Advancing leadership capacities in Ethiopia's digital health transformation: A scoping review using the integrated leadership model

Leadership has emerged as a critical determinant of the performance and indeed the digital transformation of the healthcare system, especially in developing countries. The Health Sector Transformation Plan II and the Information Revolution Roadmap in the government of Ethiopia has emphasized leadership, governance, and digitalization; however, there has been little empirical evidence about leadership style.

This scoping study was conducted following PRISMA-ScR guidelines. Electronic databases and gray literature sources were searched for studies published between 2015 and 2024. Eleven empirical studies (2015-2024) on leadership and digital transformation of health in public health service in Ethiopia were identified for included. Study synthesis was carried out using the Full Range Leadership Model. Adaptive leadership and e-leadership were established as cross-cutting concepts for this study. Study quality was assessed through the Mixed Methods Appraisal Tool and Newcastle-Ottawa Scale.

Among the different leadership styles studied, transformational leadership was found to be the dominant style, and it was the one that was highly and consistently linked to the three variables: health workforce motivation, accountability, and service delivery performance. The transactional leadership style was moderately utilized to achieve short-term compliance by performance monitoring. Passive and laissez-faire leadership strategies were rarely used, although they were always associated with negative results. Adaptive leadership behaviors were an integral part of transformational and transactional leadership styles, especially when the leadership decentralization was practiced.

Hybrid leadership models that are dominated by transformational leadership with digital leadership still emerging and having very limited capacity characterize Ethiopia's public health system. The institutionalization of adaptive and digital leadership is a must for the governance and leadership development frameworks to achieve a resilient, equitable, and digitally enabled primary healthcare in Ethiopia and other low- and middle-income countries.