PHC Leadership: Are Health Centres in Good Hands? Perspectives from 3 districts in Malawi|
Hana, J.; Maleta, K.; Kirkhaug, R. & Hasvold, T.
The study aimed to document the kinds of leadership styles are practiced
at health centres (H/C) and how these styles can be explained by the
contexts, characteristics of the health centre in charge (IC) and subordinate
trained health staff (STHS).
A well-researched leadership style model was applied, which included
task, relation and change styles. This is a cross-sectional study using selfadministered
questionnaires in 47 H/C in 3 districts. 347 STHSs (95%)
and 46 ICs (98%) responded. Questions explored background data and
perceived leadership behaviour. Style items were factor analysed, and
bivariate analyses and hierarchical regressions determined how styles
could be explained.
Two leadership styles were revealed: “Trans”style contained all relation
and the majority of task and change items; “Control” style focused on
health statistics (Health Management Information System), reporting and
evaluation. STHS and IC had a median age/median work experience of
34/5 years and 38,5/2 years, respectively. 48% of IC reported having no
management training. CHAM H/Cs had the lowest score on “Control”
style. Distance to referral hospital had no impact on style scores. No
contexts or STHS characteristics predicted any leadership styles. For ICs,
young age and increasing work experience were significant predictors for
both styles, while Nurse ICs were negative predictors for “Control style”.
Management training was not a significant predictor for any style.
Frontline PHC leadership may be forced by situation and context to
use a comprehensive style which could lack the diversity and flexibility
needed for effective leadership. The missing associations between staff
characteristics and leadership styles might indicate that this group is not
sufficiently considered and included in leadership processes in the PHC
organization. Leadership competency for the ICs seems not to be based
on formal training, but substituted by young age and work experience.
Health centre organization could also influence the options for leadership
behaviour. In conclusion this calls for a reassessment of H/C leadership
and formal leadership training.