Editor’s Note: It is no secret that we at Nigeria Health Watch contend that there are foundational challenges facing the Nigerian Health Sector, challenges that have held the sector back and will continue to do so if they are not addressed. Leadership is one area that we have not paid enough attention to over the years. Hala Daggash is the Executive Lead of the Healthcare Leadership Academy, an initiative of the Health Strategy and Delivery Foundation (HSDF) and the Private Sector Health Alliance of Nigeria (PHN). She writes this week about the evolving face of healthcare leadership and some innovative new approaches to this important sphere.
When I was asked to write a short piece on healthcare leadership, I was a bit unsure of how to handle the subject matter given its breadth, so I decided to base it on some dialogues I had recently with colleagues who held diverse opinions and ideas of what leadership really means. Those discussions were quite revealing as I discovered that the concept of leadership was often adapted from different perspectives. Though there was a lot of variation in the views expressed, it seemed that expectations of leadership were often managed to suit our unique Nigerian context – and generally, this translated to the expectations being lowered. One thing that united us all, was that there was certainly a perceived failure of “leadership” in its most idealistic form, whatever that meant to each of us, and that this accounted in a large part to the myriad of problems the health sector was beset with. Unfortunately, however, the solutions proffered during these discussions seldom sounded ground-breaking or far-reaching enough, and often concluded, with just an acknowledgment that “something radical” had to be done to achieve the widely desired goal of consistent, accessible and affordable quality healthcare provision and better health outcomes for all Nigerians.
“One thing that united us all, was that there was certainly a perceived failure of “leadership” in its most idealistic form, whatever that meant to each of us, and that this accounted in a large part to the myriad of problems the health sector was beset with.”
~ Hala Daggash
My “radical” solution came my way by virtue of the work that I, along with a very small team of committed colleagues are doing at the Healthcare Leadership Academy, where for the past year and a half, we have been fortunate enough to regularly engage and interface with a wide spectrum of healthcare professionals occupying various leaderships roles in both the public and private health sectors across the country. This has offered me the rare opportunity to gain a more accurate and deeper understanding of the specific leadership and managerial challenges these professionals face. Almost always, these interactions share one thing in common, and that is a genuine desire to effect positive change within their respective spheres of influence, motivated primarily by the conviction that Nigerians deserve better healthcare. This mindset, I believe, is the first crucial step in any strategy aimed at transforming the health system. What is lacking, from our perspective, are the skills and competencies required to execute this in concrete terms. Yet, there were very few formal opportunities open to most leaders of healthcare institutions to acquire leadership skills in Nigeria.
What has also become increasingly evident is the fact that developing the next generation of healthcare leaders who will excel in governance and the provision of services, not only in Nigeria but globally as well, requires a complete and, again, “radical” shift from the current traditional system which places most emphasis on clinical experience and expertise. Very few healthcare professionals in senior managerial roles have received any specific leadership or management-specific training. This derives from the false notion that excellent clinicians would naturally make excellent health managers/administrators, overlooking the need to equip them with the pre-requisite skills and techniques required to effectively deliver on their mandate and fully expand into their roles. In turn, these budding change agents struggle to maximize the potential their new responsibilities offer.
There is a growing recognition across a diverse range of healthcare professionals that a purely inputs-driven health system that relies heavily on financial and human resources is no longer the magic bullet in addressing healthcare challenges. With new realities brought about by Nigeria’s economic recession and ensuing health budget cuts, it is even more vital than ever to train healthcare leaders in efficient management of resources in a fiscally constrained environment without compromising the quality of care. We are faced with the reality of needing to do more with less.
I see a real opportunity here for those of us working in this healthcare space to harness this “can do” spirit and fervor to really transform healthcare delivery in Nigeria. There is much work to be done, but what we can do is start by leveraging on new and innovative approaches for capacity building to provide those individuals tasked with healthcare governance responsibilities with the relevant skills and competencies they require to catalyze system-wide changes.
It might seem like an insurmountable feat but I am exceedingly pleased and encouraged by the bold and innovative ideas being implemented by a few committed healthcare leaders both at the frontline of care and in health system governance to deliver better health services despite severe resource constraints. Some of these ideas are centered around the largest quality improvement initiative for maternal and newborn health in Nigeria in 80 public and private facilities of varying sizes across the country. Unlike other initiatives in the past, this is a solely outcomes driven initiative which applies quality improvement methodology, one of the four core modules taught at the Academy, to reduce maternal and neonatal mortality by 25% and 15 % respectively by September 2017. It’s been incredibly fulfilling to see how colleagues have immersed themselves in this and we look forward to the outcomes with great expectations.
This has deservedly earned them a respectable reputation amongst their peers as “Quality Champions”. It is our collective hope that these dedicated individuals will serve as exemplary and inspiring leaders for others to follow, and drive a critical mass of healthcare champions who will, in the not-too-distant future, generate that transformative change that we and future generations of Nigerians all seek and deserve.
There is no gain saying that leadership development ( skill acquisition) is critical in our healthcare industry yet my thinking is that we are lacking more in the area of deployment of our already available resources both in human and otherwise. There is a need for the Healthcare providers to net work more and collaborate to meet the huge demand in this sector.
Agreed! We are just too preoccupied with our clinical work! The training in leadership and governance in the health care must start during undergraduate medical training and, perhaps emphasized also even during housemanship.
As a Public Health Physician, I think that there is also a need for a radical shift in our training and practice towards nutrition as a major factor in health promotion and reduction in the incidence and burden of chronic and degenerative diseases. For example, the ‘nutrition’ content of medical students’ training needs to be expanded to build their capacity and competencies in advising patients more knowledgeably on how they can specifically modify their diets to improve their health, beyond the generic advice to ‘increase your intake of fruits and vegetables’.
Hello Dr. Jeminusi, modifying and counselling patients on diet modification is not your primary role as a physician. Getting the knowledge will not make you competent enough to handle this area.There are Nutritionist Dietitians with regulatory bodies in the health system too who are professionals in this field of study as it is obtainable in developing countries. One of the problems of Nigeria health system is that we lack respect for other professions and we tend to do what is not in our scope. Why not refer your patients to the Dietitians and relax then face the reality of your work. If your hospital have no Dietitian encourage your management to employ them. We should be thinking of international best practices and how to apply it in the Nigeria health sector. Am a Doctor too I might be sounding skeptical.
Thank you for the article calling attention to a serious matter that has always been taken for granted. While we can train people who hold leadership positions, I believe we need to also recognise that leadership seems to thrive more on soft skills. Such skills are not easily taught and what I am alluding to is the need to recognise that leadership is somewhat linked to some natural/fundamental soft skills that individuals possess and so some people seem naturally prone to being greater leaders than others.
Consequently, we need to shy away from a system that allocates comparatively huge remunerations to certain positions within our health system. A health manager should not necessarily earn so much more than the others who are also doing great work within the hospital for example. To break it down, a doctor should not earn several times more than his colleagues simply because he took on a management position in the same hospital. This will draw us closer to ensuring that only people with a flare for management pursue such appointments in the first place.
The urgent shift we need in leadership in the health sector is to move from traditional style of leadership to globally prescribed transformational style where the leaders allow followers to make innovative suggestions, contribute to decision making and participate in the tasks of healthcare delivery. They have team work spirit and just see themselves as heads of the team. They are concern with the development of the followers and are equipped to manage change when need arises. These characteristics, however, can not be achieved without formal training.