Development and Technical Adequacy of the District Capacity Assessment

The purpose of this article is to describe the methods and results used to establish the district capacity assessment’s (DCA) content validity, response process validity, construct validity, internal consistency, and test–retest reliability. The DCA measures a district’s ability to support school-level implementation of evidence-based practices (EBPs). Assessment results are then used to guide action planning. The DCA is grounded in the understanding that districts must develop knowledge and skills in the use of implementation science methods if they are to support successful use of an innovation. Specifically, three studies were conducted. The first study established the DCA’s content validity, that is, the extent to which the DCA represents constructs comprising district-level implementation capacity. The second study established the DCA’s internal structure, or the relationships among the items compared to the constructs being measured and how well the items measured the same construct. The third and final study assessed how the results of the DCA varied over time, thus establishing the instrument’s test–retest reliability. District Implementation Teams, researchers, or facilitators who use the DCA can be confident that the assessment is founded on research drawing from implementation science practices and methods.

Leadership, governance and management for improving district capacity and performance: the case of USAID Transform: Primary Health Care

Background: Primary health care (PHC) in Ethiopia serves as the main entry point for preventive, promotive and curative health services. The district health office is responsible for the planning, implementation and evaluation of all district health activities. In addition, district health offices manage service delivery facilities working on provision of PHC – primary hospitals, health centers and health posts. As the leader of the health care system tier, district health management must ensure direction, alignment and commitment within teams and organizations and make sure that achievements are consistent with the vision, values and strategy of the organization. USAID Transform: Primary Health Care provides diverse support to improve district health manager competencies including in-service trainings followed by planning and implementation of performance improvement projects and on-the-job mentoring and support. Methods: This study was conducted to compare district level capacity and performances between leadership, management and governance (LMG) and non-LMG districts. Project outcome monitoring data that shows the performance of districts was collected from 284 districts from January to December 2019. The study was carried out using a comparative-cross sectional study design, which assessed and compared district health office level indicators. Districts were classified into two categories: LMG and non-LMG districts. The study compared data from 94 LMG and 190 non-LMG districts. Propensity score matching was used to control the effect of differences between LMG and non-LMG districts. Results: Results of the independent samples t-test revealed that LMG districts scored better average performances of 61.8±121.45 standard deviation (SD) compared to non-LMG districts 56.89±110.39 SD, with t (282243) = -3.407317 and p < 0.001, two-tailed. The difference of 4.9 percentage unit in the average performance indicated a statistically significant difference between the LMG and non-LMG districts. Conclusion: District level leadership development program contributes to improving district capacity, structure and management practices, and quality of care.

Leadership, governance and management for improving district capacity and performance: the case of USAID transform: primary health care

Background Primary health care (PHC) in Ethiopia serves as the main entry point for preventive, promotive and curative health services. The district health office is responsible for the planning, implementation and evaluation of all district health activities. In addition, district health offices manage service delivery facilities working on provision of PHC – primary hospitals, health centers and health posts. As the leader of the health care system tier, district health management must ensure direction, alignment and commitment within teams and organizations and make sure that achievements are consistent with the vision, values and strategy of the organization. USAID Transform: Primary Health Care provides diverse support to improve district health manager competencies including in-service trainings followed by planning and implementation of performance improvement projects and on-the-job mentoring and support. Methods This study was conducted to compare district level capacity and performances between leadership, management and governance (LMG) and non-LMG districts. Project outcome monitoring data that shows the performance of districts was collected from 284 districts from January to December 2019. The study was carried out using a comparative-cross sectional study design, which assessed and compared district health office level indicators. Districts were classified into two categories: LMG and non-LMG districts. The study compared data from 94 LMG and 190 non-LMG districts. Propensity score matching was used to control the effect of differences between LMG and non-LMG districts. Results Results of the independent samples t-test revealed that LMG districts scored better average performances of 61.8 ± 121.45 standard deviation (SD) compared to non-LMG districts 56.89 ± 110.39 SD, with t (282243) = − 3.407317 and p < 0.001, two-tailed. The difference of 4.9 percentage unit in the average performance indicated a statistically significant difference between the LMG and non-LMG districts. Conclusion District level leadership development program contributes to improving district capacity, structure and management practices, and quality of care.

Research Use by Leaders in Canadian School Districts

This paper, part of a larger study, investigates the ways research is used by leaders in Canadian schools and districts, an area in which there is relatively little empirical evidence. The paper analyzes survey results from 188 education leaders in 11 school districts across Canada about school and district practices related to the use of research. Results indicate a growing awareness in districts of the importance of research use, reported district capacity, and many kinds of support available for research-related activities; however, actual research use remains modest. Districts appear to have relatively weak processes and systems for finding, sharing and using relevant research.