themliapproach

The MLI Approach: Country-Driven Development

The Ministerial Leadership Initiative for Global Health (MLI) is a non-governmental program that supports health ministry senior teams to advance country ownership and leadership in the areas of health financing, reproductive health and donor harmonization. MLI is defined by three guiding principles. The Building on Strengths Principle enhances the talents of individual leaders and senior teams in health ministries in developing countries.  The Country-Led Principle supports those same leaders as they set priorities and determine the scope of work within MLI’s core policy areas, and MLI, with great respect to ministry leaders responds to help fulfill their selected goals.  The Peer Learning Principle fosters relationships among ministries from different countries so they can share best practices, build expertise and inspire each other.

The MLI Approach

MLI’s principles complement the changing needs and priorities in international development today including a focus on the internationally-agreed upon priorities of improving the health care of the poorest and country-owned development. Donors increasingly require countries to show tangible results and countries seek more ownership of the programs that are critical to the well-being of their populations. MLI’s approach helps countries meet these objectives and provides unique opportunities to bring both development partners and key country leaders together. MLI helps ministries align development partner programs with health sector objectives, while simultaneously reinforcing the leadership and management skills of ministry leaders. MLI’s leadership strengthening and capacity development programs – ranging from south-to-south peer learning, workshops on negotiations, and one-on-one communications coaching – help build the skills of key leaders so they can confidently control and guide programs more effectively, leading to greater success in attaining mutual goals set by countries and their development partners. 

The overall approach adopted by MLI also reflects the perspectives of the ministerial leaders in the countries where we work.  MLI works to give these government leaders the support and space they need to lead.

A Historical Note

MLI began in 2007 by requesting proposals from ministries of health that were seeking support to advance their work in two areas: equitable health financing to ensure sustainable health care for all and development partner alignment to ensure that partners work together to support the country’s priorities.  MLI selected five countries, Senegal, Mali, Sierra Leone, Ethiopia, and Nepal, based on the merits of their proposals. In 2008, MLI added reproductive health as a target policy area recognizing that the health of women is central to the health and stability of communities and nations. For all five country-led initiatives, MLI tailored its assistance to the needs of each ministry.

While MLI works directly with ministers of health, the focus has primarily been at the second and third tier of leadership within each ministry.   Because of strong relationships built with senior teams inside the ministries, MLI has been able to keep momentum despite frequent turnover of ministers of health in several countries.  MLI found dedicated civil servants among these mid level ministry leaders and their engagement supports the longer-term impact of MLI’s approach.

Distinctive Elements of MLI’s Approach

Demand DrivenTailored Assistance

MLI believes that “learning by doing” through tailored approaches to capacity building is a necessary complement to training.   MLI strengthens leaders in ministries of health through real-time and on-the-ground capacity building approaches and works to increase the leadership effectiveness of individuals and teams in positions of authority and responsibility for health policy reform and implementation, as well as improve the organizational systems and management processes in ministries of health.

MLI’s support focuses on enhancing leadership capacities and skills in such areas as:

  • Building political strategic positioning skills to advance policy reform both within health ministries and between other government entities
  • Increasing analytic skills to assess various dimensions of potential reform efforts
  • Translating evidence into advocacy to advance policy reform
  • Strengthening negotiation skills in order to advance reform
  • Improving systems for accountability to ensure that policies are effectively implemented
  • Enhancing organizational development skills to build stronger ministerial teams
  • Broadening communications skills to help minitry leaders express their challenges and progress in compelling ways

Some examples of MLI’s work include: assisting Ethiopia’s Federal Ministry of Health to implement a management accountability system called Balanced Scorecard; helping Sierra Leone improve its financial management and donor coordination systems; training Nepalese leaders to become strong negotiators with development partners; supporting Mali’s Ministry of Health and Ministry of Social Development to put in place critical health financing reforms, including the development of a strategy to scale up community-based health insurance, or “mutuelles”, nationally; and assisting Senegal’s Ministry of Health and Prevention in its efforts to launch its IHP+ Country Compact process and strengthen the institutional capacity of the reproductive health division to accelerate progress towards achieving MDG 5

MLI’s efforts to help ministry leaders communicate more effectively include improving messages for internal meetings and preparing for media interviews to clearly describe major health policy reforms. In addition, MLI produces stories, with powerful photographs, that showcase the ministries’ work to the outside world, improving the perception of MLI country ministries, specifically, as well as health ministries in general. The goal is to help ministry leaders tell their stories in compelling, memorable ways. This fits well with MLI’s principles of building on the talents of leaders and giving them a new tool that they will use for the rest of their careers and pass on to the next generation of leaders within their ministries.

MLI includes a small technical and management team based in Washington, D.C., which is supported by independent consultants working closely with the MLI country leads on priorities determined by ministry leaders. The program strives to use in- country expertise first, followed by regional expertise and relies on international specialists only when their contributions are unique and unavailable through local or regional means.

South-to-South Peer Learning and Exchange

Another hallmark of the MLI approach is collaborative learning. The five MLI countries, even in the short time period of MLI’s existence, have reached out to each other to obtain better information on how to tackle technically complex issues or questions. Two ministry teams from Mali and Senegal, for instance, traveled together to Rwanda to look at the rapid expansion of a national health insurance program and the implementation of performance-based financing. Similarly, a senior official from Mali traveled to Nepal to participate in a negotiations training session and share Mali’s perspective on negotiating with health development partners. Representatives of all five countries have come together in numerous MLI-sponsored events to share lessons learned and to encourage one another’s vital policy work. In between face-to-face encounters, MLI has facilitated exchanges among countries via online dialogues and blogs, as well as regular newsletters featuring ministry accomplishments and spotlighting individual leaders. This kind of peer-to-peer support has surmounted great geographical distance, different languages, and a myriad of cultural backgrounds. The five MLI countries have found common ground in their joint goal of improving health care and making health care accessible to all.

Working Inside the Ministry

MLI began its work by indentifying country leads, who have significant expertise in their respective countries and who have the responsibility for developing and maintaining a trusting relationship with ministry leaders based on respect and transparency.  Although the process of building productive relationships between ”country leads” and ministry officials requires a significant time commitment, patience and flexibility, these arrangments are an important feature of MLI’s approach that can be adapted for wider development practice. This country lead model allows MLI to have an effective country presence while minimizing administrative costs and ensuring that more program funds are available to respond to ministry priorities.

Leveraging Resources

Because of its close working relationship with each ministry, MLI is often able to see program needs from a broader perspective and has been able to serve as a neutral broker leveraging additional resources to advance ministry priorities. For example, in Mali MLI has been a catalyst to bring together additional global support for the planning and implementation of the scale-up of the national mutuelle program.  In Ethiopia, MLI’s initial support of the Balanced Scorecard led to significant additional foundation funds directed to the Federal Ministry of Health.

Flexibility

MLI is flexible – extraordinarily so. MLI is what the ministry leaders make of it.  MLI has learned to adapt to the political realities facing countries and the often frequent turnover of ministers of health. MLI’s experience demonstrates that working closely with key focal points in each ministry, including senior civil servant positions (e.g. secretary generals, chief medical officers, and directors of planning) responsible for providing day-to-day leadership and management can have an impact that can be sustained beyond the vagaries of political change. 

Trust-Building

Building on the flexible, collaborative relationships it has established, MLI’s work is moving quickly, fulfilling early promises and diving into new projects. There are few other models of health and development practice that allow ministry officials to frankly share weaknesses and challenges without risking a retraction or question of funding. Instead, MLI welcomes these open dialogues and responds by jointly defining technical assistance to meet ministry needs. 

Conclusion

By supporting country ownership and fostering sound development practice, MLI’s approach is building sustainable health systems that will yield significant results. Its work in building leadership capacity in the ranks of ministries, not just with the top one or two positions, will have lasting impact. In future years, talented leaders will refine programs, energize workers, and mobilize and equitably allocate resources so that countries can measurably improve health outcomes. MLI’s approach underscores a core principle held by many around the world but often cast aside in the poorest parts of the world - that health care is a human right. Adopting this approach, ministry leaders are better equipped with the skills and support necessary to take charge of their health systems, ensuring better access to quality health care.

The MLI5

The five MLI countries, Ethiopia, Mali, Nepal, Senegal and Sierra Leone, often referred to as the “MLI5,” together form a cohort of high-level national health officials.  As part of a learning collaborative network, senior level representatives from the MLI5 work to improve their leadership capacity and advance health policy reform in each of their countries.  In order to encourage and strengthen the MLI5, ministers and their senior teams have opportunities to come together and share their experiences, discuss challenges they face and potential solutions, and develop supportive relationships with one another. These relationships are cultivated through technical sessions and informal meetings as well as peer sharing opportunities including: multi-country collaborative learning forums, specialized study tours, in-country workshops, and attendance and participation in global meetings.

Country Leadership in Action

MLI believes that lasting, large-scale change must be driven by country leaders. See how the program is working to support ministries' abilities to act on their critical priorities in this short video: Ministerial Leadership Initiative for Global Health from MLI on Vimeo.

  • An MLI Voice: Dr. LR Pathak

    Jun 1 2010 - 3:37pm

    Nepal

    Over the past several months the Ministry of Health and Population has been preparing and writing its second five-year Health Sector Programme-Implementation Plan (NHSP-IP 2) 2010-2015.  Preparations for the plan preceded a thorough review of the previous plan. In so doing, the current plan represents a continuation and further refinement of the previous plan to build on past successes, which included the implementation of cost-effective, evidence-based health interventions. The upcoming plan envisions added efforts in the areas of safe motherhood, child health, nutrition, population and family planning.  And, due to a rise in non-communicable diseases and injuries, focuses on communication interventions to change behaviour.

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