Contents

Forwards From the State Minister ................................................................................. iii

Acknowledgments from the Lead Executive Officer..................................................... iv

Lists of Acronyms .......................................................................................................... vi

Lists of Tables and Figures ........................................................................................... vii

1. Introduction .............................................................................................................. 1

1.1. Background ........................................................................................................................... 1

1.2. The Evolution of Health System Leadership ......................................................................... 1

1.3. Situation Analysis ................................................................................................................. 4

1.4. Operational Definition of High Impact Leadership ............................................................... 6

2. Rationale, Goals and Objectives .............................................................................. 8

2.1. Rationale ....................................................................................................................... 8

2.2. Goal ...................................................................................................................................... 8

2.3. Objectives of the program ..................................................................................................... 8

2.4. Scope the Program ............................................................................................................... 9

2.5. Guiding Principles ................................................................................................................. 9

3. Program Framework and Critical Competencies ................................................... 12

3.1. The conceptual framework of the High Impact Leadership Program ................................. 12

3.2. Critical Competencies for High Impact Leadership (HIL) .................................................. 14

4. High Impact Leadership Program Pillars, Sub-Programs and Interventions ......... 16

4.1. High Impact Leadership Program Pillars .................................................................... 16

4.2. High Impact Leadership Sub-Programs ...................................................................... 16

i
 4.2.1. Strategic High Impact Leadership (SHIL) ...................................................... 16

4.2.2. Mid-level High Impact Leadership (MHIL) ................................................... 17

4.2.3. Front-line High Impact Leadership (FHIL) .................................................... 17

4.2.4. Women in Leadership for Health .................................................................... 18

4.2.5. High Impact Clinical Leadership Improvement (HI-CLIP) ............................ 18

4.2.6. High Impact Leadership Incubation (HI-LIP): ............................................... 18

4.3. Program Interventions ................................................................................................. 18

4.4. Delivery Methods of the Programs Interventions ....................................................... 24

5. Coordination and Implementation Arrangement ................................................... 26

5.1. Technical Working Group (TWG) .............................................................................. 26

5.2. Roles and Responsibilities .......................................................................................... 27

6. Program Monitoring, Evaluation and Learning ........................................................ 30

6.1. Approaches of Monitoring and Evaluation of the program ................................................. 30

6.1.2. Setting-performance indicators ....................................................................... 30

6.1.2. Baseline assessment ........................................................................................ 30

6.1.3. Reporting and feedback .................................................................................. 30

6.1.4. Monitoring ...................................................................................................... 30

6.1.5. Evaluation and Operational Research ............................................................. 31

6.1.6. Knowledge Management ................................................................................ 31

6.2. Phases of the Program Implementation ............................................................................... 31

6.3. Key Performance Indicators ........................................................................................ 33

6.4. Resource Mobilization ................................................................................................ 35

6.5. Sustainability .............................................................................................................. 36

Annexes ......................................................................................................................... 37
ii

H.E. Dr. Ayele Teshome
State Minister, Ministry of Health
Forwards From the State Minister
I am delighted to launch our re-branded High Impact Leadership
Program for Health (HIL-PH), emphasizing importance of
leadership in achieving health sector goals.
Our unwavering commitment to enhancing leadership and
governance within the health system has been a consistent priority
throughout our consecutive health sector strategic plans. The
Ministry of Health, in collaboration with our development partners,
has undertaken capacity-building interventions aimed at enhancing
leadership, management and governance skills among our health
leadership and workforce in Ethiopia.
While these efforts have positively impacted public health and
clinical leadership practices, we still have identified persistent gaps
in the implementation of leadership programs. These challenges
include fragmentation of implementation, limited competency and
execution capacity, inadequate emphasis on system thinking, lack of
orientation to data use, high turnover of leaders, limited women
involvement in health leadership development, and sub-optimal
accountability practices.
Hence due to those shortcomings, the existed leadership program
has fallen short of achieving the desired outcomes. To address these
challenges the HIL-PH has built new sets of competencies and
capabilities that will enable our leaders to effectively link
organizational resources with their goals, build highly productive
teams, accelerate organizational results, and transform the
experiences of our clients and organization.
The HIL-PH offers a comprehensive set of courses that incorporate
hands-on learning experiences complement with other interventions.
Together, let us embark on this journey of strengthening our
leadership capabilities that aims to build a resilient health system for
improving the health and well-being of our population.
Ayele Teshome (MD, OBGY, IA)
State Minister, Ministry of Health
iii
Acknowledgments from the Lead Executive Officer

Preparation of this High Impact Leadership Program for Health (HIL-PH)

wouldn’t have been successful without the continuedcommitment of
different stakeholders. I would like to express my sincerest appreciation
and gratitude to all institutions and individuals who participated in the
development of this HIL-PH document.
Abas Hassen (PhD)

HSIQ LEO

My special recognition and appreciation goes to Institute of Health Improvement (IHI)-Ethiopia,

HWIP/JHPIEGO-Ethiopia and USAID Quality Health Activity (QHA)/JSI as well as the American
Jewish Joint Distribution Committee (JDC) for their financial and technical support.

Furthermore, my office extends its deepest appreciation to the senior leadership of the Ministry of Health,
desk heads, experts, and our administration staffs and other LEO/EO as well as regional health bureaus
and Universities for their invaluable guidance and technical contributions in the development of this
program document.
Lastly, my office would like to recognize the following individuals who have provided their expertise and
guidance in the preparation, validation, and overall process of the HIL-PH development.
List of contributors in thedevelopment of the High Impact Leadership Program for Health.

S/No Name Department/organization

1 Dr. Ayele Teshome, State Minister State Minister Office, MOH

2 Dr. Abas Hassen HS Innovation & Improvement, LEO, MOH

3 Gemu Tiru HS Innovation & Improvement, LEO, MOH

4 Deneke Ayele HS Innovation & Improvement, LEO, MOH

5 Shemsedin Bamboro HS Innovation & Improvement, LEO, MOH

6 Markos Gobana HS Innovation & Improvement, LEO, MOH

7 Dr. Fekadu Assefa HS Innovation & Improvement, LEO, MOH

iv
8 Lisanework Girma HS Innovation & Improvement, LEO, MOH

9 Dr. Desalegn Bekele State Minister Office, MOH

10 Dereje Ayele HWDP, JHPIEGIO,

11 Getachew Worku Abt. Associate Inc.

12 Mamo Dereje HS Innovation & Improvement, LEO, MOH

13 Tegene Arega HRD LEO, MOH

14 Dr. Shelemo Shawula USAID-Ethiopia

15 Mohammedamin Adem IHI-Ethiopia

16 Ashenafi Habtamu Arsi University

17 Esayas Mesele HS Innovation & Improvement, LEO, MOH

18 Dr. Bezawit Tsegaye QHA/JSI

19 Yeneneh Getachew (MD, phd) QHA/JSI-Ethiopia

20 Nurhan Tewfik HRD, MOH

21 Enkubahire Sabile Reform EO, MOH

22 Habtamu Bantigagne Gender EO, MOH

23 Jemil Hussen HS Innovation & Improvement LEO, MOH

24 Desalegn Wujira Center for Creative Leadership (CCL)

25 Dr. Fantu Abebe State Minister Office, MOH

26 Dr. Eshetie Abebe African Leadership Excellence Academy

27 Mezgebu Kebede HS Innovation & Improvement, LEO, MOH

Abas Hassen Yesuf( PhD)

HSIQ, LEO, Ministry of Health

v
Lists of Acronyms
CCL Center for Creative Leadership

CLIP Clinical Leadership Improvement

CPD Continuous professional Development

DHIS District Health Information Software

EO Executive office

GGI Good Governance Index

HI-CLIP High Impact Clinical Leadership Improvement

HI-LIP High Impact Leadership Incubation

HIL-PH High Impact Leadership Program for Health

HMIS Health Management Information System

HRD Human Resource development

HSTP Health Sector Transformation Plan

HSDIP Health Sector Medium-Term Development and Investment Plan

JDC Jewish Joint Distribution Committee

JSC Joint Steering committee

LEO Lead Executive office

LIP Leadership Incubation Program

LMG Leadership, Management and Governance

Mahs Managerial Accountability in the Health System

MTR Mid Term Review

NGO Non-Governmental Organization

PHCU Primary Health Care Unit

RHB Regional Health Bureau

SWOT Strength, Weakness, Opportunity, and Treat

TWG Technical Working Group

vi
 UHC Universal Health Coverage

USAID United States Agency for International Development

Woho Woreda health Office

ZHD Zonal Health Department

Lists of Tables and Figures

List of Tables

Table 1: Guiding Principles of the High Impact Leadership Program for Health ---------------------------- 10
Table 2: Critical competencies for high impact leadership (HIL) ---------------------------------------------- 14
Table 3: Program pillars, sub-programs, key interventions, and detail activities ----------------------------- 20
Table 4: HIL Program Monitoring and Evaluation Indicators -------------------------------------------------- 33

Lists of Figures
Figure 1: The Difference Between Traditional Leadership And High Impact Leadership4 ------------------ 3
Figure 2: High impact leadership program for health framework adapted from, Ministry Of Health-
Ethiopia, (Moh) Health Sector Mid-Term Development And Investment Plan (2023/4-2025/26), and
MOH, leadership, management and governance for health, 2020. ---------------------------------------- 12
Figure 3: Organogram And Coordination Platform For HIL-PH ----------------------------------------------- 27
Figure 4: Phases Of Program Implementation --------------------------------------------------------------------- 32

vii
 1. Introduction

1.1. Background

Ethiopia is a country located in the Horn of Africa. The country is characterized by rapid population growth
(2.6%), young age structure, and the second populous country in Africa with an estimated population of
over 105 million in 20231. The male and female sex ratio is almost equal and nearly 80% of the population
lives in rural areas. The country is known for its rich history, vibrant culture, and picturesque landscapes.

Ethiopia is actively committed to achieving sustainable and reliable growth as it transitions from poverty.
As part of this development agenda, the health sector has emerged as a high priority area,making significant
progress over the past three decades. The government has prioritized the improvement of healthcare
services to enhance the well-being of its population and contribute to economic development.

The health sector in Ethiopia has achieved commendable results in various areas, including the reduction
of maternal and child mortality rates, through the implementation of successive Strategic Health Sector
Development Transformation plans. Ethiopia has also made significant strides in combating major health
challenges such as HIV, TB, and malaria. These efforts have contributed to an improved health status and
better quality of life for its citizens.

The health system in Ethiopia is characterized by a mix of public and private healthcare facilities, with the
public sector being the dominant provider. Despite progress made in recent years, the country's health
system still faces numerous challenges, including inadequate infrastructure, limited access to healthcare
in rural areas, shortage of skilled healthcare professionals, limited leadership execution capacity, conflict
and some epidemics including Covid-19. Currently, with the overall objective to improve the health status
of the population, the moh in collaboration with stakeholders has developed and is implementing Health
Sector Medium-term Development and Investment Plan (HSDIP, 2023-2026)2

1.2. The Evolution of Health System Leadership

The Ethiopian health sector has recognized the importance of leadership and governance in achieving its
goals of improving the health status of the population. As part of the strategic directions outlined in the
Health Sector Transformation Plan (HSTP) I and II, leadership has been identified as a key pillar for
driving positive change and innovation.

1
Ethiopian Central Statistics Services, 2023

2
HSDIP, 2023/24-2025/26

1
The Ministry designed and implemented various leadershipdevelopment programs; mainly District Health
Management training, Leadership, Management and Governance (LMG) for senior, mid-level and facility
level managers; Leadership Incubation Program for Health (LIP-H) to create pool of young leaders in the
system, and, Clinical Leadership Improvement Program (CLIP) in order to enhance engagement of senior
clinicians toimprove patient outcome.

Over the last decades the Ministry of Health invested hugely in leadership, management, and governance
(LMG) for health cadres of the health systems. This program reached thousands of health system leaders
at all levels of health systems, particularly in developing regional states and selected low performing zones
of agrarian regions. Moreover, the program was designed to link capacity building activities with capstone
projects to expose program participants with practical interventions tailored to their areas of work and
achieved promising results. Furthermore, the health sector has been implementing accountability
mechanisms that aimed to improve managerial accountability and responsiveness. These efforts have
positively impacted public health and clinical leadership practices to a promising status.

However, despite those efforts, the evaluation of the existing leadership programs in the mid-term review
of HSTP-II identified the persistent challenges related to its implementation in the Ethiopian health system
and one of the primary challenges is the fragmentation within and across health programs3.
Existing programs often focus solely on specific programs or aspects of healthcare, neglecting the broader
perspective and connectedness of the entire healthcare system. This limited view can hinder leaders from
understanding the larger organizational context and effectively aligning resources and efforts towards
overarching goals.

Additionally, the midterm review of HSTP- II and Health Sector Development and Investment Plan
(HSDIP, 2023/4-2025/6) have also identified limited competency in leadership and execution capacity,
inadequate orientation to system thinking and improvement science, lack of orientation to data use, high
leadership turnover, limited emphasis for women leadership development, and lack of accountability.2 To
address these challenges and improve health system performance and quality, fundamental changes in
health leadership practices like designing and implementing High Impact Leadership is imperative.

High Impact Leadership is very important since organizations are now grappling with unprecedented
complexity because of digital change, increased competitive pressure and heightened organization and
clients' expectations. Surviving and thriving in this unique environment depends on the right kind of
leadership.

The current leaders need a new set of skills and competencies to complement the existing leadership,

3
Ethiopia Health Sector Transformation Plan HSTP-II | 2020/21–2024/25 (Gc), Mid-Term Review, Volume I, Comprehensive Repor, 2023

2
management, and governance program already in place. These skills and competencies allow leaders to
build highly productive teams, accelerate organizational results, transform client, and organization
experiences and even redefine the organizations4.

FIGURE 1: THE DIFFERENCE BETWEEN TRADITIONAL LEADERSHIP AND HIGH IMPACT LEADERSHIP4

High impact leaders are expected to build self-awareness, practice, and promote collaboration, leverage
diversity, seek and contribute to organizational insight, drive for results, stay client focused, create
possibilities: improvement, innovation, lead, and advocate change-champions4. Hence the existing
leadership, management and governance development efforts has been re-branded as High Impact
Leadership Program for Health (HIL-PH) by incorporating new sets of skills and competencies that allow
leaders to build highly productive teams, accelerate organizational results, transform client, and
organization experiences. The HIL-PH has three pillars and six sub-program components. The three
program pillars include High Impact Leadership (HIL) Competency, Women in Leadership for Health,
and Cultivating Managerial Accountability.

The HIL competency encompasses Strategic High Impact Leadership (SHIL), Mid-Level High Impact
Leadership (MHIL), Front-Line High Impact Leadership (FHIL), High Impact Clinical Leadership
Improvement (HI-CLIP), and High Impact Leadership Incubation (HI-LIP). The Women in Leadership
for Health aims designing and implementing interventions that promote women in health leadership
positions and gender equality. Cultivating managerial accountability also aims to hold bottom-up
accountability culture through implementing managerial accountability in the health system (mahs).
Overall, by providing a comprehensive set of courses, experiential learning opportunities, and other
interventions, this program aims to bridge the gaps in health system leadership programs in Ethiopia and
ultimately contribute for driving quality health system performance and achieve the health sector goals.

The program targets strategic, mid-level, front-line leaders/managers, women health leaders and future
leaders (non-positional health workforce at public health and clinical settings) of the health system in
Ethiopia.

3
1.3. Situation Analysis

In Ethiopia, the development of effective healthcare leadership plays a pivotal role in driving positive
change throughout the healthcare system. However, several gaps are found in the existing healthcare
leadership programs that are hindering the ability of leaders to address the complex challenges within the
sector. Additionally, from the situational analysis and a review of evaluation reports of various existing
leadership programs, the following key accomplishments and lessons are highlighted below.

The synthesis of evidence on LMG in health activities has identified a "core" LMG package, which
encompasses an array of interventions aimed at fostering competencies pertaining to the thirteen LMG
practices. Evidence suggests that implementation of this core package could have resulted in improvement
in commitment, motivation, teamwork, trust, inspiration, solution identification, and sound work climate
at individual, team and organizational level as well as improved service deliver4. However, it was noted
that the implementation is severely fragmented both inside the moh and across the implementing partners,
with a lack of a coherent vision.

Existing LMG focused solely on specific programs (WASH LMG, Nutrition and TB) neglecting the
broader perspective and connectedness of the entire healthcare system. The program was also noted to be
modified, including changing the number of trainees per thematic area, duration, and sessions of training
as well as numbers of coaching and mentorship visits. This synthesis recommends standardization of core
LMG packages with two or more on-site coaching visits to augment the impact of desired outcomes related
to LMG5.

The mid-term review of Clinical Leadership Improvement Program (CLIP) demonstrated promising
results in clinical leadership attitudes and practices. Nonetheless, it was documented that several
challenges were encountered duringits implementation including budget inadequacy, effectiveness and
simplicity issues with teaching/learning approaches and materials5. The review also recommended revision
of teaching/learning approaches and materials including mixing of non-conventional and conventional
methods.

Similarly, the Leadership Incubation Program for health (LIP-H) which has been implemented since 2019,
was designed to strengthen health leadership capacity to produce future leaders. The program evaluation
report showed that the program is relevant in meeting capacity building needs as evidenced by trainees
having improved their leadership competency, communication and relationship management, professional

4
. Jayakumar B, Assefa FJ, Guji TC, etal. Synthesis of Evidence on Leadership, Management, and Governance in Health
Activities in Ethiopia: Final Report, 2022

5
Ministry of health of Ethiopia, Clinical Leadership Improvement Program (CLIP) Mid-term Review Report, 2022

4
and social responsibilities6. Nevertheless, high direct training cost (a unit cost of 210 thousand Ethiopian
Birr per candidate), low levels of readiness of trainees to use technologies to effectively deliver courses
via virtual platforms, limited leadership competencies in business competency domain (e.g. Resources
management) and absence of a clear sustainability plan were the main challenges main identified
challenges in the evaluation of LIP-H.

The MOH also places a high emphasis on promoting social and managerial accountability at all levels,
with a focus on service-based community engagement and grievance handling to ensure good governance
and equitable health care. To achieve this, the sector has implemented various mechanisms such as the
Community Score Card (CSC) and Managerial Accountability Program in Health Care System. However,
it was learned that lack of full implementation of mahs, joint action planning, action tracking, and actions
taken based on community's feedback, and inadequate support of regions to implement mahs and CSC
were the main documented implementation challenges7

In summary, the following key challenges have been identified in existing health system leadership
program and presented in thematic areas as follows:
Fragmented leadership programs: The health system leadership programs often lack a comprehensive
approach and tend to focus solely on specific health programs, instead of addressing the broader needs of
the entire healthcare system3.

Entrapped in models and theories rather than concepts: Some health leadership programs rely heavily
on teaching models and theoretical frameworks but fail to provide practical and contextual understanding
of leadership concepts that can be applied effectively in real-world healthcare settings.
Lack of orientation to the health system: Many leadership programs overlook the importance of
providing participants with a comprehensive understanding of the healthcare system's structure,
functions, and challenges. This lack of orientation can hinder leaders' ability to navigate and lead within
the complex healthcare environment.
Lack of orientation to system thinking and improvement science: Leadership programs often neglect
to equip participants with a systemic thinking approach and a solid understanding of improvement science
methodologies. This oversight prevents leaders from effectively identifying and implementing innovative
and sustainable solutions at a system level.
Lack of orientation to data use: Effective leadership in healthcare requires analyzing and utilizing data
for informed decision-making. However, many leadership programs in Ethiopia fail to incorporate training
on data analysis, interpretation, and utilization, limiting leaders' capacity to leverage data-driven insights

6
Alemayehu YK, Yitbarek K, Hagos T, et al. Evaluation of the Ministry of Health’s Leadership Incubation Program for Health (LIP-H) in
Ethiopia : Final Report. MERQ Consultancy PLC. Addis Ababa, Ethiopia, 2022

7
Ministry of Health-Ethiopia. Managerial Accountability in Primary Health Care System (MAHs) implementation guide, 2021

5
for improved healthcare outcomes.
Traditional leadership orientation: Some health system leadership programs may uphold traditional
leadership styles and practices, which may be less effective in addressing the complexity and unique
challenges of the healthcare sector. This limited focus on traditional leadership orientations hinders the
development of adaptive (agile) and transformational leaders who can drive positive change in the
healthcare system.

Moreover, lack of structure at regional and lower levels to coordinate the program, limited emphasis for
women leadership development, and inadequate health leadership competency, high leadership turnover2,
and limited linkage of leadership training with higher educationinstitutions, and inadequate government
budget allocation and inefficient utilization of existing resources are also the key identified challenges in
health leadership improvement program in the country (Refer to Annex 1, for detail SWOT analysis).
Addressing those gaps is vital for ensuring that healthcare leaders are equipped with the necessary skills
and mindset to navigate the intricacies of the healthcare landscape and drive meaningful improvements in
healthcare delivery and outcomes.

Stakeholders are key players in the health sector leadership transformation, and understanding their focus
areas and level of influence is crucial to the success of creating high impact leadership program for health,
drive health system change and contribute for the achievement of health sector objectives. For detailed
key stakeholders' analysis (see Annex II).

1.4. Operational Definition of High Impact Leadership

The High Impact Leadership (HIL): Is a leadership type with new set of knowledge, skills, competencies
and execution capabilities that enable leaders optimally aligns an organization's resources and efforts with
its overarching goals, building highly productive teams, accelerating organizational results, transform
client and Organization experiences which ultimately results in driving health system performance,
improve quality health services, and contributing significantly to the achievement of health sector goals.

The HIL-Program for health provides a comprehensive set course with experiential learning opportunities
and complement with other interventions. The Program has three pillars and six sub-program components.
The three program pillars include High Impact Leadership (HIL) Competency, Women in Leadership for
Health, and Cultivating Managerial Accountability. The HIL competency aims to enhance leadership
competencies and execution capability through capacity building interventions. The HIL competency
encompasses Strategic High Impact Leadership (SHIL), Mid-Level High Impact Leadership (MHIL),
Front-Line High Impact Leadership (FHIL), High Impact Clinical Leadership Improvement (HI-CLIP),
and High Impact Leadership Incubation (HI-LIP). The Women in Leadership for Health aims designing
andimplementing interventions that promote women in health leadership positions and gender equality.
Cultivate Managerial Accountability also aims to hold bottom-up accountability culture through
6
implementing managerial accountability in the health system (mahs).

The Strategic High Impact Leadership sub-program (SHIL) focuses on developing topexecutives and
senior leaders accountable for setting the overall organizational direction. This program equips them with
strategic thinking, visioning, and informational leadership skills, enabling them to shape the future of
healthcare delivery in Ethiopia.

The Middle-level High Impact Leadership Sub-Program (MHIL) targets leaders responsible for
managing operational units and teams within healthcare organizations. It emphasizes skills such as
effective resource allocation, team leadership, change management, and fostering a culture of continuous
improvement.

The Front-line High Impact Leadership Sub-Program (FHIL): focuses on empoweringleaders at the
grassroots level of healthcare delivery. It equips them with skills in coaching, problem-solving,
communication, and patient-centered care, enabling them to drive excellence inservice delivery and inspire
their team members.

Women in Leadership for Health aims in enhancing women's role in decision-making and in health
leadership position. The initiative provides mentoring and support, leadership training, and development
opportunities. It aims for effective succession, assesses gender parity, and leverages the findings for
promoting women in leadership for health, and ensuring genderequality for improved health outcomes.

High Impact Leadership Incubation (HI-LIP) for Health aims to strengthen leadership capacity within
the health sector to prepare future leaders of the health sector.

High Impact Clinical Leadership Improvement (HI-CLIP)-aims to bring about excellence in clinical
care, organizational and system performance through sustained engagement of all clinicians at all levels
of the health system.

Cultivating Managerial Accountability: Cultivating managerial accountability can be achievedthrough

Managerial Accountability (mahs) intervention in the health system. Mahs hold higher-level managers
accountable to lower-level managers and customers/clients for improving quality health services and
health outcomes. This means that management services at various levels will be measured and accounted
for.

The Pillars of the program refer to the fundamental elements or core areas that support the program's
objectives and activities. These pillars serve as the foundation and framework for the program's
implementation.

7
2. Rationale, Goals and Objectives

2.1. Rationale

The rationale to develop this program is that, previously there were various leadership programs as
depicted above, however none of them were comprehensive enough to impact of the health care system,
hence High Impact Leadership Program for Health will meet these gaps.

2.2. Goal

The goal of the High Impact Leadership Program for Health is to enhance leadership competencies,
execution capability, and motivation of health system leaders at all levels of the Health System. This
comprehensive program equips leaders with the skills necessary to build high-performing teams, execute
strategic plans for achieving organizational results, transform client experiences, and enhance the overall
quality and performance of health services. Ultimately, it will contribute to achieve the goals of the health
sector.

2.3. Objectives of the program

1. Improve Harmonization and Institutionalization of health system leadership Program: The

objective focuses on promotion and advocacy of the establishment of health system leadership program
coordination structure at regional and lower levels, integrate the program with per-services training in
academic institutions and establish health system leadershipacademy in the long run to harmonize and
institutionalize the health system leadership program. In addition, the program ensures a cohesive and
comprehensive approach to leadership development in the health sector.

2. Enhance critical competencies and execution capability of health system leaders at all levels:
The objective emphasizes equipping health system leaders with the necessary knowledge, attitude and
skills needed to effectively lead in key areas such as orientation to the healthcare system and designing
effective system, system thinking, concept of leadership and management, emotional intelligence, health
system governance, Women in Leadership for Health , Cultivate Managerial Accountability , leading
health system quality, equity and innovation, building high performing team, health system resources
management, strategic planning and executing the plan, and data utilization for effective decision making.
The program participants will be also requested to design and implement quality improvement (QI)
8
projects which helps them to apply the knowledge and skills acquired from the training that can enhance
their leadership competencies and execution capability.

3. Improve enabling environment that increase the motivation of the leaders and health
professionals: To improve the enabling environment that inspires health leaders and health professionals,
fostering a culture of leadership, innovation, and continuous improvement within the health system is vital.
Incentive packages will be also revised and implemented to increase jobsatisfaction and motivation of
leaders at all levels.

4. Cultivate Managerial Accountability: To strengthen the health system's accountability mechanisms,

ensuring transparency, fairness,and inclusiveness in decision-making processes and actions within the
health sector. One approach to achieving this is through Managerial Accountability (mahs) intervention in
the health system. Mahs hold higher-level managers accountable to lower-level managers and
customers/clients for improving quality health services and health outcomes.

5. Strengthen the leadership program monitoring, evaluation, performance appraisal mechanism

and learning: To strengthen monitoring, evaluation, performance appraisal mechanisms, and learning
processes within the leadership program, ensuring that progress is continuously assessed, results are
measured, and lessons learned are applied for continuous improvement.

6. Foster Women in Leadership for Health and Succession Planning: The Women in Leadership for
Health aims designing and implementing interventions that promote women in health leadership positions
and gender equality.

By achieving these goals and objectives, the High Impact Leadership Program for Health aims to nurture
a cadre of competent, motivated, and accountable health system leaders who can effectively link
organizational resources with its goals, build productive team, accelerate organizational results, transform
client and Organization experiences, drive health system performance, improve health services, and
achieve the strategic goals of the sector.

2.4. Scope the Program

The program guides and applicable to all Strategic, Middle level, Front-line leaders, Women health
leaders, clinical leaders and pool of future Leaders at level of the health system in Ethiopia

2.5. Guiding Principles

9
 Table 1: Guiding Principles of the High Impact Leadership Program for Health
S/N Guiding principles Descriptions

Harmonization and Ensure that activities and efforts are coordinated and aligned
alignment amongrelevant stakeholders to maximize impact and minimize
1 duplication.

2 Result/Outcome Focus on achieving tangible results and outcomes that contribute

oriented tothe overall goals and objectives of HIL-PH.

Cultivate Accountability Foster a culture of accountability where individuals and organizations

take ownership of their actions and responsibilities in promoting HIL-
3 PH.

4 Evidence generationand Emphasize the use of reliable and relevant evidence to inform
use for decisionmaking decision-making processes related to HIL-PH initiatives.

Whole Systemthinking/ Adopt a holistic approach that considers the inter-connectedness and
Orientation interdependence of various components within the healthcare
5 system when designing and implementing HIL-PH strategies

The HIL-PH program is committed to promoting gender-

transformative leadership practices within the health system. It aims
6 Women in Leadershipfor to address gender disparities in leadership positions, foster a
Health supportive environment for women leaders, and ensure gender
transformative-decision-making processes within the program and
across the health sector.

Diversity and Promote diversity and inclusiveness by valuing and incorporating

inclusiveness different perspectives, experiences, and voices in HIL-PH initiatives.
7

8 Flexible and adaptive Maintain flexibility and adaptability in HIL-PH approaches to respond
to changing contexts, emerging challenges, and evolving healthcare
priorities.

9 Equity and inclusiveness The HIL-PH program is committed to promoting equity and
10 Evidence- The program isinclusiveness
grounded in latest research
in all andofbest
aspects practices and
leadership proven methodologies
development, ensuring that
BasedPractice have demonstrated positive impacts on leadership development and health system
that opportunities, resources, and support are accessible and available to
performance.
leaders from diverse backgrounds and marginalized groups.

10
11 Collaboration It seeks collaboration with various stakeholders, including government agencies, ngos,
and academic institutions, and international organizations to leverage their expertise and resources
Partnerships for the program's success

12 Context It considers the unique challenges, cultural nuances, and systemic factors that influence
Sensitivity leadership and governance in Ethiopia to ensure the relevance and effectiveness of the
program.

13 Continuous It encourages participants, facilitators, and stakeholdersto engage in ongoing reflection,

Learningand evaluation, and feedback toidentify areas for improvement and apply lessons learned for
Improvement better program outcomes.

14 Sustainability It aims to build leadership capacity and institutionalize leadership programs within the health
andScalability system to ensure long-term impact beyondthe duration of the program. This includes the
development of strategies for sustainable funding, capacity-building of local trainers, and
integration of leadership development into existing health system structures and academic
institutions

15 Participant- It aims toprovide a supportive and empowering learning environment that encourages active
Centered participation, collaboration, and knowledge exchange among participants.
Approach

11
3. Program Framework and Critical Competencies

3.1. The conceptual framework of the High Impact Leadership Program

The conceptual framework of HIL-PH is a structured map that outlines the program's overarching
goals, pillars, program components and strategies (initiatives) leading to the desired outcomes that can
have a significant positive impact on healthcare organizations and the broader healthcare ecosystem.
The framework is designed to ensure that the leadership program is comprehensive, effective, and
aligned with the unique needs and challenges of the healthcare sector.

Figure 2: High Impact Leadership Program For Health Framework Adapted From, Ministry Of Health-Ethiopia,
(Moh) Health Sector Mid-Term Development And Investment Plan (2023/4-2025/26), And Moh, Leadership,
Management And Governance For Health, 2020.

12
The conceptual framework of HIL-PH is designed to guide how program interventions to enhance
leadership performance (output) that include improve execution capability, improved team building,
stewardship resources, good governance, improve gender parity in healthcare leadership, improve
organizational culture and work climate, cultivated accountability, improve collaboration and
innovation. The program includes the three pillars and sub-program components. The three pillars are
HIL competencies, Cultivate Managerial Accountability and Women in Leadership for Health.

The high impact leadership performance (output) will lead to improved quality health services, health
system performance, accelerated organizational results and transform client experience and
organization. Finally, enhanced quality health services, system performance, accelerated
organizational results and positive experience of client will contribute towards achieving universal
health coverage (UHC) including coverage of essential health services utilization, financial risk
protection and health system responsiveness. Ultimately, HIL-PH will contribute to achieving the goals
of the health sector that is improving the health status of the population.

13
3.2. Critical Competencies for High Impact Leadership (HIL)

The Critical competencies of HIL-PH are presented in table 2 below.

TABLE 2: CRITICAL COMPETENCIES FOR HIGH IMPACT LEADERSHIP (HIL)

Leadership Competency Description Sub-Competencies Target Group
Domain

1. Profound Knowledge Deep understanding of 1. Professional Knowledge Individuals and Leaders at all Levels
subject matter and health 2. Health Systems Thinking
systems. 3. Understanding Variation
4. Building Knowledge
5. Psychology of Change
6. Health System Building Blocks
7. Health System Quality, Innovation
& Equity
8. Public Health Research Basic ICT,
Digitization & Social Media Use
2. Management & Effectively manage and 9. Scanning Environment
Improvement improve work. 10. Prioritizing & Goal Alignment
11. Planning
12. Communication
13. Inspiration
14. Implementation
15. Risk Management
16. Monitoring & Evaluation
17. Data-driven Decision Making
18. Adaptability
19. Quality Improvement Skills
20. Achieving Results
3. Governance Create good health 21. Laws & Regulations
14
 governance. 22. Managerial Accountability
23. Stakeholder Engagement
24. Shared Vision Setting
25. Stewardship of Resources
4. Leading Self, HI-CLIP & HI- Develop oneself and lead 26. Self-Awareness Pool of Emerging Health
LIP future leaders. 27. Emotional Intelligence Workforce (Non-Positional)
28. Professional Development &
Lifelong Learning
29. Integrity & Ethical Conduct
30. Working with Others
31. Managing & Improving Services
32. Setting Directions (For HI-CLIP &
HI-LIP only)
5. Leading Others (Front-Line Lead and motivate teams 33. Building & Maintaining Front-Line Leaders/Managers
Leaders) effectively. Relationships (Woreda Health Offices, PHCU,
34. Team Development & Coaching Primary Hospitals)
35. Conflict Resolution
36. Celebrating Team Success
6. Operational/Mid-Level Lead other managers and 37. Thinking & Acting Systemically Mid-Level Leaders/Managers
Leadership senior staff. 38. Managing Organizational (Zonal Health Depts., General
Complexity Hospitals, Specialized Hospitals)
39. Negotiation Skills
40. Developing Others
41. Building Resiliency
7. Strategic Leadership Lead organizations 42. Visionary Leadership Strategic Leaders (Steering
effectively with vision. 43. Policy Analysis Committees, Executive
44. Strategic Thinking & Acting Committees, MOH Management,
45. Leading Culture Regional Health Bureaus, Agency
46. Creating Culture of Innovation Management, Hospital Governing
Boards, Desk/Team Leaders &
Senior Staff)

15
4. High Impact Leadership Program Pillars, Sub-Programs and Interventions

4.1. High Impact Leadership Program Pillars

The pillars of the program refer to the fundamental elements or core areas that support theprogram's
objectives and activities. These pillars serve as the foundation and framework for the program's
implementation. The Program has three pillars and six sub-program components. The three program
pillars include High Impact Leadership (HIL) Competency, Women in Leadership for Health and
Cultivating Managerial Accountability. The HIL competency aims to enhance leadership
competencies and execution capability through capacity building interventions. The Women in
Leadership for Health aims designing and implementing interventions that promote women in health
leadership positions and gender equality. Cultivate Managerial Accountability also refers to holding
bottom-up accountability culture through implementing managerial accountability in the health
system (mahs).

4.2. High Impact Leadership Sub-Programs

The High Impact Leadership program for Health has six sub-program components. These include
SHIL, MHIL, FHIL, Women in Leadership for Health, HI-CLIP, and HI-LIP. The six components
are briefly described as follow:

4.2.1. Strategic High Impact Leadership (SHIL)

As with any organization, the healthcare industry, and the health sector in Ethiopia has established
leadership and management structures with a variety of titles, authority levels, and hierarchies.
Strategic (top-level) leaders and managers are senior executives responsible for leading and managing
the entire organization. They play a critical role in setting the direction,formulating, and executing
high-level strategies, ensuring long-term success of an organization and sustainability. Therefore,
SHIL-P is a comprehensive initiative to enhance the leadership skills and capabilities of individuals
who hold or aspire to hold top leadership positions within the healthcare industry in Ethiopia. The
aim is to equip participants with the knowledge, skills (e.g., Being Visionary, Leading the culture,
creating culture of innovation, strategic/system thinking, policy analysis, organizational
transformation etc.) And capabilities needed to optimally aligns anorganization's resources and efforts
with its overarching goals, building highly productive teams, accelerating organizational results,

16
transform client and Organization experiences which drive meaningful health system change within
their organizations, and contribute to the overall achievement of health sector goals.

The target group of SHIL includes Joint steering committee, Executive Committee, MOH
management committee, Regional Health Bureau management committee, Agenciesmanagement
committee accountable to MOH and RHB, Hospitals’ Governing Board members, Desk/team leaders
and Seniors staffs, of MOH, RHB and Agencies

4.2.2. Mid-level High Impact Leadership (MHIL)

MHIL targets leaders/managers responsible for leading/managing multiple operational teams or

departments in an organization. Mid-level leaders are responsible for translating the organization's
vision and strategy into actionable plans and ensuring their teams’ plan and performance are aligned
with the organization's overall goals. These are mostly managers within any organization and face
the double bind as they manage up/report to their managers while managing down/supervising a
group of subordinates. Thus, MHIL is a comprehensive initiative designed to equip mid-level
leaders/managers with knowledge, skills (e.g., Managing organizational complexity, negotiating
adeptly, effective resource allocation, team leadership, change management, and fostering a culture
of continuous improvement etc.), and capabilities needed to optimally aligns an organization's
resources and efforts with its overarching goals, building highly productive teams, accelerating
organizational results, transform client and Organization experiences which ultimately drive
meaningful health system change within their organizations, and contribute to the overall
achievement of health sector goals.

The target group MHIL includes Zonal Health Departments Management members and seniors'
staffs, General Hospitals management members and senior staffs and Comprehensive Specialized
Hospitals management members and senior staffs.

4.2.3. Front-line High Impact Leadership (FHIL)

FHIL is designed to develop the leadership skills of those who directly oversee and lead a team or
department. This level of leaders provides supervision directly to health care providers or front-line
workers. Within front-line management positions, individuals gain exposure to managing teams,
directly integrating clinical & non-clinical professionals, and improving quality, and reducing
inefficiencies in clinical care, frequently by addressing quality problems routinely. Good management
and inspired leadership directly improve healthcare quality, resource usage, and client satisfaction.
Front-line leaders are responsible for delivering results and ensuring operational effectiveness at the
team level. Thus, FHIL is a comprehensive initiative designed to equip front-line leaders/managers
with leadership knowledge, skills (e.g., Coaching, conflict resolution/problem-solving,
communication, and patient-centered care, enabling them to drive excellence in service delivery and
inspire their team members), and capabilities needed to optimally aligns an organization's resources
and efforts with its overarching goals, building highly productive teams, accelerating organizational

17
results, transform client and Organization experiences which ultimately drive meaningful health
system change within their organizations, and contribute to the overall achievement of health sector
goals.
The target group of FHIL includes Woreda health office managements and senior staffs (as per civil
services guideline), Primary healthcare unit (PHCU) and primary hospitals management members
and senior staffs.

4.2.4. Women in Leadership for Health

Women represent 70% of the global health and social workforce but hold only 25% of senior
leadership roles9. This disparity is pronounced in healthcare leadership, and addressing this gapis
crucial for ensuring that diverse perspectives are represented in healthcare decision-makingand
promoting innovation.
The sub-program aims towards closing the gender leadership gaps and ensuring that women havea
more prominent role in decision making and shaping the future of healthcare. The initiative provides
mentoring and support, leadership training, and development opportunities. It also aims for effective
succession, assesses gender parity, and leverages the findings for promoting women in leadership for
health, and ensuring gender equality for improved health outcomes. The targetgroup includes all
women in health leadership position and future leaders.

4.2.5. High Impact Clinical Leadership Improvement (HI-CLIP)

This aims to bring about excellence in clinical care, organizational and system performancethrough
sustained engagement of all clinicians at all levels of the health system.

4.2.6. High Impact Leadership Incubation (HI-LIP):

This sub-program aims to strengthen leadership capacity within the health sector to prepare the future
leaders of the health sector. The Program targets future leaders from health workforce.

4.3. Program Interventions

The HIL program incorporates capacity building training and other interventions. The major courses
include orientation to the healthcare system, system thinking, concept of leadership and management,
emotional intelligence, health system governance, women in leadership for health, cultivate
managerial accountability, leading health system quality, equity and innovation, building high
performing team, health system resources management, ICT/digitization use, data utilization for
effective decision making, strategic leadership, policy analysis, organizational transformation and
visioning. The program participants will be also requested to design and implement projects which
helps them to apply the knowledge and skills acquired from the training. The program will employ
different delivery methodologies.
18
The other interventions include creating enabling environment for health system leaders, design and
implement performance management and appraisal mechanisms, interventions to promote women in
leadership for health, conducting managerial accountability audit and institutionalizing health
system leadership program. Detailed activities are presented in table 3 below.

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 TABLE 3: PROGRAM PILLARS, SUB-PROGRAMS, KEY INTERVENTIONS, AND DETAIL ACTIVITIES
S.No HIL Target Audience Priority Areas Major Interventions/Activities Remarks/Targets
Programs/Pillars (Strategic
Initiatives)
1 Enhance Capacity Building: • Establish a learning
leadership • Review and develop leadership training organizational culture
capabilities to materials • Improve performance
Strategic/Senior drive health • Provide leadership training management system
Strategic High Level Leaders system change • Facilitate experience sharing
Impact Leadership • Develop coaching and mentorship program
(SHIL) • Strengthen coaching and mentorship
practices

Create enabling • Establish a conducive work environment

environment for with supportive systems (policies, procedures,
leadership resources)
effectiveness • Revise and implement incentive packages
• Revise and implement Federal Hospitals
Board Guidelines
• Develop and implement merit-based
recruitment and promotion policies
• Develop and promote Diversity, Equity,
and Inclusion (DE&I) Policy
Institutionalize Promote leadership program coordination structures
and integrate at all levels
HIL_PH program • Integrate leadership program activities into
operational plans
• Engage stakeholders and mobilize resources
• Adapt and implement leadership excellence
and accreditation system
• Review and integrate HIL program with
existing training
• Establish health leadership academy
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 Improve Build capacity on managerial accountability for
managerial leaders and stakeholders
accountability • Strengthen managerial performance audit
and feedback system
• Conduct regular managerial accountability
audits
• Develop and implement joint action plans at
all levels
2 Equip mid-level Capacity Building: * Establish a continuous
leaders to drive • Review and develop leadership training learning environment
change within materials for mid-level leaders * Implement knowledge
Mid-Level High organizations • Provide leadership training management system
Impact Leadership Mid-Level Leaders • Facilitate experience sharing
(MHIL) • Conduct coaching and mentorship
Create enabling • Implement incentive packages to improve
environment for work environment
leadership • Implement merit-based recruitment and
effectiveness promotion policies
• Implement DE&I Policy

Improve • Facilitate continuous learning and challenge

Performance compliance culture
Management • Conduct risk assessments and develop
System mitigation plans
• Implement performance appraisal metrics
aligned with health sector objectives
• Digitize performance management
• Promote data-driven decision making
• Recognize leadership champions
Institutionalize • Promote leadership program coordination
and integrate HIL- structures at lower levels
Program for • Integrate leadership program activities into
Health operational plans
• Engage stakeholders and mobilize resources
for the program

21
 Improve • Build capacity on managerial accountability
managerial • Conduct managerial accountability audits
accountability • Develop and implement joint action plans at
all levels
3 Front-Line High Front-Line Leaders Equip front-line Capacity Building: Facilitate continuous learning
Impact Leadership leaders to deliver • Review and develop leadership training Enhance teamwork and
(FHIL) results and ensure materials for front-line leaders collaboration
operational • Provide leadership training
effectiveness • Implement coaching/mentoring and
recommendations
• Implement experience sharing practices
Create enabling • Implement incentive packages to improve
environment for work environment
leadership • Implement merit-based recruitment and
effectiveness promotion policies
Improve • Facilitate continuous learning
Performance • Enhance teamwork and collaboration
Management • Implement knowledge management system
System • Digitize performance management
• Promote data-driven decision making
• Develop and implement Quality
Improvement (QI) projects
• Recognize leadership champions

Institutionalize • Integrate leadership program activities into

and integrate HIL- operational plans
Program for
Health

22
 Improve • Build capacity on managerial accountability
managerial • Conduct periodic managerial accountability
accountability audits
• Develop and implement joint action plans at
all levels

4 Promote Women in Women in Increase women's • Enhance capacity of women for leadership
Leadership for Leadership Positions representation in roles:
Health at all levels and health leadership • Implement quotas and affirmative action
future leaders • Provide mentorship for women in
leadership and management
• Create networks and support groups for
women leaders
• Provide training and development
opportunities
• Conduct gender parity assessments and
analyze data
• Implement succession and retention
practices with remuneration strategies
5 HI-CLIP Clinical Leaders - Capacity Building:
• Review and develop HI-CLIP training
materials
• Provide leadership training
• Implement coaching/mentoring and
recommendations
• Implement experience sharing practices
6 HI-LIP Pool of Future - Capacity Building:
Leaders • Review and develop HI-LIP training
materials
• Provide leadership training

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4.4. Delivery Methods of the Programs Interventions

The following delivery methods will be utilized to implement the high impact leadershipprogram for
health tailored at each subprogram level:

• Training: Provide Training for leaders at all levels on HILL-PH training packages
• Executive education: the program will design and implement contextualized, challenge and
competency-based, and performance and outcome-oriented executive education for strategic leaders.
• Board membership: The strategic leaders will be assigned to board memberships in large government
institutions [such as universities and hospitals], parastatal, and private business entities (banks,
insurance, manufacturing complexes, etc.), and non-government organizationsto develop their critical
decision-making, effective communication, and network-buildingskills. The program participants will
attend board meeting without vote as necessary.

• Team-Based Learning: the health care leaders often work in teams, and team-based learning
strategies were found to be effective in promoting collaboration and improving team performance, the
program will implement team-based learning across the intervention levels. These strategies may
include team-building exercises, case studies, and simulations that allow leaders to practice and refine
their skills in a safe, supportive environment.
• Experiential Learning: This involves providing opportunities for participants to learn through
practical experiences, such as job shadowing, apprenticeships, and real-world case studies.
• Technology–Based Learning/e-learning: Technology-based learning will be used to reach a wider
audience and provide access to leadership development opportunities to health care
• Professionals in remote areas and provide mid-level leaders with flexible learningopportunities. This
could include e-learning modules, webinars, and virtual simulations/Simulation-based learning.
• Job Shadowing and apprenticeships: Job shadowing and apprenticeships involve providing
individuals with hands-on experience in leadership roles, under the guidance of experienced
• Leaders.
• Coaching and Mentoring: This involves providing individualized coaching and mentoring support
to participants to help them develop their leadership skills and address specificchallenges they may be
facing.
• 360-degree feedback: an intervention that involves gathering feedback from multiple sources (e.g.,
peers, subordinates, superiors) about a leader’s performance and using that feedback to identify areas
for improvement. One of the tools that has gained increasing importance in order to accurately assess
leadership potential and provide feedback on areas for development is the 360-degree evaluation and
feedback tool10. The feedback tool also measures personal qualities and interpersonal skills. It has the
potential to provide a unique level of clarity about one’s strengths and areas for development and to
motivate efforts to change and grow10. Important factors for effective 360 feedback process include
the participant’s honesty in rating and confidentiality of data, communicating expectations and
commitment for continuous learning11.

24
Implementation of the 360 degree evaluation
A series of critical steps is involved to increase the odds of a successful 360 implementation11.

These include:
1. Clarify the goals for the 360 initiative.
2. Assess individual and organizational readiness.
3. Design the process.
4. Select or design a tool
5. Identify and prepare participants
6. Prepare the organization
7. Administer the assessment and process the results. For the high impact leadership programfor
health the moh decides to utilize the WHO Pathways to Leadership for Health, transformation, 360-degree
feedback tool. The tool’s content and features will be included in the training materials.
• Providing on-boarding programs: this is a process of introducing the front-line manager to
his/her new roles/assignment. It benefits the new leaders/managers to understand the
organization’s culture, policies, and procedures. It can also provide new hires and appointeeswith
the necessary training and resources to perform their job effectively.
• Delegating: Delegating work enables leaders to build team capacity and achieve results. This
program creates opportunities for potential front-line leaders/managers to
exerciseresponsibility and accountability in leadership and management roles.
• Challenge, Feedback, and Support: The program provides opportunities to take up
challenges and to receive feedback and support to enable participants to develop theirleadership
and management capabilities through a natural learning process.
• Action-Based Learning: The syllabus emphasizes learning by providing opportunities for
participants to apply what they learn to real work challenges, especially by designing and
implementing their team project. The curriculum should be delivered in a way that prepares
participants to apply what they learn in addressing priority educational challenges.
• Psychometric evaluation: trainees will undergo psychometric evaluation so that they can
understand their personality and how it interacts with a particular function or role, and they
work to develop their strengths and areas for improvement to reach their full potential.
• Certification: The participants will have three phases of certification including
• Certificate of completion,
• Certificate of practice (application) and
• Certificate of impact.

25
5. Coordination and Implementation Arrangement

Effective coordination is essential for achieving the HIL program objectives. At the national level, Health
System Equity and Leadership Improvement Desk (HSELID) under Health System Innovation, and
Quality Improvement Lead Executive Office (HSIQI LEO) of Ministry of Health has the mandate of
coordinating the National High Impact Leadership Program. In addition, the HSIQI/moh will take the
coordination roles of developing and cascading the leadership program document, implementation
guidelines, manuals, training packages, job aids and, strategic and annual plan in collaboration with
agencies, RHB and partners.

The leadership and governance structure should be established at all levels of the health system. Moreover,
the moh and RHB oversee the implementation and monitoring of planned activities.

Partners supporting the leadership program will take part in the whole process of intervention from the
planning stage, resource mobilization and allocation, monitoring, and evaluation of program
implementation. The Partners are encouraged to provide demand-based technical, financial, and material
support for the successful implementation of the program activities.

5.1. Technical Working Group (TWG)

In addition, a National Technical Working Group (TWG) that includes key stakeholders/partners and
concerned offices of MOH is established. The TWG provides overall guidance in technical support, and
resource mobilization for achieving the goal of the HIL-PH. Moreover, TWG will provide technical
support to MOH in planning, organizing, implementing,monitoring and evaluation of HIL-PH. TWG is
developed and governed by its own Term of References (TOR) and meets regularly to monitor the
implementation of HIL-PH.

26
FIGURE 3: ORGANOGRAM AND COORDINATION PLATFORM FOR HIL-PH

5.2. Roles and Responsibilities

In the context of implementing HIL-PH, Health Sector institutions at each level shall play vital roles in
supporting the program's success. For instance, MOH plays a critical role by providing strategic guidance,
mobilizing resources, facilitating stakeholder engagement, promoting sustainability, and monitoring and
evaluation.

The involvement of rhbs is critical to the success of the high-impact health system leadership program in
Ethiopia, as they are well-positioned to ensure that the program is aligned with regional health priorities
and that participants have the necessary support to translate their learning into practice within their
respective regions.

Health care facilities and administration units shall play a pivotal role in implementing a high- impact
leadership program. Their roles include identifying potential program participants, providing support to
program participants, implementing program outcomes, promoting programsustainability, and providing
feedback and evaluation to the program.

The Non-Governmental Stakeholders working in coordination with MOH can play a critical role in the
success of a high-impact leadership program through program designing and implementation, technical
assistance and capacity building, stakeholder engagement, monitoring and evaluation, and resource

27
mobilization. The Ministry remains committed to making best useof project resources and implementing
the program in the most effective manner. Some of the specific roles that the key stakeholders can play in
this program include:

MOH Level:

• Providing strategic guidance: The Ministry of Health can provide strategic guidance and support
to the leadership program. This can involve identifying priority areas for leadership development,
setting program goals and objectives, and providing input on program design and implementation.
This role also involves establishing and convening HIL-PH twgs.
• Mobilizing and equitable allocation of resources: This includes funding, technical support,and
other resources necessary to ensure the program's success.
• Facilitating stakeholder engagement: The Ministry of Health shall facilitate stakeholder
engagement and collaboration to support the leadership program's goal. This can involve bringing
together key stakeholders from the government, health care sector, and other relevant sectors to
ensure harmonization and alignment to leadership programs.
• Promoting sustainability: The Ministry of Health shall promote sustainability of the leadership
program by ensuring that it aligns with national health priorities, is integrated into existing health
systems, and has the necessary support and resources to continue beyond the program's duration.
• Monitoring and evaluation: The Ministry of Health shall monitor and evaluate the leadership
program's progress and impact. This can involve tracking program outcomes and providing
feedback on areas for improvement.

RHB/Zonal/Woreda Level:

• Identification of potential participants: rhbs shall facilitate the identification of potential

participants for the program from the pool of health professionals working in the region, based on
their leadership potential and experience.
• Coordination of the program: RHB shall serve as the primary point of contact for program
coordination within the region, ensuring that program activities are aligned with regional health
priorities and that participants have the necessary support to complete the program.
• Facilitation of program delivery: RHB shall facilitate the delivery of the program withinthe
region, working with program trainers and facilitators to ensure that training sessions and other
program activities are conducted smoothly.
• Support for mentor ship: RHB shall support the mentor ship component of the program by
identifying and matching program participants with suitable mentors within the region, and
ensuring that mentorship activities are aligned with program objectives.

28
 • Monitoring and evaluation: RHB shall be responsible for monitoring and evaluating the
program's implementation within the region, including the progress of individual participants,the
effectiveness of program activities, and the overall impact of the program on health outcomes.
• Sustainability planning: RHB shall be involved in sustainability planning for the program,
identifying strategies to ensure that program outcomes are sustained beyond the initial funding
period and that the program contributes to ongoing health system strengthening efforts within the
region.

Healthcare Facilities (Institutions Level)

• Identifying potential program participants: Health care facilities shall identify potential
program participants among their staff and refer them to the leadership program. This can involve
identifying individuals with leadership potential or those who have demonstrated a commitment
to improving health care.
• Providing support to program participants: Health care facilities shall provide support to
program participants, such as time off for training, coaching and mentorship, and other resources
necessary to participate in the program.
• Implementing program outcomes: Health care facilities shall implement the outcomes of the
leadership program within their organization. This can involve incorporating new leadership skills
and practices, developing, and implementing quality improvement initiatives, and ensuring that
leadership development is integrated into the organization's culture.
• Promoting program sustainability: Health care facilities shall promote sustainability of the
leadership program by supporting ongoing leadership development and ensuring that it alignswith
the organization's strategic goals and priorities.
• Providing feedback and evaluation: Health care facilities shall provide feedback and evaluation
to the leadership program to help improve program design and implementation. This can involve
providing input on program content and delivery, participating in program evaluation, and offering
feedback on program outcomes.

Implementing Partners:

• Program design and implementation: Implementing partners shall work with the Ministry of
Health to design and implement the leadership program. This can involve contributing to program
design, identifying key program components, developing training materials, and facilitating
program delivery.
• Resource mobilization: Mobilize resources to support the leadership program. This can involve
identifying funding opportunities, developing fundraising strategies, and coordinating with
stakeholders to secure necessary resources.
• Technical assistance and capacity building: Provide technical assistance and capacitybuilding
to support the leadership program. This can involve providing mentorship andcoaching to program
participants, facilitating leadership training, and supporting program monitoring and evaluation.

29
 • Stakeholder engagement: Engage with key stakeholders to support the leadership program'sgoal.
This can involve building partnerships with government agencies, healthcare organizations, and
other relevant stakeholders to ensure program alignment and sustainability.
• Monitoring and evaluation: Monitor and evaluate the leadership program's progress and impact.
This can involve tracking program outcomes, providing feedback on areas for improvement, and
making necessary program adaptations.

6. Program Monitoring, Evaluation and Learning

A High Impact Leadership Program for Health must have a rigorous monitoring and evaluation system to
verify that the program is reaching its objectives, achieving the desired outcomes; recommend areas of
adaptation and sustainability of the program. The approaches/techniques of M&E and selected key
indicators will be presented below:

6.1. Approaches of Monitoring and Evaluation of the program

6.1.2. Setting-performance indicators

The first step is to establish clear and measurable performance indicators (listed in the below table) that
align with the objectives and designed interventions of HIL-PH across all levels of theresult chain in the
framework (from input to outcome).

6.1.2. Baseline assessment

It involves conducting baseline assessment either nationwide or on project-targeted areas to provide a

foundation for comparing progress and measuring the impact of the program. The baseline assessment
should include data collection on relevant perspectives such as leadership competencies/capabilities,
organizational culture, and health system performance.
6.1.3. Reporting and feedback

It involves bottom-up reporting program related activities/interventions and reverse feed backing, and
documenting key activities, achievements, challenges, and lessons learned. These reports and feedback
should be shared with relevant stakeholders, including program funder, to ensure continuous improvement
and address any challenges or concerns that arise. The Ministry’s healthinformation management standard
tools and schedule will be used for regular reporting.

6.1.4. Monitoring

30
Monitor the implementation of HIL-PH interventions against the plan. This helps in tracking progress,
identifying implementation gaps, and making necessary adjustments. This can include supportive
supervision, and review meetings Supervision. Regular supportive supervision shallbe conducted using
a standardized checklist to ensure that the HIL-PH is implemented effectively as planned.
Review meeting will be organized to review program implementation progress, identify
challenges/bottlenecks, and discuss on the way forward/next steps. The reviewing process should include
tracking the progress of selected indicators. The program should also be reviewed bi- annually in
standalone sessions or integrated with other programs at the LEO level.

6.1.5. Evaluation and Operational Research

Evaluation involves measuring the program's performance, analyzing its efficiency, and assessing its
overall impact on health care leadership competencies/capabilities, system performance and health
outcomes. The evaluation of the program will be integrated with mid- term review and end line evaluation
of HSTP II and the next three years plan.
Operational research will be conducted to support decision-making, benchmarking of impact- full
interventions, capturing and disseminating best practices and lessons learned to improve theleadership
program across all levels of the health system.

6.1.6. Knowledge Management

This includes collecting and synthesizing data and knowledge (creating a central repository for program-
related documents, reports, and resources) to support decision-making, bench-marking of impact-full
interventions, conducting research, capturing and disseminating best practices and lessons learned to
enhance leadership development within the health system in Ethiopia acrossall health care level.

6.2. Phases of the Program Implementation

The HIL program interventions can be categorized into three phases; Phase one, Phase two and Phase
three. The Three Phases presented inthe figure 4 as follows:

31
 Phase I
- Finalize HIL-PH
- Launch hil-ph and mobilize resources for its
implementation
- Developing HIL-PH training manuals (PM & FG)
- Incorporate the HIL-PH training manuals in CPD
- Select pilot sites and conduct baseline assessment
- Provide TOT on HIL training manuals
- Pilot test the HIL training manuals at selected sites
- Promote HIL coordination structures at sub-national levels
- Revise the HI-CLIP and LIP

Phase II
- 360 degree evaluation
- Provide massive training on HIL for health
system leaders at all levels
Phase III
- Conduct coaching and mentoring
- Adapt and implement health system leadership
- Mid-term review excellence and accredation system
- Strengthen performance/knowledge - Integrate the HIL training program with pre-
managment service training
- Craeting enabling envirnment to enahnce - Establish health sytem leadership acadamy
motivation of leaders
- organize health leadership award
- Strengthen managerial accountability audit
- Strenghten succesion planning and women
leadership

FIGURE 4: PHASES OF PROGRAM IMPLEMENTATION

32
 6.3. Key Performance Indicators

Based on the objectives of HIL-PH, the following key performance indicators (kpis) that can be used to
measure the progress and effectiveness of the program are selected. Detail indicator guide for HIL program
will be developed.

TABLE 4: HIL PROGRAM MONITORING AND EVALUATION INDICATORS

Indicator Indicator Name Level of Category Data Source Remarks

No. Measurement

1 # Organizations Input Program Admin report

with established Implementation
HIL program
coordination
structure
(planning &
budget
allocation)

2 # Teams Output Capacity Admin report Tracks program completion and

completing HIL Building practical application
training and
successfully
implementing
projects

3 # HIL training Output Knowledge Admin report Measures creation and

materials Management dissemination of learning
developed and resources
distributed

4 # Academic Output Collaboration & Admin report Tracks program reach and
institutions Expansion institutional partnerships
integrating HIL-
PH training

5 Health System Output Program Verification Confirms establishment of a

Leadership Infrastructure dedicated leadership
Academy development entity
established

33
6 Leadership Output Leadership Assessment Measures leadership skill
Competency Development development post-training
Audit Score

7 Program Output Program Assessment Gauges participant experience

Participant Delivery and program effectiveness
Satisfaction
Score

8 Proportion of Outcome Gender Parity HMIS/DHIS2 Tracks progress in women's

female leaders leadership representation
in health
facilities

9 Percentage of Outcome Governance HMIS/DHIS2 Assesses effectiveness of

health facilities Strengthening leadership in board governance
with improved
board function

10 Hospital Outcome Management HMIS/DHIS2 Evaluates overall hospital

Management Effectiveness management practices
Audit Score

11 Proportion of Outcome Institutional HMIS/DHIS2 Measures strength of hospital

hospitals with Governance governance practices
Good
Governance
Index (GGI) >=
80%

12 Health Service Outcome Service Delivery Survey Assesses responsiveness of

Responsiveness health services to user needs
Index

13 Universal Outcome System-Level HMIS/DHIS2 Tracks progress towards

Health Coverage Impact achieving universal health
(UHC) Index coverage

14 Number of Assessment Tracks development in specific leadership skills

leadership skills
developed
(beyond

34
 communication
& problem-
solving)

15 Percentage of Assessment Measures transfer of learning to real-world situations

leaders applying
practical
leadership
concepts

16 Number of Assessment Evaluates understanding of the interconnected healthcare system

leaders
demonstrating
systems
thinking

17 Utilization of Assessment Assesses leaders' capacity to leverage data for decision-making

data for
informed
decision making

18 Number of Survey Measures adoption of a leadership style driving change and innovation
leaders
exhibiting a
transformative
leadership
orientation

6.4. Resource Mobilization

Resource mobilization for HIL-PH will follow the national HSDIP strategies: Domesticsources and
external resources mobilization.

External sources: include bilateral organizations, foundations/philanthropies and other international

organizations that are willing to support HIL programs. This can happen atnational level or regional level
depending on collaborative strategies of donors.

Domestic sources: these are sources within the country. The domestic sources include:
• Allocation from government budget
• Support from stakeholders (ngos)
• Training fees collected from participants when it linked with CPD
• Ngos paying for HIL training
• Non-monetary support from institutions (e.g. Training facilities)
35
6.5. Sustainability

The HIL program will be promoted to have the program coordination structure at regional to lower level
with its operational plan and allocated budget. The Program can also generate financefrom professionals
who sign to take the training. The critical decision includes approval and accreditation of the HIL training
program, value attached and the degree of flexibility and qualityof HIL training satisfying the needs of
participants (including career related) and the health system.

36
Annexes
Annexes 1: SWOT Analysis of Health Leadership Program

Area of Analysis Strengths Weaknesses Opportunities Threats

Coordination & Standardized training materials Non-adherence to Political Cultural norms

Integration harmonization commitment
LMG strategic guide (draft) policy Inadequate
Conducive engagement of
Engagement of higher officials Weak policy senior
accountability environment management
mechanism
Program
Fragmented thinking
leadership
programs

Not tailored
programs

Health System Leadership framework as a building block Limited integration Conducive Political
Building Blocks among directorates policy instability
WHO building blocks in leadership manuals environment
Inadequate shared
Conducive moh structure vision Leadership as a
priority agenda
Lack of systems
thinking
 Program
thinking

Women in Gender executive office at the Ministry Existing gender Inadequate women Strong political Resource
Leadership policy in managerial will for women constraints
positions leadership

Cultural norms Emerging

advocacy on
Wrong perception women's
of men towards equity
women leadership
High volume
of female
graduates

Leadership Standardized training materials Lack of succession Synergistic and Limited emphasis
Development planning tailored on quality in pre-
Experience in leadership development programs service education
Lack of merit-based
Positive policy environment appointment Conducive
Leadership curricula for young leaders policy
Incompetent environment
personnel assigned
Expansion of
Poor budget emerging
allocation technology

38
Quality, Equity & Included in transformation agenda Knowledge gaps Conducive Insufficient
Efficiency policy managerial skills
Program strategies & guidelines Inadequate environment for quality
evidence-based improvement
Health financing reforms purchasing Expansion of
Expansion of health programs emerging
Inefficient resource technology
Availability of healthcare workers utilization
High
Weak patient- household out-
centered services of-pocket
Inadequate budget expenditure
allocation Equity not
mainstreamed

Health Systems Integrated in moh structure Absence of Conducive Low risk-taking

Innovation innovation policy behavior at all
Innovation guide available competencies in environment levels
training
Increased Underdeveloped
Low risk-taking emphasis from health
behavior top infrastructure
management
Maintaining status
quo Challenge
from society to
Inadequate support accept
from leaders innovations
Stakeholder Policy for stakeholder Inadequate advocacy activities Government Unpredictable donor
Engagement engagement and partner funding
Role confusion among interest in
Resource sharing practices stakeholders leadership Budget constraints

Stakeholder platforms Inadequate coordination programs Low literacy level

Community Score Card Resource mapping issues Existence of Program-specific focus

leadership
Duplication of efforts institutes

Lack of community engagement

document

Program Leadership Executive Office Inadequate support and Expansion of Inadequate budget all
Institutionalization (LEO) in moh commitment from health leaders leadership
institutions
Leadership sustainability plan Donor-dependent funding
Postgraduate
Budget for leadership capacity Lack of Standard Operating programs on
building Procedures (SOP) health system
Integration with CPD Lack of trust in local trainers management

Political commitment Lack of follow-up

Leadership performance Hotel-based training

indicators
High leadership turnover

Limited retention mechanisms

40
Lack of integration across units

Absence in strategic and

operational plans

Inadequate program initiation

preparation
Annex II: Stakeholder’s Analysis

Table 1: National Health Stakeholders Engagement Matrix

Stakeholder Desired Behaviors Needs Anticipated Resistance Institutional Response Level of

Influence

Community Participation & Access to health information Lack of cooperation Active engagement High
Engagement & services
Dissatisfaction Community mobilization
Service Utilization Empowerment
Opting for alternative care Health literacy campaigns
Healthy Lifestyles Quality healthcare

Regional/City, Zonal Adherence to national Limited execution capacity Active engagement & High
& Woreda priorities consensus building
Governments Cooperation challenges
Stewardship Tailored support

Meritocratic health
leadership

Adequate budget

Policy implementation

Professional Harmonization & Involvement in licensing & Financial limitations Transparency & advocacy Medium
Associations alignment with national accreditation
strategy Dissatisfaction Capacity building
Promote ethical conduct
Participation Financial support

42
 Resource & technical
support
Development Alignment &
Partners harmonization
Participation at all levels
Technical & financial
support
Higher Education & Competent & ethical
Training Institutions graduates
Consultancy
Evidence generation
Community support
Media Disseminate accurate
health information
Address community
concerns
Advocate for healthy
lifestyles & health
promotion
Clear national strategy
Engagement
Government cost sharing &
priorities
Recognition
Clear policy & strategy
Engagement at all levels
Government health priorities
Prompt response to inquiries
Government leadership Medium
Collaboration throughout
intervention
Policy dialogue & consensus
building
Limited collaboration Policy dialogue & High
consultation
Graduate competency
limitations Consensus building
Institutional autonomy
Ignoring government health Strategic communication Medium
priorities
Transparency
Misinformation
44