Hrh Strategy 27 April 2006

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HUMAN RESOURCE FOR HEALTH PLAN FORMAT

THE UNITED REPUBLIC OF TANZANIAMINISTRY OF HEALTH AND SOCIAL WELFARE

STRATEGIC HUMAN RESOURCES PLAN

(DRAFT 1)

DIRECTORATE OF HUMAN RESOURCE DEVELOPMENTMINISTRY OF HEALTH AND SOCIAL WELFAREP. O. BOX 9083DAR ES SALAAM

APRIL, 2006


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Table of Contents

Abbreviations

Foreword

Acknowledgements

Executive Summary

1. Introduction

2. Rationale of the plan

3. Plan aim and objective

4. Country and Health profile

5. National Health policy and legal framework

6. Situational analysis

7. Human resource policy requirement

8. Identification and assessment of key HRH priority areas

9. HRH Strategic Plan and budget table

10. Monitoring and evaluation

11. Annexes

ABBREVIATIONS

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AIDS Acquired Immuno-deficiency SyndromeCHMT Council Health Management TeamDED District Development Director DMO District Medical Officer

HSR Health Sector reformHRHSW Human Resource for Health and Social WelfareHIVKRA Key Result AreaMoHSW Ministry of Health and Social WelfareMDGE Millenium Development GoalNHP National Health PolicyNSGRP National Strategy for Growth and Reduction of PovertyOPD Out Patient DepartmentOPRAS Open Performance Appraisal SystemRAS Regional Administrative Secretary

RHMT Regional Health Management TeamRMO Regional Medical Officer VA Voluntary AgenciesWHO World Health Organization

1.0 INTRODUCTION

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1.1MINISTRY OF HEALTH AND SOCIAL WELFARE VISION, MISSION,AND CORE VALUE

VisionThe vision of the Ministry of Health and Social Welfare is to provide healthservices of high quality that are effective, accessible and affordable to all,delivered by a well performing, intergrated and sustainable health system.

MissionThe mission of the Ministry of Health and Social Welfare is to facilitate theprovision of equitable, quality and affordable health services, which aregender sensitive and sustainable, delivered by competent and wellmotivated health staff.

Core ValuesThe core values of the Ministry of Health are: quality care,professionalism, Moral and ethical practice, accountability andcommitment.

1.2ORGANIZATION STRUCTURE OF THE MINISTRY OF HEALTH ANDSOCIAL WELFARE

The Ministry of Health & Social Welfare (MoH&SW) is charged with theresponsibility of ensuring the provision of quality health services in the

country. To accomplish this responsibility, the Ministrys functions aredivided into six directorates which includes: Hospital Services, PreventiveServices, Human Resource Development, Policy and Planning, Socialwelfare, Administration and Personnel. These departments aresubsequently divided into sections for a more effective implementation asreflected in the organogram. Apart from the section there are semi autonomous health agencies and institutes of the Ministry of Health andsocial Welfare which are Government Chemistry Laboratory, Food andDrugs Agency, Muhimbili National Hospital, Medical Stores Department,Muhimbili Orthopaedic Institute,The Ocean Road Cancer Institute,Tanzania Food and Nutrition Centre (TFNC), National Institute for Medical

Research (NIMR), Mbeya Referral Hospital.These Agencies are semi-autonomous publicly accountable government organizations managed byChief Executives at arms length from Government. They are still part ofgovernment and are discrete business units with clear responsibilities andbusiness boundaries. Agencies are to receive all the delegations or-powerand authority over their resources necessary to enable them to meet theirresponsibilities. They will become more and more self sufficient in

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managerial and in some cases, financial terms. Some agencies willgenerate all their income from charging fees and/or trading. Others willremain dependent on Government subventions, and there will be aspectrum of combinations in between. (Refer to Annex 1)

2.0 RATIONALE OF THE PLANThere are 2 major rationale for HRH plan.(i) Situational analysis done in 2002 indicates the following HRH crisis

which necessitated the need to develop HRH Plan.

Extreme shortage of staff in the health facilities and training

institutions

Increase workload in the health facilities due to HIV/AIDS

HRH reluctancy to work in the hardship environment (Districts)

Mismatch between HRH demand and supply

HRH performance appraisal not linked to productivity

Inadequate HRH capacity in line with HSR requirements

Increasing HRH attrition

(ii) Increasing customer demands and expectation which include Qualityhealth care services, customer oriented services, financial managementthat ensures value for money and transparency, gender sensitive healthservices, equity in the distribution of services, accessible, affordable andavailable services of all types, health services without corruption, efficientreferral system, community involvement, provision of health services byqualified and competent health workers, availability of primary health careservices, sustainable health services, freedom of choice on where to gethealth services, well maintained health service infrustructures, reliablecommunication facilities, and health services without violation of humanrights.

In order to meet all this customer expectations as well as to achieve HSRrequirement, development of HRHSW plan is very important.

3.0 HRH PLAN AIM AND OBJECTIVEAimThe aim of the strategic plan is to ensure availability of adequate,competent, motivated and equitably distributed staff for delivery of qualityhealth and social welfare services at all levels

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Objective To provide an insight and guidance in developing and retaining

committed human resource for health and social welfare.

To ensure increased health budget on the personnel emoluments for

increased deployment as per staffing level guideline by 2011

Develop HRH capacity to deliver a minimum essential health care andquality training by 2011

Ensure availability of a coordinated and intergrated efforts on HRH

Planning, management, training and development by 2008

To ensure equitable distribution of HRH at all levels by 2010

Ensure increased productivity of health staff at all levels by 2011

Improve human resource capacity to manage Health resources at all

levels for quality care by 2011

Ensure availability of the right number of the staff with the right skills,

at the right place, cost and motivation by 2011

4.0 TANZANIA COUNTRY AND HEALTH PROFILE4.1 COUNTRY PROFILE

4.2 HEALTH PROFILEGenerally the health of the population of Tanzanian is characterized by ashort life expectancy and a high burden of disease. The average lifeexpectancy is 48.8 for males and 47.2 for females. Communicablediseases, maternal and prenatal conditions cause the majority of the

disease burden.

The infant mortality rate is about 93 per 1,000 live births. Vaccinationcoverage is 88% for BCG, 89% for Measles and 83% for DPT 3 Vitamin ASupplementation is 90%.(2002).

The major causes of morbidity and mortality in Tanzania are infectious,and parasitic diseases. According to institutional based records, diseasesof high endemicity include malaria, AIDS, Tuberculosis, respiratoryinfections and diarrhoea.

According to hospital statistics, malaria appears to be the number onecause of morbidity in the country., diarrhoea and tuberculosis are also highon the list of leading killer diseases. The following table shows the mostfrequent causes of attendance at health facilities and the ten leadingcauses of deaths in hospitals.

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Table 1.0

Frequent Causes of Attendance at Health Facilities (All ages)

SNo. Disease % of all diagnosis

1. Malaria 36.01

2. Upper Respiratory Tract Infection (URTI) 12.40

3. Diarrhoea 6.60

4. Pneumonia 4.70

5. Intestinal Worms 4.10

6. Eye Infections 3.90

7. Skin Infections 3.50

8. Minor Surgery 2.20

9. Anaemia 2.2010. Pregnancy complications 2.00

Among important factors for a well performing health system is the humanresource development (HRD). Human resource is a crucial factor in the sensethat all initiatives within the health sector are strongly human centred. The needto determine human resource development in terms of infrastructure, institutionaland human is important so as to address all problems related to it.

4.3 TANZANIA DEMOGRAPHY AND HEALTH SERVICESINFRASTRUCTURES

4.4 HEALTH SYSTEM

The health system in Tanzania comprises of various levels of health servicedelivery, These levels are there to ensure efficiency and demarcation of roles andresponsibility for each level as follows:

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4.4.1 Level 1 (District level)

This level provides primary health care services, which are basically clinical andpublic health services. The services are provided in the dispensary which islocated at the ward level and planned to serve 3 - 5 villages with 10,000

population .

Health centre is the referral level for the dispensary and it provides a slightlybroader range of services than dispensaries, including inpatient care and coversan average population of 50,000.

District hospitals are located at the district centre and each serves an average of250,000 people. Tanzania comprises of 114 districts and there are districthospitals in all districts, except In 19 districts where there are no governmenthospitals, mission hospitals act as designated district hospitals (DDHs). Throughagreements, the government provides essential supplies such as

pharmaceuticals, and staff on secondment basis.

Tanzania has the decentralized system where the districts are provided with fullmandate in health planning implementation and evaluation of the services

4.4.2 Level II (Regional Hospitals),

A level II which is a regional Hospital serves as a referral point for level I (DistrictHospital) with more specialized services and it caters for the population of about1,000,000 people.

4.4.3 Level III (Referrals Hospitals)

At this level, there are 4 referral hospitals and four others that are specialized inpsychiatry, tuberculosis, orthopaedics/Trauma and cancer which provide highlyspecialised services.

4.5 HEALTH STATUS AND DISEASE BURDEN

Despite increased availability of health care, the occurrence of some diseases isincreasing. Such diseases include malaria, acute respiratory infections,waterborne diseases, skin conditions and chronic diseases such as hypertensionand diabetes. The most threatening are AIDS related diseases including TBwhich have affected mostly the productive work force.

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The national statistics for diseases burden have singled out top ten diseaseswhich are the most frequent cause of the mortality for all ages. Among the topten are malaria, HIV/AIDS and Tuberculosis.

Malaria

Malaria is the leading disease in Tanzania for ill health and death. It accounts for19% of all deaths and approximately 30% of all hospital visits. The groups mostvulnerable to malaria are:

Children under five years of age (7.1 million)

Pregnant women (1.69 million)

Malaria assessment at health facilities

The leading cause of outpatient attendance for children under 5 years (38%)

The leading cause of outpatient attendance for children 5 years and above

(32%)

First ranked cause of deaths in hospitalised children less than 5 years (31%)

First ranked cause of deaths in hospitalised patients of all aged (19%)

The leading cause of admissions for children under five years of age

(43%)

Control StrategiesTo reduce malaria related mortality and morbidity by half by 2010 through:

Early diagnosis and treatment at household level: Target: 60% of febrile

episodes correctly managed at home

Improve case management at health facility level: Target: 80% of malaria

cases appropriately managed

Prevention of Malaria in Pregnancy: Target 60% of pregnant mothers useintermittent preventive treatment (IPT)

The use of insecticide treated nets: Target: 60% or pregnant mothers and

60% of children ,5 years sleep under ITNS

Epidemics detection and control: Target: Increase capacity of epidemic

detection

Institutional strengthening.

HIV/AIDS/STIThe magnitude and trend of HIV/AIDS/STDI in Tanzania Mainland by January to

December, 2001 was as follows: A total of 14,112 AIDS cases were reported from 20 regions during the

year 2001. HIV prevalence is 9.2% in females, being higher than inmales.

The cumulative figure since 1983 when the first case was reported up to

2002 amount to 144,498 cases. Trend appears as follows:

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Minimal opportunity costs, and

Taking advantage of positive globalization affects.6.0 SITUATIONAL ANALYSIS

6.1 HRH AND POLICY CONTEXT

The National Strategy for Growth and Reduction of Poverty (NSGRP)1

finalized in 2005 has kept in focus the achievement of MillenniumDevelopment Goals, most of which are health related. Cluster 2 of theNSGRP aims in its second goal to improve survival, health and well-being of all children and women and of specially vulnerable groups, thesegments of the population in which the largest burden of disease,disability and death occur. The NSGRP has provided clear strategies inits operational target on human resources and management in healthincluding assessing the human resource development strategy,training in key areas, hiring and equity of deployment, incentives forhardship posts and improving human resource management

practices.

The National Health Policy (MoH, October 2003)2 has clearly outlinedthe policy objective to train and make available competent andadequate number of health staff to manage health services with dueconsideration to gender at all levels. Capacity building in healthservices management is part and parcel of this policy objective.Among the strategies for achieving the Health Policy, implementing acomprehensive human resource development plan that facilitatesdeployment and retention of well-trained and motivated staff isdirected. While the Health Policy is clear on guiding the supply of HRH

it remains quite limited in HRH planning and HRH deployment andretention.

DISPREPANCY BETWEEN POLICY STATEMENT(S) AND ACTUALPRACTICE: The target population (women, children, vulnerable groups) of theNSGRP is well addressed in terms of specificity of health interventionsand financial resource flows to deliver these interventions. However,actual practice is hampered by severe gaps of qualified human

resources to deliver the health interventions. Health Centres andDispensaries, where the largest load of morbidity affecting this targetpopulation is supposed to be serviced have the greatest shortage ofqualified health staff (Gap of NMW = 562; PHNB = 1,074, and COs =

1 NSGRP2 MOH - NHP

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531 at Health Centre level and a Gap at Dispensary level of PHNB =4,770, COs = 3,515)3. Hence policy goals such as reducing MaternalMortality remain very elusive to reach given reliance on availability of amotivated qualified health workforce

The National Health Policys (NHP) limited coverage of HRH planningand poor financing of the 5 year HRH Plan 1996 2001 may haveinfluenced the sectors slowness in taking comprehensive HRHplanning more seriously.

Insufficient articulation of HRH deployment and retention measures inthe NHP may have given room to emergence of malpractices indeployment. The special circumstances surrounding the healthworkforce needed measures to brace it against forces operating in thefree labour market. Where there were no deliberate retentionmeasures severe strain on service delivery was inflicted as personnel

gravitated to better served areas, sectors or sub sectors with betterconditions and greater opportunities for personal advancement orsimply succumbed to migration inducing factors.

HRH planning requires up to date information; when cooperation ofvarious stakeholders and all levels is not forthcoming updating of HRHdata bases becomes incomplete. Cooperation of both public andprivate health care managers specifically in providing up to date andaccurate data is critical for success in comprehensive HRH planningevents.

The policy to establish strategies to combat HIV/AIDs at workplace hastaken quite long to be implemented in the health sector. As a resultthe sector is losing significant numbers of personnel to HIV/AIDS everyyear.

Assurance of quality and professional competence is a prerogative of Training. Limitations in reaching this policy aim derive frominconsistency in linking training to comprehensive training needsassessment, lack of costs analysis of training that influences negativelyinstitutional funding and teaching facilities provision.

The National Strategy for Growth and Poverty Reduction (NSGRP)makes provision for special remuneration package for hardship postsbut this has not been translated into HRH management practice. Thespecial package has to be defined and agreed upon, followed byimplementation measures.

3 CEDHA, MOH,WHO 2005 HRH Audit

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6.4 The HRH ManagementStrengths, weaknesses, opportunities and threats.The situation analysis reveals that several strengths exist in the HRHmanagement component. There are already in place clear organizational and

management structure at all levels of the health institutions, a decentralized HRHmanagement and a Client Service Charter. Currently, there is increased genderawareness among the health workers as a result of HRH gender advocacy,increased efficiency due to public private partnership where non-core servicesare being contracted out and recruitment undertakings based on merit.The introduction of a new appraisal system namely the Open PerformanceReview Appraisal System (OPRAS) and an improved HRH scheme of serviceshave proved to be an added advantage.

The HRH management component is threatened by a shrinking health workforceas a result of high attrition rate probably due to HIV/AIDS impact, multiple HRH

management nodes and a liberalized labour market. However, a nationaladvocacy on good governance and a Public Service Reform process going on inthe country where services are being contracted out to improve efficiency and theintroduction of OPRAS constitute opportunities for the betterment of HRHmanagement.

6.5 The HRH Training and DevelopmentStrengths, weaknesses, opportunities and threats.According to the situation analysis carried out, the HRH training anddevelopment component can make use of several strengths discovered. Thereexist a reviewed curricular and other learning materials which have already been

distributed, there is availability of computers in the health learning institutions anda capacity building is going on which involves various skills at a multi-level.

Included in the strengths list are also availability of a number of tutors who havealready undergone postgraduate studies and training opportunities, improvedstudents selection procedures and advocacy for upgrading and ContinuingEducation (CE) to staff at all levels. Furthermore, there is availability of healthtraining institutions (108) and guidelines for CE/CPD for main actors.Accreditation of health training institutions is also going on and graduateinduction courses that prepare graduates to challenges of taking up new jobpositions have been introduced.

The HRH training and development is however faced with several weaknessesbecause there are lack of comprehensive training needs assessment and costanalysis of training. There are also problems of under-funding of traininginstitutions, inadequate teaching facilities and staff and inadequate self-motivation towards continuing education and continuous professionaldevelopment among health workers.

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The HRH training and development component is also confronted by limitedsponsorship of trainees and scope of practice for core primary health care staff.There is also a notable inadequate organizational learning culture and exchangeprogrammes to promote HRH performance while on the other hand there is lack

of follow-up evaluation of HRH performance on completion of training.Misallocation and underutilization of qualified/well trained teaching staff andunavailability of some key competencies and skills in the health workforce arealso notable.

As regards to threats, there are cases of changing development partnerspriorities, development of partners fatigue, the changing of knowledge gap due tofast Information and Communication Technology (ICT) and false commitment thatdoes not match with disbursement. However, the HRH training and developmentcomponent can effectively make use of the existing opportunities such asavailability of qualified applicants for health schools and willing sponsors. There

is also a global and regional integration and collaboration on HRH agenda,districts have budgets for training, the emergence of HRH as a global agendaand the existence of accredited health training institutions.

6.6 HRH financingStrengths, weaknesses, opportunities and threatsAs of the current situation, HRH financing has a number of strengths. Costsharing guidelines for health services and training institutions are in place andsupervision of cost-sharing implementation in the Health Training Institutions(HTIs) is carried out. Furthermore, there is improved transparency in financialmanagement and also HRH skills in budgeting and budgetary control (MTEF)

through training and practice.

In the light of all these strengths, the HRH financing has to brave existingweaknesses. Still there are under-funding of health services, delays indisbursement of funds and bureaucratic procurement procedures. On the otherhand, the prevailing cost-sharing exemption policy is difficult to implement andcost-sharing levels are too low. There are also problems of short landingmaterials and poor quality of supplies, poor financial management andinadequate involvement of staff in planning and budgeting process at the districtlevel. Included in the weaknesses are also weak government stewardship andutilization of the HRH financing, inability of the in-service candidates to pay cost-sharing fees, cumbersome instructions from center regarding financialexpenditure, diminished transparency that cannot match with disbursements anddisbursement delays. The HRH financing component is also threatened bydependency of the sector budget on external funding, shift of the governmentfocus from time to time and frequent shift of governance issues at global, nationaland sub-national levels.

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Data indicating the performance of health service delivery achieved usingabove indicators:

Health Status Outcomes:a) Trends in the decline of infant (99/1000) and under-five (158/1000) mortality,

which had been steady between the mid-1950s and mid-1980s stagnated andare being reversed. About one quarter of all under-five deaths occur within thefirst month and two-thirds within the first year after birth. Tanzania is not ontrack to meet the 2015 targets of reducing under-five mortality by two thirdsunless urgent actions are taken. About 90% of all child deaths are attributableto common and preventable illnesses such as malaria, pneumonia, diarrhoea,malnutrition, HIV/AIDS and complications of low-birth-weight. Eight out of tenchildren die at home and six of them without any contact with formal healthservices.

b) Low birth weight is also a proxy indicator of maternal deprivation, thusperpetuating the inter-generational cycle of deprivation and malnutrition. The

onset of malnutrition starts soon after birth, and peaks by 12-18 months ofage. 44% under-five children are stunted (implying significant chronicmalnutrition) and 30% under weight.. Micronutrient malnutrition is rampantamong women, about 14% in the high land and nearly 80% in coastal areasare anaemic during pregnancy, and nearly 70% are vitamin A deficient. About25% of maternal deaths are associated with anaemia.

c) Over 2.0 million Tanzanians are HIV infected, and an estimated cumulativetotal of 722, 490 suffer from AIDS. Only 1 in 5 AIDS cases is reported. Youngpeople aged 15-24 accounts for 60% of new HIV infections and girls aged 15-19 has a six-fold risk of infection compared with boys of the same age. About72,000 babies become infected annually through mother-to-child transmission

of HIV (MTCT).

Health Service Delivery The proportion of women receiving antenatal care and delivering with skilled

personnel varies considerably across income levels and urban/ruralresidence. The declining number of deliveries in the health facilities (60%-1984, 44%-1991/92, 38%-1996, and 36%-1999) may be a reflection of thegovernment policy on this area to train professional midwives at thecommunity level.

Tanzania has achieved high rates of coverage of antenatal care (90%),

immunization (DPT3 87%-in 2001) and vitamin A supplementation (over 90%-

in 2002). 68% of the households use iodised salt. The contraceptive prevalence rate has doubled since 1991-92, from 10 to

22% of all women. Measles, which used to be a common cause of childdeath, has been effectively contained. Despite these impressive gains, thegeneral health and nutritional status of the population of Tanzania remainspoor.

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6.9HRH AND HIV/AIDS

Declining Health workforce due to deaths related to HIV/AIDS is a seriousproblem in the Human Resource for Health Planning. A total of 300 deathsdue to HIV/AIDS among the health workers since 2003 were reported in theHRH Audit Report for HIV/AIDS care and treatment in the country. The ratio of

deaths was higher for female employees than male, number of death tofemale are higher than the male and the most leading cadres were medicalattendants followed by clinical officers.

Either there is increase in number of absenteeism due to sick leave or manlost hours to HIV/AIDS. There must be a strong initiative to educate healthworkers on the prevention of HIV/AIDS as well as provision of protectivemeasures while at work see annex seven

6.10HRH AND PARTNERSHIP

Inadequate HRH stakeholders commitment and coordination HRHstakeholders involve POPSM, PORALG, MOF, WHO, Voluntary Agencies,RAS, DED, Private Health Sector, Health Students Community andProfessional Associations.

6.11DISTRIBUTION OF STAFF PER DISTRICT

According to the HRH situational Analysis conducted by the MoH 2004, thereis a poor balance and distribution of health workers at all levels. There is anextreme shortage of staff especially in the remote districts as compared to the

most preferred districts. There is a violation of HRH policies due to the factthat unqualified staff filled the managerial and technical posts. HRH skill mixis not given priority in some facilities because there is misallocation ofqualified staff and especially in the specialist cadres like psychiatric nurses,nurse tutors, nursing officers, paediatric nurses and AMO specialists. Thestudy recommended that there should be a reallocation of staff at all levels aswell as establishing retention mechanism for the health workers to be willingto work in the remote districts. (See Annex 2 & 3.)

6.12 NUMBER AND TYPE OF STAFF AVAILABLE

The situational analysis carried out in 2004 by the MoH indicated that, 66% ofthe health facilities are suffering from the extreme shortage of staff (SeeAnnex. 4) The shortage is due to the following reasons:-

a) Increase in burden of diseases due to HIV/AIDSb) Bureaucratic recruitment proceduresc) Poor balance and distribution of health workers at al levelsd) Lack of incentive package

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e) Inadequate job rotation and low preference to work in the remotedistricts because there are no special incentives for people working inthese areas.

f) Lack of priority on human resources issues by local governmentauthoritites

g) Poor management of human resourcesh) Poor working environmenti) Lack of enough protective measures against HIV/AIDS

j) Lack of retention mechanismsk) Increasing customers demandsl) Skill mix is not given a priority

6.13 Training Capacity and OutputMinistry of Health and Social Welfare offers sponsorship for training of Healthworkers inside and outside the country in various training and development

programmes aimed at equipping health workers with skills necessary forprovision of quality health services. The capacity of training institutions in variousprogramme are not reached, Subsidized cost of training a student and thenumber of graduates for the past five years are shown in the Annexes 5 & 6

6.14 Current and Projected Resources Including Finance and HumanRetrenchment policy in the public health services declined the workforce size

from 67,000 in 1994 to 49,000 health workers in 2001. Annual increase inpopulation ratio of Tanzania is 3%. Currently Tanzania belongs to the countrieswith the lowest health workers per population ratio in Africa and the world.

The performance of HRHSW is also affected by the following factors: Number of Health professionals dying with HIV/AIDS

Increase in absenteeism (lost hours) due to sick leave accelerated byHIV/AIDS

Current employment system is limited by employment policies

Increase in demand for health services by 20% due to HIV/AIDS

According to the 1999 staffing level approximately 16,000 positions for qualifiedstaff remains vacant to date. At the same time a number of qualified healthworkers are unemployed or work in private sector or business other than health.

7.0 CURRENT HRH CHALLENGES IN THE HEALTH SECTOR7.1 HRHSW PLANNING

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HSRs and demand for capacity

Staff mobility and implications (HRH attrition)

Involvement of private sector in the provision of health care services

HRHSW planning in the prevailing HIV/AIDS pandemic

High HRHSW attrition

Too many organs dealing with HRH issues

Limited funding for HRH

7.2 HRHSW MANAGEMENT Poor linkage between recruitment and competence profile

Low salaries, lack of incentives package and retention mechanisms

HRH performance against objectives/targets centrally

Outdated rules, regulations, circular and legal issues

Top management and political commitment to HRH issues

Brain circulation, brain decay and brain drain

Employer employee interpersonal relationship

7.3 HRHSW TRAINING AND DEVELOPMENT Limited resources

Involvement of HRHSW stakeholders

7.4 HRHSW RESEARCH Competing priorities within HRHSW Researches

Meeting customers expectations

Ended professional ethics

Capacity to assure quality of health care Understaffing at various level

7.5 HRHSW FINANCING Understanding of HRSW

Low Economic power

Cross under funding of the health services as a whole affects HRH

performance

Low budget for personnel involvement and other HRHSW activities

Low remuneration for the HRHSW which is below minimum living standards,

has negative effects on staff performance and retention

8.0INSTITUTIONAL FRAMEWORK8.1Public Private partnership8.2Relationship with various stakeholders8.3Decentralization

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9.0FUTURE DEVELOPMENT AND HEALTH SERVICES9.1Assumption on future health and health care needs9.2Service target9.3Institutional Development9.4Private sector growth

9.5Public sector growth

10.0FUTURE HRH REQUIREMENTS10.1Type and number of staff required10.2Staffing norms10.3Skills mix10.4Distribution of staff/Redistribution10.5Performance and productivity changes

11.0FUTURE HRH SUPPLY11.1Expected attrition rates

11.2Public private sector movement11.3Production capacity requirement targets11.4Total supply requirements

HUMAN RESOURCE POLICY REQUIREMENT (New and amendments)

HRH planning should ensure

Planning based on a comprehensive HRH management

information system drawing from regularly updated databases

at all levels Consideration to HRH skills mix, workload and service delivery

needs

Ministry of Health will coordinate all matters related to HRH

Planning

Availability of staff retention mechanisms to minimize attrition

Availability of career development and succession plan which

ensure equity to all cadres

HRH practices in line with policies to avoid mismatch between

actual practices and policies

Regional and District Health secretaries are HRH focal persons

at the regional and district level for effective HRH planning,management, research, finance, training and development

Training and development will ensure

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Quality and professional competence assurance

HRH Management should ensure

HRH deployment and recruitment linked with competency

profile Equity and gender balance in deployment

Regular reviews of service conditions and schemes of service

Staff retention measures including improving workenvironment, tools, equipment and supplies, provision ofhousing especially in rural areas are stated. However, specialremuneration package for hardship posts referred to in theNSGRP needs clear elaboration in the HRH policy and strategicplan.

Performance appraisal system and staff motivation linked to

productivity and transparent to ensure equity and staffsatisfaction

Free permit on the deployment of Health workers to fullymanned health facilities as per staffing level

Reallocation of available Health workers for proper utilization

Socialization of new and old health workers

HRH financing should ensure

Emphasize on resource mobilization from various sources,

Coordination and disbursement resources in line with current

financial reforms.

Pooled funding for HRH is not explicitly specified

HRH support from various stakeholders will be coordinated by

MoHSW in line with national priorities.

HRH research should ensure

Strengthening of local capacity,

Resources mobilization and focus on critical HRH issues are

emphasized

HRH research to comply with national requirements.

HRH Performance and quality Assurance should ensure HRH is seen to be benchmarked against set standards

conduciveness of working environment, technical audit andinspectorate to HRH and strengthening professional bodiesand associations

Compliance to set standards of performance and quality.

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implications of unethical and iatrogenic practices by 2010.

Specific objective Target Indicators Means of verification Assumptions/Risks

Ensure adherence to ethicsin medical and nursingpractice by 2011

Practices of medical

and nursing

documented and

analysed in ethical and

legal viewpoint by 2010

Compiled case studies

illustrating legal and

ethical problems

Consultant report Legal governing bodies w

be willing to provide

information to be compile

into a compendium

Establish public debates on

state of medical and nursing

practices by 2011

Debates on state of

medical and nursing

practices established by

2010

Increase in number of

informed debates in public

media and policy forums

Increase in number

devising viable options for

restoring ethics

Media publications or

broadcasts

Associations proceedings /

minutes

Commitment of associatio

to address the issue of

eroded ethics

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HRH POLICY GUIDELINE

Key Result Area: Harmonize and implement effectively HRH policy guideline

Strategic Goal 1: Improve HRHSW Policy guideline to facilitate effective implementation by harmonizing and reviewing at

policy forums

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Specificobjective strategies Activities Responsible

Time frame Source of Fu2006/07

2007/08

2008/09

2009/10

2010/11 MOH

Community

EnsureIncentivepackage forhardship postsare

incorporated inthe HR for HSW policy by2007

Review HR for HSW policy toincorporate incentivepackage for hardship posts

1. Conduct a survey toidentify criteria forhardship posts

2. Conduct workshop toseek consensus for

hardship incentivespackage

3. Incorporate incentivepackage for hardshipposts into HRHSWpolicy

Ensure amechanism tomanagerecruitment anddeployment ofstaffs isestablished by2007

Establish a coordinatingmechanism for differentcadres to deal with issuespertaining todecentralization/centralizationof HR for Health and socialWelfare

1. Review recruitmentprocedures to reducebeauracracy

2. Study a currenttransitional centralrecruitment anddeployment system andpropose transformationprogramme

3. Appoint a multi-sectoralmonitoring mechanismwith decentralizedrecruitment anddeployment with powersto intervene whennecessary

4. Assign the mechanismto develop its work planand budget

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Specific objective strategies Activities Responsible

Time frame Source of Fu2006/07

2007/08

2008/09

2009/10

2010/11 MOH

Community

Ensure adherence to

ethics in medical andnursing practice by

2011

Advocate adherenceto ethics and legalstandards

1. Update the current legaland ethical viewpoint forquality health services

2. Conduct advocacymeetings to all health

professionals on legalaspects of health

3. Document adversemedical and nursingpractices and analysefrom legal and ethicalviewpoints

Establish public

debates on state of

medical and nursing

practices by 2011

Raising awarenessand sensitivity ofleaders, communityand health careproviders on ethicalissues

1. Introduce ethicalissues debate inmedicinepractices to themedia

2. Design posters tocreatecommunityawareness on

ethical issuesand their legalrights

Increase the numberof options to restoreethics in healthsectors

Conduct workshop todevelop options to restoreethics in health sectors

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BUDGET

Specific objective strategies ActivitiesTotal ActivityCost

Ensure Incentive package forhardship posts are incorporated inthe HR for HSW policy by 2007

Review HR for HSW policy toincorporate incentive package forhardship posts

1. Conduct a survey to identify criteria forhardship posts

2. Conduct workshop to seek consensusfor hardship incentives package

3. Incorporate incentive package forhardship posts into HRHSW policy

Ensure a mechanism to managerecruitment and deployment of staffsis established by 2007

Establish a coordinating mechanismfor different cadres to deal withissues pertaining todecentralization/centralization of HRfor Health and social Welfare

1. Review recruitment procedures toreduce beauracracy

2. Study a current transitional centralrecruitment and deployment systemand propose transformationprogramme

3. Appoint a multi-sectoral monitoringmechanism with decentralizedrecruitment and deployment withpowers to intervene when necessary

4. Assign the mechanism to develop itswork plan and budget

Improve implementation of HRHSWpolicy by 2011 Distribute resources on time forpolicy implementation 1. Conduct follow-up monitoring andevaluation to ensure timely submissionof implementation report

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Specific objective strategies Activities Total Activity CosEnsure adherence to ethics inmedical and nursing practice by2011

Advocate adherence to ethicsand legal standards

1. Update the current legal andethical viewpoint for qualityhealth services

2. Conduct advocacy meetings toall health professionals on legalaspects of health

3. Document adverse medical andnursing practices and analysefrom legal and ethical viewpoints

Establish public debates on state

of medical and nursing practices

by 2011

Raising awareness and sensitivityof leaders, community and healthcare providers on ethical issues

1. Introduce ethical issues debate inmedicine practices to the media

2. Design posters to create communityawareness on ethical issues and theirlegal rights

Increase the number of options torestore ethics in health sectors

1. Conduct workshop to develop options torestore ethics in health sectors

HR FOR HEALTH AND SOCIAL WELFARE PLANNING

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Key Result Area: Improved Planning Capacity for Health and Social WelfareStrategic Objective: Strengthen planning capacity for the HR at all levels by 2011

Specific objective Target Indicators Means of verification Assumptions/RisksEnhance knowledge and skillof health and social welfareplanning team oncomprehensive HR planningby year 2010

Knowledge and Skillsenhanced to all HR forHealth and Social Welfareplanning team by 2010

Number of trainedplanners

Training reports

staffs database

Funds are available

All stakeholders involved

committed

Fill vacant posts from 46% to76% by 2010

30% of vacant post filled by2010

vacant post filled Human resource database

Sufficient supply of qual

job seekers

Funds are available

Willingness to work in hard

area

Improve HRHSW databaseat the district and regionallevel by 2008

HRHSW database improvedat district and regional levelby 2008

FunctionalHRHSW databaseat district andregional levels

HRHSW database

Reports

Funds are available

All stakeholders are invo

and willing to cooperate

Develop and finance a rapidhiring, redeployment plan forcritical cadres by 2010

Plan for rapid hiring anddeployment developed andfinanced by 2010

Costed list of needsby needy districtsVacant posts forcritical cadres filled

Rapid hiring andredeployment plan

Availability of qualified Hmarket

Establish criteria of hardshipenvironment for staff ofMoHSW by 2008

Criteria of hardshipenvironment for staff ofMoHSW established by2008

Criteria of hardshipareas

Study report on criteriafor hardship areas forMoHSW staff

Funds are available

Top management priority oHRH

All stakeholders are involve

Establish retentionmechanism for HRHSW by2011

Retention mechanism isestablished for HRHSW by2011

Mechanism inplace

Reports Funds are availableTop management are committe

Monitor applicability of stafflevels

Applicability of staffing levelmonitoring conducted

Number of districtsvisited

HR Database

updated

Availability of funds

Key Result Area: Improve Planning Capacity for Health and Social Welfare

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Strategic Goal: Develop and support gender sensitive planning capacity of MOHSW staff to produce comprehensive health

training, employing, and improving database system

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SpecificObjectives

Strategies Activity Responsible Time Frame Sources of Fu

2006/07

2007/08

2008/09

2009/10

2010/11

2011/12

MoH LG Community

O

Enhanceknowledge andskill of HSWplanning team

oncomprehensiveHR planningby 2010

Train MOHSWplanning team toenhance knowledgeand skill on planning

1. Identify sources offunds

2. Conductstakeholders

meeting to solicitfunds on HRplanning

3. Conduct training

Ensure regular HRplanning exchangeprogramme for crossfertilization ofexperience and ideas

1. Identify ands solicitexchangeprogramme partners

2. Identify priority areasof exchangeprogramme

3. Facilitate HRplanning study toursand attachments

Fill vacantposts in health

facilities andtraininginstitutionsfrom 46% to76% by 2010

Mobilizing funds 1. Identify sources of funds

2. Conductstakeholdersmeeting to Solicitfunds

3. Recruit new staffs

Train existing staff 1. Review existingcurricula inline withservice needs

2. Increase trainingoutput by ensuring

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SpecificObjectives


2006/07

2007/08

2008/09

2009/10

2010/11

2011/12

MoH LG Community

O







3. Conduct training





ImproveHRHSW

database atthe district andregional levelby 2008

Strengthen HRHSWsystem at all levels for

effective planning anddecision making

1. Train the staffs onthe use of HRH

database2. Develop a system to

ensure thatknowledge of trainers is regularlyupdated inline withservice needs

3. Establish andmaintain accurateand up-to-dateHRHSW database at

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SpecificObjectives


2006/07

2007/08

2008/09

2009/10

2010/11

2011/12

MoH LG Community

O







3. Conduct training





Establishincentive

package forhardshipenvironmentfor staff ofMoHSW by2008

1. Developmechanism for

selecting hardshipenvironment

1. Develop indicatorsfor identification of

hardshipenvironment

DHR/D

AP/DPP

2. Conduct a study toidentify hardshipareas

3. Identify prioritycadres to retain

4. Develop affordableincentive packagefor hardship posts

DAP/DHR

5. Incorporate incentive

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SpecificObjectives


2006/07

2007/08

2008/09

2009/10

2010/11

2011/12

MoH LG Community

O







3. Conduct training





health facility tofacilitate quality

servicesBUDGET

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Specific Objectives Strategies Activity Total ActiviCost

Enhance knowledge and skill ofHSW planning team oncomprehensive HR planning by2010

Train MOHSW planning team toenhance knowledge and skill onplanning

1. Identify sources of funds

2. Conduct stakeholders meeting to solicitfunds on HR planning

3. conduct training

Ensure regular HR planningexchange programme for crossfertilization of experience and ideas

1. Identify ands solicit exchange programmepartners

2. Identify priority areas of exchangeprogramme

3. Facilitate HR planning study tours andattachments

Fill vacant posts in health facilitiesand training institutions from 46% to76% by 2010

Mobilizing funds 1. Identify sources of funds

2. Conduct stakeholders meeting to Solicitfunds

3. Recruit new staffs

Train existing staff 1. Review existing curricula inline with serviceneeds

2. Increase training output by ensuring thatthe knowledge of trainers regularlyupdated inline with service needs

3. Improving the quality and cost

effectiveness of in-service training

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3. conduct training

Improve HRHSW database at thedistrict and regional level by 2008

Strengthen HRHSW system at alllevels for effective planning anddecision making

1. Train the staffs on the use of HRHdatabase

2. Develop a system to ensure thatknowledge of trainers is regularly updatedinline with service needs

3. Establish and maintain accurate and up-to-date HRHSW database at the all levels

4. Establish/coordinate the HRH databasewhich cover the entire sector

5. Carrying out regular analysis of the staffingdata

6. procure necessary equipments forsustaining HRHSW database at all levels

Develop and finance a rapid hiring,redeployment plan for critical cadresby 2008

Mobilizing funds for emergencyhiring


2. Conduct stakeholders meeting to Solicit

funds

3. Recruit staff through emergency hiringprogramme

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3. conduct training

Establish incentive package forhardship environment for staff ofMoHSW by 2008

Develop mechanism for selectinghardship environment

1. Develop indicators for identification ofhardship environment

2. Conduct a study to identify hardship areas

3. Identify priority cadres to retain

4. Develop affordable incentive package forhardship posts

5. Incorporate incentive packages into HRHbudget

6. Disseminate circular for incentive packagefor hardship posts

7. Monitor impact of attraction and retentionpackage

Establish retention mechanism for

HRHSW by 2011

Developing retention mechanism for

HRHSW in hardship areas to assureavailability of staff in the hardshipareas

1. Initiate incentive package and other

remunerations in hardship area

2. Solicit funds for retention mechanism

Monitor applicability of staff levels Ensuring that all vacant post inMoH/SW are filled by the rightcadres, right skill mix at the righthealth facility to facilitate qualityservices

1. Conduct study to monitor applicability ofstaffing level

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3. conduct training

Establish career and successionplanning system in the health sector

Develop career and successionplans

1.Solicit finds

2.conduct situational analysis

3 Develop career development plan for allhealth cadres

4 Develop succession plan for all keymanagement posts at all levels

Key result Areas: Appropriate and adequate management of HR for Health and Social Welfare

Strategic Objective: Improve working environment, incentives and fair distribution of health staff by 2011

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Specific Objectives Target Indicators Means of verification

Assumption/Risks

Review job list and jobdescriptions of all staff of theMoHSW by 2007

Job list and Jobdescriptions of all healthstaff reviewed by 2007

Updated job listand jobdescriptions forhealth staff

Report on review of job list and jobdescriptions for HRfor Health andsocial welfare

Funds are available

All staff are involved

Review scheme of service for

health staff by 2007

Scheme of service for staff

of MoHSW reviewed by2007

Updated scheme of

service for healthstaff

Report on review of

scheme of servicefor health staff

Funds are available

All staff are involved

Establish criteria of hardshipenvironment for staff ofMoHSW by 2008

Criteria of hardshipenvironment for staff ofMoHSW established by2008

Criteria of hardshipareas

Study report oncriteria for hardshipareas for MoHSWstaff

Funds are available

Top management

priority on HRH

All stakeholders are

involved

Introduce HRHSW hardshipincentives in difficult areas by2011

Incentives for hardshipareas introduced by 2011

Incentivespackages forhardship areasimplemented

GovernmentCirculars

Funds are available

Top management

priority on HRH

Political will

Establish strategies toenhance productivity ofHRHSW by 2011

Strategies to enhanceproductivity established

A number ofstrategies toenhanceproductivity forHRHSW

Report onestablishedstrategies

Funds are available

All stakeholders

involved

Increase/Strengthen privatesector participation inrendering health and socialwelfare services by 2010

Private sector participationin rendering health andsocial welfare services by2010

Number of privatesector effectivelyparticipating inrendering healthand social welfareservices

Workshops andseminars reports

Funds are available

All stakeholders

involved

Increase support to HRHSWstaff by 30% of the current

Support to HRHSWsupport increased by 2011

% increase ofsupport to HRHSW

Performancereports

Funds are available

Technical expert are

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Specific Objectives Target Indicators Means of verification

Assumption/Risks

support by 2011 staff Willing and capable tosupport

Staff are ready to

receive support fromtechnical experts

Improve working conditions for

HRHSW by 50% of the currentsituation by 2011

Working condition for

HRHSW improved by 50%by 2011

% improve of

working conditionfor HRHSW

Renovation

reports

Rehabilitation

reports

Procurement

reports

Funds are available

Top level managers are

interested andcommitted

Strengthen managementcapacity of the MoHSWinstitutions by 2010

Management capacity ofMoHSW institutionsimproved

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Key Result Area: Improve performance of health staff for quality care

Strategic Goal: Increase MoHSW staffs motivation and flexibility to work in all areas in the country by improving incentivesand working environment

SpecificObjectives

Strategies Activity Responsible Time Frame Sources of F

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 MoH LG CommunityOt

Improve gendersensitive job listand jobdescriptions of allstaff of the healthand social welfaresector by 2007

Review job listand jobdescription forall cadres in linewith HSRrequirements

1. Select task force forreviewing job listand job description

2. Conduct 4meetings to reviewjob list and jobdescription

DAP

3. Seek approval fromtop levelmanagement

Improve scheme ofservice for healthstaff by 2007

Review schemeof service for allcadres in line

with the HSRrequirements

1. Select task force forreviewing schemeof service

2. Conduct 4meetings to reviewscheme of service

DAP


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SpecificObjectives


2006/07

2007/08

2008/09

2009/10

2010/11

2011/12

MoH LG Community

Ot

Improve gendersensitive job listand jobdescriptions of all

staff of the healthand social welfaresector by 2007

Review job listand jobdescription forall cadres in line

with HSRrequirements



DAP


Establish incentivepackage forhardshipenvironment forstaff of MoHSW by2008

Developmechanism forselectinghardshipenvironment

8. Develop indicatorsfor identification ofhardshipenvironment

DHR/DAP/DPP

9. Conduct a study toidentify hardshipareas

10. Identify prioritycadres to retain

DAP/DHR

11. Develop affordableincentive packagefor hardship posts

12. Incorporateincentive packagesinto HRH budget

13. Disseminate circularfor incentive

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SpecificObjectives


2006/07

2007/08

2008/09

2009/10

2010/11

2011/12

MoH LG Community

Ot







DAP


Identify factorscontributing to HRfor Health andSocial Welfareattrition andmeasures forimprovement by2009

Identify factorscontributing toHRHSW attrition

1. Conduct a study toidentify factorscontributing toHRHSW attrition

DHR

2. Dissemination ofthe study report toall stakeholders

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SpecificObjectives


2006/07

2007/08

2008/09

2009/10

2010/11

2011/12

MoH LG Community

Ot







DAP


Train newrecruited staffsto orient themwith the workingenvironment

1. Conduct inductioncourse to HRHSWgraduates to orientthem organisationobjectives, jobdescription,performancestandards, andsupportivesupervision

2. Monitor andevaluateperformance andtake appropriateactions

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SpecificObjectives


2006/07

2007/08

2008/09

2009/10

2010/11

2011/12

MoH LG Community

Ot







DAP


Train MOHSWstaffs to haveappropriatequalifications

1. Conduct trainingneeds

assessment

2. Solicit funds fortraining

3. Train withinappropriatequalifications to fitto their positions

Improve HRHSWadvocacy &sensitizationinitiatives to Policy& Decision makersby 2009

Carry outHRHSWadvocacy &sensitization toPolicy &Decision makers

1. Select and trainTOT on advocacyand sensitization

DHR

2. Conduct advocacyand sensitizationmeetings

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SpecificObjectives


2006/07

2007/08

2008/09

2009/10

2010/11

2011/12

MoH LG Community

Ot







DAP


Improve MoHrecordsmanagement by2011

Review effectiverecordsmanagementsystem in theMoHSW forimprovement

1. Review currentsystem to identifyweaknesses

DAP

2. Train Registryassistant on themodern recordsmanagement

3. Conduct effectivesupervision to allregistry assistant

4. Purchase enoughand modernworking tools forregistry

5. Upgrade registryassistants to FormFour

6. Computerizingrecords

management

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SpecificObjectives


2006/07

2007/08

2008/09

2009/10

2010/11

2011/12

MoH LG Community

Ot







DAP


Enhanceproductivity ofHRHSW by 2011

Developmotivation andincentivepackage

1. Conduct a study toidentify motivatingfactors

DAP/D

HR2. Introduce affordable

motivation andincentive scheme

3. Orient managementon motivation andincentive packages

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SpecificObjectives


2006/07

2007/08

2008/09

2009/10

2010/11

2011/12

MoH LG Community

Ot







DAP


Increase/Strengthen private sectorparticipation inrendering healthand social welfareservices by 2010

Designmechanism forHealth andSocial Welfareservicesprivatization

1. Identify areas forprivatization

DAP

2. Select mechanismfor contracting out

3. Set standards forservices to becontracted out

4. Develop contracts

5. Contract out theagreed services

Monitor andevaluate theimplementation

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SpecificObjectives


2006/07

2007/08

2008/09

2009/10

2010/11

2011/12

MoH LG Community

Ot







DAP


Improve workingconditions forHRHSW by 50% ofthe current situationby 2011

Designmechanism forimprovingworkingconditions

1. Solicit funds forimproving workingconditions

DAP/DHR

2. Install InformationTechnology at alllevels of health care

3. Conduct a survey toestablish needs forimproving workingenvironment

4. Procure materialsand equipmentsaccording to needs

5. Rehabilitate,renovate, andconstruct buildings

6. Providerefreshments forHRHSW staff

7. Provide transport

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SpecificObjectives


2006/07

2007/08

2008/09

2009/10

2010/11

2011/12

MoH LG Community

Ot







DAP


Strengthenmanagementcapacity of theMoHSW institutionsby 2010

Train MOHSWstaff onmanagementskills

1. Conductmanagementtraining to middleand top levelmanagers

DHR

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BUDGET

Specific Objectives Strategies Activity Total ActivityCost

Improve job list and jobdescriptions of all staff of theMoHSW by 2007

Reviewing job list and job description for all

cadres in line with HSR requirements

Select task force for

reviewing job list and

job description Conduct 4 meetings to

review job list and jobdescription

Seek approval for top

level management fromall stakeholders

Improve scheme of service forhealth staff by 2007

Reviewing scheme of service to all cadres in

line with the HSR requirements

Select task force for

reviewing scheme ofservice

Conduct 4 meetings to

review scheme ofservice

Seek approval for top

level management from

all stakeholdersEstablish criteria of hardshipenvironment for staff ofMoHSW by 2008

Develop mechanism for selecting hardship

environment

Improving ways of attracting and retaining staff

particular in the hard to work environment

Review recruitment procedures

Reviewing registration procedures

Conduct simple study to

identify hard to workenvironment

Identify priority cadre to

retain

Develop affordable

incentive package for hard

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to work environment

Improve HRH budget

Monitor impact of attraction

and retention package

Review recruitment

procedure

Review registration

procedure

Distributing hardship incentive circular

Incorporating hardship incentives into budget

Budget for hardship

incentive

Pay hardship incentive

to responsible staff

Establish factors contributing toHR for Health and SocialWelfare attrition by 2009

Conduct studies on the factors contributing to

HRHSW attrition

Develop proposal for

the study

Data collection

Data analysis and

interpretation

Report writing

Dissemination of the

study report

Develop strategies to addressfactors contributing to HR forHealth and Social Welfareattrition by 2008

Getting proposals from stakeholders Write invitation letters to

stakeholders

Conduct meeting with

stakeholders

Write strategies to address

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factors contributing toattrition

Present draft to MoH SW

management team

Write strategies to address

factors contributing toattrition & submitting to PSMoHSW

Improve performance of theHRHSW staff by 2011

Design mechanism for performance appraisal

Improving staff performance by providing them

enough skills and working tools

Conduct induction course to

HRHSW graduates

Develop clear objectives

and ensure availability of upto date job description

Develop performance

standards

Ensure effective supportive

supervision to all cadres

Monitor and evaluate

performance and takeappropriate actions

Ensure OPRAS is usedeffectively to all staff of MoHSWby 2009

Creating awareness on OPRAS to all staff Identify OPRAS facilitators

Conduct training to all staff

Visit work places to follow

up use of OPRAS

Ensure 30% increase ofMoHSW qualified personnel by2011

Increasing MoHSW qualified staff by 30% of the

current situation

Increase personnel emolument budget

Solicit funds

Long course training

Short course training

Review recruitment

procedures

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Replacement

Advocacy and sensitization onissues pertaining to HRHSW,policy and decision makers by2009

Carrying out advocacy & sensitization on

HRHSW Policy & Decision makers

Conduct sensitization

meetings

Carry out advocacy

Conduct various training

related to HRHSW issues

Introduce induction courses toall health secretaries by 2011

Organize Induction course to all Health

secretaries

Obtain list of all Health

Secretaries

Conduct induction

course to all HealthSecretaries

Improve MoH recordsmanagement by 2011

Design effective records management system in

the MoHSW

Computerizing

records management

Changing Index system

Reviewing employees data

Increase budget for MoHSW registry

Review current system to

identify weaknesses

Train Registry assistant on

the modern recordsmanagement

Conduct effective

supervision to all registryassistant

Purchase enough and

modern working tools forregistry

Upgrade registry assistants

to Form Four

Enhance productivity of HRHSW Develop motivation and incentive package Identify types of motivation

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by 2011 Train management on

motivation and incentivepackages

Introduce affordable

motivation and incentive

scheme

Increase/Strengthen privatesector participation in renderinghealth and social welfareservices by 2010

Design mechanism for Health and Social

Welfare services privatization

Identify areas for

privatization

Select mechanism for

contracting out

Set standards for

services to becontracted out

Develop contracts

Contract out the agreed

services

Monitor and evaluate

the implementation

Improve distribution of HRHSWat all levels

Ensure equitable distribution of HRHSW at

all levels

Monitor applicability of

staffing levels annually

Reallocate/retrench

excessive staff at alllevels

Improve working conditions forHRHSW by 50% of the currentsituation by 2011

Design mechanism for improving working

conditions

Improve budget for working conditions

Develop mechanism for

improving workingconditions

Repair of offices

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Purchase of office

equipment i.e.computers, printers,photocopier machinetables, chairs, file

cabinets. Provide refreshments

for HRHSW staff

Provide transport

Provide House

especially those in hardworking environment

Strengthen managementcapacity of the MoHSWinstitutions by 2010

Enhancing management capability of health and

social welfare institutions

Capacity building to

HRHSW staff

Conduct management

training to HRHSW

Strengthen pre-service

training

Total Cost

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EDUCATION/TRAINING AND SKILLS DEVELOPMENT

Key Result Area: Develop and improve Human Resource capacity in the MOH and Social Welfare

Strategic Objective: Strengthen HR for Health and Social Welfare at all level by 2011

Specific Objectives Target Indicators Means of verification Assumption/Risks

Harmonize andrationalize capacitybuilding with policyintentions by 2011

Capacity building harmonizedand rationalized with policyintentions by 2011

Number of capacitybuilding activities

Report on harmonizationand rationalization ofcapacity buildings andpolicy intention

Funds are available

Support from the top

level managers

All stakeholders involv

Increase capacitybuilding funding by 30 %of the current budget by2011

Capacity building fundingincreased by 30% of thecurrent budget by 2011

% increase of

capacity buildingfunding

Number of agreement

signed for sponsoringcapacity building

Budget document

Funding agreements

documents in place

Funds are available

Support from the top

level managers


interested

Promote gender balancefor HRHSW staff at alllevels by 20% of thecurrent situation by 2011

20% decreased of gendergaps by 2011

Number of gander gapsdecreased at differentlevels

Training reports

Sensitization reports

Employment data

Gender balance rema

a government priority

Support of the top lev

managers

Increase trainingopportunities by 20% forHRHSW staff by 2011

20% increase of training forHRHSW staff opportunitiesby 2011

Number of trainingopportunities

Training reports Funds are available

Stakeholders are willi

to support

Improve capacity of Capacity of training Numbers training Improvement reports Funds are available

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Specific Objectives Target Indicators Means of verification Assumption/Risks

MoHSW traininginstitutions by 2011

institutions improved by 2011 institutions improved Institutions database Support from

stakeholders

Political will

Improve capacityalternative medicinesproviders by 2011

Capacity of alternativemedicine providers improvedby 2011

Number of alternativemedicine providersreached

Capacity building

reports

Funds are available

alternative medicine

providers are willing Support from top leve

management

Promote communityparticipation onpreventable healthproblems by 2011

Increased communityparticipation on preventablehealth problems by 2011

Reduced number ofreported cases frompreventable healthproblems

Outpatient cases

reports

Funds are available


involved

Political will

Ensure MonitoringHRHSW performancecapacity buildinginitiatives at all cadresto 90% by 2010

90% of capacity buildinginitiates at all cadresmonitored by 2010

Number of monitoredcapacity buildinginitiatives

Monitoring reports Funds are available

Capacity building

initiatives are availabl

Target groups are

available

Ensure evaluation ofHRHSW performance

capacity buildinginitiatives at cadres to90% by 2010

90% of capacity buildinginitiates at all cadres

evaluated by 2010

Number of evaluatedcapacity building

initiatives

Evaluation reports Funds are available

Capacity building

initiatives are availabl

Target groups are

available

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Key Result Area: Develop and improve Human Resource capacity in the MOH and Social WelfareStrategic Goal: Strengthen HR for Health and Social Welfare to commensurate with demands through increasing

training opportunities, supporting alternative medicine providers in capacity building, and ensuremonitoring and evaluation of capacity building initiatives for all cadres.

SpecificObjectives


2006/

07

2007/

08

2008/

09

2009/

10

20010/

11

20011/

12

MoH LG Commu

nity

Othe

1.HarmonizeandRationalizeCapacityBuildingwith policyintentionsby 2010

Monitoringand evaluatepolicy fromtime to time toensure HRcapacityobjectiveshave beenimplemented

Create a team formonitoring andevaluation

MOH, H v v

Provide monitoringand evaluation teamwith the necessaryresource tofacilitate the process

Conduct stakeholdersconsultations meetingto harmonize policymeasures on capacitybuilding

2.Increasethe currentcapacitybuildingfunding forHRH andSW Budgetby 30% by2010

Mobilizeresources forHRH and SWCapacityBuilding

Identify and solicitfunds from variousstakeholders

v v v v

Conduct consultativemeeting to discussand agree on fundingmechanisms

Strengthenskills inbudgeting andbudgetarycontrol

Train healthSecretaries andAdministrators oneffective budgetingand funds accounting

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SpecificObjectives


2006/07

2007/08

2008/09

2009/10

20010/11

20011/12

MoH LG Community

O

3. Promotegenderbalance for

HRHSWstaff at alllevels by20% of thecurrentsituation

Mainstreaming gender inHRHSW

capacitybuildinginitiatives

1. Conduct genderawarenessseminars for policy

and decisionmakers at all levels

x x x x X

2. Review guidelinesand other workingdocuments ofHRHW toincorporate genderconcerns

3. Review curricula toIncorporate genderperspectives in atall levels

4. Increasetrainingopportunities for

HRHSWstaff by 20%by 2011.

1.Establishprioritized andcomprehensive training and

skillsdevelopmentneeds

1. Conduct trainingneeds assessment

x x x x x

2. Develop trainingprogram

3. Solicit trainingopportunities fromboth external andinternal

2.Mobilizefunds fortraining

4. Develop proposalto solicit funds fortraining

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SpecificObjectives


2006/07

2007/08

2008/09

2009/10

20010/11

20011/12

MoH LG Community

O

3. Promotegenderbalance forHRHSW

staff at alllevels by20% of thecurrentsituation

Mainstreaming gender inHRHSWcapacity

buildinginitiatives

1. Conduct genderawarenessseminars for policyand decision

makers at all levels

x x x x X



5. Enhancerapidupgrading ofphased outcadresthroughDistanceEducationby 2010

Design aprogramme tocarter for outphasedcadres inMOHSW

1. Conduct advocacyregarding selfdevelopment tophased out cadres

2. Design modality forsupporting phasedout cadres

DHR x x x x x v

3. Redesign healthand traininginstitutions toaccommodatephased out cadres

4. Enrolment of CA,MCHA andEnrolled Nursesfoe Distance

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buildinginitiatives



x x x x X



6. Improvecapacity ofHSWtraininginstitutionsby 2011

1. StrengthenHealthtraininginstitutions forqualitytraining

1. Conduct costanalysis ofrehabilitating andrenovating existinginstitutions

MOHSW

x x x x x

2. Build new orrehabilitateinfrastructurure

3. Coordinate trainingoffered at differentlevels

4. Create awarenessof AdministrativeOfficers on costeffective analysis incapacity building

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x x x x X



7. Improvecapacity ofalternativemedicinesproviders by 2011

Mobilize andsupervisealternativemedicineproviders topracticesafely andappropriately

1. Identify alternativemedicine providersfor registration andsupervision

DMO x x x x x

2. Orient alternativemedicine providerson safety measures

3. Conduct quarterlyfollow up inspection

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x x x x X



9. Ensureevaluationof HRHSWperformance capacitybuildinginitiatives forall cadres to90% by2001

1. Developmechanismsto monitorcapacitybuildinginitiatives andincorporate inoperationalplan

1. Develop tools formonitoringperformancecapacity buildinginitiatives

2. Monitorperformance aftertraining to establishthe impact ofcapacity buildinginitiatives

3. Conduct tracerstudies for curriculareview

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BUDGET

SPECIFIC OBJECTIVES STRATEGIES ACTIVITY TOTAL ACTIVITY COS

1. Harmonize and RationalizeCapacity Building with policyintentions by 2010

Monitoring and evaluate policy from time totime to ensure HR capacity objectives havebeen implemented

Create a team for monitoring andevaluation

Provide monitoring and evaluation

team with the necessary resourcetofacilitate the process

Conduct stakeholdersconsultations meeting toharmonize policy measures oncapacity building

2.Increase the current capacitybuilding funding for HRH andSW Budget by 30% by 2010

Mobilize resources for HRH and SWCapacity Building

Identify and solicit funds fromvarious stakeholders

Conduct consultative meeting todiscuss and agree on fundingmechanisms

Strengthen skills in budgeting andbudgetary control

Train health Secretaries andAdministrators on effectivebudgeting and funds accounting

3. Promote gender balancefor HRHSW staff at all levelsby 20% of the current situati

Hrh Strategy 27 April 2006

Documents

Transcript of Hrh Strategy 27 April 2006