Different circumstances different outcomes

In my quest to better understand which aspects of the local environment influence the way complex interventions are delivered, I was alerted to a comprehensive realist review of human resource management interventions that were designed to improve health workers’ performance in low and middle income countries. In the 48 included studies, the most commonly evaluated interventions were of continuing education, either alone or with other strategies such as supervision, incentives, quality improvement and decentralisation.

The exciting difference about this review, is that it aimed to both identify important contextual factors AND to explain why specific interventions work in certain contexts but not others.

Firstly, combined interventions of participatory, interactive training, job aids and strengthening health systems  can improve health workers performance – however we don’t know by how much.

Secondly, important contextual factors include;

  • involving local authorities, communities and management to maintain adequate staffing and equipment
  • involving local stakeholders in adapting the intervention to the local situation
  • involving local staff to identify problems and implement local solutions

Thirdly health workers can improve their performance by;

  • enhancing their knowledge and skills
  • improving their working conditions, motivation, job satisfaction
  • being empowered and feeling obliged to implement change
  • financial incentives

While this is only a snapshot of certain research conducted in low and middle income countries, the results are encouraging and offer directions for future research and practice.


I conduct and supervise research that promotes the translation of quality research evidence for use in clinical practice.

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Posted in behaviour, complex interventions, culture, implementation, improvement

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