Strengthening local health care management in Bolivian districts through participatory operational research.

ABSTRACT

PIP: This paper describes how using a participatory health care management and problem-related research methodology may help strengthen health service management and the capacities of local health care personnel. Reference is made to five studies conducted in three Bolivian health districts from 1993-95, in an operational research project conducted by an Italian nongovernmental organization in agreement with the local Ministry of Health and PAHO/WHO. The studies were undertaken to assess the main problems in health care delivery and to define and implement appropriate solutions. They used a methodology based upon the principles of operational research and continuous quality improvement. Both positive and negative experiences resulted during the process. On the positive side, the applied nature of the research focused upon solving a given problem; the problem was related to health service management; modern, yet simple, techniques were used which were adapted to local knowledge; and health care personnel were trained on the job during the research process. However, lack of a generic research culture and poor health personnel training were problematic.