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

 

A clear guide to improving care of mothers and babies in low-resource settings

By: Tamar Chitashvili, Silvia Holschneider, Jorge Hermida, and Nigel Livesley 

There is growing recognition that clinical training and health infrastructure — while essential—are insufficient for improving and sustaining life-saving maternal and newborn health care services in low-resource settings. Instead, broader systems strengthening and continuous quality improvement efforts at the service delivery level are needed to continuously assess gaps in processes and content of care and to plan, test, implement, regularly monitor, refine and institute changes to deliver services correctly and consistently. To respond to this need and help frontline care providers in their continuous quality improvement journey, “Improving Care for Mothers and Babies: A Guide for Improvement Teams” was recently developed through collaborative efforts of the Survive & Thrive Global Development Alliance (S&T GDA).

Listening to the voices of community health workers

Donna Bjerregaard

Senior Technical Advisor, Initiatives Inc.

In 1505, the Polish Parliament stated, "Nothing new without the common consent." Today we understand that ‘nothing about us without us’ is the rallying cry for inclusion and change.    

Lessons Learned from Applying Collaborative Improvement Methodologies to Strengthen the Performance and Productivity of HIV Human Resources

Since 2009, the USAID Office of HIV/AIDS has actively supported the application of collaborative improvement methodologies to improve the performance and productivity of HIV service providers, including at the community level. Collaborative improvement engages a large number of teams in applying process improvement to achieve a common objective, using common indicators, and actively fostering sharing of learning and successful practices across all teams to favor large-scale improvement.

Integrating Gender and Gender-based Violence in Medical and Nursing Curricula in Nicaraguan Universities

In Nicaragua, the USAID ASSIST Project supports the application of continuous quality improvement to integrate HIV prevention and treatment topics in the medical and nursing training programs in nine universities. Baseline data clearly revealed strong sentiments of discrimination and stigma towards people living with HIV (PLHIV) and sexual diversity among both students and faculty.

Improving the performance of district management teams in the Lindi Region of Tanzania

In 2012-2013, with funding support from PEPFAR, ASSIST supported a district health management performance improvement intervention in the Lindi Region of Tanzania that aimed to build the capacity of the region’s six Council Health Management Teams (CHMTs) to more effectively manage and support health care quality improvement (QI) in the 207 health facilities they supervised across their catchment areas.

Ministry of Health In-Service Training Guidelines

The Ministry of Health of Swaziland developed these guidelines to inform the planning, designing, delivery, evaluation, and follow-up of all health care worker in-service training in the country.  The guidelines cover seven areas:

The Mixed Nature of Incentives of Community Health Workers: Lessons from a Qualitative Study in Two Districts in India

This article, published in Frontiers in Public Health, examines the role that incentives play in motivating community health workers (CHWs) and in family dynamics that affect CHW performance. In India, accredited social health activists (ASHAs) are female CHWs who provide a range of services. This study interviewed 49 ASHAs in two districts in India and at least one family member (a husband, mother-in-law, sister-in-law, or son) to explore the role of family, community, and health system in supporting ASHAs in their work.

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