Effectiveness of an Integrated Transformational Leadership Based Health Systems Strengthening Model in Primary Health Care Setting, Egypt
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- Category: Vol. 85, September 2017
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Effectiveness of an Integrated Transformational Leadership Based Health Systems Strengthening Model in Primary Health Care Setting, Egypt, MOHAMED A. ABOU-NAR and ALAA EL-DINE H. MAHMOUD
Abstract
Background: Several research studies showed that trans-formational leadership attributes and behaviors positively correlated to organizational outcomes such as teamwork success, effectiveness, staff satisfaction, commitment, extra effort and improvement of the quality of service provided. Most of those studies have been conducted in secondary health care settings and were only related to short term outcomes. None of those studies tried to study the sustainability of health system outcomes changes attributable to transformational leadership interventions within the broader context of Health Systems Strengthening particularly in Primary Health Care settings.
Objective: The objective of the current study was to evaluate the effectiveness and sustainability of a Health System Strengthening Model in the primary health care settings in Egypt relying on the development of Transformational lead-ership capacities among health care professionals within the health system, community leaders as well as primary health care facilities board members.
Methods: This was an un-controlled quasi experimental follow-up interventional study conducted in 175 PHC clinics from 53 districts of nine governorates from the Arab republic of Egypt. The intervention model consisted of a batch of interventions aiming at the development of Transformational leadership capacities among health care professionals within the health system, community leaders as well as primary health care facilities board members. Quality of service and facility utilization were used as intermediate outcomes of health system strengthening and were assessed before the intervention and followed-up for a period of one year after the implementation of the intervention package.
Results: Twelve months following the completion of the study interventions, the number of facilities meeting the Ministry of Health's district quality criteria (achieving a quality score of 90% or more) reached 160 facilities (91.4% of all study facilities). This number was significantly higher than that at the baseline (126 facilities representing 72.0% of all study facilities) (p=<0.001 calculated with McNemar's test with the continuity correction, c2=31.03). There was no statistically significant difference between study facilities from Upper Egypt and those from Lower Egypt.
The mean monthly case load in the study facilities during the 12th month after the completion of the study interventions (1189±309) was more than double the mean caseload at baseline (587±152) with an average percent increase of 102.6%, and this difference was statistically significant (t=23.1260, p-value<0.001).
Conclusion: The study results showed that the interven-tions aiming at the development of transformational leadership capacities among health care professionals within the health system, community leaders as well as primary health care facilities board members, were effective in contributing the strengthening of the Health System in Primary Health Care setting as evidenced by a sustained improvement in the quality of services as well as an increased utilization of the primary health care facilities even after 12 months of the completion of the interventions.