A descriptive study on health workforce performance after decentralisation of health services in Uganda

Abstract

BackgroundUganda, like many developing countries, is committed to achieving the Millennium Development Goals (MDGs) by 2015. However, serious challenges prove to hamper the attainment of these goals, particularly the health related MDGs. A major challenge relates to the human resources for health. The health system in Uganda was decentralised in the 1990s. Despite the health sector reforms, the services have remained significantly deficient and performance of health workers is thought to be one of the contributing factors. The purpose of this study was, therefore, to investigate the performance of health workers after decentralisation of the health services in Uganda in order to identify and suggest possible areas for improvement.MethodsA cross-sectional descriptive survey, using quantitative research methods was utilised. A structured self-administered questionnaire was used to collect quantitative data from 276 health workers in the districts of Kumi, Mbale, Sironko and Tororo in Eastern Uganda. The health workers included doctors, clinical officers, professional nurses and midwives. The sample was selected using stratified random sampling. The data was analysed using SPSS version 18.0 and included both univariate and bivariate analysis. The results were presented in tabular and text forms.ResultsThe study revealed that even though the health workers are generally responsive to the needs of their clients, the services they provide are often not timely. The health workers take initiatives to ensure that they are available for work, although low staffing levels undermine these efforts. While the study shows that the health workers are productive, over half (50.4%) of them reported that their organisations do not have indicators to measure their individual performance. The findings indicate that the health workers are skilled and competent to perform their duties. In general, the results show that health workers are proficient, adaptive, proactive and client-oriented.ConclusionAlthough Uganda is faced with a number of challenges as regards human resources for health, the findings show that the health workers that are currently working in the health facilities are enthusiastic to perform. This may serve as a motivator for the health workers to improve their performance and that of the health sector.

Health workers’ perceptions of private-not-for-profit health facilities’ organizational culture and its influence on retention in Uganda

“…Decisions were imposed on them, with one-directional top-down communication, and disempowering HWs from participating or shaping the decisions at the health facilities, coupled with poor performance management which affected on their professionalism, leaving them feeling incompetent and infantilized. In the public sector in Uganda, there are also reports of inadequate performance management of HWs [ 37 ]. Similarly, a study in the public sector in Sierra Leone and found that some junior cadres felt unappreciated in their work [ 23 ].…”

Development and validation of a structured observation scale to measure responsiveness of physicians in rural Bangladesh

“…There are very few studies on the responsiveness of HRH [ 27 – 30 ], especially on physician responsiveness. Among these studies, one primarily focused on HRH performance and responsiveness was discussed as a component of performance, but the psychometric methods of developing the measurement tool was not described [ 28 ]. Another study involved telephone interviews in eight European countries, the context of which is much different than Bangladesh [ 27 ].…”

‘I have no love for such people, because they leave us to suffer’: a qualitative study of health workers’ responses and institutional adaptations to absenteeism in rural Uganda

“…Second, this also reflects higher decision-making autonomy for addressing perceived organisational injustice regarding salary delays, poor infrastructure maintenance, low financial allocation to healthcare services and the frequent stock out of medicines and sundries, reasons used to legitimate absenteeism 8 48. Weak health workforce supervision and decentralised health system leadership have been reported before in sub-Saharan Africa 63–65…”