Voices from the Field: Swaziland And Uganda—Now We Can Tell Who Is Working Where

Strengthening Human Resources Information Systems

Imagine you oversee the fire department for a vast city, home to millions of people. Houses and apartments catch on fire every day, in the heart of downtown and in the suburbs and outlying areas. You have fire stations with fire trucks, but you are not sure how many firefighters you have in any one fire station—in fact, a few stations have only one or two firefighters but there is no system to tell you that the vacancies need to be filled. Without the essential data on firefighters to plan and sustain a strong fire department, some houses survive, others burn to ashes.

Similarly, without accurate human resources information in the health care world, managers cannot determine where health workers are needed most, and many people can’t access the services and treatment they need. Through its USAID-funded Capacity Project, IntraHealth International is supporting countries to strengthen their human resources information systems (HRIS) and learn how to use data effectively so that human resources for health are better managed and supported.

One example is Swaziland, whose health workforce has been dwindling and overburdened trying to care for the high number of patients with HIV/AIDS. Many health professionals have chosen not to work in the public sector and even left the country in search of better employment opportunities. To respond, the Ministry of Health and Social Welfare needed vital information about its human resources for health. “We didn’t know who was working where,” says Thembisile Khumalo, chief nursing officer at the Ministry.

The Capacity Project organized the Swaziland HRIS Stakeholder Group, which determined the types of data and HRIS reports needed to produce the answers the Ministry sought about deployment, the incoming workforce, training, attrition and retention. The Project developed a new centralized HRIS that includes not only public service records of Ministry staff but also records of private-sector hospitals and clinics and nongovernmental organizations—in other words, of all health workers.

In Uganda, the Capacity Project helped create a Health Workforce Advisory Board to lead the process of developing an HRIS. The Board—comprised of members of the Ministry of Health, the four professional licensing associations, training institutions and nongovernmental organizations—identified the top human resources data needs and came to a consensus on a database for Uganda that would be functional for all parties involved.

After the Advisory Board identified computerization of the Uganda Nurses and Midwives Council’s data as an urgent priority, the Capacity Project improved the Council’s network and infrastructure and installed a certification and licensing information system that tracks all health professionals in Uganda—from pre-service training until they leave the workforce. The Project then led a workshop for planners and managers from the ministries of health and education and the faith-based sector. Participants reviewed reports from the new HRIS at the Council, and explored how to use the data to drive their decision-making.

Dr. Eddie Mukooyo, the Ministry of Health’s assistant commissioner, Resource Center, recounts that “of those who registered for an examination we were able to note how many were able to pass, how many were able to go on to be licensed and how many eventually were able to be deployed. Then we found that people [from] more rural areas tended to stay longer [in nearby rural posts]. That was good information for us—[we] should allocate more resources for those training schools for people in their own population to train and go on to work in their own areas.”

Back in Swaziland, armed with data, the Ministry needed to be trained in the same way as the Project had trained the managers and planners in Uganda. “Often looking at the data, I was not quite sure what to do exactly,” admitted one health manager. A three-day workshop helped 28 managers to better understand information available from their HRIS and apply tools for making evidence-based decisions. As Michael Mndzebele, Ministry regional health administrator, comments, the workshop “brought to the fore how much information we have that we don’t make use of. I will make sure that the data generated in my department is analyzed and made available to me and the rest of the team for our future decision-making.”

“Now, with the information we have, we can tell who is working where,” says Khumalo. “It is helping us a lot in planning for the [health] sector.” The Ministry has used the accurate data to develop a Health Workforce Strategic Plan, analyze vacancies and hire and deploy workers more efficiently.

IntraHealth’s HRIS strengthening process includes five key elements:

  • Building HRIS leadership using a participatory approach that also includes assessing any related systems currently in use
  • Strengthening needed infrastructure to support an HRIS
  • Developing free, open source HRIS software solutions customized to a country’s specific needs
  • Supporting managers to effectively analyze and use the data to inform decision-making
  • Through training and technical support within a country, ensuring sustainability and continuous improvement of HRIS.

For more information, visit www.capacityproject.org/hris/