Stage: Reflection

This section covers:

  • Reflective diaries
  • Support visits by facilitators
  • Inter-district meetings
  • Moving into MSI Cycle 2 and beyond

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NB The full MSI toolkit containing this text and links to all associated documents can be found here.

Reflecting is taking the time to question what worked well and what did not, why, and what changes could be made.

+++ Ensure that the Observation and Reflection stages are closely intertwined. +++

Reflection can take place at any time during the MSI cycle when the DHMT, with support from the facilitators, can step back and take stock of whether, and to what extent, problems have been solved or have evolved over the period of the action research project. They can also think about why problems have or have not been resolved. This is an important part of the learning process. It is also the most challenging stage of the cycle. 

If a DHMT finds that one of the strategies they are implementing is not working – or affecting another strategy negatively (eg there is a risk that upgrading training will have a negative impact on the strategy to reduce staff absence – especially if the number of staff in the facilities is already very low), they should be encouraged to consider modifying it or even dropping it. Modifying or dropping a strategy is not considered a failure. Rather, it is important to understand why they were dropped. When the DHMT reflects on why something changed, the DHMT is in fact learning to develop appropriate strategies to improve workforce performance within its own unique district. Alternatively, new strategies may be added if, for example, a DHMT identifies that part of the overall problem has not yet been addressed.

+++ Various tools, such as the workshop report template and the support visit template, +++
have sections for the facilitators to record their reflections on the specific event or the MSI in general.
This is for the general benefit of the programme, but also the more the facilitators reflect on their own
work the easier it should be for them to support the DHMTs in reflecting on their workplans.


There are several approaches and tools that can help reflection take place.

Reflective diaries

A reflective diary is one example of a reflective strategy that can help DHMTs document what strategies they have implemented and how they implemented them, and then reflect on what went well, what did not go so well and why, and then to think about how to do things differently. 

+++ You could explore with DHMTs how they currently reflect on their work and whether these methods +++
could be used in conjunction with or instead of the reflective diary.
Whatever method is used should be simple to operate and not too time-consuming.

Support visits by facilitators

The facilitators will visit each district and have a face-to-face meeting with the DHMT on several occasions as needed during the acting / implementing of the workplan. During these visits, the facilitators can review the workplan and the diary with the DHMT, discuss the implementation of the strategies, any challenges faced in implementing them and how they were solved, any effects of the strategies so far, and evidence for these effects. This will help the DHMT reflect on what has gone well, what has gone not so well, and what changes should be made.

+++ These meetings could be with some or all of the DHMT members, but try to ensure that most of those have +++
attended Workshops 1 and 2 as they will understand the MSI purpose and process better and therefore benefit more from the visit.

These visits could be supplemented by regular communication via telephone, texts/WhatsApp, or email, although it will be more difficult to have an in-depth discussion and exploration of the implementation with a range of DHMT members or the PERFORM2Scale focal person. 

Inter-district meetings

The three DHMTs in the District Group will come together in an inter-district meeting. This will be held on a quarterly basis in one of the three districts or an alternative convenient location.

The main purpose of this meeting is for DHMTs to share progress and learning about implementation of the strategies, how they have solved any problems, and any effects of the strategies. The key aspect of this meeting is bringing the districts together and helping them learn from each other. This will be increasingly important for subsequent MSI cycles that will have less external facilitation. DHMTs are often quite competitive with each other, and this kind of meeting, if handled well, should stimulate DHMTs to critically look at what they are doing as well as look at what other DHMTs are doing. Here are some tools that will with facilitate these meetings:

+++ These meetings can be a very important part of the MSI process and an opportunity to give the DHMTs more ownership of the MSI process. +++

+++ If there are common problems across the three districts, you could organise a relevant external speaker, +++
for example, to provide orientation on the new governmental performance appraisal tool.   

Moving into MSI Cycle 2 and beyond

The DHMT now moves into MSI Cycle 2 (see Figure 2). This may be in line with the district’s regular – usually annual – planning cycle. Learning from the Observation and Reflection stages will inform what the DHMT does in the next MSI cycle. Options include:

  • Continue to implement, observe and reflect on the strategies as they have been effective 
  • Adapt the strategies and move into MSI Cycle 2 with the same problem
  • Select another problem identified in the situation analysis to address in MSI cycle 2 

+++ The transition process to the next cycle can be adapted in numerous ways. +++
In some instances, the next cycle was started at the end of the second inter-district meeting, but make sure that you allocate enough time for this.
If the same problem is being carried forward to the next cycle, one workshop to review the problem analysis and redesign the workplan may suffice.
However, it is important to consider the needs of all three districts in the group. There seems to be a great benefit in keeping the district group together.