“Already We See the Difference”: Strengthening District Health Workforce Leadership and Management in Uganda

In Uganda, as in many other countries, critical shortages of health workers, low pay, and poor working conditions often contribute to low morale among health workers and inadequate access to quality health services for communities. This situation, in turn, can leave district health workforce managers feeling powerless and defeated.

To address this issue, health teams from 19 Ugandan districts are taking the Human Resources for Health (HRH) Leadership and Management Course, which is being conducted by the USAID-funded Uganda Capacity Program. The IntraHealth-led CapacityPlus project helped prepare instructors to carry out the course.

Professional development programs in HRH have typically been offered at the central level or by having senior national HRH leaders travel abroad for such opportunities. The goal of the Uganda course is to strengthen HRH leadership and management where the health workforce challenges are most acutely felt day-to-day: in the districts.

Building teamwork in the districts

While the course stresses practical knowledge and proven HRH tools and approaches, perhaps its most vital component for long-term success is its emphasis on sustained teamwork in the districts. “It was an eye-opener for me,” notes a participant from Kamuli District. “From my perspective as a personnel officer, I looked at the health staff as being entirely separate from me…. During the course we learned to work together as a team. Now, we are fully engaged with one another to work on our challenges.”

Taken over 24 weeks, the HRH Leadership and Management Course includes three one-week workshops interspersed with field assignments that are supported with counseling and coaching visits to the districts by the course facilitators. District health teams attend the course together and carry out field assignments as a team—focusing on the most critical HRH issue in their particular district.

National HRH leaders from Uganda’s Ministry of Health and other ministries have been involved in the design and delivery of the course, which is linked to the national HRH strategic plan. “There is a high level of government support and commitment for this course,” says CapacityPlus’s Wilma Gormley, who traveled to Uganda in April to gather information for a global guidance document the project plans to publish on effective delivery and scale-up of HRH professional development and capacity-building at the district level.

Addressing key issues such as productivity

There are many challenges to the course’s success. The sheer magnitude of the health workforce crisis makes it hard for some district HRH staff to believe they can truly make a difference by exerting leadership. Further, the idea of scaling up the course nationally is daunting, as Uganda has 112 districts. Despite these challenges, anecdotal evidence suggests that district teams are making incremental progress in addressing HRH issues in key areas such as recruitment, supervision, workforce safety, and productivity.

“Before the course we had high absenteeism, but didn’t know what to do about it,” explains a health team member from Kamuli District. “After the course, we began to have one-on-one conversations with individuals who were absent a lot. We started counseling and asking them why. There were so many issues—work environment issues—causing stress and low motivation. When we listened, we could help them.”

For a team member from Busia District, the course has made a difference in the way decisions are made: “We have learned to appreciate the power of data. Previously we were collectors of data. Now we are learning how to use that data. We can carry out needs assessments, determine priorities, and target resources to gaps.”

“The visitors noticed how motivated the staff was…”

“Our leadership skills and norms will make us better managers,” sums up a participant from Busia. “Already we see the difference. We had a group of visitors coming to look at one hospital…. The visitors noticed how motivated the staff was and asked why. We were able to explain it happened because of the leadership and management course.”

A version of this piece was originally published as CapacityPlus Voices #11, on the CapacityPlus website.