Leadership Challenges in Reproductive Health Management

By the 1990s, Indonesia had unacceptably high maternal and infant mortality rates, the highest rates in the Southeast Asian region. Many of the deaths –from hemorrhage, infection, and hypertensive diseases of pregnancy– are preventable. Approximately 75 percent of births take place at home, and are attended by traditional birth attendants or family members. Skilled attendance at delivery increased from 25% in 1992 to 67% by 1999, but has yet to reach the expected 80%, in line with international targets.

The international community has in hand today the knowledge base and low cost technologies to dramatically reduce infant, child and maternal mortality in every country in the world. Most of these technologies are currently being widely disseminated by a multiplicity of international donor agencies, yet too often these interventions are not reaching many people, particularly the most disadvantaged in the developing and poorest countries. Further, many of these projects are also not sustainable.

Although health leaders around the world are competent professionals in their own technical fields, they often are given leadership responsibilities for which they are unprepared. They have not had the opportunity to explicitly learn about leadership competencies such as:

• engaging in self-development and becoming a reflective leader,

• creating a shared vision and managing organizational change,

• getting results through team work and coalition building,

• influencing others through advocacy and effective communication, and

• developing leadership skills in others through succession planning and mentoring.

Our thinking was if a decentralized health system is to produce more effective performance of the health workforce, critical attention must be paid not only to clinical and technical competence but also to leadership competencies. Particular attention needed to be given to creating a shared vision and managing organizational change, getting results through team work and coalition building, influencing others through advocacy and effective communication, and developing leadership skills in others through succession planning and mentoring.