CapacityProject technical brief

knowledge sharing
Human Resources for Health (HRH) Strategic Planning
January 2008
9
Tim Martineau, Liverpool School of Tropical Medicine, and Margaret Caffrey,
Liverpool Associates in Tropical Health (LATH)
The consensus from recent debates about evaluation (M&E). Due to time constraints,
how to approach the current human resources planners may have to rely on existing data that
(HR) challenges in the health sector is that it may be incomplete and outdated; thus certain
is important to have a national strategic HR assumptions might be made to fill the information
plan. Perhaps this sounds obvious. However, a gaps. In 2005, the President of Zambia gave the
number of countries have no plans at all, some Ministry of Health just 60 days to develop a five-
have plans that are not strategic and others have year strategic plan. As there was no time to collect
excellent plans that were developed but never additional data, further data collection activities
used. So most have at least some work to do to were built into the plan, and the assumptions
improve their strategic HR planning processes. were highlighted and documented. This would
allow for revisions of the plan and modifications
Each country faces different HR challenges, and
or corrections of the assumptions as more
these will change from year to year. All strategic
information became available.
plans are likely to be different and evolving,
and there is no single blueprint for their Depending on the complexity of the HRH
development. This technical brief provides some challenges, there may be a wide variety of
guidance on HRH strategic planning, illustrated strategies included in the plan. These need to
with examples. be coherent to ensure that they reinforce—and
don’t work against—each other. At the national
What Is HRH Strategic Planning?
level the overall HR strategic plan needs to
First, it is important to distinguish between be integrated with other plans, such as the
strategic and operational planning. Strategic Health Sector Strategic Plan, the Public Sector
planning helps an organization make fundamental Reform Program or the National Economic and
decisions about its human resources by taking Development Plan.
a long-range view of what it hopes to achieve
and, in broad terms, how. For example, how In the development of broader plans like the
are we going to improve the staffing of remote Health Sector Strategic Plan, there may be
facilities? Operational planning is related to the conflicting interests that need to be resolved. For
implementation of the strategies on a day-to-day example, it is possible that some of the strategies
basis. For example, if training more staff is the to be pursued may change the employment
strategy selected for improving staffing in remote status of some staff and may therefore be
facilities, the operational planning would include resisted. These changes may be necessary for
the start date for training courses and the number the achievement of national health sector goals
of tutors needed. and objectives, but the change management
process should be managed sensitively. Change
We also make a distinction between the strategic management strategies could therefore be
HR plan and the workforce plan (see King and incorporated into the HR strategic plan.
Martineau, 2006). The latter is an integral part
of the strategic plan, but is generally focused How to Develop the Plan
on deciding the numbers and types of staff The process of developing and implementing a
needed over a longer timeframe than that of the strategic HR plan can be lengthy and complex.
strategic plan. It is therefore important to ensure that there
is sufficient leadership and oversight. A high-
It can help to note that the core of the task
level drafting team oversaw the development
is actually the strategic thinking that goes on
of the HRH strategic plan in Malawi. The multi-
during the development of the plan. If a critical
stakeholder group formed to draft the plan in
mass of strategic HR thinkers is developed, then
Kenya included experts in financing and M&E.
the planning process can be sustained, leading
As many ministries of health do not have
to improvements and updates in the plan. If it
in-house expertise for managing the process,
does not already exist, it is important to nurture
it may be an appropriate investment to use
this strategic thinking at least in a core group
external technical assistance to facilitate the
before writing the plan.
process and provide certain inputs. However,
HR planning should be considered an ongoing because of the need to sustain the iterative
and iterative cycle that includes situation analysis, planning cycle, some kind of skills transfer or
planning, implementation and monitoring and longer-term support will be needed.
 Current information is also needed to identify
Figure 1: Key Steps in Developing the HR Strategic Plan opportunities and challenges in the future—this
in Malawi (1999) and Eritrea (2005) is sometimes referred to as environmental
scanning. The scan could include future
Malawi Eritrea health service plans and factors that might
Mid-1998 – Nov. 1999 Dec. 2004 – Sep. 2005 affect employment (e.g., wider labor market,
public service reform, health sector reform or
Survey, analysis and Situation analysis decentralization). There will inevitably be gaps
projections in the information available, in which case
> >
assumptions need to be made and noted in the
Draft 1 Planning workshop . Draft 1 plan. Further information-gathering can always
be included in the plan.
> >
Review workshops by staff Consultation, data preparation The information needs to be analyzed to identify
group* the key issues, root causes and gaps that will
> be addressed through the plan. In Malawi in
>
1999, the management of staff performance
Full stakeholder meeting** Staffing projections added was identified as being weak. To address this,
> > the plan called for the introduction of simple
systems to monitor staff absence and later
Finalization of plan Final draft
to introduce improved annual performance
*Doctors, nurses, technicians, etc. reviews. An analysis using a computer-based
**The original plan was to do this before producing the first draft, but the risk planning tool of the data on current staffing
of stakeholders making too many demands that could not be met was considered too great. and attrition in Eritrea showed that training
output—particularly for basic nurses—needed to
Preparation for Planning be increased to meet service delivery needs.
Whether you have 60 days or a year, it makes
Developing Strategies
sense to prepare for the planning process
itself. This groundwork includes mapping the Objectives may often be developed by re-writing
key stages of the development process and a problem statement as a desired outcome—
the review steps during the implementation “inequitable staff distribution” becomes “staff
phase. Resource requirements should also be equitably distributed.” The factors contributing
identified (e.g., surveys, workshops, consultants, to the problem then need to be identified. The
computing facilities, printing and dissemination). staff distribution problem might be due to poor
Developing a mini-workplan and budget will working conditions in some locations, lack of
help to mobilize resources and negotiate for access to quality education for children and
sufficient time to produce a comprehensive, more attractive financial incentives to work
well-supported plan. This might include in other areas. Some problems—perhaps the
conducting the situation analysis, involving children’s education—may be beyond the scope
key stakeholders, selecting the drafting team, of the plan. Others may need to be prioritized or
drafting the plan, getting approval and launching tackled in the latter years of the plan. We found
and disseminating the plan. Examples of two in Eritrea and Kenya that in a workshop setting
approaches are shown in Figure 1. The way the drafting teams identified and agreed upon
in which the strategic plan is developed will the objectives, and then developed strategies
depend on a number of factors, including the and activities to achieve them. These can be
time, expertise and resources available, so these improved through presentation to the larger
suggestions will need to be adapted to your group and form the basis of the strategic plan
situation. However, we recommend that the that can later be refined, scheduled and costed.
process be kept simple and not longer than There will inevitably be a trade-off between
about six months. Finally, the plan will need the technical qualities of the inputs—unless all
to be approved. The timing of submission for workshop participants are experts—and eventual
approval might be critical if it needs to be linked ownership of the plan.
to other timetables. Stakeholder Involvement
Collecting and Analyzing Information It is important to identify the key stakeholders
Start with the best available information about (see Figure 2) and manage their involvement
the current situation in order to identify what carefully. This will usually involve a compromise
problems the plan needs to address. This between the desire for a rapidly produced
information may be collected using a special plan and the need for a longer, more complex
staffing inventory (e.g., Malawi in 1999) or process to accommodate stakeholder interests.
a review (as for Eritrea). In some cases the But a more comprehensive process is likely
information may be available in personnel to result in greater ownership, and therefore
databases (e.g., in Zambia for the public sector), a greater chance that the plan will actually
workforce reviews or studies or broader get implemented. Consultation might occur at
documents relating to the health sector. different points of the process. In Eritrea the HR
 team decided it would develop the first draft to The next step is to agree upon a wider aim for Checklist for Developing
ensure sufficient strategic thinking and analysis the plan that links to broader health service an HRH Strategic Plan
and then seek views on it at a stakeholder plans. A typical broad aim is to increase the eIs this going to be a broad HRH
consultation workshop. Starting the process number of skilled, motivated and equitably strategic plan or a narrower
with a large stakeholder workshop may run the distributed health workers in the country. workforce plan?
risk of people making inappropriate demands An agreed-upon aim provides focus for the
without reference to a situation analysis or more development of the strategies and may help to eIs there a clear demand for an
HRH strategic plan? Will it have
rigorous strategy development. Stakeholder establish some principles to guide the process
an influential person or group act
involvement can be achieved through individual and content. One of the planning principles used
as a champion or advocate for it?
meetings or seeking comments on early drafts. If in Kenya was “start from where we are now”
not everyone has been consulted before the first to avoid including overambitious strategies. eIs this going to involve real
version is produced, they can be involved later. The Zambian team wanted to ensure that its strategic thinking, or is it just a
plan “tackled the root causes rather than the paper exercise?
What Might Be Included in the Plan?
symptoms” so that problems did not simply eIs there strong and effective
At an early stage, try to clarify the scope and re-emerge. leadership for both the
the type of components that will be included,
The plan will be more useful and have more development and the
though modifications may need to be made implementation of the plan?
later on. One of the initial tasks will be reaching credibility if there is a clear rationale supporting
agreement on the plan’s timeframe. To be its strategies. The document will therefore often eIs there a team with an
strategic, a plan needs to cover three years start with an analysis of current circumstances— appropriate mix of skills to
or more. It may make sense—or even be a both the wider context and more specifically develop the plan?
requirement—to fit in with other planning cycles: related to the HR situation—and may include eWhich stakeholders should be
in Kenya the HR strategic plan was designed to “what if” projections of future staffing conditions involved in the development of
align with the three-year planning cycle of the in order to identify key issues and inform the plan and which ones should
sector-wide approach; in Malawi (1999) it had training requirements. be consulted?
to fit in with a broader five-year program of The analysis may suggest that many strategies eIs there a budgeted workplan
work. While these strategic plans may include are needed to improve the staffing situation. for developing the plan? How
staff projections for ten or even 20 years, the However, since resources are likely to be limited, complex is it? How long will it
strategies are limited to the plan period. these strategies must be prioritized. Otherwise take to finish the plan?
How much of the health sector will the plan the plan simply becomes a list of unachievable eHow will the HRH strategic plan
cover? It may only apply to government health activities. For example, given limited resources, be approved and by whom?
workers. Larger faith-based organizations should the focus be on getting more staff eWhat data do you have now?
(FBOs) may make their own strategic HR plans, or improving the quality, productivity and Has an “environmental scan”
though ideally these should be linked to wider performance of existing staff? Prioritization been done? What can be collected
plans for the sector—especially for training. could mean that a strategy discussed in the before developing the plan? What
Recent strategic plans in Kenya and Malawi early stages of the process is not included in the data collection should be included
have covered the entire sector—government, plan at all, or that it is postponed to the latter as part of the plan?
nongovernmental organizations (NGOs), part of the plan period. The main guidance on
eWhat is the scope of the plan?
FBOs and the private sector. This is helpful for prioritization will be the best way to achieve
planning training for the whole sector, and also the aim of the plan, but inevitably there will be eWhat is the broad aim?
provides information for the whole of the labor compromises. eWhat are the key strategies for
market. In many countries this is in keeping A challenge is to find the balance between achieving the aim? Are these
with moves toward developing a sector-wide based on the problem analysis?
short- and longer-term strategies. Many
approach. staffing problems have been caused by the eWhat funds are already available?
absence or failure of effective systems for HR What is the funding gap?
Figure 2: Possible Stakeholders to Be planning, management and development. But eDoes the plan include strategies
Involved in Development of a Strategic the development, testing and rolling out of these for the management of change?
HRH Plan systems takes at least two to three years. Many
eHow will implementation of the
stakeholders want to see change faster than
eCentral government departments or bodies plan be monitored and how will
that, and some rapid results may boost morale
concerned with employment (e.g., Cabinet Office, the plan be regularly updated?
and build confidence that the strategies are
Public Service Commission)
achievable and can make a difference. So it may Keep in mind:
eOther employers (local government, FBOs, NGOs, be desirable to have a mixture of longer-term eStrategic planning is an iterative
private sector, large development projects) strategies to develop or strengthen the system process, not a single event
eRegulatory bodies (e.g., Nursing Council) and “quick wins” with rapid impact on the HR eThe emphasis should be on
eRepresentative bodies (e.g., medical association, situation. strategic thinking rather than
public service union) Ensuring that the health service has a sufficient the document
eFinancers (e.g., Ministry of Finance, donors, lending number of skilled and motivated staff requires a eGet the right stakeholders
agencies) complex set of HR strategies covering planning, involved, but keep the process
management and development. Thankfully, there simple and not too lengthy
eTraining institutes (pre-service and in-service)
is generally recognition now that HR is about eEnsure that the strategies
Source: Based on the authors’ experience and on Martineau and more than just providing training. Nevertheless,
Martinez, 1997
address the root causes and are
there is a need to ensure that the plan includes feasible to implement.
www
hrhresourcecenter.org
Visit the HRH Global Resource a comprehensive, coherent set of strategies. The into existing health system M&E plans. The
Center to find, share and strategies must be broken down into specific information needs to be fed into the annual
contribute human resources activities or tasks in order for them to be planning process to help improve the plan at the
for health knowledge and translated into reality. Thus decisions need to strategic level and inform the operational plans.
tools. For those working at be made regarding the person responsible for It is this plan-do-review cycle that ensures that
the country or global level, the each task, the resources needed and the timing. the overall plan remains flexible and appropriate,
HRH Global Resource Center We suggest that this level of detail be planned but also that lessons are learned and experience
provides information to: for each year, though an estimate for the whole leads to better HR planning and management.
d Improve strategic planning planned period may also be needed. To ensure One of the principles of the Zambian plan is
and decision making that the strategic plan actually gets implemented, institutional learning, explained as the “Ministry
d Strengthen reports and it is important to develop a detailed, costed of Health learning to solve its own problems
presentations operational plan for the first year. This exercise through analysis and action.”
d Support HRH advocacy should be repeated annually. Plans for Year
Implementation: A Word of Caution
Two and beyond will depend on what has been
d Enhance professional A final point is that despite best efforts, the
achieved and what is appropriate at the time.
development plans may not be implemented, or at least not
d Save time. Without at least an indicative budget, it will be immediately. For example, the Zambian plan
impossible to sell the plan to funders such as took over nine months to get approved, but
the treasury or donors. It may help to include a now it is being used. In Kenya the plan has
table with funds that will be used to implement not actually been launched, but many of the
strategies that have already been committed as strategies are finding their way into annual
projects by government or donors in order to workplans. Even if no part of the plan is taken
identify the funding gaps. up, chances are that after a few years there
Because of the uncertainty at the planning stage will be another demand for a strategic HR
of what will work and what the future need plan. If the original plan is good enough, it
will be, a process of M&E for the outcomes can be dusted off and may only need minor
and impact of the strategies is vital. Indicators adjustments to bring it up to date to meet the
and the means of measuring them need to current challenges.
be identified, and where possible, integrated

References Additional Resources

The Capacity Project
IntraHealth International, Inc. King G, Martineau T. Workforce planning for the health sector. HRH Action Framework [website]. Capacity Project, Global
6340 Quadrangle Drive Capacity Project Technical Brief No. 6. Chapel Hill, NC: Capacity Health Workforce Alliance, United States Agency for
Suite 200
Project, 2006. Available at: http://www.capacityproject.org/images/ International Development, World Health Organization; 2007.
Chapel Hill, NC 27517
stories/files/techbrief_6.pdf Available at: http://www.hrhresourcecenter.org/node/1240
Tel. (919) 313-9100
Fax (919) 313-9108 Martineau T, Martinez J. Human resources in the health sec- HRH Global Resource Center [website]. Capacity Project; 2007.
info@capacityproject.org tor: guidelines for appraisal and strategic development. Health Available at: http://www.hrhresourcecenter.org/
www.capacityproject.org and Development Series Working Paper No. 1. Brussels,
Belgium: European Commission, 1997. Available at: http://www.
hrhresourcecenter.org/node/21
Ministry of Health, Zambia. Human resources for health stra-
tegic plan (Draft): 2006-2010. Republic of Zambia: Ministry
of Health, 2005. Available at: http://www.hrhresourcecenter.org/
node/1323
This publication is
made possible by the Research and Human Resource Development Department.
support of the American Human resources strategy for the health sector in Eritrea:
people through the 2006-2010. Eritrea: Ministry of Health, 2005. Available at:
United States Agency http://www.hrhresourcecenter.org/node/253
for International
Development (USAID).
The contents are the
responsibility of the
Capacity Project and do The Capacity Project Partnership
not necessarily reflect
the views of USAID
or the United States
Government.