Early online

Strengthening system leadership for the District Health System

Authors

  • L Gilson Health Policy and Systems Division, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK https://orcid.org/0000-0002-2775-7703
  • H Schneider School of Public Health, Faculty of Community and Health Sciences, and SAMRC Health Services to Systems Research Unit, University of the Western Cape, Cape Town, South Africa https://orcid.org/0000-0002-0418-1828
  • B Engelbrecht Health Policy and Systems Division, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa
  • M Shung-King Health Policy and Systems Division, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa https://orcid.org/0000-0001-7471-0353

DOI:

https://doi.org/10.7196/

Keywords:

Dsitrict Health System , system leadership, leadership and management, leadership development

Abstract

Those working within the South African (SA) District Health System (DHS) have various roles in addressing population health and wellbeing needs. These include motivating and co-ordinating local providers offering community, primary healthcare facility and district hospital services, including prevention and promotion services, and facilitating whole-of-government and whole-of-society collaboration with other government and social actors. These roles cannot be fulfilled by exercising traditional, command-and-control public sector managerial authority. Instead, distributed system leadership is required: a form of leadership practised by individuals and teams that enables the collective action needed to address complex health needs, and that is supported by wider organisational structures and processes. Based on a range of experience, this in-practice article presents the rationale for, and description of, system leadership within the DHS; appraises current approaches to leadership and management development in South Africa from this perspective; and outlines a system leadership development approach that offers promise for DHS and health system strengthening.

Author Biographies

  • L Gilson, Health Policy and Systems Division, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK

    Professor, Health Policy and Systems Division, School of Public Health, University of Cape Town and Department of Global Health and Development, London School of Hygiene and Tropical Medicine

     

     

  • H Schneider, School of Public Health, Faculty of Community and Health Sciences, and SAMRC Health Services to Systems Research Unit, University of the Western Cape, Cape Town, South Africa

    Professor, School of Public Health and SAMRC Health Services to Systems Research Unit

  • B Engelbrecht, Health Policy and Systems Division, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa

    Adjunct Professor, Heath Policy and Systems Division, School of Public Health

  • M Shung-King, Health Policy and Systems Division, School of Public Health, Faculty of Health Sciences, University of Cape Town, South Africa

    Associate Professor, Health Policy and Systems Division, School of Public Health

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Published

2026-04-01

Issue

SAMJ Vol. 116 no. 3

Section

DHS series

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Copyright (c) 2026 L Gilson, H Schneider, B Engelbrecht, M Shung-King

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How to Cite

1.
Gilson L, Schneider H, Engelbrecht B, Shung-King M. Early online: Strengthening system leadership for the District Health System. S Afr Med J [Internet]. 2026 Apr. 1 [cited 2026 Apr. 18];116(3):e3562. Available from: https://www.samajournals.co.za/index.php/samj/article/view/3562

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