About PERFORM2Scale

Background to the project

The current challenge in global health is to achieve Universal Health Coverage (UHC) by 2030. Having an adequate health workforce is critical to enable states to achieve that vital goal.

While efforts are in place to increase the numbers of health workers, improving health workforce performance has been somewhat neglected but is equally important. It is also very challenging to address. PERFORM2Scale seeks to meet that challenge.

About PERFORM2Scale

PERFORM2Scale took the health management strengthening intervention successfully tested in the PERFORM project and up-scaled it for a sustainable impact. The scale-up was informed by our Theory of Change - read about the steps and assumptions here.

Building on the success of PERFORM

Workforce performance improvement can be better achieved at management levels close to frontline workers. The PERFORM project successfully developed a problem-based management strengthening intervention (MSI) for management teams at district level in three African countries. Its evaluation demonstrated its effectiveness in enabling management teams to solve workforce performance and other problems locally, improve service delivery and help them become better managers.

To have a wider and lasting impact, PERFORM2Scale developed and evaluated a sustainable approach to scaling up that district-level MSI in different and changing contexts. The teams in each country increased the number of MSI cycles for each DHMT to deepen their learning and to increase the number of participating DHMTs. Each of their scale-up strategies included working with governments, non-government employers and other stakeholders to develop plans and networks to sustain the implementation and expansion of the MSI at district level.

We worked in Ghana, Malawi and Uganda. A validated framework (due for publication shortly) and strategy for scaling-up the intervention have been produced to enable other countries to also:

  • use and adapt the scale-up tools,
  • improve workforce performance and
  • improve service delivery at district level.

Our research has shown that the successful use of the management strengthening intervention at scale can make a significant contribution to these countries achieving UHC.

Ongoing MSI cycles will help DHMTs to better address workforce performance problems

What were PERFORM2Scale’s objectives?

The overall aim of the PERFORM2scale project was to develop and evaluate a sustainable approach to scaling-up a district-level management strengthening intervention in different and changing contexts. To achieve this, the project had the following objectives:

  • To develop a framework and strategy for scaling up the management strengthening intervention.
  • To implement and validate the framework and strategy for scaling up the management strengthening intervention.
  • To identify the facilitators and barriers to scale-up of the management strengthening intervention in different and changing contexts.
  • To identify the costs and effects of scaling up the management strengthening intervention.
  • To develop the individual and institutional capacity at regional and national levels to implement and sustain the use of the scaling up framework and strategy.
  • To ensure engagement of stakeholders and institutions needed to implement and sustain the scale-up of the intervention.
  • To provide ongoing communication for and about the scale-up process and to disseminate the validated framework and strategy for scaling up the management strengthening intervention.

Read about our research questions and our key findings.

Where was PERFORM2Scale delivered?

The project was delivered in Ghana, Malawi and Uganda in partnership with five European institutions – more on the partners here. The funded aspect of the project began in 2017 and ran to March 2022, with further scale-up work taking place thereafter.