Decentralized Health System Leadership: Are District Health Management Teams in Good Hands? Perspectives of 4 districts in Sierra Leone

Abstract

Background: Evidence is abound that good leadership and management practices can improve the performance of health system Conversely, poor leadership practices from health leaders have detrimental effects on the performance of the health system. Decentralized district health system is the cornerstone of a country’s health sectors. This is the more the reason the post Ebola health system strengthening in Sierra Leone had a component on staff leadership development for personnel at both central and district levels. In this study, the leadership styles of the District Medical Officers (DMOs) are examined to assess their influence on the performance of DHMTs in Sierra Leone.

Methods: The was a cross-sectional quantitative study that targeted the heads of units within the District Health Management Teams of Bo, Kailahun, Kenema, and Kono. A self-administered questionnaire using Likert Scale was provided to the subordinates (n=23) to rate the leadership and management practices of their DMOs. SPSS version 25 was used to analyze the data.

Results: The leadership and management practices of the DMOs are rated as democratic by the majority of the subordinates. However, the subordinates also reported that their DMOs are domineering and are also encouraging favouritism within the teams. The study did not find any statistically significant difference among the four districts on the influence of leadership of the DMO and DHMT performance (p >.05).

Conclusions: The leadership style of the health managers can influence the performance of the DHMT. In this study, the leadership style of the DHMTs is largely perceived to be democratic by their subordinates. The good leadership skills of the DMOs in the surveyed districts might be responsible for the relative effectiveness and efficiency of the operations of their DHMTs. However, the majority of the subordinates in all the districts testified that their DMOs are domineering and also encourage favouritism. These practices are considered autocratic and divisive. These are areas for the MoHS leadership to actually examine and address for optimal DHMT performance.

Keywords: healthcare, leadership styles, management and leadership theories, health system, health system strengthening, health system performance, district health system, district health management, decentralization, and devolution

DOI: 10.7176/JHMN/76-02

Publication date:June 30th 2020