Linking governance mechanisms to health outcomes: A review of the literature in low- and middle-income countries

Ciccone, Dana Karen; Vian, Taryn; Maurer, Lydia R.; Bradley, Elizabeth H.

doi:10.1016/j.socscimed.2014.07.010

Cited by 84 publications

(73 citation statements)

References 42 publications

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“…From this perspective, it is understood that the regional consciousness and identity encompasses the identification of inhabitants with their region, both within and outside of it [18][19][20] . Studies show the positive effects of regional governance when it is culturally appropriate and participation is equitable, although it seems always difficult learning the needs of stigmatized and poor populations 21 .…”

Section: Discussionmentioning

confidence: 99%

O protagonismo dos Conselhos de Secretários Municipais no processo de governança regional

Shimizu

Cruz

Júnior

et al. 2017

Ciênc. saúde coletiva

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Section: Discussionmentioning

confidence: 99%

O protagonismo dos Conselhos de Secretários Municipais no processo de governança regional

Shimizu

Cruz

Júnior

et al. 2017

Ciênc. saúde coletiva

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“…Research has shown that the modes of leadership and management may influence health outcomes such as life expectancy at birth, child mortality, maternal mortality, and self-reported health status. [4]. A study conducted in Kenya demonstrated increased coverage of maternal and child health services after piloting a six month leadership training in 67 management teams in Kenya [5].…”

Section: Introductionmentioning

confidence: 99%

“…Well integrated management and leadership practices can translate into positive change in organizational culture and routine processes. This can lead to improved performance which for health can be both system and health outcomes [4, 8]. This is summarised in the following logic framework:…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…Accountability may include accountability for performance to both internal and external constituents within the health system and community at large. Governance and leadership refers broadly to creating facilitative environments 19,20 and engaging with other to achieve group objectives, 6 and may include, but are not limited to, conducting governing board activities, developing organizational and corporate cultures, and ensuring succession planning. Political analysis and dialogue comprise understanding political and regulatory environments, making policy tradeoffs, conducting stakeholder analysis and advocacy.…”

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confidence: 99%

Management Matters: A Leverage Point for Health Systems Strengthening in Global Health

Bradley

Taylor

Cuellar

2015

Int J Health Policy Manag

Self Cite

123

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Despite a renewed focus in the field of global health on strengthening health systems, inadequate attention has been directed to a key ingredient of high-performing health systems: management. We aimed to develop the argument that management -defined here as the process of achieving predetermined objectives through human, financial, and technical resources -is a cross-cutting function necessary for success in all World Health Organization (WHO) building blocks of health systems strengthening. Management within health systems is particularly critical in low-income settings where the efficient use of scarce resources is paramount to attaining health goals. More generally, investments in management capacity may be viewed as a key leverage point in grand strategy, as strong management enables the achievement of large ends with limited means. We also sought to delineate a set of core competencies and identify key roles to be targeted for management capacity building efforts. Several effective examples of management interventions have been described in the research literature. Together, the existing evidence underscores the importance of country ownership of management capacity building efforts, which often challenge the status quo and thus need country leadership to sustain despite inevitable friction. The literature also recognizes that management capacity efforts, as a key ingredient of effective systems change, take time to embed, as new protocols and ways of working become habitual and integrated as standard operating procedures. Despite these challenges, the field of health management as part of global health system strengthening efforts holds promise as a fundamental leverage point for achieving health system performance goals with existing human, technical, and financial resources. The evidence base consistently supports the role of management in performance improvement but would benefit from additional research with improved methodological rigor and longer-time horizon investigations. Meanwhile, greater emphasis on management as a critical element of global health efforts may open new and sustainable avenues for advancing health systems performance.

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Linking governance mechanisms to health outcomes: A review of the literature in low- and middle-income countries

Cited by 84 publications

References 42 publications

O protagonismo dos Conselhos de Secretários Municipais no processo de governança regional

O protagonismo dos Conselhos de Secretários Municipais no processo de governança regional

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

Management Matters: A Leverage Point for Health Systems Strengthening in Global Health

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