Abstract
BackgroundHuman resources information systems (HRIS) are a key tool for collecting and analyzing health workforce data at the country level and the specific focus of milestones 4.1 and 4.2 of the Global Strategy on Human Resources for Health (HRH). Yet documentation on the capabilities of HRIS in low- and middle-income countries (LMICs) is limited. Vital Wave, with IntraHealth International and Cooper/Smith, conducted a targeted scan of the HRIS landscape in 20 countries and “deep-dive” assessments in Burkina Faso, Mozambique, and Uganda. Here we present the case of Uganda’s workforce information ecosystem. Case PresentationSince 2006, Uganda has seen investment in HRIS from different donors, overseen by the Ministry of Health (MOH) and accompanied by the rollout of IntraHealth’s open-source iHRIS software. Despite this history of investment, mapping of the country’s multiple information systems revealed uneven adoption and engagement nationally and sub-nationally, with high levels of data fragmentation due to lack of interoperability and data-sharing practices. We also mapped the administrative processes and data flows for three priority use cases: recruitment and deployment, salary payments, and performance management. What emerges is a complex, decentralized information ecosystem driven by years of donor investment, but one that still sees uneven ownership and data use across the health system. Challenges include:· Limited interoperability between systems, specifically payroll, iHRIS, and the district health information system (DHIS2)· Complex HRH planning and management policy context, with variable implementation of numerous policies and no single reference to guide investments and implementation· Limited visibility into the private and community health workforce. ConclusionsUganda’s progress in developing its HRH information ecosystem underscores the importance of continuously aligning system capabilities, incentives, and motivations to an ever-evolving country context. However, as evidenced in Uganda and our broader assessment findings, robustness of the information ecosystem itself is insufficient to making substantive strides toward the Global Strategy’s milestones 4.1 and 4.2—governance oversight and ownership are critical to success. With a better understanding of what good looks like in terms of HRIS functionality in LMICs and ensuring interventions are addressing the causal issues, there can be many pathways to making systems work.
Information systems on human resources for health: a global review
