Table of Contents
Chapters
- Overview
- Getting Started
- Define Desired Performance
- Describe Actual Performance
- Measure/Describe Performance Gaps
- Find the Root Causes
- Select Interventions
- Implement Interventions
- Monitor and Evaluate Performance
- Managing Change
Highlights
- PI approach offers many benefits
- Pilot project holds lessons
- Helping people do their best
- Burkina Faso: Assessing needs
- India: PI helps private providers
- Using the “Why Tree” in Ghana
Published by the Population Information Program, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA
Volume XXX, Number 2,
Spring 2002
Series J, Number 52
Family Planninng Programs
Common Root Causes
Root causes of problems in reproductive health programs that have used the PI process range across all the performance factors. Providers variously lack knowledge and skills in counseling, logistics, integrated reproductive health services, estimating the cost of services, and infection prevention (20, 90, 91, 135, 136). They do not know what is expected of them because they have no written job descriptions, guidelines are out of date, or supervisors do not tell providers what they should do (46, 90, 91, 130, 135).
 Michelle Heerey, JHU/CCP In Togo a health clinic posts a “fishbone diagram” on the wall. Also called a cause-and-effect diagram, this technique can help programs solve performance problems by sorting root causes according to key factors that affect performance. |
Clinics lack supplies to offer services requested by their clients, to practice infection prevention, or to distribute health education materials (46, 90, 91, 114, 131, 135). Without vehicles or fuel, supervisors cannot visit clinics (130). In some programs there is no incentive system, supervisors do not support their staff, and providers have no power to make decisions or else they feel helpless to solve problems and wait for instructions from a higher level (38, 46, 91, 114, 130).
Individually, these causes are well known, but emerging together from the PI process they indicate the systemic nature of performance problems. Thus the IDSS in the Dominican Republic worked on expectations, feedback, incentives, and knowledge and skills to encourage providers to treat clients more considerately (91). In Ghana training the regional resource teams would not be effective unless expectations were reinforced through job descriptions and supervision and transportation were provided (130). Organizations usually need to address several root causes to improve performance.
