Articles / WHO Leadership and Management Framework: Healthcare Guide
Development, Training & CoachingExplore the WHO leadership and management framework. Learn how health organisations can apply WHO guidance to strengthen leadership and management capacity.
Written by Laura Bouttell • Sun 19th October 2025
The WHO leadership and management framework provides structured guidance for strengthening leadership and management capabilities in health systems worldwide. The World Health Organization recognises that effective health service delivery depends fundamentally on capable leaders and managers—yet many health systems face critical shortages in leadership capacity. Research indicates that health facilities with strong leadership achieve 40% better patient outcomes compared to those with leadership deficiencies. Understanding and implementing the WHO framework enables health organisations to systematically develop the leadership essential for improving population health.
This comprehensive guide explores the WHO leadership and management framework, its components, and practical implementation strategies.
The WHO leadership and management framework is a conceptual model developed by the World Health Organization to guide the development of leadership and management competencies in health systems. It identifies the capabilities health leaders need and provides structure for systematic capacity building.
The framework addresses a critical challenge: whilst health systems invest heavily in clinical training, leadership and management development often receives insufficient attention. This imbalance creates capable clinicians who struggle in leadership roles, weakening overall health system performance.
Key framework characteristics include:
Systems orientation: Recognises that leadership operates within complex health systems. Individual leadership development must connect to system strengthening.
Competency-based approach: Identifies specific competencies leaders need. Clear competencies guide training design and performance assessment.
Context sensitivity: Acknowledges that leadership requirements vary across contexts. Framework application adapts to local conditions.
Integration focus: Emphasises connecting leadership development with broader health workforce strategies.
Results orientation: Links leadership to improved health outcomes. Leadership matters because it affects population health.
| Framework Element | Purpose | Application |
|---|---|---|
| Systems orientation | Connect individual to system | Strategic alignment |
| Competency-based | Define needed capabilities | Training design |
| Context sensitivity | Adapt to local needs | Flexible implementation |
| Integration focus | Link to workforce strategy | Policy coherence |
| Results orientation | Improve health outcomes | Impact measurement |
The World Health Organization developed leadership and management guidance because:
Health system performance depends on leadership: Quality healthcare delivery requires effective management at all levels. Leadership gaps undermine even well-resourced systems.
Global leadership shortages exist: Health systems worldwide face insufficient leadership capacity. The shortage threatens health security and development goals.
Systematic approaches were lacking: Many countries lacked structured approaches to health leadership development. Ad hoc training produced inconsistent results.
Universal health coverage requires capable management: Achieving UHC demands effective resource management and service organisation. Leadership capabilities enable coverage expansion.
Health security needs coordination capacity: Pandemic response and health emergencies require coordinated leadership. Recent global health crises highlighted leadership importance.
The WHO framework identifies competencies across several domains:
Leadership competencies:
Vision and strategy: Creating direction for health services. Articulating compelling futures and pathways to achieve them.
Governance: Ensuring accountability, transparency, and ethical practice. Building institutional credibility.
Change leadership: Driving transformation and adaptation. Leading reform initiatives effectively.
Stakeholder engagement: Building coalitions and partnerships. Engaging communities, governments, and development partners.
Communication: Inspiring and informing. Advocating for health priorities and mobilising support.
Management competencies:
Planning: Setting objectives and developing strategies. Creating operational plans that translate strategy into action.
Resource management: Allocating financial, human, and material resources effectively. Ensuring efficient resource utilisation.
Human resource management: Recruiting, developing, and retaining health workforce. Building team capability.
Information management: Using data for decision-making. Building health information systems.
Quality management: Ensuring service quality and safety. Implementing continuous improvement.
Supply chain management: Securing medicines and supplies. Managing procurement and distribution.
The framework structures competencies hierarchically:
Basic level: Fundamental capabilities needed by all health workers with supervisory responsibility. Foundation for further development.
Intermediate level: Enhanced capabilities for facility managers and programme coordinators. Expanded scope and complexity.
Advanced level: Strategic capabilities for senior leaders—district health officers, hospital directors, ministry officials.
| Level | Typical Roles | Competency Focus |
|---|---|---|
| Basic | Supervisors, team leaders | Operational management |
| Intermediate | Facility managers | Programme coordination |
| Advanced | District/regional leaders | Strategic leadership |
WHO recommends multi-faceted development approaches:
Formal training: Structured learning programmes addressing specific competencies. Combines classroom and practical elements.
Workplace learning: Development through real work challenges. Mentoring, coaching, and stretch assignments.
Networking: Peer learning and professional exchange. Learning from others facing similar challenges.
Self-directed learning: Individual study and reflection. Building personal development habits.
Action learning: Learning through problem-solving on real organisational challenges. Combines learning and performance improvement.
Effective training under the framework:
Competency-aligned: Training directly addresses identified competency gaps. Clear connection between learning and capability development.
Context-relevant: Content reflects local health system realities. Practical application to participants' situations.
Practice-oriented: Emphasises application over theory. Includes simulation, case studies, and workplace projects.
Blended delivery: Combines multiple methods—face-to-face, online, workplace-based. Flexibility enables access.
Sustained engagement: Learning extends over time rather than single events. Follow-up and reinforcement support transfer.
Performance-connected: Links to job performance and career development. Motivation through relevance.
Implementation steps:
Assess needs: Evaluate current leadership capacity against framework competencies. Identify priority gaps.
Design interventions: Develop training aligned with identified needs. Consider delivery methods and resources.
Deliver training: Implement programmes with quality facilitation. Ensure participant engagement.
Support application: Facilitate transfer to workplace. Coaching and mentoring support application.
Evaluate impact: Assess whether training improves leadership and health outcomes. Use findings for programme improvement.
Implementation requires systematic approach:
Assessment phase:
Planning phase:
Implementation phase:
Evaluation phase:
WHO and partners provide various resources:
Training materials: Curricula, facilitator guides, and participant materials for various competencies.
Assessment tools: Instruments for evaluating leadership capacity and development needs.
Technical guidance: Documents explaining framework components and implementation approaches.
Case studies: Examples of successful implementation in different contexts.
Expert networks: Access to technical support and peer learning opportunities.
Online resources: Digital learning materials and communities of practice.
Hospital application involves:
Senior leadership: Hospital directors and executives need advanced competencies in strategic leadership, governance, and stakeholder engagement.
Department heads: Clinical department leaders need intermediate competencies balancing clinical expertise with management capability.
Ward managers: Front-line leaders need basic competencies in team supervision, resource management, and quality assurance.
Development approach: Hospitals can use the framework to create structured leadership pathways, identify succession candidates, and design targeted development programmes.
District health management requires:
Strategic leadership: District health officers lead population health improvement across facilities and programmes.
Coordination: Managing multiple facilities, programmes, and stakeholders demands advanced coordination capabilities.
Resource allocation: Distributing limited resources across competing priorities requires sophisticated management.
Community engagement: Building relationships with local government, communities, and partners.
Health information use: Using data to guide decisions and monitor performance.
National application involves:
Policy leadership: Shaping health policy and strategy at ministerial levels.
System governance: Ensuring accountability and effectiveness across the health system.
Development partner coordination: Managing relationships with international partners and donors.
Health sector reform: Leading system transformation initiatives.
International engagement: Representing national interests in global health forums.
| Level | Primary Focus | Key Competencies |
|---|---|---|
| Facility | Service delivery | Operations, quality, team management |
| District | Population health | Coordination, resource allocation |
| National | Policy and governance | Strategy, reform, external relations |
Common implementation challenges include:
Resource constraints: Limited funding for leadership development. Competing priorities for scarce resources.
Training capacity: Insufficient trainers and facilitators with appropriate expertise. Quality assurance challenges.
Release for training: Difficulty releasing staff from service delivery for development activities. Opportunity costs.
Sustainability: Maintaining momentum beyond initial implementation. Institutionalising approaches.
Context adaptation: Tailoring framework to specific country contexts. Balancing standardisation with flexibility.
Career structures: Leadership development may not connect to career advancement. Motivation challenges.
Brain drain: Developed leaders may leave for better opportunities. Retention challenges.
Addressing challenges requires:
Integrated approaches: Embed leadership development within broader workforce strategies. Connect to career pathways.
Efficient methods: Use technology and workplace-based learning to reduce costs and time away from service.
Local capacity building: Develop in-country training capacity for sustainability.
Incentive alignment: Link leadership development to career progression and recognition.
Retention strategies: Combine development with retention approaches addressing working conditions and compensation.
Phased implementation: Start with highest priorities and expand progressively. Build momentum through early successes.
Evaluation should address multiple levels:
Reaction: Did participants find training valuable? Satisfaction and relevance assessment.
Learning: Did participants gain intended knowledge and skills? Competency assessment.
Behaviour: Are participants applying learning in their work? Observed practice changes.
Results: Is leadership development improving health service delivery? Outcome measurement.
System impact: Is organisational capacity strengthening? Institutional change assessment.
Useful indicators include:
Input indicators:
Output indicators:
Outcome indicators:
Impact indicators:
The WHO leadership and management framework is guidance developed by the World Health Organization to strengthen leadership and management capabilities in health systems. It identifies competencies health leaders need, structures them by level, and provides approaches for systematic capability development. The framework addresses the leadership gaps that undermine health service delivery globally.
Leadership is important in healthcare because effective health service delivery depends on capable management at all levels. Quality patient care requires leaders who can organise resources, develop staff, ensure quality, and navigate complex systems. Research demonstrates that facilities with strong leadership achieve significantly better health outcomes than those with leadership deficiencies.
Health leaders need competencies in both leadership (vision, governance, change leadership, stakeholder engagement, communication) and management (planning, resource management, human resources, information management, quality, supply chain). The specific mix depends on role level—front-line supervisors need different competencies than senior executives.
Health organisations can develop leaders through: formal training programmes addressing specific competencies, workplace learning through mentoring and stretch assignments, peer networking and professional exchange, action learning on real organisational challenges, and self-directed study. Effective development combines multiple approaches and sustains engagement over time.
WHO supports leadership development through: guidance documents and frameworks, training materials and curricula, assessment tools, technical assistance to countries, research and evidence generation, and advocacy for investment in health leadership. WHO works with member states and partners to strengthen health system leadership globally.
Common challenges include: resource constraints limiting investment, insufficient training capacity, difficulty releasing staff from service delivery, sustainability of initial efforts, adapting frameworks to local contexts, disconnection from career structures, and retention of developed leaders. Addressing challenges requires integrated, efficient, and sustainable approaches.
Measure leadership development impact at multiple levels: reaction (participant satisfaction), learning (competency gains), behaviour (practice changes), results (service delivery improvements), and system impact (institutional strengthening). Use combination of input, output, outcome, and impact indicators. Connect leadership evaluation to health outcome measurement.
The WHO leadership and management framework provides essential guidance for strengthening health system capacity. Effective health service delivery depends on capable leaders at all levels—from front-line supervisors to ministry officials. Systematic investment in leadership development produces returns through improved service quality, workforce effectiveness, and ultimately, population health outcomes.
Implementing the framework requires sustained commitment, adequate resources, and contextual adaptation. Challenges exist but can be addressed through integrated, efficient approaches that connect leadership development to career pathways and institutional strengthening.
Health systems that invest in leadership development invest in their capacity to serve populations effectively. The WHO framework provides the roadmap—implementation depends on national and organisational commitment to building the leadership that health improvement requires.
Assess needs systematically. Develop leaders purposefully. Measure impact rigorously. Build the leadership capacity that enables health systems to achieve their missions.