SUPPLEMENT LAUNCH: Strengthening health system leadership for better governance: what does it take?

By Lucy Gilson (University of Cape Town)

Why is health system leadership so important? And what can be done to improve health system leadership in low- and middle-income countries for better governance? A new supplement in Health Policy and Planning addresses these questions providing evidence of leadership in public hospital settings and of existing initiatives put in place to strengthen leadership in Africa and have been written by predominantly African author teams.

What are the lessons that can be learnt from this supplement?

The key messages from these papers demonstrate the weaknesses of current leadership practices –  which commonly involve authoritarian approaches and power plays and often work to undermine staff motivation, and have knock-on negative consequences for patient care. However,  these practices are also reflective of critical features of the broader public sector context. Such features not only include resource shortages, but also features of organizational culture such as centralized decision-making, individualized decision-making and medical professionals’ dominance.

Nonetheless, these papers do also provide evidence that participatory leadership practices, such as encouraging teamwork, building relationships, creating a supportive environment and spreading motivation, can offer opportunities to encourage positive staff attitudes. Current African health leaders also judge these types of leadership practices are vital in strengthening health systems.

Overall, then, these experiences show that the status quo of poor leadership and constraining contexts simply must be disrupted  – with changes are required at individual, team and system levels. Context-specific health leadership development interventions are needed and can be supported by research that acknowledges and engages with that context.

Articles in this supplement

  • Editorial: Strengthening health system leadership for better governance: what does it take?
  • Article: Leadership and the functioning of maternal health services in two rural district hospitals in South Africa
  • Article: Leadership styles in two Ghanaian hospitals in a challenging environment
  • Article: Examining clinical leadership in Kenyan public hospitals through the distributed leadership lens
  • Article: Strategic Leadership Capacity Building for Sub-Saharan African Health Systems and Public Health Governance:  A multi-country assessment of essential competencies and optimal design for a Pan African DrPH
  • Article: Achievements and challenges in developing health leadership in South Africa: the experience of the Oliver Tambo Fellowship Programme 2008-2014
  • Article: Enabling relational leadership in primary healthcare settings: lessons from the DIALHS collaboration

You may also listen to the podcast discussing papers from this supplement here.

Speakers include authors Assoc Prof Susan Cleary, Dr Matilda Aberese Ako, Dr Jacinta Mwikali Nzinga and also a health manager, Soraya Elloker, who worked with Susan in one sub-district in Cape Town. A very interesting and thoughtful debate concerning health system leadership and development in Africa and wider applicability to other low-resource settings.

Image credit: Susan Cleary


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