Promoting Evidence-based Leadership

On Friday 30th March 2007, the Makerere University Institute of Public Health and Leadership Initiative for Public Health in East Africa organized a public lecture by an eminent scholar, Professor Eamon Kelly, at the Sheraton Kampala Hotel’s Rwenzori Ballroom. It was a 2 hour programme about ‘Leadership and Implementation Science’ and started at 2.30 pm. Also present was Professor Livingstone Luboobi, Vice Chancellor Makerere University Kampala [the Guest Speaker]; Professor David Serwadda, Director Makerere University Institute of Public Health [Chairperson], Dr. Sam Okuonzi, Director Regional Center of Quality for Health Care [Discussant]; and Dr. William Bazeyo, Principal Investigator Leadership initiative for Public Health in East Africa (LIPHEA) who was the Master of Ceremony.

“Yesterday, I was talking to the Ugandan Parliament…With so much money going into projects, why are we seeing so little in results? What makes policy formation difficult and policy implementation even more difficult? I do not believe charismatic leadership is good leadership because it is arrogance based. Evidence based leadership is more effective...” Prof. Kelly said. Currently the 13th President of Tulane University (Chosen in 1981), he was born in New York City and has a Masters plus PhD in Economics. During his regime, faculties reached new heights and many new structures were constructed. As far back as 1960, Dr. Kelly was appointed Director of Policy Formation by the United States President. He developed the first domestic satellite system in the United States. Kelly was also a Special Consultant to the US House of Representatives, Special Assistant to the Secretary in the U.S. House of Labour, just to mention a few positions. In 1995, United States President Bill Clinton appointed him to the National Science Foundation (Board) and three years later he was elected as Chairman until May 2002. He sits on the boards of many civic organisations and is a professor in Economics, Latin American Studies plus Theology.
“What leaders really do is manage change. Institutions are habits of thought; psychological ways of doing things. Leaders have to be able to look around the corner, discover which changes are likely to occur and find solutions. Why are we less successful? It’s because we lack capacity in implementation. If leaders do not do a good job, it impacts those in the poorest section of society.” Dr Kelly lectured the full house.
“In strategic planning, the four most common errors are misjudged missions, too many goals, misunderstood constraints and ignorance in implementation. To determine a mission, you need to know your comparative advantage, financial feasibility, opportunities cost, and also evaluate your rivals plus environment Goals require programmatic, financial and performance measures besides feedback mechanisms. Unfortunately, no one wants to be evaluated.” He added that we should specify goals with the largest problem first, then limit the number of goals, stay with original goals, know the goals of different power groups and measure the goals. “The more goals you have, the more difficult it is to achieve those goals…Increasing revenue is the answer critical for social goals.” Non traditional sources of revenue include Specialised Consulting; Recreation Center; Cybercafés; Managing hospitals; Changing financial arrangements like banks and insurance companies, Privatization and Public fundraising from Government or international financial organisations.
Constraints should be targeted with so many things in mind: their Importance; Examples; Policy space: Personal/policy elite; Social pressures and interests; Historical conditions; Cultural factors and Economic conditions. “The role of leadership is to expand the policy space to deal with constraints. What is the most efficient combination? Leadership responds through Education (Marketing).” A Marketing Plan involves research, cultivation, soliciting (asking), proposals (before, during and after) and follow ups. “Sometimes you have to explode the constraint block…Every country that has access to I.T. will access information like the others and reduce the digital divide. A leader who understands that institutions are habits of thought has to change people’s attitudes…”

The main discussant Dr. Sam Okuonzi, Director of the Regional Center of Quality for Health Care had this to say, “In Uganda, we seem to have too many goals which are inconsistent…We are experiencing leaders who appear to be following directives …and do not appear to exhibit the kind of leadership required. The determinants of health are outside the health sector and it is leaders who can improve the general welfare of the people. According to some literature I read, ‘leaders should focus on desired results’. In health, it is improvement of the health status in the country. Leadership based on evidence is something that can be learnt, it takes time. You pass through certain processes. We are getting a rich experience from our colleagues (in the States). MUK and the Ministry are designing leadership courses. Secondly, the country should develop guidelines for leadership principles, for example through interviews, and we need to get our health goal and overall national goals clear. There seems to be a conflict. We need to harmonise these goals for a strategic way forward for this country.”

After the first question and answer session, the discussant added the following in response to two questions directed at him, “There are at least eight determinants of health according to research statistics: Peace; Proper Nutrition; Food; Adequate clean water; Level of education; Gender parity (driven by social groups); Economic growth; and Distribution of income…The only thing the ministry can do is to improve health services… There is a lot of hope to resume (Global Fund) funding for Uganda if management is sorted out.”