In the last Alumni Newsletter, you read about Chris Elias’s visit to Kenya and his dinner with IPPHL fellows. As part of this visit, Chris’s team interviewed Dr. Elizabeth Wangia, an alumni from the first IPPHL cohort. Chris recently published a short article highlighting the conversation with Liz. Read about Liz’s experience as an IPPHL fellow, what she learned, and what she sees as the key challenges as a leader in public health. A huge thank you to Liz for taking the time to answer Chris’s questions and provide some information and encouragement to others who are thinking of applying to IPPHL! Read the article here.
Category: IPPHL
Moorine Sekadde (Cohort #1) in the News
Moorine makes the news in an article by the International Union Against TB and Lung Disease. A parliamentary delegation with representatives from five countries and hosted by the Union and the Global TB Caucus visited districts in Uganda which are implementing the DETECT Child TB Project; an effort to improve the prevention, detection, and treatment of TB in children. Moorine briefed the delegation in her role as Child TB Coordinator.
Arnold Okpani (Cohort #2) Published
Arnold Okpani has been busy since the IPPHL program this year concluded. He recently published an article describing Nigeria’s experience in implementing a new DHIS2 routine immunization dashboard to better visualize and monitor key RI indicators and encourage the use of routine data for decision-making at all levels of government. Read his article by clicking the link below:
Data for decision making: using a dashboard to strengthen routine immunisation in Nigeria
Selorm Botwe (Cohort #2) in the News
Selorm Botwe and Adabraka Polyclinic, where Selorm works as Specialist-in-Charge makes the news in an article penned by Selorm for Modern Ghana. Management of the clinic hosted a well-received open house to interact with clients and stakeholders and promote accountability in the health care system.
Alumni Spotlight: Ikrama Hassan
I learnt about the IPPHL program through Abdulkarim, a Cohort 1 participant. I was one of his raters in the 360 By Design feedback tool. With encouragement from him, I read up on the program and became captivated.
At the time of my application I was the Director of Health Planning, Research and Statistics at the Nasarawa State Ministry of Health, North Central Nigeria. My department had just started some preliminary work on the conceptual framework for a social health insurance scheme for the state; but, no one was clear on how to go about it. I therefore decided to work on that for my Policy Paper.
I had never written a policy paper nor had any leadership training prior to IPPHL. The program therefore could not have come at a better time for me. I learnt the rudiments of policy paper drafting and already had a good draft before the Seattle Residency. By the end of the Residency, my mentor was happy with the work and declared it ready for implementation. I went through the processes back home, and two months later, the bill for setting up a social health insurance scheme for Nasarawa state, Nigeria, was passed by the State House of Assembly!
Midway through the IPPHL program, I was made the Chief Medical Director of the State Specialist Hospital. This is a 200 -bed tertiary hospital with a staff strength of 1400. It is the biggest state-owned hospital. After the pre-residency lectures and engagements on Zoom and Canvas and Slack and passing through the furnace in Seattle, I felt ready for such a huge responsibility. IPPHL became my compass. I studied all the reading materials several times over. I contacted some of the faculty individually for clarification of some concepts. I was constantly looking forward to my executive coaching session as the coach was interested and following every single step I was taking.
So far there is hardly anything I learnt from IPPHL that I have not had a cause to practice in my current role. I will illustrate a few.
My first assignment on resumption of duty was a review of the hospital’s ‘strategic triangle framework’! The Mission, the Capacity and the Support. This really gave me nearly all I needed to begin the work with high degree of focus.
The next challenge was selecting the core team with which to work. My first choice as my deputy was a hot-headed gentlemen who like me, was an ‘originator’ in change style leadership. I would never have had a second thought in picking him if I had not gone to Seattle. The person I ended up choosing instead was a ‘conserver’ and, therefore, on the opposite end of the change style spectrum. I had to run most of my decisions by him, and it has saved me a lot of trouble!
However, IPPHL did not emphasize the importance of stakeholder analysis enough! The higher you climb on the leadership ladder, the more important this tool becomes. You will spend more time and energy planning and engaging with stakeholders of all hues and colors than on anything else if you are to succeed. At the initial stage, I could not understand why my coach as laying so much emphasis on it. Now I know better.
One of the most important reading materials we were given during the program was an article titled: A surviving Guide for Leaders. It is a must read for every leader! One of the many concepts discussed in the article is for a leader to ‘operate in and above the fray.’ The long trip to Cape Town for the Capstone seminar offered me an opportunity to get up to the balcony to take a look on the dance floor. I came back to Nigeria with 15 pages of handwritten ideas on how to improve what we had started! And now, I look forward to putting it all in practice.
Alumni Spotlight: Joanne Ondera
I have always been passionate about working towards a health system where any Kenyan can receive health services when needed irrespective of their financial income levels. This is one of the reasons I became a medical doctor and later pursued public health partnering with the Ministry of Health and the National Hospital Insurance Fund to expand coverage of vulnerable groups first through an entitlement program for the poor then women and children. Since the incredible fellowship opportunity at the University of Washington I have taken on new responsibilities as the Country Lead of a program focusing on strategic purchasing of primary healthcare services particularly maternal neonatal child health and family planning services. Strategic purchasing is of interest to me because most services in our country are purchased by means of passive purchasing mechanisms. This means that providers receive financing that isn’t driven by explicit obligations to ensure equity, access and quality of the services they offer. In collaboration with the Ministry of Health, National Hospital Insurance Fund and County Departments of Health we intend to change this as we learn and build evidence and action towards strategic purchasing.
Likewise, although developing my policy memo was demanding, as part of the secretariat to the HF-Sub-committee on Universal Health Coverage which is part of the President’s big four agenda for the country, I have been able to unpack many of the elements in my policy memo which focused on increasing equitable access to quality healthcare services for Kenyans. The leadership training/coaching remains one of my highlights of the course because I realised leadership isn’t innate; you can be taught to become a good leader. I have drawn on lessons on managing vision and purpose since my new role requires me to engage partners and make compelling arguments for collaborative work to reach strategic country led goals for health.
Finally, last month the Kenyan Fellows were delighted to have dinner with Chris Elias, Liz, Joyce and I got to meet Lucy, Wesley and Maureen (Cohort 2) and had great time discussing healthy lifestyle decisions such as the latest diets. This topic was a result of engaging on a major health concern in the country; Cancer.
Alumni Spotlight: Samuel Kwame Buabeng-Frimpong
Post IPPHL, I still remain the Country Head for Health Information Management in Ghana. Towards the end of last year, I voluntarily applied for a year off from the office to primarily focus on my PhD program. Along the line, I took advantage of the granted time off to apply my acquired IPPHL skills to an area I have always been passionate about; setting up a private medical practice that could help cater for some unmet health needs in rural Ghana.
I am currently the Executive Administrator of my private establishment TopMED HealthCare. The primary aim for establishing TopMED was to extend quality but affordable clinical and diagnostic healthcare services to the deprived population in rural Ghana. Although I have always enjoyed my job as the Country Head of Health Information Management, I have also wished to apply my skills as a clinician and a sonologist to impact directly on the lives of people, particularly the rural poor. In fact, it has over the years been my heart’s desire to be able to give something back to humanity and I think through the establishment of TopMED HealthCare, I have partially achieved that aspiration.
TopMED HealthCare currently offers quality but affordable clinical care and medical diagnostic support to rural folks in three districts of the Eastern Region of Ghana.
Reduction of Maternal mortality has been at the forefront of my agenda. The Diagnostics wing since its establishment has offered maternal health support services to mainly pregnant women in rural communities. To ensure that the rural poor receives the essential diagnostic services, we eliminated a major bottleneck that tends to inhibit them from seeking essential services on time. Instead of them travelling over to our facility to be served, we rather moved our services to their very doorstep. With this convenient arrangement in place, we have been able to reach thousands of pregnant women with ultrasound and laboratory diagnostic services.
Through our efforts, many potentially life threatening conditions in pregnancies such as high grade placenta previa, ectopic gestations, severe anemia and significant proteinuria have been diagnosed and promptly referred to appropriate higher centers for attention. Our activities have been lauded by stakeholders within our areas of operation and our contribution towards reduction of material mortality cannot be overstated. We hope to expand the coverage of our outreach services in the months ahead to include three additional districts. To achieve this goal, I am working towards soliciting for support from potential collaborators who share in our belief that the poor also deserves quality healthcare.
Having identified the need for complementary clinical services in our catchment of operation, we decided to expand our services to include hospital care. Consequently, TopMED Hospital was started in January 2018 at Kwahu also in the Eastern Region of Ghana. Services offered include Out-patient care, In-patient care, Surgeries, Obstetric and Gynaecological Services, as well as in-house Medical Laboratory and Diagnostic services. TopMED Hospital serves as a referral point for health centers within catchment.
Surgery affordability is one of the main challenge confronting the rural folks of Kwahu. It is not uncommon to see patients with inguinal hernias, fibroid uteruses, unsightly goiters etc. walking about without seeking care. The big question is why have they not taken advantage of the National Health Insurance Scheme to have their surgical problems solved? Well, it does not come that simple!
It is TopMED’s hope to find benevolent collaborators who could at least half the cost of surgery for such clients with pressing surgical needs.
As both a director and the Executive Administrator of TopMED, I am the lead person in charge of day to day management of TopMED’s HealthCare. Right from its inception, I made it a point to apply all the leadership skills acquired from IPPHL at this private premises. I must admit that the result has so far been very amazing.
Admittedly, launching TopMED has been relevant to my policy memo. In the solution analysis of my memo titled HOW CAN GHANA ACHIEVE SUSTAINABLE FUNDING FOR ITS HEALTH INSURANCE SCHEME? , copayment for healthcare was proposed as a sure means to improve the quality of healthcare delivery in Ghana. It is interesting to know that even without any endorsement by the Ghana Health Insurance Authority, the health care systems have naturally been drifting towards copayment for services. With Health Insurance being highly politicized in Ghana, influencing a country-wide change with my policy solution would definitely be a herculean task. However, I thought it wise to find ways and means of testing the policy solution at some lower levels and evidence of a success stories shared to influence a broader scale change. And that is where TopMED becomes relevant. For example, if a rural patient would be willing to pay out of pocket for quality clinical and diagnostic services, then copayment for service which could guarantee similar quality of care at a lesser cost would highly be welcomed.
In addition, to launching TopMED, I am presently in my third year of a 4-year Ph.D. Program. My research work titled “Assessment of DHIMS2 Data Quality and Use in Ghana” seeks to elucidate reasons behind the poor data quality of Ghana’s Health Information Management System called DHIMS2. DHMS2 is Ghana’s version of DHIS2 platform developed by Oslo University in Norway. The study also intends to understand the poor use of DHIMS2 data for management decision making by managers of the country’s healthcare system.
What I’ve learned since the conclusion of IPPHL, is that one does not need to have everything or be fully ready to be able to make an impact on humanity. You can and must always start from somewhere.
Alumni Spotlight: Moorine Sekkade
The IPPHL course presented key leadership concepts that I continuously make reference to during execution of my tasks as a child and adolescent TB coordinator at the ministry of health in Uganda. The most frequently used concept is the “strategic triangle” which helps me to get a sense of direction while identifying and addressing program challenges. The “theory of change” (ToC) also comes in very handy when designing interventions and activities. I have also frequently walked my colleagues through the steps in developing a ToC. An example is a project that my colleagues and I are working on to develop a prototype aimed at improving the management of acute asthma in resource limited settings. The team was expected to develop a theory of change for this intervention and I quickly put the acquired knowledge to use. I have used different platforms to share my policy memo solutions and some of the approaches have been taken up. Negotiation is one style that I use to get consensus from the different stakeholders. I have also been invited to share on Uganda’s experience in decentralizing of child TB care to primary health care points in several forums including a webinar on TB along the lifecycle: integration of TB into HIV and maternal and child health programmes; 48th Union World Conference on Lung Health in Mexico; and more recently a regional TB workshop in Benin.
WHO Report Launched on the Benefits of Addressing Noncommunicable Diseases
A WHO report launched in May around the World Health Assembly tackles the issue of noncommunicable diseases (NCDs). The report, titled ‘Saving lives, spending less: a strategic response to NCDs’, makes the case for investing in preventing and treating NCDs such as cardiovascular disease and cancers by calculating the potential cost, cost-effectiveness, and the return on investment (ROI) in terms of deaths averted and economic gain from increased productivity. The report also shows how, if interventions to prevent and treat NCDs are scaled up globally, the world will move much closer to achieving Sustainable Development Goal 3.4; to reduce premature death from NCDs by one-third by 2030.
While NCDs had been considered primarily a problem of the developed world until recently, many developing countries are in epidemiological transition and the rate of NCDs as well as mortality and morbidity due to NCDs are rising on a global scale. NCDs now cause around 71% of all deaths according to the WHO report. In addition, due to the chronic nature of NCDs, treatment is typically long-term and can be expensive; putting a disproportionate burden on the world’s poorest. This new WHO report used cost-effectiveness analysis to make the case for scaling up prevention and treatment; analysis that could be used by policy-makers to advocate for more attention and resources to address these chronic conditions.
Read the WHO press release and the report.
Alumni Spotlight: Joyce Kyalo
I recently took up a new position in a new programme as the Regional Health Financing and Advocacy Advisor for multiple countries in Africa. In this capacity, my main role is to advocate for prioritisation of women, children and adolescent health in country plans and budgets. Most countries are entirely dependent on donors to sustain these programmes, with few domestic resources allocated to the Reproductive, Maternal, New-born, Child, and Adolescents Health (RMNCAH) continuum of care. Not only am I looking at each country’s allocation, I am also focusing on how to increase efficiency gains in budget implementation; a major challenge in most countries in Africa.
Additionally, my organization has been focusing on building the capacity of citizens, Civil Service Organizations and health care workers to effectively engage in the budgeting and its implementation processes, and this has been taken up very well. Providing evidence that links budget implementation to health outcomes nationally and sub-nationally in-country is influencing leadership and decision-makers. For instance, we linked the budget for blood donation services and the Maternal Perinatal Deaths Surveillance Review and Response (MPDSRR) data, which showed that half of the maternal deaths in one county in Kenya was due to haemorrhage and there was no prioritisation of blood services in the county plans and budgets. As a result, the governor of the county agreed to prioritise and allocate funds for the construction of a blood satellite centre. However, much still needs to be done to improve RMNCAH services.
The leadership programme has helped me in my new role. Not only have I used the technical aspects such as ‘theory of change’ and others to work towards improving health outcomes of communities. I have also become more aware of myself when engaging high-level policy-makers such as ministers of health. I have built skills in influencing by negotiating appropriately and pitching issues with senior government officials related to priorities around RMNCAH. I continue to strengthen my capacity in my influencing styles because, at times, I find myself slipping back to my comfort zone – influencing through the use of evidence – being rational. The best part is being aware and working towards the change that one wants.
My policy memo explored how Kenya can ensure quality access to reproductive health services in the context of a devolved system. Access to these services especially for the adolescents in the rural areas is a major challenge; denying them the opportunity to realise their full potential. Certain services such as family planning (FP) are not covered by insurance, neither the public national health insurance fund (NHIF) nor private health insurance in Kenya, and therefore patients have to pay from their pocket to access these services. My recent work has focused on working and advocating for the inclusion of RH services in the national health insurance and private insurance benefit packages. We recently held a meeting with the new minister of health in Kenya to brief her on prioritisation of FP in the NHIF benefit package.
a personal note, my teenagers are growing very fast and they have made me be a better negotiator! I am looking for new pastimes that will keep me busy once they leave for college by 2020. This has made me explore farming and learning how to play the piano, a passion that I have always had since when I was 5 years old. This I believe will help me unwind during my free time. Since December 2017, I have been planting avocado, passion, and tree tomato fruit trees at my farm which is about 50 km from Nairobi. I come from the lower eastern side of Kenya which has fertile soils; however, receives very little rain. It produces very sweet fruits and has some of the sweetest mangoes in the world. Mango season is from December through March each year. I would be more than happy to share the mangoes from northern and lower eastern Kenya for those visiting around that time of the year.
I think for me the one thing that I have learned since finishing the program, is related to risk-taking and exploring innovative ideas. I can be risk-averse and at times; I would prefer someone else to pilot an idea. Once successful, I would want to pick up the idea for scale-up. In previous assignments this has been the case; where, despite being a risk-taker, I settled in my comfort zone avoiding the risk that comes with exploring innovative ideas. However, since the program, I have been able to receive and adopt innovative ideas from staff.
View the photo album here