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

Abstract

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.

Balancing Management and Leadership in Complex Health Systems Comment on "Management Matters: A Leverage Point for Health Systems Strengthening in Global Health"

“…The World Health Organization (WHO) combines the elements of inputs and inspiration to define good management and leadership as: "providing direction to, and gaining commitment from partners and staff, facilitating change and achieving better health services through efficient, creative and responsible deployment of people and other health resources. " 2 In the context of increased global focus on health systems strengthening, Bradley and colleagues 3 recently noted the need for renewed focus on management as a critical way of making progress on pressing health challenges. This author agrees with them that "despite a renewed focus on strengthening health systems, inadequate attention has been directed to a key ingredient of high performing health systems: management. "…”

“…This means that input-output models of management risk overlooking the systemic interactions which in fact give rise to what we call management and leadership. As this journal has now featured editorials on management, 3 health policy and management, 4 and leadership 5 as distinct elements of health systems strengthening, this commentary presents an opportune moment to underscore their continuity: management without leadership is "dead works"; given the interactive nature of these complex phenomena, the two must be considered together. This commentary builds on Bradley and colleagues' arguments, and offers added depth by considering issues of management and leadership through the lens of complex systems.…”

On Management Matters: Why We Must Improve Public Health Management Through Action Comment on "Management Matters: A Leverage Point for Health Systems Strengthening in Global Health"

“…Health by Bradley et al, 1 describes the importance of public health management to a robust and effective global health system. Bradley and colleagues advocate for an improvement in management capacity to bolster the success of health systems.…”

“…Bradley et al 1 have presented a challenge for the global public health community to think beyond strengthening the capacity of scientists and clinicians in solving global health issues. The development of a superior cadre of public health managers will advance the public health workforce and should be viewed as an important part of the GHSA.…”

Does Management Really Matter? And If so, to Who? Comment on "Management Matters: A Leverage Point for Health Systems Strengthening in Global Health"

“…1 It has raised very important issues on a critical aspect of health systems functioning that has undermined health services performance especially in lowincome settings -management; and I am in agreement. It should be clear to policy-makers that many countries that are not able to reach the Millennium Development Goals (MDGs), have major failings in management and in accountability for results.…”