REVIEW OF LEADERSHIP FUNCTION AND REFORM TOWARDS ENHANCING PRIMARY HEALTH CARE SERVICES IN SELECTED COUNTRIES

Abstract

ABSTRACT

Background: Leadership reform was one of the primary health care (PHC) reforms proposed by the World Health Organization (WHO) in response to the failures of the ‘health for all’ goals by the Declaration of Alma Ata. WHO had recommended a leadership approach that was interpreted as the persuasive democratic leadership style. The aim of this manuscript was to analyse leadership styles and functions of different countries, as well as to study the strategies by other countries in achieving leadership reform.

Materials and Methods: Roemer’s model was used to analyse leadership styles and functions between countries. Articles, reports and related publications from online databases such as PubMed, CINAHL and Google Scholar were used for the review.

Result and Discussion: Malaysia, Indonesia, Nigeria and Australia are practising the persuasive democratic leadership style in the PHC system. This is shown by the prominent government role in PHC policy making, management and the financing mechanism to ensure universal health coverage. Element of democracy can be seen by the participation of various stakeholders from different levels of the countries’ PHC system in the negotiation of the PHC services and resources allocation in order to meet the local needs in these four countries. However, government domination became one of the challenges identified as it leads to lack of decentralisation. Several countries had found the solutions towards PHC reform, much of it by the reform in leadership through implementing policy level interventions, aligning bottom-up and top-down interventions, and distributed leadership concept among others. 

Conclusion: Different countries have different styles of leadership in its PHC reform, facing different types of challenges with its own set of solutions, approaches that many countries could learn from in enhancing their PHC services.

Keywords: leadership reform, primary health care, Roemer’s model