Data-driven allocation of HRH for HIV Services in Nigeria

Touch Foundation was asked to support and apply the POA approach to identify the optimal quantity and mix of cadres to be assigned based on actual workload and budget available. The POA set up included re-running the POA tool for HIV services only, with 649 PEPFAR-supported sites across all of Nigeria included, totaling 914 Effective GON FTE working at those sites. Seven cadres and/or cadre groupings were selected: Case Manager, Clinical, Nursing, Laboratory, Pharmacy, Data Clerk, and Medical Records. COP20 targets for various HIV services were used to estimate workload at each site, and a COVID-19 scenario was generated to capture how different service delivery approaches during the pandemic would impact HRH needs. The analysis produced an HRH needs assessment, which revealed a country-wide shortage of 6,416 (88%) HRH in the 7 cadres, costing $17.5M to fulfill. With the available HRH budget of $9.9M, 4,207 recommended assignments were made. The POA report for each Implementing Partner (IP) provided information on how many staff and the appropriate mix of cadres should be assigned to each facility based on their budget. The HRH shortage problem was addressed by determining how many additional health workers, per cadre, each facility needed to address their workload, and what the most urgent health workers to be assigned across all facilities were. Prioritized assignment of the available HRH across country facilities was based on need, budget, and supply. Guidance for redistribution across facilities was also provided, taking into account budget limitations and health worker supply constraints. The HRH needs assessment was conducted using a client pathway approach, where activities performed by each health worker were identified, and the number of health workers needed was calculated by facility and cadre. The POA analysis prioritized the list of health workers, applying budget and HRH supply constraints, and produced a prioritized list of health workers by facility and cadre for each IP and for the entire country. The final output was a POA decision-making package for each Implementing Partner, which included an editable Excel report, serving as a decision-making tool for allocation and reallocation of staff. The report could recalculate assignment based on modified budget or re-assignment of cadres, and contained full PRI lists, budget, and cost data.