Uganda Stakeholders Plan a Way Forward to Expand and Sustain Health Workforce Information System

Uganda's Human Resources for Health Information System (HRHIS) started in 2006, as the registration and licensure registry in the Uganda Nursing and Midwifery Council. The council entered its historical data to track health worker licensure and registration information. Since then, the system has expanded to support the management of employed health workers and is now being used in the remaining three professional councils, the Ministry of Health, all four national health institutions, all 13 regional referral hospitals, and 74 out of the 112 districts—impressive progress in a highly decentralized health system.

The software the system is built on, iHRIS Qualify and iHRIS Manage, was developed and refined based on experiences and needs in Uganda. Seven years later, the iHRIS software is now used by 15 countries to support over half a million health worker records. Users of the system experience its benefits such as faster and easier access to vital information for more informed decision-making, and continue to envision ways to increase its functionality and improve its ease of use. As with any evolving technology, Uganda’s HRHIS challenges (e.g., connectivity in more remote sites, interoperability of various Ministry of Health and other government information systems, availability of sufficient dedicated human and financial resources, and resistance to change by users of the system) remain to be addressed. 

In February 2013, 25 representatives of the Ministry of Health, Ministry of Education, university and training programs, professional councils, and implementing partners participated in a three-day HRHIS planning workshop, which was facilitated by the Uganda Capacity Program (UCP) and CapacityPlus. UCP and CapacityPlus have been assisting the Ministry of Health and other stakeholders to install, customize, and roll out the HRHIS throughout the country.   

My role in this activity was to develodata entrant at the Ministry of Healthp the workshop design and facilitate the planning process. To foster stakeholder leadership and country ownership of the process and resulting plans, I applied many of the principles and processes presented in CapacityPlus’s stakeholder leadership guidelines. For example, to prepare for the workshop, I interviewed key stakeholders who identified other key stakeholders to include in the planning process. As a result, although some key leaders were not able to participate due to other work obligations, we had a very diverse group involved in lively discussion and debate that contributed to more insightful planning. Interviewees also highlighted priorities for HRHIS development including: strengthening political will to provide resources to develop and sustain the system; improving connectivity, expanding the system to remaining districts in the country; developing the capacity of people who collect, enter, manage, and use the data; and creating a stable team of IT support with expertise to further develop and expand HRHIS functions and reporting options. 

The workshop participants developed a vision for HRHIS in 2016, a three-year strategic plan, a 100 Days Action Plan, and steps for establishing an HRHIS subcommittee that would report to the Ministry of Health’s eHealth Committee. The plans present strategies and activities designed to achieve three major strategic objectives: 1) to have a state-of–the-art HRHIS in place by 2016 that addresses issues of connectivity, interoperability, and user-friendliness; 2) commitment by government and all other stakeholders to using the HRHIS; and, ultimately, 3) improved health service delivery through improved human resources management and development as a result of the improved HRHIS.

Stakeholders appreciated the opportunity to engage in this highly participatory planning process. In fact, one participant commented that this was the first out of many planning workshops that he had attended where he felt as though the resulting plans were truly the group’s plans. He explained that in other planning workshops the participants were there to approve a plan that had already been written.

Although some leaders were not present in the workshop, subsequent meetings among workshop participants and these other players have been moving the process forward. The group’s eventual structural “home” has been identified as residing under the eHealth committee and stakeholders are taking steps to implement the plans. It will be important for the group to regularly monitor its progress and “re-plan” when necessary to accomplish its strategic objectives.          

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Photo 1 courtesy of Lisa Howard-Grabman. Photo 2 by Lisa Howard-Grabman (data entrant at the Ministry of Health)