Over the last eight months, whilst the world has been tackling the emerging threat of COVID-19, thirty participants in UGHE’s Executive Education Global Health Delivery Leadership Program (GHDLP) have been busy implementing their Breakthrough Projects; projects designed to address a variety of health systems challenges and in doing so, improve the health and wellbeing within different country contexts. Hailing from seven Francophone African countries, participants took part in a two-week intensive residency in February this year, where they learnedt, through the expertise of their program faculty on UGHE’s Butaro Campus, personal leadership development, effective team strengthening, and program management with a focus on applying frameworks for effective interventions and designing innovative solutions to complex health care delivery challenges. Now, in October, participants and their coaches look forward to next month’s GHDLP 4.0 reconvening, where they will share their knowledge gained from the breakthrough project process across the different country groups, present their projects, receive feedback from their peers and coaches, and graduate from the program. 

Dr. Anatole Manzi, PIH’s Deputy Chief Medical Officer in charge of Clinical Quality and Health Systems Strengthening and Partners In Health and UGHE Faculty, is one of the core program faculty and coaches. In his role, Dr. Manzi has, in his own words, been a ‘listener, catalyzer and helper’ to three GHDLP country groups – Central African Republic, Guinee, and Congo – supporting the development of their respective breakthrough projects and providing an expert sounding board for their line of thought. He speaks to us about the impact of COVID-19 on the scope of these group projects, how each group is applying the skills absorbed whilst on Butaro Campus, and what he himself has learnt from his experiences working on the equally ambitious, yet notably unique, projects of each country team. 

Q. What has your role as a GHDLP faculty been throughout the project development – from the initial two week intensive kick-off to the it’s culmination in the reconvening?

My role has split into three key parts. Firstly, it has been as a listener, secondly as a catalyst, and thirdly as a helper. I’ve realized throughout the scope of these projects that a listener is critical for leaders to have. I would receive calls or Whatsapps from program participants saying something along the lines of ‘Hey do you have a second?’ and I took this as a sign that they wanted to run an idea, or piece of new thinking past me. I was a catalyst in the sense that, whilst all the groups had plenty of great ideas, they needed someone to help process this thinking and support them in the decision making process. As a helper, I acknowledged how much time they had – which was limited – and supported them with timelines, and suggestions for how best to package the information they wanted to put forward.

Q. How have the three country groups you support – Central African Republic, Guinee, and Congo – leveraged the learnings from the two week GHDLP kick-off to develop their breakthrough projects?

That initial intensive kick-off in Rwanda was really an entry point for any development that these teams had within their respective Breakthrough Projects. It’s so impressive to see them using the language we taught them on how best to tackle problems. Not only language, but also the tools we equipped them with during those two weeks. I could witness the skills and knowledge they’d acquired working together to help shape their project and their own development as health leaders. One example was when I was discussing the project approach with one country group, and they came up with a thorough theory of change; this was a tool I’d taught in one of the kick-off sessions, and one that they might not have had in their routine practice and decision making. They really brought forward a number of leadership and strategic problem solving skills – all concepts that had come from the two weeks. So their residency in Butaro was a both a foundation and cornerstone of any progress that they’ve made since in identifying, prioritizing and tracking problems in a strategic way, and using evidence successfully.

Q. How has the COVID-19 pandemic affected the scope of the ‘Breakthrough’ projects from each country group? Has the direction/ ambition changed, and how has social distancing affected or innovated the capacity to do group work?

In a word, yes – it has affected the scope of all their projects. The country teams were really ambitious with the plans they had, but COVID-19 was a barrier to overcome. For example, within the first two meetings I had with one country group, the participants were very active, but within the third, I found out one member had been appointed to join their national command center for COVID-19 response. It was a great opportunity, but I knew it would be problematic for the group work ahead.

COVID-19 affected the team-based approach to these projects; the fact that they couldn’t meet any time they wanted, but also how it affected their financial support. Most of these groups were expecting to have some level of funding support from their countries or partners, but due to COVID-19 there was an inevitable reallocation of resources to support the national pandemic response efforts. Some of the breakthrough projects have been more affected than others. Projects that relied on someone else’s decision. If you were to apply for an ethics approval, but some members of that committee are not available as on COVID-19.

Having said that, I’ve also witnessed some amazing creative adaptations that the different teams adopted to ensure the scope of their projects could continue within the context of the pandemic. One country group adapted their project by limiting the geographic approach to their research, and applying the lessons learnt to the wider country context. So COVID-19 in a way has provided them another critical skill; that of creative thinking. Each group has been addressing one of the top country’s public health priorities. Congo has been focussing on timely detection of HIV in pregnant women, Guinee on increasing HIV testing among children born to HIV positive mothers, and the Central African Republic focussed on assessing the quality of malaria case management among under five children in COVID-19 context.

Q. What new things have you yourself learnt from helping the groups analyze and advance detection and testing of HIV, and malaria prevention in children?

I’ve learnt a lot from the design and implementation standpoint from the different country groups and this process of developing the Breakthrough Projects with them. But what has stood out to me is the different countries’ response to the areas we were focussing on. I was fascinated to learn more about how different countries keep essential services like malaria diagnosis and treatment and HIV-related services going when resources are being strategically reallocated towards pandemic efforts. There is so much to learn from looking at how innovative each country is in the way they tackle malaria and HIV, using local resources and the community around them. Every country context I looked at was unique – and so through this diversity I learnt more about adapting interventions to local resources and settings.

Another lesson I learnt around patience. Seeing how patient the country groups were with their projects given all the changes and barriers they were facing during COVID-19 was great, and I watched them strategically and collaboratively persevere with their projects as a team.

Q. In your many years of experience as an implementation scientist, and your positions within PIH cross-site Director roles, how has your career path directly helped shape the development and learning of the groups you coach over the last eight months?

I wouldn’t have been helpful to these groups if I didn’t have the lessons I’ve learnt and continued to learn within my career. A lot of what I’ve shared with the country groups is different from the traditional academic approach. These are tools validated through the implementation of health systems strengthening programs in ten countries supported by Partners In Health over the past fifteen years. I’ve always been interested in the quality of health services, how we build mentorship programs, and how we not only build skills and knowledge, but invest in sustainable and meaningful change. The traditional approaches rely on transferring knowledge, and yet there is no way to know if the knowledge is translated into practice. Consequently, I was careful with my interactions with the different teams. Theoretically, one can learn the assessment techniques and tools. However, the practice “the know-do” is not always easy. For me, learning directly from patients and health workers, experts in different areas of public health prepared me to share practical experience. have had the opportunity to work with all levels of the community health system centrally and internationally, which gives me a unique perspective in how I approach coaching.

As an example, I gave the Central African Republic group feedback to try, within their research to speak directly with the health leaders from districts and provinces, as well as the patients and community health workers. I wanted to ensure that they are involving patients and beneficiaries in a participatory approach. For example, you cannot know the reasons why some women are not being tested for HIV in Congo by just asking the clinicians and leaders. You need to speak with the community. This applies also with the group working on malaria; you need to know the traditional healers and community health workers are doing.

Find out more about UGHE’s GHDLP program here, and stay tuned for updates on the November GHDLP reconvening.