Strengthening Health Worker Allocation

With CDC funding, ThinkWell designed and implemented a time and motion study of primary health care (PHC) workers in Mozambique. In doing so, we aimed to understand HRH time allocation and implications for PEFPAR acceleration of the 90-90-90 HIV goals. A direct observational exercise which included capturing the utilization of time by the main types of health professionals, the study provided insights on the productivity of PHC workers and the quality and duration of HIV services in PHC facilities. We observed 296 working days of professionals in general nursing, maternal and child health, curative medicine (basic and middle levels), general medicine (physicians), and laboratory and pharmacy, as well as a more limited number of counselors and data typists. The sample included 29 health units in 9 of the 11 provinces in the country, making the sample representative of the primary care network in terms of geography (rural and urban), typology of health units, and levels of HIV prevalence.

The study’s results informed updates to the HRH allocation criteria to improve the country’s distribution of PHC workers. The study also responded to the need to include data in workload planning tools and health worker distribution criteria.

ThinkWell upgraded a workload-based HRH allocation tool designed for Zambezia province into a more robust tool ready for national use at all administrative levels. Our assumption was that the productivity of health professionals could be increased if the allocation of resources and the daily service delivery arrangements within PHC facilities could be improved: time is lost on “waiting without work” with too many interruptions that disturb clinic attendances.

We initiated the process to transform the tool into a normative instrument that is not just rooted in current productivity and service use levels, but that also projects staffing needs to allow for improved quality of care and better utilization of services. We gathered consensus among key MOH directorates on the design and national adoption of a workload-based HRH allocation tool. Specifically, we conducted a data availability and quality assessment, re-evaluated and re-designed the tool’s structure, collected data, tested the results of the upgraded tool, and trained key actors on how to use the allocation tool. The tool complemented existing allocation tools and criteria. Additionally, it ensured an equitable and efficient allocation of resources to ultimately improve health worker’s performance.

Ultimately, this health worker tool can be used across Mozambique’s 129 districts to improve management of health worker distribution and health worker task allocation.

Evaluating HIV Program Impact

ThinkWell partnered with Fundação Ariel Glaser contra o SIDA Pediatrico (“Ariel”), a Mozambican affiliate of the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) that increases and supports country-led HIV programming and expands local capacity. ThinkWell conducted an impact evaluation training for Airel to strengthen their capacity to inform several new approaches to increase access and retention of HIV patients on treatment. We supported Ariel to conduct rigorous evaluation for two interventions:

  •  Creating a mobile platform for community health workers to help increase HIV patient retention
  • Leveraging mobile brigades to improve antiretroviral (ARV) distribution

ThinkWell designed the impact evaluation’s methodology, wrote protocols, and guided data collection and analysis. Our support was vital to help make progress towards the goal of ensuring that quality pediatric and adult HIV & AIDS services are well-integrated into existing provincial and district health systems.