improving health workforce performance in uganda: linking research and practice through action...
TRANSCRIPT
Improving health workforce performance in Uganda: linking research and practice
through action research
Joanna Raven, Liverpool School of Tropical Medicine, UKSebastian Olikira Baine, Makerere University, Uganda
Saul Kamukama, Makerere University, Uganda Alvaro Alonso-Garbayo, Liverpool School of Tropical Medicine, UK
Tim Martineau, Liverpool School of Tropical Medicine, UK
International Health Conference26 June, 2015 Oxford
Twitter: @PERFORMtug
Rationale for PERFORM
• Need to improve workforce performance to support Universal Health Coverage;
• Integrated Human Resource and health systems approach required;
• District level managers in decentralised contexts in better position to organise integrated approach, have sufficient “decision space” and can learn;
• Challenge is to help District Health Management Teams to think strategically and to be entrepreneurial within their resource and authority constraints;
• District Health Management Team strengthening is not new, but little research.
PERFORM project in Uganda
• Investigates how a management strengthening intervention (action research) can be used to improve health workforce performance
Study design
Act
Observe
Reflect
Plan
Timeline
Initial Situation AnalysisJun-Aug
2012
National workshop 1
Initial problem analysisOct 2012
National workshop 2
Development of HR/HS strategiesFeb 2013
Final Situation AnalysisSep 2014
Implementation of strategies
Mar 2013 – Aug 2014Act
Observe
Reflect
Plan
Initial situation analysis
• Research team with District Health Management Teams conducted situation analysis on workforce performance in the district: secondary data collection, document review, interviews and focus group discussions
Health Centre, Jinja district, Uganda
Problem analysis
• Developed a list of workforce problems
• Prioritized problems • Workshop to do in-
depth problem tree analysis
Kabarole district, Uganda, Feb ‘13
Examples of problems identified District Key problems Kabarole 1. Weak leadership and management of team leaders
2. Weak supportive supervision 3. Health workers’ poor commitment 4. Poor working environment
Jinja 1. Ineffective use of the traditional control mechanisms 2. Low staff motivation 3. Inadequate supportive supervision 4. Staff training not guided by available opportunities in district
Luwero 1. Lack of professionalism 2. Poor communication 3. Inadequate capacity building 4. Inadequate supplies / equipment /medicines 5. Inadequate supportive supervision
Plan: Development of strategies
• Workshop to support development of strategies
• Integrated into district work plan
Jinja district, Uganda, Feb ‘13
Supporting integration into district plans
Kabarole district, Uganda, Feb ‘13
Act: Implementation of strategies
• Kabarole District Health Management Team was entrepreneurial: received funding for induction of newly recruited staff from private sector
• Jinja District Health Management Team: adapted supervision tools, developed plan for supervision visits, focused on support and solving problems
• Luwero District Health Management Team: introduced duty rosters and attendance books at facilities; spot checks of facilities
Observation and reflection of strategies
Adapting the strategies during implementation…
Kabarole DHMT identified a problem with the capacity of new supervisors to provide good quality supervision and so identified and trained mentors to support each supervisor
“In the beginning some members did not understand the mentorship well. But after the discussions all members were in agreement and welcomed the mentorship idea” (Diary, 12/5/13).
Final evaluation
• Focus group discussions and in-depth interviews: explored perceptions on management strengthening and health workforce improvement processes and changes
• Document review: visit reports, diaries, workshop reports, District Health Management Team minutes and plans were analysed
• Analysis of existing service delivery data
Effects on management strengthening
• Improved team work• In-depth problem analysis - finding root causes • Integrated planning, resourcing and monitoring of
processes and effects of plans • Addressed problems within existing resources • Entrepreneurial approaches • Recognised importance of data for monitoring
progress and effects
Effects on health workforce performance
• Better supervision of staff
• Reductions in absenteeism
• More staff appraised • Increases in utilization
of services
Monthly supervision visit, Jinja district
Key messages
The PERFORM approach can: • Improve workforce performance through
management strengthening • Bridge the gap between research and practice• Support sustainability and ownership through solving
real problems at district level • Enable sharing of practices and learning • Promote culture of partnership • Unlock innovation
Acknowledgements
Funding from the European Commission Seventh Framework programme
Ministry of Health in Uganda
District health management teams in Jinja, Kabarole and Luwero districts
Contact details for further dialogue
• Project PI: [email protected]
• Project website: www.performconsortium.com
• Twitter: @performtug
Many thanks for your participation