Implementation research to assess a health workers performance-based management system in Nepal.

S Baral,A Mccullough,P Paudel,T Martineau,J Raven,S Theobald,H Elsey,Hn Subedi,Mp Shrestha,Pb Chand

doi:10.1111/apa.14406

Abstract

To test and refine a performance-based management system to improve health worker performance in Nepal. A mixed-methods implementation research in three districts. The study assessed health workers' job satisfaction at the start and end of the study. Qualitative techniques were used to document processes, and routine health service data were analysed to measure outcomes. Job satisfaction significantly increased in six of nine key areas, and the proportion of staff absenteeism significantly declined in the study districts. It demonstrated an increase in immunisation coverage, the proportion of women who had a first antenatal check-up also having a fourth check-up and the proportion of childbirth in a health facility. The greatest perceived strengths of the system were its robust approach to performance planning and evaluation, supportive supervision, outcome-based job descriptions and a transparent reward system. A functional health facility environment, leadership and community engagement support successful implementation. The performance-based management system has the potential to increase health workers' job satisfaction, and it offers a tool to link facility-wide human resource management. A collaborative approach, ownership and commitment of the health system are critical to success. Considering the Nepal context, a management system that demonstrates a positive improvement has potential for improved health care delivery.

Highlights

Broad consensus and evidence show that the performance of healthcare workers directly impacts health service quality, efficiency and equity [1,2,3,4]
In the light of this, a health worker performance-based management system was assessed in Nepal and the findings indicate a positive improvement in health workers performance with mixed impact in service delivery
The nature of the intervention and the findings of the qualitative research make it likely that the performance-based management system (PBMS) contributed to improved satisfaction in some of the six domains, and in relation to ‘organisational communication’, ‘recognition for good work’ and ‘those who do well have a fair chance of promotion’

Summary

Introduction

Broad consensus and evidence show that the performance of healthcare workers directly impacts health service quality, efficiency and equity [1,2,3,4]. A well-performing workforce is seen as essential to the success of any health system [1]. Many of the countries that most need to improve health care performance are those that experience what is referred to as a ‘health workforce crisis’ [5]. Fragmented approaches to resource planning, management and development; and poor motivation and staff performance [6,7]. While all of Nepal’s human resource challenges affect the availability and quality of health services, the focus of this research is on improving health workers’ performance.

Objectives

Methods

Results

Discussion

Conclusion