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The VISION 2020 LINKS Programme has initiated ‘LEAD FORWARD’, an innovative leadership development project incorporating a commitment to cascade training and participate in achievable quality or service improvement projects. The project provides opportunities to apply leadership skills in practice as well as to generate service improvements. The purpose is to enhance leadership skills and strengthen LINK partnerships by establishing a network of learning and development. It is made possible by a two-year grant awarded and managed by Tropical Health Education Trust (THET), with funding from the Department for International Development (DFID).

The initial three-day LEAD FORWARD workshop was delivered to 24 participants from 12 different VISION 2020 LINKS in September 2015. The workshop was prepared and delivered by Amy Brockbank (Senior Leadership Development Manager, NHS North West Leadership Academy) and Clare Inkster (Consultant Ophthalmologist, Bolton NHS Foundation Trust and Associate Postgraduate Dean, Health Education England (North West); Coordinator of the Lagos-Bolton VISION 2020 LINK). The project builds on previous experience of leadership development in a VISION 2020 LINK [1]. Amy and Clare kindly volunteered their time and expertise to plan, develop and deliver the workshop and its associated materials and resources. The 24 participants were 12 ‘Educator pairs’, one person from the African partner and one from the UK partner in each of 12 LINKS. The 12 LINKS chosen were in seven African countries: Ethiopia, Kenya, Malawi, Nigeria, Tanzania, Uganda and Zambia.

“The purpose is to enhance leadership skills and strengthen LINK partnerships by establishing a network of learning and development.”

The innovative aspect of the LEAD FORWARD project is its wide cascading in the 12 LINK institutions and the implementation of the skills learned, by carrying out Quality Improvement Projects. Each of the 12 LINK pairs committed to delivering the three-day training workshop together in their African LINK institution to two different groups of 10 participants (one in 2015/16 and one in 2016/17). All 12 LINK Educator pairs have successfully delivered the first of the two three-day LEAD FORWARD workshops in their African partner institution.

Everyone benefitting from participating in these workshops was expected to:

  1. Develop, implement and report on a Quality Improvement Project (QIP) at individual, department or organisational level.
  2. Cascade the training by holding a workshop focusing on an aspect of quality or service improvement to a small group of six to eight people, as relevant to their specific work context, and report on it.

Based on the reports and feedback, by the end of the project the VISION 2020 team will have evidence to assess whether it has improved the culture of leadership and quality improvement in the different contexts where the participants work – medical, administrative, nursing and technical.


Dr Bassey Etim presenting during the LEAD FORWARD Leadership Workshop.
Umoh is pictured fourth from left in the group.


The VISION 2020 LINK between Calabar and Wolverhampton

A VISION 2020 LINK was established in 2014 between the University of Calabar Teaching Hospital eye department and the Royal Wolverhampton Eye Infirmary. The Calabar-Wolverhampton LINK was among the 12 VISION 2020 LINKS chosen for the LEAD FORWARD training workshop in Manchester, with Bassey Etim and Linda Okafor representing Calabar and Wolverhampton respectively. In Calabar the first workshop was held from 22-24 February 2016. We present information on the first workshop in Calabar, the QIPs undertaken by the participants and the resulting changes so far, together with a case report on a specific participant in the workshop in Calabar.

The LEAD FORWARD workshop

The three-day workshop developed by Amy Brockbank and Clare Inkster was delivered in its entirety by Bassey Etim and Linda Okafor to 10 participants in Calabar in February 2016. They used the leadership training and facilitation skills and resources gained from the LEAD FORWARD workshop in Manchester.

“There was so much enthusiasm about the workshop that we had an extra participant that we could not prevent from joining the sessions. Participants were split into groups of three to four for group discussions and practical implementation of leadership and facilitation skills. A range of ideas for QIPs was stimulated amongst participants and by the end of the three-day workshop they were clear on what QIP they would each undertake. Every participant was encouraged to come out of his or her shell and feel free to express their ideas and opinions. With this approach, there was a great flow of ideas and interactions, with a resultant passion and enthusiasm to carry out QIPs targeted at instituting a change in their unit. This was further enhanced by the formation of a WhatsApp chat group by the participants for information sharing.”

The QIPs and their outcomes

The workshop participants undertook their QIPs at different pace and with varying positive results. The QIP aims and results are summarised in Table 1.

There are two more QIPs yet to take place. We also present a case study from one of the participants highlighting their QIP type, methodology, outcome / impact made and conclusion.



Case Study

Name: Umoh Charles Udofia

My name is Umoh Charles Udofia. I am a 37-year-old lady working at the University of Calabar Teaching Hospital, Calabar, Nigeria. I am a Senior Administrative Officer posted to the Department of Family Medicine. I am responsible for the management, administration and delivery of all Departmental programmes and services, to ensure that they are accomplished in an effective and efficient manner within all procedural guidelines.


Umoh (second from left) participating in group activity during the workshop.


Skills learnt:
The LEAD FORWARD Facilitation and Leadership Workshop in February had a great impact on my overall perception and appreciation of the hidden potential in me. It has increased my confidence level as a potential leader. I learnt different skills like leadership and facilitating skills, communication skills, giving feedback and teamwork. I now fully appreciate that excellent leadership, commitment and teamwork are major keys to organisational success. This has greatly changed my behaviour and attitude and has given me further drive to discharge my duties based on teamwork and the acquired skills, with the overall aim of excellent service, patient satisfaction and staff satisfaction. I believe I am more aware of my personal values as revealed by the Barrett’s assessment [2, 3] during the workshop. I realised that I had self-interest personal values with associated fear to let go for development and growth. Again, this motivated me to strive towards strengthening the weak values and developing personal values for common good.
With my goal of helping to promote my department as a yardstick for measuring success in our hospital, I decided to choose commitment and teamwork as areas to work on. Punctuality is a key determinant of commitment. So I identified lateness to work as an issue to be worked upon to improve commitment to duties and help remove hindrance to effective and quality service. Hence my QIP: ‘Introduction of Time Book Register’ in the Department of Family Medicine, to improve our punctuality to work and enhance productivity.
This was discussed with my Head of Department and he gave approval to initiate the QIP to reduce lateness to work and encourage the principles and benefits of teamwork. After being convinced about the positives to be derived from my QIP, my Head of Department approved the signing of the time book register by nurses, health records staff, accounts officers and the administrative staff currently working in the Department of Family Medicine.


Umoh carrying out cascade workshop in the Department of Family Medicine.


Time book introduced as part of QIP in Family Medicine Department following the workshop.


QIP results:
There is improved staff attitude to work and there has been continuous improvement in timekeeping by staff. This is particularly true for the health records staff, who are key in sorting out patients’ folders. This has greatly reduced patient waiting time before being attended to by the doctors, with overall improvement in patient satisfaction. We are hoping that this will also positively impact patient treatment outcomes.
Cascade workshop:
As well as my QIP, I facilitated a cascade workshop, entitled ‘Team Work for Effective Job Performance’. It was held on Saturday 26 March 2016 in the departmental seminar room.
The workshop consisted of the following learning objectives:
  • Understanding the importance of teamwork
  • How to be an effective team player
  • Team building
  • Leadership and teamwork.
The six participants were drawn from the Department of Family Medicine staff as follows:
  • A doctor (Chief Resident)
  • Administrative Staff
  • Nurse / midwife
  • Accounts
  • Secretarial / laboratory staff
  • Health records.
Feedback from the participants on their key ‘take home message’:
  • Teamwork does not just happen, it requires knowledge of how the team works, also leadership and commitment are needed at all levels of the health care system to implement teamwork over the long-term.
  • There is no perfect leader, hence we learn every day to avoid mistakes. Leadership entails sacrifice.
  • Teamwork is imperative for effective work.
  • I learnt the qualities of a good leader; there is no perfect leader; anybody can be a leader.
  • The essence of cooperation in an establishment, sharing ideas together at workplace, building and moulding the conduct of individuals through team- work. A responsible leader shows a good example to their followers.
  • I learnt that anyone can be a leader and also that teamwork is results-oriented and it reduces workload and stress.
Personally the workshop has increased my understanding that teamwork provides opportunity for participation, creates an environment for peoples’ personal qualities to be released, gives personal and corporate satisfaction, and it adds value to each member of any team. I have developed the skills of listening, pulling everyone along, energising a group, reflecting on issues, treating every team member equally, openness and skills of identifying personal and shared values for organisational success.
My future hope is to sustain my leadership and facilitation skills by daily practical application, and strive to acquire more skills through exposure to advanced leadership and facilitation workshops.
The QIP activity – the time book – has impacted positively in our quest to meet our departmental and organisational goal of offering quality and timely services to our patients. From the table of QIPs and the case report presented here, one can appreciate the multiplier effect of the cascading workshop on leadership training skills in bringing about pockets of cumulative service improvement through shared learning.



1. Inkster C, Akinsola F, Zondervan M. VISION 2020 LINKS Programme: building capacity for eye care services in Nigeria through leadership and skills development. Eye News 2016;22(5):44-7.
2. Personal Values Assessment (PVA). Barrett Values Centre.

Last accessed August 2016.
3. The Seven Levels of Personal Consciousness. Barrett Values Centre.

Last accessed August 2016.



The VISION 2020 LINKS Programme offers sincere thanks to Amy Brockbank and Clare Inkster for developing, delivering and reporting on the initial LEAD FORWARD workshop and assisting in the planning and development of the cascading project; without them the entire project would not have been possible.




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Bassey Etim

Senior Lecturer, University of Calabar; Consultant Ophthalmologist, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.

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Affiong Ibanga

University of Calabar Teaching Hospital, Nigeria.

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Linda Okafor

New Cross Hospitall, Wolverhampton Eye Infirmary, The Royal Wolverhampton NHS Trust, Wolverhampton, UK.

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Marcia Zondervan

VISION 2020 LINKS Programme, International Centre for Eye Health, LSHTM, Keppel Street, London, WC1E 7HT, UK.

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