Factors that affect the management capacity, leadership and employee performance in the Ministry of Public Health (MoPH), Afghanistan: an embedded single-case study.

Abstract

Background: The importance of management capacity in the health sector has been increasingly recognised. The World Health Organization (WHO) (2008) has claimed that limited ‘management capacity’ in low-income countries is one of the main obstacles towards achieving goals. Afghanistan is identified as one of those countries (WHO 2018a). To achieve sustainability, the management and leadership capacity need improvement. Aim: to explore the perceptions of directors and senior employees about the factors that affect the management capacity, leadership and employee performance in the MoPH, Afghanistan. Methods: A mixed-methods case-study was carried out in 30 directorates of the MoPH, Afghanistan to explore capacity. Qualitative data were analysed thematically using NVivo, while quantitative data were analysed using descriptive statistics. Both followed by the analytic technique of explanation building using theoretical propositions. Results: The hiring of directors in the MoPH was found to be affected by political influence. Many directors introduced to the system by politicians did not appear to have the capability to manage well. This set of conditions resulted in a reported lack of support for their employees and the absence of a healthy work environment. This is compounded by a resource shortage. It is evident that a strategic approach to capacity building is not in place with employees attending uncoordinated and often irrelevant training. Employees believe they are not treated consistently and fairly in all respects and this is further compounded by overly complex administrative systems. The socio-cultural influence is affecting transparency, accountability and increases the potential for corruption. Overall the findings suggest that management capacity is weak. Conclusions: This study reveals management capacity in the MoPH needs a significant overhaul. The government should address political and socio-cultural influence, to allow the appointment of more competent and diverse people.