Effort Index Tool Offers a Way to Measure Health Workforce Progress

health workers in Burkina Faso

Photograph by Trevor Snapp for IntraHealth International

National decision-makers in the health sector can now take stock of their health workforces and the systems that support them using the Human Resources for Health (HRH) Effort Index, a tool developed by IntraHealth International with support from the US Agency for International Development. Results from four countries where the index was applied are now available in Human Resources for Health.

The HRH Effort Index measures health workforce status and progress, provides information that can help leaders build consensus and prioritize strategic investments, and facilitates more accurate comparisons of the HRH situation across countries, regions, or districts.

Inspired by the widely used Family Planning Effort Index, the tool surveys knowledgeable informants through 50 questions organized by the seven key dimensions of HRH:

  • leadership and advocacy
  • policy and governance
  • finance
  • education and training
  • recruitment, distribution, and retention
  • human resources management
  • monitoring, evaluation, and information systems

Scores (on a ten-point scale) are then tallied by each dimension and overall.

Through the USAID CapacityPlus project, IntraHealth applied the HRH Effort Index in Burkina Faso, the Dominican Republic (both nationally and subnationally), Ghana, and Mali. While overall scores ranged from 4.8 to 5.5—around midrange—there were important variations across dimensions within countries. In general, recruitment, distribution, retention, and financing scored lower, while leadership and advocacy scored higher.

These scores provide countries and other stakeholders with a more comprehensive, qualitative understanding of the success of their health workforce strengthening efforts, and can serve as a benchmark for measuring future progress.

The World Health Organization’s Workforce 2030 global strategy and the 2016 High-Level Commission on Health Employment and Economic Growth’s recommendations on investing in the health workforce both underscore the need for better country-level HRH data, analytics, and data sharing. Applying and refining the HRH Effort Index in more countries could help fill this gap, offering countries more information and points of comparison to inform their future policies and decisions.