Initiating systemic capacity development for leadership from the bottom-up

A realist evaluation of a leadership innovation in a South African health district

Datos Bibliográficos

ID16762891
AutoresMarsha Orgill (0000-0003-3831-6249, Children’s Institute, Department of Paediatrics and Child Health, University of Cape Town , Rondebosch 7700, autor de correspondencia), Bruno Marchal (0000-0001-7185-022X, Institute of Tropical Medicine , Antwerp 2000), Bronwyn Harris (0000-0003-4695-008X, University of the Witwatersrand), Lucy Gilson (0000-0002-2775-7703, University of Cape Town)
Año2025
Volumen40
Número1
Páginas31-41
Fecha de publicación2025-01-11
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaHealth Policy and Planning (JOURNAL)
Identificadores de la revistaISSN: 0268-1080 • E-ISSN: 1460-2237
EditorialOxford University Press (PUBLISHER • GB)
DOI10.1093/heapol/czae099
PMID39475054
OpenAlexW4403897248
IdiomaEN
Referencias citadas37

The need for leadership within district health systems is critical for the effective delivery of services and for inter-sectoral collaboration for health. Leadership capacity development (LCD) has not, however, been prioritized within health systems, and the systemic capacity (i.e. roles, structures and processes) that is needed to develop managers who can lead is not always in place. This paper aims to contribute to understanding how to build such capacity, considering a relevant bottom-up innovation. We observed, in the period 2013–15, the emergent implementation of this innovation (a ‘Leadership Commission’) in a South African health district. What started out as an effort to train individual leaders evolved into the development of systemic capacity for LCD. We adopted realist evaluation as the main methodological approach, as well as case study design, and we first developed a programme theory of the internally driven LCD initiative, through a round of interviews with senior managers. We then tested the programme theory drawing on 14 in-depth interviews and field notes of meetings and processes. Our analysis suggests that building systemic capacity for LCD requires leadership to be expressed as a strategic priority by those with positional authority and that bottom-up LCD requires institutional commitment through strengthening routine structures or creating new ones. The ability to leverage existing resources is another key element of systemic capacity. The mechanisms that enable bottom-up capacity development include tacit and experiential knowledge, sensemaking, systems thinking and trust between, and motivation of, those tasked with leading LCD. Leadership development is constrained by increased workloads for those involved as the prioritization of leadership becomes simply an additional task, and sustainability challenges are likely in the absence of additional resources for bottom-up innovation

Capacity building · Capacity development · Economic growth · Economics · Environmental planning · Geography · Leadership development · Political science · Public relations · Community Health and Development · Health Policy Implementation Science · Organizational Change and Leadership