Expert Panel: [ARCHIVED] Managing Health Care Delivery: Your expertise

When: Sept. 9, 2013 - Sept. 13, 2013 | Community: Site-wide

This Expert Panel is Archived.

This Expert Panel is no longer active as of December 2018. Thanks to those who posted here and made this information available to others visiting the site.

You may use this brief for informational, non-commercial purposes with credit attribution: The Global Health Delivery Project,, Sep 26, 2013. Please see our Terms of Use for more information.

Managing Health Care Delivery

Added on 26 Sep 2013
Last updated on 27 Sep 2013

Authors: By Marie Connelly, Julie Rosenberg Talbot; Reviewed by Rebecca Weintraub, MD

Richard Horton recently acknowledged in The Lancet a distressing awareness gap between global health leaders and those on the front lines engaged with the nuts and bolts of health delivery. Health delivery challenges can largely fall in four main categories: management, resource shortages, systems/policy, and clinical/technical.

In this Expert Panel, we asked global health professionals to focus on this first category of delivery challenges: management. Over 130 members of the GHDonline community, representing academics, clinicians, program managers, government employees, and specialists from 75 different countries, shared their expertise in five areas related to management: the importance of management, what management duties entail, the skills or capacities managers need, external influences on management, and potential interventions to address management challenges. Their responses were shared with over 10,000 members of the GHDonline community and thousands more who followed the discussion on the web.

Defining Management

  • Participants agreed that ‘management’ covers a variety of duties and responsibilities, including: managing budgets, assigning resources, fixing processes, assessing performance, supporting and training employees, implementing programs, and building relationships with stakeholders.
  • Most contributors described having some management responsibilities as part of their work; many agreed these duties were often informally integrated into their roles.

Importance of Management

  • Effective management is key to successful health care delivery in resource-poor settings, particularly because it can help address other delivery challenges, such as severely limited resources or lack of a supportive external policy environment.
  • ‘People management’ was described as one of the most important as well as one of the hardest management activities because of the challenges presented by over-stretched or unmotivated workers, high rates of turnover, and insufficient local staff.
  • Understanding and measuring drivers of staff turnover—be they positive (career advancement), mixed (interagency transfer due to conflict or frustration), or negative (career stagnation or employee burnout)—can help managers understand their roles and impact.
  • Participants agreed that while vitally important to global health care delivery, management responsibilities could be challenging to prioritize, and the importance of management was not always emphasized.

Management Skills Needed

  • Participants described a number of “non-technical” skills that enable effective management, including: communication, leadership, conflict-management, and interpersonal skills; these skills are often taught informally or “come naturally” to managers. There are minimal opportunities to learn these skills.
  • A lesser majority also mentioned the need for improving technical skills, such as budget management, computer skills, and monitoring and evaluation expertise.
  • While some participants described having access to professional development and capacity building opportunities through their employers, many felt they had learned these skills informally, through mentors and peer networks, or via other channels, such as graduate coursework.

Challenges to improving management

  • Many challenges exist to improving management of care delivery–-perhaps most significantly: a lack of political or systematic support of health systems.
  • Some of the specific political and systemic challenges raised include: understaffed health systems and centers, earmarked funds that cannot go to certain disease or patient populations, and poor country-level systems for transportation, communication, education, etc..
  • Limited access to training also impedes improvement; opportunities to access training from sources beyond employers are often limited by lack of funds or low bandwidth internet connections, which make accessing even freely available training resources (such as Massively Open Online Courses) a challenge.

Potential Interventions

  • Participants proposed many solutions to address the skill gaps described, ranging from resource development (e.g., building a referral database) to networking platform (e.g., communication platform to facilitate discussion across managers) to specific training ideas (e.g., webinars, train the trainer programs, further Expert Panel discussions, etc.)
  • Many felt that access to effective training programs for non-technical skills such as leadership would be beneficial.

GHD greatly values the input of all participants as we build additional resources and tools to support managers in health care delivery. In the short term, GHD will be developing a page of training resources and materials for those who manage aspects of health care delivery. We will continue to share updates as these materials become available.


Key References

Training Programs for Managers in Health Care Delivery:

Enrich the GHDonline Knowledge Base
Please consider replying to this discussion with:

  • Your own experiences managing various aspects of care delivery
  • Additional ideas for how the Global Health Delivery Project can best address gaps and immediate needs in management of health care delivery
  • Examples of beneficial training programs for managers in health care delivery

Download: 09_25_13_Managing_Health_Care_Delivery.pdf (98.1 KB)