Leadership and HR Systems Strengthening The Nicaragua experience

							Leadership and HR
Systems Strengthening:
The Nicaragua
experience




Elena Décima, LMS Program, MSH
April 2004
World Health Conference
INTRODUCTION




This presentation will focus on the work
  MSH is and has been doing in
  Nicaragua, where leadership has
  been used as the key to address
  many of the challenges faced by the
  health sector, using a systems
  approach.
     Three elements of HR strengthening




• The HRH Framework
• The Systems Approach
• The Leadership Model
    Systems approach
.
HRH Technical Framework
Leading and Managing Results model
             THE CHALLENGE MODEL: stage I

• Methodology      • Leadership dialogue.


• Dialogue         • Participants (Minister and high level
                     Directors) identify a challenge and
                     leadership competencies

• Challenge        • To arrive to a Health Care Model which
                     would integrate well with the Strategic
                     Plan.
                   • The competencies selected were Change
• Competencies       Management, Systemic Thought,
                     Communication and Negotiation
             THE CHALLENGE MODEL: stage II

• Dialogue         • Participants (representatives of all the
                     areas of the ministry) identified a second
                     challenge and leadership competencies

• Challenge        • To produce a proposal for restructuring/
                     modernizing the Ministry of Health.


• Competencies     • The competencies selected were
                     systemic thought, negotiation, change
                     management and some technical
                     competencies (results-based budgeting,
                     critical path design, etc.)
               RESTRUCTURING of the MOH


• Mission and vision reviewed
• Systems identified
• Processes of each system (with their
  procedures, activities, norms) defined
• Human resources identified (staff needed,
  job descriptions and profiles, work loads)
• Manuals produced for each system
• Critical paths identified
• Implementation plan drawn
              NICARAGUAN PROGRAM RESULTS


1. Human resources management
   - A redesigned Human Resource System at central level
   - Staff concerns and issues heard: staff surveys of personnel
     conducted
   - Needed human resources identified, new jobs created, job
     descriptions and profile defined, union negotiations conducted.



2. Policy
   -   New Health Care Model approved
   -   New health policies
   -   Chapter 9 of Law 290 revised to approve the restructuring of
       the MOH
               NICARAGUAN PROGRAM RESULTS


3. Finance
   - Results-based budgets and planning, which are expected to
   promote a more fair evaluation of staff performance
   - Beginning to work with Ministry of Finance on results-based
   budgeting and planning, which if approved would become a national
   policy


4. Education
   - Entrust the HR Division with human capacity development in
     coordination with the training institutions
   - Insure that this HR development responds in quantity and quality
     to the needs of the health sector
                NICARAGUAN PROGRAM RESULTS



5. Leadership
   - Leadership competencies have been developed
   - Three Leadership programs have been conducted with MOH
       personnel, one at the municipal level and the other two
       associated with the challenges here described.
               LESSONS LEARNED

• Systemic changes are “non-linear”, slow processes and at
  times results are scarcely visible.
• Communication at all levels and at every step is very
  important
• Labor unions and labor conflicts are a hurdle and have an
  impact
• Technical assistance must be present at both the
  operational and policy levels
• The participatory nature of the process is a key to the
  success of the program; counterpart ownership is
  indispensable
• Donor collaboration benefits the program
Closing the gap between

what is known about public health problems

                          and what is done

                          to solve them