ArticleJournal of healthcare leadership2026
Maturity of Systemic Leadership Among District Health Management Teams in a Post-Conflict Context: A Cross-Sectional Study in the Kasai-Central Province, Democratic Republic of Congo.
Article in Journal of healthcare leadership, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The systemic leadership of district health management teams (DHMs) is a pivotal factor in optimising health system performance, particularly within fragile and post-conflict contexts. However, the paucity of empirical data on its maturity level remains a limitation. The objective of this study is to evaluate and contrast the maturity of DHMs systemic leadership across six health districts in the Kasai-Central province of the Democratic Republic of Congo. Methods: A quantitative, cross-sectional study was conducted between March 2025 and April 2026, with 84 members of DHMs selected from five urban districts (Kananga, Katoka, Tshikaji, Bobozo and Ndesha) and one rural district (Mikalayi). The data were collected using a structured tool based on a health system leadership framework by Bigirinama and al. (2023), adapted from the NHS. The following indicators were calculated: the percentage of points achieved, the overall scores for systemic leadership maturity, and the overall composite index of systemic leadership achievement in the province of Kasaï Central. Results: The overall synthetic index of systemic leadership achievement in Kasai-Central province is moderate (62.10%), with low variability in overall systemic leadership maturity scores between districts. The dimensions related to vision and governance have the highest scores (between 70-75%), while the lowest scores concern collaboration with external partners, financial management, and internal organization (between 43-55%). Internal collaboration is generally satisfactory but marked by persistent conflicts. No significant differences are observed between rural and urban districts. Conclusion: The maturity of systemic leadership in the DHMs in Kasai-Central is constrained by structural factors. The enhancement of leadership capacity necessitates the implementation of integrated methodologies that encompass the cultivation of skills, the refinement of leadership abilities, and the implementation of systemic reforms, with the objective of optimising the performance of health districts.
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