IMPROVING DISTRICT HEALTH MANAGEMENT PERFORMANCE: A NEW FRAMEWORK WITH TOOLS FOR SITUATION ANALYSIS

In recent decades, The United Nations, national governments, and many international donors and non-governmental organizations have dedicated considerable resources to the achievement of the Millennium Development Goals (MDGs) in low income countries. Special efforts have gone into achieving the health-related MDGs. Early in the process, many realized that health systems in poor countries would have to be strengthened to deliver the services necessary to achieving the MDGs. Recently it has also become clear that to make health systems stronger, it will be paramount to improve the management of the limited available resources and service provision at the local level. The improvement of district health management performance has been recognized as a key element in the complex task of strengthening health systems. This has become even more compelling since the number of countries that have decentralized health systems has increased significantly. While many studies, essays, guidelines and manuals have been published on how to strengthen health systems as a whole, little evidence is available on how to improve the management at the district level. This work contributes to bridging this gap by providing (a) a new theoretical framework that systematizes the main determinants of the performance of district health management teams in a coherent way using WHO approach to health systems; (b) a set of tools for a quick but effective situation analysis with indicators organized by health systems functions that can be used to identify which determinants are falling short and need to be addressed to improve the performance of health district managers on the ground; and (c) a list of possible strategies to resolve the identified deficits that have been reported in the literature to be successful in different contexts. The necessary characteristics for a comprehensive implementation strategy to improve district health management performance are also discussed. The application of the framework and of the analytical tools described in this document has the potential of producing a major improvement in many countries and constitute the strategy forward in this arena for UNCIEF.