Health has evolved into a highly complex, dynamic,and adaptive social system. What used to be a simple doctor-patient interplay, has become an orchestra of multiple actors. While doctors are trained to manage complex human biological systems, the people who govern health systems are not groomed to manage these. They include political leadership, health secretaries, program or mission directors, program and facility managers/ superintendents, and public health managers among others.

In the absence of an understanding of complex health systems, policy making is unguided, with intended and unintended consequences. Political leadership is mostly concerned with the political capital they can extract out of policy decisions. Bureaucratic leadership is drawn mostly from the Indian Administrative Services (IAS) and sometimes from the medical profession. Bureaucrats have managerial skills butmay not have a full understanding of the complex health systems they are asked to lead and manage. A majority of the managerial staff assume their role either on account of political patronage or on the principle of seniority.

Professionals formally trained in health management gravitate mostly towards the private sector. Even these management teaching programs lack unified educational standards, unlike medical sciences.

Leadership is one of the six building blocks of health systems as per the health systems strengthening model articulated by the World Health Organization. Weak leadership leads to weak health systems while a strong leadership leads to strong, well-functioning systems. Hence, strengthening leadership and management is critical to strengthening health systems so that they become effective, efficient, responsive, and resilient.

Dr Krishna Reddy Nallamalla

President, InOrder

Regional Director (South Asia), ACCESS Health International