Background Like other developing countries, Uganda still struggles to meaningfully reduce child mortality. A strategy of giving information to communities to spark interest in improving child survival through inducing responsibility and social sanctioning in the health workforce was postulated. By focusing on diarrhea, pneumonia and malaria, a Community and District Empowerment for Scale up (CODES) undertaking used “community dialogues” to arm communities with health system performance information. This empowered them to monitor health service provision and demand for quality child-health services. Methods We describe a process of community dialoguing through use of citizen report cards, short-text-messages, media and post-dialogue monitoring. Each community dialogue assembled 70–100 members including health workers and community leaders. After each community dialogue, participants implemented activities outlined in generated community contracts. Radio messages promoted demand for child-health services and elicited support to implement accepted activities. Conclusion The perception that community dialoging is “a lot of talk” that never advances meaningful action was debunked since participant-initiated actions were conceived and implemented. Potential for use of electronic communication in real-time feedback and stimulating discussion proved viable. Post-dialogue monitoring captured in community contracts facilitated process evaluation and added plausibility for observed effects. Capacitated organizations during post-dialogue monitoring guaranteed sustainability.
Background Decentralisation has been adopted by many governments to strengthen national systems, including the health system. Decision space is used to describe the decision‐making power devolved to local government. Human resource Management (HRM) is a challenging area that District Health Management Teams (DHMT) need some control over its functions to develop innovative ways of improving health services. The study aims to examine the use of DHMTs' reported decision space for HRM functions in Uganda. Methods Mixed methods approach was used to examine the DHMTs' reported decision space for HRM functions in three districts in Uganda, which included self‐assessment questionnaires and focus group discussions (FGDs). Results The decision space available for the DHMTs varied across districts, with Bunyangabu and Ntoroko DHMTs reporting having more control than Kabarole. All DHMTs reported full control over the functions of performance management, monitoring policy implementation, forecasting staffing needs, staff deployment, and identifying capacity needs. However, they reported narrow decision space for developing job descriptions, resources mobilisation, and organising training; and no control over modifying staffing norms, setting salaries and developing an HR information system (HRIS). Nevertheless, DHMTs tried to overcome their limitations by adjusting HR policies locally, better utilising available resources and adapting the HRIS to local needs. Conclusions Decentralisation provides a critical opportunity to strengthen HRM in low‐and‐middle‐income countries. Examining decision space for HRM functions can help identify areas where district health managers can change or improve their actions. In Uganda, decentralisation helped the DHMTs be more responsive to the local workforce needs and analysing decision space helped identify areas for improvement in HRM. There are some limitations and more power over HRM functions and strong management competencies would help them become more resourceful.
<p>While Action Research (AR) in health systems is well established, there is a dearth of research about how its reflection phase is pragmatically employed with time-poor healthcare teams, especially within AR implemented in the Global South. This paper presents the findings of a nested qualitative study within PERFORM2Scale, a 5-year Health Systems AR project in Ghana, Malawi, and Uganda. It aimed to unpack the challenges, facilitators, and lessons learned <a>about enacting the reflection phase of the AR cycle with </a>district health management teams (DHMTs) implementing a management strengthening intervention (MSI). Semi-structured interviews and focus groups with district health managers and country research teams (CRTs) were conducted, and thematically analysed. Study findings indicate that pragmatic barriers such as time constraints, high staff turnover, and challenges utilizing a reflection diary impeded enaction of reflection. However, DHMTs more effectively engaged in reflection when conducted collectively and dialogically, and when the mechanism of reflection aligned with existing workplace processes and context. The findings indicate that for the reflection phase to be effective, it requires consistent engagement and focused support throughout all phase of the AR cycle and in ways which are contextually relevant, responsive, and collaborative.</p>
<p>While Action Research (AR) in health systems is well established, there is a dearth of research about how its reflection phase is pragmatically employed with time-poor healthcare teams, especially within AR implemented in the Global South. This paper presents the findings of a nested qualitative study within PERFORM2Scale, a 5-year Health Systems AR project in Ghana, Malawi, and Uganda. It aimed to unpack the challenges, facilitators, and lessons learned <a>about enacting the reflection phase of the AR cycle with </a>district health management teams (DHMTs) implementing a management strengthening intervention (MSI). Semi-structured interviews and focus groups with district health managers and country research teams (CRTs) were conducted, and thematically analysed. Study findings indicate that pragmatic barriers such as time constraints, high staff turnover, and challenges utilizing a reflection diary impeded enaction of reflection. However, DHMTs more effectively engaged in reflection when conducted collectively and dialogically, and when the mechanism of reflection aligned with existing workplace processes and context. The findings indicate that for the reflection phase to be effective, it requires consistent engagement and focused support throughout all phase of the AR cycle and in ways which are contextually relevant, responsive, and collaborative.</p>
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