Harnessing Management and Leadership Trainings in Strengthening Health System: Experience from IPHMDP

INTRODUCTION

Health system strengthening is defined as a range of activities and strategies that improves functioning of health system through improvement in access, coverage, quality, and efficiency of healthcare services.[1] It is based on a skilled and driven health workforce, a well-maintained infrastructure, a consistent supply of medical supplies and technology, a sound health information system, supported by adequate financing, robust health plans, evidence-based policies, and strong governance and leadership.[2] The increased and quickly changing disease burden is a critical concern in low-income and middle-income countries (LMICs) which is rooted in a complex interplay of socioeconomic, environmental, and political determinants. As a result, improving the health system and achieving universal health coverage depend equally on tackling both health and nonhealth determinants.

Leadership is one key component of World Health Organization (WHO) six building blocks along with the health workforce development for strengthening health systems.[3] Capacity building in management and leadership for achieving universal health coverage has been a mandate of various organizations like WHO,[4] United Nations (UN),[5] United States Agency for International Development (USAID),[6] and World Bank.[7,8] Trainings in leadership and management for program managers in LMICs are emphasized in the WHO’s action plan report on health systems governance to attain the Sustainable Development Goals.[4] The importance of effective leadership and management have been considered critical for developing and sustaining health systems, particularly in LMICs. Research has also shown that leadership and management trainings have strengthened the skills and competencies of health workers and influenced health outcomes in terms of increasing life expectancy and decreasing morbidity and mortality.[9] The author has also presented an evidence-based case of adopting holistic, transformational leadership approach in fulfilling the gap in jigsaw puzzle of the comprehensive solution under the Anemia Mukt Bharat initiative in light of rising and persistent trends of anemia in India in last seven decades.[10] At the same time, leadership and management training are crucial for the success of any healthcare organization as they tend to develop the skills and competencies such as communication, conflict resolution, decision-making, problem-solving, strategic thinking, planning, organizing, staffing, and controlling resources which are required for good quality healthcare service delivery. It is widely published that such trainings also improve job satisfaction, leading to increased health workforce retention and a lower turnover rate.[11]

The existing body of literature suggests that senior leadership positions are usually attained based on tenure or political considerations, not skills and competencies.[12,13] Additionally, it has been stated that health professionals play a crucial role in decision-making, planning, and the design and implementation of policies; however, they do not get formal management or leadership training before adopting these roles.[14] Furthermore, most healthcare professionals, including doctors in developing nations, have good technical expertise due to their intensive professional trainings but lack impeccable leadership and management expertise and experience because of lack of these aspects in their professional curriculum. Moreover, very few contextual training programs on leadership skills exist in developing nations, making it difficult for them to effectively practice leadership roles when they assume leadership positions. Thus, new managers are not adequately trained for their new roles, and they might be expected to develop their managerial and leadership skills through on-the-job learning. The author in another manuscript “Why All Doctors Require Leadership Trainings?” has presented the need of leadership training to doctors as ‘must have’ requirement rather than ‘nice to have’ requirement to achieve better treatment outcomes.[15]

To address the need for management and leadership training for public health managers from across the world, especially for LMIC countries, the International Public Health Management Development Program (IPHMDP) was conceived by Department of Community Medicine and School of Public Health at the Post Graduate Institute of Medical Education and Research, Chandigarh in the year 2016. The program was fully supported by the Indian Technical and Economic Cooperation[16] Ministry of External Affairs, Government of India. This flagship program aims to build the capacity of middle-level and senior-level managers of 161 Indian Technical and Economic Cooperation nations in planning, executing, monitoring, and evaluating project and program operations, along with learning soft skills like communication, problem-solving, team building, time management, emotional intelligence, change management, etc.

INTERNATIONAL PUBLIC HEALTH MANAGEMENT DEVELOPMENT PROGRAM

The course content, flow, methodology, and design were meticulously developed using Kern’s six-step framework[17] and Kirkpatrick four-step evaluation model.[18] The program has its unique selling preposition like providing a global platform to participants from various countries for peer-to-peer learning, a interdisciplinary curriculum focusing on contextual public health issues of participating nations, adult learning pedagogy focusing majorly on the concept of gamification (learning through fun games) along with traditional formal (like powerpoint presentations), and informal teaching methods (group discussions, role plays, case studies, exercises, videos, and real case scenarios) along with field visits. The program focused on eight management competencies, including project/program planning, supply chain management, leadership and governance, communication, quality management, human resource management, financial management, monitoring, and evaluation, as well as minor competencies such as decision-making, change management, conflict management, and teamwork, among others. The andragogy participatory approach is also implied, focusing on the traditional chalk-and-talk method, small-group instruction, project-based inquiry, and student-based learning. During the program, a 3-month action plan is prepared by the participants based upon reflection of the learnings of the program, which they implement on returning back to their countries. Besides academics, cross-cultural learning is done through sharing of best practices from participating countries, presenting books on leadership, and a special cultural event where participants take the lead in demonstrating management and leadership skills learnt during the program.

In the last seven years, 1,084 senior participants from 85 countries have participated in 10 physical IPHMDP for global mid-level managers, three Public Health Policy and Management programs for global policymakers, and two Executive Leadership Programs for India’s policy makers in Taiwan and Thailand. In addition, 10+ domain-specific online courses (quality control, supply chain management, artificial intelligence, digital health, management, and leadership in public health) and two country-specific (Myanmar and Nepal) and three online courses on COVID-19 management were conducted. The recently published article on the first six IPHMDP programs conducted between 2016 and 2019 has reported a significant increase in participants’ knowledge score on various health system determinants (P < .0001). The participants also witnessed increased competencies in all eight domains of health system strengthening, with financial management being the most improved, followed by monitoring and evaluation, supply chain management, project/program planning, quality management, human resource management, and communication. Furthermore, 90% of the participants submitted the plan of action, with 64% implemented it in their settings. More than half (54.7%) of those who returned to their home countries replicated the program in their institution/country. Some participants reported being engaged in health promotion activities (3.47%), collaboration with program colleagues (6.08%), and implementing knowledge learned in academic/program settings (20.8%).

CONCLUSION

Management and leadership programs are critical in improving health outcomes and overall strengthening health system. These initiatives ensure that public health resources and services are efficiently managed and provided to those who require them. In conclusion, the management and leadership program in LMIC settings reinforces the competencies of public health managers, which can be simulated in similar contextual settings across LMIC to alleviate diverse challenges in public health management. It is suggested that the curriculum of healthcare workforce (doctors, nurses, paramedics, etc.) should suitably include these topics in undergraduate and postgraduate courses. These topics can also be clubbed or piggyback upon other healthcare service training programs, for example, the National Tuberculosis Elimination Program, National Tobacco control Program, etc., Short management development programs staggered over a period of time should be a prerequisite mandatory requirement for assuming senior leadership position in health system. The health managers working in district or state level should undergo exposure visit to neighbouring state or country to witness good leadership and management practices for their potential replication in their jurisdiction.