Institutional Capacity and Governance in Oral Health: Insights From Managers in Kosovo's Oral Healthcare Facilities.

Background: Effective and equitable oral healthcare delivery relies on robust institutional capacity and good governance. In transitional health systems such as Kosovo's, the voices of managerial personnel are often overlooked in health system evaluations, particularly in the oral health sector.

Objective: This study aims to assess the institutional and governance capacities of oral healthcare facilities in Kosovo by analyzing insights from facility managers across public and private sectors..

Methods: A mixed-methods design was employed. Quantitative and qualitative data were gathered through semi-structured interviews with 40 managers of oral health institutions. Participants were purposively sampled to ensure geographical and institutional diversity across the Kosovo's seven regions. Survey topics included organizational communication, workforce issues, and policy coordination. Interview discussions explored institutional strategies, infrastructure challenges, and leadership dynamics. Quantitative data were analyzed using descriptive statistics, and qualitative data were examined through thematic analysis.

Results: Managers identified inadequate infrastructure, constrained financial flexibility, and unclear governance structures as major impediments to institutional effectiveness. Responses underscored disparities between urban and rural services and the absence of a coherent national oral health strategy. Concerns were also raised regarding fragmented responsibilities between central and municipal health authorities.

Conclusion: Kosovo's oral health institutions face considerable governance and infrastructure limitations that hinder effective service delivery. Addressing these structural and managerial deficiencies is essential for strengthening institutional capacity, enhancing strategic planning, and improving resource allocation. These findings offer relevant lessons for other transitional health systems aiming to build sustainable and responsive oral healthcare frameworks.