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Improving health workforce
performance in Ghana, Tanzania
and Uganda
Kaspar Wyss
Swiss Tropical and Public Health Institute
Contents
• Introduction to PERFORM
• Partners in the project
• Key messages
• Study countries
• Action research and how it...
What is PERFORM?
Project
Timescale
Funder
Start September 2011
Ends August 2015
4 year programme
Focus: improving health
w...
Who are our partners?
PERFORM
Consortium
Ghana
Leeds
Liverpool
Switzerland
Tanzania
Uganda
College of Health
Sciences, Sch...
Key messages
• Shortage of well performing health workers
• Deficit needs to be addressed both by training
more new person...
Study countries
• Ghana, Tanzania, Uganda – each face major
challenges in developing their health
workforce
• Selected fro...
Ghana: health status profile
• Life expectancy: 60 years (2007, World Bank)
• Maternal Mortality Rate: range from 214 (199...
Study districts in Ghana
Medical workers in health facilities: Diocese of Gaoso, Ghana
• Kwahu West
• Akwapim North
• Uppe...
Challenges: Ghana health sector
• Retaining health professionals
• Improving health worker retention in rural areas
– Two ...
Factors affecting workforce performance
Concept 1
• Availability of health personnel
• Utilisation of health personnel
Con...
Our research approach
• A systems approach to human resource
management using a coordinated set of
strategies to improve p...
What is Action Research?
Definition:
“Action research is a period of inquiry
that describes, interprets and explains socia...
How does it work in practice?
Plan
Act
Observe
Reflect
• Supported by PERFORM
Researchers – the DHMTs will
identify barrie...
Situation Analysis
This will be a two step process:
• Step 1: collect and analyse routine data such as
staffing and health...
Development of HR/HS bundles
• Using the situation analysis to design strategies to
address the problems
• These strategie...
Project phases
Phase one
Phase two
Phase
three
Preparation for implementation
Research implementation
Evaluation and feedb...
Timeline
Phases 2 and 3: June 2012 – Dec 2014
Initial
Situation
Analysis
Jun-Aug 2012
National
workshop 1
Oct 2012
Develop...
Roles of partners and DHMTs
• Researchers
– To provide support to the DHMTs
– To conduct the situation analysis
– To hold ...
Outcomes and impact
Impact: improved health in Sub-Saharan
Africa as a result of a responsive, effective
and well equipped...
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Introduction to PERFORM

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This presentation provides an overview of what we set out to do in the project.

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Introduction to PERFORM

  1. 1. Improving health workforce performance in Ghana, Tanzania and Uganda Kaspar Wyss Swiss Tropical and Public Health Institute
  2. 2. Contents • Introduction to PERFORM • Partners in the project • Key messages • Study countries • Action research and how it works in practice • Project stages and timeline • Outcomes and impact
  3. 3. What is PERFORM? Project Timescale Funder Start September 2011 Ends August 2015 4 year programme Focus: improving health workforce performance European Union (EU) Aim To understand how management strengthening can improve workforce performance
  4. 4. Who are our partners? PERFORM Consortium Ghana Leeds Liverpool Switzerland Tanzania Uganda College of Health Sciences, School of Public Health, Makerere University International Health Group, Liverpool School of Tropical Medicine School of Public Health, University of Ghana Nuffield Centre for International Health and Development, University of Leeds Institute of Development Studies, University of Dar-es- Salaam Swiss Tropical and Public Health Institute
  5. 5. Key messages • Shortage of well performing health workers • Deficit needs to be addressed both by training more new personnel and improving performance of the existing workforce • Complex factors affect workforce performance • Decentralisation of planning and management authority
  6. 6. Study countries • Ghana, Tanzania, Uganda – each face major challenges in developing their health workforce • Selected from 57 World Health Organisation (WHO) states that do not meet a minimum ratio of 2.3 key health workers per 1000 population • Decentralised structures offer DHMTs greater decision-making opportunities
  7. 7. Ghana: health status profile • Life expectancy: 60 years (2007, World Bank) • Maternal Mortality Rate: range from 214 (1999, WHO) to 586 (2001, Hill) per 100,000 live births • Under five mortality rate: improved over last ten years to 80 per 1000 live births • Top 5 causes of mortality and morbidity: – Malaria – Acute Respiratory Infections – Skin Diseases and Ulcers – Diarrhoea Diseases – Hypertension Source: Ghana Human Resources for Health Country Profile, Edition 2011
  8. 8. Study districts in Ghana Medical workers in health facilities: Diocese of Gaoso, Ghana • Kwahu West • Akwapim North • Upper Manya Krobo
  9. 9. Challenges: Ghana health sector • Retaining health professionals • Improving health worker retention in rural areas – Two teaching hospitals Korle Bu and Komfo Anokye employ more than 45% of the country’s Drs – Less than 15% are present in district hospitals • Addressing the shortage of trained midwives • Strengthening capacity of existing workforce • Developing the appropriate human resources in their right mix and numbers in order to meet the health needs of the people in Ghana Source: Ghana Human Resources for Health Country Profile, Edition 2011
  10. 10. Factors affecting workforce performance Concept 1 • Availability of health personnel • Utilisation of health personnel Concept 2 • Retention – attrition, turnover rate • Distribution – vacancy rates by cadre, geographic location, facility type • Effectiveness – Skills mix, levels of absence, quantity of work output, quality of work output
  11. 11. Our research approach • A systems approach to human resource management using a coordinated set of strategies to improve performance • A health systems approach which views HR alongside other related factors e.g. Finance, Drugs, Equipment • Action research methodology as the intervention for strengthening management at district level
  12. 12. What is Action Research? Definition: “Action research is a period of inquiry that describes, interprets and explains social situations while executing a change intervention aimed at improvement and involvement. It is problem focused, context- specific and future-oriented.”
  13. 13. How does it work in practice? Plan Act Observe Reflect • Supported by PERFORM Researchers – the DHMTs will identify barriers to workforce performance and their causes (situation analysis) and then: • Plan bundles of HR and health systems strategies • Act to implement these strategies • Observe the impact of the strategies on performance • Reflect on how well their plans have been achieved and if necessary, revise the plan
  14. 14. Situation Analysis This will be a two step process: • Step 1: collect and analyse routine data such as staffing and health service data using a standard form for all study sites • Step 2: focus on collecting data to understand the causes of particular issues or problems emerging in step 1. After reviewing the findings, DHMTs will develop clear problem statements related to health workforce performance.
  15. 15. Development of HR/HS bundles • Using the situation analysis to design strategies to address the problems • These strategies (known as bundles) will be a mixture of: – Human resource (HR) strategies – e.g. developing skills through a training workshop – Broad health systems (HS) strategies – e.g. repairing equipment so health workers can do better work • In each district, the DHMT will select the HR / HS bundles • Then develop a plan of how to implement the bundles and monitor their effects.
  16. 16. Project phases Phase one Phase two Phase three Preparation for implementation Research implementation Evaluation and feedback
  17. 17. Timeline Phases 2 and 3: June 2012 – Dec 2014 Initial Situation Analysis Jun-Aug 2012 National workshop 1 Oct 2012 Development of HR/HS bundles Jan 2013 Consortium workshop 2 Nov 2012 Implementation of bundles Jan 2013 – Aug 2014 National workshop 3 Dec 2014 Final Situation Analysis Aug-Oct 2014 Consortium workshop 3 Jan 2014
  18. 18. Roles of partners and DHMTs • Researchers – To provide support to the DHMTs – To conduct the situation analysis – To hold the national review meetings – To develop the research methodology – To manage the research project • DHMTs – To implement the action research process – To actively participate in the research – To collaborate with the researchers in the situation analysis
  19. 19. Outcomes and impact Impact: improved health in Sub-Saharan Africa as a result of a responsive, effective and well equipped health service, provided by skilled health workers Outcome: research evidence contributes to knowledge of how strengthening management in Sub-Saharan Africa can improve workforce performance and the wider health system

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