Health Workforce Registries two examples Dykki Settle & Sharon Kim 4th Meeting of the Health workforce Information Reference Group (HIRG Recife, Brazil – 13 Nov, 2013

Challenges in health workforce information Many health workforce stakeholders, each with both overlapping and distinct data and denominators Larger e/mHealth interoperability problems Many activities, little interoperability Data quality, demand and use No single data source or national denominator No easy way to triangulate using multiple data sources

Many stakeholders, many views Professional Councils Public Service HRIS Ministry of Health (plus other relevant Ministries: Education, Public Service, etc) FBO FBO Assoc NGO Assoc For Profit Assoc FP NGO Training Institutions HMIS National Health Workforce Registry HRIS HRIS HRIS Local Government This diagram reflects the many different producers and consumers of health workforce information. Starting with the Ministry of Health and other national policy bodies at the national level, they support public sector health service delivery as well as the national health policies and plans. The primary source, beneficiaries and objective of health workforce information is of course the health workers themselves in facilities and communities around the world. In-between there may be different levels of local government, depending on how decentralized the country is. Often the first electronic source of health worker information is the national HMIS – but usually this information is aggregate – imagine a table with cadres across the top, and districts down the side, for example, with numbers in the cells that might tell you the number of doctors or nurses or midwives in a given district, but little else – this information might help a country look at deployment issues or inequities, but none of the granular information essential to supporting the health workforce. Another source of health worker data most countries have is the national public service HRIS – usually a simple payroll system designed to ensure public sector workers get paid. These payroll systems usually have large gaps – for example they usually don’t include health specific information, such as cadre or health competencies. They also often don’t include the duty station – e.g. what community or facility health workers are working in – they would instead favor the ‘duty station’ where health workers get paid – perhaps the district health office, for example. Finally the public sector payroll system almost never includes non-public sector employees. This data is usually only captured by the different non-public sector organizations themselves. Usually grouped into FBO’s, NGO’s and for-profit providers and organizations, these groups will have their own payroll systems at a minimum. These organizations often have an umbrella organization or association that may provide services to all of their member organizations. Christian health associations, such as CHAK, CHAG, and CHAM in Kenya, Ghana, and Malawi respectively are good examples. So this largely rounds out the health service delivery sub-domains. As you can see, many different stakeholders have many different pieces of the puzzle. The ideal situation for policy, planning and support to different consumers of data, would be to develop a National Health Workforce Registry, to capture a minimum data set on all health workers in a country. This involves a lot of work to establish data sharing agreements and effective interoperability. There are two other important sources of data for a national health workforce registry. One of these is the training institutions, who can provide data on the incoming pipeline of health workers from pre-service educaiton, as well as improvements to competencies through in-service education. Finally, one of the most powerful sources of information are the professional councils. These regulatory bodies seek to register and license all health professionals of a particular cadre – medical boards for doctors, nursing councils for nurses and midwives, and so on. They are powerful for two reasons – first they capture all health workers regardless of the sector they are working in, and second, they gather data directly from the health workers themselves, not through any complex and error-prone management structure. Facilities & Service Providers

2012 Uganda e/mHealth moratorium

“Our mission is to improve the health of the underserved through the open, collaborative development and support of country driven, large scale health information sharing architectures.” So building on the dimensions listed on the previous slides, *HIPPP GOAL TO DEMOSTRATE HIE *Est. 2012 *Open Source Community

Provider Registry A Provider Registry is the central authority for unique identities of & basic information on all health workers within the country.

Rwanda – October 2012 (Pilot)

Making Connections eHealth systems mHealth systems

Community of Communities Client Registry Facility Registry Provider Registry Terminology Service Shared Health Record Interoperability Layer Communities of practice around 6 OHIE components Architecture call. Join: provider-registry@googlegroups.com

Expected Outcomes The OpenHIE Provider Registry… … can serve as a standards-based reference implementation of the WHO Minimum Data Set … will be a unified source of data providing a complete picture of national health workforce … will support the triangulation and comparison of different health workforce data sources to identify and resolve data quality issues

Community Health Worker Registries

Campaign Overview Focus on CHW scale-up for MDG achievement and Universal Health Coverage Operates in 10 countries in 2013 Phase 1: MoH develops a top down financial and operational plan, which specifies policies, training, deployment and management factors, along with financial envelopes that draw upon global and domestic sources  Phase 2: District-led bottom up plan that draws upon implementation partners capable of supporting the MoH and directly participating in scale-up activities Our work entails the development of a financial and operational scale-up roadmap, with the identification of financing streams and convening of implementation partners.  All our work is MoH led, with support from the Minister and President in all country settings.   CHWs as core component of basic primary health systems, not simply a stop-gap measure to address human resource shortages Rapid training and deployment of new CHWs or upgrade (quality and quantity) Establishment of real-time monitoring system of CHW activities and progress toward health goals Development & improvement of scalable management systems

1mCHW Campaign Secretariat Steering Committee and Partners CHW Scale-up Strategy Inputs Activities Outputs Impact Ministry of Health National policy and strategy development led by Ministry of Health Targeted upgrade/expansion of CHWs in high-need sub-national units (state/district) Harmonization of CHW activities Match & amplify existing domestic financing with specific incremental global financing 1mCHW Campaign Secretariat Work with GHWA, AFRO, Steering Committee + technical agencies to mobilize formal institutional support for country plans Deepening engagement with partners to close the gap between planning and operations Accelerate achievement of health-related MDGs Steering Committee and Partners Identification of high-priority districts for CHW scale-up activities Prof Jeffrey Sachs + Political Leaders Group working with Global Fund, GAVI, PEPFAR/USAID, Bilateral funders on CHW specific support

Challenges To CHW Scale-up Most countries do not have Community Health Worker Registries Country-based ownership over collection/reporting mechanism Harmonization of stakeholders to actively participate in counting and capability-tracking  Nigeria Community Health Practitioners Registration Board of Nigeria (CHPRBN) is using iHRIS Qualify to track community health workers Liberia Recently conducted a Comprehensive Mapping of Community Health Volunteers because CHWs are not part of the HRH policy framework Logistical challenge to identify CHW coverage, capacity, and available resources at district levels

Community Health Worker Registry Phase 1 Planned Functionalities Promote systematic integration of CHWs into wider health workforce and national health system District-level counting exercise of CHWs using iHRIS Build Capacity: Improve capacity of HRH managers to effectively manage CHWs District by District Counting http://1millionhealthworkers.org/operations-room-map/ National CHW tracking platform for workforce analytics (e.g., # of CHWs, contact info, payment status, training status, etc.) Promote Global Standards: Use WHO Minimum Data Set (MDS) as backbone National HRH Analytics Platform Medic Mobile Demo Dashboard Thus, there is a need for collecting district level data in a systematic and methodological way. This requires the following: Fostering country based ownership over reporting mechanism Harmonization of stakeholders to actively participate in counting and capability-tracking  Concept The ‘Operations Room’ is a comprehensive central repository of information on CHW operations to: (1) track CHW numbers and capacity, (2) assess gaps & target opportunities, (3) support HRH analytics. ‘National Operations Rooms’ collect/consolidate data on country-level CHW operations. ‘National Operations Rooms’ aggregate to a ‘Global Operations Room’. The Operations Room is an interactive, real-time monitoring system that provides information about CHW operations in sub-Saharan Africa. This centralized information hub is the ultimate destination for those requiring comprehensive and integrated information on any aspect of CHW operations. The Operations Room is a ‘one-stop-shop’ with information from a variety of sources, including governments and public and private organizations. It provides data on the quantity and quality of CHWs, as well as gaps in funding, services and resources that are required to support CHW operations. Objectives Develop and implement the Operations Room over a 3-year period as follows: Year 1: Data collection to support scale-up planning. Target completion: year-end 2013 Year 2: Begin development of real-time monitoring systems. Target start: Spring 2014 Year 3: Link real-time monitoring with HR analytic/official health statistics. Target start: Spring 2015 Identify Operations Room launch countries and begin to operationalize by the end of 2013. Analyze Operations Room functionality, performance and usability to determine needs for upgrades and enhancements for the next generation of the Operations Room.   Working with CapacityPlus/iHRIS on extending existing implementations of HRH analytics platform to include CHWs Real-time monitoring of health workforce via mobile phone applications Enhance Interoperability: Aggregate data from mobile systems + existing country e-Health architectures Integration with m-/e- Health Systems

Opportunities Improve capacity of health systems managers to oversee CHW workforce Allow systematic integration of CHWs into wider health workforce and national HRH framework/health system Inform development of global and country level CHW information system platforms, policies and protocols At the request of countries, the 1mCHW Campaign and IntraHealth will help MoH adapt iHRIS to collect national CHW data in a systematic and methodological way YOU Core Group, 2013

Thank You 1millionhealthworkers.org/ For questions about the CHW Registry, please contact: Ms. Sharon Kim sjkim@ei.columbia.edu