HRH

Human Resources for Health Inventory Tool to Assess Donor-Supported HIV Workers

WHAT WAS THE PROBLEM?

PEPFAR, The Global Fund, and other donors have invested millions of dollars to supplement the budgets of governments for human resources for health (HRH) and health worker staffing. Yet, there is a need for greater data to inform who the donor-supported workers are, where they are located, related costs, and status of alignment with existing host-country government structures and policies.  Donors and host governments need better tools to understand the scope and nature of staffing investments in order to optimize health worker utilization to advance epidemic control and to inform sustainability planning once epidemic control is achieved.

WHAT IS THE TOOL?

The HRH Inventory Tool provides countries with a wealth of information about donor investments in HRH, from the job titles of health workers supported to the names of facilities where health workers are based, and includes detailed information on health worker gender, experience, compensation, and professional development. By inventorying donor investments in HRH, development partners and host governments can more easily track and analyze investments in HRH staffing, down to the site level, which can be utilized for more robust sector-wide performance monitoring and program planning. It also can support a mapping of donor-supported workers to host government cadres and pay bands, where available, to inform stronger alignment of donor support. The HRH Tool does not require that users collect all of the elements within the tool, but rather should be customized to meet the needs of the country’s program based on subject matter expert and country Chair feedback.

The HRH Inventory Tool is available online for donors and host governments to download. An accompanying two-page overview and webinar recording are available to guide donors and host governments through the inventory process. Using the HRH inventory, donors and host governments can:

  • Customize the HRH Inventory Tool - Users can customize the tool with information specific to a country’s health sector, such as drop downs for localities, facilities, technical areas, and to reflect local context and programming needs;

  • Populate the HRH Inventory Tool – Users work with implementing partners and principal recipients who directly support health workers to populate, clean and validate the data entered into the tool capturing the current donor-supported workforce;

  • Map donor-supported staff to Government Equivalencies -  Users can map the donor-supported workforce to government cadre and pay scales, to determine if the investments are well-aligned with public service;

  • Analyze donor-supported investments – Users can analyze the HRH Inventory data, down to the site level, for sector-wide performance monitoring, program planning and MER reporting. Examples of possible analytic visualizations/dashboards are included below.

To date, the HRH inventory tool has been populated and those data have been analyzed in 5 countries. In Tanzania, the HRH Inventory is used to track and manage PEPFAR-supported investments in over 16,000 healthcare workers nationally. In Lesotho, the HRH Inventory revealed how donors collectively are amplifying government staffing, and highlighted the need to rationalize lay cadres to support governments’ HIV policies and task sharing models. In Eswatini, the HRH Inventory Tool is influencing government-led HRH transition analysis and plans, and raised the visibility of facility-based lay cadres. In Namibia, the HRH Inventory is supporting stakeholders’ consultations on sustaining gains in HIV epidemic control, even as donors withdraw. 

Some additional information can be found here!

HRH Inventory Tool (Excel)

Human Resources for Health Staffing Allocation Tool

WHAT IS THE PROBLEM?

To achieve the UNAIDS 95-95-95 targets, health facilities and community-based HIV service delivery points need to provide efficient, effective, and high-quality services to ensure that people living with HIV (PLHIV) know their status, receive antiretroviral therapy (ART), and achieve and main viral suppression. A key resource to achieve this goal, among other system factors, is the health workforce. Most low- and middle-income countries, though, experience many challenges when it comes to producing an adequate health workforce. These include, misallocation of new health workers, shortages of available health workers, and limited productivity and performance of the existing health workforce. Each of the 3 toolkits below address one of the above stated challenges, and can be used individually or in conjunction with one another.

What is the tool?

Tool 1: A Guide for Efficient and Equitable HRH Staffing Allocation

The Government of Tanzania committed to gradually increasing the number of health care workers hired annually; however, insufficient funding has been a fundamental constraint for meeting this commitment. This tool has helped Tanzania to strategically focus on improving the efficient allocation of health workers to increase service coverage and improve outcomes.

In Oct 2014, Tanzania mandated the use of the WHO Workload Indicators of Staffing Needs (WISN) to build data driven HR plans. The method determines how many health workers of a particular type are required to cope with the workload of a given health facility, and assesses the workload pressure of the health workers in that facility Concurrently, USG funded the development of a Priority Optimization and Allocation Tool (POA) that takes WISN results and prioritizes health worker allocation based on strategic priorities, budget, and supply constraints. After assisting with implementation in seven regions, USG and partners realized the approach was unsustainable and unrealistic; it required manual data collection at each facility because many of the indicators were not accessible through the Health Management Information System (HMIS).  

USG, through a PEPFAR supported private-public partnership, conducted a sensitivity analysis of WISN indicators and defined a subset that (1) comprised the majority of health worker time, and (2) could be found in the existing HMIS. The simplified WISN + POA methodology identifies the number of HRH needed at facilities based on their current performance, and prioritizes the highest burden facilities; thereby promoting equity of HRH allocation in a resource limited setting.

Tool 2: Estimating and Optimizing Human Resource Needs

Service providers have identified differentiated service delivery (DSD) models for clinically stable clients to provide HIV services through a client-centered approach that simplifies and adapts services across the HIV continuum of care. Differentiated care can reduce the burden on the health system and utilize available human resources more efficiently and effectively. This tool is a means to help plan for implementation of differenced care models based on HIV client caseload and the use of task sharing to increase efficiency among existing and proposed staff

The tool is intended for facility managers (site-level) and program planners (above-site, e.g., district, provincial, regional or national) to estimate and/or optimize human resource needs for different DSD scenarios, including:

  • Staffing needs for implementing one or a combination of HIV service delivery models.

  • Efficient ART task distribution among existing health workers to implement various DSD models.

  • Configuration of DSD and task-shifting/sharing (reassigning tasks from one health worker cadre/type to another) to reduce human resource imbalances (excesses or gaps).

  • Organization of site-level services to meet daily client needs: infrastructure, work hours and staffing.

Outputs from the tool enable users to make informed decisions for maximizing the use of the available workforce and to generate evidence for the need for additional human resources where appropriate.

Tool 3: Optimizing Health Worker Performance and Productivity

This toolkit focuses on workforce influences, as these are often the least understood and addressed. The toolkit provides a rapid, step-by-step process for addressing site-level, workforce-related barriers that contribute to HIV service delivery gaps. It also outlines additional tools that can be used to support further analysis and identify potential workforce interventions, many of which promote data use and quality improvement techniques.

The tools help:

  • Collect workforce-specific data and general data for analysis.

  • Analyze the underlying causes of the most common workforce problems observed in HIV service delivery programs, including health worker competency gaps, low staff engagement, poor allocation of tasks among staff, and inefficient workflow.

  • Identify interventions to address the causes of workforce problems.

  • Support intervention monitoring.

Case study examples highlight how the steps and tools can be applied throughout the toolkit.

The toolkit is accompanied by a slide deck and facilitator’s guide that can be customized and used by program leads to train colleagues and scale its use. 

additional resources

Tool 1

Standard Presentation on Simplified WISN Plus POA (ppt)

Tool 2

HOT4ART User Guide, English (pdf)

HOT4ART User Guide, French (pdf)

HRH Optimization Tool for ART Service Delivery (xls)

HRH Optimization Tool for ART Service Delivery, French (xls)

Tool 3

Optimizing Health Worker Performance and Productivity to Achieve the 95 -95 -95 Targets: A Toolkit (pdf)

Toolkit Slides (ppt)

Facilitator Guide (pdf)