Background: Public health management and leadership are widely recognized as paramount to health system performance. This study explores the understanding of public sector managers� knowledge and understanding of healthcare management and leadership as a field of study relevant to strengthening health system. It is intended to provide policy makers and stakeholders with insights on current system performance gaps and help them develop context-fit management and leadership interventions.\r\n\r\nMethods: This study used an exploratory approach that involved in-depth interviews with public sector managers and leaders at central and district level. A total of sixteen managers and leaders were interviewed (5 central level, 11 district level). Data collected from the interviews was transcribed and analysed thematically. \r\n\r\nFindings and Discussion: Thematic analysis of the interview transcripts identified three main themes: limited understanding that healthcare management and leadership is a field of study and profession; limited competencies impacting the performance of managers and leaders and limited career progression; and the ability to manage complexity in the health system. \r\n\r\nConclusion: Public health managers and leaders� limited knowledge and understanding of healthcare management and leadership as a field of study and profession will likely hinder a systematic approach and capacity development for healthcare managers and leaders.

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