Learning from Followers: An Examination of Follower Voice Behavior and Its Influence on Leadership Competencies of Ugandan SME Owner-Managers

Ugandan Small business owner-managers lack the desired leadership competencies yet they are a hard nut to crack as far as engaging them in competence development activities is concerned. Based upon Social Constructivism theory, exit-voice and loyalty theory and leader-member exchange theory, this paper explains how leadership competencies of SME owner-mangers can be enhanced with a general assumption that such learning provides support for the growth, development and continuing success of their firms. This paper reports the findings of a cross-sectional survey and a mixed method study involving 340 employees and 54 owner-managers in SMES in Uganda. Using hierarchical regression analysis, the findings suggest that followers through their voice exertion behaviour provides an alternative to convention learning and training by being a rich-informal source of learning for SOMs that meets their learning preferences besides overcoming their excuses for not attending face-to-face training, including time away from  operations and poor Return on Investment (ROI). Findings do provide proof of concept that follower voice behaviour is indeed a learning tool for SOMs and advances research on leadership competencies and organizational literature by introducing Follower voice behaviour as a vital source of learning for SME owner-managers. Keywords: Follower Voice Behavior, Leadership Competencies, LMX, SMEs, SOMS, Ugand

Free-Market Illusions: Health Sector Reforms In Uganda 1987–2007

Introduction: By the late 1980s, Uganda’s health system had been devastated by two decades of conflict and mismanagement. At the same time, public-funded and run health systems had begun to be viewed as inefficient and undesirable. Uganda’s attempt to rehabilitate its destroyed health infrastructure was blocked by donors in favour of reform. Introduced as pre-conditions of aid, market-based health sector reforms (HSRs) were eventually embraced by the government of Uganda as part of the wider globalized free-market policy to provide market solutions to health sector problems. The reforms were driven by ideology; they were untested and not based on evidence. Theoretical framework: The research develops a conceptual framework for critical analysis of HSRs as a policy of the free-market system, and uses policy analysis framework of Hogwood and Gunn, which starts from policy agenda setting and ends with policy maintenance, succession or termination. Where a policy fails or becomes irrelevant, it is succeeded by another policy and terminated. It also employs Raskin et al’s transition-and-trend prediction of the future; that uncontrolled free-market capitalism is hungry for markets, resources and investment opportunities with dire consequences of social polarization, terrorism, environmental degradation, climate change and breakdown of welfare, such as health care. Two possible scenario options are predicted: either to reform the free-market policy or develop a new civilization. Aim and objectives: The aim of the study was to explore the implications of market-based health sector reforms in Uganda for the development of sustainable health systems. The objectives were to 1) analyse the genesis, formulation and implementation of HSRs in Uganda; 2) to evaluate the performance of the health sector under HSRs; 3) to evaluate HSRs collectively and individually; and 4) recommend a framework for sustainable health systems. Methods: Four main methods were used in the study: a) Several evaluation studies of HSRs in Uganda were done. Ugandan studies were done in thirteen pilot health reform project districts. Evaluation studies included several separate thematic sub-studies. Most studies employed interviews, focus-group discussions, and structured observation; b) A study was done to compare Uganda’s reform with those in other countries under a bi-country study and through a review of multi-country studies; c) Systematic reviews and analyses of various household and health-facility surveys were carried out; and d) A sub-district health systems survey was carried out to assess health system inputs, functions, outcomes and efficiency. Results: Health indicators stagnated or deteriorated during the period under study. Only slight improvements have occurred recently but are associated factors outside the health sector. Of the twenty reforms, only two achieved success: setting up private facilities and community-based distribution of health commodities. Eight failed to achieve individual objectives (user-fees, pricing of health care, defining and implementing an essential health package, hospital autonomy, decentralization, contracting out, sector wide approaches, and restructuring of ministry of health). Seven reforms were not sustainable or feasible (revolving drug funds, prepayment schemes, social-health insurance, income generation for health care, payment incentives, hospital trusts and autonomy or privatization of National Medical Stores). Three reforms were found to undermine health sector objectives, especially that of equity (user-fees, privatization, and decentralization). Factors complicating HSRs include aid, macroeconomic Sam Okuonzi 12 policy, policy on economic growth, corruption, inadequate internal management capacity, and ad hoc nature of reforms in general. Discussion: The failure of market-based HSRs to achieve collective and individual objectives in Uganda is a trend also documented in other countries. The characteristics of a good health system (such as equity, solidarity, evidence-based decisions, government leadership and control, and regulation) cannot be achieved through privatization and market forces. Moreover, HSRs are linked to a much wider and entrenched socio-economic global system established and driven by free-market capitalism. Health systems crises cannot therefore be addressed independently of the wider global economic order. Either there has to be policy reform within the prevailing framework of the free-market, focussed on addressing perpetual crises as they emerge, or a new world order based on different values has to be defined and the human society has embark on the path of a new civilization. It is envisioned that only when the values upon which the free-market is based (such as materialism, winner-takes-it-all, individualism, and domination of others) are replaced with other values (such as equity, solidarity, mutual existence, and shared responsibility), will there be a suitable environment for sustainable and equitable health systems development. Conclusions, lessons and recommendations: The health system crisis in Uganda is due to freemarket policy, introduced through and driven by donor aid and its poor management. It was also due to poor leadership and governance in Uganda. Market-based approaches need close control and regulation to protect social welfare and the environment. To address the crisis caused by HSRs, Uganda requires counter-reforms in the economy, health policy, social services, leadership and governance. But globally, the market has to be controlled in favour of human development, peaceful coexistence and sustainable use of resources. Ultimately, a new civilization in which the market is fully controlled and is not the mechanism for health service delivery needs to be established

From Greed to Conscience: Framing a Global System that Works for Everyone

Trading to benefit self and unintentionally others became the most revolutionary idea over the past 200 years It has become not only the core of the global economic system but a creed and way of life This system is the free-market neoliberalism But its perils are increasing by the day Free-market health sector reforms in Uganda and other countries are the cause of health service deterioration not only in Uganda but around the world Health service crisis in low-income countries is part of a bigger global crisis arising from free-market policies These crises include the widening economic disparity an increasing number of poor hungry and angry people around the world rising tensions and restlessness terrorism mass migration and unemployment The earth s natural resources are depleting and ecosystems degrading resulting in loss of biodiversity arable land and water systems This situation is causing adverse climate change and less than adequate food production In the face of these challenges the values of free-market capitalism is becoming untenable and obsolete A new civilization is emerging and we the current generation should guide it with the values of sustainable economic production equitable wealth distribution elimination of deprivation living within the earth s carrying capacity and human fulfillment Indeed consensus is now building up to a world-wide compact for a new civilizatio

Can donor aid for health be effective in a poor country? Assessment of prerequisites for aid effectiveness in Uganda

Background: Inadequate funding for health is a challenge to attaining health-related Millennium Development Goals. Significant increase in health funding was recommended by the Commission for Macroeconomics and Health. Indeed Official Development Assistance has increased significantly in Uganda. However, the effectiveness of donor aid has come under greater scrutiny. This paper scrutinizes the prerequisites for aid effectiveness. The objective of the study was to assess the prerequisites for effectiveness of donor aid, specifically, its proportion to overall health funding, predictability, comprehensiveness, alignment to country priorities, and channeling mechanisms. Methods:Secondary data obtained from various official reports and surveys were analyzed against the variables mentioned under objectives. This was augmented by observations and participation in discussions with all stakeholders to discuss sector performance including health financing. Results:Between 2004−2007, the level of aid increased from US$6 per capita to US$11. Aid was found to be unpredictable with expenditure varying between 174−360 percent from budgets. More than 50% of aid was found to be off budget and unavailable for comprehensive planning. There was disproportionate funding for some items such as drugs. Key health system elements such as human resources and infrastructure have not been given due attention in investment. The government’s health funding from domestic sources grew only modestly which did not guarantee fiscal sustainability. Conclusion: Although donor aid is significant there is need to invest in the prerequisites that would guarantee its effective use

Can donor aid for health be effective in a poor country? Assessment of prerequisites for aid effectiveness in Uganda

Background: Inadequate funding for health is a challenge to attaining health-related Millennium Development Goals. Significant increase in health funding was recommended by the Commission for Macroeconomics and Health. Indeed Official Development Assistance has increased significantly in Uganda. However, the effectiveness of donor aid has come under greater scrutiny. This paper scrutinizes the prerequisites for aid effectiveness. The objective of the study was to assess the prerequisites for effectiveness of donor aid, specifically, its proportion to overall health funding, predictability, comprehensiveness, alignment to country priorities, and channeling mechanisms. Methods: Secondary data obtained from various official reports and surveys were analyzed against the variables mentioned under objectives. This was augmented by observations and participation in discussions with all stakeholders to discuss sector performance including health financing. Results: Between 2004−2007, the level of aid increased from US$6 per capita to US$11. Aid was found to be unpredictable with expenditure varying between 174−360 percent from budgets. More than 50% of aid was found to be off budget and unavailable for comprehensive planning. There was disproportionate funding for some items such as drugs. Key health system elements such as human resources and infrastructure have not been given due attention in investment. The government’s health funding from domestic sources grew only modestly which did not guarantee fiscal sustainability. Conclusion: Although donor aid is significant there is need to invest in the prerequisites that would guarantee its effective use

Political economy of health with reference to primary health care

Politics and economics have dealt with resource allocation from time immemorial. However, the basis for resource allocation and sharing depend on the nature and type of politics and economics, which also depend on different value laden ideologies on which they are based. Two key types of political economies have emerged: collectivism which permits the sharing of social benefits; and free market or neoclassical political economy, which provides economic advantages to a section of society at the expense of or regardless of the suffering of the majority of the population. PHC was conceived with the experiences of these two political economies in mind. However, the current free market has reached unprecedented dimensions. It is not possible to implement and accommodate the values of PHC in this sort of political economy. Fortunately, it is predicted that this sort of social and economic order cannot last long, and that its end is at hand. There are many signs that show that it is not sustainable. Only in a socio-economic order where human welfare is the central focus and where the market plays a peripheral role will the principles of PHC be successfully implemented

Consensus and contention in the priority setting process: examining the health sector in Uganda.

Health priority setting is a critical and contentious issue in low-income countries because of the high burden of disease relative to the limited resource envelope. Many sophisticated quantitative tools and policy frameworks have been developed to promote transparent priority setting processes and allocative efficiency. However, low-income countries frequently lack effective governance systems or implementation capacity, so high-level priorities are not determined through evidence-based decision-making processes. This study uses qualitative research methods to explore how key actors' priorities differ in low-income countries, using Uganda as a case study. Human resources for health, disease prevention and family planning emerge as the common priorities among actors in the health sector (although the last of these is particularly emphasized by international agencies) because of their contribution to the long-term sustainability of health-care provision. Financing health-care services is the most disputed issue. Participants from the Ugandan Ministry of Health preferentially sought to increase net health expenditure and government ownership of the health sector, while non-state actors prioritized improving the efficiency of resource use. Ultimately it is apparent that the power to influence national health outcomes lies with only a handful of decision-makers within key institutions in the health sector, such as the Ministries of Health, the largest bilateral donors and the multilateral development agencies. These power relations reinforce the need for ongoing research into the paradigms and strategic interests of these actors

Open Biomedical Engineering education in Africa

Despite the virtual revolution, the mainstream academic community in most countries remains largely ignorant of the potential of web-based teaching resources and of the expansion of open source software, hardware and rapid prototyping. In the context of Biomedical Engineering (BME), where human safety and wellbeing is paramount, a high level of supervision and quality control is required before open source concepts can be embraced by universities and integrated into the curriculum. In the meantime, students, more than their teachers, have become attuned to continuous streams of digital information, and teaching methods need to adapt rapidly by giving them the skills to filter meaningful information and by supporting collaboration and co-construction of knowledge using open, cloud and crowd based technology. In this paper we present our experience in bringing these concepts to university education in Africa, as a way of enabling rapid development and self-sufficiency in health care. We describe the three summer schools held in sub-Saharan Africa where both students and teachers embraced the philosophy of open BME education with enthusiasm, and discuss the advantages and disadvantages of opening education in this way in the developing and developed world