Modeling a reliable and valid framework for building and measuring the health system workforce’s competence to lead, manage and govern in Ethiopia: Factor analysis approach

Aim: This study aimed at modeling a reliable and valid framework for building and measuring the health system workforce’s competence to lead, manage and govern. Methods: A cross-sectional survey was conducted in three zones of Amhara regional state, Ethiopia. Eight-hundred-thirteen participants were recruited from 32 health facilities. The data were collected using a structured self-rated questionnaire. Data analysis techniques such as factor analysis, composite reliability and average variance extraction were applied. Factor analysis was unlocked to assemble the relationship among latent factors extracted, items rated and error variances observed. Latent factors were extracted using Eigenvalue greater than 1 as a cut of point. Latent factors were labeled considering the contents of the items clustered within them. Latent factors labeled, items rated and error variances observed were assembled to develop competence building and measuring framework. Its reliability and validity were tested using composite reliability and average variance extraction respectively. Results: A four-factor framework for building and measuring the health system workforce’s competence to lead, manage and govern was resulted. The factors extracted were labeled as compliance with principles, strategic sensitivity, system building, and contextual thoughtfulness. These explained 68.434% of the total variability. Composite reliability and average variance extraction for all factors were .807 and greater, and .512 and greater, respectively. Conclusions: Compliance with principles, strategic sensitivity, system building, and contextual thoughtfulness are dimensions that affect competence to lead, manage and govern, which, in turn, influence the health system performance and health outcomes. This model has implications for training, evaluation, and research.