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 performance 2.Clinical, managerial and support staff 3.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, FBOs non-formal providers) Improve productivity HS strategies HR strategies

Understanding individual staff performance Effort Performance Intrinsic Reward/ Sanction Extrinsic Direction Competencies Resources Job satisfaction 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 strategies A. 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 strategies A. 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 activities D.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 table A. 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