Innovations for HR challenges in Resource Limited Settings:

Lessons from a rural HIV/AIDS program in Mid western Uganda

Dr Richard MwesigwaInfectious Diseases Institute (IDI)-Uganda

19th April 2012

Background

Kampala

Expanded Kibaale Kiboga Project

• Capacity building HIV/AIDS project

• Focusing on Health systems strengthening

• Implemented in Mid western Uganda.

HR for Health Situation

• Average Health Worker : population ratio– Medical doctors 1:8,373 ; Nurses 1:1,212

• 70% doctors serve 12% of population

• EKKP- Staffing level 47% of MOH standard

• Low salaries (Doctors <280USD/month)

• Lack of social amenities

Realities on ground

Capacity pyramid

Skills

Staff

Structures

Tools

Facilities

Systems Roles

Cognisance of local context: Policies, trust

Default IDI model for capacity Building

requires

Enables effective

use of

*Potter C and Brough R

Capacity pyramid II

Local context: Culture, Policies, Ownership

Skills

Staff

Structures

Tools

Facilities

Systems Roles

Time to implement change

Easier

Harder

Local context interventions

• District/HW involvement for ownership

• Support for comprehensive HR planning and management

• Better advocacy facilitated by understanding of HR needs

• Stakeholders meetings for coordination

Structures, systems and roles• Integration in existing structures

• Task shifting

• Helping hands (Volunteers, PHA Network, Interns)

• HR boosting (Support recruitment of Critical staff)

• Camping strategy & Integrated Static Outreaches (ISOs)

Staff

• Motivation to enhance commitment

– Facilitation (airtime, motorcycles)

– Recognition (frontline- hero programme & Reward for performance)

– Support for career development

Facilities (Working environment)

• Cleaning and

re-arrangement

• Remodelling/ Renovations

Imparting Skills

• Training focuses on teams and not individuals

• Mentorship using Short Term Technical Assistance Teams (STTATs)

• IDI/MOH have supported training of District based trainers

Provision of Tools

• Equipment

• Policy documents and guidelines

• Buffer supplies

• Supply of data tools

Lessons learnt

• Proper planning is key to optimizing outputs with available resources

• Cognizance of local context is critical in designing HR for Health interventions.

• Non monetary rewards can keep staff motivated

Lessons learnt II• District leadership involvement is key in

designing sustainable interventions

• Task shifting to lower cadre workers is possible with adequate supervision

• Integration in existing structures ensures sustainability

Thank you