Beyond Vacancies: Improving Performance and Productivity to Strengthen Health Systems

Mesrak BelatchewTypically, a health workforce strengthening approach looks at the number of available health workers in comparison to the required number and then advises decision-makers on the need for health workforce development. Existing health workers are considered a given whereby adjustments are made in the form of additions to the system. This approach assumes that optimal health care delivery will be achieved when all the vacancies are filled.

However, these measures may not guarantee that staff turnover, performance, and/or productivity are adequately addressed.

Developing the current workforce
Efforts to attract, train, and retain health workers need to add the missing pieces to the puzzle—performance and productivity. Among health workers in developing countries, areas for improvement include:

  • Health workers’ full-time attendance on the job
  • Professional ethics and integrity
  • Accountability
  • Accomplishment of duties and responsibilities
  • Teamwork
  • Proper documentation and reporting
  • Referral and follow-up of patients.

Integrating goals for improvement
In the name of enhancing performance, countries have introduced measures such as increasing salaries as well as monetary and nonmonetary incentives for all health workers at a given time. However, when incentives are provided to all workers, regardless of good performance, these incentives may miss their objective.

I propose that we exert our efforts to link health workforce strengthening with the indicators for tracking achievement of the health-related Millennium Development Goals (MDGs) targeted for 2015. Approaches to consider include:

  • Integrating the health worker productivity and performance agenda into country-level health system strengthening efforts
  • Identifying, documenting, and disseminating promising practices on enhancing health worker performance and productivity to inform decision-makers
  • Supporting countries to identify cost-effective interventions to improve health worker performance and productivity in nutrition, maternal and child health, HIV, tuberculosis, and malaria prevention and control.

Friends Kaimosi HospitalCurrently, 57 countries, 36 of them in sub-Saharan Africa, face a health workforce crisis. While the MDGs clearly state the ends, those of us working on global health workforce issues try to see the means.

CapacityPlus provides technical assistance to develop and strengthen the health workforce. As we focus on testing and implementing new approaches, these dimensions will remain critical for the achievement of the MDGs.

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Photo 1 by Crystal Ng. Photo 2 by Trevor Snapp (Friends Kaimosi Hospital, Kenya)