Using Evidence for Human Resources for Health Decision-Making: An Example from Uganda on Health Workforce Recruitment and Retention

This 6-page technical brief from CapacityPLus discusses how countries can make informed, evidence-based policy decisions to strengthen health care workforce recruitment and retention. Based on a literature review and the authors' experience in Uganda, the brief outlines how developing and sharing evidence "can build interest, momentum, and political will to make policy decisions..." The brief outlines a process that includes generating data, designing approaches and communications for different kinds of stakeholders, and maintaining momentum to move from evidence to action.

Six recommendations are offered:

• "Ensure that evidence generation informs and drives a country-owned mandate.
• Assess the costs of implementing the evidence-based policy intervention.
• Involve relevant stakeholders, including technical experts and those with decision-making authority, in evidence dissemination and review.
• Once agreement on the need for policy change has been reached, maximize momentum so that evidence is converted into action.
• Ensure that an accountable stakeholder leadership group oversees a defined process for bringing an evidence-based policy decision to action.
• Mitigate the effects of stakeholder turnover."

The brief outlines how evidence can be gathered and information communicated among stakeholders to inform policy decisions. The evidence being generated must be responsive to and aligned with the needs of national or local priorities, as well as relevant for both public and private entities. In Uganda, the Rapid Retention Survey Toolkit was used to inform readers how to motivate health workers to accept and continue in job posts in rural and remote areas. The findings suggested combinations of incentives and interventions that would help to attract and retain health workers, a key challenge for the healthcare system. These interventions are then costed to assess the budget implications, which in Uganda was assisted by using the open source tool iHRIS Retain.

The brief outlines how various proposed strategies need to be disseminated, reviewed, and debated by various stakeholders, and communications designed for these diverse decision-makers accordingly. "The key stakeholders critical to policy changes often have differing perspectives and mandates, meaning that data review and related advocacy messages must be appropriate for each context." For example, Ministry of Health officials may have specific priorities, technical knowledge, and spheres of influence within the health sector, while members of a parliamentary body "must consider issues across all sectors, may not have a specific technical background, and likely face different political pressures." By designing messages specifically for these different groups, "there may be a better chance to identify champions who are compelled by the evidence to advocate for HRH [human resources for health] policy change."

As agreement is reached on a policy issue, it is then vital to continue with the momentum and move swiftly towards action, before any shift in commitment can take place. A multi-sectoral stakeholder leadership group can play a critical role in moving this action forward, taking stock of the political landscape, and establishing and monitoring goals, targets, and indicators. According to the brief, a factor to consider is how to cope with stakeholder turnover. "The loss of continuity and institutional memory resulting from turnover of key staff, as well as the frequent changeover of health sector management positions and political appointees, can disrupt the ongoing discussions that are necessary for a policy's eventual implementation." To maintain institutional memory, it is important to document issues, meetings, and discussions as appropriate, as well as make the responsibilities and accountability measures for actions official through the stakeholder leadership group's bylaws.

The brief concludes that, "With planning and forethought, it is possible to ensure that stakeholders use available evidence when making policies and decisions intended to improve HRH systems in general and health workforce recruitment and retention in particular. As the Uganda example illustrates, these steps can help build interest, momentum, and political will to make policy decisions for retention strategies to strengthen the health workforce and improve access to high-quality health care for the population."