Leading change in Ethiopia

Dr. Tedros Adhanom is one of the most successful change leaders in Africa. A malaria expert with a doctorate in community health, he worked his way up the ranks of Ethiopia’s Ministry of Health and eventually became its leader in 2005.

During his seven years in the position, he delivered sweeping reforms that transformed the health system and saved an untold number of lives in the East African country. The mortality rates for malaria, tuberculosis and HIV/AIDS have plunged. Millions of women were given access to health care. Tens of thousands of health workers at all levels were trained.

As Dr. Tedros seeks to be the next director-general of the World Health Organization, I talked to several of his Ethiopian colleagues about what makes him a great leader. Here’s what they said:

Seeing the larger picture

Dr. Zerihun Abebe, provost of St. Paul’s Hospital Millennium Medical College

Dr. Tedros isn’t a physician, and this helps explain his success reforming Ethiopia’s health-care system, said Dr. Zerihun, who leads one of the nation’s top public hospitals. By not being an M.D., Dr. Tedros is more open minded, Zerihun said. A good example: He initiated a program in the mid 2000s that involved training nurses to become health officers. He later scaled it up, adding a component in emergency surgery. Thousands were trained, providing Ethiopia desperately needed care in underserved areas. “A typical physician would say, ‘How on Earth do you take a nurse, train her for two or three years, call her a health officer, then train her for another year and call her an emergency surgeon?’ How come? Because it took me 12 years to be a surgeon,” Dr. Zerihun said. “Dr. Tedros doesn’t have the big ego of a doctor who says, ‘This belongs to me.’ He could see the larger picture that doctors couldn’t see at that time.”

Adjusting yourself to the situation

Noah Elias, director of policy and planning in Ethiopia’s Ministry of Health

Elias is an economist who began working with Dr. Tedros at the Ministry of Health straight out of school. He felt that Dr. Tedros always had time for him — even when he was a junior staffer. Early in his career, Elias experienced some frustration in his department and considered transferring out. He went to consult with Dr. Tedros and was surprised when the busy minister spent two hours advising him. “When I left his office, I was a different person,” Elias said. “I still remember everything he said. How I should interact with people. How I should plan my career. He talked about how when things go wrong, you often look at the external environment and play the blame game and so on. But in most cases, you don’t look at yourself and you don’t adjust yourself to the situation.”

Dedicated and restless

Wondwossen Ayele Haile, deputy director general of Ethiopia’s Pharmaceuticals Fund and Supply Agency

Wondwossen worked with Dr. Tedros in Ethiopia’s health sector for 26 years. One of their most recent initiatives involved reforming the country’s pharmaceutical system, improving the procurement, distribution and storage of drugs. Wondwossen said Dr. Tedros is a visionary with a talent for working with partners to accomplish things that seemed impossible. He recalled when Dr. Tedros wanted to buy 20 million bed nets costing US$7 each for an anti-malaria initiative. People thought he was crazy for believing it was possible to raise US$140 million for all the nets. “But he said, ‘Let’s try it. We have to have an ambitious plan,’” Wondwossen said. “Can you believe that in one year, we successfully procured 20 million bed nets?” The goal was achieved by tirelessly seeking support from the World Bank, The Global Fund and several other partners. “So that gave us a good lesson to have an ambitious plan,” Wondwossen said. “If you are dedicated and restless, then you can achieve your objective.”

Life is hoping

Dr. Mengesha Admassu, executive director of the International Institute for Primary Health Care in Ethiopia

One of Ethiopia’s biggest successes is the Health Extension Program. It has trained 39,000 health workers who promote healthy behavior and disease prevention across the nation. Countries across Africa are interested in the program, and Dr. Mengesha heads a new institute that helps them design their own program. Dr. Mengesha says the architect of HEP was Dr. Tedros, who has a special talent for boosting morale and motivating talent. He convinced the government to pay the HEP workers and create levels of training that would allow them to be promoted when they advanced their skills, Dr. Mengesha said. “Life is hoping. If you have hope, there’s life,” he said. “If they think they can have a career and development, they will be more motivated to work.”

A learning organization

Christian Tadele, expert public health professional of the health extension and primary service directorate of Ethiopia’s Ministry of Health

Christian has worked for the Ministry of Health since he earned his sociology degree. His career almost ended before it started when he got cold feet during an orientation session. He feared he would become a dull bureaucrat and thought a career in academia would be a better fit for him. But Dr. Tedros convinced him to stay. “There’s not much difference between joining the ministry and joining the university,” he told Christian. “The ministry is a learning organization, so you can benefit the ministry as well as benefit from the learning organization that I’m leading.” Flattered and a bit surprised the minister took such an interest in him, Christian decided to stay. “I’ve been here the past nine years, loving my job,” he said.

The power to convince

Dr. Daddi Jima, deputy director general of the Ethiopian Public Health Institute

Dr. Daddi is a malaria expert who has helped the mortality from the disease plunge by 75 percent in Ethiopia. He remembers a few years ago when the Carter Center approached Dr. Tedros and offered funding for a program to fight Guinea-worm disease, which was close to being eradicated in Ethiopia. Dr. Tedros appreciated the offer but explained that malaria was the bigger problem. “Dr. Tedros told them we have 18 million bed nets, and there’s a gap of 2 million, so please provide funding for 2 million bed nets,” he said. “Although they were interested in Guinea worm, they changed their minds and provided funding for the bed nets, too. He has the power to convince partners.”

Dedicated to the very end

Temesgen Ayehu, health extension and primary health services officer in Ethiopia’s Ministry of Health

Dr. Tedros’ dedication to fighting malaria was extraordinary, said Temesgen, who worked with him for three years. When it was announced in 2012 that Dr. Tedros was moving to the Ministry of Foreign Affairs, Temesgen thought that the minister would be less involved with the malaria work as he transitioned to his new job. But that wasn’t the case as Temesgen learned when there was an increase in malaria cases in an area close to the border with Sudan. Temesgen went to check out the situation and was surprised by how engaged the soon-to-be foreign minister was with the work. “Dr. Tedros would call us everyday and ask about how many patients did we see that day and what kind of actions did we take. What action should he take? What help do we need to control the increase in malaria cases?” Temesgen said.

Photography by Xaume Olleros.