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 Community Health Worker “logic model”: towards a theory of enhanced performance in low- and middle-income countries

This article published in Human Resources for Health (2014; 12:56 doi:10.1186/1478-4491-12-56) describes a generic logic model for community health worker (CHW) performance that posits that optimal CHW performance is a function of high...

Evaluation of Primary Health Care Supervision Services in Mpumalanga Province

In 2013, the Mpumalanga Department of Health proposed to evaluate the implementation of primary health care (PHC) supervision services in order to improve the quality of health care in Mpumalanga Province. In South Africa, PHC services are...

Third Global Symposium on Health Systems Research

Cape Town, South Africa

The theme of the symposium this year was the science and practice of people-centred health systems, chosen to enable participants to address current and critical concerns of relevance across countries in all parts of the world. Researchers, policy-makers, funders, implementers and other stakeholders, from all regions and all socio-economic levels, worked together on the challenge of how to make health systems more responsive to the needs of individuals, families and communities.

See below for the USAID ASSIST Staff involvement at the Symposium. Details and downloads of each presentation are provided below.

USAID ASSIST Project Experience Improving HIV Services

This technical report summarizes the experience of the United States Agency for International Development (USAID) Applying Science to Strengthen and Improve Systems (ASSIST) Project and its predecessor, the USAID Health Care Improvement...

IAMRA 2014: 11th International Conference on Medical Regulation

London, UK
The major international conference on medical regulation is coming to London in September 2014. Hosted by the International Association of Medical Regulatory Authorities (IAMRA), the 11th International Conference on Medical Regulation will bring together leaders in health professional regulation from around the world.  More than 300 participants from over 30 countries are expected to attend.

Why Universal Health Coverage Depends on Human Resources for Health

M. Rashad Massoud

Director, USAID ASSIST Project/URC

This coming September at the Third Global Symposium on Health Systems Research in Cape Town, Frances Day-Stirk, President of the International Confederation of Midwives, and I will be co-chairing a working group on the role of standards, quality improvement, and regulation for improving health worker productivity and performance in the context of universal health coverage (UHC).  We will be part of a satellite session on emerging findings and priorities for human resources for health (HRH) post 2015 and one of seven working groups contributing to this effort.  During the working group we will present a strategic paper and framework that we are developing together with global experts on this topic.  

Is health worker education and training setting health workers up to succeed? How do we build the competencies of health workers to improve care?

Tana Wuliji

Senior Improvement Advisor, USAID ASSIST Project/URC

It’s Friday afternoon, and I’ve just come out of session I was moderating with the fabulous Lesley Anne Smith of NHS Scotland. The session was packed full of folks from around the world who gave up the lures of Paris to discuss and share experiences on this very question: “How do we build the competencies of health workers to improve care in our health systems?”.  Let me tell you a little bit about where I am and how we came to this.  

Will health systems be ready to meet the post-MDG realities?

Ombretta Baggio, Senior Officer for Communications at the International Federation of Red Cross and Red Crescent Societies (IFRC), collaborated with Allison Annette Foster on this blog and is a co-author.

How often do seismic shifts happen under our very feet, and before we realize it we are toppled by a changed landscape that we have not prepared to maneuver? Countries are facing such seismic shifts as they ponder their post-2015 national health strategies. Beyond the drive to reach the Millennium Development Goals, how will we re-engineer our systems to achieve Universal Health Coverage and meet the growing needs of long-term care and chronic conditions care?

An interview with Dr. Ram Shrestha:Supporting Community Health Workers- Where do we stand?

Rhea Bright

Quality Improvement & Human Resources for Health Advisor, USAID Bureau for Global Health Office of Health Systems

In this post, Rhea Bright interviews Dr. Ram Shrestha.

As a health professional, whenever I visit a rural village in a low-or middle-income country, several thoughts come to mind. Knowing that the formal health system usually ends at a health center, dispensary, or health post in these rural communities, does everyone in this village have access to health services? How can we ensure that there are enough health workers in nearby facilities to provide needed services? Are there community health workers (CHWs) in this village, and are they well supported? I started thinking more and more about these questions as World Health Worker Week (April 7-11, 2014) approached…consequently even more questions came to mind.

Health workers not only count – they are the frontline of health systems improvement

M. Rashad Massoud

Director, USAID ASSIST Project/URC

Diana Frymus

Health Systems Strengthening Advisor, USAID

This week we appreciate and celebrate those at the frontline of our health systems.  With that, let us recognize that there are critical health workforce shortages (7.2 million) which are set to increase to an even higher level of 12.9 million in 20 years.  Although many countries have made progress in setting national policies and plans to strengthen the workforce, implementation has been weak and progress has not kept pace with expectations, manifesting in low health worker morale, absenteeism, and high turnover.