Health Workforce Development

Health Workforce training with model baby

Crucial for efforts to provide universal health coverage is the strengthening of the existing health workforce – maximizing the talents that are currently available and building mechanisms to ensure that productivity, performance, and engagement will continue to improve as these resources grow and evolve.  In order to obtain desired results, it is necessary to both explore and develop the evidence to enhance our understanding of the factors that influence health worker outputs and clinical outcomes.  This is accomplished through innovative research that is then used to develop practical tools and guidance that is applied to analyze and strengthen health workforce planning, management, and development.  Applying improvement approaches to engage health workers in providing quality care and to empower teams to deliver better services to more users is an integral part of systems strengthening. 

In many countries the performance of health workers is constrained by factors such as regular stock-out of medicines, shortage of supplies, high levels of staff turnover, unclear job expectations, and limited feedback and supervision. Growing evidence suggests that improving the productivity and engagement of health workers and addressing performance factors within the health workforce contribute to improved care outcomes.  Improvement methods can help to:

  • Clarify roles and expectations, assess work distribution and rationalize tasks among team members, and introduce measurement of performance
  • Develop and test incentives, rewards and consequences that reinforce strong performance and discourage poor performance, from verbal recognition to career path and bonus mechanisms
  • Strengthen performance feedback mechanisms among members of the care delivery team, supervisors, and community members
  • Enhance the work environment, including both the physical environment (including safety and the availability of supplies) and the non-physical environment (including management practices that build confidence and security, mechanisms for coordination and communication, and protection from violence or harassment), to enable health workers to perform at their best
  • Build the competencies needed to implement tasks and perform at expected levels


Bringing experience and knowledge to the Ebola frontline in Liberia: Honoring Dr. Anne Atai

Lani Marquez

Knowledge Management Director, USAID ASSIST Project/URC

It was the tiny pin on her jacket that caught my eye. 

At a tea break during the Safe Male Circumcision Knowledge Handover meeting held last month in Kampala, I found myself standing next to a senior physician from Jinja Referral Hospital.  She was participating in the meeting as part of a team from Jinja’s Safe Male Circumcision program, to learn from other teams in Uganda that had been working on improving the quality of safe male circumcision services.

A health worker's perspective on improving PMTCT services through a community-based system in Mozambique

Percina Paulo Mathe

Maternal and Child Health Nurse, Licilo Health Post/Mozambique

The following blog is written by Percina Paulo Mathe, a health worker in Mozambique,and was originally published in January. ASSIST is highlighting Percina's story as as part of World Health Worker Week (April 6-10). The original Portuguese entry is below the English translation.

My name is Percina Paulo Mathe, I’m a 32-year-old maternal and child health nurse in Licilo in Gaza Province, Mozambique.

After my training on PMTCT, I found it was hard to apply it in my community because there were many barriers to the community approach. For example, often all the information about a patient stayed within the hospital without being passed on to those in their own community or neighborhood who could support the patient. Language was also a barrier; sometimes topics were not explained in the hospital in the same terms as in the community, whereas using a common language would increase what is truly understood by the patient and the community, taking into account the rumors that exist in the community.  For me such incomplete communication was like trying to fight a poisonous tree by just cutting off some branches; leaving the trunk and the roots means that when the rain comes, the tree will just grow back.

A call for stronger African leadership in health

Francis Omaswa

Executive Director, African Centre for Global Health and Social Transformation

I am proud to introduce a new book entitled African Health Leaders: Making Change and Claiming the Future.  It was first launched in September 2014 during the UN General Assembly in New York. A number of contributions by the Ashgovnet community have made their way into this book, which was edited by Lord Nigel Crisp and me. There are supporting statements from the Chairperson of the African Union Commission, Her Excellency Dr. Nkosazana Dlamini Zuma and Dr. Tim Evans of the World Bank. It is available for order online on Amazon and the Oxford University Press.

Why Universal Health Coverage Depends on Human Resources for Health

M. Rashad Massoud

Director, USAID ASSIST Project/URC

This coming September at the Third Global Symposium on Health Systems Research in Cape Town, Frances Day-Stirk, President of the International Confederation of Midwives, and I will be co-chairing a working group on the role of standards, quality improvement, and regulation for improving health worker productivity and performance in the context of universal health coverage (UHC).  We will be part of a satellite session on emerging findings and priorities for human resources for health (HRH) post 2015 and one of seven working groups contributing to this effort.  During the working group we will present a strategic paper and framework that we are developing together with global experts on this topic.  

Is health worker education and training setting health workers up to succeed? How do we build the competencies of health workers to improve care?

Tana Wuliji

Senior Improvement Advisor, USAID ASSIST Project/URC

It’s Friday afternoon, and I’ve just come out of session I was moderating with the fabulous Lesley Anne Smith of NHS Scotland. The session was packed full of folks from around the world who gave up the lures of Paris to discuss and share experiences on this very question: “How do we build the competencies of health workers to improve care in our health systems?”.  Let me tell you a little bit about where I am and how we came to this.  

Will health systems be ready to meet the post-MDG realities?

Ombretta Baggio, Senior Officer for Communications at the International Federation of Red Cross and Red Crescent Societies (IFRC), collaborated with Allison Annette Foster on this blog and is a co-author.

How often do seismic shifts happen under our very feet, and before we realize it we are toppled by a changed landscape that we have not prepared to maneuver? Countries are facing such seismic shifts as they ponder their post-2015 national health strategies. Beyond the drive to reach the Millennium Development Goals, how will we re-engineer our systems to achieve Universal Health Coverage and meet the growing needs of long-term care and chronic conditions care?

An interview with Dr. Ram Shrestha:Supporting Community Health Workers- Where do we stand?

Rhea Bright

Quality Improvement & Human Resources for Health Advisor, USAID Bureau for Global Health Office of Health Systems

In this post, Rhea Bright interviews Dr. Ram Shrestha.

As a health professional, whenever I visit a rural village in a low-or middle-income country, several thoughts come to mind. Knowing that the formal health system usually ends at a health center, dispensary, or health post in these rural communities, does everyone in this village have access to health services? How can we ensure that there are enough health workers in nearby facilities to provide needed services? Are there community health workers (CHWs) in this village, and are they well supported? I started thinking more and more about these questions as World Health Worker Week (April 7-11, 2014) approached…consequently even more questions came to mind.

Health workers not only count – they are the frontline of health systems improvement

M. Rashad Massoud

Director, USAID ASSIST Project/URC

Diana Frymus

Health Systems Strengthening Advisor, USAID

This week we appreciate and celebrate those at the frontline of our health systems.  With that, let us recognize that there are critical health workforce shortages (7.2 million) which are set to increase to an even higher level of 12.9 million in 20 years.  Although many countries have made progress in setting national policies and plans to strengthen the workforce, implementation has been weak and progress has not kept pace with expectations, manifesting in low health worker morale, absenteeism, and high turnover.

Improving Human Resources Management in Health Systems

James Heiby

Project Officer, USAID ASSIST Project and Medical Officer, Office of Health Systems, USAID

The costs of health care are predominately those associated with people, the clinical and administrative staff that provide services. At the same time, there is widespread concern that these human resources are not well managed in many resource-constrained health systems. While Global Health organizations have invested substantial resources in human resources issues in recent years, few of those resources have focused on how health systems in these countries manage their largest resource.

What have we learnt so far: The in-service training session in a nutshell

Tana Wuliji

Senior Improvement Advisor, USAID ASSIST Project/URC

There are more in-service training programs than ever before with training often representing the lion’s share of investments for strengthening human resources for health (HRH). An increasing number of reports indicate that  training is rarely evaluated, frequently duplicative and may not be designed to meet needs. A growing multiplicity of poorly coordinated training providers may overwhelm and weaken training systems rather than strengthen them. Ensuring that quality of the services delivered by health workers is upheld and continually strengthened is of utmost importance to the Universal Health Coverage agenda. Training is clearly an important contribution towards the development and maintenance of health worker competencies for delivering quality services – but how can we make training more effective, efficient and sustainable?