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MOST FOR TBManagement and Organizational

Sustainability Tool for National TB Control Programs

A Guide for Users and Facilitators

Developed by The Tuberculosis Coalition for Technical Assistance (TBCTA) partners:

The Global Health Bureau, Office of Health, Infectious Disease and Nutrition (HIDN), US Agency for International Development, financially supports this document through TB CAP under the terms of Agreement No. GHS-A-00-05-00019-00.

© 2009 by Management Sciences for HealthAll rights reserved.

Trainers and facilitators may photocopy the MOST for TB instrument, forms, modules, workshop agenda, and instructions for participants without prior permission, for noncommercial use only. Any translations or adaptations of this user’s guide or of the MOST for TB instrument or process require prior written permission from the publisher.

Management Sciences for Health Tel.: 617.250.9500784 Memorial Drive Website: www.msh.orgCambridge, MA 02139-4613 USA

The trademarks or service marks used in this guide, including Microsoft, Word, and PowerPoint, are the exclusive property of Microsoft Corporation. MOST for TB is not a product of, nor is it endorsed by, Microsoft Corporation.

ISBN 978-0-9819616-0-6

Funding for this information was made possible by the generous support of the American people through the US Agency for International Development (USAID). The contents are the responsibility of TB CAP and do not necessarily reflect the views of USAID or the United States Government.

Photo, back cover: Pedro G. Suarez, TB workshops in Ecuador and Uganda

v

COnTenTS

ACKNOWLEDGMENTS vii

ACRONYMS AND ABBREVIATIONS ix

BACKGROUND xi

HOW TO USE THIS GUIDE xiii

I. INTRODUCTION TO MOST fOR TB 1What Is Most for tB? 1Most for tB Workshop and Anticipated outcomes 2the Most for tB Difference 3How Can ntps Benefit from Most for tB? 4orientation to the Assessment Instrument 5the Most for tB process 7phases of the Most for tB process 7

II. MOST fOR TB AND THE CHANGE PROCESS 9principles of Change 9tB Change Leader and tB Change team 10Leading and Managing for organizational Change 11

III. ROLES Of THE STAKEHOLDERS 14Role of the participants 15Role of the Facilitators 16

IV. USING THE MOST fOR TB ASSESSMENT INSTRUMENT 21providing Evidence 22

V. fACILITATORS’ PLAN 23phase 1: Engagement of the ntp’s Leaders 24phase 2: preparation for the Workshop 26phase 3: Workshop plan 28opening session 32Module 1: Where Are We now? 35Module 2: Where Are We Headed? 38Module 3: How Will We Manage the needed Changes? 40Module 4: How Will We Reach our objectives? 42phase 4: Follow-Up Activities 46

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VI. WORKSHOP MATERIALS 47Making the Most of Management 48Most for tB Workshop Agenda and Anticipated outcomes 51Most for tB Assessment Instrument 53Most for tB Assessment Consensus Form 69Assessment Consensus Form 70Most for tB Action plan Form 80Leading and Managing Results Model 82Leading and Managing Framework 83

VII. ADDITIONAL RESOURCES 84to prepare for the Most process 84to Focus on Improving specific Management Components 84to Manage Change More Effectively 85MsH Resources on tuberculosis 85

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ACKnOWLeDGMenTSManagement Sciences for Health (MSH) first introduced the Management and Organizational Sus-tainability Tool (MOST) in April 1997 at an International Planned Parenthood Federation (IPPF) workshop in Nairobi, Kenya. The first edition of the MOST guide was published in 1999. Since that time, MOST has been used to strengthen public- and private-sector organizations.

We are pleased to present our latest publication in the MOST series: Management and Organiza-tional Sustainability Tool for National TB Control Programs (MOST for TB). MOST for TB was pre-pared by Pedro G. Suarez and Sarah Johnson to provide complete information about the MOST for TB concept, process, and instrument.

We would like to show our appreciation to all NTP teams and organizations that gave us the opportunity to field-test the tool and participated in validation workshops between 2004 and 2008. Special thanks particularly goes to NTP teams from the Dominican Republic, Ecuador, Mozam-bique, Namibia, Pakistan, Uganda, and Zambia; WHO medical officers from Mozambique and Uganda; and the Tuberculosis Control Assistance Program (TB CAP) team from Namibia.

In memoriam, we would like to express our deep appreciation to Dr. Hassan Sadiq (Pakistan NTP Director).

We also acknowledge the valuable comments and suggestions of Ivelisse Acosta (Profamila/GFATM—Dominican Republic), Edith Alarcón (The UNION—Regional TB LAC Advisor/Peru), Rhehab Chimzizi (TB CAP Ghana), Yuriko Egami (MO STB/WHO Pakistan), Giuliano Gargioni (WHO/Geneva—TB Advisor), Lia Kropsh (Brazil), Amos Kutwa (KNCV/Kenya), Belkys Mar-celino (NTP Director—Dominican Republic), Alvaro Monroy, Chinwe Owunna (MSH/SPS), Mohammad Rashidi (TB CAP Afghanistan), Barbara Tobin, Christine Whalen, Alvaro Yáñez del Villar (TB Advisor—Chile), and David Zavala (TB Advisor—Ecuador). We are also grateful to Claire Moodie (MSH/CHS—TB CAP Project Officer) and Christine Rogers (MSH’s Communications and Knowledge Exchange Center), who coordinated the overall editing process.

We appreciate the support of the US Agency for International Development (USAID). Their investment in the MOST for TB process reflects their firm commitment to good management as a critical factor in improving the organization, delivery, and quality of health services. USAID’s ongoing support helps organizations to improve overall health outcomes and strengthen their ability to provide quality services to their clients for many years to come.

ix

ACROnYMS AnD ABBReVIATIOnSACSM Advocacy, Communication, and Social Mobilization

AIDS acquired immunodeficiency syndrome

DOTS directly observed treatment, short course

GFATM Global Fund to Fight AIDS, Tuberculosis and Malaria

HIV human immunodeficiency virus

MDGs Millennium Development Goals

MDR-TB multidrug-resistant TB

MOH Ministry of Health

MOST Management and Organizational Sustainability Tool

MOST for TB Management and Organizational Sustainability Tool for National TB Programs

MSH Management Sciences for Health

NGO nongovernmental organization

NTP national TB program

TB tuberculosis

TB CAP Tuberculosis Control Assistance Program

UNION International Union Against Tuberculosis and Lung Disease

USAID US Agency for International Development

WHO World Health Organization

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BACKGROUnDThe World Health Organization (WHO) reports that nearly one-third of the global population is infected with Mycobacterium tuberculosis and is at risk of developing the disease. More than eight million people develop active tuberculosis (TB) every year, and about two million die.

Based on the WHO framework for control of TB in developing countries, the Stop TB strategy has been adopted by ministries of health (MOHs) in 183 countries. Furthermore, significant financial resources have been mobilized through the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), and several important agencies have endorsed the Millennium Development Goals (MDGs), which include combating TB and the Stop TB strategy. Recent WHO assess-ments, however, show that while great progress has been made toward Stop TB’s target 85 percent treatment success rate (84.7 percent in 2005), the actual case detection rate for new smear-positive cases (61 percent in 2006) is well below the 70 percent target.

Although many countries have received technical and financial support ( from GFATM), scaling up and sustainability have been difficult to achieve. The rapid increase of directly observed, short course (DOTS) coverage has placed a high level of demand on program management, which is often weak.

Several factors appear to be impeding more rapid progress in detecting and reporting cases under the DOTS strategy in many countries. These include:

weak organization and management of national TB programs (NTPs);■■

lack of systems and services provided by primary health centers and hospitals for TB control;■■

insufficient DOTS coverage at public health facilities, including hospitals and primary health ■■

centers;

insufficient access to quality DOTS services;■■

weak design and use of public health criteria for case detection and poor use of sputum smear ■■

testing for diagnosis of TB;

lack of public laboratory networks to provide support to the NTPs;■■

lack of public awareness and involvement of communities in DOTS activities;■■

limited participation of private providers, nongovernmental organizations (NGOs), and aca-■■

demic institutions in proper TB care delivery as part of the NTPs’ strategy;

limited collaboration between TB and HIV control programs at all levels, particularly in coun-■■

tries with high TB and HIV burdens.

To address these issues, Management Sciences for Health (MSH) works closely with the Tubercu-losis Control Assistance Program (TB CAP) to strengthen human capacity development, organi-zational and management systems, and leadership to integrate strategic program activities at all levels of PHS and private sector in TB. MOST for TB is a tool that allows TB control program man-agers to assess and improve the management of their programs.

Originally, MSH developed a participatory approach to management assessment called MOST (Management and Organizational Sustainability Tool), which enables client organizations to assess and strengthen their existing management processes and systems. MSH, in collaboration with TB CAP partners, has adapted the MOST approach to improve the management of NTPs and thereby

xii

reduce disease transmission in the community, reduce mortality and morbidity due to TB, and prevent the development of multidrug-resistant TB (MDR-TB). This revised approach is known as the Management and Organizational Sustainability Tool for National TB Control Programs (MOST for TB). To date, this newly adapted management tool has been successfully applied in Ecuador (2004–2005), the Dominican Republic (2005), Pakistan (2007), and Namibia (2008).

With TB CAP funds provided in the 2005–2006 TB CAP work plan, MSH and WHO organized a three-day workshop, held in Kampala, Uganda, August 9–11, 2006, to discuss management chal-lenges facing national TB programs and introduce a new approach for improving the management of NTPs to achieve targeted results and improve health outcomes.

Workshop participants were drawn from five countries (Mozambique, Namibia, Pakistan, Uganda, and Zambia) and included three WHO medical officers from Uganda and Mozambique, as well as one WHO Stop TB Geneva representative. The diverse country teams included NTP program man-agers, regional and provincial TB managers, and TB laboratory personnel.

The workshop and overall discussion process led MSH, in collaboration with TB CAP partners and NTPs, to develop and disseminate the MOST for TB guide and instrument. The broad dissemination of this tool will increase the opportunity for NTPs to strengthen their management practices as a means to improve services and make their programs sustainable.

This MOST for TB guide reflects the experiences of users and facilitators in the countries where the tool was piloted (Dominican Republic, Ecuador, Namibia, and Pakistan) and our knowledge of NTPs’ needs for the expansion and implementation of the DOTS strategy.

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HOW TO USe THIS GUIDeThis guide provides complete information about the MOST for TB concept, process, and assessment instrument. It also includes all necessary materials for conducting a three-day MOST for TB workshop. The guide can therefore be used by those who want to learn about MOST for TB for the first time as well as by those who are preparing to carry out a MOST for TB assessment. Potential users should read specific sections of the guide:

NTPs directors* who are considering undertaking the MOST for TB process should read “Mak-■■

ing the MOST of Management” on page 48.

NTPs directors who have decided to implement MOST for TB should read the first three sec-■■

tions of this guide.

Facilitators who will be conducting the MOST for TB workshop and guiding follow-up should ■■

read the entire guide to become familiar with the foundations and process of MOST for TB, its participatory philosophy, and the steps involved. They should also use the workshop materi-als, which begins on page 47, to assemble a binder for workshop participants.

*Note: In some NTPs, the administrative designation may be manager, coordinator, chief, or another similar term.

MOST FOR TB

Management and organizational sustainability tool for tB 1

I. INTRODUCTION TO MOST fOR TBThe Management and Organizational Sustainability Tool for National TB Control Programs (MOST for TB) is a process for improving the management of an NTP, with the end result of contributing to the three main objectives of NTPs:

reduction of disease transmission in the community;■■

reduction of mortality and morbidity due to TB; ■■

prevention of the development of multi-drug resistant TB (MDR-TB).■■

MOst for tb is for all levels of a ntP

Most for tB can be used at any level of a national tB control program—national, regional, or local—that would like to strengthen program management in order to improve implementa-tion and expansion of the stop tB strategy.

This section of the MOST for TB guide explains what MOST for TB is, how it differs from other management assessment processes, how the MOST for TB process works, and how the assessment instrument is organized.

What is MOst fOr tb?

MOST for TB is a structured, participatory process that allows NTPs to assess their own man-agement performance and develop a concrete action plan for improvement.

Good management is the glue that holds all the internal parts of an NTP together, contributes to a positive work climate, and supports high-quality services, thus helping bring the NTP’s vision to life. MOST for TB helps NTPs focus on improving their management practices as a means of improving services and making the NTP sustainable in three ways: institutionally, financially, and program-matically.

A well-managed NTP has a strong yet flexible functional structure (institutional sustainabil-■■

ity). Its functional structure allows it to respond to the shifting priorities of its supporters and to new responsibilities toward TB patients and communities while also creating a positive work environment for health personnel. MOST for TB allows an NTP to assess its values and functional structure, as well as those systems traditionally identified as management related.

A well-managed NTP draws on various sources of revenue, which allow it to support its ongo-■■

ing efforts and undertake new initiatives ( financial sustainability). MOST for TB helps the NTP determine its stage of development in terms of financial management and revenue generation.

A well-managed NTP delivers services that respond to TB patients’ needs and anticipates new ■■

areas of need (programmatic sustainability). As a result of its success, it is able to expand its institutional, social, and community base. Using MOST for TB, an NTP can assess its mission; its strategies; its planning, monitoring, and evaluation; and its systems for delivering services.

MOST FOR TB

Management and organizational sustainability tool for tB2

Even a well-managed, successful NTP must constantly reassess and adapt its management prac-tices as new demands arise and changes at the MOH affect the environment in which the NTP works. The leadership of an NTP plays a critical role in fostering a climate of continuous assessment and improvement.

the MOst for tb Process fosters improvement of Management Practices

Most for tB allows an ntp’s leadership—the director and senior managers from the nation-al, regional, and selected local levels—to put in motion a change process that involves staff from all levels of the ntp (national, intermediate, and local) as well as other key stakeholders. Working together, they:

recognize the importance of good management to the effectiveness and long-term ■■

survival of the ntp;

assess the current status of essential components of management;■■

identify feasible changes that can make the ntp more effective;■■

develop specific plans to implement these changes;■■

generate the staff buy-in needed to support these management improvements;■■

monitor the results over time.■■

MOst fOr tb WOrkshOP and anticiPated OutcOMes

The cornerstone of the MOST for TB process is a three-day workshop. During the workshop, the NTP leadership and selected staff come together to build consensus on the stages of development of the NTP’s management components, the necessary improvements, and an action plan for making those improvements. This workshop is not an end in itself, but rather one step in a signif-icant change process. If MOST for TB is to yield its greatest benefits, all staff must play a part, one that continues long after the workshop. They must recognize the need for change, commit to the process, and help implement the identified improvements in their day-to-day work.

By the end of the workshop, it is expected that participants will have come to agreement on how well the NTP is functioning and will have planned activities for making improvements. The specific outcomes include:

a collective assessment of the current stage of development of the various management com-■■

ponents;

a prioritized list of the management components to be improved within a specified time period;■■

an agreed-upon set of objectives for improving each management component;■■

an action plan for reaching the objectives, identifying the broad activities, timing, resources, ■■

and people responsible for completing the activities, as well as defining data that can provide evidence of success;

identification of a TB change leader and TB change team who will lead the implementation of ■■

the action plan and monitor progress;

MOST FOR TB

Management and organizational sustainability tool for tB 3

a list of short-term activities for following up on the MOST for TB workshop: those the NTP ■■

staff can do themselves with existing resources, those for which they will need to seek addition-al resources, and those for which they will need technical assistance from outside the NTP;

agreement on post-workshop assistance from the facilitators (by phone or e-mail) and a ■■

follow-up MOST for TB exercise, usually six months to one year after the workshop.

the MOst fOr tb difference

Many traditional assessments rely on external evaluators, intensive data collection, and check-lists. They result in findings and recommendations but often fall short of producing a plan for improvement. MOST for TB is different. It is about making change happen through a structured, participatory process, in which staff members use an instrument to collect data from their own experience, immediately analyze the data, and use their analysis to make concrete, practical plans for improvements. And finally, the MOST for TB process recognizes that meaningful changes in management rarely occur through a single event; the process includes a six-month or one-year follow-up exercise to review progress and make any needed changes in the action plans.

The very structure of the MOST for TB process builds in the key factors that will support NTP change:

The MOST for TB assessment is carried out by the NTP’s staff, not by an external team. This ■■

self-assessment allows staff to identify the management challenges they face.

MOST for TB is participatory, harnessing the insights and creativity of staff from all levels of ■■

the NTP.

MOST for TB uses consensus-building rather than votes or top-down rulings to make deci-■■

sions about management improvements. This approach makes certain that those who will be asked to implement decisions have been fully involved in making those decisions.

MOST for TB draws on the contributions of strong, committed leaders at every level of the ■■

NTP. The director and senior managers must identify the need for change, commit to the MOST for TB process, and bring their staff on board. Staff members lead in various ways: by contributing their ideas, by serving as change agents, and by sharing with the entire staff their personal commitment tomaking the changes happen.

The participants in the MOST for TB workshop produce a realistic action plan for making improvements in the identified areas of need:

During the MOST for TB workshop, participants prioritize the management components ■■

to be improved, identify objectives for those components, and put together a concrete plan designed for immediate action. The plan identifies short-term, feasible actions to be taken toward each identified objective, along with the person(s) responsible, timing, and resources needed.

The MOST for TB action plan is integrated into the NTP’s other operational plans. It is seen ■■

as a way of helping to implement those plans through effective management, rather than as a stand-alone, unrelated set of activities.

During the workshop, the NTP sets a date for a follow-up MOST for TB exercise, aimed at as-■■

sessing progress toward the objectives, revisiting the management components that were viewed as lower priority, and identifying any new needs.

MOST FOR TB

Management and organizational sustainability tool for tB4

The MOST for TB data-collection instrument is a means of eliciting information from staff, helping them analyze the information, and building agreement about their assessments:

It allows staff to use what they each know about the NTP’s management practices as evidence. ■■

The exchange among participants as they share knowledge with colleagues enables groups to analyze management components rapidly, without a lengthy data-collection process.

It involves staff in assessing the NTP’s stages of development in terms of a set of management ■■

components, rather than simply checking off the presence or absence of a component.

hOW can ntPs benefit frOM MOst fOr tb?

Our experience shows that NTPs can benefit from MOST for TB provided that the director and senior management meet two criteria:

They are committed to open self-assessment and to decision-making by consensus.1.

They believe that the organization can take action to improve its management, even though 2. there may be some constraints beyond its control.

The first criterion requires that the decision-makers of the MOH and NTP read this guide care-fully, feel comfortable with the process it describes, and express their full commitment to the staff and other key stakeholders who will engage in the process. To make the MOST for TB experience effective, the MOH’s and NTP’s directors must demonstrate that they are genuinely enthusiastic about staff ideas, open to the airing of issues, and willing to hear all input, including criticisms. Once the process is under way, the NTP director must act as a participant equal to all others. This commitment to democratic participation will help ease participants’ fears about voicing their opinions or making unconventional suggestions. When staff and other stakeholders see their leaders’ commitment to change, they in turn will be motivated to fill their roles in making changes that will improve management.

The second criterion requires that participants in the MOST for TB process use their imagination and determination to find creative ways to improve the NTP’s management systems and practices. Clearly, not all challenges identified will be within the NTP’s control. Most NTPs work within a legal and operational context that limits their ability to modify some management practices. For example, NTPs and government health facilities may find that many aspects of their management are determined by government authorities at the national level (MOH), national boards, or interna-tional agencies with which they work.

However, apart from these policy and regulatory constraints, NTP managers and staff do have the ability to make significant management improvements. MOST for TB helps these decision-makers assess the NTP’s current management performance, agree upon ways to improve that performance, and plan activities toward that end.

MOST FOR TB

Management and organizational sustainability tool for tB 5

OrientatiOn tO the assessMent instruMent

The MOST for TB assessment instrument defines critical areas of management: mission, values, strategy, structure, systems, and other program components. These management areas are explained below.

Mission. A NTP’s mission is its purpose, the reason it exists. The mission provides guidance, con-sistency, and meaning to decisions and activities at all levels. It is the focal point around which staff members define strategies, establish goals, move in a common direction, and focus on what they know and do best. It also motivates them to stretch their capacity and take on new challenges. For the NTP, it answers the question: Why do we do what we do? MOST for TB can help an NTP assess its mission statement, if one exists, and then plan any changes needed to generate a mission that is relevant, widely known, and used.

Values. An NTP’s values are the beliefs and ethical principles that underlie its mission. These values give meaning to the NTP’s work and form the basis for staff commitment. They act as a beacon to guide strategies and shape the ways in which the managers and staff work together toward the mission. They answer the question: What are the core beliefs and principles that the NTP staff all share and that give direction to our work? Through MOST for TB, an NTP can assess its core values, and then make a plan for clarifying the values, if necessary, and for holding staff accountable for adhering to them.

Strategy. An NTP’s strategies are the broad approaches used to define the objectives and activities that will fulfill the NTP’s mission and goals. For the NTP, its strategies answer the question: How will we get to where we want to go? After assessing its current strategies through the MOST for TB workshop, an NTP can plan any changes needed to make its strategies consistent with its mission, responsive to the needs of the TB patients and communities, and able to meet the potential demands of the society, communities, and TB patients it should serve.

Structure. Structure refers to how the NTP is legally defined or organized in a country. The func-tional structure encompasses the formal lines of authority, distribution of responsibilities, and ways in which significant decisions are made and people held accountable for carrying out those deci-sions. Structure answers the question: Is the NTP organized in a way that facilitates what it wants to do and where it wants to go? An NTP can use MOST for TB to assess its functional structure and to plan ways to make the structure strong enough to fulfill the mission and carry out strategies, yet flexible enough to foster decision-making and accountability at all levels.

Systems. Systems are the interdependent functions that allow an NTP to do its work. MOST for TB addresses systems that form the key elements of management, which are listed on the next page. Organizational systems answer the question: What helps us carry out our activities? The MOST for TB process can help an NTP assess these systems, and plan and carry out the high-priority changes needed for increased efficiency and greater effectiveness.

Other Program Components. There are several other program components that are very important in an NTP. MOST for TB also assesses an NTP’s progress with respect to research for TB control; Advocacy, Communication, and Social Mobilization (ACSM); the community participation plan for TB control; and pharmacovigilance for TB medicines.

MOST FOR TB

Management and organizational sustainability tool for tB6

The MOST for TB instrument divides each of these management areas into a total of 30 separate, measurable components, as listed below.

Management components assessed by the MOst for tb instrument

MissionExistence and knowledge

ValuesExistence and application

strategyLinks to mission and valuesLinks to stop tB strategy Links to HIV & AIDs control programLinks to tB patients and community

structureInstitutionalizationLines of authority and accountability CommunicationRoles and responsibilitiesDecision-making

systemsstrategic planning Annual operational planningnorms and procedures for tB prevention, detection, diagnosis, treatment, and careGeographical and population coverage of DotsHuman resources managementLeadership developmentstaff trainingInformation management: operational and epidemiological data collectionInformation management: Use of operational and epidemiological informationMonitoring and evaluationsupervisionsupply managementFinancial managementResource mobilizationQuality assurance: norms and procedures for tB labs

Other Program componentsResearch for tB controlAdvocacy, Communication, and social Mobilization (ACsM)Community participation plan for tB controlpharmacovigilance for tB medicines

MOST FOR TB

Management and organizational sustainability tool for tB 7

the MOst fOr tb PrOcess

The central component of the MOST for TB process is a facilitated workshop lasting three days. The workshop brings together a range of people who hold management responsibilities in all parts of the NTP—the director and the technical NTP teams, which include physicians, nurses, lab techni-cians, and other health personnel at the central, intermediate, and local levels. Other stakeholders whose work is affected by, or has an effect on, day-to-day management of the NTP may also be included. This group creates a collective perspective based on their individual experiences. Their perspective guides the development of a plan to improve priority aspects of the NTP’s management.

During the workshop, participants express their individual perceptions of current management performance, share these perceptions with one another, and reach consensus on changes that will improve performance. They establish priorities and develop an action plan that specifies objectives and activities for making these changes. And, to make sure that the plan is carried out, they choose the people who will be responsible for implementing the plan.

Facilitation of the MOST for TB workshop is complex and demanding: it requires carefully observing and synthesizing often-heated discussions; serving as a resource to individuals and small groups throughout the workshop; and providing rapid, accurate documentation for participants to use as they move from module to module. Past experience with MOST has clearly shown the advan-tages of having two facilitators who are accustomed to working together as a team, complementing each other’s skills, confirming each other’s observations, and sharing the multiple simultaneous requirements of a successful workshop. Even a co-facilitator who is somewhat less experienced can provide a different set of eyes and ears, help individuals and small groups complete their assign-ments, and aid in synthesis and documentation.

Phases Of the MOst fOr tb PrOcess

Although the workshop is the main activity, the MOST for TB process begins before it and extends beyond, through four phases: engagement, preparation, the MOST for TB workshop, and follow-up. The table that follows summarizes the activities that take place during each phase.

MOST FOR TB

Management and organizational sustainability tool for tB8

Phases Of the MOst fOr tb PrOcess

Phase key activities

engagement Directors at the MoH and ntp review the Most for tB process to deter-■■

mine if Most for tB is appropriate for the MoH and ntp at this time.

the ntp director negotiates an agreement with the facilitators, who will ■■

provide technical assistance during all phases of the process (preparation, workshop, and follow-up).

the ntp director identifies a change leader: a staff member who will cham-■■

pion the changes that emerge from the workshop.

Preparation the ntp director identifies the workshop participants. ■■

the facilitators conduct interviews and/or written surveys of workshop ■■

participants.

Workshop the three-day Most for tB workshop serves to:

Assess management status: Where are we now?■■

set objectives: Where do we want to go?■■

Initiate change: How will we manage the needed changes?■■

Develop an action plan: How will we reach our objectives? ■■

follow-up post-workshop follow-up may include:

the facilitators submit a written report of the workshop.■■

the ntp director and facilitators negotiate an agreement for any additional ■■

follow-up activities.

the ntp director and change team inform the entire staff and engage them ■■

in the Most for tB plans for change.

the ntp director and staff integrate the Most for tB action plan into ■■

annual operational plans.

the change leader and change team guide the implementation of the ■■

action plan.

the change leader and change team monitor the implementation of the ■■

plan and revise it as needed.

the ntp holds a follow-up Most for tB review at an identified time (usually ■■

six months or one year later).

MOST FOR TB

Management and organizational sustainability tool for tB 9

II. MOST fOR TB AND THE CHANGE PROCESSA successful MOST for TB process results in change. Any significant change presents major chal-lenges to an NTP’s leadership and to the entire staff. Before committing to MOST for TB, the NTP director and other decision-makers of the MOH should be aware that:

MOST for TB is one step in an ongoing change process;■■

to improve performance, an NTP must make changes that may cause discomfort among staff ■■

and other stakeholders;

strong leadership will be needed to initiate and sustain these changes;■■

an NTP will have to draw on management practices that are working well if it is to improve the ■■

management practices that are less effective;

it will take time for an NTP to see the effects of MOST for TB on the program’s work, and, ulti-■■

mately, on its services and sustainability.

This section of the guide explains the principles of change underlying the MOST for TB process and details the role of the change leader and change team in implementing MOST for TB. It also describes how MOST for TB fits an existing leadership and management model for improving health outcomes.

PrinciPles Of change

Change can, of course, be imposed from the top of an NTP or MOH, with little or no staff input. But when introduced in this way, any significant change is likely to lead to some combination of reluctant acceptance and resistance among valuable health personnel.

The MOST for TB change process comes from within the NTP, the result of an open exchange of views and a successful struggle to reach consensus. MOST for TB embodies four well-established principles of managing organizational change:

The change process must meet real organizational challenges. Change for its own sake is likely to be strongly resisted. Staff will generally support change when they perceive it as essential for resolving issues that affect the NTP’s ability to live up to its mission. The MOST for TB process applies this principle by using the NTP’s own staff, rather than outsiders, to identify the areas for change. MOST for TB also requires the NTP’s director, along with a change leader and change team, to clarify for all staff the priority management issues, the rationale for changes, and the details of implementation that result from the MOST for TB process.

The change process must be “owned” and guided by key stakeholders. Stakeholders encompass those who are responsible for making decisions about changes and those who will carry out those decisions in the MOH and NTP. For them to become supporters and effective imple-menters of change, these individuals must accept the proposed changes fully and see themselves as integral to the success of the process. In the MOST for TB process, this group is likely to include staff who have management responsibilities and take part in the workshop. These staff members “own” the change process fully, because it is they who conduct the management assessment, identify the changes to be made, and develop the plans, with the full support of the NTP’s director. After the workshop, they will help mobilize their colleagues at all levels of the NTP to understand, support, and implement the changes.

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Management and organizational sustainability tool for tB10

Short-term results can be milestones on the way to broader, more substantive changes. Sometimes, NTPs set goals or objectives for change that are so ambitious that the staff perceive them to be unreachable. It is useful to break large goals or objectives into smaller segments and measure progress step-by-step along the way. MOST for TB is designed to foster smaller, feasible changes that will move an NTP toward a higher stage of development.

The change process must be supported by staff with clear roles and accountability. An NTP cannot make and sustain significant changes with casual, ad hoc oversight. To keep the change process on track and monitor progress, it is critical to assign responsibility, on a long-term basis, to one or more people whose performance will be judged, in part, by how successfully they guide the change process. The MOST for TB action plan is overseen and monitored by an assigned change leader and change team, whose authority comes from the NTP director.

One session of the MOST for TB workshop is specifically designed to prepare the NTP for the antici-pated changes. However, principles of change underlie the entire MOST for TB process. A successful MOST for TB experience will bring about changes that begin during the workshop itself and con-tinue long afterward.

tb change leader and tb change teaM

All too often, participants leave workshops agreeing on important management changes, but the changes do not actually take place. The spirit generated by a one-time event can evaporate as par-ticipants return to their “real” work, and the proposed changes become a distant memory.

MOST for TB, however, emphasizes the importance of follow-up. Before the final phase of the MOST for TB process, individuals are assigned responsibilities and made accountable for imple-menting the MOST for TB action plan.

Staff members who have participated in the workshop and fully understand the issues and plans take direct responsibility for leading the implementation of the action plan. Although every partic-ipant is expected to help implement the changes agreed upon during the MOST for TB workshop, the ultimate responsibility rests with a smaller group: the TB change leader and TB change team. The TB change leader has the authority to make decisions regarding the action plan, and he or she will be held accountable for the plan’s implementation. An effective TB change leader and TB change team will contribute significantly to visible improvements in the NTP. The accountability and support of the NTP director, however, are the key factors in the success of this process.

The TB change leader may be selected in one of several ways. In most instances, the NTP director identifies this person before the workshop. Occasionally, the director prefers to delay this decision—to have the facilitators clarify the qualifications for the role during the workshop and let participants choose the leader. The members of the TB change team are most often chosen by participants during Module 4 of the workshop, when action plans are developed. However the TB change leader and team are selected, it is imperative that the director and senior managers whole-heartedly approve the choice and offer full moral and material support. This support may include shifting some of the TB change team’s previous duties to other staff, so that members will have time to carry out their new responsibilities.

Sometimes the NTP director assumes the role of TB change leader; however, the participants of the workshop must agree to this arrangement to ensure the success of the process.

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Management and organizational sustainability tool for tB 11

Qualities of the tb change leader

the tB change leader is an individual who has:

accountability for this role;■■

the confidence and recognition of the ntp director, senior managers, and most staff ■■

members;

proven ability to lead a team toward shared goals;■■

a belief in the need for changes in ntp management practices;■■

a demonstrated commitment to the participatory nature of the Most for tB process;■■

enthusiasm about taking on the task, with full awareness of its challenges.■■

leading and Managing fOr OrganizatiOnal change

Making organizational change requires committed leaders and managers. Experience shows that NTPs that have effective leaders and managers are able to improve management practices, create a positive work climate, and respond to changing environments in the MOH. These organizational changes contribute to improving the services provided and increasing the ultimate impact of the program’s work. The model below shows the relationship of these elements in the context of an NTP. It illustrates that an NTP’s leadership and management are equally important in achieving its desired results.

managing

improvedwork

climate

improvedmanagement

systems

improvedservices

improvedhealthoutcomes

scan

focus

align/mobilize

inspire

plan

organize

implement

monitor andevaluate

Results

Leading and managing practices

leading

improvedcapacity

to respondto change

From Managers Who Lead:A Handbook for Improving Health Services

Management Sciences for Health

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Management and organizational sustainability tool for tB12

The environment in which health organizations, including NTPs, work today has become increas-ingly complex. For example, in many countries decentralization and health reform have placed greater responsibility on local programs to set challenging objectives and achieve measurable results. To meet these challenges, managers at all levels must recognize how good leadership and management practices can make a difference and must be able to carry out these practices. By putting these practices into action, the NTP will be better able to meet the needs and requirements of TB patients, the communities, and the MOH and will foster a better work climate and, ultimately, will improve its sustainability. With its participatory focus, the MOST for TB process provides an opportunity for an NTP’s staff as well as senior managers to identify and plan management improvements while building their teamwork and leadership skills. These improvements will help the MOH contribute significantly to the improved health outcomes of the population it serves.

Sound leadership and management practices are outlined below and put in the context of the MOST for TB process. A complete description of leading and managing practices is provided in the “Leading and Managing Framework,” on page 83.

leadership Practices

Scanning. Good leaders keep alert to and continually examine the environment, the program, the NTP’s stakeholders, and themselves to identify values, strengths, and weaknesses.

In the MOST for TB process, the NTP director begins by scanning the NTP to identify the need for change. The workshop participants then scan the NTP in relation to its mission, values, and the outside world to identify issues and challenges. After the workshop, they will continually scan for evidence of the effects of the management changes that have been implemented.

Focusing. Strong leaders keep themselves and their colleagues focused on the NTP’s mission, strat-egies, priorities, and challenges.

The MOST for TB process requires the NTP director and workshop participants to identify the man-agement components that are most critical to strengthening the NTP’s performance and achieve-ments. During the workshop, they set priorities and develop objectives that will have to be met and reviewed before lower-priority areas can be addressed. Afterward, they will maintain the focus on the identified management priorities as they return to their day-to-day responsibilities.

Aligning and mobilizing. Good leaders make sure that all staff work together to carry out activ-ities that are in line with the NTP’s mission, values, strategy, and resources.

The NTP director gains support from staff for the MOST for TB process and mobilizes staff to par-ticipate fully and creatively in the MOST for TB workshop. During the workshop, participants align and mobilize themselves around an action plan, specifying the resources needed to bring about the desired changes. Afterward, they will take the lead in aligning and mobilizing their NTP colleagues to carry out the MOST for TB activities; incorporating the MOST for TB action plan into the NTP’s annual plan; and moving the plan forward.

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Management and organizational sustainability tool for tB 13

Inspiring. Strong leaders motivate, challenge, and support staff creativity, innovation, and learning.

The success of the MOST for TB workshop depends on the participants’ demonstration of the integrity, trust, and creativity that can inspire them, as a group and individually, to commit them-selves to the agreed-upon changes. When they return to their day-to-day responsibilities, they will join the NTP director in inspiring their colleagues throughout the MOH and NTP, conveying their enthusiasm and building an NTP-wide commitment to change.

Management Practices

Planning. Good managers define short- and long-term results targets and allocate resources accordingly.

During the MOST for TB workshop, participants engage in an intensive exercise to plan for the desired improvements. Afterward, they will use their planning skills to integrate their action plan into the NTP’s annual and long-term plans.

Organizing. Good managers establish functional structures, systems, and work processes to support efficient operations and ensure accountability.

During the MOST for TB workshop, participants have to organize for change, selecting the TB change leaders who will oversee the action plan and specifying the time, money, and other material resources needed. After the workshop, the change leaders will organize the activities needed to implement the plan.

Implementing. Good managers integrate systems, coordinate work flow, and adjust plans as cir-cumstances change.

After the MOST for TB workshop, the participants, change leader, and change team will oversee the implementation of the management changes throughout the NTP.

Monitoring and evaluating. Good managers check for and reflect on progress and results, and use findings to provide feedback and make needed changes.

During the MOST for TB workshop, participants build into the action plan the activities needed to monitor and evaluate the progress and results of implementing the plan. After the workshop, the change leaders and designated staff will monitor these activities and share the results with the MOH’s and NTP’s decision-makers.

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Management and organizational sustainability tool for tB14

III. ROLES Of THE STAKEHOLDERSThe MOST for TB process depends on the active participation of the identified stakeholders. These stakeholders include the NTP’s leadership—the director and senior managers from the national, regional, and selected local levels)—as well as stakeholders from other entities with which the NTP is affiliated. For example, the NTP might invite members of private health services, scientific soci-eties (physicians, nurses, and others), universities, and nonprofit organizations to take part in some aspects of the process. An NTP might also involve representatives from the next-higher level of the MOH or from other MOH units with which the NTP works closely (e.g., representatives from the HIV & AIDS program, immunization program, or leprosy program).

the three types of stakeholders

the Most for tB process includes responsibilities for three types of stakeholders:

the ntp’s leadership;■■

the workshop participants;■■

the facilitators.■■

For each type of stakeholder, the guide summarizes the role before, during, and after the workshop.

rOle Of the ntP’s leaders

At the heart of the MOST for TB process is the full commitment of the NTP’s director and senior managers. No matter how productive the workshop or how much thought the participants put into the action plan, meaningful changes will not happen without the genuine, ongoing support of the NTP’s leaders.

before the Workshop

Understand MOST for TB. To decide whether the NTP will benefit from MOST for TB at this time, the NTP director and senior managers should familiarize themselves with the elements of the MOST for TB process. This will help them grasp what MOST for TB can and cannot do for the NTP, what must happen if MOST for TB is to succeed, what resources will be required, and what roles the director and senior managers will play in a highly participatory series of events.

Managers can acquire this information by reading “Making the MOST of Management,” on page 48. They may also want to talk with leaders of organizations and NTPs that have undertaken MOST or MOST for TB and consultants who have facilitated the MOST or MOST for TB process. MSH can put NTP directors and managers in touch with these resources and also answer their questions about MOST for TB.

Make the decision. Once they are convinced that they understand MOST for TB, the NTP’s director and senior managers will be better equipped to make a sound decision about whether the NTP should undertake the MOST for TB process. They should carefully consider whether man-

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Management and organizational sustainability tool for tB 15

agement changes could significantly improve the NTP’s performance and have a positive effect on its services and sustainability.

Choose the facilitators and identify a staff counterpart. After deciding to embark on the MOST for TB process, the NTP’s leadership should look for facilitators who combine MOST for TB expe-rience with a style and approach that best fit the NTP. Most NTP directors prefer to use external facilitators, rather than staff members, to guide the process, recognizing that observant, sensitive outsiders are better able to maintain objectivity and gain the trust of all participants. In addition to the facilitation team, the director should assign a counterpart from within the NTP to serve as a resource to the facilitators for logistics before and during the workshop.

Work with the facilitators. After negotiating and signing an agreement, the NTP’s director and senior managers should collaborate with the facilitators in selecting 12 to 25 staff members to participate in the MOST for TB workshop. They may choose a change leader at this time, or they may prefer to wait and let the change leader emerge from the workshop. Finally, they should set the stage for a successful MOST for TB experience by freely sharing their perspectives and concerns in at least one interview, responding to questions from the facilitators and offering any additional information that might help the facilitators understand the NTP.

Inform the staff. The NTP director should inform the entire staff of what is about to take place and how it will benefit the NTP. Those staff who have been selected to participate in the MOST for TB workshop will need additional details about their responsibilities during and after the workshop. The facilitators can provide explanatory handouts for workshop participants and non-participants alike.

during the Workshop

Participate fully and openly. The NTP’s director and senior managers should be present and involved throughout the workshop. They should view themselves as colleagues rather than bosses, learners rather than teachers. They must express their full commitment to openness and demon-strate this commitment by listening carefully and responding without defensiveness, no matter what opinions the other participants express. By showing their responsiveness, the leaders will help ease participants’ fears about admitting their own failings or voicing criticisms.

after the Workshop

Provide ongoing support. The NTP’s director and senior managers will need to provide moral and material support to the change leader and change team. During all phases of the MOST for TB process, it is the NTP’s leaders who can best encourage the staff to use their imagination and deter-mination to identify creative improvements and find ways to overcome obstacles.

Provide follow-up. In the follow-up phase, the NTP director will need to support the TB change leader in carrying out another MOST for TB exercise in six months or one year to review progress and plan for further management improvements. In the interim, the director should stay abreast of progress and be available to assist the change leader whenever necessary.

rOle Of the ParticiPants

Although the contributions of the facilitators are invaluable, it is the participants (including the NTP director) who do the greatest part of the work during the workshop and who oversee the

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Management and organizational sustainability tool for tB16

change process afterward. This is one of the features that distinguish MOST for TB from other kinds of assessment and planning processes—even those in which the opinions of staff and other stake-holders are solicited by skillful external evaluators.

before the Workshop

Understand the MOST for TB process. To be fully invested in MOST for TB, participants should understand the purpose and anticipated results of the workshop, the desired outcomes for each module, and the activities they will undertake to achieve those outcomes. They should review this information ( from handouts given to them by the facilitators) ahead of time, asking questions and expressing any concerns to the NTP’s leadership and the facilitators.

Provide information to the facilitators. Whenever possible, the MOST for TB facilitators should interview each proposed workshop participant, either individually or in small groups. When inter-views are not feasible, or when the facilitators wish to acquire supplementary information, partici-pants may be asked to complete a written questionnaire. Whatever the format, participants can make powerful contributions by providing honest, thoughtful responses to the questions asked.

during the Workshop

Participate fully and openly. The MOST for TB workshop draws on the individual insights of the participants. It compels them to record their assessments carefully, listen closely to one another, consider the merits of differing viewpoints, and reach common ground on the basis of evidence that they can all accept. It may require them to take risks: to speak openly in front of superiors, to acknowledge weaknesses in past performance, or to accept new responsibilities for managing some aspects of future change. The foundation of the workshop—indeed of the entire MOST for TB process—is the energy, creativity, openness, courage, and mutual respect of the workshop participants.

after the Workshop

Be leaders in implementing the changes. When the workshop is over, the participants will play various roles in implementing the action plan. Some of them will be members of the change team, but even those who are not will need to serve as change agents. They will be expected to take on the functions of NTP leadership by:

scanning for progress resulting from the planned changes, as well as scanning the reactions of ■■

their colleagues at all levels as changes are introduced;

focusing the NTP on the agreed-upon changes;■■

aligning and mobilizing their colleagues around the changes;■■

inspiring their colleagues through their own enthusiastic commitment and hard work.■■

rOle Of the facilitatOrs

At first glance, the MOST for TB process seems simple. The instrument is easy to use, and the imple-mentation modules and forms follow a logical sequence. Nonetheless, a skillful and perceptive facilitation team can make all the difference between a superficial MOST for TB experience and one that motivates the NTP to achieve higher levels of performance and improved services.

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Management and organizational sustainability tool for tB 17

The facilitators should carry out the following activities to set the process in motion and see it through to a successful conclusion. They may do some of these tasks together and divide others between them.

before the Workshop

Get to know MOST for TB. The first task of the facilitators is to be thoroughly familiar with every aspect of MOST for TB. They should thoroughly and carefully read the guide to be sure that they understand and are comfortable with the MOST for TB principles and process, as well as with their own roles and the roles of the NTP leadership, workshop participants, TB change leader, and TB change team. Only in this way will the facilitators be able to orient the NTP’s director and senior managers and answer the many questions that can arise.

Get to know the MOH and NTP. The facilitators also need to find out everything possible about the MOH and NTP: purpose, history, culture, achievements, and concerns. This preliminary explo-ration can be made by reading such documents as legislation, technical (norms, procedures, and others) and financial reports, evaluations, studies, and MOH/NTP publications. The facilitators will use this information not only to provide a context for their work but also to help the workshop participants identify underlying issues, address the contributing causes, and build on the NTP’s strengths.

Orient and learn from the NTP’s leadership. A director who is uncertain about committing an NTP to the MOST for TB process may seek help in making the decision. The facilitators should make sure that the director reads “Making the MOST of Management” handout, on page 48. The facilitators should then arrange one or more meetings with the MOH authorities, the NTP’s director, and selected senior managers to further clarify the MOST for TB process and differentiate it from other assessments the NTP may have undergone in the past. These meetings should help answer questions and shed light on any areas of confusion. At the same time, the meetings should also generate critical information for the facilitators. By asking perceptive questions, listening care-fully, and observing attentively, the facilitators will be able to judge whether the NTP is ready to undertake MOST for TB.

If the MOH authorities, the NTP’s director, and its senior managers decide to embark on the MOST for TB process, they should read the first three sections of this guide to confirm their understanding. At this point, the facilitators can negotiate and sign the agreement with the NTP and MOH.

Orient workshop participants. Even when the NTP’s leadership understands MOST for TB and is committed to undertaking the process, the potential participants in the workshop may not be quite so certain. They may have a skeptical view of MOST for TB as one more event in a series of assessments and plans that have added to their work and made little difference to the NTP. The facilitators, supported by the NTP director, can differentiate the MOST for TB process from these prior efforts. The facilitators should provide the proposed participants with the “Making the MOST of Management” handout (page 48).

Learn from workshop participants. The facilitators should make every effort to interview each proposed participant. Face-to-face interviews will allow the participants to air their doubts and concerns while giving the facilitators important insights into the NTP’s culture and work climate. As with the NTP’s leadership, it is critical that the facilitators be nonjudgmental, encourage frankness, and assure participants of confidentiality. Such discussions will yield important information and establish an atmosphere of trust. If interviews are not feasible, the facilitators can develop a written

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Management and organizational sustainability tool for tB18

questionnaire to glean the same types of information. In some instances, the facilitators may choose to administer the written questionnaire ahead of time and supplement it later with the interviews. Suggested questions are found in the Facilitators’ Plan section of this guide, on page 23.

Make the arrangements. The facilitators should work with a designated NTP staff counterpart to be sure that all preparations are made in advance of the workshop, including arranging for the meeting rooms, supplies ( flip-chart paper and easels, markers, overhead projector, computer, printer, photocopier, etc.), and possibly, meals and transportation. The facilitators and NTP staff counterpart can prepare workshop binders for the participants by copying the workshop materials beginning on page 47 and adding any supplementary documents they think the participants will find useful—perhaps selected reprints from the facilitators’ own store of materials. This is a good time to prepare ahead, producing flip charts, overhead transparencies, or slides to support the various workshop modules, as suggested in the Facilitators’ Plan in this guide.

during the Workshop

Explain the assessment process. The facilitators should explain clearly how to complete the MOST for TB assessment instrument and what constitutes convincing evidence for a specific assessment. This task is of critical importance, because the quality of the assessments completed by the individual participants will affect subsequent discussions and planning. To be able to fulfill this task, the facilitators should be completely familiar and comfortable with the MOST for TB Assessment Instrument, beginning on page 53.

Encourage full participation. Perhaps the most important task of the facilitators is to make sure that all voices are heard, without giving undue weight to participants who hold a higher position in the NTP or who are inclined to be more assertive than others. The workshop structure itself fosters universal participation by requiring everyone to form an opinion independently and to share that opinion with a small group. To reinforce this emphasis on participation, the facilitators should point out at the start of the workshop that everyone’s viewpoint is equally valid and that all perspectives must be heard to achieve genuine consensus. The facilitators can help small groups monitor themselves, encouraging the quieter members and reminding more talkative members of their responsibility to listen attentively to their colleagues. The facilitators may need to periodically remind the group of these participation guidelines, or even step in directly if some voices begin to dominate as the discussion intensifies.

Manage time, balancing flow and flexibility. Because different groups work at different speeds, the facilitators should be sensitive to how each small group and individual participant is func-tioning, and should lend support to move a group along when necessary. The facilitators will need to recognize and deal with the stumbling blocks that can distract the participants and divert their energy into unproductive discussions. It is very useful to check in with the participants at the end of each day, or more often if needed, to hear how they are feeling about the pace and to make minor adjustments to the schedule if needed.

Each activity in the MOST for TB workshop builds on the output of the previous activities. Thus, the action plan is the cumulative result of all the work that has gone before it. It is the responsibility of the facilitators to maintain the logical flow of the process, so that participants can use the results of each activity as the context for the next, building momentum toward the final action plan.

Synthesize. At several points in the workshop, the facilitators will need to help the participants pull together the different threads of a discussion into a set of shared perceptions. This ability to synthesize will help the group retain its focus and move forward.

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Management and organizational sustainability tool for tB 19

Resolve conflicts. The MOST for TB process often releases strong emotions and brings to light long-standing areas of disagreement that cannot be ignored. This airing of hidden grievances is valuable as a means of removing obstacles that stand in the way of management improvement. At the same time, these discussions cannot be allowed to derail the MOST for TB process. It is critical, therefore, that facilitators maintain the stance of objective outsiders and intervene when necessary, helping the participants to either resolve or postpone the resolution of some issues.

Therefore, facilitators must balance forward momentum against the occasional need to address issues that arise unexpectedly in the course of small-group or plenary discussions. Participants may have underlying concerns that, if ignored, could severely impede the implementation of the action plan. One approach is for these concerns to be written on a flip-chart page or “parking lot,” which remains posted throughout the workshop and is used to list important issues that will need to be addressed in the future. Sometimes, however, the workshop agenda must be diverted for a short time to untie the knots, cutting short some other activity or extending an already-long day. A skilled facilitator can define the dilemma for the group, clarify the consequences of ignoring or addressing the issue, and guide the group in making the most appropriate judgment within the time available.

Identify or confirm the TB change leader and TB change team. No MOST for TB workshop should end without the clear assignment of responsibility to a TB change leader and TB change team. These people should be enthusiastic supporters of the change process. They must have the full support of the NTP director and other MOH decision-makers, including the time and resources needed to carry out the activities in the action plan. The NTP director may have already appointed the TB change leader before the workshop; in that case, the facilitators can make time for the NTP director to announce this decision. If the TB change leader has not already been appointed, the facilitators should guide the group in choosing someone who fits the qualifications noted in the box on page 11. That person should be willing—even eager—to take on the assignment.

The facilitators should also help participants identify the members of the TB change team. The core of the team will be the individuals who have agreed to be responsible for key activities in the action plan. This core may be supplemented by other NTP staff members with specific skills that will be important in carrying out the action plan.

Empower the participants. One of the biggest challenges for the facilitators may be to dispel the sense of futility that some MOST for TB groups feel when they are a small part of a large, powerful organization—for example, the MOH. The facilitators will need to acknowledge that some changes will require higher-level interventions, but this reality should not dilute the considerable power that the group possesses to make some important changes. The facilitators should be prepared to cite examples of groups that have made realistic and substantive management improvements despite the constraints imposed by the laws, policies, and regulations of their larger organizational structure.

Document the decisions made. It is the responsibility of the facilitators to be sure that all points that are agreed upon are recorded. In most instances, the decisions will be documented by the workshop participants themselves, on flip-chart pages hung around the room. However, it is crucial that all decisions be entered on a computer and given to the participants as documents to verify the content and use as they move forward. During the final module, while the action plan is being developed, small groups will be working on previous group outputs, revising them, receiving feedback, and finalizing them on the same day. It will be important at the end of the day for one of the facilitators to enter the changes, print the final documents, and distribute copies to all the participants.

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Management and organizational sustainability tool for tB20

after the Workshop

Conduct follow-up activities. Even the most highly motivated TB change leaders can find them-selves overwhelmed with day-to-day pressures and lose the momentum for change. The facili-tators can help them maintain momentum and move the NTP toward achieving its objectives to improve management practices by providing support at critical junctures. Responsibilities after the workshop might include:

writing and submitting a workshop report that is complete, clear, and specific enough for the ■■

NTP director and MOH authorities, TB change leader, and TB change team to present the re-sults of the MOST for TB workshop to the rest of the NTP and to guide their next steps;

maintaining monthly contact (by phone or e-mail) and/or scheduling occasional meetings ■■

with the NTP director and TB change team to track the progress and results of the changes being implemented;

providing facilitation for in-depth assessments of management components the NTP has ■■

selected for more intensive work;

providing other kinds of technical assistance as requested, or suggesting other sources of tech-■■

nical assistance;

conducting a follow-up MOST for TB exercise or workshop to review progress and tackle ■■

additional management challenges.

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Management and organizational sustainability tool for tB 21

IV. USING THE MOST fOR TB ASSESSMENT INSTRUMENTThis section provides an example of the MOST for TB Assessment Instrument, which serves as the basis for the MOST for TB workshop. The instrument is a matrix used to assess 30 management components related to an NTP’s mission, values, strategy, structure, and systems. For each com-ponent, the instrument presents four possible stages of development, each of which is defined by a set of characteristics.

stages Of ManageMent deVelOPMent

As NTPs grow, strengthen, and mature, they evolve through a continuum of stages of development. The MOST for TB instrument describes the characteristics of management components at each of four stages of development. By comparing the NTP’s management performance to the character-istics that mark the stages, workshop participants can decide for themselves what stage the NTP has reached for each management component.

using the Management characteristics to assess stages of development

participants in the Most for tB workshop do not attempt to characterize the ntp’s overall stage of development. Rather, they identify the stage of development for each management component.

to be rated at a particular stage of development for a management component, the ntp must match all the characteristics of that stage—it cannot be rated at an in-between stage, such as “2.5.”

Each stage of development includes and builds on the characteristics of the previous stage. At the first stage, the characteristics describe an NTP that has done very little to develop that component. At the other end of the spectrum, the fourth stage, the characteristics portray an NTP that is oper-ating extremely effectively with regard to that component. In such a case, the NTP might consider directing its energies to components that are at lower stages of development.

It is important to note that different NTPs pass through these stages at different rates, even if the NTPs were founded at the same time. Even within one NTP, different management components may be at different stages of development at the same time. Discrepancies among NTPs and within an NTP—for example, rating a “3” on the links of the strategy to the mission but a “1” on the links of the strategy to TB patients and community—might be the result of a combination of factors: the focus of the NTP’s leaders, the mandates of the MOH, the comparative strengths of staff members, and the demands of the external environment.

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Management and organizational sustainability tool for tB22

PrOViding eVidence

Because workshop participants come from many parts of the MOH and NTP, they often differ in their perceptions of whether a component fits all the characteristics of a particular stage. To help resolve differing views, the instrument provides a space for the participants to individually record evidence: a brief description of an event or situation that they have seen, heard about, or experi-enced that supports them in rating the component at the stage they have selected. Later, in hetero-geneous small groups, participants will share their evidence and take into account their different perspectives as they seek to reach consensus on the stage of development of each component.

What constitutes evidence?

Many types of evidence—not simply quantitative data—may support participants’ assess-ments. Most for tB defines evidence as a fact or concrete observation that supports the iden-tified stage of development. Convincing evidence answers the question: What can we see or hear, or what do we know, that tells us that something is true?

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Management and organizational sustainability tool for tB 23

V. fACILITATORS’ PLANThis section of the guide provides a suggested plan for implementing the entire MOST for TB process. This plan is a synthesis of the experience of previous MOST facilitators—it is meant to be a guide rather than a rigid prescription.

This plan is very detailed. You should read the previous sections of the MOST for TB guide first, to obtain an overview of the process and your responsibilities. When you have a solid understanding of the purpose and process of MOST for TB, you can turn to this Facilitators’ Plan to fill in the details. You can decide with your co-facilitator how to divide responsibilities throughout the process.

The Facilitators’ Plan is organized according to the four phases of the MOST for TB process:

Phase 1:■■ Engagement of the NTP’s Leaders. During this phase, you will get to know the NTP, be sure that the NTP director fully understands MOST for TB and is prepared to undertake the process, and negotiate an agreement on the scope of work.

Phase 2:■■ Preparation for the Workshop. This phase involves interviewing potential work-shop participants and making all arrangements for the workshop.

Phase 3:■■ Workshop Plan. The workshop lasts three days. The first day includes the opening session and Module 1: Where Are We Now? The second day covers Module 2: Where Are We Headed? and Module 3: How Will We Manage the Needed Changes? The third day is devoted to Module 4: How Will We Reach Our Objectives? The proposed time frames for each module are found in the Workshop Agenda, on page 29.

Phase 4:■■ Follow-Up Activities. Follow-up should be provided over a six-month to one-year period. Follow-up includes regular contact by telephone or e-mail, and possibly another MOST for TB workshop toward the end of the period to review progress and plan for future manage-ment improvements.

For each phase, the plan identifies the objectives, describes the activities in detail, explains your role in each activity, and lists the resources you will need to prepare. (Some of the resources appear in this guide, but you will need to obtain or produce others yourself.) In addition, based on the experiences of the Most for TB facilitators, the plan includes “tips,” points to keep in mind that can enhance an activity.

Management and organizational sustainability tool for tB24

Pha

se 1

: en

ga

geM

ent

Of

the

ntP

’s l

ead

ers

Ob

ject

ives

Beco

me

fam

iliar

with

the

NTP

by

revi

ewin

g do

cum

ents

and

mee

ting

with

the

NTP

’s le

ader

ship

.■

■

Con

firm

with

the

NTP

’s le

ader

ship

that

MO

ST fo

r TB

is a

ppro

pria

te fo

r the

NTP

at t

his

time.

■■

If M

OST

for T

B is

app

ropr

iate

, fina

lize

nego

tiat

ions

and

reac

h ag

reem

ent o

n th

e sc

ope

of w

ork.

■■

Pha

se 1

: en

ga

geM

ent

Of

the

ntP

’s l

ead

ers

act

ivit

yfa

cilit

ator

s’ r

ole

res

ourc

es r

equi

red

kee

p in

Min

d .

. .

prep

arat

ion

for

the

first

m

eetin

g w

ith t

he n

tp’s

le

ader

ship

Beco

me

fam

iliar

with

the

det

ails

of t

he M

ost

for

tB p

roce

ss.

Beco

me

fam

iliar

with

the

ntp

’s m

anda

te, h

isto

ry, c

ultu

re,

achi

evem

ents

, cha

lleng

es, a

nd c

once

rns.

Firs

t th

ree

sect

ions

of t

he

Mo

st fo

r tB

gui

de

Doc

umen

ts a

bout

the

ntp

, su

ch a

s its

mis

sion

sta

te-

men

t, n

tp t

echn

ical

nor

ms

and

proc

edur

es, s

trat

egic

pl

an, a

nnua

l ope

ratio

nal

plan

, ann

ual r

epor

ts, r

epor

ts

to d

onor

s, s

ervi

ce fl

yers

, and

w

ebsi

te in

form

atio

n

Mee

ting

with

the

ntp

di

rect

or (

cont

inue

s on

ne

xt p

age)

Intr

oduc

e th

e M

ost

for

tB p

roce

ss, r

elat

ing

it (w

hen

pos-

sibl

e) t

o w

hat

you

have

lear

ned

abou

t th

e n

tp. H

ighl

ight

the

fo

llow

ing:

the

purp

ose

of t

he M

ost

for

tB p

roce

ss is

to

help

an

ntp

■

■

chan

ge a

nd d

evel

op it

s m

anag

emen

t an

d le

ader

ship

. M

anag

emen

t im

prov

emen

ts c

an le

ad t

o im

prov

ed s

er-

■■

vice

s an

d co

ntrib

ute

to s

usta

inab

ility

. st

rong

lead

ersh

ip w

ill b

e ne

eded

to

initi

ate

and

sust

ain

■■

the

chan

ges

mad

e.

the

Mo

st fo

r tB

pro

cess

is p

art

of a

n on

goin

g co

mm

it-■

■

men

t to

cha

nge.

“Mak

ing

the

Mo

st o

f Man

-ag

emen

t,”

on p

age

48

prov

ide

Mo

st fo

r tB

mat

eria

ls

seve

ral d

ays

ahea

d of

tim

e an

d en

-co

urag

e th

e di

rect

or t

o re

view

the

m

befo

re t

he m

eetin

g.

Management and organizational sustainability tool for tB 25

Mee

ting

with

the

ntp

di

rect

or (

cont

inue

d)C

hang

e be

gins

at

the

top,

as

an n

tp’s

lead

ers

dem

on-

■■

stra

te o

penn

ess

to t

he is

sues

and

idea

s of

sta

ff. t

he le

ad-

ers

are

on a

n eq

ual f

ootin

g w

ith a

ll ot

her

part

icip

ants

in

the

Mo

st fo

r tB

wor

ksho

p.

the

thre

e-da

y w

orks

hop

is t

he fo

cal e

vent

, but

not

the

■

■

final

eve

nt. t

he w

orks

hop

build

s a

colle

ctiv

e pe

rspe

ctiv

e am

ong

staf

f, ge

nera

tes

idea

s, a

nd c

reat

es b

uy-in

for

the

actio

ns s

ugge

sted

. Im

prov

ing

man

agem

ent

prac

tices

will

req

uire

impo

rtan

t ■

■

follo

w-u

p ac

tions

led

by a

cha

nge

lead

er a

nd c

hang

e te

am a

nd s

uppo

rted

with

the

ntp

’s r

esou

rces

. It

will

tak

e tim

e to

see

the

effe

cts

of M

ost

for

tB o

n

■■

the

ntp

’s w

ork

and,

ulti

mat

ely,

on

serv

ices

and

sus

tain

-ab

ility

.

Revi

ew t

he c

riter

ia fo

r un

dert

akin

g M

ost

for

tB, a

ckno

wle

dg-

ing

that

Mo

st fo

r tB

is n

ot a

ppro

pria

te fo

r ev

ery

ntp

. Det

er-

min

e w

ith t

he d

irect

or w

heth

er t

he n

tp m

eets

the

se c

riter

ia

and

is r

eady

for

Mo

st fo

r tB

at

this

tim

e.

Ans

wer

all

ques

tions

fully

and

hon

estly

.

“How

Can

ntp

s Be

nefit

from

M

ost

for

tB?,

” pa

ge 4

If th

e n

tp d

irect

or q

uest

ions

the

ne

ed fo

r m

ore

than

one

faci

litat

or,

you

may

wan

t to

dra

w o

n th

e ex

-pl

anat

ion

foun

d on

pag

e 7

in “

the

Mo

st fo

r tB

pro

cess

.”

not

e: s

ome

dire

ctor

s m

ay c

hoos

e to

invo

lve

a sm

all n

umbe

r of

se-

nior

sta

ff in

thi

s m

eetin

g. If

so,

you

sh

ould

pro

vide

the

m w

ith t

he s

ame

Mo

st fo

r tB

mat

eria

ls.

neg

otia

tion

of t

he a

gree

-m

ent

with

the

ntp

dire

c-to

r or

an

assi

gned

sta

ff co

unte

rpar

t

With

the

ntp

dire

ctor

, det

erm

ine

the

scop

e of

wor

k,

incl

udin

g:

your

leve

l of e

ffort

bef

ore,

dur

ing,

and

aft

er t

he w

orks

hop;

■

■

a de

sign

ated

sta

ff co

unte

rpar

t fr

om t

he n

tp t

o ha

ndle

■

■

logi

stic

s be

fore

and

dur

ing

the

wor

ksho

p;

the

resp

onsi

bilit

ies

of a

ll pa

rtie

s to

the

agr

eem

ent;

■

■

the

antic

ipat

ed r

esul

ts o

f you

r in

terv

entio

ns;

■■

(if p

ossi

ble)

the

sta

ff m

embe

r w

ho w

ill b

e th

e ch

ange

lead

-■

■

er a

nd o

vers

ee t

he im

plem

enta

tion

of t

he a

ctio

n pl

an.

In c

onsi

derin

g w

hat

will

hap

pen

afte

r th

e w

orks

hop,

it is

use

ful t

o pl

an fo

r a

six-

mon

th o

r on

e-ye

ar

follo

w-u

p M

ost

for

tB e

xerc

ise

to

eval

uate

pro

gres

s an

d ac

hiev

emen

ts

to d

ate,

and

to

plan

for

futu

re m

an-

agem

ent

impr

ovem

ents

.

Management and organizational sustainability tool for tB26

Pha

se 2

: Pr

ePa

ra

tiO

n f

Or

th

e W

Or

ksh

OP

Ob

ject

ives

Arr

ange

the

deta

ils o

f the

wor

ksho

p.■

■

Gai

n in

form

atio

n fr

om th

e id

entifi

ed w

orks

hop

part

icip

ants

thro

ugh

inte

rvie

ws

and/

or q

uest

ionn

aire

s.■

■

Use

the

part

icip

ant i

nfor

mat

ion

in p

lann

ing

the

wor

ksho

p.■

■

Pha

se 2

: Pr

ePa

ra

tiO

n f

Or

th

e W

Or

ksh

OP

act

ivit

yfa

cilit

ator

s’ r

ole

res

ourc

es r

equi

red

kee

p in

Min

d .

. .

Furt

her

mee

ting(

s) w

ith

the

ntp

dire

ctor

Con

firm

the

exp

ecta

tions

and

res

pons

ibili

ties

of t

he n

tp d

i-re

ctor

, fac

ilita

tors

, sta

ff co

unte

rpar

t, a

nd p

artic

ipan

ts b

efor

e,

durin

g, a

nd a

fter

the

wor

ksho

p.

With

the

dire

ctor

, cla

rify

how

Mo

st fo

r tB

will

fit

into

the

n

tp’s

ove

rall

plan

ning

pro

cess

and

any

oth

er c

urre

nt im

prov

e-m

ent

initi

ativ

es.

“Rol

es o

f the

sta

keho

lder

s,”

begi

nnin

g on

pag

e 14

Mak

ing

arra

ngem

ents

fo

r th

e w

orks

hop

With

the

ntp

dire

ctor

, rev

iew

the

follo

win

g cr

iteria

to

iden

tify

the

wor

ksho

p pa

rtic

ipan

ts:

Idea

lly, t

here

will

be

12–2

5 pa

rtic

ipan

ts.

■■

ther

e sh

ould

be

a m

ix o

f key

sen

ior

staf

f and

oth

er s

taff

■■

who

hav

e m

anag

emen

t re

spon

sibi

litie

s.

the

part

icip

ants

may

incl

ude

othe

r st

akeh

olde

rs t

he n

tp

■■

dire

ctor

con

side

rs a

ppro

pria

te fo

r m

anag

emen

t di

scus

sion

s (e

.g.,

Mo

H n

atio

nal a

nd r

egio

nal s

taff,

sta

ff of

clo

sely

re-

late

d m

inis

trie

s or

nG

os)

A

ll pa

rtic

ipan

ts m

ust

mak

e a

com

mitm

ent

to b

e pr

esen

t ■

■

and

invo

lved

thr

ough

out

the

wor

ksho

p.

Mee

t w

ith t

he n

tp’s

staf

f cou

nter

part

to

go o

ver

the

arra

nge-

men

ts a

nd lo

gist

ics

he o

r sh

e is

han

dlin

g. A

rran

gem

ents

incl

ude

sche

dulin

g th

e pr

e-w

orks

hop

part

icip

ant

inte

rvie

ws,

set

ting

the

wor

ksho

p da

tes

and

loca

tion,

gat

herin

g th

e w

orks

hop

supp

lies,

an

d pr

oduc

ing

the

part

icip

ants

’ wor

ksho

p bi

nder

s.

Con

firm

the

wor

ksho

p’s

loca

tion

(off-

site

, if p

ossi

ble)

. It

shou

ld

have

bre

akou

t sp

ace

for

seve

ral s

mal

l gro

ups

to m

eet

sim

ulta

-ne

ousl

y an

d w

all s

pace

for

post

ing

flip-

char

t pa

ges.

“Rol

e of

the

par

ticip

ants

,”

begi

nnin

g on

pag

e 15

Wor

ksho

p m

ater

ials

, beg

in-

ning

on

page

47

Add

ition

al r

esou

rces

, as

liste

d on

pag

e 83

Management and organizational sustainability tool for tB 27

pre-

wor

ksho

p in

terv

iew

s w

ith p

artic

ipan

tsM

eet

with

all

wor

ksho

p pa

rtic

ipan

ts, i

ndiv

idua

lly o

r in

sm

all

grou

ps, s

ever

al d

ays

befo

re t

he w

orks

hop.

Begi

n to

kno

w t

he k

ey p

laye

rs a

nd t

heir

area

s of

inte

rest

■

■

and

conc

ern.

o

rient

the

m t

o th

e M

ost

for

tB p

roce

ss b

y go

ing

over

■

■

“Mak

ing

the

Mo

st o

f Man

agem

ent”

with

the

m a

nd a

n-sw

erin

g th

eir

ques

tions

. In

terv

iew

the

par

ticip

ants

to

gath

er in

form

atio

n th

at w

ill

■■

help

you

pla

n th

e w

orks

hop.

sug

gest

ed q

uest

ions

incl

ude:

W

hat

is y

our

posi

tion?

■

■

Wha

t ar

e yo

ur m

ain

resp

onsi

bilit

ies?

■

■

Wha

t is

it a

bout

thi

s n

tp t

hat

mot

ivat

es y

ou t

o co

me

to

■■

wor

k ev

ery

day?

W

hat

do y

ou t

hink

mak

es t

his

ntp

uni

que?

■

■

Wha

t ar

e yo

ur m

ain

conc

erns

abo

ut t

he m

anag

emen

t of

■

■

the

ntp

? W

hat

are

your

exp

ecta

tions

for

this

wor

ksho

p?

Wha

t do

you

hop

e w

ill b

e di

ffere

nt w

hen

you

retu

rn t

o ■

■

your

day

-to-

day

resp

onsi

bilit

ies

at t

he e

nd o

f the

wor

k-sh

op?

Wha

t do

you

hop

e to

con

trib

ute

to t

he M

ost

for

tB

■■

proc

ess,

bot

h du

ring

and

afte

r th

e w

orks

hop?

Id

entif

y re

curr

ing

issu

es a

nd c

once

rns

that

mig

ht a

rise

dur-

■■

ing

the

wor

ksho

p.

Use

thi

s in

form

atio

n to

sha

pe t

he w

orks

hop.

■■

“Mak

ing

the

Mo

st o

f Man

-ag

emen

t” h

ando

ut, p

age

48Yo

u m

ay w

ish

to c

onsi

der

orie

ntin

g th

e w

orks

hop

part

icip

ants

ahe

ad

of t

ime.

Aft

er t

his

grou

p or

ient

a-tio

n, y

ou c

ould

the

n pr

ocee

d w

ith

the

indi

vidu

al in

terv

iew

s. A

lthou

gh

hold

ing

face

-to-

face

inte

rvie

ws

is

the

best

way

to

get

to k

now

par

tici-

pant

s an

d be

gin

to e

stab

lish

trus

t, it

m

ay n

ot b

e po

ssib

le. I

f it

is n

ot, y

ou

can

subs

titut

e a

writ

ten

ques

tion-

naire

tha

t w

ill b

e in

form

ativ

e w

ith-

out

plac

ing

too

muc

h of

a b

urde

n on

the

res

pond

ents

, usi

ng o

r ad

apt-

ing

the

ques

tions

sug

gest

ed fo

r th

e in

terv

iew

. Dis

trib

ute

the

“Mak

ing

the

Mo

st o

f Man

agem

ent”

han

d-ou

t an

d th

e qu

estio

nnai

re t

o th

e pa

rtic

ipan

ts, w

ith a

mes

sage

from

yo

u ex

plai

ning

the

pur

pose

of t

he

ques

tionn

aire

and

set

ting

a de

ad-

line

for

retu

rnin

g it.

Be

sure

to

allo

w

enou

gh t

ime

for

the

part

icip

ants

to

ret

urn

it so

you

can

tak

e th

eir

resp

onse

s in

to a

ccou

nt a

s yo

u pl

an

the

wor

ksho

p.

plan

ning

the

wor

ksho

pRe

view

the

ses

sion

pla

ns fo

r th

e w

orks

hop,

foun

d in

thi

s gu

ide.

Use

the

se p

lans

as

a gu

idel

ine

for

plan

ning

the

wor

k-sh

op. C

onsi

der

wha

t yo

u ha

ve le

arne

d fr

om y

our

mee

tings

an

d in

terv

iew

s w

hen

stru

ctur

ing

wor

king

gro

ups

and

allo

cat-

ing

time

for

wor

ksho

p ac

tiviti

es.

“pha

se 3

: Wor

ksho

p pl

an,”

be

ginn

ing

on p

age

28

MOST FOR TB

Management and organizational sustainability tool for tB28

Phase 3: WOrkshOP Plan

The focal point of the MOST for TB process is a structured workshop in which, over the course of three days, you will help the participants pool their individual and collective experience of the NTP. The result will be a better picture of the current management practices of the NTP and a plan for making management improvements.

Participants. Ideally, the workshop should include from 12 to 25 participants. Having fewer than 12 participants limits the richness of discussions; having more than 25 requires more time to inte-grate small-group products into consensus and may strain the three-day format. The participants should include the director, senior managers, and a mix of staff with management responsibilities. Other stakeholders with an involvement in management issues (e.g., MOH and NTP central and regional staff) may also participate, as deemed appropriate by the NTP director.

Purpose. MOST for TB provides a framework for an ongoing NTP-wide discussion about critical management practices. The MOST for TB workshop is often the first opportunity for staff and stakeholders from different levels to share their perceptions of the NTP’s management and the issues that affect their daily work. The goal of the workshop is to help participants use these percep-tions to identify concrete actions they can take in the immediate future to improve management.

Approach. The workshop process is designed to validate the contributions of each participant. Within a highly structured environment, all participants are encouraged to express their views and listen carefully to the views of their colleagues. This process allows participants to come to con-sensus on the NTP’s current management performance and make a practical plan for improving its performance.

reaching consensus

Consensus is strongly emphasized in the Most for tB workshop. this emphasis is based on two assumptions:

no single participant in the workshop possesses the complete truth about the ntp and ■■

its management; instead, every person possesses some part of the truth. An accurate picture is best obtained by pooling these individual perceptions.

Each participant’s observations about his or her experiences relative to the management ■■

components can broaden the perspective of the other participants. the evidence that the participants offer to support their opinions helps the group come to agreement on what may initially seem to be incompatible viewpoints.

the workshop participants reach consensus not by voting but by patiently sorting through all opinions until they arrive at a decision that each participant can accept and work with—even if this decision does not completely match his or her initial opinion.

MOST FOR TB

Management and organizational sustainability tool for tB 29

Workshop Agenda. The workshop consists of an opening session and four modules, with defined objectives for each session and module.

WOrkshOP agenda

session/ Module Objectives approximate

time frame

DAY 1 Opening session Review the workshop agenda and anticipated ■■

outcomes.

Clarify expectations. ■■

Introduce the Most for tB process. ■■

Establish ground rules for an open, honest, respectful ■■

exchange of ideas.

Explore the links between leadership, improved man-■■

agement, work climate, sustainability, and organiza-tional results.

1 ½ hours

Module 1: Where are We now?

Explore the meaning of the five management areas ■■

and the 30 management components.

Work in groups that cut across organizational levels ■■

and draw on the contributions of each member.

Generate consensus on the ntp’s current status in ■■

terms of each component and stage of development.

4 ½ hours

DAY 2 Module 2: Where are We headed?

Agree on one or two objectives for improving each ■■

management component.

specify evidence that will indicate progress toward ■■

these objectives.

4 hours

Module 3: how Will We Manage the needed changes?

Explore the principles of change. ■■

Explore how changes in management, together with ■■

strong leadership, can improve an ntp’s services and sustainability.

Recognize participants’ roles as leaders and managers ■■

of the change process.

4 hours

DAY 3 Module 4: how Will We reach Our Objectives?

select the highest-priority management components ■■

to improve during the coming period.

prepare an action plan for these improvements. ■■

Decide on follow-up activities that will need to be ■■

completed, and assign responsibility for the activities.

1 day

Specific plans for the workshop appear in the following pages. A one-page duplicate of the workshop agenda and anticipated outcomes that can be distributed to workshop participants appears on pages 51–52.

MOST FOR TB

Management and organizational sustainability tool for tB30

Anticipated outcomes of the workshop. By the end of the workshop, participants will have come to agreement on how well the NTP is functioning and will have planned activities for making improvements. The specific outcomes include:

a collective assessment of the current stage of development of the management components;■■

a prioritized list of the management components to be improved within a specified period;■■

an agreed-upon set of objectives for improving each management component;■■

an action plan for reaching the objectives, identifying the broad activities, timing, resources, ■■

and people responsible for completing the activities, and defining data that can provide evi-dence of success;

identification of a TB change leader and TB change team who will lead the implementation of ■■

the action plan and monitor progress;

a list of short-term activities for following up on the MOST for TB workshop: those the staff ■■

can do themselves with existing resources, those for which they need to seek additional re-sources, and those for which they will need technical assistance from outside the NTP;

agreement on post-workshop assistance from the facilitators (by phone or e-mail) and a ■■

follow-up MOST for TB exercise, usually six months to one year after the workshop.

helping to develop the MOst for tb action Plan

A critical outcome of the Most for tB workshop is a concrete plan for making the changes needed to strengthen management performance. this action plan usually covers one year, broken down by quarters or months. You can help lay the groundwork for a successful action plan by helping the participants to carry out these vital activities:

Link the action plan to the ntp’s operational plans and work plans.■■

secure the commitment and active involvement of the MoH’s and ntp’s leaders, espe-■■

cially with regard to difficult decisions about resources.

Assign responsibility for activities only to someone who agrees to do them, preferably ■■

someone who participated in the workshop. It is unrealistic and unfair to hold people accountable for activities they have not agreed to carry out.

plan realistically, allowing more time than may seem necessary to complete each activity.■■

plan for incremental improvements. small steps are often more feasible than giant leaps ■■

and may be more effective in moving the ntp toward its objectives.

Introduce the action plan to the rest of the ntp staff and include them in the activities.■■

Carefully consider the MoH/ntp organizational factors that may impede change, and ■■

seek ways to address these factors, perhaps with outside assistance.

MOST FOR TB

Management and organizational sustainability tool for tB 31

Setting. Much of the discussion during the workshop will happen in small groups, with frequent plenary meetings to synthesize the findings and make decisions. Thus, the workshop should take place in a setting in which four or five small groups can work without interfering with one another. Because much of the discussion will best be captured on flip charts, you will need to hold the workshop in a room with plenty of wall space, enough for posting as many as 20 flip-chart pages at one time.

Materials. The materials needed are few:

flip-chart pads, flip-chart easels (two for the facilitators and one for each small group), and ■■

markers in sufficient quantity for several small groups to work simultaneously;

a projector for transparencies, slides, or a computerized slide show, if you choose to present ■■

basic information by any of these methods;

data entry, printing, and copying facilities, so that the decisions made by small groups can be ■■

documented and distributed as the action planning takes place;

a binder for each participant, containing all the workshop materials beginning on page 48, as ■■

well as any additional materials you choose.

During the workshop, one important responsibility will be to document the discussions and deci-sions of the sessions. You may find it useful to have a computer and printer accessible for one facilitator to use to quickly record the information and distribute the group’s decisions to the par-ticipants.

Management and organizational sustainability tool for tB32

OPe

nin

g s

essi

On

(M

Or

nin

g O

f d

ay 1

)

Ob

ject

ives

By th

e en

d of

the

open

ing

sess

ion,

par

ticip

ants

will

hav

e:

revi

ewed

the

wor

ksho

p ag

enda

and

ant

icip

ated

out

com

es;

■■

clar

ified

exp

ecta

tions

for t

he w

orks

hop;

■■

been

intr

oduc

ed to

the

MO

ST fo

r TB

proc

ess;

■■

esta

blis

hed

the

grou

nd ru

les

for a

n op

en, h

ones

t, re

spec

tful

exc

hang

e of

idea

s th

roug

hout

the

wor

ksho

p;■

■

expl

ored

the

links

bet

wee

n im

prov

ed m

anag

emen

t, or

gani

zatio

nal s

usta

inab

ility

, and

lead

ersh

ip.

■■

OPe

nin

g s

essi

On

Wor

ksh

op a

ctiv

ity

faci

litat

ors’

rol

er

esou

rces

req

uire

dk

eep

in M

ind

. . .

Intr

oduc

tion

of p

ar-

ticip

ants

and

faci

litat

or;

pres

enta

tion

of t

he a

gen-

da a

nd a

ntic

ipat

ed o

ut-

com

es o

f the

wor

ksho

p

Intr

oduc

e yo

urse

lf an

d ha

ve t

he w

orks

hop

part

icip

ants

intr

o-du

ce t

hem

selv

es, i

f the

y do

not

all

know

one

ano

ther

.

pres

ent

agen

da a

nd a

ntic

ipat

ed o

utco

mes

. Rev

iew

the

par

tici-

pant

bin

ders

, enc

oura

ging

dis

cuss

ion

and

ques

tions

.

Revi

ew t

he fi

ndin

gs—

key

them

es, c

once

rns,

exp

ecta

tions

, et

c.—

from

the

pre

-wor

ksho

p in

terv

iew

s an

d/or

que

stio

n-na

ires.

Cla

rify

how

thi

s w

orks

hop

will

and

will

not

res

pond

to

thes

e fin

ding

s.

set

the

tone

for

the

wor

ksho

p by

em

phas

izin

g th

e ne

ed fo

r op

en, h

ones

t ex

chan

ges

and

resp

ectf

ul a

tten

tion

to o

ther

pe

ople

’s v

iew

s.

With

par

ticip

ants

, est

ablis

h gr

ound

rul

es t

hat

will

fost

er t

he

desi

red

envi

ronm

ent.

part

icip

ant

bind

ers

cont

ain-

ing

the

mat

eria

l beg

inni

ng

on p

age

48

prep

ared

flip

cha

rts

or t

rans

-pa

renc

ies

with

the

age

nda,

ob

ject

ives

, ant

icip

ated

out

-co

mes

, oth

er u

p-fr

ont

mat

e-ria

l, as

des

ired

Flip

cha

rt o

r tr

ansp

aren

cy

sum

mar

izin

g th

e in

terv

iew

fin

ding

s, in

clud

ing

expe

cta-

tions

for

the

wor

ksho

p

Flip

cha

rt a

nd m

arke

rs

Alth

ough

it is

pos

sibl

e to

pre

sent

th

is in

form

atio

n in

slid

es o

r tr

ans-

pare

ncie

s, m

any

faci

litat

ors

pref

er

to u

se fl

ip c

hart

s, w

hich

est

ablis

h an

atm

osph

ere

of in

form

ality

and

in

volv

emen

t. t

he p

ages

can

be

post

ed o

n th

e w

all f

or r

efer

ence

th

roug

hout

the

wor

ksho

p. F

acili

ta-

tors

can

eas

ily r

etur

n to

the

flip

ch

arts

at

key

poin

ts fo

r re

view

and

di

scus

sion

(e.

g., a

t th

e en

d of

eac

h m

odul

e, w

hen

part

icip

ants

can

co

mm

ent

on t

he e

xten

t to

whi

ch

the

obje

ctiv

es h

ave

been

ach

ieve

d).

this

can

be

an in

form

al b

ut p

ower

-fu

l eva

luat

ion

tool

.

Management and organizational sustainability tool for tB 33

ntp

dire

ctor

’s e

ndor

se-

men

t of

Mo

st fo

r tB

Ask

the

dire

ctor

to

expl

ain

why

he

or s

he h

as c

hose

n to

use

M

ost

for

tB a

t th

is t

ime

and

how

Mo

st fo

r tB

will

ben

efit

the

ntp

.

Be s

ure

to r

emin

d th

e di

rect

or w

ell

ahea

d of

tim

e an

d m

ake

sure

tha

t he

or

she

is c

omfo

rtab

le t

akin

g on

th

is t

ask.

Intr

oduc

tion

to M

ost

fo

r tB

Expl

ain

the

purp

ose

of M

ost

for

tB:

Impr

ove

the

ntp

’s m

anag

emen

t, s

ince

man

agem

ent

is a

n ■

■

esse

ntia

l fea

ture

of s

usta

inab

ility

and

con

trib

utes

to

the

orga

niza

tion’

s ou

tcom

es.

build

con

sens

us a

mon

g st

aff o

n th

e is

sues

and

pla

ns

■■

iden

tified

. pr

ovid

e a

tool

for

sim

ple,

effe

ctiv

e m

onito

ring

of m

anag

e-■

■

men

t in

the

futu

re.

Cla

rify

how

Mo

st fo

r tB

is d

iffer

ent

from

oth

er p

lann

ing

pro-

cess

es a

nd im

prov

emen

t in

itiat

ives

the

ntp

has

und

erta

ken

or

is c

urre

ntly

invo

lved

in:

It is

an

ntp

sel

f-as

sess

men

t, c

ompl

eted

on

site

. ■

■

All

part

icip

ants

’ opi

nion

s ar

e va

lid a

nd m

ust

be t

aken

into

■

■

acco

unt

in r

each

ing

synt

hesi

s.th

ere

is n

o ou

tsid

e as

sess

or—

the

only

out

side

rs a

re t

here

to

■■

faci

litat

e ra

ther

tha

n to

judg

e.

Dis

cuss

how

Mo

st fo

r tB

can

fit

into

and

enh

ance

oth

er p

lan-

ning

act

iviti

es.

opt

iona

l: po

wer

poin

t sl

ide

show

abo

ut M

ost

for

tB,

foun

d on

the

Mo

st fo

r tB

C

D-R

oM

(re

quire

s a

com

-pu

ter

and

LCD

pro

ject

or)

opt

iona

l: tr

ansp

aren

cy

draw

n fr

om “

the

Mo

st fo

r tB

Diff

eren

ce,”

pag

e 3

(con

tinue

d on

nex

t pa

ge)

Management and organizational sustainability tool for tB34

OPe

nin

g s

essi

On

(co

nti

nue

d)

Wor

ksh

op a

ctiv

ity

faci

litat

ors’

rol

er

esou

rces

req

uire

dk

eep

in M

ind

. . .

Cla

rifica

tion

of p

roce

-du

res

and

met

hods

to

be

use

d du

ring

the

w

orks

hop

Retu

rn t

o th

e ag

enda

to

revi

ew t

he d

iffer

ent

mod

ules

of t

he

wor

ksho

p.

Expl

ain

the

way

s in

whi

ch in

divi

dual

s w

ill fo

rm t

heir

own

opin

-io

ns a

nd t

hen

shar

e an

d di

scus

s th

em in

sm

all,

hete

roge

neou

s gr

oups

.

Expl

ain

the

proc

ess

for

reac

hing

con

sens

us in

sm

all g

roup

s an

d pl

enar

y se

ssio

ns.

Intr

oduc

e th

e “p

arki

ng lo

t” c

once

pt a

nd p

ost

a la

rge

shee

t of

pa

per

on t

he w

all o

n w

hich

par

ticip

ants

and

faci

litat

ors

will

re-

cord

idea

s, c

once

rns,

and

top

ics

that

can

not

be fu

lly e

xplo

red

durin

g th

e w

orks

hop.

the

se it

ems

will

nee

d to

be

addr

esse

d at

the

end

of t

he w

orks

hop.

Wor

ksho

p A

gend

a, p

age

51

opt

iona

l: Fl

ip c

hart

or

tran

s-pa

renc

y of

the

“Re

achi

ng

Con

sens

us”

box,

pag

e 28

Flip

-cha

rt p

age(

s) o

n th

e w

all

iden

tified

as

the

“par

king

lo

t”

Emph

asiz

e th

at c

onse

nsus

is

achi

eved

by

liste

ning

, dis

cuss

-in

g, s

harin

g ev

iden

ce, a

nd, fi

nally

, re

achi

ng a

gree

men

t. C

onse

nsus

is

not

a vo

te: e

very

mem

ber

of t

he

grou

p m

ust

be a

ble

to li

ve w

ith a

nd

supp

ort

the

grou

p’s

asse

ssm

ent.

Des

crip

tion

of li

nks

betw

een

good

man

age-

men

t an

d im

prov

ed

resu

lts

Use

the

“Le

adin

g an

d M

anag

ing

Resu

lts M

odel

” to

intr

oduc

e pa

rtic

ipan

ts’ r

ole

as m

anag

ers

and

lead

ers

with

in t

he n

tp.

Dis

cuss

brie

fly h

ow t

heir

wor

k du

ring

and

afte

r th

is w

orks

hop

will

beg

in t

o in

fluen

ce s

ervi

ces.

Revi

ew d

efini

tions

of i

nstit

utio

nal,

prog

ram

mat

ic, a

nd fi

nanc

ial

sust

aina

bilit

y. L

ead

disc

ussi

on o

f im

plic

atio

ns fo

r th

e n

tp a

nd

its w

ork.

tran

spar

ency

or

slid

e of

the

“L

eadi

ng a

nd M

anag

ing

Resu

lts M

odel

,” p

age

82

“Wha

t Is

Mo

st fo

r tB

,”

page

1

this

can

be

a ve

ry s

hort

dis

cuss

ion;

pa

rtic

ipan

ts w

ill c

over

the

top

ic in

de

tail

in M

odul

e 3.

Management and organizational sustainability tool for tB 35

MO

du

le 1

: Wh

ere

ar

e W

e n

OW

? (a

fter

nO

On

Of

day

1 a

nd

MO

rn

ing

Of

day

2)

Ob

ject

ives

By th

e en

d of

this

mod

ule,

par

ticip

ants

will

hav

e:

expl

ored

the

mea

ning

s of

the

five

man

agem

ent a

reas

and

30

man

agem

ent c

ompo

nent

s;

■■

form

ed w

orki

ng g

roup

s th

at c

ut a

cros

s or

gani

zatio

nal d

ivis

ions

and

dra

w o

n th

e co

ntri

butio

ns o

f eac

h m

embe

r;

■■

gene

rate

d co

nsen

sus

on th

e or

gani

zatio

n’s

curr

ent s

tatu

s in

term

s of

eac

h m

anag

emen

t com

pone

nt.

■■

MO

du

le 1

: Wh

ere

ar

e W

e n

OW

?

Wor

ksh

op a

ctiv

ity

faci

litat

ors’

rol

er

esou

rces

req

uire

dk

eep

in M

ind

. . .

Revi

ew o

f obj

ectiv

es fo

r M

odul

e 1

pres

ent

on fl

ip c

hart

and

pos

t on

wal

l to

rem

ain

thro

ugho

ut

the

mod

ule.

Flip

cha

rt o

f obj

ectiv

es

Age

nda

in p

artic

ipan

t bi

nder

pres

enta

tion

of t

he s

truc

-tu

re o

f the

Mo

st fo

r tB

as

sess

men

t in

stru

men

t:

five

prog

ram

are

as

■■

and

30 t

otal

man

age-

men

t co

mpo

nent

s;

four

sta

ges

of

■■

deve

lopm

ent

and

char

acte

ristic

s;ho

w w

e de

term

ine

■■

the

curr

ent

stag

e

of d

evel

opm

ent

and

mon

itor

im

prov

emen

ts;

wha

t co

nstit

utes

con

-■

■

vinc

ing

evid

ence

.

Wal

k th

e gr

oup

thro

ugh

the

Mo

st fo

r tB

Ass

essm

ent

Inst

ru-

men

t. D

iscu

ss d

efini

tions

and

des

crip

tions

of e

ach

man

age-

men

t co

mpo

nent

, ens

urin

g th

at a

ll pa

rtic

ipan

ts u

nder

stan

d th

e te

rms

used

in t

he in

stru

men

t.

Defi

ne “

evid

ence

,” u

sing

exa

mpl

es fr

om t

he M

ost

for

tB

guid

e. C

ondu

ct a

sho

rt e

xerc

ise,

dra

win

g ex

ampl

es fr

om t

he

grou

p, fi

rst

from

unr

elat

ed a

reas

(e.

g., e

vide

nce

of w

ealth

, ed

ucat

ion,

or

pow

er)

and

then

rel

ated

to

the

Mo

st fo

r tB

ch

arac

teris

tics.

post

som

e of

the

ir ex

ampl

es o

n a

flip

char

t an

d di

spla

y fo

r th

e du

ratio

n of

the

wor

ksho

p, t

o re

info

rce

thei

r un

ders

tand

ing.

tran

spar

enci

es o

f the

Mo

st

for

tB A

sses

smen

t In

stru

-m

ent,

beg

inni

ng o

n pa

ge 5

3

opt

iona

l: tr

ansp

aren

cies

or

copi

es b

ased

on

“orie

ntat

ion

to t

he A

sses

smen

t In

stru

-m

ent,

” on

pag

e 5

“Wha

t C

onst

itute

s Ev

iden

ce”

box

on p

age

22

term

inol

ogy

can

be c

onfu

sing

, es-

peci

ally

if p

artic

ipan

ts h

ave

vary

ing

leve

ls o

f man

agem

ent

expe

rienc

e or

spe

ak E

nglis

h as

a s

econ

d la

n-gu

age.

It is

use

ful t

o ac

know

ledg

e th

at s

ome

man

agem

ent

term

s ca

n ha

ve s

ever

al m

eani

ngs.

to

avoi

d lo

ng d

iscu

ssio

ns o

f defi

nitio

ns, y

ou

shou

ld h

ave

the

part

icip

ants

use

the

te

rms

as p

rese

nted

in t

he M

ost

for

tB in

stru

men

t. (con

tinue

d on

nex

t pa

ge)

Management and organizational sustainability tool for tB36

MO

du

le 1

: Wh

ere

ar

e W

e n

OW

? (c

onti

nue

d)

Wor

ksh

op a

ctiv

ity

faci

litat

ors’

rol

er

esou

rces

req

uire

dk

eep

in M

ind

. . .

Com

plet

ion

of t

he M

ost

fo

r tB

Ass

essm

ent

Inst

ru-

men

t by

indi

vidu

al p

ar-

ticip

ants

:

expl

anat

ion

by

■■

faci

litat

ors

indi

vidu

al w

ork

■■

Expl

ain:

thi

s ex

erci

se g

ives

eac

h pa

rtic

ipan

t th

e ch

ance

to

appl

y M

ost

for

tB in

divi

dual

ly. t

hen

part

icip

ants

will

wor

k to

geth

er t

o de

velo

p a

shar

ed a

sses

smen

t of

the

cur

rent

sta

ge

of d

evel

opm

ent

of e

ach

man

agem

ent

com

pone

nt.

Intr

oduc

e th

e in

stru

men

t an

d th

e pr

oces

s:

part

icip

ants

will

inde

pend

ently

rea

d th

e ch

arac

teris

tics

of

■■

each

sta

ge o

f dev

elop

men

t fo

r ea

ch c

ompo

nent

.th

ey w

ill t

hen

sele

ct t

he s

tage

the

y be

lieve

bes

t fit

s th

e cu

r-■

■

rent

sta

tus

of t

he n

tp.

they

sho

uld

prov

ide

one

or t

wo

obse

rvat

ions

in t

he “

Evi-

■■

denc

e” c

olum

n to

sup

port

the

ir ch

oice

.

Cla

rify:

Whe

n de

term

inin

g th

e st

age

of d

evel

opm

ent

of a

m

anag

emen

t co

mpo

nent

, par

ticip

ants

mus

t be

sur

e th

at t

he

ntp

fits

all

the

char

acte

ristic

s of

tha

t st

age.

If t

hey

have

no

know

ledg

e ab

out

a ce

rtai

n as

pect

of t

he n

tp, t

hey

may

ski

p th

at m

anag

emen

t co

mpo

nent

.

As

part

icip

ants

inde

pend

ently

fill

in t

heir

copi

es o

f the

Mo

st

for

tB A

sses

smen

t In

stru

men

t, p

rovi

de g

uida

nce

and

answ

er

any

ques

tions

tha

t ar

ise.

one

bla

nk c

opy

of t

he M

ost

fo

r tB

Ass

essm

ent

Inst

ru-

men

t fo

r ea

ch p

artic

ipan

t,

begi

nnin

g on

pag

e 53

and

av

aila

ble

on t

he M

ost

for

tB C

D-R

oM

this

exe

rcis

e ca

n be

som

ewha

t co

n-fu

sing

at

first

. tak

e pl

enty

of t

ime

to

expl

ain

the

task

s. M

ake

part

icip

ants

fe

el c

omfo

rtab

le a

skin

g qu

estio

ns

abou

t th

e pr

oces

s.

Management and organizational sustainability tool for tB 37

smal

l-gro

up w

ork:

C

onse

nsus

on

curr

ent

stag

es o

f dev

elop

men

t,

with

sup

port

ing

evid

ence

to e

xpos

e pa

rtic

ipan

ts t

o va

ried

perc

eptio

ns, f

orm

gro

ups

of

4–6

peop

le fr

om d

iffer

ent

part

s of

the

ntp

, cre

atin

g a

cros

s-se

ctio

n of

exp

erie

nce

and

perc

eptio

ns.

Expl

ain:

In t

heir

smal

l gro

ups,

par

ticip

ants

will

rev

iew

the

ch

oice

s an

d ev

iden

ce p

ropo

sed

by e

ach

grou

p m

embe

r. to

-ge

ther

the

y w

ill d

iscu

ss a

ny d

iffer

ence

s an

d se

ek c

onse

nsus

on

the

stag

e of

dev

elop

men

t an

d su

ppor

ting

evid

ence

for

each

co

mpo

nent

.

Enco

urag

e pa

rtic

ipan

ts t

o pr

esen

t th

eir

evid

ence

per

suas

ivel

y bu

t su

ccin

ctly

. A fe

w w

ords

sho

uld

be a

ble

to c

onve

y th

e ob

-se

rvat

ion

that

the

ir gr

oup

has

foun

d co

nvin

cing

.

Circ

ulat

e am

ong

grou

ps, o

fferin

g gu

idan

ce a

nd c

larifi

catio

n w

here

nec

essa

ry.

one

“A

sses

smen

t C

onse

nsus

Fo

rm”

for

each

gro

up, b

e-gi

nnin

g on

pag

e 70

In fo

rmin

g he

tero

gene

ous

grou

ps,

you

can

draw

on

the

pre-

wor

ksho

p in

terv

iew

s an

d on

you

r st

aff c

oun-

terp

art’s

adv

ice.

Rem

embe

r th

at

your

cou

nter

part

sho

uld

part

icip

ate

in a

gro

up.

Als

o em

phas

ize

that

the

num

bers

th

at r

epre

sent

sta

ges

of d

evel

op-

men

t ca

nnot

be

aver

aged

(e.

g.,

2.5)

. the

gro

up m

ust

agre

e th

at t

he

ntp

fulfi

lls a

ll th

e ch

arac

teris

tics

in

the

stag

e th

ey h

ave

chos

en. I

f the

y ca

nnot

agr

ee, t

hey

shou

ld s

elec

t th

e pr

evio

us s

tage

.

plen

ary

disc

ussi

on:

Revi

ew a

nd c

onse

nsus

Expl

ain:

the

inte

ntio

n of

thi

s ac

tivity

is t

o ar

rive

at a

sta

ge o

f de

velo

pmen

t th

at a

ll th

e gr

oups

can

agr

ee o

n. H

ave

smal

l gr

oups

rep

ort

thei

r ch

oice

of t

he s

tage

of d

evel

opm

ent

for

each

com

pone

nt a

nd t

he e

vide

nce

they

pro

pose

d to

sup

port

th

eir

choi

ce.

Lead

the

par

ticip

ants

in d

iscu

ssin

g th

e re

ason

s fo

r an

y di

ffer-

ence

s an

d ne

gotia

ting

thes

e di

ffere

nces

to

reac

h co

nsen

sus,

ju

st a

s th

ey d

id in

the

ir sm

all g

roup

s. R

emin

d th

em t

hat

the

resu

lts o

f thi

s pr

oces

s w

ill p

rovi

de t

he in

put

for

the

wor

k of

M

odul

e 2.

Aft

er t

his

mod

ule

is c

ompl

eted

, you

will

nee

d to

pre

pare

ha

ndou

ts t

hat

pres

ent

the

cons

ensu

s ac

hiev

ed d

urin

g th

is

disc

ussi

on (

stag

es a

nd e

vide

nce)

. par

ticip

ants

will

nee

d th

is

info

rmat

ion

for

the

first

act

ivity

in M

odul

e 2.

one

she

et o

f flip

-cha

rt p

aper

fo

r ea

ch o

f the

30

man

age-

men

t co

mpo

nent

s, w

ith

spac

e to

ent

er t

he s

tage

of

deve

lopm

ent

each

gro

up h

as

iden

tified

and

the

evi

denc

e th

ey h

ave

sele

cted

(th

e pa

-pe

r ca

n al

so b

e us

ed t

o jo

t do

wn

note

s du

ring

the

dis-

cuss

ion,

as

an a

id t

o re

solv

-in

g di

ffere

nces

and

com

ing

to a

gree

men

t)

one

“A

sses

smen

t C

onse

nsus

Fo

rm,”

beg

inni

ng o

n pa

ge

70 t

o be

use

d by

one

faci

lita-

tor

to c

aptu

re t

he d

ecis

ions

m

ade

durin

g th

e pl

enar

y di

scus

sion

Des

irabl

e: a

com

pute

r an

d pr

inte

r to

qui

ckly

rec

ord

and

dist

ribut

e th

e re

sults

of t

he

plen

ary

disc

ussi

on

In t

his

sess

ion,

con

flict

oft

en a

rises

du

e to

diff

erin

g pe

rcep

tions

refl

ect-

ing

the

part

icip

ants

’ var

ied

stat

us

and

area

s of

res

pons

ibili

ty. Y

ou w

ill

need

to

liste

n pa

tient

ly a

nd a

t-te

ntiv

ely

and

help

the

par

ticip

ants

to

do

the

sam

e. B

e on

the

ale

rt fo

r is

sues

iden

tified

in y

our

pre-

w

orks

hop

inte

rvie

ws

that

par

tici-

pant

s m

ay n

ot b

e ab

le t

o di

scus

s op

enly

.

If yo

u ca

nnot

brin

g th

e gr

oup

to

cons

ensu

s on

a c

ompo

nent

, you

m

ay w

ant

to p

ut it

in t

he “

park

ing

lot”

and

ret

urn

to it

aft

er t

he o

ther

co

mpo

nent

s ha

ve b

een

addr

esse

d.

Get

ting

som

e di

stan

ce fr

om a

con

-tr

over

sial

top

ic a

nd r

efoc

usin

g on

le

ss c

onte

ntio

us is

sues

oft

en a

llow

s pa

rtic

ipan

ts t

o re

turn

to

thei

r di

s-cu

ssio

n w

ith n

ew in

sigh

ts.

Management and organizational sustainability tool for tB38

MO

du

le 2

: Wh

ere

ar

e W

e h

ead

ed?

(Mid

-MO

rn

ing

th

rO

ug

h e

nd

Of

day

2)

Ob

ject

ives

By th

e en

d of

this

mod

ule,

par

ticip

ants

will

hav

e:

agre

ed o

n on

e or

two

obje

ctiv

es fo

r im

prov

ing

each

man

agem

ent c

ompo

nent

; ■

■

prov

ided

evi

denc

e th

at w

ill in

dica

te p

rogr

ess

tow

ard

thes

e ob

ject

ives

.■

■

MO

du

le 2

: Wh

ere

ar

e W

e h

ead

ed?

Wor

ksh

op a

ctiv

ity

faci

litat

ors’

rol

er

esou

rces

req

uire

dk

eep

in M

ind

. . .

Revi

ew o

f obj

ectiv

es fo

r M

odul

e 2

pres

ent

on fl

ip c

hart

and

pos

t on

wal

l to

rem

ain

thro

ugho

ut

the

mod

ule.

Flip

cha

rt o

f obj

ectiv

es

Age

nda

in p

artic

ipan

t bi

nder

plen

ary

disc

ussi

on:

Revi

ew o

f con

sens

us

deci

sion

s in

Mod

ule

1

Lead

par

ticip

ants

in r

evie

w p

roce

ss.

Han

dout

s w

ith r

esul

ts o

f M

odul

e 1,

and

sup

plem

en-

tary

flip

cha

rt a

nd/o

r tr

ans-

pare

ncie

s, if

des

ired

smal

l-gro

up w

ork:

Ex

plor

atio

n of

con

trib

ut-

ing

caus

es

Div

ide

the

com

pone

nts

amon

g gr

oups

, so

each

gro

up is

w

orki

ng o

n a

man

agea

ble

num

ber

of c

ompo

nent

s.

Hel

p gr

oups

look

clo

sely

at

the

evid

ence

for

each

com

pone

nt

and

ask

them

selv

es w

hy t

he c

ompo

nent

is a

t th

at s

tage

of

deve

lopm

ent.

the

y m

ay n

eed

to a

sk W

hy?

seve

ral t

imes

to

dig

bene

ath

the

surf

ace

and

find

the

mos

t im

port

ant

cont

ribut

ing

caus

es.

It is

a g

ood

idea

to

dist

ribut

e di

f-fe

rent

typ

es o

f com

pone

nts

amon

g th

e sm

all g

roup

s, s

o th

at e

ach

smal

l gr

oup

is d

ealin

g w

ith a

mix

ture

of

man

agem

ent

area

s, s

tage

s of

dev

el-

opm

ent,

leve

ls o

f im

port

ance

to

the

ntp

, etc

.

At

this

poi

nt, y

ou m

ay w

ish

to r

e-co

nfigu

re t

he s

mal

l gro

ups

so t

hat

part

icip

ants

can

sha

re t

heir

pers

pec-

tives

with

new

gro

up m

embe

rs.

For

this

mod

ule,

som

e fa

cilit

ator

s fo

rm g

roup

s th

at s

hare

the

sam

e br

oad

area

of e

xper

tise,

whi

le o

th-

ers

pref

er t

o m

aint

ain

a m

ixtu

re o

f pe

rspe

ctiv

es.

Management and organizational sustainability tool for tB 39

smal

l-gro

up w

ork,

con

-tin

ued:

set

ting

obje

ctiv

es

and

prop

osin

g ev

iden

ce

of t

heir

achi

evem

ent

Dec

ide

in a

brie

f int

rodu

ctor

y ac

tivity

, or

anno

unce

bas

ed o

n th

e di

rect

or’s

dec

isio

n, w

hat

the

time

fram

e fo

r th

e M

ost

for

tB a

ctio

n pl

an w

ill b

e. U

sual

ly it

is s

ix m

onth

s or

one

yea

r.

For

each

man

agem

ent

com

pone

nt, h

ave

the

smal

l gro

ups

draf

t be

twee

n on

e an

d th

ree

obje

ctiv

es fo

r th

at t

ime

perio

d.

the

obje

ctiv

es s

houl

d be

ach

ieva

ble

in t

he s

hort

ter

m a

nd

shou

ld r

eflec

t th

e di

scus

sion

s of

the

con

trib

utin

g ca

uses

of t

he

curr

ent

situ

atio

n.

Hel

p th

e gr

oups

focu

s on

obj

ectiv

es t

hat

will

hel

p m

ove

the

man

agem

ent

com

pone

nts

tow

ard

the

char

acte

ristic

s of

the

ne

xt s

tage

of d

evel

opm

ent.

Hav

e ea

ch g

roup

pro

pose

one

or

two

fact

s, fi

gure

s, o

r ob

ser-

vatio

ns t

hat

will

pro

vide

con

vinc

ing

evid

ence

tha

t th

ese

obje

c-tiv

es h

ave

been

rea

ched

at

the

end

of t

he t

ime

perio

d.

Flip

cha

rts

for

each

gro

up

(the

res

ults

will

nee

d to

be

post

ed fo

r pr

esen

tatio

n an

d di

scus

sion

in M

odul

e 4)

Befo

re t

he p

artic

ipan

ts u

nder

take

th

is a

ctiv

ity, e

mph

asiz

e th

at t

he

goal

is n

ot t

o st

rive

for

perf

ectio

n.

Att

empt

ing

too

big

a le

ap m

ay

resu

lt in

failu

re a

nd d

isco

urag

e st

aff

abou

t th

e po

tent

ial f

or c

hang

e.

Incr

emen

tal i

mpr

ovem

ents

pro

vide

sm

all s

ucce

sses

tha

t en

cour

age

the

staf

f to

take

on

new

cha

lleng

es.

such

cha

nges

bui

ld u

p ov

er t

ime

to

have

a g

reat

er im

pact

.

It h

elps

to

reco

gniz

e th

at t

he s

hort

-te

rm o

bjec

tives

at

this

poi

nt m

ay

or m

ay n

ot m

ove

the

orga

niza

tion

into

the

nex

t st

age

of d

evel

op-

men

t, w

here

all

char

acte

ristic

s w

ill

appl

y. If

the

ntp

is c

lose

to

that

st

age,

one

or

two

impr

ovem

ents

m

ay s

uffic

e. H

owev

er, i

f the

man

-ag

emen

t co

mpo

nent

nee

ds a

lot

of

wor

k ov

er a

n ex

tend

ed p

erio

d of

tim

e, t

he o

bjec

tives

dev

elop

ed n

ow

may

sim

ply

mov

e th

e n

tp in

the

rig

ht d

irect

ion

with

in t

he c

urre

nt

stag

e of

dev

elop

men

t.

plen

ary

disc

ussi

on:

pres

enta

tion

of a

nd

agre

emen

t on

obj

ectiv

es

Gui

de p

artic

ipan

ts in

rev

iew

ing

smal

l gro

up w

ork,

cho

osin

g th

e m

ost

appr

opria

te o

bjec

tives

and

agr

eein

g on

evi

denc

e th

at w

ill s

how

tha

t th

e ob

ject

ives

hav

e be

en a

chie

ved.

Management and organizational sustainability tool for tB40

MO

du

le 3

: hO

W W

ill

We

Ma

na

ge

the

nee

ded

ch

an

ges

? (M

Or

nin

g O

f d

ay 3

)

Ob

ject

ives

By th

e en

d of

this

mod

ule,

par

ticip

ants

will

hav

e:

expl

ored

the

prin

cipl

es o

f cha

nge;

■■

seen

how

cha

nges

in m

anag

emen

t, to

geth

er w

ith st

rong

lead

ersh

ip, c

an im

prov

e an

NTP

’s se

rvic

es a

nd im

pact

;■

■

reco

gniz

ed th

eir r

oles

as

lead

ers

and

man

ager

s of

the

chan

ge p

roce

ss.

■■

MO

du

le 3

: hO

W W

ill

We

Ma

na

ge

the

nee

ded

ch

an

ges

?

Wor

ksh

op a

ctiv

ity

faci

litat

ors’

rol

er

esou

rces

req

uire

dk

eep

in M

ind

. . .

Revi

ew o

f obj

ectiv

es fo

r M

odul

e 3

pres

ent

on fl

ip c

hart

and

pos

t on

wal

l to

rem

ain

thro

ugho

ut

the

mod

ule.

Flip

char

t of

obj

ectiv

es

Age

nda

in p

artic

ipan

t bi

nder

plen

ary

disc

ussi

on:

prin

cipl

es o

f cha

nge

Brie

fly p

rese

nt a

nd d

iscu

ss p

rinci

ples

.Fl

ip c

hart

of t

he fo

ur p

rin-

cipl

es o

f cha

nge,

bas

ed o

n pa

ges

9–10

In M

odul

e 4,

the

prin

cipl

es o

f ch

ange

will

pro

vide

a b

asis

for

re-

visi

ng t

he o

bjec

tives

dev

elop

ed in

M

odul

e 2.

plen

ary

revi

ew a

nd

disc

ussi

on: “

Lead

ing

and

Man

agin

g Re

sults

M

odel

”

pres

ent

the

mod

el, h

ighl

ight

ing

its r

elat

ions

hip

to M

ost

for

tB a

nd t

o th

e n

tp: M

ost

for

tB fo

ster

s ch

ange

s th

at im

-pr

ove

man

agem

ent,

wor

k cl

imat

e, a

nd c

apac

ity t

o re

spon

d to

cha

ngin

g en

viro

nmen

t (s

usta

inab

ility

). t

hese

cha

nges

lead

to

impr

oved

ser

vice

s an

d, u

ltim

atel

y, im

prov

ed h

ealth

for

tB

patie

nts.

pres

ent

and

lead

a d

iscu

ssio

n of

the

func

tions

of l

eade

rs a

nd

man

ager

s. R

elat

e th

ese

func

tions

to

the

part

icip

ants

’ rol

es:

they

are

dra

win

g on

lead

ersh

ip a

nd m

anag

emen

t pr

actic

es

thro

ugho

ut t

he M

ost

for

tB w

orks

hop

and

will

con

tinue

to

use

the

se p

ract

ices

as

chan

ge a

gent

s to

impl

emen

t th

e

actio

n pl

an.

tran

spar

ency

or

slid

e of

the

“L

eadi

ng a

nd M

anag

ing

Resu

lts M

odel

,” p

age

82

“Lea

ders

hip

prac

tices

” an

d “M

anag

emen

t pr

actic

es,”

pa

ges

12–1

3

opt

iona

l: tr

ansp

aren

cy o

r sl

ide

of “

Lead

ing

and

Man

-ag

ing

Fram

ewor

k,”

page

83

You

may

wis

h to

spe

nd t

ime

go-

ing

over

the

det

ails

of l

eade

rshi

p an

d m

anag

emen

t as

defi

ned

in t

he “

Lead

ing

and

Man

agin

g Fr

amew

ork.

” o

r yo

u m

ay p

refe

r to

sum

mar

ize

the

cont

ents

of t

he

fram

ewor

k, u

sing

pag

es 1

2–13

as

the

basi

s fo

r di

scus

sion

, and

sim

ply

poin

ting

out

the

fram

ewor

k, w

hich

is

incl

uded

in p

artic

ipan

ts’ b

inde

rs.

Management and organizational sustainability tool for tB 41

Dire

ctor

’s a

nnou

ncem

ent

of t

he p

erso

n w

ho h

as

been

sel

ecte

d as

cha

nge

lead

er

Ahe

ad o

f tim

e: R

evie

w w

ith t

he d

irect

or t

he b

ackg

roun

d in

for-

mat

ion

with

whi

ch t

o fr

ame

the

anno

unce

men

t, s

o he

or

she

can

anno

unce

the

cho

ice

with

con

fiden

ce a

nd e

nthu

sias

m:

reas

ons

for

havi

ng a

cha

nge

lead

er a

nd c

hang

e te

am;

■■

qual

ities

of a

n ef

fect

ive

chan

ge le

ader

;■

■

resp

onsi

bilit

ies

of t

he c

hang

e le

ader

in im

plem

entin

g th

e ■

■

actio

n pl

an.

Revi

ew “

prin

cipl

es o

f C

hang

e,”

page

s 9–

10 a

nd

“Cha

nge

Lead

er a

nd C

hang

e te

am”

and

the

box

on

“Qua

litie

s of

the

Cha

nge

Lead

er,”

pag

e 11

Be s

ure

the

ntp

’s d

irect

or—

with

yo

ur h

elp,

if n

eces

sary

—ha

s di

s-cu

ssed

thi

s ro

le w

ith t

he p

rosp

ectiv

e ch

ange

lead

er, f

ully

exp

lain

ed t

he

resp

onsi

bilit

ies

invo

lved

, and

got

ten

that

per

son’

s fu

ll ag

reem

ent

and

com

mitm

ent.

If th

e n

tp’s

dire

ctor

pre

fers

not

to

pre

sent

the

bac

kgro

und

mat

eria

l, yo

u ca

n do

so

and

help

pav

e

the

way

for

the

dire

ctor

’s

anno

unce

men

t.

If th

e n

tp’s

dire

ctor

has

not

yet

se-

lect

ed t

he c

hang

e le

ader

and

wan

ts

the

grou

p to

dec

ide,

you

will

hav

e to

set

asi

de t

he t

ime

need

ed fo

r a

full

disc

ussi

on a

nd s

elec

tion

by t

he

grou

p du

ring

Mod

ule

4.

smal

l-gro

up w

ork:

Re

visi

on o

f obj

ectiv

esEn

cour

age

grou

ps t

o re

visi

t th

eir

obje

ctiv

es in

ligh

t of

the

ch

ange

s re

quire

d an

d th

eir

antic

ipat

ed m

anag

emen

t an

d le

ader

ship

rol

es. C

halle

nge

them

to

revi

se t

heir

obje

ctiv

es, i

f ne

cess

ary,

so

that

the

ir w

ork

will

hav

e th

e gr

eate

st p

ossi

ble

effe

ct o

n al

l are

as o

f the

mod

el.

Circ

ulat

e to

ans

wer

que

stio

ns. B

e su

re e

ach

grou

p do

cum

ents

its

fina

l obj

ectiv

es o

n fli

p ch

arts

.

Ente

r th

e fin

al o

bjec

tives

for

each

man

agem

ent

com

pone

nt

as s

oon

as p

ossi

ble,

so

that

prin

tout

s ca

n be

mad

e fo

r us

e in

M

odul

e 4.

Flip

cha

rts

for

each

gro

up

Des

irabl

e: A

com

pute

r, pr

inte

r, an

d ph

otoc

opie

r to

qu

ickl

y re

cord

and

dis

trib

ute

the

resu

lts o

f the

ple

nary

di

scus

sion

plen

ary

disc

ussi

on:

Revi

ew o

f rev

ised

ob

ject

ives

and

pr

opos

ed e

vide

nce

Che

ck t

hat

the

part

icip

ants

acc

ept

the

sugg

este

d re

visi

ons

and

have

no

furt

her

ques

tions

.po

sted

flip

-cha

rt p

ages

or

dist

ribut

ed p

rinto

uts

of M

od-

ule

3 re

sults

Management and organizational sustainability tool for tB42

MO

du

le 4

: hO

W W

ill

We

rea

ch

Ou

r O

bje

cti

Ves

? (M

id-M

Or

nin

g t

hr

Ou

gh

en

d O

f d

ay 3

)

Ob

ject

ives

By th

e en

d of

this

mod

ule,

par

ticip

ants

will

hav

e:

sele

cted

the

high

est-

prio

rity

man

agem

ent c

ompo

nent

s to

impr

ove

duri

ng th

e co

min

g pe

riod

; ■

■

prep

ared

an

actio

n pl

an fo

r the

se im

prov

emen

ts;

■■

deci

ded

wha

t act

iviti

es w

ill b

e ne

eded

to fo

llow

up

on th

e M

OST

for T

B w

orks

hop.

■■

MO

du

le 4

: hO

W W

ill

We

rea

ch

Ou

r O

bje

cti

Ves

?

Wor

ksh

op a

ctiv

ity

faci

litat

ors’

rol

er

esou

rces

req

uire

dk

eep

in M

ind

. . .

Revi

ew o

f obj

ectiv

es fo

r M

odul

e 4

pres

ent

on fl

ip c

hart

and

pos

t on

wal

l to

rem

ain

thro

ugho

ut

the

mod

ule.

Flip

cha

rt o

f obj

ectiv

es

Age

nda

in p

artic

ipan

t bi

nder

plen

ary

exer

cise

: se

lect

ion

of p

riorit

y

man

agem

ent

co

mpo

nent

s

Emph

asiz

e th

e ne

ed t

o fo

cus

on im

prov

emen

ts in

a fe

w p

rior-

ity c

ompo

nent

s—th

ose

that

mee

t th

e fo

llow

ing

crite

ria:

can

be q

uick

ly a

ccom

plis

hed,

and

/or;

■■

requ

ire m

inim

al h

uman

and

fina

ncia

l res

ourc

es, a

nd/o

r;■

■

are

need

ed a

s a

basi

s fo

r ot

her

impr

ovem

ents

, and

/or;

■■

will

mak

e th

e gr

eate

st c

ontr

ibut

ion

to t

he m

anag

emen

t of

■

■

the

ntp

.

poin

t ou

t th

at s

ome

impr

ovem

ents

tha

t m

ight

mak

e gr

eat

cont

ribut

ions

to

bett

er m

anag

emen

t m

ay b

e to

o co

stly

and

tim

e-co

nsum

ing

to u

nder

take

at

this

tim

e.

prov

ide

a w

ay fo

r pa

rtic

ipan

ts t

o re

gist

er t

he c

ompo

nent

s th

ey

cons

ider

to

be o

f the

hig

hest

prio

rity.

tw

o po

ssib

ilitie

s ar

e:

to h

ave

each

par

ticip

ant

writ

e do

wn

her/

his

top

thre

e ■

■

choi

ces;

you

tal

ly a

nd a

nnou

nce

the

resu

lts;

to p

ost

all c

ompo

nent

s on

flip

cha

rts;

par

ticip

ants

che

ck o

ff ■

■

or s

tick

a co

lore

d do

t ne

xt t

o th

eir

top

thre

e ch

oice

s. t

he

entir

e gr

oup

talli

es t

he r

esul

ts.

Gui

de p

artic

ipan

ts in

usi

ng t

he t

ally

to

sele

ct t

he 4

–5 c

ompo

-ne

nts

that

the

y w

ill w

ork

on d

urin

g th

e co

min

g pe

riod.

Flip

cha

rt o

f sug

gest

ed

crite

ria fo

r pr

iorit

izin

g co

mpo

nent

s, p

repa

red

in a

dvan

ce o

r du

ring

the

plen

ary

disc

ussi

on

opt

iona

l: C

olor

ed s

elf-

adhe

sive

dot

s

the

hard

est

thin

g ab

out

sett

ing

prio

ri-tie

s is

tha

t it

mea

ns t

empo

raril

y se

ttin

g as

ide

activ

ities

tha

t ha

ve r

eal v

alue

to

the

ntp

. som

e pa

rtic

ipan

ts m

ay b

e st

rong

ly c

omm

itted

to

obje

ctiv

es in

a

com

pone

nt t

hat

the

grou

p de

cide

s is

of

low

er p

riorit

y.

You

may

nee

d to

hel

p th

e pa

rtic

ipan

ts

thro

ugh

this

pro

cess

. Cla

rify

that

com

-po

nent

s id

entifi

ed a

s lo

w p

riorit

y at

thi

s tim

e w

ill n

ot b

e ab

ando

ned.

the

y w

ill

be d

ocum

ente

d in

the

wor

ksho

p re

port

an

d re

visi

ted

in M

ost

for

tB fo

llow

-up

mee

tings

.

Management and organizational sustainability tool for tB 43

smal

l-gro

up w

ork:

pr

epar

atio

n of

act

ion

plan

s

Cre

ate

new

sm

all g

roup

s, o

ne fo

r ea

ch o

f the

man

agem

ent

com

pone

nts

iden

tified

as

a pr

iorit

y. o

nce

agai

n, b

e su

re t

he

grou

ps r

epre

sent

a c

ross

-sec

tion

of d

ivis

ions

and

leve

ls.

Gui

de s

mal

l gro

ups

in p

ropo

sing

3 o

r 4

broa

d ca

tego

ries

of

activ

ities

tha

t w

ill h

elp

reac

h th

e ob

ject

ive

for

thei

r co

mpo

-ne

nt. E

ncou

rage

the

m t

o th

ink

crea

tivel

y ab

out

varie

d bu

t pr

actic

al w

ays

to r

each

the

obj

ectiv

es.

Gui

de p

artic

ipan

ts in

car

eful

ly c

onsi

derin

g th

e re

sour

ces—

hu-

man

, mat

eria

l, an

d fin

anci

al—

need

ed t

o ca

rry

out

each

bro

ad

activ

ity, a

nd in

cla

ssify

ing

them

as

one

of t

he fo

llow

ing:

reso

urce

s th

at a

lread

y ex

ist

with

in t

he o

rgan

izat

ion;

■

■

reso

urce

s th

at a

re n

ot c

urre

ntly

ava

ilabl

e bu

t ca

n be

gen

er-

■■

ated

rel

ativ

ely

easi

ly;

reso

urce

s th

at w

ill r

equi

re c

onsi

dera

ble

effo

rt t

o ge

nera

te.

■■ th

e pa

rtic

ipan

ts w

ill t

hen

com

plet

e th

e re

st o

f the

ir ac

tion

plan

s, fi

lling

in t

he p

erso

n re

spon

sibl

e an

d tim

e re

quire

d to

co

mpl

ete

the

activ

ity.

Flip

-cha

rt p

ages

of t

he r

e-vi

sed

obje

ctiv

es fo

r ea

ch

sele

cted

com

pone

nt, d

is-

trib

uted

am

ong

the

smal

l gr

oups

so

they

can

iden

-tif

y th

e ty

pes

of a

ctiv

ities

fo

r ea

ch o

bjec

tive

new

flip

-cha

rt p

ages

on

each

of w

hich

the

y w

ill

writ

e: man

agem

ent

■

■

com

pone

ntob

ject

ive

■■

3 or

4 b

road

act

iviti

es■

■

gene

ral t

ypes

of

■■

reso

urce

s—hu

man

, m

ater

ial,

and

finan

-ci

al—

requ

ired

for

each

ac

tivity

for

each

typ

e of

■

■

reso

urce

, “C

A”

(cur

-re

ntly

ava

ilabl

e), “

GE”

(g

ener

ated

eas

ily),

or

“RE”

(re

quire

s ef

fort

).

Blan

k ac

tion

plan

form

s (f

ound

on

page

s 80

–81

and

on t

he M

ost

for

tB

CD

-Ro

M)

You

may

rel

y on

you

r st

aff c

ount

erpa

rt

for

advi

ce, u

se y

our

own

judg

men

t in

fo

rmin

g th

e gr

oups

, or

ask

the

par-

ticip

ants

to

form

the

ir ow

n ne

w m

ixed

gr

oups

.

If th

ere

are

too

few

par

ticip

ants

in t

he

wor

ksho

p, s

ome

smal

l gro

ups

may

ne

ed t

o w

ork

on t

wo

man

agem

ent

com

pone

nts.

It w

ill h

elp

if yo

u gi

ve e

xam

ples

of

the

kind

s of

bro

ad a

ctiv

ities

the

sm

all

grou

ps s

houl

d pr

opos

e. F

or in

stan

ce, t

o re

ach

an o

bjec

tive

rela

ted

to h

uman

re-

sour

ces

man

agem

ent,

an

activ

ity m

ight

be

“pr

epar

e pe

rson

nel h

andb

ook.

” th

is a

ctiv

ity c

ould

invo

lve

a nu

mbe

r of

sm

alle

r ac

tiviti

es.

the

wor

ksho

p m

ater

ials

incl

ude

a sa

m-

ple

actio

n pl

an fo

rm t

hat

has

prov

en

usef

ul in

form

er M

ost

for

tB w

ork-

shop

s. t

he p

artic

ipan

ts m

ay c

hoos

e to

us

e th

is o

r an

othe

r fo

rmat

tha

t co

rre-

spon

ds t

o th

eir

own

plan

ning

pro

cess

. If

they

use

a d

iffer

ent

form

at, t

hey

may

ne

ed t

o ad

apt

it to

incl

ude

all t

he p

lan-

ning

ele

men

ts t

hat

are

iden

tified

her

e.

Alth

ough

eac

h ac

tivity

in t

his

actio

n pl

an s

houl

d be

bro

ken

dow

n in

to s

pe-

cific

tas

ks, t

here

is r

arel

y en

ough

tim

e fo

r th

at le

vel o

f det

ail i

n th

e M

ost

for

tB w

orks

hop.

the

cha

nge

team

sho

uld

wor

k on

the

det

ails

at

a la

ter

time.

(con

tinue

d on

nex

t pa

ge)

Management and organizational sustainability tool for tB44

MO

du

le 4

: hO

W W

ill

We

rea

ch

Ou

r O

bje

cti

Ves

? (c

onti

nue

d)

Wor

ksh

op a

ctiv

ity

faci

litat

ors’

rol

er

esou

rces

req

uire

dk

eep

in M

ind

. . .

plen

ary

disc

ussi

on:

pres

enta

tion

of a

nd

agre

emen

t on

act

ion

plan

s

For

each

man

agem

ent

com

pone

nt, i

n tu

rn:

Hav

e th

e sm

all g

roup

s po

st t

heir

flip-

char

t pa

ges

or d

istr

ib-

■■

ute

copi

es o

f the

ir co

mpl

eted

act

ion

plan

s.H

elp

part

icip

ants

to

revi

ew, r

evis

e, a

nd r

each

con

sens

us o

n ■

■

5 of

the

sug

gest

ed a

ctiv

ities

tha

tw

ill b

est

help

rea

ch t

he o

bjec

tive;

■■

requ

ire r

esou

rces

tha

t ar

e av

aila

ble

or c

an b

e ge

nera

ted

■■

with

rea

sona

ble

effo

rt.

Con

tinue

the

pro

cess

unt

il al

l prio

rity

com

pone

nts

have

■

■

been

add

ress

ed. M

odify

sm

all g

roup

s’ fl

ip c

hart

s as

nee

ded

to r

eflec

t th

e fin

al r

esul

t.

Flip

-cha

rt p

ages

or

actio

n pl

ans

from

sm

all g

roup

s

A c

opy

of t

he n

tp’s

op

erat

iona

l pla

n, if

av

aila

ble

You

may

nee

d to

rem

ind

the

part

ici-

pant

s to

be

real

istic

abo

ut w

hat

ac-

tiviti

es t

hey

can

effe

ctiv

ely

unde

rtak

e,

give

n th

eir

curr

ent

and

futu

re r

espo

n-si

bilit

ies.

It is

ver

y he

lpfu

l to

look

at

exis

ting

orga

niza

tiona

l pla

ns a

nd s

ee

how

the

Mo

st fo

r tB

act

ion

plan

will

fit

with

in—

and,

hop

eful

ly, e

nhan

ce—

othe

r n

tp in

itiat

ives

.

Dis

trib

utin

g ac

tion

plan

sC

olle

ct t

he a

ctio

n pl

ans,

ent

er t

hem

on

a co

mpu

ter,

prin

t th

em o

ut, a

rran

ge fo

r ph

otoc

opie

s to

be

dist

ribut

ed t

o th

e pa

rtic

ipan

ts, a

nd in

clud

e th

em in

you

r re

port

.

A c

ompu

ter,

prin

ter,

and

phot

ocop

ier

the

chan

ge le

ader

and

cha

nge

team

ar

e lik

ely

to a

ppre

ciat

e it

if yo

u of

fer

to e

nter

the

act

ion

plan

s on

a c

om-

pute

r an

d se

nd t

hem

bac

k qu

ickl

y. t

he

prin

ted

vers

ion

will

pro

vide

the

m w

ith

a cl

ear

and

cons

iste

nt s

et o

f pla

ns t

hat

will

hel

p th

em t

o im

med

iate

ly b

egin

to

mak

e th

e ne

eded

cha

nges

. the

y ca

n al

so u

se it

to

pres

ent

the

resu

lts o

f the

w

orks

hop

to t

he r

est

of t

he n

tp, a

nd

you

will

be

able

to

use

it as

the

cen

ter-

piec

e of

you

r re

port

.

Management and organizational sustainability tool for tB 45

plen

ary

disc

ussi

on:

Dec

isio

n on

act

iviti

es fo

r im

med

iate

follo

w-u

p

Hav

e th

e sm

all g

roup

s br

iefly

sum

mar

ize

thei

r pr

ogre

ss in

co

mpl

etin

g th

eir

actio

n pl

ans

and

men

tion

any

issu

es t

hat

have

aris

en.

Faci

litat

e a

wra

p-up

dis

cuss

ion

abou

t th

e ne

xt s

teps

to

take

, in

clud

ing:

shar

ing

the

findi

ngs

and

impl

icat

ions

with

the

res

t of

the

■

■

staf

f and

oth

er s

take

hold

ers;

hold

ing

the

first

cha

nge

team

mee

ting

to fu

rthe

r sp

ecify

■

■

the

task

s fo

r ea

ch a

ctiv

ity, (

clar

ify in

divi

dual

ass

ignm

ents

, se

t de

adlin

es, a

nd d

evel

op a

pla

n fo

r m

onito

ring

prog

ress

on

the

act

ion

plan

);m

onito

ring

prog

ress

on

the

actio

n pl

an a

nd r

evis

ing

the

■■

plan

, if n

eede

d.

this

mig

ht b

e an

exc

elle

nt a

ctiv

ity fo

r th

e ch

ange

lead

er t

o fa

cilit

ate,

initi

atin

g hi

s/he

r ne

w r

ole.

If t

he c

hang

e le

ader

ag

rees

to

do t

his,

you

sho

uld

offe

r an

y as

sist

ance

nee

ded.

For

a lis

t of

sug

gest

ions

of f

ollo

w-u

p ac

tiviti

es, s

ee “

phas

e 4:

Fol

low

-Up

Ac-

tiviti

es”

on p

age

46.

Clo

sing

Retu

rn t

o th

e “p

arki

ng lo

t,”

cros

sing

off

issu

es t

hat

have

bee

n de

alt

with

and

hel

ping

par

ticip

ants

dec

ide

whe

n an

d ho

w t

o ta

ke u

p th

e is

sues

tha

t re

mai

n. p

oint

out

tha

t yo

u w

ill in

clud

e th

ese

item

s in

you

r re

port

, so

they

will

hav

e th

em o

n re

cord

to

cons

ider

whe

neve

r th

ey fi

nd it

app

ropr

iate

.

prov

ide

a fe

w m

inut

es fo

r pa

rtic

ipan

ts t

o re

flect

tog

ethe

r on

th

e w

orks

hop.

In a

n in

form

al c

onve

rsat

ion,

you

can

ask

que

s-tio

ns t

hat

will

giv

e th

em a

cha

nce

to e

xpre

ss t

heir

thou

ghts

an

d fe

elin

gs, a

nd t

hat

will

pro

vide

you

with

feed

back

. You

m

ight

ask

suc

h qu

estio

ns a

s:

Did

the

wor

ksho

p ac

hiev

e its

ant

icip

ated

out

com

es?

■■

to w

hat

exte

nt d

id it

mee

t or

not

mee

t yo

ur e

xpec

tatio

ns?

■■

Wha

t w

as t

he m

ost

usef

ul p

art

of t

his

wor

ksho

p fo

r yo

u?■

■

Wha

t w

as le

ast

usef

ul?

■■

Wha

t do

you

thi

nk y

ou p

erso

nally

can

con

trib

ute

to m

ak-

■■

ing

the

iden

tified

cha

nges

hap

pen?

Rem

embe

r to

tha

nk t

he p

artic

ipan

ts fo

r w

hat

they

hav

e co

n-tr

ibut

ed t

o th

e w

orks

hop.

You

r si

ncer

e ap

prec

iatio

n w

ill b

e a

wel

l-des

erve

d re

war

d fo

r w

hat

has

been

an

inte

nse

effo

rt.

You

may

wis

h to

dis

trib

ute

a w

ritte

n fo

rm fo

r fe

edba

ck o

n th

e pr

oces

s an

d ou

tcom

es o

f the

wor

ksho

p, a

nd o

n th

e qu

ality

of f

acili

tatio

n. H

owev

er,

it is

stil

l im

port

ant

for

part

icip

ants

to

shar

e so

me

of t

heir

thou

ghts

pub

licly

, to

cap

italiz

e on

the

ope

nnes

s th

at h

as

mar

ked

thei

r th

ree

days

tog

ethe

r.

Con

side

r go

ing

arou

nd t

he g

roup

, ask

-in

g ev

eryo

ne fo

r on

e co

mm

ent,

so

that

yo

u ge

t fe

edba

ck fr

om e

ach

part

ici-

pant

, not

just

from

tho

se w

ho r

eadi

ly

volu

ntee

r.

MOST FOR TB

Management and organizational sustainability tool for tB46

Phase 4: fOllOW-uP actiVities

A successful workshop will have set the stage for the last phase of the MOST for TB process. As quickly as possible after the workshop, you should prepare a report for the NTP, presenting the assessment findings and the resulting action plans. You should review the report in a meeting with the NTP director, TB change leader, and TB change team before it is distributed to the rest of the NTP staff. You can use this debriefing to reach agreement on follow-up activities that will move the change process forward and bring about the desired management improvements.

Suggested follow-up activities for the NTP include the following:

The NTP director, TB change leader, and TB change team meet to clarify the responsibilities ■■

they and other leaders will take on during the change process.

The NTP director, TB change leader, and TB change team integrate the MOST for TB action ■■

plans into the NTP’s operational plan.

The TB change team meets with the TB change leader to review and fine-tune the action ■■

plans, focusing on the specific tasks that will build progress toward the more broadly defined objectives, the timeline, and the individuals responsible for carrying out specific tasks. In addi-tion to defining the evidence that will be used to determine the status of objectives, the action plans specify milestones the team will use to monitor progress along the way.

The NTP director distributes the workshop report and informs the entire staff and manage-■■

ment team about the process: the rationale for conducting MOST for TB, the benefits to the NTP of improved management, the main events of the workshop, and the coming changes.

Members of the TB change team begin to achieve buy-in and engage the rest of the NTP in ■■

MOST for TB changes. They meet with individuals and work groups to discuss how the pro-posed management improvements will affect their work, answer questions, and allay fears.

Suggested follow-up activities for the facilitators include the following:

Prepare the workshop report and review it with the NTP director, TB change leader, and TB ■■

change team.

Verify that resources are allocated for a six-month or one-year follow-up MOST for TB exercise ■■

to review progress and plan for future management improvements.

Discuss options for periodic follow-up conversations, e-mails, or meetings with the TB change ■■

leader and TB change team, to check on progress and serve as a resource in implementing the action plan.

Assist the TB change team with fine-tuning their plan and in finding ways of engaging other ■■

NTP staff.

Provide technical assistance in implementing the action plan, or help the NTP find other ■■

sources of technical assistance.

Facilitate other assessment/planning exercises focusing on management components that ■■

may need more thorough consideration than was possible during the MOST for TB workshop. See the list of additional resources, on page 84, for guidelines and tools that can help NTPs conduct such assessments for several management areas.

MOST FOR TB

Management and organizational sustainability tool for tB 47

VI. WORKSHOP MATERIALS This section contains materials to be distributed to all workshop participants in a workshop binder or folder. The contents may be copied directly from this section.

The materials to be included in the participants’ binder are:

Making the MOST of Management■■

MOST for TB Workshop Agenda and Anticipated Outcomes■■

MOST for TB Assessment Instrument (to be filled out individually by each participant)■■

Assessment Consensus Form (on which participants record the assessments and comments of ■■

their colleagues, based on the individual MOST for TB instruments)

MOST for TB Action Plan Form■■

Leading and Managing Results Model■■

Leading and Managing Framework■■

resources on the MOst for tb cd-rOM

to supplement the resources listed above, the Most for tB CD-RoM includes additional ma-terials that may be useful to the workshop facilitators and participants. these resources may be used as workshop handouts or as preparatory materials for the workshop. these additional resources are:

presenting Most for tB at a staff Meeting■■

Most for tB slide presentation■■

Framework for Most for tB Action plan ■■

All additional resources listed at end of this publication can also be found on the Most for tB CD-RoM.

MOST FOR TB

Management and organizational sustainability tool for tB48

Making the MOst Of ManageMent

What is MOst for tb?

The Management and Organizational Sustainability Tool for National TB Control Programs (MOST for TB) is a structured, participatory process that allows NTPs to assess their own management performance and develop a concrete action plan for NTP-wide improvement.

NTPs that have undergone traditional management assessments may be surprised by MOST for TB. Traditional assessments rely on external evaluators, intensive data collection, and check-lists. They result in findings and recommendations but often fall short of producing a plan for improvement. MOST for TB is different. It is about making change happen through a structured, participatory process, in which staff members use an instrument to collect data from their own experience, immediately analyze the data, and use their analysis to make concrete, practical plans for improvement. Finally, the MOST for TB process recognizes that meaningful changes in man-agement rarely occur through a single event; the process includes a six-month or one-year follow-up MOST for TB exercise to review progress and make any needed changes in the action plan.

Why emphasize Management?

Management Sciences for Health (MSH), in collaboration with TB CAP partners, developed MOST for TB after years of experience in helping public- and private-sector organizations provide health services under complex and changing conditions. MOST for TB builds on a consistent finding that there are unbreakable linkages between good management, high-quality services, and organiza-tional sustainability. Good management is the glue that holds all internal parts of an NTP together, creates a positive work climate, and supports high-quality services, thus helping to bring the NTP’s vision to fruition.

A well-managed NTP that delivers high-quality services is able to satisfy the needs of the TB patients and the community. Its structure and financial base allow it to continue its work in a sometimes-changing environment within the country’s Ministry of Health.

What is the MOst for tb Process?

The MOST for TB process begins with an engagement phase to determine if MOST for TB is a good fit for the NTP; continues with a preparation phase to identify and interview staff who will lead the process; focuses on the key activity—a facilitated assessment and planning workshop; and con-cludes with follow-up activities to implement, monitor, and support agreed-upon changes.

The three-day workshop is the central component of the process. It builds a collective perspective and plan from individual experiences. It brings together, on an equal footing, managers from all levels of the NTP—from the coordinators at the local and intermediate levels to the NTP central team and the NTP director. During the workshop, participants express their individual views on management performance, share these perceptions, and reach consensus on changes that will improve performance. They establish priorities and develop an action plan that specifies objectives and activities for making these changes, including identifying the people who will be responsible for implementing the plan.

MOST FOR TB

Management and organizational sustainability tool for tB 49

For MOST for TB to yield its greatest benefits, workshop participants must play a part that con-tinues long after the workshop. They must identify the need for change, commit themselves to the process, motivate their colleagues, and take the lead in implementing the planned improvements that emerge from the workshop.

how can ntPs benefit from MOst for tb?

Through the MOST for TB process, an NTP will:

recognize the importance of good management to its effectiveness and long-term survival;■■

assess the current status of 30 essential components of NTP management;■■

assess the current status of four other program components;■■

identify feasible changes that will make the NTP more effective;■■

develop specific plans to implement these changes;■■

generate the staff buy-in needed to support the management improvements;■■

monitor the results over time and adapt the plans to changing conditions and new demands.■■

Any NTP can benefit from MOST for TB if its director and senior managers meet two criteria:

They are committed to open self-assessment and decision-making by consensus.■■

They believe that the NTP can take action to improve its management, even though there may ■■

be some constraints beyond its control.

What Management areas does MOst for tb address?

Mission. An NTP’s mission is its purpose, the reason it exists. It provides guidance, consistency, and meaning to decisions and activities at all levels. It answers the question: Why do we do what we do?

Values. An NTP’s values are the beliefs and ethical principles that underlie its mission. They give meaning to the NTP’s work and form the basis for staff commitment. They answer the question: What are the core beliefs and principles that the NTP staff all share and that give direction to our work?

Strategy. An NTP’s strategies are the broad approaches used to define the objectives and activities that will fulfill the NTP’s mission and goals. For the NTP, its strategies answer the question: How will we get to where we want to go?

Structure. Structure refers to how the NTP is legally defined or organized in a country. The func-tional structure encompasses the formal lines of authority, distribution of responsibilities, ways in which significant decisions are made, and the people held accountable for carrying out those deci-sions. Structure answers the question: Is the NTP organized in a way that facilitates what it wants to do and where it wants to go?

MOST FOR TB

Management and organizational sustainability tool for tB50

Systems. Systems are the interdependent functions that allow an NTP to do its work. MOST for TB addresses 15 systems that are the key elements of management: (1) strategic planning, (2) annual operational planning, (3) norms and procedures for TB prevention, detection, diagnosis, treatment, and care, (4) geographical and population coverage of DOTS, (5) human resources management, (6) leadership development, (7) staff training, (8) information management: operational and epidemio-logical data collection, (9) information management: use of operational and epidemiological infor-mation, (10) monitoring and evaluation, (11) supervision, (12) supply management, (13) financial management, (14) resource mobilization, (15) quality assurance: norms and procedures for TB labs. Organizational systems answer the question: What helps us carry out our activities? The MOST for TB process can help an NTP assess these systems and plan to carry out the high-priority changes needed for increased efficiency and greater effectiveness.

Other Program Components. Several other program components are very important in an NTP. MOST for TB also assesses research for TB control, ACSM, the community participation plan for TB control, and pharmacovigilance for TB medicines.

Principles underlying MOst for tb

the most effective way to initiate change in an ntp is to involve staff members at all ■■

levels in open self-assessment and consensual decision-making.

Meaningful changes in management rarely occur through a single event. they require an ■■

ongoing effort, with frequent reevaluations and adaptations.

to bring about management changes, there must be strong, committed leadership at ■■

every level of the ntp.

What else do i need to know?

If you are involved with an NTP and you sense that some management areas could be strengthened, you may want to explore MOST for TB more fully. You can talk with an experienced MOST for TB facilitator, view a slide presentation, peruse the MOST for TB guide, or speak with a representative of an NTP that has used MOST for TB.

For more information, please contact:

Management Sciences for HealthWebsite: www.msh.org

TB CAP ProjectWebsite: www.tbcta.org

MOST FOR TB

Management and organizational sustainability tool for tB 51

MOst fOr tb WOrkshOP agenda and anticiPated OutcOMes

WOrkshOP agenda

session/ Module Objectives approximate

time frame

DAY 1 Opening session Review the workshop agenda and anticipated ■■

outcomes.

Clarify expectations. ■■

Introduce the Most for tB process. ■■

Establish ground rules for an open, honest, respectful ■■

exchange of ideas.

Explore the links between leadership, improved man-■■

agement, work climate, sustainability, and organiza-tional results.

1 ½ hours

Module 1: Where are We now?

Explore the meaning of the five management areas ■■

and the 30 management components.

Work in groups that cut across organizational levels ■■

and draw on the contributions of each member.

Generate consensus on the ntp’s current status in ■■

terms of each component and stage of development.

4 ½ hours

DAY 2 Module 2: Where are We headed?

Agree on one or two objectives for improving each ■■

management component.

specify evidence that will indicate progress toward ■■

these objectives.

4 hours

Module 3: how Will We Manage the needed changes?

Explore the principles of change. ■■

Explore how changes in management, together with ■■

strong leadership, can improve an ntp’s services and sustainability.

Recognize participants’ roles as leaders and managers ■■

of the change process.

4 hours

DAY 3 Module 4: how Will We reach Our Objectives?

select the highest-priority management components ■■

to improve during the coming period.

prepare an action plan for these improvements. ■■

Decide on follow-up activities that will need to be ■■

completed, and assign responsibility for the activities.

1 day

MOST FOR TB

Management and organizational sustainability tool for tB52

anticipated Outcomes of the Workshop

By the end of the workshop, participants will have come to agreement on how well the NTP is func-tioning and will have planned activities for making improvements. The specific outcomes include:

a collective assessment of the current stage of development of the 30 management ■■

components;

a prioritized list of the management components to be improved within a specified time period;■■

an agreed-upon set of objectives for improving each management component;■■

an action plan for reaching the objectives, identifying the broad activities, timing, resources, ■■

and people responsible for completing the activities, and defining data that can provide evi-dence of success;

identification of a TB change leader and TB change team who will lead the implementation of ■■

the action plan and monitor progress;

a list of short-term activities for following up on the MOST for TB workshop: those the NTP ■■

staff can do themselves with existing resources, those for which they need to seek additional resources, and those for which they will need technical assistance from outside the NTP;

agreement on post-workshop assistance from the facilitators (by phone or e-mail) and a ■■

follow-up MOST for TB exercise, usually six months to one year after the workshop.

Management and organizational sustainability tool for tB 53

MO

st f

Or

tb

ass

essM

ent

inst

ru

Men

t

Man

agem

ent

com

pon

ent

stag

es o

f d

evel

opm

ent

and

th

eir

ch

arac

teri

stic

sc

urre

nt

stag

eev

iden

ce1

23

4

Mis

sion

exis

ten

ce a

nd

k

now

led

ge

no

form

al n

tp m

is-

sion

sta

tem

ent

ex-

ists

or

the

exis

ting

mis

sion

sta

tem

ent

is in

cons

iste

nt w

ith

the

curr

ent

prog

ram

pu

rpos

e an

d th

e ne

eds

of in

tend

ed

clie

nts.

An

ntp

mis

sion

st

atem

ent

exis

ts, i

s co

nsis

tent

with

the

cu

rren

t n

tp p

ur-

pose

, and

is s

ome-

times

cite

d by

sen

ior

staf

f.

the

mis

sion

sta

te-

men

t is

freq

uent

ly

cite

d by

key

st

akeh

olde

rs—

staf

f, ad

viso

ry b

oard

m

embe

rs, p

art-

ner

agen

cies

, and

cl

ient

s—bu

t is

not

pe

riodi

cally

rev

ised

to

refl

ect

the

need

s of

the

ntp

.

the

mis

sion

sta

te-

men

t is

wid

ely

know

n an

d re

gula

rly

revi

ewed

to

assu

re

that

it r

eflec

ts t

he

curr

ent

ntp

pur

pose

an

d th

e ne

eds

of

inte

nded

clie

nts.

Valu

es

exis

ten

ce a

nd

a

pp

licat

ion

ntp

val

ues

and

ethi

-ca

l prin

cipl

es h

ave

not

been

defi

ned.

ntp

val

ues

and

ethi

-ca

l prin

cipl

es h

ave

been

defi

ned

and

are

som

etim

es c

ited

by s

enio

r st

aff.

ntp

val

ues

and

ethi

cal p

rinci

ples

are

fr

eque

ntly

cite

d by

st

aff a

t al

l lev

els,

but

ar

e in

cons

iste

ntly

ap

plie

d ac

ross

the

pr

ogra

m.

ntp

val

ues

and

ethi

cal p

rinci

ples

are

w

idel

y kn

own,

and

st

aff a

re h

eld

ac-

coun

tabl

e fo

r ad

her-

ing

to t

hem

.

stra

teg

y

lin

ks t

o M

issi

on

and

Val

ues

ntp

str

ateg

ies

are

deve

lope

d in

re-

spon

se t

o fu

nder

s’

requ

irem

ents

or

in r

espo

nse

to t

he

pref

eren

ces

of a

few

de

cisi

on-m

aker

s,

with

out

refe

renc

e to

the

mis

sion

and

va

lues

.

ntp

str

ateg

ies

are

som

etim

es d

evel

-op

ed w

ith r

efer

ence

to

the

mis

sion

and

va

lues

, but

mor

e of

ten

in r

espo

nse

to

othe

r re

quire

men

ts,

pref

eren

ces,

and

m

anda

tes.

ntp

str

ateg

ies

are

alw

ays

deve

lope

d w

ithin

the

gen

eral

co

ntex

t of

the

mis

-si

on a

nd v

alue

s.

Beca

use

ntp

str

ate-

gies

are

dev

elop

ed

to c

onfo

rm t

o th

e m

issi

on a

nd v

alue

s,

stra

tegi

c pl

anni

ng is

vi

ewed

as

an o

ppor

-tu

nity

to

reaf

firm

or

revi

se t

he m

issi

on.

Management and organizational sustainability tool for tB54

Man

agem

ent

com

pon

ent

stag

es o

f d

evel

opm

ent

and

th

eir

ch

arac

teri

stic

sc

urre

nt

stag

eev

iden

ce1

23

4

stra

teg

y (c

onti

nue

d)

lin

ks t

o st

op t

b

stra

teg

yth

e st

op t

B st

rate

gy

is n

ot in

tegr

ated

into

n

tp s

trat

egie

s.

the

stop

tB

stra

tegy

is

inte

grat

ed in

to

ntp

str

ateg

ies,

but

is

not

defi

ned

in

coor

dina

tion

with

ot

her

publ

ic h

ealth

pr

ogra

ms

(e.g

., im

-m

uniz

atio

n, le

pros

y),

com

mun

ities

, and

/or

the

priv

ate

sect

or.

the

stop

tB

stra

tegy

is

inte

grat

ed in

to

ntp

str

ateg

ies,

and

pa

rtia

lly d

efine

d in

co

ordi

natio

n w

ith

othe

r pu

blic

hea

lth

prog

ram

s (e

.g.,

im-

mun

izat

ion,

lepr

osy)

, co

mm

uniti

es, a

nd

the

priv

ate

sect

or.

the

stop

tB

stra

tegy

is

inte

grat

ed in

to

ntp

str

ateg

ies,

and

is

alw

ays

defin

ed in

co

ordi

natio

n w

ith

othe

r pu

blic

hea

lth

prog

ram

s (e

.g.,

im-

mun

izat

ion,

lepr

osy)

, co

mm

uniti

es, a

nd

the

priv

ate

sect

or.

lin

ks t

o h

iV &

aid

s c

ontr

ol P

rog

ram

sA

join

t na

tiona

l tB

and

HIV

& A

IDs

col-

labo

ratin

g bo

dy h

as

not

been

cre

ated

to

add

ress

tB

an

d H

IV &

AID

s

colla

bora

tion.

A jo

int

natio

nal t

B an

d H

IV &

AID

s co

llabo

ratin

g bo

dy

exis

ts; h

owev

er, n

o jo

int

natio

nal p

lan

to

impl

emen

t tB

and

H

IV &

AID

s co

llab-

orat

ive

activ

ities

has

be

en d

evel

oped

.

A jo

int

natio

nal p

lan

for

tB a

nd H

IV &

A

IDs

colla

bora

tive

activ

ities

has

bee

n de

velo

ped

and

impl

emen

ted

in

pilo

t si

tes

or a

reas

. A

n H

IV &

AID

s su

r-ve

illan

ce s

yste

m fo

r tB

pat

ient

s an

d a

tB m

onito

ring

and

eval

uatio

n sy

stem

for

HIV

& A

IDs

patie

nts

exis

t in

pilo

t si

tes

or

area

s.

A jo

int

natio

nal p

lan

for

tB a

nd H

IV &

A

IDs

colla

bora

tive

activ

ities

has

bee

n im

plem

ente

d na

-tio

nwid

e. B

oth

an

HIV

& A

IDs

surv

eil-

lanc

e sy

stem

for

tB p

atie

nts

and

a tB

mon

itorin

g an

d ev

alua

tion

syst

em fo

r H

IV &

AID

s pa

tient

s ar

e op

erat

iona

l. tB

ca

se fi

ndin

gs h

ave

been

inte

nsifi

ed a

t H

IV &

AID

s pr

ogra

m

site

s an

d fo

r hi

gh-

risk

grou

ps.

Management and organizational sustainability tool for tB 55

Man

agem

ent

com

pon

ent

stag

es o

f d

evel

opm

ent

and

th

eir

ch

arac

teri

stic

sc

urre

nt

stag

eev

iden

ce1

23

4

stra

teg

y (c

onti

nue

d)

lin

ks t

o tb

Pat

ien

ts

and

com

mun

ity

stra

tegi

es a

re d

evel

-op

ed w

ithou

t re

fer-

ence

to

the

need

s of

tB

pat

ient

s or

the

ir co

mm

uniti

es.

stra

tegi

es a

re

deve

lope

d ba

sed

on

assu

mpt

ions

abo

ut

the

need

s of

tB

patie

nts

and

thei

r co

mm

uniti

es.

stra

tegi

es a

re d

e-ve

lope

d ba

sed

on a

co

mpr

ehen

sive

as-

sess

men

t/ev

alua

tion

of t

he n

eeds

of t

B pa

tient

s an

d th

eir

com

mun

ities

.

stra

tegi

es a

re d

e-ve

lope

d ba

sed

on a

co

mpr

ehen

sive

as-

sess

men

t/ev

alua

tion

of t

he n

eeds

of t

B pa

tient

s an

d th

eir

com

mun

ities

, with

th

e pa

rtic

ipat

ion

of t

B pa

tient

s an

d co

mm

unity

gro

ups.

stru

ctur

e

inst

itut

ion

aliz

atio

nth

e n

tp is

not

for-

mal

ly d

efine

d by

the

M

oH

(e.

g., d

oes

not

exis

t in

the

san

itary

co

de o

r or

gani

za-

tiona

l dia

gram

of t

he

Mo

H).

the

ntp

is fo

r-m

ally

defi

ned

by t

he

Mo

H, b

ut it

s fu

nc-

tiona

l str

uctu

re is

no

t co

nsis

tent

with

in

tern

atio

nal r

ecom

-m

enda

tions

(e.

g.,

WH

o, t

he U

nion

).

the

ntp

is fo

rmal

ly

defin

ed, a

nd it

s fu

nctio

nal s

truc

ture

fo

llow

s so

me

inte

r-na

tiona

l rec

omm

en-

datio

ns (

e.g.

, WH

o,

the

Uni

on).

the

ntp

is fo

rmal

ly

defin

ed, a

nd it

s fu

nctio

nal s

truc

ture

fo

llow

s al

l the

inte

r-na

tiona

l rec

omm

en-

datio

ns (

e.g.

, WH

o,

the

Uni

on).

lin

es o

f a

uth

orit

y an

d a

ccou

nta

bili

tyth

ere

are

no fo

rmal

do

cum

ents

tha

t de

fine

curr

ent

lines

of

aut

horit

y an

d ac

coun

tabi

lity

at t

he

diffe

rent

leve

ls o

f the

n

tp.

An

ntp

org

aniz

a-tio

nal c

hart

or

sim

ilar

docu

men

t de

fines

lin

es o

f aut

horit

y an

d ac

coun

tabi

lity

but

is

not

incl

uded

in

the

Mo

H´s

man

ual

of p

olic

ies

and

pr

oced

ures

.

An

ntp

org

aniz

a-tio

nal c

hart

or

sim

ilar

docu

men

t is

in-

clud

ed in

the

Mo

H’s

m

anua

l of p

olic

ies

and

proc

edur

es a

nd

is s

omet

imes

use

d w

hen

issu

es a

rise

pert

aini

ng t

o lin

es

of a

utho

rity

and

ac

coun

tabi

lity.

the

ntp

is c

onsi

s-te

ntly

inte

grat

ed

with

in t

he p

ubic

H

ealth

ser

vice

s (p

Hs)

at

all

leve

ls. t

he n

tp

orga

niza

tiona

l cha

rt

or s

imila

r do

cum

ent

is r

egul

arly

upd

ated

an

d co

nsis

tent

ly

used

to

reso

lve

is-

sues

per

tain

ing

to

lines

of a

utho

rity

and

acco

unta

bilit

y.

Management and organizational sustainability tool for tB56

Man

agem

ent

com

pon

ent

stag

es o

f d

evel

opm

ent

and

th

eir

ch

arac

teri

stic

sc

urre

nt

stag

eev

iden

ce1

23

4

stru

ctur

e (c

onti

nue

d)

com

mun

icat

ion

ther

e is

no

form

al

com

mun

icat

ion

mec

hani

sm t

o sh

are

info

rmat

ion

amon

g th

e di

ffere

nt le

vels

of

the

ntp

. Im

port

ant

info

rmat

ion

is c

om-

mun

icat

ed m

ainl

y by

w

ord

of m

outh

.

Com

mun

icat

ion

mec

hani

sms

are

used

to

shar

e in

for-

mat

ion

at d

iffer

ent

leve

ls o

f the

ntp

to

conv

ey n

eces

sary

in

form

atio

n fr

om

seni

or m

anag

emen

t at

the

cen

tral

leve

l to

the

rest

of t

he s

taff.

Com

mun

icat

ion

mec

hani

sms

are

used

reg

ular

ly t

o sh

are

info

rmat

ion

amon

g st

aff a

t di

f-fe

rent

leve

ls o

f the

n

tp a

nd a

re u

sed

irreg

ular

ly w

ith o

ther

pr

ogra

ms

and

pri-

vate

sec

tor.

Com

mun

icat

ion

mec

hani

sms

are

used

con

sist

ently

to

shar

e in

form

atio

n at

di

ffere

nt le

vels

of t

he

Mo

H/n

tp a

nd w

ith

the

pHs,

HIV

& A

IDs

and

imm

uniz

atio

n pr

ogra

ms,

and

oth

er

stak

ehol

ders

(pr

ivat

e he

alth

ser

vice

s an

d un

iver

sitie

s).

rol

es a

nd

r

esp

onsi

bili

ties

Role

s an

d re

spon

si-

bilit

ies

are

not

clea

rly

defin

ed. W

ork

is a

s-si

gned

on

an a

d ho

c ba

sis,

acc

ordi

ng t

o th

e pe

rcei

ved

need

s of

the

mom

ent.

Role

s an

d re

spon

-si

bilit

ies

are

in t

he

proc

ess

of b

eing

de-

fined

for

all l

evel

s of

th

e n

tp a

nd a

ll no

n-n

tp s

taff

invo

lved

in

tB

cont

rol.

Mos

t w

ork

is s

till a

ssig

ned

in a

n ad

hoc

fash

ion.

Role

s an

d re

spon

si-

bilit

ies

are

defin

ed in

a

norm

s an

d pr

oce-

dure

s m

anua

l for

all

leve

ls o

f the

ntp

and

al

l non

-ntp

sta

ff in

-vo

lved

in t

B co

ntro

l. th

ey a

re b

egin

ning

to

be

used

as

the

basi

s fo

r as

sign

ing

wor

k.

Role

s an

d re

spon

si-

bilit

ies

are

clea

rly a

s-si

gned

at

all l

evel

s of

th

e n

tp in

a n

orm

s an

d pr

oced

ures

m

anua

l. th

ey a

re

regu

larly

rev

iew

ed

to b

e su

re t

hat

staf

f as

sign

men

ts s

uppo

rt

ntp

str

ateg

ies.

dec

isio

n-M

akin

gth

e n

tp d

irect

or

mak

es a

ll si

gnifi

cant

de

cisi

ons

with

out

disc

ussi

ng t

hem

with

th

e ce

ntra

l, in

term

e-di

ate,

or

loca

l tec

hni-

cal n

tp t

eam

s.

the

ntp

dire

ctor

m

akes

all

sign

ifica

nt

deci

sion

s af

ter

liste

n-in

g to

the

vie

ws

of

the

cent

ral t

echn

ical

n

tp t

eam

, and

se-

lect

ed in

term

edia

te

tech

nica

l ntp

tea

ms.

tech

nica

l ntp

in-

term

edia

te t

eam

s ar

e en

cour

aged

by

the

ntp

dire

ctor

to

mak

e an

d ca

rry

out

sign

ifica

nt d

ecis

ions

re

gard

ing

thei

r ow

n w

ork

and

the

wor

k of

the

loca

l tea

ms.

All

ntp

sta

ff (lo

cal,

inte

rmed

iate

, and

ce

ntra

l) ar

e ex

pect

ed

to m

ake

sign

ifica

nt

deci

sion

s re

gard

ing

thei

r ow

n w

ork

and

the

wor

k of

the

ir te

ams,

and

to

carr

y ou

t th

ose

deci

sion

s.

Management and organizational sustainability tool for tB 57

Man

agem

ent

com

pon

ent

stag

es o

f d

evel

opm

ent

and

th

eir

ch

arac

teri

stic

sc

urre

nt

stag

eev

iden

ce1

23

4

syst

ems

stra

teg

ic P

lan

nin

gth

e n

tp d

oes

not

have

a c

urre

nt s

tra-

tegi

c pl

an. M

ost

stra

tegi

es, i

f the

y ex

ist,

are

unp

lann

ed,

and

deci

ded

on a

n ad

hoc

bas

is.

the

ntp

is d

evel

op-

ing

a st

rate

gic

plan

an

d co

nsid

erin

g st

ra-

tegi

c pr

iorit

ies,

but

it

is n

ot in

tegr

ated

w

ith a

ll le

vels

of t

he

pHs.

the

ntp

has

a c

ur-

rent

str

ateg

ic p

lan,

ba

sed

on a

com

pre-

hens

ive

asse

ssm

ent

of n

eeds

and

the

en

viro

nmen

t in

side

an

d ou

tsid

e th

e in

-st

itutio

n, a

nd in

line

w

ith in

tern

atio

nal

stan

dard

s. t

his

stra

-te

gic

plan

, how

ever

, is

not

fully

dis

sem

i-na

ted,

impl

emen

ted,

an

d m

onito

red.

the

ntp

has

a

defin

ed s

trat

egic

pl

an, a

nd it

is fu

lly

impl

emen

ted

and

inte

grat

ed w

ith a

ll le

vels

of t

he p

Hs

and

priv

ate

sect

or

and

mon

itore

d on

a

regu

lar

basi

s. t

he

stra

tegi

c pl

an is

ba

sed

on a

com

pre-

hens

ive

asse

ssm

ent,

an

d ea

ch n

ew s

trat

e-gi

c pl

anni

ng e

xerc

ise

begi

ns w

ith a

car

eful

an

alys

is o

f suc

cess

es

and

failu

res

in a

dher

-in

g to

the

prio

r pl

an.

Management and organizational sustainability tool for tB58

Man

agem

ent

com

pon

ent

stag

es o

f d

evel

opm

ent

and

th

eir

ch

arac

teri

stic

sc

urre

nt

stag

eev

iden

ce1

23

4

syst

ems

(con

tin

ued

)

an

nua

l Op

erat

ion

al

Plan

nin

gth

e n

tp d

oes

not

defin

e an

y an

nual

op

erat

iona

l pla

n.

Mos

t ac

tiviti

es a

re

unpl

anne

d or

not

in

tegr

ated

with

all

leve

ls o

f the

pH

s,

and

are

deci

ded

on

an a

d ho

c ba

sis.

the

ntp

is d

evel

op-

ing

an o

pera

tiona

l pl

an, b

ut t

he p

lan

is

not

inte

grat

ed w

ith

all l

evel

s of

the

pH

s.

the

ntp

has

a c

ur-

rent

ann

ual o

pera

-tio

nal p

lan.

thi

s op

-er

atio

nal p

lan

is n

ot

fully

impl

emen

ted,

bu

t it

is in

tegr

ated

w

ith a

ll le

vels

of t

he

pHs.

the

ope

ratio

nal

plan

is n

ot b

ased

on

an

asse

ssm

ent

of r

esul

ts fr

om t

he

prev

ious

yea

r or

ne

w n

eeds

tha

t ha

ve

aris

en.

the

ntp

has

a c

ur-

rent

ann

ual o

pera

-tio

nal p

lan

base

d on

a

com

preh

ensi

ve

asse

ssm

ent.

thi

s op

erat

iona

l pla

n is

be

ing

impl

emen

ted

fully

and

is in

tegr

at-

ed w

ith a

ll le

vels

of

the

pHs

and

priv

ate

sect

or. t

he a

nnua

l op

erat

iona

l pla

nnin

g pr

oces

s be

gins

with

a

care

ful a

naly

sis

of

the

prio

r op

erat

iona

l pl

an a

nd in

clud

es a

n as

sess

men

t of

new

ne

eds

and

over

all

prog

ress

mad

e by

th

e pr

ogra

m.

Management and organizational sustainability tool for tB 59

Man

agem

ent

com

pon

ent

stag

es o

f d

evel

opm

ent

and

th

eir

ch

arac

teri

stic

sc

urre

nt

stag

eev

iden

ce1

23

4

syst

ems

(con

tin

ued

)

nor

ms

and

Pr

oced

ures

for

tb

Pre

ven

tion

, d

etec

tion

, d

iag

nos

is,

trea

tmen

t,

and

car

e

the

ntp

has

not

de

fined

tec

hnic

al

norm

s an

d pr

oce-

dure

s. M

ost

tech

-ni

cal a

ctiv

ities

are

un

plan

ned,

and

are

de

cide

d on

an

ad

hoc

basi

s.

the

ntp

has

de-

velo

ped

elem

ents

of

the

nor

ms

and

proc

edur

es t

hat

will

he

lp s

taff

regu

larly

im

prov

e th

e qu

al-

ity o

f ser

vice

s, b

ut

the

elem

ents

are

no

t co

nsis

tent

with

W

Ho

and

the

Uni

on

reco

mm

enda

tions

. th

ey a

re n

ot s

yste

m-

atic

ally

app

lied

at a

ll le

vels

of t

he p

Hs.

the

ntp

has

dev

el-

oped

and

dis

sem

i-na

ted

norm

s an

d pr

oced

ures

, whi

ch

are

in a

ccor

danc

e w

ith W

Ho

and

the

U

nion

rec

omm

enda

-tio

ns. t

hey

are

regu

-la

rly a

pplie

d at

all

leve

ls o

f the

pH

s an

d in

som

e se

gmen

ts o

f th

e pr

ivat

e se

ctor

.

the

ntp

has

est

ab-

lishe

d an

d up

date

d no

rms

and

proc

e-du

res

aim

ed a

t im

-pr

ovin

g th

e qu

ality

of

ser

vice

s, w

hich

fo

llow

all

WH

o a

nd

the

Uni

on r

ecom

-m

enda

tions

. the

y ar

e co

nsis

tent

ly

appl

ied

at a

ll le

v-el

s of

the

pH

s an

d pr

ivat

e se

ctor

and

ar

e up

date

d re

gu-

larly

. tra

ined

sta

ff ar

e re

gula

rly u

sing

thi

s sy

stem

.

geo

gra

ph

ical

an

d

Pop

ulat

ion

cov

er-

age

of d

Ots

Do

ts s

trat

egy

is n

ot

impl

emen

ted

at a

ny

leve

l (ce

ntra

l, pr

ovin

-ci

al, o

r di

stric

t).

Do

ts s

trat

egy

is

impl

emen

ted

in

som

e di

stric

ts.

Do

ts s

trat

egy

has

been

impl

emen

ted

in a

ll di

stric

ts, b

ut t

B pa

tient

cov

erag

e is

be

low

100

per

cent

.

Do

ts s

trat

egy

is

fully

impl

emen

ted

at a

ll le

vels

, and

tB

patie

nt c

over

age

is

100

perc

ent.

hum

an r

esou

rces

M

anag

emen

tth

ere

are

no h

uman

re

sour

ces

polic

ies

in

the

Mo

H o

r th

e n

tp

rega

rdin

g jo

b cl

as-

sific

atio

n, s

alar

ies,

hi

ring,

pro

mot

ion,

gr

ieva

nces

, or

wor

k ho

urs.

the

re a

re n

o pr

oced

ures

for

per-

form

ance

eva

luat

ion,

st

aff d

evel

opm

ent,

or

mai

nten

ance

of

empl

oyee

dat

a.

the

Mo

H h

as r

ec-

ogni

zed

the

need

fo

r a

form

al h

uman

re

sour

ces

syst

em

and

is w

orki

ng t

o cl

arify

hum

an r

e-so

urce

s po

licie

s an

d pr

oced

ures

.

Hum

an r

esou

rces

po

licie

s an

d pr

oce-

dure

s ar

e in

pla

ce,

and

Mo

H/n

tp m

an-

ager

s ar

e be

ginn

ing

to u

se t

hem

to

hire

an

d re

tain

tal

ente

d an

d co

mm

itted

ntp

st

aff.

Hum

an r

esou

rces

po

licie

s an

d pr

oce-

dure

s ar

e in

pla

ce,

and

Mo

H/n

tp

man

ager

s us

e th

em

cons

iste

ntly

to

hire

an

d re

tain

tal

ente

d an

d co

mm

itted

ntp

st

aff.

Management and organizational sustainability tool for tB60

Man

agem

ent

com

pon

ent

stag

es o

f d

evel

opm

ent

and

th

eir

ch

arac

teri

stic

sc

urre

nt

stag

eev

iden

ce1

23

4

syst

ems

(con

tin

ued

)

lead

ersh

ip

dev

elop

men

tth

ere

is n

o po

licy

rega

rdin

g th

e de

vel-

opm

ent

of s

tron

g tB

co

ntro

l lea

ders

hip

capa

city

and

futu

re

lead

ers

for

the

ntp

.

ther

e is

a p

olic

y in

pla

ce r

egar

ding

th

e de

velo

pmen

t of

st

rong

tB

cont

rol

lead

ersh

ip c

apac

ity,

but

it is

not

follo

wed

on

a r

egul

ar b

asis

.

the

lead

ersh

ip d

e-ve

lopm

ent

polic

y is

in p

lace

and

fol-

low

ed o

n a

regu

lar

basi

s, b

ut p

artic

ipa-

tion

is s

elec

tive.

An

ntp

pla

n fo

r le

ader

ship

dev

elop

-m

ent

is in

pla

ce,

and

ther

e is

an

op-

port

unity

for

peop

le

to p

artic

ipat

e ba

sed

on p

erfo

rman

ce a

nd

othe

r es

tabl

ishe

d cr

iteria

.

staf

f tr

ain

ing

no

com

preh

ensi

ve

asse

ssm

ent

or e

valu

-at

ion

of n

tp s

taff

deve

lopm

ent

need

s in

the

con

text

of

ntp

prio

ritie

s an

d go

als

and

obje

ctiv

es

has

been

car

ried

out

for

hum

an c

apac

ity

build

ing.

the

ntp

do

es n

ot h

ave

an a

n-nu

al t

rain

ing

plan

.

A li

mite

d as

sess

men

t or

eva

luat

ion

of n

tp

staf

f dev

elop

men

t ne

eds

has

been

car

-rie

d ou

t. t

he n

tp is

aw

are

of t

he n

eed

for

a pl

an fo

r hu

man

ca

paci

ty b

uild

ing,

bu

t no

ann

ual t

rain

-in

g pl

an h

as y

et

been

defi

ned.

som

e re

fres

her

trai

ning

pr

ogra

ms

are

orga

-ni

zed,

but

with

out

inte

grat

ion

at a

ll le

vels

of t

he p

Hs.

the

ntp

has

a c

ur-

rent

ann

ual s

taff

trai

ning

pla

n ba

sed

on a

com

preh

ensi

ve

asse

ssm

ent

of t

he

need

s an

d pr

iorit

ies

for

hum

an c

apac

-ity

bui

ldin

g. t

his

trai

ning

pla

n is

not

fu

lly im

plem

ente

d.

Refr

eshe

r tr

aini

ng

prog

ram

s ar

e oc

ca-

sion

ally

car

ried

out

at lo

cal a

nd in

term

e-di

ate

leve

ls.

the

ntp

has

a c

ur-

rent

ann

ual s

taff

trai

ning

pla

n ba

sed

on a

com

preh

ensi

ve

asse

ssm

ent

of t

he

need

s an

d pr

iorit

ies

for

capa

city

bui

ldin

g.

this

tra

inin

g pl

an is

fu

lly im

plem

ente

d an

d in

tegr

ated

at

all l

evel

s of

the

pH

s an

d pr

ivat

e se

ctor

. Re

gula

r re

fres

her

trai

ning

pro

gram

s ar

e de

sign

ed a

nd

impl

emen

ted

at a

ll le

vels

to

stre

ngth

en

perf

orm

ance

.

Management and organizational sustainability tool for tB 61

Man

agem

ent

com

pon

ent

stag

es o

f d

evel

opm

ent

and

th

eir

ch

arac

teri

stic

sc

urre

nt

stag

eev

iden

ce1

23

4

syst

ems

(con

tin

ued

)

info

rmat

ion

M

anag

emen

t:

Op

erat

ion

al a

nd

ep

idem

iolo

gic

al

dat

a c

olle

ctio

n

the

ntp

has

a p

oor

info

rmat

ion

syst

em

for

data

col

lect

ion

and

repo

rtin

g. R

ou-

tine

serv

ice

data

are

of

ten

inac

cura

te,

and

thes

e da

ta a

re

rare

ly s

ubm

itted

on

sche

dule

.

the

ntp

has

intr

o-du

ced

syst

ems

that

ar

e be

ginn

ing

to

impr

ove

the

accu

-ra

cy a

nd t

imel

ines

s of

rou

tine

serv

ice

and

epid

emio

logi

cal

data

. som

e pr

oce-

dure

s co

nsis

tent

with

W

Ho

and

the

Uni

on

reco

mm

enda

tions

ar

e cu

rren

tly in

use

. th

e qu

ality

and

tim

-in

g of

rep

ortin

g st

ill

do n

ot m

eet

expe

ct-

ed s

tand

ards

.

the

info

rmat

ion

syst

em y

ield

s ro

utin

e da

ta. t

he s

yste

m’s

pr

oced

ures

and

in

form

atio

n to

ols

are

larg

ely

cons

iste

nt

with

WH

o a

nd t

he

Uni

on r

ecom

men

-da

tions

. Dat

a ar

e ge

nera

lly c

onsi

dere

d ac

cura

te, a

nd m

ost

repo

rts

are

subm

it-te

d on

tim

e.

A s

tand

ardi

zed

info

r-m

atio

n sy

stem

and

to

ols

for

data

col

lec-

tion

cons

iste

nt w

ith

WH

o a

nd t

he U

nion

re

com

men

datio

ns

exis

t, a

nd t

he s

yste

m

is fu

lly im

plem

ente

d at

all

leve

ls o

f the

n

tp. t

he q

ualit

y an

d tim

ing

of r

epor

t-in

g m

eet

expe

cted

st

anda

rds.

the

re

are

clea

rly e

nfor

ced

cons

eque

nces

for

late

rep

orts

. oth

er

orga

niza

tiona

l sys

-te

ms

prov

ide

cros

s-ch

ecki

ng t

o gu

aran

-te

e th

e ac

cura

cy o

f ro

utin

e da

ta.

Management and organizational sustainability tool for tB62

Man

agem

ent

com

pon

ent

stag

es o

f d

evel

opm

ent

and

th

eir

ch

arac

teri

stic

sc

urre

nt

stag

eev

iden

ce1

23

4

syst

ems

(con

tin

ued

)

info

rmat

ion

M

anag

emen

t: u

se

of O

per

atio

nal

an

d

epid

emio

log

ical

in

form

atio

n

thos

e w

ho s

ubm

it re

quire

d da

ta a

nd

data

rep

orts

rec

eive

no

feed

back

from

th

eir

man

ager

s.

Info

rmat

ion

is fi

led

away

and

is n

ot

used

for

man

age-

men

t or

pro

gram

-m

atic

dec

isio

ns.

the

ntp

is a

war

e of

th

e ne

ed t

o an

alyz

e an

d us

e in

form

atio

n.

som

e in

form

atio

n pr

oces

ses

are

de-

fined

, but

are

not

us

ed c

onsi

sten

tly

at a

ll le

vels

to

im-

prov

e m

anag

emen

t an

d pe

rfor

man

ce,

achi

eve

outc

omes

, an

d id

entif

y tr

ends

.

Info

rmat

ion

proc

ess-

es a

re in

tegr

ated

at

all l

evel

s of

the

ntp

an

d ar

e us

ed t

o pr

o-vi

de p

rom

pt fe

ed-

back

and

defi

ne c

or-

rect

ive

and

proa

ctiv

e st

eps

whe

n ne

eded

. th

e n

tp a

naly

zes

the

info

rmat

ion

and

uses

its

findi

ngs

at

som

e le

vels

to

im-

prov

e m

anag

emen

t an

d pe

rfor

man

ce,

achi

eve

outc

omes

, an

d an

alyz

e tr

ends

.

Info

rmat

ion

proc

ess-

es a

re in

tegr

ated

at

all l

evel

s of

the

ntp

an

d ar

e us

ed t

o pr

o-vi

de p

rom

pt fe

ed-

back

and

defi

ne c

or-

rect

ive

and

proa

ctiv

e st

eps

whe

n ne

eded

. th

e n

tp a

t al

l lev

els

toge

ther

ana

lyze

the

in

form

atio

n an

d us

e th

eir

findi

ngs

to im

-pr

ove

man

agem

ent

and

perf

orm

ance

, ac

hiev

e ou

tcom

es,

and

anal

yze

tren

ds.

Mon

itor

ing

an

d

eval

uati

onth

e n

tp d

oes

not

mon

itor

or e

valu

ate

its p

rogr

am r

esul

ts;

rath

er, i

ts r

esul

ts a

re

eval

uate

d by

ext

er-

nal e

valu

ator

s w

hen

fund

ers

dem

and

it.

the

ntp

som

etim

es

mon

itors

its

own

wor

k to

det

er-

min

e ad

here

nce

to

plan

ned

activ

ities

. Re

sults

are

eva

luat

ed

by in

tern

al o

r ex

ter-

nal t

eam

s.

the

ntp

reg

ular

ly

mon

itors

its

own

wor

k to

det

erm

ine

prog

ress

tow

ard

achi

evin

g go

als

and

obje

ctiv

es d

urin

g th

e co

urse

of t

he

prog

ram

yea

r. M

oni-

torin

g is

don

e w

ith

soun

d in

stru

men

ts.

the

ntp

eva

luat

es

resu

lts a

t th

e en

d of

ea

ch p

rogr

am y

ear.

the

ntp

reg

ular

ly

mon

itors

its

pro-

gram

, eva

luat

es r

e-su

lts, a

nd s

yste

mat

i-ca

lly u

ses

findi

ngs

to

impr

ove

serv

ices

and

pl

an n

ew a

ctiv

ities

. te

chni

cal a

nd m

ana-

geria

l com

pone

nts

are

form

ally

incl

uded

in

the

ntp

ann

ual

eval

uatio

n.

Management and organizational sustainability tool for tB 63

Man

agem

ent

com

pon

ent

stag

es o

f d

evel

opm

ent

and

th

eir

ch

arac

teri

stic

sc

urre

nt

stag

eev

iden

ce1

23

4

syst

ems

(con

tin

ued

)

sup

ervi

sion

the

ntp

doe

s no

t ha

ve a

cle

ar s

uper

vi-

sion

sys

tem

, and

no

cons

iste

nt fi

nanc

ial

supp

ort

has

been

al

loca

ted

for

supe

rvi-

sion

act

iviti

es. s

uper

-vi

sors

do

not

rece

ive

trai

ning

on

supe

rvi-

sion

ski

lls.

the

ntp

has

an

esta

blis

hed

supe

r-vi

sion

sys

tem

but

su

perv

isio

n fu

nc-

tions

and

rol

es a

re

not

unde

rsto

od, t

he

supe

rvis

ion

guid

e ha

s no

t be

en c

are-

fully

pre

pare

d, a

nd

supe

rvis

ion

take

s pl

ace

spor

adic

ally

an

d w

ithou

t in

tegr

a-tio

n at

all

leve

ls o

f th

e pH

s.

ther

e ar

e es

tabl

ishe

d to

ols

for

supe

rvis

ion

in t

he n

tp, i

nclu

d-in

g a

supe

rvis

ion

guid

e, n

orm

s an

d pr

oced

ures

for

su-

perv

isio

n, a

nd a

vis

it sc

hedu

le. H

owev

er,

supe

rvis

ion

with

all

of t

hese

inst

rum

ents

is

not

fully

impl

e-m

ente

d at

all

leve

ls

of t

he p

Hs.

the

cen

-tr

al t

eam

per

iodi

cally

su

perv

ises

the

inte

r-m

edia

te le

vels

but

w

ithou

t ad

equa

te

finan

cial

sup

port

. te

chni

cal a

nd m

ana-

geria

l com

pone

nts

of t

he n

tp a

re o

nly

som

etim

es in

clud

ed

in s

uper

visi

on.

supe

rvis

ion

is w

ell

inst

itutio

naliz

ed

with

in t

he n

tp.

supe

rvis

ion

inst

ru-

men

ts a

nd g

uide

s ar

e us

ed c

onsi

sten

tly

and

refle

ct t

B no

rms

and

proc

edur

es a

nd

best

pra

ctic

e. t

he

ntp

con

duct

s su

per-

visi

on r

egul

arly

at

all

leve

ls a

nd in

tegr

ates

th

is w

ork

with

the

pH

s an

d th

e pr

ivat

e se

ctor

. Ade

quat

e fin

anci

al s

uppo

rt

exis

ts. t

he n

tp

uses

find

ings

from

su

perv

isio

n vi

sits

to

impr

ove

serv

ices

at

all l

evel

s of

the

pH

s,

incl

udin

g th

e pr

ivat

e se

ctor

, and

to

plan

ne

w a

ctiv

ities

.

Management and organizational sustainability tool for tB64

Man

agem

ent

com

pon

ent

stag

es o

f d

evel

opm

ent

and

th

eir

ch

arac

teri

stic

sc

urre

nt

stag

eev

iden

ce1

23

4

syst

ems

(con

tin

ued

)

sup

ply

M

anag

emen

tth

ere

is n

o su

pply

m

anag

emen

t sy

stem

in

pla

ce t

o fo

reca

st,

proc

ure,

tra

ck, o

r re

gula

te s

uppl

ies

(tB

med

icin

es, l

abor

a-to

ry r

eage

nts)

use

d by

sta

ff at

all

leve

ls

of t

he n

tp. s

uppl

ies

are

stor

ed in

poo

r co

nditi

ons,

and

no

reco

rds

are

kept

for

inve

ntor

y co

ntro

l. st

ock-

outs

occ

ur

freq

uent

ly.

A s

uppl

y m

anag

e-m

ent

syst

em h

as

been

des

igne

d to

al

low

the

Mo

H/n

tp

to s

elec

t, fo

reca

st,

proc

ure,

reg

ulat

e,

stor

e, d

istr

ibut

e, a

nd

use

supp

lies

for

the

ntp

. For

ecas

ting

of

futu

re r

equi

rem

ents

is

not

con

sist

ently

do

ne; s

tock

-out

s oc

cur

perio

dica

lly.

staf

f hav

e no

t ye

t be

en t

rain

ed t

o ca

rry

out

new

func

tions

in

supp

ly m

anag

emen

t.

the

Mo

H/n

tp s

up-

ply

man

agem

ent

syst

em a

llow

s th

e n

tp t

o fo

reca

st

need

s an

d pr

ocur

e qu

ality

affo

rdab

le

supp

lies

in r

elat

ion

to t

heir

dem

and

and

use.

A g

ood

reco

rd-

keep

ing

syst

em h

as

been

impl

emen

ted

at m

ost

site

s. s

ome

staf

f hav

e be

en

trai

ned

to c

arry

out

ne

w fu

nctio

ns in

the

sy

stem

. sto

ck-o

uts

occu

r oc

casi

onal

ly.

Mo

H/n

tp s

taff

have

be

en t

rain

ed t

o ap

-pr

opria

tely

sel

ect,

fo

reca

st, p

rocu

re,

stor

e, d

istr

ibut

e an

d us

e su

pplie

s, a

nd t

o ke

ep g

ood

reco

rds

at a

ll le

vels

of t

he

supp

ly m

anag

e-m

ent

syst

em. p

atie

nt

adhe

renc

e to

tre

at-

men

t an

d ph

ysic

ian

pres

crib

ing

are

both

m

onito

red.

Goo

d qu

ality

and

affo

rd-

able

sup

plie

s ar

e co

ntin

uous

ly a

vail-

able

, with

no

stoc

k-ou

ts o

ccur

ring

in t

he

syst

em.

Management and organizational sustainability tool for tB 65

Man

agem

ent

com

pon

ent

stag

es o

f d

evel

opm

ent

and

th

eir

ch

arac

teri

stic

sc

urre

nt

stag

eev

iden

ce1

23

4

syst

ems

(con

tin

ued

)

fin

anci

al

Man

agem

ent

Fina

ncia

l sta

ff at

the

M

oH

dev

elop

bud

-ge

ts w

ithou

t in

put

from

ntp

man

ager

s.

the

finan

cial

sys

tem

do

es n

ot a

ccur

atel

y tr

ack

expe

nditu

res,

re

venu

es, a

nd c

ash

flow

.

the

ntp

man

ager

de

velo

ps t

he b

udge

t an

d us

ually

see

ks

inpu

t fr

om r

egio

nal

and

dist

rict

ntp

m

anag

ers

and

othe

r st

akeh

olde

rs. t

he

ntp

sub

mits

bud

-ge

ts t

o th

e M

oH

for

fund

ing.

the

Mo

H fi

nan-

cial

sta

ff w

ork

with

n

tp m

anag

ers

to

defin

e th

e an

nual

op

erat

iona

l pla

n an

d bu

dget

bas

ed

on e

pide

mio

logi

cal,

serv

ice,

and

fina

ncia

l da

ta. t

he fi

nanc

ial

syst

em t

rack

s ex

pen-

ditu

res,

rev

enue

s,

and

cash

flow

by

line

item

, with

som

e lin

ks

to p

rogr

am o

utpu

ts

and

serv

ices

.

ntp

man

ager

s w

ork

with

Mo

H fi

nanc

ial

staf

f to

deve

lop

bud-

gets

tha

t su

ppor

t pr

ogra

mm

atic

dec

i-si

ons.

the

fina

ncia

l sy

stem

pre

sent

s an

ac

cura

te p

ictu

re o

f ex

pend

iture

s, r

ev-

enue

s, a

nd c

ash

flow

in

rel

atio

n to

pro

-gr

am o

utpu

ts a

nd

serv

ices

.

res

ourc

e

Mob

iliza

tion

the

ntp

ope

rate

s w

ith a

sin

gle

sour

ce

of r

even

ue, u

sual

ly

gove

rnm

ent

fund

s,

who

se m

anda

tes

shap

e st

rate

gies

and

pr

ogra

ms.

the

ntp

has

sta

ted

the

need

for

dive

rsi-

fied

fund

ing.

It h

as

devi

sed,

but

not

ye

t im

plem

ente

d, a

st

rate

gy fo

r ob

tain

-in

g re

venu

e fr

om

dive

rse

sour

ces

(e.g

., G

loba

l Fun

d,

UsA

ID).

the

ntp

has

beg

un

to im

plem

ent

its

dive

rsifi

catio

n st

rat-

egy

and

has

alre

ady

obta

ined

sig

nific

ant

reve

nue

from

div

erse

so

urce

s to

cov

er

need

s.

the

ntp

follo

ws

a lo

ng-t

erm

, rev

enue

-ge

nera

ting

stra

tegy

, ba

lanc

ing

dive

rse

sour

ces

of r

even

ue

to m

eet

curr

ent

and

futu

re n

eeds

.

Management and organizational sustainability tool for tB66

Man

agem

ent

com

pon

ent

stag

es o

f d

evel

opm

ent

and

th

eir

ch

arac

teri

stic

sc

urre

nt

stag

eev

iden

ce1

23

4

syst

ems

(con

tin

ued

)

Qua

lity

ass

uran

ce:

nor

ms

and

Pr

oced

ures

for

tb

lab

orat

orie

s

the

ntp

has

not

de-

fined

a q

ualit

y as

sur-

ance

sys

tem

. Mos

t te

chni

cal a

ctiv

ities

ar

e un

plan

ned,

and

de

cide

d on

an

ad

hoc

basi

s.

the

ntp

has

dev

el-

oped

ele

men

ts o

f a

qual

ity a

ssur

ance

sy

stem

tha

t w

ill h

elp

staf

f reg

ular

ly a

sses

s an

d im

prov

e th

e qu

ality

of t

B la

bs,

but

thes

e ar

e no

t co

nsis

tent

with

WH

o

and

the

Uni

on r

ec-

omm

enda

tions

. the

sy

stem

is n

ot c

onsi

s-te

ntly

app

lied

at a

ll le

vels

of t

he p

Hs.

the

ntp

has

de-

velo

ped

a qu

ality

as

sura

nce

syst

em

for

tB la

bs t

hat

is

in a

ccor

danc

e w

ith

WH

o a

nd t

he U

nion

re

com

men

datio

ns

and

is r

egul

arly

ap-

plie

d at

all

leve

ls o

f th

e pH

s.

the

ntp

has

est

ab-

lishe

d an

ong

oing

sy

stem

for

asse

ssin

g an

d im

prov

ing

the

qual

ity o

f tB

labs

th

at fo

llow

s al

l WH

o

and

the

Uni

on r

ec-

omm

enda

tions

. It

is c

onsi

sten

tly a

p-pl

ied

at a

ll le

vels

of

the

pHs

and

priv

ate

sect

or, a

nd r

egul

arly

up

date

d. t

rain

ed

staf

f are

reg

ular

ly u

s-in

g th

is s

yste

m.

Oth

er P

rog

ram

com

pon

ents

res

earc

h f

or t

b

con

trol

Rese

arch

pol

icy

pri-

oriti

es a

nd p

roto

cols

ar

e no

t w

ell d

efine

d or

ava

ilabl

e fo

r th

e n

tp.

the

ntp

has

a r

e-se

arch

pol

icy,

but

pr

otoc

ols

have

not

ye

t be

en d

evel

oped

. th

e n

tp h

as n

ot y

et

esta

blis

hed

coor

di-

natio

n w

ith o

ther

co

mpo

nent

s of

the

M

oH

/res

earc

h in

sti-

tutio

ns.

Rese

arch

prio

ritie

s an

d ob

ject

ives

exi

st

that

are

bas

ed o

n W

Ho

rec

omm

enda

-tio

ns, a

nd a

re d

e-fin

ed in

coo

rdin

atio

n w

ith o

ther

com

po-

nent

s of

the

Mo

H.

prot

ocol

s ha

ve

been

dev

elop

ed b

ut

are

not

yet

coor

di-

nate

d w

ith n

atio

nal

regu

latio

ns.

Rese

arch

prio

ri-tie

s an

d ob

ject

ives

ar

e ba

sed

on W

Ho

an

d th

e U

nion

re

com

men

datio

ns

and

are

defin

ed in

co

ordi

natio

n w

ith

othe

r co

mpo

nent

s of

the

Mo

H. A

ll pr

otoc

ols

deve

lope

d an

d ap

prov

ed a

re

in a

ccor

danc

e w

ith

natio

nal r

egul

atio

ns.

the

rese

arch

ser

ves

as a

reg

ular

bas

is

for

reas

sess

ing

and

rede

finin

g st

rate

gies

, in

clud

ing

prio

ritie

s fo

r re

sear

ch.

Management and organizational sustainability tool for tB 67

Man

agem

ent

com

pon

ent

stag

es o

f d

evel

opm

ent

and

th

eir

ch

arac

teri

stic

sc

urre

nt

stag

eev

iden

ce1

23

4

Oth

er P

rog

ram

com

pon

ents

(co

nti

nue

d)

ad

voca

cy,

com

mun

icat

ion

, an

d s

ocia

l M

obili

zati

on

(ac

sM)

the

ntp

has

not

de

velo

ped

an A

CsM

pl

an. M

ost

AC

sM

activ

ities

are

un-

plan

ned,

and

de-

cide

d on

an

ad h

oc

basi

s.

the

ntp

has

a c

ur-

rent

AC

sM p

lan

base

d on

a c

ompr

e-he

nsiv

e as

sess

men

t of

the

nee

ds a

nd

prio

ritie

s fo

r im

ple-

men

tatio

n an

d ex

-pa

nsio

n of

the

Do

ts

stra

tegy

. How

ever

, tB

sta

keho

lder

s ar

e no

t in

volv

ed in

the

de

velo

pmen

t of

A

CsM

; and

AC

sM

is n

ot c

onsi

sten

tly

impl

emen

ted

at a

ll le

vels

of t

he p

Hs

and

the

com

mun

ity.

the

ntp

AC

sM p

lan,

ba

sed

on a

com

pre-

hens

ive

asse

ssm

ent

of t

he n

eeds

and

pri-

oriti

es fo

r im

plem

en-

tatio

n an

d ex

pans

ion

of t

he D

ots

str

at-

egy,

is c

urre

nt a

nd is

be

ing

impl

emen

ted.

tB

sta

keho

lder

s ar

e in

volv

ed in

the

de-

velo

pmen

t of

AC

sM,

and

som

etim

es it

is

appl

ied

at a

ll le

vels

of

the

pH

s, c

om-

mun

ity, a

nd p

rivat

e se

ctor

.

the

ntp

AC

sM

plan

, bas

ed o

n a

com

preh

ensi

ve a

s-se

ssm

ent

of t

he

need

s an

d pr

iorit

ies

for

impl

emen

tatio

n an

d ex

pans

ion

of t

he

Do

ts s

trat

egy,

with

in

volv

emen

t of

tB

stak

ehol

ders

, is

con-

sist

ently

app

lied

at

all l

evel

s of

the

pH

s,

com

mun

ity, a

nd

priv

ate

sect

or, a

nd is

re

gula

rly u

pdat

ed.

com

mun

ity

Pa

rtic

ipat

ion

Pla

n

for

tb c

ontr

ol

the

ntp

has

not

de

velo

ped

a co

m-

mun

ity p

artic

ipat

ion

plan

. Mos

t ac

tiviti

es

are

unpl

anne

d, a

nd

deci

ded

on a

n ad

ho

c ba

sis.

the

ntp

has

a d

e-fin

ed c

omm

unity

pa

rtic

ipat

ion

plan

ba

sed

on a

com

-pr

ehen

sive

ass

ess-

men

t of

the

nee

ds

and

prio

ritie

s fo

r im

plem

enta

tion

and

expa

nsio

n of

the

D

ots

str

ateg

y. t

he

part

icip

atio

n pl

an,

in m

any

inst

ance

s,

does

not

invo

lve

or

cons

ult

the

com

mu-

nity

sta

keho

lder

s.

the

ntp

has

defi

ned

a co

mm

unity

par

-tic

ipat

ion

plan

bas

ed

on a

com

preh

ensi

ve

asse

ssm

ent

of t

he

need

s an

d pr

iorit

ies

for

impl

emen

tatio

n an

d ex

pans

ion

of

the

Do

ts s

trat

egy.

so

met

imes

the

par

-tic

ipat

ion

plan

is

appl

ied

at a

ll le

vels

of

the

pH

s, a

nd

incl

udes

invo

lve-

men

t of

com

mun

ity

stak

ehol

ders

and

the

pr

ivat

e se

ctor

.

the

ntp

com

mu-

nity

par

ticip

atio

n pl

an, b

ased

on

a co

mpr

ehen

sive

as-

sess

men

t of

the

ne

eds

and

prio

ritie

s fo

r im

plem

enta

tion

and

expa

nsio

n of

th

e D

ots

str

ateg

y,

is d

evel

oped

and

is

bein

g im

plem

ente

d.

the

ntp

com

mun

ity

part

icip

atio

n pl

an

invo

lves

com

mun

ity

stak

ehol

ders

and

the

pr

ivat

e se

ctor

and

is

regu

larly

upd

ated

.

Management and organizational sustainability tool for tB68

Man

agem

ent

com

pon

ent

stag

es o

f d

evel

opm

ent

and

th

eir

ch

arac

teri

stic

sc

urre

nt

stag

eev

iden

ce1

23

4

Oth

er P

rog

ram

com

pon

ents

(co

nti

nue

d)

Phar

mac

ovig

ilan

ce

for

tb M

edic

ines

(a

ctiv

ities

rel

atin

g to

th

e de

tect

ion,

ass

ess-

men

t, u

nder

stan

d-in

g, a

nd p

reve

ntio

n of

adv

erse

med

icin

e ef

fect

s)

proc

edur

es fo

r ph

ar-

mac

ovig

ilanc

e of

tB

med

icin

es a

re n

ot

wel

l defi

ned

or r

eadi

-ly

ava

ilabl

e. t

he n

tp

is n

ot c

urre

ntly

con

-si

derin

g an

y st

rate

gy

for

deve

lopi

ng p

har-

mac

ovig

ilanc

e fo

r tB

m

edic

ines

.

som

e st

anda

rd p

ro-

cedu

res

exis

t bu

t ha

ve n

ot b

een

im-

plem

ente

d, a

nd t

hey

are

not

alw

ays

base

d on

inte

rnat

iona

l re

com

men

datio

ns.

the

ntp

has

not

yet

es

tabl

ishe

d co

ordi

-na

tion

with

oth

er

com

pone

nts

of t

he

Mo

H fo

r th

e de

fini-

tion

of t

he p

olic

ies

and

obje

ctiv

es.

A p

harm

acov

igi-

lanc

e sy

stem

for

tB

med

icin

es e

xist

s an

d is

bas

ed o

n in

tern

a-tio

nal r

ecom

men

da-

tions

, and

is d

efine

d in

coo

rdin

atio

n w

ith

othe

r co

mpo

nent

s of

the

Mo

H. A

ll st

anda

rd p

roce

dure

s ar

e av

aila

ble

in t

he

guid

elin

es, b

ut t

hese

pr

oced

ures

are

not

al

way

s co

nsis

tent

ly

impl

emen

ted

at a

ll le

vels

of t

he p

Hs.

phar

mac

ovig

ilanc

e pr

oced

ures

for

tB

med

icin

es a

re w

ell

defin

ed a

nd r

eadi

ly

avai

labl

e, a

re b

ased

on

inte

rnat

iona

l rec

-om

men

datio

ns, a

nd

are

defin

ed in

coo

r-di

natio

n w

ith o

ther

co

mpo

nent

s of

the

M

oH

at

all l

evel

s.

All

proc

edur

es h

ave

guid

elin

es, a

nd a

re

fully

impl

emen

ted

and

regu

larly

rev

ised

at

all

leve

ls o

f the

pH

s an

d th

e pr

ivat

e se

ctor

.

MOST FOR TB

Management and organizational sustainability tool for tB 69

MOst fOr tb assessMent cOnsensus fOrM

Before beginning the consensus step, workshop participants should work alone to identify the stage of development for each management component of the NTP. They should also list one or two examples from their experience as evidence to support their assessment. When they have finished, the facilitator will place them in groups of up to five people.

instructions

Take notes on the Assessment Consensus Form as the members of your small group each state 1. the stage of development he or she chose for each management component, along with the evidence for that decision. Use the central section of the form to record the name (or initials) of each group member, and under the name, the stage of development that person selected. In the larger white space beneath the names and individual stages, summarize the evidence pre-sented by all group members.

Discuss each management component in turn, exploring any differences in your perceptions. 2. Remember that:

everyone’s viewpoint is equally valid because it represents that person’s individual ■■

experience;

all characteristics of a given stage of development must be present to place the NTP at that ■■

stage—if any single characteristic is absent, the NTP fits an earlier stage.

For each management component, come to consensus on the stage of development that best 3. describes the NTP, citing the one or two pieces of evidence that you all agree support your decision. Record these in the far-right column of the table.

MOST FOR TB

Management and organizational sustainability tool for tB70

assessMent cOnsensus fOrM

Management component

Participant _______

Participant _______

Participant _______

Participant _______

Participant _______

group consensus

MissiOn existence and knowledge

individual stage selected consensus stage

individual evidence consensus evidence

Values existence and application

individual stage selected consensus stage

individual evidence consensus evidence

strategy links to Mission and Values

individual stage selected consensus stage

individual evidence consensus evidence

MOST FOR TB

Management and organizational sustainability tool for tB 71

Management component

Participant _______

Participant _______

Participant _______

Participant _______

Participant _______

group consensus

strategy links to stop tb strategy

individual stage selected consensus stage

individual evidence consensus evidence

strategy links to hiV & aids control Program

individual stage selected consensus stage

individual evidence consensus evidence

strategy links to tb Patients and community

individual stage selected consensus stage

individual evidence consensus evidence

MOST FOR TB

Management and organizational sustainability tool for tB72

Management component

Participant _______

Participant _______

Participant _______

Participant _______

Participant _______

group consensus

structure institutional-ization

individual stage selected consensus stage

individual evidence consensus evidence

structure lines of authority and accountability

individual stage selected consensus stage

individual evidence consensus evidence

structure communication individual stage selected consensus

stage

individual evidence consensus evidence

MOST FOR TB

Management and organizational sustainability tool for tB 73

Management component

Participant _______

Participant _______

Participant _______

Participant _______

Participant _______

group consensus

structure roles and responsibilities

individual stage selected consensus stage

individual evidence consensus evidence

structure decision- Making

individual stage selected consensus stage

individual evidence consensus evidence

systeMs strategic Planning

individual stage selected consensus stage

individual evidence consensus evidence

MOST FOR TB

Management and organizational sustainability tool for tB74

Management component

Participant _______

Participant _______

Participant _______

Participant _______

Participant _______

group consensus

systeMs annual Operational Planning

individual stage selected consensus stage

individual evidence consensus evidence

systeMs norms and Procedures for tb Prevention, detection, diagnosis, treatment, and care

individual stage selected consensus stage

individual evidence consensus evidence

systeMs geographical and Population coverage of dOts

individual stage selected consensus stage

individual evidence consensus evidence

MOST FOR TB

Management and organizational sustainability tool for tB 75

Management component

Participant _______

Participant _______

Participant _______

Participant _______

Participant _______

group consensus

systeMs human resources Management

individual stage selected consensus stage

individual evidence consensus evidence

systeMs leadership development

individual stage selected consensus stage

individual evidence consensus evidence

systeMs staff training individual stage selected consensus

stage

individual evidence consensus evidence

MOST FOR TB

Management and organizational sustainability tool for tB76

Management component

Participant _______

Participant _______

Participant _______

Participant _______

Participant _______

group consensus

systeMs information Management: Operational and epidemiological data collection

individual stage selected consensus stage

individual evidence consensus evidence

systeMs information Management: use of Operational and epidemiological information

individual stage selected consensus stage

individual evidence consensus evidence

systeMs Monitoring and evaluation

individual stage selected consensus stage

individual evidence consensus evidence

MOST FOR TB

Management and organizational sustainability tool for tB 77

Management component

Participant _______

Participant _______

Participant _______

Participant _______

Participant _______

group consensus

systeMs supervision individual stage selected consensus

stage

individual evidence consensus evidence

systeMs supply Management

individual stage selected consensus stage

individual evidence consensus evidence

systeMs financial Management

individual stage selected consensus stage

individual evidence consensus evidence

MOST FOR TB

Management and organizational sustainability tool for tB78

Management component

Participant _______

Participant _______

Participant _______

Participant _______

Participant _______

group consensus

systeMs resource Mobilization

individual stage selected consensus stage

individual evidence consensus evidence

systeMs Quality assurance: norms and Procedures for tb labs

individual stage selected consensus stage

individual evidence consensus evidence

Other PrOgraM cOMPOnents research for tb control

individual stage selected consensus stage

individual evidence consensus evidence

MOST FOR TB

Management and organizational sustainability tool for tB 79

Management component

Participant _______

Participant _______

Participant _______

Participant _______

Participant _______

group consensus

Other PrOgraM cOMPOnents advocacy, communica-tion, and social Mobilization (acsM)

individual stage selected consensus stage

individual evidence consensus evidence

Other PrOgraM cOMPOnents community Participation Plan for tb control

individual stage selected consensus stage

individual evidence consensus evidence

Other PrOgraM cOMPOnents Pharmaco-vigilance for tb Medicines

individual stage selected consensus stage

individual evidence consensus evidence

Management and organizational sustainability tool for tB80

MO

st f

Or

tb

ac

tiO

n P

lan

fO

rM

inst

ruct

ion

s

Mak

e as

man

y co

pies

of t

his

form

as

need

ed to

enc

ompa

ss a

ll th

e ob

ject

ives

in th

e ac

tion

plan

. (Th

e pa

rtic

ipan

ts m

ay c

hoos

e to

use

this

or

anot

her f

orm

at th

at c

orre

spon

ds to

thei

r ow

n pl

anni

ng p

roce

ss. I

f the

y us

e a

diffe

rent

form

at, t

hey

may

nee

d to

ada

pt it

to in

clud

e al

l the

pl

anni

ng e

lem

ents

that

are

iden

tified

her

e.)

Man

agem

ent C

ompo

nen

t: _

____

____

____

____

____

____

____

___

TB

Cha

nge

Lead

er: _

____

____

____

____

____

____

____

___

Ob

ject

ives

evid

ence

of

ach

ieve

men

ta

ctiv

itie

s

res

ourc

es

nee

ded

(h

uman

, fi

nan

cial

, M

ater

ial)

Peop

le

res

pon

sib

le

tim

elin

e

1st

Qua

rter

2nd

Qua

rter

3rd

Qua

rter

4th

Qua

rter

MO

nth

s

12

34

56

78

910

1112

Management and organizational sustainability tool for tB 81

Ob

ject

ives

evid

ence

of

ach

ieve

men

ta

ctiv

itie

s

res

ourc

es

nee

ded

(h

uman

, fi

nan

cial

, M

ater

ial)

Peop

le

res

pon

sib

le

tim

elin

e

1st

Qua

rter

2nd

Qua

rter

3rd

Qua

rter

4th

Qua

rter

MO

nth

s

12

34

56

78

910

1112

Management and organizational sustainability tool for tB82

man

agin

g

imp

rove

dw

ork

clim

ate

imp

rove

dm

anag

emen

tsy

stem

s

improve

dse

rvices

improve

dhea

lth

outcom

es

scan

focu

s

alig

n/

mob

iliz

e

insp

ire

pla

n

orga

niz

e

imp

lem

ent

mon

itor

an

dev

alu

ate

Res

ult

s

Lead

ing

and

man

agin

g p

ract

ices

lead

ing

imp

rove

dca

pac

ity

to r

esp

ond

to c

han

ge

From

Man

ager

s W

ho L

ead:

A H

andb

ook

for

Impr

ovin

g H

ealt

h Se

rvic

esM

anag

emen

t Sc

ien

ces

for

Hea

lth

lea

din

g a

nd

Ma

na

gin

g r

esu

lts

MO

del

Management and organizational sustainability tool for tB 83

lea

din

g a

nd

Ma

na

gin

g f

ra

MeW

Or

k

Prac

tice

s th

at a

llow

Wor

k g

roup

s an

d O

rgan

izat

ion

s to

fac

e c

hal

len

ges

an

d a

chie

ve r

esul

ts

lead

ing

Man

agin

gsc

ann

ing

Iden

tify

clie

nt a

nd s

take

hold

er n

eeds

and

prio

ritie

s.■

■

Reco

gniz

e tr

ends

and

ris

ks t

hat

affe

ct t

he o

rgan

izat

ion.

■■

Look

for

best

pra

ctic

es.

■■

Iden

tify

staf

f cap

aciti

es a

nd c

onst

rain

ts.

■■

Know

you

rsel

f, yo

ur s

taff,

and

you

r or

gani

zatio

n—va

lues

, str

engt

hs,

■■

and

wea

knes

ses.

Org

aniz

atio

nal o

utco

me:

Man

ager

s ha

ve u

p-to

-dat

e, v

alid

kno

wle

dge

of t

he

orga

niza

tion

and

its c

onte

xt; t

hey

know

how

the

ir be

havi

or a

ffect

s ot

hers

.fo

cusi

ng

Art

icul

ate

the

orga

niza

tion’

s m

issi

on a

nd s

trat

egy.

■■

Iden

tify

criti

cal c

halle

nges

.■

■

Link

goa

ls w

ith t

he o

vera

ll or

gani

zatio

nal s

trat

egy.

■■

Det

erm

ine

key

prio

ritie

s fo

r ac

tion.

■■

Cre

ate

a co

mm

on p

ictu

re o

f des

ired

resu

lts.

■■ O

rgan

izat

iona

l out

com

e: o

rgan

izat

ion’

s w

ork

is d

irect

ed b

y a

wel

l-defi

ned

mis

sion

, str

ateg

y, a

nd s

et o

f prio

ritie

s.a

lign

ing

an

d M

obili

zin

gEn

sure

con

grue

nce

of v

alue

s, m

issi

on, s

trat

egy,

str

uctu

re, s

yste

ms,

and

■

■

daily

act

ions

.Fa

cilit

ate

team

wor

k.■

■

Uni

te k

ey s

take

hold

ers

arou

nd a

n in

spiri

ng v

isio

n.■

■

Link

goa

ls w

ith r

ewar

ds a

nd r

ecog

nitio

n.■

■

Enlis

t st

akeh

olde

rs t

o co

mm

it re

sour

ces.

■■ O

rgan

izat

iona

l out

com

e: In

tern

al a

nd e

xter

nal s

take

hold

ers

supp

ort

the

orga

niza

tions

and

goa

ls a

nd h

ave

mob

ilize

d re

sour

ces

to r

each

the

se g

oals

.in

spir

ing

Mat

ch d

eeds

to

wor

ds.

■■

Dem

onst

rate

hon

esty

in in

tera

ctio

ns.

■■

show

tru

st a

nd c

onfid

ence

in s

taff;

ack

now

ledg

e th

e co

ntrib

utio

ns

■■

of o

ther

s.pr

ovid

e st

aff w

ith c

halle

nges

, fee

dbac

k, a

nd s

uppo

rt.

■■

Be a

mod

el o

f cre

ativ

ity, i

nnov

atio

n, a

nd le

arni

ng.

■■ O

rgan

izat

iona

l out

com

e: o

rgan

izat

ion

disp

lays

a c

limat

e of

con

tinuo

us

lear

ning

and

sta

ff sh

ow c

omm

itmen

t, e

ven

whe

n se

tbac

ks o

ccur

.

Plan

nin

gse

t sh

ort-

term

org

aniz

atio

nal g

oals

and

per

form

ance

res

ults

.■

■

Dev

elop

mul

tiyea

r an

d an

nual

pla

ns.

■■

Allo

cate

ade

quat

e re

sour

ces

(mon

ey, p

eopl

e, a

nd m

ater

ials

).■

■

Ant

icip

ate

and

redu

ce r

isks

.■

■ Org

aniz

atio

nal o

utco

me:

org

aniz

atio

n ha

s de

fined

res

ults

, ass

igne

d re

sour

ces,

and

an

ope

ratio

nal p

lan.

Org

aniz

ing

Ensu

re a

str

uctu

re t

hat

prov

ides

acc

ount

abili

ty a

nd d

elin

eate

s au

thor

ity.

■■

Ensu

re t

hat

syst

ems

for

hum

an r

esou

rces

man

agem

ent,

fina

nce,

logi

stic

s,

■■

qual

ity a

ssur

ance

, ope

ratio

ns, i

nfor

mat

ion,

and

mar

ketin

g ef

fect

ivel

y su

ppor

t th

e pl

an.

stre

ngth

en w

ork

proc

esse

s to

impl

emen

t th

e pl

an.

■■

Alig

n st

aff c

apac

ities

with

pla

nned

act

iviti

es.

■■ O

rgan

izat

iona

l out

com

e: o

rgan

izat

ion

has

func

tiona

l str

uctu

res,

sys

tem

s, a

nd

proc

esse

s fo

r ef

ficie

nt o

pera

tions

; sta

ff ar

e or

gani

zed

and

awar

e of

res

pons

ibili

ties

and

expe

ctat

ions

.im

ple

men

tin

gIn

tegr

ate

syst

ems

and

coor

dina

te w

ork

flow

.■

■

Bala

nce

com

petin

g de

man

ds.

■■

Rout

inel

y us

e da

ta fo

r de

cisi

on-m

akin

g.■

■

Coo

rdin

ate

activ

ities

with

oth

er p

rogr

ams

and

sect

ors.

■■

Adj

ust

plan

s an

d re

sour

ces

as c

ircum

stan

ces

chan

ge.

■■ O

rgan

izat

iona

l out

com

e: A

ctiv

ities

are

car

ried

out

effic

ient

ly, e

ffect

ivel

y, a

nd

resp

onsi

bly.

Mon

itor

ing

an

d e

valu

atin

gM

onito

r an

d re

flect

on

prog

ress

aga

inst

pla

ns.

■■

prov

ide

feed

back

.■

■

Iden

tify

need

ed c

hang

es.

■■

Impr

ove

wor

k pr

oces

ses,

pro

cedu

res,

and

too

ls.

■■ O

rgan

izat

iona

l out

com

e: o

rgan

izat

ion

cont

inuo

usly

upd

ates

info

rmat

ion

abou

t th

e st

atus

of a

chie

vem

ents

and

res

ults

, and

app

lies

ongo

ing

lear

ning

and

kno

wle

dge.

MOST FOR TB

Management and organizational sustainability tool for tB84

VII. ADDITIONAL RESOURCESThe following publications may be useful for organizations planning to improve the management and sustainability of their organizations.

The Manager is a continuing-education quarterly published by Management Sciences for Health. Each issue focuses on a specific management topic and includes “Working Solutions” from the field, tools and techniques, and a case scenario for staff development and training. MSH also pub-lishes management tools that can be used to improve specific management areas, many of which are available in multiple languages.

Many of the MSH’s resources listed below are available on The Manager’s Electronic Resource Center (ERC) at http://erc.msh.org. The ERC provides practical answers to management questions, easy-to-use tools, information on effective management practices, and reviews of recent management trends. For more information, please visit the ERC website or send an e-mail to erc@msh.org.

tO PrePare fOr the MOst PrOcess

Management Sciences for Health. “Creating a Work Climate that Motivates Staff and Improves Per-formance,” The Manager vol. 11, no. 3. Boston: Management Sciences for Health, 2002. This issue includes a Climate Assessment Tool.

tO fOcus On iMPrOVing sPecific ManageMent cOMPOnents

human resource Management

Management Sciences for Health. Human Resource Management Rapid Assessment Tool for HIV/AIDS Environments: A Guide for Strengthening HRM Systems. Boston: Management Sciences for Health, 2003.

———. “Tackling the Crisis in Human Capacity Development for Health Services.” The Manager vol. 13 no. 2: 1–20. Boston: Management Sciences for Health, 2004.

information Management

Sullivan, T. M., M. Strachan, and B. K. Timmons. Guide to Monitoring and Evaluating Health Infor-mation Products and Services. Baltimore, MD: Center for Communication Programs, Johns Hopkins Bloomberg School of Public Health; Washington, D.C.: Constella Futures; Cambridge, MA: Management Sciences for Health, 2007.

financial Management

Management Sciences for Health. “Assessing Your Organization’s Capacity to Manage Finances.” The Manager vol. 12, no. 1. Boston: Management Sciences for Health, 2003. This issue includes the Financial Management Assessment Tool (FIMAT).

———. “Business Planning to Transform Your Organization.” The Manager vol. 12 no. 3: 1–30. Boston: Management Sciences for Health, 2003.

———. Planning, Costing and Budgeting Framework. Boston: Management Sciences for Health, 2007.

MOST FOR TB

Management and organizational sustainability tool for tB 85

tO Manage change MOre effectiVely

Management Sciences for Health. “Developing Managers Who Lead.” The Manager vol. 10, no. 3. Boston: Management Sciences for Health, 2001.

———. “Leading Changes in Practice to Improve Health.” The Manager vol. 13. no. 3: 1–24. Boston: Management Sciences for Health, 2004.

Msh resOurces On tuberculOsis

Frye, J., ed. International Drug Price Indicator Guide. Arlington, VA: Management Sciences for Health Center for Pharmaceutical Management and World Health Organization, 2007.

Management Sciences for Health. “Improving Drug Management to Control Tuberculosis.” The Manager vol. 10, no. 4: 1–22. Boston: Management Sciences for Health, 2001.

Mundy, C., G. Kahenya, and H. Vrakking. Support to the Global TB Drug Facility: Design and In-Country Evaluation of TB Diagnostic Laboratory Kits Initiative, 2004–2006. Management Sciences for Health, 2006

Rational Pharmaceutical Management (RPM) Plus Program. Managing Pharmaceuticals and Commodities for Tuberculosis: A Guide for National Tuberculosis Programs. Arlington, VA: Management Sciences for Health, 2005.

Rational Pharmaceutical Management (RPM) Plus Program. Managing TB Medicines at the Primary Level. Arlington, VA: Management Sciences for Health, 2008.

Strengthening Pharmaceutical Systems (SPS) Program. e-TB Manager: A Comprehensive Web-Based Tool for Programmatic Management of TB and Drug-Resistant TB.

Weil, D., A. Beith, S. Mookherji, and R. Eichler. Mapping the Motivations of Stakeholders to Enable Improved Tuberculosis Control: Mapping Tool for Use in Workshops. Arlington, VA: Management Sciences for Health and Stop TB Partnership, 2004.

Zagorskiy, A., C. Owunna, and T. Moore, eds. Pharmaceutical Management for Tuberculosis Assessment Manual. Arlington, VA: Rational Pharmaceutical Management (RPM) Plus Program, Management Sciences for Health, 2005.

abOut ManageMent sciences fOr health

Management Sciences for Health (MSH) is an international nonprofit organization, dedicated to closing the gap between what is known about the overwhelming public health challenges facing many nations and what is done to address those challenges.

Since 1971, MSH has worked in more than 100 countries with policymakers, health professionals, and health care consumers to improve the quality, availability, and affordability of health ser-vices. We work with governments, donors, nongovernmental organizations, and health agencies to respond to priority health problems such as HIV/AIDS, tuberculosis, malaria, child health, and reproductive health. Our publications and electronic products augment our assistance in these technical areas.

MSH’s staff of more than 1,300 from almost 70 nations work in its Cambridge, Massachusetts, head-quarters; offices in the Washington, DC, area; and more than 25 country offices. Through technical assistance, research, training, and systems development, MSH is committed to making a lasting difference in global health.

For more information about Management Sciences for Health, please visit our web site at www.msh.org. For a catalog of MSH’s publications, please contact:

MSH Bookstore784 Memorial DriveCambridge, MA 02139-4613Telephone: 617.250.9500Fax: 617.250.9090E-mail: bookstore@msh.orgWebsite: www.msh.org