The performance of health workers in decentralised services in Uganda

Abstract

This study investigated the performance of health workers in the decentralised services in Uganda in order to develop a management framework that may be used to improve performance. The study followed a mixed research methodology and was descriptive. The survey design was used to collect quantitative data by means of a structured questionnaire. Qualitative data was collected using a semi-structured interview guide. The study population for the quantitative strand comprised 276 health workers including doctors, clinical officers, and professional nurses working in four districts: Kumi, Mbale, Sironko and Tororo. The health workers were selected using stratified random sampling. The population for qualitative strand was health services managers (N=21) from the same districts. The managers were selected purposively. Quantitative data was analysed using SPSS version 18.0, while qualitative data was coded and analysed manually. The findings revealed that the performance of health workers is generally affected by health systems and work environment related factors. The findings indicated that health workers are skilled, competent, and generally have positive attitudes and behaviours towards their clients. The study uncovered loop holes in performance management in the district health sectors. In most cases there is no target setting, no performance management planning, performance indicators are not clearly defined, and the schedules for performance measurement are not always followed. There is limited career progression and lack of functional performance feedback and rewarding mechanisms. Although health workers are committed, there is widespread political interference and nepotism in the district health sector management. Overall, the researcher is optimistic that if the proposed performance management framework is implemented, the performance of health workers might improve.