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


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...

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...

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: Training...

Health Worker Engagement Assessment Tool

With PEPFAR support, the USAID Health Care Improvement Project tested several instruments to measure health worker engagement in order to relate changes in engagement to other measures of performance and job retention. Initially,...

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 (...

Strengthening health professions regulation in Cambodia: a rapid assessment

This article, published in Human Resources for Health, describes the findings of a rapid assessment of Cambodia’s current system for regulating its health professions. The assessment, carried out in 2014, led to a consultative planning...

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.

USAID ASSIST Project Annual Performance Monitoring Report FY15

This annual report for the USAID ASSIST Project summarizes the project's accomplishments and results in FY15 supporting the application of modern improvement methods by host country providers and managers in USAID-assisted countries...

Strengthening Infection Prevention and Control in Swaziland

The global HIV and TB epidemics have placed enormous burdens upon already overstretched health care workers (HCWs) and poorly resourced health care facilities in sub-Saharan Africa. The rapid emergence of multi-drug resistant TB (MDR-TB)...

International Council of Nurses Conference, Seoul, South Korea

Dr. Massoud at the International Council of Nurses conference in Seoul
USAID ASSIST Director Dr. M. Rashad Massoud addressed the International Council of Nurses (ICN) conference in Seoul, South Korea, June 19-23, 2015, describing applications of the chronic care model and the effect of improvement on nursing productivity and engagement.  He also led a Satellite Symposium on improving health care in low and middle-income countries.  Under the theme of Global Citizen, Global Nursing, the conference brought together thousands of nurses from countries across the world to explore the importance of cross-cultural understanding and global cooperation in nursing.