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Improving health workforce performance
through better management in Ghana,
Tanzania and Uganda: overview of the
PERFORM pr...
Rationale for PERFORM initiative
• Need to improve workforce performance to support UHC
• Integrated HR and health systems...
Partners
• School of Public Health, University of Ghana
• Institute of Development Studies, University of Dar-
es-salaam, ...
Purpose of the PERFORM project
To conduct comparative analyses across districts and
countries of:
1. the management streng...
Study design
Plan
Act
Observe
Reflect
Timeline
Situation
Analysis
Jun-Aug
2012
National
workshop 1
Initial
problem
analysis
Oct 2012
National
workshop 2
Develop...
Key features of PERFORM approach
Management competencies
Root cause analysis
“Bundles” of human resource/health systems
st...
Management competencies promoted in
PERFORM
Management competencies Development strategies
Identification of root causes o...
Root cause analysis
Source document for developing HR strategies
strategies
Source: District Health Management Team Methods Manual
Example of bundle of strategies
Problem identified HR/HS Bundle to
address the problem
Activities
Poor implementation of
n...
Reflective diaries
General key messages from PERFORM
• Managers were able to develop appropriate integrated
HR/HS strategies based on root ca...
Selected lessons from PERFORM from
partner countries
Ghana
• “But with the coming of
PERFORM they made us aware
that even ...
Experience of PERFORM in Ghana
• Link to video:
https://www.youtube.com/watch?v=YzQIsO8ubF8
Global Research Uptake activities for PERFORM
• Compendium of materials to support PERFORM
approach (for use or adaptation...
Website: www.performconsortium.com
PERFORM on twitter - @PERFORMtug
Plans for building on PERFORM in Tanzania
• Develop a concept paper how to train trainers and upscale the PERFORM approach...
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Perform overview given at Uganda meeting August 2015

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Presentation for Ugandan stakeholders on our approach in PERFORM.

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Perform overview given at Uganda meeting August 2015

  1. 1. Improving health workforce performance through better management in Ghana, Tanzania and Uganda: overview of the PERFORM project Tim Martineau, Liverpool School of Tropical Medicine, UK Serena Hotel, Kampala 21 August 2015 #healthworkers
  2. 2. Rationale for PERFORM initiative • Need to improve workforce performance to support UHC • Integrated HR and health systems approach required • District level managers in decentralised contexts in better position to organise integrated approach and have sufficient “decision space” • Working in teams - better learning and retention of lessons • Challenge to help DHMT to think strategically and to be “entrepreneurial” within their resource and authority constraints. • DHMT strengthening not new, but little research
  3. 3. Partners • 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
  4. 4. Purpose of the PERFORM project To conduct comparative analyses across districts and countries of: 1. the management strengthening intervention (using action research) to support improved workforce performance, and 2. processes of implementing the integrated HR and health systems strategies and intended and unintended effects on health workforce performance and the wider health system.
  5. 5. Study design Plan Act Observe Reflect
  6. 6. Timeline Situation Analysis Jun-Aug 2012 National workshop 1 Initial problem analysis Oct 2012 National workshop 2 Development of HR/HS bundles Feb 2013 Evaluation Sep 2014 Implementation of bundles; observation and reflection Mar 2013 – Aug 2014
  7. 7. Key features of PERFORM approach Management competencies Root cause analysis “Bundles” of human resource/health systems strategies Diaries – for reflection Funding of bundles of strategies Roles of researchers – research + facilitator
  8. 8. Management competencies promoted in PERFORM Management competencies Development strategies Identification of root causes of problems SA, NW1, NW2, follow-on activities Prioritisation of problems SA, NW1, NW2, follow-on activities Options appraisal SA, NW1, NW2, follow-on activities Designing integrated HRM and health systems strategies appropriate to context NW1 – introduction; NW2; follow-on activities Resourcing NW2; follow-on activities Following through the implementation to overcome barriers follow-on activities (diaries, CRT visits and inter-district meetings)
  9. 9. Root cause analysis
  10. 10. Source document for developing HR strategies strategies Source: District Health Management Team Methods Manual
  11. 11. Example of bundle of strategies Problem identified HR/HS Bundle to address the problem Activities Poor implementation of new vaccine vaccination schedule leading to high dropout rate of pneumococcal (46.9%) and rotarix (19.1%) vaccination in the municipality - Improve data management at all levels; - Improve supportive supervision to sub- district as planned; - Reward (Certificate and material) best performing facilities (drop rate of PCV & Rota 10% & below) Train and retrain all staff including DHA on new vaccine (EPI) Conduct monthly data validation per facility by comparing tally books Enforce use of separate log books for drop-in & drop-out Train all staff on logistics management Obtain standard EPI supportive Supervision Checklist from DDPH/RHA Discuss checklist with sub-district staff Input from sub-district staff effected and final checklist circulated to all facilities On-site supportive supervision in general but EPI in particular (2 visits per facility per year) Hold quarterly meetings to review performance & share best practices Prepare and cascade a league table for measuring performance for awards of sub-district vaccination Award prize to best performing health facilities Kwahu West district, Ghana
  12. 12. Reflective diaries
  13. 13. General key messages from PERFORM • Managers were able to develop appropriate integrated HR/HS strategies based on root cause analysis • The process encouraged/strengthened team work • The approach created space for observation and reflection • Lack of project funds not necessarily a barrier to workforce improvement, but need to manage expectations • Action research seems an appropriate way to strengthen management in this context, but ‘reflection’ seemed a weak point
  14. 14. Selected lessons from PERFORM from partner countries Ghana • “But with the coming of PERFORM they made us aware that even when there are no funds something can be done and it is important to monitor and strategise on progress.” (DHMT member) • Supportive supervision enhanced the performance of community health officers. • PERFORM helped catalyse a more participatory approach. Tanzania • “Before we used to wait a long time for change, but the AR cycle has shown us that we can push change.” (Health Manager) • The quality of supervision improved with a new focus on mentoring rather than inspection. • Managers realised that they could have achieved more by collaborating with other partners.
  15. 15. Experience of PERFORM in Ghana • Link to video: https://www.youtube.com/watch?v=YzQIsO8ubF8
  16. 16. Global Research Uptake activities for PERFORM • Compendium of materials to support PERFORM approach (for use or adaptation) • Teaching materials, including case studies • Dialogue with WHO, GHWA and other global bodies • Blogs • Publications • Conference presentations (available on SlideShare) Also …
  17. 17. Website: www.performconsortium.com
  18. 18. PERFORM on twitter - @PERFORMtug
  19. 19. Plans for building on PERFORM in Tanzania • Develop a concept paper how to train trainers and upscale the PERFORM approach to other districts in Tanzania. • Proposal for exchange and learning between districts teams should be facilitated in each country through Face to Face (F2F) meetings and online exchanges and also include the sharing of experiences between countries. • Key issues for further discussion with Ministry of Health: – How can the Bundle approach address challenges of service delivery in different areas? – How can the action research method be used as method to strengthen Quality Improvement (QI) teams in health facilities? – How can Diaries be used as management tool to record activities and promote reflection in the district teams? – How can district leadership issues be addressed to strengthen governance and performance in the district? – What can be done to address the late disbursement of annual district funds which affects the performance of districts? – How can ad hoc activities of CHMTs be avoided or managed in a productive way? Source: Tanzania PERFORM dissemination meeting, Iringa, 19 August 2015

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