Investigating and Assessing the Management and Leadership Quality Styles of Sub-District Leaders in Relation to Staff Performance in the Sub-Districts: The Pursuit of Health System Strengthening, Fanteakwa District-Ghana

Background: Sub-district leaders/managers are health care professionals appointed to lead or
manage the sub-districts. A series of survey and monitoring reports have unearthed weak leadership
and management at the sub-districts which has the potential of weakening the sub-district health
systems and which contributes to the overall effect on resilient health systems. The Sub-district health
system is the first primary health care delivery point aimed to bring health care to the door steps of
clients through the community-based health planning and services (CHPS) concept in Ghana. The
objectives of the study were to: Determine the leadership styles exhibited by sub-district leaders,
analyze the association between the leadership/management styles of Sub-district leaders and
performance of their subordinates, and analyze the relationship between Leadership Styles and
performance of Sub-district leaders.
Methods: A cross-sectional survey design was employed. The average performance of the leaders
was calculated based on the Ghana Health Service performance appraisals criteria. Principal
Component and Exploratory Factor Analyses were used to determine the leadership styles exhibited
whilst correlation and regression analyses were used to determine the association
between: leadership styles and subordinates performance, and leadership styles and leaders
performance.
Results: The results showed that transformational and supportive are the leadership styles exhibited
by the leaders and both are positively related to the performance of their subordinates. However,
transformational leadership style tends to add more to the subordinates performance than the
supportive style leaders. Both leadership styles are each significantly associated to the performance
of the leaders. Additionally, a higher overall leader’s performance is associated with a higher
subordinate’s performance. Also a higher leadership ability rating is associated with higher leaders’
performance.
Conclusion: Sub-district leaders or managers’ leadership styles have a tremendous influence on the
performance of their subordinates and the leaders themselves. There was a high positive linear
association between management ability and performance of leaders. The correlation between
leaders’ performance and subordinates performance, leadership ability and leaders’ performance
were positively related. The transformational and supportive leadership styles are positively related to
the performance of the subordinates. A qualitative research is needed to obtain in-depth information
about the leadership quality styles of sub-district leaders.