SATÁNICAS
C RISTO EN LA C RUZ TRIUNFÓ SOBRE LAS POTESTADES 49 miel.
Stakeholder Roles & Responsibilities in HRM Processes
Streamline and strengthen the working relationship between MOH/HRHD and the GHS/HRDD.
Set up systems for recruitment planning and monitoring to predict the need for future staffing, and to rationally assign staff within current budget restrictions. This system would also serve to streamline appointments and reduce new appointment waiting times. Institute a process of regular HR planning and review meetings between MOH/HRHD,
GHS/HRDD and other agencies to facilitate more effective coordination and collaboration.
Personnel Policies, Plans and Procedures
Strengthen the capacity of the MOH/HRHD to perform its central coordinating role and its core functions of policy formulation and monitoring of HR management and
development within the health sector.
Review, refine and finalize the numerous draft policy documents for dissemination and use in the GHS.
Provide structured training in HR management for all regional HR managers and orientation on HRM principles and practices to key managers at regional and district levels.
Encourage the development of HR plans at the regional and district levels to ensure that available staff are posted to areas of greatest need.
Devise a system for merit based promotion that would reward service in underserved areas.
Human Resource Information System
GHS should evaluate and if feasible, modify and extend the pilot paper and electronic HR data system in Eastern Region with the already planned JICA technical assistance. Seek donor assistance to fund the continued update of the human resources and
training information systems, as these data will be valuable to all stakeholders.
Consider developing a pay system that is reports-driven (like the ADHA system) where rather than assuming workers are still there, reports/timesheets or other verification of a worker’s status are needed at least quarterly to keep them on the payroll. This would keep the IPPD system more up to date and would reduce the number of ghost workers in the system.
Make better use of the IPPD and other HRIS systems to plan for staffing requirements. Staff Performance Management
Given the tendency to equate monitoring with supervision, provide managers with both Monitoring & Evaluation and Supportive Supervision training, to assure both program monitoring and individualized supervision are carried out effectively.
Review the staff appraisal system and make it more frequent, more mutually cooperative, and more rewarding to both the manager and employee.
Job descriptions for supervisors should include the routine responsibility of annual performance appraisal for each employee.
Health system appropriate appraisal forms should be developed to replace the civil service forms and should be provided to staff free of charge.
The Director of HRDD should introduce an ‘appraisal month’ in 2005. The goal would be to establish a routine time of year for performance appraisal, as envisaged in the policy. These appraisals would be the first step in improving merit-based promotion and
incentives.
Institute administrative and technical orientations for all staff joining the MOH and the GHS. An administrative orientation would give staff insight into organizational structure,
working relationships, reporting channels, and benefit packages. Technical orientations would expose beneficiaries to their roles in the technical team and standard operating procedures and processes for getting the work done.
Each region should have a designated Personnel Records Management System Administrator who can be called upon to provide updated records to the center and receive updates from the centre on the current status of staff in that region.
Develop a general staff orientation manual and an employee manual that could be adapted by the regions/districts to ensure adequate orientation of new staff and require that each region have these documents.
Staff Training and Development
The donor community could support both the GHS and MOH by providing training materials to pre-service institutions and for continuing medical education that the government’s budgetary resources cannot supply, given that less than 100% of expected funds are released each year.
Assure that training programs address current service challenges and that participant selection is appropriate, transparent and equitable.
Pre-service Training
Assist pre-service institutions to work more closely with clinical sites to ensure that newly trained medical staff have adequate experience. This can be done by supporting pre- service institution logistics and better orientation/communication between clinical preceptors and the training schools.
Conduct more research on the possibility of accreditation for pre-service institutions to understand how to best support this process.
Increase the number of tutors and school budgets proportional to the increase in students.
Increase the transparency of the admissions process and increase overall admissions to address high rates of attrition.
Institute a regular curriculum review process which ties learning to health policy goals and agreed core competencies.
Gender Issues
Ensure that gender is factored into assigning managerial responsibilities particularly at the senior level.
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Chen, Lincoln, Timothy Evans, Sudhir Anand, et al., “Human resources for health: overcoming the crisis,” Lancet (364):1984-90, 2004.
Ghana Health Service, Conditions of Service (Draft) (Accra: Ghana Health Service, 1998). Ghana Health Service, Guidelines on Decentralizing Human Resources Management (Draft)
(Accra: Ghana Health Service, 1997).
Ghana Health Service, In-Service Training Policy (Accra: Ghana Health Service, December 2004).
Ghana Health Service, Medium Term Human Resources Strategy and Plans for the Ghana Health Service 2003 – 2006 (Accra: Ghana Health Service, 2003).
Ghana Health Service, Policy and Guidelines for Promotions. (Draft) (Accra: Ghana Health Service, 2004).
Ghana Health Service, Policy and Guidelines for Recruitment. (Draft) (Accra: Ghana Health Service, September 2004).
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Ghana Ministry of Health, Appraisal of the Information, Monitoring and Evaluation (IME) System for the Health Sector: A Report for the Annual Health Sector Review 2003 (Accra: Ministry of Health, May 2003).
Ghana Ministry of Health, Health Sector Gender Policy (Draft) (Accra: Ministry of Health, 2001). Ghana Ministry of Health, Human Resource Policies & Strategies for the Health Sector 2002 –
2006 (Accra: Ministry of Health, September 2002).
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Ghana Ministry of Health, Medium Term Health Strategy (Accra: Ministry of Health,1996). Ghana Ministry of Health, Partnerships for Health: Bridging the Inequalities Gap -- The Second
Health Sector 5-Year Programme of Work 2002-2006 (MOH/PD/005/03/02/GD) Revised Edition (Accra: Ministry of Health, 2003).
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Management Sciences for Health, Human Resource Management Rapid Assessment Tool for HIV/AIDS Environments: A Guide for Strengthening HRM Systems, 2003.
Martineau, Tim and Javier Martínez, Human Resources in the Health Sector: Guidelines for Appraisal and Strategic Development, Health and Development Series Working Paper No. 1 (Brussels: European Commission, January 1997).
Mensah K. A Critical Analysis of the Factors Influencing the Retention of Health Workers in Deprived/Hardship Areas in Ghana, 2002.
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USAID, The Health Sector Human Resources Crisis in Africa: An Issues Paper, February 2003. WHO, Health Information Systems Development and Strengthening: Guidance on Needs
Assessment for National Health Information Systems Development, WHO/EIP/OSD/00.6, January 2000.
APPENDIX A. Survey Instrument to Assess HRM Components
Human Resources Management Capacity Assessment Tool for the Regions
To be administered by the Human Resources Manager and the Regional Health Services Administrator. Please write in the number that best represents the current status of the region’s human resources management system in the row to your right (under the heading “current stage”. Check for evidence and in the row headed “Evidence” write one or two examples of what you observed to support the stage you have marked.
Organisation: ………. Division/Region: ……….. District/Unit: ……….. Job Title of Informant: ………
Stages of Human Resources Management and Their Characteristics HRM Component 1 2 3 4 Current Stage What Evidence is in Place? A standard benefits program is in place. It is assessed for its effectiveness. No action is taken based on the assessment data. No welfare benefits program is in place. A standard benefits program is in place, but it is not
assessed for its effectiveness.
Welfare Benefits Program
A standard benefits program is in place and adjusted as
appropriate. Its
effectiveness in helping to retain staff is
monitored regularly.
Staff retention There are no data
available on staff retention rates and the factors contributing to declining rates (e.g., due to sicknesses and how much are due to out-migration, retirement, or other factors. Data on staff retention are available, but no analysis has been done to determine the contributing factors to attrition.
Data on staff retention are available. An analysis has been done to determine the contributing factors, but no strategy has been developed to address these factors.
A strategy is in place to improve the staff retention rate. It is based on data and a realistic analysis of the available pool of qualified employees.
Stages of Human Resources Management and Their Characteristics HRM Component 1 2 3 4 Current Stage What Evidence is in Place?
Formal procedures for recruiting, posting, and promoting staff are used consistently, but the policy on non- discrimination on the basis on disability, HIV/AIDS and gender is not consistently applied. Recruitment, Postings and Promotion No formal process exists for recruiting, postings, and
promoting staff. There is no policy on non- discrimination on the basis on disability, HIV/AIDS, or gender.
Formal procedures exist for recruiting, postings and promoting staff, but they are not followed consistently. A policy on non- discrimination on the basis of disability, HIV/AIDS and gender exists.
Formal procedures are consistently used for recruiting, posting, and promoting staff, and the policy on non- discrimination on the basis of disability, HIV/AIDS and gender is followed.
Orientation Program
No formal orientation program exists for new employees.
An orientation program exists, but it is not implemented on a regular basis and lacks a component on the GHS’s policies. Orientation is routinely offered but does not emphasize the mission, the goals, and the performance expected by the region/GHS.
Orientation is offered to all employees. It
emphasizes the mission, goals, and performance expected, and makes people feel welcomed and valued.
HIV/AIDS Workplace Prevention Program No HIV/AIDS workplace prevention program is in place to develop awareness and protocols to prevent HIV/AIDS infection (e.g., proper handling of needles, peer education programs, condom distribution). An HIV/AIDS workplace program has been developed, but no resources are available to implement it. An HIV/AIDS program is in place. It focuses on using appropriate protocols to limit the risk of infection as well as education about HIV/AIDS, but only some staff have participated in the program.
An HIV/AIDS program is in place. It focuses on using appropriate protocols to limit the risk of infection. All staff participate, and it is monitored for effectiveness in increasing staff knowledge and use of protocols.
Stages of Human Resources Management and Their Characteristics HRM Component 1 2 3 4 Current Stage What Evidence is in Place? Employee Manual No overall employee manual exists. An employee manual exists but is out of date.
A current employee manual exists, but it is not available to all employees and is not always used as a basis for personnel
decisions.
An updated employee manual exists. It is available to all
employees and is used as a guide for all questions about employment in the GHS. It is updated regularly. Discipline and Grievance Procedures No formal procedures for discipline or grievances exist. Formal procedures for discipline and grievances exist, but they are not
practiced.
Formal procedures for discipline and
grievances exist and are practiced
occasionally.
Formal procedures for discipline and
grievances exist. These procedures are followed strictly.
Labor Law Compliance
No review of HRM policies occurs to ensure conformity with the letter and spirit of labor laws.
There is some effort to review HRM policies, but it is not done regularly.
A review of HRM policies and
procedures is done regularly, but it is not always adjusted to ensure compliance with labor laws.
HRM policy and practice is adjusted to comply with local and national/labor laws.
Job
Descriptions (i.e., job title, qualifications, roles and
responsibilities, supervisor)
No job descriptions are available for staff. Jobs are not reviewed in light of GHS
strategies, or when tasks need to be redistributed.
Some staff have job descriptions, but they are neither always up to date nor adjusted to redistribute tasks when needed.
All staff have job descriptions, but they are not adjusted to redistribute staff when needed.
All staff have job descriptions that are adjusted to redistribute tasks when needed.
Staff There is no clear
system for staff
There are
established lines of
There are established lines of supervision,
Supervision is well institutionalized within
Stages of Human Resources Management and Their Characteristics HRM Component 1 2 3 4 Current Stage What Evidence is in Place?
Supervision supervision. Lines of
authority are unclear. Supervisors do not meet regularly with their staff, nor do they receive training on supervision skills.
supervision, but supervisor’s roles and functions are not understood, and little supervision takes place. Supervisors do not receive training of any kind. and supervisors understand their roles and functions.
Supervisors are trained in general supervisory skills.
the region/GHS.
Supervisors are trained in general supervisory skills. Work Planning and Performance Appraisals No individual work planning and performance appraisal system is in place. Supervisors and supervisees jointly develop individual work plans and performance criteria. These are used to conduct appraisals of past performances at least once a year.
A formal system for work planning and performance appraisal is in place for
individuals. Supervisors are required to develop individual work plans and performance criteria with each supervisee and to appraise past
performances, but this is done inconsistently. A work planning and
performance appraisal system is in place for
individuals, but it is informal and does not include
individual work plans or performance criteria developed jointly by supervisors and supervisees. There is no regional staff training plan or ongoing assessment
Training is offered on ad hoc basis but it is neither based on
Training is a formal component of GHS and is linked to staff and
Training is a valued part of the GHS/ region, and
Stages of Human Resources Management and Their Characteristics HRM Component 1 2 3 4 Current Stage What Evidence is in Place? of individual staff development needs.
staff needs, nor linked to the regions/GHS key priorities.
GHS needs. opportunities are
developed for staff, based on their needs and on the needs of the GHS.
A management and leadership
development program is in place for staff at all levels, and everyone has an opportunity to participate based on performance and other established criteria. The program focuses on addressing
challenges facing the region/GHS.
No programs have been developed to increase management and leadership
capacity at all levels of the GHS. An emphasis on developing management and leadership capacity exists, but development is done on an ad hoc basis and not linked to addressing the challenges facing the region/GHS. Management and leadership development opportunities are available on a regular basis, but they target senior level staff and are not directly linked to addressing
challenges facing the region/GHS. Management and Leadership Development Programs Links to Pre- Service Training Links to Pre- service Training (con’t)
No formal links exist between pre-service training institutions in the region and the RHD. There is no Board of Governors for the training institutions.
A loose relationship exists between the RHD and the pre- service training institutions, but they do not use the relationship to make inputs into the management of the institutions (e.g. admissions into the institutions).
The RHD and the training institutions work together to ensure that institutions are well-managed but admissions to the institutions do not reflect regional needs. Board of Governors meets regularly but decisions are not implemented.
The RHD and the training institutions work together to ensure that institutions are well-managed and admissions to the institutions reflect regional needs. Board of Governors meets regularly and decisions are implemented.
Stages of Human Resources Management and Their Characteristics HRM Component 1 2 3 4 Current Stage What Evidence is in Place? There is a Board of Governors with representation from RHD, but the Board meets irregularly. HR Information System (e.g., data on the number of staff, grade, qualification, location, sex, date of birth, date of first appointment, salary level, rate of attrition)
None of these data are collected in any kind of systematic way.
Though most of these data are collected, there is no system to maintain them or keep them up to date. They are not used to generate reports on attrition or staff turnover.
All of these data are available and up to date. They are used to generate reports on attrition but they are not used in human resources planning.
All of these data are available and up to date. Data collection and reporting systems are in place. Data are formally used in human resources planning.
Both updated
personnel files for all employees and policies for appropriate use (e.g., confidentiality, employee access) exist.
Personnel files for all employees are
maintained and kept up to date, but there is no policy for employee access to or use of these data.
Limited employee personnel files are maintained, but not regularly updated. No individual employee records exist. Personnel Filing Systems
APPENDIX B. List of Regions and Districts Targeted in Assessment
Region District Number of Districts
Ahafo Ano Amansie West Ashanti Bosomtwe-Atwima-Kwanwoma 3 Asutifi Brong Ahafo Sene 2 Abura-Asebu-Kwamankese Agona Central Ajumako-Enyan-Essiam Asikuma-Odoben-Brakwa Assin Awutu-Efutu-Senya Cape Coast 12 Gomoa Komenda-Edina-Eguafo-Abirem Mfantsiman Twifo-Heman-Lower Denkyira Upper Denkyira Birim North Eastern Afram Plains 2
Greater Accra Dangbe West 1
Kadjebi Adidome Akatsi Sokakope Volta Nkwanta 5 Bibiani Ahanta West Western Juaboso-Bia 3 Northern * Upper East * Upper West * Total 28
* In Northern, Upper East and Upper West Regions, only the Regional Health Administrations and Training Institutions were visited; no districts were visited.