Health workforce strategies during COVID-19 response: insights from 15 countries in the WHO Africa Region.

INTRODUCTION: The COVID-19 pandemic unveiled huge challenges in health workforce governance in the context of public health emergencies in Africa. Several countries applied several measures to ensure access to qualified and skilled health workers to respond to the pandemic and provide essential health services. However, there has been limited documentation of these measures. This study was undertaken to examine the health workforce governance strategies applied by 15 countries in the World Health Organization (WHO) Africa Region in responding to the COVID-19 pandemic. METHODS: We extracted data from country case studies developed from national policy documents, reports and grey literature obtained from the Ministries of Health and other service delivery agencies. This study was conducted from October 2020 to January 2021 in 15 countries - Angola, Burkina Faso, Chad, Eswatini, Ghana, Guinea, Guinea Bissau, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal and Togo. RESULTS: All 15 countries had national multi-sectoral bodies to manage the COVID-19 response and a costed national COVID-19 response plan. All the countries also reflected human resources for health (HRH) activities along the different response pillars. These activities included training for health workers, and budget for the recruitment or mobilization of additional health workers to support the response, and for provision of financial and non-financial incentives for health workers. Nine countries recruited additional 35,812 health workers either on a permanent or temporary basis to respond to the COVID-19 with an abridged process of recruitment implemented to ensure needed health workers are in place on time. Six countries redeployed 3671 health workers to respond to the COVID-19. The redeployment of existing health workers was reported to have impacted negatively on essential health service provision. CONCLUSION: Strengthening multi-sector engagement in the development of public health emergency plans is critical as this promotes the development of holistic interventions needed to improve health workforce availability, retention, incentivization, and coordination. It also ensures optimized utilization based on competencies, especially for the existing health workers.

Workloads and activity standards for integrated health service delivery: insights from 12 countries in the WHO African region.

Over the past decade, many African countries have made progress not only in recruiting more health workers but also in rationalising their distribution and establishing evidence-based staffing norms and standards. Still, staffing of health facilities remains inadequate, unrelated to needs and the actual workloads of health facilities. Several countries in Africa applied the workload indicators of staffing need (WISN) method to address these issues. The WISN method is a facility and cadre-oriented human resource planning and management tool that enables health managers to determine the appropriate number of health workers required to deliver quality health services based on workload. In this paper, we synthesised and presented the workload components and activity standards of the health service activities for general medical practitioners, nurses and midwives in primary healthcare settings based on WISN studies conducted in 12 African countries. The workload components and activity standards were synthesised based on the time taken for each health service activity, with the minimum and maximum unit of time and the mean and median of the number of observations established. For general medical practitioners, minimal variations in the country estimations for discharging patients, referrals and emergency management presented large variations in recorded admissions, minor operations and ward rounds. The variations in service standards for nurses were minimal for 8 of 11 activities while the time spent on counselling, patient referral activities, review consultation varied greatly. For the midwives, the mean values and the median values for 10 of 14 activities were similar for the countries with wide variations observed for admission for pregnant mothers, monitoring of labour, family planning (insertion), postnatal care, normal delivery and immediate postnatal care. We also shared experiences in workload component and activity standard setting processes and considerations for practice. The findings of this synthesis are helpful to countries in defining health service activities and service standards for general medical practitioners, nurses and midwives in the primary level of care, which is relevant in essential service package delivery towards improved access to quality health services.

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.