Showing Results in Health Workforce Strengthening

Opportunities to spend time with monitoring and evaluation (M&E) colleagues from other organizations are infrequent, yet they provide a valuable way to share knowledge and ideas. Recently, I attended a meeting of the USAID Bureau of Global Health Cooperating Agencies’ M&E Working Group. The meeting convened two USAID deputy assistant administrators, senior leadership from several Bureau of Global Health offices, and dozens of M&E staff from USAID-funded projects.

The meeting's objectives were to share updates on the Global Health Initiative (GHI) and the GHI’s best practices strategy (BEST) to discuss M&E technical issues. Not only was I impressed with the active participation of USAID leadership and their emphasis on the need for research and evaluation, but I was also interested to hear their views on the role of human resources for health (HRH) and M&E in implementing the GHI. Here’s what I took away from the day.

The practical value of information is only as good as its quality.
Under the GHI, the numbers, distribution, and quality of health workers have been identified as key measures of HRH results. However, not all countries have the resources, systems, or trained personnel to routinely collect accurate data. In order to produce reliable data that can be used for policy-making and planning, developing quality health information systems and building in-country M&E capacity is essential.

The argument for investing in HRH must be backed up by concrete evidence.
Bob Emery, director of the Health Systems Division, highlighted the GHI’s focus on producing and documenting results. This notion was echoed at the recent launch of IntraHealth International’s Global Policy Symposia series, where Nils Daulaire, director of the Department of Health and Human Services’ Office of Global Health Affairs, commented on the need to demonstrate HRH achievements in the short term while also pursuing strategies with long-term effects. Without an improvement in data availability and quality, the case for investing in HRH—or any facet of health—is severely weakened.

We can’t measure whether the GHI objectives have been achieved if we haven’t defined what they are.
The GHI asks implementing agencies to show progress in sustainability, integration, and country ownership, but has not provided operational definitions of these concepts. How do we know what constitutes success in operationalizing these principles?

In one technical presentation that described a pilot test of indicators to monitor family planning/HIV services, participants acknowledged the difficulty of measuring a concept (integration) for which there is not yet a shared definition. Moreover, if we are trying to measure outcomes for which data need to be derived from multiple sources (e.g., health systems strengthening), then as my CapacityPlus colleague Carl Leitner noted in his presentation, health information systems need to be interoperable, enabling information-sharing between different parts of a system. When this is not the case, it becomes even harder to measure such cross-cutting principles.

The recursive process
In the past decade, HRH has received increasing attention and funding. Correspondingly, attention and funding for the M&E of HRH must keep up with this trend. Demonstrating that HRH investments are worthwhile is akin to following a Möbius strip—we end up where we started. In other words, we must invest in HRH if we are to show that we should invest in HRH, but it is necessary if we are to continue advancing the field.

Photo courtesy of Crystal Ng