Workplace-based learning in district health leadership and management strengthening: a framework synthesis

Effective leadership and management has been identified as critical in enabling health systems to respond adequately to their population needs. The changing nature of low- and middle-income countries' health systems, given resource scarcity, a high disease burden and other contextual challenges, has also led to learning-including workplace-based learning (WPBL)-being recognized as a key process supporting health system reform and transformation. This review used a framework synthesis approach in addressing the question: 'What forms of WPBL, support leadership and management development; and how does such learning impact district health leadership and management strengthening?'. A search for English language empirical qualitative, mixed-methods and quantitative studies and grey literature published from January 1990 to May 2024 was conducted using four electronic databases (PubMed, EBSCOhost, Scopus and Web of Science). Twenty-five articles were included in the synthesis. The findings reveal that over the last decade, WPBL has received consideration as an approach for leadership and management development. While WPBL interventions differed in type and nature, as well as length of delivery, there was no conclusive evidence about which approach had a greater influence than others on strengthening district health leadership and management. However, the synthesis demonstrates the need for a focus on the sustainability and institutionalization of interventions, including the need to integrate WPBL interventions in health systems. To support sustainability and institutionalization, there should be flexibility in the design and delivery of such interventions and they are best supported through national or regional institutions.