In all sectors, not just health, the value of investment in leadership is not easy to assess. Recently, this gap between evidence and practice has been investigated in a USAID-funded study conducted in Cameroon comparing successes with and without leadership development. The output is promising and, while requiring more research, shows increase in the effectiveness of interventions with provision of leadership training.
As part of a five-year project funded by USAID, The Leadership, Management and Governance (LMG) Project and the Evidence to Action (E2A) Project researched the impact of investments in leadership, management and governance in achieving resilient and responsive health systems. Results from the Leadership Development Program Plus.(LDP+) suggest that leadership plus clinical training, increased the number of women receiving family-planning counselling after giving birth by an average of 55% (see figure 1). Leadership training also contributed to increases in family-planning counselling during ante-natal care attendance. However, exact quantification of the value of leadership to clinical service delivery is complex and only partially addressed in this study.
Figure 1: Increase in the percentage of ante-natal care clients receiving family-planning counselling
Leadership capacity-building in practice
Upstream interventions such as leadership development, are difficult to quantify and to connect directly to results, while more proximal interventions—such as clinical training and resource provision—are perhaps easier to quantify. Qualitative data from this study suggest that leadership capacity-building may contribute to empowerment of teams, facilitating interventions to result in better outcomes than with clinical capacity-building alone. One quote from a participant in an LDP+ project on improving post-partum family-planning services in Cameroon helps to illustrate the increased awareness and ability to think beyond the immediate that leadership enables:
“…thanks to leadership [training] we learned that it was important to limit the wait times for the woman to return… that we needed, before she left, to introduce the fees for the next consultation into the delivery fees so that when the woman would arrive we would take her directly into the room.”
The study findings suggest that leadership and management play an important role in service-delivery improvement by:
- providing strategic direction and oversight;
- ensuring adequate resources;
- monitoring and evaluating results of improvement initiatives; and
- helping to create a learning culture.
Study participants consistently mentioned leaders' abilities to facilitate or hinder improvement initiatives, including in: staffing levels; task integration; communication; supportive feedback; motivation; and fostering a healthy facility culture. The study’s findings suggest that improving leadership capacity to address barriers to success can lead to measurable improvements in service delivery. This study is a step towards the research needed to connect health management theory, quantitative outcomes and the qualitative value of leadership.
USAID's Leadership, Management, and Governance (LMG) project will host an end of project event in Washington DC on April 6th.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the views of The Economist Intelligence Unit Limited (EIU) or any other member of The Economist Group. The Economist Group (including the EIU) cannot accept any responsibility or liability for reliance by any person on this article or any of the information, opinions or conclusions set out in the article.
