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Strengthening Human Resources for Health 2012- 2019

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Strengthening Human Resources for Health 2012- 2019 Strengthening Human Resources for Health 2012- 2019 Project Accomplishments 1 This document is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the Cooperative Agreement AID-663-A-12-0008 “Strengthening Human Resources for Health (HRH) in Ethiopia.” The contents are the responsibility of Jhpiego and do not necessarily reflect the views of USAID or the United States Government. Photos credit: Beruk Weldeyesus for Jhpiego March 2019 2 CONTENTS CONTEXT 5 PROJECT RESULT FRAMEWORK AND A SNAPSHOT OF HIGH LEVEL ACCOMPLISHMENTS 8 MAJOR ACCOMPLISHMENTS BY INTERMEDIATE RESULT AREA 10 Improving Human Resources for Health Management 10 Increasing Availability of Midwives, Anesthetists, Health Extension Workers and Other Essential Health Workers 14 Improving Quality of Pre-service Education and In-service Training of Health Workers 20 Generating Research and Program Learning Evidence on HRH 30 SUMMARY 32 WAY FORWARD 33 TESTIMONIES FROM KEY STAKEHOLDERS 34 MESSAGE FROM CHIEF OF PARTY 35 3 4 CONTEXT In 2011, despite having made significant progress in previous years, the maternal mortality ratio in Ethiopia was 676 per 100,000 live births, and the under-five mortality rate was 88 per 1,000 live births1, which was among the highest in the world. Among communicable diseases, HIV/AIDS, tuberculosis, and malaria were the most serious public health problems−1.5% of the adult population was infected with HIV2, and the country had the seventh highest burden of tuberculosis in the world3. One of the underlying reasons for the poor health outcomes was the lack of access to quality health care. This was best illustrated by the 10% skilled birth attendance rate4, the lowest in the world. Ethiopia’s aspirations to achieve its health development targets, which were aligned with the Millennium Development Goals (MDGs), required improving access to quality health care, which in turn depended on improving the availability, accessibility, acceptability, and quality of its health workforce. However, Ethiopia had several workforce challenges, including, but not limited to, shortages, rapid turnover, uneven distribution, and poor quality. According to the World Health Organization, countries needed a minimum of 2.3 doctors, nurses, and midwives per 1,000 population to achieve the health MDGs5, but in 2012 Ethiopia’s health worker density of 0.76 per 1,000 was no where close to this number, even when health officers and health extension workers (HEWs) were included in the numerator6. The shortage of health workers was further compounded by high attrition and inequitable geographic distribution. For example, the physician-to-population ratio varied from 1:3,056 in the capital city, Addis Ababa, to 1:98,258 in the Afar Region7. There were also serious national concerns about the quality of education of health workers, which was partly a result of the rapid scale-up in the number of institutions providing training for health workers. In-service training (IST) was also plagued with poor planning, coordination, and quality8. To address the substantial health workforce challenges, in May 2012, the United States Agency for International Development (USAID), awarded the Strengthening Human Resources for Health (HRH) Project, an investment of up to $55 million to support the efforts of the Government of Ethiopia to improve health outcomes for all Ethiopians. 1Ethiopian Demographic and Health Survey, CSA, 2011 2 Ethiopian Demographic and Health Survey, CSA, 2011 3 https://apps.who.int/iris/bitstream/handle/10665/137094/ 9789241564809_eng.pdf?sequence=1 4Ethiopian Demographic and Health Survey, CSA, 2011 5The world health report 2006 – Working Together for Health. Geneva, World Health Organization, 2006:10–13. 6 Health and Health Related Indicators. FMOH, 2004 E.C 2011/12 G.C 7 Health Sector Development Program IV 2010/11–2014/15, October 2010, FMOH 8 Health Workforce in Ethiopia, 2012, World Bank 5 6 The HRH Project had four result areas: 1. Improved human resources for health management. 2. Increased availability of midwives, anesthetists, HEWs, and other essential cadres. 3. Improved quality of education and training of health workers. 4. Generated research and evaluation evidence. The HRH Project was implemented by a Jhpiego-led consortium that included Management Sciences for Health, Ethiopian Midwives Association, Ethiopian Association of Anesthetists, Open University UK, and Project Mercy. The Project was awarded in May 2012 and closed in June 2019. To achieve its objectives, the HRH Project supported and strengthened the Federal Ministry of Health (FMOH), the 11 regional health bureaus (RHBs), the then Food Medicine and Healthcare Administration and Control Authority (FMHACA), the Federal Ministry of Education (FMOE), the Higher Education Relevance and Quality Agency (HERQA), the Technical and Vocational Education and Training Agency, regional occupational assessment and certification agencies, 52 government universities and colleges (28 universities and 24 regional health science colleges- RHSCs), over 40 private colleges, and nine health professional associations. 7 8 9 MAJOR ACCOMPLISHMENTS BY INTERMEDIATE RESULT AREA Improving Human Resources for Health Management 10 Upgraded filing system in the HRM Unit in Felege Hiwot Referral Hospital, Amhara Region uman resources (HR) are a critical component of health systems and links with other building blocks in the health system. Yet numerous challenges affected HRH management in Ethiopia’s public sector. These included poor attention to HR management, Hweak HR structures and staffing, absence of professional development opportunities for HR staff, lack of HR plans and budgets, erratic awareness and implementation of HR policies, a weak HR information system and poor inter-sectoral collaboration. In response to these gaps, the HRH Project supported: • The FMOH to develop a National HRH Strategic Plan (2016–2025). RHBs were also assisted to develop strategic and operational plans tailored to their local needs. This resulted in improved planning capacity and increased budgets for HR activities. • Restructuring of HR units and creation of 1,307 new government- funded HR management (HRM) positions at different levels of the health system. This improved the capacity of the health sector to effectively carry out HRM functions. • The RHBs HR processes with the recruitment and orientation of 67,070 new health care providers by drafting or updating job descriptions, position announcements, and determining need- based allocation and deployment of these professionals. • Training of 2,950 HR managers and officers based on a nationally approved curriculum, which improved knowledge and performance of HR managers and staff. The preparation of 60 master trainers created local capacity to sustain the training. • Development and utilization of a staff orientation manual or employee handbook to facilitate smooth integration of new hires into the sector and raise awareness about HR policies. • Improvement in knowledge and utilization of HR policies by identifying, collating, and distributing HRM policy and procedure documents at different levels of the health management system. • The FMOH and RHBs to determine the stock and distribution of the health workforce (see page 32). This support was critical to inform planning, deployment, and monitoring of progress in the absence of a robust HR information system. 11 • RHBs to update personnel files of 130,938 health workers. The Project also collaborated with United States Centers for Disease Control and Prevention (CDC) and Tulane University to support RHBs to institutionalize the Human Resource Information System (HRIS) and update the profiles of health workers nationwide. • FMHACA to strengthen regulation and governance of health workers by developing scopes of practice for 15 health occupations, ethics code of conduct, and directive for continuing professional development (CPD). • Establishment of national and regional HRH partnership forums to improve strategic collaboration and communication. The forums are led by the FMOH at national level and RHBs at regional level and include ministries of education, civil service, and finance; higher education institutions; professional associations; and development partners. • Improvement in leadership, management, and governance capacity and practices at FMOH, RHBs, and regional hospitals by training 313 leaders and managers during a nine-month leadership, management, and governance (LMG) program to help them achieve greater equity and quality of health services. Before Intervention After Intervention POLICY Number of national HRH 0 strategic plan 1 Recruitment 1,600 Number of HR staff 5,030 at all levels Training 65 Number (%) of HR staff who 3,015 received on-the-job training (4%) in HRM at all levels (60%) Partnership Forum Number of national or regional 0 HRH partnership forum 12 Health Workforce 114,362 Number of professionals in the 243,602 health sector 12 Upgraded HR filing system in Tigray Region Health Bureau, Tigray Region Magnifying HR functions as a key component of the health sector performance “With improved capacity at zonal and woreda health offices, the HR staff at those levels are effectively managing HR issues and have avoided unnecessary travel to the RHB for health workers. This has increased health workers’ satisfaction by reducing delays related to HR decisions. In addition, the pressure and workload on the RHB human resources
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