Leadership, governance and management for improving district capacity and performance: the case of USAID transform: primary health care

Abstract

Background Primary health care (PHC) in Ethiopia serves as the main entry point for preventive, promotive and curative health services. The district health office is responsible for the planning, implementation and evaluation of all district health activities. In addition, district health offices manage service delivery facilities working on provision of PHC – primary hospitals, health centers and health posts. As the leader of the health care system tier, district health management must ensure direction, alignment and commitment within teams and organizations and make sure that achievements are consistent with the vision, values and strategy of the organization. USAID Transform: Primary Health Care provides diverse support to improve district health manager competencies including in-service trainings followed by planning and implementation of performance improvement projects and on-the-job mentoring and support. Methods This study was conducted to compare district level capacity and performances between leadership, management and governance (LMG) and non-LMG districts. Project outcome monitoring data that shows the performance of districts was collected from 284 districts from January to December 2019. The study was carried out using a comparative-cross sectional study design, which assessed and compared district health office level indicators. Districts were classified into two categories: LMG and non-LMG districts. The study compared data from 94 LMG and 190 non-LMG districts. Propensity score matching was used to control the effect of differences between LMG and non-LMG districts. Results Results of the independent samples t-test revealed that LMG districts scored better average performances of 61.8 ± 121.45 standard deviation (SD) compared to non-LMG districts 56.89 ± 110.39 SD, with t (282243) = − 3.407317 and p < 0.001, two-tailed. The difference of 4.9 percentage unit in the average performance indicated a statistically significant difference between the LMG and non-LMG districts. Conclusion District level leadership development program contributes to improving district capacity, structure and management practices, and quality of care.

Comparison of maternal and child health service performances following a leadership, management, and governance intervention in Ethiopia: a propensity score matched analysis

“…Hence, the multi-faceted LMG intervention addresses some gaps in desired competencies and skills of health workers which enables them to solve existing challenges in their workplace. These findings were consistent with other similar studies documented that show significant increases of health service coverage as a result of LMG training and interventions in Zambia, Gambia, Egypt, Ethiopia, Ghana, Kenya and Mozambique [ 3 , 6 , 11 – 15 , 36 , 37 ].…”

“…This gain might be a result of the capacity building interventions in leading, managing, and governing practices. This finding is consistent with the Desta et al [ 37 ] comparative reports of LMG intervention districts which were better at capacitating health workers, strengthening teams, and availing inputs than non-LMG intervention districts. Similarly, La Rue et al [ 11 ], confirm that health service coverages were better in intervention districts than non-intervention districts through strengthening of leadership and management skills.…”

Exploring the opportunities and challenges of female health leaders in three regional states of Ethiopia: a phenomenological study

“…Leadership training and mentoring sessions, facilitated with the support of partners build the leadership capacity and competencies of women, and prepare them to be competent for leadership dispensation. This finding aligns with that of Desta et al (2020) and Argaw et al (2021), where facilitating leadership training and coaching activities were found to be effective in building the desired competencies [ 38 – 40 ].…”

Effects of The Leadership, Management And Governance Intervention On Maternal And Child Health Service Performances In Ethiopia: A Propensity Score Matched Analysis

“…Additional efforts through documentation, sharing vision or mission among all staff, enhanced organizing and aligning resource capacities, motivation of staff, also contribute to positive results. Desta et al, (2020) documented that LMG intervention districts were better at capacitating health workers, strengthening teams, and availing inputs than non-LMG intervention districts [37]. Similarly, La Rue et al, (2012), con rm that health service coverages were better in intervention districts than comparison districts through strengthening of leadership and management skills [11].…”