Performing work while upholding sustainable practices has become paramount in various spheres, and global health care is no exception. The continued viability of health projects is particularly important in the areas of health promotion, protection, and prevention, and requires long-term commitment and behavioural change by recipient populations.
The current fight to curb the spread of the COVID-19 pandemic is a timely example; the sustainability of physical distancing measures is of the utmost importance in preventing a surge in the number of positive cases and helping flatten the curve.
To date, local governments, non-governmental organisations (NGOs), and philanthropists have attempted to advance sustainability in health care, with varying degrees of success.
The five-phase project management cycle developed by Duncan is, for many, the gold standard. However, while it views management as an ongoing activity, long-term commitment among recipient populations, health care professionals, and/or governing bodies is not specifically addressed.
Thus, informed by the principles of grounded theory from Charmaz, a management and leadership framework is proposed that combines the following three overarching themes: appreciative inquiry, trust, and culture.
Appreciative Inquiry (AInq) is both a philosophy and methodology. Developed by Cooperrider and Srivastva, it aims to build a future based on lessons from the past and present knowledge. Drawing from self-reflective analysis and a participatory process, it includes five phases: definition, discovery, dream, design, and destiny.
Various reports show that AInq can improve the delivery and quality of health care services. For example, in South Asian countries, research has shown that fostering a collective role (hospital cleaners, ambulance drivers, nurses, doctors, and administrators) in service enhancement can improve the implementation of programs to reduce maternal mortality. Others have used AInq to improve infection control practices for maternity care in India. This approach allowed team relationships, motivation, and a sense of belonging to blossom while also having a positive influence on infection control.
Building a project on solid local ground seems intuitive. However, such initiatives are usually based on what is apparently missing in the recipient community or on the mistakes that have been identified and need to be corrected. AInq complements traditional management cycles by creating ideas beyond those raised by traditional goal-setting approaches.
Partnerships between donor and recipient countries, as well as among NGOs and private stakeholders, should also be created and cultivated. Project and program leaders should work at establishing partnerships by encouraging trust behaviours. According to the 2020 Edelman Trust Barometer, institutional competence only accounts for 24% of trust capital. The other 76% reflects perceptions of ethical leadership through dependability, integrity, and purpose.
In most settings, local authorities have influence, cultural knowledge, and political clout. Obtaining approval from the local government or authority can create momentum and influence people to trust a project.
Pooling financial resources, creating international norms, and reporting progress are ways to create bonds of trust among funders and development agencies, private foundations, and other stakeholders.
Trust in innovation and technology
Trust in a project’s technology is equally important in ensuring sustainability. Patient assessments of the trustworthiness of technologies are based on their observations and perceptions of how providers effectively use their skills.
Finally, leaders cannot underestimate the importance of community trust in achieving sustainability for their projects.
Overall, demonstrating integrity, good intent, and knowledge contribute to the likelihood of sustainability.
Culture consists of the shared values that are passed on within a group. In Organizational Culture and Leadership, Edgar H. Schein defines four categories of culture: macrocultures, organizational cultures, subcultures, and microcultures.
On a global scale, both private and public sector organizations do work that involves multiple facets of culture. Understanding these dynamics plays a major part in the sustainability of an initiative. In fact, the long-term acceptability of a project or program can only be possible if it respects culture.
A leader of an outside organization has very few powers, if any, to change a macroculture; it is essential to make every effort to understand the host culture instead of imposing one’s own. However, good leadership can certainly influence already existing organizational cultures and can create microcultures and subcultures.
Therefore, a leader’s responsibility resides in keeping an open mind and a non-judgmental approach regarding the behaviour and thoughts of all group members for the sake of the growth and success of the project. Navigating cross-cultural differences respectfully and highlighting shared values are critical steps that enhance effective communication and cooperation. Leaders determine what is acceptable or not, and what is part of the culture or not.
The creation of cultural islands, according to Schein, helps group members learn from their own efforts and become a group. Team members learn how to constructively address differences by performing. Collaborators must learn how to perform “frame-shifting,” which entails changing one’s perspective and behavioural approach in order to be effective in different cultural situations.
Moving forward, together
Global health projects and programs are large, complex initiatives that are difficult to manage. Their initiation and implementation require highly adaptive and effective leadership to ensure sustainability in achieving their goals.
With the proposed management model, we urge a compassionate, humane, and anthropological perspective on the traditional project/program management cycle. A high-scoring project/program that harvests wisdom accross stakeholders will be more likely to achieve a sustainable initiative and have a long-term impact —especially in times of crisis.
About the authors
Nathalie Duchesne, MD, is a fellow of The Royal College of Physicians of Canada. She is an associate professor in the Department of Radiology at Université Laval and an adjunct professor in the Desautels Faculty of Management at McGill University. Nathalie is a radiologist and a medical adviser in public health. She holds a master’s in public health from King’s College London and a master’s in health management from McGill University’s Desautels Faculty of Management. In addition to her daily clinical roles, she is an advisor for McGill’s International Masters for Health Leadership (IMHL) program.
Eliane Ubalijoro, PhD, is the deputy executive director for programs at Global Open Data in Agriculture and Nutrition (GODAN). She is a fellow of the African Academy of Sciences and a member of Rwanda’s Presidential Advisory Council and National Council for Science and Technology. Eliane has been an advisor for six cohorts of McGill’s International Masters for Health Leadership (IMHL) program. She is also on the Board of the International Leadership Association.
Article written by: Nathalie Duchesne, MD and Eliane Ubalijoro, PhD
Photography by: Franca Eyeem via Getty Images