Goals and Objectives

The HRH Project sought to increase the availability and utilization of HR policies and procedures at every level of the health system. Specific objectives were to:

• Ensure the presence and accessibility of HR manuals at all health service management offices and facilities,

• Foster consistent application of HR policies and procedures by managers, and

• Improve the recruitment, orientation, deployment, development, and performance management of health workers.

Compliance with policies and procedures during day-to-

day Human Resources Management (HRM) activities has

increased as a result of a multi-pronged strategy to raise

awareness of Human Resources (HR) policies, to make

HR policy documents readily available, and to build HR

capacity through training and mentoring.

Need for ActionHuman resources (HR) policies set expectations for employees’ behavior in the workplace. Lack of awareness of these policies, or failure to consistently implement them, leads to dissatisfaction, demotivation, low productivity, and attrition among health workers, thereby compromising the quality of health care service delivery. A rapid assessment of Ethiopia’s public health system in 2012/13 found that HR policies were not widely communicated: there was no orientation program to familiarize new staff with HR policies and procedures and copies of HR manuals were either unavailable or inaccessible at most administrative offices and health facilities. Instead, managers relied on a mix of intuition, memory, and experience to make HR decisions. Basic human resources management (HRM) functions – including recruitment, compensation, deployment, discipline, and promotion – were marred by inconsistencies, irregularities, and lack of transparency.

To improve the availability and utilization of HR policies and procedures, the Government of Ethiopia sought technical and financial support from the USAID-funded and Jhpiego-led Strengthening Human Resources for Health (HRH) Project (2012 - 2019). The goal of the HRH Project was to improve health outcomes for all Ethiopians by improving human resources for health management; increasing the availability of midwives, anesthetists, health extension workers (HEWs), and other essential health workers; improving the quality of education and training of health workers; and generating evidence to inform HRH policies and programs.

Improving Human Resources Management Policies and Procedures in EthiopiaAchievements, Lessons Learned, and the Way Forward

Key Successes

• More than 6,000 copies of HR policy packages distributed to regional, zonal and woreda health offices and health facilities.

• Federal and regional HR staff trained for consistent and fair application of HR policies and procedures.

• Multisectoral national and regional HRH forums were created where HR policies became major topics of discussion, awareness creation and collaboration.

• By June 2017, RHBs had conducted orientations for 13,282 new employees and given each a copy of the Employee Handbook.

Training staff to consistently and fairly apply HR policies and procedures. With technical and financial support from the HRH Project, the FMOH conducted a 7-day training on Federal Civil Service policies for HR managers and staff at the federal level, and 10 RHBs conducted 3- to 5-day orientations on the HR Policy Package for regional managers and staff. HR policies and procedures were also the subject of a module in the HRM In-Service Training package, allowing trainers to share positive experiences with HR policy utilization and application, and to reinforce compliance with policies and procedures. During follow-up visits, 1,489 trainees received coaching to improve their utilization of the HR Policy Package. This was also a focus area for supportive supervision and review meetings.

Developing an employee orientation system. The HRH Project collaborated with the FMOH to develop a model Employee Orientation Manual (also known as an Employee Handbook) and provided technical and financial support for RHBs to adapt the handbook to their regional contexts. The RHBs began funding orientations for new hires, using an agenda and content developed by the HRH Project. By June 2017, RHBs had conducted orientations for 13,282 new employees and given each a copy of the Employee Handbook. In addition, nine RHBs have produced leaflets and newsletters on HR policies of special interest, such as recruitment, disciplinary and grievance procedures, and transfers, and distributed over 2,500 copies to health offices, facilities, and staff.

Coordinating efforts to address cross-cutting HR policy issues. Some HR policy issues, such as remuneration, education, and qualifications, involve multiple sectors. The HRH Project worked closely with the FMOH and RHBs to agree on a framework for collaboration and bring stakeholders together in national and regional HRH forums, where HR policy was a major area of discussion. The forums were designed to improve communication, coordination, and collaboration among multiple stakeholders, including health, civil service, and finance bureaus, training institutions, professional associations, and other project partners.

Strategies and Interventions

Assessing gaps in HR policies and procedures. In 2013, the HRH Project conducted a participatory HRM Capacity Assessment with the Federal Ministry of Health (FMOH), 11 regional health bureaus (RHBs), and the Food, Medicine and Health Care Administration and Control Authority (FMHACA) to identify gaps in HRM systems, policies, and practices. Some of the key findings were that HR policy manuals were not available or accessible, HR managers and staff did not receive any training on how to apply HR policies and procedures, there was no formal orientation program for new hires, and managers did not adhere to rules and regulations on recruitment, deployment, compensation, and discipline. The results of the assessment were used to identify priority areas for intervention and develop an action plan in each region.

Raising awareness about the importance of HR policies. Advocacy to improve HR policies and practices in the public health sector raised awareness of the importance of HR policies at all levels of the health system. HRH Project staff seconded to the regions played a vital role in promoting RHB ownership and buy-in for improved HR policies and practices. Regional HRH forums also encouraged discussion of HR policies among stakeholders and facilitated buy-in.

Compiling and distributing a compendium of HR policies. HRH Project staff worked with regional HR officers to collect national and regional HR policy documents, including rules and regulations, proclamations, directives, guidelines, and standard operating procedures. These were compiled, printed, and bound together as regional HR Policy Packages. Print copies were distributed to all regional, zonal, and woreda health offices and all health facilities to serve as a reference. Electronic copies were provided to staff during trainings, mentorships, supportive supervision, and performance review meetings. By June 2017, RHBs had distributed 6,317 print copies of HR Policy Packages.

Consistent adherence to HR policies and practices has improved employee retention and motivation. In Amhara and Oromia, appropriate application of transfer and promotion policies based on employee competence, experience, and preferences has resulted in the transfer of over 1,000 health professionals to zonal and primary hospitals without complaint, while increasing their motivation and intention to stay in the public health sector.

Performance of routine HR functions, such as recruitment and deployment of health workers, has markedly improved, but turnover of trained HR staff is a challenge. Compliance with policies and procedures during day-to-day HRM activities has increased as a result of a multi-pronged strategy to raise awareness of HR policies, to make HR policy documents readily available, and to build HR capacity through training and mentoring. In some regions, however, HR policies do not clearly address important issues such as insurance and compensation for work-related accidents and disabilities. In addition, high turnover of trained HR leaders and staff, who are familiar with operational rules and regulations, poses a challenge.

The orientation of newly hired health workers has become standard practice, but mechanisms to manage employees’ departure from the organization are lacking. The orientation of new employees has been institutionalized in all regions and across all levels of the health system. These induction and orientation processes have facilitated the smooth integration of new health workers into the public health system. However, there are no formal procedures to handle the transition when employees leave the organization or change positions. In the absence of a mechanism to turn over documents to a supervisor or successor, departing HR officers tend to take valuable materials with them for their personal use, including HR policy documents.

Results and Lessons Learned

HR managers at the zonal, woreda, and facility levels recognize the importance of HR rules and regulations in safeguarding the interests of the organization and the staff. Ownership and commitment from the FMOH and RHBs were key to achieving the HRH Project’s goals in the area of HR policy and practice. Their support, along with training and orientations on the HR Policy Package, raised awareness of the importance of HR policy and procedures at lower levels of the health system. Recognizing the importance of HR policies, some woreda health offices took the initiative to disseminate HR policies to health workers during general staff meetings and review meetings, as well as with leaflets and flyers.

The HR Policy Package is readily available and easily accessible at regional and zonal levels of the health systems but less so at lower levels. RHB budgets have not been sufficient to print sufficient hard copies of the HR Policy Package to meet demand. Hence, HR policy documents are in short supply, or sometimes completely absent, at woreda health offices and health facilities. Lack of shelves or a mini-library for the proper placement of HR policy documents also limits access by staff.

Key Takeaway

The ready availability of HR policies at regional and zonal offices has reduced frustrating irregularities in recruitment, deployment, transfers, promotions, compensation, and benefits, such as delayed payment of duty and professional allowances.

“Health workers’

recruitment and deployment

at the woreda health

offices used to be open

for corruption. However,

it improved significantly

in the last four years, with

HRM training and follow

up by the RHB and the

HRH Project. Now, we

strictly follow the regional

civil service rules and

regulations to hire health

workers which increased

speed, transparency and

accountability”.

Redwan HassenHRM Officer

Woreda Health Office Silte Zone

SNNPR

Next Steps

1Promote adherence to HR policies and

procedures at the woreda and facility levels by

offering training, mentorship, and supportive

supervision to lower level HR staff and distributing print

and electronic copies of HR policy documents to woreda

health offices and health facilities.

2 Enhance access to HR policy documents by

increasing regional budget allocations to print

hard copies, provide appropriate shelves, and

support mini-libraries and also to convert important

regional policy documents into electronic formats.

3 Encourage continued stakeholder discussion on

HR policy issues at national and regional HRH

forums to develop solutions.

4 Institutionalize handover mechanisms to ensure

that HR officers leave policy documents in place

when they depart to help their successors take

over their responsibilities.

This program learning brief was prepared by Mesfin Kifle and Asfaw Demissie and reviewed by Adrienne Kols and Tegbar Yigzaw.

This program learning brief is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of the Cooperative Agreement No. AID-663-A-12-00008 Strengthening Human Resources for Health (HRH). The contents of this publication are solely the responsibility of Jhpiego and do not necessarily represent the official views of USAID or the United States Government.

For more information: Kirkos Sub-city, Woreda 02/03 | House No. 693 | Wollo Sefer/Ethio-China Street, near Mina Building | P.O. Box 2881 | Code 1250 Addis Ababa, Ethiopia| Tel: +251(0)115-502-124 | Fax:+251(0)115-508-814 | https://www.jhpiego.org/what-we-do/human-resources-health/