Health workforce performance:
developing the bundles of human
resources/health systems strategies
National workshop 2
[location, dates]
Session overview
• Interventions to improve staffing levels
• Understanding individual staff performance
• Areas for consideration for managing
workforce performance
• The concept of ‘bundles’ of strategies
• Steps for developing bundles
• Planning process and tools
PERFORM’s definition of health
workforce performance
1. Both collective and individual performance
2. Clinical, managerial and support staff
3. Availability of staff
– Right number, competencies, in right place
– Levels of absence
4. Quality and quantity of work output
Interventions to improve staffing
HR strategies
levels
HS
strategies
Change skills mix
(inc. volunteers)
Develop partnerships
(MoH, other sectors,
NGOs, FBOs
non-formal providers)
Increase entrants
Reduce losses
Improve distribution
Improve productivity
Understanding individual
staff
HR
strategies
performance
Job
satisfaction
Direction
Competencies
Intrinsic
Performance
Effort
Reward/
Sanction
Extrinsic
Resources
HS
strategies
Fairness
Praise,
incentives,
etc
Areas for consideration for managing
workforce performance
• Availability (posts filled/distribution/staff present)
• Direction (on what staff should do and how well they
are doing)
• Competencies (appropriate skills, knowledge and
attitudes to carry out the tasks assigned)
• Rewards and sanctions (to influence their behaviour
and therefore their performance)
• Health systems (other building blocks) including
resources:
– equipment, drugs and supplies
– Infrastructure (buildings)
– Transport
The concept of ‘bundles’ of
strategies
• no single magic bullet for a sustainable
solution
• coordinated ‘bundle’ of HR strategies have
greater impact that individual strategies
• Avoid ‘deadly combinations’ of HR practices
• Add wider health systems strategies to the
‘bundles’
• effectiveness of the bundles depends on
organisational context
Bundles example in DHMT manual
Steps for developing bundles
Key steps for developing bundles
• Identify problems to be addressed in
problem tree (and other related areas)
• Review options of strategies by
performance area (see Appendix 1)
• Put selected strategies in planning
table and complete all columns
Planning process and tools
Tools & guides for planning the
bundles of HR/HS strategies
• Table with sample strategies to assist planning the
HR/HS bundle of strategies - for review before
planning
• Planning table for HR/HS strategies (blank) – for
completion by DHMTs
* On memory stick
Table with sample strategies
A.
Performance
area/broad
objective
1.
Availability
Increase #
staff in post
Improve
distribution
between
rural and
urban
facilities
B. Strategy
C. Sample
activities
D. Expected
change
E. Possible
indicators for
M&E
F. Link to/conflict
with other HR/HS
strategies
G. Comments
Additional
recruitment
Advertise for
specific vacant
posts
More staff
available
% posts vacant by
cadre and facility
type
Induction
Which staff can
DHMT recruit?
Attraction
incentives
Funding initial
training with
bonding
More applications
for jobs
#
applications/post
by cadre
Ensure staff are
also being
retained
Check whether
the main problem
is attraction or
retention
More staff
available in rural
areas
% posts vacant by
cadre in rural
districts
Workforce
planning
Training takes
staff away from
the workplace;
may need to
stagger training
More strategies …
Attraction
Funding initial
incentives for rural training with
areas only
bonding
Workforce
planning
% trainees who
complete the bond
Retention
Identify financial
More staff
incentives for rural and/or
available in rural
areas
nonfinancial
areas
incentives that can
be funded from
the district budget
% posts vacant by
cadre in rural
districts
Less money
available in
operational
budget for
% trainees who
equipment and
complete the bond
supplies for staff
Note that ‘nonfinancial
incentives still cost
money
Choose relevant
performance
area(s)
Check ‘expected
change’; does it
address the
problems
D. Expected
change
identified?
Review
comments –
anything helpful
there?
Table with sample strategies
A.
Performance
area/broad
objective
1.
Availability
Increase #
staff in post
B. Strategy
C. Sample
activities
Additional
recruitment
Advertise for
specific vacant
posts
Attraction
incentives
Choose
complete set of
activities toMore strategies …
Improve
support Attraction
distribution
incentives for rural
strategiesareas only
between
rural and
urban
facilities
More staff
available
Choose
strategies to
Funding initial achieve
More applications
training with
for jobs
objective(s)
bonding
Funding initial
training with
bonding
More staff
Identify possible
available in rural
indicatorsareas
for
measuring this
change
Retention
Identify financial
More staff
incentives for rural and/or
available in rural
areas
nonfinancial
areas
incentives that can
be funded from
the district budget
Choose broad
objective(s)
E. Possible
indicators for
M&E
F. Link to/conflict
with other HR/HS
strategies
G. Comments
% posts vacant by
cadre and facility
type
Induction
Which staff can
DHMT recruit?
#
applications/post
by cadre
Ensure staff are
also being
retained
Check whether
the main problem
is attraction or
retention
% posts vacant by
cadre in rural
districts
Workforce
planning
Training takes
staff away from
the workplace;
may need to
stagger training
Workforce
planning
Identify links of
conflict with
other HR/HS
strategies
(new
% posts vacant
by Less money
cadre in rural
available in
of existing)
districts
operational
% trainees who
complete the bond
budget for
% trainees who
equipment and
complete the bond
supplies for staff
Note that ‘nonfinancial
incentives still cost
money
Steps for identifying and selecting
appropriate HR/HS bundles
A. Select relevant performance areas for your problem.
Review and select appropriate objectives.
B. Review and select appropriate strategies*.
C. Review sample activities
D. Check that the expected change given in the table fits
with what you want to achieve.
E. Review Link to other HR/HS strategies to identify
other strategies to be added to the ‘bundle’; or
identify conflicts
F. Review comments
* Note: some strategies may serve several different purposes e.g. supervision may
be useful for improving skills and provision of feedback on performance
Planning table
A. Broad
objective
B. Strategy
C. Sample
activities
D. Expected
change
E. Possible
indicators for
M&E
F. Link to/conflict
with other HR/HS
strategies
G. Comments
Next steps
• Evening activity: Read section 4 of the DHMT
manual on Selecting bundles of HR/HS strategies
to improve workforce performance (including
the 10-page table in Annex 1)
• Tomorrow:
– Develop a bundle of HR/HS strategies for improving
workforce performance using template provided
– Peer review of bundle by other district teams
– Refining bundles based on feedback