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MOST FOR TB
Other PublicatiOns by ManageMent sciences fOr health
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Extending Access to Health Care through Public-Private Partnerships: The PROSALUD Experience
FIMAT—Financial Management Assessment Tool (FIMAT—La herramienta de evaluación de la administración financiera)
Human Resource Management Rapid Assessment Tool for HIV/AIDS Environments: A Guide for Strengthening HRM Systems
Management Strategies for Improving Family Planning Services: The Family Planning Manager Com-pendium (Vols. I–IV) (Estrategias gerenciales para mejorar los servicios de planificación familiar: Un compendio de Actualidad gerencial en planificación familiar) ed. Janice Miller and James A. Wolff
Management Strategies for Improving Health and Family Planning Services: A Compendium of The Manager Series, Vols. V–IX ed. Janice Miller, Claire Bahamon, Laura Lorenz, and Kim Atkinson
Managers Who Lead: A Handbook for Improving Health Services (Gerentes que lideran: Un manual para mejorar los servicios de salud)
Managing Drug Supply: The Selection, Procurement, Distribution, and Use of Pharmaceuticals, 3rd edition with the World Health Organization
MOST—Management and Organizational Sustainability Tool: A Guide for Users and Facilitators, 2nd edition (MOST—Herramienta de administración y sustentabilidad organizacional: Una guía para usuarios y facilitadores)
Tools for Planning and Developing Human Resources for HIV/AIDS and Other Health Services with the World Health Organization
MOST FOR TBManagement and Organizational
Sustainability Tool for National TB Control Programs
A Guide for Users and Facilitators
Developed by The Tuberculosis Coalition for Technical Assistance (TBCTA) partners:
The Global Health Bureau, Office of Health, Infectious Disease and Nutrition (HIDN), US Agency for International Development, financially supports this document through TB CAP under the terms of Agreement No. GHS-A-00-05-00019-00.
© 2009 by Management Sciences for HealthAll rights reserved.
Trainers and facilitators may photocopy the MOST for TB instrument, forms, modules, workshop agenda, and instructions for participants without prior permission, for noncommercial use only. Any translations or adaptations of this user’s guide or of the MOST for TB instrument or process require prior written permission from the publisher.
Management Sciences for Health Tel.: 617.250.9500784 Memorial Drive Website: www.msh.orgCambridge, MA 02139-4613 USA
The trademarks or service marks used in this guide, including Microsoft, Word, and PowerPoint, are the exclusive property of Microsoft Corporation. MOST for TB is not a product of, nor is it endorsed by, Microsoft Corporation.
ISBN 978-0-9819616-0-6
Funding for this information was made possible by the generous support of the American people through the US Agency for International Development (USAID). The contents are the responsibility of TB CAP and do not necessarily reflect the views of USAID or the United States Government.
Photo, back cover: Pedro G. Suarez, TB workshops in Ecuador and Uganda
v
COnTenTS
ACKNOWLEDGMENTS vii
ACRONYMS AND ABBREVIATIONS ix
BACKGROUND xi
HOW TO USE THIS GUIDE xiii
I. INTRODUCTION TO MOST fOR TB 1What Is Most for tB? 1Most for tB Workshop and Anticipated outcomes 2the Most for tB Difference 3How Can ntps Benefit from Most for tB? 4orientation to the Assessment Instrument 5the Most for tB process 7phases of the Most for tB process 7
II. MOST fOR TB AND THE CHANGE PROCESS 9principles of Change 9tB Change Leader and tB Change team 10Leading and Managing for organizational Change 11
III. ROLES Of THE STAKEHOLDERS 14Role of the participants 15Role of the Facilitators 16
IV. USING THE MOST fOR TB ASSESSMENT INSTRUMENT 21providing Evidence 22
V. fACILITATORS’ PLAN 23phase 1: Engagement of the ntp’s Leaders 24phase 2: preparation for the Workshop 26phase 3: Workshop plan 28opening session 32Module 1: Where Are We now? 35Module 2: Where Are We Headed? 38Module 3: How Will We Manage the needed Changes? 40Module 4: How Will We Reach our objectives? 42phase 4: Follow-Up Activities 46
vi
VI. WORKSHOP MATERIALS 47Making the Most of Management 48Most for tB Workshop Agenda and Anticipated outcomes 51Most for tB Assessment Instrument 53Most for tB Assessment Consensus Form 69Assessment Consensus Form 70Most for tB Action plan Form 80Leading and Managing Results Model 82Leading and Managing Framework 83
VII. ADDITIONAL RESOURCES 84to prepare for the Most process 84to Focus on Improving specific Management Components 84to Manage Change More Effectively 85MsH Resources on tuberculosis 85
vii
ACKnOWLeDGMenTSManagement Sciences for Health (MSH) first introduced the Management and Organizational Sus-tainability Tool (MOST) in April 1997 at an International Planned Parenthood Federation (IPPF) workshop in Nairobi, Kenya. The first edition of the MOST guide was published in 1999. Since that time, MOST has been used to strengthen public- and private-sector organizations.
We are pleased to present our latest publication in the MOST series: Management and Organiza-tional Sustainability Tool for National TB Control Programs (MOST for TB). MOST for TB was pre-pared by Pedro G. Suarez and Sarah Johnson to provide complete information about the MOST for TB concept, process, and instrument.
We would like to show our appreciation to all NTP teams and organizations that gave us the opportunity to field-test the tool and participated in validation workshops between 2004 and 2008. Special thanks particularly goes to NTP teams from the Dominican Republic, Ecuador, Mozam-bique, Namibia, Pakistan, Uganda, and Zambia; WHO medical officers from Mozambique and Uganda; and the Tuberculosis Control Assistance Program (TB CAP) team from Namibia.
In memoriam, we would like to express our deep appreciation to Dr. Hassan Sadiq (Pakistan NTP Director).
We also acknowledge the valuable comments and suggestions of Ivelisse Acosta (Profamila/GFATM—Dominican Republic), Edith Alarcón (The UNION—Regional TB LAC Advisor/Peru), Rhehab Chimzizi (TB CAP Ghana), Yuriko Egami (MO STB/WHO Pakistan), Giuliano Gargioni (WHO/Geneva—TB Advisor), Lia Kropsh (Brazil), Amos Kutwa (KNCV/Kenya), Belkys Mar-celino (NTP Director—Dominican Republic), Alvaro Monroy, Chinwe Owunna (MSH/SPS), Mohammad Rashidi (TB CAP Afghanistan), Barbara Tobin, Christine Whalen, Alvaro Yáñez del Villar (TB Advisor—Chile), and David Zavala (TB Advisor—Ecuador). We are also grateful to Claire Moodie (MSH/CHS—TB CAP Project Officer) and Christine Rogers (MSH’s Communications and Knowledge Exchange Center), who coordinated the overall editing process.
We appreciate the support of the US Agency for International Development (USAID). Their investment in the MOST for TB process reflects their firm commitment to good management as a critical factor in improving the organization, delivery, and quality of health services. USAID’s ongoing support helps organizations to improve overall health outcomes and strengthen their ability to provide quality services to their clients for many years to come.
ix
ACROnYMS AnD ABBReVIATIOnSACSM Advocacy, Communication, and Social Mobilization
AIDS acquired immunodeficiency syndrome
DOTS directly observed treatment, short course
GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria
HIV human immunodeficiency virus
MDGs Millennium Development Goals
MDR-TB multidrug-resistant TB
MOH Ministry of Health
MOST Management and Organizational Sustainability Tool
MOST for TB Management and Organizational Sustainability Tool for National TB Programs
MSH Management Sciences for Health
NGO nongovernmental organization
NTP national TB program
TB tuberculosis
TB CAP Tuberculosis Control Assistance Program
UNION International Union Against Tuberculosis and Lung Disease
USAID US Agency for International Development
WHO World Health Organization
xi
BACKGROUnDThe World Health Organization (WHO) reports that nearly one-third of the global population is infected with Mycobacterium tuberculosis and is at risk of developing the disease. More than eight million people develop active tuberculosis (TB) every year, and about two million die.
Based on the WHO framework for control of TB in developing countries, the Stop TB strategy has been adopted by ministries of health (MOHs) in 183 countries. Furthermore, significant financial resources have been mobilized through the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), and several important agencies have endorsed the Millennium Development Goals (MDGs), which include combating TB and the Stop TB strategy. Recent WHO assess-ments, however, show that while great progress has been made toward Stop TB’s target 85 percent treatment success rate (84.7 percent in 2005), the actual case detection rate for new smear-positive cases (61 percent in 2006) is well below the 70 percent target.
Although many countries have received technical and financial support ( from GFATM), scaling up and sustainability have been difficult to achieve. The rapid increase of directly observed, short course (DOTS) coverage has placed a high level of demand on program management, which is often weak.
Several factors appear to be impeding more rapid progress in detecting and reporting cases under the DOTS strategy in many countries. These include:
weak organization and management of national TB programs (NTPs);■■
lack of systems and services provided by primary health centers and hospitals for TB control;■■
insufficient DOTS coverage at public health facilities, including hospitals and primary health ■■
centers;
insufficient access to quality DOTS services;■■
weak design and use of public health criteria for case detection and poor use of sputum smear ■■
testing for diagnosis of TB;
lack of public laboratory networks to provide support to the NTPs;■■
lack of public awareness and involvement of communities in DOTS activities;■■
limited participation of private providers, nongovernmental organizations (NGOs), and aca-■■
demic institutions in proper TB care delivery as part of the NTPs’ strategy;
limited collaboration between TB and HIV control programs at all levels, particularly in coun-■■
tries with high TB and HIV burdens.
To address these issues, Management Sciences for Health (MSH) works closely with the Tubercu-losis Control Assistance Program (TB CAP) to strengthen human capacity development, organi-zational and management systems, and leadership to integrate strategic program activities at all levels of PHS and private sector in TB. MOST for TB is a tool that allows TB control program man-agers to assess and improve the management of their programs.
Originally, MSH developed a participatory approach to management assessment called MOST (Management and Organizational Sustainability Tool), which enables client organizations to assess and strengthen their existing management processes and systems. MSH, in collaboration with TB CAP partners, has adapted the MOST approach to improve the management of NTPs and thereby
xii
reduce disease transmission in the community, reduce mortality and morbidity due to TB, and prevent the development of multidrug-resistant TB (MDR-TB). This revised approach is known as the Management and Organizational Sustainability Tool for National TB Control Programs (MOST for TB). To date, this newly adapted management tool has been successfully applied in Ecuador (2004–2005), the Dominican Republic (2005), Pakistan (2007), and Namibia (2008).
With TB CAP funds provided in the 2005–2006 TB CAP work plan, MSH and WHO organized a three-day workshop, held in Kampala, Uganda, August 9–11, 2006, to discuss management chal-lenges facing national TB programs and introduce a new approach for improving the management of NTPs to achieve targeted results and improve health outcomes.
Workshop participants were drawn from five countries (Mozambique, Namibia, Pakistan, Uganda, and Zambia) and included three WHO medical officers from Uganda and Mozambique, as well as one WHO Stop TB Geneva representative. The diverse country teams included NTP program man-agers, regional and provincial TB managers, and TB laboratory personnel.
The workshop and overall discussion process led MSH, in collaboration with TB CAP partners and NTPs, to develop and disseminate the MOST for TB guide and instrument. The broad dissemination of this tool will increase the opportunity for NTPs to strengthen their management practices as a means to improve services and make their programs sustainable.
This MOST for TB guide reflects the experiences of users and facilitators in the countries where the tool was piloted (Dominican Republic, Ecuador, Namibia, and Pakistan) and our knowledge of NTPs’ needs for the expansion and implementation of the DOTS strategy.
xiii
HOW TO USe THIS GUIDeThis guide provides complete information about the MOST for TB concept, process, and assessment instrument. It also includes all necessary materials for conducting a three-day MOST for TB workshop. The guide can therefore be used by those who want to learn about MOST for TB for the first time as well as by those who are preparing to carry out a MOST for TB assessment. Potential users should read specific sections of the guide:
NTPs directors* who are considering undertaking the MOST for TB process should read “Mak-■■
ing the MOST of Management” on page 48.
NTPs directors who have decided to implement MOST for TB should read the first three sec-■■
tions of this guide.
Facilitators who will be conducting the MOST for TB workshop and guiding follow-up should ■■
read the entire guide to become familiar with the foundations and process of MOST for TB, its participatory philosophy, and the steps involved. They should also use the workshop materi-als, which begins on page 47, to assemble a binder for workshop participants.
*Note: In some NTPs, the administrative designation may be manager, coordinator, chief, or another similar term.
MOST FOR TB
Management and organizational sustainability tool for tB 1
I. INTRODUCTION TO MOST fOR TBThe Management and Organizational Sustainability Tool for National TB Control Programs (MOST for TB) is a process for improving the management of an NTP, with the end result of contributing to the three main objectives of NTPs:
reduction of disease transmission in the community;■■
reduction of mortality and morbidity due to TB; ■■
prevention of the development of multi-drug resistant TB (MDR-TB).■■
MOst for tb is for all levels of a ntP
Most for tB can be used at any level of a national tB control program—national, regional, or local—that would like to strengthen program management in order to improve implementa-tion and expansion of the stop tB strategy.
This section of the MOST for TB guide explains what MOST for TB is, how it differs from other management assessment processes, how the MOST for TB process works, and how the assessment instrument is organized.
What is MOst fOr tb?
MOST for TB is a structured, participatory process that allows NTPs to assess their own man-agement performance and develop a concrete action plan for improvement.
Good management is the glue that holds all the internal parts of an NTP together, contributes to a positive work climate, and supports high-quality services, thus helping bring the NTP’s vision to life. MOST for TB helps NTPs focus on improving their management practices as a means of improving services and making the NTP sustainable in three ways: institutionally, financially, and program-matically.
A well-managed NTP has a strong yet flexible functional structure (institutional sustainabil-■■
ity). Its functional structure allows it to respond to the shifting priorities of its supporters and to new responsibilities toward TB patients and communities while also creating a positive work environment for health personnel. MOST for TB allows an NTP to assess its values and functional structure, as well as those systems traditionally identified as management related.
A well-managed NTP draws on various sources of revenue, which allow it to support its ongo-■■
ing efforts and undertake new initiatives ( financial sustainability). MOST for TB helps the NTP determine its stage of development in terms of financial management and revenue generation.
A well-managed NTP delivers services that respond to TB patients’ needs and anticipates new ■■
areas of need (programmatic sustainability). As a result of its success, it is able to expand its institutional, social, and community base. Using MOST for TB, an NTP can assess its mission; its strategies; its planning, monitoring, and evaluation; and its systems for delivering services.
MOST FOR TB
Management and organizational sustainability tool for tB2
Even a well-managed, successful NTP must constantly reassess and adapt its management prac-tices as new demands arise and changes at the MOH affect the environment in which the NTP works. The leadership of an NTP plays a critical role in fostering a climate of continuous assessment and improvement.
the MOst for tb Process fosters improvement of Management Practices
Most for tB allows an ntp’s leadership—the director and senior managers from the nation-al, regional, and selected local levels—to put in motion a change process that involves staff from all levels of the ntp (national, intermediate, and local) as well as other key stakeholders. Working together, they:
recognize the importance of good management to the effectiveness and long-term ■■
survival of the ntp;
assess the current status of essential components of management;■■
identify feasible changes that can make the ntp more effective;■■
develop specific plans to implement these changes;■■
generate the staff buy-in needed to support these management improvements;■■
monitor the results over time.■■
MOst fOr tb WOrkshOP and anticiPated OutcOMes
The cornerstone of the MOST for TB process is a three-day workshop. During the workshop, the NTP leadership and selected staff come together to build consensus on the stages of development of the NTP’s management components, the necessary improvements, and an action plan for making those improvements. This workshop is not an end in itself, but rather one step in a signif-icant change process. If MOST for TB is to yield its greatest benefits, all staff must play a part, one that continues long after the workshop. They must recognize the need for change, commit to the process, and help implement the identified improvements in their day-to-day work.
By the end of the workshop, it is expected that participants will have come to agreement on how well the NTP is functioning and will have planned activities for making improvements. The specific outcomes include:
a collective assessment of the current stage of development of the various management com-■■
ponents;
a prioritized list of the management components to be improved within a specified time period;■■
an agreed-upon set of objectives for improving each management component;■■
an action plan for reaching the objectives, identifying the broad activities, timing, resources, ■■
and people responsible for completing the activities, as well as defining data that can provide evidence of success;
identification of a TB change leader and TB change team who will lead the implementation of ■■
the action plan and monitor progress;
MOST FOR TB
Management and organizational sustainability tool for tB 3
a list of short-term activities for following up on the MOST for TB workshop: those the NTP ■■
staff can do themselves with existing resources, those for which they will need to seek addition-al resources, and those for which they will need technical assistance from outside the NTP;
agreement on post-workshop assistance from the facilitators (by phone or e-mail) and a ■■
follow-up MOST for TB exercise, usually six months to one year after the workshop.
the MOst fOr tb difference
Many traditional assessments rely on external evaluators, intensive data collection, and check-lists. They result in findings and recommendations but often fall short of producing a plan for improvement. MOST for TB is different. It is about making change happen through a structured, participatory process, in which staff members use an instrument to collect data from their own experience, immediately analyze the data, and use their analysis to make concrete, practical plans for improvements. And finally, the MOST for TB process recognizes that meaningful changes in management rarely occur through a single event; the process includes a six-month or one-year follow-up exercise to review progress and make any needed changes in the action plans.
The very structure of the MOST for TB process builds in the key factors that will support NTP change:
The MOST for TB assessment is carried out by the NTP’s staff, not by an external team. This ■■
self-assessment allows staff to identify the management challenges they face.
MOST for TB is participatory, harnessing the insights and creativity of staff from all levels of ■■
the NTP.
MOST for TB uses consensus-building rather than votes or top-down rulings to make deci-■■
sions about management improvements. This approach makes certain that those who will be asked to implement decisions have been fully involved in making those decisions.
MOST for TB draws on the contributions of strong, committed leaders at every level of the ■■
NTP. The director and senior managers must identify the need for change, commit to the MOST for TB process, and bring their staff on board. Staff members lead in various ways: by contributing their ideas, by serving as change agents, and by sharing with the entire staff their personal commitment tomaking the changes happen.
The participants in the MOST for TB workshop produce a realistic action plan for making improvements in the identified areas of need:
During the MOST for TB workshop, participants prioritize the management components ■■
to be improved, identify objectives for those components, and put together a concrete plan designed for immediate action. The plan identifies short-term, feasible actions to be taken toward each identified objective, along with the person(s) responsible, timing, and resources needed.
The MOST for TB action plan is integrated into the NTP’s other operational plans. It is seen ■■
as a way of helping to implement those plans through effective management, rather than as a stand-alone, unrelated set of activities.
During the workshop, the NTP sets a date for a follow-up MOST for TB exercise, aimed at as-■■
sessing progress toward the objectives, revisiting the management components that were viewed as lower priority, and identifying any new needs.
MOST FOR TB
Management and organizational sustainability tool for tB4
The MOST for TB data-collection instrument is a means of eliciting information from staff, helping them analyze the information, and building agreement about their assessments:
It allows staff to use what they each know about the NTP’s management practices as evidence. ■■
The exchange among participants as they share knowledge with colleagues enables groups to analyze management components rapidly, without a lengthy data-collection process.
It involves staff in assessing the NTP’s stages of development in terms of a set of management ■■
components, rather than simply checking off the presence or absence of a component.
hOW can ntPs benefit frOM MOst fOr tb?
Our experience shows that NTPs can benefit from MOST for TB provided that the director and senior management meet two criteria:
They are committed to open self-assessment and to decision-making by consensus.1.
They believe that the organization can take action to improve its management, even though 2. there may be some constraints beyond its control.
The first criterion requires that the decision-makers of the MOH and NTP read this guide care-fully, feel comfortable with the process it describes, and express their full commitment to the staff and other key stakeholders who will engage in the process. To make the MOST for TB experience effective, the MOH’s and NTP’s directors must demonstrate that they are genuinely enthusiastic about staff ideas, open to the airing of issues, and willing to hear all input, including criticisms. Once the process is under way, the NTP director must act as a participant equal to all others. This commitment to democratic participation will help ease participants’ fears about voicing their opinions or making unconventional suggestions. When staff and other stakeholders see their leaders’ commitment to change, they in turn will be motivated to fill their roles in making changes that will improve management.
The second criterion requires that participants in the MOST for TB process use their imagination and determination to find creative ways to improve the NTP’s management systems and practices. Clearly, not all challenges identified will be within the NTP’s control. Most NTPs work within a legal and operational context that limits their ability to modify some management practices. For example, NTPs and government health facilities may find that many aspects of their management are determined by government authorities at the national level (MOH), national boards, or interna-tional agencies with which they work.
However, apart from these policy and regulatory constraints, NTP managers and staff do have the ability to make significant management improvements. MOST for TB helps these decision-makers assess the NTP’s current management performance, agree upon ways to improve that performance, and plan activities toward that end.
MOST FOR TB
Management and organizational sustainability tool for tB 5
OrientatiOn tO the assessMent instruMent
The MOST for TB assessment instrument defines critical areas of management: mission, values, strategy, structure, systems, and other program components. These management areas are explained below.
Mission. A NTP’s mission is its purpose, the reason it exists. The mission provides guidance, con-sistency, and meaning to decisions and activities at all levels. It is the focal point around which staff members define strategies, establish goals, move in a common direction, and focus on what they know and do best. It also motivates them to stretch their capacity and take on new challenges. For the NTP, it answers the question: Why do we do what we do? MOST for TB can help an NTP assess its mission statement, if one exists, and then plan any changes needed to generate a mission that is relevant, widely known, and used.
Values. An NTP’s values are the beliefs and ethical principles that underlie its mission. These values give meaning to the NTP’s work and form the basis for staff commitment. They act as a beacon to guide strategies and shape the ways in which the managers and staff work together toward the mission. They answer the question: What are the core beliefs and principles that the NTP staff all share and that give direction to our work? Through MOST for TB, an NTP can assess its core values, and then make a plan for clarifying the values, if necessary, and for holding staff accountable for adhering to them.
Strategy. An NTP’s strategies are the broad approaches used to define the objectives and activities that will fulfill the NTP’s mission and goals. For the NTP, its strategies answer the question: How will we get to where we want to go? After assessing its current strategies through the MOST for TB workshop, an NTP can plan any changes needed to make its strategies consistent with its mission, responsive to the needs of the TB patients and communities, and able to meet the potential demands of the society, communities, and TB patients it should serve.
Structure. Structure refers to how the NTP is legally defined or organized in a country. The func-tional structure encompasses the formal lines of authority, distribution of responsibilities, and ways in which significant decisions are made and people held accountable for carrying out those deci-sions. Structure answers the question: Is the NTP organized in a way that facilitates what it wants to do and where it wants to go? An NTP can use MOST for TB to assess its functional structure and to plan ways to make the structure strong enough to fulfill the mission and carry out strategies, yet flexible enough to foster decision-making and accountability at all levels.
Systems. Systems are the interdependent functions that allow an NTP to do its work. MOST for TB addresses systems that form the key elements of management, which are listed on the next page. Organizational systems answer the question: What helps us carry out our activities? The MOST for TB process can help an NTP assess these systems, and plan and carry out the high-priority changes needed for increased efficiency and greater effectiveness.
Other Program Components. There are several other program components that are very important in an NTP. MOST for TB also assesses an NTP’s progress with respect to research for TB control; Advocacy, Communication, and Social Mobilization (ACSM); the community participation plan for TB control; and pharmacovigilance for TB medicines.
MOST FOR TB
Management and organizational sustainability tool for tB6
The MOST for TB instrument divides each of these management areas into a total of 30 separate, measurable components, as listed below.
Management components assessed by the MOst for tb instrument
MissionExistence and knowledge
ValuesExistence and application
strategyLinks to mission and valuesLinks to stop tB strategy Links to HIV & AIDs control programLinks to tB patients and community
structureInstitutionalizationLines of authority and accountability CommunicationRoles and responsibilitiesDecision-making
systemsstrategic planning Annual operational planningnorms and procedures for tB prevention, detection, diagnosis, treatment, and careGeographical and population coverage of DotsHuman resources managementLeadership developmentstaff trainingInformation management: operational and epidemiological data collectionInformation management: Use of operational and epidemiological informationMonitoring and evaluationsupervisionsupply managementFinancial managementResource mobilizationQuality assurance: norms and procedures for tB labs
Other Program componentsResearch for tB controlAdvocacy, Communication, and social Mobilization (ACsM)Community participation plan for tB controlpharmacovigilance for tB medicines
MOST FOR TB
Management and organizational sustainability tool for tB 7
the MOst fOr tb PrOcess
The central component of the MOST for TB process is a facilitated workshop lasting three days. The workshop brings together a range of people who hold management responsibilities in all parts of the NTP—the director and the technical NTP teams, which include physicians, nurses, lab techni-cians, and other health personnel at the central, intermediate, and local levels. Other stakeholders whose work is affected by, or has an effect on, day-to-day management of the NTP may also be included. This group creates a collective perspective based on their individual experiences. Their perspective guides the development of a plan to improve priority aspects of the NTP’s management.
During the workshop, participants express their individual perceptions of current management performance, share these perceptions with one another, and reach consensus on changes that will improve performance. They establish priorities and develop an action plan that specifies objectives and activities for making these changes. And, to make sure that the plan is carried out, they choose the people who will be responsible for implementing the plan.
Facilitation of the MOST for TB workshop is complex and demanding: it requires carefully observing and synthesizing often-heated discussions; serving as a resource to individuals and small groups throughout the workshop; and providing rapid, accurate documentation for participants to use as they move from module to module. Past experience with MOST has clearly shown the advan-tages of having two facilitators who are accustomed to working together as a team, complementing each other’s skills, confirming each other’s observations, and sharing the multiple simultaneous requirements of a successful workshop. Even a co-facilitator who is somewhat less experienced can provide a different set of eyes and ears, help individuals and small groups complete their assign-ments, and aid in synthesis and documentation.
Phases Of the MOst fOr tb PrOcess
Although the workshop is the main activity, the MOST for TB process begins before it and extends beyond, through four phases: engagement, preparation, the MOST for TB workshop, and follow-up. The table that follows summarizes the activities that take place during each phase.
MOST FOR TB
Management and organizational sustainability tool for tB8
Phases Of the MOst fOr tb PrOcess
Phase key activities
engagement Directors at the MoH and ntp review the Most for tB process to deter-■■
mine if Most for tB is appropriate for the MoH and ntp at this time.
the ntp director negotiates an agreement with the facilitators, who will ■■
provide technical assistance during all phases of the process (preparation, workshop, and follow-up).
the ntp director identifies a change leader: a staff member who will cham-■■
pion the changes that emerge from the workshop.
Preparation the ntp director identifies the workshop participants. ■■
the facilitators conduct interviews and/or written surveys of workshop ■■
participants.
Workshop the three-day Most for tB workshop serves to:
Assess management status: Where are we now?■■
set objectives: Where do we want to go?■■
Initiate change: How will we manage the needed changes?■■
Develop an action plan: How will we reach our objectives? ■■
follow-up post-workshop follow-up may include:
the facilitators submit a written report of the workshop.■■
the ntp director and facilitators negotiate an agreement for any additional ■■
follow-up activities.
the ntp director and change team inform the entire staff and engage them ■■
in the Most for tB plans for change.
the ntp director and staff integrate the Most for tB action plan into ■■
annual operational plans.
the change leader and change team guide the implementation of the ■■
action plan.
the change leader and change team monitor the implementation of the ■■
plan and revise it as needed.
the ntp holds a follow-up Most for tB review at an identified time (usually ■■
six months or one year later).
MOST FOR TB
Management and organizational sustainability tool for tB 9
II. MOST fOR TB AND THE CHANGE PROCESSA successful MOST for TB process results in change. Any significant change presents major chal-lenges to an NTP’s leadership and to the entire staff. Before committing to MOST for TB, the NTP director and other decision-makers of the MOH should be aware that:
MOST for TB is one step in an ongoing change process;■■
to improve performance, an NTP must make changes that may cause discomfort among staff ■■
and other stakeholders;
strong leadership will be needed to initiate and sustain these changes;■■
an NTP will have to draw on management practices that are working well if it is to improve the ■■
management practices that are less effective;
it will take time for an NTP to see the effects of MOST for TB on the program’s work, and, ulti-■■
mately, on its services and sustainability.
This section of the guide explains the principles of change underlying the MOST for TB process and details the role of the change leader and change team in implementing MOST for TB. It also describes how MOST for TB fits an existing leadership and management model for improving health outcomes.
PrinciPles Of change
Change can, of course, be imposed from the top of an NTP or MOH, with little or no staff input. But when introduced in this way, any significant change is likely to lead to some combination of reluctant acceptance and resistance among valuable health personnel.
The MOST for TB change process comes from within the NTP, the result of an open exchange of views and a successful struggle to reach consensus. MOST for TB embodies four well-established principles of managing organizational change:
The change process must meet real organizational challenges. Change for its own sake is likely to be strongly resisted. Staff will generally support change when they perceive it as essential for resolving issues that affect the NTP’s ability to live up to its mission. The MOST for TB process applies this principle by using the NTP’s own staff, rather than outsiders, to identify the areas for change. MOST for TB also requires the NTP’s director, along with a change leader and change team, to clarify for all staff the priority management issues, the rationale for changes, and the details of implementation that result from the MOST for TB process.
The change process must be “owned” and guided by key stakeholders. Stakeholders encompass those who are responsible for making decisions about changes and those who will carry out those decisions in the MOH and NTP. For them to become supporters and effective imple-menters of change, these individuals must accept the proposed changes fully and see themselves as integral to the success of the process. In the MOST for TB process, this group is likely to include staff who have management responsibilities and take part in the workshop. These staff members “own” the change process fully, because it is they who conduct the management assessment, identify the changes to be made, and develop the plans, with the full support of the NTP’s director. After the workshop, they will help mobilize their colleagues at all levels of the NTP to understand, support, and implement the changes.
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Management and organizational sustainability tool for tB10
Short-term results can be milestones on the way to broader, more substantive changes. Sometimes, NTPs set goals or objectives for change that are so ambitious that the staff perceive them to be unreachable. It is useful to break large goals or objectives into smaller segments and measure progress step-by-step along the way. MOST for TB is designed to foster smaller, feasible changes that will move an NTP toward a higher stage of development.
The change process must be supported by staff with clear roles and accountability. An NTP cannot make and sustain significant changes with casual, ad hoc oversight. To keep the change process on track and monitor progress, it is critical to assign responsibility, on a long-term basis, to one or more people whose performance will be judged, in part, by how successfully they guide the change process. The MOST for TB action plan is overseen and monitored by an assigned change leader and change team, whose authority comes from the NTP director.
One session of the MOST for TB workshop is specifically designed to prepare the NTP for the antici-pated changes. However, principles of change underlie the entire MOST for TB process. A successful MOST for TB experience will bring about changes that begin during the workshop itself and con-tinue long afterward.
tb change leader and tb change teaM
All too often, participants leave workshops agreeing on important management changes, but the changes do not actually take place. The spirit generated by a one-time event can evaporate as par-ticipants return to their “real” work, and the proposed changes become a distant memory.
MOST for TB, however, emphasizes the importance of follow-up. Before the final phase of the MOST for TB process, individuals are assigned responsibilities and made accountable for imple-menting the MOST for TB action plan.
Staff members who have participated in the workshop and fully understand the issues and plans take direct responsibility for leading the implementation of the action plan. Although every partic-ipant is expected to help implement the changes agreed upon during the MOST for TB workshop, the ultimate responsibility rests with a smaller group: the TB change leader and TB change team. The TB change leader has the authority to make decisions regarding the action plan, and he or she will be held accountable for the plan’s implementation. An effective TB change leader and TB change team will contribute significantly to visible improvements in the NTP. The accountability and support of the NTP director, however, are the key factors in the success of this process.
The TB change leader may be selected in one of several ways. In most instances, the NTP director identifies this person before the workshop. Occasionally, the director prefers to delay this decision—to have the facilitators clarify the qualifications for the role during the workshop and let participants choose the leader. The members of the TB change team are most often chosen by participants during Module 4 of the workshop, when action plans are developed. However the TB change leader and team are selected, it is imperative that the director and senior managers whole-heartedly approve the choice and offer full moral and material support. This support may include shifting some of the TB change team’s previous duties to other staff, so that members will have time to carry out their new responsibilities.
Sometimes the NTP director assumes the role of TB change leader; however, the participants of the workshop must agree to this arrangement to ensure the success of the process.
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Management and organizational sustainability tool for tB 11
Qualities of the tb change leader
the tB change leader is an individual who has:
accountability for this role;■■
the confidence and recognition of the ntp director, senior managers, and most staff ■■
members;
proven ability to lead a team toward shared goals;■■
a belief in the need for changes in ntp management practices;■■
a demonstrated commitment to the participatory nature of the Most for tB process;■■
enthusiasm about taking on the task, with full awareness of its challenges.■■
leading and Managing fOr OrganizatiOnal change
Making organizational change requires committed leaders and managers. Experience shows that NTPs that have effective leaders and managers are able to improve management practices, create a positive work climate, and respond to changing environments in the MOH. These organizational changes contribute to improving the services provided and increasing the ultimate impact of the program’s work. The model below shows the relationship of these elements in the context of an NTP. It illustrates that an NTP’s leadership and management are equally important in achieving its desired results.
managing
improvedwork
climate
improvedmanagement
systems
improvedservices
improvedhealthoutcomes
scan
focus
align/mobilize
inspire
plan
organize
implement
monitor andevaluate
Results
Leading and managing practices
leading
improvedcapacity
to respondto change
From Managers Who Lead:A Handbook for Improving Health Services
Management Sciences for Health
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Management and organizational sustainability tool for tB12
The environment in which health organizations, including NTPs, work today has become increas-ingly complex. For example, in many countries decentralization and health reform have placed greater responsibility on local programs to set challenging objectives and achieve measurable results. To meet these challenges, managers at all levels must recognize how good leadership and management practices can make a difference and must be able to carry out these practices. By putting these practices into action, the NTP will be better able to meet the needs and requirements of TB patients, the communities, and the MOH and will foster a better work climate and, ultimately, will improve its sustainability. With its participatory focus, the MOST for TB process provides an opportunity for an NTP’s staff as well as senior managers to identify and plan management improvements while building their teamwork and leadership skills. These improvements will help the MOH contribute significantly to the improved health outcomes of the population it serves.
Sound leadership and management practices are outlined below and put in the context of the MOST for TB process. A complete description of leading and managing practices is provided in the “Leading and Managing Framework,” on page 83.
leadership Practices
Scanning. Good leaders keep alert to and continually examine the environment, the program, the NTP’s stakeholders, and themselves to identify values, strengths, and weaknesses.
In the MOST for TB process, the NTP director begins by scanning the NTP to identify the need for change. The workshop participants then scan the NTP in relation to its mission, values, and the outside world to identify issues and challenges. After the workshop, they will continually scan for evidence of the effects of the management changes that have been implemented.
Focusing. Strong leaders keep themselves and their colleagues focused on the NTP’s mission, strat-egies, priorities, and challenges.
The MOST for TB process requires the NTP director and workshop participants to identify the man-agement components that are most critical to strengthening the NTP’s performance and achieve-ments. During the workshop, they set priorities and develop objectives that will have to be met and reviewed before lower-priority areas can be addressed. Afterward, they will maintain the focus on the identified management priorities as they return to their day-to-day responsibilities.
Aligning and mobilizing. Good leaders make sure that all staff work together to carry out activ-ities that are in line with the NTP’s mission, values, strategy, and resources.
The NTP director gains support from staff for the MOST for TB process and mobilizes staff to par-ticipate fully and creatively in the MOST for TB workshop. During the workshop, participants align and mobilize themselves around an action plan, specifying the resources needed to bring about the desired changes. Afterward, they will take the lead in aligning and mobilizing their NTP colleagues to carry out the MOST for TB activities; incorporating the MOST for TB action plan into the NTP’s annual plan; and moving the plan forward.
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Inspiring. Strong leaders motivate, challenge, and support staff creativity, innovation, and learning.
The success of the MOST for TB workshop depends on the participants’ demonstration of the integrity, trust, and creativity that can inspire them, as a group and individually, to commit them-selves to the agreed-upon changes. When they return to their day-to-day responsibilities, they will join the NTP director in inspiring their colleagues throughout the MOH and NTP, conveying their enthusiasm and building an NTP-wide commitment to change.
Management Practices
Planning. Good managers define short- and long-term results targets and allocate resources accordingly.
During the MOST for TB workshop, participants engage in an intensive exercise to plan for the desired improvements. Afterward, they will use their planning skills to integrate their action plan into the NTP’s annual and long-term plans.
Organizing. Good managers establish functional structures, systems, and work processes to support efficient operations and ensure accountability.
During the MOST for TB workshop, participants have to organize for change, selecting the TB change leaders who will oversee the action plan and specifying the time, money, and other material resources needed. After the workshop, the change leaders will organize the activities needed to implement the plan.
Implementing. Good managers integrate systems, coordinate work flow, and adjust plans as cir-cumstances change.
After the MOST for TB workshop, the participants, change leader, and change team will oversee the implementation of the management changes throughout the NTP.
Monitoring and evaluating. Good managers check for and reflect on progress and results, and use findings to provide feedback and make needed changes.
During the MOST for TB workshop, participants build into the action plan the activities needed to monitor and evaluate the progress and results of implementing the plan. After the workshop, the change leaders and designated staff will monitor these activities and share the results with the MOH’s and NTP’s decision-makers.
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Management and organizational sustainability tool for tB14
III. ROLES Of THE STAKEHOLDERSThe MOST for TB process depends on the active participation of the identified stakeholders. These stakeholders include the NTP’s leadership—the director and senior managers from the national, regional, and selected local levels)—as well as stakeholders from other entities with which the NTP is affiliated. For example, the NTP might invite members of private health services, scientific soci-eties (physicians, nurses, and others), universities, and nonprofit organizations to take part in some aspects of the process. An NTP might also involve representatives from the next-higher level of the MOH or from other MOH units with which the NTP works closely (e.g., representatives from the HIV & AIDS program, immunization program, or leprosy program).
the three types of stakeholders
the Most for tB process includes responsibilities for three types of stakeholders:
the ntp’s leadership;■■
the workshop participants;■■
the facilitators.■■
For each type of stakeholder, the guide summarizes the role before, during, and after the workshop.
rOle Of the ntP’s leaders
At the heart of the MOST for TB process is the full commitment of the NTP’s director and senior managers. No matter how productive the workshop or how much thought the participants put into the action plan, meaningful changes will not happen without the genuine, ongoing support of the NTP’s leaders.
before the Workshop
Understand MOST for TB. To decide whether the NTP will benefit from MOST for TB at this time, the NTP director and senior managers should familiarize themselves with the elements of the MOST for TB process. This will help them grasp what MOST for TB can and cannot do for the NTP, what must happen if MOST for TB is to succeed, what resources will be required, and what roles the director and senior managers will play in a highly participatory series of events.
Managers can acquire this information by reading “Making the MOST of Management,” on page 48. They may also want to talk with leaders of organizations and NTPs that have undertaken MOST or MOST for TB and consultants who have facilitated the MOST or MOST for TB process. MSH can put NTP directors and managers in touch with these resources and also answer their questions about MOST for TB.
Make the decision. Once they are convinced that they understand MOST for TB, the NTP’s director and senior managers will be better equipped to make a sound decision about whether the NTP should undertake the MOST for TB process. They should carefully consider whether man-
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Management and organizational sustainability tool for tB 15
agement changes could significantly improve the NTP’s performance and have a positive effect on its services and sustainability.
Choose the facilitators and identify a staff counterpart. After deciding to embark on the MOST for TB process, the NTP’s leadership should look for facilitators who combine MOST for TB expe-rience with a style and approach that best fit the NTP. Most NTP directors prefer to use external facilitators, rather than staff members, to guide the process, recognizing that observant, sensitive outsiders are better able to maintain objectivity and gain the trust of all participants. In addition to the facilitation team, the director should assign a counterpart from within the NTP to serve as a resource to the facilitators for logistics before and during the workshop.
Work with the facilitators. After negotiating and signing an agreement, the NTP’s director and senior managers should collaborate with the facilitators in selecting 12 to 25 staff members to participate in the MOST for TB workshop. They may choose a change leader at this time, or they may prefer to wait and let the change leader emerge from the workshop. Finally, they should set the stage for a successful MOST for TB experience by freely sharing their perspectives and concerns in at least one interview, responding to questions from the facilitators and offering any additional information that might help the facilitators understand the NTP.
Inform the staff. The NTP director should inform the entire staff of what is about to take place and how it will benefit the NTP. Those staff who have been selected to participate in the MOST for TB workshop will need additional details about their responsibilities during and after the workshop. The facilitators can provide explanatory handouts for workshop participants and non-participants alike.
during the Workshop
Participate fully and openly. The NTP’s director and senior managers should be present and involved throughout the workshop. They should view themselves as colleagues rather than bosses, learners rather than teachers. They must express their full commitment to openness and demon-strate this commitment by listening carefully and responding without defensiveness, no matter what opinions the other participants express. By showing their responsiveness, the leaders will help ease participants’ fears about admitting their own failings or voicing criticisms.
after the Workshop
Provide ongoing support. The NTP’s director and senior managers will need to provide moral and material support to the change leader and change team. During all phases of the MOST for TB process, it is the NTP’s leaders who can best encourage the staff to use their imagination and deter-mination to identify creative improvements and find ways to overcome obstacles.
Provide follow-up. In the follow-up phase, the NTP director will need to support the TB change leader in carrying out another MOST for TB exercise in six months or one year to review progress and plan for further management improvements. In the interim, the director should stay abreast of progress and be available to assist the change leader whenever necessary.
rOle Of the ParticiPants
Although the contributions of the facilitators are invaluable, it is the participants (including the NTP director) who do the greatest part of the work during the workshop and who oversee the
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Management and organizational sustainability tool for tB16
change process afterward. This is one of the features that distinguish MOST for TB from other kinds of assessment and planning processes—even those in which the opinions of staff and other stake-holders are solicited by skillful external evaluators.
before the Workshop
Understand the MOST for TB process. To be fully invested in MOST for TB, participants should understand the purpose and anticipated results of the workshop, the desired outcomes for each module, and the activities they will undertake to achieve those outcomes. They should review this information ( from handouts given to them by the facilitators) ahead of time, asking questions and expressing any concerns to the NTP’s leadership and the facilitators.
Provide information to the facilitators. Whenever possible, the MOST for TB facilitators should interview each proposed workshop participant, either individually or in small groups. When inter-views are not feasible, or when the facilitators wish to acquire supplementary information, partici-pants may be asked to complete a written questionnaire. Whatever the format, participants can make powerful contributions by providing honest, thoughtful responses to the questions asked.
during the Workshop
Participate fully and openly. The MOST for TB workshop draws on the individual insights of the participants. It compels them to record their assessments carefully, listen closely to one another, consider the merits of differing viewpoints, and reach common ground on the basis of evidence that they can all accept. It may require them to take risks: to speak openly in front of superiors, to acknowledge weaknesses in past performance, or to accept new responsibilities for managing some aspects of future change. The foundation of the workshop—indeed of the entire MOST for TB process—is the energy, creativity, openness, courage, and mutual respect of the workshop participants.
after the Workshop
Be leaders in implementing the changes. When the workshop is over, the participants will play various roles in implementing the action plan. Some of them will be members of the change team, but even those who are not will need to serve as change agents. They will be expected to take on the functions of NTP leadership by:
scanning for progress resulting from the planned changes, as well as scanning the reactions of ■■
their colleagues at all levels as changes are introduced;
focusing the NTP on the agreed-upon changes;■■
aligning and mobilizing their colleagues around the changes;■■
inspiring their colleagues through their own enthusiastic commitment and hard work.■■
rOle Of the facilitatOrs
At first glance, the MOST for TB process seems simple. The instrument is easy to use, and the imple-mentation modules and forms follow a logical sequence. Nonetheless, a skillful and perceptive facilitation team can make all the difference between a superficial MOST for TB experience and one that motivates the NTP to achieve higher levels of performance and improved services.
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Management and organizational sustainability tool for tB 17
The facilitators should carry out the following activities to set the process in motion and see it through to a successful conclusion. They may do some of these tasks together and divide others between them.
before the Workshop
Get to know MOST for TB. The first task of the facilitators is to be thoroughly familiar with every aspect of MOST for TB. They should thoroughly and carefully read the guide to be sure that they understand and are comfortable with the MOST for TB principles and process, as well as with their own roles and the roles of the NTP leadership, workshop participants, TB change leader, and TB change team. Only in this way will the facilitators be able to orient the NTP’s director and senior managers and answer the many questions that can arise.
Get to know the MOH and NTP. The facilitators also need to find out everything possible about the MOH and NTP: purpose, history, culture, achievements, and concerns. This preliminary explo-ration can be made by reading such documents as legislation, technical (norms, procedures, and others) and financial reports, evaluations, studies, and MOH/NTP publications. The facilitators will use this information not only to provide a context for their work but also to help the workshop participants identify underlying issues, address the contributing causes, and build on the NTP’s strengths.
Orient and learn from the NTP’s leadership. A director who is uncertain about committing an NTP to the MOST for TB process may seek help in making the decision. The facilitators should make sure that the director reads “Making the MOST of Management” handout, on page 48. The facilitators should then arrange one or more meetings with the MOH authorities, the NTP’s director, and selected senior managers to further clarify the MOST for TB process and differentiate it from other assessments the NTP may have undergone in the past. These meetings should help answer questions and shed light on any areas of confusion. At the same time, the meetings should also generate critical information for the facilitators. By asking perceptive questions, listening care-fully, and observing attentively, the facilitators will be able to judge whether the NTP is ready to undertake MOST for TB.
If the MOH authorities, the NTP’s director, and its senior managers decide to embark on the MOST for TB process, they should read the first three sections of this guide to confirm their understanding. At this point, the facilitators can negotiate and sign the agreement with the NTP and MOH.
Orient workshop participants. Even when the NTP’s leadership understands MOST for TB and is committed to undertaking the process, the potential participants in the workshop may not be quite so certain. They may have a skeptical view of MOST for TB as one more event in a series of assessments and plans that have added to their work and made little difference to the NTP. The facilitators, supported by the NTP director, can differentiate the MOST for TB process from these prior efforts. The facilitators should provide the proposed participants with the “Making the MOST of Management” handout (page 48).
Learn from workshop participants. The facilitators should make every effort to interview each proposed participant. Face-to-face interviews will allow the participants to air their doubts and concerns while giving the facilitators important insights into the NTP’s culture and work climate. As with the NTP’s leadership, it is critical that the facilitators be nonjudgmental, encourage frankness, and assure participants of confidentiality. Such discussions will yield important information and establish an atmosphere of trust. If interviews are not feasible, the facilitators can develop a written
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Management and organizational sustainability tool for tB18
questionnaire to glean the same types of information. In some instances, the facilitators may choose to administer the written questionnaire ahead of time and supplement it later with the interviews. Suggested questions are found in the Facilitators’ Plan section of this guide, on page 23.
Make the arrangements. The facilitators should work with a designated NTP staff counterpart to be sure that all preparations are made in advance of the workshop, including arranging for the meeting rooms, supplies ( flip-chart paper and easels, markers, overhead projector, computer, printer, photocopier, etc.), and possibly, meals and transportation. The facilitators and NTP staff counterpart can prepare workshop binders for the participants by copying the workshop materials beginning on page 47 and adding any supplementary documents they think the participants will find useful—perhaps selected reprints from the facilitators’ own store of materials. This is a good time to prepare ahead, producing flip charts, overhead transparencies, or slides to support the various workshop modules, as suggested in the Facilitators’ Plan in this guide.
during the Workshop
Explain the assessment process. The facilitators should explain clearly how to complete the MOST for TB assessment instrument and what constitutes convincing evidence for a specific assessment. This task is of critical importance, because the quality of the assessments completed by the individual participants will affect subsequent discussions and planning. To be able to fulfill this task, the facilitators should be completely familiar and comfortable with the MOST for TB Assessment Instrument, beginning on page 53.
Encourage full participation. Perhaps the most important task of the facilitators is to make sure that all voices are heard, without giving undue weight to participants who hold a higher position in the NTP or who are inclined to be more assertive than others. The workshop structure itself fosters universal participation by requiring everyone to form an opinion independently and to share that opinion with a small group. To reinforce this emphasis on participation, the facilitators should point out at the start of the workshop that everyone’s viewpoint is equally valid and that all perspectives must be heard to achieve genuine consensus. The facilitators can help small groups monitor themselves, encouraging the quieter members and reminding more talkative members of their responsibility to listen attentively to their colleagues. The facilitators may need to periodically remind the group of these participation guidelines, or even step in directly if some voices begin to dominate as the discussion intensifies.
Manage time, balancing flow and flexibility. Because different groups work at different speeds, the facilitators should be sensitive to how each small group and individual participant is func-tioning, and should lend support to move a group along when necessary. The facilitators will need to recognize and deal with the stumbling blocks that can distract the participants and divert their energy into unproductive discussions. It is very useful to check in with the participants at the end of each day, or more often if needed, to hear how they are feeling about the pace and to make minor adjustments to the schedule if needed.
Each activity in the MOST for TB workshop builds on the output of the previous activities. Thus, the action plan is the cumulative result of all the work that has gone before it. It is the responsibility of the facilitators to maintain the logical flow of the process, so that participants can use the results of each activity as the context for the next, building momentum toward the final action plan.
Synthesize. At several points in the workshop, the facilitators will need to help the participants pull together the different threads of a discussion into a set of shared perceptions. This ability to synthesize will help the group retain its focus and move forward.
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Resolve conflicts. The MOST for TB process often releases strong emotions and brings to light long-standing areas of disagreement that cannot be ignored. This airing of hidden grievances is valuable as a means of removing obstacles that stand in the way of management improvement. At the same time, these discussions cannot be allowed to derail the MOST for TB process. It is critical, therefore, that facilitators maintain the stance of objective outsiders and intervene when necessary, helping the participants to either resolve or postpone the resolution of some issues.
Therefore, facilitators must balance forward momentum against the occasional need to address issues that arise unexpectedly in the course of small-group or plenary discussions. Participants may have underlying concerns that, if ignored, could severely impede the implementation of the action plan. One approach is for these concerns to be written on a flip-chart page or “parking lot,” which remains posted throughout the workshop and is used to list important issues that will need to be addressed in the future. Sometimes, however, the workshop agenda must be diverted for a short time to untie the knots, cutting short some other activity or extending an already-long day. A skilled facilitator can define the dilemma for the group, clarify the consequences of ignoring or addressing the issue, and guide the group in making the most appropriate judgment within the time available.
Identify or confirm the TB change leader and TB change team. No MOST for TB workshop should end without the clear assignment of responsibility to a TB change leader and TB change team. These people should be enthusiastic supporters of the change process. They must have the full support of the NTP director and other MOH decision-makers, including the time and resources needed to carry out the activities in the action plan. The NTP director may have already appointed the TB change leader before the workshop; in that case, the facilitators can make time for the NTP director to announce this decision. If the TB change leader has not already been appointed, the facilitators should guide the group in choosing someone who fits the qualifications noted in the box on page 11. That person should be willing—even eager—to take on the assignment.
The facilitators should also help participants identify the members of the TB change team. The core of the team will be the individuals who have agreed to be responsible for key activities in the action plan. This core may be supplemented by other NTP staff members with specific skills that will be important in carrying out the action plan.
Empower the participants. One of the biggest challenges for the facilitators may be to dispel the sense of futility that some MOST for TB groups feel when they are a small part of a large, powerful organization—for example, the MOH. The facilitators will need to acknowledge that some changes will require higher-level interventions, but this reality should not dilute the considerable power that the group possesses to make some important changes. The facilitators should be prepared to cite examples of groups that have made realistic and substantive management improvements despite the constraints imposed by the laws, policies, and regulations of their larger organizational structure.
Document the decisions made. It is the responsibility of the facilitators to be sure that all points that are agreed upon are recorded. In most instances, the decisions will be documented by the workshop participants themselves, on flip-chart pages hung around the room. However, it is crucial that all decisions be entered on a computer and given to the participants as documents to verify the content and use as they move forward. During the final module, while the action plan is being developed, small groups will be working on previous group outputs, revising them, receiving feedback, and finalizing them on the same day. It will be important at the end of the day for one of the facilitators to enter the changes, print the final documents, and distribute copies to all the participants.
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after the Workshop
Conduct follow-up activities. Even the most highly motivated TB change leaders can find them-selves overwhelmed with day-to-day pressures and lose the momentum for change. The facili-tators can help them maintain momentum and move the NTP toward achieving its objectives to improve management practices by providing support at critical junctures. Responsibilities after the workshop might include:
writing and submitting a workshop report that is complete, clear, and specific enough for the ■■
NTP director and MOH authorities, TB change leader, and TB change team to present the re-sults of the MOST for TB workshop to the rest of the NTP and to guide their next steps;
maintaining monthly contact (by phone or e-mail) and/or scheduling occasional meetings ■■
with the NTP director and TB change team to track the progress and results of the changes being implemented;
providing facilitation for in-depth assessments of management components the NTP has ■■
selected for more intensive work;
providing other kinds of technical assistance as requested, or suggesting other sources of tech-■■
nical assistance;
conducting a follow-up MOST for TB exercise or workshop to review progress and tackle ■■
additional management challenges.
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IV. USING THE MOST fOR TB ASSESSMENT INSTRUMENTThis section provides an example of the MOST for TB Assessment Instrument, which serves as the basis for the MOST for TB workshop. The instrument is a matrix used to assess 30 management components related to an NTP’s mission, values, strategy, structure, and systems. For each com-ponent, the instrument presents four possible stages of development, each of which is defined by a set of characteristics.
stages Of ManageMent deVelOPMent
As NTPs grow, strengthen, and mature, they evolve through a continuum of stages of development. The MOST for TB instrument describes the characteristics of management components at each of four stages of development. By comparing the NTP’s management performance to the character-istics that mark the stages, workshop participants can decide for themselves what stage the NTP has reached for each management component.
using the Management characteristics to assess stages of development
participants in the Most for tB workshop do not attempt to characterize the ntp’s overall stage of development. Rather, they identify the stage of development for each management component.
to be rated at a particular stage of development for a management component, the ntp must match all the characteristics of that stage—it cannot be rated at an in-between stage, such as “2.5.”
Each stage of development includes and builds on the characteristics of the previous stage. At the first stage, the characteristics describe an NTP that has done very little to develop that component. At the other end of the spectrum, the fourth stage, the characteristics portray an NTP that is oper-ating extremely effectively with regard to that component. In such a case, the NTP might consider directing its energies to components that are at lower stages of development.
It is important to note that different NTPs pass through these stages at different rates, even if the NTPs were founded at the same time. Even within one NTP, different management components may be at different stages of development at the same time. Discrepancies among NTPs and within an NTP—for example, rating a “3” on the links of the strategy to the mission but a “1” on the links of the strategy to TB patients and community—might be the result of a combination of factors: the focus of the NTP’s leaders, the mandates of the MOH, the comparative strengths of staff members, and the demands of the external environment.
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Management and organizational sustainability tool for tB22
PrOViding eVidence
Because workshop participants come from many parts of the MOH and NTP, they often differ in their perceptions of whether a component fits all the characteristics of a particular stage. To help resolve differing views, the instrument provides a space for the participants to individually record evidence: a brief description of an event or situation that they have seen, heard about, or experi-enced that supports them in rating the component at the stage they have selected. Later, in hetero-geneous small groups, participants will share their evidence and take into account their different perspectives as they seek to reach consensus on the stage of development of each component.
What constitutes evidence?
Many types of evidence—not simply quantitative data—may support participants’ assess-ments. Most for tB defines evidence as a fact or concrete observation that supports the iden-tified stage of development. Convincing evidence answers the question: What can we see or hear, or what do we know, that tells us that something is true?
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V. fACILITATORS’ PLANThis section of the guide provides a suggested plan for implementing the entire MOST for TB process. This plan is a synthesis of the experience of previous MOST facilitators—it is meant to be a guide rather than a rigid prescription.
This plan is very detailed. You should read the previous sections of the MOST for TB guide first, to obtain an overview of the process and your responsibilities. When you have a solid understanding of the purpose and process of MOST for TB, you can turn to this Facilitators’ Plan to fill in the details. You can decide with your co-facilitator how to divide responsibilities throughout the process.
The Facilitators’ Plan is organized according to the four phases of the MOST for TB process:
Phase 1:■■ Engagement of the NTP’s Leaders. During this phase, you will get to know the NTP, be sure that the NTP director fully understands MOST for TB and is prepared to undertake the process, and negotiate an agreement on the scope of work.
Phase 2:■■ Preparation for the Workshop. This phase involves interviewing potential work-shop participants and making all arrangements for the workshop.
Phase 3:■■ Workshop Plan. The workshop lasts three days. The first day includes the opening session and Module 1: Where Are We Now? The second day covers Module 2: Where Are We Headed? and Module 3: How Will We Manage the Needed Changes? The third day is devoted to Module 4: How Will We Reach Our Objectives? The proposed time frames for each module are found in the Workshop Agenda, on page 29.
Phase 4:■■ Follow-Up Activities. Follow-up should be provided over a six-month to one-year period. Follow-up includes regular contact by telephone or e-mail, and possibly another MOST for TB workshop toward the end of the period to review progress and plan for future manage-ment improvements.
For each phase, the plan identifies the objectives, describes the activities in detail, explains your role in each activity, and lists the resources you will need to prepare. (Some of the resources appear in this guide, but you will need to obtain or produce others yourself.) In addition, based on the experiences of the Most for TB facilitators, the plan includes “tips,” points to keep in mind that can enhance an activity.
Management and organizational sustainability tool for tB24
Pha
se 1
: en
ga
geM
ent
Of
the
ntP
’s l
ead
ers
Ob
ject
ives
Beco
me
fam
iliar
with
the
NTP
by
revi
ewin
g do
cum
ents
and
mee
ting
with
the
NTP
’s le
ader
ship
.■
■
Con
firm
with
the
NTP
’s le
ader
ship
that
MO
ST fo
r TB
is a
ppro
pria
te fo
r the
NTP
at t
his
time.
■■
If M
OST
for T
B is
app
ropr
iate
, fina
lize
nego
tiat
ions
and
reac
h ag
reem
ent o
n th
e sc
ope
of w
ork.
■■
Pha
se 1
: en
ga
geM
ent
Of
the
ntP
’s l
ead
ers
act
ivit
yfa
cilit
ator
s’ r
ole
res
ourc
es r
equi
red
kee
p in
Min
d .
. .
prep
arat
ion
for
the
first
m
eetin
g w
ith t
he n
tp’s
le
ader
ship
Beco
me
fam
iliar
with
the
det
ails
of t
he M
ost
for
tB p
roce
ss.
Beco
me
fam
iliar
with
the
ntp
’s m
anda
te, h
isto
ry, c
ultu
re,
achi
evem
ents
, cha
lleng
es, a
nd c
once
rns.
Firs
t th
ree
sect
ions
of t
he
Mo
st fo
r tB
gui
de
Doc
umen
ts a
bout
the
ntp
, su
ch a
s its
mis
sion
sta
te-
men
t, n
tp t
echn
ical
nor
ms
and
proc
edur
es, s
trat
egic
pl
an, a
nnua
l ope
ratio
nal
plan
, ann
ual r
epor
ts, r
epor
ts
to d
onor
s, s
ervi
ce fl
yers
, and
w
ebsi
te in
form
atio
n
Mee
ting
with
the
ntp
di
rect
or (
cont
inue
s on
ne
xt p
age)
Intr
oduc
e th
e M
ost
for
tB p
roce
ss, r
elat
ing
it (w
hen
pos-
sibl
e) t
o w
hat
you
have
lear
ned
abou
t th
e n
tp. H
ighl
ight
the
fo
llow
ing:
the
purp
ose
of t
he M
ost
for
tB p
roce
ss is
to
help
an
ntp
■
■
chan
ge a
nd d
evel
op it
s m
anag
emen
t an
d le
ader
ship
. M
anag
emen
t im
prov
emen
ts c
an le
ad t
o im
prov
ed s
er-
■■
vice
s an
d co
ntrib
ute
to s
usta
inab
ility
. st
rong
lead
ersh
ip w
ill b
e ne
eded
to
initi
ate
and
sust
ain
■■
the
chan
ges
mad
e.
the
Mo
st fo
r tB
pro
cess
is p
art
of a
n on
goin
g co
mm
it-■
■
men
t to
cha
nge.
“Mak
ing
the
Mo
st o
f Man
-ag
emen
t,”
on p
age
48
prov
ide
Mo
st fo
r tB
mat
eria
ls
seve
ral d
ays
ahea
d of
tim
e an
d en
-co
urag
e th
e di
rect
or t
o re
view
the
m
befo
re t
he m
eetin
g.
Management and organizational sustainability tool for tB 25
Mee
ting
with
the
ntp
di
rect
or (
cont
inue
d)C
hang
e be
gins
at
the
top,
as
an n
tp’s
lead
ers
dem
on-
■■
stra
te o
penn
ess
to t
he is
sues
and
idea
s of
sta
ff. t
he le
ad-
ers
are
on a
n eq
ual f
ootin
g w
ith a
ll ot
her
part
icip
ants
in
the
Mo
st fo
r tB
wor
ksho
p.
the
thre
e-da
y w
orks
hop
is t
he fo
cal e
vent
, but
not
the
■
■
final
eve
nt. t
he w
orks
hop
build
s a
colle
ctiv
e pe
rspe
ctiv
e am
ong
staf
f, ge
nera
tes
idea
s, a
nd c
reat
es b
uy-in
for
the
actio
ns s
ugge
sted
. Im
prov
ing
man
agem
ent
prac
tices
will
req
uire
impo
rtan
t ■
■
follo
w-u
p ac
tions
led
by a
cha
nge
lead
er a
nd c
hang
e te
am a
nd s
uppo
rted
with
the
ntp
’s r
esou
rces
. It
will
tak
e tim
e to
see
the
effe
cts
of M
ost
for
tB o
n
■■
the
ntp
’s w
ork
and,
ulti
mat
ely,
on
serv
ices
and
sus
tain
-ab
ility
.
Revi
ew t
he c
riter
ia fo
r un
dert
akin
g M
ost
for
tB, a
ckno
wle
dg-
ing
that
Mo
st fo
r tB
is n
ot a
ppro
pria
te fo
r ev
ery
ntp
. Det
er-
min
e w
ith t
he d
irect
or w
heth
er t
he n
tp m
eets
the
se c
riter
ia
and
is r
eady
for
Mo
st fo
r tB
at
this
tim
e.
Ans
wer
all
ques
tions
fully
and
hon
estly
.
“How
Can
ntp
s Be
nefit
from
M
ost
for
tB?,
” pa
ge 4
If th
e n
tp d
irect
or q
uest
ions
the
ne
ed fo
r m
ore
than
one
faci
litat
or,
you
may
wan
t to
dra
w o
n th
e ex
-pl
anat
ion
foun
d on
pag
e 7
in “
the
Mo
st fo
r tB
pro
cess
.”
not
e: s
ome
dire
ctor
s m
ay c
hoos
e to
invo
lve
a sm
all n
umbe
r of
se-
nior
sta
ff in
thi
s m
eetin
g. If
so,
you
sh
ould
pro
vide
the
m w
ith t
he s
ame
Mo
st fo
r tB
mat
eria
ls.
neg
otia
tion
of t
he a
gree
-m
ent
with
the
ntp
dire
c-to
r or
an
assi
gned
sta
ff co
unte
rpar
t
With
the
ntp
dire
ctor
, det
erm
ine
the
scop
e of
wor
k,
incl
udin
g:
your
leve
l of e
ffort
bef
ore,
dur
ing,
and
aft
er t
he w
orks
hop;
■
■
a de
sign
ated
sta
ff co
unte
rpar
t fr
om t
he n
tp t
o ha
ndle
■
■
logi
stic
s be
fore
and
dur
ing
the
wor
ksho
p;
the
resp
onsi
bilit
ies
of a
ll pa
rtie
s to
the
agr
eem
ent;
■
■
the
antic
ipat
ed r
esul
ts o
f you
r in
terv
entio
ns;
■■
(if p
ossi
ble)
the
sta
ff m
embe
r w
ho w
ill b
e th
e ch
ange
lead
-■
■
er a
nd o
vers
ee t
he im
plem
enta
tion
of t
he a
ctio
n pl
an.
In c
onsi
derin
g w
hat
will
hap
pen
afte
r th
e w
orks
hop,
it is
use
ful t
o pl
an fo
r a
six-
mon
th o
r on
e-ye
ar
follo
w-u
p M
ost
for
tB e
xerc
ise
to
eval
uate
pro
gres
s an
d ac
hiev
emen
ts
to d
ate,
and
to
plan
for
futu
re m
an-
agem
ent
impr
ovem
ents
.
Management and organizational sustainability tool for tB26
Pha
se 2
: Pr
ePa
ra
tiO
n f
Or
th
e W
Or
ksh
OP
Ob
ject
ives
Arr
ange
the
deta
ils o
f the
wor
ksho
p.■
■
Gai
n in
form
atio
n fr
om th
e id
entifi
ed w
orks
hop
part
icip
ants
thro
ugh
inte
rvie
ws
and/
or q
uest
ionn
aire
s.■
■
Use
the
part
icip
ant i
nfor
mat
ion
in p
lann
ing
the
wor
ksho
p.■
■
Pha
se 2
: Pr
ePa
ra
tiO
n f
Or
th
e W
Or
ksh
OP
act
ivit
yfa
cilit
ator
s’ r
ole
res
ourc
es r
equi
red
kee
p in
Min
d .
. .
Furt
her
mee
ting(
s) w
ith
the
ntp
dire
ctor
Con
firm
the
exp
ecta
tions
and
res
pons
ibili
ties
of t
he n
tp d
i-re
ctor
, fac
ilita
tors
, sta
ff co
unte
rpar
t, a
nd p
artic
ipan
ts b
efor
e,
durin
g, a
nd a
fter
the
wor
ksho
p.
With
the
dire
ctor
, cla
rify
how
Mo
st fo
r tB
will
fit
into
the
n
tp’s
ove
rall
plan
ning
pro
cess
and
any
oth
er c
urre
nt im
prov
e-m
ent
initi
ativ
es.
“Rol
es o
f the
sta
keho
lder
s,”
begi
nnin
g on
pag
e 14
Mak
ing
arra
ngem
ents
fo
r th
e w
orks
hop
With
the
ntp
dire
ctor
, rev
iew
the
follo
win
g cr
iteria
to
iden
tify
the
wor
ksho
p pa
rtic
ipan
ts:
Idea
lly, t
here
will
be
12–2
5 pa
rtic
ipan
ts.
■■
ther
e sh
ould
be
a m
ix o
f key
sen
ior
staf
f and
oth
er s
taff
■■
who
hav
e m
anag
emen
t re
spon
sibi
litie
s.
the
part
icip
ants
may
incl
ude
othe
r st
akeh
olde
rs t
he n
tp
■■
dire
ctor
con
side
rs a
ppro
pria
te fo
r m
anag
emen
t di
scus
sion
s (e
.g.,
Mo
H n
atio
nal a
nd r
egio
nal s
taff,
sta
ff of
clo
sely
re-
late
d m
inis
trie
s or
nG
os)
A
ll pa
rtic
ipan
ts m
ust
mak
e a
com
mitm
ent
to b
e pr
esen
t ■
■
and
invo
lved
thr
ough
out
the
wor
ksho
p.
Mee
t w
ith t
he n
tp’s
staf
f cou
nter
part
to
go o
ver
the
arra
nge-
men
ts a
nd lo
gist
ics
he o
r sh
e is
han
dlin
g. A
rran
gem
ents
incl
ude
sche
dulin
g th
e pr
e-w
orks
hop
part
icip
ant
inte
rvie
ws,
set
ting
the
wor
ksho
p da
tes
and
loca
tion,
gat
herin
g th
e w
orks
hop
supp
lies,
an
d pr
oduc
ing
the
part
icip
ants
’ wor
ksho
p bi
nder
s.
Con
firm
the
wor
ksho
p’s
loca
tion
(off-
site
, if p
ossi
ble)
. It
shou
ld
have
bre
akou
t sp
ace
for
seve
ral s
mal
l gro
ups
to m
eet
sim
ulta
-ne
ousl
y an
d w
all s
pace
for
post
ing
flip-
char
t pa
ges.
“Rol
e of
the
par
ticip
ants
,”
begi
nnin
g on
pag
e 15
Wor
ksho
p m
ater
ials
, beg
in-
ning
on
page
47
Add
ition
al r
esou
rces
, as
liste
d on
pag
e 83
Management and organizational sustainability tool for tB 27
pre-
wor
ksho
p in
terv
iew
s w
ith p
artic
ipan
tsM
eet
with
all
wor
ksho
p pa
rtic
ipan
ts, i
ndiv
idua
lly o
r in
sm
all
grou
ps, s
ever
al d
ays
befo
re t
he w
orks
hop.
Begi
n to
kno
w t
he k
ey p
laye
rs a
nd t
heir
area
s of
inte
rest
■
■
and
conc
ern.
o
rient
the
m t
o th
e M
ost
for
tB p
roce
ss b
y go
ing
over
■
■
“Mak
ing
the
Mo
st o
f Man
agem
ent”
with
the
m a
nd a
n-sw
erin
g th
eir
ques
tions
. In
terv
iew
the
par
ticip
ants
to
gath
er in
form
atio
n th
at w
ill
■■
help
you
pla
n th
e w
orks
hop.
sug
gest
ed q
uest
ions
incl
ude:
W
hat
is y
our
posi
tion?
■
■
Wha
t ar
e yo
ur m
ain
resp
onsi
bilit
ies?
■
■
Wha
t is
it a
bout
thi
s n
tp t
hat
mot
ivat
es y
ou t
o co
me
to
■■
wor
k ev
ery
day?
W
hat
do y
ou t
hink
mak
es t
his
ntp
uni
que?
■
■
Wha
t ar
e yo
ur m
ain
conc
erns
abo
ut t
he m
anag
emen
t of
■
■
the
ntp
? W
hat
are
your
exp
ecta
tions
for
this
wor
ksho
p?
Wha
t do
you
hop
e w
ill b
e di
ffere
nt w
hen
you
retu
rn t
o ■
■
your
day
-to-
day
resp
onsi
bilit
ies
at t
he e
nd o
f the
wor
k-sh
op?
Wha
t do
you
hop
e to
con
trib
ute
to t
he M
ost
for
tB
■■
proc
ess,
bot
h du
ring
and
afte
r th
e w
orks
hop?
Id
entif
y re
curr
ing
issu
es a
nd c
once
rns
that
mig
ht a
rise
dur-
■■
ing
the
wor
ksho
p.
Use
thi
s in
form
atio
n to
sha
pe t
he w
orks
hop.
■■
“Mak
ing
the
Mo
st o
f Man
-ag
emen
t” h
ando
ut, p
age
48Yo
u m
ay w
ish
to c
onsi
der
orie
ntin
g th
e w
orks
hop
part
icip
ants
ahe
ad
of t
ime.
Aft
er t
his
grou
p or
ient
a-tio
n, y
ou c
ould
the
n pr
ocee
d w
ith
the
indi
vidu
al in
terv
iew
s. A
lthou
gh
hold
ing
face
-to-
face
inte
rvie
ws
is
the
best
way
to
get
to k
now
par
tici-
pant
s an
d be
gin
to e
stab
lish
trus
t, it
m
ay n
ot b
e po
ssib
le. I
f it
is n
ot, y
ou
can
subs
titut
e a
writ
ten
ques
tion-
naire
tha
t w
ill b
e in
form
ativ
e w
ith-
out
plac
ing
too
muc
h of
a b
urde
n on
the
res
pond
ents
, usi
ng o
r ad
apt-
ing
the
ques
tions
sug
gest
ed fo
r th
e in
terv
iew
. Dis
trib
ute
the
“Mak
ing
the
Mo
st o
f Man
agem
ent”
han
d-ou
t an
d th
e qu
estio
nnai
re t
o th
e pa
rtic
ipan
ts, w
ith a
mes
sage
from
yo
u ex
plai
ning
the
pur
pose
of t
he
ques
tionn
aire
and
set
ting
a de
ad-
line
for
retu
rnin
g it.
Be
sure
to
allo
w
enou
gh t
ime
for
the
part
icip
ants
to
ret
urn
it so
you
can
tak
e th
eir
resp
onse
s in
to a
ccou
nt a
s yo
u pl
an
the
wor
ksho
p.
plan
ning
the
wor
ksho
pRe
view
the
ses
sion
pla
ns fo
r th
e w
orks
hop,
foun
d in
thi
s gu
ide.
Use
the
se p
lans
as
a gu
idel
ine
for
plan
ning
the
wor
k-sh
op. C
onsi
der
wha
t yo
u ha
ve le
arne
d fr
om y
our
mee
tings
an
d in
terv
iew
s w
hen
stru
ctur
ing
wor
king
gro
ups
and
allo
cat-
ing
time
for
wor
ksho
p ac
tiviti
es.
“pha
se 3
: Wor
ksho
p pl
an,”
be
ginn
ing
on p
age
28
MOST FOR TB
Management and organizational sustainability tool for tB28
Phase 3: WOrkshOP Plan
The focal point of the MOST for TB process is a structured workshop in which, over the course of three days, you will help the participants pool their individual and collective experience of the NTP. The result will be a better picture of the current management practices of the NTP and a plan for making management improvements.
Participants. Ideally, the workshop should include from 12 to 25 participants. Having fewer than 12 participants limits the richness of discussions; having more than 25 requires more time to inte-grate small-group products into consensus and may strain the three-day format. The participants should include the director, senior managers, and a mix of staff with management responsibilities. Other stakeholders with an involvement in management issues (e.g., MOH and NTP central and regional staff) may also participate, as deemed appropriate by the NTP director.
Purpose. MOST for TB provides a framework for an ongoing NTP-wide discussion about critical management practices. The MOST for TB workshop is often the first opportunity for staff and stakeholders from different levels to share their perceptions of the NTP’s management and the issues that affect their daily work. The goal of the workshop is to help participants use these percep-tions to identify concrete actions they can take in the immediate future to improve management.
Approach. The workshop process is designed to validate the contributions of each participant. Within a highly structured environment, all participants are encouraged to express their views and listen carefully to the views of their colleagues. This process allows participants to come to con-sensus on the NTP’s current management performance and make a practical plan for improving its performance.
reaching consensus
Consensus is strongly emphasized in the Most for tB workshop. this emphasis is based on two assumptions:
no single participant in the workshop possesses the complete truth about the ntp and ■■
its management; instead, every person possesses some part of the truth. An accurate picture is best obtained by pooling these individual perceptions.
Each participant’s observations about his or her experiences relative to the management ■■
components can broaden the perspective of the other participants. the evidence that the participants offer to support their opinions helps the group come to agreement on what may initially seem to be incompatible viewpoints.
the workshop participants reach consensus not by voting but by patiently sorting through all opinions until they arrive at a decision that each participant can accept and work with—even if this decision does not completely match his or her initial opinion.
MOST FOR TB
Management and organizational sustainability tool for tB 29
Workshop Agenda. The workshop consists of an opening session and four modules, with defined objectives for each session and module.
WOrkshOP agenda
session/ Module Objectives approximate
time frame
DAY 1 Opening session Review the workshop agenda and anticipated ■■
outcomes.
Clarify expectations. ■■
Introduce the Most for tB process. ■■
Establish ground rules for an open, honest, respectful ■■
exchange of ideas.
Explore the links between leadership, improved man-■■
agement, work climate, sustainability, and organiza-tional results.
1 ½ hours
Module 1: Where are We now?
Explore the meaning of the five management areas ■■
and the 30 management components.
Work in groups that cut across organizational levels ■■
and draw on the contributions of each member.
Generate consensus on the ntp’s current status in ■■
terms of each component and stage of development.
4 ½ hours
DAY 2 Module 2: Where are We headed?
Agree on one or two objectives for improving each ■■
management component.
specify evidence that will indicate progress toward ■■
these objectives.
4 hours
Module 3: how Will We Manage the needed changes?
Explore the principles of change. ■■
Explore how changes in management, together with ■■
strong leadership, can improve an ntp’s services and sustainability.
Recognize participants’ roles as leaders and managers ■■
of the change process.
4 hours
DAY 3 Module 4: how Will We reach Our Objectives?
select the highest-priority management components ■■
to improve during the coming period.
prepare an action plan for these improvements. ■■
Decide on follow-up activities that will need to be ■■
completed, and assign responsibility for the activities.
1 day
Specific plans for the workshop appear in the following pages. A one-page duplicate of the workshop agenda and anticipated outcomes that can be distributed to workshop participants appears on pages 51–52.
MOST FOR TB
Management and organizational sustainability tool for tB30
Anticipated outcomes of the workshop. By the end of the workshop, participants will have come to agreement on how well the NTP is functioning and will have planned activities for making improvements. The specific outcomes include:
a collective assessment of the current stage of development of the management components;■■
a prioritized list of the management components to be improved within a specified period;■■
an agreed-upon set of objectives for improving each management component;■■
an action plan for reaching the objectives, identifying the broad activities, timing, resources, ■■
and people responsible for completing the activities, and defining data that can provide evi-dence of success;
identification of a TB change leader and TB change team who will lead the implementation of ■■
the action plan and monitor progress;
a list of short-term activities for following up on the MOST for TB workshop: those the staff ■■
can do themselves with existing resources, those for which they need to seek additional re-sources, and those for which they will need technical assistance from outside the NTP;
agreement on post-workshop assistance from the facilitators (by phone or e-mail) and a ■■
follow-up MOST for TB exercise, usually six months to one year after the workshop.
helping to develop the MOst for tb action Plan
A critical outcome of the Most for tB workshop is a concrete plan for making the changes needed to strengthen management performance. this action plan usually covers one year, broken down by quarters or months. You can help lay the groundwork for a successful action plan by helping the participants to carry out these vital activities:
Link the action plan to the ntp’s operational plans and work plans.■■
secure the commitment and active involvement of the MoH’s and ntp’s leaders, espe-■■
cially with regard to difficult decisions about resources.
Assign responsibility for activities only to someone who agrees to do them, preferably ■■
someone who participated in the workshop. It is unrealistic and unfair to hold people accountable for activities they have not agreed to carry out.
plan realistically, allowing more time than may seem necessary to complete each activity.■■
plan for incremental improvements. small steps are often more feasible than giant leaps ■■
and may be more effective in moving the ntp toward its objectives.
Introduce the action plan to the rest of the ntp staff and include them in the activities.■■
Carefully consider the MoH/ntp organizational factors that may impede change, and ■■
seek ways to address these factors, perhaps with outside assistance.
MOST FOR TB
Management and organizational sustainability tool for tB 31
Setting. Much of the discussion during the workshop will happen in small groups, with frequent plenary meetings to synthesize the findings and make decisions. Thus, the workshop should take place in a setting in which four or five small groups can work without interfering with one another. Because much of the discussion will best be captured on flip charts, you will need to hold the workshop in a room with plenty of wall space, enough for posting as many as 20 flip-chart pages at one time.
Materials. The materials needed are few:
flip-chart pads, flip-chart easels (two for the facilitators and one for each small group), and ■■
markers in sufficient quantity for several small groups to work simultaneously;
a projector for transparencies, slides, or a computerized slide show, if you choose to present ■■
basic information by any of these methods;
data entry, printing, and copying facilities, so that the decisions made by small groups can be ■■
documented and distributed as the action planning takes place;
a binder for each participant, containing all the workshop materials beginning on page 48, as ■■
well as any additional materials you choose.
During the workshop, one important responsibility will be to document the discussions and deci-sions of the sessions. You may find it useful to have a computer and printer accessible for one facilitator to use to quickly record the information and distribute the group’s decisions to the par-ticipants.
Management and organizational sustainability tool for tB32
OPe
nin
g s
essi
On
(M
Or
nin
g O
f d
ay 1
)
Ob
ject
ives
By th
e en
d of
the
open
ing
sess
ion,
par
ticip
ants
will
hav
e:
revi
ewed
the
wor
ksho
p ag
enda
and
ant
icip
ated
out
com
es;
■■
clar
ified
exp
ecta
tions
for t
he w
orks
hop;
■■
been
intr
oduc
ed to
the
MO
ST fo
r TB
proc
ess;
■■
esta
blis
hed
the
grou
nd ru
les
for a
n op
en, h
ones
t, re
spec
tful
exc
hang
e of
idea
s th
roug
hout
the
wor
ksho
p;■
■
expl
ored
the
links
bet
wee
n im
prov
ed m
anag
emen
t, or
gani
zatio
nal s
usta
inab
ility
, and
lead
ersh
ip.
■■
OPe
nin
g s
essi
On
Wor
ksh
op a
ctiv
ity
faci
litat
ors’
rol
er
esou
rces
req
uire
dk
eep
in M
ind
. . .
Intr
oduc
tion
of p
ar-
ticip
ants
and
faci
litat
or;
pres
enta
tion
of t
he a
gen-
da a
nd a
ntic
ipat
ed o
ut-
com
es o
f the
wor
ksho
p
Intr
oduc
e yo
urse
lf an
d ha
ve t
he w
orks
hop
part
icip
ants
intr
o-du
ce t
hem
selv
es, i
f the
y do
not
all
know
one
ano
ther
.
pres
ent
agen
da a
nd a
ntic
ipat
ed o
utco
mes
. Rev
iew
the
par
tici-
pant
bin
ders
, enc
oura
ging
dis
cuss
ion
and
ques
tions
.
Revi
ew t
he fi
ndin
gs—
key
them
es, c
once
rns,
exp
ecta
tions
, et
c.—
from
the
pre
-wor
ksho
p in
terv
iew
s an
d/or
que
stio
n-na
ires.
Cla
rify
how
thi
s w
orks
hop
will
and
will
not
res
pond
to
thes
e fin
ding
s.
set
the
tone
for
the
wor
ksho
p by
em
phas
izin
g th
e ne
ed fo
r op
en, h
ones
t ex
chan
ges
and
resp
ectf
ul a
tten
tion
to o
ther
pe
ople
’s v
iew
s.
With
par
ticip
ants
, est
ablis
h gr
ound
rul
es t
hat
will
fost
er t
he
desi
red
envi
ronm
ent.
part
icip
ant
bind
ers
cont
ain-
ing
the
mat
eria
l beg
inni
ng
on p
age
48
prep
ared
flip
cha
rts
or t
rans
-pa
renc
ies
with
the
age
nda,
ob
ject
ives
, ant
icip
ated
out
-co
mes
, oth
er u
p-fr
ont
mat
e-ria
l, as
des
ired
Flip
cha
rt o
r tr
ansp
aren
cy
sum
mar
izin
g th
e in
terv
iew
fin
ding
s, in
clud
ing
expe
cta-
tions
for
the
wor
ksho
p
Flip
cha
rt a
nd m
arke
rs
Alth
ough
it is
pos
sibl
e to
pre
sent
th
is in
form
atio
n in
slid
es o
r tr
ans-
pare
ncie
s, m
any
faci
litat
ors
pref
er
to u
se fl
ip c
hart
s, w
hich
est
ablis
h an
atm
osph
ere
of in
form
ality
and
in
volv
emen
t. t
he p
ages
can
be
post
ed o
n th
e w
all f
or r
efer
ence
th
roug
hout
the
wor
ksho
p. F
acili
ta-
tors
can
eas
ily r
etur
n to
the
flip
ch
arts
at
key
poin
ts fo
r re
view
and
di
scus
sion
(e.
g., a
t th
e en
d of
eac
h m
odul
e, w
hen
part
icip
ants
can
co
mm
ent
on t
he e
xten
t to
whi
ch
the
obje
ctiv
es h
ave
been
ach
ieve
d).
this
can
be
an in
form
al b
ut p
ower
-fu
l eva
luat
ion
tool
.
Management and organizational sustainability tool for tB 33
ntp
dire
ctor
’s e
ndor
se-
men
t of
Mo
st fo
r tB
Ask
the
dire
ctor
to
expl
ain
why
he
or s
he h
as c
hose
n to
use
M
ost
for
tB a
t th
is t
ime
and
how
Mo
st fo
r tB
will
ben
efit
the
ntp
.
Be s
ure
to r
emin
d th
e di
rect
or w
ell
ahea
d of
tim
e an
d m
ake
sure
tha
t he
or
she
is c
omfo
rtab
le t
akin
g on
th
is t
ask.
Intr
oduc
tion
to M
ost
fo
r tB
Expl
ain
the
purp
ose
of M
ost
for
tB:
Impr
ove
the
ntp
’s m
anag
emen
t, s
ince
man
agem
ent
is a
n ■
■
esse
ntia
l fea
ture
of s
usta
inab
ility
and
con
trib
utes
to
the
orga
niza
tion’
s ou
tcom
es.
build
con
sens
us a
mon
g st
aff o
n th
e is
sues
and
pla
ns
■■
iden
tified
. pr
ovid
e a
tool
for
sim
ple,
effe
ctiv
e m
onito
ring
of m
anag
e-■
■
men
t in
the
futu
re.
Cla
rify
how
Mo
st fo
r tB
is d
iffer
ent
from
oth
er p
lann
ing
pro-
cess
es a
nd im
prov
emen
t in
itiat
ives
the
ntp
has
und
erta
ken
or
is c
urre
ntly
invo
lved
in:
It is
an
ntp
sel
f-as
sess
men
t, c
ompl
eted
on
site
. ■
■
All
part
icip
ants
’ opi
nion
s ar
e va
lid a
nd m
ust
be t
aken
into
■
■
acco
unt
in r
each
ing
synt
hesi
s.th
ere
is n
o ou
tsid
e as
sess
or—
the
only
out
side
rs a
re t
here
to
■■
faci
litat
e ra
ther
tha
n to
judg
e.
Dis
cuss
how
Mo
st fo
r tB
can
fit
into
and
enh
ance
oth
er p
lan-
ning
act
iviti
es.
opt
iona
l: po
wer
poin
t sl
ide
show
abo
ut M
ost
for
tB,
foun
d on
the
Mo
st fo
r tB
C
D-R
oM
(re
quire
s a
com
-pu
ter
and
LCD
pro
ject
or)
opt
iona
l: tr
ansp
aren
cy
draw
n fr
om “
the
Mo
st fo
r tB
Diff
eren
ce,”
pag
e 3
(con
tinue
d on
nex
t pa
ge)
Management and organizational sustainability tool for tB34
OPe
nin
g s
essi
On
(co
nti
nue
d)
Wor
ksh
op a
ctiv
ity
faci
litat
ors’
rol
er
esou
rces
req
uire
dk
eep
in M
ind
. . .
Cla
rifica
tion
of p
roce
-du
res
and
met
hods
to
be
use
d du
ring
the
w
orks
hop
Retu
rn t
o th
e ag
enda
to
revi
ew t
he d
iffer
ent
mod
ules
of t
he
wor
ksho
p.
Expl
ain
the
way
s in
whi
ch in
divi
dual
s w
ill fo
rm t
heir
own
opin
-io
ns a
nd t
hen
shar
e an
d di
scus
s th
em in
sm
all,
hete
roge
neou
s gr
oups
.
Expl
ain
the
proc
ess
for
reac
hing
con
sens
us in
sm
all g
roup
s an
d pl
enar
y se
ssio
ns.
Intr
oduc
e th
e “p
arki
ng lo
t” c
once
pt a
nd p
ost
a la
rge
shee
t of
pa
per
on t
he w
all o
n w
hich
par
ticip
ants
and
faci
litat
ors
will
re-
cord
idea
s, c
once
rns,
and
top
ics
that
can
not
be fu
lly e
xplo
red
durin
g th
e w
orks
hop.
the
se it
ems
will
nee
d to
be
addr
esse
d at
the
end
of t
he w
orks
hop.
Wor
ksho
p A
gend
a, p
age
51
opt
iona
l: Fl
ip c
hart
or
tran
s-pa
renc
y of
the
“Re
achi
ng
Con
sens
us”
box,
pag
e 28
Flip
-cha
rt p
age(
s) o
n th
e w
all
iden
tified
as
the
“par
king
lo
t”
Emph
asiz
e th
at c
onse
nsus
is
achi
eved
by
liste
ning
, dis
cuss
-in
g, s
harin
g ev
iden
ce, a
nd, fi
nally
, re
achi
ng a
gree
men
t. C
onse
nsus
is
not
a vo
te: e
very
mem
ber
of t
he
grou
p m
ust
be a
ble
to li
ve w
ith a
nd
supp
ort
the
grou
p’s
asse
ssm
ent.
Des
crip
tion
of li
nks
betw
een
good
man
age-
men
t an
d im
prov
ed
resu
lts
Use
the
“Le
adin
g an
d M
anag
ing
Resu
lts M
odel
” to
intr
oduc
e pa
rtic
ipan
ts’ r
ole
as m
anag
ers
and
lead
ers
with
in t
he n
tp.
Dis
cuss
brie
fly h
ow t
heir
wor
k du
ring
and
afte
r th
is w
orks
hop
will
beg
in t
o in
fluen
ce s
ervi
ces.
Revi
ew d
efini
tions
of i
nstit
utio
nal,
prog
ram
mat
ic, a
nd fi
nanc
ial
sust
aina
bilit
y. L
ead
disc
ussi
on o
f im
plic
atio
ns fo
r th
e n
tp a
nd
its w
ork.
tran
spar
ency
or
slid
e of
the
“L
eadi
ng a
nd M
anag
ing
Resu
lts M
odel
,” p
age
82
“Wha
t Is
Mo
st fo
r tB
,”
page
1
this
can
be
a ve
ry s
hort
dis
cuss
ion;
pa
rtic
ipan
ts w
ill c
over
the
top
ic in
de
tail
in M
odul
e 3.
Management and organizational sustainability tool for tB 35
MO
du
le 1
: Wh
ere
ar
e W
e n
OW
? (a
fter
nO
On
Of
day
1 a
nd
MO
rn
ing
Of
day
2)
Ob
ject
ives
By th
e en
d of
this
mod
ule,
par
ticip
ants
will
hav
e:
expl
ored
the
mea
ning
s of
the
five
man
agem
ent a
reas
and
30
man
agem
ent c
ompo
nent
s;
■■
form
ed w
orki
ng g
roup
s th
at c
ut a
cros
s or
gani
zatio
nal d
ivis
ions
and
dra
w o
n th
e co
ntri
butio
ns o
f eac
h m
embe
r;
■■
gene
rate
d co
nsen
sus
on th
e or
gani
zatio
n’s
curr
ent s
tatu
s in
term
s of
eac
h m
anag
emen
t com
pone
nt.
■■
MO
du
le 1
: Wh
ere
ar
e W
e n
OW
?
Wor
ksh
op a
ctiv
ity
faci
litat
ors’
rol
er
esou
rces
req
uire
dk
eep
in M
ind
. . .
Revi
ew o
f obj
ectiv
es fo
r M
odul
e 1
pres
ent
on fl
ip c
hart
and
pos
t on
wal
l to
rem
ain
thro
ugho
ut
the
mod
ule.
Flip
cha
rt o
f obj
ectiv
es
Age
nda
in p
artic
ipan
t bi
nder
pres
enta
tion
of t
he s
truc
-tu
re o
f the
Mo
st fo
r tB
as
sess
men
t in
stru
men
t:
five
prog
ram
are
as
■■
and
30 t
otal
man
age-
men
t co
mpo
nent
s;
four
sta
ges
of
■■
deve
lopm
ent
and
char
acte
ristic
s;ho
w w
e de
term
ine
■■
the
curr
ent
stag
e
of d
evel
opm
ent
and
mon
itor
im
prov
emen
ts;
wha
t co
nstit
utes
con
-■
■
vinc
ing
evid
ence
.
Wal
k th
e gr
oup
thro
ugh
the
Mo
st fo
r tB
Ass
essm
ent
Inst
ru-
men
t. D
iscu
ss d
efini
tions
and
des
crip
tions
of e
ach
man
age-
men
t co
mpo
nent
, ens
urin
g th
at a
ll pa
rtic
ipan
ts u
nder
stan
d th
e te
rms
used
in t
he in
stru
men
t.
Defi
ne “
evid
ence
,” u
sing
exa
mpl
es fr
om t
he M
ost
for
tB
guid
e. C
ondu
ct a
sho
rt e
xerc
ise,
dra
win
g ex
ampl
es fr
om t
he
grou
p, fi
rst
from
unr
elat
ed a
reas
(e.
g., e
vide
nce
of w
ealth
, ed
ucat
ion,
or
pow
er)
and
then
rel
ated
to
the
Mo
st fo
r tB
ch
arac
teris
tics.
post
som
e of
the
ir ex
ampl
es o
n a
flip
char
t an
d di
spla
y fo
r th
e du
ratio
n of
the
wor
ksho
p, t
o re
info
rce
thei
r un
ders
tand
ing.
tran
spar
enci
es o
f the
Mo
st
for
tB A
sses
smen
t In
stru
-m
ent,
beg
inni
ng o
n pa
ge 5
3
opt
iona
l: tr
ansp
aren
cies
or
copi
es b
ased
on
“orie
ntat
ion
to t
he A
sses
smen
t In
stru
-m
ent,
” on
pag
e 5
“Wha
t C
onst
itute
s Ev
iden
ce”
box
on p
age
22
term
inol
ogy
can
be c
onfu
sing
, es-
peci
ally
if p
artic
ipan
ts h
ave
vary
ing
leve
ls o
f man
agem
ent
expe
rienc
e or
spe
ak E
nglis
h as
a s
econ
d la
n-gu
age.
It is
use
ful t
o ac
know
ledg
e th
at s
ome
man
agem
ent
term
s ca
n ha
ve s
ever
al m
eani
ngs.
to
avoi
d lo
ng d
iscu
ssio
ns o
f defi
nitio
ns, y
ou
shou
ld h
ave
the
part
icip
ants
use
the
te
rms
as p
rese
nted
in t
he M
ost
for
tB in
stru
men
t. (con
tinue
d on
nex
t pa
ge)
Management and organizational sustainability tool for tB36
MO
du
le 1
: Wh
ere
ar
e W
e n
OW
? (c
onti
nue
d)
Wor
ksh
op a
ctiv
ity
faci
litat
ors’
rol
er
esou
rces
req
uire
dk
eep
in M
ind
. . .
Com
plet
ion
of t
he M
ost
fo
r tB
Ass
essm
ent
Inst
ru-
men
t by
indi
vidu
al p
ar-
ticip
ants
:
expl
anat
ion
by
■■
faci
litat
ors
indi
vidu
al w
ork
■■
Expl
ain:
thi
s ex
erci
se g
ives
eac
h pa
rtic
ipan
t th
e ch
ance
to
appl
y M
ost
for
tB in
divi
dual
ly. t
hen
part
icip
ants
will
wor
k to
geth
er t
o de
velo
p a
shar
ed a
sses
smen
t of
the
cur
rent
sta
ge
of d
evel
opm
ent
of e
ach
man
agem
ent
com
pone
nt.
Intr
oduc
e th
e in
stru
men
t an
d th
e pr
oces
s:
part
icip
ants
will
inde
pend
ently
rea
d th
e ch
arac
teris
tics
of
■■
each
sta
ge o
f dev
elop
men
t fo
r ea
ch c
ompo
nent
.th
ey w
ill t
hen
sele
ct t
he s
tage
the
y be
lieve
bes
t fit
s th
e cu
r-■
■
rent
sta
tus
of t
he n
tp.
they
sho
uld
prov
ide
one
or t
wo
obse
rvat
ions
in t
he “
Evi-
■■
denc
e” c
olum
n to
sup
port
the
ir ch
oice
.
Cla
rify:
Whe
n de
term
inin
g th
e st
age
of d
evel
opm
ent
of a
m
anag
emen
t co
mpo
nent
, par
ticip
ants
mus
t be
sur
e th
at t
he
ntp
fits
all
the
char
acte
ristic
s of
tha
t st
age.
If t
hey
have
no
know
ledg
e ab
out
a ce
rtai
n as
pect
of t
he n
tp, t
hey
may
ski
p th
at m
anag
emen
t co
mpo
nent
.
As
part
icip
ants
inde
pend
ently
fill
in t
heir
copi
es o
f the
Mo
st
for
tB A
sses
smen
t In
stru
men
t, p
rovi
de g
uida
nce
and
answ
er
any
ques
tions
tha
t ar
ise.
one
bla
nk c
opy
of t
he M
ost
fo
r tB
Ass
essm
ent
Inst
ru-
men
t fo
r ea
ch p
artic
ipan
t,
begi
nnin
g on
pag
e 53
and
av
aila
ble
on t
he M
ost
for
tB C
D-R
oM
this
exe
rcis
e ca
n be
som
ewha
t co
n-fu
sing
at
first
. tak
e pl
enty
of t
ime
to
expl
ain
the
task
s. M
ake
part
icip
ants
fe
el c
omfo
rtab
le a
skin
g qu
estio
ns
abou
t th
e pr
oces
s.
Management and organizational sustainability tool for tB 37
smal
l-gro
up w
ork:
C
onse
nsus
on
curr
ent
stag
es o
f dev
elop
men
t,
with
sup
port
ing
evid
ence
to e
xpos
e pa
rtic
ipan
ts t
o va
ried
perc
eptio
ns, f
orm
gro
ups
of
4–6
peop
le fr
om d
iffer
ent
part
s of
the
ntp
, cre
atin
g a
cros
s-se
ctio
n of
exp
erie
nce
and
perc
eptio
ns.
Expl
ain:
In t
heir
smal
l gro
ups,
par
ticip
ants
will
rev
iew
the
ch
oice
s an
d ev
iden
ce p
ropo
sed
by e
ach
grou
p m
embe
r. to
-ge
ther
the
y w
ill d
iscu
ss a
ny d
iffer
ence
s an
d se
ek c
onse
nsus
on
the
stag
e of
dev
elop
men
t an
d su
ppor
ting
evid
ence
for
each
co
mpo
nent
.
Enco
urag
e pa
rtic
ipan
ts t
o pr
esen
t th
eir
evid
ence
per
suas
ivel
y bu
t su
ccin
ctly
. A fe
w w
ords
sho
uld
be a
ble
to c
onve
y th
e ob
-se
rvat
ion
that
the
ir gr
oup
has
foun
d co
nvin
cing
.
Circ
ulat
e am
ong
grou
ps, o
fferin
g gu
idan
ce a
nd c
larifi
catio
n w
here
nec
essa
ry.
one
“A
sses
smen
t C
onse
nsus
Fo
rm”
for
each
gro
up, b
e-gi
nnin
g on
pag
e 70
In fo
rmin
g he
tero
gene
ous
grou
ps,
you
can
draw
on
the
pre-
wor
ksho
p in
terv
iew
s an
d on
you
r st
aff c
oun-
terp
art’s
adv
ice.
Rem
embe
r th
at
your
cou
nter
part
sho
uld
part
icip
ate
in a
gro
up.
Als
o em
phas
ize
that
the
num
bers
th
at r
epre
sent
sta
ges
of d
evel
op-
men
t ca
nnot
be
aver
aged
(e.
g.,
2.5)
. the
gro
up m
ust
agre
e th
at t
he
ntp
fulfi
lls a
ll th
e ch
arac
teris
tics
in
the
stag
e th
ey h
ave
chos
en. I
f the
y ca
nnot
agr
ee, t
hey
shou
ld s
elec
t th
e pr
evio
us s
tage
.
plen
ary
disc
ussi
on:
Revi
ew a
nd c
onse
nsus
Expl
ain:
the
inte
ntio
n of
thi
s ac
tivity
is t
o ar
rive
at a
sta
ge o
f de
velo
pmen
t th
at a
ll th
e gr
oups
can
agr
ee o
n. H
ave
smal
l gr
oups
rep
ort
thei
r ch
oice
of t
he s
tage
of d
evel
opm
ent
for
each
com
pone
nt a
nd t
he e
vide
nce
they
pro
pose
d to
sup
port
th
eir
choi
ce.
Lead
the
par
ticip
ants
in d
iscu
ssin
g th
e re
ason
s fo
r an
y di
ffer-
ence
s an
d ne
gotia
ting
thes
e di
ffere
nces
to
reac
h co
nsen
sus,
ju
st a
s th
ey d
id in
the
ir sm
all g
roup
s. R
emin
d th
em t
hat
the
resu
lts o
f thi
s pr
oces
s w
ill p
rovi
de t
he in
put
for
the
wor
k of
M
odul
e 2.
Aft
er t
his
mod
ule
is c
ompl
eted
, you
will
nee
d to
pre
pare
ha
ndou
ts t
hat
pres
ent
the
cons
ensu
s ac
hiev
ed d
urin
g th
is
disc
ussi
on (
stag
es a
nd e
vide
nce)
. par
ticip
ants
will
nee
d th
is
info
rmat
ion
for
the
first
act
ivity
in M
odul
e 2.
one
she
et o
f flip
-cha
rt p
aper
fo
r ea
ch o
f the
30
man
age-
men
t co
mpo
nent
s, w
ith
spac
e to
ent
er t
he s
tage
of
deve
lopm
ent
each
gro
up h
as
iden
tified
and
the
evi
denc
e th
ey h
ave
sele
cted
(th
e pa
-pe
r ca
n al
so b
e us
ed t
o jo
t do
wn
note
s du
ring
the
dis-
cuss
ion,
as
an a
id t
o re
solv
-in
g di
ffere
nces
and
com
ing
to a
gree
men
t)
one
“A
sses
smen
t C
onse
nsus
Fo
rm,”
beg
inni
ng o
n pa
ge
70 t
o be
use
d by
one
faci
lita-
tor
to c
aptu
re t
he d
ecis
ions
m
ade
durin
g th
e pl
enar
y di
scus
sion
Des
irabl
e: a
com
pute
r an
d pr
inte
r to
qui
ckly
rec
ord
and
dist
ribut
e th
e re
sults
of t
he
plen
ary
disc
ussi
on
In t
his
sess
ion,
con
flict
oft
en a
rises
du
e to
diff
erin
g pe
rcep
tions
refl
ect-
ing
the
part
icip
ants
’ var
ied
stat
us
and
area
s of
res
pons
ibili
ty. Y
ou w
ill
need
to
liste
n pa
tient
ly a
nd a
t-te
ntiv
ely
and
help
the
par
ticip
ants
to
do
the
sam
e. B
e on
the
ale
rt fo
r is
sues
iden
tified
in y
our
pre-
w
orks
hop
inte
rvie
ws
that
par
tici-
pant
s m
ay n
ot b
e ab
le t
o di
scus
s op
enly
.
If yo
u ca
nnot
brin
g th
e gr
oup
to
cons
ensu
s on
a c
ompo
nent
, you
m
ay w
ant
to p
ut it
in t
he “
park
ing
lot”
and
ret
urn
to it
aft
er t
he o
ther
co
mpo
nent
s ha
ve b
een
addr
esse
d.
Get
ting
som
e di
stan
ce fr
om a
con
-tr
over
sial
top
ic a
nd r
efoc
usin
g on
le
ss c
onte
ntio
us is
sues
oft
en a
llow
s pa
rtic
ipan
ts t
o re
turn
to
thei
r di
s-cu
ssio
n w
ith n
ew in
sigh
ts.
Management and organizational sustainability tool for tB38
MO
du
le 2
: Wh
ere
ar
e W
e h
ead
ed?
(Mid
-MO
rn
ing
th
rO
ug
h e
nd
Of
day
2)
Ob
ject
ives
By th
e en
d of
this
mod
ule,
par
ticip
ants
will
hav
e:
agre
ed o
n on
e or
two
obje
ctiv
es fo
r im
prov
ing
each
man
agem
ent c
ompo
nent
; ■
■
prov
ided
evi
denc
e th
at w
ill in
dica
te p
rogr
ess
tow
ard
thes
e ob
ject
ives
.■
■
MO
du
le 2
: Wh
ere
ar
e W
e h
ead
ed?
Wor
ksh
op a
ctiv
ity
faci
litat
ors’
rol
er
esou
rces
req
uire
dk
eep
in M
ind
. . .
Revi
ew o
f obj
ectiv
es fo
r M
odul
e 2
pres
ent
on fl
ip c
hart
and
pos
t on
wal
l to
rem
ain
thro
ugho
ut
the
mod
ule.
Flip
cha
rt o
f obj
ectiv
es
Age
nda
in p
artic
ipan
t bi
nder
plen
ary
disc
ussi
on:
Revi
ew o
f con
sens
us
deci
sion
s in
Mod
ule
1
Lead
par
ticip
ants
in r
evie
w p
roce
ss.
Han
dout
s w
ith r
esul
ts o
f M
odul
e 1,
and
sup
plem
en-
tary
flip
cha
rt a
nd/o
r tr
ans-
pare
ncie
s, if
des
ired
smal
l-gro
up w
ork:
Ex
plor
atio
n of
con
trib
ut-
ing
caus
es
Div
ide
the
com
pone
nts
amon
g gr
oups
, so
each
gro
up is
w
orki
ng o
n a
man
agea
ble
num
ber
of c
ompo
nent
s.
Hel
p gr
oups
look
clo
sely
at
the
evid
ence
for
each
com
pone
nt
and
ask
them
selv
es w
hy t
he c
ompo
nent
is a
t th
at s
tage
of
deve
lopm
ent.
the
y m
ay n
eed
to a
sk W
hy?
seve
ral t
imes
to
dig
bene
ath
the
surf
ace
and
find
the
mos
t im
port
ant
cont
ribut
ing
caus
es.
It is
a g
ood
idea
to
dist
ribut
e di
f-fe
rent
typ
es o
f com
pone
nts
amon
g th
e sm
all g
roup
s, s
o th
at e
ach
smal
l gr
oup
is d
ealin
g w
ith a
mix
ture
of
man
agem
ent
area
s, s
tage
s of
dev
el-
opm
ent,
leve
ls o
f im
port
ance
to
the
ntp
, etc
.
At
this
poi
nt, y
ou m
ay w
ish
to r
e-co
nfigu
re t
he s
mal
l gro
ups
so t
hat
part
icip
ants
can
sha
re t
heir
pers
pec-
tives
with
new
gro
up m
embe
rs.
For
this
mod
ule,
som
e fa
cilit
ator
s fo
rm g
roup
s th
at s
hare
the
sam
e br
oad
area
of e
xper
tise,
whi
le o
th-
ers
pref
er t
o m
aint
ain
a m
ixtu
re o
f pe
rspe
ctiv
es.
Management and organizational sustainability tool for tB 39
smal
l-gro
up w
ork,
con
-tin
ued:
set
ting
obje
ctiv
es
and
prop
osin
g ev
iden
ce
of t
heir
achi
evem
ent
Dec
ide
in a
brie
f int
rodu
ctor
y ac
tivity
, or
anno
unce
bas
ed o
n th
e di
rect
or’s
dec
isio
n, w
hat
the
time
fram
e fo
r th
e M
ost
for
tB a
ctio
n pl
an w
ill b
e. U
sual
ly it
is s
ix m
onth
s or
one
yea
r.
For
each
man
agem
ent
com
pone
nt, h
ave
the
smal
l gro
ups
draf
t be
twee
n on
e an
d th
ree
obje
ctiv
es fo
r th
at t
ime
perio
d.
the
obje
ctiv
es s
houl
d be
ach
ieva
ble
in t
he s
hort
ter
m a
nd
shou
ld r
eflec
t th
e di
scus
sion
s of
the
con
trib
utin
g ca
uses
of t
he
curr
ent
situ
atio
n.
Hel
p th
e gr
oups
focu
s on
obj
ectiv
es t
hat
will
hel
p m
ove
the
man
agem
ent
com
pone
nts
tow
ard
the
char
acte
ristic
s of
the
ne
xt s
tage
of d
evel
opm
ent.
Hav
e ea
ch g
roup
pro
pose
one
or
two
fact
s, fi
gure
s, o
r ob
ser-
vatio
ns t
hat
will
pro
vide
con
vinc
ing
evid
ence
tha
t th
ese
obje
c-tiv
es h
ave
been
rea
ched
at
the
end
of t
he t
ime
perio
d.
Flip
cha
rts
for
each
gro
up
(the
res
ults
will
nee
d to
be
post
ed fo
r pr
esen
tatio
n an
d di
scus
sion
in M
odul
e 4)
Befo
re t
he p
artic
ipan
ts u
nder
take
th
is a
ctiv
ity, e
mph
asiz
e th
at t
he
goal
is n
ot t
o st
rive
for
perf
ectio
n.
Att
empt
ing
too
big
a le
ap m
ay
resu
lt in
failu
re a
nd d
isco
urag
e st
aff
abou
t th
e po
tent
ial f
or c
hang
e.
Incr
emen
tal i
mpr
ovem
ents
pro
vide
sm
all s
ucce
sses
tha
t en
cour
age
the
staf
f to
take
on
new
cha
lleng
es.
such
cha
nges
bui
ld u
p ov
er t
ime
to
have
a g
reat
er im
pact
.
It h
elps
to
reco
gniz
e th
at t
he s
hort
-te
rm o
bjec
tives
at
this
poi
nt m
ay
or m
ay n
ot m
ove
the
orga
niza
tion
into
the
nex
t st
age
of d
evel
op-
men
t, w
here
all
char
acte
ristic
s w
ill
appl
y. If
the
ntp
is c
lose
to
that
st
age,
one
or
two
impr
ovem
ents
m
ay s
uffic
e. H
owev
er, i
f the
man
-ag
emen
t co
mpo
nent
nee
ds a
lot
of
wor
k ov
er a
n ex
tend
ed p
erio
d of
tim
e, t
he o
bjec
tives
dev
elop
ed n
ow
may
sim
ply
mov
e th
e n
tp in
the
rig
ht d
irect
ion
with
in t
he c
urre
nt
stag
e of
dev
elop
men
t.
plen
ary
disc
ussi
on:
pres
enta
tion
of a
nd
agre
emen
t on
obj
ectiv
es
Gui
de p
artic
ipan
ts in
rev
iew
ing
smal
l gro
up w
ork,
cho
osin
g th
e m
ost
appr
opria
te o
bjec
tives
and
agr
eein
g on
evi
denc
e th
at w
ill s
how
tha
t th
e ob
ject
ives
hav
e be
en a
chie
ved.
Management and organizational sustainability tool for tB40
MO
du
le 3
: hO
W W
ill
We
Ma
na
ge
the
nee
ded
ch
an
ges
? (M
Or
nin
g O
f d
ay 3
)
Ob
ject
ives
By th
e en
d of
this
mod
ule,
par
ticip
ants
will
hav
e:
expl
ored
the
prin
cipl
es o
f cha
nge;
■■
seen
how
cha
nges
in m
anag
emen
t, to
geth
er w
ith st
rong
lead
ersh
ip, c
an im
prov
e an
NTP
’s se
rvic
es a
nd im
pact
;■
■
reco
gniz
ed th
eir r
oles
as
lead
ers
and
man
ager
s of
the
chan
ge p
roce
ss.
■■
MO
du
le 3
: hO
W W
ill
We
Ma
na
ge
the
nee
ded
ch
an
ges
?
Wor
ksh
op a
ctiv
ity
faci
litat
ors’
rol
er
esou
rces
req
uire
dk
eep
in M
ind
. . .
Revi
ew o
f obj
ectiv
es fo
r M
odul
e 3
pres
ent
on fl
ip c
hart
and
pos
t on
wal
l to
rem
ain
thro
ugho
ut
the
mod
ule.
Flip
char
t of
obj
ectiv
es
Age
nda
in p
artic
ipan
t bi
nder
plen
ary
disc
ussi
on:
prin
cipl
es o
f cha
nge
Brie
fly p
rese
nt a
nd d
iscu
ss p
rinci
ples
.Fl
ip c
hart
of t
he fo
ur p
rin-
cipl
es o
f cha
nge,
bas
ed o
n pa
ges
9–10
In M
odul
e 4,
the
prin
cipl
es o
f ch
ange
will
pro
vide
a b
asis
for
re-
visi
ng t
he o
bjec
tives
dev
elop
ed in
M
odul
e 2.
plen
ary
revi
ew a
nd
disc
ussi
on: “
Lead
ing
and
Man
agin
g Re
sults
M
odel
”
pres
ent
the
mod
el, h
ighl
ight
ing
its r
elat
ions
hip
to M
ost
for
tB a
nd t
o th
e n
tp: M
ost
for
tB fo
ster
s ch
ange
s th
at im
-pr
ove
man
agem
ent,
wor
k cl
imat
e, a
nd c
apac
ity t
o re
spon
d to
cha
ngin
g en
viro
nmen
t (s
usta
inab
ility
). t
hese
cha
nges
lead
to
impr
oved
ser
vice
s an
d, u
ltim
atel
y, im
prov
ed h
ealth
for
tB
patie
nts.
pres
ent
and
lead
a d
iscu
ssio
n of
the
func
tions
of l
eade
rs a
nd
man
ager
s. R
elat
e th
ese
func
tions
to
the
part
icip
ants
’ rol
es:
they
are
dra
win
g on
lead
ersh
ip a
nd m
anag
emen
t pr
actic
es
thro
ugho
ut t
he M
ost
for
tB w
orks
hop
and
will
con
tinue
to
use
the
se p
ract
ices
as
chan
ge a
gent
s to
impl
emen
t th
e
actio
n pl
an.
tran
spar
ency
or
slid
e of
the
“L
eadi
ng a
nd M
anag
ing
Resu
lts M
odel
,” p
age
82
“Lea
ders
hip
prac
tices
” an
d “M
anag
emen
t pr
actic
es,”
pa
ges
12–1
3
opt
iona
l: tr
ansp
aren
cy o
r sl
ide
of “
Lead
ing
and
Man
-ag
ing
Fram
ewor
k,”
page
83
You
may
wis
h to
spe
nd t
ime
go-
ing
over
the
det
ails
of l
eade
rshi
p an
d m
anag
emen
t as
defi
ned
in t
he “
Lead
ing
and
Man
agin
g Fr
amew
ork.
” o
r yo
u m
ay p
refe
r to
sum
mar
ize
the
cont
ents
of t
he
fram
ewor
k, u
sing
pag
es 1
2–13
as
the
basi
s fo
r di
scus
sion
, and
sim
ply
poin
ting
out
the
fram
ewor
k, w
hich
is
incl
uded
in p
artic
ipan
ts’ b
inde
rs.
Management and organizational sustainability tool for tB 41
Dire
ctor
’s a
nnou
ncem
ent
of t
he p
erso
n w
ho h
as
been
sel
ecte
d as
cha
nge
lead
er
Ahe
ad o
f tim
e: R
evie
w w
ith t
he d
irect
or t
he b
ackg
roun
d in
for-
mat
ion
with
whi
ch t
o fr
ame
the
anno
unce
men
t, s
o he
or
she
can
anno
unce
the
cho
ice
with
con
fiden
ce a
nd e
nthu
sias
m:
reas
ons
for
havi
ng a
cha
nge
lead
er a
nd c
hang
e te
am;
■■
qual
ities
of a
n ef
fect
ive
chan
ge le
ader
;■
■
resp
onsi
bilit
ies
of t
he c
hang
e le
ader
in im
plem
entin
g th
e ■
■
actio
n pl
an.
Revi
ew “
prin
cipl
es o
f C
hang
e,”
page
s 9–
10 a
nd
“Cha
nge
Lead
er a
nd C
hang
e te
am”
and
the
box
on
“Qua
litie
s of
the
Cha
nge
Lead
er,”
pag
e 11
Be s
ure
the
ntp
’s d
irect
or—
with
yo
ur h
elp,
if n
eces
sary
—ha
s di
s-cu
ssed
thi
s ro
le w
ith t
he p
rosp
ectiv
e ch
ange
lead
er, f
ully
exp
lain
ed t
he
resp
onsi
bilit
ies
invo
lved
, and
got
ten
that
per
son’
s fu
ll ag
reem
ent
and
com
mitm
ent.
If th
e n
tp’s
dire
ctor
pre
fers
not
to
pre
sent
the
bac
kgro
und
mat
eria
l, yo
u ca
n do
so
and
help
pav
e
the
way
for
the
dire
ctor
’s
anno
unce
men
t.
If th
e n
tp’s
dire
ctor
has
not
yet
se-
lect
ed t
he c
hang
e le
ader
and
wan
ts
the
grou
p to
dec
ide,
you
will
hav
e to
set
asi
de t
he t
ime
need
ed fo
r a
full
disc
ussi
on a
nd s
elec
tion
by t
he
grou
p du
ring
Mod
ule
4.
smal
l-gro
up w
ork:
Re
visi
on o
f obj
ectiv
esEn
cour
age
grou
ps t
o re
visi
t th
eir
obje
ctiv
es in
ligh
t of
the
ch
ange
s re
quire
d an
d th
eir
antic
ipat
ed m
anag
emen
t an
d le
ader
ship
rol
es. C
halle
nge
them
to
revi
se t
heir
obje
ctiv
es, i
f ne
cess
ary,
so
that
the
ir w
ork
will
hav
e th
e gr
eate
st p
ossi
ble
effe
ct o
n al
l are
as o
f the
mod
el.
Circ
ulat
e to
ans
wer
que
stio
ns. B
e su
re e
ach
grou
p do
cum
ents
its
fina
l obj
ectiv
es o
n fli
p ch
arts
.
Ente
r th
e fin
al o
bjec
tives
for
each
man
agem
ent
com
pone
nt
as s
oon
as p
ossi
ble,
so
that
prin
tout
s ca
n be
mad
e fo
r us
e in
M
odul
e 4.
Flip
cha
rts
for
each
gro
up
Des
irabl
e: A
com
pute
r, pr
inte
r, an
d ph
otoc
opie
r to
qu
ickl
y re
cord
and
dis
trib
ute
the
resu
lts o
f the
ple
nary
di
scus
sion
plen
ary
disc
ussi
on:
Revi
ew o
f rev
ised
ob
ject
ives
and
pr
opos
ed e
vide
nce
Che
ck t
hat
the
part
icip
ants
acc
ept
the
sugg
este
d re
visi
ons
and
have
no
furt
her
ques
tions
.po
sted
flip
-cha
rt p
ages
or
dist
ribut
ed p
rinto
uts
of M
od-
ule
3 re
sults
Management and organizational sustainability tool for tB42
MO
du
le 4
: hO
W W
ill
We
rea
ch
Ou
r O
bje
cti
Ves
? (M
id-M
Or
nin
g t
hr
Ou
gh
en
d O
f d
ay 3
)
Ob
ject
ives
By th
e en
d of
this
mod
ule,
par
ticip
ants
will
hav
e:
sele
cted
the
high
est-
prio
rity
man
agem
ent c
ompo
nent
s to
impr
ove
duri
ng th
e co
min
g pe
riod
; ■
■
prep
ared
an
actio
n pl
an fo
r the
se im
prov
emen
ts;
■■
deci
ded
wha
t act
iviti
es w
ill b
e ne
eded
to fo
llow
up
on th
e M
OST
for T
B w
orks
hop.
■■
MO
du
le 4
: hO
W W
ill
We
rea
ch
Ou
r O
bje
cti
Ves
?
Wor
ksh
op a
ctiv
ity
faci
litat
ors’
rol
er
esou
rces
req
uire
dk
eep
in M
ind
. . .
Revi
ew o
f obj
ectiv
es fo
r M
odul
e 4
pres
ent
on fl
ip c
hart
and
pos
t on
wal
l to
rem
ain
thro
ugho
ut
the
mod
ule.
Flip
cha
rt o
f obj
ectiv
es
Age
nda
in p
artic
ipan
t bi
nder
plen
ary
exer
cise
: se
lect
ion
of p
riorit
y
man
agem
ent
co
mpo
nent
s
Emph
asiz
e th
e ne
ed t
o fo
cus
on im
prov
emen
ts in
a fe
w p
rior-
ity c
ompo
nent
s—th
ose
that
mee
t th
e fo
llow
ing
crite
ria:
can
be q
uick
ly a
ccom
plis
hed,
and
/or;
■■
requ
ire m
inim
al h
uman
and
fina
ncia
l res
ourc
es, a
nd/o
r;■
■
are
need
ed a
s a
basi
s fo
r ot
her
impr
ovem
ents
, and
/or;
■■
will
mak
e th
e gr
eate
st c
ontr
ibut
ion
to t
he m
anag
emen
t of
■
■
the
ntp
.
poin
t ou
t th
at s
ome
impr
ovem
ents
tha
t m
ight
mak
e gr
eat
cont
ribut
ions
to
bett
er m
anag
emen
t m
ay b
e to
o co
stly
and
tim
e-co
nsum
ing
to u
nder
take
at
this
tim
e.
prov
ide
a w
ay fo
r pa
rtic
ipan
ts t
o re
gist
er t
he c
ompo
nent
s th
ey
cons
ider
to
be o
f the
hig
hest
prio
rity.
tw
o po
ssib
ilitie
s ar
e:
to h
ave
each
par
ticip
ant
writ
e do
wn
her/
his
top
thre
e ■
■
choi
ces;
you
tal
ly a
nd a
nnou
nce
the
resu
lts;
to p
ost
all c
ompo
nent
s on
flip
cha
rts;
par
ticip
ants
che
ck o
ff ■
■
or s
tick
a co
lore
d do
t ne
xt t
o th
eir
top
thre
e ch
oice
s. t
he
entir
e gr
oup
talli
es t
he r
esul
ts.
Gui
de p
artic
ipan
ts in
usi
ng t
he t
ally
to
sele
ct t
he 4
–5 c
ompo
-ne
nts
that
the
y w
ill w
ork
on d
urin
g th
e co
min
g pe
riod.
Flip
cha
rt o
f sug
gest
ed
crite
ria fo
r pr
iorit
izin
g co
mpo
nent
s, p
repa
red
in a
dvan
ce o
r du
ring
the
plen
ary
disc
ussi
on
opt
iona
l: C
olor
ed s
elf-
adhe
sive
dot
s
the
hard
est
thin
g ab
out
sett
ing
prio
ri-tie
s is
tha
t it
mea
ns t
empo
raril
y se
ttin
g as
ide
activ
ities
tha
t ha
ve r
eal v
alue
to
the
ntp
. som
e pa
rtic
ipan
ts m
ay b
e st
rong
ly c
omm
itted
to
obje
ctiv
es in
a
com
pone
nt t
hat
the
grou
p de
cide
s is
of
low
er p
riorit
y.
You
may
nee
d to
hel
p th
e pa
rtic
ipan
ts
thro
ugh
this
pro
cess
. Cla
rify
that
com
-po
nent
s id
entifi
ed a
s lo
w p
riorit
y at
thi
s tim
e w
ill n
ot b
e ab
ando
ned.
the
y w
ill
be d
ocum
ente
d in
the
wor
ksho
p re
port
an
d re
visi
ted
in M
ost
for
tB fo
llow
-up
mee
tings
.
Management and organizational sustainability tool for tB 43
smal
l-gro
up w
ork:
pr
epar
atio
n of
act
ion
plan
s
Cre
ate
new
sm
all g
roup
s, o
ne fo
r ea
ch o
f the
man
agem
ent
com
pone
nts
iden
tified
as
a pr
iorit
y. o
nce
agai
n, b
e su
re t
he
grou
ps r
epre
sent
a c
ross
-sec
tion
of d
ivis
ions
and
leve
ls.
Gui
de s
mal
l gro
ups
in p
ropo
sing
3 o
r 4
broa
d ca
tego
ries
of
activ
ities
tha
t w
ill h
elp
reac
h th
e ob
ject
ive
for
thei
r co
mpo
-ne
nt. E
ncou
rage
the
m t
o th
ink
crea
tivel
y ab
out
varie
d bu
t pr
actic
al w
ays
to r
each
the
obj
ectiv
es.
Gui
de p
artic
ipan
ts in
car
eful
ly c
onsi
derin
g th
e re
sour
ces—
hu-
man
, mat
eria
l, an
d fin
anci
al—
need
ed t
o ca
rry
out
each
bro
ad
activ
ity, a
nd in
cla
ssify
ing
them
as
one
of t
he fo
llow
ing:
reso
urce
s th
at a
lread
y ex
ist
with
in t
he o
rgan
izat
ion;
■
■
reso
urce
s th
at a
re n
ot c
urre
ntly
ava
ilabl
e bu
t ca
n be
gen
er-
■■
ated
rel
ativ
ely
easi
ly;
reso
urce
s th
at w
ill r
equi
re c
onsi
dera
ble
effo
rt t
o ge
nera
te.
■■ th
e pa
rtic
ipan
ts w
ill t
hen
com
plet
e th
e re
st o
f the
ir ac
tion
plan
s, fi
lling
in t
he p
erso
n re
spon
sibl
e an
d tim
e re
quire
d to
co
mpl
ete
the
activ
ity.
Flip
-cha
rt p
ages
of t
he r
e-vi
sed
obje
ctiv
es fo
r ea
ch
sele
cted
com
pone
nt, d
is-
trib
uted
am
ong
the
smal
l gr
oups
so
they
can
iden
-tif
y th
e ty
pes
of a
ctiv
ities
fo
r ea
ch o
bjec
tive
new
flip
-cha
rt p
ages
on
each
of w
hich
the
y w
ill
writ
e: man
agem
ent
■
■
com
pone
ntob
ject
ive
■■
3 or
4 b
road
act
iviti
es■
■
gene
ral t
ypes
of
■■
reso
urce
s—hu
man
, m
ater
ial,
and
finan
-ci
al—
requ
ired
for
each
ac
tivity
for
each
typ
e of
■
■
reso
urce
, “C
A”
(cur
-re
ntly
ava
ilabl
e), “
GE”
(g
ener
ated
eas
ily),
or
“RE”
(re
quire
s ef
fort
).
Blan
k ac
tion
plan
form
s (f
ound
on
page
s 80
–81
and
on t
he M
ost
for
tB
CD
-Ro
M)
You
may
rel
y on
you
r st
aff c
ount
erpa
rt
for
advi
ce, u
se y
our
own
judg
men
t in
fo
rmin
g th
e gr
oups
, or
ask
the
par-
ticip
ants
to
form
the
ir ow
n ne
w m
ixed
gr
oups
.
If th
ere
are
too
few
par
ticip
ants
in t
he
wor
ksho
p, s
ome
smal
l gro
ups
may
ne
ed t
o w
ork
on t
wo
man
agem
ent
com
pone
nts.
It w
ill h
elp
if yo
u gi
ve e
xam
ples
of
the
kind
s of
bro
ad a
ctiv
ities
the
sm
all
grou
ps s
houl
d pr
opos
e. F
or in
stan
ce, t
o re
ach
an o
bjec
tive
rela
ted
to h
uman
re-
sour
ces
man
agem
ent,
an
activ
ity m
ight
be
“pr
epar
e pe
rson
nel h
andb
ook.
” th
is a
ctiv
ity c
ould
invo
lve
a nu
mbe
r of
sm
alle
r ac
tiviti
es.
the
wor
ksho
p m
ater
ials
incl
ude
a sa
m-
ple
actio
n pl
an fo
rm t
hat
has
prov
en
usef
ul in
form
er M
ost
for
tB w
ork-
shop
s. t
he p
artic
ipan
ts m
ay c
hoos
e to
us
e th
is o
r an
othe
r fo
rmat
tha
t co
rre-
spon
ds t
o th
eir
own
plan
ning
pro
cess
. If
they
use
a d
iffer
ent
form
at, t
hey
may
ne
ed t
o ad
apt
it to
incl
ude
all t
he p
lan-
ning
ele
men
ts t
hat
are
iden
tified
her
e.
Alth
ough
eac
h ac
tivity
in t
his
actio
n pl
an s
houl
d be
bro
ken
dow
n in
to s
pe-
cific
tas
ks, t
here
is r
arel
y en
ough
tim
e fo
r th
at le
vel o
f det
ail i
n th
e M
ost
for
tB w
orks
hop.
the
cha
nge
team
sho
uld
wor
k on
the
det
ails
at
a la
ter
time.
(con
tinue
d on
nex
t pa
ge)
Management and organizational sustainability tool for tB44
MO
du
le 4
: hO
W W
ill
We
rea
ch
Ou
r O
bje
cti
Ves
? (c
onti
nue
d)
Wor
ksh
op a
ctiv
ity
faci
litat
ors’
rol
er
esou
rces
req
uire
dk
eep
in M
ind
. . .
plen
ary
disc
ussi
on:
pres
enta
tion
of a
nd
agre
emen
t on
act
ion
plan
s
For
each
man
agem
ent
com
pone
nt, i
n tu
rn:
Hav
e th
e sm
all g
roup
s po
st t
heir
flip-
char
t pa
ges
or d
istr
ib-
■■
ute
copi
es o
f the
ir co
mpl
eted
act
ion
plan
s.H
elp
part
icip
ants
to
revi
ew, r
evis
e, a
nd r
each
con
sens
us o
n ■
■
5 of
the
sug
gest
ed a
ctiv
ities
tha
tw
ill b
est
help
rea
ch t
he o
bjec
tive;
■■
requ
ire r
esou
rces
tha
t ar
e av
aila
ble
or c
an b
e ge
nera
ted
■■
with
rea
sona
ble
effo
rt.
Con
tinue
the
pro
cess
unt
il al
l prio
rity
com
pone
nts
have
■
■
been
add
ress
ed. M
odify
sm
all g
roup
s’ fl
ip c
hart
s as
nee
ded
to r
eflec
t th
e fin
al r
esul
t.
Flip
-cha
rt p
ages
or
actio
n pl
ans
from
sm
all g
roup
s
A c
opy
of t
he n
tp’s
op
erat
iona
l pla
n, if
av
aila
ble
You
may
nee
d to
rem
ind
the
part
ici-
pant
s to
be
real
istic
abo
ut w
hat
ac-
tiviti
es t
hey
can
effe
ctiv
ely
unde
rtak
e,
give
n th
eir
curr
ent
and
futu
re r
espo
n-si
bilit
ies.
It is
ver
y he
lpfu
l to
look
at
exis
ting
orga
niza
tiona
l pla
ns a
nd s
ee
how
the
Mo
st fo
r tB
act
ion
plan
will
fit
with
in—
and,
hop
eful
ly, e
nhan
ce—
othe
r n
tp in
itiat
ives
.
Dis
trib
utin
g ac
tion
plan
sC
olle
ct t
he a
ctio
n pl
ans,
ent
er t
hem
on
a co
mpu
ter,
prin
t th
em o
ut, a
rran
ge fo
r ph
otoc
opie
s to
be
dist
ribut
ed t
o th
e pa
rtic
ipan
ts, a
nd in
clud
e th
em in
you
r re
port
.
A c
ompu
ter,
prin
ter,
and
phot
ocop
ier
the
chan
ge le
ader
and
cha
nge
team
ar
e lik
ely
to a
ppre
ciat
e it
if yo
u of
fer
to e
nter
the
act
ion
plan
s on
a c
om-
pute
r an
d se
nd t
hem
bac
k qu
ickl
y. t
he
prin
ted
vers
ion
will
pro
vide
the
m w
ith
a cl
ear
and
cons
iste
nt s
et o
f pla
ns t
hat
will
hel
p th
em t
o im
med
iate
ly b
egin
to
mak
e th
e ne
eded
cha
nges
. the
y ca
n al
so u
se it
to
pres
ent
the
resu
lts o
f the
w
orks
hop
to t
he r
est
of t
he n
tp, a
nd
you
will
be
able
to
use
it as
the
cen
ter-
piec
e of
you
r re
port
.
Management and organizational sustainability tool for tB 45
plen
ary
disc
ussi
on:
Dec
isio
n on
act
iviti
es fo
r im
med
iate
follo
w-u
p
Hav
e th
e sm
all g
roup
s br
iefly
sum
mar
ize
thei
r pr
ogre
ss in
co
mpl
etin
g th
eir
actio
n pl
ans
and
men
tion
any
issu
es t
hat
have
aris
en.
Faci
litat
e a
wra
p-up
dis
cuss
ion
abou
t th
e ne
xt s
teps
to
take
, in
clud
ing:
shar
ing
the
findi
ngs
and
impl
icat
ions
with
the
res
t of
the
■
■
staf
f and
oth
er s
take
hold
ers;
hold
ing
the
first
cha
nge
team
mee
ting
to fu
rthe
r sp
ecify
■
■
the
task
s fo
r ea
ch a
ctiv
ity, (
clar
ify in
divi
dual
ass
ignm
ents
, se
t de
adlin
es, a
nd d
evel
op a
pla
n fo
r m
onito
ring
prog
ress
on
the
act
ion
plan
);m
onito
ring
prog
ress
on
the
actio
n pl
an a
nd r
evis
ing
the
■■
plan
, if n
eede
d.
this
mig
ht b
e an
exc
elle
nt a
ctiv
ity fo
r th
e ch
ange
lead
er t
o fa
cilit
ate,
initi
atin
g hi
s/he
r ne
w r
ole.
If t
he c
hang
e le
ader
ag
rees
to
do t
his,
you
sho
uld
offe
r an
y as
sist
ance
nee
ded.
For
a lis
t of
sug
gest
ions
of f
ollo
w-u
p ac
tiviti
es, s
ee “
phas
e 4:
Fol
low
-Up
Ac-
tiviti
es”
on p
age
46.
Clo
sing
Retu
rn t
o th
e “p
arki
ng lo
t,”
cros
sing
off
issu
es t
hat
have
bee
n de
alt
with
and
hel
ping
par
ticip
ants
dec
ide
whe
n an
d ho
w t
o ta
ke u
p th
e is
sues
tha
t re
mai
n. p
oint
out
tha
t yo
u w
ill in
clud
e th
ese
item
s in
you
r re
port
, so
they
will
hav
e th
em o
n re
cord
to
cons
ider
whe
neve
r th
ey fi
nd it
app
ropr
iate
.
prov
ide
a fe
w m
inut
es fo
r pa
rtic
ipan
ts t
o re
flect
tog
ethe
r on
th
e w
orks
hop.
In a
n in
form
al c
onve
rsat
ion,
you
can
ask
que
s-tio
ns t
hat
will
giv
e th
em a
cha
nce
to e
xpre
ss t
heir
thou
ghts
an
d fe
elin
gs, a
nd t
hat
will
pro
vide
you
with
feed
back
. You
m
ight
ask
suc
h qu
estio
ns a
s:
Did
the
wor
ksho
p ac
hiev
e its
ant
icip
ated
out
com
es?
■■
to w
hat
exte
nt d
id it
mee
t or
not
mee
t yo
ur e
xpec
tatio
ns?
■■
Wha
t w
as t
he m
ost
usef
ul p
art
of t
his
wor
ksho
p fo
r yo
u?■
■
Wha
t w
as le
ast
usef
ul?
■■
Wha
t do
you
thi
nk y
ou p
erso
nally
can
con
trib
ute
to m
ak-
■■
ing
the
iden
tified
cha
nges
hap
pen?
Rem
embe
r to
tha
nk t
he p
artic
ipan
ts fo
r w
hat
they
hav
e co
n-tr
ibut
ed t
o th
e w
orks
hop.
You
r si
ncer
e ap
prec
iatio
n w
ill b
e a
wel
l-des
erve
d re
war
d fo
r w
hat
has
been
an
inte
nse
effo
rt.
You
may
wis
h to
dis
trib
ute
a w
ritte
n fo
rm fo
r fe
edba
ck o
n th
e pr
oces
s an
d ou
tcom
es o
f the
wor
ksho
p, a
nd o
n th
e qu
ality
of f
acili
tatio
n. H
owev
er,
it is
stil
l im
port
ant
for
part
icip
ants
to
shar
e so
me
of t
heir
thou
ghts
pub
licly
, to
cap
italiz
e on
the
ope
nnes
s th
at h
as
mar
ked
thei
r th
ree
days
tog
ethe
r.
Con
side
r go
ing
arou
nd t
he g
roup
, ask
-in
g ev
eryo
ne fo
r on
e co
mm
ent,
so
that
yo
u ge
t fe
edba
ck fr
om e
ach
part
ici-
pant
, not
just
from
tho
se w
ho r
eadi
ly
volu
ntee
r.
MOST FOR TB
Management and organizational sustainability tool for tB46
Phase 4: fOllOW-uP actiVities
A successful workshop will have set the stage for the last phase of the MOST for TB process. As quickly as possible after the workshop, you should prepare a report for the NTP, presenting the assessment findings and the resulting action plans. You should review the report in a meeting with the NTP director, TB change leader, and TB change team before it is distributed to the rest of the NTP staff. You can use this debriefing to reach agreement on follow-up activities that will move the change process forward and bring about the desired management improvements.
Suggested follow-up activities for the NTP include the following:
The NTP director, TB change leader, and TB change team meet to clarify the responsibilities ■■
they and other leaders will take on during the change process.
The NTP director, TB change leader, and TB change team integrate the MOST for TB action ■■
plans into the NTP’s operational plan.
The TB change team meets with the TB change leader to review and fine-tune the action ■■
plans, focusing on the specific tasks that will build progress toward the more broadly defined objectives, the timeline, and the individuals responsible for carrying out specific tasks. In addi-tion to defining the evidence that will be used to determine the status of objectives, the action plans specify milestones the team will use to monitor progress along the way.
The NTP director distributes the workshop report and informs the entire staff and manage-■■
ment team about the process: the rationale for conducting MOST for TB, the benefits to the NTP of improved management, the main events of the workshop, and the coming changes.
Members of the TB change team begin to achieve buy-in and engage the rest of the NTP in ■■
MOST for TB changes. They meet with individuals and work groups to discuss how the pro-posed management improvements will affect their work, answer questions, and allay fears.
Suggested follow-up activities for the facilitators include the following:
Prepare the workshop report and review it with the NTP director, TB change leader, and TB ■■
change team.
Verify that resources are allocated for a six-month or one-year follow-up MOST for TB exercise ■■
to review progress and plan for future management improvements.
Discuss options for periodic follow-up conversations, e-mails, or meetings with the TB change ■■
leader and TB change team, to check on progress and serve as a resource in implementing the action plan.
Assist the TB change team with fine-tuning their plan and in finding ways of engaging other ■■
NTP staff.
Provide technical assistance in implementing the action plan, or help the NTP find other ■■
sources of technical assistance.
Facilitate other assessment/planning exercises focusing on management components that ■■
may need more thorough consideration than was possible during the MOST for TB workshop. See the list of additional resources, on page 84, for guidelines and tools that can help NTPs conduct such assessments for several management areas.
MOST FOR TB
Management and organizational sustainability tool for tB 47
VI. WORKSHOP MATERIALS This section contains materials to be distributed to all workshop participants in a workshop binder or folder. The contents may be copied directly from this section.
The materials to be included in the participants’ binder are:
Making the MOST of Management■■
MOST for TB Workshop Agenda and Anticipated Outcomes■■
MOST for TB Assessment Instrument (to be filled out individually by each participant)■■
Assessment Consensus Form (on which participants record the assessments and comments of ■■
their colleagues, based on the individual MOST for TB instruments)
MOST for TB Action Plan Form■■
Leading and Managing Results Model■■
Leading and Managing Framework■■
resources on the MOst for tb cd-rOM
to supplement the resources listed above, the Most for tB CD-RoM includes additional ma-terials that may be useful to the workshop facilitators and participants. these resources may be used as workshop handouts or as preparatory materials for the workshop. these additional resources are:
presenting Most for tB at a staff Meeting■■
Most for tB slide presentation■■
Framework for Most for tB Action plan ■■
All additional resources listed at end of this publication can also be found on the Most for tB CD-RoM.
MOST FOR TB
Management and organizational sustainability tool for tB48
Making the MOst Of ManageMent
What is MOst for tb?
The Management and Organizational Sustainability Tool for National TB Control Programs (MOST for TB) is a structured, participatory process that allows NTPs to assess their own management performance and develop a concrete action plan for NTP-wide improvement.
NTPs that have undergone traditional management assessments may be surprised by MOST for TB. Traditional assessments rely on external evaluators, intensive data collection, and check-lists. They result in findings and recommendations but often fall short of producing a plan for improvement. MOST for TB is different. It is about making change happen through a structured, participatory process, in which staff members use an instrument to collect data from their own experience, immediately analyze the data, and use their analysis to make concrete, practical plans for improvement. Finally, the MOST for TB process recognizes that meaningful changes in man-agement rarely occur through a single event; the process includes a six-month or one-year follow-up MOST for TB exercise to review progress and make any needed changes in the action plan.
Why emphasize Management?
Management Sciences for Health (MSH), in collaboration with TB CAP partners, developed MOST for TB after years of experience in helping public- and private-sector organizations provide health services under complex and changing conditions. MOST for TB builds on a consistent finding that there are unbreakable linkages between good management, high-quality services, and organiza-tional sustainability. Good management is the glue that holds all internal parts of an NTP together, creates a positive work climate, and supports high-quality services, thus helping to bring the NTP’s vision to fruition.
A well-managed NTP that delivers high-quality services is able to satisfy the needs of the TB patients and the community. Its structure and financial base allow it to continue its work in a sometimes-changing environment within the country’s Ministry of Health.
What is the MOst for tb Process?
The MOST for TB process begins with an engagement phase to determine if MOST for TB is a good fit for the NTP; continues with a preparation phase to identify and interview staff who will lead the process; focuses on the key activity—a facilitated assessment and planning workshop; and con-cludes with follow-up activities to implement, monitor, and support agreed-upon changes.
The three-day workshop is the central component of the process. It builds a collective perspective and plan from individual experiences. It brings together, on an equal footing, managers from all levels of the NTP—from the coordinators at the local and intermediate levels to the NTP central team and the NTP director. During the workshop, participants express their individual views on management performance, share these perceptions, and reach consensus on changes that will improve performance. They establish priorities and develop an action plan that specifies objectives and activities for making these changes, including identifying the people who will be responsible for implementing the plan.
MOST FOR TB
Management and organizational sustainability tool for tB 49
For MOST for TB to yield its greatest benefits, workshop participants must play a part that con-tinues long after the workshop. They must identify the need for change, commit themselves to the process, motivate their colleagues, and take the lead in implementing the planned improvements that emerge from the workshop.
how can ntPs benefit from MOst for tb?
Through the MOST for TB process, an NTP will:
recognize the importance of good management to its effectiveness and long-term survival;■■
assess the current status of 30 essential components of NTP management;■■
assess the current status of four other program components;■■
identify feasible changes that will make the NTP more effective;■■
develop specific plans to implement these changes;■■
generate the staff buy-in needed to support the management improvements;■■
monitor the results over time and adapt the plans to changing conditions and new demands.■■
Any NTP can benefit from MOST for TB if its director and senior managers meet two criteria:
They are committed to open self-assessment and decision-making by consensus.■■
They believe that the NTP can take action to improve its management, even though there may ■■
be some constraints beyond its control.
What Management areas does MOst for tb address?
Mission. An NTP’s mission is its purpose, the reason it exists. It provides guidance, consistency, and meaning to decisions and activities at all levels. It answers the question: Why do we do what we do?
Values. An NTP’s values are the beliefs and ethical principles that underlie its mission. They give meaning to the NTP’s work and form the basis for staff commitment. They answer the question: What are the core beliefs and principles that the NTP staff all share and that give direction to our work?
Strategy. An NTP’s strategies are the broad approaches used to define the objectives and activities that will fulfill the NTP’s mission and goals. For the NTP, its strategies answer the question: How will we get to where we want to go?
Structure. Structure refers to how the NTP is legally defined or organized in a country. The func-tional structure encompasses the formal lines of authority, distribution of responsibilities, ways in which significant decisions are made, and the people held accountable for carrying out those deci-sions. Structure answers the question: Is the NTP organized in a way that facilitates what it wants to do and where it wants to go?
MOST FOR TB
Management and organizational sustainability tool for tB50
Systems. Systems are the interdependent functions that allow an NTP to do its work. MOST for TB addresses 15 systems that are the key elements of management: (1) strategic planning, (2) annual operational planning, (3) norms and procedures for TB prevention, detection, diagnosis, treatment, and care, (4) geographical and population coverage of DOTS, (5) human resources management, (6) leadership development, (7) staff training, (8) information management: operational and epidemio-logical data collection, (9) information management: use of operational and epidemiological infor-mation, (10) monitoring and evaluation, (11) supervision, (12) supply management, (13) financial management, (14) resource mobilization, (15) quality assurance: norms and procedures for TB labs. Organizational systems answer the question: What helps us carry out our activities? The MOST for TB process can help an NTP assess these systems and plan to carry out the high-priority changes needed for increased efficiency and greater effectiveness.
Other Program Components. Several other program components are very important in an NTP. MOST for TB also assesses research for TB control, ACSM, the community participation plan for TB control, and pharmacovigilance for TB medicines.
Principles underlying MOst for tb
the most effective way to initiate change in an ntp is to involve staff members at all ■■
levels in open self-assessment and consensual decision-making.
Meaningful changes in management rarely occur through a single event. they require an ■■
ongoing effort, with frequent reevaluations and adaptations.
to bring about management changes, there must be strong, committed leadership at ■■
every level of the ntp.
What else do i need to know?
If you are involved with an NTP and you sense that some management areas could be strengthened, you may want to explore MOST for TB more fully. You can talk with an experienced MOST for TB facilitator, view a slide presentation, peruse the MOST for TB guide, or speak with a representative of an NTP that has used MOST for TB.
For more information, please contact:
Management Sciences for HealthWebsite: www.msh.org
TB CAP ProjectWebsite: www.tbcta.org
MOST FOR TB
Management and organizational sustainability tool for tB 51
MOst fOr tb WOrkshOP agenda and anticiPated OutcOMes
WOrkshOP agenda
session/ Module Objectives approximate
time frame
DAY 1 Opening session Review the workshop agenda and anticipated ■■
outcomes.
Clarify expectations. ■■
Introduce the Most for tB process. ■■
Establish ground rules for an open, honest, respectful ■■
exchange of ideas.
Explore the links between leadership, improved man-■■
agement, work climate, sustainability, and organiza-tional results.
1 ½ hours
Module 1: Where are We now?
Explore the meaning of the five management areas ■■
and the 30 management components.
Work in groups that cut across organizational levels ■■
and draw on the contributions of each member.
Generate consensus on the ntp’s current status in ■■
terms of each component and stage of development.
4 ½ hours
DAY 2 Module 2: Where are We headed?
Agree on one or two objectives for improving each ■■
management component.
specify evidence that will indicate progress toward ■■
these objectives.
4 hours
Module 3: how Will We Manage the needed changes?
Explore the principles of change. ■■
Explore how changes in management, together with ■■
strong leadership, can improve an ntp’s services and sustainability.
Recognize participants’ roles as leaders and managers ■■
of the change process.
4 hours
DAY 3 Module 4: how Will We reach Our Objectives?
select the highest-priority management components ■■
to improve during the coming period.
prepare an action plan for these improvements. ■■
Decide on follow-up activities that will need to be ■■
completed, and assign responsibility for the activities.
1 day
MOST FOR TB
Management and organizational sustainability tool for tB52
anticipated Outcomes of the Workshop
By the end of the workshop, participants will have come to agreement on how well the NTP is func-tioning and will have planned activities for making improvements. The specific outcomes include:
a collective assessment of the current stage of development of the 30 management ■■
components;
a prioritized list of the management components to be improved within a specified time period;■■
an agreed-upon set of objectives for improving each management component;■■
an action plan for reaching the objectives, identifying the broad activities, timing, resources, ■■
and people responsible for completing the activities, and defining data that can provide evi-dence of success;
identification of a TB change leader and TB change team who will lead the implementation of ■■
the action plan and monitor progress;
a list of short-term activities for following up on the MOST for TB workshop: those the NTP ■■
staff can do themselves with existing resources, those for which they need to seek additional resources, and those for which they will need technical assistance from outside the NTP;
agreement on post-workshop assistance from the facilitators (by phone or e-mail) and a ■■
follow-up MOST for TB exercise, usually six months to one year after the workshop.
Management and organizational sustainability tool for tB 53
MO
st f
Or
tb
ass
essM
ent
inst
ru
Men
t
Man
agem
ent
com
pon
ent
stag
es o
f d
evel
opm
ent
and
th
eir
ch
arac
teri
stic
sc
urre
nt
stag
eev
iden
ce1
23
4
Mis
sion
exis
ten
ce a
nd
k
now
led
ge
no
form
al n
tp m
is-
sion
sta
tem
ent
ex-
ists
or
the
exis
ting
mis
sion
sta
tem
ent
is in
cons
iste
nt w
ith
the
curr
ent
prog
ram
pu
rpos
e an
d th
e ne
eds
of in
tend
ed
clie
nts.
An
ntp
mis
sion
st
atem
ent
exis
ts, i
s co
nsis
tent
with
the
cu
rren
t n
tp p
ur-
pose
, and
is s
ome-
times
cite
d by
sen
ior
staf
f.
the
mis
sion
sta
te-
men
t is
freq
uent
ly
cite
d by
key
st
akeh
olde
rs—
staf
f, ad
viso
ry b
oard
m
embe
rs, p
art-
ner
agen
cies
, and
cl
ient
s—bu
t is
not
pe
riodi
cally
rev
ised
to
refl
ect
the
need
s of
the
ntp
.
the
mis
sion
sta
te-
men
t is
wid
ely
know
n an
d re
gula
rly
revi
ewed
to
assu
re
that
it r
eflec
ts t
he
curr
ent
ntp
pur
pose
an
d th
e ne
eds
of
inte
nded
clie
nts.
Valu
es
exis
ten
ce a
nd
a
pp
licat
ion
ntp
val
ues
and
ethi
-ca
l prin
cipl
es h
ave
not
been
defi
ned.
ntp
val
ues
and
ethi
-ca
l prin
cipl
es h
ave
been
defi
ned
and
are
som
etim
es c
ited
by s
enio
r st
aff.
ntp
val
ues
and
ethi
cal p
rinci
ples
are
fr
eque
ntly
cite
d by
st
aff a
t al
l lev
els,
but
ar
e in
cons
iste
ntly
ap
plie
d ac
ross
the
pr
ogra
m.
ntp
val
ues
and
ethi
cal p
rinci
ples
are
w
idel
y kn
own,
and
st
aff a
re h
eld
ac-
coun
tabl
e fo
r ad
her-
ing
to t
hem
.
stra
teg
y
lin
ks t
o M
issi
on
and
Val
ues
ntp
str
ateg
ies
are
deve
lope
d in
re-
spon
se t
o fu
nder
s’
requ
irem
ents
or
in r
espo
nse
to t
he
pref
eren
ces
of a
few
de
cisi
on-m
aker
s,
with
out
refe
renc
e to
the
mis
sion
and
va
lues
.
ntp
str
ateg
ies
are
som
etim
es d
evel
-op
ed w
ith r
efer
ence
to
the
mis
sion
and
va
lues
, but
mor
e of
ten
in r
espo
nse
to
othe
r re
quire
men
ts,
pref
eren
ces,
and
m
anda
tes.
ntp
str
ateg
ies
are
alw
ays
deve
lope
d w
ithin
the
gen
eral
co
ntex
t of
the
mis
-si
on a
nd v
alue
s.
Beca
use
ntp
str
ate-
gies
are
dev
elop
ed
to c
onfo
rm t
o th
e m
issi
on a
nd v
alue
s,
stra
tegi
c pl
anni
ng is
vi
ewed
as
an o
ppor
-tu
nity
to
reaf
firm
or
revi
se t
he m
issi
on.
Management and organizational sustainability tool for tB54
Man
agem
ent
com
pon
ent
stag
es o
f d
evel
opm
ent
and
th
eir
ch
arac
teri
stic
sc
urre
nt
stag
eev
iden
ce1
23
4
stra
teg
y (c
onti
nue
d)
lin
ks t
o st
op t
b
stra
teg
yth
e st
op t
B st
rate
gy
is n
ot in
tegr
ated
into
n
tp s
trat
egie
s.
the
stop
tB
stra
tegy
is
inte
grat
ed in
to
ntp
str
ateg
ies,
but
is
not
defi
ned
in
coor
dina
tion
with
ot
her
publ
ic h
ealth
pr
ogra
ms
(e.g
., im
-m
uniz
atio
n, le
pros
y),
com
mun
ities
, and
/or
the
priv
ate
sect
or.
the
stop
tB
stra
tegy
is
inte
grat
ed in
to
ntp
str
ateg
ies,
and
pa
rtia
lly d
efine
d in
co
ordi
natio
n w
ith
othe
r pu
blic
hea
lth
prog
ram
s (e
.g.,
im-
mun
izat
ion,
lepr
osy)
, co
mm
uniti
es, a
nd
the
priv
ate
sect
or.
the
stop
tB
stra
tegy
is
inte
grat
ed in
to
ntp
str
ateg
ies,
and
is
alw
ays
defin
ed in
co
ordi
natio
n w
ith
othe
r pu
blic
hea
lth
prog
ram
s (e
.g.,
im-
mun
izat
ion,
lepr
osy)
, co
mm
uniti
es, a
nd
the
priv
ate
sect
or.
lin
ks t
o h
iV &
aid
s c
ontr
ol P
rog
ram
sA
join
t na
tiona
l tB
and
HIV
& A
IDs
col-
labo
ratin
g bo
dy h
as
not
been
cre
ated
to
add
ress
tB
an
d H
IV &
AID
s
colla
bora
tion.
A jo
int
natio
nal t
B an
d H
IV &
AID
s co
llabo
ratin
g bo
dy
exis
ts; h
owev
er, n
o jo
int
natio
nal p
lan
to
impl
emen
t tB
and
H
IV &
AID
s co
llab-
orat
ive
activ
ities
has
be
en d
evel
oped
.
A jo
int
natio
nal p
lan
for
tB a
nd H
IV &
A
IDs
colla
bora
tive
activ
ities
has
bee
n de
velo
ped
and
impl
emen
ted
in
pilo
t si
tes
or a
reas
. A
n H
IV &
AID
s su
r-ve
illan
ce s
yste
m fo
r tB
pat
ient
s an
d a
tB m
onito
ring
and
eval
uatio
n sy
stem
for
HIV
& A
IDs
patie
nts
exis
t in
pilo
t si
tes
or
area
s.
A jo
int
natio
nal p
lan
for
tB a
nd H
IV &
A
IDs
colla
bora
tive
activ
ities
has
bee
n im
plem
ente
d na
-tio
nwid
e. B
oth
an
HIV
& A
IDs
surv
eil-
lanc
e sy
stem
for
tB p
atie
nts
and
a tB
mon
itorin
g an
d ev
alua
tion
syst
em fo
r H
IV &
AID
s pa
tient
s ar
e op
erat
iona
l. tB
ca
se fi
ndin
gs h
ave
been
inte
nsifi
ed a
t H
IV &
AID
s pr
ogra
m
site
s an
d fo
r hi
gh-
risk
grou
ps.
Management and organizational sustainability tool for tB 55
Man
agem
ent
com
pon
ent
stag
es o
f d
evel
opm
ent
and
th
eir
ch
arac
teri
stic
sc
urre
nt
stag
eev
iden
ce1
23
4
stra
teg
y (c
onti
nue
d)
lin
ks t
o tb
Pat
ien
ts
and
com
mun
ity
stra
tegi
es a
re d
evel
-op
ed w
ithou
t re
fer-
ence
to
the
need
s of
tB
pat
ient
s or
the
ir co
mm
uniti
es.
stra
tegi
es a
re
deve
lope
d ba
sed
on
assu
mpt
ions
abo
ut
the
need
s of
tB
patie
nts
and
thei
r co
mm
uniti
es.
stra
tegi
es a
re d
e-ve
lope
d ba
sed
on a
co
mpr
ehen
sive
as-
sess
men
t/ev
alua
tion
of t
he n
eeds
of t
B pa
tient
s an
d th
eir
com
mun
ities
.
stra
tegi
es a
re d
e-ve
lope
d ba
sed
on a
co
mpr
ehen
sive
as-
sess
men
t/ev
alua
tion
of t
he n
eeds
of t
B pa
tient
s an
d th
eir
com
mun
ities
, with
th
e pa
rtic
ipat
ion
of t
B pa
tient
s an
d co
mm
unity
gro
ups.
stru
ctur
e
inst
itut
ion
aliz
atio
nth
e n
tp is
not
for-
mal
ly d
efine
d by
the
M
oH
(e.
g., d
oes
not
exis
t in
the
san
itary
co
de o
r or
gani
za-
tiona
l dia
gram
of t
he
Mo
H).
the
ntp
is fo
r-m
ally
defi
ned
by t
he
Mo
H, b
ut it
s fu
nc-
tiona
l str
uctu
re is
no
t co
nsis
tent
with
in
tern
atio
nal r
ecom
-m
enda
tions
(e.
g.,
WH
o, t
he U
nion
).
the
ntp
is fo
rmal
ly
defin
ed, a
nd it
s fu
nctio
nal s
truc
ture
fo
llow
s so
me
inte
r-na
tiona
l rec
omm
en-
datio
ns (
e.g.
, WH
o,
the
Uni
on).
the
ntp
is fo
rmal
ly
defin
ed, a
nd it
s fu
nctio
nal s
truc
ture
fo
llow
s al
l the
inte
r-na
tiona
l rec
omm
en-
datio
ns (
e.g.
, WH
o,
the
Uni
on).
lin
es o
f a
uth
orit
y an
d a
ccou
nta
bili
tyth
ere
are
no fo
rmal
do
cum
ents
tha
t de
fine
curr
ent
lines
of
aut
horit
y an
d ac
coun
tabi
lity
at t
he
diffe
rent
leve
ls o
f the
n
tp.
An
ntp
org
aniz
a-tio
nal c
hart
or
sim
ilar
docu
men
t de
fines
lin
es o
f aut
horit
y an
d ac
coun
tabi
lity
but
is
not
incl
uded
in
the
Mo
H´s
man
ual
of p
olic
ies
and
pr
oced
ures
.
An
ntp
org
aniz
a-tio
nal c
hart
or
sim
ilar
docu
men
t is
in-
clud
ed in
the
Mo
H’s
m
anua
l of p
olic
ies
and
proc
edur
es a
nd
is s
omet
imes
use
d w
hen
issu
es a
rise
pert
aini
ng t
o lin
es
of a
utho
rity
and
ac
coun
tabi
lity.
the
ntp
is c
onsi
s-te
ntly
inte
grat
ed
with
in t
he p
ubic
H
ealth
ser
vice
s (p
Hs)
at
all
leve
ls. t
he n
tp
orga
niza
tiona
l cha
rt
or s
imila
r do
cum
ent
is r
egul
arly
upd
ated
an
d co
nsis
tent
ly
used
to
reso
lve
is-
sues
per
tain
ing
to
lines
of a
utho
rity
and
acco
unta
bilit
y.
Management and organizational sustainability tool for tB56
Man
agem
ent
com
pon
ent
stag
es o
f d
evel
opm
ent
and
th
eir
ch
arac
teri
stic
sc
urre
nt
stag
eev
iden
ce1
23
4
stru
ctur
e (c
onti
nue
d)
com
mun
icat
ion
ther
e is
no
form
al
com
mun
icat
ion
mec
hani
sm t
o sh
are
info
rmat
ion
amon
g th
e di
ffere
nt le
vels
of
the
ntp
. Im
port
ant
info
rmat
ion
is c
om-
mun
icat
ed m
ainl
y by
w
ord
of m
outh
.
Com
mun
icat
ion
mec
hani
sms
are
used
to
shar
e in
for-
mat
ion
at d
iffer
ent
leve
ls o
f the
ntp
to
conv
ey n
eces
sary
in
form
atio
n fr
om
seni
or m
anag
emen
t at
the
cen
tral
leve
l to
the
rest
of t
he s
taff.
Com
mun
icat
ion
mec
hani
sms
are
used
reg
ular
ly t
o sh
are
info
rmat
ion
amon
g st
aff a
t di
f-fe
rent
leve
ls o
f the
n
tp a
nd a
re u
sed
irreg
ular
ly w
ith o
ther
pr
ogra
ms
and
pri-
vate
sec
tor.
Com
mun
icat
ion
mec
hani
sms
are
used
con
sist
ently
to
shar
e in
form
atio
n at
di
ffere
nt le
vels
of t
he
Mo
H/n
tp a
nd w
ith
the
pHs,
HIV
& A
IDs
and
imm
uniz
atio
n pr
ogra
ms,
and
oth
er
stak
ehol
ders
(pr
ivat
e he
alth
ser
vice
s an
d un
iver
sitie
s).
rol
es a
nd
r
esp
onsi
bili
ties
Role
s an
d re
spon
si-
bilit
ies
are
not
clea
rly
defin
ed. W
ork
is a
s-si
gned
on
an a
d ho
c ba
sis,
acc
ordi
ng t
o th
e pe
rcei
ved
need
s of
the
mom
ent.
Role
s an
d re
spon
-si
bilit
ies
are
in t
he
proc
ess
of b
eing
de-
fined
for
all l
evel
s of
th
e n
tp a
nd a
ll no
n-n
tp s
taff
invo
lved
in
tB
cont
rol.
Mos
t w
ork
is s
till a
ssig
ned
in a
n ad
hoc
fash
ion.
Role
s an
d re
spon
si-
bilit
ies
are
defin
ed in
a
norm
s an
d pr
oce-
dure
s m
anua
l for
all
leve
ls o
f the
ntp
and
al
l non
-ntp
sta
ff in
-vo
lved
in t
B co
ntro
l. th
ey a
re b
egin
ning
to
be
used
as
the
basi
s fo
r as
sign
ing
wor
k.
Role
s an
d re
spon
si-
bilit
ies
are
clea
rly a
s-si
gned
at
all l
evel
s of
th
e n
tp in
a n
orm
s an
d pr
oced
ures
m
anua
l. th
ey a
re
regu
larly
rev
iew
ed
to b
e su
re t
hat
staf
f as
sign
men
ts s
uppo
rt
ntp
str
ateg
ies.
dec
isio
n-M
akin
gth
e n
tp d
irect
or
mak
es a
ll si
gnifi
cant
de
cisi
ons
with
out
disc
ussi
ng t
hem
with
th
e ce
ntra
l, in
term
e-di
ate,
or
loca
l tec
hni-
cal n
tp t
eam
s.
the
ntp
dire
ctor
m
akes
all
sign
ifica
nt
deci
sion
s af
ter
liste
n-in
g to
the
vie
ws
of
the
cent
ral t
echn
ical
n
tp t
eam
, and
se-
lect
ed in
term
edia
te
tech
nica
l ntp
tea
ms.
tech
nica
l ntp
in-
term
edia
te t
eam
s ar
e en
cour
aged
by
the
ntp
dire
ctor
to
mak
e an
d ca
rry
out
sign
ifica
nt d
ecis
ions
re
gard
ing
thei
r ow
n w
ork
and
the
wor
k of
the
loca
l tea
ms.
All
ntp
sta
ff (lo
cal,
inte
rmed
iate
, and
ce
ntra
l) ar
e ex
pect
ed
to m
ake
sign
ifica
nt
deci
sion
s re
gard
ing
thei
r ow
n w
ork
and
the
wor
k of
the
ir te
ams,
and
to
carr
y ou
t th
ose
deci
sion
s.
Management and organizational sustainability tool for tB 57
Man
agem
ent
com
pon
ent
stag
es o
f d
evel
opm
ent
and
th
eir
ch
arac
teri
stic
sc
urre
nt
stag
eev
iden
ce1
23
4
syst
ems
stra
teg
ic P
lan
nin
gth
e n
tp d
oes
not
have
a c
urre
nt s
tra-
tegi
c pl
an. M
ost
stra
tegi
es, i
f the
y ex
ist,
are
unp
lann
ed,
and
deci
ded
on a
n ad
hoc
bas
is.
the
ntp
is d
evel
op-
ing
a st
rate
gic
plan
an
d co
nsid
erin
g st
ra-
tegi
c pr
iorit
ies,
but
it
is n
ot in
tegr
ated
w
ith a
ll le
vels
of t
he
pHs.
the
ntp
has
a c
ur-
rent
str
ateg
ic p
lan,
ba
sed
on a
com
pre-
hens
ive
asse
ssm
ent
of n
eeds
and
the
en
viro
nmen
t in
side
an
d ou
tsid
e th
e in
-st
itutio
n, a
nd in
line
w
ith in
tern
atio
nal
stan
dard
s. t
his
stra
-te
gic
plan
, how
ever
, is
not
fully
dis
sem
i-na
ted,
impl
emen
ted,
an
d m
onito
red.
the
ntp
has
a
defin
ed s
trat
egic
pl
an, a
nd it
is fu
lly
impl
emen
ted
and
inte
grat
ed w
ith a
ll le
vels
of t
he p
Hs
and
priv
ate
sect
or
and
mon
itore
d on
a
regu
lar
basi
s. t
he
stra
tegi
c pl
an is
ba
sed
on a
com
pre-
hens
ive
asse
ssm
ent,
an
d ea
ch n
ew s
trat
e-gi
c pl
anni
ng e
xerc
ise
begi
ns w
ith a
car
eful
an
alys
is o
f suc
cess
es
and
failu
res
in a
dher
-in
g to
the
prio
r pl
an.
Management and organizational sustainability tool for tB58
Man
agem
ent
com
pon
ent
stag
es o
f d
evel
opm
ent
and
th
eir
ch
arac
teri
stic
sc
urre
nt
stag
eev
iden
ce1
23
4
syst
ems
(con
tin
ued
)
an
nua
l Op
erat
ion
al
Plan
nin
gth
e n
tp d
oes
not
defin
e an
y an
nual
op
erat
iona
l pla
n.
Mos
t ac
tiviti
es a
re
unpl
anne
d or
not
in
tegr
ated
with
all
leve
ls o
f the
pH
s,
and
are
deci
ded
on
an a
d ho
c ba
sis.
the
ntp
is d
evel
op-
ing
an o
pera
tiona
l pl
an, b
ut t
he p
lan
is
not
inte
grat
ed w
ith
all l
evel
s of
the
pH
s.
the
ntp
has
a c
ur-
rent
ann
ual o
pera
-tio
nal p
lan.
thi
s op
-er
atio
nal p
lan
is n
ot
fully
impl
emen
ted,
bu
t it
is in
tegr
ated
w
ith a
ll le
vels
of t
he
pHs.
the
ope
ratio
nal
plan
is n
ot b
ased
on
an
asse
ssm
ent
of r
esul
ts fr
om t
he
prev
ious
yea
r or
ne
w n
eeds
tha
t ha
ve
aris
en.
the
ntp
has
a c
ur-
rent
ann
ual o
pera
-tio
nal p
lan
base
d on
a
com
preh
ensi
ve
asse
ssm
ent.
thi
s op
erat
iona
l pla
n is
be
ing
impl
emen
ted
fully
and
is in
tegr
at-
ed w
ith a
ll le
vels
of
the
pHs
and
priv
ate
sect
or. t
he a
nnua
l op
erat
iona
l pla
nnin
g pr
oces
s be
gins
with
a
care
ful a
naly
sis
of
the
prio
r op
erat
iona
l pl
an a
nd in
clud
es a
n as
sess
men
t of
new
ne
eds
and
over
all
prog
ress
mad
e by
th
e pr
ogra
m.
Management and organizational sustainability tool for tB 59
Man
agem
ent
com
pon
ent
stag
es o
f d
evel
opm
ent
and
th
eir
ch
arac
teri
stic
sc
urre
nt
stag
eev
iden
ce1
23
4
syst
ems
(con
tin
ued
)
nor
ms
and
Pr
oced
ures
for
tb
Pre
ven
tion
, d
etec
tion
, d
iag
nos
is,
trea
tmen
t,
and
car
e
the
ntp
has
not
de
fined
tec
hnic
al
norm
s an
d pr
oce-
dure
s. M
ost
tech
-ni
cal a
ctiv
ities
are
un
plan
ned,
and
are
de
cide
d on
an
ad
hoc
basi
s.
the
ntp
has
de-
velo
ped
elem
ents
of
the
nor
ms
and
proc
edur
es t
hat
will
he
lp s
taff
regu
larly
im
prov
e th
e qu
al-
ity o
f ser
vice
s, b
ut
the
elem
ents
are
no
t co
nsis
tent
with
W
Ho
and
the
Uni
on
reco
mm
enda
tions
. th
ey a
re n
ot s
yste
m-
atic
ally
app
lied
at a
ll le
vels
of t
he p
Hs.
the
ntp
has
dev
el-
oped
and
dis
sem
i-na
ted
norm
s an
d pr
oced
ures
, whi
ch
are
in a
ccor
danc
e w
ith W
Ho
and
the
U
nion
rec
omm
enda
-tio
ns. t
hey
are
regu
-la
rly a
pplie
d at
all
leve
ls o
f the
pH
s an
d in
som
e se
gmen
ts o
f th
e pr
ivat
e se
ctor
.
the
ntp
has
est
ab-
lishe
d an
d up
date
d no
rms
and
proc
e-du
res
aim
ed a
t im
-pr
ovin
g th
e qu
ality
of
ser
vice
s, w
hich
fo
llow
all
WH
o a
nd
the
Uni
on r
ecom
-m
enda
tions
. the
y ar
e co
nsis
tent
ly
appl
ied
at a
ll le
v-el
s of
the
pH
s an
d pr
ivat
e se
ctor
and
ar
e up
date
d re
gu-
larly
. tra
ined
sta
ff ar
e re
gula
rly u
sing
thi
s sy
stem
.
geo
gra
ph
ical
an
d
Pop
ulat
ion
cov
er-
age
of d
Ots
Do
ts s
trat
egy
is n
ot
impl
emen
ted
at a
ny
leve
l (ce
ntra
l, pr
ovin
-ci
al, o
r di
stric
t).
Do
ts s
trat
egy
is
impl
emen
ted
in
som
e di
stric
ts.
Do
ts s
trat
egy
has
been
impl
emen
ted
in a
ll di
stric
ts, b
ut t
B pa
tient
cov
erag
e is
be
low
100
per
cent
.
Do
ts s
trat
egy
is
fully
impl
emen
ted
at a
ll le
vels
, and
tB
patie
nt c
over
age
is
100
perc
ent.
hum
an r
esou
rces
M
anag
emen
tth
ere
are
no h
uman
re
sour
ces
polic
ies
in
the
Mo
H o
r th
e n
tp
rega
rdin
g jo
b cl
as-
sific
atio
n, s
alar
ies,
hi
ring,
pro
mot
ion,
gr
ieva
nces
, or
wor
k ho
urs.
the
re a
re n
o pr
oced
ures
for
per-
form
ance
eva
luat
ion,
st
aff d
evel
opm
ent,
or
mai
nten
ance
of
empl
oyee
dat
a.
the
Mo
H h
as r
ec-
ogni
zed
the
need
fo
r a
form
al h
uman
re
sour
ces
syst
em
and
is w
orki
ng t
o cl
arify
hum
an r
e-so
urce
s po
licie
s an
d pr
oced
ures
.
Hum
an r
esou
rces
po
licie
s an
d pr
oce-
dure
s ar
e in
pla
ce,
and
Mo
H/n
tp m
an-
ager
s ar
e be
ginn
ing
to u
se t
hem
to
hire
an
d re
tain
tal
ente
d an
d co
mm
itted
ntp
st
aff.
Hum
an r
esou
rces
po
licie
s an
d pr
oce-
dure
s ar
e in
pla
ce,
and
Mo
H/n
tp
man
ager
s us
e th
em
cons
iste
ntly
to
hire
an
d re
tain
tal
ente
d an
d co
mm
itted
ntp
st
aff.
Management and organizational sustainability tool for tB60
Man
agem
ent
com
pon
ent
stag
es o
f d
evel
opm
ent
and
th
eir
ch
arac
teri
stic
sc
urre
nt
stag
eev
iden
ce1
23
4
syst
ems
(con
tin
ued
)
lead
ersh
ip
dev
elop
men
tth
ere
is n
o po
licy
rega
rdin
g th
e de
vel-
opm
ent
of s
tron
g tB
co
ntro
l lea
ders
hip
capa
city
and
futu
re
lead
ers
for
the
ntp
.
ther
e is
a p
olic
y in
pla
ce r
egar
ding
th
e de
velo
pmen
t of
st
rong
tB
cont
rol
lead
ersh
ip c
apac
ity,
but
it is
not
follo
wed
on
a r
egul
ar b
asis
.
the
lead
ersh
ip d
e-ve
lopm
ent
polic
y is
in p
lace
and
fol-
low
ed o
n a
regu
lar
basi
s, b
ut p
artic
ipa-
tion
is s
elec
tive.
An
ntp
pla
n fo
r le
ader
ship
dev
elop
-m
ent
is in
pla
ce,
and
ther
e is
an
op-
port
unity
for
peop
le
to p
artic
ipat
e ba
sed
on p
erfo
rman
ce a
nd
othe
r es
tabl
ishe
d cr
iteria
.
staf
f tr
ain
ing
no
com
preh
ensi
ve
asse
ssm
ent
or e
valu
-at
ion
of n
tp s
taff
deve
lopm
ent
need
s in
the
con
text
of
ntp
prio
ritie
s an
d go
als
and
obje
ctiv
es
has
been
car
ried
out
for
hum
an c
apac
ity
build
ing.
the
ntp
do
es n
ot h
ave
an a
n-nu
al t
rain
ing
plan
.
A li
mite
d as
sess
men
t or
eva
luat
ion
of n
tp
staf
f dev
elop
men
t ne
eds
has
been
car
-rie
d ou
t. t
he n
tp is
aw
are
of t
he n
eed
for
a pl
an fo
r hu
man
ca
paci
ty b
uild
ing,
bu
t no
ann
ual t
rain
-in
g pl
an h
as y
et
been
defi
ned.
som
e re
fres
her
trai
ning
pr
ogra
ms
are
orga
-ni
zed,
but
with
out
inte
grat
ion
at a
ll le
vels
of t
he p
Hs.
the
ntp
has
a c
ur-
rent
ann
ual s
taff
trai
ning
pla
n ba
sed
on a
com
preh
ensi
ve
asse
ssm
ent
of t
he
need
s an
d pr
iorit
ies
for
hum
an c
apac
-ity
bui
ldin
g. t
his
trai
ning
pla
n is
not
fu
lly im
plem
ente
d.
Refr
eshe
r tr
aini
ng
prog
ram
s ar
e oc
ca-
sion
ally
car
ried
out
at lo
cal a
nd in
term
e-di
ate
leve
ls.
the
ntp
has
a c
ur-
rent
ann
ual s
taff
trai
ning
pla
n ba
sed
on a
com
preh
ensi
ve
asse
ssm
ent
of t
he
need
s an
d pr
iorit
ies
for
capa
city
bui
ldin
g.
this
tra
inin
g pl
an is
fu
lly im
plem
ente
d an
d in
tegr
ated
at
all l
evel
s of
the
pH
s an
d pr
ivat
e se
ctor
. Re
gula
r re
fres
her
trai
ning
pro
gram
s ar
e de
sign
ed a
nd
impl
emen
ted
at a
ll le
vels
to
stre
ngth
en
perf
orm
ance
.
Management and organizational sustainability tool for tB 61
Man
agem
ent
com
pon
ent
stag
es o
f d
evel
opm
ent
and
th
eir
ch
arac
teri
stic
sc
urre
nt
stag
eev
iden
ce1
23
4
syst
ems
(con
tin
ued
)
info
rmat
ion
M
anag
emen
t:
Op
erat
ion
al a
nd
ep
idem
iolo
gic
al
dat
a c
olle
ctio
n
the
ntp
has
a p
oor
info
rmat
ion
syst
em
for
data
col
lect
ion
and
repo
rtin
g. R
ou-
tine
serv
ice
data
are
of
ten
inac
cura
te,
and
thes
e da
ta a
re
rare
ly s
ubm
itted
on
sche
dule
.
the
ntp
has
intr
o-du
ced
syst
ems
that
ar
e be
ginn
ing
to
impr
ove
the
accu
-ra
cy a
nd t
imel
ines
s of
rou
tine
serv
ice
and
epid
emio
logi
cal
data
. som
e pr
oce-
dure
s co
nsis
tent
with
W
Ho
and
the
Uni
on
reco
mm
enda
tions
ar
e cu
rren
tly in
use
. th
e qu
ality
and
tim
-in
g of
rep
ortin
g st
ill
do n
ot m
eet
expe
ct-
ed s
tand
ards
.
the
info
rmat
ion
syst
em y
ield
s ro
utin
e da
ta. t
he s
yste
m’s
pr
oced
ures
and
in
form
atio
n to
ols
are
larg
ely
cons
iste
nt
with
WH
o a
nd t
he
Uni
on r
ecom
men
-da
tions
. Dat
a ar
e ge
nera
lly c
onsi
dere
d ac
cura
te, a
nd m
ost
repo
rts
are
subm
it-te
d on
tim
e.
A s
tand
ardi
zed
info
r-m
atio
n sy
stem
and
to
ols
for
data
col
lec-
tion
cons
iste
nt w
ith
WH
o a
nd t
he U
nion
re
com
men
datio
ns
exis
t, a
nd t
he s
yste
m
is fu
lly im
plem
ente
d at
all
leve
ls o
f the
n
tp. t
he q
ualit
y an
d tim
ing
of r
epor
t-in
g m
eet
expe
cted
st
anda
rds.
the
re
are
clea
rly e
nfor
ced
cons
eque
nces
for
late
rep
orts
. oth
er
orga
niza
tiona
l sys
-te
ms
prov
ide
cros
s-ch
ecki
ng t
o gu
aran
-te
e th
e ac
cura
cy o
f ro
utin
e da
ta.
Management and organizational sustainability tool for tB62
Man
agem
ent
com
pon
ent
stag
es o
f d
evel
opm
ent
and
th
eir
ch
arac
teri
stic
sc
urre
nt
stag
eev
iden
ce1
23
4
syst
ems
(con
tin
ued
)
info
rmat
ion
M
anag
emen
t: u
se
of O
per
atio
nal
an
d
epid
emio
log
ical
in
form
atio
n
thos
e w
ho s
ubm
it re
quire
d da
ta a
nd
data
rep
orts
rec
eive
no
feed
back
from
th
eir
man
ager
s.
Info
rmat
ion
is fi
led
away
and
is n
ot
used
for
man
age-
men
t or
pro
gram
-m
atic
dec
isio
ns.
the
ntp
is a
war
e of
th
e ne
ed t
o an
alyz
e an
d us
e in
form
atio
n.
som
e in
form
atio
n pr
oces
ses
are
de-
fined
, but
are
not
us
ed c
onsi
sten
tly
at a
ll le
vels
to
im-
prov
e m
anag
emen
t an
d pe
rfor
man
ce,
achi
eve
outc
omes
, an
d id
entif
y tr
ends
.
Info
rmat
ion
proc
ess-
es a
re in
tegr
ated
at
all l
evel
s of
the
ntp
an
d ar
e us
ed t
o pr
o-vi
de p
rom
pt fe
ed-
back
and
defi
ne c
or-
rect
ive
and
proa
ctiv
e st
eps
whe
n ne
eded
. th
e n
tp a
naly
zes
the
info
rmat
ion
and
uses
its
findi
ngs
at
som
e le
vels
to
im-
prov
e m
anag
emen
t an
d pe
rfor
man
ce,
achi
eve
outc
omes
, an
d an
alyz
e tr
ends
.
Info
rmat
ion
proc
ess-
es a
re in
tegr
ated
at
all l
evel
s of
the
ntp
an
d ar
e us
ed t
o pr
o-vi
de p
rom
pt fe
ed-
back
and
defi
ne c
or-
rect
ive
and
proa
ctiv
e st
eps
whe
n ne
eded
. th
e n
tp a
t al
l lev
els
toge
ther
ana
lyze
the
in
form
atio
n an
d us
e th
eir
findi
ngs
to im
-pr
ove
man
agem
ent
and
perf
orm
ance
, ac
hiev
e ou
tcom
es,
and
anal
yze
tren
ds.
Mon
itor
ing
an
d
eval
uati
onth
e n
tp d
oes
not
mon
itor
or e
valu
ate
its p
rogr
am r
esul
ts;
rath
er, i
ts r
esul
ts a
re
eval
uate
d by
ext
er-
nal e
valu
ator
s w
hen
fund
ers
dem
and
it.
the
ntp
som
etim
es
mon
itors
its
own
wor
k to
det
er-
min
e ad
here
nce
to
plan
ned
activ
ities
. Re
sults
are
eva
luat
ed
by in
tern
al o
r ex
ter-
nal t
eam
s.
the
ntp
reg
ular
ly
mon
itors
its
own
wor
k to
det
erm
ine
prog
ress
tow
ard
achi
evin
g go
als
and
obje
ctiv
es d
urin
g th
e co
urse
of t
he
prog
ram
yea
r. M
oni-
torin
g is
don
e w
ith
soun
d in
stru
men
ts.
the
ntp
eva
luat
es
resu
lts a
t th
e en
d of
ea
ch p
rogr
am y
ear.
the
ntp
reg
ular
ly
mon
itors
its
pro-
gram
, eva
luat
es r
e-su
lts, a
nd s
yste
mat
i-ca
lly u
ses
findi
ngs
to
impr
ove
serv
ices
and
pl
an n
ew a
ctiv
ities
. te
chni
cal a
nd m
ana-
geria
l com
pone
nts
are
form
ally
incl
uded
in
the
ntp
ann
ual
eval
uatio
n.
Management and organizational sustainability tool for tB 63
Man
agem
ent
com
pon
ent
stag
es o
f d
evel
opm
ent
and
th
eir
ch
arac
teri
stic
sc
urre
nt
stag
eev
iden
ce1
23
4
syst
ems
(con
tin
ued
)
sup
ervi
sion
the
ntp
doe
s no
t ha
ve a
cle
ar s
uper
vi-
sion
sys
tem
, and
no
cons
iste
nt fi
nanc
ial
supp
ort
has
been
al
loca
ted
for
supe
rvi-
sion
act
iviti
es. s
uper
-vi
sors
do
not
rece
ive
trai
ning
on
supe
rvi-
sion
ski
lls.
the
ntp
has
an
esta
blis
hed
supe
r-vi
sion
sys
tem
but
su
perv
isio
n fu
nc-
tions
and
rol
es a
re
not
unde
rsto
od, t
he
supe
rvis
ion
guid
e ha
s no
t be
en c
are-
fully
pre
pare
d, a
nd
supe
rvis
ion
take
s pl
ace
spor
adic
ally
an
d w
ithou
t in
tegr
a-tio
n at
all
leve
ls o
f th
e pH
s.
ther
e ar
e es
tabl
ishe
d to
ols
for
supe
rvis
ion
in t
he n
tp, i
nclu
d-in
g a
supe
rvis
ion
guid
e, n
orm
s an
d pr
oced
ures
for
su-
perv
isio
n, a
nd a
vis
it sc
hedu
le. H
owev
er,
supe
rvis
ion
with
all
of t
hese
inst
rum
ents
is
not
fully
impl
e-m
ente
d at
all
leve
ls
of t
he p
Hs.
the
cen
-tr
al t
eam
per
iodi
cally
su
perv
ises
the
inte
r-m
edia
te le
vels
but
w
ithou
t ad
equa
te
finan
cial
sup
port
. te
chni
cal a
nd m
ana-
geria
l com
pone
nts
of t
he n
tp a
re o
nly
som
etim
es in
clud
ed
in s
uper
visi
on.
supe
rvis
ion
is w
ell
inst
itutio
naliz
ed
with
in t
he n
tp.
supe
rvis
ion
inst
ru-
men
ts a
nd g
uide
s ar
e us
ed c
onsi
sten
tly
and
refle
ct t
B no
rms
and
proc
edur
es a
nd
best
pra
ctic
e. t
he
ntp
con
duct
s su
per-
visi
on r
egul
arly
at
all
leve
ls a
nd in
tegr
ates
th
is w
ork
with
the
pH
s an
d th
e pr
ivat
e se
ctor
. Ade
quat
e fin
anci
al s
uppo
rt
exis
ts. t
he n
tp
uses
find
ings
from
su
perv
isio
n vi
sits
to
impr
ove
serv
ices
at
all l
evel
s of
the
pH
s,
incl
udin
g th
e pr
ivat
e se
ctor
, and
to
plan
ne
w a
ctiv
ities
.
Management and organizational sustainability tool for tB64
Man
agem
ent
com
pon
ent
stag
es o
f d
evel
opm
ent
and
th
eir
ch
arac
teri
stic
sc
urre
nt
stag
eev
iden
ce1
23
4
syst
ems
(con
tin
ued
)
sup
ply
M
anag
emen
tth
ere
is n
o su
pply
m
anag
emen
t sy
stem
in
pla
ce t
o fo
reca
st,
proc
ure,
tra
ck, o
r re
gula
te s
uppl
ies
(tB
med
icin
es, l
abor
a-to
ry r
eage
nts)
use
d by
sta
ff at
all
leve
ls
of t
he n
tp. s
uppl
ies
are
stor
ed in
poo
r co
nditi
ons,
and
no
reco
rds
are
kept
for
inve
ntor
y co
ntro
l. st
ock-
outs
occ
ur
freq
uent
ly.
A s
uppl
y m
anag
e-m
ent
syst
em h
as
been
des
igne
d to
al
low
the
Mo
H/n
tp
to s
elec
t, fo
reca
st,
proc
ure,
reg
ulat
e,
stor
e, d
istr
ibut
e, a
nd
use
supp
lies
for
the
ntp
. For
ecas
ting
of
futu
re r
equi
rem
ents
is
not
con
sist
ently
do
ne; s
tock
-out
s oc
cur
perio
dica
lly.
staf
f hav
e no
t ye
t be
en t
rain
ed t
o ca
rry
out
new
func
tions
in
supp
ly m
anag
emen
t.
the
Mo
H/n
tp s
up-
ply
man
agem
ent
syst
em a
llow
s th
e n
tp t
o fo
reca
st
need
s an
d pr
ocur
e qu
ality
affo
rdab
le
supp
lies
in r
elat
ion
to t
heir
dem
and
and
use.
A g
ood
reco
rd-
keep
ing
syst
em h
as
been
impl
emen
ted
at m
ost
site
s. s
ome
staf
f hav
e be
en
trai
ned
to c
arry
out
ne
w fu
nctio
ns in
the
sy
stem
. sto
ck-o
uts
occu
r oc
casi
onal
ly.
Mo
H/n
tp s
taff
have
be
en t
rain
ed t
o ap
-pr
opria
tely
sel
ect,
fo
reca
st, p
rocu
re,
stor
e, d
istr
ibut
e an
d us
e su
pplie
s, a
nd t
o ke
ep g
ood
reco
rds
at a
ll le
vels
of t
he
supp
ly m
anag
e-m
ent
syst
em. p
atie
nt
adhe
renc
e to
tre
at-
men
t an
d ph
ysic
ian
pres
crib
ing
are
both
m
onito
red.
Goo
d qu
ality
and
affo
rd-
able
sup
plie
s ar
e co
ntin
uous
ly a
vail-
able
, with
no
stoc
k-ou
ts o
ccur
ring
in t
he
syst
em.
Management and organizational sustainability tool for tB 65
Man
agem
ent
com
pon
ent
stag
es o
f d
evel
opm
ent
and
th
eir
ch
arac
teri
stic
sc
urre
nt
stag
eev
iden
ce1
23
4
syst
ems
(con
tin
ued
)
fin
anci
al
Man
agem
ent
Fina
ncia
l sta
ff at
the
M
oH
dev
elop
bud
-ge
ts w
ithou
t in
put
from
ntp
man
ager
s.
the
finan
cial
sys
tem
do
es n
ot a
ccur
atel
y tr
ack
expe
nditu
res,
re
venu
es, a
nd c
ash
flow
.
the
ntp
man
ager
de
velo
ps t
he b
udge
t an
d us
ually
see
ks
inpu
t fr
om r
egio
nal
and
dist
rict
ntp
m
anag
ers
and
othe
r st
akeh
olde
rs. t
he
ntp
sub
mits
bud
-ge
ts t
o th
e M
oH
for
fund
ing.
the
Mo
H fi
nan-
cial
sta
ff w
ork
with
n
tp m
anag
ers
to
defin
e th
e an
nual
op
erat
iona
l pla
n an
d bu
dget
bas
ed
on e
pide
mio
logi
cal,
serv
ice,
and
fina
ncia
l da
ta. t
he fi
nanc
ial
syst
em t
rack
s ex
pen-
ditu
res,
rev
enue
s,
and
cash
flow
by
line
item
, with
som
e lin
ks
to p
rogr
am o
utpu
ts
and
serv
ices
.
ntp
man
ager
s w
ork
with
Mo
H fi
nanc
ial
staf
f to
deve
lop
bud-
gets
tha
t su
ppor
t pr
ogra
mm
atic
dec
i-si
ons.
the
fina
ncia
l sy
stem
pre
sent
s an
ac
cura
te p
ictu
re o
f ex
pend
iture
s, r
ev-
enue
s, a
nd c
ash
flow
in
rel
atio
n to
pro
-gr
am o
utpu
ts a
nd
serv
ices
.
res
ourc
e
Mob
iliza
tion
the
ntp
ope
rate
s w
ith a
sin
gle
sour
ce
of r
even
ue, u
sual
ly
gove
rnm
ent
fund
s,
who
se m
anda
tes
shap
e st
rate
gies
and
pr
ogra
ms.
the
ntp
has
sta
ted
the
need
for
dive
rsi-
fied
fund
ing.
It h
as
devi
sed,
but
not
ye
t im
plem
ente
d, a
st
rate
gy fo
r ob
tain
-in
g re
venu
e fr
om
dive
rse
sour
ces
(e.g
., G
loba
l Fun
d,
UsA
ID).
the
ntp
has
beg
un
to im
plem
ent
its
dive
rsifi
catio
n st
rat-
egy
and
has
alre
ady
obta
ined
sig
nific
ant
reve
nue
from
div
erse
so
urce
s to
cov
er
need
s.
the
ntp
follo
ws
a lo
ng-t
erm
, rev
enue
-ge
nera
ting
stra
tegy
, ba
lanc
ing
dive
rse
sour
ces
of r
even
ue
to m
eet
curr
ent
and
futu
re n
eeds
.
Management and organizational sustainability tool for tB66
Man
agem
ent
com
pon
ent
stag
es o
f d
evel
opm
ent
and
th
eir
ch
arac
teri
stic
sc
urre
nt
stag
eev
iden
ce1
23
4
syst
ems
(con
tin
ued
)
Qua
lity
ass
uran
ce:
nor
ms
and
Pr
oced
ures
for
tb
lab
orat
orie
s
the
ntp
has
not
de-
fined
a q
ualit
y as
sur-
ance
sys
tem
. Mos
t te
chni
cal a
ctiv
ities
ar
e un
plan
ned,
and
de
cide
d on
an
ad
hoc
basi
s.
the
ntp
has
dev
el-
oped
ele
men
ts o
f a
qual
ity a
ssur
ance
sy
stem
tha
t w
ill h
elp
staf
f reg
ular
ly a
sses
s an
d im
prov
e th
e qu
ality
of t
B la
bs,
but
thes
e ar
e no
t co
nsis
tent
with
WH
o
and
the
Uni
on r
ec-
omm
enda
tions
. the
sy
stem
is n
ot c
onsi
s-te
ntly
app
lied
at a
ll le
vels
of t
he p
Hs.
the
ntp
has
de-
velo
ped
a qu
ality
as
sura
nce
syst
em
for
tB la
bs t
hat
is
in a
ccor
danc
e w
ith
WH
o a
nd t
he U
nion
re
com
men
datio
ns
and
is r
egul
arly
ap-
plie
d at
all
leve
ls o
f th
e pH
s.
the
ntp
has
est
ab-
lishe
d an
ong
oing
sy
stem
for
asse
ssin
g an
d im
prov
ing
the
qual
ity o
f tB
labs
th
at fo
llow
s al
l WH
o
and
the
Uni
on r
ec-
omm
enda
tions
. It
is c
onsi
sten
tly a
p-pl
ied
at a
ll le
vels
of
the
pHs
and
priv
ate
sect
or, a
nd r
egul
arly
up
date
d. t
rain
ed
staf
f are
reg
ular
ly u
s-in
g th
is s
yste
m.
Oth
er P
rog
ram
com
pon
ents
res
earc
h f
or t
b
con
trol
Rese
arch
pol
icy
pri-
oriti
es a
nd p
roto
cols
ar
e no
t w
ell d
efine
d or
ava
ilabl
e fo
r th
e n
tp.
the
ntp
has
a r
e-se
arch
pol
icy,
but
pr
otoc
ols
have
not
ye
t be
en d
evel
oped
. th
e n
tp h
as n
ot y
et
esta
blis
hed
coor
di-
natio
n w
ith o
ther
co
mpo
nent
s of
the
M
oH
/res
earc
h in
sti-
tutio
ns.
Rese
arch
prio
ritie
s an
d ob
ject
ives
exi
st
that
are
bas
ed o
n W
Ho
rec
omm
enda
-tio
ns, a
nd a
re d
e-fin
ed in
coo
rdin
atio
n w
ith o
ther
com
po-
nent
s of
the
Mo
H.
prot
ocol
s ha
ve
been
dev
elop
ed b
ut
are
not
yet
coor
di-
nate
d w
ith n
atio
nal
regu
latio
ns.
Rese
arch
prio
ri-tie
s an
d ob
ject
ives
ar
e ba
sed
on W
Ho
an
d th
e U
nion
re
com
men
datio
ns
and
are
defin
ed in
co
ordi
natio
n w
ith
othe
r co
mpo
nent
s of
the
Mo
H. A
ll pr
otoc
ols
deve
lope
d an
d ap
prov
ed a
re
in a
ccor
danc
e w
ith
natio
nal r
egul
atio
ns.
the
rese
arch
ser
ves
as a
reg
ular
bas
is
for
reas
sess
ing
and
rede
finin
g st
rate
gies
, in
clud
ing
prio
ritie
s fo
r re
sear
ch.
Management and organizational sustainability tool for tB 67
Man
agem
ent
com
pon
ent
stag
es o
f d
evel
opm
ent
and
th
eir
ch
arac
teri
stic
sc
urre
nt
stag
eev
iden
ce1
23
4
Oth
er P
rog
ram
com
pon
ents
(co
nti
nue
d)
ad
voca
cy,
com
mun
icat
ion
, an
d s
ocia
l M
obili
zati
on
(ac
sM)
the
ntp
has
not
de
velo
ped
an A
CsM
pl
an. M
ost
AC
sM
activ
ities
are
un-
plan
ned,
and
de-
cide
d on
an
ad h
oc
basi
s.
the
ntp
has
a c
ur-
rent
AC
sM p
lan
base
d on
a c
ompr
e-he
nsiv
e as
sess
men
t of
the
nee
ds a
nd
prio
ritie
s fo
r im
ple-
men
tatio
n an
d ex
-pa
nsio
n of
the
Do
ts
stra
tegy
. How
ever
, tB
sta
keho
lder
s ar
e no
t in
volv
ed in
the
de
velo
pmen
t of
A
CsM
; and
AC
sM
is n
ot c
onsi
sten
tly
impl
emen
ted
at a
ll le
vels
of t
he p
Hs
and
the
com
mun
ity.
the
ntp
AC
sM p
lan,
ba
sed
on a
com
pre-
hens
ive
asse
ssm
ent
of t
he n
eeds
and
pri-
oriti
es fo
r im
plem
en-
tatio
n an
d ex
pans
ion
of t
he D
ots
str
at-
egy,
is c
urre
nt a
nd is
be
ing
impl
emen
ted.
tB
sta
keho
lder
s ar
e in
volv
ed in
the
de-
velo
pmen
t of
AC
sM,
and
som
etim
es it
is
appl
ied
at a
ll le
vels
of
the
pH
s, c
om-
mun
ity, a
nd p
rivat
e se
ctor
.
the
ntp
AC
sM
plan
, bas
ed o
n a
com
preh
ensi
ve a
s-se
ssm
ent
of t
he
need
s an
d pr
iorit
ies
for
impl
emen
tatio
n an
d ex
pans
ion
of t
he
Do
ts s
trat
egy,
with
in
volv
emen
t of
tB
stak
ehol
ders
, is
con-
sist
ently
app
lied
at
all l
evel
s of
the
pH
s,
com
mun
ity, a
nd
priv
ate
sect
or, a
nd is
re
gula
rly u
pdat
ed.
com
mun
ity
Pa
rtic
ipat
ion
Pla
n
for
tb c
ontr
ol
the
ntp
has
not
de
velo
ped
a co
m-
mun
ity p
artic
ipat
ion
plan
. Mos
t ac
tiviti
es
are
unpl
anne
d, a
nd
deci
ded
on a
n ad
ho
c ba
sis.
the
ntp
has
a d
e-fin
ed c
omm
unity
pa
rtic
ipat
ion
plan
ba
sed
on a
com
-pr
ehen
sive
ass
ess-
men
t of
the
nee
ds
and
prio
ritie
s fo
r im
plem
enta
tion
and
expa
nsio
n of
the
D
ots
str
ateg
y. t
he
part
icip
atio
n pl
an,
in m
any
inst
ance
s,
does
not
invo
lve
or
cons
ult
the
com
mu-
nity
sta
keho
lder
s.
the
ntp
has
defi
ned
a co
mm
unity
par
-tic
ipat
ion
plan
bas
ed
on a
com
preh
ensi
ve
asse
ssm
ent
of t
he
need
s an
d pr
iorit
ies
for
impl
emen
tatio
n an
d ex
pans
ion
of
the
Do
ts s
trat
egy.
so
met
imes
the
par
-tic
ipat
ion
plan
is
appl
ied
at a
ll le
vels
of
the
pH
s, a
nd
incl
udes
invo
lve-
men
t of
com
mun
ity
stak
ehol
ders
and
the
pr
ivat
e se
ctor
.
the
ntp
com
mu-
nity
par
ticip
atio
n pl
an, b
ased
on
a co
mpr
ehen
sive
as-
sess
men
t of
the
ne
eds
and
prio
ritie
s fo
r im
plem
enta
tion
and
expa
nsio
n of
th
e D
ots
str
ateg
y,
is d
evel
oped
and
is
bein
g im
plem
ente
d.
the
ntp
com
mun
ity
part
icip
atio
n pl
an
invo
lves
com
mun
ity
stak
ehol
ders
and
the
pr
ivat
e se
ctor
and
is
regu
larly
upd
ated
.
Management and organizational sustainability tool for tB68
Man
agem
ent
com
pon
ent
stag
es o
f d
evel
opm
ent
and
th
eir
ch
arac
teri
stic
sc
urre
nt
stag
eev
iden
ce1
23
4
Oth
er P
rog
ram
com
pon
ents
(co
nti
nue
d)
Phar
mac
ovig
ilan
ce
for
tb M
edic
ines
(a
ctiv
ities
rel
atin
g to
th
e de
tect
ion,
ass
ess-
men
t, u
nder
stan
d-in
g, a
nd p
reve
ntio
n of
adv
erse
med
icin
e ef
fect
s)
proc
edur
es fo
r ph
ar-
mac
ovig
ilanc
e of
tB
med
icin
es a
re n
ot
wel
l defi
ned
or r
eadi
-ly
ava
ilabl
e. t
he n
tp
is n
ot c
urre
ntly
con
-si
derin
g an
y st
rate
gy
for
deve
lopi
ng p
har-
mac
ovig
ilanc
e fo
r tB
m
edic
ines
.
som
e st
anda
rd p
ro-
cedu
res
exis
t bu
t ha
ve n
ot b
een
im-
plem
ente
d, a
nd t
hey
are
not
alw
ays
base
d on
inte
rnat
iona
l re
com
men
datio
ns.
the
ntp
has
not
yet
es
tabl
ishe
d co
ordi
-na
tion
with
oth
er
com
pone
nts
of t
he
Mo
H fo
r th
e de
fini-
tion
of t
he p
olic
ies
and
obje
ctiv
es.
A p
harm
acov
igi-
lanc
e sy
stem
for
tB
med
icin
es e
xist
s an
d is
bas
ed o
n in
tern
a-tio
nal r
ecom
men
da-
tions
, and
is d
efine
d in
coo
rdin
atio
n w
ith
othe
r co
mpo
nent
s of
the
Mo
H. A
ll st
anda
rd p
roce
dure
s ar
e av
aila
ble
in t
he
guid
elin
es, b
ut t
hese
pr
oced
ures
are
not
al
way
s co
nsis
tent
ly
impl
emen
ted
at a
ll le
vels
of t
he p
Hs.
phar
mac
ovig
ilanc
e pr
oced
ures
for
tB
med
icin
es a
re w
ell
defin
ed a
nd r
eadi
ly
avai
labl
e, a
re b
ased
on
inte
rnat
iona
l rec
-om
men
datio
ns, a
nd
are
defin
ed in
coo
r-di
natio
n w
ith o
ther
co
mpo
nent
s of
the
M
oH
at
all l
evel
s.
All
proc
edur
es h
ave
guid
elin
es, a
nd a
re
fully
impl
emen
ted
and
regu
larly
rev
ised
at
all
leve
ls o
f the
pH
s an
d th
e pr
ivat
e se
ctor
.
MOST FOR TB
Management and organizational sustainability tool for tB 69
MOst fOr tb assessMent cOnsensus fOrM
Before beginning the consensus step, workshop participants should work alone to identify the stage of development for each management component of the NTP. They should also list one or two examples from their experience as evidence to support their assessment. When they have finished, the facilitator will place them in groups of up to five people.
instructions
Take notes on the Assessment Consensus Form as the members of your small group each state 1. the stage of development he or she chose for each management component, along with the evidence for that decision. Use the central section of the form to record the name (or initials) of each group member, and under the name, the stage of development that person selected. In the larger white space beneath the names and individual stages, summarize the evidence pre-sented by all group members.
Discuss each management component in turn, exploring any differences in your perceptions. 2. Remember that:
everyone’s viewpoint is equally valid because it represents that person’s individual ■■
experience;
all characteristics of a given stage of development must be present to place the NTP at that ■■
stage—if any single characteristic is absent, the NTP fits an earlier stage.
For each management component, come to consensus on the stage of development that best 3. describes the NTP, citing the one or two pieces of evidence that you all agree support your decision. Record these in the far-right column of the table.
MOST FOR TB
Management and organizational sustainability tool for tB70
assessMent cOnsensus fOrM
Management component
Participant _______
Participant _______
Participant _______
Participant _______
Participant _______
group consensus
MissiOn existence and knowledge
individual stage selected consensus stage
individual evidence consensus evidence
Values existence and application
individual stage selected consensus stage
individual evidence consensus evidence
strategy links to Mission and Values
individual stage selected consensus stage
individual evidence consensus evidence
MOST FOR TB
Management and organizational sustainability tool for tB 71
Management component
Participant _______
Participant _______
Participant _______
Participant _______
Participant _______
group consensus
strategy links to stop tb strategy
individual stage selected consensus stage
individual evidence consensus evidence
strategy links to hiV & aids control Program
individual stage selected consensus stage
individual evidence consensus evidence
strategy links to tb Patients and community
individual stage selected consensus stage
individual evidence consensus evidence
MOST FOR TB
Management and organizational sustainability tool for tB72
Management component
Participant _______
Participant _______
Participant _______
Participant _______
Participant _______
group consensus
structure institutional-ization
individual stage selected consensus stage
individual evidence consensus evidence
structure lines of authority and accountability
individual stage selected consensus stage
individual evidence consensus evidence
structure communication individual stage selected consensus
stage
individual evidence consensus evidence
MOST FOR TB
Management and organizational sustainability tool for tB 73
Management component
Participant _______
Participant _______
Participant _______
Participant _______
Participant _______
group consensus
structure roles and responsibilities
individual stage selected consensus stage
individual evidence consensus evidence
structure decision- Making
individual stage selected consensus stage
individual evidence consensus evidence
systeMs strategic Planning
individual stage selected consensus stage
individual evidence consensus evidence
MOST FOR TB
Management and organizational sustainability tool for tB74
Management component
Participant _______
Participant _______
Participant _______
Participant _______
Participant _______
group consensus
systeMs annual Operational Planning
individual stage selected consensus stage
individual evidence consensus evidence
systeMs norms and Procedures for tb Prevention, detection, diagnosis, treatment, and care
individual stage selected consensus stage
individual evidence consensus evidence
systeMs geographical and Population coverage of dOts
individual stage selected consensus stage
individual evidence consensus evidence
MOST FOR TB
Management and organizational sustainability tool for tB 75
Management component
Participant _______
Participant _______
Participant _______
Participant _______
Participant _______
group consensus
systeMs human resources Management
individual stage selected consensus stage
individual evidence consensus evidence
systeMs leadership development
individual stage selected consensus stage
individual evidence consensus evidence
systeMs staff training individual stage selected consensus
stage
individual evidence consensus evidence
MOST FOR TB
Management and organizational sustainability tool for tB76
Management component
Participant _______
Participant _______
Participant _______
Participant _______
Participant _______
group consensus
systeMs information Management: Operational and epidemiological data collection
individual stage selected consensus stage
individual evidence consensus evidence
systeMs information Management: use of Operational and epidemiological information
individual stage selected consensus stage
individual evidence consensus evidence
systeMs Monitoring and evaluation
individual stage selected consensus stage
individual evidence consensus evidence
MOST FOR TB
Management and organizational sustainability tool for tB 77
Management component
Participant _______
Participant _______
Participant _______
Participant _______
Participant _______
group consensus
systeMs supervision individual stage selected consensus
stage
individual evidence consensus evidence
systeMs supply Management
individual stage selected consensus stage
individual evidence consensus evidence
systeMs financial Management
individual stage selected consensus stage
individual evidence consensus evidence
MOST FOR TB
Management and organizational sustainability tool for tB78
Management component
Participant _______
Participant _______
Participant _______
Participant _______
Participant _______
group consensus
systeMs resource Mobilization
individual stage selected consensus stage
individual evidence consensus evidence
systeMs Quality assurance: norms and Procedures for tb labs
individual stage selected consensus stage
individual evidence consensus evidence
Other PrOgraM cOMPOnents research for tb control
individual stage selected consensus stage
individual evidence consensus evidence
MOST FOR TB
Management and organizational sustainability tool for tB 79
Management component
Participant _______
Participant _______
Participant _______
Participant _______
Participant _______
group consensus
Other PrOgraM cOMPOnents advocacy, communica-tion, and social Mobilization (acsM)
individual stage selected consensus stage
individual evidence consensus evidence
Other PrOgraM cOMPOnents community Participation Plan for tb control
individual stage selected consensus stage
individual evidence consensus evidence
Other PrOgraM cOMPOnents Pharmaco-vigilance for tb Medicines
individual stage selected consensus stage
individual evidence consensus evidence
Management and organizational sustainability tool for tB80
MO
st f
Or
tb
ac
tiO
n P
lan
fO
rM
inst
ruct
ion
s
Mak
e as
man
y co
pies
of t
his
form
as
need
ed to
enc
ompa
ss a
ll th
e ob
ject
ives
in th
e ac
tion
plan
. (Th
e pa
rtic
ipan
ts m
ay c
hoos
e to
use
this
or
anot
her f
orm
at th
at c
orre
spon
ds to
thei
r ow
n pl
anni
ng p
roce
ss. I
f the
y us
e a
diffe
rent
form
at, t
hey
may
nee
d to
ada
pt it
to in
clud
e al
l the
pl
anni
ng e
lem
ents
that
are
iden
tified
her
e.)
Man
agem
ent C
ompo
nen
t: _
____
____
____
____
____
____
____
___
TB
Cha
nge
Lead
er: _
____
____
____
____
____
____
____
___
Ob
ject
ives
evid
ence
of
ach
ieve
men
ta
ctiv
itie
s
res
ourc
es
nee
ded
(h
uman
, fi
nan
cial
, M
ater
ial)
Peop
le
res
pon
sib
le
tim
elin
e
1st
Qua
rter
2nd
Qua
rter
3rd
Qua
rter
4th
Qua
rter
MO
nth
s
12
34
56
78
910
1112
Management and organizational sustainability tool for tB 81
Ob
ject
ives
evid
ence
of
ach
ieve
men
ta
ctiv
itie
s
res
ourc
es
nee
ded
(h
uman
, fi
nan
cial
, M
ater
ial)
Peop
le
res
pon
sib
le
tim
elin
e
1st
Qua
rter
2nd
Qua
rter
3rd
Qua
rter
4th
Qua
rter
MO
nth
s
12
34
56
78
910
1112
Management and organizational sustainability tool for tB82
man
agin
g
imp
rove
dw
ork
clim
ate
imp
rove
dm
anag
emen
tsy
stem
s
improve
dse
rvices
improve
dhea
lth
outcom
es
scan
focu
s
alig
n/
mob
iliz
e
insp
ire
pla
n
orga
niz
e
imp
lem
ent
mon
itor
an
dev
alu
ate
Res
ult
s
Lead
ing
and
man
agin
g p
ract
ices
lead
ing
imp
rove
dca
pac
ity
to r
esp
ond
to c
han
ge
From
Man
ager
s W
ho L
ead:
A H
andb
ook
for
Impr
ovin
g H
ealt
h Se
rvic
esM
anag
emen
t Sc
ien
ces
for
Hea
lth
lea
din
g a
nd
Ma
na
gin
g r
esu
lts
MO
del
Management and organizational sustainability tool for tB 83
lea
din
g a
nd
Ma
na
gin
g f
ra
MeW
Or
k
Prac
tice
s th
at a
llow
Wor
k g
roup
s an
d O
rgan
izat
ion
s to
fac
e c
hal
len
ges
an
d a
chie
ve r
esul
ts
lead
ing
Man
agin
gsc
ann
ing
Iden
tify
clie
nt a
nd s
take
hold
er n
eeds
and
prio
ritie
s.■
■
Reco
gniz
e tr
ends
and
ris
ks t
hat
affe
ct t
he o
rgan
izat
ion.
■■
Look
for
best
pra
ctic
es.
■■
Iden
tify
staf
f cap
aciti
es a
nd c
onst
rain
ts.
■■
Know
you
rsel
f, yo
ur s
taff,
and
you
r or
gani
zatio
n—va
lues
, str
engt
hs,
■■
and
wea
knes
ses.
Org
aniz
atio
nal o
utco
me:
Man
ager
s ha
ve u
p-to
-dat
e, v
alid
kno
wle
dge
of t
he
orga
niza
tion
and
its c
onte
xt; t
hey
know
how
the
ir be
havi
or a
ffect
s ot
hers
.fo
cusi
ng
Art
icul
ate
the
orga
niza
tion’
s m
issi
on a
nd s
trat
egy.
■■
Iden
tify
criti
cal c
halle
nges
.■
■
Link
goa
ls w
ith t
he o
vera
ll or
gani
zatio
nal s
trat
egy.
■■
Det
erm
ine
key
prio
ritie
s fo
r ac
tion.
■■
Cre
ate
a co
mm
on p
ictu
re o
f des
ired
resu
lts.
■■ O
rgan
izat
iona
l out
com
e: o
rgan
izat
ion’
s w
ork
is d
irect
ed b
y a
wel
l-defi
ned
mis
sion
, str
ateg
y, a
nd s
et o
f prio
ritie
s.a
lign
ing
an
d M
obili
zin
gEn
sure
con
grue
nce
of v
alue
s, m
issi
on, s
trat
egy,
str
uctu
re, s
yste
ms,
and
■
■
daily
act
ions
.Fa
cilit
ate
team
wor
k.■
■
Uni
te k
ey s
take
hold
ers
arou
nd a
n in
spiri
ng v
isio
n.■
■
Link
goa
ls w
ith r
ewar
ds a
nd r
ecog
nitio
n.■
■
Enlis
t st
akeh
olde
rs t
o co
mm
it re
sour
ces.
■■ O
rgan
izat
iona
l out
com
e: In
tern
al a
nd e
xter
nal s
take
hold
ers
supp
ort
the
orga
niza
tions
and
goa
ls a
nd h
ave
mob
ilize
d re
sour
ces
to r
each
the
se g
oals
.in
spir
ing
Mat
ch d
eeds
to
wor
ds.
■■
Dem
onst
rate
hon
esty
in in
tera
ctio
ns.
■■
show
tru
st a
nd c
onfid
ence
in s
taff;
ack
now
ledg
e th
e co
ntrib
utio
ns
■■
of o
ther
s.pr
ovid
e st
aff w
ith c
halle
nges
, fee
dbac
k, a
nd s
uppo
rt.
■■
Be a
mod
el o
f cre
ativ
ity, i
nnov
atio
n, a
nd le
arni
ng.
■■ O
rgan
izat
iona
l out
com
e: o
rgan
izat
ion
disp
lays
a c
limat
e of
con
tinuo
us
lear
ning
and
sta
ff sh
ow c
omm
itmen
t, e
ven
whe
n se
tbac
ks o
ccur
.
Plan
nin
gse
t sh
ort-
term
org
aniz
atio
nal g
oals
and
per
form
ance
res
ults
.■
■
Dev
elop
mul
tiyea
r an
d an
nual
pla
ns.
■■
Allo
cate
ade
quat
e re
sour
ces
(mon
ey, p
eopl
e, a
nd m
ater
ials
).■
■
Ant
icip
ate
and
redu
ce r
isks
.■
■ Org
aniz
atio
nal o
utco
me:
org
aniz
atio
n ha
s de
fined
res
ults
, ass
igne
d re
sour
ces,
and
an
ope
ratio
nal p
lan.
Org
aniz
ing
Ensu
re a
str
uctu
re t
hat
prov
ides
acc
ount
abili
ty a
nd d
elin
eate
s au
thor
ity.
■■
Ensu
re t
hat
syst
ems
for
hum
an r
esou
rces
man
agem
ent,
fina
nce,
logi
stic
s,
■■
qual
ity a
ssur
ance
, ope
ratio
ns, i
nfor
mat
ion,
and
mar
ketin
g ef
fect
ivel
y su
ppor
t th
e pl
an.
stre
ngth
en w
ork
proc
esse
s to
impl
emen
t th
e pl
an.
■■
Alig
n st
aff c
apac
ities
with
pla
nned
act
iviti
es.
■■ O
rgan
izat
iona
l out
com
e: o
rgan
izat
ion
has
func
tiona
l str
uctu
res,
sys
tem
s, a
nd
proc
esse
s fo
r ef
ficie
nt o
pera
tions
; sta
ff ar
e or
gani
zed
and
awar
e of
res
pons
ibili
ties
and
expe
ctat
ions
.im
ple
men
tin
gIn
tegr
ate
syst
ems
and
coor
dina
te w
ork
flow
.■
■
Bala
nce
com
petin
g de
man
ds.
■■
Rout
inel
y us
e da
ta fo
r de
cisi
on-m
akin
g.■
■
Coo
rdin
ate
activ
ities
with
oth
er p
rogr
ams
and
sect
ors.
■■
Adj
ust
plan
s an
d re
sour
ces
as c
ircum
stan
ces
chan
ge.
■■ O
rgan
izat
iona
l out
com
e: A
ctiv
ities
are
car
ried
out
effic
ient
ly, e
ffect
ivel
y, a
nd
resp
onsi
bly.
Mon
itor
ing
an
d e
valu
atin
gM
onito
r an
d re
flect
on
prog
ress
aga
inst
pla
ns.
■■
prov
ide
feed
back
.■
■
Iden
tify
need
ed c
hang
es.
■■
Impr
ove
wor
k pr
oces
ses,
pro
cedu
res,
and
too
ls.
■■ O
rgan
izat
iona
l out
com
e: o
rgan
izat
ion
cont
inuo
usly
upd
ates
info
rmat
ion
abou
t th
e st
atus
of a
chie
vem
ents
and
res
ults
, and
app
lies
ongo
ing
lear
ning
and
kno
wle
dge.
MOST FOR TB
Management and organizational sustainability tool for tB84
VII. ADDITIONAL RESOURCESThe following publications may be useful for organizations planning to improve the management and sustainability of their organizations.
The Manager is a continuing-education quarterly published by Management Sciences for Health. Each issue focuses on a specific management topic and includes “Working Solutions” from the field, tools and techniques, and a case scenario for staff development and training. MSH also pub-lishes management tools that can be used to improve specific management areas, many of which are available in multiple languages.
Many of the MSH’s resources listed below are available on The Manager’s Electronic Resource Center (ERC) at http://erc.msh.org. The ERC provides practical answers to management questions, easy-to-use tools, information on effective management practices, and reviews of recent management trends. For more information, please visit the ERC website or send an e-mail to [email protected].
tO PrePare fOr the MOst PrOcess
Management Sciences for Health. “Creating a Work Climate that Motivates Staff and Improves Per-formance,” The Manager vol. 11, no. 3. Boston: Management Sciences for Health, 2002. This issue includes a Climate Assessment Tool.
tO fOcus On iMPrOVing sPecific ManageMent cOMPOnents
human resource Management
Management Sciences for Health. Human Resource Management Rapid Assessment Tool for HIV/AIDS Environments: A Guide for Strengthening HRM Systems. Boston: Management Sciences for Health, 2003.
———. “Tackling the Crisis in Human Capacity Development for Health Services.” The Manager vol. 13 no. 2: 1–20. Boston: Management Sciences for Health, 2004.
information Management
Sullivan, T. M., M. Strachan, and B. K. Timmons. Guide to Monitoring and Evaluating Health Infor-mation Products and Services. Baltimore, MD: Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health; Washington, D.C.: Constella Futures; Cambridge, MA: Management Sciences for Health, 2007.
financial Management
Management Sciences for Health. “Assessing Your Organization’s Capacity to Manage Finances.” The Manager vol. 12, no. 1. Boston: Management Sciences for Health, 2003. This issue includes the Financial Management Assessment Tool (FIMAT).
———. “Business Planning to Transform Your Organization.” The Manager vol. 12 no. 3: 1–30. Boston: Management Sciences for Health, 2003.
———. Planning, Costing and Budgeting Framework. Boston: Management Sciences for Health, 2007.
MOST FOR TB
Management and organizational sustainability tool for tB 85
tO Manage change MOre effectiVely
Management Sciences for Health. “Developing Managers Who Lead.” The Manager vol. 10, no. 3. Boston: Management Sciences for Health, 2001.
———. “Leading Changes in Practice to Improve Health.” The Manager vol. 13. no. 3: 1–24. Boston: Management Sciences for Health, 2004.
Msh resOurces On tuberculOsis
Frye, J., ed. International Drug Price Indicator Guide. Arlington, VA: Management Sciences for Health Center for Pharmaceutical Management and World Health Organization, 2007.
Management Sciences for Health. “Improving Drug Management to Control Tuberculosis.” The Manager vol. 10, no. 4: 1–22. Boston: Management Sciences for Health, 2001.
Mundy, C., G. Kahenya, and H. Vrakking. Support to the Global TB Drug Facility: Design and In-Country Evaluation of TB Diagnostic Laboratory Kits Initiative, 2004–2006. Management Sciences for Health, 2006
Rational Pharmaceutical Management (RPM) Plus Program. Managing Pharmaceuticals and Commodities for Tuberculosis: A Guide for National Tuberculosis Programs. Arlington, VA: Management Sciences for Health, 2005.
Rational Pharmaceutical Management (RPM) Plus Program. Managing TB Medicines at the Primary Level. Arlington, VA: Management Sciences for Health, 2008.
Strengthening Pharmaceutical Systems (SPS) Program. e-TB Manager: A Comprehensive Web-Based Tool for Programmatic Management of TB and Drug-Resistant TB.
Weil, D., A. Beith, S. Mookherji, and R. Eichler. Mapping the Motivations of Stakeholders to Enable Improved Tuberculosis Control: Mapping Tool for Use in Workshops. Arlington, VA: Management Sciences for Health and Stop TB Partnership, 2004.
Zagorskiy, A., C. Owunna, and T. Moore, eds. Pharmaceutical Management for Tuberculosis Assessment Manual. Arlington, VA: Rational Pharmaceutical Management (RPM) Plus Program, Management Sciences for Health, 2005.
abOut ManageMent sciences fOr health
Management Sciences for Health (MSH) is an international nonprofit organization, dedicated to closing the gap between what is known about the overwhelming public health challenges facing many nations and what is done to address those challenges.
Since 1971, MSH has worked in more than 100 countries with policymakers, health professionals, and health care consumers to improve the quality, availability, and affordability of health ser-vices. We work with governments, donors, nongovernmental organizations, and health agencies to respond to priority health problems such as HIV/AIDS, tuberculosis, malaria, child health, and reproductive health. Our publications and electronic products augment our assistance in these technical areas.
MSH’s staff of more than 1,300 from almost 70 nations work in its Cambridge, Massachusetts, head-quarters; offices in the Washington, DC, area; and more than 25 country offices. Through technical assistance, research, training, and systems development, MSH is committed to making a lasting difference in global health.
For more information about Management Sciences for Health, please visit our web site at www.msh.org. For a catalog of MSH’s publications, please contact:
MSH Bookstore784 Memorial DriveCambridge, MA 02139-4613Telephone: 617.250.9500Fax: 617.250.9090E-mail: [email protected]: www.msh.org