Published in PLOS One on 2026-08-14, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: David Musoke, Allan Ssembuusi, Grace Biyinzika Lubega, Filimin Niyongabo, Michael Obeng Brown, Richard Holder, Russell Pitchford, Linda Gibson
Source: PLOS One • DOI 10.1371/journal.pone.0356074
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Leadership and management are of great importance for health service delivery, yet they are understudied in Uganda. We therefore conducted a study that assessed the leadership and management competencies and practices among health managers in Wakiso District, Uganda.
A cross-sectional study that employed a structured questionnaire was conducted among 60 health managers. The health managers were in-charges of government lower-level health facilities (health centre II, III, and IV). The questionnaire had questions on leadership and management competencies including cognitive, interpersonal, organisation and supervision, as well as human resource management skills. Data was analysed descriptively in Stata version 14.
Most health managers were female 37 (61.7%), a significant proportion 43 (71.7%) were not inducted into their roles, and 37 (61.7%) lacked motivation to perform their duties. Overall, only 15 (25.0%) and 20 (33.3%) demonstrated good leadership and management competencies respectively. In addition, means for leadership and management competencies ranged from 20.9 to 37.0 and 7.8 to 36.5 respectively. According to the health managers, monitoring 39 (65.0%), speaking 36 (60.0%) and active listening 35 (58.3%) were the most important cognitive skills; while coordination 27 (45.0%), instructing 25 (41.7%), and social perceptiveness 25 (41.7%) were mentioned as the most important interpersonal skills. In addition, management of financial 38 (63.3%), logistic 34 (56.7%), and human resources 31 (52.5%) were the most important business analysis skills. Health managers frequently engaged in promoting good working relationships among subordinates 32 (53.3%), holding self and others accountable for health facility organisational goal attainment 28 (46.7%), and creating an effective work environment for subordinates 27 (45.0%).
Leadership and management competencies among health managers were generally lacking. There is need for induction and routine refresher training on leadership and management among health managers to enhance their performance.
Introduction
Leadership and management competencies are recognised globally as fundamental for effective healthcare delivery [1–4]. A good leader is one who can select, equip, train, influence and direct followers toward achieving the organisation’s mission and objectives [5]. Similarly, a good manager is one who can organise, coordinate and direct resources such as personnel, facilities, and finances to efficiently and effectively deliver services [6,7]. Therefore, a competent manager is one who has the technical skills, knowledge and attitudes required to perform a job [8]. In the context of leadership and management for health facilities, health managers’ competencies extend to overseeing all healthcare operations including strategic planning, organising, staffing, directing, and implementation of quality improvement initiatives for better healthcare outcomes within the available resources [9,10]. For many years, the World Health Organization (WHO) has reported weaknesses in management and leadership competencies among health managers in lower-tier health systems [6,11]. These incompetencies have mainly been linked to poor healthcare service delivery, misallocation and wastage of resources, low staff morale towards work, loss of trust by the community, poor health indicators, as well as compromised healthcare outcomes [12,13]. Many low- and middle-income countries (LMICs), especially those in sub-Saharan Africa, have a shortage of purpose-trained health managers [14,15]. Therefore, a number of them assume managerial roles with limited or without specific formal management training [7,16].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 David Musoke, Allan Ssembuusi, Grace Biyinzika Lubega, Filimin Niyongabo, Michael Obeng Brown, Richard Holder, Russell Pitchford, Linda Gibson. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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