Country Programs
The SMDP follow-on program includes supervision and assistance over the course of three to five years following MIPH graduation to develop in-country program sustainability.
Botswana - Since 2000, SMDP has been working with the Botswana Ministry of Health to reduce HIV/AIDS by strengthening the management skills of local health workers. To date, there are ten MIPH alumni in Botswana, five of whom work for the Institute of Development Management (IDM).
Cambodia - Cambodia's Ministry of Health has set a priority of promoting integration of categorical disease programs such as tuberculosis, malaria, and HIV/AIDS.
Côte d'Ivoire - Building on the foundation provided by two Projet RETRO-CI staff who attended the MIPH course, GAP is integrating management training into the national public health system.
Croatia - "Healthy Counties" program is launched across this Eastern European country, based on SMDP's Healthy Plan-it™.
Egypt - In 1998, SMDP began working with the Egyptian Field Epidemiology Training program (FETP) within the Ministry of Health and Population (MOHP). Three FETP staff and a WHO regional advisor on women’s health have completed SMDP’s MIPH course.
Guam - Collaboration with Guam began in 2000 when a health and nursing consultant from the University of Guam (UOG) Micronesian Health and Aging Studies attended the MIPH course.
Haiti - In 2003, the Global AIDS Program (GAP), in collaboration with USAID, began supporting the rapid start-up of a nationwide network of 40 centers for voluntary counseling and testing (VCT) and treatment to prevent mother-to-child HIV transmission.
India - In 2002, the 2001 MIPH graduate from India conducted the first management training program launched here. The program currently has more than 75 graduates from all over the world who are trained in Total Quality Management, change management, and various technical eye care topics.
Indonesia - Tailors two Healthy Plan-it™ courses, one for national-level managers, and a second one for the heads of provincial and district health offices in Indonesia.
Jordan - SMDP assisted in carrying out a Total Quality Management (TQM) workshop jointly sponsored by the Eastern Mediterranean Regional Office (EMRO) of the World Health Organization, and the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA).
Macedonia - SMDP’s partners in Macedonia are the Foundation Open Society Institute Macedonia (FOSIM), the Faculty of Medicine, University of St. Cyril and Methodius, Skopje, and the Macedonia Ministry of Health.
Malawi - SMDP’s partners in Malawi include GAP Malawi, the National TB Programme (NTP), the Malawi AIDS Counseling and Resource Organization (MACRO), and the Infection Control Program (ICP) of the Ministry of Health. To date, 10 trainers from Malawi have graduated from the MIPH course.
Mexico - SMDP’s partner in Mexico is the General Directorate of Epidemiology (DGE), Ministry of Health. MIPH graduates from Mexico developed a training course, launched in August 2002 and targeting Spanish-speaking public health professionals across Latin America.
Nicaragua - In 1997, SMDP began collaborating with CARE-Nicaragua to enhance its management training capacity in the health sector.
Nigeria - From 1996 to 2001, 450 public health workers were trained from 33 states in TQM through a program with the Carter Center River Blindness project in Jos State, Nigeria.
Northern Mariana Islands (CNMI) - SMDP began its public health capacity-building efforts in the Commonwealth of the Northern Mariana Islands (CNMI) when two public health professionals from the Department of Public Health (DOH) in Saipan attended the MIPH course in 2000.
Pakistan - SMDP began working with the Pakistan Ministry of Health in 1992 and with the Aga Khan University in 1999.
Philippines - SMDP began working with the Philippines Department of Health (DOH) in 1994 to strengthen the management capacity of local public health workers. Currently, the 20 MIPH alumni in the Philippines work at the national- and regional-level health offices and with NGOs.
Serbia - Since 2004, SMDP has partnered with the Centre School of Public Health at the University of Belgrade, School of Medicine, and the Open Society Institute (OSI) in Serbia to implement a three-year community health development project.
Taiwan - SMDP has been working with Taiwan’s Bureau of Health Promotion (BHP) since 1997 to strengthen public health management training capacity. To date, Taiwan has 12 MIPH graduates including several from the BHP and the Taiwan Center for Disease Control.
Thailand - In 2004, officials from the Thai National Institute of Health (NIH) and the Ministry of Public Health (MOPH) expressed interest in establishing a management training program modeled on the Philippines Laboratory Management Training Program.
Uganda - SMDP partners in Uganda include GAP Uganda and the Institute of Public Health at Makerere University (IPH).
Vietnam - In 1995, SMDP began training public health faculty in Vietnam. To date, 25 participants, including 8 faculty members from the Hanoi School of Public Health, have completed the MIPH course.
Zambia - SMDP’s partners in Zambia include CDC’s Global AIDS Program (GAP) in Zambia and Zambia’s Central Board of Health and Ministry of Health.
2006 Country profile updates
Botswana
Since 2000, SMDP has been working with the Botswana Ministry of Health to reduce HIV/AIDS by strengthening the management skills of local health workers. To date, there are ten MIPH alumni in Botswana, five of whom work for the Institute of Development Management (IDM). IDM is a regional NGO that conducts training and research in Botswana, Lesotho, and Swaziland.
In June 2003, IDM held a management workshop in Gaborone for 15 HIV/AIDS program managers from nine cities in Botswana, each of whom carried out an applied learning project. Organizational affiliations of the 19 participants included NGOs, governmental agencies, Tebelopele HIV Voluntary Counseling and Testing Centers, and clinicians. The workshop faculty included MIPH alumni assisted by SMDP staff members. The 2-week curriculum included sessions on Total Quality Management (TQM), team building, leadership, Healthy Plan-it™, effective presentation skills, patient flow analysis, and monitoring/evaluation. After this 2-week session, participants returned to their worksites and formed teams to address HIV/AIDS-related problems. They presented the results of these projects in November 2003 at the end of a final workshop that also covered budgeting, marketing, and project management.
In 2004, a second cohort of program managers proceeded through the management training cycle, including an initial 3-week workshop, applied learning projects, and final course week with presentations, with 12 applied learning projects completed that supported improvements in HIV counseling and testing, care and treatment of HIV/AIDS and opportunistic infections, laboratory practices, and health information systems. Teams in the first two years completed 29 HIV/AIDS-related applied management learning projects.
In 2005, a third cohort of program managers was trained in management during a two-week workshop conducted primarily by IDM consultants and MIPH alumni with minimal assistance from SMDP. Participants included laboratory technologists, pharmaceutical technicians, social scientists, nursing practitioners, informatics specialists and NGO staff members. Participants implemented 18 applied management learning projects that improved organizational performance in such areas as decreasing patient waiting time for prescriptions at a hospital pharmacy, increasing the number of HIV counseling sessions held, improving turnaround time for specimens in a hospital laboratory, improving sputum collection from tuberculosis patients, and improving adherence to treatment among mentally ill patients in a government hospital.
SMDP’s partners in Botswana include BOTUSA, a collaborative effort between CDC-GAP and the government of Botswana to combat HIV/AIDS, and the Institute of Development Management (IDM), a regional organization that conducts training, consulting, and research in Botswana, Lesotho, and Swaziland. BOTUSA employs one MIPH graduate; IDM, five, and the Ministry of Health, two. BOTUSA, IDM, and SMDP are working together to strengthen the management skills of public health program managers and staff in Botswana. With BOTUSA sponsorship and technical assistance from SMDP, IDM coordinated management training workshops in both 2003 and 2004.In August 2006, SMDP staff provided technical assistance to MIPH course graduates in facilitating Total Quality Management process improvement as part of a two-week workshop to begin the fourth management training cycle in Botswana. Attending the workshop were 20 participants from the Ministry of Health, the Ministry of Local Government Service Management, the Botswana Defense Force, two Tebelopele Voluntary Counseling and Testing Centers, and three other NGOs. The MIPH graduates in October 2006 began to facilitate a fifth complete management training cycle, and plans are for project presentations and graduation for both cycles to occur in the spring of 2007.
Also in 2006, IDM received institutional accreditation from the Botswana Training Authority (BOTA) and is now working toward receiving accreditation for individual courses, including the public health management courses based on the MIPH course curriculum. The accreditation requirements will also apply to IDM programs in Lesotho and Swaziland through the Southern African Development Community (SADC) requirements.
IDM is also registered with the Botswana Tertiary Education Council (TEC). With BOTA accreditation, IDM will provide a more institutionally sustainable program that encompasses more flexible delivery models and greater value to participants and organizations because of its accredited status and ability to provide certification to participants.
Projects
Applied management improvement teams in Botswana completed eight projects in 2006. Eight more are still ongoing and will be completed early in 2007. Two examples are below.
On average, more than 60% (11/19) of infants 6 weeks old in the Kang Clinic who had been exposed to HIV were started after the recommended time on cotrimoxazole (CTX) for pneumocystis carinii pneumonia (PCP) prophylaxis, thus putting them at risk of developing PCP. The Kang Clinic team developed an intervention to provide training on preventing maternal-child HIV transmission (PMTCT), scheduled staff talks with mothers, and developed PMTCT guidelines for health facilities. Following the intervention, no infants began PCP prophylaxis after the recommended time.
Women in the Eastern Military Garrison Clinic who were enrolled in a program to prevent maternal-child HIV transmission (PMTCT) were not bringing their partners for counseling and testing, thus exposing them and their partners to re-infection, increasing their risk of infecting others, and causing them to miss out on access to appropriate programs. The team developed an intervention designed to reduce the stigma of PMTCT and to help couples to communicate better. They organized workshops and marriage seminars for couples and families. As a result of these activities, 50% of couples were counseled together during January 2007.
Cambodia
Cambodia's Ministry of Health has set a priority of integrating categorical disease programs such as tuberculosis, malaria, and HIV/AIDS. One step toward achieving this goal was a public health management training workshop held March 24-April 4, 2003, for 20 public health professionals from the National Institute of Public Health, the National Center for TB & Leprosy Control, the National Center for Malaria Control, and the National Center for HIV/AIDS and STI. A graduate of the MIPH 2002 course translated the SMDP course materials into Khmer and co-facilitated the workshop with SMDP staff. Workshop participants formed quality improvement teams based on geography and institutional affiliation, and in August 2003 completed a series of applied learning projects on such themes as shortening the long waiting time for laboratory results and improving incorrect diagnosis of sexually transmitted diseases or tuberculosis.
Côte d'Ivoire
Building on the foundation provided by MIPH training of two Projet RETRO-CI staff, GAP is integrating management training into the national public health system. Project Retro-Ci's work in developing training materials to help prevent HIV transmission from mother to child was selected in 2004 as a best practice at the regional level. The team leader in the curriculum development process was a workshop participant from the SMDP TQM training in May 2002 , when SMDP staff taught management skills to 19 participants from across Projet RETRO-CI. Project RETRO-CI was established in Côte d'Ivoire in 1988 as a collaborative HIV/AIDS prevention and control program between CDC and the Ivoirian Ministry of Health.
Croatia
In 2002, a management capacity-building program called "Healthy Counties" was developed by 2001 MIPH graduates who teach in the Andrija Štampar School of Public Health. Nine Croatian county teams representing a number of local government institutions concerned with public health had completed the program by June 2003. Team members collaborated to develop local health plans to address local program needs, developed in response to a 1999 study of the effects of decentralization on Croatia's health system. A series of 4 workshops in 2002-2003 brought together key players for fostering healthcare improvement at the county level in Croatia: members of political councils; executives from the county departments of health, labor and social welfare; healthcare professionals from the county institutes for public health; and community representatives from the media and NGOs. The workshops gave the teams the opportunity to initiate a design of the healthcare plans. Following the workshops, the teams completed their plans before presenting their respective projects at the next workshop. The goal was to reach all 20 counties in Croatia; as of July 2004, 16 of 20 had completed County Health Plans.
In July 2004, two MIPH graduates (2002 and 2003) joined SMDP in co-supervising applied learning projects undertaken by 5 teams. The themes for 4 teams were to reduce, respectively, 1) the number of incomplete patient records, 2) the number of late deliveries of samples to the laboratory, 3) the average time between breast cancer patients’ first hospital contact and surgery, 4) overuse of emergency services for non-emergency health problems.
Egypt
In 1998, SMDP began working with the Egyptian Field Epidemiology Training program (FETP) within the Ministry of Health and Population (MOHP). Three FETP staff and a WHO regional advisor on women’s health have completed SMDP’s MIPH course.
The Egyptian FETP and CDC’s Division of International Health (DIH) invited SMDP to assist in conducting a 10-day management workshop February 19–March 2, 2005, in Cairo, Egypt, as one module of the Epidemiology and Surveillance Unit course for the Governorate Surveillance Unit (GSU) directors. To strengthen the management skills of the directors, the SMDP module focused on teambuilding, supervision, Force Field Analysis, designing and delivering effective classroom training, and TQM. USAID funded this workshop. The 32 participants included 17 GSU directors, seven FETP trainees and five central-level FETP staff, two physicians from the Infection Control Program, and one physician from the National AIDS Control Program. During the workshop, the GSU directors began work on applied management learning projects. Upon return to their worksites, they formed quality improvement teams to work on applied management learning projects based on themes they chose during the workshop. The teams’ completed projects reported organizational improvement in such areas as reducing monthly report delays, eliminating duplication of National Egyptian Disease Surveillance System records, and improving the reporting rate at fever hospitals.
Guam
Collaboration with Guam began in 2000 when a health and nursing consultant from the University of Guam (UOG) Micronesian Health and Aging Studies attended the MIPH course. The second graduate, the Director of the UOG Center for Continuing Education and Outreach Programs, attended MIPH in 2003 with support from a grant to UOG from the World Health Organization (WHO). The first MIPH graduate recognized the opportunity to use MIPH course materials to strengthen regional public health management training capacity in the Pacific.
Association of Teachers of Preventive Medicine (ATPM) funds were used to establish a permanent UOG management training center named Health Leaders Achieving Today—Tomorrow’s Excellence (HLATTE). Since its inception, HLATTE has trained 223 local program managers in the Pacific Rim and generated an income of $154,300 from training fees.
HLATTE staff taught a management workshop on Guam for 17 nurses from eight Pacific jurisdictions in June 2005. This workshop was partially funded by the Pacific Islands Health Officers Association (PIHOA). Participants’ applied management learning projects were supervised via distance-based technology after they returned home.
HLATTE conducted “Paradigm Shifts in Professional Leadership—Integrating English Instruction” for 21 visiting university allied health students from Taiwan in April 2005. HLATTE provided a Customer Service workshop for 120 case workers and supervisors from Guam’s Department of Public Health and Social Services (DPHSS) in June, and in November HLATTE staff assisted the DPHSS Guam Diabetes Program in completing a Diabetes Systems Assessment and Strategic Plan—a requirement for CDC funding. There were 33 participants in this workshop, representing Public Health, Guam Memorial Hospital, Mental Health, the Department of Education, the Diabetes Association, consumers, policy makers, health professional retirees, and the University School of Nursing.
Haiti
In 2003, the Global AIDS Program (GAP), in collaboration with USAID, began supporting the rapid start-up of a nationwide network of 40 centers for voluntary counseling and testing (VCT) and treatment to prevent mother-to-child HIV transmission. CDC also established 10 specialized centers for comprehensive care and treatment of HIV-infected persons. SMDP was invited to undertake an initial assessment and planning visit in December 2003, and targeted several possible participants for the MIPH course in 2004, especially from NGO partners. In Haiti, NGOs play a major role in providing health services.
A physician from the Ministry of Public Health and a nurse educator from GHESKIO (Groupe Haitien d’Etudes du Sarcome de Karposi et des Infections Opportunistes) graduated from the 2004 MIPH course. In 2005, MIPH graduates included an advocate with the Association for National Solidarity (ASON)—an information and advocacy group for those infected with and affected by HIV/AIDS, and the Director of Information and Communication from Zanmi Lasante—an organization that works with NGO Partners in Health to operate full service medical centers in Haiti in partnership with the Ministry of Health. The MIPH graduate from Zanmi Lasante developed and conducted two workshops to help data clerks and data managers at Zanmi Lasante to use electronic medical records to collect, analyze, and generate reports on HIV and TB patients. These electronic reports are required by the Global Fund Against AIDS, TB, and Malaria (GFATM) and the U.S. President’s Emergency Plan for HIV/AIDS Relief (PEPFAR).
India
In 2002, the 2001 MIPH graduate from India conducted the first management training program launched here. The program currently has more than 75 graduates from all over the world who are trained in Total Quality Management, change management, and various technical eye care topics.
SMDP’s partners in India are GAP India and the Indian Network for People Living with HIV/AIDS (INP+). GAP India sponsored two participants to attend the MIPH 2004 course, one each from GAP and INP+.
The two MIPH 2004 graduates organized the first Healthy Plan-it™ program management workshop for 14 INP+ project managers, in Chennai, the capital city of Tamil Nadu state, upon their return. These MIPH graduates were assisted during the 4-day workshop by the MIPH 2001 graduate from LAICO-ARAVIND Eye Care System and by SMDP staff.
Four of the 14 trained INP+ project managers assumed responsibility for conducting Healthy Plan-itTM training for several other groups, including 10 District Level Network (DLN) leaders and 12 community-based PLWHA peer educators in three districts. These PLWHA educators are key to the work of INP+, because they conduct support group meetings and represent the HIV-positive members and their families in times of need.
The leaders of two HIV/AIDS community organizations in one of the districts, Guntur, joined forces to create a sustainable plan and they then approached the district government for funding and support for an employment intervention for women infected with or affected by HIV/AIDS.
Indonesia
Four SMDP Healthy Plan-it™ courses were offered in Jakarta in 2002, one designed specifically for national-level managers, and one for the heads of provincial and district health offices in Indonesia. Drs. Hariadi Wibisono, Swandari Djojo, Lukman Tarigan, and Ms. Nelwina Tomi (all MIPH '01) organized and conducted the courses. The 60 participants from across the country maintained a high level of enthusiasm throughout the 2-day course. Based on participants' recommendations, the next two courses will be expanded. Participants learned how to distinguish "health problems" from problems in program implementation (such as "low cure rate" for tuberculosis control, or low community participation to improve water quality).
Macedonia
SMDP’s partners in Macedonia are the Foundation Open Society Institute Macedonia (FOSIM), the Faculty of Medicine, University of St. Cyril and Methodius, Skopje, and the Macedonia Ministry of Health. In 2003, these institutions partnered to implement a management capacity-building project for Macedonia similar to the Healthy Counties project in Croatia. The objective of the Health Management and Governance Project for Healthy Communities in Macedonia, or the Healthy Communities project, is to increase the capacity of the local public health workforce to implement regional public health strategies that demonstrate the use of participatory and evidence-based health promotion interventions.
MIPH graduates—all faculty in the Department of Social Medicine, University of St. Cyril and Methodius—implemented the Healthy Communities project in July 2004 in three pilot communities: Gevgelija, Strumica, and Valandovo. The multidisciplinary teams in each pilot region comprised local personnel from the Institute of Public Health, the Ministry of Labor and Social Protections, Health Insurance Fund, Center for Social Care, and NGOs. Participants attended a four-module training based on Healthy Plan-itTM and other tools from the MIPH course. The first three modules were taught in 2004; the last module in January 2005. The three pilot teams returned to their communities and completed applied management learning projects using the tools learned in the workshop modules. MIPH graduates and SMDP staff conducted supervisory visits to assist the respective teams on their projects.
The three teams from the first training cohort completed the training in the Healthy Communities project in July 2005. They presented their health strategies at a graduation in the presence of representatives from the Medical Faculty and the Chair for Social Medicine, University of St. Cyril and Methodius; the Ministry of Health; the Local Self-Government; city councils; and FOSIM. The team from Valandovo won best project award for “Caries prevention among children age 12 in Valandovo.” The other two community teams reported on projects that addressed cardiovascular disease and drug prevention and control. A fifth faculty member of the Department of Social Medicine, University of St. Cyril and Methodius, attended the MIPH course in the fall of 2005.
Malawi
SMDP’s partners in Malawi include GAP Malawi, the National TB Programme (NTP), the Malawi AIDS Counseling and Resource Organization (MACRO), and the Infection Control Program (ICP) of the Ministry of Health. To date, 10 trainers from Malawi have graduated from the MIPH course.
The first management training workshop in 2003 for 35 TB program managers focused on TQM and leadership. Stakeholders added effective presentation skills to the curriculum for the second group of 34 TB program managers in 2004. Teams in the first two years completed 12 applied management learning projects to improve work processes on a variety of TB and HIV/AIDS-related topics.
In January 2005, Malawi MIPH course graduates and SMDP staff co-facilitated a one-week workshop on TQM and leadership for the third management training cycle. The third cohort consisted of 34 participants comprising seven teams—four TB program managers each from seven district hospitals plus three teams of two senior counselors each from three MACRO sites. Their applied management learning projects reported positive impact on improving such problems as low case-detection for smear-positive TB patients, insufficient quality control for HIV counseling and testing, and overly lengthy HIV counseling sessions.
Mexico
SMDP’s partner in Mexico is the General Directorate of Epidemiology (DGE), Ministry of Health. MIPH graduates from Mexico developed a training course, launched in August 2002 and targeting Spanish-speaking public health professionals across Latin America. The first Regional Public Health Management course in Spanish, held in collaboration with SMDP, the Faculty of Medicine of the Autonomous University of Mexico (UNAM), and the Pan American Health Organization, adapted the English-language version of the MIPH course taught each year in Atlanta.
Early in 2005, the Director General and staff from the Management in Public Health Development Center (CDG) of the DGE discussed and analyzed middle management personnel performance. Most of the DGE middle managers had knowledge of neither TQM nor other tools for decision making. They were experiencing difficulties in communication and teamwork, and needed to develop leadership and management skills in order to guide their own staffs and to work more persuasively at the state and local levels of the public health system to improve the country’s epidemiological surveillance.
To address this problem, MIPH graduates in the DGE developed and taught a 3-week long Leadership and Management in Epidemiology Course in March 2005 for the 23 middle management DGE staff. Following the course, participants formed two teams to carry out projects. The Director General endorsed the course by his presence—he taught some of the sessions, was present throughout the course, and consulted on applied management learning project development.
Three workshops were held during the course—on evidence-based decision making, research results put into practice, and team building. Attitudes and abilities for teamwork, conflict resolution, and leadership skills were applied in group activities. Belbin’s team roles test was used to determine each participant’s profile to create more balanced and efficient teams within the DGE. Two quality improvement teams were created based on the results and each team developed a project. The two project themes are 1) “Improving the General Directorate of Epidemiology working environment” and 2) “Improving the process for the annual analysis of the epidemiological surveillance information.” Both projects are ongoing.
Nicaragua
In 1997, SMDP began collaborating with CARE-Nicaragua to enhance its management training capacity in the health sector. In 1999, additional support from the CARE-CDC Health Initiative facilitated expanding training activities to include the medical school faculty of the National Autonomous University of Nicaragua (UNAN). By 2002, a cadre of 9 master trainers from CARE, UNAN, and other NGOs had been trained at the MIPH course. Two additional UNAN faculty were also trained in Mexico's regional Spanish-language course in the summer of 2002. Nicaragua's current efforts focus on a self-sustaining Management Training Unit housed at UNAN, known by the initials of its Spanish name, UCG.
MIPH-trained faculty are integrating modern management tools and techniques into the 5th-year medical school curriculum to help students prepare for their obligatory government health service. The fifth-year medical students receive 54 hours consisting of 17 classroom hours and 37 practical laboratory hours. In the first year of this change in the medical school curriculum, 127 students received management training with an estimated 27 completed projects. In 2004, 185 students received management training and completed an estimated 39 projects. In addition to this pre-service training for medical students, the UCG faculty also markets and conducts short-term in-service training for government and NGO health workers. Since 2003, UCG has trained 133 health workers in a course that includes a Spanish-language Total Quality Management (TQM) workshop. Before 2003, MIPH graduates at CARE-Nicaragua, provided management training for 289 health workers in Nicaragua.
Nigeria
From 1995-1999, CDC's SMDP worked with the Carter Center's River Blindness Program in Nigeria to train six faculty in the Atlanta-based MIPH course. These MIPH graduates established a Sustainable Management Training Centre (SMTC) in Jos, Nigeria, and, between 1996 and 2001, provided management training to 450 health care workers in 33 states. A typical SMTC workshop trained 25 local program managers over a 10-day period. All trainees were required to complete an applied learning project following each workshop that demonstrated competencies in applied problem solving and evidence-based decision making.
The Sustainable Management Training Center in Nigeria was evaluated in 2001 by Dr. Deborah McFarland. Download a copy of the article here (PDF).
Northern Mariana Islands (CNMI)
SMDP began its public health capacity-building efforts in the Commonwealth of the Northern Mariana Islands (CNMI) when two public health professionals from the Department of Public Health (DOH) in Saipan attended the MIPH course in 2000.
From 2001-2002, MIPH graduates launched a management training initiative for public health program managers from Saipan, Tinian, and Rota Islands. CNMI MIPH graduates from the 2000 MIPH class were assisted by a 1998 MIPH graduate from the Philippines in developing and teaching the course, which consisted of three workshops over a 6-month period. During these workshops, participants completed applied management projects on topics such as improving the certification rates of food handlers, decreasing patient waiting time in clinics, and improving the timeliness of lab reporting. The course was partially underwritten by the Western Pacific Regional Office (WPRO), World Health Organization.
In 2004, two additional DOH staff attended the MIPH course and returned home to teach a TQM and teambuilding workshop for 28 senior hospital managers in Saipan in early 2005 with assistance from MIPH alumni in Guam. At the end of the workshop, these managers formed nine quality improvement teams to address specific management projects in organizations. Each team received ongoing supervisory support from workshop faculty during the ensuing months, and an SMDP staff member met with each team in August 2005 to review progress and provide additional guidance.
HLATTE staff from Guam, in collaboration with two MIPH 2004 alumnae from the Commonwealth of the Northern Mariana Islands (CNMI), conducted a management training workshop for 28 senior hospital managers in Saipan’s Commonwealth Health Center in March 2005. Three of nine teams completed their applied management learning projects and graduated in November 2005.
Pakistan
SMDP began working with the Pakistan Ministry of Health in 1992 and with the Aga Khan University in 1999. To date, Pakistan has five MIPH graduates, two of them faculty members at the Aga Khan University (AKU) in Karachi.
Since 1995, the Health Systems Management and Research (HSMR) course has been a regular offering in the continuing education program of the AKU Department of Community Health Sciences (CHS). This course, offered once a year, covers learning styles, leadership styles, quality of care, health systems reforms, conflict management, and marketing. The two MIPH alumni at AKU play leading roles in coordinating and directing the HSMR course, and supervised a major course realignment in 2002 to incorporate MIPH content.
The MIPH graduates at AKU apply their learning from the MIPH course at various levels of instruction. AKU undergraduate and master of public health courses on management are especially influenced by the MIPH curriculum. Teams carry out applied management learning projects, but AKU has no mechanism in place to monitor these projects.
Of the 1,371 health personnel who have participated in continuing education program courses to date, 238 (17.5%) were from Afghanistan, including 39 who attended the HSMR course in 2004; 14 students completed the HSMR course in 2005. Afghan participants come from the Ministry of Health as well as NGOs such as the Swedish Committee for Afghanistan, Ibn Sina Public Health Program, Mercy Corps International, UNICEF, Aide Medical International, WHO, and World Vision International.
The CHS department at AKU recently initiated the Afghan Capacity-Building Program under the Aga Khan Development Network, a consortium of development agencies working in health, education, and economic development. In this program, AKU currently supports four health managers from the Afghan Ministry of Health in its master of science programs in health policy and management, and three more are enrolled this year for the masters level training. The School of Nursing at AKU also participates in the Afghan Capacity-Building Program by providing training and education opportunities for Afghan nursing students.
Philippines
SMDP began working with the Philippines Department of Health (DOH) in 1994 to strengthen the management capacity of local public health workers. Currently, the 20 MIPH alumni in the Philippines work at the national- and regional-level health offices and with NGOs. About half of these graduates are still actively involved in conducting management training in the Philippines at either the national or regional levels. The Philippines DOH established the Field Management Training Program (FMTP), a program that, in combination with its regional subsidiaries, has trained 183 managers. FMTP graduates are currently working in 13 of the Philippines’ 17 health regions. Although the majority of FMTP graduates are physicians, the number of nurses and administrators has increased in recent cohorts. FMTP graduates had completed 135 applied management learning projects as of the end of 2005. These applied management learning projects serve to reinforce classroom learning and produce measurable outcomes that have an impact on public health. Some two-thirds of the projects aimed at quality improvements; the remainder addressed new health interventions.
The FMTP received SMDP’s most prestigious award for Management Training Excellence at the 2004 Biennial Conference on Strengthening Global Public Health Management Training Capacity, in Hanoi, Vietnam.
In 2002, MIPH graduates established the Philippine Laboratory Management Training Program (LMTP), which is designed to strengthen the management capacity of public health laboratory personnel. One graduate developed the curriculum and recruited Filipino MIPH graduates from the National Epidemiology Center and the Research Institute for Tropical Medicine to serve as faculty and field supervisors. The first course was conducted in 2002, and currently there are 39 graduates from regional, provincial, city hospitals, and health offices. During the 6-8-month course, participants implement an applied learning project in their respective laboratories and areas of responsibility.
In 2003, a regional management training program, Leadership and Management in Public Health Practice (LMPHP), was launched in Central Luzon, initially reaching 21 trainees. Before local government health personnel were trained, 20 additional regional office staff underwent a 6-month training-of-trainers (TOT) course to prepare them to function as field supervisors.
Filipino MIPH graduates comprise most of the faculty for the three management training programs. Aside from teaching the various modules during the workshops, they also conduct on-site visits to assist participants in implementing their applied management and applied learning projects. The MIPH graduates are occasionally joined by staff from SMDP and the Coordinating Office for Global Health, CDC.
FMTP, LMTP, and LMPHP graduates have carried out dozens of applied management projects over the years. One LMTP project earned a 2003 Applied Learning Project Award from SMDP and the FMTP won the 2003 SMDP Management Training Excellence Award. Both awards were presented at the SMDP Hanoi Conference in March 2004.
The Philippines program has become a role model for financial sustainability and decentralization. Since its inception, the FMTP has been funded entirely by the DOH; USAID funds were used to pay only for non-recurrent costs such as trainer development in the MIPH course and technical assistance from SMDP. As the program matured, FMTP graduates from the regional health offices launched their own regional management training programs using DOH funds, and have found ways to share the training and supervision costs with local government units. The trainees’ applied management learning projects have had a significant impact on a variety of public health programs by improving organizational performance in such areas as 1) record keeping, 2) the availability of pharmaceuticals, 3) food vendor compliance with sanitary certificates, and 4) newborn registration systems.
By 2005, regional programs in Central Luzon, Bicol, Mindanao, and Visayas had graduated at least one cohort each, and two more regional programs became operational in 2006. The role of the FMTP evolved in 2005 from direct provider of training to supporting the development and assuring the quality of the training programs in the region and in other countries, including Commonwealth of the Northern Mariana Islands, Thailand, and Vietnam. Technical assistance focuses on program planning, training, and supervising applied management learning projects.
In May 2005, the FMTP organized the first National Conference for MIPH and FMTP alumni. The conference, attended by 70 graduates, served as a useful opportunity to share best practices for management training, to develop advocacy strategies for starting new regional programs, and to network with other professionals. The second National Conference was held in April 2006.
Serbia
Since 2004, SMDP has partnered with the Centre School of Public Health at the University of Belgrade, School of Medicine, and the Open Society Institute (OSI) in Serbia to implement a three-year community health development project endorsed by the Serbia and Montenegro Ministry of Health. The objective of the project is to strengthen the capacity of local public health institutions to implement regional public health strategies that demonstrate the use of participatory and evidence-based health promotion interventions.
In the first phase of the Community Health Development project, multidisciplinary teams under the leadership of the regional Institutes of Public Health (IPH) were formed in four pilot regions: Pancevo, Sabac, Somber, and Leskovac. The project teams of eight members each comprise a mix of public health professionals, lawyers, teachers, NGO personnel, and local public sector workers. In April 2004, the project teams participated in an initial three-day workshop on “Public Health, Policy for Health, and Public Health Strategy.”
The regional project teams attended a four-day Healthy Plan-it™ workshop
at the Centre School of Public Health in May 2005. The training team
for the project included six faculty members from the School of Medicine,
four of them MIPH graduates. All participants passed a written exam
at the end of the workshop to receive professional continuing education
credit from the Center School of Public Health.
The four regional IPH project teams returned
to their counties to complete applied management learning projects
using Healthy Plan-it™ tools. Centre School of Public
Health staff conducted supervision visits to work with the teams on
their projects with technical assistance from SMDP. Completion of the
applied management learning project is a requirement for course certification.
The teams used Healthy Plan-it™ tools to plan priority
health interventions based on their broader regional public health
strategies. The projects selected for 2005–2006 address the public
health issues of cervical cancer mortality, respiratory disease in
schoolchildren, environmental allergens, and youth drug abuse.
The regional teams attended additional training modules on public health information systems in July 2005 and on communications for public health in November 2005. A final graduation and presentation of the regional public health strategies and Healthy Plan-it™ projects is scheduled for November 2006.
Taiwan
SMDP has been working with Taiwan’s Bureau of Health Promotion (BHP) since 1997 to strengthen public health management training capacity. To date, Taiwan has 12 MIPH graduates including several from the BHP and the Taiwan Center for Disease Control. In 2003, SMDP began providing technical assistance to develop and teach priority setting and planning based on Healthy Plan-itTM from the MIPH course to a target audience of tobacco control personnel from the city and county health departments, with some national-level staff from the Department of Health (DOH) also attending. The first round of Healthy Plan-it™ training for 30 participants took place in June 2004, with a graduation workshop and presentation of their 28 completed applied management learning projects in December. The second round of Healthy Plan-it™ training was held in April 2005 for 34 staff members from 24 city and county health bureaus. All the training for the second cohort was delivered by MIPH graduates and the 33 applied management learning projects completed by participants were reviewed by SMDP and BHP staff during a technical assistance visit in May 2005.
BHP staff developed a new training initiative in public health communications in 2005. During the 2004 MIPH course in Atlanta, participants from the Taiwan DOH and the BHP, including the BHP Deputy Director, identified a need for strengthening the management communications skills of mid-level public health professionals in Taiwan at national and local levels. SMDP staff assisted the MIPH graduates to develop and design the workshop curriculum and content. In June 2005, SMDP staff and MIPH graduates co-facilitated a 4-day workshop for 31 mid-level public health managers that covered strategic communications for public health organizations, communications and the media, and conflict resolution.
In December 2005, 21 of the 31 original workshop attendees participated in a second communications workshop on public health marketing and advocacy and presented 25 strategic communications plans for a priority program as a graduation requirement. Participants came from a wide variety of program areas within the Taiwan DOH, including health education, health promotion, cancer prevention, communicable disease control, food safety, pharmaceuticals, and planning.
The BHP will integrate both Healthy Plan-itTM and the strategic communication workshops into the annual BHP training plan. BHP staff have assumed full responsibility for facilitating future workshops.
Thailand
In 2004, officials from the Thai National Institute of Health (NIH) and the Ministry of Public Health (MOPH) expressed interest in establishing a management training program modeled on the Philippines Laboratory Management Training Program. Since then, a 2003 MIPH graduate from Mahidol University (MU) has worked with SMDP to establish a Thai Sustainable Management Training Center (SMTC). Institutional partners now include the MOPH, MU, the NIH and the Thai-MOPH CDC Collaborative (TUC). A four-person team representing all four institutions attended the 2005 MIPH course and is now assisting with the program.
The five MIPH graduates co-taught an initial SMTC Total Quality Management (TQM) course in May 2005 to 24 medical technologists representing eight hospital labs, one regional medical center, and the NIH.
A second cohort of province-level managers is being trained in 2006.
Uganda
SMDP partners in Uganda include GAP Uganda and the Institute of Public Health at Makerere University (IPH). In 2002, three Ugandans attended the MIPH course. These public health professionals came from the National TB Programme, the Uganda Viral Research Institute (UVRI), and the STD/AIDS Programme in the Ministry of Health. In 2003, the IPH became the institutional home of the public health management training program. Two persons from the IPH/CDC HIV Fellowship Program, including the fellowship coordinator, attended the MIPH course in 2003.
In 2003, one workshop was conducted for 18 mid-level managers representing public health laboratories, NGOs, Ministry of Health/Health Sub-districts (HSD), the IPH, and CDC-Uganda staff.
The 2004 management training was conducted through the IPH-CDC HIV/AIDS Fellowship Program. Current participants are IPH Fellows, host institution counterparts, and CDC-Uganda and area lab personnel. The goals of training include 1) developing and strengthening management knowledge and skills and 2) enabling participants to apply acquired skills to address a specific problem in the workplace. Thereby they will improve the delivery of health services to the population. Four additional Ugandans from Makerere University have attended the MIPH course, bringing the total to 12.
In 2005, MIPH graduates from the Makerere University IPH taught Healthy Plan-itTM to the annual cohort of ten IPH/CDC HIV Fellows. The fellows completed applied management learning projects by developing project plans for priority programs in their host institutions. In July 2005, a Ugandan MIPH graduate from IPH was invited to facilitate the first public health management module to 2005 participants in the CDC-sponsored Field Epidemiology and Laboratory Training Program in Nairobi, Kenya.
CDC Uganda sponsored two participants to the 2005 MIPH course, a laboratory manager and a trainer with the HIV Reference Laboratory, Uganda Virus Research Institute. They hope to implement management modules within laboratory training scheduled during 2006.
Vietnam
In 1995, SMDP began training public health faculty in Vietnam. To date, 25 participants, including 8 faculty members from the Hanoi School of Public Health, have completed the MIPH course. SMDP's two principal counterparts in Vietnam are the Hanoi School of Public Health (HSPH) and the National Hospital of Tuberculosis and Respiratory Diseases (NHTRD). MIPH alumni from each institution have trained dozens of program managers from the provincial and district levels and each has completed and presented an applied learning project in order to graduate. These projects represent an important step in devolving skills for problem solving, planning, and priority setting to local health workers whose responsibilities have increased dramatically in recent years, but who have had little previous access to any formal management training.
SMDP’s collaboration with the National Tuberculosis Control Program (NTP) in Vietnam and CDC’s Division of Tuberculosis Elimination in the National Center for HIV, STI and TB Prevention to build a management training program for tuberculosis program managers began in 2001. In February 2001, MIPH alumni employed by NHTRD launched a management training program for tuberculosis (TB) program managers. This program began with a 3-week skill-building workshop, including modules on Leadership, Epidemiology, Applied Research, Presentation Skills, Health Sector Reform, Team Building, Behavioral Style Analysis, Planning, and Total Quality Management (TQM). Following this course, participants completed applied learning projects to improve TB case finding and treatment.
In 2005, the fourth cycle of NTP management training was completed. Thirteen provincial TB program managers were trained in leadership, epidemiology, research, presentation skills, health sector reform, behavioral style analysis, planning, and TQM. They implemented 13 applied management learning projects addressing such issues as quality of sputum smear samples, patient follow-up, and low smear-positive detection rate. SMDP provided technical assistance to the NTP in supervising these projects. Altogether the NTP management training program has trained 81 provincial TB program managers who have completed 67 applied management learning projects throughout Vietnam. NTP has integrated continued management training into its 2006–2010 national development plan which will be presented to international stakeholders in July 2006.
In 2002, the first two participants from Vietnam's Global AIDS Program (GAP) attended the MIPH course, and in 2003, the Deputy Director of the Vietnam Ministry of Health's LIFE-GAP office attended. In 2004, the CDC Global AIDS Program (GAP) partnered with the Hanoi School of Public Health (HSPH) to enhance public health capacity for HIV prevention and care. A new 5-year agreement between GAP and the HSPH has three objectives: 1) a decentralized self-sustaining HIV/AIDS management training program, 2) a data-management system for U.S. government HIV/AIDS programs in Vietnam, and 3) an overarching HIV/AIDS strategy for the HSPH. To address the first objective—creating a decentralized self-sustaining HIV/AIDS management training program—three training centers were established: one in the HSPH in Hanoi for the north, a second in the Preventive Medical Center in Danang for the central region, and a third in the Institute for Hygiene and Public Health in Ho Chi Minh City (HCMC) for the south of Vietnam. All three training centers—in Hanoi, Danang, and HCMC—will provide management training workshops for HIV program managers in their regions.
In July 2005, three HSPH faculty who graduated from MIPH in 1997 and SMDP staff facilitated a two-week Training-of-Trainers (ToT) workshop in Hanoi focusing on Total Quality Management (TQM) and effective training techniques for HCMC and Danang public health personnel. The primary goal of the training is to enhance public health management capacity for HIV/AIDS prevention and care activities in Vietnam. Twenty-three participants from five institutions attended the ToT course and then carried out six applied management learning projects that dealt with work processes such as receiving samples in laboratories and processing rapid HIV tests. The leaders of the program from Danang Preventive Medical Center and HCMC Institute for Hygiene and Public Health also attended the 2005 MIPH course.
Since July 2005, the 23 participants who completed the July ToT facilitated TQM workshops in all three training centers. These TQM workshops reached 70 provincial HIV program managers from 24 provinces across the country. Graduation workshops at all three training centers for the participants of the regional TQM workshops are planned in the first half of 2006. A national HIV management training conference planned for July 2006 will give all participants of the TQM workshops the chance to present their best applied management learning projects. The second cycle of regional TQM workshops will begin at all three training centers in the fall of 2006.
Zambia
SMDP’s partners in Zambia include CDC’s Global AIDS Program (GAP) in Zambia and Zambia’s Central Board of Health and Ministry of Health. Laboratory managers and medical technologists representing all nine provinces participated in the first management training in March 2003. The participants’ applied management learning projects addressed such issues as late presentation of malaria test results and improperly fixed biopsy tissues. In 2004, an overview of the Zambian laboratory management training initiative was presented at SMDP’s second biennial conference in Hanoi, Vietnam.
Two GAP-funded participants attended the 2004 MIPH course: a senior lecturer at Ndola College of Biomedical Science and the Director of Clinical Services at Ndola Central Hospital. In 2005, the seventh GAP-sponsored participant from Zambia attended MIPH: the Director of Clinical Care and Diagnostic Services in the Central Board of Health, Lusaka.
Planning began in 2005 for a management training course with focus on Total Quality Management (TQM) for district HIV Voluntary Counseling and Testing laboratory personnel. The workshop will be conducted in August 2006. Participants will be involved in activities related to the President’s Emergency Plan for AIDS Relief. Several MIPH graduates will co-facilitate this workshop and supervise the applied management learning projects the workshop participants will implement at their workplaces.