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Improving health workforce performance in Uganda: linking research and practice through action research
1. Improving health workforce performance
in Uganda: linking research and practice
through action research
Joanna Raven, Liverpool School of Tropical Medicine, UK
Sebastian Olikira Baine, Makerere University, Uganda
Saul Kamukama, Makerere University, Uganda
Alvaro Alonso-Garbayo, Liverpool School of Tropical Medicine, UK
Tim Martineau, Liverpool School of Tropical Medicine, UK
International Health Conference
26 June, 2015 Oxford
Twitter: @PERFORMtug
2. Rationale for PERFORM
• Need to improve workforce performance to support Universal
Health Coverage;
• Integrated Human Resource and health systems approach
required;
• District level managers in decentralised contexts in better
position to organise integrated approach, have sufficient
“decision space” and can learn;
• Challenge is to help District Health Management Teams to
think strategically and to be entrepreneurial within their
resource and authority constraints;
• District Health Management Team strengthening is not new,
but little research.
3. PERFORM project in Uganda
• Investigates how a
management
strengthening intervention
(action research) can be
used to improve health
workforce performance
6. Initial situation analysis
• Research team with
District Health
Management Teams
conducted situation
analysis on workforce
performance in the
district: secondary data
collection, document
review, interviews and
focus group discussions
Health Centre, Jinja district, Uganda
7. Problem analysis
• Developed a list of
workforce problems
• Prioritized problems
• Workshop to do in-
depth problem tree
analysis
Kabarole district, Uganda, Feb ‘13
8. Examples of problems identified
District Key problems
Kabarole 1. Weak leadership and management of team leaders
2. Weak supportive supervision
3. Health workers’ poor commitment
4. Poor working environment
Jinja 1. Ineffective use of the traditional control mechanisms
2. Low staff motivation
3. Inadequate supportive supervision
4. Staff training not guided by available opportunities in district
Luwero 1. Lack of professionalism
2. Poor communication
3. Inadequate capacity building
4. Inadequate supplies / equipment /medicines
5. Inadequate supportive supervision
9. Plan: Development of strategies
• Workshop to support
development of
strategies
• Integrated into
district work plan
Jinja district, Uganda, Feb ‘13
11. Act: Implementation of strategies
• Kabarole District Health Management Team was
entrepreneurial: received funding for induction of
newly recruited staff from private sector
• Jinja District Health Management Team: adapted
supervision tools, developed plan for supervision
visits, focused on support and solving problems
• Luwero District Health Management Team:
introduced duty rosters and attendance books at
facilities; spot checks of facilities
13. Adapting the strategies during implementation…
Kabarole DHMT identified a problem with the capacity
of new supervisors to provide good quality supervision
and so identified and trained mentors to support each
supervisor
“In the beginning some members did not understand
the mentorship well. But after the discussions all
members were in agreement and welcomed the
mentorship idea” (Diary, 12/5/13).
14. Final evaluation
• Focus group discussions and in-depth interviews:
explored perceptions on management strengthening
and health workforce improvement processes and
changes
• Document review: visit reports, diaries, workshop
reports, District Health Management Team minutes
and plans were analysed
• Analysis of existing service delivery data
15. Effects on management strengthening
• Improved team work
• In-depth problem analysis - finding root causes
• Integrated planning, resourcing and monitoring of
processes and effects of plans
• Addressed problems within existing resources
• Entrepreneurial approaches
• Recognised importance of data for monitoring
progress and effects
16. Effects on health workforce performance
• Better supervision of
staff
• Reductions in
absenteeism
• More staff appraised
• Increases in utilization
of services
Monthly supervision visit, Jinja district
17. Key messages
The PERFORM approach can:
• Improve workforce performance through
management strengthening
• Bridge the gap between research and practice
• Support sustainability and ownership through solving
real problems at district level
• Enable sharing of practices and learning
• Promote culture of partnership
• Unlock innovation
18. Acknowledgements
Funding from the European Commission
Seventh Framework programme
Ministry of Health in Uganda
District health management teams in Jinja, Kabarole
and Luwero districts
19. Contact details for further dialogue
• Project PI: tim.martineau@lstmed.ac.uk
• Project website: www.performconsortium.com
• Twitter: @performtug
Many thanks for your participation
Notes de l'éditeur
The district health teams of the three districts were engaged to identify the factors that affect health workers performance, based on the initial situation analysis carried out with the research team. We did this at several stages in the process and this picture shows us at work in National Workshop 2. Each DHMT finalised their problem tree in this workshop. Each group identified the root causes of the problems identified and prioritised the problems they wanted to address.
The next slide shows some examples of the problems identified by the districts
