CASE STUDY 1: LEADERSHIP ATTRIBUTES

In the recent years, many health professionals have been appointed to leadership p
ositions and
management of large scale health programmes in their countries. It is generally acc
epted that the
medical education training programmes provide adequate knowledge and impart
relevant skills and
competencies for the management of diseases, therefore, management of
health care systems and programs. However, there is now a consensus that in many
countries medical education training
programs are compact and do not impart to graduates
sufficient knowledge and skills for the
management of health care systems and programmatic
services. With increasing demand for
quality services, strategic planning and working in
teams, when you lead you take a stand to create a
better future. The new leadership will not
be provided by a take charge elite but will emerge from
the capacity that lies within each
and every person. It will be leadership that does not presume to
have all the answers, but
one that seeks to empower others, as stated by Annabel Beerel, in
Leadership through
Strategic Planning". Afya Bora Fellowship aims at training leaders in global health,
therefore, it is important that the definition/meaning of leadership and leadership at
tributes are clearly understood.
Problem
You have recently been appointed Permanent Secretary to the Ministry of Health in
your country after
completion of a leadership training fellowship. An international organization
has keen interest in your
country and wants to operate a large scale health programs on NonCommunicable Diseases (NCD). However, the International Organization will not
commit the funds to your ministry until it is assured
that you have appointed a competent incountry Programme Manager who - in addition to being a
holder of an advanced degree in
a health profession - MUST have outstanding leadership attributes. You
have at most two
weeks to identify and appoint a person suitable for the post of programs Manager
who in your opinion has the required leadership attributes.

Challenge
What do you understand by the term leader?
What leadership values will you be are looking for?
What do leaders do different from Managers?
In your opinion, what influences leadership?
What criteria will you use to determine the leadership potential of candidates for t
his new position of Programs Manager?
How can you ensure continued building of leadership competencies in your Ministr
y?

CASE STUDY 2: STRATEGIC THINKING

Strategic thinking is an important attribute of successful leadership, and some woul
d claim that it is the
key to leadership. Strategic thinking involves collecting information about the
problem, analysis of the
issues; bold thinking that may challenge accepted views, and an
ability to synthesize these elements into a practical proposal or solution.
Problem: Measuring the rate of mother-to-child transmission (MTCT) of HIV
.
Country X in southern Africa has a population of about 10 million, and the prevalenc
e of HIV/AIDS among persons aged 1549 is guesstimated at about 25%. The party in power has recently changed, and
there is a newly elected President and a newly appointed Minister of
Health. The Minister of Health is a
nurse with a professional background in nurse midwifery.
The President campaigned on a platform that
included a promise to try to deal with the
HIV/AIDS epidemic, including a commitment to markedly
reduce the number of children who acquired HIV through mother-tochild transmission (MTCT). Currently, there is a
newly launched program of voluntary counseling of adults attending outpatient
clinics with those tested positive being referred for evaluation and potential antiretroviral treatment.
However, there is no program directed to the prevention of mother-to-child transmis
sion (MTCT). As one of her first actions the Minister of Health decides to invite an
external group of consultants to

advise her about the issue of MTCT. You are a group of health professionals
and you receive a request
from the Ministry of Health to formulate a program to measure mother-tochild transmission (MTCT) of HIV, in preparation to instituting a new program for the
prevention of MTCT.
Challenge
The Ministry of Health asks you to address the following questions:
How should Country X determine the impact of their proposed program to control
mother-to-child transmission?
How can the Ministry "guesstimate" the current number of babies born each year
who are infected with HIV, based on the following information?
The annual birth rate is 2.3% (2.3 births per 100 population per year); the prevalenc
e of HIV
infection among pregnant women is estimated at 25% (range 10% to 35% in
different antenatal
clinics), and the rate of transmission of HIV from infected mothers to their babies
(absent any intervention) is 30% (range 20% to 40% in different studies)
How can they determine their current ability to identify pregnant women who are
HIV positive?
How can they measure the actual rate of HIV transmission per 100 pregnant wom
en who are HIV positive?
Why is it important to develop this background information as part of the new pro
gram to prevent MTCT?
Final question
Based on this case study what can you suggest some general principles about the
process of strategic thinking?
How is strategic thinking different from strategic planning?
What processes are involved in strategic planning?

CASE STUDY 3: ENTREPRENEURSHIP

Leaders of the 21st Century increasingly need to explore alternative or additional fu
nding sources for
their programmes as well as learn how to use the resources in new ways. This
change in perspective will not only increase programs efficiency but also programed
effectiveness. Such skills are increasingly

needed by leaders in the governmental public health sector because of dwindling

resource allocation by the governments. Furthermore,
nongovernment organizations (NGOs) are playing an increasingly
important role in health
care. Many NGOs have to raise funds from governments, large donors, or
members of the
public to support their activities. Thus, the successful health leader may have to pos
sess entrepreneurial skills as part of her/his toolkit.
Problem
You are a private physician in country N, who specializes in diabetes and its complic
ations. The local
Diabetes Association asks you to become head of their organization in place of the
present director who
is retiring. You would take on a mandate to develop a prevention
program particularly focused on
obesity. Furthermore, the Minister of Health, who was a
classmate of yours in medical school,
encourages you to take on this opportunity. He
recognizes that the nutritional transition is manifesting
in Country N but recognizes that the
Ministry of Health does not have the resources to launch a
program directed at this problem.
You are persuaded that a new program to deal with nutritional
issues could have an important
impact on health in your country, and are excited by the challenge of
leading it. However, the
current income of the local Diabetes Association is very limited and is based on
public
contributions; furthermore, these funds are already stretched to support several dia
betes
treatment programs for low income patients. Clearly, you must raise external fundin
g in order to launch the new healthy living program.
Challenge
Devise a plan to raise funds to operate a new healthy living program. Include in y
our plan answers to several questions:
How would you develop a program plan to sell to potential donors?
What would be the salient features of the program that might attract donor suppor
t? What are the short
and long term goals of your program? Can these be measured? What promises can
you make to potential donors?

Do you need endorsement from authorities or other sectors of your community?

Should you align your new program with existing NGOs in your country?
Where might you look for substantial donors? Private sector? International health
organizations? National or international non-profit organizations? The public?
What pitch would you make to each group?
Final question
Can you enumerate some of the leadership qualities or attributes that contribute to
entrepreneurial success?

CASE STUDY 4: PEOPLE SKILLS: CONSENSUS BUILDING

Leaders always work with a group that is critical to developing plans and implementi
ng them, although
members of the group may vary for each task in hand. To accomplish this, the
leader has to get the
group to develop a consensus about a plan and an implementation
strategy. This is essential since
effective implementation will depend on the contributions of
each member of the task force. If
individual members dont believe in the plan and feel that
they were not involved in the planning
process, and have little ownership of the plan, implementation will be jeopardized.
The ability to build a consensus in this case is therefore
a key attribute of effective leaders.
Problem: The role of NGOs in southern Africa
Country Y in southern Africa has a population of 30 million and an average annual G
DP (gross domestic
product) per capita of $1,500. There is a national health service but much
health care is provided by international NGOs (nongovernment organizations) which operate independently of the National
Health Service. It is estimated that there are at least 1,000 such
NGOs operating in Country Y and that
their aggregate budgets are equal or greater than the
budget of the National Health Service. However,
there is no information about the impact of
these NGOs on the overall health of the population. The
Minister of Health has received a mandate from the Parliament and President, to rev
iew the NGO
situation, with full power to recommend major revisions in the status and role of

NGOs in Country Y.
In turn, the Minister of Health has convened your team as a group of
advisors to provide an analysis of the health services provided by the NGOs and to
recommend actions to organize and harmonize the
NGO programs. In particular, one goal is
to ensure that the NGO programs support the activities of the
National Health Service and
provide sustainable capacity building for the nation's health system.
Challenge
Will it be important to develop a consensus among the NGOs to achieve the assign
ed task? Why?
How would you develop a consensus among the NGOs? What role should
representatives of the National Health Service play in developing your report?
Representatives of selected NGOs? Do you
need a neutral broker to develop a proposed plan?
What information would you need to collect about the NGOs operating in Country
Y?
Should there be a national registry of all NGOs, both international and local? Shoul
d there be an
application process required before an NGO is permitted to work in Country Y?
How should the work of each NGO be harmonized with that of the National Health
Service?
How should NGOs be expected to build health worker capacity?
Final question
What does this case study illustrate about consensus building?

CASE STUDY 5: PEOPLE SKILLS: CONFLICT RESOLUTION

Conflict will always be present in a workplace and it is important to seek resolution
and not just to
contain the issues and forget about them. Senior managers in health leadership gra
pple with
conflict issues that require agreement because conflicts tend to slow progress in
developing new ways
of delivering health services. Conflict resolution is a wide range of methods of
addressing sources of conflict - whether at the inter-personal level or between
states and of finding means of resolving a given conflict or of continuing it in less
destructive forms than, say, armed conflict. Processes of conflict

resolution generally include negotiation, mediation, diplomacy and creative peacebuilding. The term conflict
resolution" is sometimes used interchangeably with the terms dispute resolution or
alternative dispute resolution. The processes of arbitration, litigation, and formal
complaint processes through an
ombudsman, are part of dispute resolution, and therefore they are also
part of "conflict resolution." The concept of conflict resolution can also
encompass the use of non-violent methods such as civil
resistance (also often called nonviolent resistance) by a party to a conflict
as a means of pursuing its goals, on the grounds that such means are more likely
than armed struggle to lead to effective resolution of
the conflict. Effective and efficient conflict resolution is therefore
critical in speeding up the
change for health policy or other reforms and in the implementation of
health programs. Leaders need
to use soft interpersonal skills to collaborate with their teams to analyze the
issue at hand, identify and
evaluate various alternative solutions, make decisions and
persuade the rest of the constituents to accept and implement the decisions made.
Problem
In one of the Sub-Saharan countries, the Government has adopted decentralization
as one of the policy
mechanisms for effective delivery of services. Various ministries have been
reorganizing their structures
and operations to be in line with the decentralization policy which make the Local
Councils as the devolved unit of government to deliver a wide range of
services. In realigning health services, it was
proposed that the Ministry of Health takes the
responsibility for health policy, development and
enforcement of health standards, training
and development of human resources for health, tertiary
facilities and providing technical
support to Local Councils. The Local Councils would employ technical
staff, and deliver
services at the local level. The Ministry of Water through regional Water Boards has
been proposed to take responsibility forwaterborne sanitation. The Ministry of Finance proposes to
channel funds directly to Local Councils for all locally delivered services including he
alth services. The
Director of Medical Services holds the position that, as the legitimate custodian
of all that appertains to
health, the Ministry of Health should remain the employer of health

personnel; coordinator of medical

supplies; supervisor of all health facilities and their
operations; and holder of all health funds. He/she proposes to subgrant funds to Local Councils to undertake delegated health service, rather than
hand over control to each Local
Council. Debate on how to implement the policy has been going on for over
five years, and the decentralization of health services is yet to take place.
Challenge
You are a health policy advisor to the Minister for Health who has asked you for a
framework for
consensus building with internal and external stakeholders. The Minister
would like answers to the following questions:
What issue or issues do we need to address in order to implement the decentraliza
tion policy in health service delivery?
Who do you need to engage to hasten the process?
In the last meeting within the Ministry a few of your senior team members mainta
ined a hard line
positions in opposition to this process. What is the best way to resolve issues
among ourselves and other Ministries?
Directors of the Ministries of Local Government, Finance and Water rarely talk in
meetings these days after one of your senior officials said that their Ministries know
nothing about health. How do you bring them on board again?
What actions do you need to take to kick off the process?

CASE STUDY 6: MENTORING

At the end of this fellowship, the graduates will either go to new positions as manag
ers in their
organizations or work in new organizations. A mentorship program helps to support
this transition.
Some organizations may have such a program in place and the fellows can use
their knowledge to
improve its effectiveness. In some cases, there may be none and the
pioneer fellows may have to create one for those who will come after them.
Problem
You are the Director of the National Aids Control Program in your country. A new gro
up of four
managers that graduated from a fellowship training program is sent to you for

deployment. They come

from various professional backgrounds but went through a similar
management training program. The
Permanent Secretary in the Ministry of Health would
like to track the progress of the fellows to see what
difference the fellowship program can make. You decide to pair the new managers
up with mentors to help them.
Challenge
What do you understand by the term mentorship?
What do you expect the mentorship program to achieve? Which activities would ta
ke place?
Which characteristics will you look for in potential mentors?
Should mentorship be mandatory or voluntary?
Should the protg (mentee) have input in selecting a mentor?
How would you evaluate your new mentorship program?
During your Fellowship, you will have a primary mentor and a mentoring committe
e that will advise
you about your project at your Attachment Site. What are your expectations
for you primary Mentor and for your mentoring committee?

CASE STUDY 7: COMMUNICATION SKILLS

One of the most important attributes of successful leadership is the
ability to communicate
effectively. Because of its importance, there will be a full Module ded
icated to
communication skills during the training. For this short exercise, we will focus
on a single
aspect of communication, the ability to develop and present a short t

alk using Power Point technology.

Problem

You will be given a short published scientific paper that contains imp
ortant information.Using the information in this paper, the group will
prepare a 10 minute power-pointpresentation. One stipulation is that
the PowerPoint contains a maximum of 8

individualframes. Fellows will be divided into two groups to make tw

o separate presentations, from different perspectives.
(1) You have heard this information presented at an international me
eting and your
assignment is to summarize the scientific study for a high level grou
p in the Ministry of Health; or
(2) You have heard this information presented at an international me
eting, and your
assignment is to present the policy implications to a high level group
in the Ministry of Health.
The data are contained in the following publication.
Karim QA, et al (2010). Effectiveness and Safety of Tenofovir Gel, an
Antiretroviral
Microbicide, for the Prevention of HIV Infection in Women. Science,
329 1168-1174.
Challenges
What

are the key areas which should be covered in a scientific pow

er-point presentation?
What

are key areas which should be included in policy power-point

presentation?
List

two important features of presentation to a lay community.