Alfredo Fort, Rachel Deussom, Randi Burlew, and Kate Gilroy, CapacityPlus/IntraHealth InternationalGlobal 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

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.

Dearth of HRH indicators

Most promising HRH indicator: Density of health professionals per 10,000 population1

However, suffers from problems…availability/quality of data, and restrictive definition. 1 WHO 2006 and 2013

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

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

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

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 HealthExtent 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 2 3 4 5 6 7 8 9 10 o

1.   Political support for HRHExtent 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 2 3 4 5 6 7 8 9 10 o

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. 

1 2 3 4 5 6 7 8 9 10 o

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

Results: Respondents

9

32%

34%

17%

7%

10%

MOH-GOVNGO-FBO-PrivProf AssnUniv/TrngHlth Fac

59%

2%

2%

37% Mngr/DirectAcademicClinicianOfficer, conslt

Nigeria n=27Kenya n= 22Male: 68% Female: 32%

Male: 74% Female: 26%

Place of employment and position of respondents in Kenya and Nigeria (n=49)

Results: Respondents by dimension*

10

Kenya Nigeria

TOTAL 22 27

Dimension

I. Leadership and Advocacy 10 16II. Policy and Governance 12 15III. Finance 12 15IV. Education and Training 13 17V. Distribution, Deployment, Recruitment, and Retention

13 19

VI. Human Resources Management 12 17VII. Monitoring, Evaluation, and Information Systems

14 16

* Respondents only answered dimensions of their expertise (Average non-response across all dimensions: 43%)

Overall

*

* Statistically significant

Analyses and feedback led to revision of tool

DIMENSION ITEMS BEFORE

ITEMS NOW

I – LEADERSHIP AND ADVOCACY 6 5

II – POLICY AND GOVERNANCE 16 6

III – FINANCE 8 7

IV – EDUCATION AND TRAINING 15 10

V – RECRUITMENT / DISTRIBUTION / RETENTION 7 5

VI – HUMAN RESOURCES MANAGEMENT 14 9

VII - MONITORING, EVALUATION AND INFORMATION SYSTEMS 13 8

TOTAL 79 50

• Simpler

• Good representation of items and dimensions

• Avoids repetition

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

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

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)

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 education22.  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

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

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

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

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

Correlations of FP Effort Index and Total Fertility Rate

1 2 3 4 5 6 7 80

10

20

30

40

50

60

70

R² = 0.20909355116834

Correlations of FP Effort Index and Total Fertility Rate (40 countries)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

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!

On behalf of the millions of health workers around the world…

Thank you!

CapacityPlusUSAID Bureau-wide global project dedicated to human resources for health (HRH)

Launched Oct. 2009, closing Sept. 2015www.capacityplus.org