PERFORM at the European Congress on Tropical Medicine and International Health

Tuesday, 08 Sep 2015

We are delighted that our colleague Tim Martineau will be presenting today at the European Congress on Tropical Medicine and International Health. Come along and meet him at 17.00 in Kairo 1 in the session on 'Health Systems and Social Exclusion'.

Tim will explain how we strengthened district management to improve health workforce performance using an action research approach with district health management teams (DHMT) in Ghana, Tanzania and Uganda.

More detail on the process that we used

The events to facilitate the action research approach were fitted around the busy schedules of three DHMTs in each country.  After a situation analysis, two participatory inter-district workshops were conducted in 2013/14 to refine the problem solving and integrated strategy development outputs.  Follow-up support and inter-district meetings were facilitated over an 18-month implementation phase. Action research or similar approaches are commonly used for implementation projects, but the process is rarely documented to derive lessons on management strengthening.  Process monitoring was carried out throughout the project and an in-depth evaluation was conducted at the end of the project – both using mainly qualitative methods.

What effect did it have?

The two most common strategies selected for improving workforce performance were strengthening supervision and controlling staff absence.  Other strategies included improving competencies, use of incentives, better appraisal systems, and increased use of volunteers.  Modest improvements in workforce performance were reported. Wider health systems strategies were also included, such as setting performance indicators for immunisation logistics, to address service delivery problems.

Reports of management strengthening included the greater use of teamwork and more participatory decision-making processes and the application of the problem analysis process to other areas of management.  Some managers found the lack of additional funding a major barrier to implementing the strategies they developed, while others found the sole reliance on existing resources challenging and educational.  The action research approach was popular, especially ownership of the process, and most teams wanted to continue using it.

Whilst the improvements to workforce performance may be at best modest after the short implementation period, the management strengthening was welcomed by DHMTs and resulted in improved teamwork and human resource management practices.