Professionalizing Under-Recognized Cadres:
Results and Success Stories

  Results and Success Stories

Approaches and Results
Applying its human resources for health (HRH) expertise, CapacityPlus developed a framework for the professionalization of under-recognized cadres and drew upon it to establish a strong foundation for advocacy and action to support the development of the social service and supply chain workforces. Activities focused on three primary areas: 1) global coordination and advocacy for professionalizing these cadres; 2) generation and use of HRH strategies, approaches, and evidence to improve planning for and managing these workforces at the country level; and 3) supporting national-level efforts to strengthen institutions and build capacity for social work and supply chain management.
Global Coordination and Advocacy
CapacityPlus supported the launch and growth of global coalitions working on behalf of social service and supply chain workers. Established with funding from USAID and PEPFAR, the Global Social Service Workforce Alliance promotes the knowledge and evidence, resources and tools, and political will and action needed to address key social service workforce challenges, especially in low- and middle-income countries. Through the Alliance, CapacityPlus introduced the first-ever multicountry knowledge-sharing platform on social service workforce strengthening, hosting 19 webinars that engaged speakers from 20 countries and 3,000 participants from 45 countries. The project also helped to refine a framework for planning, developing, and supporting this workforce, now being used by global and national partners. From the launch of the Alliance in June 2013 through June 2015, 510 members joined from 63 countries, representing a diverse membership of nongovernmental organization staff, donors, government ministry staff, professional association leaders, and academics. The Alliance website acts as a hub for information exchange and access to resources, with visitors from 180 countries. In 2015, support for and hosting of the Alliance transitioned from CapacityPlus to the new USAID 4Children Project.
In 2011, CapacityPlus contributed to the launch of People that Deliver, a broad coalition of more than 80 organizations from around the world that strives to build global and national capacity to implement evidence-based approaches to plan, finance, develop, support, and retain the national workforces needed for the effective, efficient, and sustainable management of health supply chains. People that Deliver is also supporting seven focus countries to address supply chain workforce challenges. CapacityPlus provided technical assistance in two of these countries—the Dominican Republic and Namibia. The project also played a leadership role in developing the initiative’s five-year strategic plan, the implementation of which is resulting in  increased attention to supply chain workers in other global and national efforts (e.g., the 2016–2020 Gavi strategy to immunize an additional 300 million children) and testing of HRH approaches and tools in focus countries. CapacityPlus contributed to key technical and advocacy tools, including a technical brief on applying the HRH action framework to the supply chain management workforce, a tool for assessing human resources capacity in supply chain management, and a system-wide competency compendium for supply chain management functions and tasks.

Generation and Use of Evidence at the Country Level
Recognizing the importance of data and evidence to enable national leaders and practitioners to make informed policy and programming decisions related to the social service and supply chain workforces, CapacityPlus supported a number of activities to provide national stakeholders with relevant and timely information. These resulted in reports that consolidate information about the social service workforce in HIV/AIDS-affected contexts in sub-Saharan Africa, and document promising practices from Ethiopia, Nigeria, and Tanzania in supporting parasocial workers that can be used to guide program scale-up and adaptation in other countries. In Kenya, the Ministry of Gender, Children & Social Development commissioned the project to conduct an assessment that provides an overview of the status of government-level workers, identifies gaps, and makes recommendations on workforce strengthening. In Nigeria, CapacityPlus worked with USAID/Nigeria, Maestral International, and UNICEF to carry out a mapping and assessment of the child protection systems in six states. State ministries of women’s affairs and social development and other key constituencies are using the findings to identify, prioritize, and cost gaps in state child protection systems and present feasible strategies and activities to remedy the gaps.

To promote the regular collection and use of workforce data to facilitate appropriate deployment of social workers, Malawi and Tanzania established human resources information systems (HRIS) specific to the social service workforce with support from CapacityPlus. In Namibia, the project assisted the Ministry of Health and Social Services to apply the World Health Organization (WHO)’s Workload Indicators of Staffing Need (WISN) method to calculate the required number of pharmacists, pharmacist assistants, and administrative officers based on estimated workload needs in the central medical stores and two regional medical depots. The method generated evidence confirming severe shortages of all three supply chain cadres at the central level, as well as poor distribution and mix of cadres at the regional level. Activity standards for pharmacists and pharmacist assistants have since been adjusted to better inform staffing needs to ensure antiretroviral (ARV) provision. The project also supported Namibian stakeholders in completing an incentive and retention study of pharmacists and pharmacist assistants using the CapacityPlus Rapid Retention Survey Toolkit to inform strategies to improve attraction and retention in hard-to-reach areas.

National Workforce Strengthening Efforts
Malawi: CapacityPlus collaborated with the Ministry of Gender, Children, Disability and Social Welfare, UNICEF, and USAID/Malawi to support Magomero College to establish the country’s first degree program that will produce qualified social service workers to fill identified gaps in service delivery. The first class of 39 students enrolled in April 2014. These students will soon be on the front lines of Malawi’s effort to reach the one in six children vulnerable to violence, abuse, exploitation, and neglect, and at risk from HIV/AIDS, including 476,000 children orphaned from AIDS-related causes (UNICEF 2012).

Democratic Republic of the Congo: A 2009 assessment estimated that the country had 8.2 million orphans and vulnerable children (OVC), representing one in four children (USAID/Democratic Republic of the Congo 2010). Compounding the crisis, a World Bank assessment in 2013 revealed serious weaknesses in the day-to-day functioning of the national division of child protection (DISPE) at the Ministry of Social Affairs, Humanitarian Action, and National Solidarity. To begin to reinvigorate DISPE, CapacityPlus supported institutional strengthening, including training and mentoring DISPE leadership and staff and provincial child protection staff in leadership, supervision, program planning, and monitoring skills. As a result, with support from CapacityPlus, DISPE led the development of the first-ever annual operational plan for the national OVC strategy, trained stakeholders (in collaboration with the World Bank) on national norms and standards for the care of vulnerable children, and established a DISPE monitoring and evaluation team that is monitoring progress in achieving results specified in the national operational plan. With DISPE now actively taking responsibility for its role as coordinator of the social service sector, development partners who previously worked in a parallel fashion to DISPE are now engaging with and supporting DISPE.

“What has changed the most at the DISPE is the working environment, the tools to do our job, and the strengthening of staff capacity.”—Pierrot Mabiala, Chef du Bureau Secretariat de Direction, DISPE

Latin America and the Caribbean: CapacityPlus supported a regional collaboration to build the capacity of national health supply chains to ensure reliable and sustainable access to HIV/AIDS commodities (with a spillover effect on all commodities since supply chain workers handle these across the wide range of primary health care services, including family planning). The initiative launched at a strategic and action planning workshop held in Guatemala in 2013. During the workshop, country teams from the Dominican Republic, El Salvador, Guatemala, Honduras, and Panama identified challenges, shared possible solutions, and developed short-term supply chain actions and longer-term strategies for each country.

Following the workshop, the team from the Dominican Republic began implementing its strategic plan with support from CapacityPlus. Achievements have included revising the organizational structure of the Ministry of Health unit responsible for managing medicines and supplies, creating standard job descriptions for supply chain workers, launching a new supervision process, and developing and institutionalizing a diploma course for supply chain workers. The Ministry of Health, National Institute for Public Administration, CapacityPlus, and the USAID Systems for Improved Access to Pharmaceutical Services (SIAPS) Program collaborated to train 3,500 health workers in the new operational procedures of the integrated commodities program, and 96 supply chain managers completed the diploma course during 2013 and 2014. As a result, hospitals are using a more systematic approach to procurement and distribution, integrated across health programs.

One of the key challenges identified by the ministries of health in the Dominican Republic and El Salvador was low motivation of staff with supply chain management duties, in part due to perceived lack of support and disregard from others in the health system. CapacityPlus assisted in developing and delivering three-day workshops for 79 supply chain workers in the Dominican Republic in which participants produced advocacy plans to support their efforts to address gaps in supply chain management. In El Salvador, the project facilitated a similar workshop for 37 participants. Follow-up interviews revealed that many participants had taken steps to implement their advocacy plans and were beginning to see results. For example, one participant from the central warehouse reported that he advocated successfully for the purchase of two refrigerator trucks to transport medicines to health facilities while maintaining the cold chain.