District health manager and mid-level provider perceptions of practice environments in acute obstetric settings in Tanzania: a mixed-method study.

Njoki Ng’Ang’A,Mary Woods Byrne,Helen De Pinho,Margaret E Kruk,Aloisia Shemdoe

doi:10.1186/s12960-016-0144-5

Njoki Ng’Ang’A, Mary Woods Byrne + Show 3 more

Open Access

https://doi.org/10.1186/s12960-016-0144-5

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Abstract

BackgroundIn sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs).MethodsThis study was guided by the basic strategic human resources management (SHRM) component model. A convergent mixed-method design was utilized to assess qualitative and quantitative data from the Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers project. Survey data was obtained from 837 mid-level providers, 83 of whom participated in a critical incident interview whose aim was to elicit negative events in the practice environment that induced intention to leave their job. HRH management practices were assessed quantitatively in 48 districts with 37 members of CHMTs participating in semi-structured interviews.ResultsThe eight human resources management practices enumerated in the basic SHRM component model were implemented unevenly. On the one hand, members of CHMTs and mid-level providers agreed that there were severe shortages of health workers, deficient salaries, and an overwhelming workload. On the other hand, members of CHMTs and mid-level providers differed in their perspectives on rewards and allocation of opportunities for in-service training. Although written standards of performance and supervision requirements were available in most districts, they did not reflect actual duties. Members of CHMTs reported high levels of autonomy in key HRH management practices, but mid-level providers disputed the degree to which the real situation on the ground was factored into job-related decision-making by CHMTs.ConclusionsThe incongruence in perspectives offered by members of CHMTs and mid-level providers points to deficient HRH management practices, which contribute to poor practice environments in acute obstetric settings in Tanzania. Our findings indicate that members of CHMTs require additional support to adequately fulfill their HRH management role. Further research conducted in low-income countries is necessary to determine the appropriate package of interventions required to strengthen the capacity of members of CHMTs.

Highlights

In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak
Members of council health management team (CHMT) interviewed as part of the multicountry, multi-site mixed-method study Health Systems Strengthening for Equity: The Power and Potential of Mid-Level Providers (HSSE) collectively endorsed utilizing supervisory mechanisms to create supportive practice environments centered on helping health workers achieve their patient care goals [38]
To better understand the paradox between HRH management practices utilized by members of CHMTs in Tanzania and persistence of poor practice environments, we explored data from the HSSE study

Summary

Introduction

In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. According to the International Collaborating Partners of the Positive Practice Environment Campaign, positive practice environments are those which enable a motivated, productive, and high-performing pool of personnel by (1) recognizing their professional autonomy, (2) rewarding employee performance, (3) employing effective management practices, (4) offering opportunities for professional development, (5) adopting safety standards, and (6) ensuring the well-being of personnel [10]. For a select group of facilities in the United States (US) known to epitomize positive practice environments, personnel demonstrate high levels of performance corresponding to a superior quality of health services. The leaders exhibit four key attributes: (1) a deep commitment to an organizational culture centered on quality, (2) ability to attract and retain the right talent to accomplish qualitydriven goals, (3) implementing appropriate processes for quality improvement, and (4) providing “staff with the right tools to do their job” [14, 15]

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