Over the last decade, small island states of the English-speaking Caribbean have been embarking on health sector reform initiatives in order to strengthen the quality of the delivery of health services. The wave of health sector reform measures has not placed emphasis on the management/leadership of health care delivery systems which tend to be generally weak. This in turn affects the improved delivery of quality services and superior quality health care. Management and leadership are understood as the capacity to guide the health sector’s institutions and to mobilize stakeholders, organizations and social groups. The general idea is that there are a number of challenges that affect health management of the small island developing states (SIDS) and the efficient organization of these dynamic, complex health systems. These challenges are tied to the unique cultural, organizational and political characteristics of island states. In all of this, the competencies and unique roles required of senior managers/leaders in a SIDS setting are called to question.
Objective
This article provides an overview of the management/leadership of health systems in SIDS of the English- speaking Caribbean region. It highlights the weaknesses and challenges of management and organization of these systems which in turn impact the desired outcome of promotion of quality delivery of health care. It also examines roles of senior health managers/leaders in the economic, social, political and cultural context of SIDS. The article strongly advocates the need for in-depth study of the challenges that bedevil efficient and effective management of health systems in the region as well as the processes that constrain or facilitate the activities of senior health managers. It also highlights the need for an investigation into competencies that health managers/leaders demonstrate and perceive that they need in effectively managing these health care delivery systems.
Method
I wrote this article based on literature review, experience as minister for health of the Ministry of Health of Saint Lucia—one of the island states of the English-speaking Caribbean—and in-depth, semistructured interviews with senior health managers/leaders across the region.
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