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PERFORM study and findings in
Tanzania
PERFORM Researchers
Institute of Development Studies
University of Dar es Salaam, T...
Aim and objectives of PERFORM study
• Overall aim:
– To identify ways of strengthening decentralised management to
address...
Selection of the Study Districts
• The Country Research Team (CRT) consulted the Coordinator of
District Health Services i...
Selection of the Study Districts (Cont…..)
• Iringa has four districts
– Mufindi, Kilolo, Iringa
Rural and Iringa Urban
di...
Timeline
Initial
Situation
Analysis
Jun-Aug
2012
National
workshop 1
Initial
problem
analysis
Oct 2012
National
workshop 2...
National Workshops
National workshop ONE in
Iringa
19-20 October 2012
National workshop TWO at
Makambako
25-27 February 20...
CRT support to CHMTs
• Identification of bundles and
development of strategies to
improve health workforce
performance.
• ...
CRT support to CHMTs cont...
• Review meetings were
scheduled for every four
months during year 1 and
every six months in ...
CRT support to CHMTs cont...
• The CHMT members also
shared their experiences
too and gained support in
relation to the de...
Benefits & unintended effects
Effects on management strengthening
• Improved teamwork among CHMT members (all)
• Improved...
Benefits & unintended effects cont...
Effects on improving HW Performance
• Staff skills led to better services (Iringa, ...
Key Challenges
• Late disbursement of funds from the central
government affected implementation of the bundles
(all)
• Ad ...
Key recommendations
• Involving key decision makers (national and regional)
from the early stages of the project implement...
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PERFORM study findings in Tanzania

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How did the action research process strengthen health systems in Tanzania? You can read more about it on our website http://www.performconsortium.com/ or follow us on Twitter https://twitter.com/PERFORMtug

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PERFORM study findings in Tanzania

  1. 1. PERFORM study and findings in Tanzania PERFORM Researchers Institute of Development Studies University of Dar es Salaam, Tanzania
  2. 2. Aim and objectives of PERFORM study • Overall aim: – To identify ways of strengthening decentralised management to address health workforce inadequacies in order to improve health workforce performance in sub-Saharan Africa • Objectives: – To support health managers to carry out a situation analysis on the health workforce performance, in the study districts – To identify areas of health workforce performance to be improved – To support health managers to design & implement integrated Human Resources (HR) and Health Systems (HS) strategies to improve health workforce performance – To monitor implementation of the strategies and evaluate the impact on health workforce performance, and the wider health system.
  3. 3. Selection of the Study Districts • The Country Research Team (CRT) consulted the Coordinator of District Health Services in the Ministry of Health & Social Welfare (MoHSW), who was a member of the Country Research Advisory Group (CRAG). • The Coordinator informed CRT of the MoHSW’s policy requiring any health intervention introduced in any region of Tanzania to cover the whole region and a few districts as originally planned in the PERFORM research design. • The CRT consulted the higher MoHSW authorities (Chief Medical Officer) who insisted on the project to cover the whole region. • Iringa region was ultimately selected because of the accessibility advantage over the other qualified regions.
  4. 4. Selection of the Study Districts (Cont…..) • Iringa has four districts – Mufindi, Kilolo, Iringa Rural and Iringa Urban districts. • Iringa Rural though had typical rural characteristics like Kilolo district was not included because it is adjacent to Iringa Urban district
  5. 5. Timeline 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
  6. 6. National Workshops National workshop ONE in Iringa 19-20 October 2012 National workshop TWO at Makambako 25-27 February 2013 The CRT, CHMTs for Kilolo, Iringa Urban and Mufindi districts and the RHMT for Iringa Region attended the workshop • Received and commented on the findings of the situation analysis Started thinking about formulating strategies to address the identified health workforce performance problems. The CRT, CHMTs for Kilolo, Iringa Urban and Mufindi districts and the RHMT for Iringa Region attended the workshop • Refined and finalization of the problem trees developed by the CHMTs Formulated the bundles of HR/HS strategies to address the identified health workforce performance problems in the districts
  7. 7. CRT support to CHMTs • Identification of bundles and development of strategies to improve health workforce performance. • Guidance to the CHMTs on how to link the problems identified in their districts with suitable strategies and activities under each strategy. • Use of diary to record implementation of the bundles. • During the implementation of the bundles, supportive visits to the district took place every two months in the first year and every one month in year 4. CHMTs in Iringa Urban identifying HR/HS bundles
  8. 8. CRT support to CHMTs cont... • Review meetings were scheduled for every four months during year 1 and every six months in year 2. • Review meetings provided opportunities for the CHMT members to share their experiences in the implementation of bundles and learning from other districts. CRT, EU partner, CHMT & RHMT members during inter-district review meeting
  9. 9. CRT support to CHMTs cont... • The CHMT members also shared their experiences too and gained support in relation to the design of bundles from the Regional Health Management Team (RHMT). • Additional support was provided by the CRT to the CHMT via phone and emails CRT members facilitating inter-district review meeting
  10. 10. Benefits & unintended effects Effects on management strengthening • Improved teamwork among CHMT members (all) • Improved participatory decisions among CHMT members (Kilolo, Mufindi) • Improved practices for problem analyses (all) • Increased frequency and quality of supervision (all)
  11. 11. Benefits & unintended effects cont... Effects on improving HW Performance • Staff skills led to better services (Iringa, Kilolo) • improved service quality (all) • Introduction of incentives to retain/motivate staff (Mufindi, Kilolo) Unintended Effects • Experience gained from PERFORM has trickled down to other health services areas in the Councils (Iringa and Mufindi)
  12. 12. Key Challenges • Late disbursement of funds from the central government affected implementation of the bundles (all) • Ad hoc and competing tasks facing the CHMT members (all) • Leadership problems at district level constraining implementation of bundles (Kilolo & Mufindi)
  13. 13. Key recommendations • Involving key decision makers (national and regional) from the early stages of the project implementation. • District interactions through inter-district meetings are important for networking and learning from each other • Involving lower levels of the health systems i.e. sub- district staff and community representatives • Frequent meeting between researchers and district level decision makers (CHMT) to reinforce implementation of the project

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