Leadership and management qualities for PHC leaders in LMIC are not often studied, suggesting that facility leadership competencies are often overlooked as a point of leverage in reforms. However, one component of leadership that is readily studied in LMIC is leadership committees.
Throughout LMIC, leadership committees are a common approach to integrating community members in facility management decisions and ensuring that services are tailored to the communities they serve. A systematic review of leadership committees in LMIC found that a set of common roles and functions, including: governance, co-management of facilities, resource generation, assistance in community outreach, advocacy, and social leveling: 11
In addition to identifying these functions, the review also explored leadership committees in four countries: Peru, Zimbabwe, Kenya, and Uganda. Although these examples do not provide enough evidence to make conclusions about the utility of leadership committees generally, they anecdotally illustrate the range of roles that leadership committees can play in facility management.
Of the four countries studied, the Dispensary Health Committees (DHCs) in Kenya had the most robust managerial role and autonomy. Members of the DHCs were elected democratically with particular attention to the inclusion of women. The ten members of the DHCs served 3-year terms. The DHCs were formally integrated and considered legal entities with defined roles and responsibilities. These differed by location; each DHC underwent a process to determine their specific responsibilities and working arrangements. DHCs’ powers ranged from the ability to pressure the District Health Management Teams regarding hiring and firing, management of revenue from user fees, establishment of fee levels, facilitating outreach and health education, and improving supply chains for drugs.11 The study found that implementation of DHCs made the health system more accountable to poor populations through the removal of barriers for the poorest members of the community. Additionally, areas with DHCs experienced increased access and more efficient use of funds.
While leadership committees in Peru and Zimbabwe did not have the same autonomy and range of responsibilities as the DHCs in Kenya, they also had a positive impact on health facilities and the health system more widely. In Peru, Local Committees for Health Administration (CLAS) – consisting of a physician, 3 community members selected by the physician, and three community members selected by the community – assisted in local needs assessments, operational decisions, and financial management. This involvement contributed to greater user satisfaction and access for the poor. Health Center Committees in Zimbabwe included a mix of health service professionals, local government officials, local politicians, traditional leaders, and other community members. Their responsibilities included identification of community needs and mobilization of community action, contributing to a higher likelihood of health service use for the last illness as well as utilization of antenatal care. However, the committees did not successfully exert influence on facility management or budgets, and this was attributed to resistance from health professionals as well as lack of knowledge about facility management.11