Search

Background: Strong management is important for high-value health-care systems if returns on global health investments are to be delivered and the Sustainable Development Goals met by 2030. Managers are responsible for care delivery systems and strategies, making sure that health services benefit the population they intend to serve. Most managers in resource-limited settings work at the district level and below, with little training in non-clinical skills. They are often health care providers who have been promoted into management roles. Here, we aimed to understand the most challenging aspects of the health-care management role in resource-constrained settings and to identify gaps in managers' skills and knowledge in order to better design programmes and tools to support managers in their delivery of care. Methods: We sent a web-based branching survey to frontline global health managers via Devex between October, 2014, and January, 2015. The survey used multiple-choice and Likert-scale questions about skills within five categories of management in global health: finance; human resources; facility/supply chain or inventory management; clinical, field, or laboratory team management; and relationships with community and partners. Before the survey, we did a literature review, held a virtual discussion with experts, and piloted the survey to refine areas of management and enable targeted training. The pilot survey was also completed by mid-career professionals attending the Global Health Delivery Intensive at the Harvard T H Chan School of Public Health in July, 2013. Findings: We included data from from 350 survey respondents in 44 low-income countries, the virtual discussion panel with 131 experts from five continents, and responses from 33 Global Health Delivery Intensive attendees from 11 countries. Our findings indicated that health-care managers are short on time, are required to multitask without an understanding of priorities, and that they lack management skills, motivation, and information. We refined our intensive global health delivery course to meet what were identified as the most pressing challenges, and we offer an online community of practice to facilitate peer-to-peer learning and expert guidance to these areas. In 2016, 52 professionals from 24 countries participated in the eighth annual Global Health Delivery Summer Intensive. More than 90% of respondents (n=49) said they planned to incorporate their learning to make changes to their professional approach or practice. Interpretation: Universities can play an important role in convening managers and helping them to facilitate knowledge dissemination and translation. Future investments are needed to ensure global health professionals can access continuous professional development opportunities. Funding: The Abundance Foundation.

Background: South Africa's Health Minister Aaron Motsoaledi inherited an HIV epidemic and a weak public health system when he took office in 2009. His priorities were to establish a national programme to address HIV and to create a system of national health insurance (NHI) to increase access to affordable and high-quality health care. By 2015, Motsoaledi's work on HIV was considered as a success; however, work on the creation of NHI was stymied. Here, we aimed to compare the design, promotion, and implementation of the national HIV programme—a primarily vertical programme—with that of NHI, a horizontal programme. Methods: In January and February, 2015, we conducted 20 semi-structured interviews in South Africa with government leaders, civil society, researchers, health-care practitioners, private insurers, and international non-governmental organisations. We analysed interviews and available quantitative data from government, academic, and industry sources and distilled key themes in two teaching cases. Findings: We identified several key differences between the HIV programme and NHI efforts, including the role that leadership and politics play in health policy and care delivery; the effect of historical, economic, and cultural context on outcomes and leaders' ability to institute change; and the importance of strategy in planning and decision making. We noted both contextual barriers (such as public distrust of government) and catalysts (demand for HIV treatment) in the programmes. Furthermore, the approach used by the Minister of Health sometimes hindered programme success (for example, the exclusion of private insurers from NHI design) and sometimes enabled success (such as the engagement of civil society in the HIV response). For both programmes, the availability or absence of outcomes data affected the Minister's ability to advocate for change and to make strategic decisions about how to invest in health. Interpretation: The comparison of South Africa's well known and effective HIV programme with its stalled NHI efforts—both led by the same person with very different results––sheds light on important considerations when approaching complex, large-scale change. Our analysis of the politics of health systems shows how explicit acknowledgement of the political nature of health will lead to more effective health promotion strategies and policies. Political leaders can either drive or hinder the implementation of evidence-based public health practices. Funding: The Ministerial Leadership in Health Program of the Harvard TH Chan School of Public Health, and Children's Investment Fund Foundation (CIFF), UK.

Background: The link between economic development and health is well established, but not necessarily straightforward. We explored the economic effect of investing in health-care infrastructure in Neno, Malawi. We documented findings in a teaching case that is one of the open-access Cases in Global Health Delivery on Harvard Business Publishing. The cases show value-based health-care delivery and improve students' understanding of strategy and management in health care. Methods: We did background research on Malawi's history, health system, and economy. We interviewed 40 informants in Neno, including leaders of Abwenzi Pa Za Umoyo (APZU) and its founding organisation (Partners In Health), Ministry of Health administrators, hospital staff, villagers, and business owners. We reviewed quantitative data to assess indicators of development and documented changes in Neno's economy. We investigated the management decisions APZU made, while supporting the government in building a hospital and scaling up clinical and social programmes across Neno. We piloted the case in the Global Health Delivery intensive programme at Harvard. Findings: The case discussion tested students' ability to assess synergies between APZU's work and the local economy, including population and employment growth, improved public infrastructure, improved patient outcomes, and increased government investment in the district. Students also assessed challenges related to the shifting political landscape in Malawi, APZU budget cuts, reduced staff morale, and the Malawian currency devaluation. Interpretation: Students gained a greater understanding of how investment in health-care infrastructure leads to economic development. Funding: Harvard Medical School, Harvard Global Health Institute.

Background: In 2008, the Global Health Delivery Project at Harvard University launched an online platform to generate and disseminate knowledge in health-care delivery. We borrowed a common instrument from business—professional virtual communities—used for knowledge management and exchange across multiple organisations, industries, and geographies. We adapted the concept for health care to leverage the wisdom of the crowds and create a rapid, practical means for diverse professionals to share insights and tactics. Methods: A team of engineers, implementers, and providers built a lightweight platform, accounting for the reality of sporadic electricity service or restricted internet bandwidth in resource-limited settings and launched GHDonline in June, 2008. To foster reliability and engagement, the communities were led by expert moderators, discussions were open to all, and there was no anonymous posting. Findings: Even with early successes—membership growth and daily postings to communities—user feedback and analytics encouraged the team to iterate on GHDonline. Nuanced and in-depth conversations in the communities were turned into discussion briefs—summaries of the conversations reviewed by experts. GHDonline launched new public communities based on the most pressing concerns in the specialty, and organised more than 40 virtual expert panels. As of February, 2014, GHDonline hosted more than 11 000 members across 180 countries, in 12 public and 86 private communities. GHDonline is now expanding its offering to launch GHDonline communities for US-based practitioners. Interpretation: The increased use of GHDonline by health-care implementers suggests that professional virtual communities can be a valuable instrument to disseminate best practices, support collaboration between colleagues, and improve care delivery. Funding: Abundance Foundation.