Conceptualizing and implementing a health workforce registry in Nigeria

Background Nigeria’s health sector aims to ensure that the right number of health workers that are qualified, skilled, and distributed equitably, are available for quality health service provision at all levels. Achieving this requires accurate and timely health workforce information. This informed the development of the Nigeria Health Workforce Registry (NHWR) based on the global, regional, and national strategies for strengthening the HRH towards achieving universal health coverage. This case study describes the process of conceptualizing and establishing the NHWR, and discusses the strategies for developing sustainable and scalable health workforce registries. Case presentation In designing the NHWR, a review of existing national HRH policies and guidelines, as well as reports of previous endeavors was done to learn what had been done previously and obtain the views of stakeholders on how to develop a scalable and sustainable registry. The findings indicated the need to review the architecture of the registry to align with other health information systems, develop a standardized data set and guidance documents for the registry including a standard operating procedure to ensure that a holistic process is adopted in data collection, management and use nationally. Learning from the findings, a conceptual framework was developed, a registry managed centrally by the Federal Ministry of Health was developed and decentralized, a standardized tool based on a national minimum data was developed and adopted nationally, a registry prototype was developed using iHRIS Manage and the registry governance functions were integrated into the health information system governance structures. To sustain the functionality of the NHWR, the handbook of the NHWR that comprised of an implementation guide, the standard operating procedure, and the basic user training manual was developed and the capacity of government staff was built on the operations of the registry. Conclusion In establishing a functional and sustainable registry, learning from experiences is essential in shaping acceptable, sustainable, and scalable approaches. Instituting governance structures that include and involve policymakers, health managers and users is of great importance in the design, planning, implementation, and decentralization stages. In addition, developing standardized tools based on the health system's needs and instituting supportable mechanisms for data flow and use for policy, planning, development, and management is essential.

Getting Human Resource Information Systems Right: A Case Presentation of Uganda

BackgroundHuman resources information systems (HRIS) are a key tool for collecting and analyzing health workforce data at the country level and the specific focus of milestones 4.1 and 4.2 of the Global Strategy on Human Resources for Health (HRH). Yet documentation on the capabilities of HRIS in low- and middle-income countries (LMICs) is limited. Vital Wave, with IntraHealth International and Cooper/Smith, conducted a targeted scan of the HRIS landscape in 20 countries and “deep-dive” assessments in Burkina Faso, Mozambique, and Uganda. Here we present the case of Uganda’s workforce information ecosystem. Case PresentationSince 2006, Uganda has seen investment in HRIS from different donors, overseen by the Ministry of Health (MOH) and accompanied by the rollout of IntraHealth’s open-source iHRIS software. Despite this history of investment, mapping of the country’s multiple information systems revealed uneven adoption and engagement nationally and sub-nationally, with high levels of data fragmentation due to lack of interoperability and data-sharing practices. We also mapped the administrative processes and data flows for three priority use cases: recruitment and deployment, salary payments, and performance management. What emerges is a complex, decentralized information ecosystem driven by years of donor investment, but one that still sees uneven ownership and data use across the health system. Challenges include:· Limited interoperability between systems, specifically payroll, iHRIS, and the district health information system (DHIS2)· Complex HRH planning and management policy context, with variable implementation of numerous policies and no single reference to guide investments and implementation· Limited visibility into the private and community health workforce. ConclusionsUganda’s progress in developing its HRH information ecosystem underscores the importance of continuously aligning system capabilities, incentives, and motivations to an ever-evolving country context. However, as evidenced in Uganda and our broader assessment findings, robustness of the information ecosystem itself is insufficient to making substantive strides toward the Global Strategy’s milestones 4.1 and 4.2—governance oversight and ownership are critical to success. With a better understanding of what good looks like in terms of HRIS functionality in LMICs and ensuring interventions are addressing the causal issues, there can be many pathways to making systems work.

An analysis of the Gender and Social Determinants of Health in Urban Poor Areas of the Most Populated Cities of Pakistan

Background: Recent surveys, studies and reviews have highlighted the impacts of social inequities on access of women and children to health services for women and children in Pakistan. Utilising mixed methods for urban slum profiles, and facility and coverage surveys in 4431 urban poor areas of the top 10 highly populated cities of Pakistan, this paper describes and analyses the complex interactions between economic, social and gender determinants of health care access and considers health policy and program options for addressing them. Results: Findings are classified into six analytic categories of (1) access to health services, (2) female workforce participation, (3) gender friendly health services, (4) access to schools and literacy, (5) social connections, and (6) autonomy of decision making. Out of a national sample of 14,531 children in urban poor areas of 10 cities, the studies found that just over half of the children are fully immunised (54%) and 14% of children had received zero doses of vaccine. There are large shortages of health facilities and female health workforce in the slums, with significant gaps in the quality of health infrastructure, which all serve to limit both demand for, and supply of, health services for women and children. Results demonstrate low availability of schools, low levels of female literacy and autonomy over decision making, limited knowledge of the benefits of vaccination, and few social connections outside the home. All these factors interact and reinforce existing gender norms and low levels of health literacy and service access. Conclusion: The Urban Slum profiles and coverage studies provide an opportunity to introduce gender transformative strategies that include expansion of a female health workforce, development of costed urban health action plans, and an enabling policy environment to support community organisation and more equitable health service delivery access.

Experiences of COVID-19 patients admitted in a government infectious disease hospital in Nepal and its implications for health system strengthening: A qualitative study

Introduction The COVID-19 pandemic has affected the health systems in many ways. It has put unprecedented strain on health systems worldwide and exposed gaps in public health infrastructure. A health system comprises all institutions and resources working towards improving and maintaining health. Among the different aspects of health system strengthening, a patient’s experiences and expectations play a crucial role in determining how well the health facilities function. This study aims to explore health system strengthening’s implications based on experiences and feedback provided by COVID-19 patients admitted to a government tropical and infectious disease hospital in Nepal. Methods In this qualitative study, we collected the voluntary handwritten feedback by the admitted COVID-19 patients to document the feedback and experiences from a book, maintained by the hospital. We performed thematic content analysis using the World Health Organization’s six building blocks of health system as a theoretical framework which included service delivery, health workforce, information, leadership and governance, financing, and access to medicines. Results Most patients in this study had positive experiences on service delivery and health workforce. Some also highlighted the gaps in infrastructure, cleanliness, and hygiene. Many suggested positive experiences on other dimensions of the health system such as financing, governance and leadership, and access to medicines reflected upon by the patients’ thankfulness to the hospital and the government for the treatment they received. The responses also reflected the inter-connectedness between the different building blocks of health system. Conclusion This study approached a unique way to strengthen the health system by exploring patients’ feedback, which suggested an overall positive impression on most building blocks of health system. However, it also highlighted certain gaps in infrastructure, cleanliness, and hygiene. It reinforces the hospital management and government’s role to continue its efforts to strengthen the health system.

The Nurse Practitioner Workforce in Western Canada: A Cross-Sectional Practice Analysis Comparison

Regular examination of health workforce data is essential given the pace of health system and legislative changes. Health workforce studies pertaining to nurse practitioner (NP) practice are needed to examine the gaps between work activities, policy, human resource supply, or for population needs. Jurisdictional comparison studies can provide essential information about NP practice for governments to respond to health workforce deficiencies or engage in service planning. In Canada, there is limited provincial-territorial jurisdictional NP workforce data to support health planning or policy change. This descriptive cross-sectional study was to examine the similarities and differences in practice patterns of Canadian NPs. In 2016 and 2017, an electronic survey was sent to all 852 registered NPs in three Canadian provinces, yielding a large convenience sample of 375 NP respondents. The results of this study underscore the value of NPs’ extensive registered nurse expertize as well as their ability to serve diverse patient populations, work in varied healthcare settings, and provide care to medically complex patients. The study findings also show that NPs in all three jurisdictions work to their full scope of practice, in both rural and urban settings. This study is the first to compare NP workforce data across multiple Canadian jurisdictions simultaneously. Studies of this type are valuable tools for understanding the demographics, education, integration, and employment activities of NPs and can aid governments in addressing workforce planning.