2023 Theses Doctoral

Sub-national Health Management and Leadership Strengthening in Eastern and Southern Africa: Understanding the Enabling Environment

Rogers, Braeden Michelle

Sub-national health management and leadership development is a critical component of primary health care strengthening, which is under appreciated, resourced, and theorized. Though the role of the wider institutional, systems and policy environment has been recognized as important to effectiveness of management strengthening interventions in the literature, in practice these components are often under-addressed, limiting sustainability and impact. This integrated learning experience explores sub-national health management and leadership strengthening in Eastern and Southern Africa, drawing on experience from UNICEF’s District Health Systems Strengthening Initiative (DHSSi) (2019-2022) and a subsequent case study that aimed to better characterize the enabling environment for this work in Malawi.

Insights from the application of different conceptual frameworks in the Malawi context are used to better characterize the enabling environment for sub-national health management and leadership strengthening there and contribute to a newly proposed framework to support pre-intervention situation analysis and intervention design for this work more broadly.