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Experiences from PERFORM
Comfort Mshelia
Nuffield Centre for International Health and Development,
University of Leeds
Twi...
 Introduction to PERFORM- background,
timeline, partners and study rationale
 What we did- study design and approach,
ac...
 In Sub-Saharan settings there are too few
health workers. The existing workforce could
be better utilised
 Supporting d...
Initial
Situation
Analysis
Jun-Aug
2012
National
workshop 1
Initial
problem
analysis
Oct 2012
National
workshop 2
Developm...
 School of Public Health, University of Ghana
 Institute of Development Studies, University of
Dar-es-Salaam, Tanzania
...
 Insufficient number of health workers
Health
worker
density
Country
Ghana
(2008)
Tanzania
(2006)
Uganda
(2005)
Ireland
(...
 Poor performance of existing staff
Country
Ghana Tanzania Uganda Ireland
Health
worker
Reach
index*
0.523 0.432 0.377 0....
 Help District Health Management Teams to
think strategically and to be entrepreneurial
within their resource and authori...
Plan
Act
Observe
Reflect
European partners
support Country
Research Teams
Country Research Teams
support District Health
Management Teams
District ...
Kabarole District (Uganda), 2013
National workshop (Ghana), Feb 2013
Country Research Team and District Health Management Teams meeting (Ghana)
March 2013
Country Research Team and European Partners visit a District Health
Management Team in Ghana
 Focus group
discussion
 Patient survey
 In-depth
interviews
 Follow up visits by
Country Research
Teams
 Diaries kept by
District Health
Management Teams
 Bringing District
Health...
 PERFORM used action research in nine study
sites
 Each district had their unique problems,
interventions, and context
...
 Deciding on how to record the processes,
reflection, and learning required significant
dialogue among partners
 Researc...
 We used diaries which were filled in by the
District Health Management Team members
 It was most difficult for the Dist...
 The District Health Management Team were
not familiar with action research
◦ It took some time before they assumed owner...
 Should the co-researchers (District Health
Management Teams) be paid for participating
(and held responsible)?
 Should ...
C.Mshelia@leeds.ac.uk
http://www.performconsortium.com/
What can we learn from using action research to strengthen district health management in African countries?
What can we learn from using action research to strengthen district health management in African countries?
What can we learn from using action research to strengthen district health management in African countries?
What can we learn from using action research to strengthen district health management in African countries?
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What can we learn from using action research to strengthen district health management in African countries?

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Presentation given by Comfort Mshelia at the 5th Action Research Colloquium University College, Dublin. 18-19 June, 2015
http://www.argi.nmhs.ucd.ie/activity.html

Published in: Health & Medicine
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What can we learn from using action research to strengthen district health management in African countries?

  1. 1. Experiences from PERFORM Comfort Mshelia Nuffield Centre for International Health and Development, University of Leeds Twitter: @PERFORMtug Website: www.performconsortium.com
  2. 2.  Introduction to PERFORM- background, timeline, partners and study rationale  What we did- study design and approach, action research cycle  Challenges we faced- and how we tried to manage them
  3. 3.  In Sub-Saharan settings there are too few health workers. The existing workforce could be better utilised  Supporting decentralised management to improve health workforce performance in Ghana, Uganda and Tanzania  Four year project funded by the FP7 program of the European Commission  Ghana, Tanzania and Uganda  Three districts in each country
  4. 4. Initial Situation Analysis Jun-Aug 2012 National workshop 1 Initial problem analysis Oct 2012 National workshop 2 Development of HR/HS bundles Feb 2013 Final Situation Analysis Sep 2014 Implementation of bundles Mar 2013 – Aug 2014
  5. 5.  School of Public Health, University of Ghana  Institute of Development Studies, University of Dar-es-Salaam, Tanzania  School of Public Health, College of Health Sciences, Makerere, Uganda  Swiss Tropical and Public Health Institute  Nuffield Centre for International Health and Development, University of Leeds, UK  Liverpool School of Tropical Medicine, UK
  6. 6.  Insufficient number of health workers Health worker density Country Ghana (2008) Tanzania (2006) Uganda (2005) Ireland (2008) Physicians/ 1000 0.11 0.01 0.12 3.08 Nurse, midwife/1000 0.97 0.24 1.31 15.89 Source: World Health Organization statistics database (http://knoema.com/WHOSDB/world-health-organization-statistics- database?Category=1000010-human-resources-for-health&Location=1000740- ghana)
  7. 7.  Poor performance of existing staff Country Ghana Tanzania Uganda Ireland Health worker Reach index* 0.523 0.432 0.377 0.957 *The Health Workers Reach Index is an additive index which includes three indicators: 1) a measure of health worker density, 2) DPT3 immunisation rate and 3) skilled birth attendance rate. (http://www.savethechildren.org.uk/sites/default/files/docs/HealthWorkerIndexmain_4. pdf)
  8. 8.  Help District Health Management Teams to think strategically and to be entrepreneurial within their resource and authority constraints  Improve health workforce performance in the districts
  9. 9. Plan Act Observe Reflect
  10. 10. European partners support Country Research Teams Country Research Teams support District Health Management Teams District Health Management Teams conduct action research
  11. 11. Kabarole District (Uganda), 2013
  12. 12. National workshop (Ghana), Feb 2013
  13. 13. Country Research Team and District Health Management Teams meeting (Ghana) March 2013
  14. 14. Country Research Team and European Partners visit a District Health Management Team in Ghana
  15. 15.  Focus group discussion  Patient survey  In-depth interviews
  16. 16.  Follow up visits by Country Research Teams  Diaries kept by District Health Management Teams  Bringing District Health Management Teams together in workshops
  17. 17.  PERFORM used action research in nine study sites  Each district had their unique problems, interventions, and context  This made it very complicated to go through the action research cycle as timing of events in the districts were not synchronized  Comparative analysis also very complex
  18. 18.  Deciding on how to record the processes, reflection, and learning required significant dialogue among partners  Researchers did not consult District Health Management Team on how action research should be implemented and how processes and reflection should be recorded
  19. 19.  We used diaries which were filled in by the District Health Management Team members  It was most difficult for the District Health Management Team to record their reflections  ‘As a group, (the District Health Management Team) may have had a meeting and discussed a few things then, on reflection, taken some decisions… but then when we go into their diaries, nothing shows. We realised that the diaries were only capturing major activities and training’ [Country Research Team member].
  20. 20.  The District Health Management Team were not familiar with action research ◦ It took some time before they assumed ownership of the project  Frequent visits to the districts and other methods (e.g. telephone calls, emails) were used to provide guidance and support
  21. 21.  Should the co-researchers (District Health Management Teams) be paid for participating (and held responsible)?  Should there be a dedicated researcher in each site?  What can be done to encourage reflection?  What is the best way to record processes, reflection and learning in action research projects?
  22. 22. C.Mshelia@leeds.ac.uk http://www.performconsortium.com/

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