A country’s health workers, or human resources for health (HRH), are vital for ensuring timely access to medical care. In the case of HIV, the quality of service delivery directly affects the ability of people living with HIV to know their status, receive and sustain antiretroviral therapy, and achieve viral suppression. According to the United States Agency for International Development’s (USAID) HRH2030 Program, “It is commonly recognized that health worker shortages, inadequate training, maldistribution, and ineffective skill mix have negatively impacted delivery of critical health care in low- and middle-income countries. Addressing these health workforce barriers through improving health worker performance and productivity is an important strategy toward achieving and sustaining 95-95-95 goals.”
To improve HRH planning, the Dominican Republic adopted iHRIS, an open source software, with the help of USAID’s CapacityPlus project in 2015. The web-based system to track, manage and map the health workforce in the DR represents an important shift from the paper-based monitoring system used previously, but implementing this initiative has faced multiple roadblocks. As of August 2017, approximately 7,000 personnel had been registered using the software, but over 4,500 of these entries were incomplete, and the system was still underutilized by decision-makers and administrators of the health workforce.
USAID’s Health Financing and Governance Project (HFG) is helping MSP overcome these roadblocks by updating the database of employees from MSP’s central headquarters and regional offices, as well as facilitate continued use and maintenance of the database. First, HFG provided technical assistance to populate the incomplete entries with socioeconomic data such as education and language background by designing data collection tools, overseeing the collection process and validating the results entered. HFG has updated 4,215 by August 2018 and expects to complete all 4,500 by the end of the project. HFG is also developing standard use guides and use case reports to illustrate the potential uses of the database to manage the health workforce. Finally, HFG is developing training programs for both health personnel and HRH core management teams to improve ease of use. This, along with continual support to users, will encourage stakeholders at all levels of HRH management to utilize iHRIS to its full potential. The resulting real-time data source will allow managers to make informed, evidence-based decisions about the workforce.
These improvements to the iHRIS system come at the outset of MSP’s newly-announced “Treatment for All” strategy to reach the 90-90-90 targets, which eliminates key restrictions to access to treatment for HIV. The strategy aligns the DR with international guidelines for HIV treatment, and is a huge step forward in preventing AIDS deaths and HIV infections. However, its implementation may require health workers to learn new skills and assume new responsibilities. . The iHRIS system will allow for the development of clear job descriptions, redistribution of functions and facilitation of additional training for service delivery personnel to adequately implement this new strategy.
HFG’s contributions to this activity have helped build consensus on the importance of maintaining the iHRIS system, show the system’s capabilities for workforce planning, and prepare health agencies for the installation and use of iHRIS. Effective and deliberate use of the system will greatly improve the DR’s capacity to implement “Treatment for All,” and ensure that Dominicans living with HIV receive the care they need.