PERFORM – Overview, design and methods

Reinhard Huss, Comfort Mshelia, Tolib MirzoevLIHS/ Nuffield Centre

University of LeedsUnited Kingdom

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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

R.Huss@leeds.ac.uk

http://www.performconsortium.com/

For further information