The San Lorenzo Health Center was recently named the best of the six health centers in Nicaragua’s Boaco district. This recognition caps a period of four years without a maternal death in the municipality, following several years of averaging more than three a year. Dr. Horacio Moreno, the municipality’s medical director, credits much of the success to a USAID-supported leadership development program.

Five years earlier, the program began working with the health center to develop the leadership capacity among its 75 workers. Starting with the management team and select staff from all levels of the health center, the program guided the team on a path to achieving results.

“We had never really thought about leadership before,” Moreno said. “But as part of the program, we learned to look inward to assess ourselves, and then at our situation and identify key challenges we wanted to improve upon.”

Maternal health was an important issue to the team — three women had died in the previous year alone from complications. With nearly 80 percent of San Lorenzo’s 28,000 residents living in rural areas, many women would not go in for prenatal visits or even for delivery. After going out into the community to reach expectant mothers, the team discovered that they often wanted to give birth in the health center, but couldn’t get there in time. The health center’s maternity facility was in poor condition as well — little more than an empty room with a few cots. The team secured funding to renovate it, so women would feel more comfortable waiting for their delivery time.

Following its initial success, the team committed itself to raising the leadership capacity of all staff. Moreno said, “Now new staff are quickly oriented to our system. Now when we see challenges, we don’t decide at the top what should be done. We engage the staff most closely connected to the front lines and seek their ideas. It is the ones who are experiencing the challenges first hand that have the most to gain from a solution, and the most insight. Together, we come up with a plan.”