Ensure that evidence generation informs and drives a country-owned mandate

National stakeholders should ensure that the data being generated for policy-making purposes are directly responsive to and aligned with expressed national or local needs. If capacity for generating such data does not already exist, then it should be built within national institutions and entities. Data should also respond to current priority HRH questions within the health sector, for both public and private entities (HWAI 2008; Maliselo and Magawa 2013). For example, strategic HRH planning in Namibia considered the important role of both private-not-for-profit and private-for-profit organizations in delivering key HIV/AIDS services (SHOPS 2013). This will help to ensure that the evidence follows a country-driven and country-owned mandate (United States Government 2012), while promoting autonomy to generate additional evidence in the future. Moreover, gathering evidence in a country-responsive manner will increase the evidence’s acceptability and garner subsequent support for using the evidence to take action (Health Policy Initiative 2010).


Uganda’s midterm review of its Health Sector Strategic Plan II (2005/06–2009/10) in 2008 revealed that high turnover, absenteeism, and low productivity resulted in poor health workforce performance, which was a “major constraint” (Ministry of Health [MOH] 2008, 4) to achieving the plan’s goals to reduce maternal and child mortality, fertility, malnutrition, the burden of HIV/AIDS, tuberculosis, and malaria as well as disparities in health outcomes. An MOH (2008) study that measured health worker satisfaction, motivation, and intent to stay in the health field to serve the country found that health workers considered both financial and nonfinancial incentives important. In response, the MOH developed a motivation and retention strategy for HRH to “strengthen the capacity of the health system to improve the attraction, retention, equitable distribution, and performance of the health workers” (MOH 2008, 12). To address high vacancy rates and low motivation, the MOH included improved recruitment and retention of health workers as an important part of the Health Sector Strategic Plan III (2010/11–2014/15) and its quality improvement framework (MOH 2010a; MOH 2010b).

Building on the evidence and in support of national goals, in 2010, CapacityPlus, in collaboration with the USAID Uganda Capacity Program, built the capacity of MOH staff to apply the Rapid Retention Survey Toolkit to conduct a discrete choice experiment among health professional students and currently practicing doctors, nurses, pharmacists, and laboratory technicians. The purpose was to determine their motivational preferences to increase the probability of health workers accepting and continuing in job posts in rural and remote areas (Rockers et al. 2012). The findings provided evidence regarding which combinations of incentives and interventions would be most effective in attracting and retaining health workers in the public sector. Concurrently, the MOH used data from its human resources information system on the actual staffing levels and compared them with the staffing standards for various health facility levels to identify the health workforce shortages in the country—notably the underrepresentation of doctors in health centers level IV and of midwives and nurses in health centers level III.

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