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Improving health workforce performance
in Uganda: linking research and practice
through action research
Joanna Raven, Live...
Rationale for PERFORM
• Need to improve workforce performance to support Universal
Health Coverage;
• Integrated Human Res...
PERFORM project in Uganda
• Investigates how a
management
strengthening intervention
(action research) can be
used to impr...
Study design
Act
Observe
Reflect
Plan
Timeline
Initial
Situation
Analysis
Jun-Aug
2012
National
workshop 1
Initial
problem
analysis
Oct 2012
National
workshop 2...
Initial situation analysis
• Research team with
District Health
Management Teams
conducted situation
analysis on workforce...
Problem analysis
• Developed a list of
workforce problems
• Prioritized problems
• Workshop to do in-
depth problem tree
a...
Examples of problems identified
District Key problems
Kabarole 1. Weak leadership and management of team leaders
2. Weak s...
Plan: Development of strategies
• Workshop to support
development of
strategies
• Integrated into
district work plan
Jinja...
Supporting integration into district plans
Kabarole district, Uganda, Feb ‘13
Act: Implementation of strategies
• Kabarole District Health Management Team was
entrepreneurial: received funding for ind...
Observation and reflection of strategies
Adapting the strategies during implementation…
Kabarole DHMT identified a problem with the capacity
of new supervisors to ...
Final evaluation
• Focus group discussions and in-depth interviews:
explored perceptions on management strengthening
and h...
Effects on management strengthening
• Improved team work
• In-depth problem analysis - finding root causes
• Integrated pl...
Effects on health workforce performance
• Better supervision of
staff
• Reductions in
absenteeism
• More staff appraised
•...
Key messages
The PERFORM approach can:
• Improve workforce performance through
management strengthening
• Bridge the gap b...
Acknowledgements
Funding from the European Commission
Seventh Framework programme
Ministry of Health in Uganda
District he...
Contact details for further dialogue
• Project PI: tim.martineau@lstmed.ac.uk
• Project website: www.performconsortium.com...
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Improving health workforce performance in Uganda: linking research and practice through action research

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Presentation given by Joanna Raven at the 2015 International Health Conference at St Hugh's College, Oxford on the 25th - 27th June

Published in: Health & Medicine
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Improving health workforce performance in Uganda: linking research and practice through action research

  1. 1. Improving health workforce performance in Uganda: linking research and practice through action research Joanna Raven, Liverpool School of Tropical Medicine, UK Sebastian Olikira Baine, Makerere University, Uganda Saul Kamukama, Makerere University, Uganda Alvaro Alonso-Garbayo, Liverpool School of Tropical Medicine, UK Tim Martineau, Liverpool School of Tropical Medicine, UK International Health Conference 26 June, 2015 Oxford Twitter: @PERFORMtug
  2. 2. Rationale for PERFORM • Need to improve workforce performance to support Universal Health Coverage; • Integrated Human Resource and health systems approach required; • District level managers in decentralised contexts in better position to organise integrated approach, have sufficient “decision space” and can learn; • Challenge is to help District Health Management Teams to think strategically and to be entrepreneurial within their resource and authority constraints; • District Health Management Team strengthening is not new, but little research.
  3. 3. PERFORM project in Uganda • Investigates how a management strengthening intervention (action research) can be used to improve health workforce performance
  4. 4. Study design Act Observe Reflect Plan
  5. 5. Timeline Initial Situation Analysis Jun-Aug 2012 National workshop 1 Initial problem analysis Oct 2012 National workshop 2 Development of HR/HS strategies Feb 2013 Final Situation Analysis Sep 2014 Implementation of strategies Mar 2013 – Aug 2014 Act Observe Reflect Plan
  6. 6. Initial situation analysis • Research team with District Health Management Teams conducted situation analysis on workforce performance in the district: secondary data collection, document review, interviews and focus group discussions Health Centre, Jinja district, Uganda
  7. 7. Problem analysis • Developed a list of workforce problems • Prioritized problems • Workshop to do in- depth problem tree analysis Kabarole district, Uganda, Feb ‘13
  8. 8. 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
  9. 9. Plan: Development of strategies • Workshop to support development of strategies • Integrated into district work plan Jinja district, Uganda, Feb ‘13
  10. 10. Supporting integration into district plans Kabarole district, Uganda, Feb ‘13
  11. 11. Act: Implementation of strategies • Kabarole District Health Management Team was entrepreneurial: received funding for induction of newly recruited staff from private sector • Jinja District Health Management Team: adapted supervision tools, developed plan for supervision visits, focused on support and solving problems • Luwero District Health Management Team: introduced duty rosters and attendance books at facilities; spot checks of facilities
  12. 12. Observation and reflection of strategies
  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. Final evaluation • Focus group discussions and in-depth interviews: explored perceptions on management strengthening and health workforce improvement processes and changes • Document review: visit reports, diaries, workshop reports, District Health Management Team minutes and plans were analysed • Analysis of existing service delivery data
  15. 15. Effects on management strengthening • Improved team work • In-depth problem analysis - finding root causes • Integrated planning, resourcing and monitoring of processes and effects of plans • Addressed problems within existing resources • Entrepreneurial approaches • Recognised importance of data for monitoring progress and effects
  16. 16. Effects on health workforce performance • Better supervision of staff • Reductions in absenteeism • More staff appraised • Increases in utilization of services Monthly supervision visit, Jinja district
  17. 17. Key messages The PERFORM approach can: • Improve workforce performance through management strengthening • Bridge the gap between research and practice • Support sustainability and ownership through solving real problems at district level • Enable sharing of practices and learning • Promote culture of partnership • Unlock innovation
  18. 18. Acknowledgements Funding from the European Commission Seventh Framework programme Ministry of Health in Uganda District health management teams in Jinja, Kabarole and Luwero districts
  19. 19. Contact details for further dialogue • Project PI: tim.martineau@lstmed.ac.uk • Project website: www.performconsortium.com • Twitter: @performtug Many thanks for your participation

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