“Coaching in Liberia was one of the best experiences of my life,” says Anthony Gingong. “I told them I was not coming as a foreigner. I was coming as one of them. That alone eased the tension in the room.”
Gingong is a health professional with almost 30 years’ experience within Ghana’s National Health Insurance Scheme (NHIS) where he established the Quality Assurance and Provider Payment units within the National Health Insurance Authority (NHIA) — the institution that oversees the operations of the NHIS. He is also an Accelerator Coach with decades of hands-on experience implementing health systems strengthening interventions.
Gingong is currently working with the Accelerator in Liberia to provide practical guidance to senior Ministry of Health (MOH) officials on how to adapt and use global evidence to establish their own version of national health insurance — the Liberian Health Equity Fund (LHEF) — drawing on the knowledge and skills he learned at the NHIA.
“Working with Gingong was a great experience,” says Roland Y. Kesselly, director for health financing at the Ministry of Health in Liberia. “We have always looked for partners who are more like us, and who understand our context. So, the experience with Gingong and the Accelerator was just that.”
The concept of coaching is one of several sustainability approaches the Accelerator is testing to improve the way health systems strengthening is done. Accelerator Coaches differ from consultants in several ways. Most notably, they are not the active doers of work and producers of technical outputs.
Coaches are tasked with working alongside and supporting country stakeholders through processes to identify root causes of health system challenges, interpret and apply locally generated and global evidence, develop and implement solutions that are technically valid, feasible, and have the buy-in of stakeholders.
“It’s been interesting working alongside decision-makers, government and non-governmental, in Liberia to examine the financing system, specifically the Medicine Management Systems, as well as exploring the possibility of advocating for earmarked funding, and beginning the process of costing of medicine and medical consumables for the health sector,” says Gingong.
With support from Gingong and our regional partner the Health Strategy Delivery Foundation (HSDF), the MOH and the Accelerator are jointly developing near-term adjustments to public financing to lay the foundation for longer-term transitions that will lead to more sustainable financing mechanisms for the LHEF while also exploring the short-term efforts to establish a Revolving Drug Fund.
“We didn’t know how to really go about starting the LHEF,” said Nuaker Kwenah, a health financing officer in the department of Planning, Research and M&E. “Gingong was able to guide us through when we were talking about the Revolving Drug Funds. We all had a different idea, but Gingong was able to put it all into perspective based on his experience in Ghana.”
Gingong is just one of many Coaches the Accelerator hopes to deploy over the life of the program who is testing a paradigm shifting approach that pairs technical assistance with coaching and mentorship for key staff. The working theory? That health systems interventions will produce more sustainable results if country leadership is equipped with the skills that are needed to continuously adapt, such as management capacity, knowledge translation, evidence generation and adaptive learning, as well as ‘soft skills’ like stakeholder engagement and strategic communications.
“Gingong’s work as a coach is a good example of what makes the Accelerator approach different and valuable,” said Jessica Healey, Director of USAID/Liberia’s Health Office. “The connection he has made with the MOH is tremendous, and they clearly value his advice and recommendations.”
To date, Gingong has made several trips to Liberia to provide key officials with guidance on everything from provider payment and policy considerations to the effectiveness of Revolving Drug Funds.
“Gingong helped us understand that if you are developing an intervention, you also have to support it with documentation like policy for the sector or some other aspect of it. And based on that, when you’re planning, you should reference this document,” says Nuaker. “Gingong also noted that it was important to understand the political issues that you will need to address if you are implementing health systems interventions, such as the political will, the beginning capital [to start the Revolving Drug Funds], the capacity of those who will be implementing, and the different roles and responsibilities that each of those people will need for successful implementation.”
Looking ahead, Gingong hopes to continue working as an Accelerator Coach to provide guidance to other countries that are exploring health systems strengthening interventions.
“I like that we worked with them, not for them. By working with them, even if you leave, they should see the process as something that was produced by them with support from the Accelerator,” says Gingong. “Otherwise, they only see that an additional worker has left.”
In addition to providing Coaching support, the Accelerator — led by our regional partner HSDF — is working closely with a multi-unit team from within the MOH to develop a methodology to estimate the costs of delivering Liberia’s Essential Package of Health Services. This costing tool and the capacity to use it are key inputs into the MOH’s ability to strategically plan and make decisions for the future of the health sector. The costing process will continue in close coordination with the MOH to ensure the Ministry can adapt and repeat it as needed in the future.
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