Priorities and challenges for health leadership and workforce management globally: a rapid review

Abstract Background Health systems are complex and continually changing across a variety of contexts and health service levels. The capacities needed by health managers and leaders to respond to current and emerging issues are not yet well understood. Studies to date have been country-specific and have not integrated different international and multi-level insights. This review examines the current and emerging challenges for health leadership and workforce management in diverse contexts and health systems at three structural levels, from the overarching macro (international, national) context to the meso context of organisations through to the micro context of individual healthcare managers. Methods A rapid review of evidence was undertaken using a systematic search of a selected segment of the diverse literature related to health leadership and management. A range of text words, synonyms and subject headings were developed for the major concepts of global health, health service management and health leadership. An explorative review of three electronic databases (MEDLINE®, Pubmed and Scopus) was undertaken to identify the key publication outlets for relevant content between January 2010 to July 2018. A search strategy was then applied to the key journals identified, in addition to hand searching the journals and reference list of relevant papers identified. Inclusion criteria were independently applied to potentially relevant articles by three reviewers. Data were subject to a narrative synthesis to highlight key concepts identified. Results Sixty-three articles were included. A set of consistent challenges and emerging trends within healthcare sectors internationally for health leadership and management were represented at the three structural levels. At the macro level these included societal, demographic, historical and cultural factors; at the meso level, human resource management challenges, changing structures and performance measures and intensified management; and at the micro level shifting roles and expectations in the workplace for health care managers. Conclusion Contemporary challenges and emerging needs of the global health management workforce orient around efficiency-saving, change and human resource management. The role of health managers is evolving and expanding to meet these new priorities. Ensuring contemporary health leaders and managers have the capabilities to respond to the current landscape is critical

Maternal mortality in Sierra Leone: from civil war to Ebola and the sustainable development goals

More than 1 year has passed since Sierra Leone marked the end of the largest Ebola virus epidemic ever recorded. However, maternal mortality remains a major challenge. The country’s maternal mortality ratio (MMR) is the highest in the world, estimated by the UN Maternal Mortality Estimation Inter-Agency Group to be 1360 [80% uncertainty interval (UI), 999–1980] deaths per 100,000 live births (WHO et al. 2015). This is higher than what the Demographic and Health Survey reports (1165 per 100,000 live births), given incomplete civil registration and vital statistics (CRVS) (Statistics Sierra Leone and ICF International 2014). In contrast, the Millennium Development Goal (MDG) 5A target the country needed to achieve by 2015 was 450 maternal deaths per 100,000 live births