You may remember that PERFORM2Scale was preceded by and based on the success of the PERFORM project, which used an action-research approach to strengthen human resources management in the health in Africa. Two papers produced by members of the PERFORM Research Consortium have recently been published and link directly to PERFORM2Scale.
Strengthening health district management competencies in Ghana, Tanzania and Uganda
The study initially recognised that management development benefits from being problem and action based to ensure that the learning is appropriate to the context. This approach has been used successfully in the health sector in middle-income and low-income countries, however, there has been little research on its appropriateness and effects in these contexts, hence this study.
To strengthen the capacity of district management teams to develop and deliver integrated strategies for workforce performance improvement, the study introduced an action research-based management strengthening intervention (MSI) to nine districts across three countries. It comprised two workshops, follow-up by facilitators and meetings between participating districts.
The MSI was found to be an appropriate form of management strengthening for District Health Management Teams (DHMTs), and indicates strong potential for workforce performance improvement. However, in order to reinforce and deepen their learning and to have significant impact on workforce performance and service delivery the MSI needs to be continued with participating DHMTs, and should also be scaled up to cover many more districts in each country (hence PERFORM2Scale).
The study was conducted by researchers from Liverpool School of Tropical Medicine (UK); School of Public Health, University of Ghana; Makerere School of Public Health (Uganda); Nuffield Centre for International Health and Development, University of Leeds (UK); Institute of Development Studies, University of Dar-es-Salaam (Tanzania) and Swiss Tropical and Public Health Institute (Switzerland).
Decision space for health workforce management
The second paper is also a collaboration between Liverpool School of Tropical Medicine and Makerere School of Public Health and builds upon work undertaken by PERFORM in Uganda. It aims to improve understanding about how district health managers perceive and use their decision space for human resource management (HRM) and how this compares with national policies and regulatory frameworks governing HRM.
The paper compares the roles allocated by Uganda’s policy and regulatory frameworks with the actual room for decision-making that district health managers perceive that they have. Results show that in some areas District Health Management Team (DHMT) members make decisions beyond their conferred authority, while in others they do not use all the space allocated by policy.
The study concluded that to improve workforce performance decentralisation needs to devolve power further down from district authorities onto district health managers. DHMTs need not only more power and authority to make decisions about their workforce but also more control over resources to be able to implement these decisions.
Access the papers
Martineau T, Raven J, Aikins M, Alonso-Garbayo, A, Baine S, Huss R, Maluka S & Wyss K. Strengthening health district management competencies in Ghana, Tanzania and Uganda: lessons from using action research to improve health workforce performance. BMJ Global Health 2018;3: e000619. doi:10.1136/bmjgh-2017-000619
Alonso-Garbayo A, Raven J, Theobald S, Ssengooba F, Nattimba M & Martineau T.
Decision space for health workforce management in decentralized settings: a case study in Uganda. Health Policy and Planning, 32, 2017, iii59–iii66. doi: 10.1093/heapol/czx116