A Path Ahead to Better Health

Synergos’ plan in Namibia aims for improvements in maternal health. The assignment was clear: find a way to improve health care for Namibians.

The solution? Less so. That would need time.

The Synergos Institute, a two-decade-old non-profit based in New York City, has a history of bringing together different groups in society to solve problems, health care among them. For the African Health Leadership Initiative, Synergos first had to identify the issues, and pinpoint what was causing those problems.

And then it needed to work with the country’s political and health leaders, especially those in the Ministry of Health, and help them drive the change. Namibia’s health leaders would solve the problems.

Funded by the Bill & Melinda Gates Foundation—and assisted by a detailed health systems analysis from McKinsey & Company and leadership development support from Presencing Institute—Synergos’ plan has been to show that this leader-driven approach, focused on reaching discernible goals, could markedly improve the health of a nation.

“First, we needed to do a deep dive—find out what is working and what is not working so well,” said John Heller, Synergos’ Senior Director, Partnerships, who supports the Namibian project from his New York City base. “We needed to see where some of the critical roadblocks were, and how we could help remove those roadblocks.”

Heller said a critical component was for health leaders to tackle an important issue, and create models within the health system to attempt to make progress. Namibia’s Ministry of Health, backed by Synergos’ analysis, chose to find ways to reduce the rate of maternal mortality, which had roughly doubled from 1990 to 2006 to one of the highest rates in the world.

“Our whole approach is to encourage inside-out change,” Heller said. “That means we don’t come in with an answer. We are catalysts, conveners and coaches who enable the existing leaders to get on with what they need to do. The people who are the experts in the Namibian health system are already in Namibia.”

Synergos arranged workshops for leaders across departments and regions to bring out these new approaches to reducing maternal mortality. They also made sure leaders spent time in the field to connect them back to realities in poor communities. One senior official, for instance, spent part of a day in an ambulance, accompanying an emergency-response team on its calls. Others visited maternal health clinics.

The initiative includes the encouragement of government at the higest level, including the Right Honorable Nahas Angula, Prime Minister of Namibia.

Dr. Norbert Forster, Deputy Permanent Secretary at the Ministry, said that the project activities helped to build camaraderie among staff. “About 30 of us in the Ministry went through a leadership development process,” Forster said. “We found that very, very useful, a breakthrough in many ways. People got to know each other and relate to each other much better, and communication in general improved considerably.”

Forster said that Synergos’ approach with leaders helped to break down cultural and historical barriers. “As a country, we have been independent for just 20 years,” he said. “We had a large group of people in management positions who came back from exile, and there was always a little bit of divide or one group preferring to do things one way and another wanting to do it another way. The workshops helped galvanize us to do things together. We’ve become much more a big family.”

This investment in Ministry of Health’s leaders is unusual in the world of development assistance. One of the project’s most difficult tasks is to show that investing in leaders can yield results in a very short timeframe; the project is slated to close in a little more than three years, ending in 2011.

Ministry of Health and Synergos’ leaders say that they are seeing strong indications of positive change. They are now tracking several indicators. One is measuring response times for ambulances, which has shown dramatic improvement in the first months of the program. Another is looking at ways to encourage more pregnant women to seek care in the first trimester of their pregnancy; now just 4 percent in the Khomas region, for instance, go for checkups in the first 12 weeks.

“Those project indicators will show we are on the right track,” Heller said.

“Improving the performance of our public health care system is a vital priority, and the program you are supporting could not be more timely or useful.”
– The Right Honorable Nahas Angula, Prime Minister of Namibia

The hope—from both the Ministry and Synergos—is that success in Namibia will lead to the expansion of this model to other countries, resulting in better health care in low- or middle-income nations.

“I’m quite confident we will be able to show significant changes,” Forster said. “We’ve already shown a remarkable difference in the working atmosphere, improving the environment, the frequency of communication, the openness of communication, and the preparedness of our management staff. We are thinking about solutions and we are designing solutions.”

More information


Kasee Ithana
Director, Namibia
152 Robert Mugabe Avenue
Tel: +264-61-386950
Fax: +264-61-221492