Patricia Riley, CNM, MPH, FACNM, CAPT (Ret)

Division of Global HIV/AIDSCenters for Disease Control and

Prevention

Nursing Recognition DayMay 3, 2013

Information Systems to Monitor Human Resources for

Health: A Systematic Review

Center for Global Health

Division of Global HIV /AIDS

Why is this important?

BACKGROUND/ RATIONALE

Background/ Rationale

Builds on 10 years of work developing a comprehensive workforce information system in Kenya

HR information systems (HRIS) are a critical tool to help MOH and other stakeholders target scarce resources to scale-up and retain health workers

Significant global investment in HR information systems (HRIS) by major global health initiatives

Need for a systematic review of approaches to HRIS to help develop an evidence -base to guide HRIS implementation globally in HRH “crises” vs. non-crises countries

Overview of HRIS HR information systems (HRIS): a routine

system for tracking the supply and deployment of the health workforce for strategic and operational health and HR decision-making

Professional RegulatoryBodies

HRH Managers- MOH, private, non-profit,

and faith-based sectorsPayroll

Pre-service institutions

All Provinces

All Districts

HMIS

Workforce Supply

Workforce Demand

Other Data

Routine Census/Labor Force Surveys

OBJECTIVES

OBJECTIVES Review and systematically characterize the

implementation of HRIS in countries around the world

Identify models and features of HRIS applicable to crisis and non-crisis countries

Offer recommendations to ministries of health and global health policy makers on how to improve the science and application of HRIS

METHODS

METHODS- Review Team

CDC, Atlanta WHO, GenevaPatricia Riley Neeru GuptaAlexandra Zuber Pascal ZurnAndre Verani

Nadine Sunderland Emory UniversityMichael Friedman Stephen VindigniChijioke Okoro

Heather Patrick Integrare, BarcelonaJames Campbell

METHODS- Peer Reviewed Four electronic databases (1959-2009):

• Medline (including in-process and non-indexed citations),• Excerpta Medica database (EMBASE), • PsycInfo and • Cumulative Index to Nursing and Allied Health Literature

(CINAHL)

Seven Bibliographic databases (1959-2009):• LILACS (Literature Latino-Americana e do Caribe em

Ciencias da Saude), searched in English• Global Health• Sociological Abstracts• Social Service Abstracts• ERIC (Education Resources Information Center)• Web of Science (SCI and SSCI)• Cochrane

METHODS- Grey Literature 29 electronic databases and websites, in four

languages (1999-2009):

The Capacity Project’s HRH Global Res. Center

WHO Africa Health Workforce Observatory

Health Metrics Network

Routine Health Information Network (RHINO)

Public Health Informatics Institute (PHII)

Google and Google Scholar

Int’l Council of Nurses Innovations Database

Asia-Pacific Action Alliance on HRH

European Obs. on Health Systems and Policies

PAHO Observatory of Human Resources

PAHO-USAID Partnership, Health Systems

Eastern Med. Regional Health System Obs.

Eldis.net

The Int’l Centre for Human Resources in Nursing

Global Health Workforce Alliance

Global Atlas of the Health Workforce

African Atlas of the Health Workforce

Regional Core Health Data Initiative for the Americas

Eastern Mediterranean Regional Observatory on Human Resources for Health

European Health for All Database

European Observatory on Health Systems and Policies

Regional Database of Health Indicators for the Western Pacific

Pacific Human Resources for Health Alliance Country Health System Profiles for the South-East Asia Region

OECD Health Data

Eurostat Database on Population and Social Conditions

World Development Indicators

LABORSTA Database

UNESCO Education Statistics Database

Review Process

Screening of articles Assignment of articles to review pairs* Abstraction tool, with guidance

Individual abstraction record Joint abstraction record Country composite abstraction record

Entered data into Epi-Info database Aggregated results by WHO HR “crisis” and

“non-crisis” countries

* Reviewers did not review articles for which they were listed as an author

Data

Collecti

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Data

M

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U

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RESULTS

RESULTS

11,922 articles were initially identified in the peer reviewed and grey literature

After applying our exclusion criteria, 95 articles remained, representing HRIS from 65 countries and regions 32 WHO-designated HRH “crisis” countries 31 non-crisis countries Regional systems identified in Southeast Asia,

Mercosur, and the Pacific Islands

DOCUMENTATION OF KEY HRIS FEATURES IN COUNTRIES

REVIEWED

Data Collection Data Mgmt Data Utilization

RESULTS General

“Unclear” was the most common response for 11 of 16 indicators displayed for crisis and non-crisis countries

No consistent reporting framework for HRIS Expected trends in features based on economic

development (crisis v. non-crisis countries)

Supply Data A high percentage of crisis and non-crisis countries

documented collecting workforce supply data generally (63% and 74%, respectively)

But collection of health worker qualifications and professional credentialing and demographic data was much more limited

RESULTS Deployment Data

High percentage of crisis and non-crisis countries reported as collecting demand data generally (63% and 87%, respectively)

However, specific features of deployment data was much more limited: Workforce Attrition: Only 23% of 65 HRIS

examined explicitly collect data on workforce attrition Private, non-profit, and faith-based sectors:

documented in only 34% of HRIS reviewed (28% in crisis countries, 39% in non-crisis countries)

DOCUMENTATION OF KEY HRIS FEATURES IN COUNTRIES

REVIEWED

Data Collection Data Mgmt Data Utilization

RESULTS Data Management

Linkages: 14% of countries documenting an established link between supply and deployment data, 11% linked to payroll, and 34% linked HRIS to an overall health information system

Data cleaning and accuracy: 6% of crisis countries and 19% of non-crisis countries reported methods for ensuring this component of an HRIS

Data Utilization The use of HRIS for identifying licensed practitioners,

making deployment decisions, and other planning and evaluation was limited, especially in crisis countries

Sustainability and Ownership Notable ambiguity with respect to the sustainability,

ownership, and endorsement of HRIS by local stakeholders (e.g. MOH)

LIMITATIONS The review could only abstract features of

HRIS that are documented in publicly available literature

Of the documented HRIS, it was frequently unclear whether specific features of an HRIS were present, absent, or lacked written description

Nearly one-half of the documents were based on HMN assessment tool for HIS, which were inconsistent in reporting HRIS features

DISCUSSION

DISCUSSION Despite global calls to action and significant

global investment in HRIS, there is a dearth of information on country experience, particularly in the peer-reviewed literature

Reporting emphasizes generation of supply and deployment data generation, but few reports of effective data management techniques and the use of this information for resource allocation and program planning

DISCUSSION The small number of documented HRIS

collection of demographic data prohibits basic HR planning (e.g. age trends analysis)

The lack of attrition data (e.g. outmigration) limits countries from reporting related to the WHO code of ethical recruitment

Global inability to monitor health workforce from more than one sector impedes national sector-wide health planning, which is especially important where HR is in critical shortage

PROMISING DOCUMENTED HRIS MODELS

Promising models were those that were well documented in the literature and whose features were well articulated. Based on a method of scoring the abstraction records, we identified the following: Non-crisis countries: Canada, U.S., Brazil Crisis countries: Kenya, Malawi, and Swaziland

RECOMMENDATIONS Greater global consensus on standardized

approaches to HRIS implementation and key features of HRIS, to improve implementation, with: A focus on crisis countries Emphasis on effective data management

and use Descriptive research of HRIS

implementation, including promising models and key features, to understand what successful approaches work in specific health systems contexts

Consistent framework for HRIS assessment and reporting (e.g. HMN HIS tool modification)

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Thank you!

Center for Global Health

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