So What?

Last week I attended a 6-day training focused on techniques for efficient and effective implementation of new World Health Organization (WHO) guidelines concerning prevention of mother to child HIV transmission (PMTCT). The approximately three dozen attendees included mostly Ministry of Health (MOH) employees and regional supervisors, and only a handful of partners (NGOs)—Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), Mothers to Mothers, and of course CHAI (represented by yours truly). The new guidelines, were recently adopted by Swaziland, and call for some significant adjustments to standards of care for pregnant women, such a prophylaxis to be given to children and calling for sustained breastfeeding for 12 months with continued prophylaxis.

The course for the week was basically like a rapid Executive MBA, put on through a joint effort by Johnson & Johnson (funding), UCLA Anderson School of Management and AMREF (instruction) through an initiative called the Management Development Institute. It had just finished trainings in Cape Town the week beforehand; there was another going on in Ghana.

Needless to say, many parts were redundant for me. We had three-hour courses on Leadership & Management, Organizational Planning, Financial Management, Marketing, and Operations.

The most interesting part for me was developing our goals for implementing the new PMTCT guidelines—significant changes include placing the mother on ART medication at 14 weeks of gestation and placing an exposed baby (meaning the mother is HIV positive; antibodies in the baby’s blood stream from the mom means that the baby’s on HIV status cannot be determined until six weeks) on prophylaxis at birth and continuing on it through (the encouraged) 12-months of breast feeding plus one additional week. Phew. And that’s just two of them. Things get quite technical quite fast.

In any case, back to the goals. The 35 participants were split into 5 different teams—one for each region and one national team. I was team Lubumbo, the eastern region that is one of the poor regions. We had to write out what we considered to be the major current challenges and barriers to implementing PMTCT (this can go on forever—lack of systems, human resources, training, etc.) and then decide on three problems to target, and develop a mission statement for each goal and then a process-oriented objective (i.e. Train one nurse from every facility in the region) and an outcome oriented objective (i.e. Enable nurses to provide better PMTCT care for patients) that had to be SMART (Specific, Measurable, Achievable, Realistic, Timely). We were asked to continually test our goals and objectives by asking “So what?” Such as, we are training 30 nurses—so what?? Do we really think they will then be prepared to implement all the new guidelines on a regular basis?

It proved to be very challenging for our team, as proved by the fact that that task took us close to 6 hours to accomplish. And, in fact, it’s really not simple—I should use that SMART rule for more goals in my life. The surprising thing was how hard it was to come up with goals that really hit home on those five points. And how to measure it??? I know we talked endlessly about measuring impact in many of my nonprofit management courses, and there remains no simple answer—just continued effort to try to really hone in on goals and align funding and time with these as carefully as possible.

As the only non-African participant, there were certainly a few lonely dinners in the midst of a sea of other colleagues who knew and worked together, as well as moments were I felt suffocated by a life lived day-in-day-out within a hotel and fueled by teas and enormous, underwhelming buffets every two hours. On the other hand, by the end of the week, I had formed friendly connections with many of them, and definitely bonded with my Lubombo Team (Exhibit A), and seen many of the other participants challenged and absorbed in learning and processing all the new material thrown at them. I was happy to be free of the buffet line, but also happy to have had the chance to attend.