Technical Expertise / Performance Support

The Capacity Project aimed to achieve the following results for performance support over the life of the Project:

1. Health worker job satisfaction and retention increased in intervention settings; lessons learned and approaches suggested for wider use
2. Provider productivity improved; approaches documented and disseminated
3. Supervision systems strengthened
4. Plan implementation skills of human resources for health (HRH) managers and practitioners enhanced.

The Project carried out a range of activities to increase knowledge about key factors affecting health worker productivity and retention, and assisted countries to design and test interventions to influence policies and improve service delivery. These ranged from identifying current best practices in retention to implementing work climate improvement and supportive supervision initiatives to conducting studies assessing health worker job satisfaction and reasons for leaving posts.

The most significant result of the Project’s work in productivity and retention was the design and implementation of useful, operational studies that can be replicated in other areas of a country or other countries. Supporting health worker performance with effective supervision was another key results area.

Lessons learned:

1. Stronger human resources management systems and better HR management will lead to improved work climate and more effective supervision, and this in turn can enhance health workers’ performance by encouraging motivation, productivity and retention.
2. Based on local conditions, countries should consider an appropriate mix of incentives that will be sustainable in the long term. Encouraging HRH managers to use simple survey methods and tools to solicit health worker input will help to determine the best incentive mix for a particular context.
3. Building a strong team and systems at all levels of health care delivery to lead HRH planning and management is one untapped practice that may yield good returns for addressing shortages and imbalances, including high turnover.
4. A workplace climate initiative that accounts for a skills update in management practices combined with action planning, supportive supervision and infrastructure improvement has a good chance for success, up to the service delivery level.
5. Health workers are not necessarily looking for costly incentives; they see value in taking smaller actions to improve their workplace or their living conditions (especially if placed in a rural, remote area).
6. Districts that take the initiative to include HRH interventions will more likely take actions to improve recruitment, productivity and the climate in the workplace.
7. Selecting only one service delivery or management issue helps to focus performance support efforts.
8. Gender issues often play a key role in retention and productivity of health workers.

Learn more about the Project’s performance support results.

Related resources:

• Alleviating the Burden of Responsibility: Report on a Study of Men as Providers of Community-Based HIV/AIDS Care and Support in Lesotho
• Assessment of the Additional Duty Hours Allowance (ADHA) Scheme
• Beyond the Visiting Supervisor
• Bridging the Gaps: Improving Decentralized HIV Services in Panama
• From Nightmare to Awakening: Performance Improvement for Health Management in Uganda
• Guidelines for Occupational Safety and Health, Including HIV in the Health Services Sector
• Human Resources Management in the Health Sector
• Health Worker Retention and Performance Initiatives: Making Better Strategic Choices
• Implementation of Performance Support Approaches in Central America and Uganda
• Increasing the Motivation of Health Care Workers
• It Takes a Workforce: Improving Global Health Services
• The Productivity Challenge: Developing Approaches to Improve Health Care Worker Efficiency
• Promising Practices
• Retention: Health Workforce Issues and Response Actions in Low-Resource Settings
• Retention of Health Care Workers in Low-Resource Settings
• Supporting Health Worker Performance with Effective Supervision
• Strengthening Human Resources Management: Knowledge, Skills and Leadership
• Teaming Up in Tanzania: Supporting the National Response to HIV
• Uganda Health Workforce Study: Satisfaction and Intent to Stay Among Current Health Workers
• “What about the Health Workers?”: Improving the Work Climate at Rural Facilities in Kenya
• Worker Retention in Human Resources for Health: Catalyzing and Tracking Change
• “Yielding Very Positive Results”: Improving Decentralized HIV Services in Costa Rica
• Zanzibar Health Care Worker Productivity Study: Preliminary Study Findings

See other areas in Technical Expertise : Workforce Planning and Leadership; Workforce Development; Knowledge Management