Nova Scotia Health and Dalhousie University WHO/PAHO Collaborating Centre on Health Workforce Planning and Research, 90 Lovett Lake Ct., Suite 201, Halifax, NS, B3S 0H6, Canada.
Tanzanian Training Centre for International Health, Ifakara, Tanzania.
BMC Health Serv Res. 2022 Sep 7;22(1):1129. doi: 10.1186/s12913-022-08448-7.
Strengthening leadership and management is important for building an effective and efficient health system. This paper presents the findings from a L&M capacity building initiative which was implemented as part of a larger study aimed at improving maternal and newborn outcomes within primary health facilities in the Morogoro, Tanzania.
The initiative, involving 30 stakeholders from 20 primary health facilities, 4 council health management teams and the regional health management team in the Morogoro region, provided leadership and managerial training through two 5-day in-person workshops, onsite mentoring, and e-learning modules. The initiative was evaluated using a pre-post design. Quantitative instruments included the 'Big Results Now' star-rating assessments and a team-developed survey for health providers/managers. The 'Big Results Now' star-rating assessments, conducted in 2018 (19 facilities) and 2021 (20 facilities), measured overall facility leadership and management capability, with comparisons of star-ratings from the two time-points providing indication of improvement. The survey was used to measure 3 key leadership indicators - team climate, role clarity/conflict and job satisfaction. The survey was completed by 97 respondents at baseline and 100 at follow up. Paired t-tests were used to examine mean score differences for each indicator. Triangulated findings from focus groups with 99 health providers and health management team members provided support and context for quantitative findings.
Star-ratings increased in 15 (79%) of 19 facilities, with the number of facilities achieving the target of 3 plus stars increasing from 2 (10%) in 2018 to 10 (50%) in 2021, indicating improved organizational performance. From the survey, team climate, job satisfaction and role clarity improved across the facilities over the 3 project years. Focus group discussions related this improvement to the leadership and managerial capacity-building.
Improved leadership and managerial capacity in the participating health facilities and enhanced communication between the health facility, council and regional health management teams created a more supportive workplace environment, leading to enhanced teamwork, job satisfaction, productivity, and improved services for mothers and newborns. Leadership and managerial training at all levels is important for ensuring efficient and effective health service provision.
加强领导力和管理能力对于建立一个有效和高效的卫生系统至关重要。本文介绍了一项领导力和管理能力建设倡议的结果，该倡议是作为一项旨在改善坦桑尼亚莫罗戈罗地区初级卫生保健机构孕产妇和新生儿结局的更大研究的一部分实施的。
该倡议涉及 20 个初级卫生保健机构的 30 名利益攸关方、4 个理事会卫生管理团队和莫罗戈罗地区的区域卫生管理团队，通过两次为期 5 天的面对面研讨会、现场指导和电子学习模块提供领导力和管理培训。该倡议采用前后设计进行评估。定量工具包括“立即取得重大成果”星级评估和为卫生保健提供者/管理者制定的团队调查。“立即取得重大成果”星级评估于 2018 年（19 个设施）和 2021 年（20 个设施）进行，评估了整体设施领导力和管理能力，两次评估的星级评分比较表明有所改善。该调查用于衡量 3 个关键领导力指标 - 团队氛围、角色清晰度/冲突和工作满意度。基线时共有 97 名受访者完成了调查，随访时有 100 名受访者完成了调查。配对 t 检验用于检验每个指标的平均得分差异。与 99 名卫生保健提供者和卫生管理团队成员进行的焦点小组讨论为定量研究结果提供了支持和背景。
19 个设施中有 15 个（79%）的星级评分有所提高，达到 3 星及以上目标的设施数量从 2018 年的 2 个（10%）增加到 2021 年的 10 个（50%），表明组织绩效有所提高。从调查结果来看，团队氛围、工作满意度和角色清晰度在项目实施的 3 年内都有所改善。焦点小组讨论将这种改善归因于领导力和管理能力建设。
参与卫生保健机构的领导力和管理能力得到提高，卫生保健机构、理事会和区域卫生管理团队之间的沟通得到加强，创造了更具支持性的工作环境，从而提高了团队合作、工作满意度、生产力，并改善了母婴服务。各级领导力和管理培训对于确保高效和有效的卫生服务提供至关重要。
