1. Innovations for HR challenges in Resource Limited Settings: Lessons from a rural HIV/AIDS program in Mid western Uganda Dr Richard Mwesigwa Infectious Diseases Institute (IDI)-Uganda 19 th April 2012

2. Background Kampala

3. Expanded Kibaale Kiboga Project Capacity building HIV/AIDS project Focusing on Health systems strengthening Implemented in Mid western Uganda.

4. HR for Health Situation Average Health Worker : population ratio –Medical doctors 1:8,373 ; Nurses 1:1,212 70% doctors serve 12% of population EKKP- Staffing level 47% of MOH standard Low salaries (Doctors <280USD/month) Lack of social amenities

5. Realities on ground

6. Capacity pyramid Skills Staff Structures Tools Facilities SystemsRoles Cognisance of local context: Policies, trust Default IDI model for capacity Building requires Enables effective use of *Potter C and Brough R

7. Capacity pyramid II Local context: Culture, Policies, Ownership Skills Staff Structures Tools Facilities SystemsRoles Time to implement change Easier Harder

8. Local context interventions District/HW involvement for ownership Support for comprehensive HR planning and management Better advocacy facilitated by understanding of HR needs Stakeholders meetings for coordination

9. Structures, systems and roles Integration in existing structures Task shifting Helping hands (Volunteers, PHA Network, Interns) HR boosting (Support recruitment of Critical staff) Camping strategy & Integrated Static Outreaches (ISOs)

10. Staff Motivation to enhance commitment –Facilitation (airtime, motorcycles) –Recognition (frontline- hero programme & Reward for performance) –Support for career development

11. Facilities (Working environment) Cleaning and re-arrangement Remodelling/ Renovations

12. Imparting Skills Training focuses on teams and not individuals Mentorship using Short Term Technical Assistance Teams (STTATs) IDI/MOH have supported training of District based trainers

13. Provision of Tools Equipment Policy documents and guidelines Buffer supplies Supply of data tools

14. Lessons learnt Proper planning is key to optimizing outputs with available resources Cognizance of local context is critical in designing HR for Health interventions. Non monetary rewards can keep staff motivated

15. Lessons learnt II District leadership involvement is key in designing sustainable interventions Task shifting to lower cadre workers is possible with adequate supervision Integration in existing structures ensures sustainability

16. Thank you