The leadership trinity: examining the interplay between healthcare organisational context, collective leadership and leadership effectiveness in the health sector - a multiple case study of district hospitals in the Western Cape Province, South Africa

To address the current leadership challenges within the South African health system, it is important to understand what influences the nature and practice of leadership within healthcare organisations. This thesis presents research about the interlinkages between context, leadership practices and staff satisfaction and morale – as indicators of leadership effectiveness - in district hospitals. The study represents one of the few detailed empirical inquiries into these issues in South Africa and adds to the still limited body of relevant empirical evidence in low- and middle-income countries. The research specifically drew on organisational and leadership theory to shape its strategies of data collection and analysis. It was conducted in two case study, district-level, hospitals. Multiple sources of data were collected, including document reviews, non-participant observations, and in-depth qualitative interviews. Data from staff satisfaction surveys carried out separately from this study were also considered. The in-depth interviews involved the three broad cadres of clinical, nursing, and administrative staff working within the hospitals, including those with and without formal managerial roles. Thematic analysis was applied in analysing experience in each case study hospital and also in cross-case analysis. This analysis involved iterative inductive, deductive, and abductive processes. The thesis generates insights about the leadership practices experienced in the case study hospitals that may both engender (positive practices) or undermine (negative practices) staff satisfaction and morale. Positive leadership practices also nurtured the collective leadership that itself enhanced teamworking and influenced the hospital context to spread collective leadership more widely. These leadership practices were, in turn, influenced by contextual elements internal and external to the hospital, some of which themselves had possible consequences for staff satisfaction and morale. Critical features of hospital external context included hospitals' histories and backgrounds, as well as the wider bureaucratic context of rigidity in which they are situated. Key features of hospital internal context influencing collective leadership were, meanwhile, internal power structures and processes, professional identity, and cross-professional relationships. This analysis of the interactions between hospital context, collective leadership and staff satisfaction and morale illuminates the complex dynamics of hospitals. This Leadership Trinity offers insights of relevance to health system reform in South Africa, and more specifically, to implementation of current National Health Insurance proposals

Impact of agripreneurial orientations on resilience and performance of dairy agripreneurs in Murang’a County, Kenya: the mediating effect agribusiness support services

The performance of rural smallholder dairy agrienterprises in Kenya is very critical as it contributes to welfare improvement of rural people especially the youth and women. Despite this acknowledgement, the farm productivity of rural dairy agripreneurs is persistently low. Entrepreneurial orientations and utilization of agribusiness support services have been viewed as a catalyst for improvement of agrienterprises performance. This study sought to determine impact of agripreneurial orientations on resilience and performance of dairy agripreneurs in Murang’a County, Kenya. The specific objectives were to determine; dairy agripreneurs’ preferences for production, animal health and marketing support services, factors influencing the usage of Agribusiness Support Services (ASS), effect of agripreneurial orientation mediated by ASS and effect of ASS on performance of smallholder dairy agripreneurs in Murang’a County. A multistage sampling method was used to select a sample of 682 dairy agripreneurs. Through a Cross-sectional survey, data were collected using a standardized questionnaire, discrete choice experiment (DCE) and analysed through a number of novel econometric approaches. Dairy agripreneurs had higher preference for group marketing, curative services and artificial insemination support services. However, dairy agripreneurs have less preference for business plan training service. In relation to willingness to pay (WTP), dairy agripreneurs were more willing to pay for group marketing (KES 8797.91/month), artificial insemination (KES 2816.01/month) and curative services (KES 2577.62/month), but were not willing to forgo KES 2411.29 per month for business plan training service. Secondly, the findings revealed that education level of household head, number of adults in the household, experience in dairy farming, land size, livestock type, number of cows owned, milk yield, price of milk, access to contract, type of road and level of buyer trust were the major factors that affect the likelihood of utilising agribusiness support services among dairy farmers. Thirdly, the findings indicate that there is positive and significant relationship between future orientation (β = 0.395, t=12.699, p=0.01), risk-taking orientation (β = 0.088, t=2.743, p=0.01) and market orientation (β = 0.136, t=3.609, p=0.01) on agripreneurial resilience. However, it was found that social orientation had a negative relationship with agripreneurial resilience (β = -0.166, t=3.966, p=0.01), while ASS had no mediating effect on the relationship between agripreneurial orientation and agripreneurial resilience. Finally, the results show that utilization of combination of ASS significantly increased milk productivity and income per year for smallholder dairy agripreneurs. The study recommended increased linkage on access of ASS and entrepreneusrhip capacity building programmes to smallholder dairy farmers

Determinants of adoption of GLOBAL G.A.P. standards: Evidence from smallholder French beans farmers in Murang’a County, Kenya

AbstractGLOBAL Good Agricultural Practices (GLOBAL G.A.P.) standards have appeared to increasingly control the exchange of horticultural products in the international market. To make horticulture exports viable and lucrative, smallholder farmers need to invest in GLOBAL G.A.P. While research has focused on the impact of adoption on the welfare of farmers, the factors stimulating the adoption of these standards have been ignored. This study examines the determinants of the adoption of GGAPs (GLOBAL G.A.P.) among smallholder French bean producers in Murang’a South Sub-County. The study used cross-sectional data from a random sample of 215 farmers. The adoption index was used to determine adoption levels per household while a “gologit model” was applied to assess factors influencing the adoption of GGAPs among farmers. The adoption index results indicate that farmers on the contract had higher adoption levels (66%) relative to non-contracted farmers (34%). Based on the gologit findings, the determinants of farmer’s compliance levels were age (P < 0.01), gender (P < 0.1), education (P < 0.01), household size (P < 0.01), training (P < 0.01), extension service (P < 0.05), group membership (P < 0.05), farming experience (P < 0.05), vertical coordination options (VCO) (P < 0.1) and market availability(P < 0.01) and reliability (P < 0.05). Therefore, this study recommends an incentive that will promote the improvement of agricultural extension to facilitate contract farming for the adoption of GGAPs. Additionally, the government should put in place measures to safeguard farmers from market exploitation