Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda.
Int J Health Plann Manage. 2022 Mar;37(2):770-789. doi: 10.1002/hpm.3359. Epub 2021 Oct 25.
Decentralisation has been adopted by many governments to strengthen national systems, including the health system. Decision space is used to describe the decision-making power devolved to local government. Human resource Management (HRM) is a challenging area that District Health Management Teams (DHMT) need some control over its functions to develop innovative ways of improving health services. The study aims to examine the use of DHMTs' reported decision space for HRM functions in Uganda.
Mixed methods approach was used to examine the DHMTs' reported decision space for HRM functions in three districts in Uganda, which included self-assessment questionnaires and focus group discussions (FGDs).
The decision space available for the DHMTs varied across districts, with Bunyangabu and Ntoroko DHMTs reporting having more control than Kabarole. All DHMTs reported full control over the functions of performance management, monitoring policy implementation, forecasting staffing needs, staff deployment, and identifying capacity needs. However, they reported narrow decision space for developing job descriptions, resources mobilisation, and organising training; and no control over modifying staffing norms, setting salaries and developing an HR information system (HRIS). Nevertheless, DHMTs tried to overcome their limitations by adjusting HR policies locally, better utilising available resources and adapting the HRIS to local needs.
Decentralisation provides a critical opportunity to strengthen HRM in low-and-middle-income countries. Examining decision space for HRM functions can help identify areas where district health managers can change or improve their actions. In Uganda, decentralisation helped the DHMTs be more responsive to the local workforce needs and analysing decision space helped identify areas for improvement in HRM. There are some limitations and more power over HRM functions and strong management competencies would help them become more resourceful.
许多政府采用权力下放的方式来加强国家系统，包括卫生系统。决策空间是指下放给地方政府的决策权。人力资源管理（HRM）是一个具有挑战性的领域，地区卫生管理团队（DHMT）需要对其职能进行一定的控制，以创新的方式改善卫生服务。本研究旨在考察乌干达 DHMTs 报告的人力资源管理职能的决策空间的使用情况。
采用混合方法考察了乌干达三个地区的 DHMTs 报告的人力资源管理职能的决策空间，包括自我评估问卷和焦点小组讨论（FGD）。
DHMTs 可用的决策空间因地区而异，Bunyangabu 和 Ntoroko DHMTs 报告的控制程度高于 Kabarole。所有 DHMTs 报告对绩效管理、监测政策执行、预测人员配备需求、人员部署和确定能力需求等职能拥有完全控制权。然而，他们报告在制定工作描述、资源动员和组织培训方面的决策空间狭窄，并且没有控制权来修改人员配备规范、设定工资和开发人力资源信息系统（HRIS）。尽管如此，DHMTs 通过在当地调整人力资源政策、更好地利用现有资源以及使 HRIS 适应当地需求，试图克服其局限性。
权力下放为加强中低收入国家的人力资源管理提供了一个关键机会。审查人力资源管理职能的决策空间有助于确定地区卫生经理可以改变或改进其行动的领域。在乌干达，权力下放使 DHMTs 能够更好地响应当地劳动力需求，而分析决策空间有助于确定人力资源管理的改进领域。存在一些限制因素，更多的人力资源管理职能权力和强大的管理能力将有助于他们变得更有资源。
