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Developing managerial skills for better mother-child healthcare delivery

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Dr M Hafizur Rahman :
In today’s Bangladesh, newborn babies and their mothers have better chances of surviving than in decades past. Our country has made remarkable strides toward better health for mothers and children: babies born this week are far more likely to celebrate their 5th birthdays than babies born just a few decades ago. But amid nationwide successes in reducing deaths among children under 5 and among their mothers, the rate of neonatal mortality - deaths of Bangladeshi children during their first month of life - remains an enormous concern. The first month of a baby’s life is, statistically, the riskiest; more than half of all deaths of Bangladeshi children under 5 years of age occur within that first month of life.
We know that connecting pregnant and new mothers with home- and facility-based newborn care services, especially delivery in hospitals by trained medical staff, is a vital step toward our goal of helping all mothers and babies survive. Today, Bangladesh's hospitals and clinics offer more and far better childbirth services. Yet most expectant and new mothers don't use these services; only about one of every three births occurs at a hospital or clinic. Connecting families with care services is the mission of Ministry of Health and Family Welfare (MoH&FW). Its district and upazila health and family planning programme managers are  doctors who not only see and treat patients, but also oversee  staffing, supplies and the organization of a wide range of essential health services. To do all this well, they need the skills and abilities of modern managers, in addition to the skills and specialties they learned in medical school when they became doctors. Yet it’s typical for a doctor to become a community health manager after getting an excellent medical education, but no preparation for leadership.
Believing that health managers who improve their leadership skills can then improve mother and child survival outcomes, the MoH&FW has been keen to develop leadership and managerial capabilities of its doctor-managers. UNICEF, which has been working in Bangladesh for many years to improve child health, supports MoH&FW in these efforts and formed a team with Bangabandhu Sheikh Mujib Medical University (BSMMU) and the Johns Hopkins Bloomberg School of Public Health (JHSPH) in the US to develop such a training programme for local health facility managers. I have been leading this project, which will run through 2017. We will offer this training programme to doctor-managers who work in hard-to-reach areas of the country where management resources are especially scarce. Doctor-managers of local hospitals, clinics and family planning centers will be sensitised to the challenges to ‘do things differently,’ identifying opportunities and finding creative solutions to bring high-quality health services to more mothers and children.
Our training programme will not only do classroom training but also will have training and monitoring in the field with supportive supervision, and refreshers training with post training follow up  and problem solving.
Our goal in training local health and family planning managers in these skills is to enable them to lead, as planners and actors, in offering health services that reach more mothers, newborns and young children. More accessible, more user-friendly health services for these women and children will help bring better health and lower rates of death in hard-to-reach districts of Bangladesh.
The abilities to lead people and plan activities are the building blocks of good management. Managers with these abilities can make a big positive difference in the health of communities served by the facilities they manage.
Doctor-managers who learn and practice these abilities to take initiative in collaborations with workplace colleagues and community members to plan and carry out local solutions of local problems - all these capabilities are expected of a manager. Training to be an effective leader is just as important to success as training to be a physician.
The cost of these collective leadership shortcomings is heavy across Bangladesh. Although national health policies and programmes are carefully designed with the best intentions to improve the quality of life for families and children, they cannot fulfil their goals when persons who lack strong management skills are responsible for implementing, managing and monitoring the programmes. Without professional leadership skills, the local manager of a health programme may not be equipped to steer that programme and ensure good results it was designed to produce.
Bangladesh’s health facilities operate with limited physical, financial and human resources, yet expectations are high that facility managers will lead programmes and operations    so they make a difference in achieving better health outcomes. n
(Dr M Hafizur Rahman, MBBS, MPH, DrPH, is a faculty member in the Department of International Health, at the Johns Hopkins University Bloomberg School of Public Health, USA)  

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