Data and measurement of HRH availability, accessibility, acceptability and quality

TEHCNICAL WORKING GROUP (TWG) #3

- DRAFT FOR CONSULTATION - Not to be quoted or referenced without prior permission from the

authors. Not for wider distribution

This paper serves as a background report to inform the Global Strategy for Human Resources for Health. The development of this paper has been coordinated through a thematic working group (TWG), comprising of 2 co-chairs and a group of experts drawn from various Global Health Workforce Alliance (GHWA) constituencies, operating under the oversight of the GHWA Board working group. The views expressed in the paper, do not necessarily reflect the official position of GHWA. All reasonable precautions have been taken by the co-chairs to verify the information presented in the papers

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TABLE OF CONTENTS

1. Introduction ................................................................................................................. 3

2. Methods ...................................................................................................................... 3

3. Evidence ...................................................................................................................... 4 A) The necessity to focus on HRH data ................................................................................. 4 B) Emerging issues ................................................................................................................ 4 C) Current challenges and opportunities in health workforce data and measurement ....... 6 D) Inter-operability and alignment ....................................................................................... 7 E) Forward opportunities on HRH data and inter-operability .............................................. 8

4. Forward vision and recommendations ........................................................................ 10

5. Conclusion ................................................................................................................. 13

References ..................................................................................................................... 14

LIST OF BOXES

Box 1: HRH estimate and planning approaches ........................................................................ 6 Box 2: Kenyas experience with the development of a health workforce information system 7 Box 3: The potential of Health Facility Assessment (HFA) Tools ............................................... 9 Box 4: eHealth, mHealth and inter-operability - Country experiences ................................... 10

ABBREVIATIONS AND ACRONYMS

AAAQ availability, accessibility, acceptability and quality

HFA health facility assessment

HIE health information exchange

HIS health information system

HRIS human resources information system

HRH human resources for health

ISCO International Standard Classification of Occupations

KHWIS Kenya health workforce information system

MDG Millennium Development Goals

MDS minimum data set

TWG thematic working group

UHC universal health coverage

WHA World Health Assembly

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Acknowledgements:

Our thanks to all the individual experts who provided support to the development and review of this paper: Edson Araujo, World Bank; Elsheikh Badr, WHO, EMRO; Michael Bzdak, Johnson & Johnson; Margaret Caffrey, Liverpool School of Tropical Medicine; Mario Dal Poz, University of the State of Rio de Janeiro; Marilyn De Luca, NYC; Gilles Dussault, Instituto de Higiene e Medicina Tropical; Matt Edwards, Centre for Workforce Intelligence, UK ; Alfredo Fort, IntraHealth International; Louise Holly, Save the Children UK; Sofia Lopes, ICS Integrare; Zina Maan Jarrah, Management Sciences for Health; Shiv Mathur, NIHFW; Bjorg Palsdottir, Training for Health Equity Network; Luisa Pettigrew, World Organisation of Family Doctors ; Estelle Quain, USAID; Jody Ranck, SBC Global Advisors; Jessica Rose, USAID; Edward Salsberg, George Washington University; Xenia Scheil-Adlung, ILO; Michael Schoenstein, OECD; Dykki Settle, IntraHealth International (+ colleagues) ; Amani Siyam, WHO; Neil Squires, DFID; Keith Waters, CDC; Alexandra Zuber, CDC.

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1. Introduction

In the next 15 years, countries from all income groups will experience challenges (1,2) that

will arise from and will shape the pathway towards the attainment of universal health

coverage (UHC)(3,4). UHC aims to all people obtain the health services they need without

suffering financial hardship(5). Financial and social protection are very important

components of this new health paradigm, as highlighted in the ILO 202 Recommendation (6)

and require strong commitment by countries.

Human resources for health (HRH) are recognised as central to achieve UHC, and essential to

respond to countries future challenges (7). A responsive and fit for purpose workforce

requires an increasing focus on the availability and accuracy of health workforce data that

enables workforce strategic planning and anticipation of future needs (3,8).

WHO, European Union, OECD, and other international bodies have long-recognised the

policy necessity and urgency of improving health workforce data and measurement.

Technological advances, connectedness and Internet, as well as the rise of new approaches

for health workforce futures(9), create opportunities for HRH data collection, gathering and

utilization.

This paper reviews the available evidence and outlines opportunities that would inform the

governance and effectiveness of people-centred health and social protection systems. In

particular how to progress towards minimum, inter-operable data sets, develop the

necessary strategic intelligence on HRH and create a connected health workforce.

Developed under the scope of the Global Health Workforce Alliances (GHWA) consultation,

this paper on HRH data and measurement is the outcome of one of eight thematic working

groups (TWG), which will inform the development of a global strategy on HRH relevant to

the post-2015 development agenda (2015-2030). The consultation process is described

elsewhere (10).

2. Methods

A mix-method approach was used to collect and analyse information about HRH data and

measurement:

1) Process-tracing of World Health Assembly (WHA) Resolutions

All WHA Resolutions, from 2000 to 2014, were analysed and classified according to: 1)

nature (health-related: health issues, HRH, social security; Non-health related: Financial and

regulatory issues); and 2) content (against the Comprehensive Health Labour Framework for

UHC (11)). A chronology of events linking the resolutions and HRH evidence and advocacy

(e.g. Joint Learning Initiative, Kampala Declaration and the Agenda for Global Action, Recife

Declaration) was established.

2) Non-systematic review of the literature

Literature on the best and most recently available evidence and approaches regarding

future scenarios and health and social protection systems; big data and connected

health; workforce strategic intelligence were reviewed. This included research papers,

published reports and grey literature, identified by experts of different areas involved in this

TWG.

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3) Review of available data sets containing HRH data

World Bank consultants performed a revision of the available datasets and relevant

literature on HRH data or data initiatives. A total of 10 datasets and 13 papers were

identified and revised.

4) Key informants and country examples

At regional level, key informants reported on HRH data and measurement issues from

regional and countries experiences. Information was collected using a standardized matrix

and where possible, focal points at country level were involved in data gathering. Key

informants validated the information retrieved.

5) Expert panel consultation

Experts were identified with the support of GHWA and were asked to contribute from their

field of expertise. Individual and group participation was established through email, the

GHWA discussion forum and conference calls.

3. Evidence

A) The necessity to focus on HRH data The review of the WHA resolutions generated between 2000 and 2014 shows an increasing frequency of recommendations that call for strengthening the health workforce. During this period, WHO member states generated 374 WHA resolutions. Of the total number of resolutions, 209 are categorized as health-related in nature and are further analyzed. The 165 non-health resolutions, categorized a