AlonsoGarbayo Second National Summit of Health and Population Scientists in Nepal Health and Population Research for Achieving sustainable Development Goals in Nepal April 1012 2016 Kathmandu Nepal ID: 553304
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Dr Alvaro Alonso-GarbayoSecond National Summit of Health and Population Scientists in Nepal ‘Health and Population Research for Achieving sustainable Development Goals in Nepal' April 10-12, 2016Kathmandu, Nepal
HRH for UHC
PERFORM: Improving health workforce performance through action researchSlide2
BackgroundHealth workforce is essential to achieve SDGs and UHC;Achievement of all SDG targets proposed in Nepal depends on its workforce;HWF decisions need to be based on locally generated evidence;Action research has been used in other countries to strengthening management capacity at sub-national levels (e.g. Ghana, Tanzania, The Gambia);Resilient health systems require resilient health workforce (Nepal post-earthquake);Some issues identified during the development of HRH Strategic Plan 2011-2015 (still valid today)
Shortage of HRH as a result of imbalances supply/demand
Maldistribution particularly rural/remote areas;
Poor performance including productivity, quality and availability;
Fragmented approach to HR planning, management and development;
HRH financial constraintsSlide3
Why the health workforce is important?Source: World Health Report 2006Slide4
Shortage of HRH in the SEAR* (minimum thresholds: 23)Density of HRH (physicians, nurses and midwives/10,000 population)Slide5
UHC and HRH: effective coverage
Source: Campbell, J. et al 2013Slide6
EFFECTIVE COVERAGE GAP
UHC and HRH: effective coverage
Source: adapted from Campbell, J. et al. 2013Slide7
Improving health workforce performance in decentralised environments through action research: a case study in Uganda, Ghana and TanzaniaSlide8
Action research“Action research is a period of inquiry that describes, interprets and explains social situations while executing a change intervention aimed at improvement and involvement. It is problem focused, context-specific and future-oriented.” Subjects of research are transformed into active researchers and agents of change;Takes place in “real life” settings;Involves developing, implementing and reflecting on actions;Seeks to understand and improve the world by changing it;Those affected by problems collectively act and produce change as a means to new knowledge.Slide9
What is PERFORM?Start September 2011
Ends August 2015
4 year programme
Focus: improving health workforce performance
European Union (EU)
Aim
To understand how management strengthening can improve workforce performance in 3 districts in each countrySlide10
Who are the partners?College of Health Sciences, School of Public Health,
Makerere
University
Liverpool School
of Tropical Medicine
School of Public Health, University of Ghana
Nuffield Centre for International Health and Development, University of Leeds
Institute of Development Studies, University of Dar-es-Salaam
Swiss Tropical and Public Health InstituteSlide11
BackgroundGlobal shortage of health workers;Deficit can be addressed by:training more new personnel; and improving performance of the existing workforce Complex factors affect workforce performance;
Opportunities available where planning and management is decentralised;
Action research is an appropriate approach to strengthening management to improve workforce performance.Slide12
Study designSlide13
Situation Analysis
CRTs support DHMT to carry out a situation analysis on the health workforce (performance)
in study districts AND IDENTIFY,
PRIORITIZE AND SELECT PROBLEMS
Overall Evaluation of Intervention Process and Impact
Record and reflect on the change process throughout AR cycles using learning histories.
Re-collect core data from situation analysis to identify within-district changes
.
Action Research ProcessSlide14
Effects on health workforce performanceImproved and increased staff supervision;Reductions in absenteeism; More staff appraised;Improved knowledge of existing workforce;Improved induction of new staff;
Improved staff allocation according to workload;
Increased awareness about the importance of HWF information and evidence at sub-national levels
ResultsSlide15
ResultsEffects on management strengthening Expansion of managers’ decision-space;Improved team work;Improved skills on in-depth problem analysis- finding root causes;
Integrated planning, resourcing and monitoring of processes and effects of plans;
Increased ownership
Address problems within existing resource constraints;
Entrepreneurial approaches;
Recognised importance of data for monitoring progress and evaluation of effects;Slide16
Key messages The PERFORM approach Can contribute to achievement of UHC through:Improved understanding of implementation issues at sub-national level Experiences of appropriate and sustainable management strengthening New knowledge of effective integrated health systems strategies for improving health workforce performanceImprove 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.Slide17
Funding from the European Commission 7th Framework ProgrammeProject website: www.performconsortium.comMaterialTechnical reports, tools, manuals, etc.
Publications in peer-reviewed journals
Blogs, videos, voices & perspectives form DHMT