Abstract
BackgroundDecentralisation has been adopted by many governments to strengthen national systems, including the health system. Decision space is used to describe the decision‐making power devolved to local government. Human resource Management (HRM) is a challenging area that District Health Management Teams (DHMT) need some control over its functions to develop innovative ways of improving health services. The study aims to examine the use of DHMTs' reported decision space for HRM functions in Uganda.MethodsMixed methods approach was used to examine the DHMTs' reported decision space for HRM functions in three districts in Uganda, which included self‐assessment questionnaires and focus group discussions (FGDs).ResultsThe decision space available for the DHMTs varied across districts, with Bunyangabu and Ntoroko DHMTs reporting having more control than Kabarole. All DHMTs reported full control over the functions of performance management, monitoring policy implementation, forecasting staffing needs, staff deployment, and identifying capacity needs. However, they reported narrow decision space for developing job descriptions, resources mobilisation, and organising training; and no control over modifying staffing norms, setting salaries and developing an HR information system (HRIS). Nevertheless, DHMTs tried to overcome their limitations by adjusting HR policies locally, better utilising available resources and adapting the HRIS to local needs.ConclusionsDecentralisation provides a critical opportunity to strengthen HRM in low‐and‐middle‐income countries. Examining decision space for HRM functions can help identify areas where district health managers can change or improve their actions. In Uganda, decentralisation helped the DHMTs be more responsive to the local workforce needs and analysing decision space helped identify areas for improvement in HRM. There are some limitations and more power over HRM functions and strong management competencies would help them become more resourceful.
Highlights
Decentralisation has been adopted by many governments to strengthen national systems, including the health system
A mixed-methods approach was used to examine the District Health Management Teams (DHMT)' reported decision space for HR-related functions in three districts in the Rwenzori region of west Uganda: Bunyangabu, Ntoroko and Kabarole. These three districts were part of the PERFORM2Scale programme (2017–2021) which is scaling-up a district level management strengthening intervention in Ghana, Uganda and Malawi. It supports groups of DHMTs in each country through a series of action research cycles to identify workforce-related problems and develop integrated strategies that can be included in the annual district plans using their available resources. (See https://www.perform2scale.org/) Kabarole district was chosen since it was among the participating districts in the pilot PERFORM study (2011–2015)
The DHMTs in Bunyangabu and Ntoroko reported a wider decision space than their peers in Kabarole. The latter reported a limited level of control over setting HR policy locally, developing job descriptions and all functions of the Human resources for health (HRH) information domain
Summary
Decentralisation has been adopted by many governments to strengthen national systems, including the health system. All DHMTs reported full control over the functions of performance management, monitoring policy implementation, forecasting staffing needs, staff deployment, and identifying capacity needs They reported narrow decision space for developing job descriptions, resources mobilisation, and. As reported by the World Bank (1993), transferring authority to local government is meant to improve allocative and technical competencies, and promote equity and responsiveness to local needs and quality of care.[13] Bossert claims that, in decentralised contexts, there may be varying levels of decentralisation in devolved structures that provide district managers with a certain level of autonomy or decision space.[1]
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