Regional and Country-Level Work

Regional and Country-Level Work

Africa Bureau
CapacityPlus, in collaboration with the International Finance Corporation (IFC), is participating in an assessment documenting the private sector’s role in increasing the number and capacity of health workers in sub-Saharan Africa. Once completed, the case studies will be highlighted in a health workforce labor market toolkit book, which will be jointly written, edited, and published by the World Bank, the African Development Bank, and CapacityPlus. The book will highlight the private sector’s potential to contribute to the development of the health workforce and highlight the obstacles and success factors to private sector investment in this area.

In some African countries private sector health care providers account for approximately 50% of all formal health care delivered. The private sector also plays an important role in health worker training, but how significant this contribution is and how to encourage greater participation has not been adequately addressed. CapacityPlus and the IFC jointly conducted the first private sector case study in Kenya. CapacityPlus will conduct subsequent case studies at two private health professional schools in Ethiopia.

Angola
In Angola, CapacityPlus will collaborate with the recently awarded Strengthening Angolan Systems for Health project to strengthen health workforce information needed for planning and managing health workers. CapacityPlus will support the implementation of a national routine human resources information system at the Ministry of Health and provincial health offices.

Botswana
CapacityPlus is assisting Botswana’s Ministry of Health to better manage its health workforce by using the project’s open source iHRIS Manage software to improve the tracking of health worker trainings, strengthen data quality, and support the annual budgeting process. Going forward, CapacityPlus will focus on building local capacity to maintain and customize the system, while increasing local buy-in to foster use of data for decision-making. CapacityPlus will also work with Botswana’s professional health councils to strengthen information systems that track health worker qualifications. In an effort to further improve data quality and use, project staff will ensure the Ministry’s iHRIS Manage system routinely shares data with the councils’ information systems as well as the human resources database maintained by the Department of Public Sector Management.

Dominican Republic
Over the last several years a number of studies have described the Dominican Republic’s health workforce challenges. After reviewing the findings and recommendations, CapacityPlus found that all of the studies identified weak human resources management (HRM) systems as a major problem affecting the health workforce. HRM focuses on people—how they fit within a health system; how they are hired, trained, paid, and supported; and how they can be most productive. CapacityPlus is currently helping the Dominican Republic Ministry of Health refine the HRM systems needed to create an enabling environment for the health workforce to perform effectively. The World Bank, USAID, and the Pan American Health Organization (PAHO) are collaborating to support this effort. Activities include carrying out training and coaching for new HRM specialists; serving on a work group to reform the career path for health professions; leading work groups to define performance criteria for hospitals and for three cadres of providers; and developing a performance management system for hospitals.

Ethiopia
CapacityPlus successfully piloted the SpacedEd platform, a learning methodology developed at Harvard Medical School that has been shown in peer-reviewed trials in the developed world to improve learning and change clinician behavior using a scalable model, in Ethiopia. The pilot course taught participants the practices surrounding feeding of infants and young children born to HIV-positive mothers. The pilot revealed a great degree of acceptability of the SpacedEd platform in Ethiopia (97% of participants indicated interest in further courses and 84% indicated a preference for SpacedEd over classroom lectures for refresher material), and also enabled the refinement of the platform to the developing country context. Of 44 participants, 37 completed the course. Over 90% of participants answered the post-course questions accurately; in some instances, this represented a doubling in the number of participants who answered correctly as compared to before the course. Results from the pilot test are being disseminated to inform and encourage additional applications of the SpacedEd methodology in developing countries, including CapacityPlus’s support to a course for a local nurse/midwife training institution in Uganda.

Ghana
CapacityPlus is supporting Ghana’s efforts to strengthen its health workforce. The project’s assistance began with an assessment in October 2010 to explore gaps in health workforce skills development. Using the project’s Human Resources Management Rapid Assessment Tool, the study identified priority interventions to address challenges related to the planning, coordination, resourcing, and implementation of preservice education, as well as for the health workforce more broadly. Emerging from the assessment, CapacityPlus is assisting the Ghana Ministry of Health, Ghana Health Service, and other partners in several key areas:

  • Collaborating on the development and drafting of Ghana’s new five-year Human Resource Policy and Strategy for the health sector, including plans for scaling-up preservice education
  • Developing the systems and capacity to measure and track national health worker production targets and the supply pipeline
  • Strengthening the use and application of health workforce data for evidence-based planning and decision-making, including rolling out a national human resources information system (HRIS)
  • Applying assessment protocols to guide school investment plans for preservice education scale-up, and reforming the management of health professional schools through organizational development approaches and management analysis tools

Lao People’s Democratic Republic
In Lao People’s Democratic Republic (PDR), health workers are concentrated in cities while more than 80 percent of the population lives in rural areas. As in many countries, attracting health workers to rural posts—and retaining them—is a challenge. To determine which incentives would motivate health workers to serve and stay in rural areas, the Lao PDR Ministry of Health, in partnership with CapacityPlus and the World Health Organization (WHO), conducted a retention survey in May 2011 using CapacityPlus’s Rapid Discrete Choice Experiment (DCE) Tool.

The Ministry of Health used the DCE to survey 970 health professional students and 483 health workers practicing in rural provinces to investigate their preferences for potential packages of incentives to increase recruitment and retention in the country’s rural and remote settings. The Ministry is gauging the financial feasibility of the preferred incentive packages using iHRIS Retain, the retention intervention costing tool developed by CapacityPlus in collaboration with the WHO. Together, the survey results and costing data will constitute key inputs to the policy-making process toward developing a national strategy to increase health worker attraction and retention.

Latin American and Caribbean Region (LAC) Bureau
With funding from USAID’s LAC Bureau, CapacityPlus will provide technical assistance to strengthen the health workforce in countries in the region, beginning with the Dominican Republic. In collaboration with technical staff from the Ministry of Health, CapacityPlus will help create a human resources management strategic plan for the Dominican Republic. The project will also help create an implementation plan that focuses on priority needs and contains feasible, affordable actions.

Malawi
CapacityPlus is helping the Christian Health Association of Malawi (CHAM) strengthen human resources management (HRM) in affiliated health facilities, starting with the creation of HRM policy guidelines. CapacityPlus provided technical support for a week-long consultation with the Christian Health Association of Kenya on the development of its HRM policy document, discussions with CHAM facility managers to understand HRM needs at the facility level, and a framework for developing the guidelines. The guidelines will help ensure quality service delivery by defining the responsibilities and obligations of employees, and clarifying personnel policies and procedures for senior management staff.

Mali
CapacityPlus is working with the Ministry of Health, local training institutions, and other partners to address Mali’s shortage and unequal distribution of qualified health workers, especially in the country’s rural northern regions. The project’s comprehensive program of assistance aligns with the Government of Mali’s human resources for health policy and operational plan and incorporates principles and strategies from the US Government’s Global Health Initiative. Specific activities include implementing the project’s open source iHRIS Manage software to provide health leaders with reliable health workforce data for making policy and management decisions; establishing a Mali Health Workforce Observatory to bring key stakeholders together to address health workforce challenges; improving health worker training and retention; piloting innovative education methods; empowering health workers with essential skills; and monitoring results. As many of these activities focus on family planning/reproductive health, CapacityPlus is also proposing strategies for integrating gender equality approaches into health workforce activities. Read the country brief in English or French.

Mozambique
In response to the Mozambique Ministry of Health’s request, CapacityPlus provides technical and financial support for a national community health worker program. At the core of this program, the Ministry is revitalizing a community health worker cadre, called agentes polivalentes elementares (APEs), to deliver basic health services to the most remote and marginalized communities. To guide the work, the Ministry established an APE Coordination Unit. CapacityPlus is helping the APE Coordination Unit roll the program out to the country’s districts by supporting the hiring of key staff, providing office space and equipment, and establishing operational procedures and policies. CapacityPlus is also coordinating working groups for developing training materials; a monitoring system to track key indicators; tools for supervision, including easy-to-use supervisor checklists; norms and systems for monetary APE subsidies; and standardized Work Kits (including bicycles) and Medicine Kits. The first group of APEs received a four-month training in 2010 in eight initial districts. CapacityPlus is working with USAID’s Health Systems 20/20 project to design a performance-based incentives plan for program coordinators who are working hard to expand the APE Program. In addition, CapacityPlus is working with the Ministry’s National Institute of Health to design a baseline survey to measure program impact.

Nigeria
CapacityPlus is collaborating with the Nigeria Federal Ministry of Women Affairs and Social Development, government agencies, UNICEF, and implementing partners on approaches to strengthen the social welfare workforce needed for the care of orphans and vulnerable children (OVC). With an estimated 17.5 million OVC in Nigeria, the national response requires a skilled workforce targeting children who are affected by HIV/AIDS, chronic illness, and disability; in need of alternative family care, legal protection, and shelter; and/or in need of protection from abuse, neglect, and conflict. The existing OVC workforce is spread across a wide range of areas and sectors—embracing education, health, nutrition, psychosocial support, economic assistance, shelter, and protection services—through a mix of formal and voluntary service networks, providers, and community-based organizations. However, the current National Plan of Action for OVC does not include a workforce strategy to plan, coordinate, and implement these combined efforts. CapacityPlus is currently supporting a Technical Task Team to lead the OVC workforce strengthening activities under the guidance of the National OVC Technical Coordination Group. CapacityPlus is also working with the West African Health Organization to support the Nursing and Midwifery Council of Nigeria to use the project’s open source iHRIS Qualify software to archive and maintain its registry of nurses and midwives.

Tanzania
CapacityPlus collaborates with the Tanzania Human Resource Capacity Project to strengthen the understanding and use of the country’s Tanzania Human Resources Information System (THRIS) through human resources management training of health facility leaders and other stakeholders. THRIS is a customized version of iHRIS Manage, CapacityPlus’s human resources management software. The training focuses on how data from THRIS can be used to strengthen personnel management, respond to budget allocation requests, and inform appropriate human resources decisions.

Uganda
CapacityPlus works closely with the Uganda Capacity Program and key country-level stakeholders to implement carefully selected strategies to strengthen the health workforce. In Uganda, the quantity and skill mix of health workers must be improved to effectively respond to growing health needs. For nurses alone, only half of approved public-sector positions are filled. The Uganda Capacity Program is addressing this, along with other challenges like low retention and motivation, poor performance, and high rates of absenteeism. CapacityPlus builds on this work and focuses on strengthening health workforce management and systems by improving the quality and use of health workforce data, enhancing the ability of nursing and midwifery schools to identify barriers to increasing health worker production, and providing evidence for policy-makers to use as they make health workforce compensation policies for health worker retention. Specific activities include conducting a health worker compensation study; strengthening the quality of data in Uganda’s iHRIS Manage and iHRIS Qualify software to build confidence in using the data for decision-making; undertaking a situational analysis to determine who is using iHRIS data and what for; collaborating with a local nurse/midwife training institution to plan and develop a spaced education course; and scaling-up nursing and midwifery education and training by guiding school investments. Activities will be implemented in a way that they can be adapted and replicated in other countries.