Notable achievements have been made in strengthening and integrating the HRH expertise of FBOs. These include improved HRH leadership of ACHAP itself; knowledge advancement through an eLearning course; effective HR management policies and practices within the CHAs of Kenya and Malawi; strengthened HR management within the Christian Health Association of Ghana; targeted retention mechanisms within the Churches Health Association of Zambia; and strengthened institutional capacity of the Christian Health Association of Liberia and the ACHAP secretariat. These achievements are further described below.

Africa Christian Health Associations Platform

Human resources for health technical working group: The group has held regular meetings and workshops that have built members’ capacity in key thematic areas such as retention of health workers, HR policy implementation, HR information systems, HRH advocacy, and managing HRH in changing contexts, among others. The group has been institutionalized into ACHAP’s constitution, with its membership reviewed every two years to encourage participation from additional countries.

During meetings of the group, the Christian Health Association of Ghana learned about experiences with HR information systems from CHAs in Kenya, Tanzania, and Uganda, and is now implementing a system to manage 13,000 health workers at its health facilities, which constitute 35% of Ghana’s national health services. Data from the new system are being used by health facilities for HR planning and management and are informing staff postings to facilities. This has resulted in better placement and distribution of staff, while creating awareness and providing facility-level evidence on the type and number of cadres needed. More broadly, the HR information system is making health workforce statistics more visible across different levels of the Christian Health Association of Ghana.

Human resources for health leadership: Through support of HRH activities and HR management workshops at the past four ACHAP biennial conferences, the number and scope of HR positions has increased. Eight CHAs now have full-time senior positions at the secretariat level to support HRH initiatives and provide technical assistance to HR managers and leaders at the facility level.

Human resources management policies and practices in faith-based health facilities

Kenya: The Christian Health Association of Kenya and the Kenya Conference of Catholic Bishops provide an estimated 30% of health care in the country through their more than 800 affiliated facilities. Assessments carried out in 2008 found that these entities suffered from a lack of effective HR management policies and guidelines, and that this had resulted in ad hoc, informal, or even inappropriate HR practices, often leading to lack of motivation, attrition, and litigation. With assistance from the Capacity Project and subsequently from CapacityPlus, the Christian Health Association of Kenya released a comprehensive HR management generic policy document in 2008. The document outlined organizational HR policies, procedures, and guidelines with the aim of strengthening HR management at affiliated facilities.

A study later assessed the effect of this HR management policy and practice intervention on managers, the health workforce, and—to the extent possible—service provision at Christian Health Association of Kenya facilities. Interviews were conducted between December 2013 and February 2014 with leaders, managers, and health workers. The study also included observations and data extraction in health facilities as well as client exit interviews. The HR management policy and practice intervention proved successful among managers and health workers, who indicated that the new policies had fundamentally changed the way they managed HRH. Table 1 highlights some of the key findings from the interviews and review of client records.

Table 1: Selected Results from Study of Human Resources Management Policy and Practice Intervention at Christian Health Association of Kenya Facilities

Data sources Key findings (percentages or 1-10 ordinal scales)
Interviews: managers Substantially increased knowledge, skills, authority, and effectiveness, as evidenced by:
  • Promotions and new positions
  • More staff assigned (from an average of 1.5 to 3.7)
  • Improved HR management offices (3.3 to 7.1) and computers (3.2 to 6.3)
  • Improved recruitment, contracting (5.3 to 9.4), compensation (5.1 to 8.8), and HR support practices (e.g., performance-based promotions) (4.5 to 7.3)
  • Study and travel abroad (approximately two-thirds)
  •  Interviews: health workers
Interviews: health workers Significant improvements in HR practices, including:
  • HR manual available in workplace (from 33% to 73%)
  • Safety regulations (from 28% to 67%)
  • Incentives received (from 27% in the two years preintervention to 64% in the two intervention years preceding the interviews)
  • Increased fairness in hiring, promotion, and firing (scale from 5.4 to 6.8)
Exit interviews: clients Areas of improvement:
  • Perceived increase in courtesy
  • Health workers “seem to know what they are doing and consulting” (from 50% to 83%)
Client records (2009–2012)*
  • Steady and high levels of antenatal care visits
  • Slight increase in use of labor and delivery services

Source: Mbindyo et al.
*Statistics were compiled from facilities participating in the intervention in an ecological way only (i.e., not specifically tied to the intervention). Thus, we cannot directly attribute any service delivery changes to the intervention.

The study also identified areas that need more attention. For example, although more health workers reported having received training on sexual harassment, the overall proportion was still low (24%, up from 6%), and there was no improvement in perceptions of gender discrimination in the workplace. All in all, however, the study demonstrated a significant change in the HR management practices of the Christian Health Association of Kenya and its facility managers, with large and statistically significant increases in managers’ reported capacity and satisfaction (see Figure 3) and corresponding positive changes in the workplace environment and its organization.

Figure 3: Managers’ Reported Confidence and Occupational Pride Before and After Human Resources Management Policy and Practice Intervention, Christian Health Association of Kenya (N=17-21 Facility Managers)

Figure 3
Source: Mbindyo et al.

Through ACHAP, other CHAs have sought to adapt the generic HR management policy approach used in Kenya for their own constituencies. To date, the approach has been replicated by CHAs in Ghana, Malawi, and Lesotho.

Malawi: An exchange visit between the CHAs of Malawi and Kenya was supported in 2010, which, coupled with technical assistance, allowed the Christian Health Association of Malawi to adapt the HR management generic policy document for use at its secretariat as well as its approximately 170 member health facilities. It continues to work with its facilities to customize these policies to meet different contextual needs and existing national health sector guidelines and labor laws.

Ghana: In 2012, the Christian Health Association of Ghana piloted an HR management scorecard adapted from CapacityPlus’s Human Resources Management Assessment Approach (Marsden, Caffrey, and McCaffrey 2013). Following dissemination of the scorecard to national coordinators, it was incorporated into a wider health systems assessment mechanism called the Organizational Performance Assessment Tool. The Christian Health Association of Ghana institutionalized the new tool in 2013 and plans to apply it across all 184 member health facilities through a pilot and phased approach. The pilot began in September 2013 with 14 facilities and ends in November 2014 with 30 facilities. Thereafter, the Christian Health Association of Ghana plans to review the findings and identify areas for HR management strengthening. It also plans to scale up the application of the tool across all its member facilities and adopt it as a framework for monitoring and evaluating its members.

Rural retention in faith-based health facilities

Zambia: In 2010, Churches Health Association of Zambia developed strategies to address retention of health workers in rural facilities, particularly those trained in the association’s training institutions. The strategies included strengthening partnership mechanisms with the Ministry of Health to support retention of students trained in the association’s institutions; strengthening HRH workforce development systems; targeting Churches Health Association of Zambia health facilities in implementation of country-level retention strategies; and strengthening integration of the association’s HR management systems into the wider health sector and ministry HRH systems.

The ministry and Churches Health Association of Zambia developed a retention package known as the Health Worker Retention Scheme, which they rolled out to specified districts in hard-to-reach locations. The package consisted of a rural hardship allowance to top up health worker salaries as an incentive to work in rural locations. As additional incentives, the association provided decent and affordable accommodations for health workers and modernized the health facilities. The scheme has had a positive impact on retention, increasing health workers’ motivation to stay in the rural locations and continue to offer quality health services.

Institutional capacity-building

Kenya-Africa Christian Health Associations Platform secretariat: Key outcomes of the secondment of an HR technical advisor to the ACHAP secretariat include the development of the ACHAP constitution in 2011 and ACHAP’s legal registration in 2012 as an international nongovernmental organization in Kenya. ACHAP’s membership almost doubled over the period 2009–2014, growing from 18 to 34 CHAs. In addition to the HRH technical working group, ACHAP supports additional working groups that address other advocacy issues affecting the FBO sector in Africa, including family planning, HIV/AIDS, and the increasing burden of noncommunicable diseases. Plans are in place to transition the HR technical advisor role into ACHAP’s existing structure.

Liberia: With technical assistance, the Christian Health Association of Liberia achieved its priority objectives of selecting a new board chair and full-time executive director. These crucial leadership changes brought increased dedication among staff. In addition, the association developed a plan that defines key elements and actions for sustainability and improved its visibility and external communications through the development of a website ( CapacityPlus’s support has helped renew the association’s energy to reclaim its key pre-civil war role in health service delivery as an effective implementer of health programs and the coordinating agency of its 43 member institutions in 12 of 15 counties.

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