From PERFORM to PERFORM2Scale: Lessons from scaling-up a health management strengthening intervention to support Universal Health Coverage in three African countries

Raven, Joanna ORCID: https://orcid.org/0000-0002-4112-6959, Mansour, Wesam, Aikins, M, Bulthuis, S, Chikaphupha, K, Dieleman, M, Kok, Maryse, Martineau, Tim ORCID: https://orcid.org/0000-0003-4833-3149, Ssenggooba, F, Wyss, K and Vallières, F (2024) 'From PERFORM to PERFORM2Scale: Lessons from scaling-up a health management strengthening intervention to support Universal Health Coverage in three African countries'. Health Policy and Planning, Vol 39, Issue 8, pp. 841-853.

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Abstract

Strengthening management and leadership competencies among district and local health managers has emerged as a common approach for health systems strengthening and to achieve Universal Health Coverage (UHC). While the literature is rich with localised examples of initiatives that aim to strengthen the capacity of district or local health managers, particularly in sub-Saharan Africa, considerably less attention is paid to the science of how to scale-up these initiatives. The aim of this paper is thus to examine the process of scaling-up a management strengthening intervention (MSI) and identify new knowledge and key lessons learned that can be used to inform the scale-up process of other complex health interventions, in support of UHC. Qualitative methods were used to identify lessons learned from scaling-up the MSI in Ghana, Malawi and Uganda. We conducted 14 interviews with district health management team members, three scale-up assessments with 20 scale-up stakeholders, and three reflection discussions with 11 research team members. We also kept records of activities throughout MSI and scale-up implementation. Data was recorded, transcribed, and analysed against the Theory of Change to identify both scale-up outcomes and the factors affecting these outcomes. The MSI was ultimately scaled-up across 27 districts. Repeated MSI cycles over time were found to foster greater feelings of autonomy among district health management teams (DHMTs) to address longstanding local problems, a more innovative use of existing resources without relying on additional funding, and improved teamwork. The use of ‘resource teams’ and the emergence of MSI ‘champions’, were both instrumental in supporting scale-up efforts. Challenges to the sustainability of the MSI include limited government buy-in and lack of sustained financial investment.

Item Type:	Article
Subjects:	WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Administration and Organization > WA 540 National and state health administration
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):	https://doi.org/10.1093/heapol/czae063
Depositing User:	Rachel Dominguez
Date Deposited:	11 Jul 2024 13:10
Last Modified:	10 Sep 2024 12:51
URI:	https://archive.lstmed.ac.uk/id/eprint/24905

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