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

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Baral, S, Subedi, HN, Paudel, P, Chand, PB, Shrestha, MP, McCullough, A, Raven, Joanna ORCID: https://orcid.org/0000-0002-4112-6959, Theobald, Sally ORCID: https://orcid.org/0000-0002-9053-211X, Martineau, Tim ORCID: https://orcid.org/0000-0003-4833-3149 and Elsey, H (2018) 'Implementation research to assess a health workers performance-based management system in Nepal'. Acta Paediatrica, Vol 107, pp. 24-34.

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Abstract

Aim
To test and refine a performance‐based management system to improve health worker performance in Nepal.
Methods
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.
Results
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.
Conclusion
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.

Item Type: Article
Subjects: W General Medicine. Health Professions > W 21 Medicine as a profession.
WA Public Health > WA 100 General works
WA Public Health > Health Administration and Organization > WA 546 Local Health Administration. Community Health Services
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1111/apa.14406
SWORD Depositor: JISC Pubrouter
Depositing User: JISC Pubrouter
Date Deposited: 02 Jan 2019 11:52
Last Modified: 13 Sep 2019 17:45
URI: https://archive.lstmed.ac.uk/id/eprint/9907

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