Strengthening health management: experience of district teams in the Gambia
Conn, C.P.; Jenkins, P.; Touray, S.O.
Health Policy and Planning 11(1): 64-71
1996
ISSN/ISBN: 0268-1080 PMID: 10155879 DOI: 10.1093/heapol/11.1.64Document Number: 295572
In recognition of the importance of developing strong district health teams in order to implement primary health care in developing countries, a district-level health management strengthening project took place during an 18-month period starting in 1991 in the Gambia. The objectives of the project were to teach regional health teams (RHTs) how to function as decentralized management units, improve team management skills, achieve improved resource management, and increase awareness of district health management problems at the national level. RHT training involved the introduction of a six-month planning cycle which identified priorities and problems and defined ways to address them. This analysis formed the basis for the RHTs to make realistic workplans and to begin to exhibit initiative in planning. New teamwork skills led to the delivery of more coordinated supervision and training support to health staff. The new planning process also involved initiating local analysis and use of local service delivery data and the improvement of problem analysis skills. Regional health administrators were hired to improve resources management, including repair and construction of health facilities and developing better transportation mechanisms. Project effectiveness was enhanced by a the motivation of the team members, the support of new team leaders, the problem-solving, hands-on approach, and better access to information. Restraints included national procedures that resisted decentralization, a lack of skilled national-level managers, the resistance of national-level health managers, and donor policy that created vertical and parallel programs and supported top-down decision-making. While the project resulted in some gains, it also demonstrated that the initiatives of district level health teams are not sufficient to achieve reform. Further improvements will rely on actions taken at the national level and by donors.