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PERFORM – Overview, design and methods
Reinhard Huss, Comfort Mshelia, Tolib MirzoevLIHS/ Nuffield Centre
University of LeedsUnited Kingdom
Our PERFO
RM project aim
s at a
different kind of p
erform
ance
!
Although HIV prevention was part of the work!
Outline
• Introduction: What is PERFORM? Partners, timeline, key background information
• Study Design: Objectives, What is action research?
• Implementation: Phases in the project, comparative analysis
ProjectTi
mescaleFunder
Start September 2011Ends August 2015
4 year programmeFocus: improving health workforce performance
European Union (EU)
AimTo understand how district management strengthening can improve workforce
performance
Overview
Partners• School of Public Health, University of Ghana, Ghana • Institute of Development Studies, University of Dar-es-
Salaam, Tanzania• School of Public Health, College of Health Sciences,
Makerere, Uganda • Swiss Tropical and Public Health Institute, Switzerland • Nuffield Centre for International Health and
Development, University of Leeds, UK• Liverpool School of Tropical Medicine, UK
Key background information• Global shortage of health workers • Deficit can be addressed by:
– training more new personnel; and – improving performance of the existing workforce
• Many factors and their interactions affect workforce performance • Local interventions may influence performance• Opportunities available where planning and management is
decentralised to district level• Action research is a local research intervention which may
strengthen district management and lead to improved workforce performance
Study design
Objectives of PERFORM
• Use Action Research to:– Help Council Health Management Teams (CHMTs)
to think strategically, to be entrepreneurial within their resource and authority constraints and to learn about their interventions
• Develop strategies aimed at:– Improving health workforce performance and
ultimately service delivery in the district
Our approach
• Systems perspective to human resource management using a coordinated set of strategies to improve performance
• Health systems thinking which considers Human Resources (HR) alongside other related health system (HS) factors: Finance, Medicines, Equipment, Information, Governance
• Action research methodology as the intervention for strengthening management at district level
What is Action Research?
Definition: “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.”
How does it work in practice?
Plan
Act
Observe
Reflect
• Supported by PERFORM Researchers – the CHMTs identify barriers to workforce performance and their causes (situation analysis) and then:
• Plan bundles of HR and HS strategies
• Act to implement these strategies
• Observe the impact of the strategies on performance
• Reflect on how well their plans have been achieved and if necessary, revise the plan
Research concept
Plan
Act
Observe
Reflect
European partners support Country Research
Teams
Council Health Management
Teams conduct action
researchNested action
research approach
What we did?
Project phases
Phase one
Phase two
Phase three
Preparation
Implementation
Evaluation and feedback
Timeline Phase 2 : June 2012 – Dec 2014
Initial Situation Analysis
Jun-Aug 2012
National workshop 1:
Problem analysis
Oct 2012
National Workshop 2: Development
of HR/HS bundlesJan 2013
Consortium workshop 2Nov 2012
Implementation of bundles
Jan 2013 – Aug 2014
National workshop 3: Comparative
analysisDec 2014
Final Situation Analysis
Aug-Oct 2014
Consortium workshop 3
Jan 2014
Part 1: Entry - Initial Situation Analysis
• Engagement • Initial data collection- using qualitative and
quantitative methods
• Problem identification and analysis • National workshop 1 – October ‘12 • Consortium workshop 2 to review and plan –
November ’12)
Part 2: Plan- Development of HR/HS strategies
• Used the situation analysis to design strategies to address the problems
• Strategies (known as bundles) were a mixture of:– Human resource (HR) strategies – e.g. developing skills
through a training workshop– Health systems (HS) strategies – e.g. repairing
equipment so health workers can do better work• CHMT selected the HR / HS bundles and
developed a plan of how to implement the bundlesand monitor their effects.
Part 3: Act - Implementation of Human Resource/Health System
bundles
• Check HR/HS bundles against specific criteria (feasibility, cost, time, other+)
• Incorporate into routine district plans (CCHPs)
Part 4: Observe - Measure changes during and after implementation
• Focus group discussion• Patient survey• In-depth interviews• HMIS data
Part 5: Reflect - Supporting knowledge generation and learning
• Follow up visits by Country Research Teams
• Diaries kept by CHMTs
• Bringing CHMTs together in workshops
Part 6: Comparative analysis
Conduct comparative analyses across districts and countries of:
– The management strengthening intervention (using action research) to support improved workforce performance, and
– Processes of implementing the integrated HR and HS strategies (bundles) and intended and unintended effects on health workforce performance and the wider health system.
Reflections on the PERFORM approach
• Time availability of CHMT members• Engagement• Relevance• Ownership and sustainability in the districts• Changes in use of decision space• Availability and use of quantitative data in AR• Transferability of the process to other districts
or other parts of management
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