solutions, like tapping more nurses to run facilities, and making it easier for women to have responsible positions and a family at the same time. These kinds of changes can help to increase gender parity and improve quality. After all, management skills are completely different from clinical expertise, and what you want is the best managers. Still, there are many women in leadership roles in the Kenyan health system and elsewhere. So a key step is to support the women who are already in those positions.  When they’re successful, everyone wins: the people who need good health services, the professionals who need good policies and working conditions, and the next generation of women leaders who need good role models. It’s an area where organizations like MSH can help.

JQ: How do you do that as an advisor?

SV: You operationalize the concepts of managing and leading—the approach we honed and published in Managers Who Lead—and add a personal coaching element. When you’re coaching leaders, like we've done in the Leadership, Management and Sustainability Program, a core principle is to listen to people and help them develop their own talents. Sometimes we shadowed senior leaders, to better understand their reality. All leaders come to the top with their own strengths and weaknesses, resources and baggage. As advisors we have to understand how these help and hinder in the busy-ness of everyday work. Otherwise we cannot connect. And without connection advice is not very useful.

JQ: That reminds me of the Tao of Leadership, the inspiration for MSH’s work. It says, “Start with what they have. Build on what they know.” It’s also how we approach country ownership. No two health systems are alike, so what works in one place may not be the right fit in another. The solution will be unique to the setting.

SV: And advisors can help by offering a fresh set of eyes. People in any setting can fall into an unhealthy dynamic without realizing it. For example, you sometimes find a vicious cycle in which female staff perceive themselves to lack power, so they become passive. But that’s perceived by their managers as lacking initiative, so they aren’t given more responsibility, and the cycle continues. An outsider can point that out. When I was working in Afghanistan on the Tech-Serve Project, the female staff wanted to celebrate International Women’s Day. At first they were just asking the question and looking at me. But then we discussed how they could do it themselves by working together. They created a vision for the day, designed it and divided the tasks so everyone was responsible for a piece. The group leader wasn’t the most senior woman, and she hadn’t led a meeting before. But with a few principles about leading a productive meeting in her pocket she prepared herself and brought a lot of energy to the group. They used the resources at their disposal—including me—and they pulled it off. If an outside advisor had just come in and said, “You should celebrate Women’s Day,” then it would have lasted only as long as the advisor was around. But now MSH Kabul celebrates Women’s Day every year. Those staffers learned that they were quite strong, working together. They harnessed the power of networks.

JQ: That sounds like the story from the Leadership Development Program, training nurses in Upper Egypt (PDF). The nurses are mostly women. A group of them used the training to advocate for a series of improvements at their hospital for patients with disabilities. I recall vividly the sense of confidence that one nurse supervisor, Samiha Badawi, shared with the MSH trainer. She said, “As a leader, I changed the way I interact with the nurses I work with. We are the ones who need to make the changes happen. We became one together and we all feel empowered.” That training improved clinical outcomes as well. One team got documentation of vital signs all the way to 100%, up from 20%. And another team cut its facility’s surgical infection rate by more than half.

SV: There’s no doubt that the right kind of coaching and access to proven tools, even very simple ones, can help people who never considered themselves a leader, to take that first hesitant step forward. They discover they can align people and mobilize energies to create the futures they want together. I’m very optimistic about this. We've seen it happen over and over again.

JQ:  I wholeheartedly agree.  And I would add that we've been especially gratified to see how strong women leaders in health have used this coaching to help build strong health systems---health systems that lead to healthy mothers, children and entire healthy families.

Jonathan D. Quick, MD, MPH, is president and chief executive officer of Management Sciences for Health. Dr. Quick has worked in international health since 1978. He is a family physician and public health management specialist. Sylvia Vriesendorp is technical lead on leadership at MSH, and a management and leadership and development specialist.

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