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Implementation research to assess a health workers performance‐based management system in Nepal
Author(s) -
Baral S,
Subedi HN,
Paudel P,
Chand PB,
Shrestha MP,
McCullough A,
Raven J,
Theobald S,
Martineau T,
Elsey H
Publication year - 2018
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.14406
Subject(s) - medicine , absenteeism , nursing , job satisfaction , health facility , context (archaeology) , childbirth , implementation research , service delivery framework , operations management , service (business) , psychological intervention , environmental health , health services , marketing , population , psychology , business , pregnancy , social psychology , paleontology , genetics , economics , biology
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.