The healthcare strike action that rocked South Africa in 2007 and 2010 highlighted the trend of professional nurses towards exercising their rights as employees to embark on strike actions, often also in solidarity with other categories of employees. This study aimed to highlight the problem brought about by the lack of proactive strategies to maintain a balance between human and professional rights and responsibilities of nurses within the legal framework of South Africa. The theoretical grounding of the study included both organisational change models and transformational leadership models. A descriptive and analytic design was followed, using both qualitative and quantitative non-probability sampling approaches to meet the research objectives of determining factors for nurses‘ involvement in strikes and their impact. Eighty professional nurses were included as the total sample of the study with 53 that did not participate in strike action and 27 that participated in strike action. A sample of eleven nurse managers was also included in the study to determine their views on strikes by nurses and their understanding of the changing work environment. To determine the overall impact of the nurses‘ strike, 40 healthcare consumers were included. The sample was selected from four provinces: Eastern Cape, KwaZulu-Natal; Western Cape and Gauteng. The study was limited to professional nurses, nurse managers within the public-health sector and healthcare consumers using public-health facilities. The findings and the relevant literature referred to in this study indicate that though there are different reasons for strike action in the public-health sector by area or by country, remuneration is undoubtedly the most mentioned reason. Important to note is that salary per se is not the most critical actor but it is a tangible measure of the value that the employer places on people. In the absence of other incentives in the nursing environment, it becomes the focal point. However, addressing salary issues alone will not prevent strike action in the public-health sector / Health Studies / D. Litt. et Phil. (Health Studies)

Como alternativa para superar mais uma crise do capitalismo, no final do século XX configurou-se uma nova organização geopolítica e econômica mundial de cunho neoliberal. Ela atribui ao Estado de Bem-Estar Social a responsabilidade pela crise e pela ineficiência em responder às demandas sociais do mundo em transformação. Em resposta às críticas, nasce o movimento de reforma do Estado, que vem assumindo posições nas duas últimas décadas. Nos anos 80 predominou a concepção do Estado mínimo, que encarregou o mercado da responsabilidade pelo crescimento econômico e pelo atendimento às necessidades da sociedade. Na década seguinte questionou-se esse modelo. O ideário do Estado forte regulador e coordenador de políticas sociais respondeu aquele questionamento, deixando para o mercado e o terceiro setor a produção de bens e serviços. Influenciado pela nova administração pública, esse Estado é concebido como gerenciador do desenvolvimento social, incorporando mecanismos do setor privado para aperfeiçoar resultados, como retenção de gastos e controle de custos. Essa é a orientação do plano diretor de reforma do aparelho estatal implantado pelo Governo brasileiro a partir de 1995. Uma de suas principais estratégicas foi a criação das organizações sociais – estatuto legal que permite às instituições sem fins lucrativos desenvolverem funções sociais delegadas pelo Estado. A partir de 1998, a Secretaria de Estado da Saúde de São Paulo tem repassado a gestão de hospitais para organizações sociais de saúde, mediante contratos de gestão,que discriminam objetivos e metas a serem alcançados na produção de serviços médico-hospitalares. Duas dessas experiências são analisadas aqui – os Hospitais Gerais de Itapecerica da Serra e do Itaim Paulista – com vistas a avaliar a capacidade do Estado de promover tal delegação, à luz do controle público e da garantia da eqüidade no acesso aos serviços de saúde. Empregou-se metodologia qualitativa, mediante estudo de caso. Foram realizadas trinta entrevistas com membros das equipes técnicas, das administrações e das mantenedoras dessas organizações, usuários dos serviços, representantes do Legislativo e do Executivo estadual. Procedeu-se à leitura de documentos e relatórios técnicos. Os resultados indicaram não haver incorporação do âmbito local na gestão dos serviços prestados; o principal coordenador e controlador das metas estabelecidas é a administração central da secretaria estadual. Para que se efetive a eqüidade no acesso, é fundamental a presença do Poder público local como articulador do sistema de saúde. O controle público expressa-se por ações fiscalizadoras mediante procedimentos contábil-financeiros do Tribunal de Contas do Estado ou das instâncias locais do controle social do Sistema Único de Saúde ou dos conselhos populares de saúde. A população não participa da formulação das ações de saúde. Nessa modalidade de gestão, o Poder público estadual assume presença marcante mediante financiamento global e controle administrativo dessas organizações, o que caracteriza uma desconcentração de função para instituições públicas não-estatais, responsáveis por uma lógica privada de gerenciamento por intermédio da contratação de recursos humanos e de administração financeira, aspectos limitantes da ação estatal. / At the end of the 20th century we had seen the come out of a new geopolitical and economical world configuration of neoliberal traces, as an alternative to overcome the capitalism crisis. The Welfare State is criticized by such conception, being assigned to it the responsibility for the crisis and the inefficiency to answer the social demands of a world that is constantly changing. In response to these critiques comes out the State reform movement that has assumed several propositions in the past two decades. The conception of minimum State that prevailed in the 80’s, leaving to the market the responsibility for the economical growing and caring of the society needs. In the next decade this model was questioned. Then comes the ideology of the strong State that must regulate and coordinate the social politics, leaving to the market and the non-governmental organizations the productions of goods and services. Influenced by the new public management, this State is conceived as a manager of social development, using mechanisms of the private sector to optimize results, as the retention of expenses and cost control. We observe this orientation in the director plan of reform of the governmental machine, presented by the Brazilian Govern since 1995. One of the main strategies was the creation of the Social Organizations ¾ legal statute that allows the non profit institutions to develop social functions delegated by the State. Since 1998, the Secretaria de Estado da Saúde de São Paulo has repassed hospitals to Social Organizations of Health, through performance agreements, establishing goals to be reached in the production of hospitalar services. Two of these experiences were analysed ¾ the General Hospitals from Itapecerica da Serra and from Itaim Paulista ¾ with the intention to evaluate the ability of the State in promoting such delegation, under the public control and the guarantee of equity in the access to he health services. We used qualitative methodology, through the technique of study of case. There were thirty interviews done, involving members from the technical staff, from the administration and from the owners of these organizations, users of the services, and representatives of the Legislative and Executive of the State. We did read the documents and technical reports. The results indicated that there is no incorporation at the local level in the management of the services done, and that the central level of the Secretaria Estadual is the main coordinator and controller of the goals established. As to the equity in the access, is fundamental the presence of the local Public Power to its effectiveness, in the articulation of the health system, as we have seen in the Itapecerica da Serra experience. The public control is made by inspection actions, through financial procedures of the Tribunal de Contas do Estado, or the local instances of social control of the Sistema Único de Saúde or of the popular counsils of health. There is no participation of the population in the formulation of health actions. In this kind of management the Public Power of the state of the São Paulo has a fundamental role, through the global financing and administrative control of these Organizations, characterizing a desconcentration of function for non governmental public institutions, that is responsible for a private logic of managing, through the contract of human resources and financial administration, limiting aspects of the action of the State.

Le secteur de la santé connaît depuis plusieurs décennies une transformation continue qui contribue à la perte de repères des soignants et qui affecte leur relation d’emploi. La thèse examine cette dernière au travers du concept de contrat psychologique. S’inscrivant dans les voies de recherche suggérées par la littérature qui soulignent la focalisation des travaux sur les conséquences de la rupture et de la violation de contrat psychologique au détriment de sa formation et de sa dynamique, ce travail doctoral propose d’apporter une contribution sur ces aspects moins étudiés par le biais d’une approche qualitative longitudinale. Ainsi, nous avons réalisé une étude de cas, sur une période d’une année, auprès d’une cohorte de 40 infirmiers venant d’être diplômés et ayant été recrutés dans 18 établissements sanitaires répartis sur le territoire français. La réciprocité du contrat est également étudiée du point de vue des représentants de la direction. Les données issues des 219 entretiens réalisés ont été complétées par des observations et une analyse documentaire. Sur le plan théorique, la démarche adoptée permet de comprendre la dynamique du contrat psychologique et d’en proposer une modélisation, de sa formation anticipée, lors des études infirmières, jusqu’à sa stabilisation après une année d’activité professionnelle dans un service de soins. Sur le plan managérial, ce travail élabore des pistes de réflexion pour la construction d’une relation d’emploi durable et satisfaisante entre structure hospitalière et membres soignants. / The health sector has experienced many changes over the last decades which entails a loss of caregivers’ bearings affecting their employment relationship. This thesis is placed along the avenues of research suggested by the literature which highlight the focus put on the consequences of the breach and violation of the psychological contract, neglecting its construction and dynamics. This doctoral work is intended to be a contribution to these less studied aspects through a longitudinal qualitative approach. A year-long case study was carried out with a cohort of 40 newly-graduated nurses who were recruited in 18 French health facilities nationally. The reciprocity of the contract is also considered from the perspective of the management representatives. The data resulting from 219 interviews conducted were complemented with observations and documentary analysis. On the theoretical level, the approach adopted enables the dynamics of the psychological contract to be understood and a model to be proposed; from the anticipated creation, during nursing studies, up to a stabilized phase after a year of professional activity in a care service. On the managerial level, this work suggests possible reasoning for the construction of a sustainable and satisfying employment relationship between the hospital structure and caregivers.

This study explores the practical and ideological implications of the New Public Management (NPM) paradigm as introduced in Greece by the so-called “Troika”, a sobriquet referring to a triumvirate comprising representatives of the IMF, the European Union, and the European Central Bank. In the past, attempts had been made by Greek officials to implement managerial practices within the Greek National Health Service (NHS) and the hospital sector in particular, albeit at a more leisurely pace than that of other countries’. On arrival to Greece the Troika imposed a number of changes to improve the country’s public services; and set a brisk pace to accelerate their implementation. The present doctoral thesis seeks to critically evaluate the issue of whether those reforms, especially those salient to the Greek NHS system, are true manifestations of a shift in the NPM paradigm or whether they represent yet another archetypal Greek public sector restructuring. It will also evaluate responses to and outcomes of the successive reforms in the Greece’s NHS system, ascertain the factors contributing to and/or impeding the adoption of those reforms, and identify new opportunities for growth. In order to gain access to a more profound insight into the Greek context, the collection of secondary data provides, among other things, an historical background of Greece’s public healthcare system; reviews the system’s characteristics in terms of healthcare policies, and probes into the state of working conditions within public hospitals. The heightened managerial spirit prevalent in Greece at the moment and brought about by the Troika’s tenure, has made it necessary for the literature review of the present work to focus on the ways that managerial practices and ideologies are imposed on other countries so that their public sector dysfunctionalities may be rectified. Drawing on the literature reviewed, the study develops an integrated analytical framework anchored in NPM, so as to test it in the Greek case and contribute to understanding the Greek NHS organisational realities as well as to evaluating how the new changes have been evolving and faring within Greece’s healthcare organisations. The framework is comprised of a review of the NPM paradigm so as to contextualise the Greek reforms in terms of ideology and practices; a review of Principal-Agent Theory (PAT) for illuminating the interrelationships and involvement of the key actors with the reforms; and a review of Critical Realism (CR) for assisting to reveal the underlying mechanisms and structures that bind the actors with the organisations and their development. Apart from providing the conceptual basis of the thesis, the framework also serves in informing its methodological design (i.e., generating the interview schedule), analysing the findings, and steering the discussion. The study adopts an in-depth, qualitative research approach that views social life within organisations in terms of processes, events, actions, and activities between key actors as factors unfolding over time. To that purpose, semi-structured interviews were conducted with the key stakeholders of the Greek NHS system: State hospital doctors, hospital managers, and policymakers. The contribution of the study is an in-depth analysis of reform implementation as carried out in Greece’s medical system which now stands, within a turbulent economic and political context. By means of that analytical framework, it is shown that Greece is a sui generis case whose context and historical background are altogether different than those of other countries’. Moreover, the framework demonstrates that, despite the fact that NPM is firmly ensconced, as far as practice and ideology go, it is too soon to be drawing any conclusions: NPM is still in its infancy and reforms to the Greek NHS system have yet to be finalised as they continuously stumble on the inefficiencies and blunders of the past which hinder them from functioning properly. Last, the thesis does possess one more unique feature: it delves into the thinking, manoeuvres, and behaviour of the Greek healthcare professionals as a group, a world rarely if ever explored by empirical studies.

Como alternativa para superar mais uma crise do capitalismo, no final do século XX configurou-se uma nova organização geopolítica e econômica mundial de cunho neoliberal. Ela atribui ao Estado de Bem-Estar Social a responsabilidade pela crise e pela ineficiência em responder às demandas sociais do mundo em transformação. Em resposta às críticas, nasce o movimento de reforma do Estado, que vem assumindo posições nas duas últimas décadas. Nos anos 80 predominou a concepção do Estado mínimo, que encarregou o mercado da responsabilidade pelo crescimento econômico e pelo atendimento às necessidades da sociedade. Na década seguinte questionou-se esse modelo. O ideário do Estado forte regulador e coordenador de políticas sociais respondeu aquele questionamento, deixando para o mercado e o terceiro setor a produção de bens e serviços. Influenciado pela nova administração pública, esse Estado é concebido como gerenciador do desenvolvimento social, incorporando mecanismos do setor privado para aperfeiçoar resultados, como retenção de gastos e controle de custos. Essa é a orientação do plano diretor de reforma do aparelho estatal implantado pelo Governo brasileiro a partir de 1995. Uma de suas principais estratégicas foi a criação das organizações sociais – estatuto legal que permite às instituições sem fins lucrativos desenvolverem funções sociais delegadas pelo Estado. A partir de 1998, a Secretaria de Estado da Saúde de São Paulo tem repassado a gestão de hospitais para organizações sociais de saúde, mediante contratos de gestão,que discriminam objetivos e metas a serem alcançados na produção de serviços médico-hospitalares. Duas dessas experiências são analisadas aqui – os Hospitais Gerais de Itapecerica da Serra e do Itaim Paulista – com vistas a avaliar a capacidade do Estado de promover tal delegação, à luz do controle público e da garantia da eqüidade no acesso aos serviços de saúde. Empregou-se metodologia qualitativa, mediante estudo de caso. Foram realizadas trinta entrevistas com membros das equipes técnicas, das administrações e das mantenedoras dessas organizações, usuários dos serviços, representantes do Legislativo e do Executivo estadual. Procedeu-se à leitura de documentos e relatórios técnicos. Os resultados indicaram não haver incorporação do âmbito local na gestão dos serviços prestados; o principal coordenador e controlador das metas estabelecidas é a administração central da secretaria estadual. Para que se efetive a eqüidade no acesso, é fundamental a presença do Poder público local como articulador do sistema de saúde. O controle público expressa-se por ações fiscalizadoras mediante procedimentos contábil-financeiros do Tribunal de Contas do Estado ou das instâncias locais do controle social do Sistema Único de Saúde ou dos conselhos populares de saúde. A população não participa da formulação das ações de saúde. Nessa modalidade de gestão, o Poder público estadual assume presença marcante mediante financiamento global e controle administrativo dessas organizações, o que caracteriza uma desconcentração de função para instituições públicas não-estatais, responsáveis por uma lógica privada de gerenciamento por intermédio da contratação de recursos humanos e de administração financeira, aspectos limitantes da ação estatal. / At the end of the 20th century we had seen the come out of a new geopolitical and economical world configuration of neoliberal traces, as an alternative to overcome the capitalism crisis. The Welfare State is criticized by such conception, being assigned to it the responsibility for the crisis and the inefficiency to answer the social demands of a world that is constantly changing. In response to these critiques comes out the State reform movement that has assumed several propositions in the past two decades. The conception of minimum State that prevailed in the 80’s, leaving to the market the responsibility for the economical growing and caring of the society needs. In the next decade this model was questioned. Then comes the ideology of the strong State that must regulate and coordinate the social politics, leaving to the market and the non-governmental organizations the productions of goods and services. Influenced by the new public management, this State is conceived as a manager of social development, using mechanisms of the private sector to optimize results, as the retention of expenses and cost control. We observe this orientation in the director plan of reform of the governmental machine, presented by the Brazilian Govern since 1995. One of the main strategies was the creation of the Social Organizations ¾ legal statute that allows the non profit institutions to develop social functions delegated by the State. Since 1998, the Secretaria de Estado da Saúde de São Paulo has repassed hospitals to Social Organizations of Health, through performance agreements, establishing goals to be reached in the production of hospitalar services. Two of these experiences were analysed ¾ the General Hospitals from Itapecerica da Serra and from Itaim Paulista ¾ with the intention to evaluate the ability of the State in promoting such delegation, under the public control and the guarantee of equity in the access to he health services. We used qualitative methodology, through the technique of study of case. There were thirty interviews done, involving members from the technical staff, from the administration and from the owners of these organizations, users of the services, and representatives of the Legislative and Executive of the State. We did read the documents and technical reports. The results indicated that there is no incorporation at the local level in the management of the services done, and that the central level of the Secretaria Estadual is the main coordinator and controller of the goals established. As to the equity in the access, is fundamental the presence of the local Public Power to its effectiveness, in the articulation of the health system, as we have seen in the Itapecerica da Serra experience. The public control is made by inspection actions, through financial procedures of the Tribunal de Contas do Estado, or the local instances of social control of the Sistema Único de Saúde or of the popular counsils of health. There is no participation of the population in the formulation of health actions. In this kind of management the Public Power of the state of the São Paulo has a fundamental role, through the global financing and administrative control of these Organizations, characterizing a desconcentration of function for non governmental public institutions, that is responsible for a private logic of managing, through the contract of human resources and financial administration, limiting aspects of the action of the State.

La «petite corruption» est un élément important de la relation entre personnels de santé et patients dans les contextes propices aux actes de corruption. Ce phénomène bien étudié en Europe centrale et orientale sous le nom de «paiements informels» (PIs), est peu documenté en Afrique. Pour contribuer à combler cette lacune, cette thèse propose une série d'analyses sur certains aspects clés de ce problème dans le contexte africain. Dans le chapitre 1, nous montrons que les PIs sont concentrés sur les plus pauvres. Ils sont plus susceptibles d’avoir fait face à l'absence de médicaments, à l'absentéisme des médecins et à des longs temps d'attente dans leur hôpital public local, ce qui accroît la probabilité d'encourir des frais non officiels. Une analyse plus approfondie de l'influence des facteurs d'offre dans le chapitre 2 confirme que les longs temps d'attente, la gestion du personnel de santé (par exemple, le recours à la délégation de tâches) et la perception des personnels vis-à-vis de leur revenu jouent un rôle crucial. Le chapitre 3 met en évidence l’existence d’effets de pairs dans la survenue des PIs lors de la consultation, l’effet étant plus important chez les plus pauvres. Enfin, avec un modèle théorique dans le chapitre 4, nous montrons qu’à l'équilibre, les PIs sont plus élevés en salariat pur qu’avec une rémunération basée sur la production. Aussi, une augmentation du paiement unitaire dans ce dernier système fait baisser les PIs, alors qu'une augmentation du salaire a un effet contraire. Un système mixte (salaire + rémunération à la production) semble être approprié pour assurer la participation des médecins et les inciter à réduire la recherche de rente. / « Petty corruption » is an important feature of the relationship between health workers and patients in settings that allow corrupt acts to happen. It has been well studied in Central and Eastern Europe under the term « informal payments » (IPs), but little has been done in Africa. To contribute in filling this gap in the literature, this thesis proposes a series of analyses to better understand some key aspects of this issue in the African context. In chapter 1, we show that the occurrence of IPs is concentrated on the poorest individuals. They are more likely to report having faced the lack of medicines, absenteeism of doctors and long waiting times in their local hospital, and these factors significantly increase the probability of incurring unofficial fees. In chapter 2, a deeper analysis of the influence of supply factors confirms that long waiting times, the management of the health workforce (e.g. using task shifting) and health workers’ perception vis-à-vis their earnings play a crucial role. In chapter 3, we highlight the existence of peer effects in the occurrence of IPs during consultation for HIV care, with a higher effect for the poorest patients. Finally, with a theoretical model in chapter 4, we show that at the equilibrium, the level of IPs is higher when the physician is paid by salary compared to output-based remuneration. Also, an increase of the unit payment in the later system leads to a reduction of IPs, while an increase of salary has the contrary effect. A blended remuneration (mix of salary and output-based remuneration) appears to be appropriate to both ensure the participation of physicians and introduce incentives to reduce rent-seeking.

Master of Public Health - MPH / The Health Extension Program (HEP) is an innovative, community based comprehensive primary health care program that Ethiopia introduced in 2003. It gives special emphasis to the provision of preventive and promotive services at community and household level. However, utilization of the HEP packages is low and reasons for this underutilization are not well known. The aim of this study is to assess the availability and utilization of the Health Extension Program Service in Akaki District of Oromia Region, Ethiopia. Quantitative study using a cross-sectional survey design. The study was conducted in Akaki District of Oromia Regional State in Ethiopia with 79,162 inhabitants. Random sampling was used to select 355 households. A structured data collection tool/ questionnaire was employed to collect data from the study participants. Data were analyzed using SPSS for Windows version 19. Descriptive statistics were used to analyze socio demographic characteristics of the study participants and to assess the availability and utilization of each service component. The response rate of the study was 100% with complete data obtained from 335 (94.4%) of the households. The majority (93.1%) of respondents were women. The availability of HEP services as described by the household visit of Health Extension Workers (HEWs) is very high with 86.6% visiting at least monthly and 11.3% visited sometimes. There was a highly significant association between the health extension workers’ visit to households and health extension service utilization during pregnancy (OR=16.913, 95% CI 8.074-35.427 at p<0.001). HIV testing utilization showed a tenfold increase among households who received education. Participation of households in the Model family initiative was another key factor associated with high levels of HEP services utilization. Though HEP services are available for most households, the frequency of household visits by HEWs and the involvement of Households in model family training greatly influenced service utilization. Improving frequency of services availability at household level and consistent health education will greatly improve services utilization.

The thesis describes the role of public relations and communication in the health sector and points at its specifications and differences if compared to the profitable sectors. The thesis analyses the current level of the issue in the Czech Republic, including legal and ethical perspectives of a health institution. The first part of the thesis explains the theory of the public relations and communicaiton sectors and includes a concise description of the health sector. The second part deals with internal, external and crisis communication of individual hospitals and institutions and analyses them through the method of qualitative research. Aside from other aspects, I describe pratical operation of public relations, usage of media communication tools in practice at individual health institutions. In addition to this, target audience, the public and the importance of a good reputation of a hospital have been defined in this part.

The purpose of this study was to examine the extent to which human resources capacity of the Ministry of Health and Social Services (MoHSS), Namibia, influences health care services delivery to the Namibian population. A qualitative research model using exploratory and descriptive study designs was adopted. Data were collected through semi-structured interviews with 46 health workers from two referral hospitals and two directorates in Windhoek District. The study found that there is severe staff shortage in the MoHSS, which has resulted in high workload and poor health care. Health worker migration, new services and programmes, emerging diseases, and population growth were reported to have contributed to staff shortage and high workload in the MoHSS. Study findings suggested a need to create more posts to accommodate emerging needs, and to introduce an effective retention strategy to attract and retain health professionals with scarce skills, and those working under difficult conditions. / Public Administration and Management / M. Tech. (Public Management)

Enhetschefer inom offentlig vård- och omsorgsverksamhet spelar en betydelsefull roll i uppdraget att leverera välfärdsarbete av hög kvalitet. Samtidigt präglas enhetschefsbefattningar av höga personalomsättningsnivåer i kommuner runt om i landet. Hur organisatoriska förutsättningar påverkar enhetschefer inom vård och omsorg i valet att avsluta sin anställning är inte fullt förstått. Syftet med föreliggande studie är därför att undersöka tidigare enhetschefers upplevda erfarenhet av att arbeta som enhetschef inom en offentlig vård- och omsorgsverksamhet och hur de organisatoriska förutsättningarna påverkat dem i valet att avsluta sin anställning. Genom en fenomenologisk fallstudie av en vård- och omsorgsverksamhet i en svensk kommun har 17 tidigare chefer intervjuats kring deras upplevelse av sin tidigare roll och anledningar till att ha avslutat sin anställning. Studiens resultat visar att enhetschefer inom vård- och omsorg påverkas av ett samspel mellan en rad organisatoriska faktorer i beslutet att avsluta sin anställning innefattande arbetskontroll, rollotydlighet, kontrollspann, illegitima arbetsuppgifter, kollegialt och organisatoriskt stöd samt logikkonflikter. Praktiska implikationer för att upprätta en hållbar enhetschefsroll inom offentlig vård- och omsorgsverksamhet diskuteras. / Line managers in the public health sector play a vital role in delivering high-quality welfare services. At the same time, the role of line managers demonstrates high turnover rates in municipalities throughout the country. As to how organizational work environment factors influence line managers in their decision to voluntary leave their employment is not fully understood. The purpose of the current study is therefore to investigate previous line managers’ lived experience of what it is like to work as a line manager within the public health sector and how various organizational factors affected them in their decision to leave their role. Through a phenomenological case study of a public health organization in a Swedish municipality, 17 previous line managers were interviewed regarding their lived experience as health sector line managers and reasons for leaving. The results reveal that public health sector line managers are affected by the interaction of various organizational factors in their decision to voluntary leave their employment including job control, role ambiguity, span of control, illegitimate tasks, colleague and organizational support as well as conflict of logics. Practical implications for restituting a sustainable line manager role within public health sector organizations are discussed.