Objective To systematically analyze the factors influencing the leadership competency of primary-level health emergency administrators in the field of infectious disease prevention and control, as well as their underlying mechanisms, thereby providing evidence-based references for enhancing the leadership competency of primary-level health emergency administrators.

Methods From November 2019 to March 2021, this study adopted a multi-stage stratified random sampling method to randomly select 152 primary-level health emergency administrators from Jiangsu province, Hubei province, Hunan province, Guangdong province, Anhui province, and Inner Mongolia Autonomous Region, as the research subjects. Structural equation modeling (SEM) combined with the bootstrap method was utilized to analyze and validate the paths and mediating effects of these influencing factors.

Results Through the survey of 152 primary-level health emergency administrators, this study found that human resource support had a positive impact on organizational climate (β = 0.461, P < 0.001). Organizational climate (β = 0.712, P < 0.001) and material resources support (β = 0.248, P = 0.004) had positive impacts on external social support. External social support had a positive impact on leadership competency (β = 0.519, P < 0.001). Through the mediating effect test, two mediating paths were identified. Mediating path 1 was material resources support → external social support → leadership competency (with an effect value of 0.129; 95%CI: 0.005–0.258), and mediating path 2 was human resource support → organizational climate → external social support → leadership competency (with an effect value of 0.170; 95%CI: 0.094–0.303).

Conclusions The characteristics of infectious disease prevention and control reinforce the inevitability of the indirect transmission of the mechanisms influencing health emergency leadership competency. Leadership competency is formed through complex interactions between individuals and their environment. The sustainable improvement of leadership competency among primary-level health emergency administrators needs to be achieved by optimizing resource allocation and organizational climate, as well as improving the social support network.