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

Abstract

Leadership capacity needs development and nurturing at all levels for strong health systems governance and improved outcomes. The Doctor of Public Health (DrPH) is a professional, interdisciplinary terminal degree focused on strategic leadership capacity building. The concept is not new and there are several programmes globally–but none within Africa, despite its urgent need for strong strategic leadership in health. To address this gap, a consortium of institutions in Sub-Saharan Africa, UK and North America have embarked on a collaboration to develop and implement a pan-African DrPH with support from the Rockefeller Foundation. This paper presents findings of research to verify relevance, identify competencies and support programme design and customization. A mixed methods cross sectional multi-country study was conducted in Ghana, South Africa and Uganda. Data collection involved a non-exhaustive desk review, 34 key informant (KI) interviews with past and present health sector leaders and a questionnaire with closed and open ended items administered to 271 potential DrPH trainees. Most study participants saw the concept of a pan-African DrPH as relevant and timely. Strategic leadership competencies identified by KI included providing vision and inspiration for the organization, core personal values and character qualities such as integrity and trustworthiness, skills in adapting to situations and context and creating and maintaining effective change and systems. There was consensus that programme design should emphasize learning by doing and application of theory to professional practice. Short residential periods for peer-to-peer and peer-to-facilitator engagement and learning, interspaced with facilitated workplace based learning, including coaching and mentoring, was the preferred model for programme implementation. The introduction of a pan-African DrPH with a focus on strategic leadership is relevant and timely. Core competencies, optimal design and customization for the sub-Saharan African context has broad consensus in the study setting.

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

“…Yet the papers also provide evidence of the ‘positive potential of new forms of participatory leadership’—in terms of encouraging teamwork and relationships, tackling problems collectively, spreading motivation and positive staff attitude. Senior managers consulted about the possible pan-African DrPH programme confirmed, moreover, that such leadership is what is needed in every health system ( Agyepong et al 2018 ). The particular importance of participatory leadership for health systems lies in their complexity—they are comprised of multiple sets of people and organizations working within a dynamic environment of changing health needs, medical and technological advances and resource conditions.…”

“…The other three papers in this edition offer insights into health leadership development needs and strategies: Agyepong et al (2018) report on needs assessment and other preparatory work undertaken in Ghana, South Africa and Uganda, towards the development of a pan-African professional Doctorate in Public Health (DrPH), as a professional, interdisciplinary terminal degree focussed on strategic health leadership; Doherty et al (2018) present an evaluation of a well-established South African public sector health leadership development programme offering a combination of residential training plus workplace-based learning activities, at the level of a post-graduate Diploma in Health Management; Cleary et al (2018) detail the experience of developing tailor-made leadership development (LD) processes to support relational ( Cummings et al 2010 ) and distributed ( Gronn 2002 ) leadership within a sub-district setting in Cape Town, South Africa. …”

“… Agyepong et al (2018) report on needs assessment and other preparatory work undertaken in Ghana, South Africa and Uganda, towards the development of a pan-African professional Doctorate in Public Health (DrPH), as a professional, interdisciplinary terminal degree focussed on strategic health leadership;…”

How Does District Health Management Emerge Within a Complex Health System? Insights for Capacity Strengthening in Ghana

“…Inadequate attention has been paid to the influence of the context and organizational structures in which DHMs operate in sub-Saharan Africa, including Ghana ( 13 , 32 ). Thus, the aim of this paper is to explore how district health management emerges, hereunder the contextual, organizational and individual aspects that enable or hinder DHMs in carrying out their functions.…”

Identifying health policy and systems research priorities on multisectoral collaboration for health in low-income and middle-income countries

“…Indeed, efforts to move forward the MSC research agenda may benefit substantially from close involvement of policymakers and practitioners, both in terms of shaping the specific research questions as well as interpreting and applying the results. Opportunities to do so may include country-level, multistakeholder knowledge platforms, 23–25 embedded research, 26–29 and expanded opportunities for applied, practice-based research training for policymakers, 30 among others. The broad recognition of the context specificity of MSC (as evidenced by the seventh-ranked question ‘How do contextual factors…affect MSCs?’) points to a likely need for ongoing formative research as well as practical monitoring and evaluation frameworks and metrics to help shape and manage MSCs.…”