Successful succession planning: Botswana project leaders work together to ensure a smooth transition

What happens when the leadership changes on a project in progress? Communication, teamwork, and knowledge transfer are all keys to a smooth handover. Interview with the outgoing and incoming project leads in Botswana.

Dr Jeremy Slone served as Medical Director of the Texas Children’s Hospital’s Global Haematology-Oncology Paediatric Excellence (HOPE) programme at Botswana-Baylor Children’s Clinical Centre of Excellence (Botswana-Baylor). Since 2018, he and his team have worked in partnership with the Novo Nordisk Haemophilia Foundation (NNHF) leading its first supported project in the country. The project aims to expand the national paediatric bleeding disorder programme in partnership with the Princess Marina Hospital (PMH) and other centres outside the capital of Gaborone, while also enhancing haemophilia diagnostic capabilities, and improving awareness and diagnosis in Botswana.

Now, the project leader is preparing to relocate to the US with several activities still underway following delays due to the ongoing COVID-19 pandemic. We asked Dr Jeremy Slone and the incoming leader, Ms Baraedi Winnie Mantswe, to share learnings from their experience in the project succession planning.

With Dr Slone relocating back to the US, how are you transitioning leadership of the Botswana 1 project?

Dr Jeremy Slone: The transition in leadership was functionally initiated many months ago and supported by focused meetings to ensure that any knowledge or experience I have from this programme has been transferred to the team.

The NNHF Botswana 1 project has been a true team effort. Winnie Mantswe, Programme Manager, and the existing team from the Global HOPE programme at Botswana-Baylor have been developing and implementing the core aspects of the grant for the last year or more. Together with Mr. Andries Gontshwanetse, Nurse Manager, and Dr Mamiki Chise, Paediatrician, they will continue to lead the programme. Dr Robert Kimutai Langat, Paediatric Haematologist-Oncologist, will be the clinical lead and assist the group as needed. Additionally, there are many other key stakeholders and advocates who will provide vital support to the programme.

Ms Baraedi Winnie Mantswe: This project has provided an opportunity for the Botswana Team to learn and explore possible ways to improving haemophilia care together. To begin with, we outlined four key thematic areas that were critical for the programme to be not only relevant but also sustainable. In the remaining few months of the project, the focus will be on successfully continuing to work with the PMH laboratory to procure additional reagents so as to ensure that necessary laboratory tests continue to be performed.

In addition, we have established a pool of district-based healthcare workers we call ‘Haemophilia Champions’. This cohort continues to be instrumental in training healthcare workers at our targeted 22 health facilities in their districts with mentorship from the Global HOPE Team at Botswana Baylor. Eight health facilities have already been reached to date.

What are some learnings you can share from the succession planning process?

Dr Jeremy Slone: The value of communication is paramount. Communication has been key throughout the project and continues to be critical as we transition project leadership. Through frequent broad communications, such as monthly update meetings on the progress of activities and the finances of the grant, we have been able to keep all stakeholders informed of our activities. At the same time, individual or small group meetings are also valuable as each stakeholder has different needs and expectations.

Flexibility is also important. Even before the COVID-19 pandemic, circumstances often necessitated revising plans to meet our intended goals. The exciting thing is that we have been able to do more work with greater impact than we envisioned before we submitted the original application. This is thanks to the flexibility, ingenuity and determination of the stakeholders.

Ms Baraedi Winnie Mantswe: We are continuing to conduct our monthly NNHF stakeholder meetings to provide an ongoing platform for sharing updates as well as tracking progress. I have been involved through the planning and implementation stages along with other members of our team, such as our paediatrician and nurse manager. Together, they continue to lead the awareness training for healthcare workers and are responsible for rolling out the training along with our ‘Haemophilia Champions’ to various districts across the country. There will therefore not be any deviations with regards to plans and strategies already in place.

Can you share some examples of how the team has faced challenges and delivered on their goals?

Dr Jeremy Slone: Originally, we had planned to send three healthcare workers to South Africa for bleeding disorder training. With travel restrictions, we knew this would not be possible. The team rallied and developed an intensive local two-week workshop with a variety of trainers from multiple local institutions. The training included didactics, online training, practical experiences including interaction with bleeding disorder patients, simulation training, panels discussing key topics and other methods. These were held following strict COVID-19 infection control protocols and 20 health care workers were trained from 14 health institutions around Botswana, a country the size of France.

What do you see as the current focus and future impact of the project?

Ms Baraedi Winnie Mantswe: We will focus on successfully completing the remaining activities by December 2021. Beyond that, thanks to the strong foundation of our achievements on this project, we are already thinking about what more can be done. Capacity building is an ongoing process, especially where there are frequent changes in healthcare staffing due to transfers. Continuous and sustainable initiatives will ensure that skills and knowledge are retained. Identifying more capacity-building initiatives such as establishing an online open-source course for healthcare workers to exchange learnings could be explored. There is a need to continue creating awareness of haemophilia and we strongly believe that these efforts would be better led by people with bleeding disorders and their families. Continuing to work with patient advocacy groups will be critical.

Dr Jeremy Slone:After nine years of working in Botswana, I can leave with full confidence that this programme will continue to flourish. I will remain available for counsel at any time if I can be of some assistance. The greatest impact will be the improved level of care that is now possible outside of Gaborone and PMH. The most rewarding moment for me was seeing a photo of a nurse with haemophilia, a graduate of the NNHF-sponsored training programme whom we had treated for years, demonstrating administration of treatment to his nephew with haemophilia, to healthcare workers in a small rural health post. This one picture really encompassed how far the Botswana bleeding disorder programme had come through the support of NNHF.