Close scrutiny of the recently introduced Primary Health Care (PHC) re-engineering policy reveals that little emphasis is placed on the roles, responsibilities and levels of involvement of facility-based PHC nurse managers and supervisors. Despite this apparent exclusion, the policy reveals that the PHC health facility is clearly a focal point in terms of where teams of the three streams meet and interact on a regular basis. The aforementioned policy clearly presents the scope of practice of the ward-based outreach team leaders (WBOTs) and community health workers (CHWs), suggesting that their training should incorporate a degree of public health and health information knowledge. Is the assumption therefore that PHC facility and other sub-district (SD) managers possess the necessary knowledge, skills, behaviours and attitudes to conduct their daily activities and provide support to the WBOTs?
To answer this question, a team at the Health Systems Trust (HST) conducted a study to assess the general management and public health competencies of PHC facility and other SD level managers. This mixed-methods, two-phased, cross-sectional study sought to: (1) determine the expected roles and competencies of these managers through desktop analysis and key expert interviews; (2) develop competency assessment tools based on the results obtained; (3) assess nurse managers’ competencies using these tools through convenience sampling of relevant managers working in ten districts in five rural provinces.
The results of the managers’ self-assessment of their confidence and competence levels related to activities, knowledge, behaviours, attitudes and was measured using a 140 item Likert-scale questionnaire categorised into seven domains. The latter revealed that managers rated themselves as being more confident and competent to organise, communicate, lead and control, and less confident in planning, conducting community assessments, analysing health information and budgeting. Testing of their health management analysis and numeracy skills revealed poor performance overall with better performance for working with health indicators than for interpreting graphs and formula calculations.
Focus groups discussions developed to provide information to triangulate the data showed that there was a correlation between self-assessment scores and knowledge and practices across the various domains. Overall, the results revealed that nurse managers required additional capacity building, mentoring and supervision to be able to perform their daily activities and manage their teams in the era of PHC re-engineering.
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