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


Improving Health Worker Performance

USAID ASSIST explores the role of the health workforce in improving quality of care: How can countries engage their human resources to ensure that every patient gets the right care at the right time, every time? What systems changes can be...

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?

A Global Improvement Framework for Health Worker In-Service Training: Guidance for Improved Effectiveness, Efficiency and Sustainability

Building on HCI’s previous assessments of in-service training (IST) effectiveness and in continuing to take a learning for improvement approach, HCI collaborated with development partners, Ministries of Health, professional associations...

A Global Improvement Framework for Health Worker In-service Training: Guidance for Improved Effectiveness, Efficiency and Sustainability

This short report describes the improvement framework for in-service training programs that was developed by the USAID Health Care Improvement Project in collaboration with key stakeholders. In-service training (IST) represents a...

MaNHEP Coaching Materials

This document is a compilation of coaching materials developed for the Maternal and Newborn Health in Ethiopia Partnership (MaNHEP) to provide training and tools for coaches as they supported community-level teams. The materials include...

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.”

Tanzania District Health Management Activity: Quality Improvement as a Management Practice in the Lindi Region

With marked improvements in care that QI efforts have achieved in Tanzania and other countries, the leadership of the Lindi Region hoped to build Quality Improvement capacities in their district management teams with support from the...

Improving quality of HIV services and health worker performance in Tandahimba District, Tanzania: An evaluation

The USAID Health Care Improvement Project (HCI) and Tanzania’s Ministry of Health and Social Welfare (MOHSW) implemented an improvement collaborative aimed at improving the quality of HIV services and health worker performance in 12 health...