Executive Summary

Background

As a key contribution toward increasing human capacity in national health systems, the Capacity Project is hosting a series of Human Resources for Health (HRH) Action Workshops. The initial workshop—held in Johannesburg in partnership with the United Nations Development Programme/Southern Africa Capacity Initiative (UNDP/SACI)—facilitated the exchange of knowledge and best practices in planning, developing and supporting the health workforce.

The Joint Learning Initiative (JLI) meetings in Abuja (December 2004) and Oslo (February 2005) as well as other meetings in South Africa (May 2005) and Brazzaville (July 2005) have focused global attention on critical HRH issues. While these meetings and subsequent reports have provided much needed high-level support and calls for action to address the HRH crisis, the Capacity Project’s HRH Action Workshop series is intended to focus on specific operational experiences—what is being done in countries, what is working and what is not.

Workshop Description

The first HRH Action Workshop had four primary objectives:

Promote a shared HRH vision across countries in order to facilitate collaboration and illuminate an inspirational better future toward which we are all working
Expand the HRH knowledge base by creating opportunities for participants to share knowledge about HRH issues and their potential solutions
Help develop a critical mass of HRH advocates and problem solvers that will accelerate the application of appropriate HRH practices and tools in their specific settings
Generate action plans for the implementation of new HRH practices and tools after the workshop.

Participants: The three and one-half day workshop brought together 38 HRH leaders from 11 countries (Kenya, Lesotho, Malawi, Namibia, Rwanda, Sudan, South Africa, Swaziland, Tanzania, Uganda and Zambia). Almost all of the participants are senior HR directors or practitioners working at the operational level within the Ministry of Health in their respective countries. Two representatives from faith-based organizations also attended. The Capacity Project organizers took great care to identify two to four optimal participants from each country. This was achieved through consultation with Capacity Project field staff, USAID Missions and Project and global partners. These national colleagues worked together during the workshop, shared their experiences and identified how new information and ideas would be applied after they returned home.

Methodology and agenda: To promote south-to-south dialogue among the participants—a key aim of the workshop—we used a highly dedicated participatory approach. This approach is based on the fundamental assumption that everyone can contribute and that knowledge is distributed among participants and workshop staff. We designed the workshop to facilitate knowledge sharing across countries through carefully constructed discussions during which participants addressed key topics and facilitators made appropriate inputs to build on the topics as they were discussed. All participants learned and contributed, forming general or issue-based inter-country networks and paving the way for post-workshop follow-up cooperation. Using this methodology, the group focused in-depth on the major HRH challenges each country is facing, solutions being tried at the country level and possible directions for the future.

The agenda had six major components:

After an introductory session, workshop staff focused on setting the context to achieve a shared understanding of the HRH crisis at the country level. Participants addressed these questions: What do you see as HRH progress at the country level where you work? What are the obstacles or challenges you see? What do you think is an area of HRH interest that should get more attention in the future?
Two sets of substantive in-depth working group discussions covered the following "hot topics": human resources management; retention policies and practices; health care worker productivity; performance management; performance improvement; recruitment, deployment and hiring practices; workforce assessment; and HR strategic planning. Participants had identified these as key topics in a pre-workshop survey (results available on request).
At designated times interspersed during the workshop, country groups met to share information and conclusions from the day’s activities and working group discussions and talk over any emerging implications for HRH in their country. This helped participants begin to think about possible actions to be discussed on the last afternoon.
Specific country case examples (e.g., Namibia, Malawi) highlighted approaches to HR issues that have generated much interest in the region.
During a consultation in December 2005, global partners reached agreement on an HRH Framework that will be included in the next World Health Report. Participants had the opportunity to react to the framework and make suggestions for its further development.
Country groups developed HRH action plans during the afternoon of the last day. These plans identify priority areas for work, some next steps, projected dates, technical assistance needed and point persons. The action plans were shared with Capacity Project staff and in some instances may serve as the platform for future country-level technical support from the Project depending on resource availability.

Initial Workshop Outcomes

The strategic participant invitation process and a meeting design that capitalized on having the right people in the room resulted in an extraordinarily successful workshop. In an evaluation, one participant wrote: "What was best was the rich, rich, rich environment created by virtue of who was here and how the workshop was facilitated. The knowledge and experience was phenomenal."

An unusually intense and effective depth and level of discussion characterized the plenary and, especially, the working groups. Because country level participants had a professional level and technical language in common and chose which topics to work on, the discussions were driven by shared concerns and questions and quickly got to the point. Little time was wasted in needing to define terms or create understanding about HRH topics or issues. Workshop staff facilitated the working groups effectively and added their own expertise into discussions in a targeted manner. The following initial outcomes resulted from the workshop:

A summary from the first plenary discussion highlights key elements of the HRH context in the participating east and southern African countries. This includes examples of progress (e.g., putting HRH on the national agenda, advancements in HR information systems), a variety of challenges (e.g., problems in HR strategic plan implementation, retention) and areas to be addressed in the future (e.g., looking at productivity as a tool, focusing on plan implementation, mentoring to make decentralization work).
Short working group reports were produced on the eight "hot topics" described above. Using a bulleted format, the reports spell out issues being faced in and across countries, approaches that are being tried, what appears to be working and what does not. The reports constitute a resource for understanding the current "state of play" regarding key HRH issues in the region. They also will provide guidance for those in Africa who wish to continue to network and learn across countries and for those internationally who are looking for specific actions that could be supported by donors or technical cooperation.
Each country group developed an action plan. Workshop organizers intend to share them among all participants so they are aware of one another’s plans. In some instances, inter-country networks are working on the same topics. The intent is to continue sharing knowledge about approaches being tried and results. It is important to note that the process of producing the plan is as valuable as the plan itself, as it proved to be a time when participants from each country could work together in a summative activity to choose, from the rich discussions and shared lessons, which approaches are most relevant for their particular context. While the plans themselves will be helpful, they will undoubtedly change with appropriate input and discussions in-country. We hope to learn of these revisions and support country-level progress in suitable ways.
The commitment exists to maintain the positive network that emerged as a result of the workshop. Comments from the evaluations describe how important this sort of inter-country networking is. One participant put it this way: "The networking was not just valuable, it was invaluable." Another wrote, "The rich networking exchange between a diverse group of HRH country leaders, HRH experts and donors was strategic." The Capacity Project will continue to share HRH knowledge and results with participants and plans to survey participants after four months to check on action plan implementation progress and to see what further support would help. Participants recommended that we consider inviting one person from each of the country teams to the next HRH Action Workshop, thereby continuing and expanding the HRH practitioner networks in sub-Saharan Africa.
The evaluations were extremely positive. Participants reported that the workshop objectives were generally achieved, and they provided many helpful qualitative statements to support positive ratings. There were also several helpful suggestions for future workshops.

The products described in the first three bullets above are available on the HRH Action Workshop CD, and can be found as links contained in the workshop Agenda.