Abstract
Background
Observing over-led and under-managed, over-managed and under-governed, and even out of these health organizations remains a common phenomenon in low and middle-income countries including Ethiopia. To balance these discrepancies, leadership and governance is regarded as the locus of all other critical health system building blocks. Thus, the current study looks at the performance capacity of the health system workforce towards integrated leading-managing-and-governing practices and its predictors in Ethiopia.
Methods
Eight-hundred-thirteen health system workforce were participated in this study. These were selected from 32 health care organizations located in northwest Ethiopia. Data were collected using a multi-item questionnaire. These data were fitted to factor analysis and ordinal logistic regression models. Factor analysis was used to develop scientifically reliable and empirically scalable measurement model. Once this model was tested for reliability and validity, the performance capacity of the health system workforce towards integrated leading-managing-and-governing practices (the outcome variable) was computed and labeled. Finally, ordinal logistic regression was conducted to model relationships between the outcome variable and its predictors using probability value and odds ratio.
Results
From 813 participants who rated the questionnaire, 396 (48.7%) and 582 (71.6%) were females and service owners respectively. Using these ratings, four factors were extracted. These factors together with items rated and error variances provided a four-factor measurement model. This model had estimates above .5, composite reliability above .7 and average variance extracted above .5. Using items in this model, the outcome variable was labeled as low (41.3%), moderate (42.7%), high (13.5%) and very high (2.5%). Sex and responsibility were among significantly associated predictors.
Conclusions
Empowering the health system workforce towards integrated leading-managing-and-governing practices using scientifically reliable and empirically scalable model is important, particularly in resource-limited settings. The policies and strategies developed in this regard should give due attention to females and service owners. The current results could provide foundations for training and future research.
Trial registration
The current study was part of a PhD dissertation research, which has been registered at clinical trials.gov since 9 July 2018 with identifiers: NCT03639961.