Pursuing better health care delivery at district level
Ahmed, A.M.; Desta, A.; Tekle, K.; Mweta, E.A.
World Health Forum 14(4): 360-366
1993
ISSN/ISBN: 0251-2432 PMID: 8185785 Document Number: 331105
In 1990, in Tanzania, district health managers identified barriers to health care delivery in Dodoma Region. They used district action research and education to address them. The urban district health management team developed a 1-year plan of action, focusing on improving the availability of continuing education for health workers, setting up a library, formulating guidelines for good performance, and preparing a system to acknowledge and reward the best workers. The rural district health management team's 1-year action plan aimed to improve the preparation and follow-up of supervisory activities through a workshop, morning sessions, and monthly meetings with members of the district health management team. 1 year after the plan of action was implemented job satisfaction increased in the urban district; it improved significantly for perceived value of work, fringe benefits, and transport and prospects for promotion. Recognition, reward, and quality of supervision contributed greatly to the improvement in motivation. Inadequate facilities and limited items in Swahili kept health workers from using the district library more fully. The rural health management teams were significantly more satisfied with supervisory activities 1 year after implementation. A workshop helped the members work together towards common goals. 4 of the 6 heads of health units did not receive written feedback on supervision. Health unit heads made a list of recommendations to further improve health care delivery, emphasizing the need for continuing education. Health staff at periphery health units needed improved access to health education materials and to senior colleagues. Both health management teams could indeed use district action research and education without using extra resources. This process strengthened the capacities of the district health management teams and brought about positive problem-solving attitudes. Strong involvement of the central government would further increase staff motivation.