UCSF

Leadership and management are essential to achieving the goals of global public health. Despite broad agreement that strong leadership and efficient management are essential to the achievement of global health goals, funding for building these skills remains elusive. One explanation for this mismatch between expert opinions and investment may be the paucity of evidence demonstrating the effect of these skills on health outcomes in low- and middle-income countries.

The goal of this research was to evaluate existing data and generate new evidence to support the hypothesis that that enhanced leadership skills and management capacity impact global public health outcomes. The first chapter provides an overview of existing evidence, examining the results of previous reviews and presenting a systematic review, which included publications that describe models for building leadership and management capacity in LMICs for which impact was measured. The second chapter presents a mixed-methods impact evaluation of Global Health Corps, a fellowship program that aims to build leadership capacity among young, global health professionals. Quantitative data was collected from a combination of existing databases and surveys and used to develop a logistic model examining whether those individuals who had completed the fellowship were more likely to focus their current career on global public health. Qualitative data was collected through interviews with fellowship supervisors and focus groups with alumni of the program and analyzed thematically to better understand how Global Health Corps had impacted their careers. The third chapter presents a mixed-methods impact evaluation of Born Free Africa, a quality improvement intervention to reinforce efforts of the Kenyan government virtually eliminate mother-to-child transmission of HIV through the introduction of a Rapid Response Team (RRT) providing additional program management support at the county level. Quantitative data was collected from three Kenyan health system administrative databases and used to construct a difference-in-difference model estimating the effect of the RRT on the number of HIV-positive pregnant women receiving the appropriate treatment, the number of missed opportunities, and the number of positive HIV tests for infants. Qualitative data was collected through fifty in-depth interviews with members of the RRT and their counterparts in the county governments and public health care facilities and thematically analyzed to better understand the impact of the RRT program on the processes and the activities of the county health system and facility-level implementation that may explain why and how the RRT program resulted in changes in performance on the process and health outcome indicators of interest.

This research contributes to the field of global health by offering evidence that improving leadership skills and management capacity do positively impact health outcomes. This evidence may be useful to increase investment in foundational aspects of the health system—leadership and management—without which the success of any clinically focused intervention will be limited and the successful transition of health system financing from development assistance to domestic sources may be impeded. This body of work also demonstrates the variety of methods and tools that I have mastered throughout my doctoral coursework and research and how these can be applied to a unique aspect of global health.