Kiarie Grace, Gilson Lucy, Orgill Marsha
Division of Health Policy and Systems, School of Public Health, Faculty of Health Sciences, University of Cape Town, Falmouth Rd, Observatory, Cape Town 7925, South Africa.
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom.
Health Policy Plan. 2025 Jan 11;40(1):105-119. doi: 10.1093/heapol/czae095.
Effective leadership and management has been identified as critical in enabling health systems to respond adequately to their population needs. The changing nature of low- and middle-income countries' health systems, given resource scarcity, a high disease burden and other contextual challenges, has also led to learning-including workplace-based learning (WPBL)-being recognized as a key process supporting health system reform and transformation. This review used a framework synthesis approach in addressing the question: 'What forms of WPBL, support leadership and management development; and how does such learning impact district health leadership and management strengthening?'. A search for English language empirical qualitative, mixed-methods and quantitative studies and grey literature published from January 1990 to May 2024 was conducted using four electronic databases (PubMed, EBSCOhost, Scopus and Web of Science). Twenty-five articles were included in the synthesis. The findings reveal that over the last decade, WPBL has received consideration as an approach for leadership and management development. While WPBL interventions differed in type and nature, as well as length of delivery, there was no conclusive evidence about which approach had a greater influence than others on strengthening district health leadership and management. However, the synthesis demonstrates the need for a focus on the sustainability and institutionalization of interventions, including the need to integrate WPBL interventions in health systems. To support sustainability and institutionalization, there should be flexibility in the design and delivery of such interventions and they are best supported through national or regional institutions.
有效的领导与管理已被视为卫生系统能否充分满足民众需求的关键所在。鉴于资源稀缺、疾病负担沉重以及其他背景挑战，低收入和中等收入国家卫生系统的性质不断变化，这也使得学习（包括基于工作场所的学习，即WPBL）被视为支持卫生系统改革与转型的关键过程。本综述采用框架综合法来探讨以下问题：“哪些形式的WPBL能够支持领导力与管理能力发展？以及这种学习如何影响地区卫生领导力与管理能力的强化？”。通过四个电子数据库（PubMed、EBSCOhost、Scopus和Web of Science）对1990年1月至2024年5月发表的英文实证定性、混合方法和定量研究以及灰色文献进行了检索。共有25篇文章纳入综合分析。研究结果显示，在过去十年中，WPBL已被视为一种领导力与管理能力发展的方法。虽然WPBL干预措施在类型、性质以及实施时长方面存在差异，但对于哪种方法在强化地区卫生领导力与管理方面比其他方法具有更大影响，尚无确凿证据。然而，综合分析表明，需要关注干预措施的可持续性和制度化，包括将WPBL干预措施纳入卫生系统的必要性。为支持可持续性和制度化，此类干预措施的设计和实施应具有灵活性，并且最好通过国家或地区机构提供支持。
