Table 1

Data matrix A (human resource for health strategic plans in selected countries in Africa)

NoAuthor (year)
Title of policy/strategic planTypesScopeProcessCritical evidence
Projection method
Reference to WHO HRH guide
1Botswana Ministry of Health
Chapter 5 of the Integrated Health Service Plan: A Strategy for Changing the Health Sector For Healthy Botswana
HRH strategic plan embedded in an Integrated health sector strategyPublic, private for-profit, private non-profit and traditional medicine practitioners
10-year plan
Developed alongside three key documents:
(a) Essential Health Service Package with Norms and Standards
(b) List of indicators to be used at various levels
(c) Annual Operational Plans (to be developed for all departments and districts)

An annual operational plan and review meeting is held to review the IHSP implementation and funding.
  • Current HRH statistics retrieved from MoH Infinium HR system

  • Qualitative research: key informant interviews and stakeholder consultation

Approach to projections
  • Staffing norms

The WHO Report 2006 highlights the need to make the most of existing human resources and the fact that without improved performance any recruitment and retention strategies will have limited effect.
2Eritrea Ministry of Health32Eritrea Human Resources for Health Strategic Plan
Strategic plan
  • Public sector with less focus on private sector and NGOs

5 years plan
Senior management of the MOH collaborated and consulted with key stakeholders.
A situational analysis was conducted:
  • Review of various documents provided by the Ministry and other key stakeholders in Government and WHO

  • Individual interviews with selected staff and stakeholders

  • Strategic thinking sessions with the technical working group (TWG)

  • A validation workshop organised by the policy, planning and HRD department to validate the policy

  • Financial costing was done for each of the five aspects

  • Then an implementation plan was developed for each of the five objectives

  • National Health Policy (2010)

  • Population distribution

  • Health status or disease burden

  • Economic outlook

  • Governance of the health sector

  • Heath worker densities per 1000 people

Approach to projection
  • HRH per population approach

  • Staffing norms and comparison with international recommendations in the WHO Report (2006)

WHO Eritrea office was acknowledged for financial and technical support, but the WHO 2006 guidelines were not mentioned7
3Eswatini Ministry of Health
Human Resource for Health Department: ‘Building a Competent Health Workforce for Effective Healthcare Delivery’
HRH strategy with no implementation plan
  • Public, private, faith-based, industry and NGOs

5-year plan
  • Used an HRH Technical Working Group

  • SWOT analysis followed by a Delphi

  • Document review

  • Extensive stakeholder consultations

  • Evaluate of previous HRH strategic plan

  • Determining HRH gaps from the previous implementation

  • Brainstorming section

  • Write up of a 5-year HRH strategic plan

  • Using the data collected in the preparation and assessment stages

  • Identified strategic priority areas the MoH intends to address in 5 years

  • A programme logic model was developed to align the prioritised strategies with a costed implementation plan and timelines for implementation

  • Develop M&E framework with performance indicators

  • Sharing of the draft for stakeholder inputs and validation

  • The vision, mission and goals of the HRH Unit of the Ministry of Health

  • The strategic themes, the strategic goals, the guiding principles, the enablers and the major assumptions

  • Thematic areas, the key challenges, the priorities, objectives and the key indicators for each thematic area

  • Coordination mechanism and roles of stakeholders?

  • M&E framework and indicators

  • Documents Global HRH Strategy, WHO Framework on integrated people-centred health services, national health strategy, the 90-90-90 strategy for HIV epidemic control, midterm HRH strategy review report, the health workforce assessment report and the 2017 Population and Housing Census preliminary results

  • SWOT analysis

  • Structured interviews

  • Delphi

Approach to projection
  • HIV/AIDS WISN model was used to project workforce

  • The model calculates target figures of patient loads

  • The actual time that various cadres spend providing services to each patient

  • Training projections are based on a 3-year trend of intake into the schools and

The WHO was acknowledged for providing technical support. The processes used corresponds with the Guidelines for Countries in the WHO African Region, but the document was not cited.
4Ethiopia Ministry of Health
National Human Resources for Health Strategic Plan for Ethiopia HRH Strategy 2016–2025HRH Strategy with+annual operational plan
  • Public, private, NGOs, faith-based organisations

10-year plan
  • Directorate of HR Development and Administration (DHRDA)

  • Description of the Ethiopian context

  • Situational analysis

  • Strategic directions

  • Outcomes objectives and actions

  • Implementation plan

  • Monitoring and evaluation

  • Projections and costing

  • Ethiopian Health Policy (1993)

  • Health Sector Transformation Plan (2015– 2020)

  • Visioning Ethiopia’s Path Towards Universal Health Coverage Through Primary Healthcare—Visioning 2035

  • Demographic profile

  • Economic profile

  • Health status

  • Policy context

  • Governance

  • The capacity of education institutions

  • Health workforce distribution and density

  • HRH legislation and policy

  • Partnerships

  • SDGs

Approach to projection
  • Population norms approach for health facility

  • Staffing norms were used to project the health workforce based on population to health facility standards

Though the Guidelines for Countries in the WHO African Region was not mentioned in the document, the strategic plan follows the guidelines
5Kenya Ministry of Health
Kenya Health Sector Human Resources Strategy (KHSHRS) 2019–2023HRH strategy with an annual operational planPublic, private and faith-based organisations
5-year plan
  • MoH, council of Governors and DoH from 47 countries collaborated. Description of Kenya health policy context.

  • Conduct an in-depth HRH situational analysis to determining HRH priorities

  • Formulation of strategic investment priorities

  • Strategic priorities

  • Workforce for UHC

  • HRH leadership and management systems

  • Resources required

  • Implementation

  • M&E

  • Stakeholder consultations and inputs

  • Technical input from local and international partners

  • Approval from Cabinet Secretary of Health

  • Dissemination and implementation

  • SDG 3

  • Disease burden

  • Health workforce in the public health sector

  • Public health sector growth

  • Workload, attrition and production outputs

  • Capacity to employ

Approach to projection
  • Workload Indicator Staffing Norms (WISN)

  • Staffing norms

Though the Guidelines for Countries in the WHO African Region was not mentioned in the document, the strategic plan follows the guidelines
6Liberia Ministry of Health and Social Welfare
National Human Resources Policy and Plan for Health and Social Welfare 2011–2021HRH Policy and strategic plan with a 2 yearly implementation plan
  • Public, private-for-profit, and private not-for-profit and based organisations

10-year plan
  • Analysed the implementation of the previous strategic plan

  • Conduct a situational analysis

  • Develop the strategy

  • Established HR Technical Committee (HRTC) to manage financing, implementation and M&E

  • Develop terms of reference for the HRTC

  • Determining risks and assumptions

  • Number and type of facilities needed

  • Population dynamics

  • Overview of the current workforce

  • HR challenges

  • Health sector spending

Approach to projection
  • The network of facilities, staffing norms by facility type must be multiplied by the number of facilities in each category (eg, clinics)

Though the Guidelines for Countries in the WHO African Region was not mentioned in the document, the strategic plan follows the guidelines
7Ministry of Health Human Population Malawi
Malawi Human Resources for Health Strategic Plan, 2018 – 2022HRH strategic plan with an annual operational planPublic, Christian Health Association of Malawi, private sector
5-year plan
  • June 2017–July 2018

  • HRH Technical Working Group (TWG)

  • Review of the previous strategic plan

  • Structured regional stakeholder consultations

  • Staff return data from at the district and central level

  • Qualitative and quantitative data from training institutions

  • Prioritisation workshop

  • Methodology validation

  • Development of draft

  • Review of the draft by TWG

  • Review report from previous strategic plan

  • Malawi Growth and Development Strategy III

  • National Health Policy, 2017

  • The Health Sector Strategic Plan II

  • Other national policies

  • Sustainable Development Goals

  • The Global Fund HRH Guidelines

  • Sociodemographic Context Malawi

  • Health Status

  • Health administrative structures

  • WHO and international requirements

  • The staff returns and training institution data

  • (1) Malawi’s current public sector and CHAM health workforce; (2) Malawi’s current public sector and CHAM health workforce vacancy rate; (3) Updated projections for Malawi’s public sector and CHAM health workforce over the next 5 years;

  • (4) Malawi’s training pipeline to develop, recruit and retain public sector and CHAM health workers

Approach to projection
  • Workforce target setting was conducted using a Workforce Optimisation Model (WFOM)

Though the Guidelines for Countries in the WHO African Region was not mentioned in the document, the strategic plan follows the guidelines
8Namibia Ministry of Health and Social Services
National Human Resources for Health Strategic Plan 2020– 2030
  • HRSP with a 5-year implementation plan

  • Public, Development partners, NGOs, private sector, quasi-government institutions, mission-based organisations

10-year plan
  • Nov 2017 to May 2019

  • Conceptualisation phase

    • HRH planning capacitation, consultant recruitment

    • Seeking technical support from WHO IntraHealth

  • Analyses

    • Desk review of policies

    • Stakeholder interviews,

    • Technical working group sessions to conduct a comprehensive situation analysis

    • Health workforce demand and supply projections

    • Stakeholder validation

  • Formulation and adoption phase

  • Development of the draft strategic plan

    • Broad objectives

    • Strategic interventions

    • Implementation arrangements

    • Pindicators

  • M&E plan

  • Review MOHSS and validated through consultations

  • Available but not fragmented HRH database

  • SDG 3/UHC

  • National development plan

  • The national health policy framework

  • Policy environment

  • Emerging HRH challenges

  • Global agenda

  • Population characteristics

  • Socioeconomic status

  • Disease burden

  • Health system structure

  • Age of health workforce

  • Labour market dynamics

Approach to projections
  • Staffing norms

  • This is adjusted annually based on service utilisation and expansion

  • The WHO was acknowledged for providing technical support. The processes used corresponds with the Guidelines for Countries in the WHO African Region, but the document was not cited

9Rwanda Ministry of Health14National Human Resources for Health PolicyHRH policy with HRH strategic plan and annual operational plansThe public sector, private sector, NGO, faith-based organisationsNot explicitly described.
  • Situational analysis

  • Policy development

  • Description of the governance framework

  • Monitoring and evaluation plan

  • Description of the source of funding

  • Socioeconomic situation in Rwanda

  • Health worker to population ratio

  • Health workforce distribution

  • Disease burden

  • Economic Development and Poverty Reduction Strategy (EDPRS), Vision 2020

  • Workload estimated for each health facility in terms of size of the population served and the package of services offered

Projection method
Workload related to the population served and the package of services offered
The document did not follow the WHO guidelines.
10Sierra Leone Ministry of Health and Sanitation
Sierra Leone29
Human Resources for Health Strategy 2017–2021Public, private-for-profit and private-not-for-profit
5-year plan
  • July 2016–2017

  • An inter-ministerial Steering Committee was

  • Clinton Health Access Initiative and the WHO provide technical support

  • Three technical working groups

  • Desk review of interventions that work

  • Situational analysis: regional HRH consultation workshops

  • Generate activities based on priorities

  • Costing of activities

  • Draft strategy developed

  • Stakeholders review and validation

  • Launching the HRH Strategy 2017–2021 in 2017

  • Civil Service Training Policy

  • Payroll Verification

  • Facility-level staffing norms

  • Basic Package for Essential Health Services

  • Human Resource Management Process Mapping

  • Forecasting model to assess the impact of potential workforce interventions and verify the training capacity

  • Work workforce production

  • Recruitment, remuneration, governance of the health workforce

  • HRH challenges

Approach to projection
  • Facility-level staffing norms

Though WHO provided technical support for the development of the WHO guidelines were not cited in the strategy. The development process, however, resembles the WHO recommendations.
11National Department of Health
South Africa15
2030 Human Resources for Health Strategy: Investing in the health workforce for Universal Health Coverage
Strategic plan with 5 years’ implementation plan and an investment casePublic, private-for-profit and private-not-for-profit
10-year plan
  • March 2019

  • Minister of Health appointed a Ministerial Task Team (MTT) to support the NDoH

  • Literature review of national and international policies

  • In-depth interviews with key informants

  • Workshop with all the heads of provincial health HRH heads

  • Technical analyses on the health labour market

  • HRH stakeholders’ consultations

  • Recognition of future health workforce needs

  • Five MTT work streams addressed various domains of HRH

  • Review of HRH frameworks

  • Adapted the Health Human Resources Conceptual Framework complemented with Health Labour Market Framework for UHC and a framework for HRH system development for fragile and post-conflict states

  • Global and national context

  • Local and international policy review

  • Health labour market analyses

  • Health workforce needs and costs

  • Provincial density of specialist doctors

  • Health workforce needs of primary healthcare (PHC) for National Health Insurance (NHI) system

  • Burden of disease

  • Cost of salaries

  • Health sector budget

  • Service utilisation

  • Ranked province equity target

  • SAC, HPCSA, pharmacy councils’ data

  • No database of employees in private sector

Approach to projection
  • First projection: National public health workforce needed to improve equity (third Rank Province Equity Target)

  • Second model: Health workforce needed for primary healthcare services (based on service utilisation)

  • Third module focuses on the need for specialist doctors based on national density of medical specialists

The processes used correspond with the Guidelines for Countries in the WHO African Region, but the document was not cited.
12South Sudan Ministry of Health
South Sudan18
Strategic Plan for Human Resource for health
Strategic plan with decentralised operational plansPublic, NGOs, FBOs and the Private sector
10-year plan
  • South Sudan context

    • Demographic profile

    • Socioeconomic situation

    • Burden of disease

    • Healthcare system

    • Current HRH

    • Projected outputs

    • Review of current strategic plan

  • Technical advisory team and consultants team lead

  • Situational analysis

  • Literature review

  • (ii) Consultations and interviews

  • Financial projections

  • (iii) Focus group discussions, and plenary sessions during a workshop held at AMREF Headquarters on the 30th

  • Development of the first draft

  • Draft reviewed by the technical advisory team

  • Finalised strategic plan

  • Development of institutional framework to clarify roles

  • The estimated population, norms and standards for implementing the Basic Package for Health for Southern Sudan

  • Number of health facilities and training institutions in the country

  • Development of strategic objectives

  • Focus on PHC

Approach to projection
  • The policy statements on the Primary Healthcare approach and implementation of the Basic Package of Essential Healthcare are important in determining the required essential healthcare providers including the community-based workers.

  • The use of staffing norms and standards for determining human resource for the implementation of the Basic Package of Essential Healthcare in Southern Sudan is an important tool in making projections for the required health workforce. However, starting with very little and aiming at major developments makes establishing a ‘norm’ very difficult as it should be improved constantly.

  • Use projected population and basic service package provided to do initial estimate then establish staffing norms for future HRH projections

The WHO was acknowledged in the policy, but the guidelines were not cited. The processes followed are in line with the WHO-AFRO requirements
13Tanzania Ministry of Health and Social Welfare
United Republic of Tanzania20
Human Resource for Health and Social Welfare Strategic Plan 2014–2019HRH strategic plan with operational plansPublic, private, faith-based organisations, NGOs
5-year plan
  • Description of the context

  • Situational analysis

  • Core Group formed to undertake the situational analysis

  • Literature review

  • Local, regional and national level stakeholder consultations

  • Identification of gaps

  • Development of draft

  • Sharing draft for stakeholder inputs

  • Review of draft

  • Sharing with implementers for their views and inputs

  • Finalising plan

  • Institutional arrangements

  • Health workforce projection:

    • Demographic projections

    • Macro-economic projections

    • Expected changes in the pattern of diseases

    • The vision, aspirations and expectations of policymakers of health services

    • Health system of the future to meet the changing disease pattern

    • Demands of the population in terms of access and quality of healthcare

    • Gaps in HRH recruitment and distribution

    • Basic Package of Essential Healthcare

Approach to projection
  • Supply, and Requirements Projection Model developed by WHO

WHO country office was acknowledged.2 Though the strategic plan followed the recommendations of the WHO 2006 guidelines, the guideline was not cited.7
14Zambia Ministry of Health
National Human Resources for Health Strategic Plan 2018–2024: Reshaping Zambia ’ s Human Resources for Health to Become Self-Sufficient by 2030HRH strategic plan with operational plansPublic, private, NGO
5-year plan
  • Scoping of existing policies and strategy frameworks

  • Literature review

  • District, provincial and national consultations

  • Reviews of draft frameworks

  • HRH evaluation workshops

  • Geographical context

  • Demographic

  • Socioeconomic status

  • Epidemiological transition/disease burden

  • The health system

  • The policy framework

  • HRH situation and deficits

  • Capacity for HRH planning and implementation

  • Salary and incentives

  • HRH training programme funding data, and

  • National budget and external aid data

Approach to projection
  • Staffing establishments

  • HRH, human resources for health; NGOs, non-governmental organisations; SDG, Sustainable Development Goal; SWOT, Strengths, Weaknesses, Opportunities and Threats analysis .