Report on and assessment of human resources...

Report on and assessment of human

resources management system in San

Martin and other approved regions,

including activities undertaken to

strengthen the system and

recommendations for future activities

USAID|Politicas en Salud

Contract No. GHS-I-10-07-00003-00

June 30, 2014

Prepared for:

Armando Cotrina, COR

USAID/Peru Health Office

Av. Encalada s.n.

Lima - Perú

Submitted by:

Abt Associates Inc.

4550 Montgomery Avenue

Suite 800 North

Bethesda, MD 20814

This document has been elaborated by USAID|Políticas en Salud Project, financed by the United States

Agency for International Development (USAID) under contract No. GHS-I-10-07-00003-00.

The author’s views expressed in this publication do not necessarily reflect the views of the United

States Agency for International Development or the United States Government.

Report on HH.RR. management system in San Martin and other approved regions Contract #GHS-I-10-07-00003-00

Abt Associates Inc. Contents ▌pg. i

Report on and assessment of HH.RR. management system in San Martin and

other approved regions, including activities undertaken to strengthen and

recommendations for future activities

Table of Contents

Acronyms ............................................................................................................................................... i

Executive summary .............................................................................................................................. 1

Introduction .......................................................................................................................................... 3

1. Tools and methodologies to assess HRMS implementation at national level ....................... 4

2. Results of HRMS evaluation at national level ......................................................................... 7

2.1 HHR policy and strategic planning ................................................................................. 11

2.2 Work organization ........................................................................................................... 16

2.3 Employment management ............................................................................................... 21

2.4 Development and training management .......................................................................... 26

2.5 Performance management ............................................................................................... 30

2.6 Compensation management ............................................................................................. 35

2.7 Managing human and social relations ............................................................................. 41

3. Analysis of results of HRMS evaluation in five selected regions ......................................... 45

3.1 Loreto Regional Health Directorate ................................................................................ 48

3.2 Pasco Regional Health Directorate .................................................................................. 50

3.3 Huánuco Regional Health Directorate ............................................................................. 51

3.4 Lambayeque Regional Health Directorate ....................................................................... 52

3.5 Piura Regional Health Directorate ................................................................................... 54

4. Analysis of HRMS assessment results in San Martin Regional Health Directorate

compared with national results ......................................................................................................... 57

5. Activities undertaken by MoH to strengthen HRMS and proposals for future activities . 75

6. Conclusions and Recommendations ....................................................................................... 79

7. References ................................................................................................................................. 81


Abt Associates Inc. Contents ▌pg. ii

8. Annex ........................................................................................................................................ 87

8.1 Analysis of performance evaluation results in the HHR policy and strategic planning

sub-system, in selected regions .................................................................................................. 87

8.2 Analysis of performance evaluation results in the work organization sub-system, in

selected regions .......................................................................................................................... 93

8.3 Analysis of performance evaluation results in the employment management sub-system,

in selected regions ...................................................................................................................... 97

8.4 Analysis of performance evaluation results in the performance management sub-system,

in selected regions .................................................................................................................... 103

8.5 Analysis of performance evaluation results in the development and training management

sub-system, in selected regions ................................................................................................ 108

8.6 Analysis of performance evaluation results in the compensation management sub-

system, in selected regions ....................................................................................................... 112

8.7 Analysis of performance evaluation results in the managing human and social relations

sub-system, in selected regions ................................................................................................ 117

8.8 HRMS evaluation results by Region and sub-systems. ................................................. 122

8.9 Ministerial Resolutions and Legislative Decree ............................................................ 123

Figures

Figure 1: Results for each sub-system, Peru 2014.................................................................................. 8

Figure 2: Human Resources Management System by region, Peru 2014. ............................................. 9

Figure 3: HHR policy and strategic planning, Peru 2014. .................................................................... 11

Figure 4: HHR policy and strategic planning by region, Peru 2014. ................................................... 12

Figure 5: Work organization sub-system, Peru 2014. .......................................................................... 16

Figure 6: Work organization, Peru and regions in 2014. ...................................................................... 17

Figure 7: Work organization, Peru and regions in 2014. ...................................................................... 18

Figure 8: Employment management sub-system, Peru 2014. .............................................................. 21

Figure 9: Employment management, Peru and regions in 2014. .......................................................... 22

Figure 10: Development and training management sub-system, Peru 2014 ........................................ 26

Figure 11: Development and training management sub-system. Peru and Regions in 2014 ............... 27

Figure 12: Performance management sub-system, Peru 2014. ............................................................ 30


Abt Associates Inc. Contents ▌pg. iii

Figure 13: Performance management sub-system, Peru and regions in 2014. ..................................... 31

Figure 14: Compensation management sub-system, Peru 2014. .......................................................... 35

Figure 15: Compensation management sub-system, Peru and regions in 2014. .................................. 36

Figure 16: Managing human and social relations sub-system, Peru 2014. .......................................... 41

Figure 17: Managing human and social relations sub-system, Peru and regions in 2014. ................... 42

Figure 18: Human Resources Management System by sub-system in Peru and San Martin, 2014. .... 59

Figure 19: Human Resources Management System by UE, San Martin 2014. .................................... 59

Figure 20: HHR policy and strategic planning sub-system, San Martin 2014. .................................... 61

Figure 21: HHR policy and strategic planning by UE, San Martin 2014. ............................................ 62

Figure 22: Work organization sub-system, San Martin 2014. .............................................................. 63

Figure 23: Work organization, San Martin and UEs in 2014. .............................................................. 64

Figure 24: Employment management sub-system, San Martin 2014. .................................................. 65

Figure 25: Employment management, San Martin and UEs in 2014. .................................................. 66

Figure 26: Performance management sub-system, San Martin 2014. .................................................. 67

Figure 27: Performance management sub-system, San Martin and UEs in 2014. ............................... 68

Figure 28: Development and training management sub-system, San Martin 2014. ............................. 69

Figure 29: Development and training management sub-system, San Martin and UEs in 2014. .......... 70

Figure 30: Compensation management sub-system, San Martin 2014. ............................................... 71

Figure 31: Compensation management sub-system, San Martin and UEs in 2014. ............................. 72

Figure 32: Managing human and social relations sub-system, San Martin 2014. ................................ 73

Figure 33: Managing human and social relations sub-system, San Martin and UEs in 2014. ............. 74

Tables

Table 1: HRMS assessment tool: Total number of assessed processes and questions by sub-system. .. 4

Table 2: Key processes for each HRMS sub-system in health institutions. ........................................... 5

Table 3: Budget Spending Units assessed by region, Peru 2014. ........................................................... 7

Table 4: Results for each sub-system, Peru 2014. .................................................................................. 8

Table 5: Human Resources Management System by sub-system and region, Peru 2014. ................... 10


Abt Associates Inc. Contents ▌pg. iv

Table 6: HHR policy and strategic planning, Peru 2014. ..................................................................... 12

Table 7: HHR policy and strategic planning by region, Peru 2014. ..................................................... 13

Table 8: HHR policy and strategic planning, Peru 2014. ..................................................................... 15

Table 9: Work organization sub-system, Peru 2014............................................................................. 16

Table 10: Work organization, Peru and regions in 2014. ..................................................................... 17

Table 11: Work organization, Peru 2014. ............................................................................................ 20

Table 12: Employment management sub-system, Peru 2014. .............................................................. 21

Table 13: Employment management, Peru and regions in 2014. ......................................................... 22

Table 14: Employment management. Peru, 2014 ................................................................................. 24

Table 15: Development and training management sub-system, Peru 2014 .......................................... 26

Table 16: Development and training management sub-system. Peru and Regions in 2014 ................. 27

Table 17: Development and training management processes, Peru and Regions in 2014 ................... 28

Table 18: Development and training management sub-system, Peru 2014. ......................................... 29

Table 19: Performance management sub-system, Peru 2014. .............................................................. 30

Table 20: Performance management processes, Peru and regions in 2014. ......................................... 31

Table 21: Performance management sub-system, Peru 2014. .............................................................. 33

Table 22: Compensation management sub-system, Peru 2014. ........................................................... 36

Table 23: Compensation management, Peru and regions in 2014........................................................ 37

Table 24: Compensation management sub-system, Peru 2014. ........................................................... 39

Table 25: Managing human and social relations sub-system, Peru 2014. ............................................ 41

Table 26: Managing human and social relations, Peru and regions in 2014. ....................................... 42

Table 27: Managing human and social relations sub-system, Peru 2014. ............................................ 44

Table 28: Human Resources Management System progress rating by region, Peru 2014. .................. 45

Table 29: General characteristics of the five selected RHDs, Peru 2014. ............................................ 46

Table 30: General characteristics of the five selected RHDs, Peru 2014. ............................................ 47

Table 31: Distribution of networks and micro-networks by UE, San Martin 2014.............................. 57

Table 32: Human Resources Management System processes by UE, San Martin 2014. ..................... 60

Table 33: HHR policy and strategic planning by UE, San Martin 2014. ............................................. 62


Abt Associates Inc. Contents ▌pg. v

Table 34: Work organization, San Martin and UEs in 2014. ............................................................... 64

Table 35: Employment management, San Martin and UEs in 2014. ................................................... 66

Table 36: Performance management sub-system, San Martin 2014. ................................................... 68

Table 37: Development and training management sub-system, San Martin and UEs in 2014. ........... 70

Table 38: Compensation management sub-system, San Martin 2014. ................................................. 72

Table 39: Human Resources Management System processes by UE, San Martin 2014. ..................... 74


Abt Associates Inc. Acronyms ▌pg. i

Acronyms

AETA Asignación Extraordinaria por Trabajo Asistencial / Extraordinary Assignment

for Health Care Work

ANGR Asamblea Nacional de Gobiernos Regionales

CAS Contrato administrativo de servicios / Administrative services contract

CAP Cuadro de asignación de personal / Staffing Table

CIGS Comité integubernamental en Salud / Intergovernmental Committee on Health

CLAS Comités Locales de Administración de Salud / Health Administration Local

Communities

COREPRES Comité Regional de Pre-Grado en Salud

RHD Dirección Regional de Salud / Region Health Directorate

DL Legislative Decree

ENDES Encuesta Demográfica y de Salud Familiar / National Survey of Demography

and Family Health

HR Human resources

HHR Health human resources

HRMS Human Resources Management System

INEI Instituto Nacional de Estadística e Informática / National Institute of Statistics

and Informatics

INFORHUS Información de Recursos Humanos en Salud / Human Resources Health

Information

MAPRO Manual de procesos / Procedures Manual

MINTRA Ministerio de Trabajo y Promoción del Empleo / Ministry of Work and

Employee Promotion

MOF Manual of Organizations and Functions

MoF Ministry of Finance

MoH Ministry of Health

PAP Presupuesto analítico de personal / Staff budget

PDP Plan de Desarrollo Personal / Personal Development Plan

PLAME Planilla mensual de pagos / Monthly payroll

RENIEC Registro Nacional de Identificación y Estado Civil / National Registry of

Identification and Civil Status

RHD Regional health directorate

RIT Reglamento interno de trabajo / Internal labor regulations

RNSDD Registro Nacional de Sanciones de Destitución y Despido / National Registry

of Sanctions and Dismissals


Abt Associates Inc. Acronyms ▌pg. ii

ROF Reglamento de Organización y Funciones / Regulation of Organization and

Functions

SERUMS Servicio Rural y Urbano Marginal en Salud / Civil Health Service in Rural and

Marginal Urban Areas

SERVIR Autoridad Nacional del Servicio Civil / National Civil Service Authority

SMT-RHD San Martin Regional Health Directorate

TA Asistencia Técnica( Technical Assistance

UE Unidades ejecutoras de presupuesto / Budget spending units

USAID United States Agency for International Development

WHO World Health Organization


Abt Associates Inc. Executive Summary ▌pg. 1

Executive summary

Implementation of health reform requires improvements in the availability and quality of health human resources (HHR) at all levels of the health sector. Regarding human resources (HR) improvements, in June 2008, the National Civil Service Authority (SERVIR) was created as the lead agency in managing the Human Resources Management System (HRMS) for public institutions. Within this institutional framework, the project developed a methodology and a tool to assess HRMS implementation in order to identify existing weaknesses and opportunities for improvements. In 2012, this methodology was applied in San Martin Regional Health Directorate (SMT-RHD) and results were presented in the project deliverable entitled “Report on and assessment of the human resources management system, including activities undertaken to strengthen the system and recommendations for us in other regions”.

On the other hand, within the Intergovernmental Committee on Health (Comité Intergubernamental en Salud –CIGS), the Ministry of Health (MoH) and all Regional Health Directorates (RHDs) agreed to design a strategy to strengthen HRMS at the Budget Administration Unit (Unidad Ejecutora de Presupuesto –UE) level. For this purpose, CIGS formed a HR sub-committee to develop a quick assessment of HRMS implementation. This sub-committee asked the project for TA and for using the methodology and tools designed by the project. Tools consisted in a standardized questionnaire, a spreadsheet and a technical report template.

MoH sent the questionnaire, the spreadsheet and the template to all RHDs in order to organize workshops with all its UEs and collect information. Twenty one out of twenty five RHDs sent the required information (88% of RHDs), although not all the UEs within each RHDs sent their respective results. One hundred and eight UEs out of one hundred and sixty two UEs (67%) sent all the information on time.

After consolidating the results of all 108 UEs, the HR sub-committee and the project came up with the following results at national level:

Regarding HRMS sub-systems and processes, all of them achieved between poor and moderate

level of development, on average RHDs achieved a 35% implementation rate.

The employment management sub-system achieved the best implementation rating at 45%.

Lambayeque RHD exhibited the best performance with a 62% progress rating while Cusco, San

Martin and Amazonas had the lowest scores with a 31% progress rating.

In general, all UEs focus their attention to hire personnel, control attendance and manage staff

files. However, it is surprising that UEs performance in this aspect is not adequate.

The performance management sub-system achieved the lowest level of development: 20%.

Supervision and feedback, and design of plans for individual performance improvement

processes are poorly developed: 12% and 16% respectively. Junín RHD exhibited the best

performance with a 44% progress rate while Tumbes and Piura RHDs had the lowest score with

a 1% and 5% rate respectively.

Absence of methodologies and tools add to the lack of skilled staff as main explanations of these

low rates. Regarding Junín RHD, their UEs have developed a performance evaluation last year

Human resources, the different

kinds of clinical and non-clinical

staff who make each individual

and public health intervention

happen, are the most important of

the health system´s inputs. The

performance of health care

systems depends ultimately on

the knowledge, skills and

motivation of the people

responsible for delivering

services. (WHO, 2000)


Abt Associates Inc. Executive Summary ▌pg. 2

and 60% of them have defined individual performance goals and informed workers in advance

about issues to be assessed.

Regarding HRMS performance by RHD, Loreto, Callao, Junín, and Cusco showed highest

progresses with attainments of 47%, 45%, 44%, and 43% in functions assessed. These RHDs

showed best scores in the development and training management sub-system, as compared with

the rest of RHDs where employment management was the most relevant function deployed.

Piura and Tumbes RHD had the lowest progress with attainments of 21% and 25% in functions

assessed. In these RHDs, performance management was the sub-system with the lowest rate:

5% and 1% respectively; and the lowest considering all RHDs.

Information aggregated on national perspective allows the identification of common constraints in all

UEs that the MoH should overcome through a national plan to strengthen HRMS and achieve

competent, motivated and committed health workers in the improvement of health conditions of

people living in poor and undeveloped areas.

Based on HRMS evaluation results, the CIGS-HR committee defined a plan and a group of activities

to tackle the main and common constraints in HRMS implementation. But, it is necessary to work with

each of the UEs in order to define specific improvement plans since these results have demonstrated

the existence of different levels of development in each of the HRMS processes.

Regarding activities undertaken by the MoH to strengthen HRMS, MoH has approved the following methodology and tools:

Technical guide to calculate HHR gaps for the first level of care, which was approved in March

2014.

Technical guide to identify labor competencies and design tools and standards for specific

competency assessment using the functional analysis, which was approved in March 2014.

Technical guide to calculate HHR gaps for the second and third-level-of-care, which was

approved in June 2014.

Legislative decree regulating the compensation comprehensive policy and the economic delivery

of health service staff of the State1, approved in September 2013.

.

This report presents detailed information about the results of the human resources management system assessment as well as an explanation of the results in selected regions.

1 Decreto Legislativo N° 1153


Abt Associates Inc. Introduction ▌pg. 3

Introduction

Once a package of health reform measures was approved, MoH and RHDs gathered to identify a

group of constraints which could limit the success of health reform implementation.

Some of these constraints included the poor availability of competent HHR at all levels; the lack of

reliable information about the HHR situation to determine the magnitude of necessary HHR

investment; and deficiencies in payroll administration, among others.

To improve this situation, MoH and the RHDs agreed at the Thirteenth Session of the

Intergovernmental Committee on Health (CIGS) to focus on

strengthening institutional management of HHR through a rapid

capacity assessment of HR teams at the regional level. Participants

also agreed to develop a strategy to strengthen teams after the

assessment is completed.

In this report, the project presents assessment results for all Budget

Spending Units (Unidades ejecutoras de presupuesto, UE) at the

national level using project-designed methodology and tools which

was validates in SMT-RHD.

In a previous report, the project presented in detail, HRMS

assessment results in SMT-RHD and activities undertaken to

strengthen the system. This work was an important input to develop

a HRMS evaluation at national level in a short period of time.

As part of this national assessment, each SMT-RHD UEs was evaluated and its results are presented

in each of the HRMS processes report. On average, HRMS implementation in SMT-RHD is 30%

completed, placing it in ranked 12th of 17. Progresses made with the project TA such as measuring

HHR gap in the first-level-of-care, the design and approval of the pay scale, the design of job profiles,

have been recognized in the survey despite existing high staff turnover; but it was not enough to

impact the average result of each of the processes evaluated. Regulations and technical documents

which are in the design and validation stage such as recruitment and selection directive and

performance evaluation tools, by not being in implementation process, have not been recorded as

advances in the survey.

This report attempts to go beyond analyzing only SMT-RHD and other selected regions but rather

from the work done in SMT-RHD, presenting the results at the national level in each of the HRMS

processes.

The first chapter describes the process used to collect information from MoH and the consolidation of

information at the national and regional levels, from tools and methodologies applied in SMT-RHD.

The second chapter presents the results at the national level for each process involved in HRMS

implementation.

In the third chapter, the project selected five regions in order to provide a snapshot of regional teams’

analyses of their respective HRMS assessment results.

In the final chapter, the project describes MoH proposals to counter HHR problems and constraints

based on these results.

A country’s health workforce is

made up of health workers who

are at many different stages of

their working lives; they work in

many different organizations and

under changing conditions and

pressures. Whatever the

circumstances, an effective

workforce strategy has to focus

on three core challenges:

improving recruitment, helping the

existing workforce to perform

better, and slowing the rate at

which workers leave the health

workforce. (WHO, 2006)


Abt Associates Inc. Tools and methodologies to assess HRMS Implementations ▌pg. 4

1. Tools and methodologies to assess HRMS implementation at

national level

To implement health reforms, MoH and RHDs agreed to design a strategy to strengthen HRM at the

UE level. Towards this end, CIGS formed a committee composed of MoH offices in charge of HHR;

officials from Callao, Pasco, Loreto, and Ica RHDs; and a representative from the National Assembly

of Regional Governments (Asamblea Nacional de Gobiernos Regionales, ANGR).

This committee proposed the development of the following tasks:

A quick assessment of HRMS process implementation.

A proposal for the basic organizational structure of a HR unit at the RHD level in order to

incorporate new processes approved under the civil service law and move away from personnel

administration offices to HRM offices.

A proposal for a job profile for the new HRM office head.

Regarding the quick assessment, MoH asked the project for TA.

The project presented to MoH HRMS performance evaluation methodology and tools applied in SMT-

RHD and Cajamarca RHD. Tools and methodology were reported to USAID in December 2013

through deliverable of the project entitled, “Report on and assessment of the human resources

management system, including activities undertaken to strengthen the system and recommendations

for use in other regions”.

Over several meetings, MoH reviewed each part of the assessment tool and made appropriate

adjustments. The tool was then approved to be distributed at the national level.

The instrument evaluates 29 processes within the seven sub-systems through a total of 662 closed

questions. In the form of a checklist, these questions have only two possible answers: YES or NO.

Table 1: HRMS assessment tool: Total number of assessed processes and questions by sub-

system.

HRMS sub-systems # assessed

processes # questions

HHR policy and strategic planning 6 124

Work organization 3 92

Employment management 5 137

Performance management 4 66

Development and training management 3 105

Compensation management 5 70

Managing human and social relations 3 68

HUMAN RESOURCES MANAGEMENT SYSTEM 29 662



Table 2: Key processes for each HRMS sub-system in health institutions.

Sub-system Key Processes

HHR policy and strategic planning Policies and strategies for HHR management and development

Development of operational research

HHR information management

HHR management control

HHR strategic planning

HHR financing

Work organization Design of job profiles

Identification of labor competencies

Job rating

Employment management Recruitment, selection, incorporation, and induction

Staff mobility

Management of personnel files, control of attendance

Administration of disciplinary process

Staff termination and retirement

Development and training management Labor advancement (promotion and career path)

Capacity building

Regulation of the teaching-service process

Performance management Performance planning

Supervision

Performance evaluation

Feedback and design of plans for individual performance

improvement

Compensation management Design of salary scales

Management of payroll and salaries

Administration of benefits and bonuses

Incentive management

Pension management

Managing human and social relations Management of the organizational climate and culture

Management of labor relations

Workplace health, safety, and welfare

The project-designed spreadsheet was used to facilitate consolidation of results and subsequent

analysis. It immediately allows the aggregation of results into tables and graphs for easy analysis.

Additionally, each question has been weighted according to its strategic importance in proper HRMS

functioning.

The following ratings were used to analyze the results:

High development: > 80% complete

Moderate development: 40% - 80% complete

Little Development: <40% complete



To obtain qualitative information from each UE, the project provided the scheme used to design the

SMT-RHD technical report, which contains results and analysis with proposals for improvement.

The questionnaire, spreadsheet, and technical report scheme were distributed to all RHDs.

To gather information, each RHD developed workshops with their respective UEs. All files and reports

produced by UEs were sent to MoH.

The project supported the consolidation of the information and the subsequent analysis.


Abt Associates Inc. Results of HRMS evaluation at national level ▌pg. 7

2. Results of HRMS evaluation at national level

Once approved, MoH distributed HRMS performance evaluation tools to all regional health

directorates for use by Budget Spending Units (Unidades ejecutoras de presupuesto - UE). MoH

established a deadline for evaluation results, and 67% of all UEs gathered these results.

Table 3: Budget Spending Units assessed by region, Peru 2014.

N° Regional Health

Directorate (RHD)

N° UE assessed Total UE % UE assessed

1 Tumbes 2 3 67%

2 Piura 7 7 100%

3 Lambayeque 4 4 100%

4 La Libertad 0 11 0%

5 Ancash 9 9 100%

6 Lima 9 9 100%

7 Callao 2 4 50%

8 Ica 7 8 88%

9 Arequipa 0 7 0%

10 Moquegua 3 3 100%

11 Tacna 0 2 0%

12 Cajamarca 6 6 100%

13 Huánuco 7 7 100%

14 Pasco 3 3 100%

15 Junín 5 9 56%

16 Huancavelica 8 8 100%

17 Ayacucho 6 9 67%

18 Cusco 5 8 63%

19 Puno 0 12 0%

20 Apurímac 6 10 60%

21 San Martín 5 5 100%

22 Amazonas 4 5 80%

23 Ucayali 2 5 40%

24 Loreto 6 6 100%

25 Madre de Dios 2 2 100%

Perú 108 162 67%

SOURCE: Technical report on HRMS evaluation results for each RHD.

Regarding response rates, all UEs from 12 regions answered the questionnaire while four regions did

not send any information regarding their UEs.

Obtaining information from 67% of UEs was an unexpected outcome for MoH as the regions had

approximately one month to send results, which is a relatively short period of time.



After consolidating the results for all 108 UEs, the project came up with the following results (Table

4.2):

HRMS achieved a 35% implementation rate, which is an average rating based on the level of

implementation for seven subsystems.

The employment management sub-system achieved the best implementation rating at 45%

followed by the development and training management sub-system at 43%.

The performance management sub-system achieved the lowest level of development at 20%.

The work organization sub-system also achieved a poor level of development at 29%.

Table 4: Results for each sub-system, Peru 2014.

Human Resource Management System % complete Result

Subsystem: HHR policy and strategic planning 31% Little development

Subsystem: Work organization 29% Little development

Subsystem: Employment management 45% Moderate development

Subsystem: Performance management 20% Little development

Subsystem: Development and training management 43% Moderate development

Subsystem: Compensation management 37% Little development

Subsystem: Managing human and social relations 38% Little development

Human Resource Management System 35% Little development


Figure 1: Results for each sub-system, Peru 2014


0% 10% 20% 30% 40% 50%

HUMAN RESOURCES MANAGEMENT SYSTEM

HHR policy and strategic planning

Work organization

Employment management

Performance management

Development and training management

Compensation management

Managing human and social relations



The following tables and graphs contain the results obtained by region for each HRMS sub-system.

Regarding RHD performance on HRMS implementation, the project found that Loreto and Callao

have the highest progress rates at 47% and 45%, respectively, while Piura has the lowest rate at

21%. Several explanations for these results are presented in the next chapter.

Figure 2: Human Resources Management System by region, Peru 2014.


Regarding RHD performance on each HRMS sub-system, the project obtained the following results:

Loreto achieved the highest progress rate for three sub-systems: work organization (38%);

development and training management (67%); and compensation management (60%).

Cusco achieved the best results in the HHR policy and strategic planning sub-system with a 50%

progress rate, which can be classified as “moderate development”.



Lambayeque achieved the best results in the employment management sub-system with a 62%

progress rating.

Junín achieved the best results in the performance management sub-system with a 44%

progress rating, which can be classified as “little development”.

Callao achieved the best results in the managing human and social relations sub-system with a

56% progress rating.

Piura achieved the lowest rating in the HHR policy and strategic planning and work organization

sub-systems.

Tumbes UEs have only managed to achieve a 1% progress rating for the management sub-

system and 13% in the compensation management sub-system. They have achieved the lowest

ratings for all sub-systems.

Ayacucho has the lowest progress rating in two sub-systems: the development and training

management sub-system and the managing human and social relations sub-system.

Cusco, San Martín, and Amazonas achieved the lowest ratings in the employment management

sub-system at 31%.

Table 5: Human Resources Management System by sub-system and region, Peru 2014.

Region HRMS

HHR policy

and strategic

planning

Work

organization

Employment

management

Performance

management

Development

and training

management

Compensation

management

Managing

human and

social

relations

PERÚ 35% 31% 29% 45% 20% 43% 37% 38%

Tumbes 25% 31% 28% 33% 1% 30% 13% 42%

Piura 21% 19% 15% 35% 5% 27% 27% 22%

Lambayeque 39% 29% 27% 62% 26% 46% 38% 45%

Ancash 30% 25% 17% 46% 13% 34% 41% 33%

Lima 41% 29% 36% 51% 32% 49% 38% 55%

Callao 45% 35% 29% 54% 36% 61% 46% 56%

Ica 31% 34% 19% 42% 14% 43% 33% 31%

Moquegua 32% 25% 20% 49% 22% 30% 38% 39%

Cajamarca 40% 43% 34% 53% 29% 46% 40% 39%

Huancavelica 31% 33% 36% 44% 15% 29% 31% 26%

Ayacucho 27% 28% 26% 41% 20% 19% 34% 20%

Pasco 35% 42% 19% 41% 17% 45% 50% 29%

Junín 44% 41% 29% 50% 44% 60% 41% 41%

Cusco 43% 50% 36% 31% 35% 57% 40% 49%

Apurímac 41% 35% 33% 41% 16% 61% 45% 55%

Huánuco 33% 35% 36% 45% 19% 38% 26% 32%



Region HRMS

HHR policy

and strategic

planning

Work

organization

Employment

management

Performance

management

Development

and training

management

Compensation

management

Managing

human and

social

relations

San Martín 30% 30% 30% 31% 13% 31% 39% 33%

Amazonas 26% 30% 19% 31% 11% 28% 37% 27%

Ucayali 32% 29% 25% 32% 11% 42% 49% 38%

Loreto 47% 34% 38% 54% 24% 67% 60% 51%

Madre de Dios 29% 21% 22% 45% 11% 42% 26% 37%


The instruments used to gather information allowed for detailed results for each of the processes

involved in the HRMS sub-systems. The results were analyzed by regional teams in conjunction with

MoH, and the conclusions are presented in tables.

2.1 HHR policy and strategic planning

This sub-system primarily encompasses HRMS alignment to national and regional policies; national

health strategies; and the comprehensive care model. This sub-system also facilitates coordination

among all HRMS processes to ensure suitable and competent workers where they are needed.

The following graph and table show results from six of the processes that are within this sub-system

at the national level.

On average, implementation of this subsystem is 31% completed, which indicates “little

development”. Some processes are particularly poorly developed, including operational research and

HHR management control with 8% and 18%, respectively.

According to the reported information, HHR financing and HHR information management are

functioning better but still have achieved a progress rating of less than 50%.

Figure 3: HHR policy and strategic planning, Peru 2014.

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

Policies and strategies for HHR management and development





HHR financing

HHR POLICY AND STRATEGIC PLANNING SUB-SYSTEM




Table 6: HHR policy and strategic planning, Peru 2014.

KEY PROCESSES Expected

result Obtained

result %

Complete Result


2,392 408 17% Little development

Development of operational research 624 53 8% Little development

HHR information management 5,304 2,147 40% Moderate development

HHR management control 1,872 336 18% Little development

HHR strategic planning 1,872 658 35% Little development

HHR financing 890 365 41% Moderate development

Average 12,954 3,967 31% Little development


For this sub-system, Cusco has the best performance at 50% while Piura has the lowest score at

19%.

Figure 4: HHR policy and strategic planning by region, Peru 2014.

0%

10%

20%

30%

40%

50%

60%

HHR policy and strategic planning sub-system


The table below displays RHD results for each HR policy and strategic planning process.



Table 7: HHR policy and strategic planning by region, Peru 2014.

RHD

HHR POLICY AND

STRATEGIC PLANNING

SUB-SYSTEM

Policies and strategies for

HHR management

and development

Development of operational

research

HHR information

management

HHR management

control


HHR financing

PERÚ 31% 17% 8% 40% 18% 35% 41%

Tumbes 31% 7% 0% 53% 17% 33% 15%

Piura 19% 4% 0% 32% 4% 20% 30%

Lambayeque 29% 0% 5% 43% 0% 50% 54%

Ancash 25% 2% 6% 41% 12% 20% 43%

Lima 29% 42% 20% 38% 12% 15% 42%

Callao 35% 41% 9% 42% 24% 24% 58%

Ica 34% 7% 4% 54% 13% 42% 36%

Moquegua 25% 0% 0% 37% 8% 44% 21%

Cajamarca 43% 29% 18% 46% 21% 63% 73%

Huancavelica 33% 14% 26% 35% 21% 52% 53%

Ayacucho 28% 17% 20% 22% 19% 44% 67%

Pasco 42% 58% 9% 54% 7% 46% 54%

Junín 41% 21% 0% 61% 41% 30% 40%

Cusco 50% 20% 9% 68% 61% 42% 42%

Apurímac 35% 35% 20% 43% 19% 39% 31%

Huánuco 35% 23% 10% 49% 22% 34% 38%

San Martín 30% 3% 5% 50% 8% 39% 26%

Amazonas 30% 2% 0% 56% 25% 11% 29%

Ucayali 29% 5% 0% 33% 11% 54% 62%

Loreto 34% 13% 9% 46% 25% 30% 71%

Madre de Dios 21% 4% 0% 35% 0% 21% 54%


Considering the results for each of the processes, the project formed the following conclusions:

For policies and strategies within the HHR management and development process, Pasco

achieved the best performance (58%). However, some RHDs have achieved a 0% progress

rating, including Lambayeque and Moquegua.

In the development of the operational research process, Huancavelica achieved the best

performance with 26%, but some RHDs have achieved a 0% progress rating, including Tumbes,

Piura, Moquegua, Junín, Amazonas, and Ucayali. On average, this process is the least

developed process within this sub-system at the national level.

For the HHR information management process, all RHDs have achieved a progress rating of

higher than 20%. Cusco achieved the best rating with 68% while Ayacucho had the lowest

progress rating with 22%.

For the HHR management control process, Cusco showed the best performance with 61%, but

some RHDs achieved a progress rating of 0%, including Lambayeque and Madre de Dios.



For the HHR strategic planning process, Cajamarca achieved the highest progress rating with

63% while Amazonas had the lowest score with 11%.

Regarding the HHR financing process, Cajamarca and Loreto achieved the highest progress

rating with 73% and 71%, respectively, while Tumbes had the lowest score with 15%.

An aggregate analysis of possible explanations for these results is shown in the subsequent table. In

the next chapter, results and corresponding analysis for six regions will be presented.



Table 8: HHR policy and strategic planning, Peru 2014.

KEY PROCESSES

% Complete Strengths Problem Description Analysis Proposals for Improvement


17%

Little development

At least 10% of UEs have HHR policies at regional level

Only 4% of UEs implement and monitor policies.

96% of UEs have not designed a unit responsible for the management of HHR policies, and 97% of UEs have not trained their staff in the management of HHR policies.

Managers are appointed based on trust.

There is high staff turnover and no proper transfer of the advances in HRM

Regional governments do not prioritize HR issues.

Develop training programs in the design and management of HHR policies.

MoH should provide technical assistance for the management of HHR policies.


8%

Little development

At least 14% of UEs have analyzed the HHR situation.

No competent HR to perform research.

No support for research funding.

No incentives.

Partner with universities to develop research projects.

Create awards for best research.


40%

Moderate development

48% of UEs have HHR information systems.

95% have no information from other sub-sectors.

70% have no current information on HHR availability.

Lack of coordination with other sub-sectors.

UEs do not periodically send HHR information to RHDs, nor do they possess updated information.

MoF has parallel HHR information systems.

Coordinate with MoF to force UEs to send information through RHDs.

Keep budget allocation tied to MoH HHR information systems.

Coordinate with MoF and SERVIR, the interoperability among all HHR information systems (HR Module/INFORHUS/RENIEC).


18%

Little development

At least 17% of UEs have designated a responsible unit for HRM monitoring.

93% of UEs did not define indicators to monitor HRM.

Lack of capacity to monitor HRM indicators.

Develop skills in designing indicators and dashboards.

Add a HHR management module to INFORHUS.

TA to MoH in handling management information systems.

MoH should define key indicators based on critical areas encountered in diagnosis and promote a space for national monitoring with incentives to improve performance in HRM.


35%

Little development

At least 32% of UEs are estimating HR requirements.

97% of UEs report that they have not received training in HR planning.

UEs do not have staff with the right profile for HHR planning and do not have tools for estimating HR needs.

Develop skills in HR planning.

Develop tools and methodologies for estimating HR needs.

MoH should provide TA to UE for HR planning.

HHR financing 41%

Moderate development

At least 34% of UEs have designated a responsible unit for estimating the HR budget.

90% of responsible personnel are not trained in HHR financing.

UEs do not have trained personnel or personnel with the appropriate profile for HR funding based on technical criteria.

Develop skills in HHR financing.




2.2 Work organization

This sub-system exists to optimize HHR working capacity by specifying the content of functions,

activities, and tasks as well as staff qualifications.

The following graph and table show the results of three processes included in this sub-system. On

average, the progress rating for this sub-system has been measured at 29%, which is classified as

“little development”. According to regional reports, slight improvements have taken place in the

design of job profile category with a progress rating of 42%.

Figure 5: Work organization sub-system, Peru 2014.

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

Design of job profiles


Job rating

WORK ORGANIZATION SUB-SYSTEM


Table 9: Work organization sub-system, Peru 2014


result Obtained

result %

Complete Result

Design of job profiles 5,304 2,228 42% Moderate development

Identification of labor competencies 2,288 327 14% Little development

Job rating 1,976 244 12% Little development

Average 9,568 2,799 29% Little development


On average for this sub-system, Loreto exhibited the best performance with a 38% progress rating

while Piura and Ancash had the lowest scores with 15% and 17%, respectively.



Figure 6: Work organization, Peru and regions in 2014.

0%

5%

10%

15%

20%

25%

30%

35%

40%

Work organization sub-sytem


The results of work organization processes for each RHD are displayed in the table and graph below.

Table 10: Work organization, Peru and regions in 2014.

RHD WORK

ORGANIZATION SUB-SYSTEM



Job rating

PERÚ 29% 42% 14% 12%

Tumbes 28% 43% 13% 8%

Piura 15% 28% 1% 1%

Lambayeque 27% 50% 0% 0%

Ancash 17% 27% 7% 2%

Lima 36% 52% 18% 17%

Callao 29% 38% 17% 20%

Ica 19% 29% 8% 5%

Moquegua 20% 37% 0% 0%

Cajamarca 34% 44% 15% 31%

Huancavelica 36% 52% 21% 16%

Ayacucho 26% 39% 13% 7%

Pasco 19% 31% 9% 0%

Junín 29% 42% 9% 19%

Cusco 36% 43% 34% 19%

Apurímac 33% 45% 27% 8%

Huánuco 36% 43% 27% 29%



RHD WORK

ORGANIZATION SUB-SYSTEM



Job rating

San Martín 30% 35% 21% 30%

Amazonas 19% 26% 17% 4%

Ucayali 25% 42% 9% 0%

Loreto 38% 58% 15% 13%

Madre de Dios 22% 41% 0% 3%


Figure 7: Work organization, Peru and regions in 2014.

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

55%

60%

65%

Work organization Design of job profiles Identification of labor competencies Job rating


Considering results for each of the processes, the project formed the following conclusions:

RHDs achieved their highest progress ratings in the job

profile design category. Loreto had the highest progress

rating at 58% while Amazonas had the lowest progress rating

with 26%.

Regarding identification of labor competencies, Cusco

exhibited the best performance with a progress rating of

34%. However, some RHDs, including Lambayeque,

Moquegua, and Madre de Dios, achieved no progress

towards implementation of this process. It should be noted

that there has been little development of this process among

RHDs in general.

Job profile design that clearly set

out objectives, responsibilities,

authority and lines of

accountability are consistently

associated with improved

achievement of work goals, for all

sorts of worker. Moreover, moves

to develop clear job profiles can

produce quite rapid effects.

Health workers in many countries

still lack proper job profiles, so

this strategy has widespread

potential. (WHO, 2006)



Regarding the job rating process, Cajamarca exhibited the best performance with a 31% progress

rating. However, some RHDs, including Lambayeque, Moquegua, Pasco, and Ucayali, achieved

no progress towards implementation of this process. It should be noted that there has been little

development of this process among RHDs in general.

On average, the job rating process is the least developed process at the national level.





Table 11: Work organization, Peru 2014.

KEY PROCESSES


Design of job

profiles

42%

Moderate

development

About 50% of UEs use

the Staffing Table

(Cuadro de asignación

de personal, CAP), Staff

budget (Presupuesto

analítico de personal,

PAP), and the Manual

of Organizations and

Functions (MOF) to

design job profiles.

Only 3% of UEs have assigned staff

to design job profiles, and only 1%

of UEs state that these staff

members have been trained.

Lack of capacities and suitable guides

and tools for work organization for

application in the health sector.

Coordinate with SERVIR for the adequacy of its MPP

methodology for implementation in the health sector.

Develop skills in designing job profiles.

MoH should provide technical assistance to UEs in the

use of work organization tools, which should be specially

designed for health sector application.

Identification of

labor

competencies

14%

Little development

About 15% of UEs have

competency profiles for

health care jobs. In the

design of profiles,

teams have used MoH-

defined labor

competencies as

references.

Over 90% of UEs do not have tools

or methodologies for defining

labor competencies.

MoH has defined a methodology and

tools for the design of labor

competencies, and these have been

approved by ministerial resolution.

However, they have not yet been

distributed for implementation.

MoH should disseminate the methodology to identify

labor competencies. Moreover, MoH should organize

training workshops in designing labor competencies and

target regional teams.

Job rating 12%

Little development

About 23% of UEs state

that they have

performed job rating in

the past year, and 25%

used it to set wages.

98% of UEs state that they do not

have staff trained in job

evaluation.

Lack of skills, tools, and methodologies

for job rating.

The importance and implementation

of job valuation is not understood.

MoH should propose a methodology and tools for job

rating in coordination with SERVIR.

MoH must provide TA in the application of job rating

tools.




2.3 Employment management

Employment management seeks to establish a set of policies and standards to optimize the entrance,

movement, and exit of staff in health care organizations. These policies and standards should be

based on job profiles and competencies established by the employer and should foster the

achievement of sector health objectives.

The graph presents results for the five processes involved in this sub-system.

On average, the sub-system achieved a 45% progress rating, which is classified as “moderate

development”.

Figure 8: Employment management sub-system, Peru 2014.

0% 10% 20% 30% 40% 50% 60%

Recruitment, selection, incorporation and induction

Staff mobility

Management of staff files and attendance control



EMPLOYMENT MANAGEMENT SUB-SYSTEM


In general, most processes have achieved some level of progress. The recruitment, selection,

incorporation, and induction process is the most developed with a 48% progress rating. According to

regional reports, however, some processes lag behind in development, including the staff mobility

process with a 32% progress rating and the administration of disciplinary process with a 35% rating.

Table 12: Employment management sub-system, Peru 2014.


result Obtained

result %

Complete Result

Recruitment, selection, incorporation and

induction 8,632 4,149 48% Moderate development

Staff mobility 728 325 45% Moderate development

Management of staff files and attendance control 2,184 953 44% Moderate development

Administration of disciplinary process 1,352 479 35% Little development

Staff termination and retirement 1,352 437 32% Little development

EMPLOYMENT MANAGEMENT SUB-SYSTEM 14,248 6,343 45% Moderate development




On average for this sub-system, Lambayeque exhibited the best performance with a 62% progress

rating while Cusco, San Martín, and Amazonas had the lowest scores with a 31% progress rating.

Figure 9: Employment management, Peru and regions in 2014.

0%

10%

20%

30%

40%

50%

60%

70%

Employment management sub-system


In the table below, results for each employment management process for all RHDs are presented.

Table 13: Employment management, Peru and regions in 2014.

RHD

EMPLOYMENT MANAGEMENT

SUB-SYSTEM

Recruitment, selection,

incorporation and induction

Staff mobility

Management of staff files and attendance

control

Administration of disciplinary

process


PERÚ 45% 48% 45% 44% 35% 32%

Tumbes 33% 38% 14% 50% 20% 5%

Piura 35% 37% 33% 34% 36% 24%

Lambayeque 62% 65% 32% 65% 63% 63%

Ancash 46% 44% 60% 59% 34% 40%

Lima 51% 54% 46% 61% 29% 37%

Callao 54% 56% 21% 70% 34% 63%

Ica 42% 46% 37% 44% 33% 29%

Moquegua 49% 53% 62% 51% 32% 33%

Cajamarca 53% 57% 55% 54% 54% 24%

Huancavelica 44% 57% 66% 29% 16% 13%

Ayacucho 41% 52% 48% 25% 22% 23%

Pasco 41% 42% 43% 55% 39% 4%

Junín 50% 54% 54% 49% 44% 40%

Cusco 31% 33% 34% 37% 12% 29%

Apurímac 41% 52% 38% 26% 23% 23%

Huánuco 45% 55% 39% 40% 22% 33%



RHD

EMPLOYMENT MANAGEMENT

SUB-SYSTEM

Recruitment, selection,

incorporation and induction

Staff mobility


control

Administration of disciplinary

process


San Martín 31% 39% 17% 31% 16% 12%

Amazonas 31% 38% 29% 31% 20% 8%

Ucayali 32% 36% 21% 32% 41% 5%

Loreto 54% 57% 60% 55% 37% 45%

Madre de Dios 45% 48% 57% 46% 32% 34%


Based on results for each of the processes, the project formed the following conclusions:

Callao achieved a 70% progress rating, which is the highest rating among all RHDs, in the

management of staff files and attendance control process.

Tumbes, Pasco, and Ucayali had progress ratings of 5%, 4% and 5%, respectively, which are the

lowest progress ratings among all RHDs, for the staff termination and retirement process.

Lambayeque achieved the best performance in the recruitment, selection, incorporation, and

induction process with a progress rating of 62%; the administration of disciplinary process

category with a 63% rating; and the staff termination and retirement process with a 63% rating.

Regarding the staff mobility process, Moquegua exhibited the best performance with a 62%

progress rating while Tumbes had the lowest progress rating with 14%.





Table 14: Employment management. Peru, 2014

KEY PROCESSES


Recruitment,

selection,

incorporation and

induction

48%

Moderate

development

About 80% of UEs have:

- the "user area

requirement" to

begin the hiring

process;

- calls for tenders are

only published in

the institution

mural,

- staff evaluate the

CVs using a

checklist;

- keep competition

rules on file;

- keep records and

the results of

evaluations of

contract

committees. .

18% of UEs disseminate job

opportunities via the MINTRA

(Ministerio de Trabajo – Ministry

of Labor) website.

About 30% of UEs reported that

more than 75% of employees

work in contracted positions.

In 4% of UEs, the contracted sign

the contracts after more than 30

days from the end of the contest.

Only 47% of UEs completed

induction for new staff.

There is political pressure to quickly

develop a hiring process, but this

process, done quickly, would not take

into consideration existing rules and

regulations.

The user area requirement does not

correspond to a job description or HR

needs assessment as previously

defined.

Health authorities do not provide

resources to develop induction

programs for new staff.

MoH should adapt existing norms for application in the

health sector.

MoH should provide TA to develop recruitment and

selection processes based on existing regulations.

PENDING: Coordinate with SERVIR on the design of

strategies to monitor compliance with recruitment,

selection, and hiring regulations. Should establish

penalties for noncompliance.

Staff mobility 45%

Moderate

development

Only 30% of UEs have

designated a

responsible unit to

manage staff mobility.

94% of UEs report that their staff

has not received training in staff

mobility management.

86% of UEs do not have tools to

record staff turnover.

There is no reliable information on

staff mobility to determine the

magnitude of this problem and

sensitize the authorities towards

improving this process.

MoH should provide TA to manage staff mobility.

Improve HHR information system (InfoRhus) to register

staff mobility.

Management of

staff files and

attendance

control

44%

Moderate

development

30% of UEs have

designated a

responsible unit to

manage staff files and

staff attendance

control.

80% of UEs have

designated a

responsible unit to

track staff attendance.

70% of UEs have designated a

responsible unit to manage staff

files, but only 15% of unit staff

have been trained.

Only 22% of UEs have a system to

register data and information

contained within staff files.

In 65% of UEs, only some staff,

primarily doctors, mark

attendance.

Lack of authority in requiring

attendance control for all personnel.

Lack of methodology and tools to keep

files updated.

Remove alternative attendance control systems (e.g.

manual control) and maintain a single system to register

and monitor attendance.

MoH should design a tool to keep staff files updated.



KEY PROCESSES


70% of UEs have a staff

attendance control

system as well as a

manual attendance

control.

9% of UEs has directorial

resolution to exonerate to mark

attendance

91% of those responsible for staff

files have not been trained.

Administration of

disciplinary

process

33%

Little development

At least 13% of UEs

have disseminated the

Internal Labor

Regulations

(Reglamento interno de

trabajo, RIT) to

recently hired

78% do not have RIT.

68% do not have a Disciplinary

Commission Process.

88% have updated the National

Registry of Sanctions and

Dismissals (Registro Nacional de

Sanciones y Destitucines del

Estado, RNSSD).

Authorities do not consider RIT to be

important.

Despite being in the national

regulations, regional authorities have

not named the person responsible for

updating RNSDD.

The office team has many tasks and

does not have time to update the RIT

MoH will provide TA to RHD in designing RIT.

MoH will provide a tool to RHD to monitor the updating

of RNSDD at the UE level.

Staff termination

and retirement

32%

Little development

UEs have updated

guidelines to develop

staff disengagement

processes in cases of

death (45%); waiver

(41%); dismissal (37%);

dismissal for serious

misconduct (46%);

permanent disability

(39%); retirement

(35%); and end of the

contract (38%).

Only 14% of UEs have designated

a responsible unit for managing

staff retirement, and only 4% of

unit staff has received training to

administer the process of staff

disengagement.

Only 28% of UEs have information

regarding personnel severance

and retirement.




2.4 Development and training management

The development and training management sub-system defines practices to encourage professional

and job development opportunities by providing learning opportunities as well as career path planning

within the organization.

The following graph shows results of the three processes within this sub-system.

On average, this sub-system has achieved a 43% progress rating, which is classified as “moderate

development”.

Figure 10: Development and training management sub-system, Peru 2014

0% 10% 20% 30% 40% 50% 60%

Labor advancement (promotion and career path)

Capacity building

Regulation of the teaching & service process

DEVEOPMENT AND TRAINING MANAGEMENT SUBSYSTEM

SOURCE: Technical report on HRM evaluation results for each RHD.

The regulation of teaching-service process has progressed the least with a 33% progress rating.

According to information provided by participants, the process with the greatest level of development

is the capacity building process with a 48% rating.

Table 15: Development and training management sub-system, Peru 2014


result

Obtained

result

%

Complete Result

Labor advancement (promotion and career path) 4,160 1,748 42% Moderate development

Capacity building 4,992 2,405 48% Moderate development

Regulation of the teaching & service process 1,768 587 33% Little development

Development and training management sub-system 10,920 4,740 43% Moderate development


On average for this sub-system, Loreto exhibited the best performance with a 67% progress rating

while Ayacucho had the lowest with 19%.



Table 16: Development and training management sub-system. Peru and Regions in 2014

0%

10%

20%

30%

40%

50%

60%

70%

Development and training management sub-system


Results by RHD in each of the development and training management processes are presented in

the graph and table below.

Figure 11: Development and training management sub-system. Peru and Regions in 2014

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

DEVELOPMENT AND TRAINING MANAGEMENT Labor advancement (promotion and career path)

Capacity building Regulation of the teaching & service process




Table 17: Development and training management processes, Peru and Regions in 2014

DEVELOPMENT AND

TRAINING MANAGEMENT

Labor advancement (promotion and career

path) Capacity building

Regulation of the teaching & service

process

PERÚ 43% 42% 48% 33%

Tumbes 30% 21% 43% 12%

Piura 27% 18% 34% 27%

Lambayeque 46% 34% 48% 65%

Ancash 34% 34% 36% 26%

Lima 49% 45% 59% 30%

Callao 61% 48% 68% 65%

Ica 43% 57% 38% 31%

Moquegua 30% 30% 32% 25%

Cajamarca 46% 43% 54% 27%


Ayacucho 19% 19% 26% 1%

Pasco 45% 48% 48% 30%

Junín 60% 70% 57% 50%

Cusco 57% 60% 61% 38%

Apurímac 61% 62% 69% 41%

Huánuco 38% 41% 42% 24%

San Martín 31% 36% 32% 20%

Amazonas 28% 27% 31% 19%

Ucayali 42% 42% 40% 47%

Loreto 67% 52% 81% 55%

Madre de Dios 42% 36% 49% 35%



Regarding labor advancement, Cusco exhibited the best performance with a progress rating of

60% while Piura had the lowest progress rating with 18%.

Regarding capacity building, Loreto exhibited the best performance with a progress rating of 81%

while Ayacucho had the lowest progress rating with 26%.

Regarding regulation of the teaching and service process, Lambayeque and Callao had the best

performance with a progress rating of 65%, while Ayacucho reached only 1%.


the next chapter, results and the corresponding analysis of six regions will be presented.



Table 18: Development and training management sub-system, Peru 2014.

KEY PROCESSES


Labor

advancement

(promotion and

career path)

42%

Moderate

development

32% of UEs have promoted or advanced

staff in the last year.

41% of UEs have promoted staff taking

into account years of service.

31% of UEs have promoted staff by

taking into account the evaluation of the

staff files.

94% of UEs do not have approved staff promotion

policies and regulations.

91% of UEs do not have a responsible unit for the

development of staff promotion policies.

97% of UEs stated that they do not have staff

trained in labor advancement.

Only 15% of UEs have a permanent commission for

staff promotion.

21% use "interviews" as a tool in selecting

personnel to promote.

Lack of policies governing labor

advancement process.

Lack of HR with capabilities

and competencies to manage

staff promotion.

Lack of tools to qualify and

select staff to promote.

SERVIR and MoH

should develop and

implement policies

governing labor

advancement

processes for the

sector.

Capacity building

48%

Moderate

development

84% of UEs developed training activities

last year.

More than 80% of training activities are

short courses and lectures.

66% of UEs report that the main activity

of the training unit is to manage local or

classroom and refreshments.

24% of UEs have dedicated staff to

manage training activities.

42% of UEs conducted staff training

processes last year.

37% of UEs have taken into account

regional health priorities to identify staff

training needs.

91% of UEs do not have approved training policies.

82% of UEs do not have a methodological guide for

capacity development.

Only 12% of responsible units have been trained to

manage staff training.

50% of UEs reported that participants can only be

stable staff.

Lack of knowledge and/or lack

of interest in the application of

training policies and

methodological guidelines.

Limited HR capabilities and

competencies in training

management.

MoH should

provide TA to

RHDs in the design

and implementation

of staff training

policies.

Regulation of the

teaching &

service process

33%

Little

development

23% of UEs signed agreements with

educational institutions last year.

28% of UEs currently have existing

agreements with educational institutions

for the provision of technicians to operate

teaching facilities for student practice.

96% of UEs do not have approved criteria for

qualifying teaching hospitals.

Only 4% of UEs have officially formed a Regional

Undergraduate Committee (Comité Regional de

Pre-Grado en Salud, COREPRES).

84% of UEs do not have dedicated staff to manage

teaching-service agreements.

Only 9% of responsible staff has been trained to

administer teaching-service agreements.

Lack of tools to establish

criteria for qualifying teaching

hospitals.

HR staff do not have the

capacity to manage teaching-

service agreements.

Lack of interest in forming

COREPRES.

MoH should

provide TA to

RHDs in designing

instruments to

establish criteria for

qualifying teaching

hospitals.




2.5 Performance management

The performance management sub-system seeks to align the strategy of the institution with individual

objectives through continuous improvement of staff performance and hence institutional performance.

Performance evaluation, which is part of performance management, sets specific employee

expectations in terms of quantitative and qualitative attributes for a given period. The aim of the

evaluation is to establish strategies for solving performance problems, motivate employees, and

encourage personal development.

The following graph shows results of the four processes that are involved in this sub-system.

Figure 12: Performance management sub-system, Peru 2014.

0% 5% 10% 15% 20% 25% 30%

Performance planning

Supervision


Feedback and design of plans for individual performance improvement

PERFORMANCE MANAGEMENT SUB-SYSTEM


On average, this sub-system only achieved a 20% progress rating, which is classified as “little

development”.

Some processes are particularly poorly developed, including the feedback and design of plans for

individual performance improvement process and the supervision process with 12% and 16%,

respectively.

According to reported information, the performance planning and performance evaluation processes

are functioning better but still have achieved a progress rating of less than 30%.

Table 19: Performance management sub-system, Peru 2014.


result

Obtained

result

%

Complete Result

Performance planning 1,248 327 26% Little development

Supervision 1,144 182 16% Little development

Performance evaluation 3,432 734 21% Little development

Feedback and design of plans for individual

performance improvement 1,040 126 12% Little development

PERFORMANCE MANAGEMENT SUB-SYSTEM 6,864 1,369 20% Little development


Regarding results by region for this sub-system, Junín exhibited the best performance with a 44%

progress rating while Tumbes had the lowest score with a 1% rating.



Figure 13: Performance management sub-system, Peru and regions in 2014.

0%5%

10%15%20%25%30%35%40%45%50%

Performance management sub-system


In the table below, results for each performance management process for all RHDs are presented.

Table 20: Performance management processes, Peru and regions in 2014.

PERFORMANCE MANAGEMENT

SUB-SYSTEM


Supervision Performance

evaluation

Feedback and design of plans for

individual performance improvement

PERÚ 20% 26% 16% 21% 12%

Tumbes 1% 0% 0% 0% 4%

Piura 5% 5% 11% 3% 2%

Lambayeque 26% 38% 0% 32% 24%

Ancash 13% 12% 10% 16% 13%

Lima 32% 50% 19% 33% 15%

Callao 36% 50% 0% 51% 16%

Ica 14% 18% 14% 14% 10%

Moquegua 22% 28% 20% 25% 5%

Cajamarca 29% 32% 23% 33% 21%

Huancavelica 15% 27% 17% 11% 3%

Ayacucho 20% 36% 23% 15% 0%

Pasco 17% 19% 3% 22% 19%

Junín 44% 47% 29% 57% 22%

Cusco 35% 40% 30% 36% 34%

Apurímac 16% 19% 13% 14% 21%

Huánuco 19% 15% 21% 22% 14%

San Martín 13% 10% 12% 16% 13%

Amazonas 11% 15% 11% 9% 13%

Ucayali 11% 13% 0% 16% 4%

Loreto 24% 35% 23% 23% 13%

Madre de Dios 11% 25% 0% 10% 0%





For the performance planning process, Lima and Callao achieved the most progress with ratings

of 50%. However, Tumbes achieved a 0% progress rating.

For the supervision process, Cusco exhibited the best performance with a 30% rating. However,

some RHDs, including Tumbes, Lambayeque, Callao, Ucayali, and Madre de Dios, achieved no

progress towards implementation of this process.

For the performance evaluation process, Junín achieved the highest progress rating with 57%

while Tumbes had the lowest score with 0%.

Regarding the feedback and design of plans for individual performance improvement process,

Cusco achieved the highest progress rating with 34% while Ayacucho and Madre de Dios had the

lowest score with 0%.





Table 21: Performance management sub-system, Peru 2014.

KEY PROCESS % Complete Strengths Problem Description Analysis Proposals for Improvement

Performance

planning

26%

Little

development

52% of UEs plan to

develop performance

evaluations this year.

At least 40% of UEs

have tools to evaluate

staff performance

objectively.

88% of UEs do not have staff

responsible for job performance

planning.

Only 4% of UEs have received training

for performance planning.

90% of UEs do not have the

methodology to define individual goals

for job performance.

79% of UEs do not have tools for

performance assessment.

HR with limited

capabilities and skills for

job performance planning.

Lack of methodologies

and tools for job

performance planning for

staff.

MoH shall provide TA to RHDs in the

design and implementation of

methodologies and tools for job

performance planning for staff.

RHDs should strengthen skills and

capabilities of those responsible for

job performance planning for staff.

Supervision

16%

Little

development

At least 30% of UEs

have supervision

reports recommending

corrective measures to

improve individual

performance.

96% of UEs do not have a responsible

unit for monitoring and evaluating staff

performance.

Only 4% of UEs have a responsible

person with training in supervision.

92% of UEs do not have methodologies

or tools related to management

processes for staff performance

evaluation and supervision.

HR with limited skills and

competencies for

supervision and

monitoring of staff

performance.


and tools to develop staff

assessment and

supervision processes.

RHDs should strengthen skills and

capabilities of those responsible for

staff assessment and supervision

processes.

MoH should provide TA to RHDs in

the design and implementation of

methodologies and tools for job

performance supervision and

supervision of staff.

Performance

evaluation

21%

Little

development

At least 18% of UEs

executed performance

evaluations last year.

22% of UEs have

conducted biannual

evaluations.

48% of UEs included

hired staff in

performance

evaluations.

38% of UEs inform

workers about details

of performance

89% of UEs do not have staff

responsible for evaluating job

performance.

Personnel in 4% of UEs have received

training in performance evaluation.

Over 95% of UEs are not using job

profiles to design performance

evaluation tools nor have they

established individual performance goals

or assessed required knowledge for the

position based on a job profile.

HR with limited

capabilities and

competencies to develop

performance evaluation

processes.


and tools to be

implemented at the

regional level.



methodologies and tools for

performance evaluation.




evaluation process

with sufficient advance

notice.

Feedback and

design of plans

for individual

performance

improvement

12%

Little

development

At least 38% of UEs

believe that conditions

exist to develop

performance

evaluation processes

at the institutional

level.

99% of UEs did not disseminate

performance evaluation results to staff.

96% of UEs have not designated a unit

or staff to manage dissemination of

performance evaluation results to staff.

Only 3% of UEs have received training

in feedback dissemination.

99% of UEs did not make plans for

improvement of staff performance based

on performance evaluation results.

Limited HR capabilities

and competencies to

disseminate performance

evaluation feedback to

staff.



methodologies and tools to develop

feedback and design plans for

individual performance improvement.




2.6 Compensation management

Compensation is the remuneration received by an employee in return for his/her contribution to the

organization. It is an organized practice that involves balancing the work-employee relationship by

providing monetary and non-monetary benefits to employees. Compensation is an integral part of

human resource management that helps in motivating employees and improving organizational

effectiveness.

A good compensation package is important to motivate employees to increase organizational

productivity. Adequate compensation aids in the effective functioning of an organization to help it

accomplish its goals. Salary is just one part of the compensation system. A competitive compensation

package will help an organization to attract and retain talent.

The graph below presents results for the five processes involved in this sub-system.

On average, the sub-system achieved a 37% progress rating, which is classified as “little

development”.

Figure 14: Compensation management sub-system, Peru 2014.

0% 10% 20% 30% 40% 50% 60% 70% 80%

Design of salary scales




Pension management

COMPENSATION MANAGEMENT SUB-SYSTEM


Processes related to the payment of salaries and the components of salaries, including the

administration of benefits and bonuses; pension management; and the management of payroll and

salaries, have exhibited moderate development with progress ratings of 71%, 62%, and 60%,

respectively. All tasks related to these processes are regulated, and sanctions exist in case of non-

observance. This may explain the relatively high level of progress in these processes.

However, the results also show that little development has taken place in the management of

incentives and the design of salary scales. These two processes had progress ratings of 30% and

24%, respectively.



Table 22: Compensation management sub-system, Peru 2014.


result

Obtained

result

%

Complete Result

Design of salary scales 3,328 808 24% Little development

Management of payroll and salaries 936 566 60% Moderate development

Administration of benefits and bonuses 520 367 71% Moderate development

Incentive management 1,976 601 30% Little development

Pension management 520 323 62% Moderate development

Compensation management sub-

system 7,280 2,665 37% Little development


Regarding results by region for this sub-system, Loreto exhibited the best performance with a 60%

progress rating while Tumbes had the lowest score with a 13% progress rating.

Figure 15: Compensation management sub-system, Peru and regions in 2014.

0%

10%

20%

30%

40%

50%

60%

70%

Compensation management sub-system


In the table below, results for each compensation management process for all RHDs are presented.



Table 23: Compensation management, Peru and regions in 2014.

COMPENSATION MANAGEMENT

SUB-SYSTEM


Management of payroll and

salaries

Administration of benefits and

bonuses


Pension management

PERÚ 37% 24% 60% 71% 30% 62%

Tumbes 13% 2% 53% 13% 20% 0%

Piura 27% 19% 64% 61% 20% 26%

Lambayeque 38% 0% 100% 100% 45% 65%

Ancash 41% 14% 85% 93% 34% 98%

Lima 38% 13% 78% 64% 34% 91%

Callao 46% 10% 100% 90% 50% 90%

Ica 33% 9% 90% 86% 25% 71%

Moquegua 38% 29% 59% 62% 27% 80%

Cajamarca 40% 29% 75% 70% 29% 67%

Huancavelica 31% 34% 54% 59% 14% 40%

Ayacucho 34% 31% 67% 77% 18% 37%

Pasco 50% 38% 100% 69% 36% 87%

Junín 41% 24% 76% 72% 36% 68%

Cusco 40% 24% 74% 89% 33% 64%

Apurímac 45% 43% 67% 68% 34% 60%

Huánuco 26% 18% 61% 53% 16% 40%

San Martín 39% 38% 64% 65% 25% 56%

Amazonas 37% 12% 94% 72% 31% 80%

Ucayali 49% 27% 94% 90% 39% 100%

Loreto 60% 51% 95% 88% 58% 50%

Madre de Dios 26% 0% 85% 83% 19% 60%



For the design of salary scales process, Loreto achieved the

best performance with a 51% rating. However, Lambayeque

and Madre de Dios achieved little to no progress with a 0%

rating.

For the management of payroll and salaries process,

Lambayeque, Callao and Pasco exhibited the best

performances with 100% progress ratings while Tumbes

achieved a progress rating of 53%.

Regarding the administration of benefits and bonuses

process, Lambayeque achieved the highest progress rating

with 100% while Tumbes had the lowest score with 13%.

For the incentive management process, Loreto achieved the

highest progress rating with 58% while Huancavelica had the lowest score with 14%.

Three aspects of remuneration

influence the behavior of health

workers: the level and regularity

of pay, the way people are paid,

and other incentives. Health

workers must be paid reasonably

for the work they do. They need

to receive a living wage; they also

need to believe that the wage is

commensurate with their

responsibilities and that it is fair

when compared with others in the

same or equivalent jobs. (WHO,

2006)



Regarding the pension management process, Ucayali achieved the highest progress rating with

100% while Tumbes had the lowest score with 0%.





Table 24: Compensation management sub-system, Peru 2014.


Design of salary

scales

24%

Little

development

33% of UEs have designed

salary scales that take into

account budget availability

and geographical area

where health facility is

located.

30% of UEs have used pay

scales for new contracts.

87% of UEs reported that the

responsible unit has not received

training in pay scale management.

81% of UEs did not rate jobs

before the definition of pay scales.

Only 26% of UEs designed a salary

scale last year.

Only 19% of UEs reported having a

methodology to define a pay scale.

There are no tools or

methodologies to aid in

designing pay scales.

MoH should design methodologies

or general guidelines to aid in the

design of pay scales and provide

TA for regional implementation.

Management of

payroll and

salaries

60%

Moderate

development

92% of UEs are using an up-

to-date payroll and wage

system.

81% of UEs have

designated a responsible

unit to manage payroll.

77% of UEs have

regulations to manage

salaries and payroll.

96% of UEs stated that payroll was

updated a year ago.

61% of UEs do not have a policy to

manage some aspects of payrolls

of stable staff such as survival

control, orphans, an adult

unmarried daughter, etc.

Those responsible for

payroll do not ask for a

survival certificate on a

monthly basis.

The heads of HR offices do

not know rules and

regulations for handling

payroll and therefore cannot

monitor payroll staff.

MoH should coordinate with MoF to

train HR office teams in managing

payroll and the computerized

payroll system.

Administration of

benefits and

bonuses

71%

Moderate

development

78% of UEs have a current

institutional regulation to

manage bonuses and

benefits.

92% of UEs manage

benefits and bonuses

according to current

national regulations.

46% of UEs have designated a

responsible unit to manage

benefits and bonuses without

training.

Direct and indirect beneficiaries of

bonuses and social benefits (due to

disability, death, an accident at

work, etc.) do not know their rights.

Policies are not well

understood or known

among employees and their

beneficiaries.

MoH should establish a

mechanism to ensure that UEs

implement strategies to

communicate workers’ rights

related to compensation, benefits,

and bonuses.

Incentive

management

30%

Little

development

At least 57% of UEs have

approved rules to provide

incentives.

56% of UEs are

implementing incentives for

permanent staff according

67% of UEs do not employ staff

trained in handling incentives. 79%

of UEs have not designated a

responsible unit to manage non-

monetary incentives.

95% of UEs do not provide

The performance evaluation

system is not implemented.

MoH should promote mechanisms

for coordination among regional

and local government as well as

universities to award non-monetary

incentives.




to existing regulations.

41% of UEs do not offer

monetary incentives to

employees.

40% of UEs grant days off

as an incentive.

incentives based on performance

evaluation.

Pension

management

62%

Moderate

development

70% of UEs have

designated staff to manage

pensions.

85% of UEs manage

pensions according to

existing regulations.

66% of UEs have not received

training in pension management.

There is no regulation for

granting pensions.

No dissemination of

documents detailing

workers’ rights.

MoH should ensure that EUs

implement strategies to

communicate workers’ rights with

regard to pensions.

MoH should provide TA to UEs in

pension management.


.



2.7 Managing human and social relations

This sub-system seeks to regulate and harmonize interactions between members of the institution

with a focus on the collective dimension. It includes policies and practices related to organizational

climate; labor relations; social welfare; and safety at work.

The graph below presents results for the three processes involved in this sub-system.


development”.

Figure 16: Managing human and social relations sub-system, Peru 2014.

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%

Management of the organizational climate and culture


Workplace health, safety and welfare

MANAGING HUMAN AND SOCIAL RELATIONS


Some processes are particularly poorly developed, including the workplace health, safety, and

welfare process and the management of the organizational climate process with 30% and 39%,

respectively.

According to reported information, the management of labor relations process is functioning better

with a 42% progress rating.

Table 25: Managing human and social relations sub-system, Peru 2014.


result

Obtained

result

%

Complete Result

Management of the organizational climate

and culture 1,352 402 30% Little development

Management of labor relations 2,496 1,037 42% Moderate development

Workplace health, safety, and welfare 3,224 1,264 39% Little development

Managing human and social relations 7,072 2,703 38% Little development




Regarding results by region for this sub-system, Callao, Lima, and Apurimac exhibited the best

performances with 56%, 55%, and 55% progress ratings while Ayacucho had the lowest score with a

20% progress rating.

Figure 17: Managing human and social relations sub-system, Peru and regions in 2014.

0%

10%

20%

30%

40%

50%

60%

Managing human and social relations


The table below presents results for each managing and social relations process for all RHDs.

Table 26: Managing human and social relations, Peru and regions in 2014.

MANAGING HUMAN

AND SOCIAL RELATIONS SUB-SYSTEM


and culture



PERÚ 38% 30% 42% 39%

Tumbes 42% 3% 48% 53%

Piura 22% 5% 34% 20%

Lambayeque 45% 22% 70% 36%

Ancash 33% 32% 39% 30%

Lima 55% 45% 59% 56%

Callao 56% 61% 35% 69%

Ica 31% 10% 33% 38%

Moquegua 39% 61% 41% 28%

Cajamarca 39% 25% 55% 33%


Ayacucho 20% 10% 29% 17%

Pasco 29% 11% 42% 27%

Junín 41% 12% 45% 51%

Cusco 49% 32% 41% 61%

Apurímac 55% 49% 45% 65%



MANAGING HUMAN

AND SOCIAL RELATIONS SUB-SYSTEM


and culture



Huánuco 32% 27% 29% 35%

San Martín 33% 19% 19% 48%

Amazonas 27% 12% 24% 34%

Ucayali 38% 26% 53% 32%

Loreto 51% 37% 52% 57%

Madre de Dios 37% 53% 38% 29%



For the workplace health, safety, and welfare process, Callao achieved the best performance with

a 69% rating. However, Ayacucho achieved little progress with a 17% rating.

For the management of labor relations process, Lambayeque exhibited the best performance with

a 70% progress rating while San Martín achieved a progress rating of 19%.

Regarding the management of the organization climate process, Callao and Moquegua achieved

the highest progress ratings with 61% while Tumbes had the lowest score with 3%.





Table 27: Managing human and social relations sub-system, Peru 2014.

KEY PROCESS %

Complete Strengths Problem Description Analysis Proposals for Improvement

Management of

the organizational

climate and

culture

30%

55% of UEs have designated

a responsible unit to manage

the organizational climate.

44% of UEs have

methodologies and

instruments for measuring

organizational climate.

44% of UEs have scheduled

a measurement of the

organizational climate in the

current year.

90% of UEs have not analyzed

results of the organizational

climate measurement, and only

7% of UEs have implemented

any corrective measures.


training in organizational climate

measurement.

Lack of interest from the

highest authority in

implementation of

organizational climate

improvement plans.

MoH should provide TA to RHD to

promote measurement, analysis,

and use of results to improve the


Management of

labor relations 42%

At least 37% of UEs have had

negotiations with unions, and

the results have satisfied both

parties.


training in negotiation.

71% of UEs believe that relations

inside RHD workers are not

good. 61% of UEs believe that

relations between networks and

micro-network workers are not

good.

Institutions do not promote

activities or opportunities to

improve relations with

workers.

Perception of workers'

satisfaction with their work

environment is not taken

into consideration by

authorities.


train HR team in strategies to

improve worker satisfaction,

negotiation, and conflict

management.

Workplace health,

safety, and

welfare

39%

78% of UEs celebrate the

institution’s anniversary as

part of welfare activities.

73% of UEs developed intra-

office sport competition as

part of welfare activities.

65% of UEs have developed

vaccination campaigns for

workers as part of health and

work safety programs.


training in health and safety at

work.

65% of UEs do not have health

and work safety policies and

regulations.

Despite passage of a

national law requiring public

and private institutions to

implement health and work

safety programs, health

institutions have not initiated

activities to implement this

law. There are currently no

penalties for

noncompliance.


establish a better manage in

welfare, health, and work safety

initiatives.



Abt Associates Inc. Activities undertaken by MoH to strengthen HRMS ▌pg. 45

3. Analysis of results of HRMS evaluation in five selected regions

The previous chapter presented results obtained by each UE after application of the spreadsheet

provided by MoH. These results were consolidated at the RHD level and then consolidated at the

national level. These quantitative results measure the level of progress that RHDs reached. However,

it is necessary to analyze the factors that have led to these results and the limitations of regions with

the lowest scores.

In this chapter, an analysis of the quantitative results for the five selected regions is presented.

The following criteria were used to select the five regions:

RHD with the highest comprehensive average score.

RHD with the lowest comprehensive average score.

Three RHDs with intermediate comprehensive average scores.

RHDs with 100% of UEs assessed.

RHDs with technical reports containing an analysis of the results.

For this purpose, RHDs were ranked from highest to lowest score and five selections were made:

Loreto RHD had the highest score with a 47% rating.

Piura RHD had the lowest score with a 21% rating.

Lambayeque, Pasco, and Huánuco RHDs had intermediate scores with 39%, 35%, and 33%

ratings, respectively.

All UEs within these five RHDs were assessed, and each UE sent MoH a technical report containing

an analysis of the results.

The following table shows RHDs ranked by highest to lowest score.

Table 28: Human Resources Management System progress rating by region, Peru 2014.

RHD HRMS progress

rating RANK

Loreto 47% 1

Callao 45% 2

Junín 44% 3

Cusco 43% 4

Lima 41% 5

Apurímac 41% 5

Cajamarca 40% 6

Lambayeque 39% 7

Pasco 35% 8

Huánuco 33% 9

Ucayali 32% 10



RHD HRMS progress

rating RANK

Moquegua 32% 10

Ica 31% 11

Huancavelica 31% 11

Ancash 30% 12

San Martín 30% 12

Madre de Dios 29% 13

Ayacucho 27% 14

Amazonas 26% 15

Tumbes 25% 16

Piura 21% 17

The next table presents more detailed information on the five selected RHDs.

Table 29: General characteristics of the five selected RHDs, Peru 2014.

RHD PERÚ Loreto Lambayeque Pasco Huánuco Piura

N° of UEs 162 6 4 3 7 7

HRMS progress rating 35% 47% 39% 35% 33% 21%

N° of physicians, nurses

and midwives per 10,000

inhabitants, in 2012 /1

26.1 14 21.7 26.9 18 15

Population density

(inhabitants per Km2) /3 23 3 86 12 23 50.1

Chronic malnutrition

prevalence in 2012/2013

/2

18.12 /

17.49

32.32 /

27.64

13.96 /

14.2

26 /

26.5

30.85 /

29.05

21.65/

24.9

-3% -14% 2% 2% -6% 15%

Neonatal mortality in 2011 /

2013 /2

9.8

11.97

22.1

19.1

10.2

7.62

18.9

15.79

13.9

13.93

12.1

13.62

22.1% -13.6% -25.3% -16.5% 0.2% 12.6%

Physician turnover (2012-

2013) 34% 28% 41% 68% 63% 27%

Nurse turnover (2012-2013) 26% 17% 33% 18% 49% 24%

Midwife turnover (2012-

2013) 32% 13% 28% 24% 48% 12%

Geographical location Jungle Coast Highland Highland and

Jungle Coast



Source:

1/ Ministry of Health: HR observatory.

2/ National Institute of Statistics and Informatics (INEI) - National Survey of Demography and Family Health

(ENDES).

3/ National Institute of Statistics and Informatics (INEI).

Loreto, with the best performance, is located in the jungles of Perú and has the lowest population

density. Given the region’s dispersed population, Loreto faces problems in providing access to health

services. Due to its geography, this region requires more health workers to reach its dispersed

population than other regions. In contrast, Piura, with the lowest performance, is located on the coast

of Perú and has 17 times more inhabitants per square kilometer than Loreto. Accordingly, Piura

should be better able to provide health care services in fixed facilities.

Loreto’s dispersed population and problems related to service access could explain high rates of

malnutrition and neonatal mortality. In order to correlate HRMS performance results 1 with

improvements in health indicators, the project compared the level of variation between rates found

over the last two periods.

Through this comparison, Loreto achieved a 14% reduction in chronic malnutrition while Piura

malnutrition rates increased by 15%. Similarly, the neonatal mortality rate in Loreto decreased by

14% while it increased in Piura by 13%.

Loreto and Piura have fewer health professionals per inhabitant and less turnover than other regions.

However, HHR availability is not enough to improve a population’s health status. Many other factors

influence health status improvement, including the level of labor competencies; policies to improve

individual performance; establishment of clear tasks and responsibilities; fair remuneration; incentive

policies; recruitment based on merit; and a pleasant working environment endowed with the

necessary equipment, among others.

Table 30: General characteristics of the five selected RHDs, Peru 2014.

RHD PERÚ Loreto Lambayeque Pasco Huánuco Piura

N° of UEs 162 6 4 3 7 7

HRMS progress rating 35% 47% 39% 35% 33% 21%

Sub-system with the

best development

Employment

management

(45%)

Development

and training

management

(67%)

Employment

management

(62%)

Compensation

management

(50%)

Employment

management

(45%)

Employment

management

(35%)

Sub-system with the

worst development

Performance

management

(20%)

Performance

management

(24%)

Performance

management

26%)

Performance

management

(17%)

Performance

management

(19%)

Performance

management

(5%)

Source:

1/ Ministry of Health: HR observatory.

2/ National Institute of Statistics and Informatics (INEI) - National Survey of Demography and Family

Health (ENDES).

3/ National Institute of Statistics and Informatics (INEI).



Regarding the best developed sub-system in these five regions, Lambayeque, Huánuco, and Pasco

exhibited good performances in the employment management sub-system. Loreto achieved the

highest score in the development and training management sub-system. However, in spite of efforts

to improve and build capacities in health workers through training programs, Loreto RHD is poorly

developed in the performance management sub-system as well as all RHDs at national level.

Improving the population’s health status depends not only on designing good health policies,

programs, and strategies but also correctly implementing them. HHR are both directly and indirectly

responsible for policy implementation; therefore, the quality of implementation depends on the quality

of HHR. Managing HHR is not only the management of a group of isolated processes. Rather, HHR

processes must be integrated into interrelated sub-systems whereby an output of one process is an

input for one or more processes.

At this time, Loreto has exhibited the best HRM performance. However, this does not mean that

HRMS in Loreto is properly developed as it only achieved a 47% progress rating. This rating implies

that much remains to be done in improving HRM nationwide.It is important to highlight the

achievement made by Loreto RHD in spite of unfavorable conditions as it managed to achieve the

greatest progress in HRMS implementation.The analysis developed by each UE team, consolidated

by RHD, is presented below. Detailed information about each HRMS sub-system is presented in the

annexes.

3.1 Loreto Regional Health Directorate

Regarding HR office, Loreto RHD has not designated a responsible unit to govern HRM process.

There is no budget to create staff positions for each process. Offices and units share overlapping

functions, as is the case with the quality office and social welfare unit.

In spite of this, one of the main achievements is the development of strategies to improve staff

capacities.

Achievements and opportunities for improvement in Loreto RHD and its UEs are:

In this RHD, responsible units have been designated to manage HRMS processes, including

HHR strategic planning and finance management monitoring; information management; design of

job profiles; identification of labor competencies to select human resources; management of

recruitment, selection, incorporation and induction; management of attendance control; staff

mobility and staff termination; payroll management; incentive management; labor advancement

including promotion and career paths; supervision; performance evaluation; salary scale

management; and administration of benefits and bonuses. However, management documents

are outdated in relation to national regulations.

Loreto RHD also has an approved ROF that specifies the responsible unit in identifying

institutional competencies. However, specific functions are not defined in ROF, MOF, and other

management tools; and defining specific functions has not been prioritized in HHR management

and development policies.

Loreto RHD has identified the following issues in its UEs related to capacity building and training:

- Despite weak support for skills development, training policies have been approved to support

these processes.

- Additionally, there is a designated unit and trained staff to support these policies and

processes.



- A regional health undergraduate committee (COREPRES) was approved by executive

resolution, but it does not always meet. Loreto RHD has signed agreements with training

institutions and has coordinated with other institutions on short-term training sessions.

- The limited budget for capacity building has prevented all staff from being trained.

- Training staff has not been prioritized as a key factor in institutional development.

To improve HRM, Loreto RHD is training personnel and utilizing an Excel application to determine

the HHR gap at the three levels of care. In Loreto, there are also technical and management

documents as well as HHR legislation, including the Annual Training Plan, which was approved

by RHD executive resolution.

Unlike in Loreto RHD, in most UEs there is no responsible unit or trained staff to manage HRM

processes, including planning and HR budget needs identification; information system

management; and designing, monitoring, and analyzing HR indicators, among others.

A research management unit has been implemented in Loreto RHD but not in its UEs. In UEs,

there is a lack of professionals to develop research.

There are regulations and tools for recruitment, selection, incorporation, and induction; technical

tools for supervision; and regulations to define salary scales and grant benefits, bonuses, and

incentives.

There is trained staff turnover, and permanent relocation of workers to different offices and units.

Staff performs multiple functions.

But managers are also generally uninterested in training staff. There is no unit with an exclusive

mandate to train personnel in the development of competency profiles, job rating, and personnel

recruitment.

One of senior management´s priorities is planning and implementing skills development training

for professional groups. However, given the prioritization of other activities, staff does not

exclusively perform these functions on a full time basis but rather periodically according to office

needs.

The large size of the Loreto region affects HHR management and development in a variety of

ways:

- One important issue to consider is the difficulty of developing training opportunities..

- With few training opportunities, staff are not able to develop their skills, which further

exacerbates coordination between UEs and Loreto RHD.

- There is insufficient budget to supervise each health facility.

- It has been noted that there is no equity in the management of payroll and salaries using the

job rating for remote and undeveloped areas (ZAF).

Loreto RHD does not performed objective performance evaluations.

UEs staff has little knowledge of policies, regulations, and laws that govern different HHR

processes, including the management of disciplinary proceedings and the technical criteria

required for job rating, among others.



3.2 Pasco Regional Health Directorate

Achievements and opportunities for improvement in Pasco RHD and its UEs are:

Pasco RHD has formulated and approved eight regional policies for HHR development

management. However, not all policies have been implemented, and few personnel are familiar

with them. There is little interest in their implementation at the national level. Many HR

management processes require national regulatory arrangements. There is no HR strategic

planning policy nor have HR strategic plans been developed. Few staff in the Office is dedicated

to HHR management. There is high staff turnover.

Information systems, including the Human Resources MoF Module and the PLAME Module, have

been established to filter and control HR management.

Pasco RHD and the Daniel Alcides Carrion Hospital have identified three job skills: prenatal care;

growth and development; and demonstration sessions. The first two competencies have been

assessed at health facility pilot sites. Job profiles and job rating have not been designed or

developed. No skills have been identified for staff functions.

RHD has selected and approved regional research priorities and the research management

regulation. However, a research management unit has not been implemented, and operational

research has not been developed. There is no budget for compliance, and there is a lack of

interest among professionals to develop research. The A research component and guidelines

have not been incorporated into institutional management documents.

There is coordination with training institutions, and there is a framework agreement between

universities, the regional government, and MoH. However, the lack of specialized hospitals has

resulted in limited clinical field. Training activities are not aligned with institutional needs; there is

no reliable information about training; and there are no plans for capacity development in the

medium and long term.

While there are instruments to measure the performance of first-level-of-care health facilities,

there is no policy that governs HR performance improvement planning. Performance assessment

tools have not been institutionalized nor are there monitoring tools that incorporate performance

evaluation. Institutional targets exist, but individual targets do not exist. There are no validated

models of performance improvement plans, and feedback processes as well individual

performance plans have not been designed.

Pasco RHD and the Daniel Alcides Carrion Hospital have a PDP but need to improve its content.

There is no budget to finance PDP.

No HR competencies have been identified for the design of profiles and job rating. Few

professionals have been trained in the methodology for identification and standardization of labor

skills. There is little interest in defining and developing job competencies, and there has been

slow progress in developing job profiles at the national level.

There are population density gap indicators that RHD has used for HR management, but there is

no directive governing the recruitment, selection, and incorporation of HR.

RHD and the Daniel Alcides Carrion Hospital have started entering data in INFORHUS. However,

HHR data is outdated and incomplete, and personnel displacements are not recorded.

INFORHUS also does not include goals and productivity indicators. In general, INFORHUS entry

and reporting data is more limited than with SIRHUS. RHD has little control over networks,

hospitals, and micro-grids. Little importance is given to HR information management.



Budgeting by results and capitation budget agreements establish mandatory performance targets.

However, these targets have not been monitored, and strategic budget outcomes related to

quality and health care services have not been evaluated.

There is a limited availability of financial resources to improve staff remuneration for CAS

contracts. The salary scale for CAS contracts is not standardized. SERUMS and permanent staff

salary scales are a national-level responsibility.

A disciplinary process committee has been established, but sanctioning capacity is almost not

exist. Thus personnel who are subject to the disciplinary process continue to work. The internal

audit unit does not perform prior and concurrent monitoring of administrative and disciplinary

proceedings.

There are national tools for measuring organizational climate, but they have not been

implemented in this RHD. There is a lack of interest in developing the process. Some UEs are not

currently operating under a good organizational climate.

Staff does not know their rights and responsibilities. Few social welfare activities are developed.

There is no personnel welfare service. There is no permanent staff to manage labor relations.

Safety regulations have not been developed, and therefore, personnel are vulnerable to accidents

at work. Some UEs do not provide complementary insurance to cover work safety (SCRT) for

CAS contracts.

There are resources and expertise available to implement monetary and non-monetary

incentives. Benefits and bonuses are distributed to staff. However, incentive management is not

implemented, and there is no directive or incentive plan for personnel. Benefit and bonus

payments are delayed.

Salary scales are approved at the national level. There is increased funding to hire HR, and

mandatory designation processes have been initiated at the national level. DL 1153 establishes

remunerative improvements. However, there is no increased funding for improved remuneration

for CAS contracts, administrative staff, and staff covered under DL 728.

A unit has been designated to manage attendance control in all health facilities and micro-grids,

but not all staff is in agreement to this task.

Vacant positions are not immediately filled as they are not attractive due to low salaries. New

contracted personnel do not go through the induction process. There is no induction policy for

new contracted and appointed personnel.

3.3 Huánuco Regional Health Directorate

Regarding HR office, there is a lack of personnel and physical space for the development of activities

related to HRMS processes. However, there are some achievements and several opportunities for

improvement, such as:

There is a HR unit in Huanuco RHD that is responsible for designing HR policies. But, no HHR

operational research is done to support HR policies.

There is no timely and accurate data to define HHR needs and there is insufficient budget to

cover HHR.

Insufficient HR allocation was identified as a priority and is partially a result of high staff turnover.

Qualified staff is scarce for higher level health facilities. Level I-4 health facilities are generally

under staff in terms of HHR and specialist physicians.



Huanuco RHD does utilize information systems and criteria to define HHR training requirements.

CAP, MOF are used as references in designing job profiles, but Huanuco RHD are not using

MAPRO and standardized processes to define them.

There is also a designated unit for managing the recruitment, selection, incorporation, and

induction of staff. However, staff recruitment is not based on a HHR gap study..

Specific personnel are responsible for updating staff mobility; updating staff files; and managing

staff termination and retirement.

There is no information system to record, maintain, and update staff information by occupational

group and labor regime, including staff retirement information. Information management is

considered to consist mainly of managing the names of workers and staff files. There is no

budget to hire and train staff to carry out these functions.

Huanuco RHD has defined job competencies for staff who work on growth and development in

children under five; though, trainers’ availability is very limited.

No unit exists to manage regulations for staff development, training, and teaching personnel.

There is a lack of criteria to measure knowledge and develop performance evaluations, which

would help to determine training needs.

There is a lack of skilled and committed staff to achieving institutional goals. Personnel and

management staff display little initiative in their work. As a consequence, institutional goals are

not achieved.

In general, the lack personnel with skills, commitment, and initiative negatively affects the

efficiency and performance of employees in carrying out their work.

There is no designated unit or personnel responsible for planning, organizing, implementing,

evaluating, and monitoring the individual performance evaluation process. Similarly, there is no

designated unit to provide tools to develop feedback and design plans for individual performance

improvement.

No approved rules or policies exist for implementation of incentives.

There is no designated unit to manage monetary and non-monetary incentives; benefits; and

bonuses.

Staff welfare activities are not planned.

3.4 Lambayeque Regional Health Directorate

Achievements and opportunities for improvement in Lambayeque RHD and its UEs are:

There is support from senior management and staff and budget availability to hire HR in some

UEs. However, there is no responsible unit for HHR planning. SIGA and INFORHUS systems

have been updated in each UE, and they are customizable. There are management documents

that demonstrate the need for HHR. However, management tools are outdated, and the

information entered is not analyzed.



A HHR gap analysis for primary care has been completed, but gap analyses have not been done

for the second and third levels of care.

HR requirements and financing needs have been estimated for some UEs, and information is

available as a guide in the development of indicators. However, HHR management indicators do

not exist, and HHR is not trained in the development of HR management indicators. There are no

procedures for strategic policy formulation or management.

In general, research units have not been established within health facilities. However, one does

exist in a hospital, but HHR operational research is not carried out within it.

HR is willing to participate in processes that will create changes, but little importance is assigned

to HHR management issues. There is no designated unit or specialized staff to design job

profiles, labor competencies, or job rating.

Most management documents, including a methodological guide to develop job profiles in public

institutions, are available. Reference documents on the design and definition of labor

competencies are available from other institutions like MoH and professional associations.

Unfortunately, they are not utilized. There are guidelines for selection processes, but the

induction process is insufficient for new personnel.

There is limited budget available for optimal HHR development management. As a consequence,

staff is working in positions that do not correspond to their academic training, experience, or

capabilities. Job functions do not correspond to MOF, MAPRO, and CAP.

There is an office responsible for staff file administration, affidavits, and attendance control. There

is a permanent commission for HHR recruitment and selection. However, these units are

insufficiently staffed, and the staff within the unit is often unqualified to manage employment

processes.

There is a disciplinary process commission and internal regulations for disciplinary processes.

However, there are insufficient logistical supplies and no competent legal advisors.

There is an office responsible for updating staff termination data, and updated regulations exist.

However, there is a lack of software for registering and updating staff termination by occupational

group and labor regime.

Staff files management and attendance control are not properly performed.

There is a limited number of job offers made, and low remunerative levels as well as better offers

from the private sector prevent the immediate filling of positions.

There is a job promotion regulation but no internal promotion policies. No promotion selection

processes exist.

The budget for training has increased, and there is a regulation for guaranteeing future budget

allocation. Lambayeque RHD has designated a unit and experienced staff to manage training

processes, but there are no units or specialized staff in UEs for this purpose.

Training policies have not been designed. There is no methodological guide for skills

development, and staff training needs have not been identified. There is no information system to

record training provided to staff.

There are approved tools for supervising and evaluating staff performance. However, there is no

designated unit or trained staff to plan performance targets, monitoring, evaluation, feedback, and

design of individual performance improvement plans.



There is no methodology for designing performance evaluation plans. Performance goals are not

defined. Staff performance monitoring is not performed. Performance evaluation tools modeled

on a traditional approach do not evaluate skills required for the position.

There is a different salary scale for CAS contracts in the Andean high zone and a bonus for

positions in remote and dispersed areas. However, job positions remain unattractive due to low

salaries. CAS staff salaries are particularly low.

There is a designated unit for salary and payroll management; bonus and benefit administration;

and incentive management. However, UEs are not authorized to devise their own salary scales.

There is limited budget to support these processes.

There are trained HR personnel to manage the payroll record. Payroll records are updated on a

monthly basis; however, MoH does not have an updated payroll system.

Bonus and pension regulations are followed, but there is limited budget to pay pensions at the

end of the year.

AFP does not report the transfer of employees within AFP in a timely manner. Staff is not

knowledgeable about pension systems. Payment to AFP is delayed.

Personnel are not trained in staff benefits and current bonus regulations. Non-monetary

incentives are not granted. There is no budget for CAS staff incentives.

There is no designated unit to manage organizational climate and culture. There is no trained

staff to implement and monitor the organizational climate improvement plan. The organizational

climate is not measured.

There is a designated unit and personnel to manage workplace health and safety processes.

However, there is no workplace health and safety program. Due to this, staff is not well protected

from job-related accidents.

There is a social service office, and welfare programs exist.

3.5 Piura Regional Health Directorate

Achievements and opportunities for improvement in Piura RHD and its UEs are:

Staff is available to implement policies, strategic planning, and HHR information management

despite the fact that HR planning is not promoted by the state and the absence of HHR

information management policy. Job performance is not assessed; staff profiles are not updated;

staff is not motivated by; and safety and occupational health procedures do not exist.

ROF identifies the need for systematization and updating of HR information for decision-making

and development planning. However, there are no HR policies or strategies, and there are no

specific functions for these processes in ROF. While a monthly analysis of the HHR situation

within the institution is performed, data is mostly outdated. Current systems do not record non-

remunerative concepts such as attendance, tardiness, and absences. Only remuneration data is

updated and maintained through the PLH system. There is no budget to purchase software.

Recruiting processes have been implemented based on profiles for HHR hiring, but personnel

selection is not based on HR merits. While staffing requirements have been met based on WHO

rates and service need projections, no research policy exists nor is operational research

development performed.



Over 80% of units possess management documents, including MOF, ROF, and CAP, which are

used as references in job design. However, the Piura regional government has not approved the

institutional CAP and MOF; instead, it is using outdated documents. MoH labor competencies

documents are used, but UEs are not conform with current conditions and realities. There is no

designated unit to design job profiles or identify labor competencies. There is a lack of funding,

minimum criteria, and tools for assessing and defining labor competencies (job profile,

experience, training, etc.).

Each job has a profile, and personnel know their job functions. However, there are no job rating

policies nor is there a designated unit for job evaluation. There is no training plan to improve staff

performance and competitiveness levels. Some staffs currently perform functions that are not part

of their respective job profile.

Due to the lack of knowledge, some hospital departments have not developed MAPRO or other

administrative manuals.

Piura RHD has designated a unit for employment management processes, but staff is not trained

and are responsible for. The National Register of Dismissal and Sanctions (RNSDD) is not

consulted during the selection and recruitment process.

Selection phases are carried out in accordance with DL 276. UE managers are part of the

recruitment committee. Few candidates fit the required profile, and they are not evaluated based

on their knowledge or experiences. Once selected, personnel do not go through an induction

process.

Staff mobility occurs according to health facility needs. PIURA RHD has a designated and staffed

unit to update staff mobility information within and outside the institution; UEs do not have a

designated office or staff to perform this function.

Some UEs have designated a unit and staff to manage files and attendance control. However,

personnel do not update job files, and staff tardiness and absences are not reported.

Some UEs use a computer program called SYNASYS for attendance control. However,

attendance registration is done manually in remote health facilities.

There is a permanent disciplinary process committee. Unfortunately, it rarely meets, and

members are not trained. The RNSDD data is not updated.

Some UEs have designated a unit for development and training management. The HR offices do

not fulfill its functions to manage training processes due to limited budget and lack of staff.

Staff promotion does not take into account criteria such as performance evaluations.

There are several criteria for recruitment, including no disciplinary offenses and experience in the

public sector. However, job profiles, performance evaluations, and training plans for recruitment

and selecting staff are not used.

Regional health needs were not taken into account when training programs were developed.

Some UEs have designated a unit for teaching and research. However, there are few agreements

with technological institutes, and there is no designated teaching staff. Students who have been

trained are not registered in an information system.



There is no designated unit for developing performance evaluations or implementing supervision

processes. Staff is afraid to be evaluated since evaluations are associated with dismissal.

Therefore, performance evaluations are not performed.

Job rating is not defined. The salary scale is based on national legislation, but do not pay

employees according to the scale.

There is a designated unit to manage salaries and payroll. However, staff have not been trained,

and only follow MoH directives. Payroll system information is obsolete.

The current directive for benefits and incentives management comes from the central level, but

performance is not considered in the administration of benefits and incentives. UEs have not

designated personnel to administer benefits and incentives. Benefits, including AETAS and other

legal benefits, are regulated by law.

The budget allocation for payment of benefits and bonuses is timely managed. Incentives and

bonuses are not provided according to performance evaluation results.

The Annual Budget Law restricts salary increases even when there is sufficient budget for it.

There is no designated unit or personnel responsible for managing pensions.

An organizational climate measurement has not been planned. Additionally, personnel do not

want to complete the organizational climate survey. Interpersonal relationships between staff

members are not good.

There is a designated unit responsible for managing health and safety at work. However, basic

workplace health and safety regulations have not been updated. The improvement of welfare

conditions and job safety is not considered in the budget allocation.

There are isolated activities for improving well-being at work, including workshops and contests to

improve working relationships.

There is no designated unit for workplace welfare. The Social Assistance Unit does not perform

these functions. Welfare programs, including child care and a club for the elderly, are not offered.



4. Analysis of HRMS assessment results in San Martin Regional

Health Directorate compared with national results

In the previous technical report submitted in September 2013, the project presented results obtained

by SMT-RHD after application of the project-designed spreadsheet. For that report, data was

collected from the SMT-RHD HR unit and selected networks at a workshop.

On December 2014, MoH dispatched tools and instruments to each UE to aid in information collection

related to HRMS implementation.

SMT-RHD was in charge of gathering of information from each of its UEs.

In this chapter, the project will present results for each SMT-RHD UE to compare them with results

obtained for all other UEs with the exception of La Libertad, Arequipa, Tacna and Puno RHDs, which

did not send the required information2.

Table 31: Distribution of networks and micro-networks by UE, San Martin 2014.

UE Health Network Micro-network

400: Bajo Mayo

(San Martín)

RED EL DORADO

MR AGUA BLANCA

MR SAN JOSE DE SISA

MR SAN MARTIN ALAO

RED LAMAS

MR HOSPITAL LAMAS

MR CUÑUMBUQUI

MR TABALOSOS

MR BARRANQUITA

MR CAYNARACHI

MR PACAYZAPA

RED PICOTA

MR LEONCIO PRADO

MR PICOTA

MR PUCACACA

RED SAN MARTIN

MR CHAZUTA

MR HUIMBAYOC

MR SAUCE

MR BANDA DE SHILCAYO

MR MORALES

MR TARAPOTO (NUEVE ABRIL)

MR PAPAPLAYA

MR JUAN GUERRA

2 These RHDs argued that they lacked information from all UEs, and they agreed to send the

information to MoH as soon as it is complete.



UE Health Network Micro-network

401: Alto Mayo

RED MOYOBAMBA

MR JEPELACIO

MR JERILLO

MR LLUILLUCUCHA

MR SORITOR

MR YANTALÓ

MR PUEBLO LIBRE

MR CALZADA

MR ROQUE ALONSO DE ALVARADO

RED RIOJA

MR NARANJOS

MR NUEVA CAJAMARCA

MR NUEVO RIOJA

MR BAJO NARANJILLO

MR SEGUNDA JERUSALEN

MR SAN FERNANDO

MR JUAN DE RIO SORITOR

MR YURAYACU

402: Huallaga Central

RED BELLAVISTA

MR ALTO BIAVO

MR BAJO BIAVO

MR BELLAVISTA

MR SAN PABLO-CONSUELO

RED HUALLAGA MR SACANCHE

MR SAPOSOA

RED MARISCAL

CACERES

MR CAMPANILLA

MR COSTA RICA

MR HUICUNGO

MR JUANJUI

403: Alto Huallaga RED TOCACHE

MR NUEVO PROGRESO

MR POLVORA

MR TOCACHE

MR UCHIZA

404: Hospital de

Tarapoto Hospital de Tarapoto

After consolidating results for all five SMT-RHD UEs, the project determined the following results:

SMT-RHD achieved a 29% rating for HRMS implementation, which is the average level of

implementation for all seven sub-systems. This rating is lower than the average national rating of

35%.



The compensation management sub-system achieved the best implementation rating at 39%.

This is the only sub-system in which the results are better than the national average, which, in

this case, is 37%.

The performance management sub-system achieved the lowest level of development at 13%,

which is less than the national average of 20%.

Figure 18: Human Resources Management System by sub-system in Peru and San Martin,

2014.

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%





DEVELOPMENT AND TRAINING MANAGEMENT SUB-SYSTEM


MANAGING HUMAN AND SOCIAL RELATIONS SUB-SYSTEM

HUMAN RESOURCES MANAGEMENT SYSTEM

PERU

TOTALDIRES-SMT

SOURCE: Technical report on HRMS evaluation results for each SMT-RHD UE.

Regarding UE performance on HRMS implementation, the project found that UE 404-Tarapoto

Hospital achieved the highest progress rating at 38%, which is higher than the national average. UE

400-Bajo Mayo had the lowest rating at 23%.

Figure 19: Human Resources Management System by UE, San Martin 2014.

0% 5% 10% 15% 20% 25% 30% 35% 40%

UE 400San Martin

UE 401Alto Mayo

UE 402Huallaga Central

UE 403Alto Huallaga

UE 404Hosp Tarapoto

TOTAL

DIRES-SMT

PERU

UE 400San Martin

UE 401Alto Mayo


UE 403Alto Huallaga

UE 404Hosp Tarapoto

TOTALDIRES-SMT

PERU

HRMS 23% 25% 34% 24% 38% 29% 35%


The following table shows results obtained by each UE in each of the HRMS processes.



Table 32: Human Resources Management System processes by UE, San Martin 2014.

Human Resources Management System processes

UE

40

0:

Sa

n M

art

in

UE

40

1:

Alt

o M

ayo

UE

40

2:

Hu

all

ag

a C

en

tra

l

UE

40

3:

Alt

o H

ua

lla

ga

UE

40

4:

Ho

sp

Ta

rap

oto

DIRES SMT

PERU

HHR policy and strategic planning 26% 35% 23% 45% 23% 30% 31%

Policies and strategies for HHR

management 0% 4% 0% 11% 0% 3% 17%

Development of operational research 0% 0% 0% 27% 0% 5% 8%

HHR information management 43% 52% 39% 80% 37% 50% 40%

HHR management control 0% 0% 17% 0% 23% 8% 18%

HHR strategic planning 42% 53% 26% 42% 26% 38% 35%

HHR financing 23% 77% 0% 62% 0% 32% 41%

Work organization 24% 22% 28% 22% 28% 25% 29%

Design of job profiles 25% 25% 25% 25% 25% 25% 42%

Identification of labor competencies 19% 11% 33% 11% 33% 21% 14%

Job rating 30% 30% 30% 30% 30% 30% 12%

Employment management 27% 31% 27% 32% 40% 31% 45%

Recruitment, selection, incorporation, and induction 35% 40% 39% 44% 39% 39% 48%

Staff mobility 0% 0% 14% 0% 71% 17% 45%

Management of staff files and attendance control 41% 30% 5% 35% 43% 31% 44%

Administration of disciplinary process 5% 23% 14% 9% 32% 16% 35%

Staff termination and retirement 0% 11% 21% 0% 26% 12% 32%

Performance management 4% 12% 24% 4% 24% 13% 20%

Performance planning 0% 0% 17% 17% 17% 10% 26%

Supervision 10% 0% 25% 0% 25% 12% 16%

Performance evaluation 5% 25% 25% 0% 25% 16% 21%


performance improvement 0% 8% 28% 0% 28% 13% 12%

Development and training management 3% 18% 57% 19% 61% 31% 43%

Labor advancement (promotion and career path) 0% 12% 68% 39% 62% 36% 42%

Capacity building 0% 28% 56% 10% 64% 32% 48%

Regulation of the teaching & service process 14% 0% 38% 5% 49% 21% 33%

Compensation management 46% 32% 39% 32% 47% 39% 37%

Design of salary scales 31% 37% 31% 38% 51% 38% 24%

Management of payroll and salaries 100% 88% 47% 35% 47% 64% 60%

Administration of benefits and bonuses 87% 53% 67% 53% 67% 65% 71%

Incentive management 26% 11% 33% 16% 33% 24% 30%

Pension management 100% 20% 60% 40% 60% 56% 62%




UE

40

0:

Sa

n M

art

in

UE

40

1:

Alt

o M

ayo

UE

40

2:

Hu

all

ag

a C

en

tra

l

UE

40

3:

Alt

o H

ua

lla

ga

UE

40

4:

Ho

sp

Ta

rap

oto

DIRES SMT

PERU

Managing human and social relations 34% 25% 45% 17% 45% 33% 38%

Management of the organizational climate and culture 0% 0% 47% 0% 47% 19% 30%

Management of labor relations 33% 24% 9% 21% 9% 19% 42%

Workplace health, safety, and welfare 48% 35% 69% 21% 69% 48% 39%

HUMAN RESOURCES MANAGEMENT SYSTEM 23% 25% 34% 24% 38% 29% 35%


HHR policy and strategic planning sub-system

The following graphs show regional-level results from six of the processes that are within this sub-

system compared with national results.

Figure 20: HHR policy and strategic planning sub-system, San Martin 2014.

0% 10% 20% 30% 40% 50% 60%






HHR financing


PERU

TOTALDIRES-SMT


On average, implementation of this sub-system is 30% complete, which indicates “little development”;

this is similar to the national average. Some processes are particularly poorly developed, including

policies and strategies for HHR management as well as operational research with 3% and 5%,

respectively. For these processes, SMT-RHD UEs scored lower than national averages.

According to the reported information, HHR information management and HHR strategic planning are

functioning better than the national averages: for these two processes, SMT-RHD UEs achieved 50%

and 38% ratings, respectively.

The project worked with SMT-RHD in the design, validation, and implementation of a methodology to

calculate HR staffing needs at the first level of care. One important factor in generating reliable



calculations is having timely information on current HR availability. The project’s assistance in this

area could explain the relatively high ratings for these processes.

UE 403-Alto Huallaga exhibited the best performance for this sub-system with a 45% rating while UE

402-Huallaga Central and UE 404-Hospital Tarapoto obtained the lowest score with 23% ratings.

Figure 21: HHR policy and strategic planning by UE, San Martin 2014.

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

UE 400San Martin

UE 401Alto Mayo


UE 403Alto

Huallaga

UE 404Hosp

Tarapoto

TOTALDIRES-SMT

PERU


Table 33: HHR policy and strategic planning by UE, San Martin 2014.


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HHR policy and strategic planning 26% 35% 23% 45% 23% 30% 31%

Policies and strategies for HHR

management 0% 4% 0% 11% 0% 3% 17%

Development of operational research 0% 0% 0% 27% 0% 5% 8%

HHR information management 43% 52% 39% 80% 37% 50% 40%

HHR management control 0% 0% 17% 0% 23% 8% 18%

HHR strategic planning 42% 53% 26% 42% 26% 38% 35%

HHR financing 23% 77% 0% 62% 0% 32% 41%




Considering the results for each of the UEs, the project formed the following conclusions:

For policies and strategies within the HHR management and development process, UE 403

achieved the best performance rating with 11%. However, some UEs, including UE 400, UE 402,

and UE 404, failed to achieve any progress in this category. On average, SMT-RHD UEs

achieved a 3% progress rating while the national average was 17% for this process.This process

is related to the design, approval, and implementation of HR policies. In spite of USAID project

support in helping to design SMT-RHD HHR policies, these policies have not yet been approved,

and therefore, they have not been implemented.

In the development of operational research process, UE 403 achieved the best performance

rating with 27% while all other UEs failed to achieve any progress in this category. On average,

this process is the least developed process within this sub-system at the national and regional

level.

For the HHR information management process, UEs scored an average progress rating of 50%.

UE 403 achieved the best rating with 80% while Tarapoto Hospital had the lowest progress rating

with 37%.

For the HHR management control process, Tarapoto Hospital showed the best performance with

a 23% rating. While UE 402 scored a 17% progress rating, all other UEs failed to achieve any

progress in this category.

For the HHR strategic planning process, UE 401 achieved the highest progress rating with 53%,

which is higher than the national average of 35%. UE 402 and UE404 had the lowest scores with

26% each.

Regarding the HHR financing process, UE 401 achieved the highest progress rating with 77%,

which is higher than the regional and national averages. UE 402 and UE 404 failed to achieve

any progress in this category.

A detailed analysis and proposals for improvement were presented in the previous technical report.

Work organization sub-system

The following graph shows the results of three processes included in this sub-system. On average,

the progress rating for this sub-system within SMT-RHD was measured at 25%. According to regional

reports, slight improvements have taken place in the job rating category resulting in a progress rating

of 30%, which is higher than the national average of 12%.

Figure 22: Work organization sub-system, San Martin 2014.

0% 5% 10% 15% 20% 25% 30% 35% 40% 45%



Job rating


PERU

TOTALDIRES-SMT




The project provided technical assistance to SMT-RHD in the design and validation of a tool to

measure job positions for the first level of care. Job rating implementation is a prerequisite in

designing salary scales. The project’s assistance in this area could explain the relatively high ratings

for these processes compared with the national average.

The design of job profiles process includes tasks related not only to the design and implementation of

job profiles but mainly to the design, updating, and use of managerial documents such as the

Organization and Functions Regulations (ROF); the Functions Manual (MOF); the Staff Allocation

Table (Cuadro de asignación de personal, CAP); and the Staff Analytical Budget (Presupuesto

Analitico de Personal, PAP). Although these documents are mandatory for all public institutions, very

few of them have been updated. This could be explain why the job profiles design process is poorly

developed for all SMT-RHD units in spite of strengthened elements within the process.

Figure 23: Work organization, San Martin and UEs in 2014.

0%

5%

10%

15%

20%

25%

30%

35%

UE 400San Martin

UE 401Alto Mayo


UE 403Alto

Huallaga

UE 404Hosp

Tarapoto

TOTALDIRES-SMT

PERU


UE 402 and UE 404 achieved the best performance ratings for this sub-system with 28%, which is

higher than the regional average and very close to the national average. UE 401 and UE 403

obtained the lowest ratings with 22%.

Table 34: Work organization, San Martin and UEs in 2014.


UE

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DIRES SMT

PERU

Work organization 24% 22% 28% 22% 28% 25% 29%

Design of job profiles 25% 25% 25% 25% 25% 25% 42%

Identification of labor competencies 19% 11% 33% 11% 33% 21% 14%

Job rating 30% 30% 30% 30% 30% 30% 12%





All UEs achieved a progress rating of 25% in job profile design and 30% for the job rating

process.

Regarding identification of labor competencies, SMT-RHD exhibited better performance than the

national average with a progress rating of 21%. However, some UEs, including UE 401 and UE

403, achieved less progress with an 11% rating.

While the job rating process is the least developed process at the national level, UEs throughout

SMT-RHD scored higher than the national average.

Employment management sub-system

The graph presents results for the five processes involved in this sub-system. The SMT-RHD average

progress rating for this sub-system was 31%, which is lower than the national average of 45%.

Figure 24: Employment management sub-system, San Martin 2014.

0% 10% 20% 30% 40% 50% 60%

Recruitment, selection, incorporation and induction

Staff mobility

Management of staff files and attendance control




PERU

TOTAL

DIRES-SMT


The recruitment, selection, incorporation, and induction process is the most developed process within

this sub-system with a 39% progress rating. The staff termination and retirement process is the least

developed process with a 12% progress rating.

The results are worrying since these processes are the only processes with designated staff to

manage them. The average ratings for all processes are lower than national averages. The lack of

training, high staff turnover, and implementation of a new organizational structure could explain this

poor performance.



Figure 25: Employment management, San Martin and UEs in 2014.

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

UE 400San Martin

UE 401Alto Mayo


UE 403Alto

Huallaga

UE 404Hosp

Tarapoto

TOTALDIRES-SMT

PERU


On average for this sub-system, UE 404 exhibited the best performance with a 40% progress rating,

which is higher than the regional average but lower than the national average. UE 400 and UE 402

had the lowest scores with 27% progress ratings.

Table 35: Employment management, San Martin and UEs in 2014.


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DIRES SMT

PERU

Employment management 27% 31% 27% 32% 40% 31% 45%

Recruitment, selection, incorporation, and induction 35% 40% 39% 44% 39% 39% 48%

Staff mobility 0% 0% 14% 0% 71% 17% 45%

Management of staff files and attendance control 41% 30% 5% 35% 43% 31% 44%

Administration of disciplinary process 5% 23% 14% 9% 32% 16% 35%

Staff termination and retirement 0% 11% 21% 0% 26% 12% 32%


Based on results for each of the processes, the project formed the following conclusions:

UE 404 achieved the best performance in the majority of the processes with a 71% progress

rating in staff mobility, which is higher than regional and national averages; a 43% progress rating

in the management of staff files and attendance control process, which is higher than the regional

average; 32% in the administration of disciplinary process category, which is higher than the

regional average; and 26% for the staff termination and retirement process, which is higher than

the regional average.

Regarding recruitment, selection, incorporation, and induction processes, UE 400 had the lowest

score with a 35% progress rating.



Regarding the staff mobility process, UE 400, UE 401, and UE 403 failed to achieve any progress

in this category.

Regarding the management of staff files and attendance control process, UE 402 achieved a 5%

progress rating.

In the administration of the disciplinary process category, UE 400 and UE 402 achieved progress

ratings of 5%.

Regarding the staff termination and retirement process, UE 400 and UE 403 failed to achieve any

progress in this category.

Performance management sub-system

The following graph shows results for the four processes within this sub-system.

Figure 26: Performance management sub-system, San Martin 2014.

0% 5% 10% 15% 20% 25% 30%


Supervision


Feedback and design of plans for individual performance improvement


PERU

TOTALDIRES-SMT


SMT-RHD UEs achieved a 13% average progress rating for this sub-system, which is classified as

“little development” and is lower than the national average of 20%.

The majority of processes within this sub-system are particularly poorly developed, including

performance planning; supervision; and the feedback and design of plans for individual performance

improvement with 10%, 12%, and 13% progress ratings, respectively. Progress ratings for

performance planning, supervision, and performance evaluation are lower than national averages.

According to reported information, the performance evaluation process is functioning relatively well

but has still achieved a progress rating of only 16%, which is lower than the national average of 21%.



Figure 27: Performance management sub-system, San Martin and UEs in 2014.

0%

5%

10%

15%

20%

25%

UE 400San Martin

UE 401Alto Mayo


UE 403Alto

Huallaga

UE 404Hosp

Tarapoto

TOTALDIRES-SMT

PERU


Regarding results by UE for this sub-system, UE 402 and UE 404 exhibited the best performances

with progress ratings of 24%, which is higher than national and regional averages. UE 400 and UE

403 had the lowest scores with a 4% rating.

Table 36: Performance management sub-system, San Martin 2014.


UE

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DIRES SMT

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Performance management 4% 12% 24% 4% 24% 13% 20%

Performance planning 0% 0% 17% 17% 17% 10% 26%

Supervision 10% 0% 25% 0% 25% 12% 16%

Performance evaluation 5% 25% 25% 0% 25% 16% 21%


performance improvement 0% 8% 28% 0% 28% 13% 12%



For the performance planning process, UE 402, UE 403, and UE 404 achieved the most progress

with ratings of 17%, which is higher than the regional average. However, UE 400 and UE 401

failed to achieve any progress in this category.

For the supervision process, UE 402 and UE 404 exhibited the best performances with progress

ratings of 25%, which is higher than regional and national averages. However, some UEs,

including UE 401 and UE 403, achieved no progress towards implementation of this process.

For the performance evaluation process, UE 402, UE 402, and UE 404 achieved the highest

progress ratings with 25%, which is higher than regional and national averages. UE 403 failed to

achieve any progress in this category.



Regarding the feedback and design of plans for individual performance improvement process, UE

402 and UE 404 achieved the highest progress ratings with 28%, which is higher than regional

and national results. UE 400 and UE 403 failed to achieve any progress in this category.

Development and training management sub-system

The following graph shows results for the three processes within this sub-system.

On average, this sub-system achieved a 31% progress rating, which is lower than the national

average of 43%.

Figure 28: Development and training management sub-system, San Martin 2014.

0% 10% 20% 30% 40% 50% 60%

Labor advancement (promotion and career path)

Capacity building

Regulation of the teaching & service process

DEVELOPMENT AND TRAINING MANAGEMENT SUB-SYSTEM

PERU

TOTALDIRES-SMT


The teaching-service process has progressed the least with a 21% rating. According to information

provided by participants, the process with the greatest level of development is the labor advancement

process with a 36% progress rating.



Figure 29: Development and training management sub-system, San Martin and UEs in 2014.

0%

10%

20%

30%

40%

50%

60%

70%

UE 400San Martin

UE 401Alto Mayo


UE 403Alto

Huallaga

UE 404Hosp

Tarapoto

TOTALDIRES-SMT

PERU


On average for this sub-system, UE 404 exhibited the best performance with a 61% progress rating,

which is higher than regional and national averages. UE 400 made the least amount of progress with

a rating of 3% for this sub-system.

Table 37: Development and training management sub-system, San Martin and UEs in 2014.


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DIRES SMT

PERU

Development and training management 3% 18% 57% 19% 61% 31% 43%

Labor advancement (promotion and career path) 0% 12% 68% 39% 62% 36% 42%

Capacity building 0% 28% 56% 10% 64% 32% 48%

Regulation of the teaching & service process 14% 0% 38% 5% 49% 21% 33%



UE 402 exhibited the best performance in the capacity building process and the regulation of the

teaching-service process with 65% and 49% ratings, respectively. Both scores are higher than

national and regional averages.

UE 400 failed to achieve any progress in the labor advancement and capacity building processes.

Regarding labor advancement, UE 402 exhibited the best performance with a progress rating of

68%, which is higher than national and regional averages.



Regarding regulation of the teaching-service process, UE 401 failed to achieve any progress in

this category.

Compensation management sub-system

The graph below presents results for the five processes involved in this sub-system.


development” and is slightly higher than the national average of 37%.

Figure 30: Compensation management sub-system, San Martin 2014.

0% 10% 20% 30% 40% 50% 60% 70% 80%





Pension management


PERU

TOTALDIRES-SMT


The management of payroll and salaries process is the only process within this sub-system that is

more developed in SMT-RHD UEs than it is nationally. However, the results also show that little

development has taken place in the management of incentives. For this process, SMT-RHD UEs had

an average progress rating of 24%.



Figure 31: Compensation management sub-system, San Martin and UEs in 2014.

0%5%

10%15%20%25%30%35%40%45%50%

UE 400San Martin

UE 401Alto Mayo


UE 403Alto

Huallaga

UE 404Hosp

Tarapoto

TOTALDIRES-SMT

PERU


Regarding results by UE for this sub-system, UE 404 exhibited the best performance with a 47%

progress rating, which is higher than regional and national averages. UE 401 and UE 403 had the

lowest scores with a 32% progress rating.

Table 38: Compensation management sub-system, San Martin 2014.


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Compensation management 46% 32% 39% 32% 47% 39% 37%

Design of salary scales 31% 37% 31% 38% 51% 38% 24%

Management of payroll and salaries 100% 88% 47% 35% 47% 64% 60%

Administration of benefits and bonuses 87% 53% 67% 53% 67% 65% 71%

Incentive management 26% 11% 33% 16% 33% 24% 30%

Pension management 100% 20% 60% 40% 60% 56% 62%



For the design of salary scales process, all UEs exhibited better performances than the national

average. UE 404 exhibited the best performance with a 51% rating. UE 401 and UE 403 achieved

the lowest scores with a 31% progress rating.

For the management of payroll and salaries process, UE 400 exhibited the best performance with

a 100% progress rating, which is higher than regional and national averages. UE 403 achieved

the lowest score with a progress rating of 35%.



Regarding the administration of benefits and bonuses process, UE 400 achieved the highest

progress rating with 87%, which is higher than regional and national averages. UE 401 and UE

403 had the lowest scores with 53%.

For the incentive management process, UE 402 and UE 404 achieved the highest progress

ratings with 33%, which is higher than regional and national averages. UE 401 had the lowest

score with 11%.

Regarding the pension management process, UE 400 achieved the highest progress rating with

100%, which is higher than regional and national averages. UE 401 had the lowest score with

20%.

Managing human and social relations sub-system

The graph below presents results for the three processes within this sub-system.


development” and is lower than the national average of 38%.

Figure 32: Managing human and social relations sub-system, San Martin 2014.

0% 10% 20% 30% 40% 50% 60%

Management of the organizational climate and culture



MANAGING HUMAN AND SOCIAL RELATIONS SUB-SYSTEM

PERU

TOTALDIRES-SMT


The workplace health, safety, and welfare process within SMT-RHD is more developed than at the

national level with a 48% progress rating.

The two other processes within this sub-system achieved progress ratings of 19%, which is lower

than the national averages.



Figure 33: Managing human and social relations sub-system, San Martin and UEs in 2014.

0%

10%

20%

30%

40%

50%

UE 400San Martin

UE 401Alto Mayo


UE 403Alto

Huallaga

UE 404Hosp

Tarapoto

TOTALDIRES-SMT

PERU


Regarding results by UE for this sub-system, UE 402 and UE 404 exhibited the best performances

with 45% progress ratings, which is higher than national and regional averages. UE 403 had the

lowest score with a 17% progress rating.

Table 39: Human Resources Management System processes by UE, San Martin 2014.


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Managing human and social relations 34% 25% 45% 17% 45% 33% 38%

Management of the organizational climate and culture 0% 0% 47% 0% 47% 19% 30%

Management of labor relations 33% 24% 9% 21% 9% 19% 42%

Workplace health, safety, and welfare 48% 35% 69% 21% 69% 48% 39%



Regarding the management of the organizational climate process, UE 402 and UE 404 achieved

the highest progress ratings with 47%, which is higher than regional and national averages. UE

400, UE 401, and UE 403 failed to achieve any progress in this category.

For the management of labor relations process, UE 400 exhibited the best performance with a

33% progress rating, which is higher than the regional average of 19% but lower than the national

average of 42%. UE 402 and UE 404 both achieved a progress rating of 9% for this process.

For the workplace health, safety, and welfare process, UE 402 and UE 404 achieved the best

performances with progress ratings of 69%, which is higher than regional and national averages.

However, UE 403 achieved little progress with a 21% rating.



5. Activities undertaken by MoH to strengthen HRMS and

proposals for future activities

The following guidelines and measures for HHR health sector reform have been approved by the

national government:

Implementation of a new comprehensive remunerative policy based on merit, performance, and

risk by level of care.

Regulation of HHR post-graduate training to match supply of health professionals to the health

needs of the country.

Application of non-monetary incentive schemes to recruit and retain staff who work in less

developed areas.

Implementation of these reforms requires key arrangements in the human resources management

system.

Towards this end, MoH and RHDs have agreed to develop executive agreements to implement health

policy priorities in national and regional government agendas with the goal of universal health

coverage. Agreements and their respective priorities will be monitored during CIGSs meetings.

One CIGS agreement focused on strengthening the managerial skills of HR office staff. Accordingly,

a HR committee was formed to analyze HRMS functioning in health institutions.

MoH and the CIGS-HR committee collected the necessary information from all UEs at the national

level through the HRMS evaluation.

Based on HRMS evaluation results, the CIGS-HR committee proposed that MoH develop the

following activities:

Regarding norms and regulations for HRMS functioning

Design key indicators to monitor HRM based on critical areas encountered in the assessment.

Design of incentives to UEs which demonstrate improvements in HRMS performance.

Develop tools and methodologies for estimating HHR requirements at all levels, including

administrative and managerial units.

Design, approve, and diffuse a methodology for defining job competencies.

Propose a methodology and tools for job evaluation in coordination with SERVIR.

Approve regulations to remove alternative attendance control systems (e.g. manual control) and

maintain a single system to register and monitor attendance.

Design a tool to keep staff files updated.

Design tools and methodologies to supervise individual job performance; assess job

performance; develop feedback; and design plans for individual performance improvement.

Design tools to establish criteria for qualifying teaching hospitals and health centers.

Design methodology and tools to define fair and equitable salary scales for hired staff.



Design HHR management information system as part of the existing information system

(INFORHUS).

Establish a mechanism to ensure that UEs implement strategies to communicate workers’ rights

related to compensation, benefits, and bonuses.

Establish a mechanism to promote the measurement, analysis, and use of organizational climate

measurement results to improve personnel satisfaction.

Design tool to monitor RNSDD updates at the UE level.

Regarding the provision of direct TA from MoH and SERVIR

In the framework of decentralization and according to the analysis of HRMS assessment results, the

project has identified the need for TA from MoH and/or SERVIR in the following areas:

HHR policy and planning management

Management of the HHR information system

Design of labor competencies at all levels

Use of job rating tools and methodologies

Management of staff turnover and mobility as well as timely and proper registration of this

information in INFORHUS

Design RIT according to institutional policies

Implement tools and methodologies to plan individual performance evaluations

Implement tools and methodologies to supervise individual performance

Implement tools and methodologies to evaluate individual performance and respective feedback

Implement training policies at the regional and UE level

Establish criteria to qualify teaching hospitals at the regional level

Define fair and equitable salary scales for hired staff

Manage pensions

Regarding development of HR units’ capacity

According to the analysis of HRMS assessment results, MoH should organize training programs to

satisfy the following training needs:

Design and management of HHR policies

Design of HRM indicators and a HR balanced scorecard

HHR planning and finance as well as strategies for HHR provision

Job profile design

Performance management

Staff file management and staff file information system (in coordination with MoF)



Health and work safety policy and strategies for implementation (in coordination with SERVIR and

the Ministry of Labor)

Regarding strategic alliances with institutions on HHR issues

According to the analysis of HRMS assessment results, MoH should establish coordination and

partnerships with educational institutions, MoF, and SERVIR to improve HRM offices at the regional

and local levels.

The following HHR issues require coordination with SERVIR:

Training in the design and management of HR policies

Institute awards for best HR researches

Design of HRM indicators and a HR balanced scorecard

Adapt methodology for job profile design for easy implementation at the health sector level

Management of tools and methodologies for job rating

Strategies to manage compliance with regulations governing recruitment, selection and hiring

processes as well as the application of penalties for noncompliance

Develop regulatory policies for staff promotion in the health sector

The following HHR areas require coordination with MoF:

MoF asks for HR information through RHDs.

MoF keeps budget allocation linked to the HR information systems sector.

MoF trains HR office teams in handling payroll and the payroll computer system.

The following HHR issues require coordination with both SERVIR and MoF:

The development of standards to encourage interoperability of all information systems, including

the RHUS module (HR/INFORHUS/RENIEC).

Provide TA to define salary scales for hired staff.

The following activities require coordination with other institutions:

Partner with universities to development HHR research projects and give awards for excellence in

research.

MoH should promote coordination mechanisms with regional and local governments as well as

universities to award non-monetary incentives to staff exhibiting good performance.

MoH will coach HR office team in staff welfare as well as health and work safety in coordination

with SERVIR and MINTRA.



Regarding HRM policies, MoH has approved the following methodology and tools:

Technical guide to calculate HHR gaps for the first level of care3, which was approved in March

2014.

Technical guide to identify labor competencies and design tools and standards for specific

competency assessment using the functional analysis4, which was approved in March 2014.

Technical guide to calculate HHR gaps for the second and third-level-of-care5, which was

approved in June 2014.

Legislative decree regulating the compensation and comprehensive policy and the economic

delivery of health service staff of the State6, approved in September 2013.

(See annex 6.9)

3 Resolución Ministerial N° 176-2014/MINSA.

4 Resolución Ministerial N° 251-2014/MINSA

5 Resolución Ministerial N° 437-2014/MINSA.

6 Decreto Legislativo N° 1153



6. Conclusions and Recommendations

Improving the population’s health status in San Martin requires skilled HHR who are correctly

positioned and capable of providing good quality health care services that meet standards.

Achieving this outcome requires the implementation of strategies to recruit and retain competent staff

in the most remote and least developed areas. These strategies entail the implementation of

processes to determine the quantity of human resources needed and the type, taking into account

experience, knowledge, and skills. Based on this information, SMT-RHD can develop recruitment,

selection, and hiring processes based on job profiles, and it can allocate HHR to positions where they

are most needed while offering a fair and equitable salary. Additionally, it is necessary to evaluate

staff performance to ensure that individual performance is continuously improving. It also necessary

to ensure that an institution is able to reward good performance as well as encourage staff by

designing training programs to fill gaps found in performance evaluations.

Implementation of these processes requires a trained and committed management team.

Unfortunately, policymakers do not place enough importance on this issue as they often allocate

untrained staff to HR offices. The lack of methodologies and tools to guide and help HR teams in

adequately managing HR processes also undercuts successful implementation.

Encouragingly, MoH is now committed to better understanding how HRM is developing in UEs

nationwide through its analytical efforts.

Prior to analyzing the technical reports, one concern was that the information within the reports, which

was provided by UEs, might not be valid. The CIGS-HR Committee and MoH began to look for

specific data in specific UEs in order to verify the veracity of the information. There was no systematic

investigation, but all queries showed that the specific information analyzed was true. MoH also

informed all RHDs that their information would be verified in supervision visits conducted by MoH.

In SMT-RHD, all HRMS processes were evaluated for each UE, and the results were presented in

tables and graphs. UEs exhibited varying levels of performance in HRMS processes:

UE 404, which only includes the Tarapoto hospital, exhibited the highest level of development for

HRMS processes in SMT-RHD with a 38% progress rating. This UE exhibited the best

performance in the staff mobility process with a 71% rating but failed to achieve any progress in

three processes within the HHR policy and strategic planning sub-system

UE 400-Bajo Mayo, which includes the El Dorado, Lamas, Picota, and San Martin networks,

obtained the lowest score for HRMS processes with a 23% progress rating. While it achieved

100% progress ratings in the management of payroll and salaries process and the pension

management process, it failed to achieve any progress in ten processes within the five sub-

systems.

UE 401-Alto Mayo, which includes the Moyobamba and Rioja networks, exhibited the best

performance in the management of payroll and salaries process with an 88% progress rating.

However, it failed to achieve any progress in seven processes within the five sub-systems.

UE 402-Huallaga Central, which includes the Bellavista, Huallaga, and Mariscal Caceres

networks, had the best performance in the workplace health, safety, and welfare process with a

69% progress rating. However, it failed to achieve any progress in three processes within the

HHR policy and strategic planning sub-system.



UE 403-Alto Huallaga, which only includes the Tocache network, exhibited the best performance

in the HHR information system process with an 80% progress rating. However, it failed to achieve

any progress in seven processes within four sub-systems.

These results demonstrate the generally poor state of HRM processes and illustrate the necessity of

developing a long-term program to encourage improvement of the 29 processes evaluated. Due to

differences in UE performance related to HRM, each UE should design and implement its own plan.

Improving HRM means designing management tools that would facilitates implementation of HRMS

processes. These tools would help train personnel in HR management, problem solving, negotiation,

and timely decision making to incrementally improve staff performance.

MoH designed a national plan to counter common problems uncovered in this assessment, but each

UE has their own problems. Given this, MoH must provide feedback on UE technical reports and

support the improvement of processes.


Abt Associates Inc. References ▌pg. 81

7. References

1. Ley del Servicio Civil, in Ley 30057 2013, Congreso de la República: Perú.

2. GORESAM, Ordenanza Regional N° 003-2013-GRSM/CR, in OR 003-2013-GRSM/CR.

2013: Región San Martín.

3. Nivel de implementación del sistema de gestión de recursos humanos de la DIRES San

Martín. 2013, Dirección de Desarrollo de RR.HH. de la DIRESA San Martín.

4. Informe de sistemas de gestión de RR.HH. de la DIRESA Cajamarca.

5. Chiavenato, I., Gestión del Talento Humano. Mc Graw-Hill ed. 2009, México D.F.

6. WHO, Working together for health - The World Health Report 2006. 2006, World Health

Organization: Ginebra.

7. WHO, Health Systems: Improving performance - The World Health Report 2000. 2000,

World Health Organization: Ginebra.

8. DIRES Loreto - UE de Salud Loreto. Documento Técnico “Nivel de implementación del Sistema

de Gestión de Recursos Humanos”.

9. DIRES Loreto - UE de Salud Alto Amazonas. Documento Técnico: “Nivel de implementación del

Sistema de Gestión de Recursos Humanos”.

10. DIRES Loreto - UE de Salud Datem del Marañon. Documento Técnico “Nivel de implementación

del Sistema de Gestión de Recursos Humanos”.

11. DIRES Loreto - UE Hospital Santa Gema, Yurimaguas. Documento Técnico “Nivel de

implementación del Sistema de Gestión de Recursos Humanos”.

12. DIRES Huánuco – UE Red Huánuco. Documento Técnico “Nivel de implementación del Sistema


13. DIRES Huánuco – UE Red Humalíes. Documento Técnico “Nivel de implementación del Sistema


14. DIRES Huánuco – UE Red Dos de Mayo. Documento Técnico “Nivel de implementación del


15. DIRES Pasco - UE Salud Pasco. Documento Técnico “Nivel de implementación del Sistema de

Gestión de Recursos Humanos”.

16. DIRES Pasco - UE Hospital Daniel Alcides Carrión. Documento Técnico “Nivel de


17. DIRES Pasco – UE Red de Salud Oxapampa. Documento Técnico “Nivel de implementación del


18. GERESA Lambayeque – UE Gerencia Regional de Salud Lambayeque. Documento Técnico

“Nivel de implementación del Sistema de Gestión de Recursos Humanos”.

19. GERESA Lambayeque – UE Hospital Regional Docente “Las Mercedes” de Chiclayo. Documento

Técnico “Nivel de implementación del Sistema de Gestión de Recursos Humanos”.

20. GERESA Lambayeque – UE Hospital Provincial Docente “Belén” de Lambayeque. Documento


21. GERESA Lambayeque – UE Hospital Regional de Lambayeque. Documento Técnico “Nivel de


22. DIRESA Piura – UE Dirección Sub Regional de Salud Luciano Castillo Colonna. Documento


23. DIRESA Piura – UE Hospital de Apoyo Sullana II. Documento Técnico “Nivel de implementación




24. DIRESA Piura – UE Red de Salud Morropón - Chulucanas. Documento Técnico “Nivel de


25. DIRESA Piura – UE Hospital de Chulucanas. Documento Técnico “Nivel de implementación del


26. DIRESA Piura – UE Hospital Las Mercedes - Paita. Documento Técnico “Nivel de


27. DIRESA Amazonas – UE DIRESA. Aplicativo “Nivel de implementación del Sistema de Gestión

de Recursos Humanos”.

28. DIRESA Amazonas – UE Bagua. Aplicativo “Nivel de implementación del Sistema de Gestión de

Recursos Humanos”.

29. DIRESA Amazonas – UE Hospital Gustavo Lannata. Aplicativo “Nivel de implementación del


30. DIRESA Amazonas – UE Red de Salud Utcubamba. Aplicativo “Nivel de implementación del


31. DIRESA Ancash – UE Salud Ancash. Aplicativo “Nivel de implementación del Sistema de Gestión


32. DIRESA Ancash – UE Red Recuay-Carhuaz. Aplicativo “Nivel de implementación del Sistema de


33. DIRESA Ancash – UE Red Huaraz. Aplicativo “Nivel de implementación del Sistema de Gestión


34. DIRESA Ancash – UE Hospital Eleazar Guzmán Barrón. Aplicativo “Nivel de implementación del


35. DIRESA Ancash – UE Red La Caleta. Aplicativo “Nivel de implementación del Sistema de


36. DIRESA Ancash – UE Red Caraz. Aplicativo “Nivel de implementación del Sistema de Gestión de


37. DIRESA Ancash – UE Red Pomabamba. Aplicativo “Nivel de implementación del Sistema de


38. DIRESA Ancash – UE Red Huari. Aplicativo “Nivel de implementación del Sistema de Gestión de


39. DIRESA Ancash – UE Red Pacífico Sur. Aplicativo “Nivel de implementación del Sistema de


40. DIRESA Ayacucho – UE Salud Ayacucho. Aplicativo “Nivel de implementación del Sistema de


41. DIRESA Ayacucho – UE Hospital de Huamanga. Aplicativo “Nivel de implementación del


42. DIRESA Ayacucho – UE Red de Salud Centro Ayacucho. Aplicativo “Nivel de implementación del


43. DIRESA Ayacucho – UE Red de Salud Ayacucho Norte. Aplicativo “Nivel de implementación del


44. DIRESA Ayacucho – UE Red de Salud Huamanga. Aplicativo “Nivel de implementación del


45. DIRESA Ayacucho – UE Red de Salud San Miguel. Aplicativo “Nivel de implementación del


46. DIRESA Ayacucho – UE Red de Salud San Francisco. Aplicativo “Nivel de implementación del




47. DIRESA Cajamarca – UE Salud Cajamarca. Aplicativo “Nivel de implementación del Sistema de


48. DIRESA Cajamarca – UE Red de Salud Chota. Aplicativo “Nivel de implementación del Sistema


49. DIRESA Cajamarca – UE Red de Salud Cutervo. Aplicativo “Nivel de implementación del


50. DIRESA Cajamarca – UE Red de Salud Jaén. Aplicativo “Nivel de implementación del Sistema de


51. DIRESA Callao – UE Hospital de Apoyo San José. Aplicativo “Nivel de implementación del


52. DIRESA Callao – UE Hospital de Ventanilla. Aplicativo “Nivel de implementación del Sistema


53. DIRESA Cusco – UE Red de Salud Canas-Canchis-Espinar. Aplicativo “Nivel de implementación


54. DIRESA Cusco – UE Hospital Lorena. Aplicativo “Nivel de implementación del Sistema de


55. DIRESA Cusco – UE Red de Salud La Convención. Aplicativo “Nivel de implementación del


56. DIRESA Cusco – UE Red Cusco Sur. Aplicativo “Nivel de implementación del Sistema de Gestión


57. DIRESA Huancavelica – UE Red Acobamba. Aplicativo “Nivel de implementación del Sistema de


58. DIRESA Huancavelica – UE Red Angaraes. Aplicativo “Nivel de implementación del Sistema de


59. DIRESA Huancavelica – UE Red Castro Virreyna. Aplicativo “Nivel de implementación del


60. DIRESA Huancavelica – UE Red Churcampa. Aplicativo “Nivel de implementación del Sistema


61. DIRESA Huancavelica – UE DIRESA Huancavelica. Aplicativo “Nivel de implementación del


62. DIRESA Huancavelica – UE Hospital Departamental. Aplicativo “Nivel de implementación del


63. DIRESA Huancavelica – UE Red Huaytará. Aplicativo “Nivel de implementación del Sistema de


64. DIRESA Huancavelica – UE Red Pampas. Aplicativo “Nivel de implementación del Sistema de


65. DIRESA Huánuco – UE Salud Huánuco. Aplicativo “Nivel de implementación del Sistema de


66. DIRESA Huánuco – UE Red Tingo María. Aplicativo “Nivel de implementación del Sistema de


67. DIRESA Huánuco – UE Hospital Hermilio Valdizán. Aplicativo “Nivel de implementación del


68. DIRESA Huánuco – UE Red Leoncio Prado. Aplicativo “Nivel de implementación del Sistema de


69. DIRESA Huánuco – UE Red Huánuco. Aplicativo “Nivel de implementación del Sistema de




70. DIRESA Huánuco – UE Red Huamalíes. Aplicativo “Nivel de implementación del Sistema de


71. DIRESA Huánuco – UE Red Dos de Mayo. Aplicativo “Nivel de implementación del Sistema de


72. DIRESA Ica – UE Salud Ica. Aplicativo “Nivel de implementación del Sistema de Gestión de


73. DIRESA Ica – UE Hospital San José de Chincha. Aplicativo “Nivel de implementación del


74. DIRESA Ica – UE Red de Salud Palpa-Nazca. Aplicativo “Nivel de implementación del Sistema


75. DIRESA Ica – UE Hospital Regional de Ica. Aplicativo “Nivel de implementación del Sistema de


76. DIRESA Ica – UE Hospital San Juan de Dios - Pisco. Aplicativo “Nivel de implementación del


77. DIRESA Ica – UE Hospital de Apoyo Santa María de Socorro. Aplicativo “Nivel de


78. DIRESA Ica – UE Red de Salud Ica. Aplicativo “Nivel de implementación del Sistema de Gestión


79. DIRESA Junín – UE Red de Salud Daniel Alcides Carrión. Aplicativo “Nivel de implementación


80. DIRESA Junín – UE Red de Salud El Carmen. Aplicativo “Nivel de implementación del Sistema


81. DIRESA Junín– UE Red de Salud Tarma. Aplicativo “Nivel de implementación del Sistema de


82. DIRESA Junín – UE Red de Salud Chanchamayo. Aplicativo “Nivel de implementación del


83. DIRESA Lambayeque – UE Salud Lambayeque. Aplicativo “Nivel de implementación del Sistema


84. DIRESA Lambayeque – UE Hospital Regional Docente Las Mercedes. Aplicativo “Nivel de


85. DIRESA Lambayeque – UE Hospital Belén de Lambayeque. Aplicativo “Nivel de implementación


86. DIRESA Lambayeque – UE Hospital Regional de Lambayeque. Aplicativo “Nivel de


87. Dirección de Salud III-Lima Norte. Aplicativo “Nivel de implementación del Sistema de Gestión


88. DISA III-Lima – Hospital Huacho - Huaura. Aplicativo “Nivel de implementación del Sistema de


89. DISA III-Lima – UE Servicios Básicos de Salud Cañete. Aplicativo “Nivel de implementación del


90. DISA III-Lima – UE Hospital de Apoyo Rezola. Aplicativo “Nivel de implementación del Sistema


91. DISA III-Lima – UE Hospital de Barranca. Aplicativo “Nivel de implementación del Sistema de


92. DISA III-Lima – UE Hospital de Chancay. Aplicativo “Nivel de implementación del Sistema de




93. DISA III-Lima – UE Servicios Básicos de Salud Chilca. Aplicativo “Nivel de implementación del


94. DISA III-Lima – UE Hospital de Huaral. Aplicativo “Nivel de implementación del Sistema de


95. DISA III-Lima – UE Red de Salud Huarochiri. Aplicativo “Nivel de implementación del Sistema


96. DIRESA Loreto – UE Salud Loreto. Aplicativo “Nivel de implementación del Sistema de Gestión


97. DIRESA Loreto – UE Salud Yurimaguas. Aplicativo “Nivel de implementación del Sistema de


98. DIRESA Loreto – UE Hospital de Apoyo Iquitos. Aplicativo “Nivel de implementación del Sistema


99. DIRESA Loreto – UE Hospital Regional de Loreto. Aplicativo “Nivel de implementación del


100. DIRESA Loreto – UE Red de Salud Datem del Marañon. Aplicativo “Nivel de implementación del


101. DIRESA Loreto – UE Hospital Santa Gema Yurimaguas. Aplicativo “Nivel de implementación del


102. DIRESA Madre de Dios – UE Salud Madre de Dios. Aplicativo “Nivel de implementación del


103. DIRESA Madre de Dios – UE Hospital Santa Rosa. Aplicativo “Nivel de implementación del


104. DIRESA Moquegua – UE Salud Moquegua. Aplicativo “Nivel de implementación del Sistema de


105. DIRESA Moquegua – UE Red de Salud Ilo. Aplicativo “Nivel de implementación del Sistema de


106. DIRESA Moquegua – UE Hospital Regional de Moquegua. Aplicativo “Nivel de implementación


107. DIRESA Pasco – UE Salud Pasco. Aplicativo “Nivel de implementación del Sistema de Gestión de


108. DIRESA Pasco – UE Hospital Daniel Alcides Carrión. Aplicativo “Nivel de implementación del


109. DIRESA Pasco – UE Salud UTES Oxapampa. Aplicativo “Nivel de implementación del Sistema de


110. DIRESA Piura – UE Salud Piura. Aplicativo “Nivel de implementación del Sistema de Gestión de


111. DIRESA Piura – UE Luciano Castillo Colonna. Aplicativo “Nivel de implementación del Sistema


112. DIRESA Piura – UE Hospital III Sullana. Aplicativo “Nivel de implementación del Sistema de


113. DIRESA Piura – UE Red Morropón-Chulucanas. Aplicativo “Nivel de implementación del


114. DIRESA Piura – UE Hospital de Chulucanas. Aplicativo “Nivel de implementación del Sistema de


115. DIRESA Piura – UE Hospital Nuestra Señora de las Mercedes. Aplicativo “Nivel de




116. DIRESA Piura – UE Hospital Santa Rosa. Aplicativo “Nivel de implementación del Sistema de


117. DIRESA San Martín – UE Salud San Martín. Aplicativo “Nivel de implementación del Sistema de


118. DIRESA San Martín – UE Red de Salud Alto Mayo. Aplicativo “Nivel de implementación del


119. DIRESA San Martín – UE Red de Salud Huallaga Central. Aplicativo “Nivel de implementación


120. DIRESA San Martín – UE Red de Salud Alto Huallaga. Aplicativo “Nivel de implementación del


121. DIRESA San Martín – UE Hospital de Tarapoto. Aplicativo “Nivel de implementación del Sistema


122. DIRESA Tumbes – UE Salud Tumbes. Aplicativo “Nivel de implementación del Sistema de


123. DIRESA Tumbes – UE Hospital de Apoyo JAMO-Tumbes. Aplicativo “Nivel de implementación


124. DIRESA Ucayali – UE Salud Ucayali. Aplicativo “Nivel de implementación del Sistema de


125. DIRESA Ucayali – UE Salud Ucayali. Aplicativo “Nivel de implementación del Sistema de


126. DIRESA Ucayali – UE Hospital Amazónico. Aplicativo “Nivel de implementación del Sistema de



Abt Associates Inc. Annex ▌pg. 87

8. Annex

8.1 Analysis of performance evaluation results in the HHR policy and strategic planning sub-system, in selected regions

Loreto RHD

Strengths Problem Description Restrictions Consequences Proposals for Improvement

Senior management

committed.

Annual Training Plan

approved by Executive

Resolution (RHD).

There is an office

responsible for HHR

strategic planning and

financing management

monitoring. There is staff

dedicated exclusively to

HHR management;

however, some UEs don´t

have this staff.

There are technical and

management documents

and HHR legislation.

There is an Excel

application and trained

staff to determine HHR

gaps at the three levels of

care.

Trained and experienced

staff in operational

research (RHD).

Most UEs do not have staff

who are responsible for

managing HHR

development; planning HHR

needs and financing;

operating the information

system; and designing,

monitoring, and analyzing

HHR indicators.

There is not information

about HHR from other

institutions that provide

health services in the

Region.

Limited budget and no

designated office to create

staff positions related to HHR

strategic planning and

monitoring of HHR indicators.

No budget allocated for the

strengthening of HHR

capacities.

No qualified staff to evaluate

results of trainings.

HHR operational research

has not been prioritized due

to the demand for and

prioritization of health

interventions

Poor coordination among

UEs and RHD.

Poor coordination with other

institutions that provide

health services in the region.

Poor planning and little

knowledge of HHR needs

prevent a true estimate of

needed financing and capacity

strengthening.

Over- or underestimation of

HHR in health networks, micro-

networks, and health facilities.

There are no job profiles, which

causes duplication of functions,

internal user dissatisfaction

(wages), and internal labor

disputes.

No available regional HHR

indicators or results for decision

making.

Develop HHR management proposal to

incorporate key processes.

Set a budget goal for implementing the

HRMS.

Set up a unit to formulate and evaluate

regional policies; plan and develop

budgets; monitor and analyze; and

develop research in HHR. Or establish

new sections in existing areas.

Train responsible personnel to improve

performance of their functions. Propose

financing and development of the

corresponding positions.

Design systematized tools to collect

information from other institutions.



Huánuco RHD


Design of HHR policies.

There is HR Observatory.

Some information systems

and criteria exist to define

HHR requirements.

Some employees are

motivated by a desire to

serve their communities,

and they have been

trained.

Implementation of HHR

module.

Inconsistent HHR data.

Understaffing of HHR and

specialist physicians in Level

1-4 health facilities.

Insufficient budget to cover

HHR gap.

Not all staff is committed.

No operational research is

done.

Limited budget to reduce

HHR gap.

HHR planning only considers

specific aspects related to

natural growth of the

population.

Information management is

considered to consist mainly

of managing the names of

workers, staff files, etc.

No equity in achieving goals

and objectives.

Low staff skills and high staff

turnover.

There are new executive

units.

HHR policies have not been

designed.

Insufficient budget for human

resources.

Belated information flow, and

HHR information delayed.

There are no indicators.

New personnel in Level I health

facilities possess few skills to

provide care.

There is little health care

coverage.

Consider the processes required to design

policies; information management; and

strategic human resource planning.

Increase UEs budget for adequate HHR

management.

Hire more personnel and train them.

Budget availability for operational

research.



Pasco RHD


RHD has formulated and

approved 08 HHR regional

policies of HHR

Development

Management.

RHD has selected and

approved regional

research priorities and the

regulation of research

management.

RHD/Daniel Alcides

Carrion Hospital have

started entering data in

INFORHUS.

There are information

systems (Human

Resources MEF Module

and PLAME Module) that

serve to filter and control

HR management.

There are population

density gap indicators that

RHD has used for HR

provision.

Increased funding to hire

HR and have initiated

designation processes.

DL 1153 establishes

remunerative

improvements.

No HHR regional policies have been

implemented, and few personnel are

familiar with them. There is little interest

in their implementation at the national

level.

A Research Management Unit has not

been implemented.

Operational research has not been

correctly developed.

Lack of interest among professionals to

develop research.

HHR data is outdated and incomplete;

personnel displacements are not

recorded.

INFORHUS does not include goals and

productivity indicators. Entry and

reporting data from INFORHUS is more

limited than within SIRHUS.

Control actions are limited. RHD has

little control over networks, hospitals,

and micro-grids.

There is no HR strategic planning

policy nor have HR strategic plans

been developed.

No increased funding for staff

remuneration improvements for CAS

contracts, administrative staff, and staff

of DL 728.

Small staff in the

HR office which

limits HHR

management. No

units to develop

HR strategic

planning.

There is high staff

turnover.

Many HRM

processes require

national regulatory

arrangements.

Little importance is

given to HR

information

management.

Research function

has not been

incorporated into

institutional

management

documents.

No budget for

compliance.

Limited availability

of financial

resources to

improve staff

remuneration for

CAS contracts.

Inadequate HR management

and no strategic planning.

Inadequate HR rationalization.

HR gap has not yet been closed.

Research function has not been

adequately developed.

HR control regulations

implemented in health facilities

are distorted.

High staff turnover for CAS

contracts.

Personnel is not motivated.

Implement regional development HR

policy.

Designate responsible staff for HR

management.

Incorporate the role of health research in

management documents and assign a

budget for this task.

Establish monitoring, evaluation, control,

and productivity of HR indicators.

Designate a responsible unit for the HHR

information system.

Establish a unit for HR strategic planning.

Unit staff should be trained.

Suggest a policy remuneration

improvement for CAS contracts,

administrative staff, and staff of DL 728.

Approve remuneration scale.



Lambayeque RHD


Support of senior

management.

Budget availability to hire

HR in some UEs.

There is available staff,

predisposed to the work.

SIGA and INFORHUS

systems have been

updated in each EU, and

they are customizable.

There are management

documents that

demonstrate the need for

HHR.

HHR gap analysis in

primary care.

HR estimated

requirements and

financing needs exist for

some UEs.

Information is available as

a guide in the

development of indicators.

Salary increase for

permanent staff.

There is no responsible

instance for planning HHR.

Outside authorities

developed plans.

Lack of procedures for

strategic policy formulation or

developing management.

Lack of HHR

trained/specialized in various

processes.

HHR management indicators

do not exist. HHR is not

trained or specialized in the

development/formulation of

personnel management

indicators.

Outdated management tools;

information entered is not

analyzed.

Human resources gap

analysis has not been done

for the second and third

health care levels.

The staffing table, which

includes requirements, has

not been implemented due to

insufficient budget.

A Research Unit has not

been implemented.

A research unit only exists in

Las Mercedes Hospital, but

HHR operational research is

not carried out within it.

There is weak organization.

Inadequate infrastructure and

insufficient HR with the skills

required to develop policies

and strategic planning.

HR office has limited

autonomy for decision

making.

There is insufficient budget

for recruitment.

Lack of a research unit in the

organizational structure of

the Office of Human

Resources.

Human resource gap studies

have not been carried out.

No HR policies are formulated.

Lack of human resources

management

Development of low-level skills

Delay in reporting human

resource needs, thus limiting

analysis and decision making.

Incorrect HR allocation that is

not based on existing criteria

needs.

Complaints of workers.

Low efficiency of organizational

units.

Inadequate and inefficient health

care is provided to users.

Design and implement HR management

policies in line with reality

Create the instance for HR strategic

planning within the Human Resources

Unit.

Recruit and select qualified/skilled

personnel, and train staff available.

Create a research unit in the

organizational structure of the entity and

develop HHR operational research.

Develop management documents and

assign roles to a team.

Formulate and define indicators for HHR

management.

Update management tools in line with

computer system innovations and

improved tools (reports, applications, etc.).

Develop HHR gap studies.

Allocate budget according to regional

needs and CAP requirements.



Piura RHD


Staff is available to

implement policies,

strategic planning, and

HHR information

management.

There is an office in

charge of planning HHR

policies and strategies

(Chulucanas - Morropón

Health Network).

Updated health policies

focused on public health.

ROF points out

systematization and

updating of HR information

for decision-making and

development planning.

Employees can assess

their performance,

including tardiness, status,

salary, and payroll record,

through official reporting

systems.

Recruiting processes have

been implemented based

on profiles for HHR hiring.

A monthly analysis of the

HHR situation within the

institution is performed.

Staffing requirements have

been met based on WHO

rates and the projection of

service needs.

Maintenance of production

HR planning is not promoted

by the State.

No responsible unit or trained

personnel exists to formulate

management and develop

staff policies.

Personnel selection is not

based on HR merits.

Organizational units with

insufficient personnel.

Personnel not meeting

expectations

Processes to capture,

develop, and maintain HHR

quality does not exist. More

specifically, job performance

is not evaluated; staff profiles

are not updated; there are no

incentives to improve or

motivate staff; and safety

and occupational health

procedures do not exist.

Absence of HHR information

management policy. No

support for making decisions

based on evidence. While

there is data, current

systems do not record or

report non-remunerative

concepts such as

attendance, tardiness,

absences, public competitive

examinations, or current

location of the worker. There

is no database that contains

Inefficient budget allocation

and use of resources.

Staff members do not

establish management

guidelines; HR policies and

strategies are not

established; and there are no

specific functions in ROF.

There is no policy or

personnel training plan, and

there are no HR

management manuals. There

is limited budget for health

and administrative personnel

training.

Inadequate staff selection

and constant changes.

Staffing requirements are not

determined through

appropriate criteria like

"operational need"; there is

no real needs assessment.

Inadequate performance

evaluation policy. Staff

disagrees with evaluation.

Resistance to change.

There is no policy for staff

incentives.

An occupational safety and

health plan has not been

developed.

No research policy. Lack of

staff capacity for

development of research.

Staff does not possess

appropriate labor competencies

for optimal performance of the

functions assigned. Lack of

competitiveness among

workers.

There is no real diagnosis of

staff performance.

Work is not planned or

evaluated based on job profiles

and competencies.

Decisions taken do not

correspond to the real needs of

the institution.

There is no research policy,

which makes it impossible to

cultivate good management,

development, and planning of

activities.

Health and administrative

personnel train themselves (or

are trained) and then seek to

use this investment in other

positions, thus leavings UEs

without trained professionals.

Staff does not know the rules

because they are not trained.

Staff files are outdated.

There is no management

information system. Decisions

are then based on insufficient

information.

No real information about worker

specialties, potential skills, and

Assign non-historic budget from central

and regional levels to UE to strengthen

HR.

Incorporate the following specific functions

in institutional ROF: management and

development of policy formulation; and

long-term planning and tools for workforce

development.

Implement a HR management control

system and restructure the current

management information system,

including a information system.

Form a team to develop HHR

management and development policies.

Develop an innovation capacities plan that

includes functions associated with

management and control of human

resources as well as document

management.

Perform induction and training to

personnel entering work after evaluation.

Develop guidelines for evaluating staff and

reward those staff members who exhibit

good job performance.

Introduce incentives to improve work

performance and for staff working in

remote areas as well as those who have

not been considered in the RM 190-2013.

Staff should be evaluated for

qualifications.

There should be an only pay scale so as

not to discriminate against staff.

Form a committee for occupational safety.




policies according to

service needs. Personnel

are engaged to improve

care for the external user.

All personnel positions are

funded within the budget

formulation.

Despite low wages,

personnel are seeking to

improve their health care.

all HR processes.

No information system to

update personnel files. Files

updated only through data

sheet (Excel).

Periodic measurement of

performance indicators is not

performed.

Only remuneration data is

updated and maintained; this

is done through the PLH

system (spreadsheet assets).

There is no estimate or

assessment of HR needs.

Insufficient financial

resources for comprehensive

improvement of HHR. Not all

positions required by UE are

financed.

No development of

operational research nor is

there a unit with personnel

trained to perform this. The

support unit, which is

responsible for training and

research, does not perform

its functions.

Low budget for training in

research.

The information provided by

the current information

systems is insufficient for

decision making. There is no

budget to purchase software,

and only SIAF and SIGA are

used. This is evidence of the

lack of interest in controlling

HHR management.

Personnel files outdated, and

there is no shared

information between the

personnel area and the files

area. Also lack of staff to

update files.

Weak coordination between

employers and training

institutions in designing

curriculum according job

profiles.

Low salaries generate high

turnover.

knowledge means that the

institution cannot benefit from it.

Inadequate recruitment, which is

reflected in work deficiencies.

Actual staffing needs are not

met; poor quality customer

service is a result of staff

shortages.

No improvement in quality of

services, systems, or health

programs.

Delayed money transfers.

Finance operational research for HHR

situational diagnosis. Appoint qualified

staff to develop it.

Create a file registration system as well as

worker awareness about its importance.

Improve salaries of health workers.

Define existing HHR in the region and

establish real staff needs by identifying

HHR gap.

Establish funding requirements for better

redistribution in different units.



8.2 Analysis of performance evaluation results in the work organization sub-system, in selected regions

Loreto RHD


There is a responsible unit

within RHD to design job

profiles and identify

competencies in selecting

health professionals.

Management technical

documents exist; ROF

approved that specifies the

responsible unit in

identifying institutional

competencies.

Knowledge of the

importance of job rating.

Each position, according

to the hierarchy, has a job

profile.

No personnel are dedicated

exclusively to designing and

evaluating job profiles within

UEs.

Staff with multiple functions

is unable to determine

competency profiles and

selection of professionals.

ROF does not specify which

units are responsible of staff

development training

Management documents and

job profile classifier is

outdated.

Lack of job profile

implementation. Lack of

technical criteria for job

evaluation.

No permanent staff to

schedule and coordinate

trainings or select job

profiles.

Lack of interest within staff

members to train personnel.

Given the prioritization of

other activities, staff does not

exclusively perform with

functions.

Lack of decision from the

national government

regarding regional proposals.

Staff has geographic

limitations which hinder their

work.

No information regarding

competency profiles.

Staff working in positions that do

not match their competencies.

Lack of specialized staff.

Few health professionals in

remote and border areas.

Human resources are not

properly managed.

Goals, schedules, and activities

are not developed.

MoH support needed.

Restructuring of management documents,

including ROF and MOF.

Implement unit with exclusive and trained

personnel to develop competency profiles

and job rating.

Designate appropriate personnel

according to job profiles.



Huánuco RHD


CAP, MOF, and PAP are

used as references in

designing job profiles.

Staff commitment to

achieving goals.

There are health care

competencies for staff who

work on growth and

development in children

under 5.

Very limited staff availability.

No MAPRO or standardized

processes.

Lack of initiative from

personnel and senior

management.

Little financial support.

Institutional goals are not

met.

Excessive workload.

Incomplete management

documents for proper

functioning of the institution.

Suboptimal care.

Hire more staff.

Technical workshops to include all

functional areas in order to develop

MAPRO.

Internships in skill development centers.

Pasco RHD


RHD and Daniel Alcides

Carrion Hospital have

identified three job skills:

prenatal care; growth and

development; and

demonstration sessions.

Job profiles and job rating

have not been designed or

developed.

Competencies have been

assessed only at health

facility pilot sites.

No skills have been identified

in all staff functions.

No HR competencies

identified for the design of

profiles and job rating.

Little interest in defining job

competencies.

Few professionals trained in

the methodology of

identification and

standardization of labor

skills.

Job profiles do not exist.

No job rating exists.

Develop the skills and competencies to

design job profiles.

Train UE HR managers in labor

competencies and job rating methodology.

Reactivate the Regional Competency

Standards Committee on Health.



Lambayeque RHD

Strengths Problem Description Restrictions Consequences Proposals for improvement

Support of senior management and staff.

Human resources willing to participate in change processes.

Most management documents as well as a methodological guide to develop job profiles in public institutions are available.

Reference documents on the design and definition of labor competencies are available from other institutions like MoH and professional associations.

No designated office or specialized staff to design job profiles.

No defined HHR labor competencies according to areas or services. Job rating has not been carried out.

Inadequate personnel selection and no specialized personnel.

Staff in jobs that do not correspond to their academic training, experience, or capabilities; therefore, job functions do not correspond with MOF, MAPRO, and CAP.

Available management documents are not used.

Weak organization. HR has not been trained or is not specialized to design job profiles, labor competencies, and job rating.

Insufficient budget for optimal HHR development management.

Little importance is assigned to personnel unit.

Inadequate staff distribution.

Misallocation of job functions.

Staff with limited competencies and low performance, which affects users.

Differences in salaries among workers.

Create a work organization unit within the personnel unit and designate appropriate personnel according to job profile.

Design and use a job profile manual.

Design a job rating chart.

Recruit specialized personnel.

Set up multidisciplinary teams to identify labor skills and train staff.



Piura RHD


Over 80% of units have management documents, including MOF, ROF, and CAP, which are used as references in job design.

Staff is able to perform their duties given a positive and efficient work atmosphere

Decision making is coordinated to achieve positive results.

Each job has a profile. Personnel know the functions to be performed within their job.

MAPRO has been updated. There are qualified personnel to develop it.

No designated unit or sufficient personnel to design job profiles or identify labor competencies.

Lack of funding for training.

Due to lack of staff, job profiles are not respected.

Institutional CAP and MOF are not aligned with current reality.

As a consequence of the lack of knowledge, there are areas within the hospital that have not developed their MAPRO or other administrative manuals.

Staff does not certify labor competencies to increase their labor productivity level.

Tools for developing competencies are not used.

Repetitive or routine tasks hinder good performance in the workplace.

No job rating policies nor is there a responsible unit for evaluating jobs.

No responsible unit for designing labor competencies; MoH established labor competencies are used, which do not meet expectation Lack of minimum criteria and tools for assessing and defining labor competencies (job profile, experience, training, etc.). According to the planning unit, the Piura Regional Government has not approved the institutional CAP and MOF; it is using outdated documents. Due to staff shortages, some staff who are currently in positions are not according with his job profile. Due to the lack of staff has not achieved that 100% is in the position according its job profile. Constant staff turnover in some positions interferes with the long-term institutional plan. Health personnel are not trained to prepare MAPRO or other administrative manuals. No training plan to improve staff performance and competitiveness levels. Lack of budget for training.

Staff recruitment and selection processes are not efficient. Personnel profiles do not match positions, which lead to job misallocation and weakened performance. There is no health career; path positions are not valued; and there is a lack of knowledge of job functions. Functions performed are not properly classified, and there is duplication of functions; consequently, there is no basis for setting salaries. Personnel are not satisfied with salaries. Staff turnover hinders performances. Objectives and/or goals included in the institutional operating plan are not achieved. There is no real or official information about the jobs budget, expected jobs, jobs filled, etc. This would help assess real personnel needs. Some units do not have procedure manuals, and they operate without standardized protocols. No personnel assessment exists.

Coordination of the management team with the regional government for increased budgetary allocation. Implement job design program with trained personnel according to diagnosis and HHR gap studies. The institution must guide their investment in human resource capacities development. Train staff and perform periodic evaluation to measure performance and strengthen work. Annual update of job profiles. Develop job profiles for managerial or administrative levels, and update MOF. Reiterate the need to approve the institutional CAP and MOF to the regional government. Train personnel in the development of MAPRO and other administrative manuals. Train and appoint a responsible unit for job rating policy.



8.3 Analysis of performance evaluation results in the employment management sub-system, in selected regions

Loreto RHD


There is a designated unit for recruitment, selection, incorporation, and induction processes.

There are standards and tools for these processes.

There is a responsible unit for attendance control, staff mobility, and management of staff files for permanent and contract staff.

Radiogram is used as an information tool to communicate the updating of staff files.

There in a responsible unit to manage the institutional disciplinary process.

Staff performs multiple functions. No dedicated personnel to manage employment management processes; staff mobility; and staff termination and retirement. The staff is not fully trained to recruit HHR according job profiles. The size of the region makes training development difficult. Undue and excessive payments to staff. No computer application exists to manage staff files. Staff is not able to submit their staff reference file, like experience, education, etc. Weak coordination between offices. No disciplinary process committee.

Limited financial resources to fund staff exclusively for each process. Not all UEs have or know the approved rules, laws, and regulations for staff recruitment. By prioritizing other activities, the staff does not carry out their specific functions according to their position but instead focuses on immediate office needs. Turnover of trained staff and staff relocation to different areas or units. Lack of tools to coordinate activities or personnel training. No timely information regarding attendance control, subsidies, retirements, and licenses. Absence of approved rules, laws, and regulations for administration of disciplinary proceedings. Lack of planning with regards to the disciplinary processes.

Lack of adequate staff to take responsibility for job profile requirements. Staff capabilities are unknown. Staff do not know their job functions or evade the responsibilities of the designated job. No timely personnel information is available, and there is a risk of losing staff file information. Non-compliance regarding disciplinary processes. Accounting, tax, and administrative problems in HHR management, which could lead to improper payments.

Train responsible network units on the different management processes. Given the size of the region, implement mechanisms to facilitate coordination with staff. Procure funding to hire/appoint and train personnel responsible for the management of recruitment, selection, incorporation, and induction processes. Update centralized registration forms. Procure funding to modernize job file management; develop a software to record personal and work HR data; and update information. Staff documents should be filed promptly. Implement strategies for personnel in remote zones to update their staff files. Plan disciplinary processes and disseminate them to committee for timely implementation and compliance. Implement and train a committee. Monitor compliance with provisions about staff termination and retirement. Monitor compliance of approved standards.



Huánuco RHD


There is qualified staff in critical areas. Staff is committed to achieving goals. There is a responsible unit for managing the recruitment, selection, incorporation, and induction of staff. There are responsible personnel for updating staff mobility, updating staff files, and managing staff termination and retirement.

The need for staff recruitment is not done based on a gap study. Lack of human resources. Qualified staff is scarce for higher level health facilities. No system to record, to maintain, and update staff information.

Necessary aspects are not considered for recruitment, selection, incorporation, and induction processes Lack of skilled and committed staff. No budget to contract staff. Lack of software for registering and updating staff information and staff retirement by occupational group and labor regime.

Work overload results in low quality care in health facilities. Institutional goals are not met. Delayed information dissemination. Job management processes are not optimal for all steps.

Strengthen recruitment and induction staff process and provide ongoing training to improve performance of higher level health facilities.

Develop a gap study to define HR recruitment needs.

Have a system to record and maintain updated staff information, performance evaluation reports, attendance control, and staff retirement.



Pasco RHD


Pasco RHD and Daniel Alcides Carrion Hospital have a human resources selection process committee for various budgets. Staff mobility is not a management policy; it occurs through institutional and personnel interest. There is a responsible unit for attendance control in all health facilities and micro-grids. Pasco RHD and Daniel Alcides Carrion Hospital have a disciplinary process committee established through a directorial resolution.

New contracted personnel do not receive induction. Vacant positions are not immediately filled; they are not attractive due to low salaries. Some newly hired professionals and technicians have been mobilized but not in accordance with established standards. Staff files are incomplete and outdated. Institutional sanctioning capacity is almost nonexistent. Personnel who are subject to the disciplinary process are still working. There is no staff termination process. There is no personnel welfare service.

There is no directive governing the recruitment, selection, and incorporation of HR. There is no induction policy for new contracted and appointed personnel. No accredited skills development centers. DL 1057 establishes conditions and restrictions for contract personnel. DL 276 and SERUMS establish personnel mobility terms. Few HR staff with staff file administration skills. Personnel with low attendance compliance. Limited availability of attendance control system. Lack of human resources, including social workers and organizational psychologists. Internal audit unit does not perform prior and concurrent monitoring for administrative and disciplinary proceedings.

Dissatisfaction with poor skills of newly recruited staff.

New staff has poor problem-solving skills.

Personal and professional development of HHR is not improved, which leads to low productivity and motivation of staff.

Attendance control and staff files are incomplete and unreliable.

Ethical standards and labor rules are not followed by staff.

Labor rights are not always recognized.

Staff and users (patients) are dissatisfied.

Establish health policy and develop labor skills and competencies of staff according to their functions.

Assess and accredit skills development centers.

Develop selection process directives.

Reformulate induction directive and extend its scope.

Develop and establish a policy to govern staff shifts as a way of promoting human development.

Improve attendance information systems.

Train responsible personnel in management of staff file regulations.

Reorganize the disciplinary process committee with appropriately selected members.

Develop and establish policy to regulate staff termination processes.

Hire social workers and/or psychologists for three UEs.



Lambayeque RHD


There are guidelines for selection processes. There is a permanent commission for HHR recruitment and selection. Increased RHD budget. Official documents for staff mobility processes exist. There is an office responsible for staff file administration, affidavits, and attendance control. There is a disciplinary process commission and internal regulations for disciplinary processes. There is a General Administrative Procedure Law (Law N° 27444) and General Act of Ethics Code. There is an office responsible for updating staff termination data. Updated regulations for staff termination exist. Staff termination data is updated.

Insufficient and unqualified personnel for managing recruitment, selection, hiring, staff files, attendance control, staff mobility, and staff termination. Staff files management and attendance control are not properly performed. Political interests related to staff termination.

Limited job offers, low remunerative levels, and better offers from the private sector. Insufficient induction for new personnel. Insufficiently trained personnel for managing staff files, disciplinary processes, staff attendance control, staff termination, and staff mobility. Insufficient logistical supplies like record books. No competent legal advisors. Lack of software for registering and updating staff termination by occupational group and labor regime.

The job position remained vacant. Limited supply of human resources for units. Low efficiency of units in managing staff files. Documents and staff data are lost. Lengthy processes. Delay in disciplinary proceedings. Staff with multiple functions and high turnover

Train UE personnel.

Procure funding for recruiting processes.

Increase incentives offered to personnel.

Disseminate recruitment processes through various communication channels.

Implement information systems to improve unit efficiency.

Maintain updated internal job regulations.

Implement an information system for updating staff termination by labor regime.

Qualified and competitive human resources needs for filling vacancies.



PIURA Sub-system: Employment Management


There is an office and staff

dedicated to HHR

recruitment, selection,

incorporation, and induction.

Staff is hired through a

recruitment process in

accordance with DL 276, and

selection steps are

performed according to

regulations.

UE directors are members of

the selection committees.

The selection process

committee is responsible for

the recruitment, selection,

incorporation, and induction

of staff. The internet is used

todisseminate the process to

the public.

Recruited personnel for

service and administrative

tasks have started work in

their positions.

Staff mobility occurs

according to EESS needs;

there is an office and staff

who are responsible for

maintaining updated

information on HHR mobility

within and outside the

institution.

There is sufficient staff to

Personnel who are assigned to

various employment management

processes lack proper training and

are overloaded with multiple

functions.

During the staff selection and hiring

process, some steps detailed in the

regulation are omitted due to lack of

time. RNSDD is not consulted during

selection and recruitment process;

also, unqualified candidates are not

filtered out early on.

There is no regulation on CAS

contracts, and unassigned CAP

positions are not used.

Recruitment and selection processes

are done only at the request of the

user unit and only if there is

allocated budget. Candidates’

knowledge is not taken into account.

The induction process for new staff is

not performed.

There is no designated personnel to

maintain information on staff

mobility.

Inadequate infrastructure: there is

no space for file storage.

The unit responsible for maintaining

files lacks software to register and

systematize personnel information.

Attendance unit does not report staff

attendance, tardiness, or absences.

The creation of a permanent office

to manage recruitment and

selection processes has not been

prioritized.

There is a lack of knowledge

concerning the selection process.

Steps in the selection and

recruitment process have

inappropriate deadlines. Call

spreading is not done properly.

There is no induction stage for

newly recruited staff; additionally,

there is no designated or trained

staff to perform the induction

process.

Few applicants meet the required

profile for the available positions.

Staff working in an institution for

at least three months are allowed

to work in budgeted CAP positions

if they have gone unfilled; these

positions may also be filled by

agreement between

administrative and assistance

unions.

Staff is evaluated based on

references and not on relevant

knowledge. Staff information is

not readily available due to lack of

storage space and files.

Staff mobility is not properly

managed because there is no

There are no proper staff

recruitment and selection

processes.

Selected staff is poorly

trained, and that not

possess the necessary skills

they are not able to fulfill

their duties because they

are not familiar with job

tasks.

Salaries are below the

expectations of applicants,

and there is no information

about it in selection

processes.

Staff registered in RNSDD is

hired against regulation.

Mobility requirements are

not met on a timely basis.

Personnel are relocated

without considering

technical job criteria.

Intellectual capital is lost

when staff move to other

organizations.. budget

assigned to the position

cannot be used towards

the replacement.

There is no attendance

register; established

schedules are not kept, and

man-hours are lost.

Improve infrastructure of the HR office.

Training and designation of a staff to manage

different processes according to regulations.

Increase budgetary allocation to cover the

shortfall in staff by increasing CAS contracts.

Define guidelines and procedures for

selection, hiring, and incorporation of

personnel. Add a knowledge section to

assessments.

Establish a permanent committee that will be

properly trained in recruitment processes for

either CAS positions or DL 276 .

Establish an induction policy for newly

recruited staff to optimize performance.

Train personnel to manage the RNSDD

website.

Improve coordination between staff who are

responsible for file management and

attendance.

Implement computer applications for: control

of staff attendance and permanence in CLAS;

registration of personnel relocations; and

planning, adaptation, and control of

personnel files.

Improve legal advice entities to avoid rule

violations.

Strengthen the disciplinary proceedings

committee by implementing schedules;

appointing staff to update information; and

training staff on MoH disciplinary proceedings

and the use of the RNSDD register.

Establish a regulation or internal rules to




manage files, affidavits, and

attendance registers.

Some UEs use an computer

to update files.

A digital system (SYNASYS)

exists to register staff

attendance. Some UEs have

fingerprinting devices to

monitor attendance.

There is a designated office

and personnel to manage

disciplinary processes.

Members of the permanent

committee are appointed by

a executive resolution.

Some staff members do not have an

updated file although it is an

institutional. Affidavits are not

updated according to the fiscal year.

Some physicians avoid the

attendance registration process.

Attendance registry needs support:

Designated attendance registry staff

are overloaded with various tasks..

The disciplinary proceedings

committee rarely meets. Members

of the committee lack training and

cannot offer full-time commitment.

There are no updated files on

administrative proceedings. RNSDD

(National Register of Dismissal and

Sanctions).

There is no internal policy for

employing management.

There is no internal regulation

regarding dismissal proceedings, and

there is no assigned office for this

task.

designated personnel to manage

it. No software exists to record

staff mobility. Workers do not

update their files or affidavits.

It is difficult to recorder staff

attendance. Control register and

attendance in far health facilities

is done manually

Some physicians do not sign

attendance based on orders from

institutional managers. This

situation creates discomfort, and

it is against MoH and SERVIR

regulations.

Administrative proceedings are

delayed as committee members

do not have enough time due to

their assigned tasks and lack

training.

The RNSDD register is not

updated. There is no office,

trained personnel, or system to

manage staff dismissal

proceedings.

The budget is insufficiently

allocated.

File information is not

updated and systematized.

manage employee dismissals the

disengagement cases to avoid relying only on

DL 276.

Designate staff to manage dismissals and

update information accordingly.



8.4 Analysis of performance evaluation results in the performance management sub-system, in selected regions

LORETO Sub-system: Performance Management


Within ROF and MOF, there

is a designated office to

implement performance

improvement evaluations in

some UEs.

There is staff to manage HHR

performance evaluations.

Senior management has

prioritized the planning and

implementation of

performance evaluations for

professional groups.

There are technical tools to

aid staff for supervising.

There are no job profiles.

In many cases, UEs do not have

offices or staff to manage:

planning and organization of

performance plans; monitoring

and supervision in the

workplace; and evaluation,

feedback, and design of

individual performance plans.

There are no job profiles.

The performance evaluation

function is not prioritized. The

process itself is not well

understood.

There is no office or trained

personnel to plan, organize,

monitor, evaluate, provide

feedback, or design individual

performance plans.

There is insufficient budget to

supervise each health facility.

Senior management shows little

interest in supporting training

activities.

Designation of an office for

planning, organization, monitoring,

evaluation, feedback, and design of

individual performance plans is not

prioritized.

There are no targets set within

evaluations nor are there technical

instruments to measure goals and

results.

Supervision processes are not

implemented.

Staff is generally not evaluated;

when they are, the evaluation is

subjective. Actual, objective

performance is not measured.

The lack of individual performance

plans and objectives leads to

unmotivated staff who are often

untrained and not able to

accomplish job functions and

targets.

The staff promotion policy does not

exist.

Establish an office with trained staff to manage

design, evaluation, and feedback of performance

plans.

Train responsible staff in this functions for Provide

legal consultation to UEs for elaboration of HHR

profiles and implementation.

Procure budget for increased staff supervision to

better enforce staff tasks and goals.

Incentivize staff by offering training opportunities to

improve commitment and encourage them to

achieve results.



HUÁNUCO Sub-system: Performance Management


Staff is committed to

achieving goals.

There is no office or staff

responsible for the following:

planning, organizing,

implementing, evaluating, and

monitoring the performance

evaluation process; and

supervising and managing

feedback of the assessed staff

to design individual

performance plans.

Personnel are unmotivated.

Falta de conocimiento para el

desarrollo de los procesos de

gestión del desempeño.

Lack of knowledge for

performance management

processes.

Goals are not accomplished.

The planning and performance

evaluation process as well as the

supervision, feedback, and design

of individual performance plans are

ineffective.

Develop a plan and design tools to aid in

planning, organization, implementation,

evaluation, supervision, feedback, and design

of plans to improve employee performance.



PASCO Sub-system: Performance Management


Mandatory goals are set

through performance

budgeting and budgeting by

signed agreement.

There are instruments to

measure the performance of

EESS level one.

DIRESA Pasco/HDAC has

developed performance

evaluations in pilot sites for

two functions: prenatal care,

and growth and

development.

There is no policy to encourage

HHR staff performance

improvements. There are no

institutionalized instruments to

aid in performance evaluation.

There are no tools to help

supervisors incorporate

performance evaluations into

their offices There are

institutional goals, but they are

not individualized for

employees.

There are no performance

evaluation standards for most

functions.

No feedback processes have

been developed nor have plans

been designed to improve

individual performance.

There are no validated models

for performance improvement

plans.

The design of job profiles at the

national level is slow.

Managers do not have the

capacity to plan and set skills

performance standards

(including performance

assessments).

Supervision plans should be

linked to performance

evaluations.

Monitoring and evaluation of

strategic budget outcomes

should be linked to goals and

service quality.

There are noset performance goals

and plans at any organizational

level.

Performance evaluations are not

performed.

There is no supervision at the

intermediate level, which includes

networks and micro-networks, or

first level (EESS).

There are no improvements in the

quantity or quality of health service

provision.

There is no feedback on

performance gaps or plans for

individual performance

improvement.

Develop and validate a proposal for plans to

improve performance.

Train HHR managers in all UEs to develop

performance plans.

Train professionals in the identification and

standardization of labor skills.

Establish supervision plans and develop

monitoring tools linked to performance.

Validate performance assessment instruments

for the prenatal and growth and development

areas. Set competencies standards for other

key functions.



LAMBAYEQUE Sub-system: Performance Management


There is support from senior

management There is

sufficient budget due to

support from the regional

government.

Instruments have been

officially approved to

monitor and evaluate staff

performance.

The necessary requirements

are in place to carry out


There is staff available to

monitor and evaluate

performance.

Recruited CAS personnel are

subject to periodic

evaluation.

There is an approved PDP.

HHR has a desire to excel.

There is no designated office or

qualified staff to plan

performance goals, supervision,

evaluation, feedback, and

design of performance

improvement plans.

There is no plan for


Performance goals have not

been defined.

Staff performance is not

monitored or supervised, and

there is no methodology for

this.


instruments are based on a

traditional approach and do not

evaluate the required

competencies for the position.

There is no trained or

specialized staff to manage HHR

processes, including planning

performance management,

supervision, evaluation,

feedback, and design of

individual performance plans.

There is low supply of potential

employees in the local labor

market.

There are no reports or

information available for

decision making.

There is no objective evaluation

of performance linked to

competencies.

There are no instruments to

evaluate competencies.

HHR management is inefficient and

functions poorly. As a result, goals

are not achieved.

There is no plan for staff


Staff refuses to be evaluated.

. After the evaluations, staff

performs functions as usual, and

there is no improvement or change

in attitude.

Poor health service provision.

Create an office responsible for the different

processes associated with assigning and

training staff.

Create a separate unit to set objectives and

goals for staff based on their functions and

activities.

Design and validate methodology and tools

for monitoring and supervision of staff for

heads of organizational units.

Design tools, including a competency profile,

to enable precise evaluation in order to

achieve institutional goals and improve

institutional performance.

Develop PDP to strength the competencies

required in different job positions.

Design methodology to provide efficient

feedback to improve individual performance.

Develop plan to monitor compliance with

individual performance improvements plans.



PIURA Sub-system: Performance Management


There are mechanisms to

record monitoring processes.

Employees are given

advanced notice of

evaluation.

The objective of the

evaluation process is for staff

to improve performance

according to a plan.

The supervisor’s role is to

improve work performance.

There is no policy for

performance evaluation plans.

Performance evaluations are

not scheduled or carried out.

There is no office or unit

responsible for planning,

organizing, implementing, and

recording performance

evaluation processes. There is

no feedback mechanism

between supervisors and staff

in designing individual

improvement plans. The

performance evaluation

process, methodology, design,

and tools are not well

understood.

There is no comprehensive plan

for monitoring and providing

feedback to staff, including

EESS. There is no defined

methodology nor are there

instruments for the heads of

units to utilize.

There is no office or unit

responsible for planning,

organizing, implementing, and

monitoring processes.

Supervision is almost inexistent.

Personnel fear being evaluated

as they associate it with

dismissal.

There is no plan nor are there

tools for measuring and

evaluating job performance.

There is no office or personnel

assigned to this task. Due to

this situation, processes to

manage feedback and design

individual performance

improvements plans do not

exist.

There is no defined

methodology to evaluate by

occupational group; there are

no defined goals for

occupational groups.

Unions are not providing

information to their members

on the benefits of evaluation.

There is a lack of staff

cooperation related to


Supervision is limited due to a

lack of methodology. There is

no designated office to manage

these processes.

Department heads have not

been adequately trained in

employee supervision.

There is limited budget

allocation for performance

management.

There are no performance targets,

and there is no estimated or

updated information related to

employee performances. This

situation hinders progress in

improving institutional

performance. Staff performance is

subjectively evaluated.

Correct assignment of staff to

positions is not monitored. Staff

training needs are unknown.

There are no plans for individual

performance improvement

Institutions provide only mínimum

performance improvement

opportunities for staff

Staff does not want to be

evaluated for fear of the results.

Administrative procedures are not

properly carried out and goals are

not achieved due to low

productivity. Institutions expect

employees to perform their work

but do little to enforce standards.

Monitoring activities do not

improve performance and do not

lead to good decision making.

There are no promotion or

compensation policies. There are

no staff incentives, which cause

dissatisfaction.

Implement a plan backed by budget for the

measurement and evaluation of job

performance.

Establish an office with trained personnel to

plan, measure, and evaluate staff job

performance; provide office with

methodology and tools to set individual

performance goals and to perform objective

evaluation and feedback for performance

improvements.

Elaborate a comprehensive supervision plan

backed by a budget.

Train unit heads for performance managing

and provide the necessary tools, including

report models and others, to support

monitoring.

Promote constant job performance evaluation

and staff training.



8.5 Analysis of performance evaluation results in the development and training management sub-system, in selected regions

LORETO Sub-system: Development and Training Management


There is an office responsible

to manage staff proceedings

for promotion and career

path.

There is an approved training

policy and a designated

office with qualified and

experienced personnel to

manage trainings.

Agreements to have short

trainings in other institutions

have been initiated Although

there was little support for

capacity building, the staff

expanded their knowledge.

The Health Graduate

Regional Committee

(COREPRES) was approved by

directorial resolution.

Some agreements have been

signed with training

institutions.

There is no approved job

promotion policy.

There is a lack of funds to

develop abilities, and not all

staff is qualified to do their

jobs.

COREPRES does not regularly

meet.

There is no designated unit to

manage agreements.

Staff is overloaded with

multiple tasks.

Promotion is based on years of

service.

Functions are not prioritized in

policy making. Training is not

prioritized as a key factor in

institutional development.

There is no meeting scheduled

to develop the reaching-service

regulation.

Staff are not motivated.

Staff claim that their files are not

updated, and thus, they are not

eligible for promotions or wage

increases.

Unqualified staff hinders

achievement of targets and success

of programs.

Coordination with training

institutions is ill-defined

Prioritize the establishment of a promotion

policy. Create regulations, laws, and directives

for staff promotion.

Take action to secure budget for a capacity

building policy; secure budget for elaboration

and execution of a staff development plan.

Incorporate outcomes of performance

evaluations to elaborate a staff development

plan.

Establish alliances with universities for better

operation of COREPRES.

Establish agreements with institutions and

universities.



HUÁNUCO Sub-system: Development and Training Management



achievement of goals.

Some criteria are taken into

account to identify staff

training needs.

Outcomes of knowledge and

performance evaluations are

not taken into account to

identify staff training needs.

There are no regulations for

management of development,

training, and teaching.

Lack of trained staff and criteria

to carry out knowledge and

performance evaluations to

determine training needs.

Promotion is delayed.

Capacity building is not tailored to

institutional goals and realities.

Staff works for many years without

promotion.

Take into account necessary inputs to develop

and implement capacity building.

Assign qualified personnel to manage

different aspects of capacity building.

PASCO Sub-system: Development and Training Management


DIRESA/HDAC has a PDP,

although its contents need

improvement, and it is

insufficiently funded.

There is good coordination

with teaching institutions.

A framework agreement has

been signed between the

university, the regional

government, and MoH.

Clear career paths have not

been established nor are they

regulated; there are no

established mechanisms for

promotion based on merit.

On capacity building: training is

not aligned with institutional

needs; there is no reliable

database to manage and track

training; and there are no

medium- or long-term plans for

capacity building.

Clinical fields are insufficient

due to the lack of specialized

hospitals interns (obstetricians,

nurses, nutritionists,

psychologists, etc.) are not

being paid.

A very strict regulation in HHR

promotes stability.

The training office is allowed a

limited leadership role in

planning academic events.

No budget has been allocated

to fund PDP.

Universities are not

communicating well with

service providers.

.

Promotions do not regularly occur

. Professionals and administrative

technicians are given little

opportunity for capacity building.

Low productivity related to health

services.

Deregulation of internship

practices.

The teaching-service process does

not meet basic regulations.

Develop a proposal to improve HHR

development administration and incorporate

a promotion process. Establish competitive

career paths based on merit.

Reformulate the PDP to incorporate the three

UEs according to SERVIR methodology.

Formulate a training policy to emphasize

internships..

Reformulate agreements to involve training

institutions; encourage regional and local

authorities to establish a training policy.



LAMBAYEQUE Sub-system: Development and Training Management


Staff is committed.

A promotion regulation has

been implemented.

There is increased budget for

training (supplied by the

regional government).


and qualified and

experienced staff to manage

training.

There is a regulation

governing budget allocation

for training.

Agreements have been set

up with educational

institutions.

There is a growing demand

for hospitals that offers

educational opportunities.


for managing the teaching-

service process. This office

has evaluation criteria.

There is no internal promotion

policy.

Training policies have not been

designed, and there are no

methodological guidelines for

capacity building.

There are no internships.

There is no evaluation on the

impact of training.

Staff training needs have not

been identified.

Universities do not respect

agreements

Time periods for tutors and

students are not specified.

There are no criteria to to

assess the office responsible for

the teaching-service process

Trained and specialized staff to

manage training is not available

for every UE.

There are a limited number of

job positions.

There is no IT system to

manage staff training.

Lack of procedures to ensure

fulfillment agreements with

universities.

Staff has unfulfilled expectations.

Job vacancies take a long time to

fill.

HHR is not trained in the whole

GERESA. There is no equity

regarding staff access to training

opportunities and capacity

building.

Personnel are not efficient.

Patients are observed by a large

number of student, which causes

discomfort.

Create new job positions.

Assign and train personnel to manage

promotion.

Promotions must occur on a regular basis.

Implement a training program that is

accessible to staff on an equitable basis.

Increase budget for training.

Set up agreements with prestigious

educational Institutions.

Identify training opportunities.

Periodic monitoring and evaluation of

agreements to ensure fulfillment.

Elaborate and approve criteria to assess the

office that manages the teaching-service

process.



PIURA Sub-system: Development and Training Management


Some UEs have an office to manage

human development (promotion)

and training.

There is a welfare and training

section within the personnel unit

that is responsible for managing

training.

The administration has granted

career promotions based on years

of service and evaluation of

personnel files.

Several criteria are used in

recruiting personnel: candidates

must not have incurred disciplinary

sanctions; they must have public

sector experience and experience

with the functions to be

performed; and they must have

professional experience and

training.

Training needs are identified

according to office objectives.

Some training programs have taken

place: short courses, lectures, and

workshops according to specific

section and employee demands.

Some UEs have an office to support

teaching and research.

There is an agreement to set up

practices with technological

institutes.

There is no capacity building policy nor is there assigned

personnel, a training unit, or methodological guidelines

associated with capacity building.

The HHR unit is not carrying out its role and functions in

managing staff training.

Few training opportunities. There are no internships or

certification programs.

Training is not programmed or carried out according to

adequate criteria, i.e. regional health needs, training

offered by MoH, or other regional institution training.

Assessments results from training measuring knowledge

or performance are not collected.

There is no staff promotion policy, and there are no

assigned personnel or permanent committee to manage

these processes.

Certain criteria, including performance evaluations, merit-

based competitions, interviews, knowledge tests, and

group dynamics, are not taken into account when

promoting staff.

Files are not updated.

The job profile, performance evaluations, and training

plan guidelines are not used when selecting and

recruiting staff.

DIRESA and UEs are not educational institutions, and

therefore, there is no staff responsible for teaching. There

are training agreements with educational institutions, but

students are being trained only in administrative

activities.

There is no information system database to track

students trained in the institution.

There is no promotion

policy nor is there assigned

personnel or allocated

budget.

Promotion is not a

function of the UE but is

directed from MoH.

No capacity building

policies have been

designed.

The office responsible for

capacity building cannot

accomplish its tasks due to

lack of budget and HHR

personnel.

There is a lack of training

for the heads of UEs.

There are no signed

framework agreements

with training institutions.

There are no accredited

health professionals

assigned to lead training

activities.

There is little allocated

budget for development

and training management,

There are no inter-

institutional agreements

or strategic alliances with

other institutions such as

NGOs.

Personnel assigned to

positions that do not

correspond to their

professional profile do

not fulfill all job duties.

There is little staff

capacity building, which

has caused

dissatisfaction.

Staff claim that job files

are not updated.

Financial resources

related to capacity

building come from MoH

and other centralized

sources.

There are no framework

agreements with other

institutions to train staff.

There is no updated

information about the

student population

trained at the hospitals.

Implement a promotion

policy based on staff capacity

and performance as well as

professional profiles.

Develop a promotion plan

that is tied to budget

allocation.

Develop a plan to encourage

performance improvements;

plan should be tied to budget

allocation and include a plan

for promotion.

Keep updated personnel

files.

Develop a training policy

based on staff and

institutional needs.

Implement training plans to

align with these needs.

Consider, as a priority at the

MoH, the capacity building of

public sector staff in the

provinces.

Sign framework agreements

with training institutions.



8.6 Analysis of performance evaluation results in the compensation management sub-system, in selected regions

LORETO Sub-system: Compensation Management


There is a regulation on

remuneration scales that

covers benefits, bonuses,

and incentives. There is

designated office responsible

for this task.

There is trained staff who are

responsible for managing the

salary scale system. Despite

an unfavorable geographical

location and lack of

upgraded tools, staff

receives all appropriate

compensation and benefits

(DATEM).

There is no full-time staff to

manage remuneration

processes.

There is no quick way to update

the system.

RM190 does not take into

account the EESS Putumayo

basin, which borders Colombia,

or Lagunas and Shucushyacu

districts.

Incentives are not granted

according to performance

evaluation results. Incentives

are constantly changing.

No objective performance

assessment is performed.

Not all UEs are in ZAF.

It has been noted that there is

no equity in the management

of payroll and salaries using the

job rating for remote and

undeveloped areas Not all UEs

support pensioners.

Lack of information hinders

decision making related to

incentives.

Personnel are dissatisfied and

unmotivated.

Request timely information from MoH.

Update the salary structure.

Negotiate with MoH to incorporate ZAF bonus

payments to Putumayo basin establishments

and the Shucshyacu and Lagunas districts.

Increase staff and train them to form teams

specialized in administration of benefits,

bonuses, and compensation.

Implement performance evaluations and take

them into account when granting incentives.

Comply with regulations.

HUÁNUCO Sub-system: Compensation Management



achieving goals for

Management of salaries and

payroll in the institution.

Staff are not promptly

compensated.

There is no assigned staff to

manage non-monetary and/or

monetary incentives, including

benefits and bonuses.

Policies are not consistent with

reality. There are no approved

rules or policies for the

implementation of incentives.

Limited staff and space to

establish office to manage

compensation activities.

There is no staff or office to

manage incentives.

Personnel are unmotivated.

Untrained personnel are

implementing activities related to

compensation management.

Inquire about rules allowing development and

implementation of compensation and

incentive policies.

Ensure appropriate physical space for the

development of activities for compensation

management.



PASCO Sub-system: Compensation Management


Salary scales are approved at

the national level.

Staff is trained in payroll

management.

Allocation of benefits and

bonuses is done in

compliance with regulations.

Availability of resources and

expertise for the

implementation of monetary

and non-monetary

incentives.

Adequate and available

budget for administration of

pensions.

CAS worker scale is not

standardized.

Trained staff for payroll

management is underused.

Non-compliance with the

payment schedule set out in

legal regulations due to

untimely information from

networks and micro-networks.

Payment of benefits and

bonuses is not done in a timely

manner.

There is no budget to satisfy

requirements of DU 037-94,

Law 25303, and other legal

provisions.

There is plan for incentives.

There are no incentive

directives for workers.

Limited budget available to

standardize pay scales.

Payment scales for HHR and

SERUMS are the responsibility

of MoH.

There is limited personnel who

are trained to manage the

payroll system and process.

Information is not provided on

a timely basis by networks. The

payment of benefits and

bonuses is delayed.

MEF sets the conditions and

schedule for transferring

benefits and bonuses despite

limited budget for this.

Incentives are not well

managed.

Pay scales do not correspond to

regional realities.

The pay scale for CAS recruits

differs from staff and SERUMS pay

scales.

Staff payments are delayed.

Payment of benefits and bonuses is

delayed.

Workers are dissatisfied and

therefore exhibit low productivity.

Set up technical meeting with staff to outline

responsibilities and improve key processes for

compensation management.

Suggest and set pay scale for CAS contracts

based on DL 1153.

Provide payroll unit with trained and

experienced personnel.

Formulate and implement an incentive

directive; develop and implement the

incentive plan.

Establish a training rotation plan and

permanent training policy.

Establish social welfare programs for

pensioners.



LAMBAYEQUE Sub-system: Compensation Management


There is a different pay scale

for High Andean Zone CAS

staff.

There is a bonus for

employees working in

remote and dispersed zones.


for managing payroll and

wages; bonuses and benefits

administration; and incentive

management.

There are trained HHR that

are able to develop a site-

specific payroll. The pay

sheet is updated monthly.

Compliance with existing

directives for the

management of bonuses and

staff pensions.

Monetary incentives are

granted, and all workers

have the opportunity to

receive them.

There is assigned staff and an

information system for the

administration of staff

pensions.

Vacancies remain vacant due to

low wages; personnel are

unmotivated.

There is a lack of training for

human resources.

There is no office responsible

for designing salary scales.

MoH does not have an updated

payroll system. PLH is an old

DOS system. Lambayeque has a

separate system, which is slow

when the system is updated

with changes (SIGA). The

implementation of new

standards is not immediate.

CAS professionals have low

salaries.

Staff is not aware of the latest

regulation regarding benefits

and bonuses.

CAS personnel are not eligible

to receive incentives.

No non-monetary incentives

are granted.

Under Law 20530, a pension is

not granted when personnel

are dismissed upon cessation of

personnel.

Payment to AFPs is delayed.

Limited budget for

implementing a salary scale

system.

No official permission exists to

allow development of

differentiated pay scales.

There is a lack of trained or

qualified personnel and a lack

of funds for training.

There is a high possibility that

payments cannot be made in

accordance with the

regulations.

Lack of budget to fund

incentives.

There is no legislation related to

incentives for the CAS system.

There is no policy for non-


Lack of budget to pay out

pensions at the end of the year.

AFPs do not report employee

transfers between AFPs in a

timely manner.

Staff lacks information about

pension systems.

There is no differentiated salary

scale, only the national wage scale.

Low staff productivity is reflected

in health indicators.

Pay and pension formats are not

updated according to the new

directive. Delayed information

from MoH generates payment

delays.

Poor understanding of certain

processes in the administration of

staff benefits and bonuses.

Staff perceive that the work

environment is unsatisfactory,

especially CAS staff and other

employees who perform their jobs

adequately but do not receive

incentives.

Pensioners are unsatisfied because

they are not receiving their full

pensions. AFP levies fines or

penalties on the institution.

Train responsible staff to carry out processes

related to management of compensation.

All staff and CAS personnel must have fair

remuneration arrangements. Design a pay

scale structure and prioritize CAS staff.

Secure budget to improve infrastructure.

Manage implementation of PLH and assign

trained personnel.

Grant incentives taking into account the

available budget, and base incentives on staff

productivity.

Design policies and strategies to utilize non-

monetary incentives to recognize and

motivate workers.

Ensure full pensions at the time of

termination.



PIURA Sub-system: Compensation Management


The salary scale is based on

national legislation. Pay

scales for all types of staff

have been developed and

approved. Pay scales are

used in new contracts

according to budget

availability and functions of

the position.


for managing wages and

payroll. According to the

current ROF, there is a

designated unit responsible

for administering wages and

payroll.

There is also a computer

spreadsheet application that

updates pay lists according

to regulations.

There is designated staff in

the Planning Office to

monitor pay scales.

There is a current directive

and an office with assigned

staff to manage benefits,

bonuses, and incentives.

There is designated staff

which is responsible for


Budgetary allocations to

cover benefit and bonus

There is no office or

methodology to design and

monitor pay scales; there are

no standards for compliance

and maintenance.

While there is an approved pay

scale, it is not used.. There is no

one salary scale for all staff.

Salary increases are not allowed

for public servants according to

MoH.

There are applications within

the DOS platform to manage

obsolete forms based on an

MoH design.

Staff has not been trained in

payroll management; they only

execute instructions given by

MoH.

MoH does not provide timely

replies to emails concerning

remuneration issues (bonuses)

Benefits and bonuses are

determined at the central level

regardless of performance.

There is no designated unit to

manage benefits and bonuses;

staff is trained on its own

initiative or through work

alone.

There is no equity in the

administration of benefits and

The Annual Budget Act restricts

salary increases even though

there is available budget.

There is a lack of methodology

for designing salary scales.

Proposals to improve salary

scale from the sub-regional

level are not welcomed; only

ftp-MoH computer manuals are

used.

UEs receive requests from

employees requesting salary

increases.

The pay slip is not available via

internet.

Differences in employee job

performances are indiscernible;

there is no designated staff

responsible for performance

evaluations.

Incentives are not applied in

relation to the level of

performance.

There is no trained and

responsible staff to manage

benefits and bonuses; there is

no software to quickly calculate

benefits and bonuses.

There is a budget deficit and

staff is unavailable to work on

procuring it.

There are no requirements for

The policy for designing salary

scales is inadequate. Employees

are dissatisfied with wage

differences.

Strikes occur.

There have been no increases in

salaries.

When there are changes in the

salary structure, the payroll

operation application slows down.

Personnel must go to the

administrative office to receive pay

slips.

There is a lack of responsible

personnel, and the training policy is

inadequate.

Performance improvement is not

encouraged; personnel are

unmotivated.

Calculation of benefits and bonuses

is done manually.

The granting of monetary

incentives is not based on job

performance.

Pensions are not well managed,

and there has been no

management decision to address

this.

Design of a salary scale according to job

profiles, functions, and hierarchy of each

worker; increase must be proportional to the

rising cost of living.

Standardize wages based on work experience

and studies.

Redesign UE application for payroll and salary

management to address technological

limitations.

Designate and train staff to design pay scales;

develop salary payroll management; and

manage administration of benefits and

bonuses.

Design a proposal for a law to define and

implement benefits, bonuses, and incentives

related to performance.

Designate an office to manage not only

monetary incentives..

Acquire software to improve the management

of benefits and bonuses.

Designate personnel responsible for non-

monetary incentives. Recalibrate work

incentives using the central level as a

reference point.

Recruit qualified professionals to manage

administration of pensions.




payments are managed in a

timely manner.

Non-monetary incentives are

granted to the "worker of

the month."

MoH provides advice about

remuneration; application of

monthly remuneration

manuals and consolidation of

pension information.

bonuses. Payment of monetary

job incentives is a fraction of

what is paid at the central level.

Only benefits regulated by law,

including AETAS and other legal

benefits, are paid.

Staff which has not been paid is

disgruntled and have filed

claims. There is no designated

unit responsible for non-


Incentives are not provided

based on performance

evaluation results. Not all UEs

grant incentives.

There is no designated unit or

assigned staff to manage

administration of pensions.

managing staff pensions.

There is a lack of funding to

train or hire qualified

personnel.



8.7 Analysis of performance evaluation results in the managing human and social relations sub-system, in selected regions

LORETO Sub-system: Managing human and social relations


There are designated offices

with trained personnel

responsible for the different

processes, including

managing the organizational

climate; labor relations; and

welfare and safety at work.

Duplication of functions

between the Department of

Quality and the Department of

Social Welfare.

Lack of an integrated office to

manage human and social

relations..

There are no instruments to aid

in implementing the process.

Lack of coordination with other

offices regarding safety and

health at work.

Dissatisfaction of the union and

the institution related to

agreements.

Functions are not defined in

MOF and ROF management

tools.

No decisions have been made

regarding safety and health at

work.

Unmet expectations and

disagreements on decisions

related to labor relations and

health and safety at work.

Dissatisfaction of personnel and

patients.

Unmotivated personnel;

interpersonal and labor disputes.

Disagreement over decisions.

Possible increased risks related to

occupational accidents and

occupational diseases.

Restructure ROF and MOF management

documents.

Designate an office responsible for managing

the organizational climate and labor dispute

resolution.

Implement security and health-at-work

processes.



HUÁNUCO Sub-system: Managing human and social relations


There is a quality office and a

welfare unit.


achieving goals.

The participation of

employees in unions is not

restricted.

There are no documents to

guide management of the

organizational climate; labor

relations; and welfare and

safety at work.

The organizational climate is

inadequate; personnel are

unmotivated and insecure at

work.

There is no defined

methodology to measure

organizational climate; only

remunerative issue

management has

accompanying methodology

Requirements for the

development of welfare and

safety at work are not

considered.

Lack of training budget.

Lack of specific functions for

managing human and social

relations sub-systems.

Lack of methodology to

measure organizational climate.

Changes that could enhance

employee efficiency and

performance are not discussed

No welfare activities are

planned.

Processes related to the

management of the organizational

climate are not developed.

Partial development of welfare and

safety-at-work processes.

Personnel show no interest in their

work.

Inadequate or poor interpersonal

relationships between staff.

Staff interferes in work outside

their positions.

There have been no negotiations

with unions.

Implement and prioritize management

documents.

Apply tools to evaluate and manage the


Provide training on managing the


Promote labor relations, and develop social

welfare programs.

Establish a unit to manage labor relations.



PASCO Sub-system: Managing human and social relations


National instruments are

used to measure the


DIRESA reports few labor

disputes.

There is a social welfare

resolution.

There has been no

measurement of the

organizational climate, and the

related methodology has not

been disseminated.

The organizational climate in

the three execution units is not

adequate.

There are no joint committees

for conflict prevention.

Staff is unaware of their rights

and duties.

Few social welfare activities are

developed.

Workers are not financially or

physically protected against

accidents at work.

Some UEs do not make

contributions towards the

Insurance Risk Work (SCRT) for

CAS staff.

There is little interest in

developing organizational

climate processes at all levels.

There is no stable and exclusive

staff to manage labor relations.

. There are numerous

regulations that govern labor

relations

The union has no legal status.

There is no assigned social

worker for a welfare unit.

Standards and safety-at-work

instruments have not been

developed.

The organizational climate is

inadequate at all levels. There are

no plans to improve the


Certain labor rights are not

enforced .

Workers are exposed to hazardous

situations.

Development of chronic

degenerative diseases.

Little motivation and commitment

to work.

Implement regular measurement of the


Provide training in the implementation and

systematization of instruments to measure

the organizational climate.

Managers must develop the capacity to

manage labor relations and conflict

prevention.

Develop promotional activities for workers

centered on prevention of accidents at work.

Develop safety standards in the workplace.

Require contribution to SCRT.

Hire a social worker.



LAMBAYEQUE Sub-system: Managing human and social relations


Senior management and

staff are supportive.

There is a budget and

support from the regional

government.

There is a designated unit to

manage the organizational

climate and develop

activities to strengthen this

area. Motivational

workshops are developed

periodically.

Good relations between

unions and institutional

authorities. Authorities are

willing to listen to union

demands.


and staff responsible for the

management of health and

safety processes.

Approved standards or

policies are followed.

There is a social service unit.

There are social welfare

programs.

There is no office responsible

for climate management and

labor relations.

There is no methodology to

measure and analyze the work

environment; the

organizational climate has not

been measured.

Some staff are resistant to

changes.

Occasionally, labor unions are

opposed to administrative

actions that contained within

laws.

Medical staff disagrees with the

current administration.

A program for occupational

health and safety at work has

not been implemented. Staff is

not protected against work

accidents.

No planning of social welfare

programs.

Research on organizational

climate is not done.

Limited staff that is not trained

to implement and monitor the

organizational climate

improvement plan.

MEF does not favor granting 22

productivities (Law 29912) to

administrative staff.

There is no budget to

implement regulations and/or

formulate welfare and safety-

at-work plans.

A health and safety at work

study has not been carried out.

Lack of knowledge related to


The organizational climate has not

been measured, and therefore,

there is no starting point for

improvement.

Personnel are dissatisfied with the

organizational climate; as a result,

they are unmotivated and not

committed.

Quality of patient care has not

improved.

Labor relations are not good.

Workers are unprotected against

potentially risky situations.

Inadequate planning of social

welfare programs and limited

activities.

Create an office responsible for training

personnel in management of the


Implement and strengthen mechanisms for

measuring the organizational climate.

Encourage activities to promote better staff

relations.

Encourage dialogue to prevent conflict and

foster agreements between staff.

Encourage channels of communication

between the various unions, guilds, and

institutional authorities improve coordination.

Designate an office to be responsible for

welfare and safety at work.

Allocate budget for the management of the

organizational climate and staff welfare.



PIURA Sub-system: Managing human and social relations


There are unions, guilds, and

associations that represent workers;

these have good relationships with

authorities.

According to the current ROF, Quality

unit is responsible for measuring and

analyzing labor relations; social

welfare; and health and safety at work.

There is willingness for organization

and a climate of solidarity among

workers.

There are personnel responsible for

managing health and safety processes

at work. Workers are familiar with

welfare and safety-at-work standards.

There are measures to protect the

health of workers; prevent accidents;

and promote the care of equipment

and materials.

Activities and mechanisms have been

organized to improve welfare at work:

a workshop on improvement of labor

relations; welfare office staff is in

charge of planning activities such as

celebrating birthdays, anniversaries,

and championships; and provision of

financial support for training.

There is an office for quality

management, but there is no

designated unit responsible for

managing organizational climate

or labor relations.

There is no methodology to

measure the organizational

climate, and no measurement has

been planned.

Inadequate communication

between management and

subordinate staff.

Lack of planning programs to

improve the management,

training of human resources.

Basic rules of safety and health in

the workplace need to be updated

implemented. Conditions do not

currently exist for the

implementation of regulations.

There is no team to manage staff

welfare; the social assistance unit

does not take charge of these

functions. Personnel are not

trained to manage welfare

processes.

There are no welfare programs,

including child care, elderly clubs,

and travel.

There is no office

responsible for


There is a lack of logistical

resources and a lack of

personnel with suitable

profiles; it is not included in

the current ROF.

There is no willingness on

the part of the staff to

complete the organizational

climate survey.

Staff is not encouraged to

create business synergies.

Interpersonal relationships

are partially damaged.

There is no annual training

plan.

Improving welfare

conditions and job security is

not included in budget

programming.

There is a lack of interest in

social assistance for the

welfare of workers. There is

no assigned unit to manage

social welfare activities.

There is no interdisciplinary

work team for managing

human and social relations.

There is perceived

discrimination among

workers. Polarization and

confrontation with the

management generates

strikes.

No plans have been

made to improve the

working environment;

the organizational

climate has not been

measured which could

improve the quality of life

in the workplace.

; Personnel are not

valued for their

professional experiences.

The work environment is

ambiguous and tense,

and there is poor

communication. Staff is

discontented, and this

affects the quality of

service.

Lack of knowledge

related to the rules and

procedures for worker

health and safety has

consequences: accidents,

infections, and diseases

among workers are more

likely to occur.

Develop a plan to measure the organizational

climate; survey staff to improve HHR policies

and management.

Implement management strategies to foster

an organizational climate that takes into

account needs, motivations, and interests of

workers in performing their duties.

Develop a strategic plan that includes design,

implementation, and evaluation of programs

and activities aimed at continuous

improvement of labor relations within UEs,

both individually and collectively.

Strengthen ties between labor groups with

common objectives and interests, including

cultural, sport, and academic interests.

Designate an official in the current ROF to

manage the organizational climate.

The development of standards and

procedures must ensure safety and health at

work in order to preserve the physical and

mental integrity of workers.

Elaborate an annual work plan and schedule

health and safety-at-work activities.

Create an interdisciplinary team to formulate

and plan social welfare activities to benefit

staff Designate a unit and staff responsible for

welfare activities.



8.8 HRMS evaluation results by Region and sub-systems.

HRMSPeru

(108/162)

Loreto

(6/6)

Callao

(2/4)

Junin

(5/9)

Cusco

(5/8)

Lima

(9/9)

Apurimac

(6/10)

Caja-

marca

((6/6)

Lamba-

yeque

(4/4)

Pasco

(3/3)

Huanuco

(7/7)

Ucayali

(2/5)

Moque-

gua

(3/3)

Ica

(7/8)

Huanca-

velica

((8/8)

San

Martín

(5/5)

Ancash

(9/9)

Madre de

Dios

(2/2)

Ayacucho

(6/9)

Amazonas

(4/5)

Tumbes

(2/3)

Piura

(7/7)

HUMAN RESOURCES MANAGEMENT

SYSTEM35% 47% 45% 44% 43% 41% 41% 40% 39% 35% 33% 32% 32% 31% 31% 30% 30% 29% 27% 26% 25% 21%

HHR policy and strategic planning 31% 34% 35% 41% 50% 29% 35% 43% 29% 42% 35% 29% 25% 34% 33% 30% 25% 21% 28% 30% 31% 19%

Policies and strategies for HHR management

and development17% 13% 41% 21% 20% 42% 35% 29% 0% 58% 23% 5% 0% 7% 14% 3% 2% 4% 17% 2% 7% 4%

Development of operational research 8% 9% 9% 0% 9% 20% 20% 18% 5% 9% 10% 0% 0% 4% 26% 5% 6% 0% 20% 0% 0% 0%

HHR information management 40% 46% 42% 61% 68% 38% 43% 46% 43% 54% 49% 33% 37% 54% 35% 50% 41% 35% 22% 56% 53% 32%

HHR management control 18% 25% 24% 41% 61% 12% 19% 21% 0% 7% 22% 11% 8% 13% 21% 8% 12% 0% 19% 25% 17% 4%

HHR strategic planning 35% 30% 24% 30% 42% 15% 39% 63% 50% 46% 34% 54% 44% 42% 52% 39% 20% 21% 44% 11% 33% 20%

HHR financing 41% 71% 58% 40% 42% 42% 31% 73% 54% 54% 38% 62% 21% 36% 53% 26% 43% 54% 67% 29% 15% 30%

Work organization 29% 38% 29% 29% 36% 36% 33% 34% 27% 19% 36% 25% 20% 19% 36% 30% 17% 22% 26% 19% 28% 15%

Design of job profiles 42% 58% 38% 42% 43% 52% 45% 44% 50% 31% 43% 42% 37% 29% 52% 35% 27% 41% 39% 26% 43% 28%

Identification of labor competencies 14% 15% 17% 9% 34% 18% 27% 15% 0% 9% 27% 9% 0% 8% 21% 21% 7% 0% 13% 17% 13% 1%

Job rating 12% 13% 20% 19% 19% 17% 8% 31% 0% 0% 29% 0% 0% 5% 16% 30% 2% 3% 7% 4% 8% 1%

Employment management 45% 54% 54% 50% 31% 51% 41% 53% 62% 41% 45% 32% 49% 42% 44% 31% 46% 45% 41% 31% 33% 35%

Recruitment, selection, incorporation and

induction48% 57% 56% 54% 33% 54% 52% 57% 65% 42% 55% 36% 53% 46% 57% 39% 44% 48% 52% 38% 38% 37%

Staff mobility 45% 60% 21% 54% 34% 46% 38% 55% 32% 43% 39% 21% 62% 37% 66% 17% 60% 57% 48% 29% 14% 33%


control44% 55% 70% 49% 37% 61% 26% 54% 65% 55% 40% 32% 51% 44% 29% 31% 59% 46% 25% 31% 50% 34%

Administration of disciplinary process 35% 37% 34% 44% 12% 29% 23% 54% 63% 39% 22% 41% 32% 33% 16% 16% 34% 32% 22% 20% 20% 36%

Staff termination and retirement 32% 45% 63% 40% 29% 37% 23% 24% 63% 4% 33% 5% 33% 29% 13% 12% 40% 34% 23% 8% 5% 24%

Performance management 20% 24% 36% 44% 35% 32% 16% 29% 26% 17% 19% 11% 22% 14% 15% 13% 13% 11% 20% 11% 1% 5%

Performance planning 26% 35% 50% 47% 40% 50% 19% 32% 38% 19% 15% 13% 28% 18% 27% 10% 12% 25% 36% 15% 0% 5%

Supervision 16% 23% 0% 29% 30% 19% 13% 23% 0% 3% 21% 0% 20% 14% 17% 12% 10% 0% 23% 11% 0% 11%

Performance evaluation 21% 23% 51% 57% 36% 33% 14% 33% 32% 22% 22% 16% 25% 14% 11% 16% 16% 10% 15% 9% 0% 3%


performance improvement12% 13% 16% 22% 34% 15% 21% 21% 24% 19% 14% 4% 5% 10% 3% 13% 13% 0% 0% 13% 4% 2%

Development and training management 43% 67% 61% 60% 57% 49% 61% 46% 46% 45% 38% 42% 30% 43% 29% 31% 34% 42% 19% 28% 30% 27%

Labor advancement (promotion and career

path)42% 52% 48% 70% 60% 45% 62% 43% 34% 48% 41% 42% 30% 57% 30% 36% 34% 36% 19% 27% 21% 18%

Capacity building 48% 81% 68% 57% 61% 59% 69% 54% 48% 48% 42% 40% 32% 38% 36% 32% 36% 49% 26% 31% 43% 34%

Regulation of the teaching & service process 33% 55% 65% 50% 38% 30% 41% 27% 65% 30% 24% 47% 25% 31% 7% 20% 26% 35% 1% 19% 12% 27%

Compensation management 37% 60% 46% 41% 40% 38% 45% 40% 38% 50% 26% 49% 38% 33% 31% 39% 41% 26% 34% 37% 13% 27%

Design of salary scales 24% 51% 10% 24% 24% 13% 43% 29% 0% 38% 18% 27% 29% 9% 34% 38% 14% 0% 31% 12% 2% 19%

Management of payroll and salaries 60% 95% 100% 76% 74% 78% 67% 75% 100% 100% 61% 94% 59% 90% 54% 64% 85% 85% 67% 94% 53% 64%

Administration of benefits and bonuses 71% 88% 90% 72% 89% 64% 68% 70% 100% 69% 53% 90% 62% 86% 59% 65% 93% 83% 77% 72% 13% 61%

Incentive management 30% 58% 50% 36% 33% 34% 34% 29% 45% 36% 16% 39% 27% 25% 14% 25% 34% 19% 18% 31% 20% 20%

Pension management 62% 50% 90% 68% 64% 91% 60% 67% 65% 87% 40% 100% 80% 71% 40% 56% 98% 60% 37% 80% 0% 26%

Managing human and social relations 38% 51% 56% 41% 49% 55% 55% 39% 45% 29% 32% 38% 39% 31% 26% 33% 33% 37% 20% 27% 42% 22%

Management of the organizational climate and

culture30% 37% 61% 12% 32% 45% 49% 25% 22% 11% 27% 26% 61% 10% 16% 19% 32% 53% 10% 12% 3% 5%

Management of labor relations 42% 52% 35% 45% 41% 59% 45% 55% 70% 42% 29% 53% 41% 33% 41% 19% 39% 38% 29% 24% 48% 34%

Workplace health, safety and welfare 39% 57% 69% 51% 61% 56% 65% 33% 36% 27% 35% 32% 28% 38% 21% 48% 30% 29% 17% 34% 53% 20%




8.9 Ministerial Resolutions and Legislative Decree

Report on and assessment of human resources...

Documents

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