PERFORM will use a systems approach at the district level to understand the factors affecting and potential to improve, workforce performance. A systems approach means using a coordinated set of strategies to improve performance. A health systems approach views human resources as a sub-system alongside and closely related to other sub-systems such as information, finance, drugs and equipment. Our research will be conducted in Ghana, Tanzania and Uganda.
The project uses Action Research methodology, the district management teams will assess the performance of the health workforce in their districts (supported by PERFORM researchers). They then plan strategies to address any problems identified, act to implement these strategies and observe their impact on performance. Finally, they reflect on how well their plans have been achieved and if necessary, revise them.
The research will assess the effectiveness of this approach and will include a comparison across districts and countries.
The dire shortage of effective, well-performing health workers is a key obstacle to improving health and saving lives in Africa. The deficit of health workers needs to be addressed both by training more new health personnel and improving the performance of the existing and future workforce.
A number of complex factors affect workforce performance, including: maldistribution of staff, inappropriate task allocation and a poor working environment.
This research project will enhance understanding of how management strengthening can improve workforce performance at the district level. It will also increase the effectiveness of future health workers trained and deployed by scaling up initiatives.
The research objectives are:
The main project outputs will include developed and tested district-level interventions to improve the management of decentralised health systems in Ghana, Tanzania and Uganda. These interventions can be potentially replicated in other districts and in other similar countries.
The outcomes of the research will contribute to the body of knowledge of how strengthening management in sub-Saharan Africa can improve workforce performance and the wider health system.
The action research approach will develop the skills and ability of participating district health managers to resolve human resource problems in the future, with the possibility of scaling up this approach if it proves successful.