Involve relevant stakeholders, including technical experts and those with decision-making authority, in evidence dissemination and review

During evidence dissemination and review, it is important to consider the diverse stakeholders who need to be involved in decision-making, and tailor communications to these decision-makers accordingly. The key stakeholders critical to policy changes often have differing perspectives and mandates, meaning that data review and related advocacy messages must be appropriate for each context.

MOH officials may have specific priorities, technical knowledge, and spheres of influence within the health sector. Members of a parliamentary body, on the other hand, must consider issues across all sectors, may not have a specific technical background, and likely face different political pressures. In addition, many policy changes related to HRH systems affect multiple sectors and stakeholders. Consequently, it is vital to consider how the roles, responsibilities, and management structures of the political landscape influence the policy environment and decision-making process (Zulu et al. 2013).

Based on the specific HRH issues under consideration, the key stakeholders should include a mix of representatives from the central and local government (ministries of health, education, finance, planning and economic development, and public administration); training institutions, health professional associations, councils, and unions; donors and other partners; and civil society. For example, in 2005, Kenya’s MOH effectively assessed key stakeholders and involved them in a policy review on human resources guidelines resulting in the expansion of voluntary HIV counseling and testing services to include all health cadres (Taegtmeyer et al. 2011).

A technical working group (TWG) or other stakeholder leadership group composed of technical experts and individuals knowledgeable about HRH systems and management structures can be an effective coordinating and review board for proposed HRH decisions. Stakeholders with high-level decision-making authority—in particular, individuals who make funding decisions or have access to those who do—should either be part of the group or have the evidence review and policy recommendations directly communicated to them to promote informed HRH policy decisions. A helpful approach is first to present results from health workforce studies to an HRH TWG, so that members can review the data and recommendations and propose a way forward to engage higher-level policy-makers. In addition, evidence dissemination may offer a chance to identify champions who are compelled by the evidence to advocate for HRH policy change. For example, an advocacy campaign in Tanzania—where hiring freezes had prevented a majority of graduates from health training institutes from practicing in the public sector—used relevant locally collected data on staffing disparities and their detrimental effect on safe motherhood efforts, resulting in the president’s office issuing a letter permitting all graduates from health training institutions to be hired into the public sector (Ministry of Health and Social Welfare 2008; Songstad et al. 2012; Health Policy Initiative 2010). The letter subsequently encouraged the deployment of almost 4,000 new health workers to address critical HRH shortages and improve maternal health, resulting in a 33% increase in staffing levels (Health Policy Initiative 2010).


Established in 2001, Uganda’s HRH TWG is composed of diverse stakeholders from the health, finance, gender, and public service sectors, as well as representation from civil society, training institutions, the private sector, donors, and faith-based organizations (Howard-Grabman and Jaskiewicz 2013). While the Uganda HRH TWG illustrates that sustaining a group over such a long period of time through changes in leadership, membership, and political context is not easy, the group has been able to assist in achieving important policy changes. To overcome challenges, stakeholders have at times been able to work through a smaller group on behalf of the larger TWG. With technical assistance from the Uganda Capacity Program and using data generated with technical support from CapacityPlus, a subgroup of HRH TWG members reviewed human resources information system data showing health worker shortages by type and location and discrete choice experiment results to formulate retention strategy and policy recommendations. The group sent its recommendations to the MOH’s Senior Management Committee, which reviewed them and proposed policy options for consideration by the MOH Health Policy Advisory Committee and finally the Top Management Committee, led by the minister of health. The Top Management Committee then took these recommendations to advocate with the Ministry of Finance. As a result, an additional $20 million, or a 16% increase, was allocated for the health wage bill. This allowed the MOH to offer jobs to 8,353 new health workers in one fiscal year (2012–2013), of whom 7,211 were deployed to their posts by June 2013. MOH recruitment had previously averaged about 500 health workers annually. In addition, the health wage bill doubled the pay of medical doctors working at health centers IV to attract more doctors to work in these lower-level facilities located mostly in rural areas and increase access to family planning, HIV/AIDS, and other essential health services.

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