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BACKGROUND: Nigeria's health sector aims to ensure that the right number of health workers that are qualified, skilled, and distributed equitably, are available for quality health service provision at all levels. Achieving this requires accurate and timely health workforce information. This informed the development of the Nigeria Health Workforce Registry (NHWR) based on the global, regional, and national strategies for strengthening the HRH towards achieving universal health coverage. This case study describes the process of conceptualizing and establishing the NHWR, and discusses the strategies for developing sustainable and scalable health workforce registries. CASE PRESENTATION: In designing the NHWR, a review of existing national HRH policies and guidelines, as well as reports of previous endeavors was done to learn what had been done previously and obtain the views of stakeholders on how to develop a scalable and sustainable registry. The findings indicated the need to review the architecture of the registry to align with other health information systems, develop a standardized data set and guidance documents for the registry including a standard operating procedure to ensure that a holistic process is adopted in data collection, management and use nationally. Learning from the findings, a conceptual framework was developed, a registry managed centrally by the Federal Ministry of Health was developed and decentralized, a standardized tool based on a national minimum data was developed and adopted nationally, a registry prototype was developed using iHRIS Manage and the registry governance functions were integrated into the health information system governance structures. To sustain the functionality of the NHWR, the handbook of the NHWR that comprised of an implementation guide, the standard operating procedure, and the basic user training manual was developed and the capacity of government staff was built on the operations of the registry. CONCLUSION: In establishing a functional and sustainable registry, ...

BACKGROUND: Many countries are faced with a multitude of health workforce-related challenges partly attributed to defective health workforce planning. Earlier efforts to guide the process and harmonise approaches to national health workforce policies and planning in the Africa Region included, among others, the development of the WHO Africa Regional Office (WHO/AFRO) Policies and Plans for Human Resources for Health Guidelines for Countries in the WHO African Region in 2006. Although this guideline has led to uniformity and rigour in developing human resources for health (HRH) policies and strategies in Africa, it has become imperative to synthesise the emerging evidence and best practices in the development of health workforce strategies. METHODS: A document analysis was conducted using the READ (Readying materials; Extracting data; Analysing data and Distilling) approach. RESULTS: Fourteen HRH policy/strategic plans were included in the study. The scope of the HRH strategic plans was described in three dimensions: the term of the strategy, sectors covered by the strategy and the health workforce considered in the projections. We found that HRH strategic plan development can be conceptualised as a cyclical, sequential multimethod project, with one phase feeding the subsequent phase with data or instructions. The process is very complex, with different interest groups and sectors that need to be satisfied. The HRH strategic plan development process comprises five main phases linked with external forces and national politics. CONCLUSION: There is a need for accurate and comprehensive HRH data collection, astute HRH leadership, and broad base and multisectoral stakeholder consultation with technical support and guidance from experts and major external partners for effective HRH strategic plan development.

The COVID-19 pandemic had multiple adverse impacts on the health workforce that constrained their capacity to contain and combat the disease. To mitigate the impact of the pandemic on the Ghanaian health workforce, the government implemented a strategy to recruit qualified but unemployed health workers to fill staffing gaps and incentivise all public sector health workers. This paper estimated the cost of the new recruitments and incentives given to health workers and presented lessons for health workforce planning in future health emergencies towards health systems resilience. Between March and November 2020, 45 107 health workers were recruited, representing a 35% boost in the public sector health workforce capacity, and an increase in the recurrent public health sector wage bill by about GHS103 229 420 (US$17 798 176) per month, and about GHS1.24 billion (US$213.58 million) per annum. To incentivise the health workforce, the government announced a waiver of personal income taxes for all health workers in the public sector from April to December 2020 and offered a 50% additional allowance to some health workers. We estimate that the Government of Ghana spent about GH¢16.93 million (equivalent to US$2.92 million) monthly as COVID-19 response incentives, which translates into US$35 million by the end of 2020. Ghana invested considerably in health workforce recruitment and incentives to respond to the COVID-19 pandemic, resulting in an almost 37% increase in the public sector wage bill. Strengthening investments in decent employment, protection and safety for the health workforce using the various resources are helpful in addressing future pandemics.

BACKGROUND: The Government of Lesotho has prioritised health investment that aims to improve the health and socioeconomic development of the country, including the scaling up of the health workforce (HWF) training and improving their working conditions. Following a health labour market analysis, the paper highlights the available stock of health workers in Lesotho's health labour market, 10-year projected supply versus needs and the financial implications. METHODS: Multiple complementary approaches were used to collect data and analyse the HWF situation and labour market dynamics. These included a scooping assessment, desk review, triangulation of different data sources for descriptive analysis and modelling of the HWF supply, need and financial space. FINDINGS: Lesotho had about 20 942 active health workers across 18 health occupations in 2020, mostly community health workers (69%), nurses and midwives (17.9%), while medical practitioners were 2%. Almost one out of three professional nurses and midwives (28.43%) were unemployed, and nearly 20% of associate nurse professionals, 13.26% of pharmacy technicians and 24.91% of laboratory technicians were also unemployed. There were 20.73 doctors, nurses and midwives per 10 000 population in Lesotho, and this could potentially increase to a density of 31.49 doctors, nurses and midwives per 10 000 population by 2030 compared with a need of 46.72 per 10 000 population by 2030 based on projected health service needs using disease burden and evolving population size and demographics. The existing stock of health workers covered only 47% of the needs and could improve to 55% in 2030. The financial space for the HWF employment was roughly US$40.94 million in 2020, increasing to about US$66.69 million by 2030. In comparison, the cost of employing all health workers already in the supply pipeline (in addition to the currently employed ones) was estimated to be US$61.48 million but could reach US$104.24 million by 2030. Thus, a 33% gap is apparent between the financial space ...