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January 21, 2011

MLI's Wisman: Looking back -- and ahead -- at opportunities, challenges

    Rosann Wisman


Rosann Wisman has been director of the Ministerial Leadership Initiative for Global Health (MLI) for nearly three years.  Here are her reflections on what has worked and what have been MLI’s biggest challenges, as well as its goal in the next year. John Donnelly interviewed her on Thursday.

Q: When you look back at 2010, what do you see as highlights?

A:  The things that come to my mind are the visit by Mary Robinson to Sierra Leone and the meeting we just had in Ethiopia – the Learning Collaborative Forum.

Mary Robinson’s visit spotlighted the role of the head of state in Sierra Leone in driving and leading health reform and how critical that leadership is to take something to scale and to ensure equity. What Mary Robinson was able to do was speak peer to peer with President (Ernest Bai) Koroma. Her presence was an opportunity for MLI to share with a wider audience -- development partners, civil society, advocates – how the Ministry of Health and Sanitation and the government as a whole is really leading health reform on behalf of its citizens. So often in this work NGOs and development partners end up bypassing the government because it’s too complicated or they are worried about corruption, and here was a case where it was really the government leading and the development partners falling in line behind.

In the Ethiopia forum, it was great because we’ve been working for three years to build a network of ministry leaders in these five countries, and it’s been a very slow process. Leaders are so busy and so stretched and it has taken time for us to build relationships with them and also for them to build those relationships with each other. So we saw the result of these efforts in Ethiopia.  There was trust and candid sharing about successes and challenges.  It was very powerful.

Q: What have been your challenges in the first three years?

A: Our approach is to support demand-driven development. But some of these countries aren’t used to partners asking what they want. So getting clarity from the ministries about their priorities was difficult.   And sometimes, the problem was that the countries had so many demands, and we had limited resources. We worked at being very strategic in supporting specific priorities.

Q: In a major speech on development this week, USAID Administrator Rajiv Shah talked about independent reviews of all USAID projects and he promised to publish both successes and failures. What do you think about that and what have your evaluations shown about MLI successes and failures?

A: We‘ve seen real progress toward health policy and systems reform in several countries. In Mali, we were responsive to the ministry’s demands around support for the  expansion of community based health insurance. We’ve seen real progress there. I also think that MLI’s  emphasis on development diplomacy, how to help ministries, particularly with negotiations trainings like we’ve done in Nepal, has made an important contribution. It means helping ministry leaders to be clearer about their priorities and make a strong case to development partners. A lot of people talk about the importance of country leadership, but first the countries have to lead. They have to have a vision. Development diplomacy is a way to help level the playing field so that ministry leaders can be more confident in dealing with development partners.

Q: What about evaluation? And what about things that didn’t succeed?

A: I was really pleased to hear Raj Shah say that about outside evaluators. It could help all of us achieve more effective results. One of the things I’m proud of is that MLI has had outside evaluators, EnCompass,  from the beginning.  The evaluation piece has been one of the most challenging things we’ve had in this project. We could talk a lot about anecdotal progress, but we’re working with EnCompass to have more rigorous documentation and define replicable results that we can share with others. Evaluation is still a challenge though. We have this commitment to country ownership, but what does that mean and how do you measure it? How can we inform development practice in the future?

Q: What are the most important lessons you have learned and what is your advice to others?

A: We have learned how to build trust and credibility in the ministry. We have learned that development partners need to be focused on results but also flexible around realities. We talk about the value of being behind the scenes so that ministry leaders are out front in all of our work. One of the most affirming things is that our approach of south-to-south peer learning really worked as we saw in the Learning Collaborative Forum in Ethiopia. And this year we also rolled out a blog and have written quite a bit about what happens inside ministries. We are realizing that so many people and organizations working in development practice don’t know what happens in ministries and I feel like we are opening a window into them through our communications efforts. We need to continue to grow that.

What’s our advice to others? You shouldn’t come in saying to the Minister of Health, ‘This is the program we’re going to do.’ First, listen to the ministry leaders and try to respond to their priorities. It may sound good to say you are going to help the ministry by giving them an advisor, but you have to make sure it is what the ministry leaders want and ensure that the advisor has some accountability to the ministry. And we quickly adjusted to the fact that we can’t focus everything around ministers. The fact is that in four of our countries, all except for Ethiopia, there has been turnover in ministers. So it’s not just about ministers. It’s really about the unsung heroes, the implementers, the leaders in the second and third tier in these ministries.

Q: What’s important in the next year for MLI?

A: We want to build on the momentum from the Learning Collaborative Forum so we are looking at a series of opportunities to give greater visibility to our ministry leaders, keep them connected to one another, and keep that bonding alive. We want to keep our policy and system reform activities going on in all our countries. We hope that the current funding will turn out to be phase one of MLI, and we get more funding for phase two. And we are working with outside evaluators to document the lessons we’ve learned as well as the model we’ve begun to establish on how to foster country-driven development.

 Photo Credit Dominic Chavez