Facility-based supervision was usually carried out jointly by a team of three DHMT members.
We DHMT need this training so we can integrate supervision--supervision is more than a checklist, but when you don't know about STIs [for example] you have to rely on the [supervision] checklist, not so?
DHMT members were unhappy about lack of recognition and reward, in the light of the many new tasks and responsibilities assigned to them by the central Ministry.
We as DHMT have a very slim chance of convincing the policymakers otherwise.
DHMTs, who reported a clear preference for an integrated supply system, believed that some central and regional managers were resisting this.
Under the two approaches under scrutiny in this study, performance premiums are granted according to the level of a limited number of quantitative indicators (see Table 1) which are measured monthly and checked quarterly, plus a qualitative checklist comprising a large number of indicators (92 for health centres, 110 for district hospitals and 49 for the DHMT in the BTC approach; 125 for health centres, 112 for district hospitals and 10 for the DHMT in the WB approach) which are checked quarterly by a specific PBF verification team.
The two approaches have been implemented progressively; they have evolved during implementation so as to adapt to needs; and at the time of our survey, the WB approach was still only partially implemented, with some elements (community counter-verification and DHMT assessment) not being in place yet.
This is especially the case in the BTC approach since, as shown in Table 1, while the DHMT monopolised substantial individual premiums at the time of our visit, staff in district hospitals could only expect to get between 32 and 80 US dollars per quarter, and health centre staff only between 10 and 30 US dollars.
Especially, stakeholders' perceptions pointed the issue of unfairness for health staff inherent in the two PBF approaches under study, which is illustrated by the fact that operational staff receive very low premiums compared to DHMT staff in the BTC approach, and that all facilities are subject to the same requirements while they do not have the same resources and assets.
Le District Health Management Team (DHMT) doit renforcer l'education sanitaire sur l'alcool dans les CAN et a travers la radio et le DHMT doit collaborer avec le Ghana Education Service pour commencer la sensibilisation des eleves et des etudiants concernant les effets nuisibles de l'alcool pendant la grossesse (Afr J Reprod Health 2012; 16:55-60).
The DHMT must also liaise with the churches, mosques and the prayer camps for this health education to be effective.