In this chapter the author looks at the background of the study, significance and purpose of the study, research questions, and delimitations. The chapter concludes with the definition of terms.

Background of the Study

Health workers form the foundation of health service delivery. Their numbers, skills and commitment are critical for the delivery of good health care (Serneels, Montalvo, Petterson, Lievens & Butera, 2010). According to WHO (2009), a host of contextual issues including the health workforce need to be considered before effective solutions can be designed. At all levels of government, effective, performance-oriented program management is needed, that is management that focuses on program quality and on the results achieved through the use public resources (Wholey & Hatry, 1992). Managing the performance of Public Health Officers (PHOs) in The Gambia is vital to achieving high quality of health service delivery through the execution of the public health component of the strategic goals of Ministry of Health. This can be realized by ensuring the alignment of the strategy to the performance of PHOs.

Organizational alignment is the degree to which the design, strategy, and culture of an organization are working in harmony to achieve the desired goals. Alignment brings about efficiency in organizations while misalignment leads to inefficiency in organizational efforts toward goal achievement (Semler, 1997). This research focused on the alignment of the public health aspect of the strategies of Ministry of Health and Social Welfare (MOHSW) and the performance of PHOs in The Gambia. The Ministry has highlighted the existence of a disparity in the demand by the population and quality of services at different levels of health care. A coordinated monitoring and evaluation system to measure performance, plan for improvements and ensure


accountability were lacking (Ministry of Health and Social Welfare [MOHSW], 2011).

This indicates the existence of a deficiency in the performance management system at various levels of health service delivery. However, there was a scarcity of research in the academic literature on performance management in health especially in The Gambia. Most of the studies with regards to the field of human resources (HR) were devoted to areas like motivation and job satisfaction. As for The Gambia, no researches had been found in the area of performance management of PHOs.

Therefore, it was crucial to examine the system of managing the performance of PHOs by examining how their jobs were aligned to the strategy of the MOHSW. It was expected that the findings of this research would provide information that might help improve the performance of PHOs and narrow the research gap that existed in the area of human resources in the health sector as far as performance management is concerned.

Significance of the Study

According to Semler (1997), the creation of high performance work systems depends on the ability to align properly the elements of the organization that must work in synergy. Assessing alignment, even in a qualitative way, can enable organizations reach this goal. In The Gambia, PHOs are posted after graduation to various health facilities or stations. Without a clear outline of areas of responsibility, expected results, and the availability of mechanisms to measure the extent to which the expected results are realized based on the goals of MOHSW, it would be difficult if not impossible to know the contributions of PHOs to the strategic objectives. This may cause loss of sense of direction and lower productivity. Therefore, it was crucial to find out how the job of PHOs was aligned to the strategies of MOHSW to come up with findings which would help improve their performance.

PHOs were supervised by Regional Public Health Officers (RPHO) based on


qualifications and experiences RPHOs accumulated during substantial lengths of service. The functions of RPHOs were similar in the sense that they supervise the performance of PHOs. Additionally, the public health cadre in The Gambia was composed of experienced and highly trained professionals through which the country registered a lot of success stories. An investigation into the current system of managing the performance of this cadre was crucial to providing information that will assist both supervisors and supervisees in the effective execution of their duties and responsibilities.

There had been limited studies conducted on the area of human resources in health sector of The Gambia. This research shall therefore contribute to the knowledge gap which existed with regard to the area of human resources management and development. Moreover, the findings of this research shall assist the Ministry of Health and Social Welfare (MOHSW) in the design of policies aimed at improving the quality of health service delivery and health promotion. Furthermore, the results of this research can provide a basis for conducting further studies in other sectors of the ministry.

Purpose of the Study

Using a qualitative approach, this research was intended to contribute in narrowing the knowledge gap that existed in The Gambia’s health sector’s human resources situation through the study of the current system of managing the performance of PHOs by examining the alignment of their performance to the strategies of the MOHSW in the Gambia. The findings of this research can be used to help shape the execution of the strategic intents of the various institutions in health and of other departments in The Gambia’s public sector. As such, this research sought to find out:

1. The extent of alignment of the job of PHOs to the strategies of the MOHSW.


2. The effect of alignment of the job of PHOs and the strategies on the performance of PHOs.

3. The existence of the necessary support for PHOs to carry out their responsibilities.

4. The current system of managing the performance of PHOs.

Research Questions

This study investigated the alignment of the strategies of the MOHSW and the performance of PHOs. Thus, based on the purpose of the study, the research questions were:

4. What is the current system of managing the performance of PHOs?


There were various categories of PHOs in the health sector of The Gambia.

However, this research focused on only PHOs who serve at health facility level. PHOs who served elsewhere in the MOHSW were not included in this study nor did it include PHOs who served in the private sector. Similarly, health workers outside the public health cadre were outside the scope of this study.

There were six health regions in The Gambia. Three regions out of a total of six were selected for the conduct of this study. Within these selected regions, not all PHOs had the chance to be selected as participants. Also, RPHOs (i.e. supervisors of PHOs) included in this study were only those from the regions selected.

Definition of Terms Cadre

A small group of people specially trained for a particular purpose or profession


(Oxford Dictionaries, 2012), e.g. a cadre of public health officers, community health nurses, etc. In this study unless otherwise indicated, the public health cadre is used specifically to mean public health officers working at health facility level in The Gambia.

Public Health Officers

In this study the term Public Health Officers (PHO) denote Public Health Officers who work at health facility level under the Ministry of Health and Social Welfare (MOHSW) in The Gambia.


While there are various aspects of alignment, for the purpose of this study, the performance aspect of alignment was investigated. According to Semler (1997), the performance aspect of alignmentdescribes the agreement between the actual behavior of an organization's individuals and processes and the behavior that is required for attainment of the strategic goals. In this study, alignment refers to the agreement between the work that Public Health Officers were doing at health facility level and the behavior that was required for the attainment of the strategic goals of the MOHSW as outlined in the Health Policy of the Ministry of Health and Social Welfare (2011-2015). The study did not take into account the agreement between processes and the behavior required for attainment of the strategic goals.


Strategy as a plan is some sort of consciously intended course of action, a guide (or set of guidelines) to deal with a situation (Mintzberg, 1987, p.11). It is the framework of choices that determines the nature and direction of an organization (Brache & Bodley-Scott, 2007, p.59). Strategy in this research shall mean the objectives, goals and strategies of the MOHSW which concerns the work of PHOs as contained in the Health Policy (2011- 2015) of MOHSW of The Gambia.



In document The Alignment of Strategy and Performance: A Study on the Current (Page 15-21)