What Governs District Manager Decision Making? A Case Study of Complex Leadership in Dangme West District, Ghana.

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2015
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Abstract
-Management and leadership in complex health systems have been little addressed as contributors toward improving maternal and newborn health. Widespread perceptions of weak district-level management and leadership have encouraged capacity strengthening interventions with a predominant focus on individual rather than systemic capacities. However, both types of capacities matter. Greater understanding is required about how managerial decision making and policy implementation are influenced by the systems in which managers operate. This article presents an exploratory case study to understand the balance of top-down and bottom-up dynamics influencing district manager decision making in one district in the Ghanaian health system. Our study was theory driven, drawing on concepts of decision space, power, and trust from the literature. Data collection methods included document review, participant observation, and semistructured interviews. Using analysis that drew upon complex leadership theory, we found that contexts of hierarchical authority and resource uncertainty constrained district manager decision space. These constraints also gave rise to a leadership type oriented toward serving the bureaucratic functions of the health system (more top-down than bottom-up). The analysis of this case study showed that, as a result, district-level management and leadership were less responsive to maternal and newborn health service delivery challenges.
Reference Key
kwamie2015whathealth Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors Kwamie, Aku;Agyepong, Irene Akua;van Dijk, Han;
Journal health systems and reform
Year 2015
DOI
10.1080/23288604.2015.1032475
URL
Keywords
Management maternal health governance dhmt, district health management team emonc, emergency obstetric and neonatal care hird, high-impact rapid delivery mdgs, millennium development goals mmr, maternal mortality ratio mnh, maternal and newborn health complex leadership theory district health system

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