Developing Winning GF Proposals For HSS: Case Examples for Human Resource Strengthening

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• Developing Winning GF Proposals For HSS Case
  Examples for Human Resource Strengthening
• Regional RBM Workshop
• Global Fund Round 8
• Anne Martin-Staple PhD
• President and Chief EconomistHealth Strategies
  International LLC
• Anne.staple_at_hsinternational.org
• www.hsinternational.org

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Objectives

• To support and promote HSS proposals
• To support HSS needs assessments and gap analysis
• Illustrate levels of analysis needed for winning
  HSS proposals using HR as a case example
• Present illustrative tools for HR gap analysis
• Encourage countries to begin now to define HSS
  and HR strategy

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WHO building blocks for HSS

• Directly related to service delivery
• Human resources
• Health information systems
• Health products and technology
• Health finance
• Policy and strategic capacity

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HSS Winning Themes
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Winning Theme 1 Technically Sound HR Proposal

• Based on Comprehensive, detailed evidence
• The 1st imperative emergency national plans
  for the health workforce must combine credible
  technical input on HR issues within trepid and
  innovative strategies WHR 2006

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6-Steps to Technically Sound HR Need and Gap
Analysis
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STEP 1 Need AssessmentNational Perspective
of HR Situation
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Current Wage Bill

• Salary by Cadre
• Allowances
• Benefits
• Taxes

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Step 2 Current Malaria HR Situation

• Show evidence that
• There is a gap of trained staff for malaria
  control
• Gap threatens scale-up, outcomes and
  sustainability
• Malaria scale-up strains existing staff

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Determine HR Supply Malaria Control
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Case Example Zambia Rapid Quantification of HR
LOE for 3-Year Implementation

• Activity-based analysis of 3-Year Activity Plans
  for ITN, IRS and case management
• Expert focus groups/interviews
• Survey of NGOs engaged in malaria control to
  capture CHW LOE

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Public Health HR Target for Malaria
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CHW Targets for Malaria
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Defining HIV/AIDS HR Targets Malawi
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Define HR Costs for Malaria Control

• Current and Projected
• Salary by Cadre
• CHW
• Compensation
• Allowances
• Benefits

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STEP 3 Need Analysis QUANTIFYING THE HR CRISIS

• MoH HR Targets
• Malaria Scale-up HR Need
• -
• Current HR supply
• Health Sector and Malaria Control HR Shortfall

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Quantify HR Crisis
STAFF PER 100,000 POPULATION
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Human Resource Shortfall Zambia
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TRAINING SHORTFALLDefining Targets
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Step 4 Need Analysis Detailed Analysis of
Labor Market Issues

• Evidence of HR Shortfall Causes
• Inability to utilize existing labour supply?
• Lack of labour market supply?

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LABOUR MARKET ISSUES
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Poor Retention Push-Pull Factors

• Poor pay and benefits
• Poor working conditions
• Delayed payment
• Lack of incentive schemes/career development
• Personal security
• Poor supervision and management
• Poor living conditions housing
• Braindrain to other countries, private sector,
  NGOs

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RECRUITMENT

• LACK OF MOH CAPACITY
• LACK OF SUPPLY
• HIRING FREEZE

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Inadequate Trained Labor Supply

• Lack of training capacity to meet output
  requirements
• Lack of physical infra-structure
• Lack of tutors
• Recurrent costs

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Deployment

• Provide evidence of need for incentives or other
  strategies i.e. bonding enforcement
• 97 of RNs in urban areas
• 10 districts without a MOH doctor
• 6 districts have nursing vacancies over 70

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Step 5 Comprehensive Costed HR Solutions For
Malaria Scale-up
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Comprehensive Retention Strategies

• Working conditions
• Career development opportunities
• Supervision
• Student loan agreements
• Part-time work contracts
• Bonding and compulsory service schemes
• Service time bonuses
• Tax/fee from departing workers or country
• Return scheme for temporary return of emigrated
  professionals

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TRAINING SOLUTIONSDEFINING COST TO MEET TARGETS

• Capital costs for classrooms, dormitories, and
  labs
• Salary costs for newly hired tutors and staff
• Staff recruitment and training costs (overseas
  PhD programs)
• Increase in operating costs as enrolment expands

xx million estimated over 6 years
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Resource Envelop HR support for malaria scale-up
2006-08 (US)

• Government
• Civil Society
• World Bank m
• Bilaterals m
• MACEPA m
• Global Fund - m
• TOTAL RESOURCES for HR m
• Shortfall m

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Winning Theme

• Involve and empower key stakeholders and
  explain how they work together

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CROSS-CUTTING HR and Budgets

• HSS cross-cutting budgets should be separately
  identifiable (whether in disease or not)
• If a rapid HR analysis is carried out be sure to
  include concise assumptions in budget.
• A more complicated model can be provided as an
  attachment but still clearly explain in proposal

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Thank you
Dr. Anne Martin-Staple President and Chief
Economist Health Strategies International (anne.st
aple_at_hsinternational) www.hsinternational.org