Evaluating the economic and operational impact of a leadership development programme for primary health care managers in South Africa: A cost and outcome analysis of the MDP
1
Health Economics and Epidemiology Research Office (HE²RO), Parktown, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A1791
ABSTRACT
BACKGROUND:
Effective leadership at primary healthcare (PHC) level is critical for achieving Universal Health Coverage (UHC) and improving service quality in South Africa. The Aurum Institute’s Management Development Programme (MDP) aims to strengthen PHC managers’ leadership, planning, and decision-making through blended training, mentorship, and applied learning. We evaluated the cost of the MDP and associated early outcomes on leadership competencies and patient experience.
METHODS:
We conducted a retrospective cost–outcome analysis. Costs were estimated from the provider perspective using expenditure records for 2023/2024 period, valued in 2025 South African Rand (ZAR). The primary cost outcome was cost per learner enrolled. Leadership and patient experience outcomes were assessed using a matched comparison across 20 PHC facilities in the Western Cape Province (10 MDP-supported; 10 non-MDP-supported). Leadership was measured using the Leadership Practices Inventory (LPI), and patient experience using a factor-analytic Patient Experience Index (PEI). We estimated incremental cost per unit improvement in PEI domains and examined staff-rated leadership outcomes using the LPI.
RESULTS:
The average cost per learner enrolled was ZAR 73,711, with labour accounting for 73.8% of total costs. Of 109 managers enrolled, 106 (97%) completed training and were competent, corresponding to an average cost of ZAR 75,800 per learner. Staff-rated leadership outcomes showed higher performance among MDP-trained managers than comparison, particularly in leadership domains of Models the Way and Inspires a Shared Vision. Patient experience improved in domains linked to staff behaviour and managerial responsiveness. Communication and respect improved by a standardised mean difference (SD) of +0.12 SD (p = 0.046), at an estimated cost of ZAR 60,800 per 0.1 SD improvement, while attentiveness and responsiveness showed larger gains (+0.25 SD; p < 0.001) at ZAR 29,200 per 0.1 SD improvement.
CONCLUSIONS:
The MDP is a labour-intensive investment with measurable early improvements in leadership behaviour and patient experience.
Effective leadership at primary healthcare (PHC) level is critical for achieving Universal Health Coverage (UHC) and improving service quality in South Africa. The Aurum Institute’s Management Development Programme (MDP) aims to strengthen PHC managers’ leadership, planning, and decision-making through blended training, mentorship, and applied learning. We evaluated the cost of the MDP and associated early outcomes on leadership competencies and patient experience.
METHODS:
We conducted a retrospective cost–outcome analysis. Costs were estimated from the provider perspective using expenditure records for 2023/2024 period, valued in 2025 South African Rand (ZAR). The primary cost outcome was cost per learner enrolled. Leadership and patient experience outcomes were assessed using a matched comparison across 20 PHC facilities in the Western Cape Province (10 MDP-supported; 10 non-MDP-supported). Leadership was measured using the Leadership Practices Inventory (LPI), and patient experience using a factor-analytic Patient Experience Index (PEI). We estimated incremental cost per unit improvement in PEI domains and examined staff-rated leadership outcomes using the LPI.
RESULTS:
The average cost per learner enrolled was ZAR 73,711, with labour accounting for 73.8% of total costs. Of 109 managers enrolled, 106 (97%) completed training and were competent, corresponding to an average cost of ZAR 75,800 per learner. Staff-rated leadership outcomes showed higher performance among MDP-trained managers than comparison, particularly in leadership domains of Models the Way and Inspires a Shared Vision. Patient experience improved in domains linked to staff behaviour and managerial responsiveness. Communication and respect improved by a standardised mean difference (SD) of +0.12 SD (p = 0.046), at an estimated cost of ZAR 60,800 per 0.1 SD improvement, while attentiveness and responsiveness showed larger gains (+0.25 SD; p < 0.001) at ZAR 29,200 per 0.1 SD improvement.
CONCLUSIONS:
The MDP is a labour-intensive investment with measurable early improvements in leadership behaviour and patient experience.
| eISSN: | 2654-1459 |
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