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Rebuilding human resources for health: a case study from Liberia.

Varpilah ST, Safer M, Frenkel E, Baba D, Massaquoi M, Barrow G - Hum Resour Health (2011)

Bottom Line: While the nursing cadre numbers are strong and demonstrate significant improvement since the creation of the Emergency HR Plan, equitable distribution, retention and performance management continue to be challenges.This paper illustrates the process, successes, ongoing challenges and current strategies Liberia has used to increase and improve HRH since 2006, particularly the nursing workforce.The methods used here and lessons learned might be applied in other similar settings.

View Article: PubMed Central - HTML - PubMed

Affiliation: Ministry of Health and Social Welfare, Monrovia, Liberia. stvarpilah@yahoo.com.

ABSTRACT

Introduction: Following twenty years of economic and social growth, Liberia's fourteen-year civil war destroyed its health system, with most of the health workforce leaving the country. Following the inauguration of the Sirleaf administration in 2006, the Ministry of Health & Social Welfare (MOHSW) has focused on rebuilding, with an emphasis on increasing the size and capacity of its human resources for health (HRH). Given resource constraints and the high maternal and neonatal mortality rates, MOHSW concentrated on its largest cadre of health workers: nurses.

Case description: Based on results from a post-war rapid assessment of health workers, facilities and community access, MOHSW developed the Emergency Human Resources (HR) Plan for 2007-2011. MOHSW established a central HR Unit and county-level HR officers and prioritized nursing cadres in order to quickly increase workforce numbers, improve equitable distribution of workers and enhance performance. Strategies included increasing and standardizing salaries to attract workers and prevent outflow to the private sector; mobilizing donor funds to improve management capacity and fund incentive packages in order to retain staff in hard to reach areas; reopening training institutions and providing scholarships to increase the pool of available workers.

Discussion and evaluation: MOHSW has increased the total number of clinical health workers from 1396 in 1998 to 4653 in 2010, 3394 of which are nurses and midwives. From 2006 to 2010, the number of nurses has more than doubled. Certified midwives and nurse aides also increased by 28% and 31% respectively. In 2010, the percentage of the clinical workforce made up by nurses and nurse aides increased to 73%. While the nursing cadre numbers are strong and demonstrate significant improvement since the creation of the Emergency HR Plan, equitable distribution, retention and performance management continue to be challenges.

Conclusion: This paper illustrates the process, successes, ongoing challenges and current strategies Liberia has used to increase and improve HRH since 2006, particularly the nursing workforce. The methods used here and lessons learned might be applied in other similar settings.

No MeSH data available.


National optimal workforce needs by cadre (2010). Source: [18].
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Related In: Results  -  Collection

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Figure 1: National optimal workforce needs by cadre (2010). Source: [18].

Mentions: As of 2009, the census showed that the numbers of physicians, RNs and nurse aides surpassed the BPHS minimum requirements. Recognizing that the requirements were four years old and set with limited sector information, the MOHSW HR Unit, with Clinton Health Access Initiative (CHAI) support, conducted a workforce optimization study to review minimum staffing requirements and calculate optimal workforce needs. The workforce optimization analysis utilized a demand-based model, which calculated the optimal number of health workers needed by cadre at health facilities based on service utilization rates and workload, obtained from the Health Management Information System (HMIS) database and worker interviews. Findings showed that while BPHS staffing requirements correctly identified the need for nurse aides and dispensers, the need for CMs was overestimated, and the need for physicians, PAs and RNs significantly underestimated. To inform priority setting, the study also identified the relative need for each of these cadres. Figure 1 shows the national optimal workforce relative needs by cadre.


Rebuilding human resources for health: a case study from Liberia.

Varpilah ST, Safer M, Frenkel E, Baba D, Massaquoi M, Barrow G - Hum Resour Health (2011)

National optimal workforce needs by cadre (2010). Source: [18].
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3117767&req=5

Figure 1: National optimal workforce needs by cadre (2010). Source: [18].
Mentions: As of 2009, the census showed that the numbers of physicians, RNs and nurse aides surpassed the BPHS minimum requirements. Recognizing that the requirements were four years old and set with limited sector information, the MOHSW HR Unit, with Clinton Health Access Initiative (CHAI) support, conducted a workforce optimization study to review minimum staffing requirements and calculate optimal workforce needs. The workforce optimization analysis utilized a demand-based model, which calculated the optimal number of health workers needed by cadre at health facilities based on service utilization rates and workload, obtained from the Health Management Information System (HMIS) database and worker interviews. Findings showed that while BPHS staffing requirements correctly identified the need for nurse aides and dispensers, the need for CMs was overestimated, and the need for physicians, PAs and RNs significantly underestimated. To inform priority setting, the study also identified the relative need for each of these cadres. Figure 1 shows the national optimal workforce relative needs by cadre.

Bottom Line: While the nursing cadre numbers are strong and demonstrate significant improvement since the creation of the Emergency HR Plan, equitable distribution, retention and performance management continue to be challenges.This paper illustrates the process, successes, ongoing challenges and current strategies Liberia has used to increase and improve HRH since 2006, particularly the nursing workforce.The methods used here and lessons learned might be applied in other similar settings.

View Article: PubMed Central - HTML - PubMed

Affiliation: Ministry of Health and Social Welfare, Monrovia, Liberia. stvarpilah@yahoo.com.

ABSTRACT

Introduction: Following twenty years of economic and social growth, Liberia's fourteen-year civil war destroyed its health system, with most of the health workforce leaving the country. Following the inauguration of the Sirleaf administration in 2006, the Ministry of Health & Social Welfare (MOHSW) has focused on rebuilding, with an emphasis on increasing the size and capacity of its human resources for health (HRH). Given resource constraints and the high maternal and neonatal mortality rates, MOHSW concentrated on its largest cadre of health workers: nurses.

Case description: Based on results from a post-war rapid assessment of health workers, facilities and community access, MOHSW developed the Emergency Human Resources (HR) Plan for 2007-2011. MOHSW established a central HR Unit and county-level HR officers and prioritized nursing cadres in order to quickly increase workforce numbers, improve equitable distribution of workers and enhance performance. Strategies included increasing and standardizing salaries to attract workers and prevent outflow to the private sector; mobilizing donor funds to improve management capacity and fund incentive packages in order to retain staff in hard to reach areas; reopening training institutions and providing scholarships to increase the pool of available workers.

Discussion and evaluation: MOHSW has increased the total number of clinical health workers from 1396 in 1998 to 4653 in 2010, 3394 of which are nurses and midwives. From 2006 to 2010, the number of nurses has more than doubled. Certified midwives and nurse aides also increased by 28% and 31% respectively. In 2010, the percentage of the clinical workforce made up by nurses and nurse aides increased to 73%. While the nursing cadre numbers are strong and demonstrate significant improvement since the creation of the Emergency HR Plan, equitable distribution, retention and performance management continue to be challenges.

Conclusion: This paper illustrates the process, successes, ongoing challenges and current strategies Liberia has used to increase and improve HRH since 2006, particularly the nursing workforce. The methods used here and lessons learned might be applied in other similar settings.

No MeSH data available.