African Health Workforce Project
African Health Workforce Project (AHWP) has built a regulatory human resource information system (rHRIS), in partnership with Emory University, the Kenyan Ministry of Health and related regulatory agencies, that has revolutionized how health professionals are credentialed and licensed in Kenya. The project is now working to replicate the system and scale up the project in other developing countries.
AHWP started in 2002 with an initial focus on improving training programs for Kenya’s nursing workforce. It soon became apparent that Kenya lacked comprehensive, accurate data about its entire healthcare workforce. Most personnel records were paper-based and officials could not ensure that healthcare professionals were maintaining their training, licensing, and certification requirements. The system also presented barriers to healthcare workers in renewing their licenses, especially those who worked in remote areas of the country and had to travel for days to the capital Nairobi to submit the required paperwork. Finally, the lack of accurate data constrained the ability of the ministry to health to allocate healthcare workers where they were needed. Thus, with the help of an all Kenyan staff to establish sustainability in-country, the rHRIS project was piloted.
What AHWP Does
To transform health workforce management by promoting the utilization of human resource for health (HRH) data for quality service delivery at national & county levels.
To implement sustainable interventions that promote the utilization of HRH data in health workforce management and program planning.
The first phase of the project to be implemented in a country is to establish electronic health workforce information systems that provide accurate and real-time data for policy, health program planning, and management of the country’s human resources for health (HRH). This was completed by the project in Kenya during 2006 – 2017. When they started, Kenya health professional regulatory agencies were all paper-based systems with no ability to analyze their human resources, hampering their ability to access the needs for health workers and conduct health program planning. Additionally, health professionals had to come physically to Nairobi to access services such as updating their credentials and getting their licenses. Therefore, there was poor compliance with health professional standards and guidelines and low quality of service.
rHRIS Core Functionalities
- Regulate Training: tracks student training, internship management, and examination management;
- Regulating Practice: initial registration and licensing of health professionals, license renewals on a periodic basis, and continuous professional development management; and
- Standards: ensuring standards of practice are maintained; inspect training institutions, internship centers, public, private, community and faith based training/health institutions
Successes of Phase 1
In Kenya, the system has improved efficiency of regulatory functions through: increasing compliance on registration and license renewal based on CPD points; enhancing revenue collection through improved compliance; and reducing processing time (from a 3 months waiting period to instantaneously receiving the license).
It has also allowed the ministry of health to enhance the detection of fraudulent applications during the recruitment of health professionals through online registers by providing enforced checks. Tracking registration also enables regulatory bodies to identify non-registered practitioners and health institutions for follow-up. The rHRIS has also enhanced compliance with the e-GOVT policy through development of IT, data protection/security policies and cloud hosting. A self-sustaining regulatory system that is customer focused, collaborative, and based on identified business processes.
- Goal: Increase access and utilization of HRH data at the national and county level to improve workforce management for better provision of HIV care and treatment.
Once a country has a working health human resources tracking system, they have the capabilities to use skilled and trained health workforce for more diverse needs and address workforce capacity inefficiencies and challenges. For example, currently in Kenya, and many other countries, an estimated 80% of HIV workforce is funded by the U.S. through the President’s Emergency Plan for AIDS Relief (PEPFAR) project. While this is unsustainable and countries are struggling to find long-term replacements, having a complete picture of their health workforce will provide Kenya, and hopefully other countries as well, with the ability to assess where they can reallocate resources and train necessary personnel to build internal capacity to address treatment needs for diseases like HIV, replacing the need for external resources.
However, despite having the workforce data, further analysis on where the gaps are needs to be done in order to accurately train and dispatch health professionals to the correct areas. This includes addressing the following challenges:
- Data that is necessary for this analysis exists in many systems that are not linked to each other e.g. rHRIS(HW supply data), iHRIS(HW deployment data), EMRs (HW workload and patient outcomes data), DHIS (facility-based aggregate workload data);
- HW regulatory data is not available at the county level where workforce is managed; and
- Many county officials need basic data interpretation and analytic skills training
How to solve these challenges?
To implement Phase 2, AHWP works with the ministry of health and counties to produce higher-level analyses so that it can inform the health management teams on their HIV workforce sustainability. However, it takes various information to inform this analysis, through interoperability, systems can talk to each other and data combined for better situational analysis. The interoperability technology makes the generated data more accessible and understandable for high-level officials to make more informed decisions about public health programs such as HIV treatment. Finally, to ensure data use and analysis capacity is adequate in-country, AHWP will develop and implement online trainings for health management teams, to learn how to access the system, download and view dashboards and reports, and interpret the data available so that the data from rHRIS and all health databases are used effectively.
Now that the project in Kenya has matured to be used as a case study for the impact of developing a rHRIS for a country, AHWP is eager to work with their Kenya team and The Task Force to develop a south-to-south approach to with neighboring countries to help build similar systems and provide equal clarity among their health workforces. We are also eager to develop a consensus among all East, Central, and Southern African (ECSA) region countries, and beyond, to develop systems that will speak to each other throughout the region so that areas where the workforce is inadequate can be identified and health professionals can be deployed to those areas throughout the region no matter their origin or nationality. With additional funding, AHWP is eager to scale up the project in Africa and other regions so that eventually every country has a stronger health system because they have a defined and adequately staffed workforce with appropriately licensed professionals.
Watch: A Digital Revolution
Celebrating Kenya’s Health Workforce System as Government Takes the Helm: Q&A with Program Leads Agnes Waudo and Martha Rogers
For the last 15 years, a team in Kenya has built a
Until recently, health professional licensing and credentialing boards in Kenya had to
Help Make Healthcare Workforces Stronger
AHWP is operated by an all Kenyan staff based in Nairobi and lead by Martha Rogers.
Martha Rogers, MD
Centers for Disease Control and Prevention
A doctor takes a patient’s blood at a local hospital in Kajiado County, Kenya. Before AHWP was introduced in Kenya, many residents in counties like Kajiado had to travel long distances to find a doctor and even then it wasn’t even guaranteed that the doctor of was adequately credentialed.