Do management capacities in clinicians really matter for maternal health? This is a key question that MSD for Mothers, along with some of its partners, is trying to tackle. MSD for Mothers is a 10-year global initiative launched in 2011 by Merck Sharp & Dohme (MSD)—better known as “Merck” in the United States and Canada—to help create a world where no woman dies from complications of pregnancy and childbirth.
Since we are in the early stages of our intervention development and determining our investment path, we need you to share your thoughts and insight on this important topic and the evidence it requires.
Maternal mortality needs our attention as Millennium Development Goal (MDG) 5—the target to reduce maternal mortality by three-quarters by 2015—is the most off-track MDG and is even further behind where health systems are poor. Recently, experts have concluded that progress has been stunted by a lack of commitment from development partners to strengthen the health systems that serve women and their maternal health needs. It has been argued that there is a link between safe motherhood and the performance of a health system, and—conversely—that strategies to improve safe motherhood may be a means of achieving wider health service improvements.
If this is true, could improving the management skills of clinicians in leadership positions help improve health facilities’ capacity to respond to obstetric emergencies, and ultimately reduce maternal and perinatal deaths?
Nick Bloom, Professor of Economics at Stanford University, and colleagues—whose research interests focus on measuring and explaining management practices across firms and countries—has found that:
- There is a strong relationship between management practice and health outcomes (as well as better financial performance)
- Hospitals with more clinicians as managers have better management
- Larger hospitals perform better, and competition appears to be good for management
- Government ownership is associated with poor incentives management (hiring, firing, pay and promotions)
If an intervention approach could be developed and tested to make clinicians better managers and if this were to result in better health outcomes, this could be an important innovative contribution to reducing maternal deaths.
The work of MSD for Mothers focuses on building the management capacity of clinicians who serve in leadership positions at facilities that offer comprehensive emergency obstetric care in Tanzania. These individuals typically split their time between delivering care to patients and overseeing the operations and management of a facility. They are often placed and/or promoted into managerial positions without adequate management training or tools to operate effectively and efficiently.
In April and May of 2014 we conducted a 360° assessment of clinicians in leadership positions across 17 operational and people management capabilities at six public and two private health facilities in Tanzania. A number of gaps were identified across a variety of management areas specifically for the publically managed facilities, but “data-driven decision-making” was identified as the key management capability since having a deeper understanding of and application of data will likely have an impact on maternal and perinatal health indicators and outcomes.
We believe the development of data-based decision-making capabilities must follow a cyclical path. Our recommendation to the Tanzania Ministry of Health and Social Welfare is to build an intervention package that helps clinicians progress through the full capability development cycle:
- Improve Data Collection Awareness
- Build Capacity for Data Interpretation
- Enable Data-Based Decision Making
Our focus on data-driven decision-making for an upcoming intervention package targeted to be launched 2015 is at a critical development point. We are looking to the Maternal Health Task Force community to help provide some insight into what levels of evidence this intervention needs to have to show relevance, scalability, and most importantly, sustainability. Understanding what type of evidence would be attractive to this community and beyond in the global health and international development space will help ensure that we build the right evaluation approach, and ultimately a smart investment decision.
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