Background: A decentralised health system is the cornerstone
of a country’s health sector. However, for this system to perform effectively,
it requires good leadership and management practices, in addition to the
requisite inputs, notably finances and human resources, among others.
Aim: The present study aimed to investigate the factors that
influence the performance of the district health management team (DHMT) in
Sierra Leone.
Methods: This was a cross-sectional study with a
mixed-method design conducted in four (4) DHMTs (Bo, Kailahun, Kenema, and
Kono). A self-administered questionnaire was used to rate the leadership and
management practices of District Medical Officers (DMOs), while an interview
guide was used to explore the perceived factors that influence the performance
of the DHMTs. SPSS version 25 was used to analyse the quantitative data, and a
thematic analysis was carried out for the qualitative data.
Results: The leadership and management practices of the DMOs
are rated as democratic by the majority of the subordinates. While leadership
was mainly viewed as democratic, qualitative interviews uncovered underlying
issues of domineering behaviour and perceived favouritism, indicating a
disconnect between formal management styles and interpersonal dynamics. Despite
the geographic variation across the four districts, the influence of leadership
on performance remained consistent (p > .05).
On the perceived factors that influence the performance of
DHMTs, the notable issues are the inadequate and late disbursement of funds to
the district. This affects the implementation of planned activities. Further,
the lack of adequate and capable staff within the DHMTs was highlighted. Other
concerns were the poor coordination between national and district levels, and
the poor working conditions (for example, poor office spaces, unreliable power
supplies, and internet connectivity).
Conclusions: To make district health management teams work
in Sierra Leone and in similar contexts, addressing the human resource gaps;
ensuring a better flow of funds to the districts; and improving the
coordination in health program planning and implementation between the national
and the districts are promising measures that will optimise the performance of
the decentralised health system.
Author(s) Details
Alhassan Fouard Kanu
Institute for Health Professionals Development (IHPD), Sierra Leone and
Paris Graduate School, France.
Please see the book here :- https://doi.org/10.9734/bpi/aodhr/v8/6905
