HRH exchangeCommunity of Practice

Summary of moderated online discussion on the

HRH toolkit and HRH policy impact assessment tool

20 June - 15 July 2011


Theme and objectives (page 2)

Summary of contributions (pages 3-4)

Conclusion and Way Forward (page 5)

List of suggested tools and resources(pages 6-7)

Detailed contributions(pages 8-20)

For more information on the HRH Exchange and a full list of previous moderated discussions, please visit the Global Health Workforce Alliance global web site at: and objectives of the sixth online community of practice moderated by the Global Health Workforce Alliance:

The purpose of this online discussion was to seek contributions from experts on the following two issues:

HRH Policy Impact Assessment Tool

The Alliance would like to facilitate the development of an HRH policy impact assessment tool. This will assist documentation and accountability efforts by providing a tool that countries can use to collect and analyse relevant data. The overall purpose of the tool is to help inform decisions in the context of scarce financial resources and also to demonstrate accountability for the resources already invested.

HRH Toolkit

Over the years, many tools have been developed by different agencies. The HRH Toolkit being proposed will help to bring together a minimum set of existing tools addressing various aspects of HRH from situation analysis, planning, implementation to monitoring and evaluation. The intention is to build on previous work commissioned by the Alliance through its technical working groups and task forces as well as through its members and partners.

Acknowledgement of contributions:

First of all we would like to most heartily thank all of you for your participation through the many excellent contributions, sharing of materials and experiences, as well as statements of interest on the discussion on the proposed development of a HRH policy impact assessment tool and HRH toolkit. We are now formally closing the discussion on the HRH Exchange on this topic. However, we remain open to receiving additional comments or suggestions which should be sent to George Pariyo on .

Summary of contributions:

Marco Gomes reminds of the critical importance of data and evidence for decision-making. He is optimistic that even though statistics on health workforce are generally scarce, diverse sources can be tapped in low and middle income countries such as population censuses and surveys, facility assessments and routine administrative records such as payroll, registration and licensure. He offers suggestions for some potentially useful tools (see full list below).

Catherine Sanga suggests to clarify the rationale, potential benefit and potential beneficiaries of the policy impact assessment tool. She recommends a survey of HRH managers to help identify their needs.

Eric Friedman (in an e-mail contribution) supports the development of a HRH policy impact assessment tool and HRH toolkit and offers suggestions to include a number of tools developed by the Health Workforce Advocacy initiative (HWAI) (included in the list below).

Tom Hall (in two separate e-mail contributions) informs of the work he and other colleagues conducted for WHO in the 1990s resulting into an HRH toolkit in 2000 comprising of tools covering HR planning, HR management and a range of other aspects of HRH. He has shared some extracts and brief overview of the previous work. He strongly supports the effort to develop an HRH toolkit as he states;

"I continue to believe that the toolkit concept is extremely important and it can bring a wide variety of materials to the attention of persons worldwide at no cost. The resources included in such a toolkit can be much more focused on the day-to-day needs of practitioners than are many of the articles that can be found in the medical literature. When online for easy download, they are much preferable to recommending monographs to busy planners, trainers and managers".

Elsheikh Badr welcomes the initiatives and informs of their on-going efforts in the Sudan to develop an HRH policy assessment and evaluation framework based on the policy triangle framework (Walt and Gilson, 1994). He stresses the need for user-friendly tools and writes; "In our experience, HRH managers and leaders do not often uptake the complex tools that link to an array of technical resources and technical papers"…"developing countries are desperately in search of a user-friendly effective tool on HRH projections…". He calls on the Global Health Workforce Alliance and WHO to "devote special attention to develop and pilot such a tool in order to help countries better develop their health workforce.."

Scott Loeliger enthusiastically supports and welcomes the concept of an HRH toolkit and would like to introduce such a resource to his family medicine residents under training.

Samantha Fox shares their experiences at the International Centre for Eye Health (London School of Hygiene and Tropical Medicine) in developing a tool to provide information on eye care workforce requirements and availability. She points out that their experience suggests that the kind of policy questions that require answering for a new strategic direction during planning are often of a broad nature at the country level and could be met using available data rather than detailed facility by facility counts of health workers which prove to be resource intensive. She urges that the toolkit should be flexible to more readily allow adaptation to particular situations. They (ICEH) are adapting the WHO-AIMS mental health tool for use for eye health, taking into account information on burden.

Fiona Walsh and Charmaine Pattinson provide details of their experiences in the collaboration between the Clinton Health Access Initiative (CHAI) and ministries of Health of a number of countries. They have developed the "workforce optimization model" to calculate demand for health workers, the "HRH pipeline model" to forecast health workforce supply, and the "national training operational planning tool" to estimate feasibility and costs of scaling up training. They suggest that an ideal HRH toolkit should enable ministries of Health to; a) establish the optimal workforce composition and size needed to meet the country’s demand for health services; b) set workforce targets that are realistic and achievable within a country’s financial context and that can help a country prioritize which targets to achieve in the short-term vs. medium-to long-term; c) identify the main drivers behind health worker shortages based on training enrollment, graduation rates, attrition rates, and public sector entry rates of graduates; d) determine the training, hiring, and attrition conditions under which the public sector can reach its HRH targets within the next ten years; e) determine the combined impact of health worker densities and coverage rates on morbidity and mortality, and what level of investment is required for each scenario investigated (i.e. what is the most effective and efficient skill mix of health workers to maximize the impact on health outcomes); f) identify the resources and actions needed in the short-term to achieve long-term staffing goals (i.e. number of additional tutors and classrooms needed to scale-up training institutions and ultimately increase the number of health graduates); and g) assess the feasibility and costs of implementing this intervention in order to provide the government with a fully costed plan. They suggest that, "the end goal of the HRH toolkit should be to provide HRH planners with the evidence needed to set realistic staffing targets and develop actionable strategic plans that can be implemented to effectively and efficiently scale up their health workforce".Arie Rotem informs of the Staff Projection Tool (SPT) that was designed to estimate the workforce required to deliver an agreed package of health services. It enables planners to determine the implications of different policy scenarios on the production, recruitment and deployment of health personnel, and can be applied at both national and sub-national levels such as province or district. The tool is being refined for wider distribution under contract with WHO/WPRO.

Conclusion and Way Forward

The foregoing discussion has shown that there is a wide interest and on-going efforts in various contexts to develop and/or use tools to better plan for and develop a country's health workforce. Contributors enthusiastically welcomed and endorsed the need for an HRH policy impact assessment tool and HRH toolkit, and many shared examples and/or references to their own materials and efforts in the same direction. There is a clear desire at the country level that the tools should be user-friendly and flexible, and as much as possible use available data rather than collection of detailed new data. Rather than each country "re-inventing the wheel" in addressing HRH problems or developing tools, a global sharing of experiences and materials already developed will go a long way to speed up the process particularly for those countries that are facing the most acute HRH shortages. A sharing of experiences and materials could help develop and improve available tools and speed up the processfor those countries that may not have the capacity and/or resources to develop their own tools from scratch. The Global Health Workforce Alliance will continue to work with its members, partners and country collaborators to collate materials and efforts so as to promote sharing and joint learning in this area. We are in the process of collating available tools and will be sharing drafts and seeking further collaboration going forward.

The following list of tools and resources were suggested or cited by contributors (NB: this list is not meant to be comprehensive or exhaustive):

HRH policy impact assessment tool

  • Incorporating the Right to Health into Health Workforce Plans: Key Considerations. (
  • Walt G, Gilson L. Reforming the health sector in developing countries: the central role of policy analysis. Health Policy and Planning. 1994;9:353–70.
  • WHO. WHO-AIMS Mental health systems in selected low- and middle-income countries: a WHO-AIMS cross-national analysis. [Online]. Geneva, WHO; 2009. Available from: [Accessed 05 August 2011].
  • Aaron Tjoa, Margaret Kapihya, Miriam Libetwa, Kate Schroder, Callie Scott, Joanne Lee, and Elizabeth McCarthy (2010). Meeting human resources for health staffing goals by 2018: a quantitative analysis of policy options in Zambia. BioMed Central Ltd. Hum Resour Health. 2010; 8: 15. Published online 2010 June 30. doi:10.1186/1478-4491-8-15

HRH toolkit

The WHO Service Availability Mapping tool

The Zambia Ministry of Health/JICA Health Facility Census Tool 2007.

The Assessment of Human Resources for Health by WHO

The Service Provision Assessment by Macro International

The PHRplus survey tool by Partners for Health Reformplus

The Facility Audit of Service Quality rapid monitoring tool by MEASURE Evaluation (help with source please?)

iHRIS Software Suite by Capacityplus including: iHRIS Quality, iHRIS Manage, iHRIS Plan, iHRIS Appliance

  • Incorporating the Right to Health into Health Workforce Plans: Key Considerations by Health Workforce Advocacy Initiative (HWAI) (
  • The Right to Health and Health Workforce Planning: A Guide for Government Officials, NGOs, Health Workers and Development Partners by Physicians for Human Rights ( (and also in French:
  • Guiding Principles on National Health Workforce Strategies by HWAI (English: (French: (Spanish:
  • Addressing the Health Workforce Crisis: A Toolkit for Health Professional Advocates by HWAI (
  • Human Resources for Health: A ToolKit for Planning, Training and Management, Toolkit Flyer, by Department of Organization of Health Services Delivery, World Health Organization (source: Tom Hall)
  • Fapohunda B, Fronczak N, Minichiello SN, Buckner B, Schenck-Yglesias C, Bates C Patil P. Use of facility-based assessments in health workforce analysis. In Dal Poz M, Gupta N, Quain E, & Soucat ALB. (eds.) Handbook on Monitoring and Evaluation of Human Resources for Health with special applications for low- and middle-income countries. [Online]. Geneva, WHO:2009. Available from: [Accessed 05 August 2011].
  • Bruckner TA, Scheffler,RM, Shen G, Yoon J, Chisholm D, Morris J, Fulton BD, Dal Poz MR, Saxena S. The mental health workforce gap in low- and middle-income countries: a needs-based approach. Bulletin of the World Health Organisation [Online] 2011; 89: 84–194. Available from: [Accessed 05 August 2011].
  • Aaron Tjoa, Margaret Kapihya, Miriam Libetwa, Joanne Lee, Charmaine Pattinson, Elizabeth McCarthy, and Kate Schroder (2010). Doubling the number of health graduates in Zambia: estimating feasibility and costs. BioMed Central Ltd. Hum Resour Health. 2010; 8: 22. Published online 2010 September 22. doi:10.1186/1478-4491-8-22.
  • S Tornorlah Varpilah, Meredith Safer, Erica Frenkel, Duza Baba, Moses Massaquoi, and Genevieve Barrow (2011). Rebuilding human resources for health: a case study from Liberia. BioMed Central Ltd. Hum Resour Health. 2011; 9: 11. Published online 2011 May 12. doi:10.1186/1478-4491-9-11.
  • WHO. Workload Indicators of Staffing Need.
  • Chanthakhath Paphassarang, Khampasong Theppanya, and Arie Rotem (2009).Improving availability and retention of health workers in remote and underserved areas: The Lao PDR experience. Paper presented at the Joint AAAH-WHO conference. "Getting committed health workers to the underserved areas: a challenge for the health systems" 23-25 November in Hanoi, Vietnam. Department of Organization and Personnel, Ministry of Health, Lao PDR.

The detailed contributions of online posted content follows below.


Launch of online discussion on the ‘HRH Policy Impact Assessment Tool and HRH Toolkit’: 20 - 30 June 2011

Dear HRH Exchange members,
Welcome to the Online discussion on the ‘HRH Policy Impact Assessment Tool' and 'HRH Toolkit’. Unlike previous fully moderated discussions, this is a semi-structured discussion. Therefore, in lieu of daily summaries we will provide a summary report of the main outcomes of the discussions at the end. In your contribution please attempt to offer answers or suggestions to any or all of the questions and areas provided. Below you will find a short introduction and questions. Brief background notes are provided.
1. Development of a Human Resources for Health (HRH) Policy Impact Assessment Tool
The Alliance, with support from the German Government, would like to facilitate the development of an HRH policy impact assessment tool. This will assist documentation and accountability efforts by providing a tool that countries can use to collect and eventually to analyse the relevant data as a periodic exercise to help inform programming and resource allocation decisions (see brief background note).
Questions for a semi-structured discussion
1.1. Which approach would you propose be followed in the development of an HRH policy impact assessment tool?
1.2. Are you familiar with or have you come across or used such a tool at the country level? If so, could you provide us references, copies or examples of such a tool? (NB: All sources will be properly acknowledged).
1.3. Which data variables and sources should, in your view, be included in trying to identify or document the impact investments in HRH have had or are likely to have on health outcomes and impact? Any suggestions for additional references?
2. Development of a Human Resources for Health (HRH) Toolkit
The Global Health Workforce Alliance (the Alliance), in exercise of its core functions of advocacy (A), brokering knowledge (B) and convening partnerships and stakeholders (C) has received a number of requests and expressions of interest by countries and other stakeholders, for user-friendly tools to address the Human Resources for Health (HRH) crisis. The Alliance is proposing a toolkit that will help to bring together a set of existing tools addressing various aspects of HRH from situation analysis, planning, implementation to M & E (see brief background note).
Questions for a semi-structured discussion
2.1. Which tools and/or materials available in the public domain have you found most relevant and useful for various aspects of country level HRH development? Of particular interest are the following areas:
2.1.1. Stakeholder analysis, political mapping, policy risk analysis
2.1.2. Situation analysis
2.1.3. HRH projections and planning
2.1.4. Implementation of HRH interventions and HR management
2.1.5. Monitoring and Evaluation Routine monitoring of HRH situation (e.g., minimum reporting using HMIS) Comprehensive HRH database development (including freeware electronic tools and others)
2.2. From your experience, which areas, if any, still have gaps in the current repertoire of tools? How would you suggest that these gaps be addressed?

posted 20 June 2011 by myselffromweb

Backgroundnotes - HRH policy impact assessment tool
Background notes - HRH toolkit


Marco Gomes

posted 27 June 2011 by Marco Gomesfromemail

Data and evidence are critical to inform decision making among countries, donors, MoH and other stakeholders among human resources for health policy and programme planning, management, monitoring and evaluation. Despite all the efforts made and evidence available, suggesting that human resources for health must be adequately funded and increased to achieving the Millennium Development Goals (MDGs), prevailing view that statistics on the health workforce are scarce, diverse sources that can potentially produce relevant information exist even in low and middle income countries – including population census and surveys, health facility assessments and routine administrative records (including records on public expenditure, staffing and payroll as well as professional training, registration and licensure).
In my research and experience in working with other initiatives in collecting and identifying relevant variables and possible data resources for of tools, the decision must be made whether to complement these resources with new data collection activities, such as specialized HRH assessment. When considering approaches to measuring a country’s health workforce at a given moment. It is crucial to distinguish whether the snapshot reflects workers employed at health facilities (differentiating between those on facility duty rosters versus those actually head-counted on the day of the assessment), person having been trained in a health-related field regardless of place of employment and/or persons having been trained in a health-related field regardless of current labour force status (including those who are unemployed or have left the labour force for personal reasons).
Drawing upon a combination of complementary data sources, both new and existing can results in reach and useful information for measuring and monitoring health workforce stock and flows, and the impact on health and health systems. For experience I would recommend review and assessment of the following tools used to meet a range of specific information needs on human resources in health systems:
· The WHO Service Availability Mapping tool, designed to conduct a complete enumeration of all private and public health facilities via the use of districts and health facility data collection modules. Availability and location of health workers and key domains of this instrument. {
· The JICA Health Facility Census, developed by the Japanese International Cooperation Agency’s which includes instruments for conducting a head count of all health workers present on the day of visit
· The Assessment of Human Resources for Health, developed by WHO, includes four instruments designed for collecting data at the national and institutional levels, as well as from a sample of health care providers. Domains include health workforce training, regulation, demographics, distribution, skill mix, remuneration and dual employment. [
· The Service Provision Assessment, developed by Marco International. This tool can be used to collect data on current workforce versus staffing norms by means of a sample survey of health facilities. [
· The PHRplus survey tool, developed by Partners for Health Reformplus, used to collect data on size, skills mix and distribution of HRH in the public health sector. This tool has the approach where it can be adapted to national contexts to address deficiencies in information that health managers needs for programme monitoring. [
· The Facility Audit of Service Quality rapid monitoring tool, developed by MEASURE Evaluation, intended to help district- and programme-level officials design and implement a tailored facility assessment. Measure Evaluation notes that this tool is not intended for use at the national level domains of health workforce information include staff present norms and staff qualifications.
· To this I would recommend a look at Capacitplus iHRIS Software Suite. Capacityplus develops free and Open Source core software solutions, each addressing a specific human resource for health. Some of the Open Source which the Centre for Health Policy and Innovation works with when working with health facilities include: iHRIS Quality, iHRIS Manage, iHRIS Plan. [iHRIS Appliance [
To research on papers on HRH data sets and identified variables used in HRH standardize data collection, and I found the following analysis very interesting: “data completeness is critical for producing meaning, functional reports that are used to inform decision-making. Review paper data collection forms to ensure that they match any electronic forms and database structures, Making sure that data collected are consistent across districts, facilities and cadress. Streamlining forms so data are collected only once from each respondent ( I believe that this statement make absolute sense in developing a routine monitoring systems with human resources.
Marco Gomes