Leadership in health and medical education: lessons from a symposium on health sector development in Ghana

The Ghana College of Physicians and Surgeons (GCPS) has established an annual leadership symposium celebrating innovative leadership in the health sector. The 2022 symposium under the theme "Health Sector Development in Ghana; The Power of Good Leadership" was held in honour of Professor Samuel Ofosu-Amaah (the laureate), an Emeritus Professor of Public Health at the University of Ghana, about his leadership legacy. This article reflects on the leadership challenges in the health sector, the lessons learnt from the symposium, and the way forward. Leadership challenges identified in the health sector included the need for mentorship and coaching, the importance of teamwork and networking for delivering high-quality healthcare, and the role of leadership and governance in the health system. Key lessons from the symposium focused on skills in leading an event organisation, effective collaboration and teamwork, and learning from recognising prominent leaders' contributions to the health sector while these leaders are still alive. Key lessons from the personal and professional life of the laureate included a focus on giving back to the community, building mentorship of health leaders, being a catalyst of change, leadership and governance in public health institutions and publication of research findings. Suggestions were made to name the School of Public Health of the University of Ghana after Professor OfosuAmaah, to include a leadership and management module in all training modules at the GCPS and to establish a health leadership "Observatory" to focus on research on how leadership influences

Engaging students to improve sexual and reproductive health: a report of the university leadership for change initiative in Niger

Few development projects have addressed the sexual and reproductive health (SRH) needs of university students in West Africa or sought to promote student leadership to extend SRH benefits to others. This report presents results from the Evidence-to-Action Project's University Leadership for Change Initiative in Niger which had the goal to begin filling this gap. The Initiative used an innovative behavior change methodology with students at Abdou Moumouni University in Niamey, Niger and subsequently expanded it to three additional universities by applying ExpandNet scale-up approaches. 200 students trained as peer leaders reached almost 8,000 youths with SRH information and counseling, student leaders and university clinic staff distributed nearly 80,000 condoms and the project achieved national policy change through its collaboration with the Ministry of Public Health and the Ministry of Higher Education, Research and Innovations. The report concludes with key lessons about the benefits of student engagement and creativity in this effort

The bird's-eye perspective: how do district health managers experience the impact of family physicians within the South African district health system? A qualitative study

Background: Health policy-makers in Africa are looking for local solutions to strengthen primary care teams. A South African national position paper (2015) described six aspirational roles of family physicians (FPs) working within the district health system. However, the actual contributions of FPs are unclear at present, and evidence is required as to how this cadre may be able to strengthen health systems.Methods: Using semi-structured interviews, this study sought to obtain the views of South African district health managers regarding the impact made by FPs within their districts on health system performance, clinical processes and health outcomes.Results: A number of benefits of FPs to the health system in South Africa were confirmed, including: their ability to enhance the functionality of the local health system by increasing access to a more comprehensive and coordinated health service, and by improving clinical services delivered through clinical care, capacitating the local health team and facilitating clinical governance activities.Conclusions: District managers confirmed the importance of all six roles of the FP and expressed both direct and indirect ways in which FPs contribute to strengthening health systems' performance and clinical outcomes. FPs were seen as important clinical leaders within the district healthcare team. Managers recognised the need to support newly appointed FPs to clarify their roles within the healthcare team and to mature across all their roles. This study supports the employment of FPs at scale within the South African district health system according to the national position paper on family medicine

A situational analysis of eye care services in Swaziland

Compared to other African countries, Swaziland performs the worst in terms of providing eye health care services. A priority goal of the World Health Organization (WHO) is to alleviate childhood blindness, particularly in low-income countries such as Swaziland, where many people live in poverty, which is a contributor to poor health outcomes. A mixed method approach that entailed a document review, key informant interviews and clinical facility assessment questionnaires was used. Hospitals and mission clinics offering ophthalmic services were identified through the website of the Ministry of Health and verified during key informant interviews. A saturated sampling procedure was applied due to the few facilities that offer eye care services. Six framework components from the WHO for analysing health systems were utilised in an eye health care service context: leadership and governance, eye health services, eye health workforce, eye health financing systems, eye health medical supplies and technologies, and eye health information systems. Poor management, lack of accountability, poor monitoring and evaluation mechanisms, weak coordination and ineffective private-public sector regulations were identified as factors that lead to poor eye care in the country. The optometrists indicated that refractive services are the most rendered ophthalmic services. The exodus of healthcare practitioners has contributed to the downfall of the public health sector in the country. Five government eye care facilities, 3 government hospitals, 1 non-governmental organization (NGO) and a church mission clinic were included in this analysis. The eye services distribution favors the more affluent areas, particularly the more urban Hhohho Region, which is also where most of the eye health professionals are located. No campaigns have been conducted to prevent childhood blinding diseases or create awareness about getting children's eyes tested for refractive correction. The burden of eye diseases among children in Swaziland remains unknown. More eye health care personnel and equipped facilities are needed throughout the country, and the eye health care program needs to be adopted

Perceptions of the impact of an advanced training programme on the management skills of health professionals in Gauteng, South Africa

Background. South Africa's health sector spans the private and the public sectors. Within the sectors, health managers take on strategic leadership roles without formal training in management or leadership ­ a trend more common in the public sector than the private sector. Health managers are selected based on their clinical skills rather than their leadership or management skills.Objective. To compare self-rated competencies in management and leadership before and after training of the participants; to assess participants' experience of the training programme; and to evaluate the management and leadership skills of the participants after training.Methods. A cross-sectional, descriptive analytical method and 360° interviewing were used in this study. Participants were evaluated ~18 months after completion of the training programme. A 360° evaluation (360° E) of six of the 12 leadership/management competencies was done with the supervisors, colleagues, and subordinates of the participants.Results. All participants rated themselves as improved in 12 managerial and leadership competencies. The 360° E affirmed five of these competencies as improved, with the ability to create and implement a marketing plan rating poorly.Conclusion. Training in management leads to improvement in both leadership and managerial skills of health professionals

Multidisciplinary leadership training for undergraduate health science students may improve Ugandan healthcare

Background. Community-based education research and service (COBERS) is a platform for embedding progressive transformative leadership and research-related medical education in Uganda. The leadership development programme (LDP) developed at Mbarara University of Science and Technology (MUST); Uganda is a key component of COBERS. Health science students at MUST are equipped by means of the LDP with leadership knowledge and skills; and a positive attitude towards leadership and rural communities. The programme involves employing interactive learner-centred education techniques; with the opportunity to implement these skills in a community setting immediately after the training.Objective. To assess the students' self-reported perception and effectiveness of the precommunity placement LDP at MUST and its impact during the community clinical placement; and to measure the self-reported improvement of students' knowledge and their application of leadership skills in the community. The results of the evaluation will improve and build on this educational programme. The study also evaluated the effectiveness of the preplacement leadership training course for undergraduates at MUST; as reported by students.Methods. The programme evaluation of the LDP used quantitative pretest and post-test measures and qualitative data from focus group discussionsto enrich the evaluation. Data were collected from students before and after the 1-week leadership training course using the same self-administered questionnaire. Variables were then compared to evaluate the impact of the LDP.Results. Prior to the intervention; only 14% of the participants had ever attended a leadership training session. There was significant self-reported change in the task accomplishment skills; interpersonal relationship skills and quality of leadership.Conclusion. The results suggest that the LDP may increase leadership skills among health science students to improve healthcare in Uganda. Our study recommends that this leadership programme be considered for use by Ugandan medical training faculties and similar environments elsewhere

"PHC Leadership: Are Health Centres in Good Hands?Perspectives from 3 districts in Malawi"""

"The study aimed to document the kinds of leadership styles are practiced at health centres (H/C) and how these styles can be explained by the contexts; characteristics of the health centre in charge (IC) and subordinate trained health staff (STHS). Methods A well-researched leadership style model was applied; which included task; relation and change styles. This is a cross-sectional study using self-administered questionnaires in 47 H/C in 3 districts. 347 STHSs (95) and 46 ICs (98) responded. Questions explored background data and perceived leadership behaviour. Style items were factor analysed; and bivariate analyses and hierarchical regressions determined how styles could be explained. Results Two leadership styles were revealed: ""Trans""style contained all relation and the majority of task and change items; ""Control"" style focused on health statistics (Health Management Information System); reporting and evaluation. STHS and IC had a median age/median work experience of 34/5 years and 38;5/2 years; respectively. 48"

The Systems Psychodynamic Leadership Coaching Experiences of Nursing Managers

The mostly linear and mechanistic nature of the nursing manager role is rapidly becoming more dynamic and systemic. The change involves task and people management within a constantly changing organisational identity; taking up multiple leadership roles; having to authorise oneself and others in a complex matrix system; and managing conscious and unconscious psychological boundaries within and between conflicting systems. The aim of this study was to describe the systems psychodynamic learning experiences of nursing managers during leadership coaching. The coaching task was to provide learning opportunities to the individual leader; towards gaining insight into conscious and unconscious leadership dynamics in terms of anxiety; task; role; authorisation; boundaries and identity. A qualitative research design was used. Six nursing managers attended ten leadership coaching sessions over ten weeks. Field notes and reflective essays were analysed using systems psychodynamic discourse analysis. The findings indicated clarity and authorisation in the participants' primary task and normative roles; anxiety and de-authorisation in their experiential and phenomenal roles; anxiety in boundary management related to the misuse of power by others; and the continuous exploration of their leadership role identity towards achieving integration. Participants' learning experiences were evaluated in terms of criteria for organisational learning; after which a general hypothesis was formulated

Review of national AIDS councils in Africa: Findings from five countries

National AIDS councils (NACs) were established in many African countries to co-ordinate the multi-sectoral response to HIV/AIDS. Their main mandate is to provide strategic leadership and co-ordinate activities geared to fight against HIV/AIDS. This study sought to understand the extent to which NACs have achieved their goals and the challenges they face. Best practices were identified and shared among countries involved; so as to enhance their efforts. This review is crucial given that the fight against HIV/AIDS is far from being won. Data for this study were collected from five countries: Ghana; Tanzania; Kenya; Zimbabwe and Lesotho. A qualita- tive study approach was employed by conducting individual in-depth interviews with senior staff members of NACs. We also collected important NAC documents that are used in achieving their mandates. The NAC documentation seemed to be in order in all countries visited; and there was a good understanding of the NACs' mandate and their functioning. There were numerous constraints and challenges that need to be addressed in order to make NACs perform their activities better. NACs need to operate independently of the usual government bureaucracy. Additional work is still needed by governments in making NACs responsible

Building a shared vission among leaders across sectors and professions

Many attempts have been made to give responsibility for leadership in health to community committees or inter-sectoral bodies. Often such attempts have failed due to lack of common understanding; vision and direction. The article provides a tool that can explore difference is in perception and facilitate the creation of a shared vision among leaders who have different backgrounds and insights with regards to health and community development. Through a test case at the University Teaching Hospital in Zambia this article provides an example of how the tool can be used in the change processes which are essential in any health reform. The test case describes the use of a Hospital Management Board; but the tool will be useful for any board; committee or group that is heterogeneous in respect of knowledge; view and insights