Human resources improvement collaboration in Niger’s Tahoua Region
Author: United States Agency for International Development (USAID)
Country: Niger
Challenges
In Niger, the Tahoua district’s public health system was fraught with human resource management problems. This included poor training of health workers, a lack of clarity on job tasks, the lack of performance evaluations, frequent staff movements, heavy work burdens and insufficient supervision. In addition, according to 2008 data compiled by Niger’s Ministry of Health (MOH), Tahoua’s total ratio of doctors to patients was 1 per 100,000, nurses to patients was 1 per 8,000, and there was 1 midwife per 9,000 women of child-bearing age. The problem was greatest in rural areas, accounting for more than 80 percent of the Tahouan population.
Policy description
Niger’s MoH sought support from the United States Agency for International Development (USAID) to conduct an HR Improvement Collaboration in the Tahoua region. This essentially involved bringing together health workers from all system levels – ministry, health facilities and community—to outline objectives, define health worker roles, and implement tasks detailed in a change package.
The priorities in the change package included increasing health workers’ engagement, their productivity and patients’ quality of care. The collaboration is being implemented in 15 health facilities (seven district hospitals, six primary care centers, and two referral maternity centers and hospitals) through 26 Quality Improvement teams.
The Niger HR Collaboration’s Change Package outlined seven actions to increase health worker efficiency and effectiveness: 1) detailing clear expectations and goals; 2) conducting competency development; 3) relaying frequent feedback; 4) providing a fair evaluation; 5) giving reward and consequences; 6) offering opportunities for professional advancement; and 7) ensuring a safe and adequate working environment.
The collaboration approach has been unique in that it combines HR functions with targeting clinical indicators, allowing health workers to understand how both are linked. The collaboration also emphasizes simple, efficient tasks to encourage facilities’ health workers to prioritize roles and responsibilities necessary to improve patients’ quality of care. Such tasks include workers’ assessing their own duties and how they could be conducted more effectively, holding regular meetings with staff to evaluate work and provide feedback, and celebrating and rewarding goals when they are met.
Team-based performance management is at the centre of the collaboration’s approach. It also emphasizes capacity building of local management systems to ensure sustainability.
Outcomes
Even though all components of the change package have not been fully rolled out yet (some will be continued into 2011), initial results seem very encouraging. A greater degree of clarity of specific work-related goals has been reported, as well as greater work satisfaction, which has also translated into lower waiting times for patients. A clearer understanding of duties expected to be performed has increased staff concentration and prioritization. In July 2010, the MOH invited representatives from Tahoua’s quality improvement teams to present the collaboration’s results to MOH officials working nationwide, following which the MOH adopted a national resolution to integrate the HR collaboration’s improvement strategies into the upcoming five-year national health plan.
Conclusions
The collaboration has demonstrated the importance of ensuring health workers’ satisfaction and motivation to achieving project goals. It has underscored the importance of clearly defining workers’ tasks as a vital first step in this direction. The government’s positive reception of the collaboration’s efforts is encouraging as this could help extend the benefits of this approach beyond the Tahoua region.