PERFORM –
Overview, design and methods
Reinhard Huss, Comfort Mshelia, Tolib Mirzoev
LIHS/ Nuffield Centre
University of L...
Outline
• Introduction: What is
PERFORM? Partners,
timeline, key background
information
• Study Design:
Objectives, What i...
Project
Timescale
Funder
Start September 2011
Ends August 2015
4 year programme
Focus: improving health
workforce performa...
Partners
• School of Public Health, University of Ghana, Ghana
• Institute of Development Studies, University of Dar-es-
S...
Key background information
• Global shortage of health workers
• Deficit can be addressed by:
– training more new personne...
Study design
Objectives of PERFORM
• Use Action Research to:
– Help Council Health Management Teams (CHMTs)
to think strategically, to ...
Our approach
• Systems perspective to human resource
management using a coordinated set of
strategies to improve performan...
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 CHMTs
identify barriers to...
Research concept
Plan
Act
Observe
Reflect
European partners support
Country Research Teams
Country Research Teams support
Council Health Management
Teams
Council He...
What we did?
Project phases
Phase one
Phase two
Phase
three
Preparation
Implementation
Evaluation and feedback
Timeline
Phase 2 : June 2012 – Dec 2014
Initial
Situation
Analysis
Jun-Aug 2012
National
workshop 1:
Problem
analysis
Oct ...
Part 1: Entry - Initial Situation
Analysis
• Engagement
• Initial data collection- using qualitative and
quantitative meth...
Part 2: Plan- Development of HR/HS
strategies
• Used the situation analysis to design strategies
to address the problems
•...
Part 3: Act - Implementation of
Human Resource/Health System
bundles
• Check HR/HS bundles against specific criteria
(feas...
Part 4: Observe - Measure changes
during and after implementation
• Focus group discussion
• Patient survey
• In-depth int...
Part 5: Reflect - Supporting
knowledge generation and learning
• Follow up visits by Country Research Teams
• Diaries kept...
Part 6: Comparative analysis
Conduct comparative analyses across districts
and countries of:
– The management strengthenin...
Reflections on the PERFORM
approach
• Time availability of CHMT members
• Engagement
• Relevance
• Ownership and sustainab...
R.Huss@leeds.ac.uk
http://www.performconsortium.com/
For further information
Tanzania dissemination meeting presentation on action research
Tanzania dissemination meeting presentation on action research
Tanzania dissemination meeting presentation on action research
Tanzania dissemination meeting presentation on action research
Tanzania dissemination meeting presentation on action research
Tanzania dissemination meeting presentation on action research
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Tanzania dissemination meeting presentation on action research

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This presentation was given in August 2015 at our Tanzania stakeholder meeting

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  • Liverpool initial design workshop with reminder in the toilet
  • Add comments
    Time availability of DHMT members
    Engagement
    Relevance
    Ownership
    Changes in use of decision space
    Transferability of the process to other districts or other parts of management or links to other initiatives e.g. UNICEF bottleneck approach
  • Tanzania dissemination meeting presentation on action research

    1. 1. PERFORM – Overview, design and methods Reinhard Huss, Comfort Mshelia, Tolib Mirzoev LIHS/ Nuffield Centre University of Leeds United Kingdom
    2. 2. Outline • Introduction: What is PERFORM? Partners, timeline, key background information • Study Design: Objectives, What is action research? • Implementation: Phases in the project, comparative analysis
    3. 3. Project Timescale Funder Start September 2011 Ends August 2015 4 year programme Focus: improving health workforce performance European Union (EU) Aim To understand how district management strengthening can improve workforce performance Overview
    4. 4. Partners • School of Public Health, University of Ghana, 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, Switzerland • Nuffield Centre for International Health and Development, University of Leeds, UK • Liverpool School of Tropical Medicine, UK
    5. 5. Key background information • Global shortage of health workers • Deficit can be addressed by: – training more new personnel; and – improving performance of the existing workforce • Many factors and their interactions affect workforce performance • Local interventions may influence performance • Opportunities available where planning and management is decentralised to district level • Action research is a local research intervention which may strengthen district management and lead to improved workforce performance
    6. 6. Study design
    7. 7. Objectives of PERFORM • Use Action Research to: – Help Council Health Management Teams (CHMTs) to think strategically, to be entrepreneurial within their resource and authority constraints and to learn about their interventions • Develop strategies aimed at: – Improving health workforce performance and ultimately service delivery in the district
    8. 8. Our approach • Systems perspective to human resource management using a coordinated set of strategies to improve performance • Health systems thinking which considers Human Resources (HR) alongside other related health system (HS) factors: Finance, Medicines, Equipment, Information, Governance • Action research methodology as the intervention for strengthening management at district level
    9. 9. 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.”
    10. 10. How does it work in practice? Plan Act Observe Reflect • Supported by PERFORM Researchers – the CHMTs identify barriers to workforce performance and their causes (situation analysis) and then: • Plan bundles of HR and HS 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
    11. 11. Research concept Plan Act Observe Reflect
    12. 12. European partners support Country Research Teams Country Research Teams support Council Health Management Teams Council Health Management Teams conduct action research Nested action research approach
    13. 13. What we did?
    14. 14. Project phases Phase one Phase two Phase three Preparation Implementation Evaluation and feedback
    15. 15. Timeline Phase 2 : June 2012 – Dec 2014 Initial Situation Analysis Jun-Aug 2012 National workshop 1: Problem analysis Oct 2012 National Workshop 2: Development of HR/HS bundles Jan 2013 Consortium workshop 2 Nov 2012 Implementation of bundles Jan 2013 – Aug 2014 National workshop 3: Comparative analysis Dec 2014 Final Situation Analysis Aug-Oct 2014 Consortium workshop 3 Jan 2014
    16. 16. Part 1: Entry - Initial Situation Analysis • Engagement • Initial data collection- using qualitative and quantitative methods • Problem identification and analysis • National workshop 1 – October ‘12 • Consortium workshop 2 to review and plan – November ’12)
    17. 17. Part 2: Plan- Development of HR/HS strategies • Used the situation analysis to design strategies to address the problems • Strategies (known as bundles) were a mixture of: – Human resource (HR) strategies – e.g. developing skills through a training workshop – Health systems (HS) strategies – e.g. repairing equipment so health workers can do better work • CHMT selected the HR / HS bundles and developed a plan of how to implement the bundlesand monitor their effects.
    18. 18. Part 3: Act - Implementation of Human Resource/Health System bundles • Check HR/HS bundles against specific criteria (feasibility, cost, time, other+) • Incorporate into routine district plans (CCHPs)
    19. 19. Part 4: Observe - Measure changes during and after implementation • Focus group discussion • Patient survey • In-depth interviews • HMIS data
    20. 20. Part 5: Reflect - Supporting knowledge generation and learning • Follow up visits by Country Research Teams • Diaries kept by CHMTs • Bringing CHMTs together in workshops
    21. 21. Part 6: Comparative analysis Conduct comparative analyses across districts and countries of: – The management strengthening intervention (using action research) to support improved workforce performance, and – Processes of implementing the integrated HR and HS strategies (bundles) and intended and unintended effects on health workforce performance and the wider health system.
    22. 22. Reflections on the PERFORM approach • Time availability of CHMT members • Engagement • Relevance • Ownership and sustainability in the districts • Changes in use of decision space • Availability and use of quantitative data in AR • Transferability of the process to other districts or other parts of management
    23. 23. R.Huss@leeds.ac.uk http://www.performconsortium.com/ For further information

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