Between April 19 and May 6, 2017, together with three Malagasy Leadership Development Program (LDP) facilitators—Virginia Razafindrakoto, LMG/Madagascar Program Manager, Elie Rasoloniaina, and Adolphe Rakotonandrasana— I travelled over 2,200 kilometers (1,367 miles) across three regions of Madagascar to visit 16 LDP teams who had shown proof of their leadership after the completion of an LDP through the LMG/Madagascar project.
All the teams visited had demonstrated measurable results based upon indicators set forth by CARMMA, the African Union’s Campaign to Accelerate the Reduction of Maternal and Child Mortality. The results of LDP on the health indicators have been impressive. For example, at a hospital in Ambohimiandra, neonatal and infant mortality decreased by 6% between July-December 2015 and July-December 2016; another hospital saw a reduction in maternal mortality from 1,000 per 100,000 deliveries to 50 per 100,000 deliveries; and at a health center in Tsaralalana, the number of pregnant women attending prenatal consultations rose 40% during the same time period. Furthermore, an LDP+ team at a health center in Mangidy improved vaccination coverage rates from 62% to 100%, also during the same time period. These are just a sample of the successes and accomplishments evidenced across all 16 teams.
To understand the great progress in these health indicators, the teams were asked “how did you get the numbers to improve?” The main response was that the LDP strengthened team relationships, which made the positive changes possible. The participants in the LDP had created relationships where none existed or improved relationships that were strained or poor; they had moved these relationships from mistrust to trust. Contrary to popular opinion that trust, once broken, is hard to put back together, I and the LMG team saw that trust could be established or re-established easily through the simple acts of inviting, listening, and sharing.
Essentially, what we believe happened is that people had realized that it was only through the relationships—and thus through conversations—that they could hope to make things better and improve health indicators. The simple act of approaching and asking can change everything–it led to sharing and discovery, and to finding out that one’s point of view was not the only one and not necessarily the right one. When interactions are based upon trust rather than mistrust, all things become possible that were not possible before.
Ultimately, through the LDP+ process, people changed. The same echoes we heard wherever the LMG staff went: “I changed from dictatorial to cooperative; I changed from impulsive and careless to caring and thoughtful!” These changes strengthened team dynamics and fostered collaboration, which improved motivation and the quality of care provided, ultimately driving lasting change within their respective health center or hospital.