TCI University Toolkit: TCI Essentials
How to Be a TCI Leader
The Challenge Initiative’s (TCI’s) “business unusual” model puts local governments and implementers in the driver’s seat, but what exactly does that mean? And how can TCI model transformational leadership?
An essential element of TCI’s leadership approach is helping and enabling local governments to commit to, take ownership of and lead their own efforts to reach their family planning goals. Committed stakeholders are inherently positioned to lead and implement successful programs. When they recognize and take ownership of the problem that they are working to change and of the risks they must take to achieve their goals, they drive programs to success.
As a prime example, after nearly a decade of decline in the modern contraceptive prevalence rate (mCPR) in Rwanda, local leaders rallied behind the government’s vision, leadership and commitment to family planning, dramatically reversing the decline in mCPR and increasing it tenfold in less than a decade, from 4% in 2000 to 45% in 2010. Local champions at the district and community level made significant changes to the country’s health and financing systems, addressing both supply- and demand-side issues, resulting in a decrease in unmet need for family planning and the total fertility rate.
Modern Contraceptive Prevalence Rate in Rwanda: Sharp Rise
Source: DHS; Married women of reproductive age
WATCH Henry Mosley, MD, MPH, Discuss What It Means for Cities to Own the Solution
What Is Transformational Leadership?
Good management and strong leadership go hand-in-hand, as they contribute to an organization in different ways. Managing consists of planning, organizing and using resources to produce intended results. Leading involves mobilizing others to envision and realize a shared vision for the future. Leadership and management should complement one another, and effective programs need both. We never ask a carpenter which tool is more important, a hammer or a screwdriver. That is not a productive question because each serves a different purpose. The same goes for leadership and management.
TCI’s demand-driven approach lends itself to a new, critical shift taking place in global health and development, where local ownership and management is key to a successful and sustainable program. This shift cannot happen without effective, dynamic leaders who have the ability to lead and manage change.
TCI facilitates that shift by advancing transformational leadership, which transforms the personal values of local counterparts to support the TCI vision of scaling up and sustaining proven urban reproductive health solutions by fostering an environment where relationships can be formed and by establishing a climate of trust in which visions can be shared. Transformational leaders serve as role models and inspire others. They have the ability to persuade others to accomplish more than what is expected of them. Additionally, they develop leadership among team members which enhances the chance of success. They strive for culture change to drive improvement and performance.
“To be a leader, one has to recognize a reality that needs changing.”
Henry Mosley, MD, MPH, Johns Hopkins Bloomberg School of Public Health
WATCH Henry Mosley, MD, MPH, discuss the types of transformational leadership needed to ensure the successful implementation of TCI and achievement of family planning goals.
What Are the Essential Elements of Transformational Leadership?
An effective leader embodies several qualities and competencies. These competencies are particularly relevant for TCI’s approach to transformational leadership.
See the big picture, communicate it effectively, share it with others
Leaders should have the ability to communicate their vision effectively to a larger team and inspire others to join the vision. This buy-in transforms the personal vision of the leader into a shared vision within the organization. A good vision is one that is shared by all stakeholders. The emphasis is on shared, not on vision. Anyone can write a vision, but if that vision is not shared by others, confusion prevails with little energy produced. The vision should take into account all of the key actors of the health production system – that is, the households, the community institutions and the government agencies. A clear shared vision guides people in their choices and actions. When the vision is not clear, people are reluctant to act because the direction is unclear or absent. In contrast, when visions are clear, people can decide or act, even in the absence of specific orders and guidelines. A shared vision inspires leadership at all levels within an organization, initiative or health system.
“A vision is not a bunch of numbers because people don’t understand numbers. But they do understand that clinics would be available maybe after hours and on weekends and evenings so that women could come. That medical providers would be available so that they could provide management for side effects at any time, day or night, if something were to occur…”
Henry Mosley, MD, MPH, Johns Hopkins Bloomberg School of Public Health
TCI’s shared vision translates to a future in which effective and efficient family planning programs, owned and implemented by the people and organizations in the cities themselves and fully accessible to the poor, produce satisfied family planning users and prevent unintended pregnancies.
WATCH Henry Mosley Discuss Establishing a Shared Vision
Mastering leadership competencies on a personal level begins with knowing your values, beliefs, strengths and weaknesses; having the ability to reflect and learn continuously; and understanding your sources of personal reward. Personal mastery is the discipline of personal growth and learning. It is the expansion of ability to create the results in life that one is truly seeking. Personal mastery is a process; it is not something you possess. It goes beyond competence and skills. It means approaching one’s life as a creative process, not a reactive one. Personal mastery is crucial to leadership as leaders go to places where there are no maps, where other people have never been. Personal mastery requires knowing what is important to us and what to see more clearly. Resourcefulness is at the heart of personal mastery.
Be aware of your perspective and be willing to change it
Mindsets, or mental models, are both the lenses through which we observe reality and the structures that we impose on reality and are based on values. Values are deeply held views of what we find worthwhile. They come from many sources: parents, peers, schools, religions, persons we admire, and culture. Many go back to childhood; we take on others as adults. As with all mental models, there is a distinction between our “espoused values” – those we profess to believe in – and our “values in action” – those that actually guide our behavior. These latter values are coded into our brain at such a fundamental level we cannot easily see them.
An essential part of being a good leader is to recognize and challenge our existing values and mindsets as they affect a team’s choice of priorities for action and implementation strategies. To attain the future we desire, we need to first be aware of what needs to change. Teams that have the ability to continuously learn and grow – learning teams – are able to, together, build organizations and initiatives that can truly learn to reach their visions and goals.
TCI’s “business unusual” approach requires a shift in mindset to:
- Build the capacity of others and empower them to become engaged leaders themselves through coaching, not the traditional technical assistance approach
- Encourage TCI stakeholders to identify their problems themselves and develop appropriate evidence-based solutions to address them
- Listen carefully and offer coaching support
- Promote self-reflection and a culture of data use for decision-making to enable ongoing course correction
Build respect and trust to encourage team learning
Transformational leadership thrives in an environment where information sharing and decision making are decentralized and non-hierarchical. Leaders can create an enabling environment by nurturing a shared vision and encouraging team learning, trust, transparency and shared accountability for all programmatic outcomes. Trust needs to be built and maintained in all aspects of life, including leadership. Building trust starts with respecting others and listening to their points of view and their needs. Effective leaders nurture respectful work relationships throughout all levels of TCI.
“… it takes a long time to build trust. This is particularly true if you are going into a new setting. … You are going to have to engage with people in these countries – the political leaders, physicians, community leaders, the press, religious leaders – sit down, talk with them and listen to them carefully. Really engage in a dialogue with them about the vision you have but also listen to what their visions are and gradually over time, you can build trust.”
“Trust is like a ladder. You only go up a ladder one rung at a time and it may take a long time to climb that ladder. However, if you slip, you fall all the way to the very bottom. Once you lose trust, you lose it totally and completely.”
Henry Mosley, MD, MPH, Johns Hopkins Bloomberg School of Public Health
WATCH Henry Mosley, MD, MPH, Talk about Building Trust
“Team learning is the process of aligning and developing the capacity of a team to create the results its members truly desire” “ Teams require both individual and mutual accountability. Team learning relies more on group discussion, debate and decision rather than just the sharing of information or best practices. Through team learning, what is produced is produced jointly and the performance of the team is more than the sum of the individual contributions. For successful team learning, we need to connect learning with action. Action learning is a process that involves a small team working on real problems, taking action and learning as individuals, as a team, as a geography and as a TCI Team while doing so. TCI applies this action learning in all it does – a type of learning we refer to as “thinkering.”
As TCI’s hubs strategically think and learn, they course correct in real time and, in a sense, “tinker” with new ways to drive improved performance. As hubs operationalize the TCI model by testing and assessing it, they improve the model through this tinkering-and-thinking cycle. This makes each hub a self-learning center, whereby hubs learn from the geographies with which they are working – in other words, where the action and results are taking place. These learnings fuel improvements to the TCI model, ensuring that it is effective and replicable.
Coach, support and motivate
TCI’s approach to coaching adds an innovation that is unique to TCI: a locally owned and implemented model of coaching with a systematic yet flexible process to bring about long-term, sustainable transformation. The coaching approach aims to facilitate and produce the rapid, cost-efficient expansion of accessible, quality urban family planning information and services, led and sustained by stakeholders in TCI geographies.
To catalyze and support its “business unusual’ model, TCI uses a blended learning approach to meet the needs of city managers, implementers and other members of the TCI community.
The flexible coaching process accounts for several factors in the local context including:
- Needs of the individual coachee(s) and/or teams being coached
- Coachees’ existing knowledge, skills, and confidence in identifying, adapting, and applying solutions
- Specific complexities of the challenge, task(s), or problems at hand
Use data to prioritize and make decisions
All TCI stakeholders need access to high-quality data on program performance to ensure the initiative is on track to rapidly scale up high-impact family planning approaches. Likewise, they need to use that data at regular intervals to iteratively adjust program design, implementation and management. Good data can also make a compelling case for advocacy for needed resources. TCI’s Monitoring, Evaluation and Learning (MEL) Framework highlights the critical role of data use for decision making to track and assess the TCI model across all implementation sites. MEL activities serve three key objectives:
- To continuously monitor, assess, and advocate scale up and sustainability progress and generate lessons learned for improving the implementation and design of future strategies, approaches and materials
- To report results of TCI interventions to provide accountability to counties, cities, states, countries, TCI hubs, and the Bill & Melinda Gates Foundation
- To feed new learning back into the project in a timely way to inform adaptations and improvements to program design, implementation, supervision, and management
Learning and adaptation can occur only if relevant data are (1) available, (2) accurate, and (3) used to inform decision-making and enhance program performance. Thus, data use for decision-making is a key component of the way TCI does business and a foundational competency for all TCI staff and stakeholders at all levels – Global, hub, and geography – where implementation is occurring.
Systems thinking is the understanding that cause and effect are connected and the ability to see patterns within organizations. “Business and other human endeavors … are bound by invisible fabrics of interrelated actions, which often take years to fully play out their effects on each other” Viewing things from a systems perspective gives you the ability to see things from a wide angle, rather than a telephoto lens, to understand the interrelationships around you; some have called this broader vision “peripheral vision.” When we start seeing things differently, we behave differently and our organizations become more effective by understanding the whole in addition its parts. Just as a keyboard is as much a part of a computer system as a monitor, so is the electric grid that allows the computer to get the power it needs to function. In a system, there is no outside.
Source: Content for this page was adapted from Gates Institute’s Strategic Leadership and Management for Population and Reproductive Health Guidebook for Facilitators, 2006.
Tools Related to this Approach
- TCI Approach to Leadership Powerpoint
- Developing & Empowering Effective Leadership Powerpoint
- Mindsets & Facilitating Change Powerpoint
- Nine-Step Coaching Job Aid: English | French
- How to be a great leader playlist (TED)
- What Makes a Leader slidedeck (Harvard Business Review)
- 2×2 Matrix Explains Good vs. Great Leadership’ video (Harvard Business Review)
- Leadership in Strategic Health Communication: Making a Difference in Infectious Diseases and Reproductive Health Workshop Manual (Johns Hopkins University)
- Dependency to Partnership: Leading/Managing Change (Global Health eLearning Center)
- Country Ownership and Organizational Capacity Building: Beyond Principles to Practices (USAID)
- Consultation & Participation for Local Ownership: What? Why? How? (Save the Children)
- Managers Who Lead: A Handbook for Improving Health Services (Management Sciences for Health)