Building the Knowledge Base: Monitoring and Evaluation and the HRH Effort Index

Accurate and timely information for decision-making and advocacy is a key system component in strengthening human resources for health toward achieving the goals of AIDS-Free Generation, Ending Preventable Child and Maternal Deaths, and Family Planning 2020. However, indicators used to measure efforts and progress in HRH have been limited and often unreliable, especially in countries with weak or no monitoring and evaluation (M&E) plans and/or human resources information systems (HRIS). The skilled health professionals density ratio (SHPDR) and the health workers reach index are two indicators that have increasingly been used to measure progress in improving the health workforce. However, these indicators are limited by variable data quality and by the fact that they exclude certain cadres of health workers, such as auxiliary and community health workers. CapacityPlus helped to bridge these gaps by developing a more robust measurement approach to assessing the complex framework for HRH—the HRH Effort Index—and by increasing capacity for M&E of HRH at the country level through improved measurement approaches and M&E skills. CapacityPlus developed the HRH Indicator Compendium, which provides a summary of standardized indicators in the areas of global leadership; health workforce policy, planning, and management; health workforce development; and health workforce performance support. The Compendium details how the varied indicators (e.g., rates, ratios, and indices) can be calculated. To complement the Compendium, CapacityPlus developed M&E Guidelines for HRH, which address the need for a conceptual framework for any HRH intervention, guiding the reader through the domains of interest (e.g., from overarching policies to the health facility level) and the logical steps (from inputs and processes to outputs and outcomes) to ensure that a solid M&E plan is formulated (including indicators and data collection methods) to measure progress and results of HRH interventions. The project also published an eLearning course, An Introduction to Monitoring and Evaluation of Human Resources for Health, on the HRH Global Resource Center to provide stakeholders with the essentials on M&E of HRH and inform them about tools and resources to develop M&E systems and plans. To better inform HRH investments and support more equitable health systems, the project developed the HRH Effort Index, using the HRH Action Framework as a conceptual guide and inputs from an international advisory group (including USAID and WHO), reviews of the relevant literature, and interviews with HRH experts in Mali, Nigeria, Uganda, and the Dominican Republic. The Index guides key informants through a self-administered survey tool covering 50 items across seven HRH dimensions identified in the HRH Action Framework. CapacityPlus conducted several evaluations of innovative HRH investments that generated much-needed evidence. These used a variety of methods including a pre- and post-intervention design in the pilot of an mHealth family planning in-service training application among health workers in Senegal to foster retention of training content. The evaluation demonstrated improved knowledge of family planning side effects 10 months after the training. In Nigeria, the project obtained and analyzed existing data available from the community health and midwifery associations to assess the effectiveness of support to preservice education institutions and students in increasing the number of newly qualified health workers, and complemented these results with additional primary data collection at schools that received support, among key preservice education stakeholders involved in the processes, and with scholarship recipients. In Uganda, the project linked HRIS data with client record systems such as DHIS 2 to elucidate the association between increases in the health workforce and changes in service delivery.