 Now we will carry on with the presenters of this presentation, Maria de Lourdes de la Pesa. And I will hand over to you, Lourdes. Thank you, Annette. Good morning, afternoon, evening to everybody. I'm very glad to be here with you. I'm Maria de Lourdes de la Pesa, I'm Mexican, but I have been working internationally for 30 years now in the health area. I'm a consultant in organizational development. I'm a trainer, educator, consultant, and my passion has been training leaders and managers in the health sector. So I'm very pleased to be here with you to share my experience in interesting how leadership, management, and governance skills can be developed to improve midwifery. Can you give me rights to move the slides, please, Annette? Yes, I can. Okay. Today we are going to talk about, first of all, the need of leadership management and governance training for midwives, and the background of the midwifery manager's course for leadership management and governance. And also the course objective structure methodology and content. And, and also we are going to share with you the results of the implementation of the course. And at the end we are going to have time for you to make questions and comments. First of all, the, in fact, I work for management sciences for health for more than 20 years. One of our, and I participate in five different five different five year projects, which were focused on management and leadership development. So, for us, within the management sciences for health, our passion was precisely the importance of leadership management for health workers in general and for, and of course for midwives in particular. But more than just us, for instance, in their state of worlds midwifery in 2014 recommends the employment of 112,000 midwives in 38 developing countries, but they questions when the curricula just teach clinical skills. And for instance, the Australian College of Nursing has established the strong that the strong nursing and midwifery leadership leads to better patient health outcomes. But also, training midwives in leadership management and governance has given at the five as key intervention by Lancet and W show to ensure effective maternal and non aton and child health services worldwide. And that's why management sciences for health in the LMG project, which was from 2011 2017 and make an interviews to key to 16 key informal midwives in South Saharan Africa, and they identify a lot of gaps in terms of leadership management and governance skills among midwifery managers. So, they decided to create the midwifery manager certificate course that was implemented by management sciences for health and AMREF, which is an research and education institution in Africa. So as a result of that, a total of 20 midwives from 10 different countries were trained to become leadership management and governance for midwifery trainers. And they train a total of 99 midwives. And after the training tricked and document individual progress towards targets set in their action plans. So the programming, what key piece of the program of the program was that the participants develop an action plan, how they were going to apply leading managing and governance skills in specific midwifery challenges. So the countries that participate in the training in the first cohort was where Ethiopia, Kenya, Uganda, Tanzania and Malawi. And in the second one, Risotto, Rwanda, South Sudan, Zambia and Zimbabwe. The results at the end of the program, MSH conducted an inline evaluation of the course, and the information was triangulated from the midwives participants in the program, as well the facility managers in where they were working and the trainers. And they evaluated the evaluation indicated that participants, all participants reported increased capacity to lead and manage that allow them to address barriers and solve complex problems in their day to day work. But also, participants across all 10 countries, overwhelming reporting that they can tell improvement in their team work and joint problem solving, documentation, conflict resolution, that also were mentioned by the facility managers for whom they work. These improved skills were reportedly sustained for one to two years after the completion of the course. But what is the origin of this program? It was the combination of management sciences for health, have a signature leadership development program, as they call LDP, that was developed and implemented for more than 15 years in more than 40 countries. And this program was the base in which the midwifery program was developed with the help with AMREF, AMREF Africa, with their experience in training for more than 50 years in eight African countries. So they both together created and implemented the program. And this, the rationale of the training was to provide the health system with effective managers, midwives, with ability to lead, build the capacity of midwifery managers to improve their problem solving, the resource mobilizations and monitor and evaluation capabilities, but also to utilize leadership management and government skills to improve service delivery quality and efficiency. And the course guiding principles where this is a program that is action based learning, gender responsive, focus on health outcomes, team focus, relevant to local needs and supported by stakeholders. I'm going to explain a little bit each of these. In terms of action learning, we know that adults learn better when we start reflecting about our own actions, what results we obtain and conceptualize better ways to do it based on experience and then apply these ideas to new situations. But also the program is organizing a way that participants identify one challenge they have in their workplace in midwifery challenge, but then through the program they receive support to address that challenge, but also they were receiving feedback in how to do it better. And in terms of gender responsive, it is the program put special attention is how to select participants in terms of gender. The language is very taken care of the language to be gender responsive, sensitive, the content is gender sensitive, but also the program has some exercises to examine specific gender based challenges and solutions to common workplace issues. One key feature of the program is that has to focus on challenges in priority health areas and a set of clear indicators that can impact results. For instance, I work in Mozambique with nine health midwives from nine health facilities in a region, and they have facing a problem related to transmission from mother to child HIV transmission. So they have to choose a specific indicator how they were going to address that. So how can we improve adherence to the HIV treatment. And this is the indicator in order to improve, to avoid the transmission. And, but also it is very important to involve the team, because midwives alone cannot solve the problems. So the participants to the program when they, they participate in the program but then they return to their facilities and work with all the people that work with them and create a team, and they together start to create a positive vision of the result they want to address. For instance, with the midwives in Mozambique, they start with a vision that they, until no baby was born infected of HIV. It was a positive vision they want to create. But then they, they work with their teams to apply leading and managing practices and use a solving problem tool that I'm going to show you which is called the challenge model to address that challenge. But they also have to align the stakeholders to support them in addressing that challenge. So when we talk about leading and managing practices, this program is, is focused in action. We don't teach people about theories about leadership or management. We talk them, for instance, when we are talking about leading, we talk about the ability to scan the environment for opportunities and threats to focus on priorities, to align and mobilize people and resources to address those priorities and to inspire people to address them. And, but they really, they also need to manage when you find a challenge, you need to make a plan, organize the people, implement, monitor, monitor how you are advancing, but also you need to cultivate accountability and engage stakeholders, maintain the direction and store resources. So, but this is not linear. Leading and managing are combined. For instance, on the top, you can see in the top left, you can scan the environment and when you identify important challenges, you focus on a priority. But when everything is important, nothing is important. So you have to choose a priority. And then, but then you have to combine this leading ability to your, your management ability to plan. When you identify a challenge, you have to make a good plan. But then you go up with the arrow and see that you need to inspire people. So they are inspired to work on that challenge. So you need to align them to achieve results, which we can see in the, in the right of this, of the slide. To achieve results, you have to implement, but in order to do that, you have to also use your management ability to organize people. And then we go to the bottom, your management ability to monitoring advances, evaluate, and based on what you learn, plan again, and the circle is started all over again. So, but I told you that also you have to apply your leading and managing practices, but as well, you need to use a solving problem methodology. And this is the, this challenge model is the solving problem methodology we use. You can see that the very top that we start with a priority. And in the example that I explained you, we were talking about to avoid vertical transmission of HIV from mother to child. So that's the health area. But then what's the vision until no child is born infected with HIV? But then we have that vision at the top, which is what we're going to lead us. But then we have to go to the bottom of the, of the format to see, okay, this is where we went, but what is our current situation in this moment. So then the midwives in that they scan and they evaluate what was the indicator, which was the at that point, they have a very good identification of women, HIV pregnant women, and they have a good way to take them to the service and test them and counsel them. So they put them in treatment. But the challenge was that once women were pregnant women, positive pregnant women was in treatment. Some of them abandoned the treatment. Some of them after three months, some of them after six months. So they don't, they have to learn how to adhere to have better adherence to treatment. So they put you go, you can see that this format has the is an arrow, because we want to go from the current situation, which is in the bottom to the top, which is the vision. But in the middle of that we have a measure of a result. We need to have a specific step that we want to go in to go to our result. So in their case, their specific step was to increase adherence to treatment. And then in the middle of the current situation and the measure of a result, we have, you can see the column on the left, we have obstacles and root causes. So they say, what is preventing women to adhere to treatment, and then using the techniques of why, why, why identify the main obstacles and root causes. And for instance, in that case, women, some of the promise was that women, there is a lot of stigma in the community. So they don't want people to know that they were coming to the health center to get treatment because they were infected with HIV. This is one other is that they were far away from the, from the health facility, so they have trouble to come every month for their, from their drugs. So they have to analyze in deeper why people are not coming and not adhering to the treatment in order to go into the right column to say what actions we can take to increase adherence to treatment. And so if you implement those actions, probably you are going to make your current situation go up and closer to your measure of a result and then closer to your vision. So using your leading in managing practices and these solving problem methodology is the way that they can work in implementing an action plan to address one of the midwifery challenges and demonstrate their leading and managing practices. But also, as I already tell you, it is very important that this is relevant to local needs. In that case, the local need was to increase adherence to treatment so no child was born with HIV. But the, the course content example, etc. has to be tailored, locally tailored to the local needs. And finally, it is very important to address the challenge that you engage the stakeholders in your region or in your environment. For instance, these midwives in Mozambique engage the region, the religious leaders so they can encourage husbands and communities to support women. So they have been protected and then the children can be born healthy, but they also involve other authorities and other NGOs. So everybody was aligned working with the same challenge in order to avoid transmission, mother to child transmission of HIV. But how is the course organized? The course is midwives participating in a five day training that covers five modules. And then during the five days training, using the challenge model, they identify a challenge, develop an action plan, a real action plan, and then implement this action plan in the next six months. Utilizing the skills that I learned during the program, but then receive support supervision from facilitators to apply their skills and implement their action plan. The content of the program is leadership management and governance practices, strategic sovereign problem using the challenge model that I already showed you, how to lead people, how to manage resources, and how to monitor and evaluate. And, but also as I already told you, it is very important the training methods because it's based on action learning approach. So we don't use the, we call facilitators, not the, the trainers are facilitator more than experts because in the action learning, people has to start from their own experiences and learn how they have learned from experience. And then apply some reflect on some tools or theories, but also how to apply leadership management skills, but the real challenges. So we try to minimize the use of lectures and use all the other learning techniques at hand. And also the evaluation of the results of the program are based on how they implement their action plans. So you can access the program, the entire program at the MSH site, but also you can also access the evaluation of this first implementation approach. But also you can access the LDP, the leadership development program, the signature MSH program, which is a more comprehensive program. So all the resources you can access. And now we can open the floor for questions and comments. Do you have any questions? Annette, you can coordinate the questions. Yes, I will. Do you have any questions from Maria de Lourdes? There is a comment from Tara Mati Barker, writing that she remembered this model when she did the leadership and management training program in USAID. Okay. But so far no questions. Also we can receive comments. Yeah, there is, I have a question in the private chat. What other examples can you give of problems to be solved in this model? Good. I also have a very good experience in Guagualada in Nigeria. And also we have, they have a huge challenges related to the women we were pregnant that they were not coming to receive to their consultancies. Every three, they have to come three times before delivery. And then was important how they can complete their consultations. So they were well prepared when they deliver. And this is another kind of challenges they're facing. And, but also we have a lot of challenges also related to family planning. And also there are challenges that women don't want to be tested for HIV because they were concerned that they were tested. They could be suffered for discrimination. So it was important that they implemented it, for instance, that they make counseling with women and their husbands at the same time. They were encouraging them to come to the health centers accompanied by their husbands. So all the process was taking care for both of them together. So it was different kind of challenges related to pregnancy, to delivery, the facility, to family planning, to avoid when they don't want to be pregnant again. And there are any challenges you can face, but also you can face challenges that are not related directly with clients, but internally. If you have infections in the facility, so you can work together with the team to analyze what's happening and work together how it can be solved. So the challenges can be related directly to service delivery, but that also can be related to something internally that is happening with the service. Great. Thank you. There is another question about if there are any limits of age to participate in this course. No. The most important thing, we encouraged, when it's possible, that people from the same facility participate together. The course, it's what you can access in MSH is all the materials. So you can organize the course. But for instance, the LDP material leadership development program. It's a program that is developing a way that the facilitator manual is step-by-step designed in a way that a good trainer or trainer can use it easily to implement the program. So you don't need to find someone to do it for you. You can download the materials and find a good midwife, which is her facilitator skills, and she or he can deliver the program. So for instance, the LDP plus, you can see session by session, step-by-step, what you have to say, what and all details are there. So it's to be self-managed that we in Management Sciences for Health were interested in develop friendly materials that can be distributed all over the world and use by everyone else that wants to use it. So I invite you to go to the site. And because the midwifery course in the way that is organized, it's for trainers that have a little more skills. The kids is the syllabus and some ideas, but it's not step-by-step. But if you go to the LDP leadership development program, it is step-by-step. And so you just can do by the book. Okay. Do we have more questions for Maria de Lourdes? Other thing is that I can give you my email. And if you have any questions or comments, I'm more than happy. I'm going to put in the chat public my email address. So if you want, you can send me questions or comments if you have doubts. Okay. But check back. Another important thing is one other thing that we did in MSH, Management Sciences for Health, was working with midwifery schools. And so they could introduce this curricula in their programs, because sometimes I also work, for instance, in Ethiopia, because they were introducing the curricula in health practitioners curricula, not just midwives, but especially midwives. But the problem is that sometimes in the schools, they provide management and teaching, management and leadership training in a very theoretical way. In a way that midwives don't know how to go from this theory to the day-to-day practice. And what our materials have and our approaches have is very, very practical. So they really learn not theories, but how they can lead and managing when they are facing challenges in their real work day-to-day. So that's why I encourage you, you participate in training of midwives that go to MSH site and look for our materials and see if they can be useful for you when you are training midwives. Anything else? There's comments about that. It sounds really useful, this model. Okay. Yeah. I am part of the team that developed the LDP, the leadership development program, the Signature Management Sciences for Health program, but also the midwifery course. So if you are in the process of implementing it or trying to implement the leadership program and have any questions or comments, you can just email me and I'm more than glad to have a private conversation. Great. Thank you very much, Maria de Luzes, for your presentation. I think I will move on to the closing slides. Okay. So thank you everybody for your participation. It was a pleasure. Hopefully, we can meet personally someday. And if you need me, just send me an email.