Action Research Toolkit

This comparative analysis brief provides a quick overview of the outcomes of the perform project.

We also have briefs that give an overview of the work in Tanzania, Ghana and Uganda.

This brief provides a quick overview of the methodology.

This is our methods manual. It goes through the process that we followed, from start to finish. We also produced a manual for the DHMT members to guide them through the process and help with the design of the workplans.

The initial situation analysis lays the foundation of problem analysis. During the problem analysis, the research team asks questions of their collected data, such as:  

• What are the areas that are in need of improvement or change?
• Are these problems specific to different cadres, gender or other criteria?
• What appears to be the root causes of these problems?
• What is the larger picture in which these problems and their causes seem to exist?

Are there links between the problems? There are various techniques that can be used to undertake problem analysis. Two such techniques are problem trees (see Appendix 11) These are used to develop a comprehensive list of problems, their root causes and relationships between seemingly different problems. Having identified the problems affecting workforce performance in a health district using tools like the Problem Tree analysis (included in Situation analysis tools) these need to be ranked in order of priority. In PERFORM this work was undertaken in collaboration with a wider stakeholder group in a series of two workshops.

There are a wide range of strategies that can be used to improve workforce performance, depending on the particular problem(s) to be addressed. The challenge is to identify strategies that are feasible to implement and likely to be effective in the short term within each unique local situation. Selected strategies should complement each other. When creating a bundle of strategies it is important to consider:

• Staff availability – what are the required cadres and specialists available in the district?
• Staff competencies – what skills does the available staff require to do their job?
• Staff direction – what tasks need to be performed to achieve the expected results?
• Rewards and sanctions – how can good performance be rewarded and what sanctions could be put in place to curb poor performance?
• The health system within which staff work – what system wide issues may be encouraging good performance or demotivating staff?

 

Workshop 1

These guidelines for your first stakeholder workshop provide sample aims and objectives and a guide to how the two days could be structured.

This Power Point presentation provides a guide that you can adapt for your first stakeholder workshop. 

Observation checklist for situation analysis presentation. In the months before the stakeholder workshop you will have worked with District Health Management Teams to conduct a situation analysis - identifying health workforce performance problems. This will include the collection and analysis of routine data such as staffing and health service information, reviewed existing report and documents, and facilitated group discussions with District Health Management Teams to better understand their role and health workforce performance. This will have led to the creation of problem statements related to health workforce performance. This document provides advice on how you can feed this information back to a wider stakeholder group.

Health workforce performance and the use of bundles of human resources/health systems strategies. This presentation leads stakeholders through what kind of strategies they might develop to address the problems that they are facing. It explains how the performance of the collective workforce is largely a result of management decisions and individual performance is, in part, a result of interactions between managers and/or supervisors and the individual health worker. It prompts stakeholder to consider the role of non-clinical staff such as managers and support staff.  It includes a discussion of potential interventions to improve staffing levels and how research teams can better understand individual staff performance. Because it is unlikely that any one strategy will solve all the human resource and health system challenges that are being faced it talks about how a number of strategies can be combined.

Worksheet for listing and reviewing human resources/health systems strategies. This simple hand out enables stakeholders to list the potential problems that they will work on and the strategies that they will test in overcoming them.

Evaluation questionnaire. This tool allows stakeholders to provide feedback on your workshop.

Workshop 2

These guidelines for your second stakeholder workshop lead you through the process of refining problem statements and problem trees, using reflective diaries, and ensuring ongoing support and communication throughout the research process.

This Power Point presentation provides introductory slides for the second stakeholder workshop. 

Guidance for refining problem tree analysis. This can be used during small group work in the workshop to help participants improve and peer review their problem trees.

Developing bundles of human resources/health systems strategies. This Power Point presentation provides an overview of human resources/health systems bundles of strategies and this types of interventions that District Health Management Teams might consider. It then helps participants to develop and evaluate different bundles of interventions.

This table for planning  bundles human resources/health systems strategies is to be used as a handout to guide small group work during the workshop. 

Worksheet for reviewing bundles of human resources/health systems strategies to improve workforce performance. This tool enables workshop participants to review the bundles of strategies that are developed during the small group work.

Instructions for using District Health Management Team diaries. This handout can be taken away from the meetings as a guide to ensure that appropriate process data is collected throughout the research process.

Guidance for ongoing support and communication session. This is a very important session to ensure continued collaboration between research teams and District Health Management Teams in the project. This guidance for workshop facilitators provides some ideas for this session; please adapt as you feel appropriate.

It is important to evaluate the workshop. The form from the first workshop can be adapted for this.

Having selected the human resources/health system bundle, the research team is now in a position to plan implementation. Participating districts will likely have existing plans and targets, so first consider how these may be modified to address the prioritised problems. The plan is not necessarily a complex document. It can be as simple as a table noting the issues set out in bullet points:

• Identify the particular strategy you want to use
• Identify the activities needed to implement the strategy
• Develop targets based on expected improvements in performance when compared to the situation analysis. The targets should be time-bound
• Identify linkages to other strategies in a bundle

Strategies should always be developed within local budgets, integrated into local planning cycles and take account of authority constraints. Facilitators in the research team should focus on what is feasible for District Health Management Teams to undertake within a limited period of time. They should also ensure that the selected strategies are compatible with the regional and national human resources priorities and strategies. Second, District Health Management Teams will already have human resources/health systems strategies in place. These could also be included in a bundle or tweaked to be more effective. Strategies that are already in the routine plan will be funded so are more likely to be implemented. Do consider whether any new strategies may have negative unintended consequences on strategies already in place.