Voices from the Field: Swaziland Program Develops Leadership, Improves Health Care Facilities

“The Leadership Development Program has taught us shared vision, collaborative approach and enhanced team spirit. Teamwork has replaced the historical differences between the hospital administrator, the matron and the medical superintendent, and we all work to achieve results,” says Leonard Dlamini, hospital administrator at Raleigh Fitkin Memorial (RFM) in Swaziland.

The leadership program is part of the IntraHealth International-led Southern African Human Capacity Development Coalition (SAHCD), whose work is funded by USAID through the President’s Emergency Plan for AIDS Relief. Coalition partner Management Sciences for Health (MSH) trained Dlamini and four others in leadership development facilitation to tackle some of the issues challenging the country’s health care system. The newly trained facilitators then led 36 health workers, mainly hospital managers, from six Swazi health care facilities through four leadership workshops with additional coaching in between workshops. At the end of the six-month course, participants presented results of real challenges they had addressed in their hospitals.

Dlamini, with RFM for 22 years, is now a champion of the Leadership Development Program (LDP). “LDP has strengthened my professional life. . . . It has assisted me in not seeing myself as an island but as one of the players working towards the overall problem solving in the health sector,” remarks Dlamini.

Another facilitator—Mavis Nxumalo, deputy chief nursing officer with Swaziland’s Ministry of Health and Social Welfare—echoes Dlamini’s enthusiasm. “Through LDP, you can now bring together in one room doctors, nurses and administrators who will work together to solve one problem,” she says.

During the LDP, Dlamini’s RFM team focused on improving patients’ assessment of the outpatient department (OPD). Realizing they needed patient feedback, the team members developed:

  • Policies and guidelines for patient assessment
  • New assessment and follow-up sheet for the OPD
  • Twelve suggestion boxes
  • Patient’s information leaflet
  • Client satisfaction survey
  • Monthly audit system.

Dlamini reports that because of the LDP, attendance in the OPD has gone up from an average of 300 people to 450 per day.

“[T]he hospital has become a best practice on how to work with the public so that they can give feedback to a health facility,” notes Nxumalo.

RFM is not the only facility to see success: “Ward 12 at Mbabane Hospital was so dilapidated,” says Nxumalo, who is responsible for deploying nurses to hospitals across the country.

“Through resource mobilization, the LDP participants have restored it by repairing the leaking roof, putting in new tiles, painting the ward with bright colors and installing new curtains. This has improved morale among health workers who now don’t mind working in ward 12. It is more relaxed and motivating and a good environment to work in.”

LDP participants identified the following as lessons they learned through the workshops:

  • Leaders are not born but they can be made.
  • One should deal with problems that are within one’s scope of influence.
  • Resistance to change needs to be managed.
  • A positive and healthy work climate is essential to success.
  • Group work and team spirit constitute the backbone to achieving results.
  • The coaching approach is beneficial in between workshops.
  • One needs to recognize the difference between a challenge and a problem.

“It is clear that these officers have mastered the concept of leading and managing for results. These teams faced challenges and enabled others to face these challenges and achieve results under complex conditions,” says Njabulo Mabuza, minister of health and social welfare. “[T]the LDP team’s success was based on shared vision, commitment to implement resolutions and compete for results. As part of the ongoing search for solutions for the health challenges facing the country, we invite all sectors of the population to contribute towards realization of this goal.”

The SAHCD Coalition is comprised of five organizations besides IntraHealth: Council for Health Service Accreditation of Southern Africa (CoHSASA); Management Sciences for Health (MSH); East, Central and Southern African Health Community (ECSA); Foundation for Professional Development (FPD); and Training Resources Group (TRG) Inc. The Coalition aims to establish a strong coordinated regional response to the HIV/AIDS epidemic in Southern Africa and to improve the capacity of the public and private sectors to deliver HIV/AIDS services. An associate award of the IntraHealth-led global Capacity Project, the Coalition:

  • Provides technical assistance in human resources for health planning, policy and advocacy
  • Contributes to the development of training programs, curricula, standards and policies
  • Strengthens human resources information and management systems
  • Builds local capacity in policy development and implementation
  • Enhances knowledge management and best practices programming.

IntraHealth Voices #6. Swaziland: Program Develops Leadership, Improves Health Care Facilities. March 2008.