Mbarara University of Science and Technology (MUST) was established in 1989, with the explicit aim of developing a curriculum which would facilitate the interaction between the local communities, University lecturers and students, to make them more directed towards the prevailing and emerging needs within Uganda and beyond. MUST continue to tailor its curriculum towards the emerging health and health care needs and demands. Recent evidence from MSH reveals that unless Universities champion production of health managers who lead, through embracing leadership training that incorporates the challenge model, health problems and diseases will escalate to insurmountable proportions. The 2010 Leadership and Community Placement (LCP) course was implemented to pilot this new approach.
The LCP course carried out in the fourth year of study emphasises a multidisciplinary approach to understanding and addressing of health care challenges in community settings practically. The course is geared towards instilling leadership knowledge and skills essential for confronting the health challenges of the 21st Century. Students are expected to gain the essential skills and tools required for playing a leadership role in their work environment. In addition to the grounding in primary health care, community diagnosis, health systems and family medicine, students are introduced to leadership and management. A cross cutting expected course output will be ‘health managers who lead’ for effective implementation of Primary Health Care and Uganda’s minimum health care package. It is also expected that students will have developed a positive attitude towards working in rural/community placements.
The LCP Course is intended
• To introduce students to leadership and management in health and the tools required to identify the main health challenges within their area of influence
• To introduce students to the tools required to focus on priority areas for intervention
• To introduce the tools, skills and techniques required to create solid, logical and coherent action plans that guide students towards achieving measurable results
• To introduce the tools and techniques for aligning and mobilising populations to address health care challenges
• To introduce the tools, techniques and strategies for inspiring, and inspired, leadership, to address existing and future health care challenges
• To train students in communities and rural health units under conditions similar to those in which they will eventually work as qualified doctors.
• To enable students and community members to interact and learn from each other in order to appreciate each other’s role in health care and delivery.
A brief course description
A community placement is preceded by classroom-based sessions that employ interactive student-based learning methodologies, using group discussions and assignments, role-plays, case studies and to a lesser extent, lectures. The themes / topics covered include at least the following:
Theoretical and practical knowledge of scanning enables students to develop the necessary skills to understand and diagnose the current situation in health facilities and communities. This includes Leading & Managing for Results, Creating a Vision – Personal and Shared, Differentiation between a challenge and a problem, Introduction to the Challenge Model and practicing tools of scanning: Client Exit interviews, Focus Group Discussions / Interviews and Listening.
Focusing builds on the capacity of teams to focus their energy and resources on priorities and results, and analysis of gaps between desired results and current situations. The teams apply the Challenge Model in a simple process that helps them work together to move from developing a shared vision to prioritising activities in an action plan, to achieving measurable results. Students fill their first drafts of their team Challenge Models, which they refine at their selected health facilities. The sessions, tool and exercises include: The Challenge Model, Sphere of Influence, Developing Measurable Results using the SMART Criteria, Stakeholder Analysis, Diagnosing Root Causes, Identifying priorities, Distinguishing between ‘Important’ and ‘Urgent’, Scanning of / for best practices and Choosing priority interventions.
Planning, Aligning and Mobilising
Planning, Aligning and Mobilising enables students to develop the skills, as individuals and teams, on how to consolidate successes, and approach challenges that are more difficult, with confidence. In addition to increasing their ability and capacity to work in teams, students will gain an increased familiarity and confidence in using Monitoring and Evaluation (M & E) terminology. This course aspect includes the following tools, exercises and sessions: Developing Action Plans, Mobilisation of Stakeholders, Development of M & E Plans, Application of M & E to Action Plans, Coaching to support others, Gaining commitments, Roles in teamwork, Giving feedback and Making effective requests
This LCP Course aspect develops students’ understanding of and for the need to inspire other people and introduces ways to inspire. The exercises, tools and sessions applied in this module, include: Inspiring through building trust, Leading change, Leading through breakdowns, Preparing to present and Practicing presentations
Students are placed within different host communities. Particular emphasis is on the needy hard to reach areas. They also reside at and participate with host health facilities. Students rotate and participate in the health facility based activities during the mornings and participate in understanding and addressing prevailing and emerging health problems within the communities during the afternoons where applicable, guided by the course guidelines. The students are required to at least learn and understand the constraints and opportunities that retard or promote good health in the community. They appreciate that communities have the potential to identify and provide solutions to many health problems. Their work should involve, but is not limited to the following broad areas: Health Systems, Child health, growth and development, Nutrition, Communicable disease control, Environmental sanitation, Obstetric and surgical care, Use and misuse of common drugs and health education. Together with host communities, students identify and prioritise community health and health care issues. They carry out community meetings / seminars and home visits during and facilitate discussions on preventive aspects of health care. An added incentive is practicing within a Rural Health facility setting in order to understand constants of rural health and healthcare.
During the community-based activities phase, teams share with each other and with the host health-facility personnel what they learn throughout the process of implementing their Leadership Project. The course is assessed by MUST Faculty supervisors, in conjunction with Site Supervisors, who play the role of coaches / tutors to the teams and are expected to meet regularly with students, to review the LCP course content and to support progress. The MUST lecturer is expected to constantly follow up the performance of individuals and groups through writing a performance report at every visit. On finalising the community based activities students are expected to present a report, assessed by the Faculty that attracts marks that will feature prominently on the academic transcript. The coaches support student teams to prepare the final-results presentation.
LCP Course Core reading list
• Handout: Leadership Development Programme (LDP) Participants’ Handout
• MSH: Managers Who Lead. A Handbook for Improving Health Services. Cambridge, MA: Management Sciences for Health.
• On-line Support. LeaderNet, Electronic Resource Center and Health