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Uganda study: methods and key findings
Saul Kamukama, MUSPH
Serena Hotel, Kampala
21 August 2015
#healthworkers
PERFORM project in Uganda
• Investigates how a
management
strengthening intervention
(action research) can be
used to impr...
Initial situation analysis
• Research team with
DHMTs conducted
situation analysis on
workforce
performance in the
distric...
Initial problem identification and prioritisation
Kabarole DHMT, NW1 Oct ‘12
Examples of problems identified
District Key problems
Kabarole 1. Weak leadership and management of team leaders
2. Weak s...
Examples of problems identified
District Key problems
Kabarole 1. Weak leadership and management of team leaders
2. Weak s...
Problem analysis (root causes)
• Developed list of
workforce problems
• Prioritized problems
• Workshops to do in
depth pr...
Plan: Development of “bundles” of
strategies
• Workshop to support
development of
bundles
• Integrated into
district work ...
Example of bundle (Kabarole and Jinja)
Supporting incorporation into district plans
Kabarole DHMT, NW2, Feb ‘13
Act: Implementation of workplan
• Kabarole DHMT was entrepreneurial: received
funding for orientation of newly recruited s...
Observation and reflection of bundles
Adapting the strategies during
implementation…
Kabarole DHMT identified a problem with the capacity
of new supervisors to ...
Evaluation
• FGDs and IDIs to explore perceptions of DHMT, sub-
district managers, health staff and relevant
stakeholders ...
Effects on management strengthening
• Improved team work
• In-depth problem analysis - root causes
• Integrated planning, ...
Effects on health workforce performance
• Better supervision of
staff
• Reductions in
absenteeism
• More staff appraised
•...
Key messages
• The management strengthening approach appears to be
acceptable, effective and viable at district level.
• T...
Acknowledgements
Funding from the European Commission
Seventh Framework programme
Ministry of Health
District health manag...
Contact details for further dialogue
• Project PI: tim.martineau@lstmed.ac.uk
• Uganda team PI: sbaine@musph.ac.ug
• Proje...
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Findings from the Uganda PERFORM study

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Presentation of the findings from Uganda given to stakeholders in August 2015

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Findings from the Uganda PERFORM study

  1. 1. Uganda study: methods and key findings Saul Kamukama, MUSPH Serena Hotel, Kampala 21 August 2015 #healthworkers
  2. 2. PERFORM project in Uganda • Investigates how a management strengthening intervention (action research) can be used to improve health workforce performance
  3. 3. Initial situation analysis • Research team with DHMTs conducted situation analysis on workforce performance in the district: secondary data collection, document review, interviews and FGDs and brainstorming Health Centre IV, Kabarole district
  4. 4. Initial problem identification and prioritisation Kabarole DHMT, NW1 Oct ‘12
  5. 5. Examples of problems identified District Key problems Kabarole 1. Weak leadership and management of team leaders 2. Weak supportive supervision 3. Health workers’ poor commitment 4. Poor working environment Jinja 1. Ineffective use of the traditional control mechanisms 2. Low staff motivation 3. Inadequate supportive supervision 4. Staff training not guided by available opportunities in district Luwero 1. Lack of professionalism 2. Poor communication 3. Inadequate capacity building 4. Inadequate supplies / equipment /medicines 5. Inadequate supportive supervision
  6. 6. Examples of problems identified District Key problems Kabarole 1. Weak leadership and management of team leaders 2. Weak supportive supervision 3. Health workers’ poor commitment 4. Poor working environment Jinja 1. Ineffective use of the traditional control mechanisms 2. Low staff motivation 3. Inadequate supportive supervision 4. Staff training not guided by available opportunities in district Luwero 1. Lack of professionalism 2. Poor communication 3. Inadequate capacity building 4. Inadequate supplies / equipment /medicines 5. Inadequate supportive supervision
  7. 7. Problem analysis (root causes) • Developed list of workforce problems • Prioritized problems • Workshops to do in depth problem tree analysis (NW2) Luwero DHMT, NW2 Feb ‘13
  8. 8. Plan: Development of “bundles” of strategies • Workshop to support development of bundles • Integrated into district work plan Jinja DHMT, NW2 Feb ‘13
  9. 9. Example of bundle (Kabarole and Jinja)
  10. 10. Supporting incorporation into district plans Kabarole DHMT, NW2, Feb ‘13
  11. 11. Act: Implementation of workplan • Kabarole DHMT was entrepreneurial: received funding for orientation of newly recruited staff from private sector • Jinja DHMT: adapted supervision tools, developed plan for supervision visits, focused on support and solving problems • Luwero DHMT: introduced duty rosters and attendance books at facilities; spot checks of facilities
  12. 12. Observation and reflection of bundles
  13. 13. Adapting the strategies during implementation… Kabarole DHMT identified a problem with the capacity of new supervisors to provide good quality supervision and so identified and trained mentors to support each supervisor “In the beginning some members did not understand the mentorship well. But after the discussions all members were in agreement and welcomed the mentorship idea” (Diary, 12/5/13).
  14. 14. Evaluation • FGDs and IDIs to explore perceptions of DHMT, sub- district managers, health staff and relevant stakeholders and the researchers themselves on management strengthening and health workforce improvement processes and changes • Document review: visit reports, diaries, workshop reports, DHMT minutes and plans were analysed
  15. 15. Effects on management strengthening • Improved team work • In-depth problem analysis - root causes • Integrated planning, resourcing and monitoring of processes and effects of plans • Entrepreneurial approaches • Address problems within existing resources • Inter-district learning
  16. 16. Effects on health workforce performance • Better supervision of staff • Reductions in absenteeism • More staff appraised • Reported increases in utilization of services Monthly supervision visit, Jinja district
  17. 17. Key messages • The management strengthening approach appears to be acceptable, effective and viable at district level. • There is now a critical mass in the DHMT with improved problem solving and planning skills and a better understanding of workforce performance problems and appropriate strategies. This momentum needs to be sustained. • Some improvements can be made without extra resources. With more resources even greater things could be achieved. • Managers have proved that they can be very resourceful when implementing their own plans. They could be encouraged to be more “entrepreneurial”. • Action research can be a powerful tool for management strengthening. Options for capitalizing on the investment made by the PERFORM are needed.
  18. 18. Acknowledgements Funding from the European Commission Seventh Framework programme Ministry of Health District health management teams in Jinja, Kabarole and Luwero districts
  19. 19. Contact details for further dialogue • Project PI: tim.martineau@lstmed.ac.uk • Uganda team PI: sbaine@musph.ac.ug • Project website: www.performconsortium.com • Twitter: @PERFORMtug

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