Improved Management through Participatory Appraisal and Continuous Transformation (IMPACT) is an integrated approach to strengthen vital elements in managing health services. Its focus is on improving health care delivery at facility level. It helps introduce management reforms, while building the skills of managers. IMPACT consists of four components:
1. Peer and participatory rapid health appraisal for action (PPRHAA)
2. Building management systems and capacity
3. Integrated support and supervision
4. Quality assessment and recognition
Key features that make IMPACT successful:
- Simplicity to enable all health staff to participate, even those with limited skills
in appraisal, planning or management
- Comprehensive in its coverage of health systems
- Sustainable approaches to institutionalise better management practices and systems
- Constructive and non-threatening, with an emphasis on moving forward
- Supports the development of achievable plans and identifies practical solutions
- Promotes active engagement of clients and communities
- Strong peer participation that encourages sharing and objective appraisal
- Increases communication and dissemination of best practice within and across health services.
IMPACT uses a systems approach and acknowledges that health services are complex organisations. Hospitals consist of technical departments delivering many different services; complicated medical equipment and plant; ‘hotel’ facilities for patients and staff; sales outlets for drugs; and a wide range of support services. Each area has various systems that need to run effectively to provide quality health services to communities. The same is true for primary health care and the broader health sector.
IMPACT helps health managers at all levels to build the skills they need to understand and strengthen all these systems. A health facility must be seen as a whole organism, dependent on the functioning of all of its parts. Therefore, IMPACT has broad based processes for assessment, planning, implementation and review. Tinkering with only a few small parts will not induce or sustain the required systems improvements. We have developed a range of IMPACT manuals for implementation across the different levels of the health system.
IMPACT was developed collaboratively by health managers from across Africa, through Health Partners International (HPI) and Health Partners Ghana (HPG). Together, we adapted several tools to the specific needs of resource poor health services. These tools included Participatory Rapid Appraisal, systems analysis, change management techniques and methodologies for assessment and accreditation.
We use IMPACT with local health managers who adapt and integrate it into their own organisations. IMPACT is constantly being developed and improved by those who use it. Its components are immensely popular at all levels and have helped managers implement major improvements in health services.