Advances in Pediatrics 58 (2011) 11–26

ADVANCES IN PEDIATRICS

Developing Leadership in GlobalChild Health

Kevin Chan, MD, MPHa,b,*aDivision of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children,University of Toronto, 555 University Avenue, Toronto, Ontario, Canada M5G 1X8bMunk Centre for Global Studies, University of Toronto, Toronto, Ontario, Canada

Twenty years ago, when I (the author, K.C.) was a young medical student,a little girl asked the group of us who were working in rural Malawi,‘‘Why can you who have so much not help us who have so little?’’

Twenty years ago, the challenge was identifying health as an issue. I rememberspeaking at a meeting of leaders in Malawi in the late 1990s about the specter ofHIV/AIDS affecting both men and women, and was told that the disease wassomething seen only in Western countries.

Around the world, we have seen a large transformation occurring in the atti-tudes toward health, with a significant push made by governments and leadingphilanthropic organizations, such as the Bill and Melinda Gates Foundationand the One Foundation, led by the rock star Bono. These visible leadershave put global health into the conversation of important priorities, especiallyin developing countries.

Yet despite a 30% decline in childhood deaths around the world from 1990to 2009, the United Nations Children’s Emergency Fund (UNICEF) stillreports 8.1 million deaths in children under the age of 5 in 2009 [1]. Approx-imately 70% of these deaths are preventable by available knowledge and tech-nology [2]. Therefore, 5.5 million deaths in children can be prevented by whatwe know and have available to us. These simple questions still exist: Why dothese deaths occur when we know how to prevent them? How can we reducethe gap between our knowledge base and our actions leading to these poorhealth outcomes?

Obviously there is a large gap between what is known and what is done toimprove global child health. One of the issues is how do we make these solu-tions, visible, viable, and acted upon? The challenge is not just to review the

There are no disclosures of relevance to this study.

*Corresponding author. Division of Pediatric Emergency Medicine, Department ofPediatrics, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto,Ontario, Canada M5G 1X8. E-mail address: kevinjchan@aol.com

0065-3101/11/$ – see front matterdoi:10.1016/j.yapd.2011.03.015 � 2011 Elsevier Inc. All rights reserved.

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state of where global child health is, but to provide fresh, new insight intopossible solutions. The missing gap is something that is not discussed inmany medical or public health schools, but something we find in businessand management schools: leadership. My belief is that the major weakness isa lack of global child health leadership globally, nationally, and locally thatprohibits faster improvements in morbidity and mortality.

What is known about global child health leadership? The unfortunateanswer is: not very much.

This article looks at the realm of global child health leadership and examinesprior attempts to reduce mortality and morbidity. The philosophy and outlookat building global child health leadership currently being developed betweensub-Saharan Africa and the Hospital for Sick Children in Toronto is high-lighted. Examples are provided of concrete programs and efforts being workedupon to develop this global child health leadership capacity. The author hopesto inspire more participation in building global child health leadership.

First, a brief survey is given of global child health programs: Primary HealthCare, the Integrated Management of Childhood Illnesses, and MillenniumDevelopment Goal #4.

PRIMARY HEALTH CAREIn 1978, Primary Health Care (PHC) was launched at Alma Ata with theslogan ‘‘Health for All by the Year 2000’’ [3]. PHC aimed to create nationalhealth systems, based on the economic abilities of each country [4]. The type ofhealth care employees would be dependent on each country’s goals andresources available.

The specific Alma Ata declaration aimed to increase the participation ofcommunity members in the development of health care, and aimed to decen-tralize health care to individuals at a local level [3].

The key principles can be summarized as follows: (1) PHC aimed to promoteequity within health care; (2) community participation was paramount at alldecision-makingpoints; (3) preventionwashighlightedover cure; (4) available tech-nology should be used; (5) other sectors should be involved in health care (suchas education, agriculture and housing); (6) decentralization of decision-makingwas important; and (7) leadership was needed to achieve the goals of PHC [5].

Therefore, as far back as 1978 it was clear that global health leadership wasa basic requirement to achieving health for all people. However, although therewere programs to ‘‘train’’ health leaders, there was little systematic develop-ment that targeted national or local leaders effectively.

THE INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESSESIn the mid 1990s, the World Health Organization (WHO) and UNICEF adop-ted the Integrated Management of Childhood Illnesses (IMCI). IMCI builds onthe concept of PHC, using the community health worker (CHW) as the corner-stone of assessing a child’s well-being. If a sick child presents to the CHW, theCHW decides how to best treat a child, using a color-coded system with red

13DEVELOPING LEADERSHIP IN GLOBAL CHILD HEALTH

(danger), yellow (caution), or green (safe) to determine whether a child shouldbe managed at home or in hospital.

IMCI has other foci including improving the training of CHWs, strengtheningpreventive health care measures, and upgrading existing health care services. Itprovides a first-line approach to treating child health problems. AlthoughIMCI has been a standard of care, its proper adoption has been a challenge.

THE MILLENNIUM DEVELOPMENT GOAL #4: REDUCINGCHILD MORTALITYThe fourth Millennium Development Goal (MDG #4) is to reduce the under-5mortality rate by two-thirds from 1990 to 2015 [6]. We have seen the numberof children dying from developing countries decrease from 100 (1990) to 72(2008) deaths per 1000 live births, with only 10 of 67 countries with high childmortality on track to meet the MDG target [7]. The continuing challenge,however, has been the slow decline in childhood deaths in sub-Saharan Africa,with high fertility rates and a slow reduction in under-5 mortality rates (Fig. 1).

Other associated MDG #4 objectives include reducing the infant mortalityrate, and increasing the proportion of 1-year-old children immunized againstmeasles (Fig. 2).

There are obvious trends downward in the number of childhood deaths.There have been large falls in under-5 mortality rates across all areas of theworld, but because of high fertility rates, there has been little progress in overallnumbers of childhood deaths in sub-Saharan Africa [7].

Fig. 1. Mortality rate in children younger than 5 years by WHO region. (Reprinted fromwww.who.int/whosis/whostat/EN_WHS10_Part1.pdf, p. 13; copyright The World HealthOrganization; with permission.)

Fig. 2. Measles immunization coverage among 1-year-olds by WHO region. (Reprinted fromwww.who.int/whosis/whostat/EN_WHS10_Part1.pdf, p. 14; copyright The World HealthOrganization; with permission.)

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WHY ARE WE FAILING TO REDUCE CHILD DEATHS FASTER?As far back as David Morley’s classic textbook on global child health, PaediatricPriorities in the Developing World, there was widespread recognition that improve-ments in children’s health were not strictly rooted in medical answers [8]. Thechallenge is that many of the underlying root causes of child deaths are notsimple and straightforward medical causes that health professionals tackle ona daily basis. For example, poverty, poor female education, and poor waterand sanitation remain barriers to successfully reducing childhood mortality.

The challenge in children’s health is but one small portion of a government’slist of competing priorities. Child health competes with adult health; healthcompetes with other departments, such as defense, industry, education, transpor-tation, and agriculture for limited government resources. Improving children’shealth requires both technological improvements in tackling children’s diseases,and providing enough funding and resources to deliver proper services.

Regarding the solution to global child health mortality, the technical aspectsare not the problem as much as access to health care. For example, one areawhere there has been little reduction in global child mortality in the past decadehas been on perinatal mortality. The challenge remains in identifying motherswho will run into trouble, getting access to the right level of care, and ensuringthe quality of care once they arrive at the facility [9].

Our current global child health leaders continue to face a combination ofeconomic, policy and political challenges to improve health systems and health

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outcomes for children. In particular, a cadre of child health leaders who canadvocate for children and policy change should be developed in the existinghealth care system. Leveraging existing collaborative networks, such as theProgram for Global Pediatric Research, can bring together child health leadersfrom Africa and around the world to forward the global child health agenda [10].

It is with this in mind that the author now looks at leadership as an integralpart of developing global child health programs.

WHAT IS LEADERSHIP?There is great difficulty in defining what leadership is. Is it experience? Is itlogic? Is it vision? Pulitzer Prize winner James MacGregor Burns, in his influ-ential book Transforming Leadership, aptly states: ‘‘I have come to see leadershipnot only as a field of study but as a master discipline that illuminates some ofthe toughest problems of human needs and social change’’ [11]. The reality isthat leadership occurs at various levels, both from positions of power and fromindividuals at the grassroots level.

Leaders such as Gandhi in India, Mao Tse-Tung in China, and Alexanderthe Great are well-known leaders who helped transform countries and societies.The question is whether the intrinsic characteristics of an individual, the ‘‘GreatMan’’ theory proposed by Sidney Hook, ‘‘creates’’ leadership through thenatural intellect and strength of character [12]. Countervailing ideas suggestthat leadership may be a product of time and circumstances, and by decisionsmade at opportune times. This idea was championed by Karl Marx [13] andlater by the philosopher, Herbert Spencer [14]. In particular, Spencer champ-ioned the concept that complex influences were what created the conditionsby which leaders, through a Darwinian process, would succeed through thecreation of wealth and power. So the concept of a great leader was hypothe-sized either to be intrinsic to the leader oneself, or a concept dependent onthe circumstances and the situation. Thus, leadership can also occur at locallevels around specific issues that lead to direct activism, such as protectingwomen from being sexually exploited or by protecting a local park or forestfrom being harmed.

The development of the program for global child health leadership comesfrom a perspective that leadership qualities, characteristics, and traits can bemaximized, and specific situational opportunities identified to improve globalchild health.

Leadership begins with ‘‘vision’’: what is the purpose and goal we seek? Lead-ership provides purpose to an idea or goal. However, vision is insufficient.Leadership should bring components such as logic and pragmatic approachesthat can be performed in a systematic fashion. There are also some basic charac-teristics that are important for a leader to bring to the fore, such as integrity, adher-ence to principles and values, humility and respect for others, communication,and the ability to persuade people and demonstrate commitment to the vision.Experience often helps in leadership, but it may act as a barrier if preconceivednotions limit the capacity to invoke change.

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WHAT DOES LEADERSHIP IN GLOBAL CHILD HEALTH MEAN?Before 2000, global child health leadership was provided internationally byUNICEF and the WHO. There were many local champions of child health,but little systematic training of these leaders.

There are 3 fundamental components of global child health leadership. First,there must be recognition that children have increased morbidity and mortalityaround the world. Second, it is important to work out how to make theproblem a priority issue, facilitating resources and funding. Finally, it is impor-tant to identify the means and methods to address problems and resolve issues,and communicate how to effectively promote constructive change.

There are cross-cutting themes that exist no matter what level of health careprovider and leader is sought. These themes include: identification of problemsand issues; setting policy priorities and agendas; communication; teambuilding; managing conflict and change; understanding and interacting withthe political system; building health capacity; and conducting health systemplanning at the district, national, and international levels.

The goal of training global child health leaders is to develop a cadre of indi-viduals who can effect positive change and help shape policy within the existingand future health care systems. Leveraging on large-scale collaborativenetworks around the world can help advance the skills and agendas of globalchild health leaders. The aim is to create agents of change and advocates forchildren’s health issues.

WHAT DO WE KNOW ABOUT HEALTH LEADERSHIPIN DEVELOPING COUNTRIES?Although there is a broad recognition of the need to develop health leadership,there is very little information on systematic training for health leadership. Areview of PubMed and a Google search revealed the several global child healthleadership programs (Table 1) and global health leadership programs (Table 2).

There is a surprising paucity of concrete leadership training programs thathelp train global child health leaders. Most programs do not present an orga-nized approach to training leaders.

The hospital for sick children and developing a leadership programin global child health

In 2009, The Hospital for Sick Children was given a grant by the CanadianInternational Development Agency (CIDA) to develop a leadership programin global child health. The grant was to help developed leadership programsin global child health in 3 countries, namely Ghana, Ethiopia, and Tanzania,with very different leadership requirements. Ghana’s leadership programfocuses on pediatric nursing leaders; Ethiopia’s program focuses on buildingacademic leaders; and Tanzania’s leadership program focuses on developingmaternal and child health community leaders.

With these varying requirements, there exists a large challenge in finding acore set of values, skills, and principles to teach leaders.

Table 1Global child health leadership programs

Organization Program Name Description Internet Address

African Medical andResearch Foundation(AMREF)

Child Health A self-contained 16-unit course on how totake a sick child’s history, performphysical examinations, and ensure theproper management of a sick child

www.amref.org/info-centre/amref-courses-training-programmes/distance-education-programme

Johns Hopkins University Maternal and Child Health A set of training modules designed forsmall group to explore differentleadership concepts in a Maternal ChildHealth (MCH) context

www.jhsph.edu/wchpc/MCHLDS/index.html

Tanzanian Training Centerfor International Health(TTCIH)

Integrated Managementof Childhood Illnesses(IMCI)

This is an innovative software applicationto support IMCI. It is meant as a tool toadopt with IMCI guidelines at thenational and subnational levels

www.healthtraining.org/schools/ifakara.php#Crs4

USAID Global Health eLearningCenter

The eLearning Center provides Internet-based courses on a variety of healthtopics

www.globalhealthlearning.org/learnmore.cfm

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DEV

ELOPIN

GLEA

DERSH

IPIN

GLO

BALCHILD

HEA

LTH

Table 2Global health leadership programs

Organization Program Name Description Internet Address

Higher Education Alliancefor Leadership ThroughHealth (HEALTH)Alliance

Leadership Initiative for PublicHealth in East Africa(LIPHEA) Projects

Aims to strengthen the capacity of the MakerereSchool of Public Health (Uganda) and MuhimbiliUniversity College of Health Sciences (Tanzania)through effective public health leadership training

www.liphea.org

International Councilof Nurses (ICN)

Leadership for Change Program assists senior nurses to influence healthpolicy and decisions and to be effective leadersand managers

www.icn.ch/pillarsprograms/leadership-for-change

McGill University International Masters for HealthLeadership

Designed to act as a catalyst for developing anintegrated and sustainable approach to health

www.mcgill.ca/desautels/imhl

Open University The HEAT (Health Educationand Training) Program

Work-based training initiative with Web-basedhealth education resources

www.open-ac.uk/africa/HEAT_project.shtm

African Medical andResearch Foundation(AMREF)

Executive HealthcareManagement Program

Trainees will develop skill sets and leadershipqualities to create high-performing health careorganizations

sbs.ac.ke/index.php/programs/executive-programs/advanced-healthcare-management-program

Synergos Institute African Public HealthLeadership & SystemInnovation Initiative

Increases leadership effectiveness in a health careenvironment by cultivating managerial skills andaddressing the attitudes, values, and relationshipsthat drive behavior

www.synergos.org/partnerships/publichealthnamibia.htm

Johnson&Johnson Management DevelopmentInstitute (MDI)

Designed to enhance the management andleadership skills of healthcare leaders in familieswith HIV/AIDS

www.jnj.com/connect/caring/corporate-giving/healthcare-leadership/doctor-training

Management Science forHealth (MSH)

Leadership ManagementSystem and SustainabilityPrograms (LMS)

The program is intended to develop leaders andmanagers in family planning, reproductive health,HIV/AIDS, and health service delivery

www.msh.org/projects/lms

Management Science forHealth (MSH)

Virtual Leadership DevelopmentProgram (VLDP)

A combination of a general leadership program withCD-ROMs and workbooks with on-site teammeetings

www1.msh.org/projects/lms/ProgramAndTools/LeadingAndManaging/VLDP.cfm

Tanzania Training Centrefor International Health

Best Practices for MaternalSurvival in Sub-SaharanAfrica

This course is to strengthen nonphysician cliniciansincluding midwives to help reduce maternalmortality

www.healthtraining.org/schools/ifakara.php/Crs#4

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19DEVELOPING LEADERSHIP IN GLOBAL CHILD HEALTH

This section highlights some thought processes in developing a leadershipprogram in global child health. Although some steps seem basic, the combinationof these steps will help develop and enhance the skills of leaders to forward thechild health agenda. The basic modules in global child health are highlighted.

Identifying the scope of the problem

One of the first aspects of the training program is the need to develop basicconcepts and understanding of epidemiologic conditions on health, includingthe understanding of how to survey and collect data on health conditions foran area. Although the scope of the course does not outline the details of how tosurvey and collect mortality and morbidity data, the aim is to outline basic epide-miologic concepts for child health, including verbal autopsies to identify causes ofdeath; create and understand neonatal, infant, and under-5 mortality rates; iden-tify disease outbreaks, including proper water and sanitation sources; highlighthealth care access points to identify where populations can get primary,secondary, and tertiary levels of health care, including basic health practicessuch as immunization and maternal and perinatal health care; and identify thepopulation’s health care knowledge, understanding, and practices. The goal forthe trainee is not necessarily to conduct all of these surveys, but to understandhow to gather, organize, and understand information collected from the field,and to recognize gaps in knowledge and understanding in child health.

Identify personalities, motivations, and skills

The second module assesses a participant’s personality, sources of motivation,natural skills, and areas that may require development. The concept comes fromthe Meyer Briggs personality test, which is a standard assessment tool for manyleadership training courses [15]. Themodule aims to make participants appreciatedifferent personality types, how to work and communicate with different person-ality types, and how to use their natural skills and minimize potential conflicts.

1. Approach to People and Participation in Activities. Some people are quiteextroverted, whereas others are introverted. Descriptions of extrovertedpeople include being active, open, outward-focused, sociable, expressive,breadth, and liking variety; they enjoy acting with other people in the world.Descriptions of introverted people include being reflective, private, inward-focused, reserved, quiet, depth, and focused on tasks at hand; they tendto require ‘‘private’’ time to feel refreshed.

2. Approach to Processing Information. There are two major personality types:sensing and intuitive individuals. ‘‘Sensors’’ are individuals who are detail-oriented, practical, precise in directions, and focused on the present situation.These people trust what they perceive with their senses to be the truth and thustend to be ‘‘reality’’-based. The second group looks at the gestalt or biggerpicture to find patterns, using hunches and imagination, and tend to beforward-looking. These individuals also tend to look at amyriad of possibilitiesto try and find the optimal future.

3. Approach to Making Judgments and Decisions. The two major categoriesare thinking and feeling. Thinkers tend to be objective, logical, analytical,and evaluate cause and effect; they operate from core principles and apply

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logic in a formal, critical manner to come up with conclusions. Feelers tendto be subjective empathizers who stress personal relationships and values;they tend to enjoy harmony and avoid conflict.

4. Approach to Getting Things Done. The two major categories are judgingand perceiving. Judgers tend to like things in an organized, structuredfashion, and like to make deliberate, decisive, controlled plans. Perceiverslike to adapt to things as they experience them; they like to be spontaneousand wait for things to occur, and can manage ambiguity more easily.

Creating vision

In the first 2 modules the importance is established of collecting baseline infor-mation and understanding the situational context in developing programs byidentifying the scope of the problem, and providing an evaluation of the peoplewho will be working in the process. In this third module, the aim is to teachhow to create vision.

Vision is looking at the larger picture and imagining what can be achieved inthe future through enabling possibilities, and enlisting others to participate intheir own dreams through shared goals and aspirations. However, it is insuffi-cient to create vision without a means to achieving these aims.

Vision should take into account the aspirations and goals of each stakeholderto ensure that each stakeholder’s wishes are achieved, or to minimize opposi-tion to a project or proposal. It should also take into account reasonableshort-, medium-, or long-term frames to meet each stakeholder’s goals andclarify who is responsible for achieving each goal.

Vision should also stretch the goals of individual members, to take them outof comfort zones and push their capabilities.

In the context of global child health, the aim may be to develop a global childhealth program, to strengthen the overall health system to deliver a package ofgoods, or to promote collective advocacy to highlight a shortfall (such as peri-natal care) at the global level. Successful vision development, however, allowsas many stakeholders as possible to participate in the engagement process, andinvolves as many parties as possible in a concrete, focused objective that ismeasurable and achievable.

Communication

One of the most important skills to develop is the ability to communicate effec-tively with other team members, stakeholders, clients, and the public. Thereare various methods of communication including reflective listening, verbalcommunication through the media and press, and presentations such as video,social media, and Powerpoint. There are also important nonverbal communi-cation clues to observe and act upon.

It is important that roles are clearly defined, yet sufficiently flexible to adapt tochanging circumstances. It is also important that the environment created enablesmembers tomaximize their potential and to come upwith new and creative ideas.

Communication should allow honest views, opinions, and feelings. In manycultures this may not be the norm, and may take time to develop. However,

21DEVELOPING LEADERSHIP IN GLOBAL CHILD HEALTH

there should be means by which team members can communicate their feelingsif open forums do not allow their opinions to be heard.

The other important aspect of communication is providing feedback. Thekey in providing feedback is to be as objective as possible, and to be positiveand constructive. Often feedback is seen as being highly critical; however,when provided in a positive, constructive way, it may help enhance and ener-gize fellow team members.

Team building

Leadership requires followers to help deliver the message and to perform thetasks that help make the vision reality [16].

To build a successful team, several things are important. The values andvision should be aligned for all team members, so that they can work togethereffectively. Roles should be clearly defined and a supportive environmentcreated. Meetings and gatherings should be focused, with clear implementationand outcome goals. Decisions should be discussed and agreed upon by themembers of the team, allowing for dissention, but ultimately agreeing ona common pathway to achieve the vision. There should be a clear timelineand pathway for deliverables, with focused, measurable achievements. Indi-vidual goals should challenge each individual team member to achieve to thebest of their ability.

One of the other important aspects is for constant feedback and examination ofways to improve how effectively the team works together. There should also bean analysis by which teammembers look at how their working relationship inter-acts with their fellow teammembers and with other people that may be involvedwith their organization (including patients, clients, suppliers, and the public).

Some characteristics of successful teams include strong individual initiative,including team members making suggestions, and volunteering to solve prob-lems; finding creative ways to resolve disputes, and developing consensus oncomplex issues; open communication between team members, including antic-ipating and communicating about potential problems; allowing members tolead at different times depending on the task to be completed; frequent socialexchange and little hesitation in expressing concerns; maintaining calm evenin the face of significant problems; and positive constructive encouragementand honest feedback throughout the process.

Edgar Schein highlighted how leaders convey to their teams, their beliefs,values, and assumptions through 6 primary mechanisms [17]:

1. What they pay attention to, measure, and control on a regular basis2. How they react to critical incidents and organizational crises3. How resources are allocated4. By role modeling, teaching, and coaching5. How they provide reward and status6. How recruitment, selection, promotion, or removal of team members occurs.

Team building is one of the most difficult aspects to implement, especially inhierarchical societies, but it is helpful to build consensus and sustainability in

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projects. Without broader buy-in, projects can build up and dissipate relativelyquickly; however, with buy-in, people get broader-based ownership of an ideaand sustain a program over time.

Managing conflict and change

Edgar Schein, one of the great management thinkers of the twentieth century,in his influential book Organizational Culture and Leadership, highlighted theintrinsic biases that leaders bring to their organizations by imposing theirbeliefs, values, and assumptions on other members of the group [17].

Conflict occurs in all manners of leadership. One of the key aspects in ad-dressing conflict is to effectively listen to the problem at hand before attemptingto find a resolution to the problem. If the problem is between team members,open communication is necessary between both sides to resolve any conflict. Ifthe problem is between leaders and their team it is necessary to clearly identifythe problem, seek resolution, or to find amicable ways to part.

Change is an inevitable part of organizations. Change occurs throughvarious stages: (1) introduction and growth; (2) maturity; and (3) decline.During each of these stages, organizations may face different types of chal-lenges to change and adopt different approaches.

Often change cannot be anticipated, especially by external outside forces[18]. However, if change is anticipated, one should try to be proactive andfix things ahead of time. Positive change can occur when recognition of oppor-tunities occur. To recognize these opportunities, it is important to look atresource capabilities but also to interact with customers, suppliers, teammembers, and the public to increase awareness of existing opportunities.Change should happen incrementally and be clearly understood by all keystakeholders. It does not have to be quick and sweeping. Rapid changes canlead to confusion, and a lack of clarity of mission and purpose. Change shouldalso attempt to provide the best outcomes for any given resources, and shouldfocus on the present situation and not only look to the future. If change fails toaddress current issues, change is unlikely to be sustainable.

The politics of health

Health and health care remain one of the most contentious areas of any govern-ment. The first part of this module focuses on recognizing how health competeswith other sectors of government for priority standing. This approach includesboth financial and public policy support at the various government levelsand how this translates into both fiscal and nonfiscal resources developed byhealth.

The second part focuses on how to practically make a local vision sustain-able, and how to broaden the vision to a state, national, regional, or interna-tional level. For example, malaria bed netting was tested in the 1990s inTanzania. After research showed its benefits, it was publicized nationally andinternationally, and local companies began producing malaria bed nets foruse through East Africa. The international accolades played an importantrole in influencing and adopting malaria bed nets in Africa.

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Building health capacity and health system planning

So how do we tie this all together for global child health leadership? The firstmodule focuses on obtaining an understanding of the diseases, problems, andunderlying health conditions of the area that is being served. The modulefocuses on acquiring facts that can help shape decisions and provide informa-tion to the leader in question. It does not focus on the ‘‘how to,’’ but on what todo to try and elicit information and what to do once information is available.

The second module focuses on looking at the actors in the program. Whatare their underlying characteristics and motivations? The module focuses onhow to engage different individuals, and listen, shape, and change theirthoughts and motivations to make them align with the leader’s goals and objec-tives. Understanding individuals and what shapes their desires is important ingetting them to buy into the vision.

The third module focuses on the development of the vision. Using the bestavailable information and recognizing the players involved in the situation,how can we create a collective vision congruent with a leader’s personal vision,and recognize potential barriers and harms that may make the vision unachiev-able? For example, Bill Clinton’s health care vision to provide health care toevery American was a wonderful vision, but ended up having significantbarriers because of the opposition from health care associations, Health Main-tenance Organizations, businesses, and leaders from the pharmaceuticalindustry. Failing to recognize how the different actors would react led to itsgeneral downfall.

More successfully, the Campaign for Access to Essential Medicines, led byMedecins Sans Frontieres, brought together HIV/AIDS organizations andhealth leaders of developing countries, and with public health pressure forcedgovernments and drug companies to allow cheaper generic drugs to replacemore expensive developed-country drugs. Vision, when combined witha focused message, clear goals, and simple steps to achieving outcomes, worksbest.

The fourth module focuses on communication needs. Communicationoccurs at many different levels, within and outside the organization. Thereare verbal, written, and nonverbal communication skills essential for anyleader. Establishing clear lines of communication and being aware of back-channel talking is important to being an effective leader.

The fifth module looks at the concept of the team, and building teams towork effectively to turn vision into reality. It emphasizes that successful teamshave great communication, various expertise, and different people who caneffectively lead at different times. The role of the ‘‘leader’’ in effective teamsis to act as a role model, and can help shape and determine the behavior of indi-vidual team members. At the same time, effective team leaders listen to theirmembers and facilitate open discussion of novel approaches to addressproblems.

The sixth module focuses on the times when things are not going well orwhen change is happening. This time of conflict and change creates problems

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within team dynamics and may question the capacity and role of the leader it-self. The module focuses on getting leaders to address issues of conflict directlyand to look at change from a positive fashion, focusing on concrete, incre-mental changes, rather than bold changes without clear focus.

The seventh module looks at the importance of putting health into a politicalcontext. Politics occurs at all levels—regional, national, state, and local. Under-standing the different political actors, their agenda, and their perceptions areimportant in making improvements in global child health a reality.

The final module ties in all the modules looking at the broader vision andlooking at the global child health sector, to figure out how this can be integratedin the bigger picture. How do we build capacity in global child health? Althoughthis could be seen as a ‘‘what do we want in the future’’ exercise, the constantchallenge is, given our current and future resources and our current skill leveland expertise, how can we best use it to obtain the ‘‘best’’ health outcomes?

The concept is to create health planning, by looking at trade-offs betweenareas that can potentially grow quickly to improve health, or be eliminated ifthere is little evidence of health impact. The aim is to improve health conditionsover time. The module looks at the alignment between current personnel andhealth delivery, services, and outcomes, and identifies areas of weaknesses andgaps in knowledge and the means to address them. It compares the potentialimpact of financing health directly versus collaborating with other political enti-ties, such as improving maternal education through the Ministry of Education,or improving roads through the Ministry of Planning or Infrastructure. Finally,it emphasizes the use of different tools, including using political pressure,media, and developing collaborations with other organizations, to translatethe underlying vision into reality.

The goal of this module is to strengthen health planning and health capacitybuilding, by emphasizing creative vision-building to promote global child healthby all means possible.

How do we turn the training into the global child health reality?

The Leadership Training Program in Global Child Health aims to provideeach trainee with the following skills.

The ability to collect and understand epidemiologic data in global child health

At the most basic level, the leader should develop the means, techniques, andunderstanding of how to gather the best information available, and interpretthe meaning of these data.

Formulate a plan to address priority areas

Leaders will be expected to have the capability of forming teams, identifyingpeople’s strengths, create common goals and vision, and articulate a clearplan to address priority areas. Part of the process must be the ability to commu-nicate not only internally but externally, the wanted and desired goals, and theroad map to achieve them. Furthermore, the ability to anticipate and adapt tochallenges is important.

25DEVELOPING LEADERSHIP IN GLOBAL CHILD HEALTH

Create a sustainable plan

A successful program will sustain itself through financial and nonfinancialmeans. There will be a combination of human resource planning, resourceacquisition and development, and continued public awareness. The organiza-tion will clearly have succession plans, and promote knowledge disseminationto other organizations, government agencies, and international neighbors, if theprogram is seen to be successful.

Evaluation and measurement

The global child health leader will constantly evaluate and collect new informa-tion, reevaluate goals, values, and vision, and create new sustainable plans withteams and stakeholders alike.

SUMMARYIn an era of vast knowledge, when we know what to do to improve children’shealth, there is still a massive global failure in preventing mortality andmorbidity in millions of children around the world. The author argues thatthis failure is because we have not developed a cadre of global health leadersthat puts child health at the forefront of political agendas nationally andglobally.

Unfortunately, we have failed to find, develop, and champion enough ofthese global child health leaders at the local, national, regional, and globallevels. The Sick Kids Global Child Health Leadership program aims to changethat, by providing a leadership component combined with global child healthcare knowledge and understanding. By promoting leadership, we aim todevelop champions who can evaluate health care conditions and the qualityof personnel, and bring them together to achieve a common goal and visionto improve child health. Only then can we achieve ‘‘Health Care for All.’’

Acknowledgments

The author gratefully acknowledges Katie Johnson and Leticia Rebello fortheir work on Tables 1 and 2.

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