Legacy Series: Using Health Workforce Data to Improve Access to Services

The iHRIS software is now used in 20 countries to manage almost a million health worker records at a potential cost savings of over $275 million when compared to commercial software. A strong human resources information system (HRIS) helps health care leaders to quickly answer key policy questions affecting service delivery in areas related to workforce planning, education, deployment, management, and retention. However, health systems in most low- and middle-income countries have had poor data on their health workforce numbers, skills, and location, and, therefore, limited ability to address health workforce challenges. The Capacity Project worked with national stakeholders to develop and release the open source iHRIS software designed to capture and maintain high-quality information for health workforce planning and management. iHRIS has been developed into multiple applications to meet the needs of a variety of stakeholders and support health workers throughout their life cycle. These applications include iHRIS Manage, which tracks and manages health workers actively engaged in service delivery; iHRIS Qualify, which enables health professional councils and associations to register, license, and regulate their respective cadres; iHRIS Train, which supports tracking and management of preservice education pipelines and in-service training; iHRIS Plan, which informs workforce planning and provides predictive modeling, forecasting changes in the health workforce supply over time; and iHRIS Retain, which helps countries plan and cost rural health worker recruitment and retention interventions in alignment with the World Health Organization's rural retention guidelines. CapacityPlus emphasized open access to iHRIS through publishing the software, source code, and other resources online at www.ihris.org. These resources include the iHRIS Implementation Toolkit, which represents a strong example of open contributions to a global capacity-building product. Providing guidance and materials to assist in the implementation of all iHRIS software, the toolkit has received contributions of more than 100 resources from iHRIS users in 12 countries, all seeking to support others in the adoption and implementation of the software. As iHRIS implementations expanded and matured in countries supported by CapacityPlus, national and subnational HRH leaders and managers increasingly began using iHRIS data for decision-making to improve both the accessibility and quality of health services. In Uganda, the Ministry of Health used iHRIS data to successfully advocate for an investment of $20 million to fund recruitment and deployment of 7,200 health workers. The increased availability and more equitable distribution of health workers has likely contributed to Uganda's significant increases in selected HIV/AIDS, family planning, and maternal, newborn, and child health indicators. In Mali, the Ministry of Public Health piloted iHRIS Manage in Sikasso Region, with results showing that urban facilities had disproportionately more midwives than health centers in the rural areas where 63% of the population lives. Taking quick action, regional leaders implemented a rotation system, in which midwives work one week each month in a rural health center to mentor lower-level auxiliary midwives and provide access to long-acting reversible contraceptive methods. These services are critically important in a country with a fertility rate of 6.1 births per woman and 26% unmet need for contraceptives. In Ghana, the MOH, Ghana Health Service, and the Christian Health Association of Ghana led the rollout of iHRIS Manage, with support from CapacityPlus. More than 18,500 health worker records are captured in the system, which is being used to plan and adjust facility staffing levels to improve service delivery and to analyze data on issues such as retirement planning.