The document discusses strategies to strengthen Haiti's health workforce. It outlines a strategy to expand community health coverage through family health teams of 60 community health workers each serving populations of 30,000-60,000. It also discusses improving health workforce data and governance capacity, which helped Haiti identify and eliminate "ghost workers" saving $3.1 million. A sustainable process was implemented to recognize qualified nursing schools in order to increase the number of high-quality nurses and midwives graduating and becoming licensed.

1. Strengthening Human Resources for Health (HRH) in Haiti
USAID Health Finance and Governance Project
The HRH strategy calls for the scale-up of family health teams
to expand community health coverage and link communities with
health facilities. Each team, with a base of 60 community health
workers, will cover a population of approximately 60,000 in
urban areas and 30,000 in rural areas.
Nurses at Justinien University Hospital. Health workforce
data improvement, coupled with governance capacity building,
has helped Haiti increase efficiency and recruit more health
workers, such as nurses.
Recognized nursing schools receive a
Reconnaissance logo from the MSPP.
Percentage of Haitian midwifery, nursing and medical
students who intend to practice overseas after completing
training (2018 preliminary survey data, HFG)
IDENTIFICATION AND ELIMINATION OF
GHOST WORKERS
Data quality audits and improved MSPP capacity helped
Haiti save US$3.1 million in the last year alone by
identifying and eliminating ghost workers, known as
zombis. The government plans to use the savings to
recruit additional health workers and make pay equity
adjustments.
MORE HIGH-QUALITY NURSES AND
MIDWIVES
 HFG assisted the MSPP’s Department of Training in
designing and implementing a sustainable process,
called Reconnaissance, to recognize private nursing
schools that meet quality standards. HFG helped the
department develop a budget and mobilize internal
resources to sustain the process.
 Estimated 400 schools in existence after earthquake;
81 now recognized through Reconnaissance program.
Only students from recognized schools can register for
national exam to receive a license.
 MSPP expanding program to medical and pharmacy
schools.
PATHWAYS FOR CAREER ADVANCEMENT
AND RETENTION
 HFG supported MSPP development of health worker job
descriptions, standardized salary classifications, and a
performance evaluation system (SYSEP), and helped
implement SYSEP in 10 MSPP directorates. SYSEP
allows health workers to set goals with their supervisors
and identify resources and support they need to achieve
them. Supervisors, in turn, hold employees accountable
for performance and help them advance in their careers.
 To inform rural retention planning, HFG is conducting an
outmigration study to understand the scale of health
worker migration out of Haiti and ‘push’ and ‘pull' factors.
Secondary data shows that Haitian health workers are
primarily migrating to the U.S. and Canada. Outmigration
of nurses has increased over the past 10 years, whereas
the pattern of outmigration of physicians varies
according to the host country. Final results on primary
data regarding Haitian medical and nursing students’
intent to migrate is forthcoming.
Family Health Team Model
EVIDENCE BASE FOR NATIONAL HRH
STRATEGY
 HFG partnered with Haitian Ministry of Health (MSPP)
to draft the country’s first national HRH strategy for
management and governance of the health workforce.
 The strategy was informed by data quality audits of
public and private health facilities. Analysis showed
only 12% of health workforce practiced in rural areas,
where 50% of population lives, plus critical shortage of
nurses and midwives.
 Strategy strengthens governance, data for decision-
making, pre- and in-service education, and health
workforce management and retention. Strategy calls
for scale-up of family health teams to improve primary
and community health care coverage.
 HFG supported MSPP to develop a costed operational
plan for the strategy and advocate for resource
mobilization. MSPP presented the HRH strategy and
costed operational plan to a donor roundtable in May
2018.
March 3, 2018: National newspaper reports on savings
from removal of ghost workers.
“The Ministry of Health, as part of operations to recover
zombie checks, seized checks worth approximately 200
million Haitian Gourdes [US$3.1 million].”
“We have students who come to register, and the first
question they ask is, ‘Do you have the Reconnaissance
logo?’ Our student body has increased and we are thrilled to
be a part of this process.”
– Pasteur Gideon, President, Faculty of Nursing Sciences,
Antenor Firmin University.
27%
35%
14%
0% 20% 40%
medical (n=400)
nursing (n=457)
midwifery (n=123)
INTENTION TO PRACTICE
OVERSEAS
Photo: Valérie Baeriswyl for Communication for Development Ltd.
The HFG project (2012-2018) is funded by the U.S. Agency for International Development (USAID) and is led by Abt Associates in collaboration with Avenir Health, Broad Branch Associates,
Development Alternatives Inc., the Johns Hopkins Bloomberg School of Public Health, Results for Development Institute, RTI International, and Training Resources Group, Inc.
This presentation was made possible by the generous support of the American people through USAID. The contents are the responsibility of Abt Associates and do not necessarily reflect the views of USAID or the United
States Government.