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Bosongo S, Belrhiti Z, Ekofo J, Kabanga C, Chenge F, Criel B, Marchal B. How capacity building of district health managers has been designed, delivered and evaluated in sub-Saharan Africa: a scoping review and best fit framework analysis. BMJ Open 2023; 13:e071344. [PMID: 37532484 PMCID: PMC10401232 DOI: 10.1136/bmjopen-2022-071344] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVES We aimed to understand how capacity building programmes (CBPs) of district health managers (DHMs) have been designed, delivered and evaluated in sub-Saharan Africa. We focused on identifying the underlying assumptions behind leadership and management CBPs at the district level. DESIGN Scoping review. DATA SOURCES We searched five electronic databases (MEDLINE, Health Systems Evidence, Wiley Online Library, Cochrane Library and Google Scholar) on 6 April 2021 and 13 October 2022. We also searched for grey literature and used citation tracking. ELIGIBILITY CRITERIA We included all primary studies (1) reporting leadership or management capacity building of DHMs, (2) in sub-Saharan Africa, (3) written in English or French and (4) published between 1 January 1987 and 13 October 2022. DATA EXTRACTION AND SYNTHESIS Three independent reviewers extracted data from included articles. We used the best fit framework synthesis approach to identify an a priori framework that guided data coding, analysis and synthesis. We also conducted an inductive analysis of data that could not be coded against the a priori framework. RESULTS We identified 2523 papers and ultimately included 44 papers after screening and assessment for eligibility. Key findings included (1) a scarcity of explicit theories underlying CBPs, (2) a diversity of learning approaches with increasing use of the action learning approach, (3) a diversity of content with a focus on management rather than leadership functions and (4) a diversity of evaluation methods with limited use of theory-driven designs to evaluate leadership and management capacity building interventions. CONCLUSION This review highlights the need for explicit and well-articulated programme theories for leadership and management development interventions and the need for strengthening their evaluation using theory-driven designs that fit the complexity of health systems.
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Affiliation(s)
- Samuel Bosongo
- Faculté de Médecine et Pharmacie, Département de Santé Publique, Université de Kisangani, Kisangani, Congo (the Democratic Republic of the)
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
| | - Zakaria Belrhiti
- Département santé publique and management, Ecole Internationale de Santé Publique, Université Mohammed VI des Sciences de la Santé, Casablanca, Morocco
- Centre Mohammed VI de la recherche et Innovation (CM6), Rabat, Morocco
| | - Joël Ekofo
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
| | - Chrispin Kabanga
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
| | - Faustin Chenge
- Faculté de Médecine et Pharmacie, Département de Santé Publique, Université de Kisangani, Kisangani, Congo (the Democratic Republic of the)
- Centre de Connaissances en Santé en République Démocratique du Congo, Kinshasa, Congo (the Democratic Republic of the)
- Ecole de Santé Publique, Université de Lubumbashi, Lubumbashi, Congo (the Democratic Republic of the)
| | - Bart Criel
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Maulina F, Hasanbasri M, Busari JO, Scheele F. Primary care doctors' perceived needs for physician leadership development in rural and remote settings of Aceh province, Indonesia. BMJ LEADER 2023:leader-2023-000757. [PMID: 37192122 DOI: 10.1136/leader-2023-000757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 04/25/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Globally, rural/remote health systems fall short of optimal performance. Lack of infrastructure, resources, health professionals and cultural barriers affect the leadership in these settings. Given those challenges, doctors serving disadvantaged communities must develop their leadership skills. While high-income countries already had learning programmes for rural/remote areas, low-income and middle-income countries (LMICs), such as Indonesia, are lagging behind. Through the lens of the LEADS framework, we examined the skills doctors perceived as most essential to support their performance in rural/remote areas. METHODS We conducted a quantitative study, including descriptive statistics. Participants were 255 rural/remote primary care doctors. RESULTS We discovered that communicating effectively, building trust, facilitating collaboration, making connections and creating coalitions among diverse groups were most essential in rural/remote communities. When rural/remote primary care doctors serve in such cultures, may need to prioritise harmony within the community and social order values. CONCLUSIONS We noted that there is a need for culture-based leadership training in rural or remote settings of Indonesia as LMIC. In our view, if future doctors receive proper leadership training that focuses on being competent rural physicians, they will be better prepared and equipped with the skills that rural practice in a specific culture requires.
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Affiliation(s)
- Fury Maulina
- School of Health Professions Education, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Department of Public Health, Faculty of Medicine, Universitas Malikussaleh, Lhokseumawe, Aceh, Indonesia
| | - Mubasysyir Hasanbasri
- Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health and Nursing, Gadjah Mada University, Yogyakarta, Indonesia
| | - Jamiu O Busari
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Pediatrics, Dr Horacio E Oduber Hospital, Oranjestad, Aruba
| | - Fedde Scheele
- Department of Obstetrics and Gynaecology, OLVG, Amsterdam, The Netherlands
- Department of Medical Education, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Liu L, Desai MM, Benyam T, Fetene N, Ayehu T, Nadew K, Linnander E. An Analysis of Zonal Health Management Capacity and Health System Performance: Ethiopia Primary Healthcare Transformation Initiative. Int J Health Policy Manag 2022; 11:2610-2617. [PMID: 35219284 PMCID: PMC9818125 DOI: 10.34172/ijhpm.2022.6247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 01/19/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND District management is emerging as a lynchpin for primary healthcare system performance. However, delivery of district-level interventions at scale is challenging, and overlooks the potential role of management at other subnational levels. From 2015-2019, Ethiopia's Primary Healthcare Transformation Initiative (PTI), aimed to build a culture of performance management and accountability at the zonal level. This paper aims to evaluate the longitudinal change in management practice and performance in the 19 zones participating in PTI, which included 315 districts and 1617 health centers. METHODS Using data from PTI intervention (2018 to 2019), we employed quantitative measures of management capacity at health center, district, and zonal levels, and quantified primary healthcare service performance using a summary score based on antenatal care coverage, contraception use, skilled birth attendance, infant immunization, and availability of essential medications. We used multiple generalized linear regression models accounting for clustering of health centers within zones to quantify (1) change in management and performance during the two-year intervention, (2) associations between the changes in management capacity at the zonal, district, and health facility level. RESULTS Adherence to management standards at the zonal, district, and health facility level improved significantly over two years (37%, P<.001; 18%, P<.001; 18%, P<.001; respectively), as did the performance summary score (14%, P<.001). Adherence at the zonal level in year one was associated with district level adherence in year one (P=.04), and, over the two-year period (P=.002), and district management mediated the relationship between management practice at zonal and health center levels (P<.001). CONCLUSION Improvements in zonal-level management practice were associated with significant improvements in district-level management and performance in PTI sites. Investments in managerial practices at the zonal level may provide an immediate way to energize primary healthcare system performance at scale in low-income country settings.
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Affiliation(s)
- Lingrui Liu
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Mayur M. Desai
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Tibebu Benyam
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
| | - Netsanet Fetene
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
| | - Temesgen Ayehu
- Health Extension Program, Ethiopia Federal Ministry of Health, Addis Ababa, Ethiopia
| | - Kidest Nadew
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Erika Linnander
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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Johnson O, Sahr F, Sevdalis N, Kelly AH. Exit, voice or neglect: Understanding the choices faced by doctors experiencing barriers to leading health system change through the case of Sierra Leone. SSM. QUALITATIVE RESEARCH IN HEALTH 2022; 2:None. [PMID: 36531296 PMCID: PMC9748299 DOI: 10.1016/j.ssmqr.2022.100123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/09/2022] [Accepted: 07/02/2022] [Indexed: 06/17/2023]
Abstract
This paper presents a study from Sierra Leone that explored the experiences of doctors as they endeavored to improve the health care systems in which they worked. Twenty-eight interviews were conducted with doctors in Sierra Leone, complemented by long-standing experience of national health provision and research by the authors. Drawing on Hirschman's theory of 'exit, voice and loyalty', the paper's framework analysis elaborates the doctor's career decisions and choices under systematic political and economic constraints, and in particular, the specter of retribution, including posting to undesirable jobs and withholding of salaries. This retribution was considered a driver of exit by doctors from the system, and few examples were given of doctors successfully advocating for change through advocacy ('voice'). We suggest that the relevance of Hirschman's theory to this setting is in drawing attention to the critical themes of retribution, opportunity, loyalties, and partial exits, ones often neglected in efforts to reduce emigration of doctors and strengthen their leadership. Ultimately, this paper critiques the overemphasis of mechanistic 'capacity building' in global health and recommends that health system strengthening must be viewed as a jointly political as well as technical exercise.
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Affiliation(s)
- Oliver Johnson
- Centre for Implementation Science, Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
- Centre for Health Policy, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Foday Sahr
- Department of Microbiology, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Military Hospital, Wilberforce, Sierra Leone
| | - Nick Sevdalis
- Centre for Implementation Science, Health Services & Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Ann H. Kelly
- Department of Global Health & Social Medicine, School of Global Affairs, Faculty of Social Science & Public Policy, King's College London, London, United Kingdom
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Rasheed MA, Hussain A, Hashwani A, Kedzierski JT, Hasan BS. Implementation evaluation of a leadership development intervention for improved family experience in a private paediatric care hospital, Pakistan. BMC Health Serv Res 2022; 22:944. [PMID: 35870912 PMCID: PMC9308933 DOI: 10.1186/s12913-022-08342-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
A study from a tertiary care center in Pakistan demonstrated that a leadership development intervention led to improved family experience of care outcomes. The objective of the current paper is to assess the implementation of this intervention and identify barriers and facilitators to inform sustainability and scalability.
Methods
A working group designed the intervention using a theory-of-change model to strengthen leadership development to achieve greater employee engagement. The interventions included: i) purpose and vision through purpose-driven leadership skills trainings; ii) engaging managers via on-the-job mentorship programme for managers, iii) employee voice i.e., facilitation of upward communication to hear the employees using Facebook group and subsequently inviting them to lead quality improvement (QI) projects; and iv) demonstrating integrity by streamlining actions taken based on routine patient experience data. Implementation outcomes included acceptability, adoption, fidelity across degree & quality of execution and facilitators & barriers to the implementation. Data analyzed included project documentation records and posts on the Facebook group.
Analysis indicated acceptability and adoption of the intervention by the employees as178 applications for different QI projects were received. Leadership sessions were delivered to 455 (75%) of the employees and social media communication was effective to engage employees. However, mentorship package was not rolled out nor the streamlined processes for action on patient experience data achieved the desired fidelity. Only 6 QI projects were sustained for at least a year out of the 18 approved by the working group. Facilitators included leadership involvement, real-time recognition and feedback and value-creation through participation by national and international celebrities. Challenges identified were the short length of the intervention and incentives not being institutionalized.
The authors conclude that leadership development through short training sessions and on-going communications facilitated by social media were the key processes that helped achieve the outcomes. However, a long-term strategy is needed for individual managerial behaviours to sustain.
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Poursheikhali A, Alkhaldi M, Dehnavieh R, Haghdoost A, Masoud A, Noorihekmat S, Cheshmyazdan MR, Bamir M. What the policy and stewardship landscape of a national health research system looks like in a developing country like Iran: a qualitative study. Health Res Policy Syst 2022; 20:116. [PMID: 36307850 PMCID: PMC9617330 DOI: 10.1186/s12961-022-00905-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/02/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The health research system (HRS) is an important national priority that requires a systematic and functional approach. Evaluating the HRS of Iran as a developing country and identifying its challenges reveals the stewardship-related role in how the whole system is operating well. This study aims to assess the HRS in terms of stewardship functions and highlight the enhancement points. METHODS This study was carried out between March 2020 and April 2021 using a systematic review and meta-synthesis of evidence to examine the Iranian HRS stewardship challenges and interview 32 stakeholders, using a critical case sampling and snowballing approach which included both semi-structured and in-depth interviews. The interviewees were selected based on criteria covering policy-makers, managers, research bodies and nongovernmental organizations (NGOs) in health research-related fields like higher education, research, technology, innovation and science. All data were analysed using content analysis to determine eight main groups of findings under three levels: macro, meso, and micro. RESULTS Analysis of the findings identified eight main themes. The most critical challenges were the lack of an integrated leadership model and a shared vision among different HRS stakeholders. Their scope and activities were often contradictory, and their role was not clarified in a predetermined big picture. The other challenges were legislation, priority-setting, monitoring and evaluation, networking, and using evidence as a decision support base. CONCLUSIONS Stewardship functions are not appropriately performed and are considered the root causes of many other HRS challenges in Iran. Formulating a clear shared vision and a work scope for HRS actors is critical, along with integrating all efforts towards a unified strategy that assists in addressing many challenges of HRS, including developing strategic plans and future-oriented and systematic research, and evaluating performance. Policy-makers and senior managers need to embrace and use evidence, and effective networking and communication mechanisms among stakeholders need to be enhanced. An effective HRS can be achieved by redesigning the processes, regulations and rules to promote transparency and accountability within a well-organized and systematic framework.
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Affiliation(s)
- Atousa Poursheikhali
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Medical University Campus, Haft-Bagh Highway, Kerman, Iran
| | - Mohammed Alkhaldi
- McGill University Health Center, Faculty and Department of Medicine, School of Physical and Occupational Therapy, McGill University, Montreal, Canada
- Health System Impact Fellowship, Canadian Institutes of Health Research, Ottawa, Canada
- Department of Environmental Health Sciences, Canadian University Dubai, Dubai, United Arab Emirates
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Reza Dehnavieh
- Health Foresight and Innovation Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - AliAkbar Haghdoost
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Medical University Campus, Haft-Bagh Highway, Kerman, Iran.
| | - Ali Masoud
- Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Somayeh Noorihekmat
- Social Determinant of Health Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Reza Cheshmyazdan
- Department of Medical Library and Information Science, Kerman University of Medical Sciences, Kerman, Iran
| | - Mousa Bamir
- Health Foresight and Innovation Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Liu L, Desai MM, Fetene N, Ayehu T, Nadew K, Linnander E. District-Level Health Management and Health System Performance: The Ethiopia Primary Healthcare Transformation Initiative. Int J Health Policy Manag 2022; 11:973-980. [PMID: 33327692 PMCID: PMC9808198 DOI: 10.34172/ijhpm.2020.236] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 11/15/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite a wide range of interventions to improve district health management capacity in low-income settings, evidence of the impact of these investments on system-wide management capacity and primary healthcare systems performance is limited. To address this gap, we conducted a longitudinal study of the 36 rural districts (woredas), including 229 health centers, participating in the Primary Healthcare Transformation Initiative (PTI) in Ethiopia. METHODS Between 2015 and 2017, we collected quantitative measures of management capacity at the district and health center levels and a primary healthcare key performance indicator (KPI) summary score based on antenatal care (ANC) coverage, contraception use, skilled birth attendance, infant immunization, and availability of essential medications. We conducted repeated measures analysis of variance (ANOVA) to assess (1) changes in management capacities at the district health office level and health center level, (2) changes in health systems performance, and (3) the differential effects of more vs less intensive intervention models. RESULTS Adherence to management standards at both district and health center levels improved during the intervention, and the most prominent improvement was achieved during district managers' exposure to intensive mentorship and education. We did not observe similar patterns of change in KPI summary score. CONCLUSION The district health office is a valuable entry point for primary healthcare reform, and district- and facility-level management capacity can be measured and improved in a relatively short period of time. A combination of intensive mentorship and structured team-based education can serve as both an accelerator for change and a mechanism to inform broader reform efforts.
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Affiliation(s)
- Lingrui Liu
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - Mayur M. Desai
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Netsanet Fetene
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
| | - Temsgen Ayehu
- Federal Ministry of Health, Government of Ethiopia, Addis Ababa, Ethiopia
| | - Kidest Nadew
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
| | - Erika Linnander
- Global Health Leadership Initiative, Yale University, New Haven, CT, USA
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
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Nzinga J, Boga M, Kagwanja N, Waithaka D, Barasa E, Tsofa B, Gilson L, Molyneux S. An innovative leadership development initiative to support building everyday resilience in health systems. Health Policy Plan 2021; 36:1023-1035. [PMID: 34002796 PMCID: PMC8359752 DOI: 10.1093/heapol/czab056] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 03/26/2021] [Accepted: 05/04/2021] [Indexed: 11/13/2022] Open
Abstract
Effective management and leadership are essential for everyday health system resilience, but actors charged with these roles are often underprepared and undersupported to perform them. Particular challenges have been observed in interpersonal and relational aspects of health managers’ work, including communication skills, emotional competence and supportive oversight. Within the Resilient and Responsive Health Systems (RESYST) consortium in Kenya, we worked with two county health and hospital management teams to adapt a package of leadership development interventions aimed at building these skills. This article provides insights into: (1) the content and co-development of a participatory intervention combining two core elements: a complex health system taught course, and an adapted communications and emotional competence process training; and (2) the findings from a formative evaluation of this intervention which included observations of the training, individual interviews with participating managers and discussions in regular meetings with managers. Following the training, managers reported greater recognition of the importance of health system software (values, belief systems and relationships), and improved self-awareness and team communication. Managers appeared to build valued skills in active listening, giving constructive feedback, ‘stepping back’ from automatic reactions to challenging emotional situations and taking responsibility to communicate with emotional competence. The training also created spaces for managers to share experiences, reflect upon and nurture social competences. We draw on our findings and the literature to propose a theory of change regarding the potential of our leadership development intervention to nurture everyday health system resilience through strengthening cognitive, behavioural and contextual capacities. We recommend further development and evaluation of novel approaches such as those shared in this article to support leadership development and management in complex, hierarchical systems.
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Affiliation(s)
- Jacinta Nzinga
- Health Services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, PO Box 43640, Nairobi 00100, Kenya
| | - Mwanamvua Boga
- Health Services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, PO Box 43640, Nairobi 00100, Kenya
| | - Nancy Kagwanja
- Health Services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, PO Box 43640, Nairobi 00100, Kenya
| | - Dennis Waithaka
- Health Services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, PO Box 43640, Nairobi 00100, Kenya
| | - Edwine Barasa
- Health Services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, PO Box 43640, Nairobi 00100, Kenya.,Nuffield Department of Medicine & Department of Paediatrics, University of Oxford, Henry Wellcome Building for Molecular Physiology, Old Road Campus, Headington, Oxford OX3 7BN, UK
| | - Benjamin Tsofa
- Health Services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, PO Box 43640, Nairobi 00100, Kenya
| | - Lucy Gilson
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, 7925 Cape Town, South Africa.,Department of Global Health and Development, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Sassy Molyneux
- Health Services and Research Group, Kenya Medical Research Institute/Wellcome Trust Research Programme, PO Box 43640, Nairobi 00100, Kenya.,Nuffield Department of Medicine & Department of Paediatrics, University of Oxford, Henry Wellcome Building for Molecular Physiology, Old Road Campus, Headington, Oxford OX3 7BN, UK
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Johnson O, Begg K, Kelly AH, Sevdalis N. Interventions to strengthen the leadership capabilities of health professionals in Sub-Saharan Africa: a scoping review. Health Policy Plan 2021; 36:117-133. [PMID: 33313871 PMCID: PMC7938510 DOI: 10.1093/heapol/czaa078] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 12/12/2022] Open
Abstract
Leadership is a critical component of a health system and may be particularly important in Sub-Saharan Africa, where clinicians take on significant management responsibilities. However, there has been little investment in strengthening leadership in this context, and evidence is limited on what leadership capabilities are most important or how effective different leadership development models are. This scoping review design used Arksey and O’Malley’s approach of identifying the question and relevant studies, selection, charting of data, summarizing of results and consultation. A comprehensive search strategy was used that included published and unpublished primary studies and reviews. Seven databases were searched, and papers written in English and French between 1979 and 2019 were included. Potential sources were screened against inclusion and exclusion criteria. Data were grouped into common categories and summarized in tables; categories included conceptual approach to leadership; design of intervention; evaluation method; evidence of effectiveness; and implementation lessons. The findings were then analysed in the context of the review question and objectives. Twenty-eight studies were included in the review out of a total of 495 that were initially identified. The studies covered 23 of the 46 countries in Sub-Saharan Africa. The leadership development programmes (LDPs) described were diverse in their design. No consistency was found in the conceptual approaches they adopted. The evaluation methods were also heterogeneous and often of poor quality. The review showed how rapidly leadership has emerged as a topic of interest in health care in Sub-Saharan Africa. Further research on this subject is needed, in particular in strengthening the conceptual and competency frameworks for leadership in this context, which would also inform better evaluation. Our findings support the need for LDPs to be accredited, better integrated into existing systems and to put greater emphasis on institutionalization and financial sustainability from their early development.
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Affiliation(s)
- Oliver Johnson
- Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, David Goldberg Centre, De Crespigny Park, London SE5 8AF, UK.,Centre for Health Policy, School of Public Health, School of Public Health Building. University of the Witwatersrand, 27 St Andrews Road, Parktown, 2193 South Africa
| | - Kerrin Begg
- School of Public Health and Family Medicine, University of Cape Town, Falmouth Building, Anzio Road, Cape Town, 7925, South Africa
| | - Ann H Kelly
- Department of Global Health & Social Medicine, School of Global Affairs, Faculty of Social Science & Public Policy, King's College London, Bush House, North East Wing, 40 Aldwych, London, WC2B 4BG, UK
| | - Nick Sevdalis
- Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, David Goldberg Centre, De Crespigny Park, London SE5 8AF, UK
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Johnson O, Sahr F, Begg K, Sevdalis N, Kelly AH. To bend without breaking: a qualitative study on leadership by doctors in Sierra Leone. Health Policy Plan 2021; 36:1644-1658. [PMID: 34226922 PMCID: PMC8597969 DOI: 10.1093/heapol/czab076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/08/2021] [Accepted: 06/17/2021] [Indexed: 11/25/2022] Open
Abstract
Strong leadership capabilities are essential for effective health services, yet definitions of leadership remain contested. Despite the acknowledged contextual specificity of leadership styles, most leadership theories draw heavily from Western conceptualizations. This cultural bias may attenuate the effectiveness of programmes intended to transform healthcare practice in Sub-Saharan Africa, where few empirical studies on health leadership have been conducted. This paper examines how effective leadership by doctors was perceived by stakeholders in one particular context, Sierra Leone. Drawing together extensive experience of in-country healthcare provision with a series of in-depth interviews with 27 Sierra Leonean doctors, we extended a grounded-theory approach to come to grips with the reach and relevance of contemporary leadership models in capturing the local experiences and relevance of leadership. We found that participants conceptualized leadership according to established leadership models, such as transformational and relational theories. However, participants also pointed to distinctive challenges attendant to healthcare provision in Sierra Leone that required specific leadership capabilities. Context-specific factors included health system breakdown, politicization in the health sector and lack of accountability, placing importance on skills such as persistence, role modelling and taking initiative. Participants also described pressure to behave in ways they deemed antithetical to their personal and professional values and also necessary in order to continue a career in the public sector. The challenge of navigating such ethical dilemmas was a defining feature of leadership in Sierra Leone. Our research demonstrates that while international leadership models were relevant in this context, there is strong emphasis on contingent or situational leadership theories. We further contribute to policy and practice by informing design of leadership development programmes and the establishment of a more enabling environment for medical leadership by governments and international donors.
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Affiliation(s)
- Oliver Johnson
- Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, David Goldberg Centre, De Crespigny Park, London SE5 8AF, UK.,Centre for Health Policy, School of Public Health, University of Witwatersrand, 60 York Road, 2193 Johannesburg, South Africa
| | - Foday Sahr
- Department of Microbiology, College of Medicine and Allied Health Sciences, University of Sierra Leone, 12 Victoria Street, Kossoh Town, Freetown, Sierra Leone.,Joint Medical Unit (34 Military Hospital), Wilberforce Barracks, Wilberforce Village, Freetown, Sierra Leone
| | - Kerrin Begg
- School of Public Health and Family Medicine, University of Cape Town, Falmouth Building, Anzio Road, Cape Town 7925, South Africa
| | - Nick Sevdalis
- Centre for Implementation Science, Health Services and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, David Goldberg Centre, De Crespigny Park, London SE5 8AF, UK
| | - Ann H Kelly
- Department of Global Health and Social Medicine, School of Global Affairs, Faculty of Social Science & Public Policy, King's College London, London WC2R 2LS, UK
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Liu V, Whitford R, Damji KF. Leadership development facilitated by the "sandwich" and related glaucoma fellowship programs. Leadersh Health Serv (Bradf Engl) 2021; ahead-of-print. [PMID: 34106557 DOI: 10.1108/lhs-10-2020-0085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to evaluate leadership training in the Sandwich Glaucoma Fellowship (SGF), a program in which fellows learn skills in a developed world institution and their home country to become leaders in glaucoma care. DESIGN/METHODOLOGY/APPROACH This paper is a retrospective, qualitative and quantitative evaluation. Participants of the SGF between 2007 and 2019 were provided a survey eliciting demographic information, leadership training exposure, development of leadership competencies and feedback for the fellowship program. FINDINGS Seven of nine alumni responded. The fellowship strongly impacted leadership competencies including integrity (8.8, 95% CI 7.8-9.8), work ethic (8.64, 95% CI 7.7-9.6) and empathy (8.6, 95% CI 7.7-9.5). A total of 85% of alumni indicated positive changes in their professional status and described an increasing role in mentorship of colleagues or residents as a result of new skills. Lack of formal leadership training was noted by three respondents. Informal mentorship equipped fellows practicing in regions of Sub Saharan Africa with competencies to rise in their own leadership and mentoring roles related to enhancing glaucoma management. Suggested higher-order learning objectives and a formal curriculum can be included to optimize leadership training catered to the individual fellow experience. ORIGINALITY/VALUE Leadership is necessary in health care and specifically in the context of low- and middle-income countries to bring about sustainable developments. The SGF contains a unique "Sandwich" design, focusing on the acquisition of medical and leadership skills. This evaluation outlines successes and challenges of this, and similar fellowship programs. Other programs can use a similar model to promote the development of skills in partnership with the fellows' home country to strengthen health-care leaders.
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Affiliation(s)
| | - Rita Whitford
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
| | - Karim F Damji
- Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Canada
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Gopolang F, Zulu-Mwamba F, Nsama D, Kruuner A, Nsofwa D, Kasvosve I, Gomo R, Motlhabane T, Chohan B, Soge O, Osterhage D, Campbell N, Noble M, Downer A, Flandin JF, Nartker A, Koehn C, Nonde LK, Shibemba A, Ndongmo CB, Steinau M, Perrone LA. Improving laboratory quality and capacity through leadership and management training: Lessons from Zambia 2016-2018. Afr J Lab Med 2021; 10:1225. [PMID: 34007816 PMCID: PMC8111616 DOI: 10.4102/ajlm.v10i1.1225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 02/22/2021] [Indexed: 11/03/2022] Open
Abstract
Background Competent leadership and management are imperative for delivering quality laboratory services; however, few laboratory managers receive job-specific training in organisational management and leadership. Objective To develop and evaluate participants' competencies in organisational leadership and management as measured through learner and laboratory quality improvement assessments. Methods This professional development programme employed a mentored, blended learning approach, utilising in-person didactic and online training, with the practical application of a capstone project in the laboratories. Programme impact was evaluated through a series of pre- and post-laboartory assessments using the Stepwise Laboratory Improvement Process Towards Accreditation checklist, as well as learner-competency assessments through online quizzes and discussions. Results From 2016 to 2018, 31 managers and quality officers from 16 individual laboratories graduated from the programme having completed capstone projects addressing areas in the entire laboratory testing process. Laboratories increased their compliance with the International Organization for Standardization 15189 standard and all but two laboratories significantly increased their accreditation scores. Two laboratories gained three stars, two laboratories gained two stars, and five laboratories gained one star. Five laboratories subsequently achieved International Organization for Standardization 15189 accreditation in 2019. Conclusion This programme taught leadership theory to laboratory managers and allowed them to implement leadership and management practices in the laboratory setting. Programmes such as this complement existing laboratory quality management training programmes such as Strengthening Laboratory Management Toward Accreditation.
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Affiliation(s)
- Felicity Gopolang
- Department of Global Health, Schools of Public Health and Medicine, International Training and Education Center for Health (I-TECH), University of Washington, Seattle, Washington, United States
| | - Fales Zulu-Mwamba
- Laboratory Services Unit, Directorate of Clinical Care and Diagnostic Services, Ministry of Health Zambia, Lusaka, Zambia
| | - Davy Nsama
- Laboratory Services Unit, Directorate of Clinical Care and Diagnostic Services, Ministry of Health Zambia, Lusaka, Zambia
| | | | - Dailes Nsofwa
- Laboratory Quality Management Systems, Centers for Disease Control and Prevention (CDC) Zambia, Lusaka, Zambia
| | - Ishmael Kasvosve
- Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | | | - Tiny Motlhabane
- Medical Laboratory Technology Department, Institute of Health Sciences, Gaborone, Botswana
| | - Bhavna Chohan
- Department of Global Health, Schools of Public Health and Medicine, International Training and Education Center for Health (I-TECH), University of Washington, Seattle, Washington, United States
| | - Olusegun Soge
- Department of Global Health, Schools of Public Health and Medicine, International Training and Education Center for Health (I-TECH), University of Washington, Seattle, Washington, United States
| | - Daniel Osterhage
- Department of Global Health, Schools of Public Health and Medicine, International Training and Education Center for Health (I-TECH), University of Washington, Seattle, Washington, United States
| | - Nancy Campbell
- Department of Global Health, Schools of Public Health and Medicine, International Training and Education Center for Health (I-TECH), University of Washington, Seattle, Washington, United States
| | - Michael Noble
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ann Downer
- Department of Global Health, Schools of Public Health and Medicine, International Training and Education Center for Health (I-TECH), University of Washington, Seattle, Washington, United States
| | - Jean-Frederic Flandin
- Department of Global Health, Schools of Public Health and Medicine, International Training and Education Center for Health (I-TECH), University of Washington, Seattle, Washington, United States
| | - Anya Nartker
- Department of Global Health, Schools of Public Health and Medicine, International Training and Education Center for Health (I-TECH), University of Washington, Seattle, Washington, United States
| | - Catherine Koehn
- Department of Global Health, Schools of Public Health and Medicine, International Training and Education Center for Health (I-TECH), University of Washington, Seattle, Washington, United States
| | - Linda K Nonde
- HIV and AIDS Twinning Center Program, American International Health Alliance (AIHA), Lusaka, Zambia
| | - Aaron Shibemba
- Laboratory Services Unit, Directorate of Clinical Care and Diagnostic Services, Ministry of Health Zambia, Lusaka, Zambia
| | - Clement B Ndongmo
- Center for Disease Control and Prevention (CDC) Zambia, Lusaka, Zambia
| | - Martin Steinau
- Center for Disease Control and Prevention (CDC) Zambia, Lusaka, Zambia
| | - Lucy A Perrone
- Department of Global Health, Schools of Public Health and Medicine, International Training and Education Center for Health (I-TECH), University of Washington, Seattle, Washington, United States
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Orgill M, Marchal B, Shung-King M, Sikuza L, Gilson L. Bottom-up innovation for health management capacity development: a qualitative case study in a South African health district. BMC Public Health 2021; 21:587. [PMID: 33761911 PMCID: PMC7992952 DOI: 10.1186/s12889-021-10546-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 03/03/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND As part of health system strengthening in South Africa (2012-2017) a new district health manager, taking a bottom-up approach, developed a suite of innovations to improve the processes of monthly district management team meetings, and the practices of managers and NGO partners attending them. Understanding capacity as a property of the health system rather than only of individuals, the research explored the mechanisms triggered in context to produce outputs, including the initial sensemaking by the district manager, the subsequent sensegiving and sensemaking in the team and how these homegrown innovations interacted with existing social processes and norms within the system. METHODS We conducted a realist evaluation, adopting the case study design, over a two-year period (2013-2015) in the district of focus. The initial programme theory was developed from 10 senior manager interviews and a literature review. To understand the processes and mechanisms triggered in the local context and identify outputs, we conducted 15 interviews with managers in the management team and seven with non-state actors. These were supplemented by researcher notes based on time spent in the district. Thematic analysis was conducted using the Context-Mechanism-Outcome configuration alongside theoretical constructs. RESULTS The new district manager drew on systems thinking, tacit and experiential knowledge to design bottom-up innovations. Capacity was triggered through micro-practices of sensemaking and sensegiving which included using sticks (positional authority, enforcement of policies, over-coding), intentionally providing justifications for change and setting the scene (a new agenda, distributed leadership). These micro-practices in themselves, and by managers engaging with them, triggered a generative process of buy-in and motivation which influenced managers and partners to participate in new practices within a routine meeting. CONCLUSION District managers are well placed to design local capacity development innovations and must draw on systems thinking, tacit and experiential knowledge to enable relevant 'bottom-up' capacity development in district health systems. By drawing on soft skills and the policy resources (hardware) of the system they can influence motivation and buy-in to improve management practices. From a systems perspective, we argue that capacity development can be conceived of as part of the daily activity of managing within routine spaces.
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Affiliation(s)
- Marsha Orgill
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Bruno Marchal
- Institute of Tropical Medicine Antwerp, Antwerpen, Belgium
| | - Maylene Shung-King
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Lucy Gilson
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- London School of Hygiene and Tropical Medicine, London, UK
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Sepeng W, Stander MW, van der Vaart L, Coxen L. Authentic leadership, organisational citizenship behaviour and intention to leave: The role of psychological capital. SA JOURNAL OF INDUSTRIAL PSYCHOLOGY 2020. [DOI: 10.4102/sajip.v46i0.1802] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Mutambo C, Shumba K, Hlongwana KW. User-provider experiences of the implementation of KidzAlive-driven child-friendly spaces in KwaZulu-Natal, South Africa. BMC Public Health 2020; 20:91. [PMID: 31964361 PMCID: PMC6975036 DOI: 10.1186/s12889-019-7712-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/30/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND KidzAlive is a child-centred intervention aimed at improving the quality of HIV care for children in South Africa. Through this intervention, 10 child-friendly spaces were created in 10 primary healthcare centres (PHCs) in KwaZulu-Natal to enhance child-centred HIV care. However, the user-provider experiences of these child-friendly spaces in these facilities have not been explored. This paper addresses this gap. METHODS We conducted qualitative interviews with children (n = 30), their primary caregivers (PCGs) (n = 30), and KidzAlive trained healthcare workers (HCWs) (n = 20) using and providing child-friendly spaces, respectively. Data were generated, using a semi-structured interview guide printed in both English and IsiZulu. The interviews were audio-recorded transcribed and translated to English by a research team member competent in both languages. Data were imported to NVivo 10 for thematic analysis. The COREQ checklist was used to ensure that the study adheres to quality standards for reporting qualitative research. RESULTS Child-friendly spaces contributed to the centredness of care for children in PHCs. This was evidenced by the increased involvement and participation of children, increased PCGs' participation in the care of their children and a positive transformation of the PHC to a therapeutic environment for children. Several barriers impeding the success of child-friendly spaces were reported including space challenges; clashing health facility priorities; inadequate management support; inadequate training on how to maximise the child-friendly spaces and lastly the inappropriateness of existing child-friendly spaces for much older children. CONCLUSION Child-friendly spaces promote HIV positive children's right to participation and agency in accessing care. However, more rigorous quantitative evaluation is required to determine their impact on children's HIV-related health outcomes.
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Affiliation(s)
- Chipo Mutambo
- The Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Howard College Campus, King George Avenue, Durban, 4041 South Africa
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Howard College Campus, King George Avenue, Durban, 4041 South Africa
- Department of Public Health Medicine, University of KwaZulu-Natal, George Campbell Building, Room 217, 2nd Floor, King George V Avenue, Glenwood, Durban, KwaZulu-Natal 4041 South Africa
| | - Kemist Shumba
- The Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Office IX06 TB Davies Ext, Howard College Campus, Durban, 4041 South Africa
| | - Khumbulani W. Hlongwana
- Department of Public Health Medicine, University of KwaZulu-Natal, George Campbell Building, Room 217, 2nd Floor, King George V Avenue, Glenwood, Durban, KwaZulu-Natal 4041 South Africa
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Belrhiti Z, Van Damme W, Belalia A, Marchal B. Unravelling the role of leadership in motivation of health workers in a Moroccan public hospital: a realist evaluation. BMJ Open 2020; 10:e031160. [PMID: 31900266 PMCID: PMC6955542 DOI: 10.1136/bmjopen-2019-031160] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study aimed at opening the black box of the relationship between leadership and motivation of health workers by focusing on a high-performance hospital in Morocco. DESIGN We adopted the realist evaluation approach and used the case study design to test the initial programme theory we formulated on the basis of a scoping review on complex leadership. We used the Intervention-Context-Actors-Mechanism-Outcome Configuration as a heuristic tool to identify plausible causal configurations. SETTINGS Since 2000, the Ministry of Health in Morocco initiated many reforms in the frame of the governmental deconcentration process called 'advanced regionalisation'. The implementation of these reforms is hampered by inadequate human resource management capacities of local health system managers. Yet, the National 'Concours Qualité', a national quality assurance programme implemented since 2007, demonstrated that there are many islands of excellence. We explore how leadership may play a role in explaining these islands of excellence. PARTICIPANTS We carried out a document review, 18 individual interviews and 3 group discussions (with doctors, administrators and nurses), and non-participant observations during a 2-week field visit in January-February 2018. RESULTS We confirmed that effective leaders adopt an appropriate mix of transactional, transformational and distributed leadership styles that fits the mission, goals, organisational culture and nature of tasks of the organisation and the individual characteristics of the personnel when organisational culture is conducive. Leadership effectiveness is conditioned by the degree of responsiveness to the basic psychological needs of autonomy, competence and relatedness, perceived organisational support and perceived supervisor support. Transactional and overcontrolling leadership behaviour decreased the satisfaction of the need for autonomy and mutual respect. By distributing leadership responsibilities, complex leaders create an enabling environment for collective efficacy and creative problem solving. CONCLUSIONS We found indications that in the Moroccan context, well-performing hospitals could be characterised by a good fit between leadership styles, organisational characteristics and individual staff attributes.
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Affiliation(s)
- Zakaria Belrhiti
- Ecole Nationale de Santé Publique, Rabat, Morocco
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Gerontology, Vrije Universiteit Brussel, Brussel, Belgium
| | - Wim Van Damme
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Gerontology, Vrije Universiteit Brussel, Brussel, Belgium
| | | | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Michel J, Chimbindi N, Mohlakoana N, Orgill M, Bärnighausen T, Obrist B, Tediosi F, Evans D, McIntryre D, Bressers HT, Tanner M. How and why policy-practice gaps come about: a South African Universal Health Coverage context. JOURNAL OF GLOBAL HEALTH REPORTS 2019. [DOI: 10.29392/joghr.3.e2019069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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18
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Gilson L, Agyepong IA. Strengthening health system leadership for better governance: what does it take? Health Policy Plan 2018; 33:ii1-ii4. [PMID: 30053034 PMCID: PMC6037056 DOI: 10.1093/heapol/czy052] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2018] [Indexed: 11/13/2022] Open
Abstract
This editorial provides an overview of the six papers included in this special supplement on health leadership in Africa. Together the papers provide evidence of leadership in public hospital settings and of initiatives to strengthen leadership development. On the one hand, they demonstrate both that current leadership practices often impact negatively on staff motivation and patient care, and that contextual factors underpin poor leadership. On the other hand, they provide some evidence of the positive potential of new forms of participatory leadership, together with ideas about what forms of leadership development intervention can nurture new forms of leadership. Finally, the papers prompt reflection on the research needed to support the implementation of such interventions.
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Affiliation(s)
- Lucy Gilson
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, South Africa
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Irene Akua Agyepong
- Health Policy and Systems Division, School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, South Africa
- Division of Research and Development, Dodowa Health Research Centre, Box DD1, Dodowa, Ghana
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
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