The world spends billions of dollars each year developing drugs, vaccines, and other lifesaving interventions to help low-income countries. However, every dollar spent is wasted if there is no health worker to provide these essential health services to patients. The critical shortage of health workers is astonishing. More than four million health workers are needed globally, more than half of which are doctors, nurses, and midwives. The largest shortages are in countries with the highest levels of preventable mortality. Immediate action is needed to resolve this accelerating global crisis.
CHAI's vision is to help governments transform their national human resources capacity so more patients can receive appropriate care and treatment from a qualified health worker. Throughout all their interventions, CHAI works hand-in-hand with the highest level of government to ensure that all efforts are sustainable, aligned with the government’s priorities, and tailored to each country’s particular challenges. By embracing a unique approach, CHAI first partners with the government to understand the root of the local HRH crisis. This helps focus their interventions and prioritize government financial resources more effectively. For example, the Zambian government and its partners spent a great deal of money countering “brain drain” even though CHAI found that the real problem was the insufficient number of new health workers being trained.
Second, CHAI works to strengthen each component of the healthcare worker pipeline: training, hiring and deployment, productivity, and attrition. This creates a comprehensive portfolio of interventions that delivers both immediate positive effects and medium- to long-term results.
Third, CHAI prioritizes practical interventions that governments and organizations can implement under existing systems to create permanent solutions. This novel approach has helped Zambia train, graduate, and deploy more than 3,200 healthcare workers who can manage more than one million patient cases per year. In just three years, CHAI has helped the Zambian Ministry of Health (MOH) double the growth rate of its workforce, and mobilize more than $16 million for national HRH priorities, leveraging their program budget by more than three times. CHAI has helped contribute almost 60 percent of the MOH workforce increase since 2008. CHAI works with governments to pursue the following three goals:
1) Increase the Number of Qualified Health Workers
By examining how health workers are produced on a national scale, for example, CHAI quantifies the cost to dramatically expand the number of workers trained, identifies novel approaches to accelerate training, and develops innovative strategies to train more workers with existing resources. They then work with the government to set bold targets and identify the practical steps for each intervention necessary to achieve these results. For example, CHAI helped the Zambian MOH develop a five-year plan to double the number of graduates at each of Zambia’s 39 training institutions. In parallel, CHAI helped implement a new fast-track program that halves the training time for midwives and nurse tutors.
2) Optimize the Distribution of Healthcare Workers
CHAI uses a data-driven approach to ensure that the distribution of health workers matches patient needs on the ground, which has been a major problem. CHAI accelerates the speed and equity with which new graduates are hired and deployed by implementing new recruitment strategies. They also build management capacity in governments to make more accurate and timely decisions for health worker deployment.
In Zambia, CHAI helped the MOH develop the country’s first formal health graduate recruitment and deployment process. Using data from the Ministry’s payroll and information systems, CHAI worked with the Ministry to create a deployment system that allows them to make real-time hiring decisions that optimize the deployment of health workers.
3) Maximize Health Workers’ Productivity
In resource-limited settings, CHAI introduces new strategies that allow highly-trained health workers to see more patients while other professionals can provide community level health services. Such innovative strategies have included: reforming the national nurse prescription policy, designing and implementing that national training of community healthcare workers, and strengthening the management skills of hospital administrators.
In partnership with Zambia’s MOH and the UK’s Department for International Development, CHAI is creating and rolling out a pilot program that will recruit, train, and deploy 330 community health workers across 48 districts through 2013. The goal is to produce more than 5,000 community health workers within five years, a 33 percent increase in the overall health workforce.
Building on Success
CHAI’s Human Resources for Health initiative has helped governments transform their health systems to decrease the massive shortage of qualified health workers. With additional funding, their holistic, innovative model can be taken to scale in many more countries where there is an urgent need.