Universal health coverage (UHC) means anyone can access necessary, good quality health care without suffering financial hardship. A strong health workforce is crucial to achieving UHC, but poor quality pre-service training and governance often weaken the health workforce. In many countries, governments and families alike spend their limited funds on pre-service training institutions that graduate health workers with inadequate skills, which can result in poor patient care and poor health outcomes. Further, some governments do not provide strong stewardship of the health workforce, and miss critical opportunities to improve morale, retention, and skills. This presentation focuses on three countries that are taking a systems approach to solving these two problems, with help from HFG: Haiti, Côte d’Ivoire, and Swaziland. In Haiti, HFG is working with the Ministry of Health to bolster its process for accrediting nursing education institutions, known as reconnaissance. More than 40 schools have already received the new accreditation. The government of Côte D’Ivoire identified task-sharing between nurses/midwives and doctors for HIV care as a key strategy to improve HIV outcomes. HFG is supporting the Ministry of Health in developing policies and training programs on task-sharing to integrate into health worker training curricula. In Swaziland, HFG is working with the government to establish standardized hiring and compensation policies for health workers, and to strengthen human resource information systems. HFG also worked with the Swaziland Nursing Council to strengthen their capacity to regulate the nursing profession and expand nursing competencies to incorporate international best practices.

1. 1
Abt Associates Inc.
In collaboration with:
Avenir Health | Broad Branch Associates | Development Alternatives Inc. (DAI) | Johns Hopkins Bloomberg School of Public Health (JHSPH) |
Results for Development Institute (R4D) | RTI International | Training Resources Group, Inc. (TRG)
Strengthening the Health Workforce
to Improve Quality and Achieve
Universal Health Coverage
December 10, 2015

2. Experts
Sarah Dominis, MBA, MPH, MGM
Associate, International Health, Abt Associates Inc.
Human Resources for Health Specialist
Kate Greene, MBA
Associate, International Health, Abt Associates Inc.
Human Resources for Health Specialist
Laurel Hatt, PhD, MPH
Principal Associate, International Health, Abt Associates Inc.
Health Financing Lead, HFG Project
Moderator
Presenters
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3. UHC and the Health Workforce
 Universal Health Coverage (UHC) = everyone can access the good quality
health care they need, without suffering financial hardship or impoverishment
as a result.
 A strong health workforce is crucial to increase coverage of priority services
and achieve UHC. 3

4. Taking a Systems Approach to Solve
Health Workforce Problems
Côte d’Ivoire
 Task sharing to expand
access to care
Swaziland
 Policy and information
system reforms
Haiti
 Accreditation to improve
quality of pre-service training
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5. CÔTE D’IVOIRE: TASK SHARING
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6. Côte d’Ivoire’s Health Workforce
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Only medical schools training
for HIV care and treatment
Shortage of doctors in rural
and remote areas
50% of HIV+ adults and
children not enrolled in
treatment
Working towards national
health insurance, UHC

7. Task Sharing
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Change policy to incorporate HIV care and treatment in
nursing and midwifery schools
Train new graduates before posting in public facilities

8. Next Steps
Place newly trained staff in
high-burden HIV areas with
greatest HRH need
Track number of new HIV
patients reached
Explore expansion of scope
of practice in other disease
areas
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9. SWAZILAND HRH PLANNING AND
MANAGEMENT 9

10. Swaziland Health Workforce:
The Numbers
Health Worker/1,000 Population WHO
Benchmark
Swaziland
Ratio
Doctors 0.55 0.10
Nurses 1.73 1.22
Doctors + Nurses + Midwives 2.5 1.32
Total Health Workforce (All Categories) 4.1 3.14
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11. HRH Management Challenges
Severely understaffed
facilities
Maldistribution across regions
Scarce skilled HRH
Inaccurate HRIS data
Budget request based on
previous year
Cumbersome process for
establishing posts
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12. HFG’s Strategy
1. Clean the HRIS data
2. Produce annual HRH status reports
3. Submit data-based budget requests
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13. Year One: A Running Start
Produced first annual HRH status report using existing
HRIS data
 475 positions not filled
 18 facilities/units nonfunctional/compromised due to lack of staff
2015 budget request based on data
 Received 112 new positions (approximately 40% of request)
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14. Intensive HRIS Data Cleaning
Data Verification
 Facility Manager Surveys  Site Visits
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15. New Status Report
Findings:
 Over 444 established
positions still vacant
 87 posts which appeared
filled were actually vacant
 Great variation in fill rates
by cadre, facility level and
individual facilities
 At least 60 workers retiring
annually
 27 graduates expected in
2016, including specialty
cadres
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16. Successful Evidence-based Planning
HRU submitted budget request to MOPS:
 Based on updated data about existing work force
 Used staffing norms to support decisions about what was needed
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 Political savvy: HRU
used advocacy in
advance to explain
changes
 Results will be
announced in April
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17. Moving Ahead
Currently, HFG is supporting the MOH to:
 Reallocate positions to address vacancies, ‘ghost’ workers, and
over or under-resourced facilities/regions
 Modify the establishment register to include new specialties
 Manage the pipeline to prepare for new graduates and retiring
workers
Swaziland’s HRU more confident in their requests to MOPS
and able to advocate based on accurate data
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18. HAITI: NURSING SCHOOL
ACCREDITATION
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19. Haiti’s Private Nursing Institutions
 More than 400 private nursing
education institutions in Haiti of
unknown quality
 Existing government
accreditation system paper-
based, overwhelmed with
increasing number of schools
 Politically difficult environment
for change
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© PAHO_WHO David Spitz

20. HFG’s Role: School Accreditation
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Updated standards and criteria for
nursing education institutions
Created new forms, manuals, tools
Trained evaluators to conduct site visits
Conducted first phase
 38 schools met standards
Built capacity of schools
Designed website

21. Sustaining Progress
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 Complete evaluation of 60
additional schools
 Media campaign to educate public
 Institutional capacity building to
sustain new reconnaissance
system beyond HFG support

22. Resources: www.hfgproject.org
 Côte d’Ivoire
 Task-Sharing for Better HIV Care and Treatment in Côte d’Ivoire
 Brief: Supporting the Scale-Up of HIV Care and Treatment through Human
Resources for Health Interventions in Côte d’Ivoire
 Swaziland
 Data Drives Decisions to Increase Number of Health Workers in Swaziland
 Swaziland: Entry-to-Practice Competencies for Nurses to Improve HIV, TB
Services
 Haiti
 Brief: Improving Nursing Education in Haiti by Strengthening Quality Standards
 Haiti Takes Steps to Rebuild Its Nursing Workforce
 Report: Impact of Health Systems Strengthening on Health
Questions? Email us at: hfgproject@abtassoc.com.
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23. Thank You!
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www.hfgproject.org
@HFGProject