Uganda’s health sector, like in many developing countries, has faced challenges related to staffing and human resources management that affect productivity and efficiency of service delivery. For the USAID SUSTAIN project, improving human resources and staff engagement directly translates into better service delivery for quality HIV/AIDS interventions.
Beginning in March 2013, the project piloted a human resources performance improvement (HRPI) activity focused on improving productivity and efficiency in HIV Counseling and Testing (HTC) at three SUSTAIN-supported hospitals (Mubende, Fort Portal, and Entebbe). The activity aimed to address staff efficiency through clarifying responsibilities, linking tasks to goals and targets, initiating self-assessment and peer support, and establishing mechanisms for performance feedback.
Working with the hospital quality improvement teams and other staff (e.g., unit in-charges), SUSTAIN facilitated a series of interventions, including learning sessions and mentorships to orient teams to the activity and establish action plans. They also guided the hospital teams through a human resource (HR) change package designed to address key elements of the human performance framework, such as clear expectations, capacity development, and performance feedback. The HRPI interventions were tested over the course of six months and
These trends were generated by linear regression for monthly HTC rates at intervention (*) and control (**) hospitals
periodic data was collected for comparison with two other hospitals (Kawolo and Jinja) serving as the control group.
During the HRPI period, all supported hospitals registered increases in staff engagement in the provision of HTC services. Mubende and Fort Portal showed especially large increases compared to the control hospitals.
Staff participating in the HRPI activity attributed the achievements to setting clear HTC targets for each unit. By setting and communicating the targets, the hospitals engaged all units in HTC and clarified roles for individual staff, which increased their ability to improve HTC service delivery. Finally, staff felt that holding regular meetings to review HTC results helped them to keep committed to increasing service delivery and generated more engagement from previously disaffected staff members.
“Following the first learning session, it was clear what individuals were expected to do. We set targets by department, whereas before this we had a general target. People understood and agreed on what they felt was achievable by their departments and everybody performed to meet the target,” said Annet Nayiga, Senior Nursing Officer and HTC focal person at Mubende Hospital.
While committed to maintaining progress at the pilot hospitals to address remaining components of the human performance cycle, SUSTAIN is also considering integrating elements of the human resource change package into quality improvement efforts at other project-support hospitals to enhance clinically-focused QI interventions. This focus on HR is critical because when health workers are engaged, are productive, and perform well, the quality of the health care they provide to clients is more likely to improve. According to Acting Principle Nursing Officer Rachel Mubeezi, this has been the case at Mubende Hospital: following the HRPI activity, “There has been an increase in clients tested in the whole hospital. The public out there knows when you go to Mubende Hospital you can easily access testing services.”
Written by; Irene Seguya Biraro, Human Resource for Health Technical Advisor, Julian Natukunda, Communications Specialist with contributions from Jessica Ziegler, Knowledge Management Specialist at URC