the performer issue 2 dec 2013-final version

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  • 7/27/2019 The Performer Issue 2 Dec 2013-Final Version

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    PERFORM Districts Posting Impressive Results

    Partnership Forming and Support being Realised

    In a bid to effectively implement their bundles of humanresource and health systems strategies, the districts have

    worked within their environment and sought

    partnerships and support. So far, these efforts areyielding impressive results in the areas of support fortraining, support supervision and other bundles.

    In Kabarole district, Baylor Childrens Foundation has

    taken up the training of health workers in supportsupervision, which has been done successfully.

    In Jinja, allocation of funds for supervision has improved

    and increased support supervision. Funds have beensecured from the GAVI Alliance for immunisation

    supervision while funds have also been secured from TheGlobal Fund to Fight AIDS, Tuberculosis & Malaria, for TBsupervision.

    Jinja district also received funding from the Uganda AIDSCommission and conducted training in M & E to improve

    the skills of the health workers. The recent M & Etraining has increased the capacity of in-charges to lookat data and see where gaps exist, one DHMT membernoted.

    Luwero district has been able to conduct regular supportsupervision with support from USAID-fundedStrengthening Decentralisation for Sustainability (SDS)

    initiative. Health Sub District in-charges have also been

    empowered to appraise their staff. By the time of thevisit, Luwero had developed a new supervision toolwhich is expected to capture more information than the

    old tool.

    For the three districts; the end is not yet near, butprogress made is impressive.

    In Jinja, where the bundles consisted of strengthening theappraisal mechanism and strengthening support

    supervision, resources have been identiied and allocatedto support supervision.

    As one member of the Jinja team noted, PERFORM does

    not introduce anything new. What it does is to activate us,do the things we are expected to do.

    In Kabarole, one element of the bundles was increasing

    the number of supervisors, 12 new supervisors wererecruited and mentored. Management skills have actuallyimproved; judging from the past when things were in a

    mess at some facilities. Now you ind things done well,one member of the Kabarole team pointed out.

    The district has also put in place a reward scheme to

    recognize the best performing staff/facility.

    Appraisal has also improved, especially how it isconducted. Those days we used to do appraisal just for

    the sake of it, but now we do it with meaning, anothermember of the Kabarole team emphasized.

    How Small Deliberate actions can Lead to Amazing

    Changes

    It was a day for sharing successes, innovations and

    interesting experiences in the journey to implementingtheir bundles of human resources/health systems

    strategies.

    Members of District Health (Management) Teams fromLuwero, Jinja and Kabarole; the three districts where theImproving Health Workforce Performance (PERFORM)

    project is implemented, on November 15 th 2013converged at Kolping Hotel in Kampala.

    District teams during group discussions at the meeng

    The Performer is a Publicaon of the Uganda team of the PERFORM Project ; Improving health workforce performance in Ghana,Tanzania and Uganda

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    The Performer Issue 2: December 2013

    The Performer is a Publicaon of the Uganda team of the PERFORM Project ; Improving health workforce performance in Ghana,Tanzania and Uganda

    DHMT Experiences and Challenges in Using the Diary

    In Luwero district, the open appraisal system was re-instated. Before PERFORM came our core problem wasabsenteeism but after PERFORM we realized we could do a number of things without more resources. We were ranked

    very low, but now we have improved to 9 thposition up from 56thposition, said one Luwero team member.

    PERFORM didnt give us new things, but opened our eyes, yet another one asserted.

    Looking forward districts are planning to strengthen implementation of their bundles by; improving management skills

    of heads of units, re-activation quality improvement teams, improving faulty payroll, improving communication betweenthe DHMTs and the PERFORM Country Research Team, inducting Health Unit Management Committees, expanding the

    responsibilities of the rewards and sanctions committee, explore opportunities for training health managers in healthperformance management, engaging district leadership to support capacity building of health workforce in leadershipand management.

    Documentation and Information Sharing within

    the DHMTsDocumentation and information sharing is a key

    element in the implementation of the PERFORMproject, for it facilitates relection and learning acrossteam members. Documentation in PERFORM is

    mainly done through recording of key learning

    details of events in diaries at each of the threeDHMTs.

    District Experiences using the Diary so far For purposes of clarity, the composition of thedistrict teams differs across the three districts;

    Luwero and Kabarole districts have District Health

    Management Teams (expanded to include Health Subdistrict in-charges) while Jinja has a District HealthTeam (only includes oficers based at the District

    Health Ofice) by Sept/Oct 2013 when we last visited.This composition has therefore impacted how thedairy has been used.

    The Luwero diary is a dairy on the road; movingfrom one health sub district to another. Thistherefore means that at the time it is in one HSD (say

    Nyimbwa), others are not able to access it untilsomeone at headquarters deliberately makes sure it

    leaves Nyimbwa or when there is a meeting and theperson from Nyimbwa carries it along. In this mix

    too, is the factor of time constraints on the part of thehealth workers. The implication is that even writingin the book may not happen. Although the teams

    reported that it has improved sharing informationwithin the DHMT, its accessibility is still a major

    challenge.

    In Luwero, the travelling diary had been to KalagalaHSD for long, before it found its way to Nyimbwa. Theteam in Nyimbwa though didnt know how to ill it in.

    We still need to start using Facebook for online

    sharing, said some members of the Luwero DHMT.

    Although the Jinja diary is based at the District HealthOfice within easy access to the DHT members,

    documenting is still a challenge. As we go out, mostof us when you come back you try to write. We havebeen working out of ofice most of the time (morning

    to evening) and not getting time to enter this in thediary.

    The Luwero diary has undergone metamorphosis to

    accommodate reecon and learningSeveral people wait to use it at the same time; sometimespeople keep it in their ofices and you have to be keen tolook for it, one member noted. Indeed the last entry then

    was on 23/09/2013 while the one before that was

    entered in May 2013.

    The Kabarole team has designated one member of the

    DHMT; Tonny Mugisa to keep the diary and spot thingsthat should go into the diary and enter them. They alsonoted that they have challenges with the format. Therelection column; we are not really sure all people would

    understand what to put there, noted that DHO, RichardMugahi.

    All is not lost however, despite all the challenges, the

    diary is still appreciated. Me I have learnt somethingfrom that book. It doesnt target only meetings; it alsocaptures things from facility visits. It is also a centre of

    sharing by the DHMT one member of the Kabarole

    DHMT said. It is a good book but some of our membershave not embraced it because a lot has been done but notwritten in the diary. Some visitors came and saw it and

    they liked it a lot, they thought it is a very good book. Thefact is that there are many things done but few arewritten is clear testimony that there is something wrong,

    yet another added.

    In all the three districts, there were suggestions forimprovement in this area and they included the

    following:

    Using the diary should be put on the monthly

    meeting agenda to review what has been written in thediary. Trying out Facebook to go hand-in-hand with the

    book/diary in the district where the book takes long onits journey from one place to another.

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    The Performer is a Publicaon of the Uganda team of the PERFORM Project ; Improving health workforce performance in Ghana,Tanzania and Uganda

    Makerere University School of Public Health Successfully Hosts Third PERFORM

    Consortium Meeting

    The Performer Issue 2: 2013

    The PERFORM consortium consists of three African

    institutions; Makerere University (Uganda), University of

    Dar es Salaam (Tanzania) and University of Ghana

    (Ghana). Each of the three institutions is paired with a

    European partner with whom they collaborate in the

    implementation of the Action Research activities;

    Liverpool School of Tropical Medicine with Makerere

    University, University of Leeds with University of Dar es

    Salaam and Swiss School of Tropical and Public Health

    with University of Ghana.

    The three countries where PERFORM is conducted(Ghana, Tanzania and Uganda) face major problems of

    inadequate health workforce. They also havedecentralised management structures that offer

    management teams greater decision-making spaceincluding in the area of human resources. PERFORM is

    studying how management strengthening interventionscan be used, and under what conditions, to enhanceworkforce performance

    November 18th 22nd 2013, all partners converged at

    Ridar Hotel in Seeta near Kampala to take stock of the

    previous year as well as plan for the subsequent year. This

    is the last consortium meeting (CW3) for the action

    research project that ends in 2015.

    PERFORM (Improving Health Workforce Performance) is

    an action research project that supports District Health

    Management Teams in the three countries to carry out

    situation analyses on their health workforce focusing on

    performance. Teams then develop and test context-

    speciic management strengthening processes, focused on

    improving workforce performance (identify areas to be

    improved, implement integrated human resource and

    health systems strategies within existing contexts) and

    monitor the implementation of the strategies.

    Country progress reports indicated that all the three

    countries are in the process of implementing bundles of

    human resource and health system strategies with varying

    degrees of success and challenges. While in somecountries, the documentation of experiences and

    relections by the district teams( a key element in action

    research) is still weak; in some settings like Tanzania

    districts lack leadership to manage the process of

    implementation.

    Successes include noticeable innovation in the

    implementation of the bundles of strategies, including in

    resource mobilization, Country Research Teams being

    creative around provision of support as well as a general

    appreciation of the approach by the district and national

    technical leadership.

    With just less than two years of the project left, a big part

    of the discussion at the consortium meeting focused on

    how best comparative analyses across countries and

    districts will be conducted and how lessons learnt will be

    shared across the consortium and globally.

    The comparative analysis of the indings will add new

    knowledge as to the effect of different country contexts

    on these interventions, hopefully leading to insights intothe application of the new approaches in different Sub

    Saharan Africa country contexts.

    The CW3 meeting also involved visits to two of the three

    sites where PERFORM is implemented in Uganda; Luwero

    district and Jinja district. The visits involved sharing of

    progress, successes and challenges between the

    consortium members and the district health management

    teams. This focused on technical review of bundles, action

    research and documentation.

    A Luwero field visit discussion. In the meeting were

    consortium members from Leeds, Liverpool, Ghana,

    Switzerland, Tanzania and Uganda

    The MUSPH team with the European partners during

    a group discussion. Back to camera is Dr. Sebastian

    Olikira Baine the PI

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    The Performer Issue 2: December 2013

    Strengthening Support Supervision

    yields Results for Jinja District

    Through strengthened support supervision, there is

    observed improvement in the performance of health

    workers.

    One of the districts broad objectives was to

    strengthen the appraisal system as one of the ways

    of improving staff performance in the district. The

    district now has an effective appraisal system and

    all staff were appraised at the time of the support

    visit. The timely appraisal enabled the team toidentify and know those who were not working,

    according to the discussion with the CountryResearch Team (CRT). The district team therefore

    reported some improvements in conducting the

    appraisal process, although some more support is

    still needed.

    Four people have already faced the disciplinary

    committee and two of these accepted that they were

    ineffective and promised to style up. However, they

    were being followed up to ensure that they areavailable at their workstations said the DHMT

    members present at the meeting.

    Good Practice: Good performers have been

    motivated by the DHO; recognizing in-charges who

    performed well at Kakaire, Kakira and LukolaHealth Centre IIIs. The recognition was at a public

    meeting (during a workshop) in front of everybody

    and we believe this motivates.

    Some members of the Jinja DHT during the support visit

    meeng

    District Support Visits Reveal Impressive Progress and Growing

    EnthusiasmControlling Arrival and Departure at

    the Health Facility Improves staff

    AvailabilityIn the months of September and October, theCountry Research Team (CRT) conducted support

    visits to the three districts. The discussions held

    during the visits indicated the enormous effort that

    DHMTs have put in to implement their bundles.

    In Luwero district, the DHO, Dr. Joseph Okware said

    that the objective of the partnership is now very

    clear to all; even at facility level. We are deliberately

    pursuing change for the better. It cannot be left to

    luck but need to focus on a few things. The district

    appreciates where it is; understanding its position

    and working through the why to improve.

    He said PERFORM has worked to sensitise the team

    on weak performance, but although they believe

    they are on the right track, they still had challenges

    in data management.

    The district has also been able to conduct regular

    support supervision with support from USAID-

    funded Strengthening Decentralisation for

    Sustainability. Health Sub District in-charges have

    also been empowered to appraise their staff. By the

    time of the visit, Luwero had developed a new

    supervision tool which is expected to capture more

    information than the old tool.

    The Performer is a Publicaon of the Uganda team of the PERFORM Project ; Improving health workforce performance in Ghana,Tanzania and Uganda

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    From page 1Partnerships Forming...

    An element in one of their bundles is to increase the

    number of staff present at work. In realising this,

    attendance monitoring has been instituted with

    arrival and departure books put at every health

    facility for this purpose. Letters of caution have also

    been issued to those found not performing to the

    expected standards. The team reported that this has

    reduced on absenteeism.

    Regular meetings at Health Sub District (HSD) and

    Health facility level are also happening, although

    members mentioned that the quality of meetings

    may be an area that needs improving.

    Kabarole PERFORM progress on a

    Rollercoaster

    The Kabarole team has formed ive supervisory

    teams each of four members, with each team

    supervising speciic areas. The team said it is still

    concerned with improvement of leadership and

    management since this is where results come from.

    Health Sub District (HSD) in-charges have been

    attached to the District Health Ofice to know and

    learn what happens at top management. They also

    chair Monday morning meetings as a way of

    building their management and leadership

    potential.

    The DHO has initiated mentorship of HSD in -

    charges for 2 days for each in-charge; they can see

    how things are done so that there is no leadership

    gap. When the DHO is not there, any of the DHT

    members can be in charge and it is working out

    well, one of the DHMT members noted.

    Innovation:the DHO has special meetings with the

    medical doctors; every two weeks on weekends. He

    meets them at social places and they discuss among

    others things, management issues. If you do not

    support them socially, even If you put in more

    money they can resign. Someone else can match

    what you are paying, said the DHO.

    Luwero DHO, Dr. Joseph Okware with part of his

    team

    The Performer is a Publicaon of the Uganda team of the PERFORM Project ; Improving health workforce performance in Ghana,Tanzania and Uganda

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    The Performer Issue 2: December 2013

    Innovation:the DHO holds special meetings with

    the medical doctors; every two weeks on weekends.

    He meets them at social places and they discuss

    among others things, management issues. If you do

    not support them socially, even if you put in more

    money they can resign. Someone else can matchwhat you are paying, said the DHO.

    Whatever mentorship and support happens,

    Some Tips on recording Reflections in the Diary

    What does relection involve?During the October district Support visits and the

    interaction with other PERFORM districts, it was

    observed that recoding DHMT experiences in the

    diary is still a challenge. Speciically, it was noted

    that the area of relection is quite weak. In the

    following article, are some tips on how to improve

    our relection.

    When we relect, we consider deeply something

    which we might not otherwise have given much

    thought to. We sit back and look at the event

    (from a distance) and dissect it.

    When we relect on our activities, we examine

    them deeply and in detail as opposed to just

    living them or doing them and walking away.

    the HSD in-charges are expected to pass on

    the knowledge and skills to the lower

    levels.

    The DHMT also agreed to have junior staff

    as in-charges as long as they have

    leadership qualities. These are attached to

    senior mentors (about 20) who have been

    trained in complete mentorship package

    From page 5...Kabarole on Rollercoaster progress

    Relection enables us learn from our

    activities, actions and experiences from

    which we learn. We can relect on a

    meeting, an interaction, an event or an

    entire project.

    The great beneit of relecting in our

    activities is that, by understanding why we

    do something in a particular way and

    recognising how we feel about it, we can

    spot where we are doing well and where

    we are not doing so well, which gives us the

    chance to consolidate our successes and

    address the gaps. We are encouraged to be

    descriptive, analytical and evaluative in our

    relection.

    The Performer is a Publicaon of the Uganda team of the PERFORM Project ; Improving health workforce performance in Ghana,Tanzania and Uganda

    Sources:http://www.alara.net.au/aral/actionresearch

    http://cadres.pepperdine.edu/ccar/deine.html

    http://www.alara.net.au/aral/actionresearchhttp://www.alara.net.au/aral/actionresearchhttp://cadres.pepperdine.edu/ccar/define.htmlhttp://cadres.pepperdine.edu/ccar/define.htmlhttp://cadres.pepperdine.edu/ccar/define.htmlhttp://www.alara.net.au/aral/actionresearch
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    Relection can focus on some or all of the elements in the table below:

    Sample Questions for Relection Who was there? (descriptive) What did she say? (descriptive) What did I say? (descriptive) Why did I respond in that way? (analytical/relective) How did each of us feel as a result? (analytical/relective) What if I had chosen my words more carefully? (analytical/relective) So what? Would that have made any difference to the outcome? (relective/evaluative) Where can I go from here in my interactions with this person? (relective/evaluative)

    Check list/Tips Start your relection as soon as you can. You will forget things with time and may lose valuable l

    learning experience s or even marks as a result. Do some free writing on your experiences to get you started Remember that relective writing is personal; its OK to write about your feelings and emotions. Get the balance right, dont be too descriptive. Its easy to write about what happened where; its

    the why, how and what if which is really important.

    Facts (about the meeting, event,

    etc) why the meeting, who is

    attending, how many attending,

    etc.

    Questions(why did we do it

    this way? What If we did it

    another way? What are the

    implications of continuing with

    this strategy?)

    Ideas (how else we can do it, how

    we can share our successes, how

    we can overcome the challenges,

    etc)

    Feelings( I am happy we

    agreed on that issue, I am

    feeling a little nervous about

    continuing with this bundle, I

    like working with this team,

    etc)

    The Performer is a Publicaon of the Uganda team of the PERFORM Project ; Improving health workforce performance in Ghana,Tanzania and Uganda

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    The Performer Issue 2: December 2013

    The PERFORM Uganda Partnership

    Makerere University College of Health

    Sciences, School of Public Health, Uganda 1. Dr. Sebastian Olikira Baine (PI)2. Dr. Freddie Ssengooba3. Mr. Saul Kamukama4. Milly Nattimba

    Liverpool School of Tropical Medicine, UK

    1. Mr. Tim Martineau (PI)2. Dr. Joanna Raven

    Study Districts

    1. Luwero District Health Management Team (DHMT)2. Jinja District Health Management Team (DHMT)3. Kabarole District Health Management Team

    The Performer ce

    The Performer is a Publicaon of the Uganda team of the PERFORM Project ; Improving health workforce performance in Ghana,Tanzania and Uganda

    More information about PERFORM can be accessed on the consortium

    website: http://www.performconsortium.com/

    http://www.performconsortium.com/http://www.performconsortium.com/