“I Made Some Changes”: A Nurse/Midwife’s Experience with Leadership and Management Training
This post originally appeared on the Maternal Health Task Force blog as part of the “Supporting the Human in Human Resources” blog series cohosted by the Maternal Health Task Force and Jacaranda Health.
“Things were really a bit appalling.”
That’s what conditions at her rural health center felt like to Habiba Shaban Agong, a senior nursing officer and midwife in Uganda.
She says she loves her profession. “In midwifery I do a lot,” she adds proudly. “I help mothers in carrying out their pregnancies. During deliveries I help them to conduct live babies—to make a better future.” But it pained her that her facility wasn’t able to deliver the high quality of services the community deserved.
For starters, there weren’t nearly enough health workers to meet the demand. Each department had only “about one human resource working day and night,” Habiba says. “They get exhausted, and that can hinder service delivery.”
And there were other challenges. The facility wasn’t well maintained, water was unreliable, waste wasn’t segregated. There wasn’t adequate equipment in the wards. Beds were broken and too few in number, and mattresses were torn. “As a patient, you wouldn’t like to stay in a dirty environment,” Habiba points out. Many staff arrived late or didn’t show up at all.
The district health officer recognized Habiba’s potential. “He thought I was one of the health workers who could go for training in leadership and management,” she says.
Habiba joined several others to form Dokolo District’s team in the Human Resources for Health Leadership and Management Program, intended to strengthen Uganda’s decentralized health systems. Two USAID-supported projects led by IntraHealth International—the Uganda Capacity Program and the global CapacityPlus project—delivered the program in partnership with the Ministry of Health.
Teams from 19 priority districts were guided in identifying challenges, selecting priorities, developing action plans, and implementing the plans at their sites. Everyone came together for three one-week workshops over a six-month period and supplemented this work with field assignments. Instructors provided coaching support between workshops, and participants built skills in such areas as health workforce planning, recruitment, deployment, performance management, retention, teamwork, and advocacy.
“When I came back,” Habiba recounts, “I made some changes.” For example:
- Infection control measures were implemented.
- A system for segregating waste was set up.
- A new incinerator was purchased.
- Facility maintenance improved.
- Her supervision became more supportive, and discussions with staff helped decrease tardiness and absenteeism.
- Small rewards, such as a chicken, are regularly given to selected staff to demonstrate appreciation and increase their motivation.
Prenatal and antenatal visits are increasing, and the number of deliveries is going up. “We used to get only about five or ten patients [per month] who delivered in our facilities,” says Habiba, “but last month we got more than 60 deliveries!” And child mortality is decreasing. “In the pediatric ward, during the last three months we have not observed any death at all.”
Habiba is also happy that the Ministry of Health’s successful advocacy convinced Parliament to allocate $20 million to recruit more health workers. Dokolo District benefitted by getting 36 new health workers and raising its staffing level from 49% to 84%. The district rose in the national rankings for health service delivery, from 57 to 11 in the country.
Empowered health workers can improve maternal and child health, one facility at a time. To read other participants’ perspectives and learn about recommendations for adapting the leadership and management program to other contexts, read the related publication. And meet Habiba in a short video, “That’s Improvement!”: Uganda Focuses on Health Workers.
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Photo 1 by Trevor Snapp, courtesy of IntraHealth International (Sarah Dwyer); photo 2 by Carol Bales (Habiba Shaban Agong); photo 3 by Sarah Dwyer (Habiba and a client with newborn twins)
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