Strengthening Health Workforce Data for Improved Health Service Delivery

To improve health services, Uganda is focusing on the people that provide quality care. In our new video, Ugandan health workers, managers, and leaders show how the country’s efforts are paying off—and how service delivery has improved. The following story highlights one aspect of this work.

“My office is like a web. All information about human resources is needed in my office,” explains Ojulun Joreme. He’s the principal personnel officer for Dokolo District in Uganda. “Left and right I have to keep giving out information about each individual.”

Ojulun is in charge of supplying human resources information to district leaders so they can make decisions about the health workforce. But it hasn’t been easy.

“It was very difficult for me”

Uganda’s health woOjulun Jeromerkforce managers previously relied on a paper filing system that made it almost impossible to compile and analyze health workforce information. “It was very difficult for me,” admits Ojulun. “My biggest challenge was how to memorize who has gone to school, who is on interdiction, which employee is continuously absent, and which employee is to retire.”

To improve health workforce management, Uganda implemented the electronic Human Resources for Health Information System (HRHIS), built on the open source iHRIS software for tracking, managing, and planning the health workforce. The Uganda Capacity Program tailored the iHRIS software to meet the country’s needs and provides technical assistance for rolling it out. CapacityPlus develops the core iHRIS software and releases updates. The two USAID projects work together to build stakeholder leadership and country ownership, improve data quality, and increase the use of data for decision-making.

Now, Uganda’s four health professional councils use the HRHIS to maintain records on the country’s 56,383 qualified health workers. They use it to track the number of health workers by cadre, verify licenses and practice requirements, and provide information to ensure new hires are properly qualified.

“Service improves when people are informed”
Dr. Katumba SsentongoDr. Katumba Ssentongo, registrar of the Uganda Medical and Dental Practitioners Council, says the system is helping in several ways. “We can know who has paid [for] the license and who has not paid,” he notes. And the council made its data available to the public via a website and mobile directory, so anyone can check if a health provider or clinic is properly qualified. “Service improves when people are informed where the registered clinics are, and where they should not go,” says Dr. Katumba. The system is also saving council staff and health workers’ time because they can quickly process paperwork and create certificates: “Somebody comes and they can go away within five minutes, but it used to be six months.”

Health workforce managers like Ojulun use the system to manage employed health workers. They produce reports such as staff lists that are compared with approved staffing norms to identify vacancies or overstaffing, and with payroll systems to recognize and eliminate “ghost workers”—those who remain on the payroll but are not actually working. Managers can also generate detailed profiles of an individual health worker’s employment history and run reports to project staff losses due to retirement.

All this information is shared with the Ministry of Health, which uses it to produce annual health workforce reports, inform the country’s health workforce strategic plan, influence funding for preservice education, and advocate for the recruitment of more health workers.

“A click of a button”

And the HRHIS makes Ojulun’s work easier. “A click of a button, I am able to see all about one employee and make a decision,” he exclaims. He’s now able to supply information to district health leaders so they can make better decisions, like how to plan for the health workers that will soon retire. He’s able to process their retirement packages so they get their benefits on time. He’s also able to ensure health workers are properly qualified, because he can compare their photographs and information to what’s been entered by health professional councils. Ojulun is even able to track and follow up on any disciplinary issues, something that was previously a liability for the district: “Many cases of disciplinary nature which we made after some period of time, the staff would go to court and win cases and this would mean huge costs for the district. But now with this intervention we are able to make decisions very fast and timely, within the time of the law.”

Dr. Samuel Ojok, district health officer for Dokolo, also uses the HRHIS. “By a click you can know that this health center has this many nurses, this one has this number, and you can compare the services within them and do a redistribution according to the workload they have. So this has made work pressures for our staff reduced—the work pressure that could make staff run away.”

Patients at Dokolo Health Center IVThe HRHIS is helping Dokolo District to improve service delivery, says Dr. Ojok. “Our staffing position was very low—it was around 49%.” The Uganda Capacity Program helped the Ministry of Health advocate for additional resources to recruit over 7,000 new health workers across the country. Dokolo District benefited by getting new health workers and raising its staffing level to 84%. The district even rose in the national rankings for health service delivery, from 57 to 11 in the country. 

The system also helps improve health workers’ job satisfaction, according to Ojulun. “They feel loved, they feel cared for, because like the new staff there, we are giving them their appointments. After six months you are confirmed in appointment, after two weeks or one month you are getting your salary.”

The Uganda Capacity Program is funded by USAID and led by IntraHealth International. IntraHealth is the lead partner in the CapacityPlus global project, also funded by USAID.

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Photos by Carol Bales (Ojulun Joreme, Dr. Katumba Ssentongo, and patients at Dokolo Health Center IV)