We used diaries to encourage reflective practice among District Health Management Teams. This presentation provides some insights into the outcomes of this action research method.

1. But I wrote it down!
Experience of using diaries to promote
reflective practice among district health
management teams in three African countries
Comfort Mshelia, University of Leeds, UK

2. Plan for my talk
• Overview of PERFORM project
• Why diaries?
• Use of diaries in PERFORM
• Reflections
• Conclusion

3. Overview
• Title : Supporting decentralised management to
improve health workforce performance
• Acronym: PERFORM
• Study countries: Ghana, Tanzania, Uganda
• Funded by the European Commission (FP7)
• 4-year project which started in August, 2011.

4. • Problem: Lack of adequate and well-performing
health workers.
• PERFORM is focused on improving health workforce
performance in sub-Saharan Africa.
• Assumption: Strengthening district health
management will lead to improvement in health
workforce performance.
Background

5. • The research:
– is taking place in three districts in each of the three
African countries.
– Will study how management strengthening can be
used, and under what conditions, to enhance
workforce performance.
• Comparative analysis of the findings will add new
knowledge as to the effects of different country
contexts on these interventions.
Research design

6. Action research Cycle
Plan
- Describe and analyse the
problem they face
- Identify and plan solutions
Act
Implement the
changes needed
Observe
Observe the effects of the
implemented changes
Reflect
Reflect on the process and the
effects of changes made
Lewin, K. (1958) Group decision and social change. In Readings in social
psychology, ed. Maccoby, E. E., Newcomb, T. M., & Hartley, E. L., 197-211.
New York,NY: Holt, Rinehart, Winston.
Action Research cycle

7. Partners
School of Public Health, University of Ghana, Ghana
Institute of Development Studies, University of Dar-es-
salaam, Tanzania
School of Public Health, College of Health Sciences,
Makerere , Uganda
Swiss Tropical and Public Health Institute, Switzerland
Nuffield Centre for International Health and Development,
University of Leeds, UK
Liverpool School of Tropical Medicine, UK

8. Why diaries?
• Need to record what was done and how it was done
• Other options considered: learning history

9. What we did
• Designed a template including prompts
• This was introduced to the District Health
Management Teams (DHMTs) by the CRTs
• Freedom to adapt to context

10. What we did (2)
Prompts
How we chose this bundle of strategies -describe the bundle of strategies
How we implemented a bundle of strategies
Why we implemented in this way
How we have observed the effects of the strategies
What were the effects (and unintended effects) of the strategies
What worked well
What worked not so well
What we would change next time
Any changes in the environment that may affect the process and results

11. How are the diaries used?
• Examples of use of diaries in health systems research
is lacking
• Interviewed DHMTs in the 9 study districts.
• Interviewed members of each of the country
research teams

12. Use of Diaries
• Purpose:
– To record what is implemented
– To record how it was implemented
– Tool to encourage reflection and learning
• To follow the Action Research cycle

13. Reflections
- Consistency in what
is being recorded
- Encourage learning
from other’s
experiences
- Increased
organisation
- Time constraints
- Workload issues
- Access to the diary
- Reflection

14. Key messages
• Need to consult with users at the design stage
• Use a clear and simple template
• Link the diary to existing processes/practices such as
meetings
• Adequate support to the users

15. Conclusion
• Will the diaries have contributed to management
strengthening?
• Will the diaries have contributed to improvements in
workforce performance?

16. Thank you!