NS Prashanth has successfully defended his PhD thesis on April 21st at UCL entitled “Capacity building and performance in local health systems – A realist evaluation of a local health system strengthening intervention in Tumkur, India”. His promoters were professors Jean Macq and Bart Criel.
Prashanth is known to be a creative and prolific writer, and apart from writing his dissertation, he also wrote a poem (!) about capacity building.
Capacity, capacity, capacity
Why this effort at explaining the obvious,
is it so difficult to understand performance?
If there be a good woman, with the right education,
a heart of gold, and a life of public-spirited vision.
And if she found the right supervisor, and a good job
with a cheerful team and not a nagging mob.
If she worked in a district hospital,
with a well-endowed team and an ambience tranquil,
with grateful patients and a plan to summarise
the community’s health and their demands realise.
Then, she could lead a team,
that laid a vision healthy.
Mortality checked and indicators supreme
Keeping equity and wealthing society!
Such is the promise of performance,
And these good (wo)men!
Simple is it not, hence
To build a hospital with a few good (wo)men?
“Oh! No” cried the researcher,
“You think so”, quipped the minister,
“Where be these good men, and where be these resources?” asked the doubtful manager
“Ah!” said the people surprised, “Is it possible at all at the hospital nearby?”
“Here’s many policies. Why don’t you make them work?” cried the policymaker.
“Yes. Why not?” cried the researcher.
Where be the right policy?
Where be the right implementer?
“Your policy designed in the sky”, said the manager
“Not well implemented”, said the evaluator.
What makes performance then?
The good man? the right job?
The cheerful workplace?
The nice district and the well-endowed hospital?
Is it the man who makes a good team,
and the team that makes a good hospital?
Or the hospital instead that maketh the team cheerful, and the man nice?
Or the policy instead that brings about some respite
Or the capacity to improve that’s not here, everything in spite?
Therein lies then the puzzle of performance
Therein lies the puzzle of capacity
Could the answer lie in our penance
To predict, nay, understand, or at least explain this complexity?
Abstract: In countries such as India, local health systems struggle to utilise their resources optimally and to deliver quality health services in an effective manner. While the reasons for these are many, poor health management capacity has been postulated to contribute to this problem. Understanding how public health organisations can move towards change through capacity building interventions is crucial to strengthening health systems. By studying a capacity building intervention of health managers in Tumkur district of southern India using a realist evaluation approach, we advance the understanding of how these interventions could contribute to organisational change. We find that capacity building programmes need to go much beyond transfer of knowledge and skills in order to effect organisational change and identify several individual and institutional factors and various alignments within decentralising local health systems that are crucial to achieving change. We conclude that human resources management strategies in Karnataka ought to invest in altering workplace conditions and organisational culture through restructuring the current health bureaucracy so that committed health managers could better utilise change opportunities presented by capacity building programmes.