Complexity of Measurement No Excuse for Not Counting

The worldwide shortage of four million health workers remains a critical obstacle to achieving the Millennium Development Goals, but too often “the abstract language [we use to discuss the]… ‘health workforce crisis’ and ‘human resources for health’ obscures the suffering of people in need who cannot reach a trained, supervised, and supported health care provider,” wrote Maurice Middleberg, vice president of global policy, in a 2010 strategy paper, Saving Lives, Ensuring a Legacy: A Health Workforce Strategy for the Global Health Initiative.1

Increasing and counting only the absolute number of qualified health workers is not enough; the health workforce crisis is intensified by maldistribution and migration—from rural to urban centers, and low- to high-income countries—attrition, productivity, and a number of other problems. Just as HIV/AIDS researchers monitor progress using an established set of disease indicators, programs aimed at closing gaps in the global health workforce must be carefully appraised, evaluated, and when they are not working, reconsidered. The question remains, however, about how best to gauge growth, decline, and other trends in human resources for health, and what to measure?

“Health systems goals, including human resources for health, may be perceived as more difficult to state in measurable terms than disease-specific goals for which there are clear biomedical markers.”1

In a service delivery project, for instance, you can develop concrete metrics:

  • How many people received medication?
  • How many vaccinations were given out?
  • How many women were attended during childbirth?

“Complexity of measurement cannot be used as an excuse for failing to address the health workforce crisis, setting unclear objectives, or not making reasoned judgment about whether progress is occurring. Indicators are just that—they provide clues and insight into whether change is occurring.” 1

To give public health planners, practitioners, and policy-makers a one-stop source for measurement and evaluation indicators, CapacityPlus recently developed the HRH Indicator Compendium, which offers a compilation* in an interactive format of 67 specific indicators for measuring work to build the health workforce and the health system.

Concrete Indicators to Measure System Change

For example, under the global leadership section, one of the 12 indictors is leadership development, which can be measured with a yes or no response to the question: “Is there a systematic process for developing and choosing new leaders on a periodic basis?” Under the health workforce development section, the indicators focus on preservice education, in-service systems, and continuing professional development. Two of the 15 indicators under preservice education are “the number of students graduating from secondary schools,” which can be expressed as a percent of the total number children of secondary school age, and “the percent of health schools that are accredited.”

These indicators are grouped under four broad categories: global leadership; health workforce policy, planning, and management; health workforce development; and health workforce performance support. The compendium is aimed at supporting the monitoring and evaluation work of health workforce practitioners such as employees of ministries of health or nongovernmental organizations, or monitoring and evaluation experts.          

*These indicators were compiled from existing resources developed by the Asian Action Alliance for Human Resources for Health Development, Child Survival Technical Support Plus (CSTS+) Project, Management Sciences for Health, the Pan American Health Organization, and the World Health Organization. The compendium is also available as a PDF to make it more accessible to practitioners working in areas with slow Internet connectivity.


1. Middleberg, M.I.  2010. Saving Lives, Ensuring a Legacy: A Health Workforce Strategy for the Global Health Initiative. IntraHealth International: Chapel Hill, NC.