Highlights of Results

Building Country Capacity in Monitoring and Evaluation
CapacityPlus’s M&E tools have been accessed by and disseminated to a wide range of users around the world. For example, the interactive online version of the HRH Indicator Compendium has been visited 14,794 times (an average rate of 308 times per month) and the PDF downloaded 3,942 times since the tool’s launch in June 2011.
 
Similarly, in the four months after the release of the HRH M&E eLearning course, the number of users grew more than 100 times, after which it continued to grow at a slower pace of about 20 users per month, with users coming from 116 countries. As of June 2015, the course had been visited by 1,303 users, with 158 certificates issued.

Applying the HRH Effort Index
The pilot test of the Index in Kenya and Nigeria in May-June 2014 included 49 HRH and health systems experts from ministries, professional councils, training institutions, NGOs and FBOs. This initial application resulted in differences in total scoring between the two countries (Kenya= 5.7 and Nigeria= 4.2) as well as variations in scoring by individual dimensions. The project subsequently applied the finalized HRH Effort Index in four countries: Burkina Faso, the Dominican Republic (nationally and in three sub-national regions), Mali, and Ghana, among 19,16, 27 and 20 respondents, respectively. Respondents came from government, FBOs, multilateral and bilateral organizations, NGOs, professional associations and councils, health facilities, and academic institutions.
 
While all countries consistently scored in the mid-range across the various criteria related to national HRH efforts, the lowest scores were given to the “Recruitment, Distribution and Retention” dimension, followed by financing of HRH (which was also consistent with the pilot test results in Kenya and Nigeria). When looking deeper into the items scored in these dimensions, the two most critical were the lack of an effective distribution strategy for human resources serving rural and remote populations and insufficient efforts on incentives to encourage retention of workers, especially in rural areas. In the finance dimension, insufficient funding for HRH from domestic budgets, to support tuition to students or to produce adequate numbers of health workers, also received lower scores. More refined analyses can be made within and across countries to understand these differences better.

In Mali, CapacityPlus convened a workshop in mid-2015 to disseminate the findings from the individual scoring and ask high-level technical experts and members of the HRH stakeholder leadership group to jointly re-evaluate and reach a consensus score for each of the individual elements within each domain of the survey tool. The 43 experts collectively scored many elements similarly or less favorably than the average of the individual application. More importantly, the exercise led to in-depth discussions about strengths and weaknesses in Mali’s multisectorial efforts to improve HRH and participants proposed recommendations across all the domains—such as discussing how the government can better control quality at private health professional educational institutions, reduce ghost workers, and better apply the national career plan to improve health worker retention in difficult areas. Participants appreciated the rapid assessment nature of the exercise and suggested that the HRH Directorate at the Mali Ministry of Public Health and Hygiene and the stakeholder leadership group use the findings in their evaluation of the Mali 2009–2015 HRH strategic plan and incorporate the emerging recommendations into the next strategic planning cycle.