The Effect of Leadership Training on Health Worker Attitudes towards Clients Attending Primary Health Centres in Benue State, Nigeria

Abstract

ABSTRACTNegative attitudes and interpersonal misconduct among healthcare providers constitute a critical, modifiable structural barrier to primary healthcare utilisation across sub-Saharan Africa. The Leadership Development Program (LDP), developed by Management Sciences for Health (MSH), empowers frontline health teams to apply core leading and managing practices to address performance challenges and strengthen workplace climate. This study evaluated the interventional effect of a 5-day LDP workshop on health worker attitudes towards clients attending rural Primary Health Centres (PHCs) in Benue State, Nigeria. A quasi-experimental study utilising mixed quantitative and qualitative evaluation methods was conducted over 12 months across 16 rural PHCs in Benue State, North-Central Nigeria. Semi- structured questionnaires were interviewer-administered to Women of reproductive age (WRAG) at baseline and at 6 months post-intervention, with qualitative triangulation. Quantitative data were analysed with IBM SPSS version 20 at a 95% confidence level (p<0.05). Frontline health workers demonstrated a statistically significant mean knowledge gain of 40.6% points following the LDP workshop (p<0.001). Among WRAG receiving care, the proportion of women reporting poor health worker attitudes in the intervention group fell from 18.8% to 0.0% (p<0.001). Qualitative accounts from Officers-in-Charge and mothers corroborated improved staff commitment, punctuality, and client-centred communication. The Leadership Development Program is an effective, low-cost, evidence-based health systems strengthening intervention that significantly improves healthcare provider attitudes and addresses attitudinal barriers to primary maternal healthcare utilisation. Institutionalising LDP within continuing professional development could accelerate progress towards respectful, person-centred maternal healthcare in similarly resourced rural settings.