#	Pagina
attuale pagina	/open-h2020/projects/207231/results.html

Report

Teaser, summary, work performed and final results

Periodic Reporting for period 1 - Perform 2 scale (Strengthening management at district level to support the achievement of Universal Health Coverage (PERFORM2scale))

Teaser

Summary

The new challenge in global health is to achieve Universal Health Care (UHC) by 2030. This involves addressing three dimensions of who is covered (population coverage), what is covered (health-care benefits) and how much of the cost is covered (financial protection). In the next decade, an increasing number of African countries will become able to finance essential health services from domestic resources and will then face critical decisions on how to invest these funds most effectively to accelerate progress towards UHC (Brandford 2007). Having an adequate workforce is critical to achieving societal goal of UHC. Efforts are in place to scale up the numbers of health worker. Improving health workforce performance is equally important as the quantity of health workers, but more challenging. Workforce performance improvement can be achieved better at levels closer to front-line workers. The PERFORM project (2011-15) developed a problem-based management strengthening intervention for management teams at district level in three African countries to improve both health workforce performance and service delivery more generally. The evaluation of the management strengthening intervention demonstrated its effectiveness in enabling the management teams to both solve workforce performance and other problems locally and to become better managers. To have a wider impact and thus contribute to the achievement of UHC the PERFORM management strengthening intervention needs to be scaled up and embedded.

The overall aim of the PERFORM2scale project is â€œto develop and evaluate a sustainable approach to scaling up a district level management strengthening intervention in different and changing contextsâ€. To achieve this aim the project has the following research and enabling objectives:
1. To develop a framework and strategy for scaling up the management strengthening intervention
2. To implement and validate the framework and strategy for scaling up the management strengthening intervention
3. To identify the facilitators and barriers to scale-up of the management strengthening intervention in different and changing contexts
4. To identify the costs and effects of scaling up the management strengthening intervention
5. To develop the individual and institutional capacity at regional and national levels to implement and sustain the use of the scaling up framework and strategy
6. To ensure engagement of stakeholders and institutions needed to implement and sustain the scale-up of the intervention
7. To provide ongoing communication for and about the scale-up process and to disseminate the validated framework and strategy for scaling up the management strengthening intervention.

Work performed

The official start of the project was in January 2017. However, a postponement in the start of the project was requested due to major commitments of the consortium lead in January. As this request was not granted by the EC, it was agreed with the funder that some of the early deliverables and milestones could be delayed by a month or two. A start-up consortium workshop (CW1) was held in Liverpool from 27th-31st March 2017. Work package leaders prepared concept notes for consideration during the workshop. A smaller, shorter consortium workshop (CW2) was held in Amsterdam from 14th-16th June 2017 to focus on the research methods. It was agreed that because of the complexity of the research design, developing the methods would take longer than anticipated and so the target date for finalising the protocol and starting the ethical approval process was moved to August 2017. This had implications for the start of the Initial Context Analysis (ICA) studies and consequently the start of the Management Strengthening Interventions (MSIs).

Following CW1, the Country Research Teams (CRTs) in Ghana, Malawi and Uganda began the process of stakeholder analysis in earnest, and subsequently undertook stakeholder engagement to create the National Scale-up Steering Groups (NSSG) and ultimately the national Resource Teams (RT). Following some field testing of data collection tools, the ICA studies commenced; these were completed or in draft form at the end of this reporting period. This process has been slower than planned and, in some cases, has overlapped with the start of the MSIs. A consortium workshop was conducted in Uganda from 26th Februaryâ€“2nd March 2018, primarily to build capacity for the PERFORM2Scale facilitators to conduct the MSIs CW3a. A four-day workshop was added from 5th-8th March 2018 to start the process of data analysis for the ICA (CW3b). The MSI cycles have been initiated in each country, and by 30th June the problem analysis workshops (Workshop 1) had been conducted in all three countries and the second strategy development workshop (Workshop 2) completed in Ghana. Data collection for the process and outcome evaluation has started in all three countries.

Final results

The project is building on the lessons learnt about management strengthening for improved workforce performance during the PERFORM project. A review of the PERFORM project districts in Ghana and Uganda showed that: the management strengthening approach was still popular and the problem-solving approach still being used in some districts; further development of strategies would be needed to make them more effective, as the District Health Management Teams understood the problem in more depth; the \'reflection\' part of the Action Research cycle was the most challenging part of the process. These lessons have been fed into the revised toolkit for the management strengthening process which started before the end of this reporting period. We expect to learn many more lessons from the management strengthening approach as district teams tackle new problems and the project moves into new districts.

The project was designed with a model of scale-up based on the experience of ExpandNet. The use of this model was confirmed at the inception of the project and has been used from an early stage by the country research teams. In one country, where the scale-up has initially been focused in on region, the establishment of the supportive structures for scale-up to ensure sustainability has been relatively straight-forward. In another country the challenge has been setting up meetings with busy officials, though participation in the management strengthening activities by individual officials has been good. In our third country, where devolution is unfolding, it was initially unclear where the lead for scale-up should come. Now the Ministry of Health has become very engaged. These experiences are providing rich lessons on the practicalities of scale-up and will be shared with two other EU-funded projects on scale-up at the Fifth Global Symposium on Health Systems Research in Liverpool in October 2018.