Leadership at district, facility, and community levels

Much primary and secondary health care delivery takes place at local levels, provided by local institutions and practitioners. With increasing responsibility and additional financial resources being transferred downward through devolution or decentralization governance policies in many countries, the need to find ways to actively and effectively engage local authorities takes on heightened importance (Dafflon and Madies 2012). Municipal and provincial governments must have the capability to choose among health spending alternatives and possess the planning skills to meet realistic constituent health needs while adhering to national policies and guidelines. Health professional schools—which are located close to their constituencies—are well situated to help design municipal and provincial programs, articulate health facility needs for catchment area coverage, enhance information flow and interactions between health service providers and consumers, and train health professionals to respond to local priorities.  

One example of this type of leadership is in the Philippines, where health professional schools have found a way to both support and be supported by local government. Following devolution, the University of the Philippines–Manila School of Health Sciences (UPMSHS) recognized that mayors and other local officials were being given increasing resources and responsibilities for health care provision. At the same time, local officials had limited knowledge and awareness of the multiple health investment options available and lacked in-depth experience in developing health policy goals and plans and monitoring service provision (Tayag and Clavel 2011). In addition, under decentralized systems, the health sector often has to compete with other sectors such as education, transportation, utilities, and business development for limited local funds. Prior to devolution, health investment decisions made at the national level were made by national health experts with earmarked health budgets. Under the decentralized system, however, health investment choices were being made at the local government level by people with little or no training in making such choices or in drawing on a pooled budget for all sectors.  

UPMSHS undertook two programs. The first aimed to reduce the shortage of health workers by recruiting and training workers locally and using centrally allocated funds to provide non-tuition support and accommodations for students. The second program focused on training local officials and district health officers to make evidence-based health investment decisions. Specifically, UPMSHS developed an innovative program to bring the technical expertise of its health faculty concretely to meet the needs of local jurisdictions, assisting them in understanding the complexities of health service delivery and learning to strategize, plan, and make use of incremental resources in the decision-making process. UPMSHS designed a week-long course for mayors and other local officials, using the six health building blocks described by the World Health Organization (2007). The course sensitized participants to public health issues and used the health building blocks to guide them in preparing a health road map and plan for their jurisdiction. Roughly six months after development of the road map, the school met with the individual mayors to review the progress made. As the UPMSHS experience has shown, providing local officials with access to nearby health professional school expertise can contribute to finding local solutions for local problems and promotes needed expertise in regular health management and program decision-making processes. This concrete application of a problem-driven iterative adaptation approach has those involved engage in a self-organized search for solutions to problems in a dynamic and shifting environment (Andrews, Pritchett, and Woolcock 2012).

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