News

Catherine Barker, a senior associate with HRH2030 partner Palladium, specializes in health economics. Over the last four years, Catherine has provided technical assistance to ministries of health and civil society organizations in Africa and Asia to inform health systems strengthening initiatives, particularly related to health financing and human resources for health.

Why is there a need in high HIV burden countries, like Uganda, to develop HRH investment cases for HIV service delivery?

Globally we need to share financial responsibility for controlling the HIV/AIDS epidemic, and this includes sufficient and efficient use of funding for the health workforce delivering HIV services. However, in many high-burden countries, there is a shortage of funding or inefficient processes to recruit, train, support, and retain these health workers. HRH investment cases can be developed to convince the government to make more strategic investments in HRH for HIV, including increasing funding for HRH (e.g., absorbing donor-supported health workers – both facility and community-based); improving efficiency in spending (e.g., balancing investment in pre-service education vs. in-service training); making more efficient use of existing staff; and improving use of the health workforce as a whole (e.g. rationalized HRH allocation, skill mix composition, and implementation of differentiated models of care). HRH investment cases are supported by evidence and typically include a description of the various potential HRH investment scenarios, their respective efficiency gains, and why they are needed, including estimates of the potential impact of these investments on health outcomes and economic growth. Having an HRH investment case allows stakeholders and advocates to rally behind a single message and funding ask of the Ministry of Finance.

How is HRH2030 equipping health advocates with the information or evidence they need to inform more strategic investments and efficiencies in HRH for HIV?

HRH2030 provides technical assistance in generating evidence for making smarter and more efficient HRH investments. As an example, HRH2030 estimated the costs, fiscal space, and political economy of HRH investment for HIV in Uganda. The analyses demonstrated that Uganda needs to make additional investments in the HIV workforce and improve efficiency in HIV service delivery to reach its HIV targets. Notably, the analyses found that scaling-up differentiated care models for HIV treatment, where stable patients spend less time with facility-based health workers compared with previous service delivery models, could improve HRH efficiencies and reduce the HRH for HIV funding gap by 60 percent in 2020. The remaining gap must be filled by additional investments in the health workforce. This evidence can be used by the Ministry of Health, civil society, parliament members, and other stakeholders and advocates to mobilize the domestic resources required, and to make more strategic and efficient use of their health workforce, to reach the country’s HIV goals.

How will stronger national investment in HRH ensure long-term sustainability of programs working to control the HIV/AIDS epidemic?

Strategic investment in HRH may require increased spending, reallocation of existing financial resources, and/or smarter use of HRH through differentiated models of care and streamlining of services to gain more efficiencies. Strategic government investment in HRH is particularly critical in countries facing transitions in donor funding. For many years, PEPFAR and other donors have made significant investments in countries’ health workforce to fill acute shortages as countries scaled-up access to HIV services, with the expectation that this funding would transition from external to domestic sources over time. As countries, like Uganda, are now in the process of sustainability planning, they need to increase spending on HRH while making more efficient use of existing funds and workforce to maintain current coverage of HIV services. Strategic national investment in HRH will support a country’s efforts to maintain a sufficiently-skilled and motivated workforce that is willing and able to provide high-quality HIV services over time.

Others in this Series

Part 1: Increasing HIV Impact through Human Resources for Health Interventions
Part 2: Optimizing the Role of Community-Based Workers in HIV Service Delivery
Part 3: Standardized Use of Site-Level HRH Data for Differentiated Models of ART Delivery
Part 4: Making the Case for Investing in HRH

Catherine Barker, a senior associate with HRH2030 partner Palladium, specializes in health economics. Over the last four years, Catherine has provided technical assistance to ministries of health and civil society organizations in Africa and Asia to inform health systems strengthening initiatives, particularly related to health financing and human resources for health.

Why is there a need in high HIV burden countries, like Uganda, to develop HRH investment cases for HIV service delivery?

Globally we need to share financial responsibility for controlling the HIV/AIDS epidemic, and this includes sufficient and efficient use of funding for the health workforce delivering HIV services. However, in many high-burden countries, there is a shortage of funding or inefficient processes to recruit, train, support, and retain these health workers. HRH investment cases can be developed to convince the government to make more strategic investments in HRH for HIV, including increasing funding for HRH (e.g., absorbing donor-supported health workers – both facility and community-based); improving efficiency in spending (e.g., balancing investment in pre-service education vs. in-service training); making more efficient use of existing staff; and improving use of the health workforce as a whole (e.g. rationalized HRH allocation, skill mix composition, and implementation of differentiated models of care). HRH investment cases are supported by evidence and typically include a description of the various potential HRH investment scenarios, their respective efficiency gains, and why they are needed, including estimates of the potential impact of these investments on health outcomes and economic growth. Having an HRH investment case allows stakeholders and advocates to rally behind a single message and funding ask of the Ministry of Finance.

How is HRH2030 equipping health advocates with the information or evidence they need to inform more strategic investments and efficiencies in HRH for HIV?

HRH2030 provides technical assistance in generating evidence for making smarter and more efficient HRH investments. As an example, HRH2030 estimated the costs, fiscal space, and political economy of HRH investment for HIV in Uganda. The analyses demonstrated that Uganda needs to make additional investments in the HIV workforce and improve efficiency in HIV service delivery to reach its HIV targets. Notably, the analyses found that scaling-up differentiated care models for HIV treatment, where stable patients spend less time with facility-based health workers compared with previous service delivery models, could improve HRH efficiencies and reduce the HRH for HIV funding gap by 60 percent in 2020. The remaining gap must be filled by additional investments in the health workforce. This evidence can be used by the Ministry of Health, civil society, parliament members, and other stakeholders and advocates to mobilize the domestic resources required, and to make more strategic and efficient use of their health workforce, to reach the country’s HIV goals.

How will stronger national investment in HRH ensure long-term sustainability of programs working to control the HIV/AIDS epidemic?

Strategic investment in HRH may require increased spending, reallocation of existing financial resources, and/or smarter use of HRH through differentiated models of care and streamlining of services to gain more efficiencies. Strategic government investment in HRH is particularly critical in countries facing transitions in donor funding. For many years, PEPFAR and other donors have made significant investments in countries’ health workforce to fill acute shortages as countries scaled-up access to HIV services, with the expectation that this funding would transition from external to domestic sources over time. As countries, like Uganda, are now in the process of sustainability planning, they need to increase spending on HRH while making more efficient use of existing funds and workforce to maintain current coverage of HIV services. Strategic national investment in HRH will support a country’s efforts to maintain a sufficiently-skilled and motivated workforce that is willing and able to provide high-quality HIV services over time.

Others in this Series

Part 1: Increasing HIV Impact through Human Resources for Health Interventions
Part 2: Optimizing the Role of Community-Based Workers in HIV Service Delivery
Part 3: Standardized Use of Site-Level HRH Data for Differentiated Models of ART Delivery
Part 4: Making the Case for Investing in HRH

Dr. Samson Kironde is a medical doctor and public health professional with more than 17 years of experience in strengthening health systems in developing countries, in particular to combat communicable diseases, such as HIV/AIDS, tuberculosis, malaria, and childhood infections. His areas of expertise include strategic project planning, management and implementation, operational research, monitoring and evaluation, and provision of technical assistance. He currently serves as director of PEPFAR/Global Fund human resources for health activities for HRH2030, as well as director for program support and monitoring at the University Research Company and Center for Human Services.

What are the implications of HRH for implementation of new HIV service delivery models or differentiated care models?

The adoption of the “Test and Start” strategy to accelerate the achievement of the UNAIDS 90-90-90 targets opens the door for a growing number of people living with HIV to receive antiretroviral therapy (ART) and achieve viral suppression in order to control the epidemic. A rapid increase in the number of clients on ART, however, may result in various health workforce bottlenecks that can hinder the delivery of critical services in high HIV burden countries. These challenges include inadequate number of health workers for the increased patient load resulting in long wait times for clients, increased workload which may cause low motivation and poor performance, and work processes which may be inefficient under a bigger daily case load. Streamlined service delivery approaches are essential to ensure that patients have access to the quality care they need and that countries can meet the 90-90-90 goals.

A solution with potential is the adoption of differentiated ART delivery models. These differentiated models have been developed to allow for a smoother process for patients who don’t need to see a clinician. They include two facility-based models (group and individual) and two community-based models (also group and individual). Differentiated models enable service delivery to respond to the preferences and expectations of ART clients. Differentiated ART delivery models can minimize unnecessary burdens on the health system by accommodating different client schedules; reducing the number of clinical and laboratory follow-up visits; separating clinical visits from drug refills and providing alternative locations for ART refills; and modifying client-flow patterns to reduce waiting times. For example, a stable patient on ART does not need to visit the clinic for a prescription refill each month. If he or she receives enough medication for several months, it provides clinic staff more time for other patients and saves the stable patient from unnecessary clinic visits. Overall, a differentiated ART delivery model will maximize the use of available resources — including the health workforce — to ensure access to quality care and treatment for more patients.

How is HRH2030 helping to address these health workforce challenges and support differentiated ART service delivery?

HRH2030, through support from USAID and PEPFAR, is developing a standardized, user-friendly tool. This tool will help facility managers who are adopting “Test and Start” to maximize the use of their health workforce, while using differentiated ART delivery models. It provides differentiated ART delivery model options, considering the health facility’s characteristics, clinical status of ART clients, special sub or key-populations, and the health worker skills mix, workload, and workflows.

The tool also contains benchmarks to help estimate the type and number of health workers needed for various tasks along the ART service delivery continuum depending upon selected ART delivery models. HRH2030 formulated these HRH estimates based upon extensive data gathered from facilities that offer varying models of differentiated ART delivery in Uganda.

To use the tool, a facility manager would input site-specific characteristics. These include health worker types and numbers at the facility, estimated proportion of time various types of staff allot to HIV service delivery, and differentiated ART models that the facility currently implements or would like to implement. The tool would then use these inputs and the benchmarks to estimate staffing needs for the facility. Based on these estimates and other contextual factors, the facility manager and ART team could then determine the best combination of differentiated ART models for the site. The team would be able to make an informed decision about reconfiguring its staffing options, workflows and task distribution, or requesting additional staff to meet its targets for clients on ART.

HRH2030 is piloting this tool in Uganda and Cameroon. How will HRH2030 promote its adoption at the national and/or local level to ensure that facilities have the right number and kind of health workers in place to deliver critical HIV services according to local population needs?

Having tested and refined the tool at facilities in Uganda and Cameroon, HRH2030 will work with USAID, implementing partners, and national ministries of health to promote the tool’s use at facilities that are just starting to implement differentiated ART delivery models, or who may be facing challenges in implementing ART services, in PEPFAR-supported high HIV burden countries. HRH2030 will work to ensure that the tool is customizable to different country contexts, taking into consideration staffing norms at facilities offering HIV services, the national guidance on task shifting, and country-specific policies and guidelines for the implementation of differentiated ART delivery models.

>> Next Q&A in the series

Others in this Series

Part 1: Increasing HIV Impact through Human Resources for Health Interventions
Part 2: Optimizing the Role of Community-Based Workers in HIV Service Delivery
Part 3: Standardized Use of Site-Level HRH Data for Differentiated Models of ART Delivery
Part 4: Making the Case for Investing in HRH

René Berger is a director in the global health division of Chemonics. He has more than 17 years of experience working with USAID and implementing partners as an HIV/AIDS expert. Mr. Berger has been involved with PEPFAR since its inception and brings a strong understanding of the process and expectations of the initiative from both the Washington and field perspective.

What is the importance of the community-based workforce for delivery of HIV services, and how can this workforce be further leveraged to advance HIV goals?

Community-based workers play a number of key roles in supporting our effort to achieve epidemic control. Across the entire continuum — from identifying infected individuals, to linking them to treatment, and ensuring that they remain adherent to medications — community-based workers play an essential identification, linking, and motivating role. PEPFAR and USAID have seen the value of community-based workers. They assist in rolling out models of differentiated care. They also help to decongest healthcare facilities of patients who do not need to see a clinician or other type of provider. Community-based workers may also lead or support community groups that facilitate the distribution of anti-retrovirals. I strongly believe it will be the support that comes from the community that will help us reach the final milestone of viral suppression.

One of the many benefits of community-based workers is they are from the community and, therefore, know the community. They know who has been sick and when they’ve linked them with HIV care and treatment. They know who is receiving treatment for HIV and can help ensure that those individuals continue to take their medication and receive the follow-up care they may require. Ultimately, we may find that these community-based workers are also helping us defeat the stigma around HIV by showing the human side of HIV care.

What work is HRH2030 currently doing to support the community-based workforce?

HRH2030 is supporting a number of activities to assess the community-based workforce for USAID. In Uganda, we are working to build a model to identify the human resource needs around providing differentiated care. Two of the four common models are community-based — these are community-led groups overseeing HIV treatment (mostly refills for medications) and individual pharmacy distribution points based in the community. These too may be overseen by a community-based worker.

In South Africa and Zambia we are also doing assessments of the community-based workforce to identify who they are working with, what services they are providing, where they are providing services, how long it takes to provide the services, and how much they are compensated. The goal of these assessments is to identify efficiencies — for both the services being provided and the compensation that the community-based workers receive.

How can community-based workers impact national efforts to control the HIV epidemic, especially long-term?

Community-based workers have an important role to play if we are going to achieve the UNAIDS 90-90-90 goals. Whether it’s identifying new patients who require treatment or ensuring that someone who has been receiving anti-retrovirals for years continues to take their medication, these community-based personnel will be invaluable. They are really the eyes and ears on the ground and the ones who will be able to best say whether we are achieving the ambitious goals we’ve set out to achieve control of this epidemic.

>> Next Q&A in the series

Others in this Series

Part 1: Increasing HIV Impact through Human Resources for Health Interventions
Part 2: Optimizing the Role of Community-Based Workers in HIV Service Delivery
Part 3: Standardized Use of Site-Level HRH Data for Differentiated Models of ART Delivery
Part 4: Making the Case for Investing in HRH

Diana Frymus is the health workforce branch chief at USAID, Office of HIV/AIDS in Washington D.C. Her work focuses on advancing USAID and PEPFAR strategic approaches and technical programming for health workforce for achieving 90-90-90 goals and sustaining program efforts.

How can human resources for health (HRH) interventions for HIV support an increase in transparency, accountability, and partnership?

Across PEPFAR countries, countries continue to face health worker constraints that impede HIV service delivery. Partnering with countries and supporting interventions that advance capacity to manage the health and social workforce not only helps strengthen countries’ health status but also promotes inclusive growth and self-resiliency. This yields greater transparency and accountability of the workforce required for achieving and maintaining further progress in HIV.

What are some of the most critical HRH challenges impacting HIV service delivery?

Many countries face fiscal constraints that prohibit significant increases in HRH financing to produce and hire additional health workers. This has placed greater emphasis on optimizing the utilization of existing available workers working across facilities and communities from both public and private sectors. This is key as countries continue to roll out differentiated service delivery models for HIV, which places greater emphasis on the role of the community-based workforce. In order to advance sustainable financing for HRH, countries need to place greater priority on improving the efficient use of existing resources for the health workforce and maximize the value of existing health workforce investments.

What are some new opportunities and strategies to overcome HRH challenges to advance achievement of 90-90-90?

HRH2030 has been working on some new and exciting activities to advance HRH for achievement of 90-90-90. These include advancing the use of HRH data and analysis through innovative assessment methodologies such as health labor market analyses, HRH investment cases, and models to help determine appropriate staffing for HIV service delivery models and efficiencies of HRH utilization — all of which you will learn more about in this series! Greater use of HRH data to inform and monitor impact of HRH investments is needed to yield greater achievement of 90-90-90.

>> Next Q&A in the series

Others in this Series

Part 1: Increasing HIV Impact through Human Resources for Health Interventions
Part 2: Optimizing the Role of Community-Based Workers in HIV Service Delivery
Part 3: Standardized Use of Site-Level HRH Data for Differentiated Models of ART Delivery
Part 4: Making the Case for Investing in HRH

Among the poorest countries in Africa, Malawi faces myriad health challenges. Approximately 28,000 of an estimated 18 million Malawians are infected with HIV annually and nearly 980,000 Malawians are HIV positive. Of these, more than one third do not know their HIV status.* The HIV/AIDS epidemic is most severe in the Southern Region where about 18 percent of the population lives with HIV. In the capital city Lilongwe, more than 10 percent of people are HIV positive. The country also has one of the most severe health worker shortages in the world, which constrains epidemic control. The World Health Organization estimates that Malawi has three doctors, nurses, and/or midwives per 10,000 population against its recommended number of 23.**

HRH2030, in partnership with USAID through PEPFAR, supports implementation of the Government of Malawi’s commitment to control the HIV/AIDS epidemic, including test and start and the 90-90-90 goals. HRH2030 is recruiting nearly 300 health workers for 64 Ministry of Health and Christian Health Association of Malawi (CHAM) health facilities in Lilongwe and Zomba, two of the highest HIV/AIDS burden districts in the country. Salary support of these workers will last until 2019. The Government of Malawi welcomes the support to recruit and pay salaries for health workers, who are critical to the provision of health and HIV/AIDS services and has signed an agreement with the U.S. Government to gradually absorb the health workers by 2020.

“We have noted a tremendous improvement in the delivery of services since HRH2030 recruited for us additional health care workers. We had health centers [that] were handicapped because they only had nurses without a clinician … Now with the recruitment, we have been able to post at least one medical assistant in these facilities.”

— Dr. Wilson Ching’ani, District Medical Officer, Zomba

Salary support not only relieves work pressures in the health facilities, but also provides job opportunities for health workers who have been unemployed due to a multiyear government freeze on recruitment. By November 2017 — one month after initiation of the recruitment drive — HRH2030 had deployed 222 health workers. Of these, 195 officially reported to health facilities, representing an 88 percent retention rate at initial deployment. Health workers recruited include nurse midwife technicians, clinical technicians, laboratory assistants, medical assistants, and pharmacy assistants. Twenty-eight percent of these health workers are PEPFAR scholarship beneficiaries who had been unemployed for nearly a year since graduation. Therefore, the salary support also ensures that PEPFAR’s pre-service education efforts benefit Malawi’s health sector.

“There is a need for qualified pharmacy assistants in Malawi but, since I graduated, I have been working in the private sector in temporary jobs. The job [through] HRH2030 is for a longer period, so it is an improvement,” said Blessings Mbengwa, a newly recruited pharmacy assistant in Lilongwe.

Of the 195 health workers who reported to their posts, the majority (117) work in outpatient departments, antenatal clinics, and labor and maternity wards, providing much-needed health and HIV/AIDS services to the Malawian population.
Dr. Wilson Ching’ani, Zomba District health officer, has already noted one benefit of the additional health workers.
“As a district, we also had a challenge of over expenditure on the budget for medicines because the medicines were being handled by security guards or cleaners due to lack of pharmacy cadres. Now with the pharmacy assistants, we are optimistic things will improve … the change is visible.”

Photo: Newly recruited health workers participate in induction in October 2017 before deploying to health facilities for service. The health workers recruited include nurse midwife technicians, clinical technicians, laboratory assistants, medical assistants, and pharmacy assistants.

______
*Malawi Population-Based HIV Impact Assessment, MPHIA (2016)
**Malawi Country Operational Plan COP16 Strategic Direction Summary (2016)

On November 13, 2017 HRH2030 hosted the satellite session Work Smarter: Tools for boosting health workforce efficiency at the Fourth Global Forum on Human Resources for Health to highlight several tools and approaches piloted by the program. Presentations and supporting materials from the session can be downloaded using the links below.

Featured Tools and Approaches

Optimizing Provider Performance and Productivity

Assembled by HRH2030, a suite of evidence-based tools enables facility managers and service delivery teams to measure and improve health worker performance and productivity. While initially developed for use by PEPFAR implementing partners to support HIV/AIDS services at health care facilities, the toolkit can be more generally applied across health service delivery areas.

Presentation (complete toolkit expected soon!)

Aligning HRH Competencies with Local Health Needs

HRH2030 has simplified an existing task analysis approach to create a “rapid” task analysis method. By applying this method, health system decision-makers can identify a core set of specific HIV, family planning, reproductive, and/or maternal and child health tasks that health workers must perform on a routine basis to match local health needs and align education, human resources management, and other strategies to address competency gaps.

Presentation      Sample Questionnaire

Increasing Use of Facility-level Data to Address HRH Barriers to Service Delivery

Developed by PEPFAR’s Interagency HRH Technical Working Group, the PEPFAR Rapid Site-Level Workforce Assessment Tool provides a quick snapshot of the adequacy of facility-level health workers in terms of numbers, skill mix, and performance to deliver HIV services. The tool can be modified to similarly assess and address HRH gaps affecting delivery of other health services.

Presentation     Tool (and related materials)

Making the Case for Strategic HRH Investments

HRH2030 has developed a mixed-method analytical approach to enable countries to estimate their projected HRH needs and costs for national HIV programs and build the investment case based on differentiated models of care. This approach illustrates how countries can use fiscal, socio-demographic, epidemiological, and other health data to make more strategic investments in support of an efficient health workforce.

Presentation     Checklist

 

Country: Global, Madagascar, Malawi, Uganda, Zambia

Resource Type: Presentations

Topic: Performance and productivity

 

With support from USAID’s Office of Population and Reproductive Health, HRH2030 recently convened a group of gender, family-planning, gender-based violence, and HRH experts and practicing midwives and nurses for a consultative forum to vet its work on defining and advancing gender competence in the family planning workforce.

HRH2030 is working to define what it means to be gender-competent as a family planning service provider and delineate the specific knowledge, skills, and attitudes that form the building blocks for gender competency. By increasing health workers’ awareness of gender and fostering the development of the skills needed to provide gender-equitable health care, the team hopes to improve reproductive health outcomes and increase gender equity. HRH2030 has proposed a definition of gender competence and created a framework of gender competencies for family planning providers.

At the forum, held November 2, experts from multiple disciplines reviewed and provided feedback on the draft definition and framework developed by the HRH2030 team. Following a brief orientation, the event was organized into two parts. The first part encouraged participants to examine and suggest tweaks to the definition of gender competence. The second part of the session provided an opportunity to analyze the draft competency framework and provide feedback. The conversation was rich, and HRH2030 received useful feedback to incorporate into future drafts of the definition and framework.

With the forum complete, the HRH2030 team will incorporate feedback into the draft definition and framework and conduct an additional round of review for remote experts. Those interested in reviewing virtually should contact us for more information. HRH2030 will then pilot the gender competencies in one or two countries. The pilot will inform refinement of the resource and serve as a needs assessment for trainings.

Stay tuned in 2018 for a copy of the gender competencies for family planning service providers resource!

Participating Organizations
  • Chemonics International
  • EngenderHealth
  • FHI 360
  • Georgetown University’s Institute for Reproductive Health
  • Intrahealth
  • Iris Group International
  • Jhpiego’
  • Johns Hopkins University Center for Communications Program
  • Palladium
  • UNFPA
  • University Research Company
  • USAID

 

 Audio interview with Dr. Al Hadidi (in Arabic)

In Jordan, HRH2030 works with the High Health Council (HHC) to strengthen the council’s capacity to govern the health workforce. A critical piece of this work is collaborating with the HHC to bolster the National Human Resources for Health (HRH) Observatory. The National HRH Observatory is meant to serve as a primary source of reliable HRH data to inform policy development and decision-making. HRH2030 is supporting the observatory to become a national resource for HRH data and information for policymakers, researchers, health care leaders, and other stakeholders.

HRH2030 recently conducted an assessment of the National HRH Observatory’s current contributions to HRH decision-making, gaps in these contributions, and resources needed to address these gaps. The overall findings of the assessment revealed that many factors have hindered the observatory’s efforts to become Jordan’s national HRH data arm. These include lack of strategic vision and clear lines of authority, inactive governance structures, inadequate human and non-human resources, and limited capacity to manage core functions. Based on its assessment, HRH2030 recommends restructuring the observatory by revisiting its functions, diversifying the membership of the observatory’s National HRH Policy Coordination Forum, and developing an automated reporting system for data collection to be able to more closely monitor movement within the health workforce. These changes will lead to more strategic HRH direction for the country and support institutional and financial sustainability of the observatory. HRH2030 will work with the observatory to achieve these goals.

This interview with former National HRH Observatory Director and current HRH2030 Governance Component Lead Dr. Raghad Al Hadidi (pictured above with HRH2030 Jordan Project Director Edward Chappy) highlights the observatory’s history, role, and assessment findings.

What is the role of the National HRH Observatory?

The National HRH Observatory is a cooperative initiative among all stakeholders responsible for human resources for health data collection, analysis, and distribution for both the public and private sectors. It is considered a tool for designing evidence-based health policies and providing data for decision-making.

What were the observatory’s main accomplishments during the past few years?

The National HRH Observatory started operating in 2008. One of its first efforts was a survey of all related stakeholders to analyze the status of HRH in Jordan. The survey findings revealed HRH priorities and challenges facing the health workforce in Jordan. Moreover, the observatory was listed in the national agenda and the executive development program covering the years 2011 to 2013. A national event was held bringing together all national HRH stakeholders, including policymakers and decision-makers. Based on the recommendations made during the event, the Prime Minister formed a national coordination policy forum comprised of representatives from all national HRH stakeholders. Following that step, a field working group of data collectors was formed. This group collected data annually to feed into the observatory’s annual reports. The observatory launched its own website, linking to the HHC website, after that.

On July 16, 2009, the National HRH Observatory was officially launched, followed by development of a country profile on human resources for health in 2010. The observatory has produced its annual report since 2009. This report is considered a policy-making tool as it revealed the distribution of health workers at both the national and governorate levels. It uncovers the level of equity in the distribution process, the number of health workers, and the number of health students in both public and private universities. The observatory also produced leaflets, conducted HRH-related studies, and developed policy briefs that were used for driving health policies.

How does the observatory collect data and share it to inform decision-making? How could this process be improved?

The national observatory’s data collection process is usually done through the field working group, which collects data at the governorate level from the public and private sectors and at the central level from all health institutions. As for sharing the data, it is done through the observatory’s annual report, which is linked from the HHC website and printed and disseminated among HRH related stakeholders if budget allowed.

What are some decisions that were based on the observatory’s data?

Decisions based on the observatory data are split into two parts. The first relates to stock analysis; for example, identifying equitable distribution of health workers between governorates, between levels of the healthcare provision (primary and secondary) and within the level itself (primary versus comprehensive health care centers). The second relates to production. When we talk about producing health workers, we can make decisions related to the number of students admitted to and graduated from health programs in public and private universities in the previous year to align with the labor market needs. Decisions can also be related to the percentages of university admissions based on gender and specialty.

I mentioned that the national observatory provides data on the number of students admitted to health programs. We recently had an issue related to nurses in Jordan. There is high demand for female nurses in hospitals and health centers, but there is a shortage of female nurses. The observatory flagged this shortage and a policy was issued to increase the number of female students admitted to nursing programs in public and private universities. Universities started admitting more female applicants than their male counterparts to bridge the gap in the labor market needs.

What do you view as the observatory’s biggest challenges?

There are two types of challenges facing the observatory: financial challenges that are related to lack of financial resources allocated for the observatory and non-financial challenges. The latter includes lack of human resources like IT staff, lack of a central computerized system to analyze the collected data, lack of a marketing and advocacy plan, and weakness in utilizing the observatory’s data in the decision-making and policymaking process.

There are often data discrepancies between different jobs and sectors. Considering its role as a national entity that collects data from different sectors, how does the observatory coordinate across sectors to link and harmonize the data?

The observatory has been facing the data discrepancy problem since its establishment. Many efforts were paid to overcome this challenge, including forming a national working group that includes all HRH data-related stakeholders. Also, in the 2016 HRH Annual Report, the HRH operational definitions were standardized, and an inclusion criteria was developed for certain professions. For example, when we talk about doctors, we agreed to exclude the non-practicing doctors, doctors working abroad, and the retired ones. Identifying the target groups and definitions have contributed to enhancing the data quality. In the 2016 report, the observatory also unified the data collection methodology with the Ministry of Health, which decreased the level of data discrepancy between the data collected by the observatory and the data collected by the ministry.

Through your current position as a governance component lead at HRH2030, how do you believe the Jordan activity can support the observatory to achieve its objectives and strengthen its role as a reliable HRH data source?

HRH2030 has the financial and technical capacity to support the observatory’s objectives and strengthen its role. This can be done through enhancing public and private sector databases, particularly those available through the country’s medical, pharmaceutical, dental, and nursing and midwifery associations. Those databases [currently] lack accuracy and advanced information related to the health workforce.

HRH2030 can also help the observatory create a central computerized system that links HRH data in the High Health Council’s central database with data available at the Ministry of Health directorates, which are spread across the country’s governorates. HRH2030 can also help develop a strategy to promote data use for decision-making and policymaking, in addition to providing on-the-job data collection trainings to HHC staff.

In July, HRH2030 and Senegal’s Ministry of Health and Social Action’s Directorate of Human Resources (DRH) hosted a workshop to develop DRH staff members’ ability to effectively use the country’s human resources information system (HRIS). The workshop builds on collaborative efforts to create a full picture of the current and future health workforce in Senegal by improving collection, analysis, and use of health workforce data.

In 2014 the Ministry of Health and Social Action (MSAS) adopted the open source software iHRIS as its tool for collecting and managing human resources (HR) data. Since the software’s introduction, the ministry and its partners have noted several challenges with its implementation:

  1. Variability of use across regions due to skill gaps among HR staff
  2. Weak infrastructure, including electricity and internet connectivity
  3. Programming of the current system captures HR data only for the public sector and neglects community-based and private sector workers
  4. A heavy focus on data entry has diverted attention from data analysis for decision-making

 

The three-day July workshop focused on reducing skills gaps between regional- and central-level staff on the use of the iHRIS software. During the workshop, attendees watched iHRIS demonstrations and practiced data entry, enrolling new health workers, and modifying previously enrolled workers’ information. The 20 attendees came from MSAS directorates, services, programs, and central divisions. Technical staff from the DRH, the national iHRIS focal point, and HRH2030 iHRIS Technical Advisor Moussa Diakhate led the session.

DRH staff members who participated in the workshop underscored the need to conduct similar trainings for all departments within the MSAS to ensure harmonization of human resources management. They also highlighted the benefit that the rollout of iHRIS implementation will have on the management of human resources at the central, regional, and district levels. Participants unanimously agreed that country-wide iHRIS training would help guarantee that the right health workers with the appropriate skills were positioned in suitable posts, including those in traditionally underserved areas.

“If the implementation of iHRIS tool succeeds this will be extremely beneficial for all human resources for health in Senegal,” remarked DRH staff member Ndeye Coumba Thiam, who participated in the workshop. “[HRH2030] has been able to pick up the unfinished work, provide direction and guidance, and move iHRIS implementation forward.”

HRH2030 will continue to support iHRIS training and rollout for data entry and use throughout the country with a continuous focus on the use of data to inform higher-level decisions. The program will also support DRH efforts to address select infrastructure challenges to ensure that rollout of iHRIS is not further delayed.