But I wrote it down!Experience of using diaries to promote

reflective practice among district healthmanagement teams in three African countries

Comfort Mshelia, University of Leeds, UK

Plan for my talk

• Overview of PERFORM project

• Why diaries?

• Use of diaries in PERFORM

• Reflections

• Conclusion

Overview

• Title : Supporting decentralised management toimprove health workforce performance

• Acronym: PERFORM

• Study countries: Ghana, Tanzania, Uganda

• Funded by the European Commission (FP7)

• 4-year project which started in August, 2011.

• Problem: Lack of adequate and well-performinghealth workers.

• PERFORM is focused on improving health workforceperformance in sub-Saharan Africa.

• Assumption: Strengthening district healthmanagement will lead to improvement in healthworkforce performance.

Background

• The research:

– is taking place in three districts in each of the threeAfrican countries.

– Will study how management strengthening can beused, and under what conditions, to enhanceworkforce performance.

• Comparative analysis of the findings will add newknowledge as to the effects of different countrycontexts on these interventions.

Research design

Action research Cycle

Plan

- Describe and analyse theproblem they face

- Identify and plan solutions

Act

Implement thechanges needed

Observe

Observe the effects of theimplemented changes

Reflect

Reflect on the process and theeffects of changes made

Lewin, K. (1958) Group decision and social change. In Readings in socialpsychology, ed. Maccoby, E. E., Newcomb, T. M., & Hartley, E. L., 197-211.New York,NY: Holt, Rinehart, Winston.

Action Research cycle

PartnersSchool 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

Why diaries?

• Need to record what was done and how it was done

• Other options considered: learning history

What we did

• Designed a template including prompts

• This was introduced to the District HealthManagement Teams (DHMTs) by the CRTs

• Freedom to adapt to context

What we did (2)Prompts

How we chose this bundle of strategies -describe the bundle of strategies

How we implemented a bundle of strategies

Why we implemented in this way

How we have observed the effects of the strategies

What were the effects (and unintended effects) of the strategies

What worked well

What worked not so well

What we would change next time

Any changes in the environment that may affect the process and results

How are the diaries used?

• Examples of use of diaries in health systems researchis lacking

• Interviewed DHMTs in the 9 study districts.

• Interviewed members of each of the countryresearch teams

Use of Diaries

• Purpose:

– To record what is implemented

– To record how it was implemented

– Tool to encourage reflection and learning

• To follow the Action Research cycle

Reflections

- Consistency in whatis being recorded

- Encourage learningfrom other’sexperiences

- Increasedorganisation

- Time constraints

- Workload issues

- Access to the diary

- Reflection

Key messages

• Need to consult with users at the design stage

• Use a clear and simple template

• Link the diary to existing processes/practices such asmeetings

• Adequate support to the users

Conclusion

• Will the diaries have contributed to managementstrengthening?

• Will the diaries have contributed to improvements inworkforce performance?

Thank you!