The effect of governance, leadership, and management training on the provision of primary health care services

The effect of governance, leadership, and management training on the provision of primary health care services

Primary health care (PHC) is the first level of contact between individuals, families, communities, and the health system. It aims to provide comprehensive, accessible, affordable, and quality health services to all people, regardless of their location, income, or social status. PHC is essential for achieving universal health coverage and the Sustainable Development Goals.

However, PHC faces many challenges in low- and middle-income countries (LMICs), such as inadequate funding, shortage of skilled health workers, poor infrastructure, weak governance, and lack of accountability. These challenges affect the performance and quality of PHC services, leading to low satisfaction, poor health outcomes, and increased health inequities.

One way to address these challenges is to improve the governance, leadership, and management (GLM) capacities of PHC providers and managers. GLM refers to the processes and practices that guide and direct the planning, implementation, monitoring, and evaluation of PHC activities. GLM also involves engaging with stakeholders, setting goals and priorities, allocating resources, ensuring accountability, and fostering a culture of learning and improvement.

GLM training is a form of capacity building that aims to enhance the knowledge, skills, attitudes, and behaviours of PHC providers and managers in relation to GLM. GLM training can be delivered through various methods, such as workshops, online courses, mentoring, coaching, or peer learning. GLM training can cover various topics, such as strategic planning, quality improvement, human resource management, financial management, data management, or community engagement.

The evidence on the effect of GLM training on the provision of PHC services is limited and mixed. Some studies have reported positive effects of GLM training on PHC performance indicators, such as service coverage, quality, efficiency, equity, or responsiveness. For example,

– A study in Ethiopia found that GLM training improved the availability and utilization of maternal and child health services in rural health centres.
– A study in Nigeria found that GLM training improved the quality of antenatal care services in primary health facilities.
– A study in India found that GLM training improved the efficiency and productivity of community health workers in delivering PHC services.

However, other studies have reported no or negative effects of GLM training on PHC performance indicators. For example,

– A study in Kenya found that GLM training had no effect on the quality of HIV care services in primary health facilities.
– A study in Uganda found that GLM training reduced the motivation and retention of health workers in rural health centres.

The variation in the effects of GLM training on PHC provision may depend on several factors, such as the design and delivery of the training programme, the characteristics and needs of the trainees, the context and culture of the PHC setting, or the availability and use of supportive supervision and follow-up mechanisms.

Therefore, it is important to tailor GLM training programmes to the specific needs and preferences of PHC providers and managers. It is also important to monitor and evaluate the impact of GLM training programmes on PHC provision using rigorous methods and relevant indicators. Furthermore, it is important to complement GLM training programmes with other interventions that address the systemic barriers and enablers of PHC provision.

In conclusion, GLM training is a potential strategy to improve the provision of PHC services in LMICs. However, more evidence is needed to understand how GLM training can be designed and delivered effectively and efficiently to achieve optimal results.

Bibliography

: Tesfaye B et al., ‘Effectiveness of governance leadership management (GLM) strengthening intervention for improving maternal child health (MCH) service delivery at primary health care facilities in Ethiopia: a cluster randomized controlled trial’, BMC Health Services Research 20 (2020), 1–13 .

: Ogbuabor DC et al., ‘Effectiveness of a governance leadership management intervention on improving quality antenatal care services at primary healthcare facilities in Ebonyi State Nigeria: a cluster randomized controlled trial’, BMC Health Services Research 21 (2021), 1–14 .

: Singh D et al., ‘Effectiveness of a blended learning program for capacity building among primary healthcare workers: a cluster randomized controlled trial from India’, Human Resources for Health 18 (2020), 1–11 .

: O’Malley G et al., ‘A process evaluation of performance-based incentives for village health workers in Kibwezi Sub-county Kenya’, Human Resources for Health 15 (2017), 1–11 .

: Namazzi G et al., ‘Strengthening health facilities for maternal and newborn care: experiences from rural eastern Uganda’, BMC International Health and Human Rights 15 (2015), 1–13 .