School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
Department of Medical Education, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
Glob Public Health. 2022 Jul;17(7):1267-1281. doi: 10.1080/17441692.2021.1924220. Epub 2021 Jun 7.
District health managers (DHMs) lead and manage Ministry of Health programmes and system performance. We report on the acceptability and feasibility of inter-related activities to increase the agency of DHMs in Kenya, Nigeria, South Africa and Uganda using a cross-sectional rapid appraisal with 372 DHMs employing structured questionnaires. We found differences and similarities between the countries, in particular, who becomes a DHM. The opportunity to provide leadership and effect change and being part of a team were reported as rewarding aspects of DHMs' work. Demotivating factors included limited resources, bureaucracy, staff shortages, lack of support from leadership and inadequate delegation of authority. District managers ranked the acceptability of the inter-related activities similarly despite differences between contexts. Activities highly ranked by DHMs were to employ someone to support primary care staff to compile and analyse district-level data; to undertake study tours to well-functioning districts; and joining an African Regional DHM Association. DHMs rated these activities as feasible to implement. This study confirms that DHMs are in support of a process to promote bottom-up, data-driven, context-specific actions that can promote self-actualisation, recognises the roles DHMs play, provides opportunities for peer learning and can potentially improve quality of care.
地区卫生经理（DHMs）领导和管理卫生部的计划和系统绩效。我们报告了在肯尼亚、尼日利亚、南非和乌干达增加 DHMs 代理机构的相关活动的可接受性和可行性，使用横断面快速评估，对 372 名使用结构化问卷的 DHMs 进行了评估。我们发现这些国家之间存在差异和相似之处，特别是谁成为 DHM。提供领导和改变的机会以及成为团队的一部分被报道为 DHMs 工作的有益方面。令人沮丧的因素包括资源有限、官僚主义、人员短缺、领导层缺乏支持和授权不足。尽管背景不同，但地区经理对相关活动的可接受性评价相似。DHMs 高度评价的活动包括聘请人员支持初级保健工作人员编制和分析地区一级的数据；进行考察访问以了解运作良好的地区；以及加入非洲区域 DHM 协会。DHMs 认为这些活动具有实施的可行性。这项研究证实，DHMs 支持促进自下而上、以数据为驱动、具体情况的行动的过程，这可以促进自我实现，认识到 DHMs 所扮演的角色，为同行学习提供机会，并有可能提高护理质量。
