Optimizing health worker performance to improve health ......DAY 1: Crystal City, April 9, 2019....

DAY 1: Crystal City, April 9, 2019

HRH2030

Optimizing health worker performance to improve health care quality in low- and middle-income countries

PHOTO CREDIT GOES HERE 2

Wanda JaskiewiczProject DirectorHRH2030, Chemonics International

@HRHWanda @HRH2030Program@Chemonics


Lisa ManiscalcoHealth SpecialistOffice of Health SystemsUSAID Bureau for Global Health

@USAID @USAIDGH


Alex RoweChief of Strategic and Applied Science Unit, Malaria BranchCenter for Disease Control & Prevention (CDC)

@CDCgov @CDCglobal


Please click herefor Alex Rowe’s

HCPPR presentation

https://hrh2030program.org/wp-content/uploads/2019/04/HCPPR-phase-12-45-min-seminar-4x3-no-extra-slides-animated-v5-DC-policy.pdf

TeaBreak

Overview ofcurrent efforts onhealth workforceperformance and HSS for quality

services

Brandina Kuyere, Malawi. Credit: Michelle Byamugisha


Rachel DeussomTechnical DirectorHRH2030, Chemonics International

@Rachel_Deussom@HRH2030Program@Chemonics

Preliminary findings

HRH2030 Landscape Analysis on Enhanced

Supervision Approaches:

Best practices to improve health worker performance

and service quality

Chemonics International

10

The untapped potential of health worker supervision

• The supervision “status quo”• Limited accountability, supervisory capacity & resources• Fragmentation of private sector and community-based

workforce• Limited continuity & data integration within health

information flows

• Beyond other HSS interventions, enhanced supervision is estimated to have the highest potential impact (USAID 2017)

• How can enhanced supervision improve service quality?* Impact population health?

• What are supervision “enhancements”?

What is enhanced supervision?“A broad set of supervisory

interventions that improve provider performance through team-based,

learning approaches, including supportive supervision, the use of checklists, and in-person visits.”

– AOTC Report: USAID, 2017

* Building on evidence from: Kallander et al., 2015; Bailey et al., 2016; Webb, Bostock and Carpenter, 2016; Rowe et al., 2018.

11

Database search methodology

Databases: Popline, USAID DEC, WHO Global Health Library, Health Systems Evidence, Cochrane Database of systematic reviews, GlobalHealth & PubMed,ResearchGate, HRH Global Resource Center, mHealth compendium databases, Global Health Science & Practice, The Lancet, References from Bailey et al. 2015, Healthcare Management Information Consortium

Identification: Number of references identified through initial database search: 66,945

Search Terms: “enhanced supervision” OR “mentorship” OR “supportive” OR “team-based” OR “site-visit*” OR “coaching” OR “problem-solving” OR “check-list” OR “learn*” AND “health worker*”

• Duplicates: 298• Not related to health sector: 61,296• Not in English: 2• Intervention completed prior to 2010: 1,042• Applying further database filters: 2,608

Screening: Number of titles screened: 1,699

Eligibility: Number of titles and abstracts screened: 87

• Irrelevant to health worker supervision: 1,612

• Did not meet CASP Checklist criteria: 18• Did not demonstrate positive results: 24

Number of references excluded:

Included in landscape analysis: 45

12

HRH2030 Landscape Analysis Framework

1. Positive results? 2. Supervision enhancements? (e.g., inputs, processes)3. Scaled and/or sustained?

Source: HRH2030 2019. Adapted from GHWA 2014, Dieleman et al 2009, and informed by Campbell et al 2013.

CONTEXT INPUTS PROCESSES RESULTS

OUTPUTS OUTCOMES EFFECTS IMPACTMacro-level

Micro-level

Individual

Human resourcesTrainers, supervisor & supervisee profile(s)

Financial resourcesBudget source

Informational, technical & material resources

ModalityFrequencyLocation / FeedbackIn person, distanceService Delivery fociStructureAssessment type, # supervised, formalityData Use for Decision-MakingComplementary Intervention(s) “Enhancements”

HRH Outputs

HRH Outcomes

Population health

Maturity

Cost-effective-ness

HRH Effects Performance Productivity

HSS Outcomes

HSS Effects

Service Delivery

Type of study

Country

Health area(s)

Preliminary Findings

Tanjung Priok Health Center, Indonesia. Credit: Andi Gultom

14Source: HRH2030 2019. Adapted from GHWA 2014, Dieleman et al 2009, and informed by Campbell et al 2013.

Landscape analysis taxonomy for classifying enhanced supervision approaches


• 76% from Sub-Saharan Africa• Diverse methodologies used

• 24% case study/program report

• 22% RCT

• All focused on primary or community health care service delivery improvement

• Half dedicated to supervising CHWs

• Many disease- or program-specific

• District management team-led supervision

• Some policy-led approaches • PHC, CHWs, service equity, or task shifting

• Majority donor-funded (78% - additional

16% unspecified)

Characteristics of enhanced supervision approaches reviewed (n=45)

Cote d’Ivoire medical facility. Credit: Gildas Gbacada

16

Preliminary findings from inventory of enhanced supervision approaches (n=45)

Source: HRH2030 2019. Adapted from GHWA 2014, Dieleman et al 2009, andinformed by Campbell et al 2013.

17

Preliminary findings from inventory of enhanced supervision approaches (n=45)

Source: HRH2030 2019. Adapted from GHWA 2014, Dieleman et al 2009, andinformed by Campbell et al 2013.

PROCESSES Modality:• Quality improvement (QI) methodsFeedback:• Multi-level, timely feedback loops Data use for decision-making:• HMIS interoperabilityComplementary interventions:• Clinical mentoring • Community engagement

INPUTS Informational resource:• HMIS / health system performance data

RESULTS

Outputs, Outcomes or Effects:• Noteworthy achievements

Impact:• Scaled up and/or sustained over time

18

Supervision enhancement: Use HMIS to inform and prioritize sites and/or service areas

HMIS + clinical mentoring

Achieved task-shifting among mid-level providers for higher-quality HIV and TB services in Uganda

Naikoba et al. 2017

HMIS + mHealth app + weekly calls + job aid

Facilitated performance feedback for CHWs delivering nutrition services in India, who were more motivated, self-efficacious, and solved more technical problems

Kaphle, Matheke-Fischer and Lesh, 2016

HMIS + mHealth app + checklist + QI

Improved quality of care for private sector & CHW providers in malaria and FP services across Africa and Asia

Lussiana et al. 2016

HMIS + mHealth app + mentoring

Increased CHW data use, productivity, and accountability for adhering to iCCM / child health standards of care

Biemba et al. 2017

Potential for cost-effectiveness(Campbell et al., 2014; Biemba et al., 2017)

19

Supervision enhancements: Quality improvement (QI)

Of the 16 supervision approaches having QI as the primary modality:

Outputs • 63% [10] improved HRH skills, knowledge and attitudes

Outcomes • 69% [11] improved HRH competence• 50% [8] documented improved quality

standardsEffects • 81% [13] improved HRH performance

and/or productivity• 56% [9] improved the quality of care

Impact • 56% [9] improved population health … compared to 17% [3/18] of HR management as primary modality

20

Supervision enhancements:Digital data integration & multi-level feedback loops

District-level dashboards

• Promotes efficiency• Automates some

supervisory tasks

Manzi et al., 2012Agarwal et al., 2016

Interprofessional or network support

• Reinforces formal visits and promotes self-efficacy

Okuga et al., 2015Mkumbo et al., 2014

Data review meetings & facility improvement plans

• Improved health worker competencies in data-driven decision-making, including for CHWs

Aikins et al., 2013Manzi et al., 2018

21

Supervision enhancements:Complementary interventions

Clinical mentoring

• Addresses pre-service education and performance gaps

• Where continuing professional development is limited; for enhanced/new scopes of practice

Anatole et al., 2013 Manzi et al., 2014Som et al., 2014Ajeani et al., 2017

“Whole-of-system” approach

• Strengthens supervisor capacity• Strengthens health system enabling environment,

safety, equipment and supplies

Green et al., 2014Deussom et al., 2014 Battle et al., 2015 Gueye et al., 2016Kok et al., 2018

Community engagement

• Provide feedback on service quality / utilization, especially for CHWs

• Problem-solve; maintain or improve facility; advocate• Appropriate where there are issues of accessibility,

perceived quality, trust, and/or utilization

Okuga et al., 2015 Gueye et al., 2016

22

Discussion & next steps

• More country-led assessments of more advanced approaches; longer evaluation periods

• Limited detail of implementation approach, resource requirements• Limited ability to compare supervision enhancements in different

contexts, with different objectives

• Using the conceptual framework and taxonomy to review supervision enhancements (including the HCPPR) could help strengthen the evidence base & further define trends

Data-driven prioritization for supervision | QI methods | Digital data integration | Effective feedback loops | Community engagement | Clinical mentoring |

Strengthening supervisors and health system enabling environment

THANK YOU

Maliana Community Health Center staff, Timor-Leste. Photo credit: Rachel Deussom

Rachel Deussom [email protected]

Acknowledgements:Doris Mwarey, Katy Gorentz, Leah McManus, HRH2030 Core Team


Kathleen HillTeam LeadUSAID Maternal Child Survival Program (MCSP) Jhpiego

@MCSPglobal @Jhpiego

Improving Health Worker Performance in multi-faceted QI Initiatives

Kathleen Hill, M.D., M.P.H. Maternal Health Team Lead, MCSP/Jhpiego

Optimizing Health Worker Performance for Improved Health Care QualityWashington D.C., April 2019

Donabedian Quality of Care Framework

* Skilled motivated health workers are one important health system input and contributor to care processes and outcomes

I

Inputs• Skilled, motivated

workers• Commodities• Policy, guidelines• Finances• Infrastructure

Care ProcessesCompetent People-

Centered Care

OutcomesPeople-

Centered and Health

Source: Donabedian Framework for Measuring quality of care

WHO Quality of Care Framework for Childbirth

Source: BJOG 2015

The MNCH QoC Network – launched in 2017Goals• Reduce maternal and newborn deaths and stillbirths in

participating health facilities by 50% over five years• Improve experience of care

10 First Wave Countries: Bangladesh, Côte d’Ivoire, Ethiopia, Ghana, India, Malawi, Nigeria, Sierra Leone, Tanzania, Uganda

12 “New” Countries participated in Addis Meeting: Botswana, Cameroon, Chad, DRC, Kenya, Liberia, Mozambique, Namibia, Niger, Senegal, South Sudan, Sudan

Health Worker QI/Health Systems Capabilities –historically neglected

Many managers and health workers lack QI skills and confidenceDiscrete QI competencies are needed by actors at distinct system levels to:

Develop national quality policy/strategyDesign RMNCH improvement work for scaleManage district/region-wide improvement (support to front-line teams)Improve care at the front-lines, including managing change and regularly measuring quality of care

Sierre Leone – QoC Network country: Conceptualizing clinical mentorship, QI coaching, Supervision

30

*Source: Sierre Leone Presentation QoC Network Meeting, Addis, 2019

MCSP Works at Global and Country Level in 30+ Countries…

To support global RMNCH efforts, including the WHO multi-country MNCH QoC NetworkTo support government and partners to improve quality of RMNCH care at scaleTo build country capacity across system levels to improve and sustain quality care - and to improve care continuously

Global leadership

Country implementation

National leadership

Regional and district

management

Service delivery

Systems Approach to Achieve Reliable Delivery of Quality Care for Every Person Every Time

System wide action: National – quality policy, strategy, governanceRegional/district – Management, leadership of qualityService delivery – facility, community

Leveraging of existing structures and processes; context mattersEngaging Community and civil society

Improving Quality of Maternal and Newborn Care in Nigeria –Ebonyi and Kogi States

Key Activities at National Level

Creation of first-ever National RMNCH QI Technical Working Group:National RMNCH QoC Policy & Strategy - building on WHO QoC frameworkParticipation as first-phase country in WHO QoC MNCH network

Development of operational roadmap, specifying national, state, LGA and facility-level activities

Improving RMNCH Care in Ebonyi & Kogi States: Key Approaches (sub-national level)

Facility level - 91 Primary Health Centers and Hospitals • QI team work – regular meetings• Change management targeting critical

quality gaps• Routine measurement & analysis of

prioritized quality measures• Strengthening facility readiness • Regular shared learning across sites

State / District Managers• State-wide RMNCH improvement strategy • Phased improvement aims, quality measures• Capacity-building for QI/measurement and

clinical skills – managers, facility teams• Refining of established state integrated

supportive supervision processes• Investments in pre-service education

35

KogiEbonyi

Improving Woman-centered Intrapartum CareMonitoring BP, fetal heart rate; partograph use; prophylactic uteronic(N=27,643 total deliveries in 91 facilities)

0

10

20

30

40

50

60

70

80

90

100%

of w

omen

Month

% of deliveries for which partograph was used% of women who delivered and uterotonic given within 1 min of delivery of last baby% of women with blood pressure measured during labour% of women with documented fetal heart rate (FHR) during labour

Data Source: MCSP quality of care dashboard (DHIS and additional data)

Illustrative changes:• Re-organizing care

pathways to be more woman-centered and to expedite timely care

• Drug-revolving scheme, buying essential medications from pharmacies to sell to patients at a fair price

• Changes to ensure privacy for women in high-volume facilities

• Targeting additional support to lower-performing facilities

Improving Early Postnatal Care for Newborns: Skin to Skin, early Breastfeeding, Chlorhexidine Gel to Umbilical Cord

(N=27,643 total deliveries in 91 facilities)

Data Source: MCSP quality of care dashboard (DHIS and additional data)

0

10

20

30

40

50

60

70

80

90

100%

of n

ewbo

rns

Month

% of newborn babies put in skin-to-skin contact with mother% of newborn babies put to mother's breast within 30 minutes of birth% of newborn babies with Chlorhexidine gel applied to cord

Illustrative changes:• Preparing for delivery

with all commodities ready in delivery room

• Creating & sustaining hand-washing corners

• Introduction of chlorhexidine

• Establishing protected, stocked corners for immediate care of small sick newborns

Improving Quality of Maternal and Newborn Care and Postpartum Family Planning Services in

Madagascar

National level – policy, pre- and in-service curricula16 regions, 80 districtsFacilities supported - 826

753 primary level facilities (CSBs)63 hospitals

Population served: 17,391,085

Multi-faceted quality improvement interventions across regional, district and facility levels to improve RMNCH care in 763 PHCs and 63 Hospitals

Support to regional/district managers, 250 clinician trainers/mentorsto build clinical skills of 1,450 providers in 822 health facilities

• Competency-based training in low, repeating doses (on- and off-site)

• Regular reinforcement of MNH and PPFP skills via mentoring and supportive supervision (blended in-person and mobile)

• Establishment of Skills labs in 55 districts• Donation of equipment and materials to

health facilities (including anatomic models for peer-supported simulated practice)

MOH district teams supported to supervise and mentor facility teams to implement QI interventions to improve RMNCH services

Facility teams supported to achieve common priority improvement aims by:

•Analyzing underlying contributors to critical quality gaps•Identifying and testing sustainable changes to overcome gaps•Calculating and analyzing trends in quality indicators using dashboard•Sharing learning across sites

-

10

20

30

40

50

60

70

80

90

100

Aug Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun

2015 2016 2017 2018

% o

f wom

en

Month

Improved Antenatal Care Processes in 513 PHCs: increased proportion of women screened for PE/E with a blood pressure check

(N = 1,002,989 total ANC visits in which women’s BP checked)

Illustrative improvements:• Reorganizing patient flow and care pathways• Measuring and documenting blood pressure

for every pregnant woman • Stocking and monitoring essential

commodities and medications in ANC area• Tracking BP measure on standardized

dashboard

Improved uptake of Postpartum Family Planning before discharge

(N = 203,213 total women delivering in 576 CSBs)

*does not include lactation amenorrhea methodIllustrative improvements:• Reorganizing postnatal care• Provision of PPFP

counselling in ANC, early labor and after delivery

• Improving counselling methods, patient materials, and provider skills

• Stocking FP methods in maternity postpartum area for easy access

8% 8%

16% 15%

20%

25%

22%

19% 20% 21%

T1 T2 T3 T4 T1 T2 T3 T4 T1 T2

2016 2017 2018Quarter

Improved outcomes in 513 PHCs: decreasing institutional maternal mortality ratio and fresh stillbirth rate (2015-2018)

0

50

100

150

200

250

T3 T4 T1 T2 T3 T4 T1 T2 T3 T4 T1 T2

2015 2016 2017 2018

MM

R (

per

100,

000

deliv

erie

s)Maternal mortality ratio in CSBs

(N = 183,483 total women delivered and 151 total maternal deaths)

0

2

4

6

8

10

12

14

16

18

T3 T4 T1 T2 T3 T4 T1 T2 T3 T4 T1 T2

2015 2016 2017 2018

Fres

hst

illbo

rnra

te (

per

1,00

0 bi

rths

)

Fresh stillbirth rate in CSBs (N = 183,483 total newborns [live and stillborn], including 2,035 total

fresh stillbirths)

Improved outcomes in 5 hospitals: decreasing hospital newborn mortality rate 2015-2017

(N = 9,321 live births; 211 pre-discharge newborn deaths in five regional hospitals)

Illustrative improvements:• Mapped and redesigned

patient care pathways • Enhanced coordination

across departments to accelerate provision of care

• Strengthened compliance and adherence to national guidelines

• Introduced and maintained resuscitation equipment where deliveries happen (operating / delivery room)

0

5

10

15

20

25

30

35

40

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2

Year 1 Year 2 Year 3

Pre-

disc

harg

e N

MR

Quarter

Reflections….recommendations

• Promote favorable policy, effective governance and partnerships across system levels

• Leverage local sustainable structures and processes to greatest extent possible

• Embed health worker capacity-building in broader QI efforts

• Build clinical and QI skills (and other skills per health worker cadre and need)

• Promote regular opportunities to share learning –motivates health workers and accelerates improvement across sites

• Invest in quality pre-service education and continuing professional development – “fit for purpose workforce”

Thank You

Learn more at: www.mcsprogram.org

Twitter.com/MCSPglobal

Facebook.com/MCSPglobal


Luigi NuñezMonitoring AdvisorMalaria and WASH Population Services International (PSI)@PSIimpact

Health Network Quality Improvement System (HNQIS):Using DHIS2 for strategic health worker performance supportLuigi Nuñez9 April 2019

PSI Global Strategy

Leverage digital technology to ensure Sara can access simple, quick, affordable, lasting and

high-quality primary care

Leveraging market research - Where do people seek care?

Nigeria 2013Kinshasa, DRC 2013 Madagascar 2013 Uganda 2013Kenya 2014Tanzania 2014

Proportion of antimalarials distributed to consumers (ACTWatch)

To increase health impact, go where the people go.

The health care system is extremely diverse and managing health workers is a complex effort because

of the size.

Health Network Quality Improvement System (HNQIS)

Assess

Monitor

Plan

Improve

Targeting support based on where it is needed most and where it will have most impact

• Android-based tool to make supportive supervision more efficient

• DHIS2-based

• Offline capabilities

• Tailored to health supervisors’ catchment area

• Leveraged learnings from PMI’s MalariaCare project to address the limitations of past supervision tools, such as EDS

Improved health outcomes

Provider Quality at Scale

Improved Provider PerformanceImproved allocation of supervision resources

Repeated assessments

against standards

Tailored, real-time feedback

Frequency of visits targeted to QoC &

client load

GOAL

Long term outcome

Intermediate outcome

Outputs

Client Load

Quality score

XX%

XX%

XX%

Low High

+ 1 month+ 3 months

+ 6 months

Automated schedulingPLANHNQIS

Targeting based on where support is

needed most ANDwhere it will have

most impact

Automated scheduling

Based on a literature review of existing supportive supervision tools, this represents a shift from the application of other support supervision tools

HNQIS

Client Load

Quality score

XX%

XX%

XX%

Low High

+ 1 month+ 3 months

+ 6 months

ASSESS IMPROVE MONITORHNQIS

HNQIS – DHIS2 example dashboards

Identify recurring gaps and weaknesses

**

HNQIS – DHIS2 example dashboards

Identify geographic priority areas

Coming soonCote d’Ivoire, Ghana, Niger, South Africa

From Oct 2015:20 countries 10,000 outlets600 QAOs38,500 assessments13 Health Areas (+PBCC, DQ, Stock Mngt, CBRM)

HNQIS Implementation Status

HNQIS Implementation Status

Public Sector Private Sector

Clinics Clinics and HFs Pharmacies Drug stores

Angola, Haiti, Mali, Mozambique, Zimbabwe 1,034

Benin, Burundi, Cameroon, Ethiopia, Haiti, Kenya, Laos, Madagascar, Malawi, Nepal, Nigeria, Tanzania, Uganda, Vietnam, Zimbabwe

4,212

Cambodia, DRC, Laos, Myanmar 5,962

Nigeria, Tanzania 281

9% 37% 51% 3%

Health provider, Kenya: “I like the videos since I remember what I see more than what I amtold. It also takes a short time to receive feedback; then I can get back to attending to the restof my patients.”

Health supervisor, Mozambique: “I like using the tablet because it’s quick, easy, and practical.Also, I can show and discuss results with nurses directly on the tablet and I can forget aboutpapers, even when I have to share action plans. I wish we had more videos in the app.”

National QA officer, Uganda: “Using data properly is powerful. HNQIS and DHIS2unquestionably optimize the process of reading data and enhancing support supervision bydriving evidence-based decisions, changing system designs, and combatting low skill levels.”

Voices from the field

Evidence – Improving quality of health service provision

Targeting support based on where it is needed most and where it will have most impact

Layered with

Leveraging mobile phones to undertake remote network management

Thinking ahead - Remote Network Management

Supportive supervision is resource intensive AND Not all circumstances require face to face support Integrating remote mobile support into supportive supervision

Client Load

Quality score

XX%

XX%

XX%

Low High

+ 1 month+ 3 months

+ 6 months

HNQIS automated scheduling

Prioritize on-sitesupportive supervision

Mobile phone engagement can further

be leveraged for network management

tasks such as stock availability tracking or

BCC

Layer mobile engagement

Thinking ahead - Remote Network Management

To deploy a user-friendly DHIS2 app for (1) monitoring and improving desired KPIs in health care and (2)

managing large networks of service delivery outlets easier and more

cost-effective

Going for the end game – What does success look like?

Assess

ImproveMonitor

PlanPaper, static, rigid

checklists Real-time, dynamic, customizable

Blanket schedulingTargeted Scheduling

Hard to monitor changes Decision-making at fingertips

Standard feedback, hard to filter gaps Real-time,

tailored feedback

Questions?


Dominique Zwinkels Executive ManagerPeople that Deliver Initiative (PtD) UNICEF

@PplthatDeliver @UNICEF@GHSupplyChain

USAID GLOBAL HEALTH SUPPLY CHAIN PROGRAMProcurement and Supply Management

People that Deliver BuildingHuman Resources for Supply Chain Management: Theory of Change for optimizing workforce performance

Dominique Zwinkels, People that Deliver

Phot

o: G

HSC

-PSM

Why do we need to focus on Human Resources (HR) for Supply Chain Management (SCM)?The People that Deliver Building HR for SCM Theory of ChangeRwanda Case study

Overview

USAID GLOBAL HEALTH SUPPLY CHAIN PROGRAM – Procurement and Supply Management

Issues facing HR in SCM

Why do we need to focus on HR for SCM?


75

Global Partnership

People That Deliver

76

Our Goal

We envision a world where health supply chain workforces are empowered and equipped to optimize health outcomes by improving access to health commodities.

We aim to create a competent, supported, and adequately staffed supply chain workforce that is deployed across the public and private sectors within the health system.

A global partnership of more than 250 organizations seeking to providea coordinated, multi-organizational approach to addressing human resources for supply chain management.

Hosted at UNICEF Supply Chain Division in Copenhagen, Denmark, The secretariat is responsible for day-to-day operations and priorities setby the Board.

Governed by a Board representing governments, donors and aid agencies, NGOs, academic institutions, professional associations, and private sector organizations. The Board is led by a Chairman and a Deputy.

VISION GOAL

PURPOSE SECRETARIAT

BOARD

Our Goal

• Describes how and why a desired change is expected to occur

• Explains the pathway through which a specific result can be achieved

• Shows the chain of events that exists between a program’s interventions and its goals and desired outcomes


What? The Theory of Change Process

Outcome Diagram(s) Narrative


• In general, we need to know – what is the change we’re trying to create – and we need to have a clear hypothesis about how that change is going to occur.

• More specifically, we need to be able to describe the impact of interventions and investments in HR for SCM that aim to improve SC performance.

79

Why A Theory of Change?


Six potential uses for the HR4SCM TOC

80

Understand and convey the complexity of SCM HR systems.

Explain the causal pathway & change process for optimizing workforce performance to internal and external partners.

Advocate for the importance of investing in aspects of HR for SCM.

Design SCM HR interventions based on solid rationale to maximize impact.

Plan & measure the effect of interventions to improve selected HR management systems.

Assess the effectiveness of HR management systems


ULTIMATE GOAL

LONG-TERM OUTCOME

FOUR PATHWAYSFOUNDATIONAL PRINCIPLE

The People that Deliver Building HR for SCM Theory of Change

ULTIMATE GOAL

What does the future look like?

Commodities are available at service delivery points

to meet needs in the most cost effective way possible

sothat

Health outcomes are improved

Enabling improved health outcomes, through continual commodity availability, is the overall purpose of our programs


LONG-TERM OUTCOME

What must be true in order to reach

our Ultimate Goal?

Workforce performance is optimized

A workforce must be in place and performing optimally in order for commodities to be available in the most cost-effective way possible


What needs to happen for the

Long-Term Outcome to occur?

Workforce performance is optimized through four distinct, mapped pathways.

To reach the long-term outcome, four top-level outcome areas must be in place.

Staffing Skills Working Conditions Motivation

All critical SC positions and/or competencies

are filled

Staff apply their skills as

appropriated at every level of

the SC

Working conditions support

performance

Workers are motivated to do

their jobs


FOUR PATHS

3. Rwanda Case Study (Preliminary data)

Acknowledgement: Erin Meier (GHSC-PSM Consultant)


Identified preconditions that are already developed and priority areas ready to be targeted

Conducted workshop with MOH to agree on priority outcomes & review indicators, usingInterventions & Indicators Catalog

Conducted site visits at all levels to identify the data source for selected indicators and capture baseline data.

STEP 1

STEP 2

STEP 3

SURVEY

WORKSHOP

SITE VISITS

Identified priority outcomes from the PtD HR4SCM TOCPROCESS


Used baseline data to refine the list of priority outcomes and interventions Removed preconditions that were met at

nearly all sites Interventions selected based on needs

Conducted focus groups to validate data and receive feedback on potential interventions for identified gaps.

Confirmed prioritized intervention areas, based on identified gaps. Created M&E plan.

STEP 4

STEP 5

STEP 6

DATA REVIEW

M&E PLAN

FOCUS GROUPS

PROCESSRefined priority outcomes & interventions, using baseline data


MOTIVATION PATHWAYPRIORITIES: AFTER DATA REVIEW

• 10/15 complete (67%)

• 4 priority outcomes

• 1 for next stage

✔

✔✔

✔✔✔

✔ ✔

✔

✔

✔

1. Provide a structure to prioritize INTERVENTIONS in Human Resources for Supply Chain Management (HR4SCM)

2. Provide an effective M&E process to monitor INDICATORS for the selected interventions

3. Provide the foundation for developing an HR for SCM STRATEGY

Key Takeaways


Acquire a detailed understanding of the change pathway that connects

Interventions & Investments in

HR

Health SC performance improvement

by applying the PtD HR4SCM Theory of Change

Broader Objective


TOC Narrative (English and French)o Provides an overview

of all assumptions that support the HR4SCM TOC

o Contains the Outcome Diagram and Indicators Interventions Catalog

Coming Soono Video

Summary Briefo Two-pager that

supports advocacy efforts for HR4SCM TOC

o Contains the HR4SCM TOC Overview

Multiple Tools to Support Your Use of the TOC


• Become a PtD member (go to www.peoplethatdeliver.org)

• Subscribe to PtD’s newsletter (e-mail [email protected])

• Follow PtD on Twitter (@PplthatDeliver)• Follow PtD on LinkedIn

(www.linkedin.com/company/people-that-deliver)• Tell us your HR for SCM stories or projects (e-mail [email protected])

• Contact the PtD Secretariat:Dominique ZwinkelsExecutive [email protected]

Alexis StraderProject [email protected]

Our Goal Engage with People that Deliver

http://www.peoplethatdeliver.org/

mailto:[email protected]

http://www.linkedin.com/company/people-that-deliver




On Twitter @GHSupplyChain

www.GHSupplyChain.org



Rachel MarcusSenior Health Systems Strengthening AdvisorOffice of Health SystemsUSAID Bureau for Global Health

@USAIDGH

DiscussionKey question: How can research (which often has important limitations) on the effectiveness of strategies to improve health worker performance be used to inform programmatic decision-making to improve health care quality in LMICs?

Optional Afternoon Workshop

Analyzing the HCPPR databases

Alex Rowe, CDC

THANK YOU

HRH2030

Optimizing health worker performance to improve health ......DAY 1: Crystal City, April 9, 2019....

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