Attitude of Clinic Staff Improved by Nicaragua Training

MANAGUA, Nicaragua – Reina Margarita Maltez has often visited the clinic in the rural town of Tisma, 25 miles southeast of this capital. Having five children has seen to that.

"Sometimes the staff would not even raise their heads to greet me, and that made me feel bad. It was terrible," she said. "When your child is sick, you are already anxious, and if the staff does not even care, it makes you even more anxious."

But in recent years, Maltez found the attitude of clinic health workers had changed after a series of projects funded by USAID were implemented to improve health services.

The projects include management training, leadership courses, monitoring the health system, and institutionalizing successful efforts. As a result, the medical staff is more attentive and courteous to patients.

"Traditional leadership development programs . . . show you what the characteristics of a good leader are," said Violeta Barreto, director of human resources at the Ministry of Health, which worked with the USAID contractor.

"The [USAID] program is made for public sector organizations and NGOs, and recognizes the importance of leaders who are managers, who all have important objectives and who must prioritize those objectives in light of scarce resources," she said.

Some 80 percent of Nicaragua -- second poorest country in the Western hemisphere -- depends on public clinics.

In Boaco, a rural area north of Managua, health directors recently met --on a day when a power outage left them in the dark – to discuss monthly health statistics and identify gaps in service delivery.

Just a two-minute walk from the regional office, where health services are budgeted and managed, a local health post treats about 300 patients per day. Its health providers depend on administrators like Dr. Armando Incer, the regional medical director, who helps ensure they have the tools to offer quality service, monitor that service, and treat patients well.

"We knew that how we treat patients is important. However, many of our staff did not keep this in mind," Dr. Incer said. "They did not know our mission or our vision for health services in the region."

The leadership program began in July 2001 in the poorest of Nicaragua’s 17 regions. After an assessment identified problems in the work place climate, MSH and the Ministry of Health produced leadership development training modules directed at the biggest deficiencies.

"Before, we had no common vision. Our staff had attitude problems...and did not see how their actions negatively impacted services," said Rosa Martines, municipal health leader for the Masaya region, which was one of the original project sites. "As a team, we've improved our communication. The information flows and no longer stays at one level or with one person or program."

After training two groups at the municipal level, the program was offered nationally.

In mid-2003, the program began working with senior managers at the central level of the Ministry of Health, focusing on regulatory and policy challenges. Leadership was strengthened, and led to the development of a National Health Plan. Now the Ministry's management and operational systems are also being reengineered and improved.