better systems, better health
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Strategies that Work Exploring the impact of Health Systems 20/20 worldwide
Revitalizing the Kinshasa School of Public Health by Building Capacity In 2008, Health Systems 20/20 partnered with the Kinshasa School of Public Health, at the request of USAID, to boost their organizational capacity and increase scholarship support for Master of Public Health (MPH) students and also for graduate assistants’ doctoral studies. Founded in 1984 with USAID funding, KSPH offers an MPH program with three focus areas – health management, health economics, and bio-ethics. KSPH is part of the University of Kinshasa, operating under the Faculty of Medicine, and currently has 69 full-time students as well as 12 professors, 30 graduate and research assistants, and 44 administrative staff members. KSPH provides two invaluable services to the Democratic Republic of Congo’s (DRC) public health sector – training public health leaders and carrying out research that is essential to health systems strengthening. A five-person management committee oversees the school, and its members are named for three-year terms by the Minister of Higher Education. An initial organizational assessment found the school lacked standard operating procedures and had weak financial systems. The school’s finances, for example, were tracked intermittently on a Microsoft Excel spreadsheet by the accountant. Indirect costs from research contracts were kept by the individual projects and not contributed to the school itself. In addition, the school’s management did not have a complete list or copies of current contracts. As is common in developing countries, frequent electrical outages left the school without power and interrupted classroom presentations. The Internet connection was so poor and unreliable that professors often travelled into the city center, about an hour away, to check their e-mail. Finally, at that time, the Management Committee met only intermittently to discuss mostly routine matters.
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The biggest change from Health Systems 20/20 was due to getting everyone at the school involved. This was very important because people could speak out and share their mind, get at the issues. Also, the leadership workshops put people together from different levels. They talked to one another. Everyone’s opinion was very important. They spoke as equals, and this felt good. As a result, people felt like a team, had a sense of ownership, and became committed to the school.
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Dr. Patrick Kayembe, Dean, Kinshasa School of Public Health
Comprehensive Strengthening Between 2008 and 2012, Health Systems 20/20 collaborated with KSPH on a variety of activities aimed at broad-based institutional strengthening. This assistance included developing a succession plan for the next generation of faculty, increasing the number of women in the MPH program, strengthening leadership and financial management skills, improving information technology capacity, building resource mobilization capacity, procuring critical resources, and revising the MPH academic program. The goal of this comprehensive approach was to revitalize the school so it could carry out its core academic and research functions more effectively. The MPH academic curriculum, for instance, had changed little in over 20 years, and did not reflect current thinking in key areas such as the importance of social and behavioral foundations. Health Systems 20/20 found that it took almost a year to begin to affect the kind of change needed in the school, but by the second year, the momentum was built and meaningful progress began to occur. A fourth year was added to complete the work underway. In particular, KSPH faculty and leaders cited the value of participatory workshops as playing a key role in establishing a foundation for real organizational change. See Table 1 for summary of the results. A combination of local consultants and organizations implemented most of the activities including those related to financial management, resource mobilization, information technology (IT), and local coordination. Strong NKV, a Congolese audit firm, strengthened KSPH’s financial management capacity and the American University of Beirut assisted in reviewing and revising the academic curriculum. An organizational development expert acted as team leader to ensure all the various activities were integrated and complementary.
What Works in Building Organizational Capacity? After nearly four years of collaborating with KPSH, Health Systems 20/20 has learned what works well when strengthening an organization so it can contribute to improving its country’s health system. yy In a fragile state such as the DRC, staff are less concerned with the collective well-being of their organization and more concerned about their own personal livelihood, including their salaries. Health Systems 20/20 did not attempt to change the existing incentives, but instead focused on increasing opportunities for faculty and staff by expanding the number of research projects and ensuring involvement of young faculty in those projects.
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The leadership workshops came at an extremely low point in faculty relations. The workshops allowed graduate assistants to express their frustrations. Even though we had arguments and expressed strong feelings, the fact that we had the exchange created a team spirit and made us realize we needed to stick together.
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Fulbert Kwilu Nappa, former graduate student and now Deputy Director, KSPH
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Table 1. Improvements in KSPH’s Organizational Capacity Result Cohesive leadership team that provides overall direction and takes responsibility for KSPH’s long-term institutional health Improved financial sustainability
Measures of Progress • Management Committee focused on strategic issues • Guiding coalition and action teams established to expand leadership beyond the Management Committee
Strengthened internal management systems
Next generation of KSPH faculty in place and given increased responsibility Number of women MPH students increased Improved KSPH infrastructure so it can function more efficiently Updated MPH program to be responsive to needs in DRC and better aligned with international standards Administrative services more efficiently provided and at lower cost
• Justifiable indirect cost rate established, indirect cost rate policy approved by KSPH, and $147,000 in indirect costs collected in first 14 months after policy adopted • Resource mobilization plan developed and aligned with national health development plan • KSPH business development center created • IT infrastructure in place and functioning that provides a network, secure system, and Internet access • KSPH paying recurrent costs of IT maintenance and Internet service provider • Financial management policies and procedures established and followed • Automated financial management system in place and utilized • KSPH budget established and being utilized to guide financial decision making • Three new professors, supported by USAID, completed PhDs, joined faculty, and took on leadership responsibilities. A fourth is expected to complete his PhD and join the faculty in 2012 • Mentoring program for junior faculty in place • Eligibility criteria, recruitment, and selection process revised to increase opportunities for women • Number of women increased from an average of 4 to 9 per year or 32 women out of a total of 99 MPH students supported by USAID over 4 years • Basic equipment in place and functioning, e.g., generator, copiers, projectors, minivan, and IT system • MPH program restructured with a common core and three concentrations • New syllabi developed that are benchmarked to international standards • Curriculum being phased in during academic years 2011-12 and 2012-13 • Improved supervisory skills of section heads • Job descriptions created • Procurement policies document created
yy In an academic institution, such as KSPH, where professors have a high degree of autonomy and little accountability, there is limited incentive to devote much time to managing the school. Professors are not held accountable in ways usually found in other types of organizations. KSPH faculty members who serve on the Management Committee typically have no background or training in management, leadership, or administration. Health Systems 20/20 addressed this by expanding leadership opportunities, coaching, and leadership and management training. yy Many lessons were learned about the institutional strengthening process itself, including: establishing mutual trust between the consultant and the client is critical to bringing about lasting change; an internal champion, such as the dean, is essential; mutual reinforcement of different interventions increases impact (e.g. indirect costs cannot be determined without an accurate accounting system, which in turn, depends on a functioning IT system); providing
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tangible improvements enhances credibility and builds support; and the organizational development specialist plays a unique role integrating the various interventions.
Strong Momentum While much has been accomplished, KSPH’s institutional strengthening process is not yet complete. The academic program changes still need to be fully implemented, the school’s Business Development Center is still in its infancy, the financial management system needs additional strengthening, and more new faculty will need to be developed to replace older professors as they retire. The school’s much improved morale or esprit de corps, however, provides a strong foundation for the school to continue progressing in its institutional development. As the newly named Dean, Professor Antoinette Tshefu, said recently about Health Systems 20/20 activities, “The work was extremely important and moved us towards the future and helps us compete in today’s more competitive world. We have not only consolidated what we already do, but we are more able to grow and extend our reach.”
Looking Ahead At this time of global economic uncertainty, health systems should be even more efficient and, increasingly, are asked to provide more services with fewer resources. To meet these challenges and build sustainability, Health Systems 20/20 collaborates with our partners to assess their health system, identify its strengths and weaknesses, and then choose the most effective strategies and tools to build a more effective health care delivery system. We recognize that each country’s story is unique. Our staff combines expertise and flexibility to craft solutions that strengthen individual health systems and eliminate barriers to the use of priority health services, such as for HIV/AIDS, tuberculosis, reproductive health, and maternal and child health care. Strengthening health systems is a process, not an outcome. Since 2006, Health Systems 20/20 has worked hand-in-hand with our partners in 50 countries to cultivate and grow the next generation of health leaders. While each country will progress at its own pace, depending on its health care needs, resources, and leadership, our goal remains the same everywhere – healthier men, women, and children.
About the Better Health Systems: Strategies that Work Series The Better Health Systems briefs explore Health Systems’ 20/20 strategies and tools, why they work, and how they contribute to better health systems. Collectively, the series will distill valuable lessons learned in an effort to share the project’s wisdom with our partners and colleagues. For more information, please visit www.healthsystems2020.org. Recommended citation: Rosensweig, Fred. May 2012. Revitalizing the Kinshasa School of Public Health by Building Capacity . Brief. Bethesda, MD: Abt Associates Inc. Photo credit: Abt Associates Inc. staff About Health Systems 20/20 Health Systems 20/20 is USAID’s flagship project for strengthening health systems worldwide. By supporting countries to improve their health financing, governance, operations, and institutional capacities, Health Systems 20/20 helps eliminate barriers to the delivery and use of priority health care, such as HIV/AIDS services, tuberculosis treatment, reproductive health services, and maternal and child health care. Abt Associates Inc. leads a team of partners that includes: | Aga Khan Foundation | Bitrán y Asociados | BRAC University | Broad Branch Associates | Deloitte Consulting, LLP | Forum One Communications | RTI International | Training Resources Group | Tulane University School of Public Health
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www.healthsystems2020.org info@healthsystems2020.org Abt Associates Inc. www.abtassociates.com 4550 Montgomery Avenue, Suite 800 North, Bethesda, MD 20814