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


Materiales para vigilancia neurodesarrollo infantes Nicaragua


El paquete pedagógico es una herramienta para el desarrollo de competencias en el personal de las instituciones prestadoras de servicios de salud y en los estudiantes de las que son formadoras de recursos humanos para el sector salud. Se diseñó con enfoque de mejoramiento continuo de la calidad y está integrada por diseños metodológicos y material didáctico, basado en las normas y protocolos del MINSA, para el estudio de temas priorizados sobre salud materna-infantil, planificación familiar, VIH/Sida y Zika, en las unidades de salud e instituciones formadoras de recursos del sector salud. Los objetivos del paquete pedagógico son:
1.    Contribuir con el desarrollo de competencias en el personal de las unidades de salud, para brindar una atención de calidad y con calidez a la población de Nicaragua, según las normas y protocolos del MINSA.
2.    Fortalecer la institucionalidad y sostenibilidad del mejoramiento continuo de la calidad en la atención en las unidades de salud.
3.    Promover cambios en la planificación docente en relación con las metodologías, a fin de alcanzar aprendizajes significativos para el desarrollo de competencias.
4.    Contribuir con el desarrollo de competencias durante la formación de los recursos del sector salud en las instituciones formadoras.

The pedagogical package is a tool for the developing competencies in health service providers and among medical and nursing students – future health practitioners. It was designed for the study of prioritized topics on maternal and child health, family planning, HIV/AIDS and Zika with a focus on continuous quality improvement. The instructional design and teaching methods and materials are based on standards and protocols of the Nicaraguan Ministry of Health (MINSA) and are intended for use in health facilities and institutions that train health care providers. The objectives of the pedagogical package are:
1.    Contribute to the development of key competencies in the personnel of health facilities to provide high-quality, people-centered care to the population of Nicaragua, per the norms and protocols of the Ministry of Health.
2.    Strengthen the institutionalization and sustainability of continuous quality improvement in health facilities.
3.    Promote changes in instructional design and methods, in order to achieve significant learning for the development of skills.
4.    Contribute to the development of competencies during the training of medical and nursing student during pre-service training.


Survive & Thrive Final Report

Demonstrated that training is not enough and that quality improvement approaches are essential to sustain quality care for mothers and newborns in low-resource settings, the Survive & Thrive Final Report highlights the efforts that partners shared through developing tools and resources.

A breakthrough contribution of the Global Development Alliances (GDA) was its development of a practical approach to engage frontline health workers in improving quality of maternal and newborn care.  The GDA’s Improving Care of Mothers and Babies guide, developed by the USAID ASSIST Project and the American Academy of Pediatrics, breaks down the process of improvement in clear steps that providers can follow to plan, test, implement, continuously assess, and sustain process changes to deliver care in the best way possible for the setting. The guide, which has been translated to French and Spanish, is a critical resource to ensure care is optimized once providers have been trained.   

An equally important component of the GDA was to ensure that quality improvement (QI) is part of the implementation and long-term sustainability of maternal and newborn care. The Improving Care of Mothers and Babies: A guide for improvement teams, includes information and tools to facilitate implementation of quality improvement activities at the facility level.  The Guide outlines the process of improvement step-by-step, helping providers plan, test, implement, continuously assess and sustain interventions that enable care to be delivered in the best way possible.  Improving Care of Mothers and Babies can guide those new to improvement methodologies, as well as provide further support to those who have experience implementing and managing improvement projects.  It can be used by a leader or facilitator to help others learn about improvement in both clinical and workshop settings and can also be used as a self-study manual by improvement teams and individuals.

Download Survive & Thrive Final Report

Responding to Gender Issues to Improve Outcomes in Zika-related Health Care

This document provides information on the issues surrounding gender with regards to Zika- related health care.

It highlights the main issues:

• Gender-related roles and values
• Limited access to and/or control over sexuality education, contraceptives, and other reproductive health services
• Women’s lack of power to negotiate contraceptive use (including condoms)
• Stigma leading to mother and child abandonment

English Version


Privacy, a companion of choice and swift referrals; the key to improve mothers' experience of care

Since March 2017, the Ministry of Health in Uganda, in collaboration with USAID ASSIST Project has been working to improve the experience of care for mothers delivering their babies in health facilities. The focus was on 15 health facilities in the two districts of Gulu and Nwoya in Northern Uganda. Through exit-interviews with mothers who had delivered both in the hospital and at home, health facilities were able to identify areas to specifially improve the experience of care.

Mary Atim Ladwong, a midwife in Anaka hospital, and Lilly Grace Ayamo, a clinical officer in Koch Goma Health Centre IV, share what steps they took to improve experience of care, and how it affected their work.

Listen here

Improving postpartum care in a large hospital in New Delhi, India

Despite recent progress, the maternal mortality ratio (MMR) in India remains high at 174 per 100 000 live births. Bhagwan Mahavir Hospital (BMH) is a secondary level hospital in New Delhi. In 2013, five women died in BMH’s postpartum ward. In January 2014, a United States Agency for International Development-funded team met with BMH staff to help improve their system for providing postpartum care to prevent maternal deaths. The hospital staff formed a quality improvement (QI) team and, between January and December 2014, collected data, conducted root cause analyses to understand why postpartum women were dying and tested and adapted small-scale changes using plan-do-study-act cycles to delivery safer postpartum care. Changes included reorganising the ward to reduce the time it took nurses to assess women and educating women and their relatives about common danger signs. The changes led to an increase in the number of women who were identified with complications from two out of 1667 deliveries (0.12%) between January and May 2014 to 74 out of 3336 deliveries (2.2%) between July and December 2014. There were no deaths on the postpartum ward in 2014 compared with five deaths in 2013 but the reduction was not sustained after the hospital started accepting sick patients from other hospitals in 2015. QI approaches can improve the efficiency of care and contribute to improved outcomes. Additional strategies are required to sustain improvements.

Improving postpartum care in a large hospital in New Delhi, India

USAID ASSIST Project Semi-Annual Performance Monitoring Report FY18

University Research Co., LLC (URC) and its partners have completed 5.5 years of implementation of the USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project. This report is the eleventh Semi-Annual Performance Monitoring Report for ASSIST, summarizing the project’s accomplishments and results during the first two quarters (Q1-2) of Fiscal Year 2018 (FY18).  In late September 2017, the project was awarded a two-year costed extension with additional funding for Zika-related activities.  No further funding was provided for non-Zika work.  The project’s FY18 work plan thus focuses mainly on Zika-related support in eight countries and completion of previously funded work in other countries.

Overall goals
The USAID ASSIST Project fosters improvements in a range of health care processes through the application of modern improvement methods by host country providers and managers in USAID-assisted countries. The project’s central purpose is to build the capacity of host country health and social service systems to improve the effectiveness, efficiency, client-centeredness, safety, accessibility, and equity of the services they provide. In addition to supporting the implementation of improvement strategies, the project seeks to generate new knowledge to increase the effectiveness and efficiency of applying improvement methods in low- and middle-income countries.
USAID ASSIST country programs align with the goals of United States Government’s global initiatives and policies, including preventing child and maternal deaths, achieving HIV epidemic control, combating other public health threats, protecting life, and addressing gender inequalities.

Where we work
During the first half of FY18, USAID ASSIST provided technical support in 23 countries through field and core funding. USAID Mission funds supported work in nine countries: Cambodia, Côte d’Ivoire, India, Indonesia, Lesotho, Mali, Swaziland, Tanzania, and Uganda. USAID core funds from the Office of HIV/AIDS supported activities in seven countries: Kenya, Lesotho, Malawi, Mozambique, Namibia, Tanzania, and Zimbabwe.  Funds for Neglected Tropical Diseases supported improvement work to combat the Zika virus in the Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Jamaica, Nicaragua, Paraguay, and Peru.  USAID cross-bureau-funded activities, through the Office of Health Systems, supported malaria prevention activities in Malawi and global and regional initiatives that contribute to local and global learning in improvement.

FY18 Q1-2 accomplishments and results:

  • Improvement in key indicators: As discussed in this report, ASSIST-supported programs demonstrated improved care and outcomes for a range of services, including antenatal and postnatal care, essential obstetric and newborn care, screening of pregnant women and newborns for Zika-related signs and symptoms, Zika care and support, PMTCT, and HIV prevention.
  • Research and evaluation studies: At of the end of the reporting period, the project had 29 research studies in planning, underway or completed in 14 countries. Three are multi-country studies.
  • Promoting the use of improvement methods: During the reporting period, project staff published nine peer-reviewed articles; seven case studies; four technical and research reports; and 10 guides, tools, and job aids. ASSIST staff led six sessions and made eight oral presentations at six regional and international conferences. ASSIST’s work continued to be promoted through the project’s website and social media engagement, with some 27,867 visitors viewing 61,572 pages within the ASSIST Knowledge Portal during the past two quarters.