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Staff Publications

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    'Staff publications' is the digital repository of Wageningen University & Research

    'Staff publications' contains references to publications authored by Wageningen University staff from 1976 onward.

    Publications authored by the staff of the Research Institutes are available from 1995 onwards.

    Full text documents are added when available. The database is updated daily and currently holds about 240,000 items, of which 72,000 in open access.

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Record number 507119
Title What Governs District Manager Decision Making? A Case Study of Complex Leadership in Dangme West District, Ghana
Author(s) Kwamie, Aku; Agyepong, Irene Akua; Dijk, Han Van
Source Health Systems & Reform 1 (2015)2. - ISSN 2328-8604 - p. 167 - 177.
DOI http://dx.doi.org/10.1080/23288604.2015.1032475
Department(s) Sociology of Development and Change
WASS
Publication type Refereed Article in a scientific journal
Publication year 2015
Abstract Management and leadership in complex health systems
have been little addressed as contributors toward improving maternal
and newborn health. Widespread perceptions of weak district-level
management and leadership have encouraged capacity strengthening
interventions with a predominant focus on individual rather than
systemic capacities. However, both types of capacities matter. Greater
understanding is required about how managerial decision making and
policy implementation are influenced by the systems in which
managers operate. This article presents an exploratory case study to
understand the balance of top-down and bottom-up dynamics
influencing district manager decision making in one district in the
Ghanaian health system. Our study was theory driven, drawing on
concepts of decision space, power, and trust from the literature. Data
collection methods included document review, participant observation,
and semistructured interviews. Using analysis that drew upon complex
leadership theory, we found that contexts of hierarchical authority and
resource uncertainty constrained district manager decision space. These
constraints also gave rise to a leadership type oriented toward serving
the bureaucratic functions of the health system (more top-down than
bottom-up). The analysis of this case study showed that, as a result,
district-level management and leadership were less responsive to
maternal and newborn health service delivery challenges.
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