Public health leadership in Nepal: development, enactment and competencies

Author: Sudarshan Subedi

Subedi, Sudarshan, 2020 Public health leadership in Nepal: development, enactment and competencies, Flinders University, College of Medicine and Public Health

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Background: Leadership in public health has been emphasized to address complex public health challenges at national level as well as to assist with global public health threats. In this context, research on why and how someone becomes a leader in public health and what might influence the leadership development and practices are deemed important. Due to evidence that poor and improper leadership affects the health system in developing countries, it was vital to explore the leadership practices and competencies among public health leaders in developing countries like Nepal.

Aims and objectives: The major aim of this study was to develop a grounded theory to understand public health leadership in the Nepalese context. To achieve this aim, this study explored the methods of leadership development and its enactment at the individual level as well as the qualities and competencies needed for effective public health leadership.

Methodology and methods: The methodology of this study was grounded theory and the methods used for retrieving information were database analysis (HR database of MoH), document analysis (Job Description n=6), in-depth interviews (46 interviews with 22 participants) and focus group discussions (n=6). Each public health official was interviewed at least once to a maximum of three times to explore their leadership journey and leadership practices. Interviews with those officials as well as focus group discussions with their staff were undertaken to explore the leadership qualities and competencies essential for public health. Data were analysed by adopting the procedures of constructivist grounded theory. Memo writing, transcription and mind maps were used as tools for data analysis whereas initial coding, focused coding and constant comparison were done rigorously to develop a theory grounded on collected data. Measures to ensure the credibility, originality, resonance, and usefulness of developed theory were also adopted.

Findings: Grounded theory illustrates four phases of leadership development within an individual – initiation, identification, development and expansion. The initial phase is related to the individual's childhood and adolescents in which family environment, socio-cultural environment and individual characteristics play a role in developing the backup for leadership. In this phase, an individual observes the social dimensions of leadership and becomes aware of the competencies required for leadership. The identification phase is about being identified as a public health leader after having formal positions in health organisations. From this phase, individuals formally start their leadership journey in public health and utilize leadership skills learned from academic and social settings. In the 'development' phase, individuals develop core leadership capabilities mostly through exposure and experiences. During this phase, an individual pursues supplementary leadership roles/strategies that help in developing additional skills and competencies. The last phase is 'expansion' in which an individual expands their leadership capabilities and recognition mostly by continuous self-directed learning. In this phase, the individual goes beyond the organisational hierarchy and often negotiates the bureaucratic processes for the betterment of public health. From the time of being identified as public health leaders (phase 2) up to the time of being recognized as a national figure (phase 4), an individual enacts his/her leadership to a varied extent, such as leading the management, emphasizing the system, structure and processes, focusing on people and relationships, and political negotiation. Leadership qualities and competencies identified and expected among public health leaders in Nepal were – subject expertise, passion, vision and being influential in having skills of managing people and organisation, socio-cultural intelligence, and goodness.

Conclusions: This study developed a grounded theory to explore how an individual becomes a leader in public health and represents a combined framework on leadership development, enactment and competencies in the Nepalese context. The theory has implications in academia to fulfil the absence of leadership theory in public health as well as at the policy level to recommend the best practices in leadership and further enhance the relationship between leader and followers.

Keywords: Public health, leadership, Nepal, grounded theory

Subject: Public Health thesis

Thesis type: Professional Doctorate
Completed: 2020
School: College of Medicine and Public Health
Supervisor: Colin MacDougall