Publication Date: April 14, 2014
Nneka Mobisson-Etuk, MD, MPH, MBA
Executive Director of African Operations
Institute for Healthcare Improvement
Q: How did your career path lead to IHI?
I grew up in Nigeria. I was born in Cambridge, Massachusetts, but I moved to Nigeria when I was very young. My father is Nigerian and my mother is American, from a small town in Wisconsin. She and my father met in Boston when he was at MIT and she was at Northeastern University.
My father was an engineer. He was passionate about technology and really wanted to give back to our country; to apply his skills there. So he became a professor of computer science at one of the universities in Nigeria. In some ways I think I am trying to follow his path.
The summer after my junior year at MIT, I had a truly transformative experience. I went to Tanzania and worked in a very rural area in the Shinyanga region with a nonprofit organization, AHEAD. Charles Vest, the former President of MIT, was instrumental in making this experience a reality for me — after being rejected by over 20 departments for funding of the internship, his office approved the financing of the internship.
We did a lot of work around immunization campaigns and HIV education there. I was even able to use my engineering skills: the operating theater in the only maternity hospital there had no electricity. They used to hold kerosene lanterns to conduct surgeries, so my team installed solar panels for lighting.
Even though I had been exposed to health care inadequacies in my country, the experience in Tanzania highlighted for me the tremendous need for improvement. And the people I worked with that summer introduced me to the field of public health.
I chose to get my master’s in public health, with a focus on international health, right after college, at Emory, largely because it happens to be next door to the CDC [Centers for Disease Control and Prevention]. While at Emory I interned at the CDC and my mentor there encouraged me to go to medical school. He emphasized the importance of understanding health care delivery at the micro level and its related impact at the macro level.
I spent a year before medical school at Merck in southern Georgia, working with health departments throughout the state to increase immunization coverage in public schools and county health departments. It was a phenomenal experience!
Then I went to Yale Medical School, and during my second year I decided to apply for the MD/MBA program to better understand the business of health care and the impact of economic decisions on health globally.
During this period, I was able to spend time in countries including Nigeria, Ghana, and Zimbabwe, working in public health. I also did a summer internship and consultancy at the World Bank. After Yale, I completed a pediatrics residency at the Children’s Hospital of Philadelphia. I absolutely love pediatrics, and these years gave me some of the best training ever in the practice of medicine and helped solidify my understanding of how social determinants impact the health of individuals and the greater good of a city or region.
After my residency I spent four years at McKinsey, working in pharma, health care IT, and hospitals and health systems. After I left McKinsey, I became the Vice President of Community Health and Population Health Management at the Connecticut Hospital Association (CHA), but I always had a yearning to return to my continent. Both my husband and I — he is a founding partner of a telehealth company, who’s also originally from Nigeria — have been committed to moving back to Africa because we want to contribute to its exponential growth. We also want our kids to be raised there.
Around this time I connected with IHI. I had known of IHI for years; at the CHA, for example, we leveraged quality improvement learnings from IHI — collaborative models, leadership training, board governance strategies, and so on.
Nana Twum-Danso [IHI’s former executive director of African operations] and I connected (we’d both been in Cambridge at similar times for university) and I learned more about IHI’s work in Africa. I became increasingly excited because I could see how clear-cut quality methodologies had led to direct improvement. So coming to IHI to help scale up the work in Africa seemed like a perfect fit.
Q: What are you focusing on in your work at IHI?
We’re continuing to build on the large-scale programing that IHI teams have been doing for nearly a decade in Africa. We’ve expanded to 11 countries and are working primarily in maternal and child health, HIV/AIDS, and quality strategy planning, with a focus on the integration of quality assurance and quality improvement to optimize health care provision.
In these programs we are essentially building will among leaders, harnessing front-line workers — their intrinsic motivation — to prototype innovative methods of delivering high-quality care and then systematically scaling that up. And what’s exciting about this work is the linkage to actually improving clinical outcomes.
We’re also leading a multi-country infant-feeding collaborative, funded by PEPFAR and involving a number of major partners, called the Partnership for an HIV-Free Survival. The goal is ensuring an HIV-free generation in Africa — basically to accelerate the uptake of the World Health Organization 2010 Guidelines on eMTCT [eliminating mother-to-child transmission of HIV]. The focus is specifically on the post-natal phase, the 18-month window following birth. We’re working in Lesotho, South Africa, Mozambique, Kenya, Uganda, and Tanzania, supporting existing programs of health ministries through a learning network; promoting the sharing of best practices that we believe will accelerate progress in this area. It’s exciting to see stakeholders in the program — government and other partners — truly engaged to get results.
In Nigeria, we’re supporting the Ministry of Health in developing a national health care quality strategy or framework for improvement throughout the country. Increasingly, we’re seeing health systems in Africa recognize the need for a cohesive agenda whereby stakeholders are aligned on quality strategies; on figuring out what it’s going to take to make transformative change in care delivery and linking those steps to clinical outcomes. And Nigeria has been one of the countries at the forefront of this promising trend in Africa.
We’re also working in Ethiopia, with the Ministry of Health, which is exploring how to further integrate quality improvement strategies into the fabric of their impressive health care system. They see a focus on specific quality improvement [QI] methodologies as a vehicle to advance their work.
Q: What do you see as challenges ahead in this work?
Financing is an ongoing challenge. IHI’s work in low- and middle-income countries has been funded primarily through grants. We have to be more creative, thinking about innovative ways to fund programs as we scale up this important work.
IHI’s smaller physical presence in Africa is also a challenge. In many African countries, it is important to demonstrate commitment by having a dedicated person or team on the ground who can be responsive to evolving needs of growing health systems. We run very lean, so this makes “being present” challenging. But I am fortunate to have a phenomenal team that is committed to achieving results.
We work through partnerships, believing in building capability at the local level. But it’s still a challenge. I think QI is a skill that requires time and investment on the ground. So building that capability, having a cadre of Africa-based experts and faculty members, is an ongoing effort. We have been intentional about rolling out courses in quality improvement in Africa for senior leaders, middle managers, and frontline workers.
There are also challenges around knowledge management, finding ways to better integrate IHI’s programs in Africa — within each country and across the continent. Even though each program is focused on a different area — HIV, safety, maternal health, and so on — the QI learnings are very similar. I also hope to better integrate IHI’s programs in Africa with our work in the US and elsewhere. I see tremendous untapped opportunity. There are impressive learning across our work in the continent and globally; we need to make sure IHI teams and other QI teams share and learn from each other across continents.
Q: What are you most excited about?
It’s an exciting time for us in Africa. You hear about the “evangelism” for quality improvement that’s taking hold here, and we’re definitely experiencing that in the level of demand and interest in what IHI’s doing; how we work through collaborative partnerships to drive improvement.
Also, because we know that system change in Africa requires engaging health ministries, who are essentially in charge of driving change, it’s encouraging that there is so much interest in quality improvement at the government level. We’ve been able to build on the successes in countries we’ve been supporting — now other countries, other ministries, and private sector organizations are reaching out to us, and we’re having a lot of promising conversations.
I’m really excited about work underway bringing the IHI Open School to Africa — the commitment to leverage this tremendous resource to increase access to QI learning across health care communities; to adapt the content to make it relevant in Africa and to scale up this virtual means of learning.
In a way, this work for me is about the legacy of my father. His focus was on improvement in technology in Africa — and he really did transform the technology landscape in Nigeria. My focus is on improvement in health care — a different sector, but all pointing toward the same goals. It’s a powerful motivation.
Learn more about IHI’s work in Africa