ICTworks

Amidst the COVID-19 pandemic and the WHO’s Year of the Health and Care Worker, the importance of the health workforce has never been more apparent. However, many country governments are unable to see the “big picture” of who plays a critical role in service delivery by region, cadre, and sector.

This reality hampers efforts to mobilize all available human resources – public, private, not-for-profit – efficiently for pandemic response and limits longer-term planning and management based on data. Human resource information systems (HRIS) are a key tool for collecting and analyzing such data, yet documentation is limited on the capabilities of existing systems globally.

The Bill and Melinda Gates Foundation engaged Vital Wave, IntraHealth International, and Cooper/Smith to identify key success factors and concrete opportunities for low- and middle-income countries (LMIC) to better design, plan, and manage their health workforce using HRIS.

The report, “Human Resources for Health: Workforce Analytics for Design and Planning” shares insights from a targeted scan of HRIS landscape in 20 countries and three deep-dive assessments in Burkina Faso, Mozambique, and Uganda.

Please RSVP Now to join Vital Wave, IntraHealth International, and Cooper / Smith on Wednesday, October 13 at 14:00 UTC for a webinar on this report with simultaneous interpretation of this webinar will be available in English, French, and Spanish.

7 Key Assessment Findings

1. Private sector and community health workers (CHW) data are frequently unavailable to governments, impeding decision making and planning.

Data on the CHWs and the private sector workforce are generally unavailable to governments. In both Mozambique and Burkina Faso, there are policies in place to allow for the Ministry of Health (MoH) to have oversight of the private sector, but they are not enacted at this time. In both countries, the private sector is nascent but growing.

The data that are available are from labor force and facility surveys, but they are not up to date. A lack of data about CHWs and the private sector workforce means that Ministry of Health deployment decisions do not take these health workers into account. This may lead to suboptimal use of limited resources and impede referral planning.

Professional councils should be a strong source for health workforce data, but they are often under-resourced and lack the authority or capacity to enforce regular licensure, thus hindering their utility.

2. HRH management requires high levels of actor coordination as data are found across multiple sources.

HRH data sources come from multiple programs, ministries, departments, and levels of the heath system. In Oman; Mozambique; and Andhra Pradesh, India (with its education management information system), efforts to convene all stakeholders in system design and development were extensive. A cross-sectoral HRH unit, observatory, or taskforce could also address this need and provide oversight over time.

In Burkina Faso, a new, dedicated functional committee oversees donor and partner inputs into HRH to veto projects and ensures alignment with Ministry’s goals (part of a broader network of oversight committees). There is a need to ensure that such oversight committees have membership with strong data and digital competencies, so they can oversee the HRIS ecosystem.

3. HRIS system design and implementation do not meet current user needs for routine HRH management.

There are several ways in which HRIS do not meet user needs. Systems are often not designed to meet the needs of subnational level actors, even though this is where many decisions are made and where problems can be identified and solved. This impacts system utility and engagement. Even at the national level, some users’ needs are not met.

In Mozambique, decision makers at the national level need reports about career progression (who is nearing retirement, who is due for pay increases), which are currently compiled manually. In Uganda and Burkina Faso, stakeholders report that they have a hard time accessing HRIS data, undermining system engagement and use.

4. A unique identifier (UID) is key to data quality and interoperability.

A UID is key to data quality and is a foundational element for interoperability. Mozambique has a routine biometric “proof- of-life” process to counter fraud, which is managed by the Ministry of Public Administration, involving an annual in-person visit during the birth month to confirm that the employee entry matches a real human. All three countries have unique IDs of some form in place, including employee ID, tax ID, national ID, or council registration.

5. Performance management has not been prioritized and is not aligned with health system goals and objectives.

Individual performance management systems are primarily paper based with no ties to performance outputs and service delivery data, making data difficult to review, use, and aggregate.

In all three countries, performance appraisals are primarily based on subjective opinions of the supervisor. This means that they are not useful sources of data, nor does the process incentivize good work. In all three countries, there are anticipated system developments in this area.

There is an opportunity to align performance management processes with larger health systems goals and objectives and broader planning processes. Uganda has made some progress toward this with the performance appraisal process, including a goal setting and planning process.

In many country contexts, individual performance processes may be occurring parallel to facility or team-based review approaches, which are more strategic in approach, presenting an opportunity for alignment.

6. Interoperability with payroll is a high-value goal but hard to achieve. Interoperability with other information systems is easier and provides efficiencies.

Multiple data systems and lack of interoperability result in systems fatigue by system users. To ensure data quality and integrity, interoperability between the health worker registry and payroll can have many data quality, cost saving, and efficiency benefits (e.g., eliminating ghost workers).

In Uganda, interoperability between payroll and the health worker registry has long been called for, but concerns about compromising data integrity of payroll have been a major barrier. A new human capital management system that will integrate these data sources, including performance data, is currently under development.

7. Across the public sector, health is perceived to be a leader in HRIS.

In Uganda, the education sector has replicated the HRIS success of the Ministry of Health by tracking attendance and digitizing workforce management systems. In Mozambique, the MoH provides a high level of leadership around HRIS system development.

Overall, there is a low level of awareness around the HRIS work of other sectors, including the private sector. However, there are lessons to be learned here.

An integrated EMIS in Andhra Pradesh, India has a number of features that are interesting for the health sector, including interoperability of nine different system components, mobile-based system access for teachers and headmasters for routine administrative tasks, success in attendance tracking, performance-based staff transfers, and generation of huge costs savings through identifying schools with low enrolments and merging them with other nearby schools.

This is a lightly edited synopsis of Human Resources for Health: Workforce Analytics for Design and Planning by Vital Wave, IntraHealth International, and Cooper / Smith.