Abstract：
Strengthening management and leadership competencies among district and local health managers has emerged as a common approach for health systems strengthening and to achieve Universal Health Coverage (UHC). While the literature is rich with localised examples of initiatives that aim to strengthen the capacity of district or local health managers, particularly in sub-Saharan Africa, considerably less attention is paid to the science of how to scale-up these initiatives. The aim of this paper is thus to examine the process of scaling-up a management strengthening intervention (MSI) and identify new knowledge and key lessons learned that can be used to inform the scale-up process of other complex health interventions, in support of UHC. Qualitative methods were used to identify lessons learned from scaling-up the MSI in Ghana, Malawi and Uganda. We conducted 14 interviews with district health management team members, three scale-up assessments with 20 scale-up stakeholders, and three reflection discussions with 11 research team members. We also kept records of activities throughout MSI and scale-up implementation. Data was recorded, transcribed, and analysed against the Theory of Change to identify both scale-up outcomes and the factors affecting these outcomes. The MSI was ultimately scaled-up across 27 districts. Repeated MSI cycles over time were found to foster greater feelings of autonomy among district health management teams (DHMTs) to address longstanding local problems, a more innovative use of existing resources without relying on additional funding, and improved teamwork. The use of \'resource teams\' and the emergence of MSI \'champions\', were both instrumental in supporting scale-up efforts. Challenges to the sustainability of the MSI include limited government buy-in and lack of sustained financial investment.
摘要：
加强地区和地方卫生管理人员的管理和领导能力已成为加强卫生系统和实现全民健康覆盖（UHC）的共同方法。虽然文献中有丰富的旨在加强地区或地方卫生管理人员能力的本地化举措实例，特别是在撒哈拉以南非洲，对如何扩大这些举措的科学关注要少得多。因此，本文的目的是研究扩大管理加强干预措施（MSI）的过程，并确定可用于为其他复杂健康干预措施的扩大过程提供信息的新知识和关键经验教训。支持UHC。定性方法用于确定从加纳扩大MSI中吸取的经验教训，马拉维和乌干达。我们对地区卫生管理小组成员进行了14次访谈,与20个扩大利益攸关方进行了三次扩大评估，与11名研究小组成员进行了三次反思讨论。我们还保留了整个MSI和扩展实施过程中的活动记录。记录数据,转录，并根据变化理论进行分析，以确定扩大成果和影响这些成果的因素。MSI最终在27个地区扩大了规模。随着时间的推移，重复的MSI周期被发现可以在地区健康管理团队（DHMT）中培养更大的自主性，以解决长期存在的当地问题。在不依赖额外资金的情况下更创新地使用现有资源，和改善团队合作。“资源团队”的使用和MSI“冠军”的出现，两者都有助于支持扩大规模的努力。MSI可持续性面临的挑战包括政府有限的购买和缺乏持续的金融投资。
