I found that the approach promoted collaboration, creativity, monitoring of progress and goal attainment among health managers.
This study aimed at examining strategies for strengthening the capacity of health managers at the sub-national level from their own perspectives with a focus on the Participatory Action Research (PAR) approach.
We began by investigating what health managers in Uganda saw as important for strengthening their capacity and found three interrelated sub-processes: professionalizing of health managerial roles, the use of engaging approaches to learning, and ensuring a supportive work environment.
Next, we turned to study the use of engaging approaches to strengthening managers' capacity in Uganda through PAR. PAR was experienced as a nuanced awakening strategy. On the one hand, stakeholders felt engaged, valued, responsible, awakened and a sense of ownership when using PAR. On the other, they felt conflicted, stressed and uncertain. To counter the undesirable experiences, tolerance, risk consciousness and collaboration was exercised. This nuanced experience enabled managers to enhance key management competencies such collaboration, creativity, control and goal attainment driven by responsiveness to client needs. Expanded spaces for interaction, the encouragement of flexibility, the empowerment of local managers and the promotion of reflection and accountability enabled this enhancement.
Lastly, we examined how PAR had been used to strengthen health managers' capacity internationally. We found elements that supported the harnessing of PAR to strengthen health managers' capacity. These included; having shared purpose, skilled facilitation and social psychological safety, activity integration into organizational procedures, organizational support and supportive external monitoring.
We concluded that health managers have a central role in strengthening health systems. The formalization of the health managers' role especially within the public sector is needed. This needs to be followed by significant investments into developing and strengthening their capacity in order to make health systems more responsive. Strengthening the capacity of health managers is an iterative process that draws synergies from different approaches. The process leans on formal trainings as well as more engaging means of learning such as PAR. Participatory approaches are relevant for dealing with the complex challenges bedeviling health systems. The approach nonetheless should be applied with a more nuanced appreciation of the challenges when using it and the elements for harnessing it to strengthen health systems.
This was an emergent qualitative study having primary data collection and a literature review. Individual interviews, Focus Group Discussions (FGDs), review of documents, observations and meeting minutes was undertaken in three rural districts in Uganda. While searching of peer-reviewed databases was used for the literature review. Several analysis methods were applied.
I am a Ugandan with an academic background in Social Sciences and public health attained at Makerere University, where, I also work partly, as a research fellow. I am interested in making health systems more responsive to population needs by research and practice around the world.