together4AMR#5 Essential Leadership Competencies for Sustaining Progress in AMR Management

In this podcast series, global health leaders discuss the essential competencies needed for public health leaders to address communicable diseases and antimicrobial resistance (AMR). These competencies include effective communication, strategic planning, engagement with stakeholders, advocacy for funding, and upskilling in behavioral science. Leaders should also possess skills in data analysis, collaboration, adaptability, ethical decision-making, and systems thinking. They must have a clear strategic vision and the ability to turn data into meaningful information and intelligence. The goal is to strengthen collective responses to AMR and integrate initiatives into broader health programs. My name is Anwar Parvez Syed and I welcome you to this series of podcasts together for AMR. In this podcast series, we interviewed five global health leaders who have dedicated their professional careers to combating communicable diseases and antimicrobial resistance. Although they are affiliated with esteemed organizations such as WHO, CDC and World Bank, the views they share in these interviews are personal and based on their extensive work experiences and they do not reflect the official positions of their organizations. This is the fifth episode of this series and in this episode, we asked our panel members what essential leadership competencies should public health leaders possess to sustain progress in long-term disease-specific initiatives and send them the overall management of AMR. And here is what they said. Communication here is vital and in good communication, it's not just about talking to people, it's about listening to people. It's about understanding where they're coming from, what their concerns are, what their interests are, what's motivating them and then helping to align agendas and getting people to collaborate. So that sort of understanding people coming from different perspectives, communicating very well and bringing people together as a team is really important. And I think that convening power and that is a competency that some people have it naturally but certainly to a certain extent it can be learned. Good project management is also really important because in this sort of thing, it's so important to have some sort of deliverables and to hold other people to account so that when we're working, we are clear what we're trying to achieve and how we can monitor and measure it in a simple light touch way. So I think that's a really important competency. And then I think, you know, strategical and operational thinking and planning is something that one can certainly, again, learn a lot about and building those competencies to think in a more strategic way is a really important thing that we should be working on. These sorts of skills, I think, are important for addressing AMR but they're also going to be important because the world is changing so fast and how we deal with other challenges and opportunities, be it new threats and pathogens, be it AI, be it whatever. So we need to have our workforce, we've done pretty well in getting them good at doing the standard stuff, now they need to be encouraging more collaborative working, a bit more agile and responsive working. The first important competency in leadership is awareness through effective communication. We need to have visionary thinking, the leaders must envision a comprehensive approach of integrating their initiative into broader health programs. So we need to have strategic planning, we need to develop ability to develop long-term strategies which align with disease-specific goals but also with the AMR management. And for that, we need to have engagement with a diverse range of stakeholders which includes government, healthcare providers, community and strong advocacy skills. Another important is that we need advocacy for adequate funding. The current funding mechanisms are notably limited, enough resources have not been earmarked for the AMR in most countries. Also the One Health approach which has been adopted by WHO needs to be adopted now by all the countries. Focus on human, animal and environmental sectors, the organizations like FAO, UNEP, WHO, they have developed this One Health Joint Plan of Action for 2022-2026 which has 6 independent actions and these include AMR as one of the focus area. So we really need to work together, bring all these actions under one umbrella. Of course, the vertical program, some part will continue but lot of it can be actually incorporated into one user unit program where everybody contributes their bit to reducing the chances of antimicrobial resistance. One of the things that we quite often struggle with is that our public health leaders may be very strong in their own technical side of the program, so the clinical management, the program management. This is even a problem at the global level, you know, the behavioral science and the management science and the value addition that programs, that side of the whole management that there's a weakness. Our leaders need to be upskilled in terms of developing their soft skills, their ability to understand the behavioral insight which is both at the program level and also at the individual level. So I think we need a really a shift in the way that we produce our leaders for public health programs. They cannot be just techno-managerial, they need to be beyond that, they need to understand the behavior of programs, the behavior of the population and the behavior of people in the program. People means the people who implement the program. That is like a really big shift that is, which requires the way in which we train our leaders, which requires the training programs, not just postgraduate degrees that we are talking about, but even the training programs that we organize for our leaders should have additional components. It should not be just a namesake of communication. Communication by itself is like a big area of understanding, which cannot be just like a half a day session in a training program, it needs real investment. The way that you can understand and appreciate programs and the behavior of people that needs real investment by national government, international agencies, I believe now, you know, for example, WHO has recently started their own restructuring with a lot of emphasis on behavioral science and trying to build its own Department of Behavioral Science after several, several years. So I think that sort of shift in the thinking should enable us to produce leaders with better communication, better coordination skills, and they should also be able to really use data and analytics, which help them to really understand the benefit of collaboration, for example. So if you see there are classic cases of, you see, industries or commercial sector, you know, you can see companies like really using the benefit of data and analytics and insights to really get into new areas of business. You know, that's, that's, that's like really they move from one area to another. So we need to have such skills, which should enable our program managers within public health leadership to really find that, to find the benefit of working together. And I think the most important things are communication, coordination, and openness. And of course, the ability to synthesize and use data and understanding the behavioral patterns of organizations and people. They should have a systems thinking who can understand interdependencies and address the complex challenges. AMR is a very complex problem. So they should understand the challenges and they should understand, you know, like everybody is needed, you should have a holistic approach. So that system thinking quality is very important. There are so many people like who take, who take action based on experiences. Yes, experience is really good. But I have a leader who will take evidence based actions, right? People don't understand the value of data. So there is huge amount of data generated. But again, like how much of the data is really converted into a good meaningful information to generate knowledge, and that knowledge is generated into policies and guidelines. And that's really, I think, that is a gap in the current leadership. We have to have leaders who will not only, you know, generate data, but also make the data work for them and take decisions based on the information which is generated. But as a leader, if they use the data for action, and they are more of evidence based decision makers, like that quality, like I would like to have in a leader like who's working for AMR. Third thing is like they should have collaboration skills. So they should be ready to partner, they should be ready to negotiate, they should be ready to bridge the gap. Like many a places, you know, they want to work in silos. And if there is a leader, you know, with the quality of collaborative skills and understands, you know, everybody is needed, like, if you really want to have a better system for AMR containment, so AMR response, like that would be really great. And they should be also adaptable, things keep changing, they should be able to navigate changing landscapes and respond to emerging threats. This is a very evolving field, AMR is rapidly evolving and things keep changing, you know, every day this strategy doesn't work, you know, the glass surveillance like may not be giving the right representative data. So you may have to go for a case-based survey and like AMR, this strategy doesn't work. So it's a rapidly evolving threat and you should, they should have this quality of adaptability. Ethical decision makers like are really needed, you know, who can balance public health priorities with individual needs. So we are dealing with diseases like HIV and TB and things like that, which could stigmatize people. We worked in that, so we know very well. So balance public health priorities with individual needs. Effective leadership in compacting AMR requires a blend of technical expertise, have a clear strategic vision and commitment to collaborative action by fostering all the synergies so that they can strengthen the collective response from all these vertical programs together. The key set of competencies that they need to possess, ethical leadership should have a good understanding of the overall region, local context related to antibiotics, antimicrobial use and also antimicrobial resistance patterns. We need somebody with skills for having an eye for the data and we need people to have skills to turn the data into information. And we need a person who can actually turn the information as intelligence, which can then be transitioned to the positional leadership. Right now, the lack of the use of data and presenting the data appropriately to the leadership is what is lacking. And I don't blame that for the technical community right now, because I think technical community is also working on generating and developing or building up that evidence at this point in time. We do have evidence, but we don't have a lot of granular evidence and a lot of detailed evidence, which actually is required for the positional leadership to take certain very strong policy decisions. So I think overall you need skills from public health people specifically on analytics, on epidemiological stuff and also technical details in terms of how AMR works and the nuances of the overall antimicrobial resistance itself. So you need a cadre of technical people who are experts in the area of AMR irrespective of the disease itself. They should be AMR specialists for HIV, TB, malaria, everything, including antibacterial, antifungal, everything. So we need a cadre of staff, cadre of people who are like that. We don't have a lot of infectious disease specialists and very few institutions actually develop and build those capacities, but we do have good stalwarts on that. But you know, we need to generate that so that they can help state level, sub-national level or at the national level in terms of continuing the discourse at the policy in terms of what needs to be done, how and when it needs to be done. So we need those type of technical people. In the same breath, I would say that we would also need people beyond the public health in this. We would need people from other sectors in this. So we need, you know, AMR technical people from multiple sectors working together. Public health workforce actually bears the burden of carrying this whole thing and take it towards a good logical and better outcome related conclusion. But I think other sectors also needs to step up on this. So we need a group of technical leaders, multidisciplinary and multisectoral technical leaders on this. And the second thing in terms of sustaining the progress of the communicable diseases. This is a bit off on the AMR front because there are multiple other factors which play a role for the communicable diseases programs. But I think if we have technical leaders with public health background and background related to epidemiology, background related to global health and some of these aspects, I think they can still handle the overall sustaining the technical leadership for the communicable diseases, maybe even some of the people with implementation science experience and things like that. But AMR is going to be a big elephant in the room. But that's what it is. Nobody knows which is the tail. Nobody knows which is the trunk. Nobody knows which is the ears. So we'll have to sort of start defining that big elephant in the room and then start putting things together as a jigsaw puzzle. To summarize, public health leaders must possess a range of essential competencies to sustain long-term disease-specific initiatives and strengthen AMR management. Effective communication is crucial, including listening to the stakeholders and facilitating the teamwork. Leaders need a strategic vision to integrate AMR initiatives into broader health programs. Coupled with operational thinking for adaptable planning, project management skills such as setting clear deliverables and measuring success are vital. Advocacy and securing funding require leaders to generate political commitment and engage with diverse stakeholders. Understanding behavioral and management science helps manage program and individual behaviors effectively. Advocacy in data and analytics enables evidence-based actions and insights for policy decisions. Collaboration and negotiation skills are needed to partner with various stakeholders and bridge program gaps. Leaders must be adaptable, navigating change and making ethical decisions. Systems thinking is essential for understanding health system interdependencies and multidisciplinary expertise is required for a One Health approach. This is the end of Episode 5. Stay tuned for the next episode, which will be the last and concluding episode of this series. And in that episode, we will try to reflect on the overall learning of this series and final takeaways. So, stay tuned.