Achieving better HIV care with engaged health care workers

Sarah Smith Lunsford

Senior Improvement Advisor, Research & Evaluation, USAID ASSIST/EnCompass LLC

As we work toward ending the global HIV epidemic by the year 2030, optimizing the health workforce has never been more important. PEPFAR 3.0 directs investment to target regions and services to achieve epidemic control. Yet, as countries strive to achieve more with less, what activities and approaches will best support and enable increased utilization of the existing health workforce to deliver and sustain quality HIV/AIDS services? An engaged health workforce is more productive, stays on the job longer, and provides better care.

With support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), USAID ASSIST undertook a mixed methods study to explore the factors that contribute to an engaged health care worker providing HIV care in Tanzania. We developed and validated a health worker survey to assess engagement and found four characteristics associated with health worker engagement:

  1. Being a change agent: proactive, focused on improvement, being a team player
  2. Job satisfaction: having pride in one’s work, employee trust, relationships
  3. Being accountable: understanding of job expectations, answerable to responsibilities
  4. Delivering equitable and client-centered care: respectful care delivered to all patients

We also identified factors that influenced engagement:

  • Perceived support from immediate supervisor
  • Perceive adequacy of competencies to perform assigned tasks
  • Perceived adequacy of inputs in the health facility

Qualitative data, however, present a more complex picture of these factors. Support from supervisors was not limited to on-the-job guidance and feedback, but support of the worker as a whole. For example, one respondent appreciated that her supervisor did not put her on night shifts when she was late in her pregnancy. Additionally, support was not limited to immediate supervisors; encouragement and feedback from colleagues and patients was motivating. Interview respondents also shared that inadequate supplies did increase their dissatisfaction with their work.

This research, and the accompanying validated tools, offer insight into how to engage health workers to achieve better patient outcomes and reach HIV goals. As we enter into a new era of HIV response under the Sustainable Development Goals and continued PEPFAR 3.0 Agenda, our mixed methods research points to the importance of compassion and support for improving health worker engagement and better HIV care. (See the attached presentation for summary findings from the research.)

This work also highlights the opportunities for more direct focus on human resources for health at the facility level as aligned with the approach outlined in the PEPFAR HRH Strategy. It provides further evidence for the importance of focus on the health workforce to achieve an AIDS-Free Generation.

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Thank you for this insightful blog, Sarah, where you eloquently summarize findings that confirm every employee's personal experience, and what is well documented in the psychology and leadership literature. Daniel Pink in his book Drive talks about what motivates people, and describes three different motivations. Many of us are motivated by mastery in our job, i.e. we really want to do a good job. This is in line with W. Edwards Deming's findings in Total Quality Management that people basically want to do a good job. Then, many of us want to have independence of self-determination in our job. No wonder health workers experience stress when they do not have the supplies they need to get their work done. And then, Pink writes about purpose, and certainly healthcare work attracts people who are motivated by purpose, i.e. want to serve people. My takeaway from this study is how important it is to appreciate and care for health workers, because they are trying to do a good job in imperfect health systems that thwart them. Kudos to ASSIST and USAID for focusing the spotlight on these central actors in the healthcare system who deserve supervisors' and colleagues' support and care, so they can in turn support and care for patients.

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