NEW! Briefing comparing our work in Ghana, Tanzania and Uganda

Thursday, 20 Aug 2015

You can access the brief here.

Many countries in Sub-Saharan Africa have undergone a process of decentralising health system planning and management, shifting authority to varying degrees from central government to local districts. There are gaps in research on health worker performance at the district level. We have applied action research using a holistic “systems approach” to explore how improving management skills can enhance workforce performance at district level. Our aim was to boost the capacity of health managers in three districts in Ghana, Tanzania and Uganda to identify health workforce related problems themselves, understand the systemic factors affecting performance (including uneven distribution of health workers, inappropriate allocation of tasks and lack of training, management and support) and apply and monitor strategies.

This new brief summarises the findings of the research and provides the following key messages:

  1. Health workers are a central component of the health system. Applying a systems approach to improving health workforce performance is therefore key: this means not only considering human resource factors but other health system issues such as stock- outs of medicines, equipment and supplies and delays in disbursing funds. These are challenges that policy-makers need to address.
  2. Change in health workers’ performance requires an in-depth analysis of the underlying causes of problems. Empowering managers and creating a sense of ownership is critical: action research builds their capacity to identify and resolve health workforce problems themselves.
  3. Lack of financial resources is not an impediment to progress: inexpensive changes can yield significant results. What’s more, supported managers may proactively find ways to generate income by fundraising, lobbying and building partnerships with other stakeholders.
  4. By documenting results, modest progress becomes more visible which in turn can motivate staff.
  5. By leveraging partnerships and integrating activities, managers can enhance systems efficiency.
  6. Leadership is key in order to bring about change, introduce innovation and overcome challenges.
  7. In practice, many aspects of the health system remain centralised, for example the supply and distribution of medicine; recruitment and payment of salaries. For decentralisation to be effective, districts need resources and the authority to make decisions about expenditure.

Read the brief