Leadership and management training as a catalyst to health system strengthening in low-income settings: Evidence from implementation of the Zambia Management and Leadership course for district health managers in Zambia

Abstract

BackgroundResearch has shown that the modes of leadership and management may influence health outcomes. However, majority of health leaders and managers in many low-income countries are promoted on account of clinical expertise. It has been recognised that these new managers are often ill-prepared for managing complex health systems. In response to this challenge, the Zambian Ministry of Health (MoH) has developed the Governance and Management Capacity Building (GMCB) Strategic Plan (2012–2016), whose overarching goal is to improve health sector governance and create an environment that is result-oriented, accountable and transparent. This led to the introduction of a new in-service leadership and management course, which has come to be known as the Zambia Management and Leadership Academy (ZMLA). This paper presents the results of an impact evaluation of the ZMLA programme conducted in 2014.MethodsThis was a cross-sectional mixed method study. The study targeted health workers, stakeholders and course implementers. ZMLA trainees were targeted to gain perspectives on the extent to which the programme affected levels of self-confidence resulting from knowledge gained. Perspectives were sought from both ZMLA and non ZMLA trainees to measure changes in the work environment. Stakeholder perspectives were collected from trainers and key informants involved in providing ZMLA training.ResultsOn average, knowledge levels increased by 38% after each workshop. A comparison of the average self-rated scores from 444 management and leadership survey responses before ZMLA and after ZMLA training showed a significant increase in the proportion of participants that felt adequately trained to undertake management and leadership, from 63% (before) to 99% (after) in phase 1 and 43% (before) to 98% (after) in the phase II cohort. The calculated before and after percentage change for work environment themes ranged from 5.8% to 13.4%. Majority of respondents perceived improvements in the workplace environment, especially in handling human resource management matters. The smallest improvement was noted in ethics and accountability. Qualitative interviews showed improvements in the meeting culture and a greater appreciation for the importance of meetings. Shared vision, teamwork and coordination seemed to have improved more in work places where the overall manager had received ZMLA training.ConclusionLeadership and management training will be a key ingredient in health system strengthening in low-income settings. The ZMLA model was found to be acceptable and effective in improving knowledge and skills for health system managers with minimal disruption to health services.

Leadership, governance and management for improving district capacity and performance: the case of USAID Transform: Primary Health Care

“…Capacity building is also thought to improve team motivation and performance of planning skills and enhances management practices (18). Other studies also show that capacitating managers improves workplace environments, including handling human resource management, and the day-to-day activities and teamwork (19).…”

Health system strengthening—Reflections on its meaning, assessment, and our state of knowledge

“…One of the key mechanisms for improving outcomes was seen to be collaborative working approaches involving different stakeholders working in synergy to achieve long‐term strategic reform goals across all levels of the health system from facility to national and within the public sphere There is evidence that governance‐specific interventions, including civil participation and engaging community members with health service structures and processes, can lead to tangible improvements in health (focusing usually on maternal and child health outcomes) as well as better service uptake and quality of care Leadership capacity development and mentoring are central for effective governance.…”

“…Leadership capacity development and mentoring are central for effective governance. There is evidence that complex leadership programmes blending skills development, mentoring, and promotion of teamwork bring about improvements in service quality, management competence, and motivation There is mixed evidence on the effect of decentralisation on health outcomes and access to services .…”

Managerial capacity among district health managers and its association with district performance: A comparative descriptive study of six districts in the Eastern Region of Ghana

“…Several studies suggest a positive association between district-level management capacity and health system performance [4,[24][25][26][27][28][29][30]. However, the study of Fetene et al in Ethiopia (2019) is to our knowledge the only in a lower income setting that has applied a quantifiable and precise measurement of management capacity at district level.…”