Dr. John Opolot’s dream was to become an obstetrician-gynecologist but he did not quite get to it, however, he qualified as a clinician. For over twenty years now he has been working in rural hospitals around Soroti area and has continuously been given leadership positions but with no skills.
“Most health workers are taught the science but not the leadership skills,” says Opolot, a District Health officer, of Kumi district, a position he has occupied for the last seven years. Naturally, because of their medical qualifications, the health system elevates doctors to positions that make them team leaders at health facilities, says Opolot.
An invitation by Baylor-Uganda to attend a leadership training that fell on Opolot’s desk was not like any other, it was targeting high-level cadres who would also become mentors. Caring Togather, an innovative approach, identified the gap and paved the way to train health workers in leadership skills.
After three years the approach has resulted in a reduction in patient waiting times from 61 to 35 minutes per patient, an increase in patient satisfaction, with 61% more patients satisfied with their care says Dr. Adeodata Kekitiinwa, Executive Director, Baylor-Uganda.
There was also a drop in staff late arrivals from 27% to 20% which reflects an additional 24,000 hours per year worked by staff and at the end of the project 81% of facilities in the survey had held at least two meetings in the past three months (up from 47%) while there was also a 57% increase in facilities tracking lateness.
Developed by Baylor-Uganda, in partnership with Pepal and Janssen Pharmaceutical Companies of Johnson & Johnson, and funded by Comic Relief the Caring Together project was tested, refined and rolled out in 270 health facilities across sixteen districts in Eastern and Rwenzori regions in Uganda between 2015 and 2018 and covered a population of 4.4 million.
Its implementation involved peer-to-peer mentorship, involving 83 health care mentors in 270 health facilities, reaching 5,000 health workers and in 2,000 villages.
In addition, Janssen funded Makerere University School of Public Health to undertake parallel research study, together with Baylor-Uganda, to investigate the impact of leadership skills on health care worker motivation.
The tools used during the Caring Together Project included patient waiting cards, a team Performance Monitoring Tool, monthly staff meetings book, stock inventory management tool, as well as awards for high-performing employees.
Dr. Kekitiinwa says Caring Together addressed operational gaps in leadership through training frontline health workers as mentors in key leadership competencies like time management, teamwork, and communication skills leading to better service delivery and more satisfied patients.
“I am most proud of the district healthcare mentors. They embody the sustainability of driving the programme forward,” says Julie Saunders, Executive Director, Pepal.
“We are all proud of the outcomes. We have something to show that there is an impact,” says Dr. Wim Parys, R&D Head of Global Public Health, Janssen Global Public Health
The mentors like Opolot were trained and empowered to deliver leadership training at their allocated health facilities, says Michael Musiime Koima, the Project Manager, of Caring Together Baylor-Uganda.
He says the mentors, in turn, taught these skills to their peers at allocated health facilities, creating an empowered and efficient health workforce in the two regions. As well mentors also established long-term mentorship relationships with mentees centered on action plans for improvements staff can make in their own facilities.
“We wanted an empowered, motivated and accountable frontline health workforce, with the skills to adapt to the challenges of an under-resourced health system,” says Musiime. He says 97% of those trained believe that their team performance improved.
“It did not mean anything to me until we got into sessions and started doing small things that made a difference,” says Opolot who attended the training in his area district in eastern Uganda.
After the training Opolot realised that the facilities in Kumi and his team had improved service delivery in the areas of; teamwork, time management, resources management improved, there was regular communication, continuous quality improvement, easy resolution of conflict as well as appreciation and rewards.
Dr. Richard Obeti, District Health Officer, Bunyangabu, District was a qualified medical doctor who also found himself in leadership by chance.
“Caring Together introduced the concept of leadership in health workers. As time went on I found unique things like clear measurable indicators, flexibility, and now I know that you can adjust to the people you serve,” said Dr. Obeti. “It is a very unique and sustainable,” he said.
In another setting, the people who attend Katooke health center III were adjusted to open on time and the patients were assured of finding health workers at their duty stations. “It is different now at the health center. We come early and leave early to go farming,” says Cathy Nyangoma who lives and attends Katooke health center III.
“We work as a team. We also resolved that our patients will report early and leave early. You cannot be at home at 8.30 am when patients are waiting, said Martin Businge Holden, a senior Clinical officer and the in-charge at Katooke health center III in Kyenjojo district.
As a result of implementing what he learned from the Caring Togather project the patient retention at Katooke is 90% and the team stands by their motto of ‘work early and leave early’. This model is also perfect not only because their clientele is farmers but also because 83% are children who depend on care takers for their health needs.
As a result of the success of this project, government officials have assured that they will take it up and strengthen Uganda’s healthcare system.
Sarah Opendi the State Minister for Health, in charge of General Duties, says based on lessons from the Caring Together Project the vices such as late coming and early departure from duty, negligence of duty, inappropriate facility duty rosters and off-duty guidelines would be stamped out.
Studies done on Uganda’s health system show that absenteeism of health workers costs the government of up to 40% of their time of employment.
Opendi says this innovation from Baylor-Uganda which has culminated in the formation of a Health Leadership Academy would be used for admission criteria, harmonization of the fees structure with the Ministry of Health, the Ministry of Education and Sports and National Council for Higher Education among others.
“I want to assure all of you that Government will put this valuable contribution to great use because these outcomes are going to enrich our Ministerial Policy statement especially on Human Resources for Health,” says Opendi.
The Baylor-Uganda leadership academy that will train health workers in leadership was launched at an International Summit on Leadership in Healthcare.
“Age has caught up with me but hopefully now that this Baylor leadership Academy has started I can enjoy quality health care services during my retirement,” said Opolot.
