Human Resources for Health
Policy and Strategic
Implementation Plan
BY
Dr Saka M.J
December, 2013
IntraHealth is a global champion for health workers committed to ensuring that more health workers
are present, ready, connected, and safe in health systems around the world. Funded by USAID and
implemented through CapacityPlus, IntraHealth is working in partnership with the Government of
Nigeria and other stakeholders, to foster local solutions to health care challenges by improving health
worker performance, strengthening health systems, harnessing technology, and leveraging
partnerships that empower health workers to better serve communities in need.
i
This report is funded by USAID; however the views expressed does
not necessarily reflect the views of USAID’s official policies.
This publication was produced by IntraHealth International Nigeria,
in collaboration with the Ogun Sate Government.
ii
1.
1.1
1.2.1
1.2.2
1.2.3
Table of Contents
Page(s)
Table of Content
Abbreviations
Acknowledgement
Forward
Executive Summary
II-III
IV
V
VI
VII -IX
Section 1.Background information
Introduction
Geography and Demography
Political Context
Ogun State Health Indicators
1-3
1-2
2-3
3
3
SECTION 2 STATE SITUATION ANALYSIS
SECTION 3 VISIONS, MISSION, GOAL AND TARGET
3.0 Defining Workforce Projection
4-13
14 -15
14-15
SECTION 4 DEVELOPMENT OF THE HRH STRATEGIC PLAN
16 -17
SECTION 5: SSHRHP THEMATIC AND PRIORITY AREAS
18-19
5.1. 1 Policy goal, objectives and policy direction
5.1 2 Quick wins
5.1.3 HRH leadership policy direction and strategic interventions
5.2.0 Production of HRH policy direction and strategic interventions
5.3.0 HRH management policy direction and strategic interventions
5.4.0 HRIS policy direction and strategic interventions
5.5.0 Cross cutting policy direction and strategic interventions
18
19
21- 22
27 -29
32-33
36- 37
40-41
Section 6 Resourcing the Plan Funding Mechanisms
6.1.1 Principles of Sustainability
6.2.0 Sources of Funding
45-47
45
46-47
Section 7 Results matrix and Monitoring and Evaluation of HRH SIP
7.2 Coordination Structures for Monitoring and Evaluation
7.3 Critical Success factors
7.4 Monitoring frameworks and Indicators
7.5 Indicators of HRH SIP Thematic Areas
48 -63
48 -49
49-50
51-52
60- 63
Section 8 Costing of HRH SIP 2014-2018
8.1 Estimated cost of implementing the Strategic Plan
8.2 Financing Option
Bibliography
63- 64
63
64
65-66
TABLES
Table 1
State Health Status Indicator 3
iii
Table 2 DEFINING WORKFORCE PROJECTION
14 - 15
Table 3 HRH Thematic Areas Policy Goal, Objective and Policy Direction
18
Table 4 Quick Wins
19
Table 5 Log framework and Timeline of HRH SIP on Leadership
24-26
Table 6 Log Framework and Timeline of HRH SIP on Production of HRH
30-31
Table 7 Log Framework and Timeline of HRH Health work force Management
33- 35
Table 8 Log Framework strategy, objectivse and activities with TTimeline of HRH SIP on HRHIS 38 -39
Table 9 Log Frameworks and Timeline of HRH SIP on Cross Cutting 41- 42
Table 10 Results Matrix and Monitoring and Evaluation 51 58
TABLE 10: BUDGET SUMMARY FOR HRH SIP
62
Fig 1 Ogun State College of health technology School Enrolment by Discipline
5
Fig 2 Health Workforce Employee 2013
7
Fig 3 Key health personnel presently in the state
9
Fig 4 As shown in the above chart the actual amount spent on Health Sector compared to State total
expenditure between 2010-2013 reflected 12
Fig 5 Proportion of HRH Personnel Cost To Health Sector Budget 12
Annexes
Appendix
iv
ABBREVIATIONS
CHEW
Community Health Extension Worker
CHO
CPD
CSC
PRSD
Community Health officer
Continuing Professional Development
Civil Service Commission
Planning Research and Statistics Department
DPRS
Director of Planning Research and Statistics
ECOWAS
Economic Community of West African States
FBO
Faith Based Organization
FGD
Focus Group Discussion
FMOH
Federal Ministry of Health
HAF
Health Action framework
HOS
HRIS
Head of Service
Human Resource Information Systems
HRM
IMR
Human Resources Management
Infant Mortality Rate
KII
Key Informant Interview
LGA
LGSC
Local Governments Areas
Local Government Service Commission
MNCH
Maternal Neonatal and Child Health
MLGCA
Ministry of Local Government and Chieftaincy Affairs
MSS
MTSS
Midwives Service Scheme
Medium Term Sector Strategy
OGPHECADEB
Ogun State Primary Health Care Development Board
PHC
Primary Health Care
SCSC
State Civil Service Commision
SMOH
SURE-P
State Ministry of Health
State Strategic Health Development Plan
Subsidy Re-investment Program
TWG
Technical Working Group
U5MR
WHO
Under-5 Mortality rate
World Health Organization
SSHDP
v
ACKNOWLEDEGMENT
On behalf of the Top Management Committee (TMC) of the State Ministry of Health, I
would like to express my sincere appreciation to all those who made the HRH SIP document
possible.
Most notable appreciation is due to the several people interviewed at the various ministries
departments, units, agencies and local government area.
The collaboration of all Directors in the health ministry and other sectors along with their
officials in State that actively participated is hereby acknowledged and appreciated. They
facilitated the interviews at the state and LGA levels as well as visits to schools as well as the
health facilities.
Our sincere appreciation also goes to the State level officials visited in the Budget Office of
the State under the State Ministry of Budget and Planning, and the Civil service commission.
Our profound gratitude also goes to the officials of the State Ministry of Health and its
agencies visited for their prompt response to requests for documents, interviews granted and
clarifications made.
We owe a debt of gratitude to USAID through the Capacityplus project implemented by
partnership led by intraHealth who supported this activity. Without their support the planning
and development of this HRHSIP exercise would have been futile. They provided a
consultant, Dr. Saka M. Jimoh who coordinated the whole exercise. ; they also dedicated
their personnel to directly supervise the exercise.
Special mention must be made to our other WHO, UNFPA and ENR for their presence and
active participation at all stages in development of the policy and strategic plan. In a special
way, our appreciation goes to the consultant that facilitated the whole process Dr Saka
Mohammaed Jimoh for the dedication, sacrifice and skillful experiences he profusely
rendered.
Finally, I appreciate the support of the Chief of Party of the CapacityPlus project in Nigeria,
Mr. Samuel Ngobua and the Top Management Committee of the SMOH under the leadership
of the Honorable Commissioner of Health, Dr Olaokun Soyinka, the Permanent Secretary
Ministry of Health, Dr G.D Odeninyi who gave us the strategic direction and support as at
when due and who also fully participated in the exercise.
Thank you
Dr A.E Ayinde
Director Planning, Research and Statistics
vi
FOREWORD
The Ogun State Human Resource for Health Policy and Strategic Implementation plan is a
strong expression of the common goal and determination by the State to move away from
paradigms of poor health status to a healthy and well informed populace having access to
high quality health services. The State HRH Health Policy and Strategic Implementation plan
is therefore designed deliberately to encompass the process of transforming the State health
system into one that will be accessible, affordable, equitable and sustainable.
The HRH Health Policy and Strategic Implementation plan provides the operational frame
work that keeps up with social, economic, legislative and technological trends which impacts
positively on human resource for health. The policy is made flexible so that the SMoH and
other line Ministries applying it (the policy) can manage the changes in the HRH arena if the
future is different from the anticipated. To this end, the quest for adequate numbers of
competent health workers in their right mix and gender to deliver quality health care to all the
people of Ogun State at the right places on a sustainable basis will now become the watch
word.
The State HRH Health Policy and Strategic Implementation plan describe the goals, the
structure, policy directions and strategies for human resources for health planning,
management and development. It also responds to the human resources for health
implications to the State health sector reforms, including addressing the accreditation of
institutions and Maternal and child health, priority disease burdens.
The State HRH policy seeks to articulate systems and structures that are required to be
strengthened at different levels to facilitate effective planning, production, recruitment,
deployment, utilization, retention and management of health workers at all levels (Primary &
Secondary) of health care delivery system. With sustained advocacy and effective stakeholder collaboration at State and LGA level, public private sector collaborations and the tacit
support pouring in from capacity plus, Ogun State can and will be able to write her history of
quality health care delivery in gold.
The long term goals are to ensure that optimum numbers of well-motivated and committed
health workers are available and providing quality health services in areas where their
services are most needed. It is believed that while a clear policy direction and strategies are
essential for effecting the desired change, implementing the necessary interventions is more
crucial. This policy deeply rests on the principles of evidence-based decision making in staff
management and development, and overall monitoring and evaluation of key interventions at
all levels.
Thank you
Dr Olaokun Soyinka
Hon. Commissioner for Health
vii
SECTION ONE: EXECUTIVE SUMMARY
Workforce planning for the health service is challenging and complex. Nonetheless,
workforce planning is an important process. The health, policy, strategy, legislative and
economic context influence the task of visualizing and implementing improvements in the
health workforce. The policy context provides the framework for the development of the
HRH Strategy implementation plan.
The purpose of this Human Resource for Health (HRH) Strategic Plan is to guide the health
sector in proper planning, development, management and effective utilization of human
resource. The Plan focuses on improving the following key strategic areas: human resource
leadership and planning; HRH Production; management of HRH; HRH Information System
and HRH Crosscutting Gender & Partnership
and promotion of adequate financing in
executing responsibilities related to management of human resource for effective services.
In the process of developing the Strategic implementation Plan, various approaches have
been applied including consultations, conducting working sessions, document review, use of
study findings and presentations. The Ministry of Health along with technical working group
has sought views and inputs from various individuals, stakeholders and partners in human
resource. The list included Ministries, Development
Partners, Major Programs,
Governmental and Non – Governmental Institutions, Professional bodies and Associations,
Private Sector, and health workers.
Ogun State is one in the league, yet to adapt and domesticate the National HRH strategic
instruments into a State specific policy and plan; and currently facing considerable
challenges in the effective and efficient management of its health workforce to meet the
needs of its teeming population.
Human resource management systems are under-developed. HR management unit at the
State Ministry of Health is not fully established while none exist at the LGA level. HR
functions are more of ad hoc activities. Personnel data are not readily available at the facility
level. No formal HR department exists.
Ogun State includes a wide range of health care workers in both the public and private
sectors, such as public facilities managed by Federal, State, and Local Governments, private
for-profit providers, NGOs, community-based and faith-based organizations, religious and
traditional care givers. The state has one of the largest stocks of human resources for health
in Nigeria comparable only to FCT, Lagos, Edo, Osun and Oyo State.
viii
As at 2013, a total of 1416 medical doctors were working in Ogun State an increase of
1.47% from the 2009 figures. Based on population size1, the current number of medical
doctor equates to a ratio of 37.76 medical doctors per 100,000 members of the population.
There is small increase compared to 2009 figures of 33.84 medical doctors per 100,000
members of the population. This density is one of the highest in the country comparable to
national figure of 38.92 medical doctors for every 100,000 population. Even though these
ratios indicate that Ogun State is substantially better supplied with Medical doctors in the
south West Nigeria than Ondo state, the state compare unfavorably with immediate
neighboring states in Lagos, Oyo and Osun. The nurses and midwifes combined workforce
(3,365) translates into a density of 37.76 and a nursing and midwifery staff of 100,000
population; this is less than half of National average.
Comparing the data of 2009 with 2013 there is very little change in the total number of health
workers/100,000 population. For all categories of health workers available, the state’s
HW/100,000 population ratio is less than national and neighbouring state in the region. It is
thus very obvious that there is a drastic shortage of skilled health workforce in the state.
HRHSDP is partially captured in SSHDP and State Economic plan for Development 20122015 but conspicuously missing as an entity in Midterm Sector Strategy, no budget line items
in State MoH yearly budget and inadequate budget for HRH. World class cancer center and
Community nursing /midwifery is about to commence in the State. Framework for effective
practice and implementation is not yet developed, some health institutions like schools of
Nursing and Midwifery are not accredited for 2013 academic session.
HR information system in the State is partially transformed from paper-based to system
based. There is urgent need for the development of a costed comprehensive Human Resource
for health Strategic implementation plan with full complement of Information System with
clearly defined minimum data sets to be collected on regular basis, processes for routine staff
data collection, processing, storage, retrieval and use for decision-making. Both the
regulatory bodies and the HRH planning divisions of all levels of government and the private
sector need to perform their functions according to such evidence-based needs. The needs
1
3.75 million population, National Population Commission and Ogun State 2007-2009 Health Bulletin
2
Nigeria health work force profile as at December 2012
ix
should be reviewed periodically in line with well-determined staffing gaps in both private
and public institutions.
In order to address all the gaps and HRH problems, HRH SIP was developed to minimize the
problem of human resource for health shortages through advocacy for increased funding and
reallocation of staff for optimum utilization. It also addresses the issue of shortage through
matching demand and supply by increasing training output through building new training
institutions, and cancer centers with expansion of students’ intake and involvement of the private
sector in training health workers. The Ministry through technical working group will assess the
capacity gaps for health workers and facilitate the development of the training plan to build both
management and employee capacity at all levels.
Moreover, the plan aims at increasing
productivity of health and social welfare workers at all levels through establishment of effective
performance management systems. To enhance the effectiveness of this system, incentive
mechanisms will be identified/developed and implemented. In the process of implementation,
partnership among HRH stakeholders will be strengthened through sharing of information on the
unfolding circumstances and the policy context.
The budget estimates for activities identified for implementation of the plan for 2014 and 2015 is
N152, 343,590.0 and 167,567,940.00 respectively. There are twenty eight strategies and strategic
objectives with Ninety five activities to be carried out for the successful implementation of this
strategic plan. Sixty seven objectives verifiable indicators and fifty three identified means of
verification.
The HRHSIP is structured into seven main sections. The first section gives introduction and
background Information which provide rationale of the Plan based on the current status on
human resource in the health sector. The second section presents key findings of situation
analysis current human resource status and management environment. The third section provides
vision mission and workforce projections. Section four covers the process of development of
Strategic implementation plan. Section five identifies thematic areas,
policy goal, policy
direction and strategic objectives. It also includes quick wins risks and assumption and detail
narrative of strategic with table of interventions. While section six, describes resource plan and
funding mechanism. Section seven illustrates monitoring and evaluation of the Plan. Lastly,
budget summary is in section eight with detail costing of implementation plan in appendix
(annex).
x
SECTION 1 BACKGROUND
1.1.1 Introduction
Human Resources for Health is not all about number of health workers. It also involves
production of quality health workforce, their distribution how this health workforce are
supported, enabled and utilized. In essence, HRH is concerned with getting the right number
of staff, in the right places, at the right time, doing the right job, with the right motivation, at
the right cost3.Within many health care systems worldwide, increased attention is being
focused on human resources management (HRM). Specifically, human resources are one of
three principles of health system inputs, with the other two major inputs being physical,
capital and consumables4.
There is a global HRH crisis both in developed and developing countries. There are several
reasons for this, but primarily it is as a result of the disparity between production of HRH and
the rising health needs of various populations across the globe. This has resulted in an
inequitable distribution of health professionals among developed and developing countries5.
African countries have a very low density health workforce, compounded by poor skill mix
and inadequate investment (Chen L et al 2004)3. Yet trained healthcare staff continue to
migrate from Africa to more developed countries. The World Health Organization6, has
estimated that, to meet the ambitious targets of the millennium development goals, African
health services will need to train and retain an extra one million health workers by 2010.
1.1.2 HRH issues in Nigeria
Mal-distribution between states is fuelled largely by variations in hiring arrangements as
health professionals move from one locations to the other. Hiring arrangements in some
states do not favour non-indigenes.
Mobilization, allocation, and utilization of health resources are fragmented among different
players. Activities of private sector health providers are poorly coordinated. This affects staff
3
4
WORLD Health Organization. Working Together For Health, The World Health Report 2006, Geneva
Human Development Report, UNDP, 2001
5
Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, et al. Human resources for health: overcoming the crisis. Lancet 2004;364: 198490.[CrossRef][ISI][Medline]
6 World Health Organization. High level forum on the health MDGs. Addressing Africa's health workforce crisis: an avenue for action. 2004.
www.hlfhealthmdgs.org/Documents/AfricasWorkforce-Final.pdf (accessed 28 March 31, 2011).
1
development and utilization. There are no standards to guide staffing and their utilization for
both the private and public sector. Whilst worker productivity in the public health sector is
very low, many private sector health practices, the major challenge Nigeria faces is how to
ensure availability and retention of adequate pool of competent human resources in their
right mix to provide health care in areas where their services are in most need.
1.1.3 Policy context
Existing national policies and plans, along with international commitments and goals, guided
the development of this HRH strategic plan and are intended to address the challenges of
inadequate human resource for health.
1.1.4 National Strategic Health Development Plan
A key goal of this strategic plan is to improve health worker productivity through better
management systems and practices. The plan has adopted a sectorwide approach and
addresses HRH issues in the public, private for-profit and NGO/FBO sectors.
1.1.5 National Human Resources for Health Policy
The policy seeks to provide a strategic basis for human resources development, deployment
and compensation for the health sector. The policy supports a process that ensures a fit
between HRH interventions and the health sector goals, proper planning for staff
requirements, staff recruitment, selection and deployment, effective and efficient
management of staff performances to ensure improved health worker productivity all over
the country, staff training and development and orientation of new managers into the health
services.
1.1.6 National Human Resources for Health Strategic Plan
The Human Resources for Health Strategic Plan is another policy document that is aimed at
guiding the implementation of the HRH Policy at all levels. It provides a framework for
resource mobilization based on priority areas for intervention in health workforce planning,
management and development.
1.2.1 National Health Development Initiatives
Currently, the health sector is characterized by a lack of effective stewardship role of
government, fragmented health service delivery, inadequate and inefficient financing, weak
health infrastructure, weak health information system with low quality of data and limited
use and understanding of evidence in planning as well as mal-distribution of health work
force with poor coordination amongst key players.
2
1.1.2 Vision 20:2020
The document, focused on transforming Nigeria into one of the top 20 global economies by
2020. The importance of human capital development, with health, being one of the cardinal
factors, has been underscored in the Vision20:2020. Therefore Human Resource for health
Strategic Plan for Health has been developed to reflect vision 2020 for macro-policy linkage.
1.2.3 Millennium Development Goals
The Millennium Development Goals aim at reducing child mortality by two-thirds, Maternal
Mortality rate by three-quarters, combat HIV/AIDS Malaria and other diseases by controlling
them by 2015. Human Resource for health strategic Plan has been developed to ensure
availability of the necessary resources such as adequate health workforce to provide health
services.
1.2.4 President’s Comprehensive Response Plan (PCRP) for HIV/AIDS in Nigeria
The President’s Comprehensive Response Plan for HIV/AIDS in Nigeria (PCRP) is a
response tool to the challenges facing the national response. It is designed with the mission of
addressing priority system and service delivery challenges to the HIV and AIDS response in
Nigeria. The goal of the PCRP is to accelerate the implementation of key interventions over a
two year period to bridge existing service access gaps, address key financial, health systems
and coordination challenges and promote greater responsibility for the HIV response at
Federal and State levels. This plan will contribute to critical human resource need necessary
to achieve reduction in the HIV prevalence in the country.
It is therefore appropriate to state that any country that tends to have a low level of human
resources for health (HRH) would not be on tract in reaching the health MDGs. Insufficient
HRH capacity is definitely one of the key barriers to scaling up health services in Nigeria 7.
The impact of the HRH shortage is greater in the developing countries as compared to the
developed countries. This scenario is currently worsened by the diseases such as HIV/AIDS,
TB and Malaria that are exacting greatest toll in these same countries; most especially
Nigeria.
Ogun State is one in the league, the state is yet to adapt and domesticate the National HRH
strategic instruments into a state specific policy and plan; and currently facing considerable
challenges in the effective and efficient management of its health workforce to meet the
Ayenbe, W; Bezzano, J; and Foot, S. An Analytical Framework for Understanding the Political Economy of Sector Policy Arenas – Country Level Testing:
The Health Sector in Nigeria. November 2005 – unpublished
7
3
needs of its teeming population. Although no objective and comprehensive assessment of the
HRH situation had been conducted before now.
1.3.1 Geography and Demography
Ogun State was created on the 3rd of February, 1976. It was carved out of the old Western
State of Nigeria and named after the Ogun River which runs across it from North to South.
The State is strategically located, bordered to the East by Ondo State, in the North by Oyo
and Osun States, in the South by Lagos State and the Atlantic Ocean and in the West by
Republic of Benin, which makes it an access route to the expansive markets of the Economic
Community of West African States (ECOWAS). Abeokuta, the capital and largest urban
centre, is about 90 kilometres from Lagos and 740 kilometers from Abuja, the Capital of
Nigeria. There are 3.75million (2006 census) with 5.1million (projected figure as at 2012);
the State has a land area of 16, 432sq.km. It is peopled predominantly by the Egbas, Ijebus,
Yewas, Remos and Aworis who belong to the main Yoruba ethnic group. It also has subgroups, namely,Ketu, Ikale, Ilaje, Ohori, Anago and Egun. There are also significant
numbers of Nigerians from other parts of the country as well as foreign nationals. The
predominant languages spoken are Yoruba and Egun with several dialects while English is
the official language8.
1.3.2 Political Context
The State is sub-divided into three (3) Senatorial districts, nine (9) Federal Constituencies
and twenty-six (26) State Constituencies. For local administration, the State has twenty (20)
Local Government Areas and Two Hundred and Thirty Six (236) wards as follows9:
The State has a State Legislative house- the State House of Assembly.10 The administrative
structure is decentralized into Local Government Council and Wards. Wards are the smallest
political and administrative units which constitutes the political voice of communities in the
8
Ogun State Health Bulletin
9
Ogun State Health Bulletin
10
Ogun State Strategic Health Development Plan; 2010-2015
4
identification, discussion and prioritization of problems and actions to be taken at LGA level.
There are currently twenty Local Governments Areas (LGAs) and 236 political wards.11
1.3.3 Ogun State Health Indicators
The state figures as obtained from hospital data and the public and private sector. Below are
the health indicators & statistics for Ogun State from 2008 – 2012. These are compared with
national values.
Table 1
State Health Status Indicator
Indicators
National (×)/
Ogun
2008
2009
2010
2011
2012
29/1000
27/1000
24/1000
21/1000
14/1000
13/1000
16/1000
14/1000
10/1000
9/1000
295
245
235
124
202
Perinatal mortality rate (/1000 births)
22/1000
25/1000
20/1000
17/1000
23/1000
Still birth rate(/1000 births)
15/1000
21/1000
19/1000
16/1000
21/1000
18/1000
21/1000
20/1000
16/1000
11/1000
3.1%
3.1%
Under – 5MR (/1000 live births)
201/100
Neo-natal mortality rate(/1000 live births)
MM Ratio (/100,000 live births)
300-200
Infant mortality rate(/1000 live births)
100/1000
HIV prevalence rate (××)
4.4 (2005)
No of poliomyelitis cases (×××)
374
8.5
4
Incidence of smear positive TB (/100,000
population)
34
55
34
36
54
New borns with low birth weight (%)
11.39
7.65
9.2
7.91
2.54
Sources World Health Statistics 2005, 12 National sero-prevalence survey13, WHO, Ogun State SACA14, NARHS15
SECTION 2: STATE SITUATION ANALYSIS
2.1 GOVERNANCE /LEADERSHIP FOR HUMAN RESOURCES FOR HEALTH IN THE STATE
The State leadership in the health sector are well deposed to provide and develop HRH
strategic development which is partially captured in SSHDP16 and State Economic plan for
Development 2012-201517 but conspicuously missing as an entity in midterm strategy18.
11
Ogun State Health Bulletin 2012
12
Sources World Health Statistics 2005
13
National sero-prevalence survey
14
Ogun State SACA
15
NARHS
5
Career development and promotion of the health work force is sole responsibility of Bureau
of establishment and training, civil service commission (CSC), office of the Head of Service
(HOS) and Local Government Service Commission (LGSC). All the ministries and
department are involved in performance management. The key gaps in stewardship/
leadership for HRH include;- Human resource management systems are under-developed.
HR management unit at the State Ministry of Health is not fully established while none exist
at the LGA level. HR functions are more of ad hoc activities. Personnel data are not readily
available at the facility level. No formal HR department exists and few evidence of job
description at the state level but no evidence at local governments and private sector to
develop and provide job descriptions for all categories of health workers.
2.2 PLANNING FOR HUMAN RESOURCES FOR HEALTH
Since neither a State HRH policy nor a state HRH strategic plan has been developed in Ogun
state, the most appropriate extent HRH Implementation Plan/Strategy for the State is the
HRH component of its SSHDP which aimed to plan and implement strategies to address the
human resources for health needs in order to enhance its availability as well as ensure equity
and quality of health care. There are still on resolved problems which include inadequate, HR
planning at the various levels and this is compounded by the non-availability of reliable,
complete and up to date information on staff for decision making. There are no standards to
guide staffing and their utilization for both the private and public sector. Whilst worker
productivity in the public health sector is very low, many private sector health practices on
the other hand suffer from poor work quality because of commercial pressures, no HRH
specific SIP is evidence based. HRHSDP is partially captured in SSHDP and State Economic
plan for Development (2012-2015) but conspicuously missing as an entity in Midterm Sector
Strategy. No budget line items in the State MoH yearly budget and inadequate budget for
HRH budget for health institutions.
2.3 PRODUCTION OF HUMAN RESOURCES FOR HEALTH
16
Ogun State Strategic Health Development plan
17
Ogun State Government Economic Plan Development 2012-2015
18
Ogun State 2013 -2015 Ministry of Health Mid Term Strategy.
6
Ogun State has a relatively good number of health training institutions. As at 2013, there
were one (1) accredited medical and dental school, (1) private medical school, two (2)
Federal owned health Institutions (Nuro-Psychiatric Hospital and Federal Medical Centre), 2
approved schools of nursing, 2 approved schools of midwifery, six institutions in College of
Health Technology located in Ilesa Ijebu Ode. The institutions in the college made up of
school of Environmental Health Technology; School of Medical Laboratory Technician;
School of Medical Laboratory Assistants; School for Community Health Extension Workers;
School for Health Information Officer and School for Public Health Nurses.
However there is a poor distribution of these training institutions with majority (75%) of
them being located in the central parts of the State, although there is capacity and capability
within the state for production of quality HRH.
Fig 1 Ogun State College of health technology School Enrolment by Discipline
KEY GAPS; - HUMAN RESOURCES FOR HEALTH PRODUCTION
1. Training institutions are managed as separate entities although funded by the Ministry
of Education &MOH.
7
2. There are however no alignment between the student intake, training capacity per
curriculum and actual staff requirements in SMoH at hospital and PHC levels.
3. Enrolment of trainees and production of health manpower in the state health training
institutions are currently not determined by any evidence-based HRH needs.
4. Both the regulatory bodies and the HRH planning divisions of all levels of
government and the private sector need to perform their functions according to such
evidence-based needs. The needs should be reviewed periodically in line with welldetermined staffing gaps in both private and public institutions.
5. Community nursing /midwifery about to commence in the State School of Nursing
and midwifery. There is no framework for effective practice of community nursing
and midwifery in all local government areas in the state
6. Loss of accreditation of schools of Nursing and Midwifery
7. Budgetary allocation for training institutions is inadequate
2.4 HEALTH WORK FORCE MANAGEMENT
Distribution of Health Workers
Ogun State includes a wide range of health care workers in both the public and private
sectors, such as public facilities managed by federal, state, and local governments, private
for-profit providers, NGOs, community-based and faith-based organizations, religious and
traditional care givers. The state has one of the largest stocks of human resources for health
in Nigeria comparable only to FCT, Lagos, Edo, Osun and Oyo State.
The total number of skilled health workers in Ogun State is 10,584. These comprise 1416
Medical Doctors and Dentists; 3,356 Nurses and Midwives; 372 Pharmacists; 285
Pharmacists Technicians; 178 Environmental Health Officers; 56 Physiotherapists; 92
Medical Laboratory Scientists; 138 Medical Laboratory Technicians; 61 Health Record
Officers; 1,588 Community Health Extension Workers; 12 Dental Technologists; 50 Health
Educators; 499 VHW/TBA; 2317 Health Attendants/Ward Orderlies; 66 Scientific Officers
and 26 Rural Health Officers19. See details in Table 2
19
Ogun State 2012 Health Bulletin
8
In 2012, a total of 1416 medical doctors were working in Ogun State an increase of 1.47%
from the 2009 figures. Based on population size20, the current number of medical doctor
equates to a ratio of 37.76 medical doctors per 100,000 members of the population. There is
small increase compared to 2009 figures of 33.84 medical doctors per 100,000 members of
the population. This density is one of the highest in the country comparable to national figure
of 38.921 medical doctors for every 100,000 population. Even though these ratios indicate
that Ogun State is substantially better supplied with Medical doctors in the south West
Nigeria than Ondo state, , the state compare unfavorably with immediate neighboring states
of Lagos, Oyo and Osun.22
The nurses and midwifes combined workforce (3,365) translates into a density of 37.76
nursing and midwifery staff of 100,000 population; this is less than half of National average.
Figures of all health workforces obtained from Ogun State Health Management Board
captured only those in employment of State government, thus an incomplete data. It is
important to note that the figures as obtained from the health bulletin may be more detailed
as it include data from private and public institutions. However, it does not reflect actual
health workforce for 2013, which is due to lack of HRH HRIS in the state.
The figures presented below are for some health professional categories registered by the
State’s professional medical/health regulatory bodies as in 2012. They include health workers
in both the private and public health sectors, and, very likely, health professionals who are
not practicing in the State or may not be practicing health care at all. Comparing the data of
2009 with 2012 there is very little change in the total number of health workers/100,000
population. For all categories of health workers available, the state’s HW/100,000 population
ratio is less than national and neighboring state in the region. It is thus very obvious that there
is a drastic shortage of skilled health workforce in the state.
20
3.75 million population, National Population Commission and Ogun State 2007-2009 Health Bulletin
21
Nigeria health work force profile as at December 2012
22
Nigeria health work force profile as at December 2012
9
Fig 2 Health Workforce Employee 2013
10
Fig 3 Key health personnel presently in the state
2.5.0
HUMAN RESOURCE FOR HEALTH INFORMATION SYSTEMS MANAGEMENT
Accurate health information is essential for efficient running of a healthcare service. HRH
information management is critical to the effective and efficient planning and utilization of
the health workforce to meet service delivery targets and to provide qualitative and equitable
health services. However no baseline information on HRH in the state, effort to carry out
compreshive assessment baseline of health workforce was in 2010. Ogun State has embraced
the Introduction of the latest version of the National Health Management Information System
(HMIS) software. The state trained M&E officers to use the system. Forms are also
distributed to all health institutions for routine collection, collation and analysis of health
data. The state also released funds to facilitate collection of statistics data from their local
government facilities by monitoring and evaluation officers, presently there is online
registration of private health facilities. Even though there is health research working group
and a health research ethics committee, there is currently no Human Resources for Health
Information Management system in place in the health sector. However, HRH information
11
and data is collected from different units, professional bodies and departments by Project
Manager Health Systems Development Project II (HSDP II) in department of planning
research and statistics. The information is published on quarterly basis in Health Bulletin
with funds from World Bank health systems development project II (HSDP II). There is a
designated HRH officer in DPRS, yet no data system in the state to enable effective HRH
workforce planning and management. Consequently, most of the HRH management
functions such as recruitment, deployment, retention, motivation and performance
assessment are not undertaken in a systematic manner and decisions regarding them are not
reached based on evidence. The only function that is performed in a seemingly systematic
way is promotion but this is done based on information from APAR form which was
apparently designed for serving only that purpose. The challenge in the management of
Human Resources Information in the health sector are as follow;
Latest version of the National Health Management Information System (HMIS)
software is well embraced.

Fully function HMIS unit with well-trained M&E officers in SMoH .

There are highly skills personnel within the SMOH, SPHCA, HMB, DAS, CSC and
Establishment.

The coordination of HRH in the system is exit though fragmented between ministries
departments and units

There is no specific HRH policy guideline or strategic framework to create the
enabling environment.

HR information system in the State is partially transformed from paper-based to
system based.

There exit accurate and up to date information on staff, though manual and electronic
computation is laborious and time-consuming.

In Ministry of Budgeting there is HR systems on payroll that is regularly updated and
maintained to provide comprehensive details on employees though in not available in
SMoH.

The state is ready to provide enabling environment for the development of a
comprehensive HRHIS with clearly defined minimum data sets to be collected on
regular basis, processes for routine staff data collection, processing, storage, retrieval
and use for decision-making.
12
2.6 CROSS CUTTING; - RESOURCE ENVELOPE
The government of Ogun state recognizes health as one of the sectors that greatly contributes
to the well-being of the nation and, therefore, remains committed to providing quality health
services to all of its citizens. In this regard, the government has gradually increased its share
in the state budget towards the attainment of the Abuja target of 15 percent. Growth in
overall state budget, specifically the health budget, has in part been due to a very impressive
economic growth rate, averaging 8.0% in the three years.
During 2013, a total of N14, 752,200,000.00 is estimated to be available for the
implementation of the health activities. Most Government resources are already committed to
personal emoluments and other constitutional expenditures, but a total of N211,
789,806,088.51 billion is available for the implementation of the programmes, of which
6.97% is earmarked for development programmes of the health sector, including human
resources for health, as shown in the fig. below. These resources correspond to the personal
emoluments in the MoH budget and do not include grants from Partners.
Fig 4 As shown in the above chart the actual amount spent on Health Sector compared to State total
expenditure between 2010-2013 reflected
13
Fig 5 Proportion of HRH Personnel Cost To Health Sector Budget
The SHRHSIP will be implemented though the Medium Term Expenditure Framework
(MTEF) and associated annual activity based budgets. In 2014-2018, the Government’s
intention is to direct more financial resources to the health sector, especially in the wake of
the reduced sector support by a number of the Cooperating Partners.
The allocation in the MTEF for 2014-2016 will continue to address challenges of the double
disease burden, inadequate clinical staff and equipment and the erratic supply of essential
drugs. The MTEF 2014-2016 is also providing financial space for the recruitment of more
health workers per year 2014-2016.
There are facts that HSDP II World Bank project is coming to an end, other funds on HIV is
also reducing or ending in 2014, a number of major development partners’ funds will be
reduced to the health sector. There is thus a high level of uncertainty when attempting to
estimate the contributions from DPs in the in coming years.
Ogun State has traditionally had four main sources of financing for health. These include
Government funding, donor funding, household contributions, and “others,” which are
mainly private sector (employer) contributions to the health sector. Future funding from DPs
will depend on the successful implementation of the MoH’s Governance Management and
support from the DPs.
14
SECTION 3.0 VISIONS, MISSION, GOAL AND TARGET
3.1. VISION
A competent and highly motivated Health Workforce for holistic health care services for the
people of Ogun State
3.2. MISSION
The Ministry’s mission statement is: To facilitate capacity enhancement of Health Workforce
to work as a team in decision making on issues affecting health of the people
3.3 Goal;To have an adequate, competent, evenly distributed, well-supported and motivated health
workforce for the provision of safe, ethical, cost effective and quality health care services
3.4 Target (Workforce Projections);One of the key goals of this strategic plan is to ensure that the State has adequate health and
social welfare staff, with the right competencies and skills, who are well distributed and managed
for optimal productivity. In working out the workforce projections different variables has been
used such as; Workforce status for public and private (2013), workforce projection by cadres
relating national to State figures.
Table 2 DEFINING WORKFORCE PROJECTION
Cadre
National
Figure ratio
State
Figure
ratio
2014
2015
2016
2017
2018
65,759
1:39
1416
1487
1636
1800
1980
21788
Nurses/Midwives
249,566
1:148
3356
1:66.0
3524
3877
4265
4692
5161
Medical Laboratory Scientists
19,225
1:12
92 .0
1:19
97
107
118
130
143
Medical Laboratory
Technicians
8,202
1:55
138
1:27
144
159
175
193
212
Medical Doctors
1:28
15
Medical Laboratory
Ass/Science Officers
11,067
1:70
66
1:1.30
70
77
85
94
103
Pharmacists
16,979
1:10
372
1:7.2
391
430
473
521
573
1,849
285
300
330
363
399
439
1:
1:5.5
64
71
78
86
95
Pharmacy technicians
2,926
1: 2
61
Radiographers
1,286
1:1
33
1:0.6
35
39
43
47
52
Physiotherapists
2,818
1:20
56
1:1.1
59
65
72
79
87
-
26
1:0.50
28
31
34
37
41
-
1588
1:31.1
1668
1835
2019
2221
2443
-
178
1:35
187
206
227
250
275
499
524
577
635
699
769
Health Information managers
health record officers
Dispensing officers/Rural
health Officers
CHEWs
Envt.. Health Officers
VHW/TBA
1:1.2
168
1:98
Occupational Therapists
34
-
Speech Therapists
28
-
2,676
1:1.6
-
Optometrists
Sources; National FMoH HRH profile 2013,Ogun State health bulletin
16
SECTION 4: PROCESSES FOR THE DEVELOPMENT OF THE HRH STRATEGIC
PLAN
4.0 Methodology;The process for the development of this State human resource for health Policy, strategy and
implementation plan was participatory involving stakeholders at the state and LGA levels.
Consequently, Technical Working Group and Inter-departmental committees (Core group,
Research/field committee, programme officers, Budget & costing and advisory group) on
HRH SIP were constituted.. The TWG was chaired by the Permanent Secretary of the state
ministry of health (MoH). The mandate of the committee formed on 13th Nov 2013 was to
formulate the HRH policy and strategic implementation plan.
The need for the state HRHSIP became imperative as it was noted that the state lack
standards to guide human resource for health in the state. This observation was noted by
FMoH, SMoH, National HRH Forum, and development partners such as the WHO, USAID,
intraheath, DFID, UNICEF, as well as stakeholders in Ministries of Health and Education.
The Honorable commissioner for Health in the state was very enthusiastic in the provision
of an enabling environment as well as give full support that would aid in the process of the
formulation.
Capcityplus supported HRH situation analysis in the state using HRM Assessment Approach
and HRH Action Framework (http://www.capacityproject.org/framework/) as a means of
assessing and analyzing HRM issues in a comprehensive manner. A matrix of leading
questions was adapted from the HRM Assessment approach and other country specific
questionnaires previously used to collect data on HRH issues. The findings from the
assessment served as a foundation and guide towards the development and implementation of
a well-planned, coordinated and managed HRH management system, in order to facilitate an
improved delivery of healthcare services in Ogun State.
The process included the following steps and activities:
 Inter- departmental and sectorial stakeholder forum for HRH- September 2013
 HRH SA using HRA framework tool: September –October 2013
 The State Human Resource for Health stakeholder forum which made up of a crosssection of professionals and directors in MoH, HMB, LGAs, Health institutions
amongst others carried out an extensive in-depth interview, desk review of existing
17
health and related policies, State Strategic health plans, report of documentation and
HR Audit report.
 Meetings with the wider stakeholders was held, the sensitization and validation
meetings was held with all the Directors of the SMOH, HMB, OSPHCB, Director of
in Ministry of Education, Civil services commission and Budget. Honorable
Commissioner of Health was represented by Permanent Secretary MoH, international
partners WHO, UNFPA were also in attendance.
 Following the conduct of the background study situation analysis and reflections of
existing state and national health agenda, a Technical Working Group was constituted
by the Honorable Commissioner of Health on Nov 12, 2013.
 Sub committees (Core group, research/field group, programme officers, Budget &
Costing and Advisory group of TWG) were also put in place.
 Inter-sectoral TWG Workshop for health workforce was held in October – November
2013
 Development of Follow up plan: November -December 2013
 Development of initial working document on HRH strategy Policy and
Implementation plan November, 2013.
 Internal critique of the draft working document by the TWG, relevant line ministries
and parastatals (SMoH, OGSPHB, HMB, Budgeting and Planning, Civil services
commission,) and development partners (WHO, UNFPA, and USAID/Capacity plus
in November -December 1st -16th 2013.
 Development of draft one of the State Strategic Implementation plan: December 2013
 Circulation of the first draft for input by stakeholders at state levels: December 2003..
 State Stakeholders’ Workshop to critique the draft one and development of draft two
of the State Strategy Policy and implementation plan: 19th December, 2013.
 Presentation of draft two of the State to the Reference Session of the TWG:
December 20th, 2013
 Circulation of draft two for inputs from stakeholders December 2013.
 Approval of the State HRH SIP State Council on Health (SCH) or Top management
for approval: December/January 2014.
18
Section 5: SSHRHP Thematic and Priority Areas
Table 3 HRH thematic areas Policy Goal Objectives and policy Direction
THEMATIC
AREAS
KEY ISSUE/JUSTIFICATION
POLICY GOAL
OBJECTIVES
POLICY DIRECTION
Health
Workforce
Leadership and
Planning
There are no standards to
Goal; - To co-ordinate
and provide leadership
for all cadre of health
care service.
To Provide a framework
for
analysis
and
implementation aimed at
addressing the HRH
crisis in the State.
Health
Workforce
Production
There is no alignment
between the student intake,
training capacity and actual
staff
requirements
in
hospitals.
To ensure equilibrium
in production and
demand of quality front
line health worker
Health
Workforce
Management
There is need for
evidence based HWFs
management approach.
To provide a conducive
and affordable good
environment for Health
workforce
To strengthening supply
of adequately trained
cadres of health
professionals to the meet
the need of the health
sector
To Apply best practices
of HRH management
that promotes equitable
distribution
and
retention of the right
quality and quantity
workforce in the state.
Human
Resources
Information
Systems
HRHIS in the State is weak
partially transformed from
paper-based to electronic
system based
To establish a HRHIS
unit in PRS MoH with
analysts
and
networking system for
regular updated HRH
IS
To
Strengthen
the
development and use of
information technology
in HRHIS
HRH
coordination
HRH activities in the
health sector are poorly
coordinated.
To ensure a sense of
responsibility in HRH
for self-appraisal to
make appropriate
recommendation
To Foster collaboration
among public –private
sector, non-government
providers of health
services and other HRH
stakeholders
Ogun State Government
shall provide leadership
and
institutionalize
rational planning of
human resources for
health at all levels of
service delivery
Government shall
prioritize and plan for
increase in the
production and demand
of quality frontline
health workers,
Government shall
conduct Annual review
of Health workforce
management, provide
conducive environment,
in-service training for all
cadre of health
workforce
Government
shall
provide an effective
HRH
Information
System to be used as a
management tool for
informed
decisionmaking at all levels and
improved health care
State Government shall
provide enabling
environment to foster
collaboration with all
stakeholder
Monitoring and
evaluation
There is need to
properly
integrated
M&E systems
M&E
system
To document dynamics
of HRH in the State to
take evidence based
decision
To Strengthen
monitoring and
evaluation mechanism to
access progress and
impact
guide
HWFs
and
their
utilization.
19
Government
shall
support monitor and
evaluate all workforce
through the training of
M&E
officers
and
provide computers and
database
management
system for analysis and
result of work done
Quick Wins
A number of quick wins were identified as part of the Strategic Planning Process. These
quick wins were selected as they were seen as representing opportunities for producing rapid
and significant results that will build the momentum of implementing this strategic plan.
These quick wins fall under different Strategic Objectives as shown in the table below:
Table 4 QUICK WINS
Strategic Objectives
Quick Wins Activities
S.O.1 Establish and ensure a Institutionalization of TWG actions for
functional HRH TWG in the State
HRHSIP and meeting quarterly
Launch and disseminate the HRH SIP at all
levels
S.O .2 Strengthen the institutional Create an HRH unit office, Appoint and train
framework for HRH Mgt practices HRH Desk Officers at the State and LGA
in the health sector
levels
S.O.3 To create a platform for Organizing
Continuous
Professional
cross learning among health Trainings for different cadre of health
workers
workers
S.O.4 To rationalize and align Adopt the new policy of the Nursing &
supply of health workforce to the Midwifery council of Nigerian to train lower
priorities need of the health sector carder man power for Nursing and Midwifery
practice at the PHC level
Accreditation of Nursing/Midwifery schools
Responsible
DPRS, TWG
DD-HRH,
DPRS,TWG
DPRS, DD-HRH
DD-HRH
Dir.
Nursing,
TWG
S.O.5 To improve Workforce
Manpower Needs Assessment e.g for cancer TWG , DPRS
Management and Utilization
centers and others
Streamline recruitment Bottlenecks to meet TWG,
DAS
the needs
DPRS
Orientation and Training of New HWF DD HRH
employed . Track and monitor new recruited
employees
Track and monitor new recruited employees
TWG DD-HRH
Procurement of necessary tools and TWG DAS
equipment to cancer centers and others
S.O.6 To establish of routinely Provision of computers, software, ICT DAS, partners,
updated HRH database at DPRS
materials
DPRS
Training on ICT/ software
DAS, partners,
DPRS
S.O.7To Promote adequate
Disseminate the HRH strategic plan and
DAS, partners,
financing of HRH strategic Plan
detailed budget to relevant government
DPRS
ministries and development partners
20
THEMATIC AREAS AND PRIORITIES POLICY AND STRATEGIC INTERVENTIONS
5.1.0 HEALTH WORKFORCE POLICY AND STRATEGIES
Human resources for health policies are vital for guiding the management and development
of the workforce. Policies are statement of intent of direction that provides institutions and
individuals with guidelines and it is a critical guide to the development of plans that highlight
priorities for action in addressing the human resources gaps in Ogun State.
5.1.1 Health workforce Leadership and Planning;- An effective response to the health
workforce challenges entails collaboration among multiple sectors of governments (including
health, education, finance, labor, science and research), and multiple constituencies including
the private sector, professional associations, international organizations, development
partners, foundations.
This is to ensure that human resources for health supply and utilization are tailored to the
national strategies for reducing the disease burden and achievement of the health sector
goals. Planning shall take short, medium and long term perspectives. Planning for current and
future human resources needs and requirements must actively consider a number of complex
and inter-related issues which include:
HRHSIP is partially captured in SSHDP and State Economic plan for Development 20122015 but conspicuously missing as an entity in the State Midterm Sector Strategy. Human
resource management systems are also under-developed as HRH management unit at the
State Ministry of Health is not fully established while none exist at the LGA level; also HRH
functions are more of ad hoc activities. Personnel data are not readily available at the facility
level.
Inadequate HRH planning at the various levels which is compounded by the non-availability
of reliable, complete and up to date information on staff for decision making, There are no
standards to guide staffing and their utilization for both the private and public sector. Whilst
worker productivity in the public health sector is very low, many private sector health
practices on the other hand suffer from poor work quality because of commercial pressures.
More importantly no budget line items in State MoH yearly budget, however, health
intuitions HRH budget is inadequate. All this gaps led to
21
I. Unmet expectation of health care services with regards to coverage, efficiency, equity
and quality;
II. Poor access to health care services for the disadvantaged due to poverty, ill-health and
difficult senatorial terrain;
III. Availability, accessibility, or utilization of data in relation to the number of villages,
settlements, and neighbourhood areas in Ogun which constitute the lowest level of
health service provision for health human resource planning.
IV. Demand for health services which increases with high incidence of morbidity and
mortality among neonates, children and women, high accident load, and high burden of
disease;
5.1.2
INSTITUTIONALIZING
HRH
LEADERSHIP
AND
PLANNING
FUNCTION
Due to this challenges and key gaps in health workforce and planning above, it is evidence
that health workforce leadership and planning for HRH has been compromised, however, the
leadership in health sector is committed to meet these challenges by co-ordinating and
providing leadership for all cadre of health care service in the state.
5.1.3 Policy Direction
Ogun State Government shall provide leadership and institutionalize rational planning of
human resources for health at all levels of service delivery.
5.1.4 Strategic Interventions
To achieve this goal and policy direction, the health sector will pursue the following
strategies (Interventions) for the attainment of the objectives set out in the OSHRH SIP 20142018: State Ministry of Health, working in collaboration with LGAs and other relevant
institutions will;(Strategy (Intervention); - Institutionalize TWG actions for HRH in the State
The state will generate agreement on the development and operationalization of the HRH
strategic Implementation Plan (HRHSIP) by creating intersectoral and intergovernmental
TWG committees which will meet quarterly for follow-up of progress on HRH SIP in line
with MTSS and Economic Development. There will be documentation and presentation of
22
annual progress reports on HRH during HRH conference or forum workshop which may
collaborate with the State Council on Health meeting. The events will consider and adopt
HRH SIP among others.
Strategy (Intervention); - Developed Policy and Strategy is consistent with the health
needs of the state and appropriate minimum standards are set in all aspects of the HRH
Structure advocacy program will be initiated in addition to development of minimum
standards in design, planning and implementation HRHSIP. To enhance capacity building of
health workers there will be engagement with health professional associations in the
development of relevant continues professional education programs for their members.
Strategy (Intervention); - Establish/Create HRH Office /Unit
To create an HRH office unit and appoint and train HRH Desk Officer which will also step
down training
to the HRH desk officer to other staff. There will also be a coordination
mechanism for HRH, Institutionalization of TWG actions for HRHSIP.
Strategy (Intervention); - Make HRH unit a Secretariat for cross-learning
The unit if establish will functions by organizing continuous professional trainings for
different cadre of health workers, development of cross - learning CPD policy and
framework, learning. Develop tools to capture the job description of each cadre of health
workers and Institutionalizing in - service training for cadre of staff.
Strategy (Intervention); - Create and Sustain Conducive Work Environment HWFS
There will be advocate/advocacy for the provision of quarters for staff and provision of
Personal Protective Apparel. The systems will reward excellent performance, discipline of
erring workers. Provision of basic materials to work with and advocate and encourage a
scheme that allows property acquisition / retirement plans for health workers.
Strategy (Intervention); - Working with the private sector to improve standard
practice;- Recommend and Encourage the points above to the private sector.
Strategy (Intervention); - Improve budget line for Human Resources for Health
Budget on Human Resources for health should be improved in the annual budget of the
MOH.
23
24
Table 5 Log framework and Timeline of HRH SIP on Leadership 2014-2018
Table 5 THEMATIC AREAS HEALTH WORKFORCE LEADERSHIP AND PLANNING
1.0
Strategy;- Institutionalize TWG actions for HRH in the State
1.0
Objective 1.;- To establish and ensure a functional HRH TWG in the State
1.1
Activities
2014
Q1
2015
Q2
Q3
Q4
Q1
20
16
Q2
Q3
20
17
201
8
MOV
Assumption
Q4
1.1.1
Generate State agreement on the development and
operationalization of the HRH SIP
List of SH informed and participated
in HRHSIP
Political inertia
1.1.2
Create intersecoral and intergovernmental TWG committees for
follow-up of progress on HRH SIP in line with MTSS and Economic
Development
Final HRH SIP document List of SH
informed and participated in
HRHSIP
Acceptance to work as a member of
the committee
1.1.3
Documents & present annual progress reports on HRH SIP
Progress Report of HRHSIP
Rapid turnover of political appointee
& technical leadership
1.1.4
In the State Council on Health meets 1 x per year to consider and
adopt HRH SIP
State HCH report
All level of health sector leadership
will buy into HRHSIP
1.1.5
Quarterly Meeting of TWG of HRH SIP
Report of the meetings
Adequate plan
2.Strategy ;- HRH Strategy and policy formulation are consistent with the health needs of the state and appropriate minimum standards are set in all aspects of the HRH
1.2.0 Objective ;- To provide clear policy and Strategic directions for Human Resource for health development
1.2.1
Create structure advocacy program initiate/ advocate for HRH SIP
Number of advocacy visits
Political will
1.2.2
Develop and monitor minimum standards in design, planning and
implementation of HRHSIP
Monitoring tool for HRHSIP
developed
Expect in HRH M&E available in
SMoH
1.2.3
Engage health professional bodies in the development of relevant
CPD education programs for their members
Number of CPD conducted
Professional regulatory al bodies
accepted
# of HRH Office
SMoH accepted
# of Skill HRH officer
Availability of training
# of HRH training conducted
Fund for training available
Strategy Establish/Create HRH Office /Unit
1.3.0 Objective;- To Strengthen the institutional framework for human resources management practices in the health sector
1.3.1
Create an HRH unit office
X
1.3.2
Appoint and train HRH Desk Officer
13.3
Step down training by the HRH desk officer to other staff
1.3.4
Institutionalization of TWG actions for HRHSIP linked to objective
1.1
x
Minutes of the meetings
TWG meeting and activities wellcoordinated
1.3.5
Institutionalization of coordination mechanism for HRH HRHSIP
linked to objective 1.1
x
Minutes of the meetings
TWG meeting and activities wellcoordinated
x
X
Strategy ;- Make HRH unit a Secretariat for cross-learning (Continuous Professional Development, CPD) for all health workers
Objective;- To create a platform for cross learning among health workers
1.4.1
Organizing CPD for different cadre of health workers
Developed framework and cross
learning guidelines
Inter professional disharmony and
funding
1.4.2
Development of cross - learning CPD policy and framework
3Developed framework and crosslearning guidelines
Inter professional disharmony and
funding
1.4.4
Develop tools to capture the job description for HWS
Tool developed
Well develop Job description
1.4.5
Institutionalizing in - service training
# of in services training
Well planned for
# of advocate done
Quarters is well budget
Strategy ; Create and Sustain Conducive Work Environment for health workers
Objective ;- To ensure provision of infrastructure and adequate health work force
1.5.1
Advocate for the
staff
Provision of quarters for
1.5.2
provision of Personal Protective Apparel
#of personnel protective
Personnel protective available
1.5.3
Reward excellent performance from committee
Reward carried out
Performance available
1.5.4
Discipline of erring workers with establish committee
# of with discipline
1.5.5
Provision of basic materials to work with
# of basic material
Funding for materials
1.5.6
Advocate and encourage a scheme that allows property acquisition
/ retirement plans for health workers
# of retirement plan in place
Scheme in place
Availability of document on standard
operating procedures
Readiness of private practitioners
Improved budget allocation for HRH
(1% Budget)
Political will
Strategy; Working with the private sector to improve standard practice
Objective;- To Foster collaboration with private sector, and other HRH stakeholders
1.6.1
Recommend and Encourage the points above to the private sector
Strategy; Improve budget line for Human Resources for Health
Objective;- To advocate and ensure regular funding
1.7.1
Budget on Human Resources for health should be improved in the
annual budget of the MOH
1.8.1
Strategy Providing reward for hazards on the job beyond allowances and including death benefit The State to develop policies on these diseases
Objective; To reduce professional related health hazards
1.8.1
Legislate provision of life insurance HWFs
Identity Card
Life insurance Legislature in place
1.8.2
Provision of health insurance to health workers
Identity Card
Health Insurance Legislature in
place
1.8.3
Free medical service for HIV Positive Patients and put
Pay Slip
Register
them on Pay roll
1.9.1
Strategy; Collaborating with LGAs to develop concise job description for all categories of health worker with clear delineation of roles and responsibilities to minimize friction among staff Involving relevant stakeholders in
HRH activities from the planning stage
Objective; To provide job specification and development of standards operating procedures (SOPs)
1.9.1
Job description for all categories of HWS.
Scheme of Service
Job description
5.2.0. PLANNING THE PRODUCTION OF HUMAN RESOURCES FOR HEALTH
5.2.1 Goal;- To ensure equilibrium in production and demand of quality front line health
worker by ensuring that all health institutions are accredited for a rapid reduction in
maternal, neonatal and child mortality rate in the state..
5.2.2 Rationale;Despite a substantial increase in the number of graduates during the 2010 to 2013 period, a
large gap still exists between what is required and what is available. This is specifically
notable for Nurses and Midwives, Medical Doctors, Clinical Officers, Laboratory staff, and
Pharmacy staff. These needs have been identified through the application of 2013 Workforce
Optimization Model (WOM), which indicated that the current workforce has a 5-10%
vacancy rate (audit report gap etc) as compared to the optimal staffing level. To close this
gap, the training capacity of the various health training institutions needs to be expanded.
More so most of the health training institutions are managed as separate entities although
funded by the Ministry of Education and ministry of health. There are however no alignment
between the student intake and actual staff requirements in SMoH at hospitals and PHC
levels. Also enrolment of trainees and production of health manpower in the state health
training institutions are currently not determined by any evidence-based HRH needs.
In addition there is no framework for effective practice of community nursing and midwifery
in all local government areas of the state in preparation for the establishment of community
nursing /midwifery. There is no accreditation of state owned schools of Nursing and
Midwifery and budgetary allocation to training institutions is inadequate. However, both the
regulatory bodies and the HRH planning divisions of all levels of government and the private
sector need to perform their functions according to such evidence-based needs. The needs
should be reviewed periodically in line with well-determined staffing gaps in both private
and public institutions.
Furthermore, the training capacity of health sector should be updated on an annual basis to
reflect the required skills for effective and efficient service delivery. Training programs
should continually be adjusted to meet future health challenges. New and specialist programs
should be created in clinical and basic sciences. All programmes for the training of health
professionals need to include education in leadership and management.
29
Finally, the competence of the existing health workforce will require continued maintenance
through a combined set of interventions that aim at developing and maintaining its
competence and capacity to ensure appropriate delivery of services through the following
Goal and Policy direction.
5.2.3 Policy Direction;- State Government shall prioritize and plan for increase in the
production and demand of quality frontline health workers, such as nursing and midwifery
personnel to ensure a rapid reduction in maternal, neonatal and child mortality rates.
5.2.4. Strategic Interventions
To achieve the goal and objective, the sector will pursue the following strategies:
Strategic Intervention; - Balancing human resource for health supply with demand
State government shall adopt minimum standard requirements stimulated by the regulatory
bodies for training, making available alternative sources of funding for trainees (in-service
training) scholarships, study leave with pay, bonds, and grants. Develop a model project that
professional staff needs, and liaise with Ministry of Education and training institutions to
plan how to train sufficient graduates. Establish other health-workers programme (Med.lab.
physiotherapy) at OOU (Ago-Iwoye), adopt the new policy of the Nursing & Midwifery
council of Nigerian to train lower carder manpower for Nursing and Midwifery practice at
the PHC level. The state will work towards granting full autonomy to the health institutions,
exploring funding opportunities to the health institutions and work towards given subvention
for the health institutions.
Strategy (Intervention); - Review and refine the functions, mandates and
responsibilities of professional regulatory bodies
Establish a process to review the functions and mandates of regulatory bodies on an ongoing
process with the aim of strengthening adequate. Establish and strengthen the regular
monitoring process to ensure that training curricula and programmes are reviewed and
appropriately accredited and that the regulatory bodies ensure that they reflect multi-tasking
and task shifting as appropriate. Production and registration of health professionals to be
undertaken by the SMOH, with the involvement of the regulatory bodies and training
institutions. Review admission criteria for disciplines in response to HRH crisis in
disadvantaged areas of the State and continuously review assessment conducted by training
30
institutions to meet accreditation and professional requirement and expand training of
auxiliary cadres of HRH such as community health workers and multipurpose health
workforce.
Strategy (Intervention); - Review existing training programmes and certification of
health workforce and develop new ones to respond to the sector’s needs
State Ministry of Health will devise a plan to review all health related training institutions to
discuss the adaption of curricula for training programmes for State HRH priorities. After the
adaptations state shall provide mechanism to monitor the training programmes. All the
training shall be elevated, new one establish and deployment of community based health care
workers as appropriate.
31
Table 6 Log Framework and Timeline of HRH SIP on Production of HRH 2014-2018
Strategy; Balancing human resource for health supply with demand
1.1
Objective;- To rationalize and align supply of health workforce to the priorities need of the health sector
Activities
2014
2015
Q
1
Q
2
Q
3
Q4
Q
1
Q
2
Q
3
201
6
201
7
201
8
MOV
Assumption
Q
4
1.1.1
Conducting regular review meetings on curriculum of
health institutions
# of curriculum review carried out
Acceptability of health institution
1.1.2
Adoption the standard minimum requirements stimulated
Report of meeting
Regulatory bodies acceptability
1.1.3
Provide alternative sources of funding for trainees (inservice training)
# other funding
Political will
1.1.4
Work with SMoH and SoME Ministry of Education and
training institutions to plan how to train sufficient
graduates
List of workers sponsored for
training.
Funding for training available
1.1.5
Establish other HWFs (Med.lab. physiotherapy etc) at
OOU (Ago-Iwoye)
# of programme established
Accreditation of courses
1.1.6
Adopt the new policy of the Nursing & Midwifery council
to train lower carder Nursing and Midwifery
Memo of adopted policy
Political will
1.1.7
Work towards granting full autonomy to the health
institutions
Report of autonomy
Government willingness
1.1.8
Explore alternative funding opportunities for the health
institutions
Increase budget
Fudging opportunity available
1.1.9
Work with SMoH and SMoE to given subvention to the
health institutions
Report of subvention to the health
workers
Readiness of government
1.2.1
X
Strategy Review and Refine the functions, mandate and responsibilities of professional regulatory bodies with a view to strengthening adequate production of various health professional
Objective;- To make available sufficient and adequately trained relevants caders of health professional
Establish a process to review the functions and
Review committee report and list
The council or regulatory bodies is
of attendance
ready to make amendment ratification in
mandates of regulatory bodies
regulatory law and activities of health
workers
1.2.2
Accredited training programs and to ensure multi-tasking
and task shifting as appropriate
# of training curriculum establish
Report of accredited curriculum
Curriculum availability
1.2.3
production and registration of health professionals to be
undertaken by the SMOH
# of health professional by SMoH
Availability of professional
1.2.4
With the regulatory bodies and training institutions, review
admission criteria for disciplines in response to HRH crisis
# of admission criteria review
Training institution readiness
1.2.5
Expand training of auxiliary cadres of HRH such as
community health workers and multipurpose HW
# of review
Accredited institution
1.3.1
X
Strategy;-Review and adapt relevant training programmes for the production of adequate number of community health oriented professional
Objective;- Too Establish adequate and qualified community health oriented professional
State MOH to plan, discuss and adapt of curricula for
X
Report of the meeting
training programmes for State HRH priorities
1.3.3
Monitor adaptation of training programmes
1.3.4
Promote the training and deployment of community based
health care workers as appropriate
X
X
X
X
Minute of meeting with health
related
# of trainings
# of Community HWF employed
Curriculum available for review
Skilled community health workers
available
5.3.0 HEALTH WORKFORCE MANAGEMENT
Work force management will include recruitment, deployment, retention, promotion and
utilisation, in service, health and safety, motivation & reward systems, managing staff exits,
access to quality health services, and consumer awareness.
5.3.2 Rationale
i.
Over the years, recruitment drives at all levels of government have been negatively
affected by poor funding, embargos, and unexpected exits of the health workers.
ii.
In addition, recruitments have not been based on evidence-based needs.
iii.
HRH that are available for service provision are mal-distributed between rural and
urban areas of the state.
iv.
Lopsidedness of HRH also exists along divides of state and LGAs as well as clinical
and preventive health services.
v.
Poor retention of health staff create extra burden on the existing staff. These retention
problems are induced by poor conditions of service, lack of equipment, inadequate
development of infrastructure at the state and the lower levels of government.
vi.
Delays in promotion, poor placement after training and inadequate opportunities for
professional advancement.
vii.
Staff distribution is skewed towards urban areas because the development agenda of
governments do not create platforms for equitable distribution of social amenities.
viii.
In regular incentives for health workers with particular reference to those that are
meant to attract and retain staff in rural and deprived areas, especially Nursing and
midwives staff (MSS).
5.3.3 Policy Direction;-State Government shall conduct Annual review of Health workforce
management, provide conducive environment and ensure that health workers at every level
and in all health institutions are managed professionally and in a way that will nurture staff
commitment and dedication to duty.
5.2.4. Strategic Interventions
To achieve the goal and objective, the sector will pursue the following strategies:
Strategic Intervention; - Manpower Needs and Recruitment
34
State government shall conduct manpower needs assessment and recruitment to meet the
needs. Shall also procure necessary tools and equipment for delivery of health care services
Strategic Intervention; - Institutionalize succession plan
State government shall conduct update data on all available staff for availability of posting or
deployment plan and Mandatory rural posting for existing staff and entrants in the service
Strategic Intervention; - Institutionalize succession plan
State government shall conduct update data on all available staff for availability of posting or
deployment plan and Mandatory rural posting for existing staff and entrants in the service
Strategic Intervention; - Supportive supervision and positive work attitude
Ministry of health shall conduct regular supportive supervisory visits and on the job-capacity
building, organize workshop geared towards positive work attitude and continuous
professional training and conduct joint supportive supervision and positive work attitude.
Strategic Intervention; - Motivation and reward systems
Ministry of health shall conduct Mandatory rural posting for existing staff and new entrants
in the service
Strategic Intervention; - Equitable distribution of workforce
Ministry of health shall conduct periodic staff performance evaluation, provide scholarship,
grant to outstanding staff and re-training for low performance staff. Provision of incentives
(financial, comfortable accommodation, comfortable transport system) for staff posted to
rural areas and Procurement of necessary tools and equipment.
35
Table 7 STATE STRATEGIC HEALTH WORKFORCE MANAGEMENT 2014-2018
Table 7 THEMATIC AREA; - HRH MGT GROUP THREE
Strategy; Manpower Needs and Recruitment
1.1
Objective; To Improve quality of services (by recruitment competent personnel, providing infrastructure)
Activities
2014
2015
Q1
Q2
Q3
Q4
Q
1
Q
2
201
6
Q3
201
7
2018
MOV
Assumption
Q
4
1.1.1
Conduct Manpower Needs Assessment
Approved Proposal and report of
assessment
Establishment agreed to
this
1.1.2
Establish a process for Recruitment to meet the needs
# of HWFS employed
Fund or budgeted for
1.1.3
Procure and distribute necessary tools and equipment
# of tool procured and
distributed
Available Budgeted
Strategy; Institutionalize succession plan
Objective; To enable programme sustainability To enhance man power development
1.2.1
Update data on all available staff
1.2.2
Develop a posting or deployment plan
1.2.3
Facilitate mandatory process of rural posting for existing
staff and entrants in the service
√
√
√
Policy in place at the ministry to
distribute staff
√
√
Software in
place
# of people posted
√
# of HWFS rural area
Strategy; Supportive Supervision and Positive Work Attitude
Objective; To identify gaps and give on the job training ,to improve the quality of services
1.3.1
Conduct regular supportive supervisory visits and on the
job-capacity building
Report of Supportive Supervision
carried out.
TWG in place for
OJSSP
1.3.2
Organize workshop geared towards positive
work attitude and CPD
Improvement in the Service
Delivery
BCC and CPD
Strategy; Motivation and Reward System
1.4.1
Objective;- To achieve effectiveness and optimal productivity
Facilitate mandatory process of rural posting for existing
staff and entrants in the service
√
√
Q3
Commendation letters, Pay Slips to
reflect evidence of allowance and
Promotion Letters
Mandatory rural posting
Strategy; Equitable Distribution of Workforce
Objective;- To improve accessibility for effective healthcare delivery
1.5.1
Conduct periodic Staff performance evaluation
√
√
Records of Posting
1.5.2
Provide scholarship grant to outstanding Staff and retraining for low performing staff
√
√
# of scholarship granted
Scholarship committee
in place
1.5.3
Provide Incentives(financial, comfortable
accommodation, comfortable transport system) for staff
posted to rural areas
# of incentive
Service welfare
committee in place
1.5.4
Procure and distribute necessary tools and equipment
√
√
√
√
Q
3
Q3
# of tool procured and distributed
5.4.0 HUMAN RESOURCE FOR HEALTH INFORMATION SYSTEMS
5.4.1
Goal;- To establish a human resource for health information systems unit in planning
and research statistics Ministry of health with analysts and networking system for
regular updated HRH information distribution.
5.4.2
Rationale
Human resource for health information system in the State is partially transformed from
paper-based to electronic system based; obtaining accurate and up to date information on
staff is usually difficult. Manual and electronic computation is laborious and timeconsuming. There is an electronic nominal roll that captures workforce data which is limited
to biographic and other information on staff disposition, recruitment and expected retirement
dates as well as qualifications. However, not much analysis of this workforce data is being
done to aid HRH planning, management and development in the health sector; due to weak
systemic capacity for data analysis and effective utilization. An electronic health workforce
registry is not yet establish in the state. There is the urgent need for the development of a
comprehensive Human Resource Information System with clearly defined minimum data sets
to be collected on regular basis, processes for routine staff data collection, processing,
storage, retrieval and use for decision-making.
5.4.3
Policy Direction; - Government shall provide an effective HRH Information
System to be used as a management tool for informed decision-making at all levels and
improved health care
Strategic Intervention; - Development of routinely updated HRH database
Ministry of health shall make provision of computers, software, and ICT materials with
training on ICT/ software. There will also be regular payment of internet subscription,
designing database format for each level. Provision of avenue/platform for data collation and
review. It is hope that a central HRH IS data bank at MoH state headquarter with back-up
will be establish, effort to produce and distribute HRH bulletin bi-annually.
Strategic Intervention; - Ensure that HRHIS registers are available in all health service
delivery points at all levels
38
Government shall make provision for adequate funding of HRHIS through budgetary
provision for production of HRH registers at all levels. Ogun States will produce and
distribute adequate numbers of HRH register on a regular basis.
Strategic Intervention; - Periodic review of HRHIS data collection registers
Government shall make provision for adequate funding of HRHIS through budgetary
provision for production of HRH registers at all levels.
Strategic Intervention; - Strengthening the use of information technology in HRHIS
SMOH to roll out use of software for data collection, it will also pursue Public Private
Partnerships in the management of HRH data and promote the use of e-health (Electronic
Management Intelligence Information System, websites, HWF Information System) widely.
Strategic Intervention; - Provision of HRHIS minimum package at the different levels
(SMOH& LGA) of data management
Ministry of health shall advocate to state and LGA health managers to provide basic
infrastructure for data storage, analysis and transmission (Computers, power supply,
internet). Deployment and acquisition of database software at all levels and training technical
staff at all levels on database software.
39
Table 8 State Strategic HRH Plan 2014-2018 HEALTH INFORMATION SYSTEMS
THEMATIC AREA; - HUMAN RESOURCE FOR HEALTH INFORMATION SYSTEMS
Strategy; Development of Routinely updated HRH database
1.1
Objective;- To establish of routinely updated HRH database at DPRS
Activities
2014
Q1
2015
Q2
Q
3
Q
4
Q
1
201
6
Q
2
Q
3
201
7
201
8
MOV
Assumption
Q4
1.1.1
Procure and distribute computers, software, ICT materials
X
HRH Database available and
produced regularly
Resource in place
1.1.2
Train of staff on ICT/ software
X
Soft and hard copy of database
Database
1.1.3
1.1.4
1.1.5
Maintain internet subscription by regular payment
Designing database format for each level
Providing avenue/platform for data collation and reviews
Internet in place
Database
# of data collated
Network connectivity
1.1.6
1.1.7
Create a central data bank at state headquarter with back-up
Produce and distribute HRH bulletin bi-annually.
Data bank in place
# of HRH bulletin
Facility at the HQ
Fund in place
Amount of Budgetary provision
Political will
# of registrar
Provision
# of registrar
Mechanism in
Report of HRH review
Database already working
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Avenue and platform
Strategy Ensure that HRHIS registers are available at all health service delivery points at all levels
1.2.1
1.2.2
Objective; To ensure that routine HRH data is available, consistent and valid
Adequate funding of HRHIS through budgetary provision for
X
X
production of HRH registers at all levels
X
X
X
X
X
X
X
X
Produce and distribute adequate numbers of HRH register on a
regular basis
X
Strategy; Periodic review of HRHIS data collection registrar
1.3.1
Objective; To establish a feedback mechanism on improving HRIS in the State
Create a mechanism for feedback from users on registers being
used
1.3.2
Annual review of database of HRH
A
N
N
U
A
L
Strategy; Strengthen the use of information technology in HRHIS
1.4.1
Objective; To provide infrastructural support and computerisation of health databases and staff training
X
X
X
X
Roll out use of software for data collection.
1.4.2
Pursue Public Private Partnerships in the management of HRH data
1.4.3
Promote the use of e-health (Electronic Management Intelligence
Information System, websites, HWF Information System) widely
X
X
X
X
X
X
X
Software working in the SMoH
Software install
X
X
X
X
X
X
X
X
X
Signed MOU of PPP
PPP in regulation
X
X
X
X
X
X
X
X
X
e-health in place
Competent skill personnel to
man e health
CROSS CUTTING; - Human Resource for Health Partnership and
Linkage, Collaboration among Stakeholders
.
5.4.1
5.5.1. Goal; - To ensure collaboration and Linkages among stakeholder on HRH.
5.5.2. Rationale
Mobilisation, allocation, and utilisation of health resources are fragmented among different
players. Activities of private health sector providers are poorly coordinated. This affects staff
development and utilization. Women in management positions provide role models for other
women and help to ensure that the views of women are represented at management level.
Performance appraisal is in place in some areas but is not properly administered
5.5.3. Policy Direction; - State Government shall prioritize and plan in partnership
cooperation and collaboration of all stahkholder for HRH
5.5.4. Strategic Interventions
To achieve the goal and objective, the sector will pursue the following strategies:
Strategic Intervention; - Strengthen communication, cooperation and collaboration between
health professional associations and regulatory bodies
Periodic coordination meetings among different players, government Enforcement of
Monthly data submission should be a prerequisite for renewal of license.
Strategic Intervention; - Collaborating with LGAs to develop concise job description for all
categories of health worker
Development and implementation of job description for all categories of health workers and
to follow it to the letter, communicating to all relevant Stakeholders (Seminars, Meetings,
Circular) and getting their feedbacks and input on HRH activities.
Strategic Intervention; - Strengthening public institutions for PPP and collaboration
Government should put inn appropriate mechanism for collaboration and linkages of all
health institutions. Government should coordinate public sector, private health providers and
Faith Based Organization (FBO) to develop staffing standards for their health facilities.
42
43
Table 9 STATE STRATEGIC HRH PLAN 2014-2018 HRH PARTNERSHIP
THEMATIC AREA; - HRH PARTNERSHIP
Strategy; Strengthening communication, cooperation and collaboration between health professional associations and regulatory bodies on professional issues that have significant implication for the health system Strengthen
Objective;- To ensure harmonious relationship among health professional bodies
1.1
Activities
1.1.1
Periodic coordination meetings among different players.
1.1.2
Allocate 15% of the budget to health 10% of the Health
budget for HRH
1.1.3
Monthly data submission should be a prerequisite for
renewal of license.
1.3.
2
Stakeholders (Seminars, Meetings, Circular) and getting
their feedbacks.
2015
2014
Q1
Q2
Q3
X
Q4
Q1
Q2
Q3
Q4
X
2016
201
7
2018
MOV
Assumption
1
1
2
# of Meetings
Availability of funds
Budget Estimate
X
X
1
1
2
No. of Licenses issued
Register and Minutes of Meeting
Meetings Held
Strategy, Strengthening public institutions in respect of infrastructure and personnel
Objective;- To provide public health institution in term of infrastructure and personnel
1.4.
1
Government should renovate and equip existing health
facilities.
List of Health facilities renovated
All Health Facilities are
renovated
1.4.
2
Employment of Skilled health Personnel in all cadres.
List of Skilled Health Personnel
employed
Recruitment of Staff
Strategy; Encouraging private providers to take advantage of training opportunities provided by public sector and vice-versa Public sector and association of private provider including Faith Based Organization, collaborating to
develop and make available staffing standard
Objective;- To enhance synergy between public and private health providers for training
1.5.
1
Private health providers should be involved in training
programs
List of trainings
Training and Retraining
of Health Workers
1.5.
2
Staff List and Health List
Staffing standard for their health facilities for public and
private, FBOs
Strategy; Liaise with the LGAs to work towards one or two females to be appointed as Assistance Directors at LGAs
Objective;- To advocate for 30% of the assistance directors post should be for females
1.6.1
50% of Directorate should be females
X
X
1
1
2
# of Female Ass. Directors
appointed
Strategy; Strengthen monitoring and evaluation mechanisms to access progress and impact
Objective To have reliable quality and timely HRH data
1.7.1
Development of HRH software monitoring tools
HRH Unit in place
Yearly recruitment
exercise
Section 6: Resourcing the Plan; - Funding Mechanisms
Successful Implementation of the HRH Strategic Plan will require substantial resources and
commitment of all stakeholders including SMOH, Development Partners, professional
associations, health workers unions, private practitioners and Non-Governmental
Organizations (NGOs).
Most of the human resources for health costs which are related to salaries and training are
borne by government. The private sector also makes provisions for their personnel. These
recurrent costs are therefore not reflected in the budget in this document. The costing
included in this document thus reflects the cost implications for capacity strengthening
activities and interventions required accelerate actions towards achieving a qualitative,
adequate, efficient and cost-effective HRH in the state.
This comprehensive and integrated HRH Strategic Plan aims at attracting funding agencies to
partner with governments at the various levels in order to provide adequate support to
government to deliver optimum management and development of the health workforce in
the state, in a well-coordinated manner.
Potential sources of funding for human resources for health management and development
during the plan period include:
o Government sources – Federal, state and LGAs
o Development Partners, and other external sources of funding
o Public – Private Partnerships
o Individual and community self-help/ investment in human resources
development
o Philanthropic sources
o Faith Based Organizations(FBOs)
o Other special funds.
Section 7: Results Matrix and Monitoring and Evaluation
7.1 MONITORING AND EVALUATION OF HRH SIP
There is the need to monitor closely the Implementation of the HRH policy regularly at all
levels in order to harness relevant evidence to support decision making and re-planning.
46
Regular structured monitoring and evaluation will also facilitate a platform for cross-state
learning and capacity building for continuous and sustainable improvement in HRH systems,
procedures and practices state-wide.
There are two perspectives to monitoring and evaluation in the context of the HRHSP and its
implementation process. First, it is important to monitor and evaluate the plan’s operational
elements (in this case, the required activities) that are essential ingredients in ensuring the
successful implementation of the plan. Secondly, it is equally essential to monitor and
evaluate programme outputs and impacts. The latter concerns measurable variables and
changes in the health status of the population and the health services as a consequence of the
implementation of the SHDP.
Policy Direction for Montoring gand Evalluation
The State Government shall create state human resources for health unit with a secretariat in
the PRS, State Ministry of Health to monitor and support human resources management
systems, procedures and practices strengthening initiatives in the state. Further, all
regulatory bodies will be encouraged and resourced to collect, collate and generate
accurate, reliable and timely report on their membership.
Strategies for Monitoring and Evaluation
The State Ministry of Health:
(i)
Developing standards and gender-sensitive indicators for assessing HRH systems,
procedures and practices at different levels.
(ii)
Collaborating with regulatory bodies to enable them effectively monitor closely
practices of professional groups.
(iii)
Building capacity of regulatory bodies to develop monitoring systems and set up
structures in the senatorial zones to facilitate effective monitoring of professional
practices.
(iv)
Analysing regularly HR information that are generated within the system and
send feedback regularly to stakeholders at all levels.
(v)
Conducting a comprehensive state-wide evaluation of the state of human
resources for health management and development every three years to feed/fit
into the planning process.
47
7.2 IMPLEMENTATION ARRANGEMENTS
The OHRHSP-IP 2014-2018 will be implemented, monitored and coordinated through the
existing health sector organizational and management structures, including the HRH
technical working group TWG (TWG), the MoH at central level, the OGPHCB, the LGAs,
the Hospital Management Board, the public and private-for-profit health training institutions,
the regulatory bodies, and other stakeholders, including faith based, health NGOs, privatefor-profit facilities, health unions and civil society.
The MoH, through the DPRS, assisted by the HRHTWG, will be responsible for the overall
coordination and monitoring of the SHRH SP 2014-2018. Additional mechanisms for
consultation and supervision will be established as needed, .such as experts’ ad hoc technical
working groups with input from relevant stakeholders.
The coordinating partners (CPs) will be requested to support the SHRH SIP by aligning and
synchronizing their interventions with the MoH’s priorities and timelines, as specified in the
SHRH SIP 2014-2018.
As a subset of the SHRHSIP, it is expected that the implementation of the SHRH SIP will
fall within the scope of the Memorandum of Understandings signed between stakeholders
and the government in regard to the implementation of the SHRHSIP.
7.3 CRITICAL SUCCESS FACTORS
Experiences in other states and other countries have shown that four factors are instrumental
for the successful and timely funding, implementation and monitoring of HRH strategic
plans:
7.3.1 Sound leadership: The HRHTWG will be the coordinating body for the
implementation and monitoring of this Plan, with the DDPRS acting as the focal point,
serving as secretariat to carry out the required routine coordination, communication and
facilitation. To improve the capacity of the HRHTWG, its ToR will be reviewed and
membership adjusted to ensure stakeholders and senior officials from all relevant
government institutions are represented.
7.3.2 Strong partnerships: To promote effective collaboration with its stakeholders,
partners and beneficiaries, the MoH, will:
48
(i) Promote effective communication with stakeholders and beneficiaries in the
implementation and monitoring of the NHRH SIP 2014-2018, clearly outlining
the division of labor and the targets to be met
(ii) Write and share annual action plans with partners, stakeholders and beneficiaries to
promote accountability, transparency and collaboration.
7.3.3 Sound and feasible M&E system using measurable indicators against an
established baseline
Please see results matrix indicators for details information regarding the M&E structures for
this Plan. Based on these structures, the MoH believes it is well-positioned to successfully
implement and monitor this Plan within the given targets and deadlines.
7.4. MONITORING FRAMEWORKS AND INDICATORS
7.4.1. M&E systems and structures:
A lesson learned from the previous OSSHDP is that it is unnecessary to separate monitoring
system from process for HR, rather it should be properly integrated in the MoH general
M&E system. Data for the specific indictors proposed for the SHRH SIP 2014-2018 should
be collected as part of the general M&E system. The following are important parts of the
M&E system:
7.4.2 Performance Management Package system: Training in the PMP will be cascaded to
assess the performance of individual workers, using job descriptions and individual work
plans.
7.4.3 Quarterly and annual narrative and financial progress reports: These reports are
required for the overall management of joint financing of the health sector. The DDPRS will
prepare quarterly reports concerning the implementation of the SHRH SIP to be presented to
the HRHTWG.
7.4.4 Facility-based performance assessments: This assessment is conducted twice a year
using semi-structured questionnaires in all health facilities. The assessments follow a Total
Quality Management (TQM) approach and are one of the monitoring instruments of the
SHRH SIP to improve planning and management of the health workforce.
49
7.4.5 Technical Supportive Supervision (OJCBISS): Visits to the sites addressing the
weaknesses found in the facility-based performance assessments. SUNMaP is already
supporting this in the state.
7.4.6 The Joint Annual Reviews (JAR): The reviews aim to assess the progress made in
implementing the Annual Action Plans, with an emphasis on key thematic areas. During the
review, various stakeholders at all levels would participate in the assessment. The JAR
should follow-up on agreed indicators of the NHRH SIP.
7.4.7 The Mid-Term Review (MTR) and final evaluation of the implementation of the
NHRH SIP 2010-2015 and annual action plans: the implementation of the Ogun state
HRH
SIP 2014-2018 will be assessed through a midterm review and a final evaluation.
50
Table 10: Results Matrix and Monitoring and Evaluation
S/N
Priority
Strategy
Area:
Priority
Activities
Indicators
Indicators Type
Output
Outcome
Data Source
Frequency
Impact
Resp.org/
Target
Milestone
Target
unit/agency
2014
2016
2018
Thematic Area;- Leadership and Planning
Objectives ;- To establish and ensure a functional HRH TWG in the State
Institution
alize TWG
actions for
HRH in
the State
Agreement on
operationalizati
on the HRH
SP-IP
Technical
guidelines
developed
TWG
committees for
follow-up of
progress on
HRH SIP
Inaugurated
TWG Functional
X
X
X
Consultant
Report
Annually
PRS/ HRH Unit
TWG
1
2
4
Annual and
Quarterly
reports
Annually
and
Quarterly
PRS/ TWG
Hon Com
4
8
32
Technical
report of
External HRH
Expert
Annual
SMoH/PRS
1
2
4
Consultant
report
Annual
1
2
4
Objective;- To provide clear policy and Strategic directions for HRH for development
HRHSP-IP
appropriate
minimum
standards
dev.
Develop and
monitor
minimum
standards in
impl.of
HRHSP-IP
Costed HRHSIP
are in operation
X
HOS
Objective;- To create a platform for cross learning among health workers
HRH unit
a CPD
and job
descriptio
Development
of cross learning CPD
policy and
framework
Frame work and
guidelines dev.&
implemented
X
DPRS
n) HWFs
Organizing
CPD for
different cadre
of health
workers
CPD training
guide developed
HWFs acquired skill
x
CPD Training
report
Quarterly
HRH PRS
4
8
12
Thematic Areas;-HRH Production
Objective;- To rationalize align supply of HWFs with Demand and to develop capacity of HWFs
Balancing
human
resource
for health
supply
with
demand
Conduct
Manpower
Needs
assessment
Number of
workforce
distribution
analysis
conducted
and
X
Consultants
reports
Annually
DPRS/HRH
TWG
1
2
4
X
Payroll List
Annually
LGSC,SCSC
1
2
4
Quarterly
SCSC, LGCSC
20%
50%
80%
Annually
HRH TWG/
DPRS
1
2
4
Recruitment
Redeployme
nt of work
force.
No of
redeployment
exercises
conducted
Recruitment
of adequate
number of
workforce
Proportion of
needed
workforce
recruited.
X
Payroll List
Objective;- To develop the capacity of health workforce.
Review
and adapt
relevant
training
programm
Assessmen
t of
training
needs of
TWG and
Number of
need
assessments
conducted.
X
Assessment
Reports
es and
To train,
retrain and
provide
inservice
training for
TWGs
HRH and
other
HWFs
different
health
cadres.
Organize
specialized
trainings
for TWG
and
specific
cadres of
health
workers.
Provide
opportunit
ies for
study
tours.
Number
of
training
conducted.
Number of
planned study
tour
conducted.
X
Training
reports
Quarterly
HRH TWG/
DPRS
4
12
16
X
Study tour
reports
Quarterly
SMOH, Head
of service
4
12
16
Log book,
Monthly,
Dep., Agency,
Thematic Area ;- Health Work Force Management
Objectives ;-To improve quality of services
Supportive
Render on-the-
Supervision
job
# of SS carried out
x
Attendance
quarterly,
office of Head of
and
register, APER
annually.
service
Positive
form
Work
Attitude
practice
55%
70%
85%
Objective;- To achieve Job satisfaction, effectiveness and reduce HRH attrition rate to not more than 10% annually
Motivation
Prompt
and Reward
payment of
System
salary
X
Pay slips
and
Payment
vouchers
Quarterly
Office of Head of
80%
90%
95%
service. Budget
PRS/ TWG
Improvem
ent in
Rural
posting
allowance
to health
workers in
rural areas.
Proportion
of health
workers in
rural areas
with
enhanced
rural
allowance.
X
Pay slips
and
Payment
vouchers.
Quarterly
OYSG
60%
90%
90%
Annual
Merit
Awards for
best
performing
health
workers.
Proportion
of deserving
health
workers
given merit
awards.
X
Letters of
commenda
tion and
gifts/prese
nts
Annually
OYSG
100%
100%
100%
Priority Area
Strategy Areas
Development of
Routinely updated
HRH database
Strategic
Objectives
To Establish
routinely HRH
database
Ensure that
HRHIS registers
are available SDs
To ensure that
routine HRH data
is available &
consistent
Proportion of
routine HRH
data that is
available
Periodic review of
HRHIS Registers
To establish a
feedback
mechanism
on
improving HRIS in
the State.
Strengthen the
use of information
technology in
HRHIS
To provide
infrastructural
support and
computerisation of
health databases
and staff training
No of
consultative
meetings held
towards
improving
HRHIS in the
State
Increase in the
skilled HRIS
officers
#of HRHIS
Database
installed and
used at DPRS
OGUN STATE INDICATOR MATRIX OF HRH STRATEGIC INFORMATION SYSTEMS PLAN (2014 – 2018)
THEMATIC AREA: HRH INFORMATION SYSTEMS
Indicators Type
Data Source
Frequency
Resp.org/unit
/agency
Output
Outcome
Impact
DPRS
&
Admin
Quarterly
DPRS
x
dept. Report from
Director
HRH data
Monthly
DPRS
X
Baseline2013
0
Mile stone
2014
1
30%
0
Mile stone
2016
4
Target
2018
7
60%
70%
HRH Data
summary forms
Monthly
basis
HMIS Officer
0
40%
60%
80%
X
HRH Data files
HRH Data files
Quarterly
Quarterly
Desk Officer
HRH
0
0
4
40%
4
70%
4
90%
X
Facility report
Monthly
basis
Quarterly
State HRH
Focal Person
0
0
1
1
4
6
7
12
THEMATIC AREA;- HRH Partnership, M&E, Gender and Coordination
Priority area Strategy
Areas
Objectives
Priority
Activities
Indicators
Indicator
Output
Strengthening
communication,
cooperation
and
collaboration between
HWFS
To
ensure
harmonious
among HWFs
Providing reward for
hazards on the job
To reduce
health
hazards
Strengthening public
institutions in respect of
infrastructure and
personnel.
Outcome
Data Source
Frequency
Impact
Resp.org/
Baseline
Milestone
Target
unit/agency
2013
2016
2018
Harmonious
relationship and
team spirit achieved
x
Health bulletin
Bi-annual
quarter
Ministry of
Health/DPRS
None
Quarterly
stakeholders
meeting
Monthly
stakeholders
meeting
Life Health
Insurance
scheme
No of job acquired
injury or death
x
Report of
hospital
Yearly
Hospital Estab
0
0
0
Provide
infrastructure
and personnel
infrastructure
and personnel
Improved quality
services
x
State Health
Bulletin
3 years
SMOH/DPRS
Available
2 years
Yearly
staffing standard
available
Enhance
synergy
between
HWFS
Production of
staff standard
brochure or
SOP
Proficient and
Competent HWFS
x
Training
Brochure
Yearly
Estab. SMoH
Available
Bi- Annual
Quaterly
One or two females to
be appointed as
Assistance Directors at
LGAs
30% of the
asst. Dir. Post
for females
Position of
Asst. Director
created in the
State
Female Assistant
Directors appointed
LG Regulation
2 years
LGSC
Nil
60%
Implementati
on
Full
Implementati
on
Strengthen monitoring
and evaluation
mechanisms to access
progress and impact
To have
reliable quality
and timely
HRH data
HRH quality
data provided
Improved quality
timely data.
Consultant
report on HRH
M&E Tool
Health Bulletin
3 years
SMOH/DPRS
Nil
70% of
Implementati
on
Full
Implementati
on
Trained HRH
and M&E
tools
developed
X
x
Remarks
Nil
SECTION 8;-COSTING OF HRH SIP 2014-2018
8.1 ESTIMATED COST OF IMPLEMENTING THE STRATEGIC PLAN
The estimated costs (excluding the baseline costs for salaries and other recurrent costs) for
the implementation of SHRH SIP 2014 is N152,343,590.00 with 10% added to allow for
inflation the estimated financial requirement to implement the comprehensive plan for two
year in Ogun state is about N167,577,949.00 only. The breakdown of the 2014 -2015 costs
according to priority areas is approximately as follows:
TABLE 10: BUDGET SUMMARY FOR HUMAN RESOURCE FOR HEALTH
STRATEGIC IMPLEMENTATION PLAN 2014-2018
S/No
.
Thematic Area
Estimated Cost
(N) 2014
Estimated
(N) 2015
1
Leadership
Planning
and
53,337,290.00
58,671,019.00
2
Health workforce
production
2,716,500.00
3
Health work force
management
4
HRH HIS
5
HRH
Cutting
Total
Croos
Cost
Estimated
(N)2016
Cost
Estimated
Cost (N)2017
Estimated Cost
(N)2018
64,538,120
70,991,932
78,091,126
2,988,150.00
3,286,965
3,615,661
3,977,227
11,321,000.00
12,443,100.00
13,687,410
15, 056,151
16,561,766
22,310,000.00
24,541,000.00
26,995,100
32, 994,610
36,294,071
62,658,800.00
68,924,680.00
75,148
83,398,862
92,238,749
152,343,590.00
167,567,949.00
184,324,743.9
206,057,218.29
227,162,940.119
8.2. FINANCING OPTIONS
The HRH SIP 2014-2018 is within the estimated resource envelope, but if more resources
become available for the second half of the plan period, it is suggested that the midterm
review revisit the plan and propose amendments based on progress made and the situation at
that time. Activities that can be added to the plan during the latter half of the plan period are:
 Increasing the funded establishment for clinical cadres e.g world class cancer
center/institute and Increase the training capacity and diversify training institutions.
 Building more staff houses and other improvements of staff conditions.
57
BIBLIOGRAPHY
1. Report of Situation Analysis of Human Resource for Health November, 2013
2. National Population Commission and Ogun State 2007-2009 Health Bulletin
3. Nigeria health work force profile as at December 2012
4. World Health Organization. Working Together For Health, The WHO 2006, Geneva
5. Human Development Report, UNDP, 2001
6. Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, et al. Human
resources for health: overcoming the crisis. Lancet 2004; 364: 198490.[CrossRef][ISI][Medline].
7. World Health Organization. High level forum on the health MDGs. Addressing
Africa's health workforce crisis: an avenue for action. 2004.
www.hlfhealthmdgs.org/Documents/AfricasWorkforce-Final.pdf (accessed 28 March
31, 2011).
8. Ayenbe, W; Bezzano, J; and Foot, S. An Analytical Framework for Understanding
the Political Economy of Sector Policy Arenas – Country Level Testing: The Health
Sector in Nigeria. November 2005 – unpublished
9. Ogun State Health Bulletin
10. Ogun State Strategic Health Development Plan; 2010-2015
11. Ogun State Health Bulletin 2012
12. Sources World Health Statistics 2005
13. National Sero-prevalence survey
14. Ogun State SACA
15. NARHS
16. Ogun State Strategic Health Development plan
17. Ogun State Government Economic Plan Development 2012-2015
18. Ogun State 2013 -2015 Ministry of Health Mid Term Strategy
19. Ogun State College of Health Technology 2013
20. Nigeria health work force profile as at December 2012
21. Ogun State Health Bulletin 2007-2009 and 200-2012 edition
22. Ogun state health management board accessed September 2013
23. Ogun State (NMA, NMCN etc). Accessed Oct 2013.
58