To what extent do site-based training, mentoring, and operational research improve district health system management and leadership in low- and middle-income countries: a systematic review protocol

Abstract

BackgroundDistrict health managers play a key role in the effectiveness of decentralized health systems in low- and middle-income countries. Inadequate management and leadership skills often hamper their ability to improve quality of care and effectiveness of health service delivery. Nevertheless, significant investments have been made in capacity-building programmes based on site-based training, mentoring, and operational research. This systematic review aims to review the effectiveness of site-based training, mentoring, and operational research (or action research) on the improvement of district health system management and leadership. Our secondary objectives are to assess whether variations in composition or intensity of the intervention influence its effectiveness and to identify enabling and constraining contexts and underlying mechanisms.MethodsWe will search the following databases: MEDLINE, PsycInfo, Cochrane Library, CRD database (DARE), Cochrane Effective Practice and Organisation of Care (EPOC) group, ISI Web of Science, Health Evidence.org, PDQ-Evidence, ERIC, EMBASE, and TRIP. Complementary search will be performed (hand-searching journals and citation and reference tracking).Studies that meet the following PICO (Population, Intervention, Comparison, Outcome) criteria will be included: P: professionals working at district health management level; I: site-based training with or without mentoring, or operational research; C: normal institutional arrangements; and O: district health management functions. We will include cluster randomized controlled trials, controlled before-and-after studies, interrupted time series analysis, quasi-experimental designs, and cohort and longitudinal studies. Qualitative research will be included to contextualize findings and identify barriers and facilitators.Primary outcomes that will be reported are district health management and leadership functions. We will assess risk of bias with the Cochrane Collaboration’s tools for randomized controlled trials (RCT) and non RCT studies and Critical Appraisal Skills Programme checklists for qualitative studies. We will assess strength of recommendations with the GRADE tool for quantitative studies, and the CERQual approach for qualitative studies. Synthesis of quantitative studies will be performed through meta-analysis when appropriate. Best fit framework synthesis will be used to synthesize qualitative studies.DiscussionThis protocol paper describes a systematic review assessing the effectiveness of site-based training (with or without mentoring programmes or operational research) on the improvement of district health system management and leadership.Systematic review registrationPROSPERO CRD42015032351Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0239-z) contains supplementary material, which is available to authorized users.

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“…Mentoring program of any type was considered for inclusion. Mentorship is defined as “a flexible learning and teaching process that serves specific objectives of a health program” 24. The review did not consider mentorship programs and interventions conducted during pre-service training.…”

Leadership, governance and management for improving district capacity and performance: the case of USAID transform: primary health care

“…Like this finding -in other countries -in-service training has been shown to empower leaders and managers to appropriately implement district health activities in an organized way through sound management of primary health services, team building, and supervision. In addition, inservice training for managers is a significant investment in creating and maintaining critical competencies required for district level service settings [10].…”

Exploring the Human Factors Affecting Health Service Managers: A Qualitative Study

“…The appointment of inexperienced managers without adequate technical knowledge and out-of-organization is one of the most important factors in managing managers within the organisations. The majority of scholars in management science believe that the managers’ beliefs and attitudes have a direct impact on their behaviour, and the managers’ behaviour has a significant effect on their internal organisational performance as well [8], [22], [23]. In other words, managers need skills to protect them from being “managed” [24].…”

“…The main objective of management in health-service systems is to provide health services of high quality [3], [7]. Health-service systems’ managers are often responsible for planning, budgeting, managing human resource, and monitoring service quality [8]. Improvement and promotion of health-service systems require strengthening the capacity of managers [9] because health-service systems’ managers can promote communication among various components of the health system and can provide human relationships within the organisation and among different system factors [10].…”

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