Article Text

How does capacity building of health managers work? A realist evaluation study protocol
  1. N S Prashanth1,
  2. Bruno Marchal2,
  3. Tom Hoeree2,
  4. Narayanan Devadasan1,
  5. Jean Macq3,
  6. Guy Kegels2,
  7. Bart Criel2
  1. 1Institute of Public Health, Bangalore, Karnataka, India
  2. 2Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
  3. 3Institut de Recherche Sante et Societe, Universite Catholique de Louvain, Brussels, Belgium
  1. Correspondence to Dr N S Prashanth; prashanthns{at}


Introduction There has been a lot of attention on the role of human resource management interventions to improve delivery of health services in low- and middle-income countries. However, studies on this subject are few due to limited research on implementation of programmes and methodological difficulties in conducting experimental studies on human resource interventions. The authors present the protocol of an evaluation of a district-level capacity-building intervention to identify the determinants of performance of health workers in managerial positions and to understand how changes (if any) are brought about.

Methods and analysis The aim of this study is to understand how capacity building works. The authors will use realist evaluation to evaluate an intervention in Karnataka, India. The intervention is a capacity-building programme that seeks to improve management capacities of health managers at district and subdistrict levels through periodic classroom-based teaching and mentoring support at the workplace. The authors conducted interviews and reviewed literature on capacity building in health to draw out the programme theory of the intervention. Based on this, the authors formulated hypothetical pathways connecting the expected outcomes of the intervention (planning and supervision) to the inputs (contact classes and mentoring). The authors prepared a questionnaire to assess elements of the programme theory—organisational culture, self-efficacy and supervision. The authors shall conduct a survey among health managers as well as collect qualitative data through interviews with participants and non-participants selected purposively based on their planning and supervision performance. The authors will construct explanations in the form of context–mechanism–outcome configurations from the results. This will be iterative and the authors will use a realist evaluation framework to refine the explanatory theories that are based on the findings to explain and validate an improved theory on ‘what works for whom and under what conditions’.

Discussion The scope for applying realist evaluation to study human resource management interventions in health are discussed.

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  • To cite: Prashanth NS, Marchal B, Hoeree T, et al. How does capacity building of health managers work? A realist evaluation study protocol. BMJ Open 2012;2:e000882. doi:10.1136/bmjopen-2012-000882

  • Contributors NSP, DN, BC and GK conceived and designed the study. NSP, BM and GK developed the methodology. NSP, TH, BC and JM developed the tools. NSP wrote the first draft of the present manuscript. All authors reviewed and commented on the first draft. All authors read and approved the final manuscript.

  • Funding Sir Ratan Tata Trust (SRTT), Mumbai & Directorate General for Development Cooperation (DGDC), Government of Belgium. SRTT grant ID Health-IPH-20100122 and DGDC FA3 (II) grant 2011-2013. SRTT and DGDC financed various aspects of the capacity-building programme. SRTT provided financial support for research expenses in the form of travel, accommodation and training of data collectors. NSP is the recipient of a PhD grant under the DGDC funding that provides monthly stipend and a bench fee to cover local travel and research expenses. Both funders had no role in the study design; collection, management, analysis and interpretation of data; writing of the report and the decision to submit the report for publication. The ultimate authority over each of these activities is the responsibility of NSP in consultation with BC.

  • Competing interests None.

  • Ethics approval Ethical approval was provided by Institutional Review Board, Institute of Tropical Medicine, Antwerp & Institutional Ethics Committee, Institute of Public Health, Bangalore.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement No additional data available.

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