Building health system capacity to improve maternal and newborn care: a pilot leadership program for frontline staff at a tertiary hospital in Ghana.

BACKGROUND: Frontline healthcare workers are critical to meeting the maternal, newborn and child health Sustainable Development Goals in low- and middle-income countries. The World Health Organization has identified leadership development as integral to achieving successful health outcomes, but few programs exist for frontline healthcare workers in low-resource settings. METHODS: An 18-month pilot leadership development program was designed and implemented at Greater Accra Regional Hospital, a tertiary care facility in Ghana. A multi-modal training approach was utilized to include individual coaching, participatory discussions, role plays, and didactic sessions on leadership styles, emotional intelligence, communication, accountability and compassionate care. RESULTS: A cross-section of 140 staff from 8 distinct hospital wards and 19 ranks were involved in various components of the leadership program from January 2014 to June 2015. At baseline, the primary leadership challenges and goals of the staff included: interpersonal communication, institutional logistics, compliance, efficiency and staff attitudes. Thirteen participants developed a total of 17 leadership projects to apply their training, many of which focused on improving challenges in organizational culture and systems through bettering leadership skills and interpersonal communication. The staff highly valued the program and found it beneficial to their work. CONCLUSIONS: Self-selected individual leadership projects mirrored areas of concern found in the needs assessment, indicating that the program was successful in achieving its goals. The on-site nature of the program was cost-effective and led to maximum staff participation despite clinical responsibilities. A longstanding relationship between the design team and the local hospital staff allowed for an exploration of approaches, many of which were new to the local context. Further research is needed on adapting the program to other settings in Ghana and integrating it into broader systems strengthening interventions. This pilot program was well received and warrants further adaptation and scale up.