“Five lessons from a mid-level health manager intervention to increase uptake of tuberculosis prevention therapy in Uganda: 'It is a completely different thing to implement what you know'”.

Johnson-Peretz J, Christian C, Akatukwasa C, et al. (2024). Global Health Action.

"We look at those that have done very well, but there are also strugglers. Then we share those experiences: for those who are doing well, what have we done? Why is it working for you, and <why> is it not working elsewhere? Those that are struggling, what support would you like to get from those that are getting on well?" District Health Officer, Intervention Arm

"There is a difference between you knowing and it is a completely different thing to implement what you know. So, what this collaboration improved was the implementation and the running and the facilitation of the teams, the sharing of information, the sharing of the burden. … It was those links and intricacies that we discussed in those groups as colleagues." District Health Officer, Intervention Arm

Synopsis: A thematic analysis of six focus-group discussions from the intervention and 23 key informant interviews with control group participants from the SEARCH-IPT trial, which led a series of mini-collaborative meetings to provide business leadership and management training for an intervention group of mid-level healthcare system managers in rural Eastern, East-Central, and Southwestern Uganda to increase uptake of isoniazid-prevention therapy (IPT) for people living with HIV.
Key Findings: District Health Officers and District Tuberculosis and Leprosy Supervisors deployed five implementation skill sets to achieve sustainable implementation and clarify ambiguous decision-making space: data-based decision-making, root-cause analysis, quality assurance, evidence-based empowerment, and sharing best practices with colleagues, thereby reaching beyond outcome measures to address root problems around the District Health Officer’s range of authority and obtain buy-in from district health workers.
Recommendations: Horizontal accountability, in which mid-level health system managers share their experiences implementing core practices, made concrete, demonstrably sustainable implementation changes at the district level, suggesting that capacity building at the mid-manager level must reach beyond identifying knowledge gaps and also show people how to implement knowledge they may already possess. Focusing on core practices – rather than competencies – is objectively implementable and measurable at the system level.