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Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Research article

Determinants of effective organisational capacity training: lessons from a training programme on health workforce development with participants from three African countries

Authors: Woldekidan Kifle Amde, Bruno Marchal, David Sanders, Uta Lehmann

Published in: BMC Public Health | Issue 1/2019

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Abstract

Background

Health systems in sub-Saharan Africa face multifaceted capacity challenges to fulfil their mandates of service provision and governance of their resources. Four academic institutions in Africa implemented a World Health Organisation-funded collaborative project encompassing training, curriculum development, and partnership to strengthen national leadership and training capacity for health workforce development. This paper looks into the training component of the project, a blended Masters programme in public health that sought to improve the capacity of personnel involved in teaching or management/development of human resources for health. The paper aims to explore factors influencing contribution of training to organisational capacity development.

Methods

We chose a case study design. Semi-structured interviews were held with 18 trainees that were enrolled in the training programme, and who were affiliated to health ministries or public health training institutions. We gathered additional data through document reviews, observation, and interviews with 14 key informants associated with the programme and/or working in the collaborating institutions. The evidence gathered were analysed thematically.

Results

Thirteen of the 18 training participants stayed in the target institutions and contributed to improved capacity of their institutions in the fields of management, policy, planning, research, training, or curriculum development. Five left for private and international agencies due to dissatisfaction with payment, work conditions, or career prospect.
Factors that were associated with the training, trainees, and the institutional and broader context, determine contribution of training to organisational capacity development. These include relevance of newly acquired knowledge and skills set of trainees to the role/position they assume in the organisation; recognition of trainees by employing organisations in terms of promotion or assignment of challenging tasks; and motivation and retention of trained staff.

Conclusion

Training, even if relevant and applicable, makes no more than a ‘latent’ contribution, one which is activated and realised through alignment of clusters of interacting contextual and relational factors related to the target institutions and trained personnel. While not predictable, implementers need to focus more deliberately on the likely interaction and best possible alignments between training relevance, student selection for potential to contribute, recognition and career advancement potential.
Literature
1.
go back to reference Seims LR, Cheburet S, Dedzo M. Leadership and management to empower the health workforce. In: DeLuca MA, Soucat a, editors. Transforming the global health workforce. 1st ed. New York: New York University, College of Nursing; 2013. Seims LR, Cheburet S, Dedzo M. Leadership and management to empower the health workforce. In: DeLuca MA, Soucat a, editors. Transforming the global health workforce. 1st ed. New York: New York University, College of Nursing; 2013.
3.
go back to reference African Union. Fourth Session of the African Union Conference of Ministers of Health 4–8 MAY 2009 CAMH / EXP / 13a ( IV ) Theme. “Universal Access to Quality Health Services: Improve Maternal, Neonatal and Child Health”; 2009. African Union. Fourth Session of the African Union Conference of Ministers of Health 4–8 MAY 2009 CAMH / EXP / 13a ( IV ) Theme. “Universal Access to Quality Health Services: Improve Maternal, Neonatal and Child Health”; 2009.
4.
go back to reference Nyoni J, Gedik G. Health workforce governance and leadership capacity in the African Region Review of human resources for health. Geneva: World Health Organization; 2012. Nyoni J, Gedik G. Health workforce governance and leadership capacity in the African Region Review of human resources for health. Geneva: World Health Organization; 2012.
7.
go back to reference Dieleman M, Gerretsen B, Van Der Wilt GJ. Human resource management interventions to improve health workers’ performance in low and middle income countries : a realist review. Heal Res Policy Syst. 2009;7(7):1–13. Dieleman M, Gerretsen B, Van Der Wilt GJ. Human resource management interventions to improve health workers’ performance in low and middle income countries : a realist review. Heal Res Policy Syst. 2009;7(7):1–13.
8.
go back to reference Ijsselmuiden C, Marais DL, Ghannem H. Africa’s neglected area of human resources for health research – the way forward. SAMJ. 2012;102(4):228–33.PubMed Ijsselmuiden C, Marais DL, Ghannem H. Africa’s neglected area of human resources for health research – the way forward. SAMJ. 2012;102(4):228–33.PubMed
9.
go back to reference Baser H, Morgan P. Capacity, Change and Performance: Study Report. Maastricht: World Health Organization; 2008. Baser H, Morgan P. Capacity, Change and Performance: Study Report. Maastricht: World Health Organization; 2008.
10.
go back to reference Hope KR. Capacity development for good governance in developing countries: some lessons from the field. Int J Public Adm. 2009;32(8):728–40.CrossRef Hope KR. Capacity development for good governance in developing countries: some lessons from the field. Int J Public Adm. 2009;32(8):728–40.CrossRef
11.
go back to reference Potter C, Brough R. Systemic capacity building: a hierarchy of needs. Health Policy Plan. 2004;19(5):336–45.PubMedCrossRef Potter C, Brough R. Systemic capacity building: a hierarchy of needs. Health Policy Plan. 2004;19(5):336–45.PubMedCrossRef
15.
go back to reference Analoui F, Danquah JK. Critical capacity development. Cham: Palgrave Macmillan; 2017.CrossRef Analoui F, Danquah JK. Critical capacity development. Cham: Palgrave Macmillan; 2017.CrossRef
16.
go back to reference Alexander L, Igumbor EU, Sanders D. Building capacity without disrupting health services: public health education for Africa through distance learning. Hum Resour Health. 2009;7:28.PubMedPubMedCentralCrossRef Alexander L, Igumbor EU, Sanders D. Building capacity without disrupting health services: public health education for Africa through distance learning. Hum Resour Health. 2009;7:28.PubMedPubMedCentralCrossRef
17.
go back to reference WHO. Towards better leadership and management in health: Report on an international consultation on strengthening leadership and management in low-income countries, 29 January-1 February 2007, vol. 2007. Geneva: World Health Organization. WHO. Towards better leadership and management in health: Report on an international consultation on strengthening leadership and management in low-income countries, 29 January-1 February 2007, vol. 2007. Geneva: World Health Organization.
18.
go back to reference UNDP. Capacity Development: Practice Note. New York: UNDP; 2008. UNDP. Capacity Development: Practice Note. New York: UNDP; 2008.
20.
go back to reference Morgan P. The idea and practice of systems thinking and their relevance for capacity development. Maastricht: ECDPM; 2005. Morgan P. The idea and practice of systems thinking and their relevance for capacity development. Maastricht: ECDPM; 2005.
21.
go back to reference Pearson J. Training and beyond: seeking better practices for capacity development, OECD Development Co-operation Working Papers, No. 1, Organisation for Economic Co-operation and Development. 2011. Pearson J. Training and beyond: seeking better practices for capacity development, OECD Development Co-operation Working Papers, No. 1, Organisation for Economic Co-operation and Development. 2011.
22.
go back to reference Brown L, LaFond A, Macintyre K. Measuring Capacity Building. North Carolina: World Health Organization; 2001. Brown L, LaFond A, Macintyre K. Measuring Capacity Building. North Carolina: World Health Organization; 2001.
23.
go back to reference Aragón AO, Giles Macedo JC. A ‘systemic theories of Change’Approach for purposeful capacity development. IDS Bull. 2010;41(3):87–99.CrossRef Aragón AO, Giles Macedo JC. A ‘systemic theories of Change’Approach for purposeful capacity development. IDS Bull. 2010;41(3):87–99.CrossRef
24.
go back to reference Coulson N, Goldstone G, Ntuli A, Pillay I. Developing capacity for health: a practical approach. Johannesburg: Heinemann; 2010. Coulson N, Goldstone G, Ntuli A, Pillay I. Developing capacity for health: a practical approach. Johannesburg: Heinemann; 2010.
25.
go back to reference Hongoro C, Normand C. Health Workers: Building and Motivating the Workforce Charles. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al., editors. Disease Control Priorities in Developing Countries. New York: Oxford University Press; 2006. p. 1310–22. Hongoro C, Normand C. Health Workers: Building and Motivating the Workforce Charles. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, et al., editors. Disease Control Priorities in Developing Countries. New York: Oxford University Press; 2006. p. 1310–22.
27.
go back to reference Topp SM. Health worker performance, practice and improvement. In: George A, Scott K, Govender V, editors. A health policy and systems research reader on human resources for health. Geneva: World Health Organization; 2017. p. 73–87. Topp SM. Health worker performance, practice and improvement. In: George A, Scott K, Govender V, editors. A health policy and systems research reader on human resources for health. Geneva: World Health Organization; 2017. p. 73–87.
28.
go back to reference Bhatnagar A. Health worker motivation: individual, organizational and cultural factors. In: George A, Scott K, Govender V, editors. A health policy and systems research reader on human resources for health. Geneva: World Health Organization; 2017. p. 91–101. Bhatnagar A. Health worker motivation: individual, organizational and cultural factors. In: George A, Scott K, Govender V, editors. A health policy and systems research reader on human resources for health. Geneva: World Health Organization; 2017. p. 91–101.
29.
go back to reference Bennett S, Franco LM. Health worker motivation and health sector reform: a conceptual framework, Major Applied Research 5, Technical Paper 1. 1999;(1). Bennett S, Franco LM. Health worker motivation and health sector reform: a conceptual framework, Major Applied Research 5, Technical Paper 1. 1999;(1).
31.
go back to reference Johnston S, Steinman L, Bradford V, Walkinshaw L, Johnson D. An analysis of the adoption and implementation of breastfeeding policies in Washington state clinics. J Community Med Health Educ. 2017;7(3):1–9. Johnston S, Steinman L, Bradford V, Walkinshaw L, Johnson D. An analysis of the adoption and implementation of breastfeeding policies in Washington state clinics. J Community Med Health Educ. 2017;7(3):1–9.
32.
go back to reference Greenhalgh T, Bate P, Kyriakidou O, Macfarlane F, Robert G. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):607–10.CrossRef Greenhalgh T, Bate P, Kyriakidou O, Macfarlane F, Robert G. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004;82(4):607–10.CrossRef
33.
go back to reference Amde WK, Sanders D, Lehmann U. Building capacity to develop an African teaching platform on health workforce development: a collaborative initiative of universities from four sub Saharan countries. Hum Resour Health. 2014;12(1):1–11.CrossRef Amde WK, Sanders D, Lehmann U. Building capacity to develop an African teaching platform on health workforce development: a collaborative initiative of universities from four sub Saharan countries. Hum Resour Health. 2014;12(1):1–11.CrossRef
34.
go back to reference Yin R. Case study research: design and methods. California: SAGE Publications Ltd; 2003. Yin R. Case study research: design and methods. California: SAGE Publications Ltd; 2003.
35.
go back to reference Chen HT. A theory-driven evaluation perspective on mixed methods research. Res Sc. 2006;13(1):75–83. Chen HT. A theory-driven evaluation perspective on mixed methods research. Res Sc. 2006;13(1):75–83.
36.
go back to reference Mathison S. Encyclopedia of Evaluation. In: SAGE Researcg Methods: Encyclopedia of Evaluation; 2005. p. 416–21.CrossRef Mathison S. Encyclopedia of Evaluation. In: SAGE Researcg Methods: Encyclopedia of Evaluation; 2005. p. 416–21.CrossRef
37.
go back to reference Berg BL. Qualitative research methods for the social sciences. 4th ed. A Pearson Education Company: Massachusetts; 2001. Berg BL. Qualitative research methods for the social sciences. 4th ed. A Pearson Education Company: Massachusetts; 2001.
38.
go back to reference Merriam SB. Qualitative research: a guide to design and implementation: revised and expanded from qualitative research and case study applications in education. San Franscisco: Jossey-Bass; 2009. p. 293. Merriam SB. Qualitative research: a guide to design and implementation: revised and expanded from qualitative research and case study applications in education. San Franscisco: Jossey-Bass; 2009. p. 293.
39.
go back to reference Patton MQ. Qualitative Research & Evaluation Methods. 3rd Editio. London: Sage Publications; 2002. Patton MQ. Qualitative Research & Evaluation Methods. 3rd Editio. London: Sage Publications; 2002.
41.
go back to reference Stake RE. Multiple case study analysis. New York: The Guilford Press; 2006. Stake RE. Multiple case study analysis. New York: The Guilford Press; 2006.
42.
go back to reference Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.CrossRef
44.
go back to reference Renmans D, Holvoet N, Criel B. Combining theory-driven evaluation and causal loop diagramming for opening the ‘black box’ of an intervention in the health sector: a case of performance-based financing in Western Uganda. Int J Environ Res Public Health. 2017;14(9):1007.PubMedCentralCrossRef Renmans D, Holvoet N, Criel B. Combining theory-driven evaluation and causal loop diagramming for opening the ‘black box’ of an intervention in the health sector: a case of performance-based financing in Western Uganda. Int J Environ Res Public Health. 2017;14(9):1007.PubMedCentralCrossRef
45.
go back to reference Vermaak H. Using causal loop diagramsto deal with complex issues: mastering an instrument for systemic and interactive change. In: Jamieson DW, Barnett RC, Buono AF, editors. Consultation for organizational change revisited: research in management consulting. 23rd ed. Charlotte, NC: Information Age Publishing; 2016. p. 231–54. Vermaak H. Using causal loop diagramsto deal with complex issues: mastering an instrument for systemic and interactive change. In: Jamieson DW, Barnett RC, Buono AF, editors. Consultation for organizational change revisited: research in management consulting. 23rd ed. Charlotte, NC: Information Age Publishing; 2016. p. 231–54.
46.
go back to reference Vermaak H. Working Interactively with Causal Loop Diagrams: Intervention Choices and Paradoxes in Practical Applications. In: Boonstra J, L de C, editors. Intervening and Changing: Looking for Meaning in Interactions. West Susse: Wiley; 2007. p. 175–94. Vermaak H. Working Interactively with Causal Loop Diagrams: Intervention Choices and Paradoxes in Practical Applications. In: Boonstra J, L de C, editors. Intervening and Changing: Looking for Meaning in Interactions. West Susse: Wiley; 2007. p. 175–94.
47.
go back to reference Creswell J, Miller D. Determining validity in qualitative inquiry. Theory Pract. 2000;39(3):124–30.CrossRef Creswell J, Miller D. Determining validity in qualitative inquiry. Theory Pract. 2000;39(3):124–30.CrossRef
48.
go back to reference Gilson L, Hanson K, Sheikh K, Agyepong IA, Ssengooba F, Bennett S. Building the field of health policy and systems research: social science matters. PLoS Med. 2011;8(8):e1001079.PubMedPubMedCentralCrossRef Gilson L, Hanson K, Sheikh K, Agyepong IA, Ssengooba F, Bennett S. Building the field of health policy and systems research: social science matters. PLoS Med. 2011;8(8):e1001079.PubMedPubMedCentralCrossRef
49.
go back to reference Shenton K, Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Educ Inf. 2004;22:63–75. Shenton K, Shenton AK. Strategies for ensuring trustworthiness in qualitative research projects. Educ Inf. 2004;22:63–75.
50.
go back to reference Krefting L. Rigor in qualitative research: the assessment of trustworthiness. Am J Occup Ther. 1991;45(3):214–22.PubMedCrossRef Krefting L. Rigor in qualitative research: the assessment of trustworthiness. Am J Occup Ther. 1991;45(3):214–22.PubMedCrossRef
51.
go back to reference Neufeld V, Johnson N. Training and development of health leaders: joint learning initiative Working paper 2–9. Ontario: World Health Organization; 2004. Neufeld V, Johnson N. Training and development of health leaders: joint learning initiative Working paper 2–9. Ontario: World Health Organization; 2004.
52.
go back to reference Pearson J. LenCD learning package on capacity development; 2011. Pearson J. LenCD learning package on capacity development; 2011.
54.
go back to reference Willis-shattuck M, Bidwell P, Thomas S, Wyness L, Blaauw D, Ditlopo P. Motivation and retention of health workers in developing countries : a systematic review. BMC Health Serv Res. 2008;8:1–8.CrossRef Willis-shattuck M, Bidwell P, Thomas S, Wyness L, Blaauw D, Ditlopo P. Motivation and retention of health workers in developing countries : a systematic review. BMC Health Serv Res. 2008;8:1–8.CrossRef
55.
go back to reference Amde WK, Sanders D, Chilundo B, Rugigana E, Mariam DH, Lehmann U. Exploring multiple job holding practices of academics in public health training institutions from three sub-Saharan Africa countries : drivers , impact , and regulation. Glob Health Action. 2018;11(1):1491119.PubMedPubMedCentralCrossRef Amde WK, Sanders D, Chilundo B, Rugigana E, Mariam DH, Lehmann U. Exploring multiple job holding practices of academics in public health training institutions from three sub-Saharan Africa countries : drivers , impact , and regulation. Glob Health Action. 2018;11(1):1491119.PubMedPubMedCentralCrossRef
56.
go back to reference Ferrinho P, Van Lerberghe W, Fronteira I, Hipólito F, Biscaia A. Dual practice in the health sector: review of the evidence. Hum Resour Health. 2004;2:1–17.CrossRef Ferrinho P, Van Lerberghe W, Fronteira I, Hipólito F, Biscaia A. Dual practice in the health sector: review of the evidence. Hum Resour Health. 2004;2:1–17.CrossRef
57.
go back to reference Hailu A, Mariam DH, Fekade D, Derbew M, Mekasha A. Turn-over rate of academic faculty at the College of Health Sciences, Addis Ababa University: a 20-year analysis (1991 to 2011). Hum Resour Health. 2013;11(61):1–6. Hailu A, Mariam DH, Fekade D, Derbew M, Mekasha A. Turn-over rate of academic faculty at the College of Health Sciences, Addis Ababa University: a 20-year analysis (1991 to 2011). Hum Resour Health. 2013;11(61):1–6.
58.
go back to reference Bates I, Phillips R, Martin-Peprah R, Kibiki G, Gaye O, Phiri K, et al. Assessing and strengthening African universities’ capacity for doctoral programmes. PLoS Med. 2011;8(9):e1001068.PubMedPubMedCentralCrossRef Bates I, Phillips R, Martin-Peprah R, Kibiki G, Gaye O, Phiri K, et al. Assessing and strengthening African universities’ capacity for doctoral programmes. PLoS Med. 2011;8(9):e1001068.PubMedPubMedCentralCrossRef
60.
go back to reference John P. Finding exits and voices: Albert Hirschman’s contribution to the study of public services. Int Public Manag J. 2017;20(3):512–29.CrossRef John P. Finding exits and voices: Albert Hirschman’s contribution to the study of public services. Int Public Manag J. 2017;20(3):512–29.CrossRef
61.
Metadata
Title
Determinants of effective organisational capacity training: lessons from a training programme on health workforce development with participants from three African countries
Authors
Woldekidan Kifle Amde
Bruno Marchal
David Sanders
Uta Lehmann
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-7883-x

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