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Alfredo Fort, Rachel Deussom, Randi Burlew, and Kate Gilroy, Capacity Plus /IntraHealth International Global Health Mini-University | March 2, 2015 | 11:00–12:00.

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Presentation on theme: "Alfredo Fort, Rachel Deussom, Randi Burlew, and Kate Gilroy, Capacity Plus /IntraHealth International Global Health Mini-University | March 2, 2015 | 11:00–12:00."— Presentation transcript:

1 Alfredo Fort, Rachel Deussom, Randi Burlew, and Kate Gilroy, Capacity Plus /IntraHealth International Global Health Mini-University | March 2, 2015 | 11:00–12:00 pm The views expressed in this presentation do not necessarily reflect the views of the United States Agency for International Development or the United States Government. The HRH Effort Index New Indicators to Help Systems Strengthening

2 What is the HRH Effort Index? 2 Modeled after successful indices Will alleviate scarcity of HRH indicators Standard, easy to measure “efforts” Routine applications, comparisons over time (in-across countries) Could be related to outcomes (e.g., service coverage) The Human Resources for Health (HRH) Effort Index is a new tool to obtain HRH indicators contributing to health systems strengthening.

3 Dearth of HRH indicators Most promising HRH indicator: Density of health professionals per 10,000 population 1 However, suffers from problems…availability/quality of data, and restrictive definition. 1 WHO 2006 and 2013

4 Example of Family Planning Effort Index From 1972, 81 countries (93% of developing world) 31 indicators in 4 dimensions: Policies Services Evaluation (M&E) Access to cc methods

5 Example of Family Planning Effort Index From 1972, 81 countries (93% of developing world) 31 indicators in 4 dimensions: Policies Services Evaluation (M&E) Access to cc methods

6 How is the index implemented? 6 1 Key informants identified (“experts”) Government, NGOs, FBOs, professionals, academics, public/private 2 Survey tool provided (self- administered) Each item scored 1-10 (1=weak; 10=strong) 50-item form encompassing 7 dimensions 3 Dimensions: Leadership and Advocacy Policy and Governance Finance Education and Training Recruitment, Distribution and Retention Human Resources Management Monitoring, Evaluation and Information Systems

7 Example of tool structure 7 #DIMENSION AND ITEM CIRCLE YOUR RATING : 1 =Extremely weak/ No national effort 10 = Extremely strong/High-level national effort/ Optimal I Don’t Know I.LEADERSHIP and ADVOCACY (5 items) 1. Human Resources for Health (HRH) prominence within the Ministry of Health Extent to which there is a permanent HRH office or post within the Ministry of Health (MOH) that develops and monitors HRH policies and strategies, that is well-placed within the government, and staffed by adequately skilled personnel  1. Political support for HRH Extent to which elected officials in the country prioritize meeting HRH needs to strengthen the workforce by passing laws and regulations and sponsor actions and policies aimed at improving the health workforce  1. Influence of HRH Leaders or Champions Extent to which the country has one or more clear influential leaders or champions who successfully advocate for HRH needs (e.g., increasing funding for HRH) at high levels, promote HRH in the country by making positive public statements about HRH and/or support actions and policies aimed at improving the health workforce 

8 Pilot testing of tool (2014) 8 Consultants: contacted key informants Handed them paper-based tool Returned in-person to collect tool once complete Compilation: Survey tools checked, compiled and data entered into SPSS database

9 Results: Respondents 9 Nigeria n=27 Kenya n= 22 Male: 68% Female: 32% Male: 74% Female: 26% Place of employment and position of respondents in Kenya and Nigeria (n=49)

10 Results: Respondents by dimension* 10 KenyaNigeria TOTAL2227 Dimension I. Leadership and Advocacy 1016 II. Policy and Governance 1215 III. Finance 1215 IV. Education and Training 1317 V. Distribution, Deployment, Recruitment, and Retention 1319 VI. Human Resources Management 1217 VII. Monitoring, Evaluation, and Information Systems 1416 * Respondents only answered dimensions of their expertise (Average non-response across all dimensions: 43%)

11 Overall * * Statistically significant

12 Analyses and feedback led to revision of tool DIMENSION ITEMS BEFORE ITEMS NOW I – LEADERSHIP AND ADVOCACY 65 II – POLICY AND GOVERNANCE 166 III – FINANCE 87 IV – EDUCATION AND TRAINING 1510 V – RECRUITMENT / DISTRIBUTION / RETENTION 75 VI – HUMAN RESOURCES MANAGEMENT 149 VII - MONITORING, EVALUATION AND INFORMATION SYSTEMS 138 TOTAL 7950 Simpler Good representation of items and dimensions Avoids repetition

13 I. Leadership/Advocacy (5) 13 Q#Leadership and Advocacy 1. Human resources for health (HRH) prominence within the Ministry of Health 2. Political support for HRH 3. Influence of HRH leaders or champions 4. Strength of an HRH stakeholder leadership group 6. Media coverage for HRH

14 II. Policy/Governance (6) 14 Q # Policy and Governance 6. National HRH plan 7. Evidence-based national HRH strategies 8. Recognized and defined health worker cadres and scopes of practice 9. Inclusion of nongovernmental actors in the national HRH plan 10.Health worker remuneration 11.Gender and diversity inclusion in the national HRH plan

15 III. Finance (7) 15 Q #Finance 12.Costed national HRH plan 13. Domestic funding of the national HRH plan 14. Funding for producing adequate numbers of qualified health workers 15. Access to and availability of funding for tuition for preservice education 16. Funding for in-service training and continuing professional development 17. Government payroll system 18. Funding for human resources information systems (HRIS)

16 IV. Education/Training (10) Q #Education and Training 19. Health workforce education strategy 20. Gender in preservice education (PSE) policy 21.Quality preservice health institutions and education 22. Adequate faculty for PSE institutions 23. Diverse recruitment of students 24. Preservice education student tracking 25. High health worker graduation and certification rates (low dropout rates) 26. Provision of career support to PSE graduates 27. Provision of relevant in-service training to health workers 28. Links between in-service training and certification/ relicensure 16

17 V. Recruitment, Distribution, Retention (5) 17 Q #Recruitment, Distribution, and Retention 29. Health workforce analysis of shortages and labor market dynamics 30. Absorption of preservice education graduates 31. Effectiveness of health workforce recruitment strategy 32. Health worker deployment and distribution strategy 33. Effectiveness of health worker retention strategy

18 VI. Human Resources Management (9) 18 Q#Human Resources Management 34. HR management leadership capacity and availability 35. Strength of professional associations and councils and their licensing and certification 36. Existence and availability of HR manuals/guidelines 37. Performance support strategies 38. Performance evaluation and rewards 39. Career development 40. Health workforce occupational safety and health (OSH) strategy 41. Nondiscrimination, equal opportunity, and gender equality in the workplace 42. Assessment of health workforce productivity and quality

19 VII. M&E/Information Systems (8) 19 Q#Monitoring, Evaluation, and Information Systems 43. Monitoring and evaluation (M&E) of national HRH plan 44. M&E implementation capacity 45. Use of data in HRH planning 46.Staffing and employment information system 47.Interoperability 48. National health workforce registry 49. Health worker licensure and registration system 50.ICT infrastructure and capacity

20 Future applications Should increase sample size to fully validate index (items, components and scores) Should allow for further analyses (e.g., correlations with outputs/outcomes such as other indices, workforce density, coverage, quality of care) Example of analyses with the FP Effort Index

21 Correlations of FP Effort Index and Total Fertility Rate FPEI TFR FP Effort Index: Though low overall correlation (variation and outliers), multiple regression keeps independent influence of scores (plus IMR, female education, socioeconomic factors) on total fertility rate From: Jain, AK, Ross, J, Fertility Differences Among Developing Countries: Are they still related to Family Planning Program Efforts and Social Settings?, Int Fam Plann Perspectives on Sex & Rep Hlth, 2012, 38(1): 15-22

22 Practice 1.Divide audience in two (countries) 2.Pretend you are the HRH experts (a stakeholders group) and you are asked to complete the tool 3.Use the example survey (it’s an extract of items from the real survey) to add your ratings to each of the items 4.Arrive at consensus and score all 20 items. You have 10 minutes to complete the exercise and return to the plenary 5.You will see the results of your ratings in the total scoring and the graph (Excel sheet) 6.Compare scores and discuss Good luck!

23 On behalf of the millions of health workers around the world… Thank you!

24 CapacityPlus USAID Bureau-wide global project dedicated to human resources for health (HRH) Launched Oct. 2009, closing Sept


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