Africa needs ‘visionary’ public health leaders who can organize and mobilize people: IPPHL Fellow Birara Melese Yalew

Birara Melese Yalew will never forget how easily preventable communicable diseases such as malaria, pneumonia, diarrhea affected the lives of people, including his brother, in his village in northern Ethiopia.

Those experiences motivated Melese Yalew, who is now a FHI360 Alive & Thrive project director, to pursue a career in public health and nutrition. While studying public health at Gondar University, he became interested in child, maternal, and adolescent nutrition "because in Ethiopia stunting, wasting, underweight, and micronutrient deficiency are all prevalent."

After working for more than a decade at both the ministry of health and then with Alive & Thrive, Melese Yalew was accepted into the current cohort of the International Program in Public Health Leadership (IPPHL), an eight-month program for emerging leaders working in or closely with African ministries of health that aims to expand their "policy and leadership acumen ... to develop and implement lasting public policy solutions and transform health systems."

The program, created by the Evans School of Public Policy and Governance at the University of Washington and funded by the Gates Foundation, has trained 150 public health professionals across 29 African countries over the past seven years. The program's curriculum now also incorporates lessons from Exemplars in Global Health.

It was during the program, Melese Yalew said, that he realized African countries need public health leaders "who are advocates, who are visionaries, who can organize and mobilize people and resources to implement public health plans."

Exemplars News spoke with Melese Yalew about his journey and the IPPHL program, including the lessons he would share with other aspiring public health leaders.

Could you tell us about your personal journey? How did you become interested in global health?

Melese Yalew: My interest in global health came from the people in my locality. I'm from the northern part of Ethiopia and I saw how the local clinics supported health services and local people. Malaria is endemic in my village. I was even infected with malaria when I was in Grade 11. I wanted to get to the source of these kinds of problems and then be able to treat my family and community. One of my brothers also had severe pneumonia when I was a student. Hygiene and sanitation was also an issue that concerned me – there is no clean, piped water. Our family fetched water from the river – it's not clean so sometimes small children got diarrhea. All of these things ignited my interest in health.

I also remember one of my older classmates went to university and got his first degree in public health – he immediately became the head of the health office for our district. He inspired us and that helped motivate me to join the public health sector. I went to Gondar University and took the health sciences program, specializing in public health. I remember the department head saying that we would have to go to rural communities – even taking mules and horses – to serve communities. That made me think of my upbringing – I wanted to serve people in villages.

I was lucky – immediately after graduation I joined the ministry of health at the national level. There was a new initiative called Business Process Reengineering, or BPR, and they were looking for new graduates from universities to join. They wanted new blood from different disciplines. As a public health officer, I worked on strategic planning, advocacy, data generation, social and behavior change, and capacity building. That was the starting point for me.

After six years with the ministry, I obtained my second degree at University of Gondar, a Master of Science degree in applied human nutrition. I then became the national nutrition case team leader at the ministry, leading the development of various policies, strategies, programs, guidelines, and training manuals related to nutrition. I helped develop two national nutrition programs, the Segota Declaration roadmap, the country’s first ever Food and Nutrition Policy, and the National Nutrition Strategy.

Could you tell us about your work with Alive & Thrive? What are you trying to accomplish and why?

Melese Yalew: After almost 10 years of government service at the ministry of health, I was interested in child nutrition and maternal nutrition, and adolescent nutrition because in Ethiopia stunting, wasting, underweight are all prevalent. I joined the FHI360 Alive & Thrive project in 2018 and am now the project director.

Alive & Thrive is an international organization that specifically supports children at the grassroots level. We aim to accelerate maternal, infant and young child nutrition (MIYCN), which means supporting the government to ensure that nutrition services reach the household level. The government has policies, strategies, guidelines, and procedures – Alive & Thrive has the expertise and financial support. My work is to bring those two things – the policy guidelines from the government side and the technical and financial support from the partner side – together to ensure MIYCN services are promoted and improved, especially exclusive breastfeeding, complementary feeding, dietary diversity, etc. I try to support the project by positively influencing the government to ensure MIYCN is part of their action plan and that MIYCN indicators are included in health sector plans.

Could you tell us about your experience with the International Program in Public Health Leadership? What's it been like for you?

Melese Yalew: I participated in the International Program in Public Health Leadership (IPPHL) training when I was still with the ministry, so it was a time of transition. The program especially helped with my capacity and abilities, and motivation in the area of public leadership in general. It's also helped me join hands with other nutrition champions in the country. We actually developed a national leadership training together, which is also aligned with the African Nutrition Leadership Program. We've already conducted more than 10 rounds of national training. This is just the starting point – the IPPHL will transform public health in the country. We're producing more leaders and more Ethiopian nutrition champions.

What specific lessons from the program would you share with other global health professionals in Africa who are looking to implement lasting public policy solutions and transform health systems?

Melese Yalew: One thing is that creating more champions is very, very important. Just having a few individuals [working on a challenge] will not make a significant difference, even if we increase their capacity. I think that, in general, public health leadership is weak compared to other disciplines. What I mean is that most of the time we're technocrats, not real leaders. We need more leaders in public health, not only at the national level but also at the local level. We need leaders who are advocates, who are visionaries, who can organize and mobilize people and resources to implement public health plans. We have very nice policy strategies, but these things need to be implemented at the local level.

How do you think the program will impact your future work in Ethiopia?

Melese Yalew: Positively – it's helped improve my individual capacity. Currently, I'm leading a new project in Ethiopia – a multi-sectoral coordination, governance, and leadership project supported by the Gates Foundation in 11 of the country’s 14 regions. Leadership will be one of our main activities. We aim to positively influence nutrition programs and implementation at all levels using what we learned from IPPHL. We recently conducted a national leadership training for 60 people, most of them from Alive & Thrive supported regions. We selected two people per region and provided them with a national-level assignment for cascading this training. We plan to do regional training in all of the regions. This leadership training will impact coordination at all levels. We're using input from the IPPHL and its leadership concepts to influence our programs and personnel at the national and regional levels.

What are you personally hoping to accomplish in the future with your life, your career?

Melese Yalew: Previously, I was just focusing on accomplishing planned activities. The training has helped me think of self-development considering the whole person paradigm concept of building myself intellectually, physically, mentally, socially and spiritually – all those things together.

As a director for the Alive & Thrive project in Ethiopia, I manage the project in 11 regions, but now I'm looking at broader projects that could be implemented at the national level. We are creating more champions and positively influencing the environment in the area of food and nutrition. Even though it's a cumulative effect, there is a progressive change in the area of food and nutrition. I'll continue supporting the system personally plus mobilizing with others, maybe we can develop more projects for food and nutrition and get more budget for nutrition in Ethiopia so we can end all forms of malnutrition including ending stunting by 2030.