THE MDI: STRENGTHENING THE MANAGEMENT CAPACITY OF HEALTH CARE SYSTEMS IN SUB-SAHARAN AFRICA

Rene Kiamba, Johnson & Johnson

5TH BIENNIAL ACHAP CONFERENCE

Challenges Facing African Health Care Organizations

  National and international health care reforms   Decentralization of decision-making authority   Acute shortage of resources including human

resources, drugs, other supplies and equipment   Emerging health problems & growing disease

burden   Increased demand for health services due to

population growth

The Capacity to Satisfy Health Care Needs Depends on Many Inputs

Effective Management is Essential and Frequently Overlooked

Scarcity Makes Good Management Essential

Managers in Health Care Are Seldom Trained in Management

“Acumen in clinical, surgical and community health care skills has been mistakenly equated with acumen in leadership and

management. It is therefore not surprising to find that the ‘Nurse of the Year’ is promoted to District Nursing Officer or the ‘Top

Cardiothoracic Surgeon’ is made Chief Medical Officer (Director of Medical Services) or even Permanent Secretary (Principal

Secretary) in the Ministry of Health, without any prior exposure, training and experience in leadership and management.”

Peter Ngatia: Director of Capacity Building, AMREF

(In a recent study conducted by AMREF and Management Sciences for Health (MSH) ( July 2009) in Kenya, Ethiopia, Tanzania and Uganda, 75% of managers vested with the responsibility of Human Resource Management (HRM) indicated that they lacked the knowledge and skills to

carry out the numerous HR management functions.)

Management Programs Can Have Health Outcomes   In Guinea, vaccination coverage improved from

  0% in December 2002 to 47% in June 2003 and to   62% in December 2003.   This was attributed to skills gained in scanning, mobilizing, resolving

conflict, negotiating and delegating acquired from a management program. (Rachel & Goldenberg, 2003)

  MSH implemented a four-month leadership development program for staff from health facilities, focusing on the capacity of managers to produce organizational results. The outcomes were a   12% decline in infant mortality   35% decline in maternal mortality and a   17% increase in contraceptive prevalence in a span of five (5) years.

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MDI Partners

•  The Anderson School at The University of California at Los Angles

•  African Medical and Research Foundation

•  Funding: Johnson & Johnson •  Implementing partners

•  University of Cape Town Graduate School of Business

•  Ghana Institute of Management and Public Administration (GIMPA)

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Key Features of the MDI

  Seven day intensive emersion in management

  Taught mainly by local faculty

  Emphasis on practical, relevant management competencies

  Examples drawn from relevant clinical and geographic context

  Understanding of health issues by program designers and faculty

  Focus on country’s unique implementation of national health priorities

  Deployment of an action plan – called the Community Health Improvement Plan (CHIP)

  Commitment to follow-on consultation and technical assistance during project implementation

  Measurement of the impact of the program

The Mission of the MDI (Until 2011)

The mission of the MDI is to increase the scope, scale and quality of care, treatment, prevention and support services for people and their families living with HIV/AIDS by enhancing the management skills of executive directors and leaders of African organizations devoted to providing these services.

MDI Participants

138

45

40

39

32

31

25

19

16

15

12

10

6

6

6

4

4

4

3

0 20 40 60 80 100 120 140 160

Kenya

Ghana

Nigeria

Swaziland

Uganda

Tanzania

Ethiopia

Somalia

Sudan & So. Sudan

Cameroon

South Africa

Zambia

Liberia

Sierra Leone

Malawi

Burkino Faso

Lesotho

Zimbabwe

D.R.Congo

472 Graduates through 2010

14 Intakes through 2010

Most MDI Faculty Are From African Business Schools

The MDI Curriculum Builds Relevant Management Competencies

Organizational Challenges, Issues &

Obstacles

Requisite Management Competencies: Skills, Knowledge & Abilities

Curriculum

Planning

Monitoring & Evaluation

Financial Management

Health IT

Operations Management

Social Marketing

Leadership

Health Economics

Curriculum of the MDI

  The uses for monitoring and evaluation

  Types of evaluation; Formative. Monitoring & Summative

  Conceptual framework design: Health and economic outcomes

  Outputs, Outcomes and Impact

  Evaluation approaches

  Creating a vision and mission for the unit or organization

  Identifying unmet community health needs

  Creating solutions to solving service gaps

  Setting goals and objectives

  Action planning   Budgeting

Organizational Planning Monitoring & Evaluation

Curriculum of the MDI

  Collecting information related to health care operations, clinical outcomes and financial systems

  Data analysis to support strategic, operational and financial decision making

  Data analysis for program and services evaluations

  Data reporting for accountability

  Using computers and the Internet to collect, analyze and report information

Financial Management Health Information Systems

  Concepts of finance and accounting in health services

  Activity-based costing   Budgeting & Forecasting   Differences between financial

(external) and managerial (internal) accounting

  Recording and reporting non-cash contributions (human resources, medication, supplies)

  Compliance with funding agencies reporting requirements

Curriculum of the MDI

  Social marketing versus commercial marketing: differences and similarities

  Achieving desired outcomes and impact: social change at individual, group and society levels

  Determining the target group for intervention (demographics/geographic segmentation and selection)

  Developing & implementing a social marketing mix and strategy

  Determining marketing effectiveness

  Aligning operations with corporate mission and strategy

  The importance of operations management in scaling up services

  Service process analysis and re-engineering for effective operations management

  Service-process matrix model for ensuring, effectiveness, efficiency and productivity in service delivery

  Service demand forecasting, inventory systems and policies

Operations Management Social Marketing

Curriculum of the MDI

  Creating alignment   Motivation and goal setting   Human resources management   Leading and managing change   Leading versus managing   Teamwork and collaboration   Negotiation   Effective communication

  Economic tools for allocating scarce financial resources across competing health programs

  The identification of economic outcomes from health care interventions and programs

  Creating maximum value from health care expenditures

  Comparative effectiveness analysis

  Cost effectiveness analysis   Cost benefit analysis

Health Economics Leadership

Outputs

Our Graduates Organizational Effectiveness

Intermediate

Outcomes

Short Term

Management Skills

Impact

More and Better Care

Evaluating the MDI

From the Head of the Kenya Medical Society

“The Management Development Institute (MDI) Program helped me realize that we were not as efficient as we

initially thought we were. It helped me improve my time management skills both on an individual and

organizational level. Better management of time has helped us to cope with congestion by streamlining the internal systems and operational flow at the clinic”.

Dr. Andrew Suleh, Medical Director of Mbagathi District Hospital, Nairobi

Sample Community Health Improvement Projects

  Coptic Hope Center for Infectious Diseases – Coptic Hospital: “Expanding its HIV/AIDS program to three new locations while maintaining high-quality services”

  HEAL Africa: North Kivu, Democratic Republic of the Congo: “PMTCT Program in Rutshuru and Kayna”

  John Snow International, Nairobi, Kenya: “JSI Making Medical Injections Safer”

  Kenyatta National Hospital, Nairobi, Kenya: “Establishment of a Community-Based PMTCT Adherence System”

  Konkola Copper Mines Community Medicine, Chingola, Zambia: “KCM Door-to-Door Family Health Check”

  Liverpool VCT, Care and Treatment, Nairobi, Kenya: “LVCT Strategic Planning for Sustainability”

  Nairobi Women’s Hospital, Nairobi, Kenya: “Capacity Building in Management of Sexual and Gender-Based Violence for Health Workers”

  Tutulane AIDS Organization, Chitipa District, Northern Region, Malawi: “ART and Nutrition Access Improvement for PLWHIV in Underserved Traditional Authorities”

New Directions for the MDI in 2011

  Emphasis on broad health systems rather than being disease-specific

  To include chronic care in addition to communicable diseases

  Multi-person teams to work collectively on   National health care priorities   NGO partners invited to participate with MOH

personnel

Management Is Essential to New Emphasis in Global Health

  Through the Global Health Initiative (GHI) the United States will invest $63 billion over six years to help partner countries improve health outcomes through strengthened health systems

  “Sustainable programs must be country-owned and country-driven.” (PEPFAR)

Sustainability & Systems Strengthening

The Redesigned MDI Reflects PEPFAR’S Goals   Transition from an emergency response to promotion of

sustainable country programs.   Strengthen partner government capacity to lead the

response to this epidemic and other health demands.   Expand prevention, care, and treatment in both

concentrated and generalized epidemics.   Integrate and coordinate HIV/AIDS programs with

broader global health and development programs to maximize impact on health systems.

  Invest in innovation and operations research to evaluate impact, improve service delivery and maximize outcomes.

The U.S. President's Emergency Plan for AIDS Relief: Five-Year Strategy (December 2009)

The 2011 MDI Focuses on Addressing National Health Care Priorities

The Structure of the Community Improvement Project (CHIP)Process: Problem Identification to Evaluating the Solution

MISSION OR NATIONAL HEALTH

PRIORITY

POSSIBLE PROBLEM

POSSIBLE PROBLEM

SELECTED PROBLEM

POSSIBLE SOLUTION

POSSIBLE SOLUTION

OPTIMAL SOLUTION

GOAL

PROCESS & OUTCOME OBJECTIVES

ACTION PLAN EVALUATION

Pilot MDI in Swaziland

ELIMINATION OF MTCT

TRANSPORT UNRELIABLE SUPPLIES OF DRUGS

LACK OF TRAINING IN PMTCT

SOLUTION: TRAINING OF

NURSES

GOAL: COMPREHENSIVE PMTCT TRAINING

PROCESS OBJECTIVE: 2 NURSES PER

FACILITY BY 2011

OUTCOME OBJECTIVE: 90% OF

HIV+ WOMEN INITIATED ON AZT

ACTION PLAN

Implementing the WHO PMTCT Guidelines in

Swaziland

Three 2011 MDI Locations

East Africa

Southern Africa

West Africa

  Nairobi, Kenya: May 2 – 7

  Cape Town, South Africa: August 21 – 27

  Accra, Ghana: August 28 – September 3

To apply: http://www.anderson.ucla.edu/mdi.xml

Candidates

We are seeking teams or clusters of individuals having related leadership responsibilities for implementing specific national health care programs and priorities in their country or region.

  Director   Project Manager   Program Manager   Executive director   Program coordinator   Public health coordinator   Regional coordinator   Chief Medical officer   Chief nurse   Medical superintendent   Country coordinator

Questions