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

 

Quality Improvement and Human Resources Management Enhances HIV Services in Tanzania

Macdonald Kiwia

Quality Improvement Advisor, USAID ASSIST Project/URC

This post originally appeared on the K4Health Blog.

Dr. Stella Mwita, Dr. Yohana Mkiramwene, Kim Ethier Stover, and Tana Wulji, Quality Improvement Advisors working with USAID’s Health Care Improvement Project (HCI) in Tanzania, also contributed to this blog.

We are the Quality Improvement Advisors to University Research Co., LLC, in Tanzania. In this role, we support the Tandahimba District in Mtwara Region in combining improvement and health workforce development approaches through the Tanzania Human Resources for Health Quality Improvement Collaborative. Our efforts aim to improve anti-retroviral therapy and prevention of mother-to-child transmission care.

A quality improvement team develops a process map on enrollment in HIV treatment at Tandahimba District Hospital, Mtwara, Tanzania

A quality improvement team develops a process map on enrollment in HIV treatment at Tandahimba District Hospital, Mtwara, Tanzania. 

Photo by Yohane Mkiramweni, URC.

The Tandahimba District has a severe shortage of health care workers in most of its health facilities. Rather than trying to add more health workers, USAID, HCI, and the Ministry of Health (MOH) decided to focus on maximizing the productivity of the few existing staff.  We expected that improved productivity might cover the service gaps created by the shortage of health workers.  Our work in Tanzania is adapted from HCI’s successful experience in Niger, where teams improved productivity, engagement, and clinical outcomes by combining human resources interventions and improvement approaches. 

Health Care Improvement Project’s CHW AIM Tool Strengthens Community Health Worker Programs

Donna Bjerregaard

Senior Technical Advisor, Initiatives Inc.

This post originally appeared on the K4Health Blog.

The global shortage of health workers has created cracks in the bridge to health services for Africa’s communities. Many countries and donors are looking toward community health workers (CHWs), who have a vested interest in the health of their communities, to fill the gaps.  Although CHWs have played a role in prevention and care for over 50 years, we have not had a way to evaluate whether the programs are meeting communities’ needs. We also don’t know the level of support CHWs receive to help them provide quality services. 

A community health worker in Dhaka, Bangladesh, follows up on a child with fever

A community health worker in Dhaka, Bangladesh, follows up on a child with fever.

It was this thinking that led Initiatives Inc. and the USAID-funded HCI Project to develop the Community Health Worker Assessment and Improvement Matrix (CHW AIM). Through a literature review and repeated testing, 15 components of a well-functioning program emerged, ranging from recruitment and training to community involvement and country ownership. 

We designed the process to be used by program managers, CHWs, donors, and stakeholders. Led by a facilitator, the group engages in discussions about where they stand on each programmatic component on a scale from 0 (non-functional) to 3 (highly functional or best practice). In many cases, this is the first time ideas are shared from so many different perspectives. This can lead to awareness and sometimes confrontation, but the process also creates understanding and builds team spirit and commitment to improve. The group builds an action plan for the changes needed based on the assessment. Sue England of World Vision Australia observed, “The tools make it clear to all participants that we are assuming a lot and that’s why many programs fail.”

The Human Experience of Supporting a Humphrey Fellow

Emily Lanford

USAID ASSIST Project/URC

Beginning on May 1, 2013, the health workforce development (HWD) unit at University Research Company (URC), LLC began its six week sponsorship of Madhavi Dwivedi, a Humphrey Fellow from India whose host was Emory University.  The objective of her work was to identify ways to strengthen the existing engagement tool that is being applied to URC’s Community Support activity in Uganda.   As a part of her work at URC, she conducted a literature review on engagement and influencing factors such as supervision and feedback.  Additionally, Madhvi identified existing M-health initiatives that are cu

Applying Quality Improvement Methods to HR Performance Management

Maina A. Boucar

Quality Improvement Advisor, USAID ASSIST Project/URC

This post originally appeared on the K4Health Blog.

Dr. Karimou Sani, former USAID-HCI Advisor Tahoua, Niger; Dr Ekoye Saidou, Director General MOH Niger; Mr. Sabou Djibrina, UASID – HCI Niger; and Lauren Crigler, USAID HCI Bethesda, USA contributed to this blog post.

Faced by a severe shortage of health care professionals throughout Niger, the country’s Ministry of Public Health requested assistance from USAID’s Health Care Improvement Project (HCI) in 2009 to implement a program to address the health workforce crisis within the country.  In response, my team and I recognized this has an exceptional opportunity to implement a program to improve the management of human resources in selected facilities and management offices within the Tahoua Region.

As a part of the collaborative approach we adopted, quality improvement (QI) teams tested and implemented changes within their own facilities, while simultaneously monitoring performance with QI advisors and coaches from both HCI and the Ministry of Public Health. 

Applying improvement methods to HR performance management

Applying quality improvement methods to HR performance management

As Quality Improvement Advisors, we recognized the importance of supporting the facility teams in strengthening their ability to recognize where they needed to improve their performance and helping them to have confidence in managing the quality of that service within their team. In order to address areas that were in need of improvement, we determined the variables that were adversely impacting health worker performance, engagement, and productivity.  The steps we undertook to address these areas are displayed in the diagram to the right. We began by aligning and clarifying tasks, and we measured progress in performance by tracking clinical indicators. 

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