Abstract:
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.