Getting Human Resource Information Systems Right: A Case Presentation of Uganda

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.

Analisis pelaksanaan program indonesia sehat dengan pendekatan keluarga (PIS-PK) pada Puskesmas di Kabupaten Nagan Raya

Background: The achievement indicators of the healthy Indonesia program with a family approach (PIS-PK) at the Nagan Raya District Health Center was still low. The implementation of the PIS-PK program was only training, preparation, analysis of the initial healthy family index. In contrast, further intervention and analysis have not run optimally, so the existing data has not been used appropriately.Objective: The purpose of the study, to analyze the implementation of the healthy Indonesia program with a family approach at the Public Health Centers (PHC) in Nagan Raya Regency.Method: This research design is a cross sectional study conducted in Nagan Raya Regency in 2021. The data were collected using a questionnaire with a sample size of 70 officers. The measurement of the variables of government support, infrastructure, community support, human resources for health workers, monitoring and evaluation, was measured using a questionnaire sheet. Data analysis used Chi-Square statistical test and Binary Logistic Regression with a significance level of 95%.Results: The results was showed that there was a relationship between community support (p= 0.010, OR = 3.72), facilities and infrastructure (p= 0.019, OR= 3.2),, government support (p= 0.00, OR= 6.15), health personnel resources (p=0.008, OR= 4.8), monitoring evaluation (p= 0.007, OR= 4.52) with the implementation of the PIS-PK program. Based on the multivariate test, the dominant variable associated with the PIS-PK program was government support.Conclusion: The good government support is 6.15 times related to the success of the PIS-PK program implementation program compared to less government support.

Systematic review of performance-enhancing health worker supervision approaches in low- and middle-income countries

Background The strength of a health system—and ultimately the health of a population—depends to a large degree on health worker performance. However, insufficient support to build, manage and optimize human resources for health (HRH) in low- and middle-income countries (LMICs) results in inadequate health workforce performance, perpetuating health inequities and low-quality health services. Methods The USAID-funded Human Resources for Health in 2030 Program (HRH2030) conducted a systematic review of studies documenting supervision enhancements and approaches that improved health worker performance to highlight components associated with these interventions’ effectiveness. Structured by a conceptual framework to classify the inputs, processes, and results, the review assessed 57 supervision studies since 2010 in approximately 29 LMICs. Results Of the successful supervision approaches described in the 57 studies reviewed, 44 were externally funded pilots, which is a limitation. Thirty focused on community health worker (CHW) programs. Health worker supervision was informed by health system data for 38 approaches (67%) and 22 approaches used continuous quality improvement (QI) (39%). Many successful approaches integrated digital supervision technologies (e.g., SmartPhones, mHealth applications) to support existing data systems and complement other health system activities. Few studies were adapted, scaled, or sustained, limiting reports of cost-effectiveness or impact. Conclusion Building on results from the review, to increase health worker supervision effectiveness we recommend to: integrate evidence-based, QI tools and processes; integrate digital supervision data into supervision processes; increase use of health system information and performance data when planning supervision visits to prioritize lowest-performing areas; scale and replicate successful models across service delivery areas and geographies; expand and institutionalize supervision to reach, prepare, protect, and support frontline health workers, especially during health emergencies; transition and sustain supervision efforts with domestic human and financial resources, including communities, for holistic workforce support. In conclusion, effective health worker supervision is informed by health system data, uses continuous quality improvement (QI), and employs digital technologies integrated into other health system activities and existing data systems to enable a whole system approach. Effective supervision enhancements and innovations should be better integrated, scaled, and sustained within existing systems to improve access to quality health care.

Caring for the Caregivers Through Healthy Human Resource Practices

India has a colossal shortage of human resources for health. The management of human resources in a healthcare institution is vital to enable the delivery of efficient and effective medical services and to achieve patient satisfaction. Everyone proclaims that the human asset is the most important asset. On the other side, health is declared to be one of the most important wealth. Hospitals and pharmaceutical companies constitute two arms of the “health management/ maintenance” effort of humanity. Human resource professionals face many hurdles in their attempt to deliver high-quality health care to citizens. Some of these constraints include budgets, lack of congruence between different stakeholders' values, absenteeism rates, high rates of turnover, and low morale of health personnel.

Examining health sector stakeholder perceptions on the efficiency of county health systems in Kenya

Efficiency gains is a potential strategy to expand Kenya’s fiscal space for health. We explored health sector stakeholders’ understanding of efficiency and their perceptions of the factors that influence the efficiency of county health systems in Kenya. We conducted a qualitative cross-sectional study and collected data using three focus group discussions during a stakeholder engagement workshop. Workshop participants included health sector stakeholders from the national ministry of health and 10 (out 47) county health departments, and non-state actors in Kenya. A total of 25 health sector stakeholders participated. We analysed data using a thematic approach. Health sector stakeholders indicated the need for the outputs and outcomes of a health system to be aligned to community health needs. They felt that both hardware aspects of the system (such as the financial resources, infrastructure, human resources for health) and software aspects of the system (such as health sector policies, public finance management systems, actor relationships) should be considered as inputs in the analysis of county health system efficiency. They also felt that while traditional indicators of health system performance such as intervention coverage or outcomes for infectious diseases, and reproductive, maternal, neonatal and child health are still relevant, emerging epidemiological trends such as an increase in the burden of non-communicable diseases should also be considered. The stakeholders identified public finance management, human resources for health, political interests, corruption, management capacity, and poor coordination as factors that influence the efficiency of county health systems. An in-depth examination of the factors that influence the efficiency of county health systems could illuminate potential policy levers for generating efficiency gains. Mixed methods approaches could facilitate the study of both hardware and software factors that are considered inputs, outputs or factors that influence health system efficiency. County health system efficiency in Kenya could be enhanced by improving the timeliness of financial flows to counties and health facilities, giving health facilities financial autonomy, improving the number, skill mix, and motivation of healthcare staff, managing political interests, enhancing anticorruption strategies, strengthening management capacity and coordination in the health sector.

How to attract and retain health workers in rural areas of a fragile state: Findings from a labour market survey in Guinea

Most countries face challenges attracting and retaining health staff in remote areas but this is especially acute in fragile and shock-prone contexts, like Guinea, where imbalances in staffing are high and financial and governance arrangements to address rural shortfalls are weak. The objective of this study was to understand how health staff could be better motivated to work and remain in rural, under-served areas in Guinea. In order to inform the policy dialogue on strengthening human resources for health, we conducted three nationally representative cross-sectional surveys, adapted from tools used in other fragile contexts. This article focuses on the health worker survey. We found that the locational job preferences of health workers in Guinea are particularly influenced by opportunities for training, working conditions, and housing. Most staff are satisfied with their work and with supervision, however, financial aspects and working conditions are considered least satisfactory, and worrying findings include the high proportion of staff favouring emigration, their high tolerance of informal user payments, as well as their limited exposure to rural areas during training. Based on our findings, we highlight measures which could improve rural recruitment and retention in Guinea and similar settings. These include offering upgrading and specialization in return for rural service; providing greater exposure to rural areas during training; increasing recruitment from rural areas; experimenting with fixed term contracts in rural areas; and improving working conditions in rural posts. The development of incentive packages should be accompanied by action to tackle wider issues, such as reforms to training and staff management.

A mapping of health education institutions and programs in the WHO African Region

Background: Information on health education institutions is required for planning, implementing and monitoring human resources for health strategies. Details on the number, type and distribution of medical and health science programs offered by African higher education institutions remains scattered. Methods: We merged and updated datasets of health professional and post-graduate programs to develop a mapping of health education institutions covering the World Health Organization African Region as of 2021. Results: Nine hundred and nine (909) institutions were identified in the 47 countries. Together they offered 1,157 health professional programs (235 medicine, 718 nursing, 77 public health and 146 pharmacy) and 1,674 post-graduate programs (42 certificates, 1,152 Master’s and 480 PhDs). Regionally, East Africa had the most countries with multiple academic health science centres - institutions offering medical degrees and at least one other health professional program. Among countries, South Africa had the most institutions and post-graduate programs with 182 and 596, respectfully. A further five countries had between 53-105 institutions, 12 countries had between 10 and 37 institutions, and 28 countries had between one and eight institutions. One country had no institution. Countries with the largest populations and gross domestic products had significantly more health education institutions and produced more scientific research (ANOVA testing). Discussion: We envision an online database being made available in a visually attractive, user-friendly, open access format that nationally, registered institutions can add to and update. This would serve the needs of trainees, administrators, planners and researchers alike and support the World Health Organization’s Global strategy on human resources for health: workforce 2030.

Does Inter-Border Conflict Influence the Views of Task Sharing Among Community Health Volunteers in Nigeria? a Qualitative Study

Background: Volunteer community health workers are increasingly being engaged in Nigeria, through the World Health Organization’s task sharing strategy. This strategy aims to address gaps in human resources for health, including inequitable distribution of health workers. Recent conflicts in rural and fragile border communities in northcentral Nigeria create challenges for volunteer community health workers to meet their communities increasing health needs. This study aimed to explore the perception of volunteers involved in task sharing to understand factors affecting performance and delivery in such contexts.Methods: Eighteen audio recorded, semi-structured interviews with volunteers and supervisors were conducted. Their perceptions on on how task sharing and allocation affect performance and delivery were elucidated. The transactional social framework was applied during the thematic analysis process to generate an explanatory account of the research data.Results: Promotive and preventive tasks were shared among the predominantly agrarian respondents. There was a structured task allocation process that linked the community with the health system and mainly cordial relationships were in place. However, there were barriers related to ethnoreligious crises and current conflict, timing of task allocations, gender inequities in volunteerism, shortage of commodities, inadequate incentives, dwindling community support and negative attitudes of some volunteers.Conclusion: The perception of task sharing was mainly positive, despite the challenges, especially the current conflict. In this fragile context, reconsideration of non-seasonal task allocations within improved community-driven selection and security systems should be encouraged. Supportive supervision and providing adequate and timely renumerations will also be beneficial in this fragile setting.

Need for Increased Investment in Human Resource for Health in India: Estimating the Required Investment for Increased Production of Health Professionals for Achieving Universal Health Coverage and Sustainable Development Goals by 2030.

BACKGROUND: COVID-19 has reinforced the importance of having sufficient, well-distributed and competent health workforce. In addition to improving health outcomes, increased investment has the potential to generate employment, increase labour productivity along with fostering economic growth. With COVID-19 highlighting the gaps in human resources for health in India, there is a need to better and empirically understand the level of required investment for increasing the production of health workforce in India for achieving the UHC/SDGs.METHODS: The study used data from a range of sources including National Health Workforce Account 2018, Periodic Labour Force Survey 2018-19, population projection of Census of India, and review of government documents and reports. The study estimated shortages in the health workforce and required investments to achieve recommended health worker: population ratio thresholds by the terminal year of the SDGs 2030.RESULTS: Our results suggest that to meet the threshold of 34.5 skilled health worker per 10,000 population, there will be a shortfall of 0.16 million doctors and 0.65 nurses/midwives in the total stock of human resources for health by the year 2030. The shortages at the same threshold will be much higher (0.57 million doctors and 1.98 million nurses/midwives) in active health workforce by 2030. The shortages are even higher when compared with a higher threshold of 44.5 health workers per 10,000 population. The estimated investment for the required increase in the production of health workforce ranges from INR 523 billion to 2,580 billion for doctors. For nurses/midwives, the required investment is INR 1,096 billion. Such investment during 2021-25 has the potential of an additional employment generation within the health sector to the tune of 5.4 million and contribute to national income to the extent of INR 3,429 billion annually.Conclusion: India needs to significantly increase the production of doctors and nurses(/midwives) through investing in opening up of new medical colleges. Nursing sector should be prioritized to encourage talents to join nursing profession and provide quality education. India needs to set-up a benchmark of skill-mix ratio and provide attractive employment opportunities in health sector to increase the demand and absorb the new supply of graduates.

Data Collection on Donor-Supported Health Workers: Lessons Learned From Improving Health Workforce Data Supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)

The Global Strategy on Human Resources for Health: Workforce 2030 has called for the improvement of health workforce data and implementation of health workforce registries. It is critical to capture the health workforce supported by donors in order to have a complete understanding of the health workforce across countries. The United States Agency for International Development (USAID) developed an innovative pilot human resources for health (HRH) data collection system (including a data entry template and structured dataset) to collect HRH data for the health workforce supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). The pilot system filled HRH data gaps in nine key countries, providing valuable insight for program planning. The implementation details of this exercise can be used as a case study on collecting and applying data on health workers, including those supported by donor funding.