Leadership, management and governance practices and associated factors among primary health care unit managers in selected areas of Eastern Ethiopia

Abstract

Background: Primary health care managers operate in an increasingly complex environment that requires updated skills and competencies. However, little is known about the strength of leadership, management and governance practices of front-line health care managers in low-income countries like Ethiopia. Identifying such practices could help strengthen health systems and improve health outcomes. Objective: To assess the strength of leadership, management and governance (LMG) practices and associated factors among primary health care managers in eastern Ethiopia. Methods: We conducted a mixed-method, cross-sectional study in four areas of eastern Ethiopia from August through September 2018. Using a multi-stage sampling technique, we selected 555 participants for the quantitative portion of the study. Twenty senior health care providers were purposively sampled for in-depth interviews. A structured pre-tested, self-administered questionnaire was used to collect quantitative data and structure interviews informed the qualitative study. Frequencies and percentages were used to summarize quantitative data. Bivariate and multivariate logistic regression analyses were conducted to assess the associations between LMG practices and predictor variables, controlling for potential confounders. Qualitative data were transcribed verbatim and analyzed thematically. Results: Slightly over half of the participants were found to engage in good management and governance practices (55% and 54.6%, respectively) and less than half demonstrated good leadership practice (48%). In multivariate logistic regression analysis, the odds of good leadership practice increased with nurses, midwives and other professionals compared with health officers. The odds of good leadership practice also increased with experience sharing with peers working at other health facilities. Experience working at another organization and sharing with peers from other facilities were significantly associated with good management practice, and having a job description was significantly associated with good governance practice. Senior health care providers perceived that managers lacked innovation and key management skills such as decision-making, time management and financial management. Although senior care providers acknowledged that there were mechanisms for holding officials accountable, they expressed concern about the potential for corruption at health facilities. Conclusion: We found that the strength of leadership, management and governance practices among the study participants was moderate. Most health care providers observed that managers lacked crucial skills that impacted organizational performance. We recommend in-service trainings, performance-oriented job descriptions and increased opportunities for managers to share with peers as strategies to improve leadership, management and governance practices in the study area, and Ethiopia more broadly.