How Insead made Dr Lola Dare rethink her work

The thing that strikes you when meeting Lola Dare is her laugh. It is loud, explosive and frequent. "One of the things I like doing is laughing", she points out, redundantly. "You might find that I tend to laugh a lot." With that, she lets out one of her show-stopping belly laughs. On the topic of Insead, the business school she attended for three months in France in 2006, she switches gear, becoming contemplative. A kind of reverie takes hold.

The raucous, switched-on Nigerian sitting here in her home in the north London suburb of Finchley - just down the road from her office at the Centre for Health Sciences, Training, Research and Development (Chestrad), the African public health social enterprise she founded - is very different from the person she was 10 years ago.

It was grief that drove Dr Dare to Insead. After her daughter Oreoluwa died from malaria in 2005, her professional life, once a source of vitality, became inconsequential.

"I'm not sure that I had the will to do anything," she says.

Her partner encouraged her to embark on the course, hoping it would inspire her to return to work and find some meaning to her life again. She signed up to the three-month advanced management course in 2006 begrudgingly. "I was very angry," she says. "I thought: 'Can't you just leave me in my misery? I'm very happy in my misery. I'm very comfortable in it.'"

Once at Insead she felt out of place - an African woman working on public health in a class of predominantly western male executives from private companies. "I was with chiefs of global industry and I just thought, these are multimillion dollar corporations - what am I doing here? I was the only one from the public sector. I was the only one from the non-governmental sector and I was loudest," she says.

But soon she realised she and her fellow students had problems in common. "Their issues were just the same as the issues we were [dealing] with in health systems. They were management issues. I used to say, 'You guys produce something. I produce what you need: healthy people.'"

The experience got her thinking about applying business processes to health. "I would say, 'If you were in the health sector what would you do?'" Dr Dare found the experience revitalising. "It really touched me," she says. Insead became a "place of solace, motivation, innovation and curiosity".

The programme made her rethink Chestrad's model. She had launched the organisation in 1993 as a not-for-profit, using savings earned from lecturing at a teaching hospital to fund it. The centre's mission early on was to look at the reproductive health of young people. After Insead she transformed Chestrad into a social enterprise. Its aim now is to support African governments to build sustainable healthcare systems that are close to their clients and equitable.

Insead also made her examine accountability in the health sector.

As a young girl she wanted to become a psychiatrist. "I wanted to know why people react differently to different situations. As a young child it used to fascinate me: Why is he angry? Why is he crazy? Why did she do this? And the same person didn't do that?"

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"It was a huge house and it was full of joy. I really am not the typical African child who's grown up miserably. I grew up with a fantastic environment, with an extended family."

Her mother was passionate that girls went to school and that boys were taught to cook and clean. Dr Dare attended a Catholic convent school, mingling with British expatriates.

She went to the University of Ibadan to study medicine but became diverted from her original ambition to become a psychiatrist, turning to paediatrics instead. "I realised I wanted to study medicine because I wanted to save lives. I didn't want people to die. I didn't even want cats to die," she says.

Working in paediatrics involved a lot of death in Nigeria at that time, Dr Dare says. "We just seemed to be signing death certificates."

The defining moment came after she had been nursing a child with neonatal tetanus for a week. "We had to maintain him on oxygen. I went home to sleep. I got to work at 7am and [he] was dead. The hospital ran out of oxygen." Within 24 hours she had signed six death certificates. The final straw came when a mother who had struggled with infertility for many years gave birth to a baby who later died from neonatal jaundice.

Dr Dare walked out of the clinic and decided not to go back. "[The deaths] were easily preventable with known tools. There were known strategies," she says.

<>Later, the hospital's medical director persuaded Dr Dare to do a stint in public health. In the villages she saw at close quarters the problems that she diagnosed as ignorance, social stigma, lack of medical services and poverty.

Those experiences inform Chestrad's work helping governments build health systems appropriate to Africa. She says international donors are often misguided or labouring under "well-intentioned goodwill". They get it wrong "because they want us to be like the US, especially the NGOs".

For example, she says, "if you advocate for women's empowerment in certain ways you are going to destroy family structures in Nigeria, in Africa." But approaching the issue with sensitivity to social context can help achieve the same goals without causing division.

Insead changed the way Dr Dare devised solutions. Today, she likes to use a "lives-saved analysis".

"I began to look at the return on my investment by how many lives we saved," she says. "Although we still need to improve on that measure, it gives us an [indicator] like return on equity."

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