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IMPROVING HEALTH WORKER PRODUCTIVITY AND
PERFORMANCE IN THE CONTEXT OF UNIVERSAL HEALTH
COVERAGE: THE ROLES OF STANDARDS, QUALITY IMPROVEMENT,
AND REGULATION TECHNICAL WORKING GROUP (TWG) #7
This paper serves as a background report to inform the Global Strategy for Human Resources for Health.
The development of this paper has been coordinated through a thematic working group (TWG),
comprising of 2 co-chairs and a group of experts drawn from various Global Health Workforce Alliance
(GHWA) constituencies, operating under the oversight of the GHWA Board working group. The views
expressed in the paper, do not necessarily reflect the official position of GHWA. All reasonable
precautions have been taken by the co-chairs to verify the information presented in the papers.
- DRAFT FOR CONSULTATION -
Not to be quoted or referenced without prior permission from
the authors. Not for wider distribution.
Final Draft – August 29, 2014 1
IMPROVING HEALTH WORKER
PRODUCTIVITY AND PERFORMANCE IN
THE CONTEXT OF UNIVERSAL HEALTH
COVERAGE: THE ROLES OF STANDARDS,
QUALITY IMPROVEMENT, AND
REGULATION – FINAL DRAFT
BY TECHNICAL WORKING GROUP #7
CO-CHAIRS:
Frances Day-Stirk
President, International Confederation of Midwives (ICM)
The Hague, Netherlands
M. Rashad Massoud, MD, MPH, FACP
Director, USAID Applying Science to Strengthen and Improve Systems Project,
Senior Vice President, Quality & Performance Institute,
University Research Co. LLC. - Center for Human Services
Bethesda, Maryland, USA
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INTRODUCTION
The Global Health Workforce Alliance (GHWA) has coordinated a global consultation, with the objective
to inform a future strategy on human resources for health (HRH) that will be relevant to the post-2015
development agenda (2015-2030) for all countries at all stages of socio-economic development. The
consultation builds on earlier work on the HRH implications of Universal Health Coverage (UHC), with
additional analyses of: future scenarios in the period 2015-2030; multi-sectoral government activities,
such as the International Labor Organization’s work with its Member States on strengthening social
protection systems, and; opportunities arising from the anticipated economic, demographic, and
epidemiologic transitions in many low- and middle-income countries. The consultation includes eight
themesi that can contribute to the overall development of a forward-looking strategy. The objective of
this paper by Working Group #7 is to examine the evidence and provide recommendations on the roles
of standards, quality improvement, and regulation for improving health worker productivity and
performance at all levels of the health system (see Table 1 for working definitions used in the paper).
We present a framework based on the review of selected evidence of factors promoting and impeding
productive and performance (Figure 1).
Table 1: Working Definitions
Human resources management
Interventions that aim for effective utilization of human resources in an organization1
Incentives All the rewards and punishments that providers face as a consequence of the organizations in which they work, the institutions under which they operate and the specific interventions they provide
2
Pay for performance The transfer for money or material goods conditional on taking a measurable health related action or achieving a predetermined performance target
3
Performance Performance of health workers includes the quality of their work, the technical skills they
use, the care they deliver, and the impact of their work on health outcomes.4
i Working group themes: 1)The drivers of change in health labor markets; 2) The role of transformative education;
3)Data and measurement of HRH availability, accessibility, acceptability and quality; 4) Accountability and
alignment for post-2015: the roles and responsibilities of state and non-state actors; 5) Leadership, governance
and policy alignment in public/private health systems; 6) The drivers of change in Fragile States; 7) Improving
productivity and performance: the roles of regulation, professional associations and standards; and 8) Building on
human capability beyond the health sector.
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Productivity Productivity of health workers is determined by the setting in which they work, their level of motivation, work organization, management capacity, the division of labor and other resources (e.g., equipment, drugs, examination rooms, and other characteristics of the setting) available.
5
Quality Quality of care is the function of the healthcare delivery system to deliver safe, effective, and patient-centered care in an efficient, timely and equitable manner. The Institute of Medicine (IoM) defines quality of care as the “degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”
6
Recognition systems A systematic approach or strategy to acknowledge, reward, and motivate the performance of health workers to provide quality health services through appropriate financial and non-financial incentives.
7
Regulation All those legitimate, appropriate and sustained means where order identify, consistency, control and accountability are brought to health systems through legally enforced and/or voluntary action.
8
Standards Explicit statements of expected quality in the performance of a healthcare activity – i.e., how a particular healthcare activity will be performed in order to produce the desired results. May take the form of procedures, clinical practice guidelines, treatment protocols, critical paths, algorithms, standard operating procedures, or statements of expected healthcare outcomes.
9
BACKGROUND
Improving health workers’ performance and productivity is vital to improving health care delivery, the
Millennium Development Goals, and commitments, policies, and actions beyond 2015. The evolving
momentum for Universal Health Coverage offers an important opportunity to look at HRH challenges in
the context of UHC.10 During the last decade, numerous intergovernmental resolutions as well as action
plans have highlighted the importance of HRH investments.11-16 However, policy makers and program
planers still struggle to determine the correct set of actions to improve worker performance and
productivity.
Critical human resources shortages, particularly in low-resource settings, require that we not only
develop long-term strategies for increased production and retention of health workers 17 but more
importantly that we strengthen the productivity and performance of the workforce we have so as to get
the best possible results and the highest impact with existing resources.
Health worker performance barriers such as unclear roles and expectations, unclear guidelines, poor
processes of work, inappropriate skills mix within the work setting, competency gaps, lack of feedback,
difficult work environments and unsuitable incentives mean that even where there are no critical
workforce shortages, health workers may still fail to provide quality care. While substantive evidence of
the effectiveness of different types of interventions to improve worker performance and productivity is
still limited, salient features are emerging from existing studies and country experiences that can help
inform a strategy for optimizing the performance and productivity of health workers and health worker
teams.18-19
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METHODS
This paper was developed by a group of experts comprised of representatives of professional
associations, non-governmental organizations, multi-lateral organizations and bilateral organizations
representing all regions of the world. The paper and its recommendations were informed by a targeted
desk study of published and grey material. In addition, detailed feedback from a group of expert
reviewers on the roles of quality improvement, regulation in HRH, and standards in addressing health
worker performance and productivity was obtained on drafts of the paper. An adaptation of the
Dieleman et al. framework formed the focus and direction of the paper (Figure 1).20
IMPROVING HEALTH WORKER PERFORMANCE AND PRODUCTIVITY
FRAMEWORK OVERVIEW
Figure 1 highlights that the determinants of health workers‘ performance and productivity are rooted in
factors related to: 1) the macro, or overall health systems, socio-economic/labor market, and political
level; 2) the micro level, such as the workplace itself or the communities in which health workers live;
and 3) the individual characteristics of health workers themselves.21 HRH interventions such as
standards of health care, quality improvement and regulation (inputs and processes) work in a dynamic
relationship with each other to improve health worker performance and productivity: Standards should
codify the evidence based interventions that should be incorporated into practice and the performance
expectations in the delivery or implementation of quality of health services. Standards drive the
improvement efforts needed to ensure their reliable implementation in everyday practice, yet at the
same time the experience of improving care can shed light on the realities of how to implement the
statndards and can consequently inform the revisions of these standards. Through regulatory
approaches, governments can establish expectations for the competence of healthcare providers and
the standards of the services.
Other inputs and processes such as strong human resource management and recognition systems to
support quality services and ongoing monitoring and evaluation of care processes are also needed to
improve the availability, responsiveness, and competence of the health workforce. As will be described
in the following sections, there is no clear linear relationship between inputs, processes and outcomes,
and between outcomes and effects. Instead, these issues are intricately related to each other and
interventions must be comprehensive and multifaceted, taking place simultaneously and at different
levels of the health system.22
KEY FINDINGS FROM EVIDENCE, RECOMMENDATIONS, AND AGENDA ITEMS THAT NEED TO
BE ADDRESSED IN THE FUTURE
STANDARDS
Global standards, or those adapted to a local situation, are explicit statements of expected quality in the
performance of a health care activity.23 They may take the form of procedures, clinical practice
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guidelines, treatment protocols, critical paths, algorithms, standard operating procedures, or statements
of expected health care outcomes, among other formats.
Standards communicate expectations for how a particular health care activity will be performed in order
that it achieve the desired results and define, for both health workers and clients, what is needed to
produce quality services. Standards are thus the cornerstone of most health care improvement
approaches, including accreditation of health facilities, external quality evaluation, continuous quality
improvement, and performance improvement. In fields like health care that are continuously evolving
with the development of new technologies, drugs, and procedures and that have an enormous body of
scientific evidence available to support clinical decision-making, ensuring that standards are regularly
updated, communicated to providers, and “evidence-based” is critical to assuring health care
effectiveness and outcomes.
Adherence to evidence-based standards has been shown to be associated with improved health
outcomes.24 Similarly/conversely failure to provide clinical care in accordance with evidence-based
standards has serious negative effects on patient outcomes.25 A substantial body of research on
guidelines implementation suggests many reasons why standards-based performance is often difficult to
achieve and sustain. At the most basic level, health workers may simply not be familiar with standards
because these have not been clearly communicated or disseminated from national to facility level. In
other cases, systemic factors such as lack of the necessary supplies or equipment to perform according
to standards; poor monitoring and evaluation of guideline implementation; and lack of human resources
can affect implementation of standards. Evidence has shown that combinations of interventions are
more effective than single interventions to induce and maintain health workers’ adherence to evidence
based-standards (e.g., graphic aids; clarity and repetition of messages; provision of opportunities to
discuss and try out new behaviors; making desired behaviors compatible with existing practices; and
approval and support of patients, peers, and supervisors).26
Proposed agenda:
1. Better tools and processes are needed that help health care providers know about evidence-based
standards in order to apply standards in their daily work. Further research is needed to test locally
appropriate and sustainable strategies for helping healthcare providers perform according to
standards in diverse and resource constrained conditions, including primary health care facilities
with non-physician health workers.
QUALITY IMPROVEMENT
The science of improvement aims at making systematic changes in the way healthcare is delivered to
increase the likelihood that those changes will result in better care. Despite an abundance of evidence-
based guidelines and consensus on what should be done, many simple, high-impact interventions
capable of saving lives and alleviating suffering are not reaching the people who most need them. Much
of this implementation gap is related to poorly designed processes of care delivery and weak health
systems. The fundamental concept of improvement science is that improvement requires change.
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Because not every change makes care better, changes must be tested to determine whether the change
improves care.27 Quality improvement approaches (e.g., implementation, execution, delivery, etc…) aim
to enable the health system, teams, and individuals to find ways in which to provide evidence based
interventions to performance expectations on a routine basis for every patient, every time in the most
safe, effective, patient-centered, timely, efficient, equitable way.28
Improving health worker engagement, performance, and productivity:
To achieve UHC so that all sectors of the population have access to quality care involves improving the
performance of the health workforce at every system level – sub-national management levels, local
facilities, and communities. To do so, we need to strengthen the capacity of managers, frontline
providers, community health workers, and volunteers to manage their own performance, identify
strategies for improving care, and monitor and evaluate best practices and health outcome results, so
that evidence will inform decisions and shape policies. This capacity, developed at all delivery levels,
results in strengthened systems and sustained quality of care.29
Much of the current focus of quality improvement has been on redesigning care delivery processes to
enable providers to follow evidence-based guidelines. These experiences in adapting improvement
methods to work across organizations levels are showing promising results.30 Employee involvement
through quality improvement teams has resulted in improved processes of care and patient outcomes.31
Bringing teams of health workers from across the levels of the health system to work together in
improvement teams allows the system to tap into their knowledge of the system’s inner workings and
develop potential solutions that can work. Engaging health workers in the design, testing and
implementation of changes enables clinical and non-clinical health workers at all levels of the system to
innovate and test practical ways that better utilize existing resources to improve health care.32-33
Educating health workers may only further magnify the “know-do” gap if health workers do not see
themselves as agents of change and are not empowered to make changes.34 Increased engagement
among nurses, for example, in high income countries has been associated with greater patient
satisfaction, nurse retention, and morale; lowered complications; and improved clinical measures such
as reduced infections and medication errors.35 Similarly, a recent unpublished study from Tanzania
found that health facilities with health workers with below average levels of engagement had three
times the proportion of HIV clients that were lost to follow-up.36 Since most providers who participate in
improvement activities carry out this work without compensation, suggests that non-material incentives
are at play. Research in this area is just beginning and we need to understand better what motivates
providers to participate in improvement activities and build these factors into their improvement
work.37
Improving health worker in-service training effectiveness, efficiency, and sustainability
A large portion of funding has been spent on in-service training (IST) to rapidly build health worker
competence to provide quality services. IST has gained prominence as a method to rapidly build health
worker competencies at scale. However challenges such as unnecessary duplication in training and
significant service disruptions have raised questions of the effectiveness, efficiency, and sustainability of
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training investments. Organizations such as the USAID Applying Science to Strengthen and Improve
Systems (ASSIST) Project have responded by developing and launching the Global Health Worker In-
service Training Improvement Framework, which codifies 40 training recommendations.38
Integrating improvement competencies into pre-service and in-service training
All health systems have some aspect of dysfunction, inefficiency, and ineffectiveness and continuous
improvement is a necessary part of day to day work for all health workers. While health worker
education and training systems have been doing increasingly better to build specific competencies to
practice in their profession, most health professions’ education and training systems are not equipping
health workers with the competencies to brainstorm, test, study, implement, and spread changes.
Consequently, improvement initiatives depend on ad hoc in-service training, while staff turnover and
rotations dilute the capacity of improvement teams.39
A key precondition to the sustainability of past and current investments in health care improvement is
the availability of a current and future workforce across the health system that has the competence to
lead and participate in improving care. Work is being conducted in the East Africa Region to define basic
core improvement competencies that can be integrated into health worker education and training, as
well as incorporating improvement competencies into pre-service training.40 There is currently a dearth
of literature and opportunities for shared learning to integrate improvement competencies into health
worker education and training. Going forward, a platform is needed to bring together key stakeholders
to share learning, curricula, evaluations, and adult learning methodologies.
Proposed agenda
1. Further research of improvement applications in worker productivity and performance is necessary
to determine how sustained results can be best achieved across time. Most experience in
developing and even in developed countries of improvement applications and health worker
productivity are based on time limited projects. There are very few examples where national spread
of quality improvement has worked over extended periods of time to ensure sustained results.41 42
2. Use innovative approaches such as best practices benchmarking or institution to institution
partnerships to share improvement approaches and results across thematic areas and sites with
policy makers and program implementers. Replicating results across type of settings, i.e. taking
improvement approaches usable in surgery and adapting them for safe childbirth, have rarely been
done successfully. In many cases, the approach is designed from scratch rather than sharing
approaches and results across sites.
3. Additional research is needed to address the role of improvement approaches to HRH interventions
such as task sharing, referral systems, pre-service training for quality improvement, motivation of
providers to carry out quality improvement work through non-material incentives, as well as
integrating quality improvement approaches into the private sector (i.e., large networks of NGOs).43
4. Improvement is top led, bottom fed. Priority-setting and empowerment for change is a leadership
function. Insightful testing and implementing of changes happen by the staff delivering the work
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processes. This top-bottom relationship and how it can be enhanced is worthy of further
investigation.
5. There is limited research on the relationship between health worker engagement and healthcare
improvement in low resource settings. Further research is required to strengthening our
understanding of health worker engagement and interventions that can better engage health
workers to improve care.
REGULATION
The purpose of health professional regulation is to define and set rules regarding standards for
professional practice and education to ensure that health professionals are competent to practice at a
standard acceptable to the public who are recipients of that care.44 Regulators do so by holding
registers of individuals who meet their standards of education, training, professional skills, behavior and
health. There are four recognized elements: registration, standard setting, accreditation and
management of conduct, performance and impairment matters.45
The 2006 World Health Report identified major deficits in regulator systems while outlining three basic
models of regulatory systems: self-regulating professional associations; the command and control
approach of institutional regulators; and the advocacy of civil society. The report highlights that,
individually, none of these is sufficient to regulate the behavior of health workers and institutions and
concludes that “regulations resulting from the participation of all three bodies, as well as health care
institutions and the workforce, are more likely to generate trust and cooperation.” 46
As the scope of practice of existing practitioners has expanded, and the range of health workers has
increased, the issue of unique scopes of practice and overlapping responsibilities have presented task-
sharing as a challenge rather than a means of better meeting patient and population needs. 47
The evidence base on the whole focused on single profession or jurisdictional experience. With few
exceptions studies have been descriptive in nature and rarely examined aspects of the most efficient
and effective means of implementing regulatory systems and processes. Yet the aspects that need to be
addressed from multiple country case studies are consistent – regulation that protects the public yet
facilitates change; a register of the competent and practicing rather than those that have simply
completed a program; oversight or accreditation of pre-service education programs; mechanisms to
assure continuing competence; approaches that enable amendment of scopes of practice to meet
changing health needs; fair and transparent processes that support practitioner mobility and
simultaneously protect the public; and a range of conduct and competence approaches that are
proportionate to risk and efficient and effective to operate.
A consistent legal framework enables regulators to uphold their duty to protect the public yet,
dissonance between ministries of education, health, labor and others have contributed to fragmentation
and inefficiencies in planning.48 It has been argued that a systems based approach is needed to address
these and other performance gaps.49 Recently the African Health Professions Regulatory Collaborative
for Nurses and Midwives (ARC), a 17-country initiative, introduced a system-based approach for country
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assessment regarding regulatory reform and a methodology to track and assess change. 50-52 Regulatory
reforms cannot be done in isolation or without regard to the cultural and legal traditions of the
jurisdictions concerned or other regulatory and quality assurance systems that interface and interact
with professional regulation.
Proposed agenda
1. Distil from available evidence a systems based approach to the development and
implementation of contemporary statutes and regulatory mechanisms and processes.
2. Undertake research to characterize/identify the impact of regulations and quality assurance
features that need to be addressed by any regulatory system so as to underpin the attainment
of UHC and improved population health.
3. Identify research gaps and propose a list of priorities for study that will focus on enhancing the
performance of regulatory systems.
OTHER FACTORS
This paper has focused specifically on the roles of standards, quality improvement, and regulation for
improving health worker productivity and performance at all levels of the health system. There are
many other factors that influence workforce performance and productivity. For example, there is a
growing body of research that shows that that job satisfaction, productivity and organizational
commitment – all “influencers” of quality and performance – are affected by management and
governance systems and leadership practices. Recent reviews of human resources management,
supervision and mentoring interventions identified key success factors to include: active involvement of
staff to identify and implement solutions to problems, active involvement of stakeholders in program
design, implementation and evaluation; organizational commitment and leadership; and networking and
supportive relationships.53 -54 Other important predictors of health worker performance and productivity
include:
Community involvement: The role of communities is significant for community health workers, whose
performance depends upon support from both the community and formal health system.55 Supervision
and management of communities’ health workers is historically provided by the health system yet often
reported as weak and ineffective. 56-66 It is necessary that level and scope of supervision is clearly
articulated to ensure that the supervisor and supervised understand what is expected of each in the
particular context. Experience with community involvement in supervision of community health
workers includes: provision of feedback on evaluations67 public recognition of performance and
contribution68 and provision of feedback and monitoring through village health committees.
Recognition systems: Research is showing that nonmonetary incentives (linked to health workers’ career
development, working environment – e.g., individualized mentoring, performance reviews with
feedback, continuing education, supportive career structures, non-monetary recognition of good
performance) are as important as financial incentives.69 There is mounting evidence that intrinsically
motivated public service providers (i.e. desire to perform an activity for no apparent reward other than
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the activity itself)70 “exert more effort and require fewer extrinsic incentives than self-interested
providers”71 -74and that the provision of financial incentives can undermine motivation, conflict with or
reduce intrinsic motivation, “worsen performance on complex cognitive tasks” and “reduce the desire to
perform an activity for its inherent rewards (e.g. pride in excellent work, empathy with patients)”.75-80
Even in cases where financial incentives have worked, they were “not the sole reason, and often not the
main reason, for motivation” but that other motivators such as recognition and esteem (i.e., from
public, peer, manager, community), appreciation (i.e. from managers, peers, patients, community),
conducive workplace norms and conditions, and opportunities for professional advancement and
development are also key. 81-83
CONCLUSION
This paper has highlighted the theme of the roles of standards, quality improvement, and regulation for
improving health worker productivity and performance in the context of UHC. As mentioned above, this
theme is not exhaustive in the factors influencing health worker productivity and performance, however
when addressed by a deliberate design can contribute to a forward looking strategy on HRH that will be
relevant to the post-2015 development agenda. Specific recommendations include:
Recommendation 1 (Standards): Conduct further research to test locally appropriate and sustainable
strategies for helping healthcare providers perform according to evidence-based standards in diverse
conditions; continually improve tools and processes to help health providers know about evidence-
based standards and apply them in their daily work.
Recommendation 2 (Quality improvement): Conduct further research and share results on the effect of
quality improvement approaches as a core strategy for better healthcare and health workforce
performance and productivity.
Recommendation 3 (Regulation): Adopt a systems based approach to develop and implement
contemporary regulatory structures and processes that align with changing health, education, and social
needs.
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Figure 1: Framework for improving health worker performance and productivity
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1 The World Health Report 2006 – Working Together for Health. 2016. Available at http://www.who.int/whr/2006/en/index.html 2 World Health Report 2000 – Health Systems: Improving Performance. 2000. Available at http://www.who.int/whr/2000/en/ 3 Eichler R, Levine R. 2009. Performance Incentives for Global Health: Potential and Pitfalls. Washington, DC: Center for Global Development. 4 The World Health Organization (WHO). The Labour Market for Human Resources for Health in Low- and Middle-Income Countries. 2012. Available at http://www.who.int/hrh/resources/Observer11_WEB.pdf 5 WHO, 2012. 6 Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. 2001. Available at http://www.iom.edu/Global/News%20Announcements/Crossing-the-Quality-Chasm-The-IOM-Health-Care-Quality-Initiative.aspx. 7 Dieleman M and Harnmeijer JW. Improving Health Worker Performance: In Search of Promising Practices. 2006. Geneva: WHO P17. Available at http://www.kit.nl/net/KIT_Publicaties_output/ShowFile2.aspx?e=1174 8 David B. please insert source here 9 Marquez, L. Helping Healthcare Providers Perform According to Standards. 2001. Operations Research Issue Paper 2(3). Bethesda, MD: Published for the U.S. Agency for International Development (USAID) by the Quality Assurance Project. 10 Global Health Workforce Alliance, World Health Organization. The Universal Truth: No Health without a Workforce: Third Global Forum on Human Resources for Health Report. 2013. Available at http://www.who.int/workforcealliance/knowledge/resources/hrhreport2013/en/index.html 11 World Health Organization, Global Health Workforce Alliance. Kampala Declaration and Agenda for Global Action. 2008. Available at http://www.who.int/workforcealliance/knowledge/resources/kampala_declaration/en/ 12 Global Health Workforce Alliance Strategy. The Global Health Workforce Alliance Strategy 2013-2016: Advancing the Health Workforce Agenda within Universal Health Coverage. 2012. Available at http://www.who.int/workforcealliance/knowledge/resources/ghwastrat20132016/en/index.html 13 Global Health Workforce Alliance, World Health Organization. 2013. 14 The Recife Political Declaration on Human Resources for Health: Renewed Commitments towards Universal Health Coverage. 2013. Available at http://www.who.int/workforcealliance/forum/2013/3gf_finaldeclaration/en/index.html 15 Human Resources for Health: Overcoming the Crisis [report of the Joint Learning Initiative]. 2004. Available at http://www.who.int/hrh/documents/JLi_hrh_report.pdf 16 World Health Organization. The World Health Report 2006: Working Together for Health. 2006. Available at http://www.who.int/whr/2006/en/index.html 17 Health Workforce Australia. Health Workforce 2025: Doctors, Nurses, and Midwives. Volume 1. 2012. Available at http://www.hwa.gov.au/sites/uploads/FinalReport_Volume1_FINAL-20120424.pdf
Final Draft – August 29, 2014 13
18 Dieleman M, Harnmeijer JW. Improving Health Worker Performance: In Search of Promising Practices.
2006. Geneva: World Health Organization. Available at
http://www.kit.nl/net/KIT_Publicaties_output/ShowFile2.aspx?e=1174 19 The World Bank. Global Conference on Universal Health Coverage for Inclusive and Sustainable Growth: Lessons from 11 Country Case Studies: A Global Synthesis Report. 2013. Available at http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2013/12/05/000461832_20131205145919/Rendered/PDF/831410WP0JPP0U0Box0379884B00PUBLIC0.pdf 20 Dieleman M, Gerretsen B, and van der Wilt, GJ. Human Resource Management Interventions to Improve Health Workers’ Performance in Low and Middle Income Countries: A Realist Review. Health Research Policy and Systems 2009, 7:7. 21 Dieleman M and Harnmeijer JW, 2006. 22 Dieleman M and Harnmeijer JW, 2006. 23 Marquez L. Helping Healthcare Providers Perform According to Standards. Operations Research Issue Paper 2(2). 2001. Bethesda, MD: Published for the U.S. Agency for International Development (USAID) by the Quality Assurance Project. 24 Grimshaw, JM and IT Russell. Effect of Clinical Guidelines on Medical Practice: A Systematic Review of Rigorous Evaluation. The Lancet 1993, 342: 1317-22. 25 Walker, JA, DEC Ashley and RJ Hayes. The quality of care is related to death rates: Hospital Inpatient Management of Infants with Actual Gastroenteritis in Jamaica. American Journal of Public Health 1988, 78: 149-52. 26 Marquez L, 2001. 27 USAID ASSIST Project. Improvement Science. 2014. Available at https://usaidassist.org/topics/improvement-science 28 Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. 2001. Available at http://www.iom.edu/Global/News%20Announcements/Crossing-the-Quality-Chasm-The-IOM-Health-Care-Quality-Initiative.aspx. Accessed June 30, 2014. 29 USAID ASSIST Project. Improving Health Worker Performance. 2014. Bethesda, MD: University Research Co., LLC. Published for the U.S. Agency for International Development (USAID) by the Quality Assurance Project. Available at https://www.usaidassist.org/sites/assist/files/improving_health_worker_performance_feb2014.pdf 30 Heiby, J. The Use of Modern Quality Improvement Approaches to Strengthening African Health Systems: A 5-year Agenda. International Journal for Quality in Health Care 2014, Jan 30. 31 Franco, L.M., Marquez, L. Effectiveness of Collaborative Improvement: Evidence From 27 Applications in 12 Less-Developed and Middle-Income Countries. BMJ Qual Saf 2011; 20:658-665. 32 Maggige H, Kiwia M, Mwita S, Mkiramweni Y, Stover K, Nswila A et al. Improving Quality of HIV Services and Health Worker Performance in Tandahimba District, Tanzania: An Evaluation. Research and Evaluation Report. 2013. Bethesda, MD: University Research Co., LLC (URC), Published by the USAID Health Care Improvement Project.
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33 Crigler L, Boucar M, Sani K, Abdou S, Djibrina S, Saley Z. The human resources collaborative: Improving maternal and child care in Niger. Final Report. 2012. Bethesda, MD: University Research Co., LLC (URC), Published by the USAID Health Care Improvement Project. 34 Dieleman M, Gerretsen B, and van der Wilt, GJ. 2009. 35 Schmidt FL, Hayes TL. Business-unit-level Relationship between Employee Satisfaction, Employee Engagement, and Business Outcomes: A Meta-analysis. Journal of Applied Psychology. 2002. 87(2):268-79. 36 Wuliji T and Kundy, USAID Health Care Improvement Project and Applying Science to Strengthen and Improve Systems Project [flyer]. Available at https://www.usaidassist.org/resources/health-worker-engagement-study 37 Heiby J, 2014. 38 USAID ASSIST Project. Experience Improving HIV Services. 2014. Available at https://usaidassist.org/resources/usaid-assist-project-experience-improving-hiv-services 39 Heiby J, 2014. 40 USAID ASSIST Project. Experience Improving HIV Services, 2014. 41 Twum-Danso et al. Using Quality Improvement Methods to Test and Scale up a New National Policy on Early Post-natal Care in Ghana. Health Policy Plan. 2013 Jul 26. [Epub ahead of print]. 42 Singh et al. Impact Evaluation of a Quality Improvement Intervention on Maternal and Child Health
Outcomes in Northern Ghana: Early Assessment of a National Scale-up Project. International Journal for
Quality in Health Care 2013. 25(5): 477–487. 43 Heiby J, 2014. 44 Bryant R. Regulation, Roles and Competency Development. International Council of Nurses 2005. 45 Chiarella M and White J. Which Tail Wags Which Dog? Exploring the Interface Between Health Professional Regulation and Health Professional Education. Nurse Education Today 2013. Available at http://www.nurseeducationtoday.com/article/S0260-6917(13)00046-4/fulltext 46 World Health Organization. The World Health Report 2006. 47 McCarthy C, Zuber A, Kelley M, Verani A, and Riley P. The African Health Profession Regulatory Collaborative (ARC) at Two Years. African Journal of Midwifery and Women’s Health 2014, 8:2. 48 Insert source 49 Moran AM, Coyle J, Pope R et al. 2014. 50 McCarthy C, Kelley M,Verani A, Louis M, and Riley P. Development of a Framework to Measure Health Profession Regulation Strengthening. Evaluation and Program Planning 2014, 46:17–24. 51 McCarthy and Riley P. The African Health Profession Regulatory Collaborative for Nurses and Midwives, Human Resources for Health 2012, 10:26. Available at http://www.human-resources-health.com/content/10/1/26 52 McCarthy CF, Voss J, Verani AR, Vidot P, Salmon ME, and Riley P., Nursing and midwifery regulation and HIV scale-up: establishing a baseline in east, central and southern Africa, Journal of the International AIDS Society 2013, 16:18051. Available at: http://www.jiasociety.org/index.php/jias/article/view/18051
Final Draft – August 29, 2014 15
| http://dx.doi.org/10.7448/IAS.16.1.18051 53 Dieleman M, Gerretsen B, and van der Wilt, GJ. 2009. 54 Witter S, Fretheim A, Kessy FL, Lindahl AK. Paying for Performance to Improve the Delivery of Health Interventions in Low-and Middle-income Countries. Cochrane Database of Systematic Reviews 2012. Issue 2. Art. No.: CD007899. 55 Marquez L, Brownlee A, Molzan J, Reynolds J, Seims L. Community Health Workers: A Comparative Analysis of PRICOR-funded Studies. Chevy Chase: Primary Health Care Operations Research Project. 1987. 56 Robinson S, Larsen D. The Relative Influence of the Community and the Health System on Work Performance: A Case Study of Community Health Workers in Colombia. Social Science & Medecine 1990, 30(10):1041-48. 57 Ayele F, Desta A, Larson C. The Functional Status of Community Health Agents: A Trial of Refresher Courses and Regular Supervision. Health Policy Plan 1993, 8(4):379-84. 58 WHO, UNICEF: Joint Statement on Management of Pneumonia in Community Settings. New York: UNICEF. 2004. 59 Gilroy K, Winch P. Management of Sick Children by Community Health Workers: Intervention Models and Programme Examples. World Health Organization and the United Nations Children’s Fund (UNICEF). 2006. 60 Phillips J, Bawah A, Binka F. Accelerating Reproductive and Child Health Programme Impact with Community-based Services: The Navrongo Experiment in Ghana. Bulletin of the World Health Organization 2006, 84(12):949-55. 61 Teklehaimanot A, Kitaw Y, Yohannes A, Girma S, Seyoum S, Desta H, et al. Study of the Working Conditions of Health Extension Workers in Ethiopia. Ethiop J Health Dev 2007, 21(3):240-45. 62 Meyer-Capps J, Carruth M, Nitkin T, Doty D, Dechasa S. Grand Cape Mount Child Survival Program: Improved Child Health in a Transitional State through IMCI, October 2006 - September 2010; Final Evaluation Report. Medical Teams International and USAID, 2010. 63 Nair N, Tripathy P, Prost A, Costello A, Osrin D. Improving Newborn Survival in Low-income Countries: Community-based Approaches and Lessons from South Asia. PLoS Medicine 2010, 7(4). doi: 10.1371/journal.pmed.1000246. 64 Rahman S, Ali N, Jennings L, Seraji M, Mannan I, Shah R, et al. Factors Affecting Recruitment and Retention of Community Health Workers in a Newborn Care Intervention in Bangladesh. Hum Resour Health 2010, 8(12). doi: 10.1186/1478-4491-8-12. 65 Sadler K, Puett C, Mothabbir G, Myatt M. Community Case Management of Severe Acute Malnutrition in Southern Bangladesh. 2011. Boston: Tufts University, Feinstein International Center. 66 Kroeger A, Meyer R, Mancheno M, González M. Health Education for Community-based Malaria Control: An Intervention Study in Ecuador, Colombia and Nicaragua. Trop Med Int Health 1996, 1(6):836-46. 67 Amare Y. Non-financial Incentives for Voluntary Community Health Workers: A Qualitative Study. Working Paper No. 1. The Last Ten Kilometers Project 2009.
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68 Crigler L, Boucar M, Sani K, Abdou S, Djibrina S, Saley Z. 2012. The Human Resources Collaborative: Improving Maternal and Child Care in Niger. Final Report. Published by the USAID Health Care Improvement Project. Bethesda, MD: University Research Co., LLC (URC). 69 The World Bank 2013. 70 Deci EL. 1975. Intrinsic Motivation. New York. Plenum Press. 71 Delfgauuw J, Dur R. Incentives and Workers’ Motivation in the Public Sector. Economic Journal 2008. 118:171-91. 72 Prendergast, C. The Motivation and Bias of Bureaucrats. American Economic Review 2007. 97:1. 73 Francois, P. Public Service Motivation as an Argument for Government Provision. Journal of Public Economics 2000. 78:3, 275 – 299. 74 Leonard KL. Serneels P. Brock JM. 2013. Chapter 14. Intrinsic Motivation. The Labor Market for Health Workers in Africa: A New Look at the Crisis. The World Bank. Washington, DC. 75 Woolhandler S, Ariely D, Himmelstein DU. Why Pay for Performance May Be Incompatible with Quality Improvement. BMJ 2012, 345:e5015. 76 Bénabou and Tirole, 2003. 77 Leonard KL, 2013. 78 Deci E, Koestner R, Ryan R. A Meta-analytic Review of Experiments Examining the Effects of Extrinsic 79 Leonard KL, 2013. 80 Miller and Babiarz, 2013. 81 Dieleman M and Harnmeijer JW, 2006). 82 Leonard KL, 2013. 83 Miller G, Babiarz KS. Pay-for_Performance Incentives in Low-and Middle-Income Country Health Programs. Working Paper 18932. 2013. National Bureau of Economic Research, Cambridge, MA.