paper is about the role of leadership for effective management of maternal health
in Kagera Region Tanzania. Maternal health leadership is a very important component
in the entire Maternal and child health (MCH) Programme and its smooth running depend
on leadership capacities in management of services. In Kagera region it was claimed
that leadership gaps contribute to low user rate of maternal health services that
lead to high maternal mortality. However, its role in management, success and challenges
in the overall programme has not been explored. Therefore, this paper is detailing
about findings on what extent to which leadership is responsible for ensuring effective
maternal health delivery.
design was an exploratory qualitative approach that employed in-depth interviews.
involved formal health leaders who are involved in maternal health services including:
Regional Health Management (RHMT) members and Council Health Managing Team (CHMT)
members who were considered to be information rich cases. Ethical consideration
was attained through approval from Texila American
and seeking permission from Tanzania Government authority. Participation was voluntary
whereby informed consent from participants was sought and adherence to confidentiality.
Result: Coding and analysis of results on self-competencies revealed
Professionalism, Ethic, Self-reflection, critical thinking, developing others through
teaching, developing others through mentoring, interdisciplinary team building and
negotiation. Leadership competences in relation to wider community revealed; working
with community, working with systems, policy adherence and policy advocacy. It was
found out that respondents have high level of understanding in working with community,
policy adherence and working with system. However, it was observed that; respondents
lacked awareness and recognition, ethics, self-reflection, critical thinking and
less aware on developing others through mentoring, interdisciplinary team building
Conclusion: Basing of the above finding it is concluded that leadership
play a major role in the management of maternal health services. Recommendations
were put forward including to increase understanding about maternal health
leadership competence in MCH programme with more emphasis on interdisciplinary team
building, negotiation, and capacity, policy advocacy practices which were not recognized
by respondents and improve understanding
on all identified weakness.
Role, Leadership, maternal health, management, Kagera region, Tanzania.
K. Shenton (2004) Strategies for Ensuring Trustworthiness in Qualitative Research Project: Division of Information and Communication
Anell, Anna H Glenngård, Sherry Merkur, (2012) Sweden Health system review
Vol. 14 No. 5, Health Systems in Transition, European Observatory on Health
Anuja Jayaraman1, S. Chandrasekhar
&Tesfayi Gebreselass, (2008).Factors Affecting Maternal Health Care Seeking
Behavior in Rwanda.
Christiana R Titaley, Michael J Dibley
and Christine L Robert, (2007). Factors associated with underutilization of
antenatal care services in Indonesia: results of Indonesia Demographic and
Health Survey 2002/2003 and 2007
Cindy Cartis, (2005).Devolving a Human
Right Based Approach to address Maternal Mortality. DFID Health Research
Centre, Desk review.
Cresswell, J W & Miller, D. L.
(2000).Determining Validity in Qualitative Inquiry. Theory into Practice, 39
Daniel M. Jenkins & Amanda B.
Cutchens, (2011).Leading critically: A Grounded Theory of Applied Critical
Thinking in Leadership Studies Journal of Leadership Education. Volume 10,
Issue 2 – summer 2011. Ages New York: The Free Press: on line available: https://www.leadershipeducators.org/Resources/Documents/jole/2011_Summer/Jenkins%20and%20Cutchens.pdf
David Werner, (1993). The life and Death
of Primary Health Care or the Mcdonaldization of Alma Ata. A talk by David
Werner Seminar organized by: Medicine for the People Medical Aid for the Third
World International People's Health Council. On line available: http://www.healthwrights.org/content/articles/Life_and_Death_of_PHC_Belgium.pdf
Fagbamigbe F.A, (2015).Barriers to
antenatal care use in Nigeria: evidences from non-users and implications for
maternal health programming. Online available: https://www.k4health.org/sites/default/files/focused%20antenatal%20care_eng.pf
Freddie Ssengooba, Stella Neema, Anthony
Mbonye, Olive Sentubwe, Virgil Onama (undated) Maternal Health Review Uganda.
Members of the Health Systems Development Programme, Makerere University
Government of India, (2014). Indian’s
Reproductive, Maternal, New Born, Child health and Adolescent Health Strategy.
A case of Extraordinary Government Leadership
Golafshan. N, (2003).Understanding
Reliability and Validity in Qualitative Research, University of Toronto,
Toronto, Ontario, Canada: online available at http://www.nova.edu/ssss/QR/QR8-4/golafshani.pdf
Glenn D. Israel and Sebastian
Galindo-Gonzalez, (2014). Cooperative Extension Service, IFAS. University of
Florida, Using Focus Group Interviews for Planning or Evaluating Extension
Programs on line available at: http://edis.ifas.ufl.edu/pd036
Gupta S, Yamada G, Mpembeni R, Prudence
G, Callaghan-Koru JA, Stevenson R, et al. (2014). Factors Associated with Four
or More Antenatal Care Visits and Its Decline among Pregnant Women in Tanzania
between 1999 and 2010. PLoSONE9(7):e101893.doi:10.1371/journal.pone.0101893:on
line available on http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0101893
Gupta S, Yamada G, Mpembeni R, Frumence
G, Callaghan-Koru JA, Stevenson R, (2014). Factors Associated with Four or More
Antenatal Care Visits and Its Decline among Pregnant Women in Tanzania between
1999 and 2010.
Informatic Lipman building, Northumria
University New Castle upon Tyne, NEI 8ST.
Education for information 22(2004) 63-75 IOS Press.
Crybosk, Nancy .V Yinger, Ricordo H. Dios, Heidi Worley, and Fariyal. F. Firee
(2006). Working with Community for Improved health. Health Bullet .3 Washington
DC Population reference Burue.
, L. (1991), Rigor in qualitative research , The Assessment of Trustworthiness,
Qeens University, Kingston, Ontario, Canada. Kriasta Hawkins, Karen Newman,
Deborah Thomas and Larisa Popovich, Elena Potapchik, Sergey Shishkin, Erica
Richardson, Alexandra Vacroux and Benoit Mathivet, (2011). Health Systems in
Transition, Russian Federation Health system review Vol. 13 No. 7 2011,
European Observatory on health system policy.
J., & Chan, J. (2004-2014). What Is Critical Thinking? On line available: http://www.oalib.com/references/14622148
Mancuso, Peter Johnson, Leah Hart and Kate Austin, (2015). Addressing Maternal
and Newborn .A Leadership Perspective. Online available at: http://www.longwoods.com/content/24498
P. R. & Ezzy, D, (2005). Ch 3- Indepinterviews. In Qualitative Research
Methods. Sydney: Oxford Univsersity Press: 54- 74.
Gilson, Judith Daire and Susan Clear, (2014). Developing leadership and
management competencies in low and middle-income country health systems: a
review of the literature. Working Paper 4, Health Economics Unit University of
Cape Town. South Africa: Available on line: http://r4d.dfid.gov.uk/pdf/outputs/ReSyst/WP4_resyst.pdf
Cuet (undated) The Origins of Primary Health Care and Selective Primary Health
Care. Selective Primary Health Care. Universidad Peruana Cayetano Heredia.
Online Available: http://www.who.int/kms/initiatives/ghhcueto.pdf
Leadership Competencies Workgroup, (2009). Maternal and Child Health Leadership
Competencies VERSION 3.0. On line available at: http://devleadership.mchtraining.net/mchlc_docs/mch_leadership_comp_3-0.pdf
Ndhlovu, (2013). The role of intensive mentorship in EmONC in improved Quality
of Care, The NCHIP approach in Mansa Zambia save mother giving life
A, (2004).Factors influencing utilisation of postnatal services in Mulago and
Mengohospitalskampala, Uganda. Minthesis submitted in partial fulfilment of the
requirements for the degree of Master of Science Physiotherapy in the
Department of Physiotherapy, University of the Western Cape.
National Communication Strategy for Maternal, Newborn and Child Health,
(2011-16). on line available http://scalingupnutrition.org/wp-content/uploads/2012/09/Nepa-National-Communications-Strategy-on-MNCH-2011-2016_en.pdf
SeipatiMothebesoane-Anoh, Patricia Gomez, Stephen Munjanja. Antenatal Care
(undated) Opportunities for Africa’s Newborns Chapter 2
M. (1990). Qualitative Evaluation and Research Methods (pp. 169-186) Beverly
Hells CA; Sage
Kumar Singh, Chandan Kumar, Rajesh Kumar Rai and Lucky Singh,(2013). Factors
associated with maternal healthcare services utilization in nine high focus
states in India: A multilevel analysis based on 14 385 communities in 292 districts.
Rivas-Loría & Caroline Shelto, (2004).analysis of health sector reforms
region of the Americas. Strategic Health Development Area at PAHO/WHO,
Ochako, Jean-Christophe Fotso, Lawrence Ikamari, and Anne Khasakhala,
(2003).Utilization of maternal health services among young women in Kenya:
Insights from the Kenya Demographic and Health Survey
M. K. (2011). Validity and Reliability in Qualitative Studies Excerpted from
Dissertation and scholarly research: Recipes for success (2011 Ed.). Seattle,
WA, Dissertation Success, LLC on line available at: http://dissertationrecipes.com/wp-content/uploads/2011/04/Validity-and-Reliability-in-a-Qualitative-Study.pdf
Government of TZ (2014) Tanzania Big Results Now Health Care Lab. On line
available at: http://www.tzdpg.or.tz/fileadmin/documents/dpg_internal/dpg_working_groups_clusters/cluster_2/health/Sub_Sector_Group/BRN_documents/Tanz_Healthcare_Lab_Report_Part_1_0212_RH_-_v21__Final_Lab_Report_.pdf
Government of Rwanda Ministry of health, (2013). Maternal, neonatal and child
health national strategy 2013- 2018: online available at: www.moh.gov.rw
Partnership for Maternal, Newborn and Child Health, (2008). Successful
leadership country actions for maternal, Newborn and Child Health
United republic of Tanzania (2015) .The prime minister’s office Regional
Administration and Local Government. Action plan to accelerate the reduction of
maternal, newborn and child deaths 2014 – 2015. Kagera region sharpened one
plan, Regional Commissioner’s Office, Health Department P.O Box 265, and Kagera
Phone: 028-2220351 Fax No: 028-2221425 Eemail@example.com
united republic of Tanzania, (2011).A performance audit on the monitoring,
Evaluations and budget allocation for maternal health care activities in
Tanzania. Ministry of health and social welfare a report of the controller
United republic of Tanzania, (2003).MOHSW Second Health Sector Reform strategic
united republic of Tanzania, (2015) .The prime minister’s office Regional Administration
and Local Government. Action plan to accelerate the reduction of maternal,
newborn and child deaths 2014 – 2015.
united republic of Tanzania, (2015). RHMT annual plan 2015-2016, KAGERA
.Regional Commissioner’s Office, Health Department
Republic of Tanzania Ministry of Health and Social Welfare (2008).The National
Road Map Strategic Plan To Accelerate Reduction of Maternal, Newborn and Child
Deaths in Tanzania 2008 – 2015
Republic of Tanzania Ministry of Health and Social Welfare, (2008). The
National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn
and Child Deaths in Tanzania 2008 – 2015
(2014). South African Mentor Mother improves Perinatal Health Outcome.
available at: http://newsroom.ucla.edu/releases/south-african-mentor-mothers-program-improves-perinatal-health-outcomes
Maternal and Child health Services, (2009). Maternal and Child Health Service:
Practice Guidelines On line available.
(2008).Social Determinant of Health Report. Closing the gap in a generation,
health equity though action on social determinant of health. Online available http://www.who.int/social_determinants/thecommission/finalreport/en/
Health Organization, (1978). Primary Health Care, Report of International
Conference on Primary Health Care, Alma Ata, USSR, 6-12 September 1978: 43-48.
. WHO, (2015)
Health in 2015: from MDGs to SDGs, Monitoring Health for the SDGs. WHO: Geneva.
On line available: http://www.whoint/gho/publication/mdg/en/