AITHM James Cook University


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12 April 2022

For the past ten years AITHM researcher and JCU Professor of Management and Organisation Studies, Peter Case, has been a health systems management consultant for the Bill and Melinda Gates Foundation funded Malaria Elimination Initiative (MEI), working on malaria elimination programs in the Greater Mekong region of Southeast Asia.

His work with the MEI includes assisting with the development of a leadership and management tool called LEAD (Leadership and Engagement for Improved Accountability & Delivery of Services Framework), which has been designed to be applied to a range of healthcare problems. Peter is currently co-leading a project for the MEI in Zimbabwe on restructuring HIV prevention services at both a national and subnational level.

“The main message is that if you're trying to eliminate malaria or prevent HIV or deal with other healthcare issues, that it’s not simply a matter of technical resources. Health programs need effective management and efficient organisation at the centre of its efforts if they are to achieve high quality care."

“The LEAD organisational change methodology has been tried and tested and borrows from Participant Action Research, with an emphasis on valuing the local knowledge of frontline workers and then working on how to get their voices heard by middle ranking and senior staff, so that actions and resources can be allocated accordingly.”

Harnessing the local knowledge of frontline health workers and the community is critical to effectively dealing with the isolated seasonal outbreaks of malaria transmission that can occur with countries as they progress towards malaria elimination, says Peter.

“Delivery of interventions require greater precision to targeted and often difficult to reach populations and malaria control strategies need to be specifically tailored. For example, from my time spent working in mountainous regions of Vietnam I learnt from the local health workers that many villagers were travelling for work into the forest area that borders Laos, with malaria transmission then being imported back into their home village. This insight then led to intervention strategies that had not been previously considered.”

Making programs more aligned with the local context while also facilitating local ownership requires an inverted model of the usual health system hierarchy, says Peter.

“We are advocating for a decolonised approach to health systems management, one that requires facilitating and empowering on-the-ground health workers to make local decisions."

“It’s all very well developing a government ministry strategy with lots of targets and metrics, but they can end up being completely meaningless to people on the ground. In fact, if you're setting unrealistic targets, people can just turn off.”

Another important dimension to Peter’s work on organisational development is to engage, motivate and enthuse the people involved.

“People have all sorts of motives that come into play, and so our approach has been to acknowledge that and to incorporate those complexities into the LEAD management and leadership framework."

“We have found by bringing together people from all levels of the health system to engage with each other in a series of workshops, where the frontline workers are listened to and action plans are made as a result, that the health workers have become incredibly motivated about the work they do."

“It's probably the first time that someone like a community nurse, for example, has been listened to by someone senior from a government ministry, and this process not only enthuses people but also generates a lot of energy.”

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