Peer-reviewed article
Leadership practices and maternal and child health outcomes in Sub-Saharan Africa: a systematic review.
Samuel Yao Mayeden, Ildiko Hoffmann, Myo Chit, Jussi P Posti, Michael Lowery Wilson et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined how leadership and management practices in primary health care systems affect maternal, newborn, and child health outcomes across Sub-Saharan Africa. The review found thirteen studies from seven countries showing that three types of leadership approaches—capacity building with supervision, participatory governance, and community engagement—consistently improved health service coverage. Improvements included increases in antenatal care use, skilled birth attendance, and immunization rates. The authors conclude that strengthening leadership and management in health systems is essential for reducing preventable deaths of mothers and children in the region.
Key points
- Leadership capacity building and supportive supervision were associated with improvements in service coverage and quality
- Antenatal care utilization increased by 12% to 48% where leadership practices were strengthened
- Skilled birth attendance increased by 10% to 34% across included studies
- Immunization completion rates increased by 8% to 27%
- Management practices including mentorship, routine monitoring, and data-driven decision-making strengthened provider performance and service delivery
Limitations
This is a systematic review that synthesizes evidence from existing studies rather than collecting new data; it cannot determine causation or account for contextual factors that may vary between settings. The review does not provide information on the costs, feasibility, or sustainability of implementing these leadership approaches in resource-limited settings.
Abstract
BACKGROUND: Maternal, newborn, and child health (MNCH) remain a major public health challenge in Sub-Saharan Africa (SSA), where preventable mortality persists despite global commitments to reduce deaths. Weak leadership and management within primary health care (PHC) systems contribute to inefficiencies, inequities in access, and suboptimal quality and continuity of care. METHODS: This systematic review examined how leadership and management practices influence MNCH outcomes in SSA. The systematic review followed PRISMA 2020 guidelines and was conceptually informed by the WHO Health System Building Blocks framework and governance-oriented leadership concepts. Searches were conducted in PubMed/MEDLINE, Web of Science, Scopus, CINAHL, Embase, Google Scholar, and the WHO African Index Medicus (AIM) for peer-reviewed studies published between 1978 and July 2025. The protocol was registered in PROSPERO (CRD42024514304). CLINICAL TRIAL NUMBER: Not applicable. Studies were eligible if they examined leadership or management practices in PHC settings and reported MNCH outcomes. RESULTS: Thirteen studies from seven countries and one multi-country analysis met the inclusion criteria. Leadership approaches clustered around three domains: leadership capacity building and supportive supervision, participatory and accountable governance, and community engagement mechanisms. These approaches were consistently associated with measurable improvements in service coverage and quality. Reported gains included increases in antenatal care utilization (+ 12% to + 48%), skilled birth attendance (+ 10% to + 34%), and immunization completion rate (+ 8% to + 27%). Management practices including mentorship, routine monitoring, and data-driven decision-making strengthened provider performance, coordination, and service delivery efficiency. CONCLUSION: Leadership and management are critical system-level drivers of PHC performance and MNCH outcomes in SSA. Strengthening leadership and management capacity within PHC systems represents a high-impact strategy for improving service delivery and accelerating progress toward MNCH targets in SSA.