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 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...

HWD Frequently Asked Questions, Activity Descriptions, and Common Definitions

For more information about the work of URC's health workforce development unit at URC, please reference the resource entitled "Frequently Asked Questions, Activity Descriptions, and Common Definitions".

The Human Experience of Supporting a Humphrey Fellow

Emily Lanford


Beginning on May 1, 2013, the health workforce development (HWD) unit at University Research Company (URC), LLC began its six week sponsorship of Madhavi Dwivedi, a Humphrey Fellow from India whose host was Emory University.  The objective of her work was to identify ways to strengthen the existing engagement tool that is being applied to URC’s Community Support activity in Uganda.   As a part of her work at URC, she conducted a literature review on engagement and influencing factors such as supervision and feedback.  Additionally, Madhvi identified existing M-health initiatives that are cu

Applying Quality Improvement Methods to HR Performance Management

Maina A. Boucar

Quality Improvement Advisor, USAID ASSIST Project/URC

This post originally appeared on the K4Health Blog.

Dr. Karimou Sani, former USAID-HCI Advisor Tahoua, Niger; Dr Ekoye Saidou, Director General MOH Niger; Mr. Sabou Djibrina, UASID – HCI Niger; and Lauren Crigler, USAID HCI Bethesda, USA contributed to this blog post.

Faced by a severe shortage of health care professionals throughout Niger, the country’s Ministry of Public Health requested assistance from USAID’s Health Care Improvement Project (HCI) in 2009 to implement a program to address the health workforce crisis within the country.  In response, my team and I recognized this has an exceptional opportunity to implement a program to improve the management of human resources in selected facilities and management offices within the Tahoua Region.

As a part of the collaborative approach we adopted, quality improvement (QI) teams tested and implemented changes within their own facilities, while simultaneously monitoring performance with QI advisors and coaches from both HCI and the Ministry of Public Health. 

Applying improvement methods to HR performance management

Applying quality improvement methods to HR performance management

As Quality Improvement Advisors, we recognized the importance of supporting the facility teams in strengthening their ability to recognize where they needed to improve their performance and helping them to have confidence in managing the quality of that service within their team. In order to address areas that were in need of improvement, we determined the variables that were adversely impacting health worker performance, engagement, and productivity.  The steps we undertook to address these areas are displayed in the diagram to the right. We began by aligning and clarifying tasks, and we measured progress in performance by tracking clinical indicators. 

CHW Regional Meeting | Addis Ababa, Ethiopia, June 19-21, 2012

The USAID-sponsored Community Health Worker (CHW) Regional Meeting held in Addis Ababa, Ethiopia from June 19 to 21, 2012, was attended by over 60 government and nongovernmental (NGO) representatives from six African countries (Ethiopia,...

Innovating for Impact: HCI approaches that strengthen human resources for health

Health worker gaps have been demonstrated by the USAID Health Care Improvement Project (HCI) to be effectively addressed through the combined application of human performance technology and quality improvement (QI) methods. Through this...

Exploring the relationship between engagement, performance, and retention of health workers delivering HIV/AIDS services in Tanzania

This study seeks to develop a validated tool to measure health workers’ engagement with their work, and to examine the relationships between health worker engagement, performance, and retention. It builds on the Health Care Improvement (...

Strengthening the Health Workforce in Tanzania

Since 2008, the USAID Health Care Improvement Project (HCI) has supported the Ministry of Health and Social Welfare (MOHSW) and implementing partners in Tanzania to apply modern quality improvement (QI) methods to build the capacity of...

Improving CHW Program Functionality, Performance, and Engagement: Operations Research Results from Zambia

The United Nations Millennium Project identified the large-scale training and deployment of community health workers (CHWs) as an important strategy to fill the human resources gap and achieve the Millennium Development Goals (MDGs)...

Tanzania Human Resources for Health Collaborative

Date improvement activities began: October, 2010 Aims/objectives: This work builds in the HCI-supported Human Resources Collaborative in Niger and utilizes a modified change package from that project. The specific objectives were: -To...