Five lessons from a mid-level health manager intervention to increase uptake of tuberculosis prevention therapy in Uganda: ‘it is a completely different thing to implement what you know.’
Background Leadership skills are essential for middle-level healthcare manager efficacy. Capacity-building efforts may attempt behavioural change by filling ‘knowledge gaps’ while neglecting a sustainable application of that knowledge. Sustainable application of that knowledge, or implementation kno...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2024-12-01
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| Series: | Global Health Action |
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| Online Access: | http://dx.doi.org/10.1080/16549716.2024.2427434 |
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| author | Jason Johnson-Peretz Canice Christian Cecilia Akatukwasa Fred Atwine Elijah Kakande Moses R. Kamya Diane V. Havlir Carol S. Camlin Gabriel Chamie |
| author_facet | Jason Johnson-Peretz Canice Christian Cecilia Akatukwasa Fred Atwine Elijah Kakande Moses R. Kamya Diane V. Havlir Carol S. Camlin Gabriel Chamie |
| author_sort | Jason Johnson-Peretz |
| collection | DOAJ |
| description | Background Leadership skills are essential for middle-level healthcare manager efficacy. Capacity-building efforts may attempt behavioural change by filling ‘knowledge gaps’ while neglecting a sustainable application of that knowledge. Sustainable application of that knowledge, or implementation know-how, must resonate with local cultural patterns. When it is neglected, root issues like unclear decision-making space and local authority to interpret policy during implementation remain unaddressed. Particularly in decentralized healthcare systems, the impact can appear in implementation challenges, subjective decision-making, poor teamwork, and an absence of disseminating best practices. Objectives The SEARCH-IPT trial led a series of mini-collaborative meetings, which provided business leadership and management training for an intervention group of mid-level healthcare system managers in rural Eastern, East-Central, and Southwestern Uganda to see whether this would increase uptake of isoniazid-prevention therapy (IPT) for people living with HIV (PLHIV) in intervention districts. IPT is known to reduce active tuberculosis (TB), a leading cause of death among PLHIV, by 40–60%. Methods We performed a thematic analysis of six focus-group discussions from this intervention (held in May 2019, January 2020, September 2021) and 23 key informant interviews with control group participants (between February and August 2019 and September and December 2020). Results Analysis revealed five implementation skill sets District Health Officers (DHOs) and District Tuberculosis and Leprosy Supervisors (DTLSs) deployed to achieve sustainable implementation and realize their decision-making space. The five practices were as follows: data-based decision-making, root-cause analysis, quality assurance, evidence-based empowerment, and sharing best practices with colleagues. Conclusion These practices reached beyond outcome measures to address root problems around the DHO’s range of authority and elicit buy-in from district health workers. For successful capacity building at the mid-manager level, focusing on core practices as part of competency is objectively implementable and measurable at the system level and does not rely on DHO self-assessments. |
| format | Article |
| id | doaj-art-484ed6b99a3c44acb3fddf45b786d0b4 |
| institution | Kabale University |
| issn | 1654-9880 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Global Health Action |
| spelling | doaj-art-484ed6b99a3c44acb3fddf45b786d0b42025-02-05T12:46:14ZengTaylor & Francis GroupGlobal Health Action1654-98802024-12-0117110.1080/16549716.2024.24274342427434Five lessons from a mid-level health manager intervention to increase uptake of tuberculosis prevention therapy in Uganda: ‘it is a completely different thing to implement what you know.’Jason Johnson-Peretz0Canice Christian1Cecilia Akatukwasa2Fred Atwine3Elijah Kakande4Moses R. Kamya5Diane V. Havlir6Carol S. Camlin7Gabriel Chamie8University of CaliforniaUniversity of CaliforniaInfectious Diseases Research Collaboration (IDRC)Infectious Diseases Research Collaboration (IDRC)Infectious Diseases Research Collaboration (IDRC)Infectious Diseases Research Collaboration (IDRC)University of CaliforniaUniversity of CaliforniaUniversity of CaliforniaBackground Leadership skills are essential for middle-level healthcare manager efficacy. Capacity-building efforts may attempt behavioural change by filling ‘knowledge gaps’ while neglecting a sustainable application of that knowledge. Sustainable application of that knowledge, or implementation know-how, must resonate with local cultural patterns. When it is neglected, root issues like unclear decision-making space and local authority to interpret policy during implementation remain unaddressed. Particularly in decentralized healthcare systems, the impact can appear in implementation challenges, subjective decision-making, poor teamwork, and an absence of disseminating best practices. Objectives The SEARCH-IPT trial led a series of mini-collaborative meetings, which provided business leadership and management training for an intervention group of mid-level healthcare system managers in rural Eastern, East-Central, and Southwestern Uganda to see whether this would increase uptake of isoniazid-prevention therapy (IPT) for people living with HIV (PLHIV) in intervention districts. IPT is known to reduce active tuberculosis (TB), a leading cause of death among PLHIV, by 40–60%. Methods We performed a thematic analysis of six focus-group discussions from this intervention (held in May 2019, January 2020, September 2021) and 23 key informant interviews with control group participants (between February and August 2019 and September and December 2020). Results Analysis revealed five implementation skill sets District Health Officers (DHOs) and District Tuberculosis and Leprosy Supervisors (DTLSs) deployed to achieve sustainable implementation and realize their decision-making space. The five practices were as follows: data-based decision-making, root-cause analysis, quality assurance, evidence-based empowerment, and sharing best practices with colleagues. Conclusion These practices reached beyond outcome measures to address root problems around the DHO’s range of authority and elicit buy-in from district health workers. For successful capacity building at the mid-manager level, focusing on core practices as part of competency is objectively implementable and measurable at the system level and does not rely on DHO self-assessments.http://dx.doi.org/10.1080/16549716.2024.2427434decision spacehealthcarecapacity buildingdecentralizationtuberculosishivmanagementimplementation |
| spellingShingle | Jason Johnson-Peretz Canice Christian Cecilia Akatukwasa Fred Atwine Elijah Kakande Moses R. Kamya Diane V. Havlir Carol S. Camlin Gabriel Chamie Five lessons from a mid-level health manager intervention to increase uptake of tuberculosis prevention therapy in Uganda: ‘it is a completely different thing to implement what you know.’ Global Health Action decision space healthcare capacity building decentralization tuberculosis hiv management implementation |
| title | Five lessons from a mid-level health manager intervention to increase uptake of tuberculosis prevention therapy in Uganda: ‘it is a completely different thing to implement what you know.’ |
| title_full | Five lessons from a mid-level health manager intervention to increase uptake of tuberculosis prevention therapy in Uganda: ‘it is a completely different thing to implement what you know.’ |
| title_fullStr | Five lessons from a mid-level health manager intervention to increase uptake of tuberculosis prevention therapy in Uganda: ‘it is a completely different thing to implement what you know.’ |
| title_full_unstemmed | Five lessons from a mid-level health manager intervention to increase uptake of tuberculosis prevention therapy in Uganda: ‘it is a completely different thing to implement what you know.’ |
| title_short | Five lessons from a mid-level health manager intervention to increase uptake of tuberculosis prevention therapy in Uganda: ‘it is a completely different thing to implement what you know.’ |
| title_sort | five lessons from a mid level health manager intervention to increase uptake of tuberculosis prevention therapy in uganda it is a completely different thing to implement what you know |
| topic | decision space healthcare capacity building decentralization tuberculosis hiv management implementation |
| url | http://dx.doi.org/10.1080/16549716.2024.2427434 |
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