Management of human resources for health in health districts in Uganda: A decision space analysis

Abstract

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.

Using a theory of change in monitoring, evaluating and steering scale-up of a district-level health management strengthening intervention in Ghana, Malawi, and Uganda – lessons from the PERFORM2Scale consortium

“…At the start of PERFORM2Scale, the development of the ToC assisted in creating a common vision for the programme. We triangulated consortium members' experience-based knowledge 4 with research evidence during ToC development [15,28]. Following Stein and Valter's broad categories of the purpose of ToCs, the PERFORM-2Scale ToC articulated expected processes and outcomes that were reviewed over time (monitoring and evaluation purpose) and served as a thinking tool, helping the consortium to clarify and develop the theory behind the programme (learning purpose) [29].…”

“…The reflections were based on consortium members’ insights from the following processes: their involvement in MSI implementation and scale-up, and results of mixed-methods outcome and process evaluations. These evaluations, of which parts have been [ 4 , 6 , 22 ] and will be published elsewhere, assessed outcomes of the MSI concerning health management competencies, health workforce performance and service delivery. These evaluations also assessed how the MSI and its scale-up were implemented and why (intermediate) outcomes were or were not achieved.…”

“…3 Department of Psychology, Maynooth University, Kildare, Ireland. 4 Department of Health Policy, Planning & Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Accra, Ghana. 5 Makerere University School of Public Health, Kampala, Uganda.…”

“…While the size, composition and quality of the health workforce in the public health system are the responsibility of the national level, performance management of primary level staff is often a district-level responsibility [2]. Decentralization has led, to different extents, to increased decision space of district health management teams (DHMTs) in low-and middle-income countries, providing potential for improved human resource management [2][3][4]. However, not all district-level health managers have undergone management training [5,6].…”

Understanding staff competencies and training needs of Environmental Health Professionals in Uganda: an online cross-sectional survey

“…Our results are in agreement with other studies including the one with Wesam et al which showed that decision making and policy in uence is very critical for improving health service delivery. In their paper they found out the sta ng of staff including EHPs in leadership positions at the districts of Bunyangabo and Ntoronko (Uganda) required ling in bid to improve decision making for better service delivery [9]. Furthermore, the need to have environmental health professionals is underlined by Norback et al (2017) citing that environmental health is key and crucial to the concept of sustainable development [10].Our survey results revealed that there are few EHPs employed substantively in leadership and managerial positions like Assistant district health o cers, commissioners.…”