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Developing leadership competencies in the health system

Practical lessons from a South African district

Decentralization has been widely implemented in South Africa and other developing countries. It transfers authority over functions such as financial management and human resources from higher to lower levels of the health system, seeking to achieve efficiency, innovation and service adaptation to local contexts.

Achieving these outcomes requires effective management and leadership in the health system, particularly at district level. Management entails coordinating technical processes such as planning and budgeting. Leadership refers to individuals who create a vision, inspire, motivate and enable staff to achieve results in complex conditions.

Although some researchers have treated management and leadership separately, we have found them to overlap in practice and to both be crucial to strengthening the district health system. However, despite its centrality to the success of decentralisation and the implementation of health reforms, there are significant leadership challenges at the district level.

Effective leadership requires a range of competencies (Figure 1). This policy brief highlights district-level informal, workplace-based learning through which these key leadership competencies can be learnt and developed. This adds to the relatively small body of empirical literature on informal learning in the health system and complements existing leadership development thinking, much of which is focused on formal training through courses or workshops. Click here