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Bigirinama RN, Makali SL, Mothupi MC, Chiribagula CZ, St Louis P, Mwene-Batu PL, Bisimwa GB, Mwembo AT, Porignon DG. Ensuring leadership at the operational level of a health system in protracted crisis context: a cross-sectional qualitative study covering 8 health districts in Eastern Democratic Republic of Congo. BMC Health Serv Res 2023; 23:1362. [PMID: 38057862 DOI: 10.1186/s12913-023-10336-7] [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: 05/18/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND This study examines how leadership is provided at the operational level of a health system in a protracted crisis context. Despite advances in medical science and technology, health systems in low- and middle-income countries struggle to deliver quality care to all their citizens. The role of leadership in fostering resilience and positive transformation of a health system is established. However, there is little literature on this issue in Democratic Republic of the Congo (DRC). This study describes leadership as experienced and perceived by health managers in crisis affected health districts in Eastern DRC. METHODS A qualitative cross-sectional study was conducted in eight rural health districts (corresponding to health zones, in DRC's health system organization), in 2021. Data were collected through in-depth interviews and non-participatory observations. Participants were key health actors in each district. The study deductively explored six themes related to leadership, using an adapted version of the Leadership Framework conceptual approach to leadership from the United Kingdom National Health Service's Leadership Academy. From these themes, a secondary analysis extracted emerging subthemes. RESULTS The study has revealed deficiencies regarding management and organization of the health zones, internal collaboration within their management teams as well as collaboration between these teams and the health zone's external partners. Communication and clinical and managerial capacities were identified as key factors to be strengthened in improving leadership within the districts. The findings have also highlighted the detrimental influence of vertical interventions from external partners and hierarchical supervisors in health zones on planning, human resource management and decision-making autonomy of district leaders, weakening their leadership. CONCLUSIONS Despite their decentralized basic operating structure, which has withstood decades of crisis and insufficient government investment in healthcare, the districts still struggle to assert their leadership and autonomy. The authors suggest greater support for personal and professional development of the health workforce, coupled with increased government investment, to further strengthen health system capacities in these settings.
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Affiliation(s)
- Rosine N Bigirinama
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo.
- School of Medicine, Université Catholique de Bukavu, Avenue Michombero No. 02, Bukavu, Democratic Republic of Congo.
- Ecole de Santé Publique, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo.
| | - Samuel L Makali
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- Centre de Recherche Politiques, Systèmes de Santé, Santé Internationale (CR3), Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Mamothena C Mothupi
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Christian Z Chiribagula
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
| | - Patricia St Louis
- Centre de Recherche Politiques, Systèmes de Santé, Santé Internationale (CR3), Ecole de Santé Publique, Université Libre de Bruxelles, Bruxelles, Belgique
| | - Pacifique L Mwene-Batu
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- School of Medicine, Université Catholique de Bukavu, Avenue Michombero No. 02, Bukavu, Democratic Republic of Congo
- School of Medicine, Université de Kaziba, Bukavu, Democratic Republic of Congo
| | - Ghislain B Bisimwa
- Ecole Régionale de Santé Publique, Université Catholique de Bukavu, Bukavu, Democratic Republic of Congo
- School of Medicine, Université Catholique de Bukavu, Avenue Michombero No. 02, Bukavu, Democratic Republic of Congo
- Centre de Recherche en Sciences Naturelles, Lwiro, Democratic Republic of Congo
| | - Albert T Mwembo
- Ecole de Santé Publique, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Denis G Porignon
- Département des Sciences de la Santé Publique, School of Medicine, Université de Liège, Liège, Belgium
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Kanyama C, Phiri S, Matola BW, Banda A, Loyse A. How to DREAMM and end HIV-related deaths. Lancet Glob Health 2023; 11:e1857-e1858. [PMID: 37804852 DOI: 10.1016/s2214-109x(23)00429-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/01/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Cecilia Kanyama
- University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | | | | | - Amanda Banda
- O'Neill for National and Global Health Law, Lilongwe, Malawi
| | - Angela Loyse
- Institute for Infection and Immunity, St George's University of London, London, UK; Unité de Mycologie Moléculaire, Institut Pasteur, Université Paris Cité, 75015 Paris, France.
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Training Curriculum, Skills, and Competencies for Global Health Leaders: Good Practices and Lessons Learned. Ann Glob Health 2021; 87:64. [PMID: 34307067 PMCID: PMC8284497 DOI: 10.5334/aogh.3212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objectives: This paper aims to depict unique perspectives and to compare and contrast three leadership programs for global health in order to enable other training institutions to design impactful curricula. Methods: We purposively selected three global health training programs. We used a six-step curriculum development framework to systematically compare the curriculum process across programs and to identify best practices and factors contributing to the impact of each of these programs. Findings: All three fellowship programs undertook an intentional and in-depth approach to curriculum development. Each identified competencies related to leadership and technical skills. Each defined goals, though the goals differed to align with the desired impact of the program, ranging from improving the impact of HIV programming, supporting stronger global health program implementation, and supporting the next generation of global health leaders. All programs implemented the curriculum through an onboarding phase, a delivery of core content in different formats, and a wrap-up or endline phase. During implementation, each program also utilized networking and mentoring to enhance connections and to support application of learning in work roles. Programs faced overlapping challenges and opportunities including funding, strengthening partnerships, and finding ways to engage and support alumni. Conclusions: Local ownership of programs is critical, including tailoring curricula to the needs of specific contexts. Strong partnerships and resources are needed to ensure program sustainability and impact. Key Takeaways
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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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Ryoo SB, Park H, Han YD, Moon HG, Kim HJ, Yoon KC, Bae J, Park YJ, Cho JY, Jeong WK, Jeong SY. A survey investigating the current situation of the international visiting scholar program at the department of surgery in Korea. Ann Surg Treat Res 2020; 99:189-196. [PMID: 33029477 PMCID: PMC7520232 DOI: 10.4174/astr.2020.99.4.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose The number of international visiting scholars has been on the increase in Korea and we aim to investigate the program's current situation. Methods This cross-sectional study is based on an online survey questionnaire responded by international visiting scholars in surgical departments of 8 Korean hospitals between 2014 and 2018 about their experiences and satisfaction with the visiting scholar program. Results A total of 1,496 international scholars from 80 countries visited various surgical departments in 8 Korean hospitals between 2014 and 2018. The numbers have been on the increase over the years. Out of 355 visiting scholars in 2018, 71 replied to the online survey, of whom 52 were male and 19 female, and mostly in their 30s and 40s. Information about the program was accessed mostly through friends or colleagues (42.3%) and international conferences (36.6%). The commonest funding source was private (35.2%) and more than half stayed for less than 3 months. The visiting scholar's main roles were mostly observation or participation in surgery and clinical research. All but 1 were satisfied with the program (98.6%) and would recommend it to friends and colleagues, although the language barrier was identified as an inconvenience. Those aged 20–39 years with governmental or institutional funding were associated with stays of more than 1 year. Conclusion The number of international visiting scholars at surgical departments in Korean hospitals has been on the increase with high satisfaction levels. Improvements need to be made on funding sources and lengthening visiting period to maximize the benefits of the program.
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Affiliation(s)
- Seung-Bum Ryoo
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyunmi Park
- Department of General Surgery, Nottingham University Hospitals, North Trent Deanery, Health Education England, Nottingham, United Kingdom.,Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yoon Dae Han
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeong-Gon Moon
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Jeong Kim
- Department of Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
| | - Kyung Chul Yoon
- Department of Surgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Jaseong Bae
- Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yang Jin Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University College of Medicine, Seoul, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Woon Kyung Jeong
- Department of Surgery, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
| | - Seung-Yong Jeong
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.,Cancer Research Institute, Seoul National University, Seoul, Korea
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