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Strengthening health district management competencies in Ghana, Tanzania and Uganda: lessons from using action research to improve health workforce performance
BACKGROUND: To achieve Universal Health Coverage (UHC), more health workers are needed; also critical is supporting optimal performance of existing staff. Integrated human resource management (HRM) strategies, complemented by other health systems strategies, are needed to improve health workforce pe...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898347/ https://www.ncbi.nlm.nih.gov/pubmed/29662692 http://dx.doi.org/10.1136/bmjgh-2017-000619 |
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author | Martineau, Tim Raven, Joanna Aikins, Moses Alonso-Garbayo, Alvaro Baine, Sebastian Huss, Reinhard Maluka, Stephen Wyss, Kaspar |
author_facet | Martineau, Tim Raven, Joanna Aikins, Moses Alonso-Garbayo, Alvaro Baine, Sebastian Huss, Reinhard Maluka, Stephen Wyss, Kaspar |
author_sort | Martineau, Tim |
collection | PubMed |
description | BACKGROUND: To achieve Universal Health Coverage (UHC), more health workers are needed; also critical is supporting optimal performance of existing staff. Integrated human resource management (HRM) strategies, complemented by other health systems strategies, are needed to improve health workforce performance, which is possible at district level in decentralised contexts. To strengthen the capacity of district management teams to develop and implement workplans containing integrated strategies for workforce performance improvement, we introduced an action-research-based management strengthening intervention (MSI). This consisted of two workshops, follow-up by facilitators and meetings between participating districts. Although often used in the health sector, there is little evaluation of this approach in middle-income and low-income country contexts. The MSI was tested in three districts in Ghana, Tanzania and Uganda. This paper reports on the appropriateness of the MSI to the contexts and its effects. METHODS: Documentary evidence (workshop reports, workplans, diaries, follow-up visit reports) was collected throughout the implementation of the MSI in each district and interviews (50) and focus-group discussions (6) were conducted with managers at the end of the MSI. The findings were analysed using Kirkpatrick’s evaluation framework to identify effects at different levels. FINDINGS: The MSI was appropriate to the needs and work patterns of District Health Management Teams (DHMTs) in all contexts. DHMT members improved management competencies for problem analysis, prioritisation and integrated HRM and health systems strategy development. They learnt how to refine plans as more information became available and the importance of monitoring implementation. The MSI produced changes in team behaviours and confidence. There were positive results regarding workforce performance or service delivery; these would increase with repetition of the MSI. CONCLUSIONS: The MSI is appropriate to the contexts where tested and can improve staff performance. However, for significant impact on service delivery and UHC, a method of scaling up and sustaining the MSI is required. |
format | Online Article Text |
id | pubmed-5898347 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-58983472018-04-16 Strengthening health district management competencies in Ghana, Tanzania and Uganda: lessons from using action research to improve health workforce performance Martineau, Tim Raven, Joanna Aikins, Moses Alonso-Garbayo, Alvaro Baine, Sebastian Huss, Reinhard Maluka, Stephen Wyss, Kaspar BMJ Glob Health Research BACKGROUND: To achieve Universal Health Coverage (UHC), more health workers are needed; also critical is supporting optimal performance of existing staff. Integrated human resource management (HRM) strategies, complemented by other health systems strategies, are needed to improve health workforce performance, which is possible at district level in decentralised contexts. To strengthen the capacity of district management teams to develop and implement workplans containing integrated strategies for workforce performance improvement, we introduced an action-research-based management strengthening intervention (MSI). This consisted of two workshops, follow-up by facilitators and meetings between participating districts. Although often used in the health sector, there is little evaluation of this approach in middle-income and low-income country contexts. The MSI was tested in three districts in Ghana, Tanzania and Uganda. This paper reports on the appropriateness of the MSI to the contexts and its effects. METHODS: Documentary evidence (workshop reports, workplans, diaries, follow-up visit reports) was collected throughout the implementation of the MSI in each district and interviews (50) and focus-group discussions (6) were conducted with managers at the end of the MSI. The findings were analysed using Kirkpatrick’s evaluation framework to identify effects at different levels. FINDINGS: The MSI was appropriate to the needs and work patterns of District Health Management Teams (DHMTs) in all contexts. DHMT members improved management competencies for problem analysis, prioritisation and integrated HRM and health systems strategy development. They learnt how to refine plans as more information became available and the importance of monitoring implementation. The MSI produced changes in team behaviours and confidence. There were positive results regarding workforce performance or service delivery; these would increase with repetition of the MSI. CONCLUSIONS: The MSI is appropriate to the contexts where tested and can improve staff performance. However, for significant impact on service delivery and UHC, a method of scaling up and sustaining the MSI is required. BMJ Publishing Group 2018-04-09 /pmc/articles/PMC5898347/ /pubmed/29662692 http://dx.doi.org/10.1136/bmjgh-2017-000619 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ |
spellingShingle | Research Martineau, Tim Raven, Joanna Aikins, Moses Alonso-Garbayo, Alvaro Baine, Sebastian Huss, Reinhard Maluka, Stephen Wyss, Kaspar Strengthening health district management competencies in Ghana, Tanzania and Uganda: lessons from using action research to improve health workforce performance |
title | Strengthening health district management competencies in Ghana, Tanzania and Uganda: lessons from using action research to improve health workforce performance |
title_full | Strengthening health district management competencies in Ghana, Tanzania and Uganda: lessons from using action research to improve health workforce performance |
title_fullStr | Strengthening health district management competencies in Ghana, Tanzania and Uganda: lessons from using action research to improve health workforce performance |
title_full_unstemmed | Strengthening health district management competencies in Ghana, Tanzania and Uganda: lessons from using action research to improve health workforce performance |
title_short | Strengthening health district management competencies in Ghana, Tanzania and Uganda: lessons from using action research to improve health workforce performance |
title_sort | strengthening health district management competencies in ghana, tanzania and uganda: lessons from using action research to improve health workforce performance |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898347/ https://www.ncbi.nlm.nih.gov/pubmed/29662692 http://dx.doi.org/10.1136/bmjgh-2017-000619 |
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