1. Collins, Amy M.


As the largest part of the health care workforce, it's nurses, says Leslie Mancuso, who will make the difference.


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Leslie Mancuso-who calls herself a nurse first and president and chief executive officer of the international nonprofit Jhpiego second-says that her successful career as a pediatric nurse took an unexpected turn when she was invited to take her expertise overseas.

Figure. Leslie Mancu... - Click to enlarge in new window Leslie Mancuso, PhD, RN, FAAN, greets nurses from the Bissinghin health center in Burkina Faso. Photo courtesy of Jhpiego.

She was teaching and getting her PhD in education and organizational leadership when she was asked to go to Costa Rica with a group of physicians to assess the needs of the children there. "I didn't grow up in a family that traveled, so I had never been anywhere," she said. Consultancies in Nicaragua, Poland, Indonesia, and China followed-trips she says that reinforced not only that she had much to offer, but that there was a lot she could learn from the world. "I realized I could accept the way things are in the countries I visited, or I could accept responsibility for changing them," she said. So she decided to go into global international health full time.


She left teaching and took a position at a nonprofit called Project Hope, where she remained for 13 years. From there she was recruited by Jhpiego, an international nongovernmental organization affiliated with Johns Hopkins University. The organization, which is dedicated to improving the health of women and families in developing countries, helps these countries develop strategies to care for their citizens by training nurses, midwives, and other health care workers; strengthening health systems; and improving delivery of care.


"Quite often we see that nurses and midwives are alone out there, having to manage enormous workloads and needing support. And so a lot of our work is trying to get them the latest evidence-based information, whether it's about HIV-AIDS, cervical cancer screening, or maternal-child health, and bringing them new tools they can adapt to work within the context of their countries."



Mancuso says she now spends almost 80% of her time traveling, visiting the more than 40 countries in which Jhpiego works. She boasts a staff of over 3,700, many of them nurses and midwives, as well as physicians and public health experts-and most are in the field. She stresses that rather than telling these nurses what to do, it's about empowering them. "You don't go into these countries and say 'you need to do this,'" she said. "I have incredibly talented people who let me know what the countries are trying to do and then we help them do it."


By having nurses and midwives on Jhpiego's staff, the organization has experienced insight into the unique challenges of each country. "Right now, 90% of all health care worldwide is provided by nurses and midwives," Mancuso said, noting that they are often the only links to health care for millions of people in underserved communities. "They know so much-they know the gaps in coverage. They know what's working and not working. They understand why women aren't bringing their children in to be immunized, getting cervical cancer screening, or utilizing safe methods of family planning. So we work with these nurses and midwives to help them help these underserved communities access health care in a better way."


According to Mancuso, many nurses and midwives aren't brought into decision making when it comes to defining health care priorities and goals. So one of Jhpiego's commitments is to help give them opportunities to build their management and leadership skills.


"We've heard a lot recently about how women need to be in leadership positions. Well I think nurses need to be in leadership positions. We are the worldwide experts in health care. We are the biggest part of the global health workforce," Mancuso said, stressing that for this reason nurses should be in a position to make decisions, as part of an interdisciplinary team, about health care goals and priorities around the world. "I constantly hear that nurses are saying, 'I'm not part of this decision,' and so I say, 'If you don't have a seat at the table, bring your own chair.'"



Mancuso says Jhpiego has had to be nimble, adaptive, and innovative to keep up with a constantly changing health care landscape. Under her leadership, the organization has grown from having five programs to more than 126, and from having an annual budget of $5 million to one of $405 million. Mancuso says that the organization's successes are because of her staff. "I have this incredible group of people around the world who are dedicated to making sure that where women and families live does not determine if they live," she says. And the impact of Jhpiego's work in the countries it serves proves this dedication is paying off.

Figure. Mancuso meet... - Click to enlarge in new window Mancuso meets a mother from India who was counseled on her family planning options before leaving the hospital with her second child. Photo by Indrani Kashyap.

One of the biggest effects of Jhpiego's efforts is in family planning. In India, for example, Mancuso says there has been government interest in helping women choose a family planning method and space their pregnancies to preserve their health. Mancuso's global staff are also working to provide voluntary male circumcision, which reduces the risk of HIV transmission from women to men. Over time, women also benefit as they have a decreased chance of encountering an HIV-infected male partner. Mancuso has also seen changes with respect to screening. "In December I was in Burkina Faso, where women are being screened for cervical cancer-for the first time in their lives-using an innovative screening and treatment approach Jhpiego has been working with for years," she said. In maternal-child health, Jhpiego's work focuses on making sure women are delivering babies with skilled attendants, receiving education on the importance of breastfeeding, and continuing to care for their children. But Mancuso says there is still a long way to go. "If you look at the global maternal mortality rate, it has dropped significantly since 1990, but we have a lot more to do."



In terms of future goals, Mancuso wants to continue her mission of helping women and families survive. "I still believe there are women who are dying needlessly, and we have a lot more work to do in family planning and in making sure countries have the skills and knowledge to manage a woman in pregnancy, delivery, and postpartum." In addition to maternal-child health goals, Jhpiego is focusing on HIV prevention, and recently launched a new program called "Oral PrEP," which brings preexposure prophylaxis to vulnerable populations, including adolescents. The group is also working in a new area called "safe surgery," which aims to improve outcomes for the 5 billion people around the globe who don't have access to safe surgical care-including for cesarean sections. And, according to Mancuso, nurses and midwives will play a significant role in this. "Nurses and midwives must be part of the solution if we are to reach the UN's Sustainable Development Goals," she said.



While not all nurses have an interest in international work, Mancuso says there are many ways to be involved right here at home. "Nurses need to understand that they have colleagues around the world who need their support." One place to start, Mancuso said, is participating in organizations such as the International Council of Nurses, the International Confederation of Midwives, and Sigma Theta Tau International. "It's our responsibility to go to these meetings and be part of these groups. Nurses can be advocates. They can stand up for themselves and for nurses around the world."


Mancuso also says that Jhpiego is always looking for dedicated, experienced, motivated nurses to join them in their efforts, whether here at home or abroad (nurses can visit "We really need nurses to come on board and work with us to go after the changing health landscape and the things we know we can do. It's nurses who will make the difference."-Amy M. Collins, managing editor