Niger| Human Resources for Health Collaborative
Topics: Employee Engagement, Motivation/incentives, Performance management, Retention of health workers/reducing attrition
Region and Country: Niger
The change package is a performance management cycle with 7 improvement objectives:
Improvement Objective #1: Ensure that all workers have an achievable workload with clear expectations and measureable objectives that are in line with the organizational goals and health needs of the community and are kept currant through a consistent process of review and discussion.
Improvement Objective #2: Ensure that workers have the knowledge and skills to accomplish the required tasks as specified in job requirements, are able to build new skills on the job for future tasks, and have the materials and performance support to maintain and improve skill levels.
Improvement Objective #3: Ensure that workers receive frequent feedback on their performance according to the expectations defined, and are able to discuss issues and challenges in an open and supportive environment.
Improvement Objective #4: Ensure that workers are evaluated fairly, with clear and specific evaluation criteria based on the expectations described in advance.
Improvement Objective #5: Ensure that workers are recognized and rewarded for performing well, and/or provided with specific feedback on how expectations were not met if they were not.
Improvement Objective #6: Offer all workers, regardless of level, opportunities to develop and grow in their careers. Ensure that workers understand what opportunities are available and what requirements must be met in order to progress.
Improvement Objective #7: Create a secure and adequate environment for health workers.
The interventions for the HR Collaborative have come directly from the change package, which has been modified and adapted to the situation on the ground by human resource experts in Niger, staff from the MOH, district health teams, and health workers participating in the collaborative. As of January 2011, the QI teams have implemented objectives 1 - 3 and are in the process of implementing objectives 4 - 5.
A baseline assessment of human resources management, productivity, and employee engagement was conducted in March 2009 in 20 facilities – 15 facilities in the Tahoua Region and 5 other control facilities located in other regions of Niger before the launch of the collaborative. To identify major gaps and problems on the ground, several tools were employed: a time utilization tool to measure worker productivity; an employee engagement questionnaire to gauge the level of engagement employees have to their work; and a client flow tool to track how much time patients spend waiting for and receiving care at each stage of their clinical visit. In addition, interviews were conducted with health workers, district team members, and managerial staff from the districts and the Ministry of Health to obtain feedback on the system, gauge retention, and measure individual perceptions of the functionality of the current human resources management system. In general, baseline results showed that the majority of health workers (not including doctors and nurses) spend half of their time unproductively, health workers are not very engaged in their work, and client flow is very poor. QI teams gather monthly human resources and clinical indicators to monitor the impact of interventions as well as assess employee engagement, client flow and time utilization. We expect the results for all of these measurements to gradually improve throughout the collaborative. In addition, an endline assessment will be conducted in late 2011.
The pilot phase of the collaborative includes 15 facilities and 11 management teams from all 8 districts of Tahoua Region, one of 8 health regions in Niger. Multi-disciplinary QI teams have been formed at each participating facility and include a member from the district health management team, the facility manager, a nurse, another provider, and a union member. There are a total of 540 staff employed in the 15 facilities, all of whom will benefit from the improvements the quality teams implement. Five facilities in other two other regions of Niger are undergoing the same assessments and will serve as control sites for the intervention.
QI teams receive regular bi-monthly on-site coaching and needs-based training from external coaches that integrate technical and QI skills to assist teams with problem-solving and reduce any obstacles they encounter in implementing new practices and standards in their local setting. In addition to the coaching visits, HCI staff also provide ongoing technical assistance to individual teams.
Quarterly learning sessions are held for the QI teams participating in the collaborative. One or two participants from each QI team take part in each learning session to share best practices, results and challenges faced. Presentations and written summaries of the most effective changes are also be distributed to all teams following the learning session so that individual teams can begin adopting successful practices that have been tested by other sites.
Since the collaborative began in May 2009, there has been an increase from one to six districts meeting the national target of 25% of skilled birth attendance; postpartum hemorrhage has halved in collaborative sites; and adherence to essential newborn care standards has increased from 72% to 98%.
In August 2010 the Ministry of Public Health convened a National Meeting in Niamey to discuss the results to date of the HRH collaborative and how to institutionalize the process and scale-up nationally. Over 400 participants from the MOPH attended the meeting. HCI will assist the MOH in this endeavor by providing technical assistance for national scale-up.
