# Health care management in Africa: a debate for future research and agenda

## TL;DR

This paper reviews healthcare management in Africa, focusing on how managerial skills affect digital health initiatives and proposes a future research agenda.

## Contribution

It offers a new research agenda for improving digital health adoption through managerial competence in African health systems.

## Key findings

- Managerial digital skills are unevenly distributed, affecting digital health outcomes.
- Resistance to change and system fragmentation hinder digital health integration.
- Digital exclusion is a potential unintended consequence of poor management.

## Abstract

This article provides a critical narrative synthesis of literature on healthcare management in Africa, focusing on two interconnected areas: the impact of managerial capability on shaping integrated healthcare ecosystems and the adoption, implementation, and governance of digital health innovations within diverse health system contexts. Based on health systems strengthening frameworks and socio-technical views on digital transformation, the article explores how managerial skills influence the development and outcomes of digital health initiatives across African settings. Rather than presenting new empirical data, it uses comparative analysis of existing studies to highlight opportunities and ongoing challenges, such as uneven managerial digital skills, resistance to change, system fragmentation, and unintended effects like digital exclusion. The article concludes with a clear and practical agenda for future research and policy, emphasising the vital role of digitally competent managers in fostering supportive organisational cultures, promoting system integration, and ensuring meaningful adoption of digital health innovations by frontline health workers and patient populations.