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

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dc.contributor.authorRaven, Joanna
dc.contributor.authorMansour, Wesam
dc.contributor.authorMansour, Wesam
dc.contributor.authorAikins, Moses
dc.contributor.authorBulthuis, Susan
dc.contributor.authorChikaphupha, Kingsley
dc.contributor.authorDieleman, Marjolein
dc.contributor.authorKok, Maryse
dc.contributor.authorMartineau, Tim
dc.contributor.authorSsengooba, Freddie
dc.contributor.authorWyss, Kaspar
dc.contributor.authorVallières, Frédérique
dc.date.accessioned2024-09-17T07:56:20Z
dc.date.available2024-09-17T07:56:20Z
dc.date.issued2024-09
dc.description.abstractStrengthening 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 localized 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 (DHMT) 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 were 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 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 instrumental in supporting scale-up efforts. Challenges to the sustainability of the MSI include limited government buy-in and lack of sustained financial investment.
dc.identifier.citationRaven, Joanna, Wesam Mansour, Moses Aikins, et al. '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/no. 8, (2024), pp. 841-853.
dc.identifier.issnISSN 1460-2237, 0268-1080
dc.identifier.issnEISSN 1460-2237
dc.identifier.urihttps://nru.uncst.go.ug/handle/123456789/9615
dc.language.isoen
dc.publisherOxford University Press
dc.titleFrom PERFORM to PERFORM2Scale: lessons from scaling-up a health management strengthening intervention to support Universal Health Coverage in three African countries
dc.typeArticle
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