Sylvia's Journal

With my system recovered from the flushing activity of Tuesday, I was ready for a full day of work. It turned out not all that full as we had only been able to secure one appointment in the morning. A dinner meeting was added later in the day, unplanned but welcomed, with a team of consultants assessing the health system’s health.

I found myself less certain of the good outcome of this trip after meeting with one of the regional directors who challenged me, indirectly, and politely, on bringing in yet another training program. She listed training programs done by other organizations – some of which I know – that all came with promises that weren’t realized.

Organizations and projects often put training workshops in their plans because it is something that you can do no matter what and then tick off as accomplishments. Of course they are not accomplishments unless the participants go back and change their ways but that requires intensive support and coaching over a long period of time. That rarely happens. How can I explain that what we bring is different?

I like that we were being challenged because it actually shows that someone is not happy with this state of affairs. No one should be, but people have a love-hate relationship with the donors: they like the treats and the trips but they don’t like to be bossed around.

In the afternoon I got a surprise call from a (Dutch) compatriot who is in country with a multi-donor team that is here to validate self assessments from various parts of the health system in preparation for the Health Summit that happens next month. It’s a lofty idea but only works if people actually do their self assessments which they had not. So the team went fact finding on its own.

What they are finding is not a surprise and could be found in any country that receives mega donor funds. Every part that plays a role in the larger health system is disconnected from every other part, from the community down at the bottom of the societal pyramid all the way up to the donor community with their earmarked funds. Everyone knows this, but it is mostly an abstraction as long as the fingers of blame point away to others.

One of the team’s conclusions is weak leadership at the top. That too is not new – but then what? Sending people to Harvard or Oxford, or bringing in a big consulting firm to teach these leaders about management and leadership has been tried before and not produced any of the hoped for systemic changes, even though individuals changed.

Here, like in most other places I visit, the work is embedded in a culture that does not let criticism rise to the top. As a result higher ups are not benefitting from any meaningful and actionable feedback about their own contributions to bottlenecks and miscommunications. Thus it is not surprising that people are looking for causes and solutions that do not include them. What’s bad and hurtful about this state of affairs is that the criticism is voiced to others, outsiders or peers, and so it does enter into the organizational bloodstream after all. And yet it cannot be acted upon in a direct way because of the way it is voiced, softly and behind people’s backs. No one will ever be successful this way.

All this makes my mission very timely and at the same time difficult because everyone wants other people to be trained in leadership, yet there is no open communication about any of this. I am making these visits and notice that the dots are not connected, and no one wants to be fixed unless the training is seen as a nice vacation from work and some extra income.

How all this is playing out in my psyche was obvious from a frightening dream I had during my afternoon nap in which my brain was disconnecting from my limbs and senses, or more correctly, the place that the sensory nerves went to was disconnected from the command center that told the motor nerves what to do. I wanted one thing but my body did something else, my eyes weren’t registering what was in front of me and I had no control over where I was going. It was a perfect representation of the team’s findings that were communicated to me many hours after I had the dream. On a cellular level I knew.