5 questions … for Leslie Mancuso, president and CEO of Jhpiego

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Dr. Leslie Mancuso is president and CEO of Jhpiego.

Leslie Mancuso has been at the helm of Jhpiego, an international health affiliate of the Johns Hopkins University, for more than a decade.

Under her leadership, the Fells Point-based organization has expanded significantly. The nonprofit's budget has multiplied nearly 50 times and its staff has increased ninefold. Most of those employees are located in outposts around the world.


But the organization's mission has remained constant. Working with local governments and community leaders, Jhpiego trains health professionals and develops economical methods to improve care.

The goal is to provide communities with lagging health care systems — in Africa, Asia, Latin America and elsewhere — tailored, sustainable methods of preventing and treating diseases. The group's focuses include maternal and child health, HIV/AIDS, tuberculosis and malaria.


"It's been an incredible journey," Mancuso said.

How have you shaped Jhpiego's structure and mission during the 11 years you've led the organization?

When I arrived at Jhpiego in 2002, I quickly realized that in order to expand the reach of our work, we had to build a truly global culture from the ground up. Of our 188 employees, 65 percent were Americans, and a majority of them were based in our Baltimore headquarters, not in the field, where our programs were being implemented.

As a result of years of recruitment and development, today 83 percent of our more than 1,600 employees, many of whom are nurses, midwives or doctors, are based in the field, and a vast majority work in the regions where they are originally from. These are individuals who know firsthand the challenges of providing care in the vulnerable places where we work and whose expertise has helped save countless lives.

Also, while we are a nonprofit, we still need a consistent pipeline of funding to accomplish our mission. I redirected our efforts to diversify our funding stream, focusing heavily on new program development and creating a rigorous system of compliance and accountability. Over the past 11 years, our budget has grown from $5 million to $230 million, and the number of programs has expanded from four to 98.

How has your experience as a nurse informed your leadership style?

Although I'm very proud to be the president and CEO of an amazing organization like Jhpiego, I consider myself to be a nurse first and foremost, and one of the greatest leadership lessons I've learned came from my fellow nurses. It's simple: Good leaders build leaders around them. The best nurses in my units were ones who helped develop the talent and skills of nurses around them. They tapped into the potential of others and enhanced their abilities. This approach not only made our team stronger, but also improved the care we provided to our patients.

I've tried to embed that leadership philosophy into all aspects of Jhpiego. From a mentoring program for new employees to professional development opportunities — both within the U.S. and internationally — and targeted job recruitment, I want our leaders to encourage and mentor their staffs to become leaders themselves.


I also think that being a nurse has made me a compassionate and passionate leader. As Gandhi said, "You must be the change you wish to see in the world." That idea of personal responsibility drives me to do more, reach more people, save more lives.

Over 40 years, Jhpiego has spearheaded many significant health care innovations. What are the Jhpiego achievements you're most proud of?

I'm truly proud of all of our innovations, as each has improved the health of women and their families in real, tangible ways. But I would say that the single-visit approach to cervical cancer prevention and treatment and the use of misoprostol to prevent bleeding after birth are standouts in my mind.

Each year, 270,000 women die from cervical cancer, a disease that is 100 percent preventable if women have access to screenings, which, unfortunately, 95 percent of women in the developing world don't have. To address this lack of access, Jhpiego pioneered an innovation called the single-visit approach, which uses simple vinegar to identify precancerous cells on the cervix. We call it the single-visit approach because a woman can be screened with the vinegar solution, and if abnormal cells are detected, they can be treated in the same visit. The screening costs only $5, and screening with treatment is $30. To date, over a million women have been screened using this innovation, saving many of them from an early death due to cervical cancer.

The No. 1 cause of maternal deaths is postpartum hemorrhage or excessive bleeding after birth. Since 50 percent of women give birth at home in the countries where we work, without the help of a skilled birth attendant, Jhpiego developed an innovative approach that uses community health workers. Many of them are mothers and grandmothers themselves who provide lifesaving instructions with illustrated flash cards and three little pills called misoprostol, which stops bleeding from postpartum hemorrhage. The health workers educate pregnant women about danger signs in pregnancy and childbirth and how to use misoprostol safely, if needed. This innovation has brought care to women where they live. In Afghanistan, 10,212 women have received misoprostol through these lifesaving home visits. And in Nepal, 18,761 pregnant women received misoprostol from female community health volunteers trained through Jhpiego.

What have you learned about management from working in so many different environments throughout the world?


During the course of my career, I have traveled throughout many, many parts of the world and met extraordinary health care champions, both within Jhpiego and outside of the organization. While we are all dedicated to improving the lives of women and their families, each country has their own set of cultural and social practices we have to be mindful of. We may know that husbands and elder family members have to be brought into the conversation on family planning if we are going to get women access to services they need and save their lives. In Nigeria, for example, we realized that having male counselors visit men to discuss this sensitive topic was the way to go.

The staff in our country offices are members of the communities they serve, they understand the burden of accessing care and unequal gender roles, and they know how to address these issues.

That same lesson applies to managing an international organization operating in 50 countries. There isn't a one-size-fits-all approach that will work in every country. We must trust and listen to our staff and partners on the ground — heed their advice and expertise, and use their institutional knowledge to make informed decisions.

You spend 80 percent of your time traveling to Jhpiego's offices across the globe. What do you miss most about Baltimore when you're away?

Of course, my husband would be first on that list. Thankfully, he understands why I'm so passionate about our work, and he picks me up at the airport after each of my trips, and brings me a bouquet of flowers. I love the theater and have season tickets to Center Stage, but I often miss out on great performances because I'm traveling. Also, if I'm gone too long, I crave Italian from La Scala and miss my favorite booth at Ouzo Bay in Harbor East.


Leslie Mancuso

Title: President and CEO, Jhpiego

Age: 57

Hometown: Enfield, Conn.

Current residence: Harbor East


Education: Bachelor's degree in nursing, Southern Connecticut State University; master's degree in nursing, University of Pennsylvania School of Nursing; doctorate in education-organizational leadership, University of Pennsylvania, 1997

Family: Husband, Ty Carter

Hobbies: Staying fit, attending performances at Center Stage