The Virtual Consultant

How Virtual Development Assistance is Making a Sustainable Difference in Realizing Global Health

Summary

Development consultants help reach global health goals and objectives in the context of a country’s development agenda, a development project or donor strategy. Previously, consultants traditionally lived in or traveled to developing countries to assess progress or results, sort out problems, improve the health system and deliver better programs and services.

This white paper describes how virtual global health consultants, although not onsite, add value by facilitating the analysis of problems, helping workers improve their performance, and assisting to design and implement improved systems and services. Learn more about the long-term benefits gained from this approach – whether you’re interested in working with a virtual consultant in development assistance or you’re the consultant looking to transition in virtual services.

Introduction – What’s Needed to Realize Global Health

At RGH we believe that safe, quality health care delivery can be realized now, worldwide. Our mission is to see every country establish and maintain an effective, self-reliant health system. Only then will we see real progress in eliminating unnecessary deaths and in realizing the right every human being has to the highest attainable standard of health.

The good news is that we know what to do realize global health. We already have the medical knowledge and technology to save millions of lives. The bad news is that in most developing countries we lack is an effective system to deliver care. Millions of dollars has been donated and thousands of global health projects have been created, however due to a serious lack of coordination and accountability, the results seldom live up to the good intentions.

Which is why governments, foundations and organizations turn to public health consultants for solutions. These consultants understand the big picture and have the knowledge and experience to avoid problems and create innovative solutions. They can assist in implementing projects and assisting health professionals in developing countries to deliver better screening and treatment services for diseases, expanding quality preventive and curative maternal and child health services, as well as improving the overall management, financing and development of the health sector.

In this paper I discuss why “virtual” consulting is a smart investment – empowering clients to develop and maintain sustainable, quality healthcare at a lower cost than most development projects today. Whether you’re interested in hiring a virtual consultant or being hired as a virtual consultant, you will learn how to establish an effective virtual partnership in development assistance.

Why “Virtual” Consulting is the Answer

Since development consultants have traditionally lived in or traveled to developing countries some find it difficult to see how the job can be done virtually. Our position is that not only can it be done, but that virtual consultants can actually do a better job at creating long-term, sustainable results.

Here are eight reasons why consultants should virtualize their work and governments, foundations and organizations should turn to virtual consultants for solutions:

1. Accessibility. The increased availability of cellphones, email, instant messaging, web-cameras, and other internet-based communication tools and programs allow virtual consultants to be just one click or phone call away. In this way, virtual consultants can work on retainer and respond quickly to emerging situations and provide ongoing support and assistance in solving urgent problems a project, program or health facility manager may face.

Virtual consulting allows for rapid dissemination and application of lessons learned and best practices among stakeholders using different tools from Facebook and LinkedIn, to client only portals for sensitive information. In this way, rapid, collective and concerted action can be taken by all parties affected by the problem at hand.

2. Cost-effectiveness. Development donors are fortunately increasingly emphasizing cost-effectiveness and demanding a tangible return on their investment. Consequently, the amount of funds used to pay for consultants tends to be limited in favor of funding local organizations and actual improvements in the delivery of health services. This trend can limit the access to prompt help when needed to solve serious health service delivery problems that cannot wait.

Working with a virtual consultant is more cost-effective because there are no costs associated with plane tickets, travel time, hotel stays or per diem. Since travel time is no longer a factor a virtual consultant is more efficient – quickly focusing on the task at hand without travel time and jetlag. This means it takes less time to complete the assignment and submit their report. Additional cost-effectiveness is demonstrated by their objectiveness and willingness to transfer capacity to local experts, which we will explore further below.

3. Objectiveness. Most donors wait to address unsatisfactory progress until the midterm or final project evaluation, which does little to help the project’s results. Being prompt at correcting slow or unsatisfactory progress will save lives and money by allowing the project team learn from their experience faster so as to correct any issues. A virtual consultant can help because he or she is not involved in the project and can easily and objectively propose solutions and options to adjust the course of the project.

4. Empowerment and transference of capacity. The relationship between traditional consultants and their counterparts usually doesn’t lead to increasing the capacity of the counterparts or to a measurable improvement of their performance. The reason for this is the relationship is usually perceived as the consultant knowing it all and the counterparts being passive receivers of this knowledge. This imbalanced relationship ends up with the consultant taking over the job and the counterpart feeling disempowered.

In contrast, today’s virtual consultant uses tools and approaches to rapidly support the local staff to solve service bottlenecks and inefficiencies and build local capacity. They build partnerships and allow counterparts to gain the confidence and skill to address on the job challenges in real time. To be effective, the virtual consultants needs to create a balanced mentoring and coaching relationship with local staff without taking over or interfering with their work but supporting it. A virtual consultant has greater impact because they win when the local counterparts win and they develop others’ ability to do the work. Since the consultant is not physically present, the beneficiary, mentee or coachee assumes full responsibility and, most importantly, all credit for the results.

A virtual consultant is more apt to transfer capacity to the in-country decision-makers. Today there is increased availability of qualified staff and reliable local or in-country consultants. These local professionals are very talented and their daily rates are usually lower, making them very cost-effective. With the guidance, objective perspective and the, virtual consultants work with local organizations and local health providers, managers and consultants who become empowered to implement solutions. In this way, the virtual consultant builds local capacity that remains in country. This yields a much higher return on the investment in a virtual consultant.

5. Tangible results. Development donors are also increasingly emphasizing effectiveness and accountability for tangible results. The value of a traditional consultant is sometimes hard to measure as most only leave behind a report that gathers dust on forgotten shelves. The value of a virtual consultant is more tangible because the virtual consultant works with and through others who can account for the impact on performance, such as increased staff productivity and improved outputs and outcomes. The goal of an effective virtual consultant is to take him or herself out of the job to allow local staff to take over and then moving on to other
challenges!

6. Targeted and continuous support. Increased awareness of the long-term challenges of managing and sustaining health services and executing a health strategy has raised the need for ongoing support for health managers in developing countries. The old approach of massive and cascade training needs to be substituted by a more targeted approach. Ongoing virtual coaching of strategic health facility or program managers, whose performance will not only set the example for others but also impact the quality and coverage of services, is the answer. For example, we have coached health professionals online to expand an adolescent health program in Rwanda in just a few weeks.

Every health manager needs a coach, particularly health managers in developing countries who face enormous challenges every day. Rather than the stigma of having a consultant shadow their work, they can establish a rapport with their virtual consultant/coach. This empowers health managers to make the best of what they have, position themselves to access more resources by demonstrating better performance, and to gain the confidence of taking each challenge one day at a time. This coaching takes place via regular, yet brief interactions over a period of time and propels health managers to take their careers to the next level and overcome long-term challenges.

7. Increased specialization in complex areas. Health services in developing countries are not simple systems any more. Just the magnitude of the health problems, the number of people affected and the increasing number of donors and organizations assisting has created new challenges in communication, collaboration and coordination for maximum impact and sustainability. The problems that emerge and the challenges government, donors and health providers are facing are becoming more and more complex and require the services of a variety of specialized experts.

Virtual consultants specialize their consulting practice in their area of expertise, and quickly respond to problems in that area. For example, a donor interested in disease eradication and expanding immunization services can hire a virtual consultant that only works in measles or polio eradication and can assist the country’s immunization program manager to reach a common vision of success for measles or just polio eradication. Clients working towards global health have specific needs for a virtual consultant specializing in medical waste disposal, medical engineering, hospital architecture, health worker job description development, community health worker or nurse aid curriculum development, etc.

8. Innovation and Scalability. There is increased evidence that the project-modality of providing development assistance is not effective in every circumstance. Many times projects are focused on their own short-term objectives and bypass the country’s systems and overlook opportunities, local assets and capacities.

In contrast with the intensive high-cost of project-based assistance, virtual consulting is a new development modality that allows donors to provide a targeted response and timely inputs to coach the country’s agency directors, senior health executives, hospital leadership teams and public health program managers. By learning to run their programs better it strengthen the work of those that are actually responsible for the country’s health sector. Virtual consultants have emerged as capable, yet flexible experts that cater for a well-defined or focused service or expertise. In this way, when a client identifies a challenge or problem, he can turn to a specific virtual consultant with clear expectations of what deliverables they are paying for as well as the long-term, sustainable results they will achieve.

How the Virtual Consultant Delivers Effective Results

There are many reasons why virtual consulting is more effective than the older, traditional model. However, the most distinctive feature of virtual consulting is that the response to the client’s need is almost immediate, just an email away. Also, the solution is provided in the context of a “partnership” between the virtual consultant and the client. The internet has facilitated the work of virtual consultants who can easily share their experience and coach clients to implement improvements.

Since the virtual consultant is not present when the solution is implemented so he or she only succeeds if the client succeeds. This aspect of virtual consulting is what makes it particularly effective in development assistance where sustainability is a major concern and dependence on foreign assistance needs to be avoided if clients are to be empowered and independent of assistance in the future.

As with traditional consulting, the client and virtual consultant need to have a written contract. The contract signifies the commitment of both parties to succeed in the most effective and efficient way and includes the activities the client and the virtual consultant will undertake, how the work will be performed to achieve the objectives and how progress will be measured. The contract also defines the measures they will use to determine whether these objectives have been achieved.

We recommend that a contract for virtual consultant in development assistance at a minimum include the following seven key areas:

1. A statement for both parties’ vision of the goal to be achieved to visualize success and inspire action.
2. Measurable objectives and expected value of improved performance for the client.
3. A fixed format for measuring progress and for communications between both parties and both parties’ commitment to a schedule of regular, mutual and continuous feedback.
4. Methodology for information sharing including how knowledge will be managed, what do if information is not available and the standard for minimum information required for informed action. (This is important to avoid overwhelming either party with information that may not be relevant to solve the problem at hand.)
5. How intellectual property will be managed and protected.
6. How payment will be made in a timely manner.
7. How the contract can be cancelled.

Through this type of contract, the virtual consultant commits to add value, improve the client’s situation and demonstrate achieving all the objectives. No excuses! Although in our experience it’s rare, if objectives are not achieved as anticipated and it is the virtual consultants’ responsibility, then he or she must commit to work without a fee until the work is done. Virtual consultants are global health experts and commit to results in global health that can be guaranteed. The client must pay for results and not for ineffective performance. At RGH, we believe this applies to both onsite and virtual consultants.

Benefits for Consultants by Working Virtually

We’ve reviewed in-depth the benefits those that require technical global health assistance in a developing country derive from working with a virtual consultant. For the client, the main advantage is the reduced cost and the ability to receive rapid and personalized assistance to increase competence, local capacity and results in realizing global health.

However, is there a benefit to the consultant? Virtual consulting definitely has advantages for the consultant on a personal and professional level.

One of the most satisfying advantages for the virtual consultant is to be able to influence a large number of people and have a measurable impact from the comfort of his or her office. This reduced travel time enhances their quality of life. Since location isn’t an issue the virtual consultant also enjoys a broader reach and can make a difference in the lives of many people by leveraging their individual know-how and intellectual products in various ways without having to be present. Then there is the level of deep professional satisfaction that comes from helping clients succeed, and take all the credit for that success, while they offer unstinting support behind the scenes.

Summary of Advantages of Virtual Consulting to the Consultant and the Client

Sample Menu of Virtual Consulting Services

The virtual consultant can provide a number of services to improve the delivery of health services in hospitals, clinics, health centers or community-based programs. Below is a sample list of the services global health donors and developing country clients usually require assistance with:

1. Consulting to solve a clinic, hospital or public health program management problem.
2. Develop new training curricula.
3. Develop training manuals and standard class plans.
4. Develop training e-books and work books.
5. Develop or revise standard job descriptions and performance objectives.
6. Edit reports and compile multiple-author books and manuals.
7. Virtual coaching for improved individual or team performance.
8. Clinical consulting and telemedicine.
9. Write best practices and how-to apply them guidelines.
10.Web content for Ministry of Health’s websites.
11. Create online forms for health staff to download or fill out and submit.
12. Process checklists and tools for frontline workers to be downloaded from the MOH website and use in health centers and hospitals.
13. Develop and disseminate continuous education programs for health worker at various levels in the health system.
14. Develop and assist to implement private practitioner accreditation guidelines and develop and manage training to meet accreditation criteria.
15. Develop and update Public health school curricula and standard class plans for teachers and instructors.
16. Develop or update hospital management training modules.
17. Develop or update standard community-based program planning templates and tools.
18. Design, desktop monitoring and desktop evaluation of various documents, programs or services.
19. Conduct confidential and or anonymous online surveys of stakeholders’ views and satisfaction.
20. Design and assess progress of disease control programs and country strategies.
21. Develop standard operating procedures. (At RGH, our process improvement uses Six Sigma or other appropriate innovative process design approach.)
22. Assist to develop and revise Global Fund Grant application.
23. Review of grant management and reporting procedures and M&E plan.
24. Research design, analysis and report preparation.
25. Design and analysis of situational assessments.
26. Health systems analysis and improvement planning.
27. Strategic and implementation planning.
28. Stakeholder interviews, analysis and coordination.
29. Knowledge management design, assessment and training.
30. Effectiveness assessment and accountability.
31. Quality assessment and improvement planning, standard tools and operating procedures
32. Change planning and management planning and implementation oversight.
33. Training and mentoring of health professionals in various stages of their careers.
34. Document reviews.

Recommended Tools for the Virtual Consultant

The virtual consultant uses a number of tools to provide consulting including:   <change to p>

• Email communications
• Email distance training
• Online training
• Voice over the Internet such as Skype www.skype.com and Microsoft Instant Messenger with a web camera the internet allows for “Face over the Internet” consulting.
• Internet chats and bulletin boards: www.blackboard.com
• Teleconferences: gotomeeting.com
• Webinars: www.gotowebinar.com
• Blogs: http://www.blogger.com/start or www.blog.com
• Website with pages for clients only (RGH has a private client hub)
• Client-customized web portals
• Podcasts
• Video and audio recordings and classes
• Newsletters
• Radio programs

Conclusion – Virtual Consulting is the Future of Development Assistance

Change is inevitable in global health and development assistance. We must deliver more with less and do it at larger scale. There are numerous best practices and proven life-saving interventions that are just waiting to be spread worldwide. There is evidence that projects alone do not bring sustainable improvements.

Virtual consulting in development assistance is a win-win proposition for the client and the virtual consultant. Virtual consultants can have as much or even more impact than traditional consultants and can achieve outstanding results. Clients get tangible value for the investment. Virtual consulting is one of the ways of accelerating improvements, and will continue to grow because of its cost-effective and empowering results. Virtual consultants make a difference in realizing global health because they work in partnership with professionals in developing countries.

RGH has a proven track record in virtual consulting to governments, foundations and organizations. We also provide training programs for consultants who want to transition into offering virtual services. Please visit our website to learn more about results and our clients’ experience: www.realizingglobalhealth.com.

Immediate Response

Ask about our RGH Problem-Solving Proposal™ that allows us to respond to client problems within 24 hours.

Analyzing Project Effectiveness

 RGH conducted an online survey of the project staff and reviewed a project’s quarterly report and work plan. Based on this information we provided advice and suggestions that helped the project address overlooked opportunities and expand its coverage.

Improving Quality Services

Virtual consultants can help health center directors to improve their services. For example, utilizing our innovative RGH consulting™ approach we helped a health center director improve the antenatal program in several local facilities. Now he is empowered to scale up the intervention to the whole province on his own.

Individual Training

RGH’s 7-Day Online Coaching Programs have helped hundreds of health professionals get sustainable results – such as reducing HIV stigma or hospital-acquired infections in matter of weeks. Click here to read about the results gained from online coaching.

At RGH, we define “measures of success” for our clients to clearly describe what “success” will look like, that is what outcomes the stakeholders and others not involved in the assignment will be able to observe when the solution is successfully implemented.