Strengthening human resources for health through information,coordination and accountability mechanisms: the case of the Sudan

Problem

Human resources for health (HRH) in the Sudan were limited by shortages and the maldistribution of health workers, poor management, service fragmentation, poor retention of health workers in rural areas, and a weak health information system.

Approach

A “country coordination and facilitation” process was implemented to strengthen the national HRH observatory, provide a coordination platform for key stakeholders, catalyse policy support and HRH planning, harmonize the mobilization of resources, strengthen HRH managerial structures, establish new training institutions and scale up the training of community health workers.

Local setting

The national government of the Sudan sanctioned state-level governance of the health system but many states lacked coherent HRH plans and policies. A paucity of training institutions constrained HRH production and the adequate and equitable deployment of health workers in rural areas.

Relevant changes

The country coordination and facilitation process prompted the establishment of a robust HRH information system and the development of the technical capacities and tools necessary for data analysis and evidence-based participatory decision-making and action.

Lessons learnt

The success of the country coordination and facilitation process was substantiated by the stakeholders’ coordinated support, which was built on solid evidence of the challenges in HRH and shared accountability in the planning and implementation of responses to those challenges. The support led to political commitment and the mobilization of resources for HRH. The leadership that was promoted and the educational institutions that were opened should facilitate the training, deployment and retention of the health workers needed to achieve universal health coverage.     

Strengthening human resources for health systems resilience to care for mothers and children

Community-based strategies that foster frequent contact between caregivers of children under five and provide credible sources of health information are essential to improve child survival. Care Groups are a community-based implementation strategy for the delivery of social and behavior change interventions. This study assessed if supervision of Care Group activities by Ministry of Health (MOH) personnel could achieve the same child health outcomes as supervision provided by specialized non-governmental organization (NGO) staff. The study was a pretest-posttest quasi-experimental design implemented in Burundi. A total of 45 MOH-led Care Groups with 478 Care Group Volunteers (CGVs) were established in the intervention area; and 50 NGO-led Care Groups with 509 CGVs were formed in the comparison area. Data were collected from 593 and 700 mothers of children 0-23 months at baseline and endline, respectively. Pearson’s chi-squared test and difference-in-difference analysis assessed changes in 40 child health and nutrition outcomes. A qualitative process evaluation was also conducted midway through the study. The MOH-led Care Group model performed at least as well as the NGO-led model in achieving specific child health and nutrition outcomes. Mothers of children 0-23 months in the intervention and comparison sites reported similar levels of knowledge and practices for 38 of 40 dependent variables measured in the study, and these results remained unchanged after accounting for differences in the indicator values at baseline. Process monitoring data confirmed that the MOH-led Care Group model and the NGO-led Care Group model were implemented with similar intervention strength. The study demonstrated that behavior change interventions traditionally led by NGOs can be implemented through the existing MOH systems and achieve similar results, thereby increasing the potential for sustainable child health outcomes. Future research on the MOH-led Care Group model is required to systematically document all inputs and monetary costs borne by the MOH to implement the model.     

Building multisectoral partnerships for population health and health equity

Poor performance in achieving population health goals is well-noted - approximately 10% of public health measures tracked are met. Less well-understood is how to create conditions that produce these goals. This article examines some of the factors that contribute to this poor performance, such as lack of shared responsibility for outcomes, lack of cooperation and collaboration, and limited understanding of what works. It also considers challenges to engaging stakeholders at multiple ecologic levels in building collaborative partnerships for population health. Grounded in the Institute of Medicine framework for collaborative public health action, it outlines 12 key processes for effecting change and improvement, such as analyzing information, establishing a vision and mission, using strategic and action plans, developing effective leadership, documenting progress and using feedback, and making outcomes matter. The article concludes with recommendations for strengthening collaborative partnerships for population health and health equity.     

Governance and human resources for health

ABSTRACT: Despite an increase in efforts to address shortage and performance of Human Resources for Health (HRH), HRH problems continue to hamper quality service delivery. We believe that the influence of governance is undervalued in addressing the HRH crisis, both globally and at country level. This thematic series has aimed to expand the evidence base on the role of governance in addressing the HRH crisis. The six articles comprising the series present a range of experiences. The articles report on governance in relation to developing a joint vision, building adherence and strengthening accountability, and on governance with respect to planning, implementation, and monitoring. Other governance issues warrant attention as well, such as corruption and transparency in decision-making in HRH policies and strategies. Acknowledging and dealing with governance should be part and parcel of HRH planning and implementation. To date, few experiences have been shared on improving governance for HRH policy making and implementation, and many questions remain unanswered. There is an urgent need to document experiences and for mutual learning.     

Gender and health promotion: a multisectoral policy approach

Women and men are different as regards their biology, the roles and responsibilities that society assigns to them and their position in the family and community. These factors have a great influence on causes, consequences and management of diseases and ill-health and on the efficacy of health promotion policies and programmes. This is confirmed by evidence on male-female differences in cause-specific mortality and morbidity and exposure to risk factors. Health promoting interventions aimed at ensuring safe and supportive environments, healthy living conditions and lifestyles, community involvement and participation, access to essential facilities and to social and health services need to address these differences between women and men, boys and girls in an equitable manner in order to be effective. The aim of this paper is to (i) demonstrate that health promotion policies that take women's and men's differential biological and social vulnerability to health risks and the unequal power relationships between the sexes into account are more likely to be successful and effective compared to policies that are not concerned with such differences, and (ii) discuss what is required to build a multisectoral policy response to gender inequities in health through health promotion and disease prevention. The requirements discussed in the paper include i) the establishment of joint commitment for policy within society through setting objectives related to gender equality and equity in health as well as health promotion, ii) an assessment and analysis of gender inequalities affecting health and determinants of health, iii) the actions needed to tackle the main determinants of those inequalities and iv) documentation and dissemination of effective and gender sensitive policy interventions to promote health. In the discussion of these key policy elements, we use illustrative examples of good practices from different countries around the world.     

International service trade and its implications for human resources for health: a case study of Thailand

This study aims at analysing the impact of international service trade on the health care system, particularly in terms of human resources for health (HRH), using Thailand as a case study. Information was gathered through a literature review and interviews of relevant experts, as well as a brainstorming session.     

Healthcare systems and organizations: implications for health human resources

What will the healthcare system and healthcare organizations look like in the year 2020? What requirements will they have for health human resources? This article is organized in five brief sections, beginning with looking backward to look forward and proceeding through key trends, organizational evolution by sector and future health organizations and concluding with 10 implications for health human resources.     

Motivation of human resources for health: a case study at rural district level in Tanzania

An increasing number of studies explore the association between financial and non‐financial incentives and the retention of health workers in developing countries. This study aims to contribute to empirical evidence on human resource for health motivation factors to assist policy makers in promoting effective and realistic interventions. A cross‐sectional survey was conducted in four rural Tanzanian districts to explore staff stability and health workers' motivation. Data were collected using qualitative and quantitative techniques, covering all levels and types of health facilities. Stability of staff was found to be quite high. Public institutions remained very attractive with better job security, salary and retirement benefits. Satisfaction over working conditions was very low owing to inadequate working equipment, work overload, lack of services, difficult environment, favouritism and ‘empty promotions’. Positive incentives mentioned were support for career development and supportive supervision. Attracting new staff in rural areas appeared to be more difficult than retaining staff in place. The study concluded that strategies to better motivate health personnel should focus on adequate remuneration, positive working and living environment and supportive management. However, by multiplying health facilities, the latest Tanzanian human resource for health plan could jeopardize current positive results. Copyright © 2012 John Wiley & Sons, Ltd.     

A comprehensive presentation of Iran's human resources for health information systems: A mixed-method case study

ObjectivesThis study is designed to evaluate the characteristics of the Human Resources for Health Information Systems (HRHIS_s) of Iran. It also explores the challenges of HRHISs that need to be addressed to plan a national health workforce strategy.MethodsThis mixed-method study was carried out through observational research, and semi-structured interviews with key informants in health policy, information technology and HRH management. It was conducted over two months from May to July 2019. The WHO-HRHIS assessment tool was used during the observational phase. We purposively selected representatives from different organizations and departments involved in managing the HRHIS. In the qualitative phase, purposeful and snowball sampling methods were used, and 20 interviews were conducted that each lasted minimum of 45 minutes. A content analysis was used to discuss findings.ResultsHuman Resources (HR) departments are fully equipped with information communication technology (ICT). There were 30 different HRH databases with varying HRH data elements ranging from 10 to 115 HRH data elements. Sixty-three percent of the databases were directly captured data online and daily (78%). Most organizations had no feedback mechanism for cross-checking the HRH data; only 28 % of the databases were accurate and trustworthy. Data analysis was not a regular input in the decision-making process. Data reporting and information dissemination were not provided regularly. We categorized HRHISs weaknesses into the following themes: managerial, technical, infrastructural, and systemic barriers. The categories included unintegrated governance, miscommunication between the MoHME and other organizations, organizational factors, inaccuracy in HRH data, wide disparities of HRH information in databases, infrastructural weaknesses, inadequate competent staff, and non-use of research evidence in decision making.ConclusionsThe overall HRHIS assessment demonstrated an unintegrated computerized system with various data elements generated through multiple databases in different sectors. It has not fully covered the HRH data in all parts of health sectors, particularly the private sector. This study illustrates that the current HRIS used in the country have several major challenges. We suggest planning on the identified barriers of HRHISs so that the gaps are better tackled to implement the "Global Strategy on Human Resources for Health: Workforce 2030".     

Recovery of recurrent health service costs through provincial health funds in Cameroon

This article describes the Provincial Health Funds pioneered in two Provinces of Cameroon. These funds are non-profit associations and financed by the community through drug fees and—to a lesser extent—through fees for services. The financial objective of the Funds is the full coverage of both the costs of the drug supply and the recurrent non-salary costs of the entire public health services in the province. In addition the funds are channels for community participation in the management and improvement of health services. Following a discussion of the institutional and legal framework, the paper examines the cost recovery targets and the mark-up necessary to achieve them. Comparison is made with mark-up and prices of private for-profit pharmacies. In its third year of operation, the Fund currently covers 62% of recurrent health service costs, up from 22% in the first year. With increasing number of health centers joining the fund full coverage of recurrent costs is projected to occur at the earlies in year four of operations. The authors argue that the appropriate role of donor assistance is not only to finance investment but also to subsidize recurrent costs, until the fund has reached its optimal anticipated size, thus realizing economies of scale. While the final word on sustainability can only be said years after the funds have reached their final size, the consistent trend towards full cost recovery is encouraging.     

Measuring human betterment through avoidable mortality: a case for universal health care in the USA

The USA system of health care has begun a monumental change that will affect everyone, irrespective of their socioeconomic status, professional status or pre-existing health insurance status. Whatever type of plan is finally implemented through the legislative process, there will need to be a way to evaluate its success (or failure). One way to evaluate the plan's effectiveness is through its impact on human betterment as viewed by a reduction in 'avoidable mortality' for those most in need of health care; the poor and uninsured. For one USA minority population, universal health care has improved human betterment by reducing avoidable mortality, even in the face of a severe burden of poverty.     

统筹城乡卫生资源合理配置的途径探讨

解决目前我国城乡二元卫生经济结构问题,必须坚持科学发展观和统筹的思路,建立健全城乡卫生资源合理配置的新体制,逐步实现城乡卫生资源配置的合理化和科学化,实现城乡卫生事业发展的良性互动和一体化发展.     

Beyond personnel: human resources comes to grips with its leadership role

The human resources department has emerged as a major thrust in healthcare organizations. Strong CEO and human resources relations are critical to successful strategic planning and implementation.     

Mapping the governance of human resources for health in Serbia

This article maps the current governance of human resources for health (HRH) in relation to universal health coverage in Serbia since the health sector reforms in 2003.The study adapts the Global Health Workforce Alliance/World Health Organization four-dimensional framework of HRH in the context of governance for universal health coverage. A set of proxies was established for the availability, accessibility, acceptability and quality of HRH. Analysis of official HRH documentation from relevant institutions and reports were used to construct a governance profile of HRH for Serbia from the introduction of the reform in 2003 up to 2013. The results show that all Serbian districts (except Sremski) surpass the availability threshold of 59.4 skilled midwives, nurses and physicians per 10,000 inhabitants. District accessibility of health workforce greatly differed from the national average with variances from +26% to −34%. Analysis of national averages and patient load of general practitioners showed variances among districts by ±21%, whilst hospital discharges per 100 inhabitants deviated between +52% and −45%. Pre-service and in-service education of health workforce is regulated and accredited. However, through its efforts to respond to population health needs Serbia lacks a single coordinating entity to take overall responsibility for effective and coordinated HRH planning, management and development within the broader landscape of health strategy development.