A little more skills for a healthier nation


Nurses provide direct care to patients and clients and in Chitipa district, this means providing health services to the nearly 18,000 patients who visit the district’s public health facilities in a month.

With this large number of patients, Janet Kaboko’s role as District Nursing Officer (DNO) is extremely pressing as she has to manage the entire workforce of nurses and hospital attendants in the whole of the district.

She, along with the many other health sector key management personnel in the district, has the potential to transform the health care experience of each one of those patients.


Janet, who has been DNO for six years, is well-qualified and highly experienced in her role. She rose quickly through the ranks to her current position.

She was recruited as a Nursing Officer after graduating with a Diploma in Nursing from Kamuzu College of Nursing (KCN) in 1995.

She returned to KCN for upgrading, and eventually graduated with a BSc in Nursing in 2002 and was promoted to the position of District Nursing Officer (DNO) for Chitipa after passing promotional interviews in 2009.


Despite her proficiency and qualifications, Janet feels that her ascendancy to the DNO position would have been smoother if she had received a comprehensive Leadership and Management training earlier on.

“The DNO is a Senior District Health Leadership and Management position, so it is very critical to the delivery of quality care in the district –as well as the entire health sector. As such, there is need for an extra set of higher level leadership and management skills,” she says.

Sentiments like the ones expressed b y Janet are common among health professionals holding management positions in Malawi’s public health sector.

Due to high turnover rates, health professionals are often thrust in leadership positions — including district health officers, nursing managers, and programme managers—without the requisite leadership and management competencies.

They have to learn on the job, with little mentorship support.

Although the new managers may be hard working and motivated, this lack of training can cause serious gaps in efficiency and effectiveness in the health sector.

The importance of a leadership and management skill set is well-established in the private sector; however, its role in healthcare has been overshadowed by the more visible clinical roles in healthcare organizations.

The World Health Organization (WHO) places leadership and governance at the centre of all the key elements of health systems – and this includes human resources, information, medical products, vaccines and medicines, and health financing.

In short, without leadership and management, these other critical parts of the health sector will fall short of their potential.

As a developing low – income country, Malawi’s health sector is characterized by resource constraints, poorly motivated staff, and increased public demand for health care.

Effective leadership and management is therefore particularly critical for efficient use of scarce resources, as this is paramount to attaining health goals. In its 2012 report on health services reform, the Department of Human Resources in Malawi’s Office of the President and Cabinet highlighted inadequate leadership and management training as a critical challenge for the public health sector.

In response, the Ministry of Health, with technical support from the USAID-funded Support for Service Delivery Integration (SSDI)-Systems project, developed the Leadership and Management Programme (Lamp), tailored specifically to the health sector. The project was initiated in 2014.

The Lamp equips Ministry of Health (MoH) leaders and managers with skills to lead, own, transform, and get results in the delivery of health care.

It is designed to help staff identify and address key constraints in the delivery of health services, and they can in turn develop and implement practical strategies to expand coverage and improve quality of services.

Specifically, the course is designed to instill a culture of strategic leadership and capable management at all levels of the health system; cultivate a cadre of leadership that is capable of operating at a decentralised level in harmony with national level policies; and build effective health management teams while fostering a culture of transparency, accountability and responsiveness to client needs.

The programme approach is flexible: It begins with a one-week initial workshop, followed by on-site cohort coaching, which avoids the disruption of services that would be caused by removing participants from their workplace.

During this period, participants develop action plans to deal with practical leadership and management challenges in their work environments. This is followed by individual coaching and sharing tailor-made leadership and management resources. The activities take place over 6 months.

Last year, Kaboko joined 36 other District Health Management Team members from 10 districts, 11 middle and 13 zonal managers at a triumphant graduation from the Lamp programme.

She says her leadership and management style since has been transformed by the training.

“Basically it’s like I acquired a third eye, I am now more strategic in my approach; I am able to see the connections among the elements of the health system and understand enabling and impeding forces in the alignment of resources and my key objectives.

“I am more aware that as a leader and manager, I get results through others. So I mostly delegate operational tasks to my team, and focus on coaching and mentoring them. This enables me to focus on more strategic activities, and effectively contribute to the role of the District Health Management Team,” she says.

Kaboko is optimistic and feels more motivated to continue working in the health sector, despite the daunting challenges.

She describes her Leadership and Management approach prior to going through the Lamp as being reactionary and stressful.

“I was distant from my subordinates and regarded them with suspicion, so my overall approach was more focused on enforcing rules and ensuring compliance,” she says.

Rose Maleta, Chief Human Resources Development Officer at the MoH headquarters, concurs with the health team members.

“It is an important management development programme for the Ministry of Health, and has the potential to transform delivery of health care if adequately implemented in the country,” she says.

A total of 122 key managers have graduated from the programme as at June, 2015.

Kaboko and fellow DHMT members in Chitipa feel that if all health facility in-charges and managers of key health programmes went through a similar training, they would be more innovative in dealing with challenges that have rocked the public health sector in the country.

The SSDI-Systems is a technical assistance project that supports the Ministry of Health to improve policies, management and leadership, and fiscal responsibility to strengthen health care system.

It is funded by the United States Agency for International Development (USAID) and led by Abt Associates Inc. The project works in partnership with the Malawi Institute of Management (MIM) to deliver the Lamp.

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