Sam Agatre Okuonzi*

Arua Regional Referral Hospital, Arua, Uganda

*Corresponding Author: Sam Agatre Okuonzi, Arua Regional Referral Hospital, Arua, Uganda.

Received: June 29, 2023; Published: September 13, 2023

Abstract

Background: Although good leadership is necessary for effective functioning of the health system, developing countries such as Uganda do not adequately prepare health workers for the leadership tasks ahead. Donor funding has been used to try and fill the gap in leadership capacity development under “capacity building” projects. But these projects have not helped either. In many cases, health systems, including health leadership and governance have increasingly got worse. This study sought to understand the root causes of the leadership capacity challenges and suggest some solutions.

Methods: The concept of root cause analysis for planning, implementing and monitoring was used to design the study. Selected documents were reviewed to elaborate on key concepts and definitions of leadership, capacity building and sustainability. Selected government and project documents were also reviewed. Key informant interviews were conducted targeting district-level leaders, central government officials administering leadership development activities in the health sector, and officials of donor organizations as well as of donor-funded projects. Analysis was done against the key elements in the conceptual framework.

Findings: Leadership at the district level has huge gaps in all aspects. Most leaders in the health sector were found to be academically well educated and technically competent. And the government has put in place leadership development policies and institutions. But these were not fully functional or operational due largely to under-funding. There was relatively good gender balance in leadership positions at the district level, with women occupying 38% of key health leadership positions. There was no local budget or initiative for leadership capacity building. The work environment was not conducive for productive work, as there was rampant nepotism, corruption and bureaucracy. Even the private health sector organizations were faced with similar leadership challenges. None of the capacity building initiatives was found to be sustainable. Key donor funded projects did not provide the kind of support to effectively develop leadership capacity at the district level.

Discussion and Conclusion: Four main root causes of the dismal performance of leadership capacity development initiatives are: 1) gross underfunding of leadership development, 2) problematic donor funds, 3) disjointed government and donor planning and funding, and 4) poor work environment. Systematic leadership needs assessment should be done. Gaps in all aspects of leadership need to be characterized and quantified. A desired level of leadership capacity should be defined and interventions packaged to address them. Leadership courses should be introduced in schools and at higher institutions of learning. Selected civil servants and health workers should be trained on leadership regularly. There should also be specialized and tailor-made leadership training for certain categories of public workers. The government and donors need to harmonize their planning and funding of leadership development. Regular monitoring of leadership capacity should be done and the information fed into periodic situation assessment, planning and implementation of leadership capacity development.

 Keywords: Donor; Leadership; Health Sector

References

1. Omaswa F and Boufourd J. “Strong Ministries for Strong Health Systems: Supporting Ministerial Health Leadership: A System for Health Systems Strengthening. African Center for Global Health and Social Transformation (ACHEST) Kampala, Uganda and The New York Academy of Medicine (NYAM), New York, USA (2010).
2. Potter C and Brough R. “Systematic capacity building: A hierarchy of needs”. Health Policy and Planning (2006).
3. Blue R., et al. “Monitoring and Evaluation Management Services Project, implemented by Management Systems International”. November 6^th, 2006. Final Evaluation Report of the AIM Project. USAID Uganda. Report (2006).
4. Barron P., et al. “Management Systems International”. June 2007. Final Evaluation of Program for Human and Holistic Development (UPHOLD). USAID Uganda. USAID Uganda. Report (2007).
5. Benavente J., et al. “End-of-Project Evaluation of the ACE Program”. for the Mitchell Group, Inc. Uganda Monitoring and Evaluation Management Services (UMEMS) (2009).
6. Okuonzi SA. “Learning from failed health reform in Uganda”. British Medical Journal: BMJ Volume 329 (2004): 1173-1175.
7. Okuonzi S A., et al. “Free market illusions: Health sector reforms in Uganda 1987-2007: Dissertation for the doctoral degree”. University of Bergen, Norway (2009).
8. Okuonzi S A., et al. “Towards a sustainable world: implications for universal health coverage”. Journal of Political Sciences and Public Affairs 6 (2018): 3.
9. , et al. “Regional Center for Quality of Health Care, Makerere University School of Public Health: “Manual on root cause analysis”. Kampala (2006).
10. Sen A. “Development as freedom” Oxford University Press, UK (1999).
11. Balyeku A., et al. “External Evaluation of the Joint Clinic Research Centre-Treat Program for Monitoring and Evaluation Management Services Project”. Report by Management Systems International, June ,30^th (2008).
12. Freeman P., et al. “Final Evaluation Report for End-of-Project Evaluation of the Capacity Project for Mitchell Group, Inc”. Uganda Monitoring and Evaluation Management Services, UMEMS, Contract Number 617-C-00-08-00012-00, March (2010).
13. UMEMS September. “Final Evaluation Report”. Report of UMEMS Uganda Monitoring and Evaluation Management Services (2009).
14. Omaswa F and Okuonzi S. “USAID Uganda capacity building framework and assessment of leadership enhancement initiatives for the Mitchell Group, Inc”. Uganda Monitoring and Evaluation Management Services (UMEMS). Report (2011).
15. World Health Report: Health Systems: Improving Performance. Geneva, World Health Organization.
16. Schiber G., et al. “Getting real on health financing”. Washington DC, The World Bank (2017).
17. Rodman D. “An index of donor performance”. Washington DC Global Center for Development (2005).
18. Fritz V and Menacol A R. “Development states in new millennium”. In Development Review 25 (2007): 531-552.
19. Sridhar D. “Seven challenges in international development assistance for health and ways forward”. in Jnl of Law, Med and Ethics 36.3 (2010).
20. United States Agency International Development (USAID), “Learning for Performance: A Guide and Toolkit for Health Worker Training and Education Programs”. Capacity Project: Planning, Developing and Supporting the Health Workforce, Intra Health International (2007).
21. Uganda Management Institute (UMI) 2011: 2010/2011 Prospectus. UMI Kampala.
22. Ministry of Health. “The World Bank District Health Services Pilot And Demonstration Project May 15, 2003 Implementation Completion Report (Ida-26790; Project Id: P002971) on a Loan/Credit/Grant In The Amount Of Us$ 66 Million to the Republic Of Uganda.”. Report (2003).
23. Ministry of Health. “Uganda Human Resources for Health: Responding to Health Sector Strategic Plan and Operationalizing the HRH Policy”. in Strategic Plan 2005-2020, June 2007. Kampala (2007).
24. Ministry of Health. “Mapping the Human Resources Management Processes in Uganda”. Ministry of Health and the Capacity Project: Report (2008).
25. Ministry of Health. “HRH Assessment Report on Nine Districts in Northern Uganda (Acholi and Lango Sub-Regions) Report”. 5^th May 2008. Report Kampala (2008).
26. Ministry of Health. “Mapping the Human Resources Management Processes in Uganda. Ministry of Health and the Capacity Project: Report”. Capacity Project Planning Developing and Supporting the Health Workforce, March (2009).
27. Ministry of Health. “Annual Health Sector Performance Report”. November 2009. Financial Year 2008/2009. MoH Kampala (2010).
28. Ministry of Local Government. “Strengthening Decentralization for Sustainability (SDS) Program: Description”. Kampala (2009).
29. Ministry of Public Service. “Induction Training Manual for Newly Appointed Public Officers”. February 2006. Ministry of Public Service (2006).
30. Ministry of Public Service. “The Public Service Training Policy”. February 2006. Ministry of Public Service (2006).
31. Ministry of Public Service. “The Integrated Performance Management Framework for the Uganda Public Service”. July 2007. Ministry of Public Service (2007).
32. Government of Uganda. Second National Development Plan (NDPII) 2015/16 – 2019/20. National Planning Authority, Kampala (2015).
33. Mentor Consult Limited. “Inception Report for Assessment of Payment of “Hardship Allowance”. on Attraction and Retention of Staff in Hard-To-Reach Areas in Public Service Reform Program (PSRP)”. Procurement No. MPS/SRVCS/09-10/00183/01. Ministry of Public Service, Kampala (2010).
34. Lopes C and Theisohn T. “Ownership, leadership, transformation: can we do better?”. United Nations Development Program. One United Nations - New York Plaza, New York, NY (2003).

Citation

Citation: Sam Agatre Okuonzi. “District Health Leadership Capacity Development in Uganda: Challenges and Way Forward”.Acta Scientific Medical Sciences 7.10 (2023): 18-33.

Copyright

Copyright: © 2023 Sam Agatre Okuonzi. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.