A participatory action research approach to strengthening health managers’ capacity at district level in Eastern Uganda
Abstract Background Many approaches to improving health managers’ capacity in poor countries, particularly those pursued by external agencies, employ non-participatory approaches and often seek to circumvent (rather than strengthen) weak public management structures. This limits opportunities for st...
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| Format: | Article |
| Language: | English |
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BMC
2017-12-01
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| Series: | Health Research Policy and Systems |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12961-017-0273-x |
| _version_ | 1819080602663518208 |
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| author | Moses Tetui Anna-Britt Coe Anna-Karin Hurtig Sara Bennett Suzanne N. Kiwanuka Asha George Elizabeth Ekirapa Kiracho |
| author_facet | Moses Tetui Anna-Britt Coe Anna-Karin Hurtig Sara Bennett Suzanne N. Kiwanuka Asha George Elizabeth Ekirapa Kiracho |
| author_sort | Moses Tetui |
| collection | DOAJ |
| description | Abstract Background Many approaches to improving health managers’ capacity in poor countries, particularly those pursued by external agencies, employ non-participatory approaches and often seek to circumvent (rather than strengthen) weak public management structures. This limits opportunities for strengthening local health managers’ capacity, improving resource utilisation and enhancing service delivery. This study explored the contribution of a participatory action research approach to strengthening health managers’ capacity in Eastern Uganda. Methods This was a qualitative study that used open-ended key informant interviews, combined with review of meeting minutes and observations to collect data. Both inductive and deductive thematic analysis was undertaken. The Competing Values Framework of organisational management functions guided the deductive process of analysis and the interpretation of the findings. The framework builds on four earlier models of management and regards them as complementary rather than conflicting, and identifies four managers’ capacities (collaborate, create, compete and control) by categorising them along two axes, one contrasting flexibility versus control and the other internal versus external organisational focus. Results The findings indicate that the participatory action research approach enhanced health managers’ capacity to collaborate with others, be creative, attain goals and review progress. The enablers included expanded interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability. Tension and conflict across different management functions was apparent; for example, while there was a need to collaborate, maintaining control over processes was also needed. These tensions meant that managers needed to learn to simultaneously draw upon and use different capacities as reflected by the Competing Values Framework in order to maximise their effectiveness. Conclusions Improved health manager capacity is essential if sustained improvements in health outcomes in low-income countries are to be attained. The expansion of interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability were the key means by which participatory action research strengthened health managers’ capacity. The participatory approach to implementation therefore created opportunities to strengthen health managers’ capacity. |
| first_indexed | 2024-12-21T19:47:30Z |
| format | Article |
| id | doaj.art-7f4ae376b3ba42cd90bee94ee92bd14a |
| institution | Directory Open Access Journal |
| issn | 1478-4505 |
| language | English |
| last_indexed | 2024-12-21T19:47:30Z |
| publishDate | 2017-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Health Research Policy and Systems |
| spelling | doaj.art-7f4ae376b3ba42cd90bee94ee92bd14a2022-12-21T18:52:18ZengBMCHealth Research Policy and Systems1478-45052017-12-0115S2395310.1186/s12961-017-0273-xA participatory action research approach to strengthening health managers’ capacity at district level in Eastern UgandaMoses Tetui0Anna-Britt Coe1Anna-Karin Hurtig2Sara Bennett3Suzanne N. Kiwanuka4Asha George5Elizabeth Ekirapa Kiracho6Makerere University School of Public Health (MakSPH), Makerere University, New Mulago ComplexSociology Department, Umeå UniversityEpidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå UniversityDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins UniversityMakerere University School of Public Health (MakSPH), Makerere University, New Mulago ComplexDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins UniversityMakerere University School of Public Health (MakSPH), Makerere University, New Mulago ComplexAbstract Background Many approaches to improving health managers’ capacity in poor countries, particularly those pursued by external agencies, employ non-participatory approaches and often seek to circumvent (rather than strengthen) weak public management structures. This limits opportunities for strengthening local health managers’ capacity, improving resource utilisation and enhancing service delivery. This study explored the contribution of a participatory action research approach to strengthening health managers’ capacity in Eastern Uganda. Methods This was a qualitative study that used open-ended key informant interviews, combined with review of meeting minutes and observations to collect data. Both inductive and deductive thematic analysis was undertaken. The Competing Values Framework of organisational management functions guided the deductive process of analysis and the interpretation of the findings. The framework builds on four earlier models of management and regards them as complementary rather than conflicting, and identifies four managers’ capacities (collaborate, create, compete and control) by categorising them along two axes, one contrasting flexibility versus control and the other internal versus external organisational focus. Results The findings indicate that the participatory action research approach enhanced health managers’ capacity to collaborate with others, be creative, attain goals and review progress. The enablers included expanded interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability. Tension and conflict across different management functions was apparent; for example, while there was a need to collaborate, maintaining control over processes was also needed. These tensions meant that managers needed to learn to simultaneously draw upon and use different capacities as reflected by the Competing Values Framework in order to maximise their effectiveness. Conclusions Improved health manager capacity is essential if sustained improvements in health outcomes in low-income countries are to be attained. The expansion of interaction spaces, encouragement of flexibility, empowerment of local managers, and the promotion of reflection and accountability were the key means by which participatory action research strengthened health managers’ capacity. The participatory approach to implementation therefore created opportunities to strengthen health managers’ capacity.http://link.springer.com/article/10.1186/s12961-017-0273-xDistrict health managersHealth systemsParticipatory action researchCompeting values frameworkUganda |
| spellingShingle | Moses Tetui Anna-Britt Coe Anna-Karin Hurtig Sara Bennett Suzanne N. Kiwanuka Asha George Elizabeth Ekirapa Kiracho A participatory action research approach to strengthening health managers’ capacity at district level in Eastern Uganda Health Research Policy and Systems District health managers Health systems Participatory action research Competing values framework Uganda |
| title | A participatory action research approach to strengthening health managers’ capacity at district level in Eastern Uganda |
| title_full | A participatory action research approach to strengthening health managers’ capacity at district level in Eastern Uganda |
| title_fullStr | A participatory action research approach to strengthening health managers’ capacity at district level in Eastern Uganda |
| title_full_unstemmed | A participatory action research approach to strengthening health managers’ capacity at district level in Eastern Uganda |
| title_short | A participatory action research approach to strengthening health managers’ capacity at district level in Eastern Uganda |
| title_sort | participatory action research approach to strengthening health managers capacity at district level in eastern uganda |
| topic | District health managers Health systems Participatory action research Competing values framework Uganda |
| url | http://link.springer.com/article/10.1186/s12961-017-0273-x |
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