Helen Lugina is the coordinator for the Human Resources Development and Capacity Building program of the East, Central and Southern Africa Health Community (ECSA-HC). Based in Arusha, Tanzania, ECSA-HC is an inter-governmental organization, currently consisting of 10 member countries. ECSA-HC’s mandate is to improve the quality of health care delivery in member countries, working mostly through advocacy and policy development. Dykki Settle, Capacity Project HRIS team leader, describes Helen as “our greatest champion in the ECSA region.” Helen has been a huge supporter of establishing and strengthening HR information systems (HRIS) in member countries, and she is responsible for presenting Capacity’s HRIS strengthening concepts to Health Ministers (ECSA-HC’s highest governing body) at their annual conferences.
ECSA-HC has many programs, including HR Development and Capacity Building, Health Systems Development, HIV/AIDS, Food and Nutrition, Family and Reproductive Health, and Information, Communication and Dissemination. Although ECSA-HC has an overall strategic plan, most of the programs also have their own individual plans. Recently, by working with USAID, the HR Development and Capacity Building program developed a draft strategic HR plan and presented it at a Direct Joint Consultant Committee (DJCC) meeting in September 2007. The DJCC advises the ECSA-HC secretariat on operational and technical issues. The draft plan addresses issues such as retention, migration, and leadership in management, and focuses on strengthening HRIS in member countries.
The draft plan states that one of the major Human Resources for Health (HRH) challenges among member countries is the lack of accurate and reliable HR information for decision making. To address this, one of the strategic objectives is to improve HR intelligence in these countries through HRIS, documentation and dissemination of best practices. Better HR intelligence will help countries establish, monitor and evaluate national Health Workforce Observatories that will ensure accurate HRH data is readily available for planning purposes. Helen describes the Observatories as being composed of teams of “gatekeepers” that analyze and monitor HR intelligence in their countries. She explains that they are emphasizing HRIS so that countries will “know the type of data that should be generated to answer their policy questions.”
Helen points out that the ECSA-HC member countries are at different levels in developing their HR information systems, “it is a major challenge that we really need to work on in most of the countries.” Some countries, like Kenya and Uganda, have partnered with Capacity Project and other projects/organizations to strengthen their HRIS. Capacity was also working to strengthen HRIS in another member country, Swaziland, and the work was transferred to the South Africa Human Capacity Development Coalition (SAHCD) last year. Helen says ECSA-HC is delighted to be working with both the Capacity Project and SAHCD and hopes that ECSA-HC will eventually take the lead in strengthening HRIS in the region. “Through the SAHCD Coalition in Swaziland, ECSA hopes to identify a person to conduct trainings so that we can continue to provide technical assistance to the countries.”
“HRIS can tell policy makers and decision makers the status of the health workforce in the country,” states Helen. She explains that, without an accurate HRIS, countries cannot know, for example, the numbers of health workers they need to train, how much they should invest in training and where to deploy them after they are trained. When it comes to the management of day-to-day HR issues, Helen says that “if you don’t know who is there to do what, in terms of skill mix, then you don’t know how to utilize them according to your needs.” She adds that the required mix can often be present but inequitably distributed. “If you don’t know who you have, you might be leaving women to be attended by unskilled birth attendants, which is a risk for maternal and neonatal death. So that is just one example that if you have the right person at a certain moment, then it can prevent a lot of deaths.”
From the Capacity Project’s work in the ECSA region, including the strengthening of Stakeholder Leadership Groups, Helen has witnessed progress in several member countries. She singled out Uganda as a country where she sees all the important stakeholders beginning to “own” entire issues and planning together, making sure they know exactly how to use the data that is available. “It is one thing to have nice and beautiful graphs and data and databanks and so forth, but the second thing is for this information to be used by the decision makers.” She described notable progress in this regard. Helen also recognized Capacity’s commitment to presenting at African Health Workforce Observatory conferences and ECSA Health Ministers’ Conferences and added that, as a result of this, the health ministers have come to know and value HRIS as one of the major priorities in the region. Helen explains that “the Ministers know that without a sound information system there is no backbone to the decisions people make.”
“It is almost like each year we have a minister’s conference, there is a resolution coming out working to strengthen HR information systems. For example, the next minister’s meeting is this February in Seychelles. We [previously] presented the whole workforce observatory concept including the HRIS, and they are going to ask where we are. So we needed to really follow up and monitor and, as much as possible, inform them of the progress.”
Helen believes it is important the HRIS strengthening work the Capacity Project has helped start in the region continues, even after the project ends, and that there exists a “capacity in the African region or in the ECSA region to walk in the footsteps of Capacity Project.” She also has hopes ECSA or similar organizations are able to help other countries set up their information systems, implement software that is sustainable and then ensure that countries are able to continue generating and interpreting information for use in policy development. She concludes that what really needs to be followed up on is “the support for capacity development, in terms of knowing the software, how to do the data analysis and how to use the data itself for projections and for planning.”
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Much was accomplished in December at the PEPFAR-funded HRIS Inventory Project workshop. Leaders from several partner and donor organizations gathered to review the project scope, suggest improvements to the proposed data framework, and define the data elements necessary to capture an informative systems inventory in their areas of expertise. Participants grouped themselves into areas of focus and expressed interest in continuing to support the inventory project. We will continue to work with these focus groups to develop communities of practice and help each define best practices in their fields.
The project team is currently compiling and digesting information from the workshop and will share with all participants via email and the Capacity website. In addition, as use cases are re-written based on feedback obtained in the workshop we will share with the focus groups for suggested improvements.
Posted by
Angela Self on 1/27/2008 • Tags: Community, HRH, HRIS, Information Systems, Workshops
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With the start of the new year, it is traditional to predict trends for the coming months. So I thought I’d take a look at our ICT work and identify what I see as trends for our work moving forward and for ICT for development in general. I don’t think any of these predictions are earth-shattering, but they should be helpful as guides for our work and areas for further discussion.
Generally, I see two strong trends and then one I’m not so confident about:
- Greater focus on using cell phones and text messaging to connect systems to users
- Broader acceptance of Open Source technologies in nonprofits and in the developing world
- Increased use of social networking tools to improve communications among people doing this work and people using our systems (this trend is “iffy” because I don’t know if this is something that will really take off in 2008, at least in our organization)
Cell phones and text messaging
It is clear that cell phones are the fastest growing and probably most accessible technology for two-way communication in the developing world. Text messaging, in particular, has become an efficient way to send and receive necessary information, more ubiquitous than email. People in the developing world are more likely to have access to a cell phone than to an Internet-connected computer, they are familiar with the technology, and it is generally cheaper for them. Some unique uses of the technology I’ve seen recently are texting locations of mobile HIV clinics in South Africa and tracking epidemics in Rwanda.
We will need to take advantage of this trend to make our Web-based systems, such as iHRIS, easier for our clients to use, particularly in areas where there is no Internet access. The cell phone may even be a solution for accessing just-in-time information from online repositories, such as the HRH Global Resource Center.
Open Source technologies
I see a promising trend for Open Source technologies becoming more widespread in both the sectors that we work in–nonprofit and public health–and the countries where we work. As Open Source becomes more familiar and thus more trustworthy, the advantages will become too clear to deny. The costs are significantly lower, and the potential for turning over systems to local developers to maintain and grow is much higher.
For our part, we’ll be using such technologies as the Asterisk telephony system and possibly Open Source software on cell phones in addition to the standard LAMP (Linux-Apache-MySQL-PHP) set of development technologies, as well as releasing all of our software developed in-house under Open Source licenses and actively encouraging outside developers to improve them. I expect we will expect our partners to also leverage Open Source technologies. Most importantly, though, I am hearing from the country level that strategic technology plans are being made based on adopting Open Source software for everything from servers to desktops. .
What about social networking?
I think the surge of social networking tools, such as blogs, wikis, podcasts and more, is a very exciting development for those of us who live with always-on, high-speed Internet connectivity. But how does that translate to our work in low-resource settings? I’m not sure, but many nonprofits are exploring that question now and sharing their ideas.
Social networking tools are so powerful and so popular because they tap into our very basic human desire to connect and share with one another. Last year we dipped our toe in the water through this blog and virtual learning environments, which were essentially online communities for sharing information. Perhaps this year we can use them more thoughtfully as a way to better connect with dispersed employees, volunteers and even our clients who are using the technologies we develop. We can exchange ideas, get feedback and work collaboratively faster and more effeciently than we have before.
But for that to happen, the tools have to be accessible, easy to use and compelling. We should start with a few small, targeted projects and see what happens. Instead of trying to reinvent the wheel, we should harness those free tools that have already been developed for us, tools like Twitter and YouTube. Tapping into the power of these tools will require creative thinking and a willingness to experiment, as well as time to see what works best for us and our community.
Does anyone have any ideas or predictions for 2008? Please share them in the comments.
Posted by
Shannon Turlington on 1/21/2008 • Tags: Cellphones, FOSS, ICT4d, Mobile Technology, NPtech, Open Source, Public Health, Social Networking
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I’ve had the opportunity to follow the development of OpenID and related technologies from afar for a couple years. Watching the good work of some friends who have developed ClaimID has opened my eyes to what the hurdles are in keeping a unique identity as we move more and more digital.
Here’s the problem: Identity on the web can be nefarious at best. An email address is at its heart temporary and often not the only unique email one person might have. Who hasn’t either contemplated or actually dumped an email address after a particularly bad week of spam? Identities are also defined online by the many services and sites we might have a login for. Yet these are usually different IDs - we can’t be sure of a person’s identity by looking at various accounts.
ClaimID is a great example of a way to combat this by allowing a person to manage their online identity themselves. Further, they are doing so by using the very simple and elegant OpenID protocol. The concept of OpenID being that we have a unique identity which allows us to log in to various services and sites with one single ID by allowing the services to retrieve credentials from a trusted identity provider of the user’s choosing. This last part being key: “of the user’s choosing”.
OpenID is still very much in a phase where, although it is being adopted by some well known services, it is still in roll-out. Although this means we can’t use our OpenIDs in many places yet, the tools for developers to add OpenID support are available and ready for use.
This could be very important for our work here at IntraHealth. This week there have been a couple of different projects plans come up which have made me think about how we could use OpenID. In both cases it comes down to patient records and tracking. The thought of such use in places like Uganda has made me step back and wonder why this type of implementation hasn’t been talked about much in Western medical records and services development. Perhaps it has and I have missed it, nonetheless I do feel like a tool like OpenID could present the beginnings of the type of security which is needed to provide patients and health care givers records online or on handheld devices.
The trick here is creating the trusted identity provider. In the case of the Ugandan projects we could propose that the Ministry of Health become a trusted provider for a Ugandan citizens “Medical ID”. This ID could then be used on the already growing list of servers and applications which have to have unique identifiers for their patients. The same system could also be used to identify health workers as they pass from systems like iHRIS Qualify to a training center’s application - therefore more easily (and automatically) updating either system’s records on what type of training the health worker has completed. The beauty of the OpenID process is that, if implemented correctly, it allows the patient or worker to be in charge of their own identity and who they trust with the creation and storage of that identity. As long as we keep them first in any design, they win.
Posted by
David Mason on 1/14/2008 • Tags: Design, Development, Software, Technology, Tools
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The facilitators of the pilot Data Driven Decision Making (DDDM) workshop held in Uganda last summer felt it was a success and received positive feedback from participants. Fourteen attendees filled out evaluation forms at the close of the workshop and all agreed that that the workshop met its objectives and DDDM was relevant to their work. Also, while only one person felt ‘very comfortable’ with the topic prior to the workshop, eleven did afterwards. Still, efforts must be made to support and sustain this type of work amongst decision makers in Uganda.
Ummuro Adano, Senior HR Systems Advisor for the Capacity Project, has said DDDM is a “mental shift that can take place over time” and cannot be fully accomplished through just one workshop. One participant agreed, and explained, “We learned that data use in decision making needs to be developed. It’s about ‘how can I prove this and what is the rationale?’ It’s having the inquiring process in the thinking and decisions that we make.“ He added that by attending the workshop, participants began to realize it was a lot more risky to make decisions without the use of data, “We also learned that data can be deliberately ignored to achieve certain objectives.”
When asked how attendees will use what they learned at the workshop in the future, one participant said they will train themselves to look for evidence in all decisions that they make. “We should be able to make a reference to a source of data so that people can confirm and be certain we are using data that is authentic,” he said. He also mentioned that it is important to share current records from the various sources, “We need a system in place to maintain the databases that we are creating and maintain up to date (information) because data that is out of date, as we learned, is not very useful in decision making.”
The workshop produced several outcomes that will help participants utilize DDDM in their future work and encourage other decision makers in Uganda. One activity produced a finalized list of HR policy and management questions for the Ugandan health sector. Another result was a list of next steps and actions that included strengthening the MOH Resource Center so that it can function as the effective HRH data storage facility that collects, integrates, and provides access to the various sources of data. The Resource Center will also promote using data for decision making.
Some participants offered other suggestions for how to sustain this work. One participant said, “We need to create demand for data among policy makers and managers. We need to motivate each other in terms of further workshops to engage policy planners at the level higher than we had so in the future they may demand a certain level of quality.” Another participant agreed and added, “These kinds of trainings need to be replicated, followed up, because we are getting to a stage where we are now, that we want now to use information more.” He said they need to follow up with trainings, etc. with as many of the decision makers as possible.
A follow up to the Ugandan DDDM workshop is scheduled for this summer. Other DDDM workshops are planned for Swaziland and Rwanda this spring, where information is now becoming available from their HR Information Systems and ready to be evaluated.
Posted by
Carol Bales on 1/8/2008 • Tags: Africa, Decision-Making, HRIS, ICT4d, Information Systems, Public Health
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