FHI 360 Experiences with Strengthening Human Resources within the Health System

FHI 360 - The Science of Improving Lives

“Retired but Not Tired”, “Adherence Support Workers” or “Community-Based Distribution (CBD) of Injectables" are among the innovative and successful projects carried out by Alliance member FHI 360 as part of its work on strengthening human resources for health (HRH). In addition to family planning, reproductive health and HIV/AIDS, FHI 360's experience in HRH spans several different domains that affect human resource performance and address human resource shortages. Here is an overview of selected HRH activities recently conducted by FHI 360.


In Andhra Pradesh, India, FHI 360 led a DFID-funded consortium of technical partners that facilitated the Andhra Pradesh Health Sector Reform Project (APHSRP) along with the Ministry of Health. This technical consortium facilitated policies and memorandums of understanding that supported auditing and supportive supervision mechanisms to improve health worker performance at the facility level.


In Rwanda, FHI 360 piloted a shifting of HIV care tasks from physicians to nurses in 2005. Patient outcomes in our pilot program compared favorably with other ART cohorts in sub-Saharan Africa and with those from a recent evaluation of the national ART program in Rwanda. These findings suggest that nurses can effectively and safely prescribe ART when given adequate training, mentoring, and support.

In Zambia, FHI 360 reviewed the effectiveness of lay counsellors in addressing staff shortages and the provision of HIV counselling and testing services. These volunteers were trained using the standard national counselling and testing curriculum. Lay counselors were found to provide counselling and testing services of quality and relieve the workload of overstretched health care workers. The data review revealed lower error rates for lay counsellors, compared to health care workers, in completing the counselling and testing registers.

In Madagascar, FHI 360 worked to improve access to combined injectable contraceptive (injectables). Injectables have not been an option for African women lacking convenient access to health facilities, and since very few family planning programmes permit community-based distribution (CBD) of injectables by non-medically trained workers. This project proved to be useful in addressing a need of the population. Over 1500 women accepted injectables from CBD workers, reported to be very satisfied with the service and even encouraged friends to go for it. This programme was supported by the Ministry of Health and Family Planning (MOHFP) of Madagascar.


Worldwide, FHI 360 works with various cadres of community health workers to extend the reach of the health system to the community. In Tanzania, FIH 360's “Retired but Not Tired” program allows retired nurses and other health workers to return to work for limited hours each week if they desire, alleviating the burden on full-time health workers.

In Zambia, FHI 360 worked with “adherence support workers” in order to address staff shortages and improve adherence counseling for people taking antiretroviral therapy (ART). When evaluated, the quality of adherence counseling by ASWs was comparable to the conventional method of care. Loss to follow-up rates of new clients declined from 15% to 0% after the deployment of adherence support workers.

FHI 360's work demonstrates great commitment to strengthening the health workforce as an essential part of a development strategy targeted at effectively and sustainably improving the health of populations. The Alliance Communications will continue to work with FHI 360 to feature progress on specific programmes carried out in countries.