alfredo fort, rachel deussom, randi burlew, and kate gilroy, capacity plus /intrahealth...
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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
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