BACKGROUND:
The dysfunction in African health systems is fundamentally a leadership and governance challenge. Evidence suggests that centralized decision-making-weak policy implementation-ineffective performance management-and poor stewardship account for nearly two-thirds of perceived health system problems across Africa. This session addresses this gap. The workshop is a focused-evidence-driven effort to co-create culturally grounded leadership indicators for health-system strengthening. It builds on a solid foundation-the proven methodology of the African National Health Research Systems Barometer-that prioritizes context-specific-outcome-oriented-and dynamic evaluation over existing bureaucratic checklists. By convening a diverse group of practitioners-policymakers-and scholars-the session will collaboratively draft the core architecture of an African Health Leadership Barometer-transforming-a well-defined problem into the blueprint for its solution.

METHODS:
This workshop will bring participants to co-create a preliminary set of indicators and methodological principles for the Barometer. It will draw on findings from a scoping review that systematically mapped the landscape of leadership evaluation frameworks used in (LMICs). Session Structure The workshop will begin with a presentation of synthesized scoping review findings-highlighting the dominance of short-term-non-contextual leadership programs and the absence of a core comparable metric for leadership and governance in multi-country health-system assessments. Followed by a presentation on critical leadership and governance challenges in South Africa and Sierra Leone during pandemic. These studies will frame the leadership “outcomes” the barometer must be able to predict and improve. Phase 2-Participants supported by the scoping review summary-will work in parallel stations: A-Defining core domains and indicators by translating high-level leadership variables into measurable-context-specific indicators. B-Designing evaluation methods by establishing methodological principles to ensure the tool is equitable-practical-and integrated into existing health information systems. Phase 3 focuses-on synthesis-developing the Prototype Framework and launching a community of practice.

CONCLUSIONS:
The outcome will equip attendees with a critical evaluative lens and a collaboratively drafted prototype framework that can be piloted across participating countries.