Exposure to NCDs in Trinidad

Ffyona Patel, 2014 GHLI Fellow

My experience in  Trinidad has married complex health information system (HIS) ambitions  with mango chow (garlic, hot pepper, cilantro mango salad) and chicken roti (essentially a curried chicken burrito -- forgive me, Trini friends!). Here at South West Regional Health Authority (SWRHA), where about 60% of the nation’s health care is provided, all agree that an electronic HIS for NCDs is an imperative systems improvement to how primary care is provided, reported, planned, and translated into policy. However, ushering this in has required the Ministry of Health, SWRHA leadership, key departments, providers and other stakeholders to engage and commit to managing necessary changes.  Now in the formative phase of planning the HIS pilot, these requirements prove challenging.

I spoke with a Health Records staff manager who shared just how murky the “sugars” (diabetes) landscape is without timely data. With its universal health care, Trinidad patients can travel from hospital to health center to pharmacy to receive care and medications. However, largely paper-based medical records beget fragmented accounts of medical history and limited capacity to collect and aggregate epidemiological data, resulting in gross estimates of incidence and prevalence for diabetes and other NCDs. The current system also places great burden on support staff that sift through the paper records and hand count data for reporting. An electronic HIS carries promise for greater efficiency, higher quality of care, and model-worthy integration of data into planning for nationwide NCD intervention.

Between supporting the formative phase of the pilot project and the early-stage planning for the GHLI Forum for Change in Trinidad, I am grabbing my interests in strengthening health systems, strategic change management, and data-informed policy by the reins. While here, I aspire to continue sparking the small steps of leadership, management, and support staff toward realizing their big system-level change via a much needed HIS for NCDs.

Expanding and Improving Leadership and Management in Rwanda

Kidest Nadew and Sarah Trent, HRH Rwanda Health Managers

This year, we are working as health managers at King Faisal Hospital (KFH) in a partnership with local leadership to implement quality improvement projects. As part of the Human Resources for Health Rwanda program (HRH) funded by the US President’s Emergency Plan for AIDS Relief through the Centers for Disease Control and Prevention, and the Yale Global Health Leadership Institute we helped design and implement a nurse leadership and management education series that trained sixteen KFH nurse managers about topics such as time management, decision-making, communication skills, and team building.  The ten-week training was structured around an inclusive partnership model co-developed by US faculty and KFH leaders.  The program provided a better understanding of how to offer culturally and professionally relevant leadership training content.

We have already seen the results of the training, as demonstrated by more effective working relationships between King Faisal nursing leadership. The leadership and time management sessions provided insight into how different cultures perceive leadership, preferences around leadership styles, and time management practices. Sessions were tailored to facilitate improved participation and experiential learning through group exercises and dialogue. Students were highly engaged throughout the interactive training sessions. We also learned more about our own communication skills and styles as the sessions helped us to reflect on the cultural constructions surrounding time management habits in the Rwandese and Western cultures. We were especially attentive to language differences, cultural viewpoints, and unique working styles as we moved through the training content.

Participants’ feedback has been extremely positive and given this response, we launched subsequent leadership and management trainings at two other Rwandan hospitals in partnership with their leadership teams. It is extremely motivating to partner with such talented and eager colleagues and we are grateful for the time our colleagues committed to this important training.