Kushitor Mawuli, Wright Kalifa, Biney Adriana, Kanmiki Edmund W, Kyei Pearl, Phillips James F, Awoonor-Williams John Koku, Bawah Ayaga A
The Department of Health Policy, Planning and Management (UHAS), School of Public Health (SPH), University of Health and Allied Sciences (UHAS), Ho, Ghana.
The Center for Health Information and Analysis, Boston, MA, USA.
Res Health Serv Reg. 2023 Oct 18;2(1):15. doi: 10.1007/s43999-023-00030-w.
Health care systems in low and middle-income countries are decentralizing and devolving power to the periphery. Transferring power without systematic processes to develop and nurture leaders at the district compromises the effectiveness and sustainability of the decentralized health system. To address this problem, we developed an approach to leadership learning by observation and experience that improved the organization and performance of the health care system in a district in Ghana.
Using two rounds of a longitudinal qualitative study, the study explores the determinants of implementing the Community-Based Health Planning and Services (CHPS) initiative in a district in Ghana. Insights were gained concerning the leadership regimes of two leaders who administered health services in a common geographic area at different points in time with remarkably contrasting outcomes. Insights of health workers who participated in both periods were elicited to clarify interview contexts. Ten focus group discussions (FGDs) and five expert interviews were conducted for each round of the study. The study was informed by a systems appraisal approach that utilized a thematic analytical framework.
Providing district leaders with a practical observational experience had a significant influence on health care delivery in all aspects of health care provision at the district level. Exposing participants to models of best practices facilitated the replication of processes that improved the conduct of service delivery and CHPS implementation. Upon reflection, district leaders attributed performance constraints to their lack of understanding of practical ways of responding to complex district health system development needs. Observation from community members, volunteers, and health workers who witnessed the system development period corroborated narratives that leaders had expressed.
Effective leadership is optimally developed with participatory learning that provides leaders with direct access to fully functioning systems. Learning by observation can be structured and used to quicken the spread of managerial excellence.
低收入和中等收入国家的医疗保健系统正在进行权力下放，将权力下放到周边地区。在没有系统流程来培养地区层面领导者的情况下进行权力转移，会损害分权式医疗系统的有效性和可持续性。为了解决这个问题，我们开发了一种通过观察和实践进行领导力学习的方法，该方法改善了加纳一个地区医疗保健系统的组织和绩效。
通过两轮纵向定性研究，探讨在加纳一个地区实施基于社区的卫生规划与服务（CHPS）倡议的决定因素。研究获得了关于两位在同一地理区域不同时间管理卫生服务的领导者的领导模式的见解，他们的结果截然不同。收集了参与两个时期的卫生工作者的见解，以澄清访谈背景。每轮研究进行了10次焦点小组讨论（FGD）和5次专家访谈。该研究采用了一种利用主题分析框架的系统评估方法。
为地区领导者提供实际观察经验对地区层面医疗保健提供的各个方面都产生了重大影响。让参与者接触最佳实践模式有助于复制改进服务提供和CHPS实施的流程。经过反思，地区领导者将绩效限制归因于他们对应对复杂的地区卫生系统发展需求的实际方法缺乏了解。社区成员、志愿者和目睹系统发展时期的卫生工作者的观察证实了领导者所表达的观点。
有效的领导力通过参与式学习得到最佳发展，这种学习为领导者提供直接接触全面运作系统的机会。通过观察进行学习可以系统化，并用于加速卓越管理的传播。
