Enabling relational leadership in primary healthcare settings: lessons from the DIALHS collaboration

dc.contributor.authorCleary, Susan
dc.contributor.authordu Toit, Alison
dc.contributor.authorScott, Vera
dc.contributor.authorGilson, Lucy
dc.date.accessioned2018-07-17T07:22:25Z
dc.date.available2018-07-17T07:22:25Z
dc.date.issued2018
dc.description.abstractStrong management and leadership competencies have been identified as critical in enhancing health system performance. While the need for strong health system leadership has been raised, an important undertaking for health policy and systems researchers is to generate lessons about how to support leadership development (LD), particularly within the crisis-prone, resource poor contexts that are characteristic of Low- and Middle-Income health systems. As part of the broader DIALHS (District Innovation and Action Learning for Health Systems Development) collaboration, this article reflects on 5 years of action learning and engagement around leadership and LD within primary healthcare (PHC) services. Working in one sub-district in Cape Town, we cocreated LD processes with managers from nine PHC facilities and with the six members of the sub-district management team. Within this article, we seek to provide insights into how leadership is currently practiced and to highlight lessons about whether and how our approach to LD enabled a strengthening of leadership within this setting. Findings suggest that the sub-district is located within a hierarchical governance context, with performance monitored through the use of multiple accountability mechanisms including standard operating procedures, facility audits and target setting processes. This context presents an important constraint to the development of a more distributed, relational leadership. While our data suggest that gains in leadership were emerging, our experience is of a system struggling to shift from a hierarchical to a more relational understanding of how to enable improvements in performance, and to implement these changes in practice.en_US
dc.identifier.citationCleary, S. et al. (2018). Enabling relational leadership in primary healthcare settings: lessons from the DIALHS collaboration. Health Policy and Planning, 33: ii65–ii74en_US
dc.identifier.issn0268-1080
dc.identifier.urihttp://dx.doi.org/10.1093/heapol/czx135
dc.identifier.urihttp://hdl.handle.net/10566/3885
dc.language.isoenen_US
dc.privacy.showsubmitterFALSE
dc.publisherOxford University Pressen_US
dc.rightsVC The Author(s) 2018. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
dc.status.ispeerreviewedTRUE
dc.subjectLeadership developmenten_US
dc.subjectGovernance and accountabilityen_US
dc.subjectPrimary healthcareen_US
dc.titleEnabling relational leadership in primary healthcare settings: lessons from the DIALHS collaborationen_US
dc.typeArticleen_US

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