Strengthening health district management competencies in Ghana, Tanzania and Uganda: lessons from using action research to improve health workforce performance

Abstract

BackgroundTo achieve Universal Health Coverage (UHC), more health workers are needed; also critical is supporting optimal performance of existing staff. Integrated human resource management (HRM) strategies, complemented by other health systems strategies, are needed to improve health workforce performance, which is possible at district level in decentralised contexts. To strengthen the capacity of district management teams to develop and implement workplans containing integrated strategies for workforce performance improvement, we introduced an action-research-based management strengthening intervention (MSI). This consisted of two workshops, follow-up by facilitators and meetings between participating districts. Although often used in the health sector, there is little evaluation of this approach in middle-income and low-income country contexts. The MSI was tested in three districts in Ghana, Tanzania and Uganda. This paper reports on the appropriateness of the MSI to the contexts and its effects.MethodsDocumentary evidence (workshop reports, workplans, diaries, follow-up visit reports) was collected throughout the implementation of the MSI in each district and interviews (50) and focus-group discussions (6) were conducted with managers at the end of the MSI. The findings were analysed using Kirkpatrick’s evaluation framework to identify effects at different levels.FindingsThe MSI was appropriate to the needs and work patterns of District Health Management Teams (DHMTs) in all contexts. DHMT members improved management competencies for problem analysis, prioritisation and integrated HRM and health systems strategy development. They learnt how to refine plans as more information became available and the importance of monitoring implementation. The MSI produced changes in team behaviours and confidence. There were positive results regarding workforce performance or service delivery; these would increase with repetition of the MSI.ConclusionsThe MSI is appropriate to the contexts where tested and can improve staff performance. However, for significant impact on service delivery and UHC, a method of scaling up and sustaining the MSI is required.

Managerial capacity among district health managers and its association with district performance: A comparative descriptive study of six districts in the Eastern Region of Ghana

“…This cross-sectional study, consisting of a self-administered survey, took place as part of the baseline assessment of the P2S project aiming to scale up a piloted district management strengthening intervention [31].…”

Levels of the health system workforce’s competence and predictors to lead, manage, and govern in northwest Ethiopia

“…Contemporary, low and middle-income countries have launched integrated Leadership, Management, and Governance (LMG) capacity-building program (9)(10)(11). The program aims to build the competence of the workforce in influencing people, improving performance and ensuring societal health and wellbeing (12,13).…”

Health system workforce’s performance capacity towards integrated leading, managing and governing practices: with special reference to the application of factor analysis and ordinal logistic regression

“…Currently, there is a promising signal in that the health system workforces at all levels look forward to applying scientifically reliable and empirically scalable integrated Leading-Managing-and-Governing (L+M+G) practices [11][12][13]. Following this, though donor driven, many low and middle income countries including Ethiopia have launched an integrated L+M+G practices capacity building package [11,14].…”

“…Integrated health system L+M+G practices can generally be stated as the process of influencing people for functioning tasks in an ethical and moral manner to improve and maintain societal health and well-being. Although integrated health system L+M+G has caught the attention of the health system workforce in considerable number of low and middle-income countries, yet, there has been dearth of attempts to develop or test scientifically reliable and empirically scalable integrated models of practices of the three paths [4,[13][14][15]. Some reasons can be mentioned to such dearth of attempts.…”

“…Studies indicate that the health system workforce capacity towards leading or/and managing or/and governing practices improves Key Performance Indicators (KPIs) [1,13,[22][23][24][25][26]. Some other studies report that there is a significant duplication among the practices of the three dimensions [22,27] .…”