November 24, 2009
Page 1
Global South-South Development Expo 20009 Nomination Submission
Part 1: Project Information Brief:
Project/Solution name: Developing National Human Resources Information (HRIS)
Systems through South-to-South Collaboration
Countries: This project has engaged Kenyan public sector officials in providing
technical assistance and collaboration with peer officials in Zimbabwe and Nigeria to
develop national HRIS.
Nominated by: The Centers for Disease Control and Prevention (CDC)
Sector: HIV/AIDS and Health Systems Strengthening
Sponsor(s)/Donor(s): The project was funded with resources provided by the
President’s Emergency Plan for AIDS Relief (PEPFAR). CDC’s Global AIDS
Program awarded the project and oversees project activity.
Implementing agency: The Lillian Carter Center for International Nursing, Emory
University, Atlanta, GA, is responsible for implementing the project; however, the incountry implementers include several organizations and agencies. Specifically they
comprise:
1. The Government of Kenya’s (GoK) health ministries (Ministry of Medical
Services and the Ministry of Public Health and Sanitation),
2. The professional regulatory boards of Kenya (i.e., Nursing Council of Kenya,
Medical and Dental Professional Board, Medical Laboratory Technicians and
Technologists Board and the National Clinical Officers Council),
3. Staff from the Emory University project, which is entitled: The Kenya Health
Workforce Information System (KHWIS). KHWIS staff include: a Kenyan
Country Project Director, a Kenyan Data Analyst, a Kenyan programmer and a
Kenyan networker.
Project Status: The south-to-south collaboration between Kenya, Zimbabwe,
and Nigeria is currently implementing the second of three phases:
 Phase 1: Orientation site visits to Kenya by Nigerian and Zimbabwean health
officials to introduce a center of excellence model of HRIS in Kenya
 Phase 2: Kenyan health officials conduct technical assistance visits to Zimbabwe
and Nigeria to assist with assessment, planning, and implementation of national
HRIS
 Phase 3: Kenya, Nigeria, and Zimbabwean health officials meet and engage
periodically to provide technical exchange and ongoing collaboration
Project Period: 2009-2012
November 24, 2009
Page 2
Part 2: Project Summation (word count: 1,983 - excluding headings)
Background and Overview of the Project:
(Description of the initiative, why it emerged and the issue/problem it addresses)
Workforce shortages pose one of the greatest obstacles to expanding health care in subSaharan Africa. According to the World Health Organization (WHO), 57 African
countries have a critical shortage of healthcare workers, comprising a deficit of 2.4
million doctors and nurses for basic health standards. Despite recent global health
investments, the growing health needs of communities in Africa continue to outpace
health worker supply; in the region, 3% of the world's health workers face 25% of the
global disease burden.1
KHWIS
The Kenya Healthcare Workforce Information System (KHWIS) represents the longest
running and most comprehensive human resources information system (HRIS) in subSaharan Africa. The system was born out of a request in 2001 initiated by Kenya’s
health leadership to the CDC for assistance in developing a new nursing degree program
in order to address nursing shortages within the public sector. After conducting an
intensive in-country assessment, CDC and Kenyan stakeholders determined that the
challenge in Kenya was not an underproduction of nurses--warranting a new degree
program--but in fact the lack of accurate data on the number of qualified nurses in the
country (as many qualified nurses were, in fact, unemployed). At the time of this
assessment, no one in Kenya could provide the national number of qualified, licensed
nurses in the country.
CDC subsequently funded Emory University to help the GoK develop an integrated
nursing informatics system, one that could connect registration and licensing data with
deployment and payroll information. Two years later, the system began producing
accurate nursing data that was used repeatedly for health planning and policy-making by
Kenya’s Ministries of Health (MOH), professional bodies, and even donors. In 2005,
CDC, with new support from the President’s Emergency Plan for AIDS Relief
(PEPFAR), supported expansion of the successful project to include other health cadres
(e.g., physicians, dentists, laboratory professionals, etc.).
South-to-South Collaboration
When reflecting on why the Kenya model of HRIS has been so successful in relation to
other models in the region, the project team determined it was the deep ownership and
engagement of Kenyan health institutions (the ministries of health and regulatory bodies)
in designing, managing, and advocating for the system. Thus, when other countries
started expressing interest in adopting the “Kenya model”, CDC decided that the best
partner to help provide orientation, training, and technical assistance was not an
1
http://www.who.int/whr/2006/en/
November 24, 2009
Page 3
American implementing partner, but the Kenyan health officials and Kenyan project team
themselves. Indeed, in an era of ever growing and complex foreign assistance,
supporting an African-led dialogue and collaboration on human resources for health
(HRH) is a critical approach to sustainability.
Project Objectives:
Objective #1: Support Kenyan health officials to help Zimbabwe and Nigeria
establish national HRIS, for more effective planning and management of scarce
human resources
Objective #2: Establish a low-cost platform for ongoing technical exchange,
dialogue, and collaboration between health officials in Kenya, Zimbabwe, and
Nigeria, to promote African-led models of tracking, planning, and managing scarce
human resources.
Objective #3: Promote an African-led dialogue on HRH, HRIS, and using data for
evidence-based HRH decision-making.
Objective #4: Continue to support the Kenya HRIS as a center of excellence for
HRH informatics, epidemiology, and using HRH data for decision-making
Project Approach
The KHWIS is comprised of:
 a national database of all registered and licensed health workers in the country
(i.e., workforce supply), generated from each professional regulatory board
 a national database on their current deployment status (workforce demand),
by ward, health facility, district, and province
 the automation of an existing quarterly data reporting system that provides
updated information on staff deployment from district to national levels.
 linkage with the national payroll register to ensure accuracy in compensation
Earlier this year the Kenyan Chief Nursing Officer and CDC presented the KHWIS as a
best practice at the first PEPFAR Human Resources meeting that convened in Pretoria,
SA. Following this presentation, several countries expressed interest in the KHWIS,
which resulted in the GoK offering to host learning site visits for any interested country.
During the months of May and July 2009, the KHWIS team hosted two site visits for
Nigerian and Zimbabwean delegations of over 15 MOH, professional regulatory boards,
and U.S. government staff. These site visits included:
 tours and meetings of the Kenyan regulatory boards where the system was
operational.
 site visits to a typical GoK provincial office, which afforded the visiting Nigerian
and Zimbabwean officials the opportunity to observe how KHWIS tracks
November 24, 2009

Page 4
workforce dynamics—including health worker vacancies, promotions and even
illegal health providers (i.e., health provider who lack proper credentials).
a provincial data training workshop, in which the KHWIS team instructed
provincial and district staff (from a rural areas) on data usage.
These visits enabled Nigerian, Zimbabwean, and Kenya MOH, regulatory board, and
information technology professionals to start an African-led, international discussion on
health worker shortages, workforce tracking, and data management. This experience
convinced the Nigerian and Zimbabwean officials on the feasibility of launching a
similarly designed system within their respective countries. Upon returning home, each
delegation successfully obtained the support of their national health leadership and
PEPFAR country team to launch national HRIS in their respective countries.
After obtaining buy-in for a national HRIS from national health leadership and the
CDC/PEPFAR team, the Zimbabwe delegation requested a week-long reverse south-tosouth technical assistance visit in September, 2009 to plan the first four years of their
HRIS project.
Specific components of this visit included:






Conducting an information technology (IT) assessment of Zimbabwe’s current
hardware and software capability
Site visits to discuss HRIS challenges and needs with district, provincial, and
national hospital and health office staff
Stakeholder engagement and discussion with the Zimbabwe Minister and
Deputy Ministers of Health, Permanent Secretary, HR Department, Nursing
Directorate, Nursing Council, Ministry of ICT, Payroll Department, and CDC
Zimbabwe team
Establishing roles and responsibilities for national stakeholder groups and
project team
Helping draft a shared vision and four-year plan for developing an integrated
health workforce information system with appropriate quality control and
safeguard measures
Advising on Zimbabwe’s program development of the system – e.g., costs,
contracting, data security, software and hardware development, and more.
Project Outcomes and Benefits
There are two levels of project outcomes and benefits in this initiative. First, the
impact of the national HRIS in Kenya is indicative of the future impact of similar
systems in Zimbabwe and Nigeria. Some examples include:

Policy- Workforce information generated by KHWIS has already influenced
important Kenyan government policies. For example, in March 2009, KHWIS
data was used to successfully advocate an increase in the Kenyan civil service
retirement age from 55 to 60 years of age. This decision was made by the Kenyan
November 24, 2009
Page 5
Parliament after KHWIS nursing workforce demographic data documented an
aging workforce that could not be replaced with the current numbers of younger
healthcare providers entering the workforce. The decision has had an immediate
impact in expanding number of health care providers who are eligible to continue
serving in GoK healthcare facilities.

Payroll- Additionally, the linkage of KHWIS data with payroll registers has
helped identify over 1,000 mismatches between who is being paid by the GoK
and who is registered and deployed as a health worker. Most of these
‘mismatches’ are ‘ghost workers’- individuals who are being paid but are not
currently working in a health reality, and this wastage of government resources is
currently being rectified.

Compensation- KHWIS data also has been used to rectify thousands of
promotions for eligible nurses, which is a significant factor in workforce
retention. Previous to the KHWIS, promotion eligibility was handled through
paper-based files, which could become lost or backlogged. Now, with a click of a
button, the Chief Nursing Officer can run a report on all promotion-eligible
nurses, and through the linkage with payroll, ensure they are being compensated.

Planning- Additionally, KHWIS data has been used by donors, such as to identify
the most understaffed health facilities in Kenya for priority placement of nurses
through the Emergency Hiring Plan (a program underwritten by five separate
donor organizations).
Secondly, there are a number of more qualitative impacts brought about through the
south-to-south partnership which are equally significant. These include:



Close working relationships formed between African professionals in Kenya,
Zimbabwe, and Nigeria
High level political support from the Governments of Zimbabwe and Nigeria
for a national HRIS;
Growth in the Kenyan HRIS “TA” team
Innovation
The traditional model of helping establish national information systems- and even HRIS
in particular- has been to depend on American non-governmental organizations (NGOs)
to travel from country to country to design and implement the project and “hand-off” the
finished product to local officials at a later date. This system is prone to dependency on
foreign partners and produces a very costly model of overhead and expatriate staff.
CDC believed in supporting the expansion of HRIS in a more innovative, sustainable
manner which enabled the very people who made the first system work to help other
fellow counterparts throughout the region establish their own systems.
November 24, 2009
Page 6
KHWIS’s south-to-south collaboration to scale-up national HRIS includes several
innovative aspects:
 Leadership for the consultation reflected a Southern orientation and cultural
awareness. The entire site visit agenda and individual presentations were Kenyan
inspired and developed, which help create rapport among the visiting delegations.
 The technical assistance provided by the Kenyan was low-budget and appropriate
for delegations from low-resource setting.
 The technical assistance provided during the initial orientation was unusually
comprehensive. The week-long orientation consisted of formal presentations
which described the various features of the system, tours of several regulatory
boards and national and provincial offices. These visits enabled each delegation
to observe first-hand how workforce data was being collected and how that
information was being utilized by indigenous stakeholders on a day-to-day basis.
At the end of the week-long site visit, each delegation was familiar with KHWIS
and able to describe how such a system could function within their respective
settings.
 The South-to-South consultation has resulted in multiple HRIS planning and
implementation activities within Nigeria and Zimbabwe, which would not have
occurred so quickly had this consultation not taken place.
Sustainability
The most unique feature of the KHWIS is the degree of its ownership, favorable support,
and financing by the Kenya government – features that ensure its sustainability over the
long term. The KHWIS databases and satellites are housed within regulatory boards and
GoK institutions, and they are updated and maintained by their staff. The Chief Nursing
Officer has a full-time dedicated national HRIS coordinator paid for by the GoK who is
responsible for analyzing data from KHWIS for policy and programmatic decisions.
Whereas PEPFAR resources were used to initially purchase the IT hardware, support the
software development and a local Kenyan project team, each regulatory board will be
capable of fully maintaining their database system with fees associated with professional
licensure and renewal within the next three years. The GoK, too, has begun preparing
budgetary instruments to allow the MOH to assume the full costs of supporting the
system once the project concludes in 2012.
While launching this project in Kenya (and elsewhere) requires an initial investment of
donor resources, the project’s overarching intent is that the workforce information system
will be locally owned and fully supported with indigenous resources. This model has
demonstrated its functionality in low resource settings and builds on the local strengths
and resources. These features and its relatively low-budget approach especially resonate
with other sub-Saharan HRH stakeholders, as seen in our south-to-south exchange visits.
Replicability
November 24, 2009
Page 7
The workforce database system and the south-to-south exchange are not only are capable
of replication, they are already being replicated. The project itself--the HRIS--is being
replicated in Zimbabwe, Nigeria with CDC/PEPFAR support, and in several other
countries through other donor agencies. More countries have contacted CDC to
implement an HRIS in their countries. As additional resources become available, CDC
will expand the south-to-south collaboration to accommodate these new requests