Human Resources for Health

ISSUE

APPROACH

A skilled health workforce is the backbone of health service delivery, yet many low- and middle-income countries face a chronic health workforce shortage and lack the systems necessary to recruit, train, and deploy health workers where they are most needed. CHAI works with governments to address this massive shortage and produce high quality, sustainable healthcare systems.

 

The Issue

A skilled health workforce is the backbone of health service delivery, yet the world is facing a massive shortage. This lack of skilled health workers is especially acute in Africa, which bears over one-third of the global burden of maternal, newborn, and childhood disease and over two-thirds of the world's HIV-positive population, yet is home to less than 3 percent of the world’s health workforce.

The Approach

CHAI partners with governments to understand the root causes of health workforce crises to develop holistic strategies that strengthen government capacity to train, recruit, manage, and deploy the health workforce necessary to deliver high-quality, sustainable healthcare services.

Human Resource for Health

Issue

Health workers are the backbone of global health delivery, yet the world is facing a massive shortage. This lack of skilled health workers is especially acute in Africa, which bears over one-third of the global burden of maternal, newborn, and childhood disease and is home to over two-thirds of the world¹s HIV-positive population, yet has less than 3 percent of the world’s health workforce. Conventional aid programs focus on “vertical” disease specific programs without building the foundational health system.

The chronic health workforce shortage in low and middle income countries is compounded by the limited capacity of governments to coordinate investments in national-level strategies. Additionally, weak linkages between Ministries of Health and the education sector limit the capacity of governments to effectively plan for, train, recruit, and deploy health workers, ultimately compromising the quality and efficiency of health services. The inequitable distribution of health services is particularly acute in rural communities; approximately half of the global population lives in rural areas, but is served by less than a quarter of the total physician workforce.

Approach

CHAI’s programming in health workforce aims to assist partner countries to build the health education infrastructure and health workforce management capacity necessary to ensure high quality, sustainable healthcare systems.

CHAI’s programming strategically focuses on: generating evidence needed to prioritize high-impact national plans and investments to dramatically expand health workforces, improving the quality of health worker education and training, improving efficient deployment of health workers to rural and underserved areas, and building government human resources management capacity. To do this, CHAI analyzes country-specific factors contributing to health workforce shortages, supports governments to convene and coordinate national and international partners and donors and supports appropriate resource mobilization efforts for targeted interventions. CHAI works with governments to create sustainable programs that align with the national plans and strategies, ultimately leading to increased access to care and improved population health.

Change

CHAI-led health workforce analyses in Zambia (2009), Malawi (2010), Lesotho (2010), Rwanda (2011), Nigeria (2013), and Liberia (2014) have armed government partners with the data and tools to design effective health workforce policies and advocate for strategic investment of government and donor resources. With its government partners, CHAI has effectively designed and managed national-level programs that improve the quality, quantity, and distribution of health workers. Major accomplishments include:

  • In Zambia, between 2008-2011, CHAI worked with the Ministry of Health to develop a 5-year US$60 million plan to double the national training capacity of the country by recruiting necessary faculty in priority health areas, upgrading infrastructure to accommodate increased enrollment, and working with the General Nursing Council to develop the necessary training and accreditation tools to improve and assure the quality of training programs; CHAI also worked with the General Nursing Council to design and implement a clinical-based mentorship program to strengthen the skills of existing nurses and midwives. Building on these successes, CHAI assisted the Ministry of Health to design and implement training programs for medical specialists (in Surgery, Obstetrics and Gynecology, Internal Medicine, and Pediatrics) to be deployed to rural and underserved areas; more than 308 specialists will receive training in 2016 and an additional 248 specialists are expected to receive training by the end of 2017.
  • In Malawi, CHAI has worked closely with the Ministry of Health to develop a 5-year US$20 million program (2013-2018) to significantly increase the number of health workers providing emergency obstetric care and family planning services, while implementing evidence-based strategies to improve health worker retention and management. At the request of the government, CHAI has helped manage scholarships for more than 725 nursing students across four disciplines (nurse midwife technician, community midwife assistant, registered nurse midwife, and diploma nurse) and coordinated additional training for 22 nurse educators and 39 clinical preceptors. CHAI has also worked to manage infrastructure improvements at 11 training sites, including a maternity ward to increase access to essential maternal health services and improve clinical exposure for nursing and midwifery students.
  • In Lesotho, CHAI worked to design and implement a training program to scale-up the production of nurses delivering basic and specialized care, especially at rural service delivery sites for patients living with HIV/AIDS (2012-2014). At the request of the government, CHAI coordinated investments at six schools of nursing and midwifery, facilitated the development of a mentorship program to improve the quality of practicing nurses in the area of HIV care, and consulted the Ministry of Health on the allocation of investments and distribution of health workers. CHAI successfully transitioned the management of these programs to the government.
  • In Rwanda, CHAI supported the government to establish an innovative partnership with a consortium of universities – the first of its kind – that sends year-long visiting faculty to Rwanda to improve teaching and strengthen curriculum, facilitate research, provide mentorship for priority cadres. CHAI supported the Rwandan Government to mobilize US$150 million to fund the seven-year program and coordinated more than 20 academic institutions. Now in year five, the Rwanda HRH Program has enabled Rwanda faculty and public health experts to partner with more than 300 visiting faculty to launch 11 new health workforce training programs (including six medical specialty training programs, a Bachelor of Science in Midwifery program, a Masters of Science in Nursing, a Masters in Health Administration, and a Bachelors of Dental Surgery), strengthen existing training programs, mentor the next generation of medical and health faculty in the country, and launch quality improvement and assurance projects at hospitals around the country.