In this study, main dimensions of health management and leadership capacity were identified in five categories: competencies required for managers; selection and appointment of managers; establishment of managers' database; deployment of functional support system; and environmental sensitivity.
The first dimension that all the experts mentioned in relation to management and leadership capacity building was the competencies required for managers. In their view, the first requirement for capacity building depends on the individual and personal capabilities of the manager. The findings also show that these competencies include a wide range of knowledge, skills, attitudes and behaviors. For example, specialized knowledge in the field of health, power of change, team leadership, evidence-based decision making, communication and information exchange were among the skills frequently mentioned by the interviewees. The identification of core managerial competencies is a fundamental step towards sustainable hospital service provision. These core competencies included evidence-informed decision-making; operations, administration and resource management; knowledge of healthcare environment and the organization; interpersonal, communication qualities and relationship management; leading people and organization; enabling and managing change and professionalism [10, 11].
Capacity building refers to the need for consistent improvement of individuals’ potential and organizational development to achieve organizational objectives effectively [12, 13]. This is also evident in the themes extracted from our study.
Human resources, external, infrastructure and financial have been introduced four dimensions of management capacity in the context of an organization [14–16]. Also, Eisinger (2002) has introduced resources, effective leadership, skilled and sufficient staff, institutionalization and external linkages as elements of capacity . All of these dimensions are consistent with our findings.
Research capacity building in health services has been recognized to be important for decision making in policy and practice. A framework is required for the establishment of planning change and measuring progress building research capacity. The proposed framework includes six principles of capacity building: 1) skills and confidence building, 2) close to practice, 3) linkages and collaborations, 4) appropriate dissemination, 5) continuity and sustainability, and 6) infrastructures . In this study, based on the opinion of interviewees, providing the necessary infrastructure to play the role of manager, manager's specialized knowledge and skills and general knowledge and skills of the manager are among the dimensions of capacity building.
Leadership is a critical component of a health system particularly in Sub-Saharan Africa where clinicians take on management responsibilities. However, there have been weaknesses in strengthening leadership capabilities. The leadership development programs (LDPs) described was diverse. No consistency was found in the conceptual approaches they adopted. Our findings showed need for further research on strengthening the conceptual and competency frameworks for leadership [18, 19]. One of the most important competencies required for managers was leadership skills and influencing members. This shows that acquiring leadership skills plays an important role in building the management and leadership capacity of the health system.
Capacity building has been applied as a strategy for achieving a healthy society at levels ranging between the individual and entire organization. Four capacity building approaches have been identified are: top-down organizational; bottom-up organizational; partnerships, and community organizing . In other words, the first two approaches point to the importance of organizational structure that is consistent with our findings.
The strengthening health system through improved leadership and management skills of health team can contribute to an increase in health-service delivery outcomes. Results of the study in six provinces in the Republic of Kenya showed significant increase in health-service coverage at the district level (p = < 0.05) in the intervention group compared to the comparison teams. Similarly, there were significant increase in the number of client visits at the facility level (p < 0.05). The leadership development program (LDP) intervention was used in this study . The findings of the present study have also identified the establishment of centers for the creation and development of managers' competencies in this regard.
The effectiveness of health system depends on management. Therefore, there should be facilitated and ensured availability of effective managers in system. In Iran, like other developing countries, clinicians without formal management training are in charge of health management of districts. Almost all of district health managers have not been trained in basic management. District health managers and experts of a health center announced the necessity of management and leadership competencies courses . Sub-theme of establishment of centers for creating and developing managers' competencies also refers to this fact.