Tracking and Counting 140,000 New Health Workers

The PEPFAR Monitoring and Evaluation and Human Resources for Health Technical Working Groups asked CapacityPlus to develop tools and guidance to support country team efforts in tracking and counting the new health workers being trained with PEPFAR support.

As part of its reauthorization, PEPFAR now includes an indicator that mandates its contribution to addressing the health workforce crisis. The legislation states that PEPFAR will “…help partner countries to train and support retention of health care professionals and paraprofessionals, with the target of training and retaining at least 140,000 new health [workers].”

Conducting interviews
Dykki Settle and I began this work by conducting telephone interviews with 13 PEPFAR country teams to determine what activities were underway to increase health worker production, and what activities were being counted toward the 140,000. We then visited Tanzania to further explore these trends. After analyzing all of these data, one main ground truth emerged—it takes a systems approach to produce health workers.

A systems approach
The majority of contributions that PEPFAR teams are counting are either tuition support or direct training. This type of support is easily measurable: one tuition paid = one new health worker.

However, there is quite a bit of work being done that supports production that is not as easily measured, but without which students would not be able to enroll, graduate, and subsequently enter the health workforce.

Sustainably increasing the number of health workers completing preservice education is dependent on a combination of factors. Some predominant examples that were mentioned time and again are:

• Curriculum development
• Infrastructure improvements
• Faculty support
• Practica/internship support
• Materials and equipment.

This combined approach creates a greater likelihood that the system will be able to produce more health workers now and in the future. Simply increasing enrollment through tuition support, for example, will not be successful unless the students also have access to qualified faculty, books, equipment, classrooms, dormitories, running water, etc.

Empty classroom, crowded dormitory
Investments need to be made to ensure that the system is being addressed holistically. During one interview, a story was shared in which a government invested money to build new classroom buildings; however, there was no money left to fill it with desks and chairs and other necessary equipment, so it remains empty.

In another story shared with us, six students had to share three beds in a room intended to sleep two because the dormitory facilities were not adequate.

Investing in these systems approaches to health worker production will go a long way toward helping PEPFAR achieve this important target.

Photo courtesy of Dana Singleton