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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Dr. Invocaviths Swai joined the IntraHealth/Capacity Project Tanzania team in September, as an HR Specialist seconded to the Ministry of Health and Social Welfare (MoHSW). With the Ministry’s five year Human Resources for Health Strategic Plan (HRSP) recently approved, he believes his new position came at the right time.
Dr. Swai brings a unique skill set to the HR Specialist position. He is a medical doctor and a community health specialist who has practiced in some of the most underserved areas of Tanzania. For the last few years, he has worked in administrative posts within the MoHSW — as a district medical officer and then in the central Ministry’s training section. While serving as the District Medical Officer in Tanzania’s Rombo district, Dr. Swai worked with data at district level. With that base of experience, he is a strong advocate for establishing a centralized Human Resources Information System (HRIS) that works effectively with the districts in Tanzania. In his present position, he is the liaison between the MoHSW, local Human Resources for Health (HRH) stakeholders, and the Capacity Project as he provides guidance to implement the MoHSW’s HRSP and organizes HRIS stakeholders. He describes his position as “trying to reach consensus for action and helping stakeholders come together.” He says he will continue to “coordinate all those collecting and using HRH data to have harmonized software use that can facilitate data and information sharing.”
The HRIS in Tanzania is currently being established as a component of the existing Health Management Information System (HMIS), which Dr. Swai describes as “well-managed but with some limitations.” For instance, the HMIS was created to track service management and performance, but not to comprehensively cover human resources management. Although some partners and funders have collected their own Human Resources data, this data is not readily available to all stakeholders. In addition to this, maintenance of the current system is time and labor intensive. Dr. Swai believes that these combined factors have created the need for a “unified database using software that facilitates sharing from a common source - one that is more user-friendly.”
The types of reports the existing HMIS is capable of producing only partially answer key policy and management questions. Dr. Swai explains this is not only because important staff information is missing from the current system, but also because there are no regular updates. He would like to see a routine HRIS in place that is capable of generating reports showing the number of staff in each cadre and where they are deployed. Using his experience in the MoHSW’s training section, he would also like to ensure the HRIS monitors current health worker skills, and how this relates to their quality of service. He would also like to be able to analyze information about applicant tracking, interviewing and selection, response to recruitment and attendances to workplace, and would like to see an HRIS that is integrated with payroll.
The MoHSW and the Capacity Project have jointly planned a number of HRIS strengthening activities for the upcoming year, including training the HR department and health managers in HRH information management and developing a data collection tool and software. There are plans to train key, central-level staff on HRH planning and workforce analysis, and HRH leaders at the district level on HR Management. Finally, they plan to establish a comprehensive HR Information System at all levels. Dr. Swai believes a complete HRIS can help ensure data quality by reducing paperwork, and therefore errors, and making development of aggregate reports less labor and time intensive.
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Kenyan born Samwel Wakibi is a Human Resource Information Systems Advisor for IntraHealth. With over 18 years of experience in IT, social research, data management and project monitoring and evaluation, Mr Wakibi helps to develop, implement and strengthen HRIS databases in the field.
As an HRIS advisor Mr. Wakibi works to initiate and facilitate these processes and is a firm believer in the participatory process undertaken by IntraHealth and the Capacity Project. “The strength of HRIS is in the development and implementation process. These are the points at which data quality ingredients of accuracy, completeness and timeliness can be inculcated. Participatory approach, adopted in all IntraHealth and Capacity Project system development, is crucial as it generates ownership, empowers database owners, builds capacity and opens communication channels between users and also developers,” said Mr. Wakibi. “Health care, just like any other service, is dependent on the person delivering the services. HRIS provides information about the number of health workers, their work stations and their skills. This information can be used to deploy and allocate tasks to health workers according to the needs in the health sector as guided by the burden of diseases and injury trends experienced over time.”
Mr. Wakibi has helped to implement programs most recently in Uganda, Southern Sudan, Lesotho and Kenya.
In Uganda, a registry database has been developed and fully implemented. iHRIS Qualify for the Uganda Nurses and Midwives Council (UNMC) is now fully operational and data entry is current. Reports have been designed and developed based on identified management and policy questions gathered from the system owners at the UNMC and in the health sector. Presently, similar modules for the other professional councils in Uganda are being completed. Training on data use for decision making has also been conducted to expand the scope of managers in the health sector on evidence-based decision making and policy formulation.
Southern Sudan is emerging from 25 years of civil war that destroyed the infrastructure and institutions both private and governmental. The demand was so great for an HRIS system to provide answers and information, guide decision making, policy formulation, development and sound implementation of HR strategic plans that a quick fix step solution was preferred. After the stakeholder leadership group was formed, Mr. Wakibi conducted a needs assessment and developed a Microsoft Access-based “step” solution to provide answers as better alternatives are being sought. Data are currently being collected from training schools and states. Data collection and entry should be completed in November 2007.
Most recently in Lesotho, Mr. Wakibi conducted a needs assessment and developed an HR database. Similar to iHRIS Manage, the Microsoft Access-based system is designed to track staff movement, attrition and monthly payments made to employees. In addition, it will provide staff statistics for budgeting purposes, monthly under/overpayments to staff and staff complements that will trigger a recruitment process where there are shortages due to transfers, promotion and attrition. It is estimated that by the end of October 2007, a complete and clean dataset for all employees of the Ministry of Health and Social Welfare will be ready and available to managers for decision making. Reports are to be designed and developed in November 2007. Other system developments under way include an iHRIS Qualify for the Nursing Council.
In Kenya, a stakeholder leadership group has been formed, a needs assessment undertaken and required equipment has been acquired. The development of iHRIS Manage is under way.
In all these developments, staff members from the client government ministry or council are fully involved in order to build capacity to develop and enhance the database and production of tailored reports from the databases.
Mr. Wakibi is committed to helping implement systems that can build human capacity and wants to make certain those systems are effective and that health professionals feel confident using and developing HRIS independently.
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