Health workforce performance: developing the bundles of human resources/health systems

strategies

National workshop 2[location, dates]

Session overview

• Interventions to improve staffing levels• Understanding individual staff performance• Areas for consideration for managing

workforce performance• The concept of ‘bundles’ of strategies• Steps for developing bundles• Planning process and tools

PERFORM’s definition of health workforce performance

1. Both collective and individual performance2. Clinical, managerial and support staff3. Availability of staff

– Right number, competencies, in right place– Levels of absence

4. Quality and quantity of work output

Interventions to improve staffing levels

Increase entrants Reduce losses

Change skills mix(inc. volunteers)

Improve distribution

Develop partnerships (MoH, other sectors, NGOs, FBOsnon-formal providers)

Improve productivity

HS strategies

HR strategies

Understanding individual staff performance

Effort Performance

Intrinsic

Reward/Sanction

Extrinsic

Direction Competencies

Resources

Jobsatisfaction

Praise, incentives,

etc

HR strategies

HS strategies Fairness

Areas for consideration for managing workforce performance

• Availability (posts filled/distribution/staff present)• Direction (on what staff should do and how well they are

doing)• Competencies (appropriate skills, knowledge and attitudes to

carry out the tasks assigned)• Rewards and sanctions (to influence their behaviour and

therefore their performance)• Health systems (other building blocks) including resources:

– equipment, drugs and supplies– Infrastructure (buildings)– Transport

The concept of ‘bundles’ of strategies

• no single magic bullet for a sustainable solution• coordinated ‘bundle’ of HR strategies have

greater impact that individual strategies• Avoid ‘deadly combinations’ of HR practices• Add wider health systems strategies to the

‘bundles’• effectiveness of the bundles depends on

organisational context

Bundles example in DHMT manual

Steps for developing bundles

Key steps for developing bundles

•Identify problems to be addressed in problem tree (and other related areas)

•Review options of strategies by performance area (see Appendix 1)

•Put selected strategies in planning table and complete all columns

Planning process and tools

Tools & guides for planning the bundles of HR/HS strategies

• Table with sample strategies to assist planning the HR/HS bundle of strategies - for review before planning

• Planning table for HR/HS strategies (blank) – for completion by DHMTs

* On memory stick

Table with sample strategiesA. Performance area/broad objective

B. Strategy C. Sample activities

D. Expected change

E. Possible indicators for M&E

F. Link to/conflict with other HR/HS strategies

G. Comments

1. Availability

           

Increase # staff in post

Additional recruitment

Advertise for specific vacant posts

 

More staff available

 

% posts vacant by cadre and facility type

Induction

Workforce planning

 

Which staff can DHMT recruit?

  Attraction incentives

Funding initial training with bonding

More applications for jobs

 

# applications/post by cadre

Ensure staff are also being retained

Check whether the main problem is attraction or retention

  More strategies …          Improve distribution between rural and urban facilities

Attraction incentives for rural areas only

Funding initial training with bonding

More staff available in rural areas

% posts vacant by cadre in rural districts

% trainees who complete the bond

 

Workforce planning

Training takes staff away from the workplace; may need to stagger training

  Retention incentives for rural areas

Identify financial and/or nonfinancial incentives that can be funded from the district budget

More staff available in rural areas

% posts vacant by cadre in rural districts

% trainees who complete the bond

 

Less money available in operational budget for equipment and supplies for staff to work with

Note that ‘non-financial incentives still cost money

More objectives …

More strategies …          

Table with sample strategiesA. Performance area/broad objective

B. Strategy C. Sample activities

D. Expected change

E. Possible indicators for M&E

F. Link to/conflict with other HR/HS strategies

G. Comments

1. Availability

           

Increase # staff in post

Additional recruitment

Advertise for specific vacant posts

 

More staff available

 

% posts vacant by cadre and facility type

Induction

Workforce planning

 

Which staff can DHMT recruit?

  Attraction incentives

Funding initial training with bonding

More applications for jobs

 

# applications/post by cadre

Ensure staff are also being retained

Check whether the main problem is attraction or retention

  More strategies …          Improve distribution between rural and urban facilities

Attraction incentives for rural areas only

Funding initial training with bonding

More staff available in rural areas

% posts vacant by cadre in rural districts

% trainees who complete the bond

 

Workforce planning

Training takes staff away from the workplace; may need to stagger training

  Retention incentives for rural areas

Identify financial and/or nonfinancial incentives that can be funded from the district budget

More staff available in rural areas

% posts vacant by cadre in rural districts

% trainees who complete the bond

 

Less money available in operational budget for equipment and supplies for staff to work with

Note that ‘non-financial incentives still cost money

More objectives …

More strategies …          

Choose broad objective(s)

Choose relevant performance

area(s)

Choose strategies to

achieve objective(s)Choose

complete set of activities to

support strategies

Check ‘expected change’; does it

address the problems

identified?

Identify possible indicators for

measuring this change

Identify links of conflict with other HR/HS

strategies (new of existing)

Review comments –

anything helpful there?

Steps for identifying and selecting appropriate HR/HS bundles

A. Select relevant performance areas for your problem. Review and select appropriate objectives.

B. Review and select appropriate strategies*.C. Review sample activitiesD. Check that the expected change given in the table fits

with what you want to achieve. E. Review Link to other HR/HS strategies to identify other

strategies to be added to the ‘bundle’; or identify conflicts

F. Review comments

* Note: some strategies may serve several different purposes e.g. supervision may be useful for improving skills and provision of feedback on performance

Planning tableA. Broad objective

B. Strategy C. Sample activities

D. Expected change

E. Possible indicators for M&E

F. Link to/conflict with other HR/HS strategies

G. Comments

Next steps

• Evening activity: Read section 4 of the DHMT manual on Selecting bundles of HR/HS strategies to improve workforce performance (including the 10-page table in Annex 1)

• Tomorrow:– Develop a bundle of HR/HS strategies for improving

workforce performance using template provided– Peer review of bundle by other district teams– Refining bundles based on feedback