THE HEALTH MANAGER ISSUE 3, 2017

INTERNATIONAL MANAGEMENT DEVELOPMENT PROGRAMME® (IMDP)

IN THIS ISSUE ON AN APPROACH TO STRENGTHENING HEALTH SYSTEMS

EXECUTIVE PERSPECTIVE:

DR. ANNE DETJEN

PARTICIPANT PROFILE:

NAMUNA KARKI DAHAL

IMDP TIPS:

WAYS OF ENHANCING LEADERSHIP TO STRENGTHEN HEALTH SYSTEMS

unioncourses.org

WELCOME TO

THE HEALTH MANAGERISSUE 3, 2017 AN APPROACH TO STRENGTHENING HEALTH SYSTEMS

Dear Reader,

This issue of The Health Manager addresses strengthening health systems. Strengthening health systems sharpens the productivity and efficiency of health systems in health programme administration and delivery. The goal of this issue, and the related course, is to provide solutions for health professionals to improve their ability to bring in the necessary changes in their programmes.

In this issue, Dr Anne Detjen, Childhood Tuberculosis (TB) Specialist, at the United Nations Children’s Fund, shares her perspective on the plan to strengthen the integration of childhood TB management into existing community-based health systems.

This issue also features IMDP alumni Namuna Karki Dahal, Section Officer at the National Tuberculosis Centre (NTC) within Nepal’s Department of Health Services, who talks about how she applied the skills and knowledge acquired in supply chain management to her everyday work.

Hopefully you find that this issue of The Health Manager offers you some new insight into successfully implementing your health programme.

JOSÉ LUIS CASTRO EXECUTIVE DIRECTOR, THE UNION

Cover Photo Credit: The Union

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INSIDE THIS ISSUE

The IMDP is a Union programme implemented by Vital Strategies. The Health Manager is published by The Union’s International Management Development Programme (IMDP). Executive Director: José Luis Castro. Director of Publications: Kerensa Haffenden © 2017 The Union.

Letter From the Executive Director by José Luis Castro _______________________ 2

Executive Perspective: Dr. Anne Detjen __________________________________ 5

Participant Profile: Namuna Karki Dahal _________________________________ 8

IMDP Tips _____________________________________________________ 10

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COURSE DATE LOCATION FACULTY LEVEL COURSE FEE LANGUAGE

An Approach to Strengthening Health Systems

14 – 18 August

Singapore Rajesh Kapoor and RK Thakur

Middle- to senior-level managers

1,650 USD English

Gestión de Proyectos América Latina

11 – 15 September

Lima, Peru Victor Hugo Venegas and Roxana Fidelbus

Middle- to senior-level managers

1,650 USD Spanish

La Gestion de Projet 6 – 10 November

Cotonou, Benin

Miranda Brouwer and Oriol Ramis

Middle- to senior-level managers

1,650 USD French

Results-Based Monitoring and Evaluation

13 – 17 November

Dubai, United Arab Emirates

Rajesh Kapoor and Swati Devgon

Middle- to senior-level managers

1,650 USD English

Supply Chain Management

4 – 8 December

Singapore Ron Wehrens and Miranda Brouwer

Middle- to senior-level managers

1,650 USD English

A residential package fee is available for each course that includes the course fee, accommodation and breakfast.

FOR ADDITIONAL INFORMATION, VISIT UNIONCOURSES.ORG OR EMAIL UNIONCOURSES@THEUNION.ORG.

The application deadline is two months prior to the courses/upon acceptance into the course, applicants will be invoiced/fee payment is due within 30 days of invoicing.

TO REGISTER FOR A COURSE, PLEASE VISIT OUR WEBSITE AT UNIONCOURSES.ORG OR CONTACT UNIONCOURSES@THEUNION.ORG.

2017 IMDP COURSESREGISTER AT UNIONCOURSES.ORG

The Union’s International Management Development Programme (IMDP) strengthens health systems by training health professionals in the specific management competencies that are essential for healthcare programmes to provide quality care for patients.

Photo: Courtesy of Dr Anne Detjen 5

EXECUTIVE PERSPECTIVE:DR ANNE DETJEN

HEALTH SPECIALIST, CHILDHOOD TB UNITED NATIONS CHILDREN’S FUND (UNICEF) NEW YORK, UNITED STATES OF AMERICA

Dr Anne Detjen, a childhood tuberculosis (TB) specialist, joined UNICEF in 2015 after serving as a consultant to The Union. UNICEF supports children’s health activities in many countries. Dr Detjen is passionate about addressing TB through integration into the broader public/child health landscape, and about the important role of health system strengthening in achieving that goal effectively and efficiently.

Below Dr Detjen talks about her experience in Uganda, where she played a role in the plan to strengthen the integration of childhood TB management into existing community-based health systems: the participating community-based health professionals had enthusiastically bought into the programme’s potential value, and had been trained in the necessary techniques and procedures. Unfortunately, implementation was not as smooth as it could have been: community health workers lacked some basic equipment, and many referral facilities lacked adequate supplies of medicine, diagnostic equipment and other essential tools.

To Dr Anne Detjen, this experience underscored the importance of strengthening health systems in a comprehensive way.

Q What does strengthening health systems mean to you?

A From a fundraising perspective it is still not a glamorous term, but it is crucial to what we are trying to achieve: ensuring children’s health. If I think of the huge gaps we face in saving lives of children affected by TB, many of the key challenges are related to health system failures and not unique to TB.

Q Where does this typically manifest itself?A In childhood TB we have made great strides in developing policies and guidelines, at global and country level – and yet we are failing to implement these policies. We are good in piloting interventions, showing their effectiveness, but we fail to scale them up.

We see success in programmes that have dedicated leadership at the ministry level, engage all key actors well beyond those working on TB, and that comprehensively embed their activities within the broader goals of improving child health and service delivery.

Q Why do you think system strengthening fails to take place adequately in some situations?A We often focus on service delivery priorities (health workers diagnosing a sick child with TB at primary care level) – without properly understanding or taking into account the broader system needed to ensure this can actually happen.

Q What do you see as major elements of health system strengthening?A Integration is a good place to start. There is the TB world, the HIV world, the malaria world, the pneumonia world – and yet it is one child that is sick and needs care. Vertical programmes operate from a disease perspective, while integrated care should start from a child’s perspective. Integration helps to address the key common challenges all these vertical programmes face, including funding constraints, human resources and supply chain management. Also, especially at the frontline, there is one health worker and not one for each disease.

Q How does an organisation know when it is succeeding at strengthening health systems?A Programmes often look at the effectiveness, or specific results, of one pilot but do not think enough about their efficiency, which is an important factor in this time of declining resources. In my world we ask ourselves, “Are we reaching the most vulnerable children close to where they live, and getting them to front-line health services that are adequately equipped and well-linked with the upstream health system?”

Q What are some other important ingredients in strengthening health systems?A Documentation and data are critical. I remember being taught as a pediatric resident in Germany: “What you haven’t written down, you haven’t done.” Data are not only for reports to donors or for global reports. They help us, each health worker, to understand our programmes and where they might need strengthening.

Q Often data collection is a logistical or practical challenge.A There are innovations taking place that can address this challenge, especially mobile solutions.

Q How do you build system improvements to last?A We need to consider sustainability from the onset when planning a new intervention. Important questions to ask include: Does what we are trying to do address programme priorities? Are the key partners involved? Who ‘owns’ a project and takes leadership? How integrated is it within routine structures? We need to understand, when we do a pilot, not only how well an intervention improves outcomes for patients, but also the elements that determine whether it can be scaled up and sustained.

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DATE LOCATION LEVEL COURSE FEE LANGUAGE

14 – 18 August 2017

Singapore Middle- to senior- level managers

1,650 USD Course fee includes tuition, training material, lunch and two tea breaks. Residential package fee available at 2,610 USD (course fee + 960 USD for accommodation and breakfast).

English

UNIONCOURSES.ORG/AN-APPROACH-TO-STRENGTHENING-HEALTH-SYSTEMS-14

AN APPROACH TO STRENGTHENING HEALTH SYSTEMSREGISTER AT UNIONCOURSES.ORG • SINGAPORE

• Provide benefits at the national and provincial levelhealth programme administration and delivery

• Increase the competence of the participants toimprove, modify and re-engineer systems

• Strengthen and modify systems with greaterinvolvement and participation of concernedshareholders

• Improve their ability to bring in the desired changesin their respective programmes

• Ensure effective implementation of the newlystrengthened health systems

• Understand the importance of documentation,certifications and knowledge management

WHO SHOULD ATTENDBENEFITS OF TRAINING

This five-day course focuses on improving the productivity and efficiency of health systems. Participants will learn how to identify challenges and opportunities in the current health systems functioning in their domain, understand linkages between health system, policy and research, and learn how to improve or re-engineer any health system to make it more efficient.

An Approach to Strengthening Health Systems will teach participants how to measure efficiency and effectiveness and how to establish optimum controls while laying down the system.

This course is designed for middle- to senior-level managers, working in public health from national, provincial government or international agencies and non-governmental organisations, who are responsible for health programmes in communicable and non-communicable diseases, their various administrative aspects and donor communications for the implementation of health programmes.

8 Photo: Courtesy of Namuna Karki Dahal

Namuna Karki Dahal is a Section Officer at the National Tuberculosis Centre (NTC) within Nepal’s Department of Health Services. Last year, she attended the IMDP course on Supply Chain Management.

“My role at the NTC includes writing the annual procurement plan, managing the efficient supply chain of medicines and other medical consumables; quantification, budget planning, and stock record-keeping; and overseeing the tendering process for needed supplies.”

“I decided to attend Supply Chain Management because of a few big challenges I was facing, that were costing us a lot of money. One was simply that our supply chain wasn’t systematic enough, and the other involved some problems with the staffing of our central store. Together, these issues led to many of our drugs and consumables expiring before they could be used. I was looking for a way to manage both of these situations more effectively.”

“The course turned out to be extremely helpful. I learned some important ways to improve the tendering process by getting everyone involved in it, which has been very fruitful in my workplace. I also found the Pareto Analysis, which helps you prioritise tasks by analysing their impact, to be a valuable exercise.”

PARTICIPANT PROFILE:

NAMUNA KARKI DAHAL

SECTION OFFICER NATIONAL TUBERCULOSIS CENTRE NEPAL DEPARTMENT OF HEALTH SERVICES NEPAL

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“The course facilitators were very experienced, and they created a learning environment that was really interactive. They had the class simulate a National Tuberculosis Programme, with participants assigned to groups for different activities—there was a quantification/forecasting group, an accounting/costing group, a procurement group, etc. So, we got to experience and train ourselves in various positions.”

“One of the great tools I learned about in the course was a kind of software, QuanTB, that is very useful in the rational quantification of tuberculosis drugs. I have now shared this information with both medical and non-medical colleagues, and we use it together. I was also able to share my learning about bidding procedures, and how to use rational quantification and forecasting to make the best use of the available budget. All of these things have made a big difference in the smooth, more efficient running of our supply.”

“I recommend this course not only to health professionals

but to non-health professionals who are working on

supply chain management in any organisation. Many

of us in this role are working under budgetary or human

resource constraints, and the course really addresses how

to build your organisation’s capacity despite this.”

“I recommend this course not only to health professionals but to non-health professionals who are working on supply chain management in any organisation. Many of us in this role are working under budgetary or human resource constraints, and the course really addresses how to build your organisation’s capacity despite this.”

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According to the World Health Organization, health systems strengthening is the process of identifying and implementing the changes in policy and practice in a country’s health system, so that the country can respond better to its health and health systems challenges.

Some important components of strengthening health systems are developing and enhancing proper leadership efforts in health systems roles.

Here are some ways of enhancing leadership to strengthen health systems.

ü ENSURE LEADERSHIP DEVELOPMENT IS THE FOUNDATION OF YOUR

HEALTH SYSTEM REFORM.

Empower leaders to achieve specific objectives and to overcome organisational and programmatic challenges.

ü CREATE AND IMPLEMENT A MASTER PLAN FOR LEADERSHIP DEVELOPMENT.

A master plan must include a well-coordinated development programme, reach the right leaders and include the right skills.

ü PUT EXISTING SENIOR SYSTEM LEADERS AT THE CENTRE OF LEADERSHIP DEVELOPMENT.

Senior system leaders should implement the new model behavior and lead their colleagues into organisational change.

ü STRENGTHEN WHO LEADERS ARE, NOT JUST WHAT THEY DO. Provide leadership training programmes that will improve the leaders’ self-awareness,

including how they identify and use their core strengths, respond to crises, delegate and handle conflict.

ü ADMINISTER REQUIRED SYSTEMATIC AND STANDARDISED PROCESSES TO IMPROVE COMPETENCIES OF LEADERSHIP.

Enforce systematic processes that will strengthen the defined behaviors of leaders.

IMDP TIPS"WAYS OF ENHANCING LEADERSHIP TO STRENGTHEN HEALTH SYSTEMS"

THE 48TH UNION WORLD CONFERENCE ON LUNG HEALTH

11—14 OCTOBER 2017GUADALAJARA, MEXICO

ACCELERATING TOWARD

ELIMINATION

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The IMDP is a Union programme implemented by Vital StrategiesVital Strategies 61 Broadway, Suite 1010 · New York, NY 10006 USA Tel: (+1) 212 500 5720 ·· Fax: (+1) 347 772 3033 email: unioncourses@theunion.org · unioncourses.org

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THE HEALTH MANAGER ISSUE 3, 2017

INTERNATIONAL MANAGEMENT DEVELOPMENT PROGRAMME® (IMDP)