Observing Healthcare Leaders in Action After a Pathways to Leadership for Health Transformation Programme by World Health Organization Regional Office for Africa in Benin and Niger.

Purpose: This study aimed to assess the effect of the Pathways to Leadership for Health Transformation Programme (PLHTP) by World Health Organization Regional Office for Africa (WHO AFRO) on the leadership practices of its participants at their workplaces in Benin and Niger. Participants and Methods: The study was conducted among leaders of healthcare facilities in Benin and Niger who had participated in the WHO PLHTP. Missions were deployed to Benin and Niger to observe changes in the leadership behaviors and healthcare outcomes at the workplaces of the PLTHP participants. Qualitative data were collected through observations, interviews, and document analysis. The data from the various methods were triangulated thematically to assess the effectiveness of PLHTP. Results: PLHTP improved the leadership caliber and enhanced effective decision-making among the trained leaders in both Benin and Niger. The healthcare leaders in Niger applied the acquired leadership knowledge and skills better as evident in pragmatic resource management, innovation, and staff empowerment compared to Benin where excess resource wastage, suboptimal resource mobilization, poor external communication, and challenges in conflict management and team cohesion neutralized the program's positive effects. Niger has more participative cultures, accommodative health policies, and investments in healthcare compared to Benin, hence PLHTP had better outcomes in Niger than in Benin. Resistance to change by experienced colleagues of the trained healthcare leaders hindered the introduction of changes in the healthcare facilities in both Benin and Niger. Conclusion: PLHTP improved the leadership capabilities of the participants in both Benin and Niger. Application of the leadership skills had better effect in Niger than Benin since its culture, policies and health systems are more accommodative. Integrating context-specific scenarios in the modules of PLHTP and leveraging digital technologies to make it freely accessible by all healthcare workers can enhance its effectiveness.