Ripples of the LDP+ in Cote d’Ivoire: Maternal side effects

“I thought I knew all there was to know about leadership. I had participated in several leadership training programs when the invitation came to join a group of future facilitators for this thing called the LDP+ in Grand-Bassam [Cote d’Ivoire].” These were the words from an LDP+ facilitator when we reflected on what had happened since that day in May, nearly five months earlier. His real learning about leading and managing started a surprising journey for him that very day.

Using the LDP+ training manual, six facilitators from central and regional levels of the Cote D’Ivoire Ministry of Health and four MSH facilitators lead the LDP+ process for district and regional teams of the health regions of N’Zi-Iffou-Moronou and Indenie-Djuablin in Côte d’Ivoire. The purpose of this leadership development program is to increase the retention rates of HIV patients on anti-retroviral treatment. As the regional health director from N’Zi-Iffou-Moronou told us recently, “at the beginning of the process this was my challenge: “how to get all the 6 district officers and providers whose activities I coordinate, to work in a way that is dynamic and creates synergetic action so that we could increase the 12 month retention rates of HIV patients in our ARV treatment program in our region to 80%?” A year ago at the regional level, this rate was barely at 50% and we didn’t know what to do about it. I was very worried because my superiors and the donors have been challenging us to increase the retention rate since January 2013.”

The mixed MOH and MSH facilitation team is always one workshop ahead of the teams they are teaching. During the first LDP+ workshop with an emphasis on scanning and knowing what is going on around them, the facilitators learned the ropes, adjusting to a style of facilitating (rather than teaching) that wasn’t altogether comfortable. I served as a coach when they were preparing their sessions, facilitating only those that were too far out of the newly minted LDP+ facilitators’ comfort zones.

When we looked back at the 3 day TOT in Grand Bassam, most facilitators admitted they had been anywhere from ‘panicked’ to very uncomfortable that first week. For the second workshop on focusing, about two months later, they were on their own with only the facilitator notes as their guide. Now, at the start of the 3rd workshop on aligning, mobilizing and inspiring, I have the privilege to observe this extraordinary LDP+ team in action, entirely from the sidelines. They have clearly found their groove: tasks are divided, everyone is confident and prepared, their intimacy with the teams they accompanied as coaches is palpable, and the teams they have been working with are on fire.

The facilitation team had decided to insert an extra day before the two day workshop to help the district and regional improvement teams prepare their documentation. This can be a tedious task, that I know, often gets shortchanged because of busy work days back in their respective districts and regions. Now they had an entire day, supported by their coaches, to finalize their challenge model, their action plan, their M&E plan, what they are doing differently now and a few success stories.

After each workshop the teams return to their respective regional and district offices and share with their colleagues what they have learned, the tools, concepts and any other insights they gained. Having witnessed such ‘restitutions’ elsewhere, I had no inkling of the motivational power these ‘restitutions’ had with this particular group. Four districts told the group about some surprising ripple effects: of midwives and nurses taking the tools and applying them to challenges related to improve pregnancy outcomes.

With their supervisors’ permission to do what they had wanted to do all along, these service providers started talking with the women in the communities about something of great concern: why they were dropping out of prenatal visits and why they were not coming to deliver at the health centers.

Health center staff started scanning intentionally to find out the reasons. They talked with village elders and the women themselves and discovered that, since most babies announced their imminent arrival in the middle of the night, and the health centers were either closed or had no electricity, they preferred to deliver at home. Besides, the women didn’t really understand why prenatal visits and supervised deliveries were so important. In one zone, the village women association raised funds to buy a solar panel and as a result the facility can receive women for their deliveries at night. Many more women are now coming for all four of the prenatal visits and deliver in the health facilities.

This LDP+ was about increasing the retention rate of patients on ARV treatment. The regional health director of N’Zi-Iffou-Moronou is happy about the progress: “today the preliminary results indicate an 81% retention rate in the region overall and all of the 6 participating districts have already reached their target. It is extraordinary! Unimaginable! “

But there is more: the “ripple” effects of the program are also proving to be beneficial for women and their families who are now more likely to bring their pregnancies to a safe and happy ending.