Assessment of management capacity to improve the value of health-care systems: a survey

Abstract Background Strong management is important for high-value health-care systems if returns on global health investments are to be delivered and the Sustainable Development Goals met by 2030. Managers are responsible for care delivery systems and strategies, making sure that health services benefit the population they intend to serve. Most managers in resource-limited settings work at the district level and below, with little training in non-clinical skills. They are often health care providers who have been promoted into management roles. Here, we aimed to understand the most challenging aspects of the health-care management role in resource-constrained settings and to identify gaps in managers' skills and knowledge in order to better design programmes and tools to support managers in their delivery of care. Methods We sent a web-based branching survey to frontline global health managers via Devex between October, 2014, and January, 2015. The survey used multiple-choice and Likert-scale questions about skills within five categories of management in global health: finance; human resources; facility/supply chain or inventory management; clinical, field, or laboratory team management; and relationships with community and partners. Before the survey, we did a literature review, held a virtual discussion with experts, and piloted the survey to refine areas of management and enable targeted training. The pilot survey was also completed by mid-career professionals attending the Global Health Delivery Intensive at the Harvard T H Chan School of Public Health in July, 2013. Findings We included data from from 350 survey respondents in 44 low-income countries, the virtual discussion panel with 131 experts from five continents, and responses from 33 Global Health Delivery Intensive attendees from 11 countries. Our findings indicated that health-care managers are short on time, are required to multitask without an understanding of priorities, and that they lack management skills, motivation, and information. We refined our intensive global health delivery course to meet what were identified as the most pressing challenges, and we offer an online community of practice to facilitate peer-to-peer learning and expert guidance to these areas. In 2016, 52 professionals from 24 countries participated in the eighth annual Global Health Delivery Summer Intensive. More than 90% of respondents (n=49) said they planned to incorporate their learning to make changes to their