By Tendai Gotora, Director of Programs, Spark Health Africa
For decades, African governments and their health systems have received donor funding. Although this practice has had a significant impact on health outcomes, it has also created stockpiles of physical assets that in many instances are not being efficiently and effectively utilized and has demonstrated that reliance on long-term external funding is unsustainable.
The past few years have seen donor governments reducing aid contributions to Africa, and more so caused by the global economic fall-out from the COVID-19 pandemic. This means that African countries face potentially significant disruptions in service delivery and healthcare gains if our governments are unable to do more with existing resources.
Over the past decade, Spark Health Africa has supported district health management teams across Africa to change how they look at and use their assets and existing resources to solve everyday challenges. The organization advocates to change the status quo from a deficit mindset—an over-reliance on receiving donor aid passively, in perpetuity—to an asset-based approach.
An asset-based approach looks beyond tangible physical assets to identify protective factors that support communities' health and well-being, including a sense of purpose and a commitment to learning, family and supportive networks, political democracy, and social justice.
Since 2018, the Johnson & Johnson Center for Health Worker Innovation, with funding from the Johnson & Johnson Foundation, has worked with Spark Health Africa to develop context-specific, sustainable solutions to address healthcare delivery challenges and strengthen health systems in Uganda. Targeting 10 district health management teams and with an initial focus on maternal and child health, this transformative leadership and culture change initiative later shifted focus to respond to the COVID-19 pandemic. The program comprised two transformative leadership igniting workshops and ongoing in-depth on-the-job mentoring and thought-partnership for more than 950 public health officials and frontline health workers.
Spark Health Africa made notable observations during their mentorship of how the teams applied asset-based thinking to their everyday work, concluding that this approach leads to a more effective workforce than a deficit-based mindset:
Reframing mindsets towards assets: Intentionally reframing and increasing the frequency of conversations around asset-based thinking and its benefits signalled a shift in work practices.
In Uganda’s Iganga District, the district health team would previously independently select areas for community immunization outreach. Results were poor, with communities dissatisfied about the lack of consultation, which resulted in them deliberately absconding from these outreach visits. Now, before any visit, the district health management team involves the community in deciding where to locate an outreach site to serve everyone, especially marginalized communities. Furthermore, the district health management team involves community leaders to create demand for immunization services.
Healthcare service providers that take full advantage of all resources at their disposal to co-create solutions with communities create positive outcomes Likewise, communities that actively participate in generating demand for healthcare services and holding their service providers accountable for their actions and performance create social accountability.
A new language also emerged among participating district health management teams, who use the term “sparked” for a person or a group that has been transformed from the old way of doing things—indicating the adoption of a new work ethic that values teamwork and collaboration with the community, the shift to transformative thinking and a change in the work culture agenda.
The importance of a clearly defined vision: having a clearly defined vision allows them to gather more stakeholders, including the community, behind that vision. Adopting a developmental and collaborative leadership style promotes an asset-based approach to work.
In 2019, Uganda’s Mbarara district struggled to reach the 90% annual target coverage for consultations conducted at a healthcare facility versus at home. Participating teams conducted assessments to review the district’s assets, reached out to the community and business sector to understand what they could contribute to the assets pool, and secured the identified assets for deployment.
The Mbarara District Health Officer (DHO) developed a public-private partnership project proposal that mapped the full support at the district’s disposal and invited private sector collaborators to visit project areas and hear communities’ needs directly. By bringing together the private sector collaborators and the public health service providers around a common goal, the DHO successfully utilized previously untapped assets.
Creating resilient health systems: Combining assets and co-creating solutions helps to create resilient health systems and communities.
In Uganda’s Bushenyi District, strategic efforts were made to empower health facility managers to develop meaningful relationships and to mobilize community resources through, for example, formal and informal gatherings at Health Unit Management Committee meetings.
The culture change initiative produced several benefits across program districts. It facilitated unprecedented collaboration between political and health leadership; encouraged health teams to fill job vacancies internally with existing personnel and targeted redeployment; and supported health management teams in moving away from the assumption that only health providers understand the needs of communities and that only they can provide solutions.
“For too long, communities have been marginalized and left out of important conversations around feasible solutions to address healthcare challenges and service delivery issues,” says Anthony Gitau, Director for Global Community Impact at Johnson & Johnson, Sub-Sahara Africa. “Communities are on the ground, living the reality of these challenges every day, and need to be at the forefront of informing critical health decisions. They are equal partners who want to be consulted—it’s time we listened. We are proud to work with Spark Health Africa; together, we have laid an important foundation for co-creation, driving an asset-based narrative, strengthening leadership capabilities, and fostering a culture of change to produce sustainable health outcomes and well-being for more communities.”
Maria Nansasi Nkalubo, Principal Operations Officer (and Transformation Lead), Department of Emergency Medical Services (EMS), Ministry of Health of Uganda, says that to date the approach has enabled the 10 pilot districts to take stock of what they have in terms capabilities, resources and the good will of individual players and institutions. “They are in a better position to respond to a wide range of challenges given the current finance cuts brought about by COVID-19,” she says. “In terms of scaleup, I encourage districts and all our stakeholders to embed asset-based approaches to the traditional health promotion interventions to complement existing efforts to improve the health and well-being of individuals and communities in Uganda.”