The Influence of ‘Context’ and ‘Nature of Challenges’ on Leadership and Leadership Development: Perspectives From Senior Health Systems Leaders in Sub-Saharan Africa

Abstract

There has been a growing recognition to make Africa an equal player in the global health community and to strengthen leadership capacity building for health systems in the region. Leadership is widely acknowledged as vital to effective health systems functioning as well as positive population health outcomes. However, there is little empirical research on health leadership and leadership development in sub-Saharan Africa. Additionally, most of the research has focused on identifying individual competence characteristics of influential leaders, and while these are vital, they are not sufficient without consideration of context. From the perspectives of senior health system leaders in sub-Saharan Africa, this research analyzes how ‘context’ and ‘nature of challenges’ influence leadership and leadership development in the region. A qualitative study was conducted using interviews with strategic African leaders (n=15) who had in-depth knowledge and experience working to transform healthcare systems in sub-Saharan Africa. Purposive sampling was used to ensure a diversity of perspectives. Male and female leaders, originally from 13 different African countries and working from around the globe at national or international levels, were interviewed. The interviews were conducted virtually and were audiotaped and transcribed. For data analysis, thematic analysis was used, applying both inductive and deductive approaches and facilitated by Nvivo. A case study of leadership lessons in a health crisis was also conducted to identify key leadership behaviors and actions that can be applied to the current Covid-19 pandemic. Research findings show that senior health systems leaders in Africa have a similar conceptualization of leadership as leaders in the West. However, ‘humility’ was identified as a representative leadership value amongst African leaders. Secondly, there were several social, economic, political as well as organizational contextual factors that influence leaders’ abilities to cope the nature of challenges strategic -level leaders face. Thirdly, societal constructs of leadership were more connected to women’s opportunities for leadership positions rather than their abilities as leaders. This research provides evidence of the contextual factors influencing individual leadership within health systems in sub-Saharan Africa. The findings will inform leadership development for senior health leaders in the region.