Dr. Muluken Melese Discusses Leadership Strategies that Guide his Success as a TB Physician, Project Director, and Researcher

Twenty years ago, Muluken Melese was the only doctor serving thousands of residents at a rural health facility in southern Ethiopia. The community’s poverty and health system weaknesses made this position particularly challenging. Over time, the young doctor realized that the great majority of his patients’ illnesses could be prevented through community education or easily treated under a strengthened health system. This awareness piqued Muluken’s interest in public health and, after two years as a physician, he began pursuing other professional opportunities to supplement his clinical experience.

Recognizing his passion and skill, ActionAID invited Muluken to work as a project health manager and, later, the World Health Organization hired to him support the Ministry of Health in developing emergency health systems and addressing gender-based violence. He also served as the deputy country director for ORBIS International and as a program director at Columbia University’s International Center for AIDS Care and Treatment Programs. In these positions, Muluken coordinated health services, trained health workers, and led community-based water and sanitation projects. Muluken’s medical expertise and public health experience also gave him a unique perspective on the Ethiopian health care system and equipped him to publish over 30 journal articles on TB, HIV, and blindness.

Six years ago, learning of Muluken’s leadership experience and clinical expertise, Management Sciences for Health (MSH) asked him to serve as the technical director for the HIV/AIDS Care and Support (HCSP) project. USAID’s HCSP was one of the largest projects in Africa working to decentralize HIV & AIDS care and treatment services to the health center level.  Muluken’s success in this position inspired MSH to promote and, in 2011, he had accepted his current position as project director for the USAID funded-project, Help Ethiopia Address Low Tuberculosis (HEAL TB). Today, just half way through the project’s five-year lifespan, Muluken’s expert leadership has made HEAL TB a thriving and successful health project reaching thousands of residents in 21 zones of Ethiopia. Hardworking, yet humble, Muluken attributes this success to his dedicated project team and committed stakeholders at all levels of the health system.

“We have great support from USAID, not only financially but also technically. The government is also supportive – they feel as we are one of their team.  You know – they don’t consider us as an outsider – if something fails we’re also responsible. We are involved in the planning, implementing, decision making, and evaluation. The Ministry… considers us their own team. We’re not creating a parallel structure, we’re working in the existing system.”

For Muluken, these partnerships go beyond contractual agreements to include regular, transparent communication, and collaborative work planning.

“Before we develop our work plan, we discuss it with the ministry and the regions to determine what they need. It’s open—we share. I know what they have, they know what we have, so we don’t overlap.”

Muluken’s management strategies have allowed HEAL TB to effectively navigate the political context, while his clinical experience has guided the project’s technical strategy.

“Capacity building and community mobilization have allowed us to bring hundreds of TB patients to treatment. We also focus on helping these patients access proper treatment and adhere to their medications. If you do all of this, it reduces TB transmission and incidence. Furthermore, by building health extension workers’ capacity, we can reach neglected segments of the community, such as mothers, children, and the elderly.”

Muluken’s strong leadership experience is helping to improve TB control in Ethiopia and has equipped him to provide mentorship support to MSH’s other TB projects, such as USAID’s TRACK TB Activity project in Uganda. As an experienced physician and public health professional, Muluken’s work is also impacting the global health community at large. At this year’s Union World Lung Health Conference, for example, Muluken and the HEAL TB team presented five posters and one oral presentation showcasing the project’s results. This year, the team also published three journal articles detailing HEAL TB’s strategic approach to TB control and significant project results.

“Research and advocacy influence health systems… we should use our experiences to improve health-related policies and interventions at national and international levels. It’s the way you sell it – we don’t do it for conferences, we do it to address the gaps, to improve project implementation.”

For more information of HEAL TB’s work, please view their conference posters and the following journal articles:

MSH Shares its “Bread and Butter” TB Control Strategies at the Union Conference

The Union World Conference on Lung Health concluded on Sunday, November 3, with a symposium on tuberculosis (TB) case detection strategies in sub-Saharan Africa. Moderated by MSH’s Global Technical Lead for TB, Pedro Suarez, the symposium began with a riveting presentation from Rhehab Chimzizi, the TB CARE I Project Director and Management Sciences for Health (MSH)’s Country Representative in Ghana. Rhehab outlined the strategies his team used to implement standard operating procedures (SOPs) for TB case detection at six large Ghanaian hospitals and then discussed the significant improvements that occurred at these hospitals. He emphasized that this low cost, simple intervention involved training just 120 health workers and, in 12 months, increased TB case detection by 46 percent and reduced TB patient mortality by 38 percent.

“Ghana has 213 districts and we only did this in two,” Rhehab told the room. “The point is, if we do this in all hospitals, the national TB case detection rate will go up and TB deaths will also go down!”

After his speech, the room buzzed with energy as Rhehab fielded questions from six of his colleagues. Many of the audience members had been taking notes during his speech and these health professionals asked Rhehab to elaborate on the causes of patient mortality, the study design, the implications for expansion, the staff trainings, and the patient treatment strategies. Rhehab answered each of his colleagues and invited further questions and discussion by referring participants to his contact information.

Rhehab Chimzizi prepares for his presentation on effective TB control strategies in Ghana. {Photo credit: Jessica Charles/MSH.}

Rhehab Chimzizi prepares for his presentation on effective TB control strategies in Ghana. {Photo credit: Jessica Charles/MSH.}

After Rhehab’s speech, the audience turned its attention to Habtamu Ayalneh, a TB and TB/TB Clinical Diagnosis Coordinator for USAID’s TB CARE I project in Ethiopia. Habtamu’s presentation showed how both the Help Ethiopia Address the Low TB Performance (HEAL TB) and TB CARE I projects have improved TB case detection in Ethiopia through health worker trainings, SOP development and distribution, TB patient contact screening, and staff supervision and mentoring. Habtamu also discussed how the projects are improving laboratory services in Ethiopia through by external quality assurance activities and enhanced recording and reporting systems. Slides detailing these interventions then led into results data showing a 1,034 percent increase in the number of TB suspects identified in the intervention areas and a 155 percent increase in the number of TB suspects examined.

Habtamu also shared data reflecting improved trends in the TB cure rate, diagnostic accuracy, and patients with multidrug resistant TB enrolled in treatment.

Habtamu Ayalneh. {Photo credit: Jessica Charles/MSH.}

Habtamu Ayalneh fields questions. {Photo credit: Jessica Charles/MSH.}

Audience members praised both Habtamu and Rhehab for sharing their project implementation strategies and one participant emphasized the importance of keeping these “bread and butter” interventions at the forefront of our discussions on TB prevention and control, especially at global conferences where innovation and technical research often take center stage. In line with this sentiment, Rhehab ended his talk by imploring the audience and donors to continue funding these critical interventions, even in, and especially in, countries where the TB epidemic is now more controlled.

“People are talking about zero TB deaths,” Rhehab said. “But let’s make sure that the zeros do not include zero funding – it should be zero TB deaths but more funding for TB control services!”

Rhehab and Habtamu’s presentations demonstrate their technical expertise, leadership capacity, and commitment to advocacy for improved TB control. Both presentations will be available below. The presenters are eager to engage in further discussions about their projects and findings.

Improving TB Case Detection in Big Hospitals in Ghana (PDF)
Authors: Rhehab Chimzizi, Bismarck Adusei, Angela Quaye, George Bonsu, Pedro Suarez, Frank Bonsu.

Improving TB Case Detection through Strengthening of the Health System in Ethiopia: From Pilot to Scale Up (PDF)
Authors: Habtamu Ayalneh; Muluken Melesse; Belaineh Girma.

For more information about the USAID-funded, TB CARE I project, led by KNCV Foundation with MSH and partners, visit: TB CARE I.

For more information about the PEPFAR- and USAID-funded, HEAL TB project, led by MSH and partners, visit: HEAL TB.

Informed Choices for Improved Health: Training Health Professionals in Data-Driven Decision-Making

The decisions we make in public health have a direct impact on people’s quality of life and well-being. Whether working at the national or community level, with millions of beneficiaries, or a single village, we have a responsibility to make well-informed choices and timely decisions regarding interventions, resources, and finances. Each life is invaluable. Each decision critical.

On October 31, 23 Union Conference participants from 21 nations completed a post-graduate course designed to improve their use of data for decision making. Some of these professionals struggle with a lack of data to inform health programming, whereas others shared that the abundance of data is often overwhelming when it comes to strategic planning and effective project implementation. As members of the USAID-funded TB CARE I Program Management Unit, the course facilitators from KNCV Tuberculosis Foundation and Management Sciences for Health (MSH) empathize with these concerns. Using their program implementation experience and expertise in data management, these six professionals developed a course called, “Data for Decision for Making and Use of Data for Continuous Improvement.” During this full-day course, the facilitators led presentations and discussions that challenged participants to apply intuition, personal experience, and prioritization strategies to decision making. They also highlighted the importance of assessing outcomes to inform and refine decision, rather focusing only on the data.

 [They] emphasized that we need to look at the impact – there’s so much data that you get but it’s also helpful to focus on the effect. Rather than look at the process indicators – we should look at the outcomes, said participant Bernard Sichinga, a monitoring and evaluation officer from Zambia.

Dr. Ersin Topcuoglu, TB CARE I’s Deputy Director of Operations and M&E, encouraged participants to make timely decisions and take action with the understanding that all choices require regular reassessment and revision.

It’s important to be predictive not reactive – you have data so, based on this data, you make a decision and predict what’s going to happen next. Then you just need to test and improve – not only the data but also the decision.

Claire Moodie, TB CARE I’s Monitoring and Evaluation Officer, and Rosanne van Halm, TB CARE I’s Finance Team Leader, helped participants apply these strategies by facilitating a case study activity. In the first case study round, Claire and Rosanne divided the class into groups and gave each team a country map and 12 magnets representing GeneXpert machines (TB diagnostic instruments). They asked the teams to make a plan for distributing the GeneXpert machines throughout the country in a manner that would maximize health impact. As they’d been taught, participants assessed the information provided in the map and applied their intuition and field experience to fill in the gaps and develop a dissemination plan in the allotted time.

In each subsequent round, Claire and Rosanne offered slightly more data, allowing the groups to revise and improve their plans as they developed their knowledge of the nation’s population density, disease burden, resources, and other details.

Participants were eager to apply these strategies and others to improve decision making and data quality in their respective countries. Alexinah Muadinohamba, deputy director of the Health Sector Response for Namibia’s Ministry of Health, explained how she would apply the course’s lessons on shared ownership of decision making:

Health workers should be able to use the [data] tools themselves to make decisions. They should be able to analyze it [and] use it themselves for operational research. If you don’t do that, staff feel demotivated and they don’t provide quality data.

As he concluded the session, Dr. Ersin Topcuoglu reminded the class that decision-making is a process.

Don’t be paralyzed waiting for the perfect set of data. Put your experience on the table and then constantly evaluate the data to determine how well the decision-making is working.

Eugenne Elliott nodded at Dr. Topcuoglu’s remarks from the back row. “It’s true,” she said. “I love data but we have to remember we’re not treating numbers – we’re treating real people.”

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Learn more about TB CARE I.

Jessica Charles is a communications specialist at MSH.