The Southern Africa Human Capacity Development (SAHCD) Coalition is a four year associate award (AA) which began on October 1, 2006 and will be ending in January 2011. The project is designed to strengthen Human Resource Management and Information Systems to improve Workforce Planning and Policy, develop better skilled workforce and sustain health worker performance to implement quality HIV and AIDS programs. The current HCD Coalition is made up of six organizations; IntraHealth International (Lead) , Management Sciences for Health (MSH), Foundation for Professional Development (FPD), Council of Health Service Accreditation of Southern Africa (COHSASA), The Eastern, Central, and Southern African (ECSA), and Institute of Development Management (IDM). A new competitive bid will be developed with the AA coming to an end in 2011.

The overall goal of the SAHCD activity is to improve human resources for health (HRH) workforce policies, planning, development and support systems for retention and productivity to increase both access to and quality of HIV-related services and support. SAHCD's activities provide the core of the human resources for health component of the HICD pillar of the Partnership Framework (PF); contribute directly and significantly to the response management thematic area of the National Strategic Framework on HIV and AIDS 2009-2014 (NSF) and support the aims of objectives of the Health Sector Strategic Plan. These activities address the human resource constraints limiting scale up of all aspects of the HIV response, including prevention, care, treatment and support. This entire portfolio is dedicated to strengthening the healthcare system workforce for a sustained, locally owned HIV response. As such, the full budget of the project is reflected under the HRH cross cutting budget code.

SAHCD's target population is the public sector health workforce, primarily the Ministry of Health (MOH) and Department of Social Welfare (DSW) from the national to facility level; NGO's contributing to the HIV response and volunteer workforce at community level.

By strengthening the local human resources management and the local workforce, SAHCD's activities will realize cost efficiencies across the breadth of the PF as the requirement for expatriate staff and external consultants will be reduced and tasks can be allocated efficiently across the various cadres of health workers.

SAHCD has a comprehensive Performance Monitoring Plan that tracks all activity implementation based on PEPFAR and other custom-designed indicators. The program employs a full-time M&E specialist. SAHCD has a training database, reporting and documentation mechanism and a dissemination strategy as well as a web-based COHSASA Quality Information system (CoQIS) in 19 health care facilities. SAHCD issues monthly bulletins to stakeholders and conducts routine data audits and assessments for program improvement. There is also a Best Practice and Knowledge Management Strategy to guide the sharing of best practices as a means to improve program approaches.

In FY009, the HRIS was decentralized to regional offices. SAHCD recruited a regional HRIS (Human Resource Information System) Advisor and a HR Information officer attached to the MOH and has trained HR managers in data driven decision making. SAHCD will continue to provide technical assistance and training managers, regulatory councils and managers at national and regional levels to utilize the HRIS. The system will be expanded to link with other health management information system, logistics systems to flag facility performance in relation to HR productivity and retention issues for managers to make quick management decisions. These include responsive supervision and redeployment of staff according to service demand.

Based on GKOS plans, regional offices will have access to internet in the coming year. SAHCD, through CoHSASA, will install CoQIS at regional and hospital levels and train managers to enter quality data, and generate and use reports to improve the quality of health services. Training on CoQIS will be linked to utilization of HRIS and HMIS to highlight service utilization challenges and problem solving techniques to address the bottlenecks.

In FY 11, SAHCD will continue to provide direct support focuses on:

Strengthening Human Resources (HR), including improving HR management systems (HRMS) SAHCD will assist the MOH to expedite and fast-track recruitment of healthcare workers (HCWs) for critical existing vacant posts and new positions based on the new MOH structure at senior management and technical HCW positions (laboratory, pharmacy, radiographers, doctors and nurses). Through a consultative process with MOH priority recruitment cadres will be identified each year so that there is clear understanding on the recruitment SAHCD will support from the pool of graduates from local and regional pre-service training (PST) institutions, working closely with the Ministry of Public Service (MOPS) Scholarship Board and MOH. A streamlined recruitment and deployment system will be developed with the Civil Service Commission (CSC) under MOPS, and Nursing Council so that registration and recruitment processes for nurses and specialized cadres (doctors, pharmacists) are shortened. SAHCD will support capacity building for the MOH Training Unit in external recruitment.

Developing an Attraction and Retention strategy To attract and retain recruited HCWs, SAHCD will engage Ministries of Health, Finance, Education, Economic Planning, MOPS and the CSC to develop an Attraction and Retention strategy and an Orientation Package for technical HCWs. SAHCD will also conduct an assessment of current performance and evaluation systems at MOH and MOPS to identify gaps and develop an effective performance management system (PMS) for MOH including PMS tools and performance based supervision systems. An assessment will be conducted of current promotion criteria of the MOH and CSC and career promotion structures realigned to ensure effective promotion policies leading to upward career mobility for HCWs. Career promotion structures will be linked to PMS, attraction and retention strategy, orientation packages and the new MOH organizational structure.

Implementation of the new functional MOH organizational structure SAHCD will support implementation of the new MOH structure by recruiting for key new positions, providing temporary salary support for the HR Director and senior HR management positions at national and regional levels with a focus on building capacity in the HR Unit. SAHCD will support advocacy for creation of new positions in the establishment register and absorption by MOH. Job descriptions will be updated and/or developed for critical existing and new positions, including administrative positions (Director General Technical/Health Services; Director, Administration; Director HR; Director, MOH HQ HRM; Director, Regional HRM; Superintendent, National Reference Hospital) and technical positions. SAHCD will collaborate with other development partners (UN agencies, EU, World Bank, Global Fund) to develop a Standardized Package of Health Services for all levels of care, mechanisms for tracking Attrition rates for HCWs (linked to HRIS and HRMS), and a Capacity Development Framework/National Workforce Plan. MOH will be supported to utilize the Staffing Norms for health facilities to inform decisions on HCW deployment and distribution. A recruitment policy/strategy will be developed for MOH using lessons learnt in recruitment to ensure efficient recruitment and deployment of HCWs.

Support to establish an HRH Advisory Committee Refining of the terms of reference (TOR) for the HRH Advisory Committee will be guided by the MOH to create a forum for government and developmental partners involved in HRH. . SAHCD will support advocacy to government, regulatory councils, PST institutions and development partners to ensure buy-in and participation, and provide financial and secretariat support for meetings.

Strengthen PST training institutions There are only three local training institutions for health professionals in the country. The Faculty of Health Sciences of the University of Swaziland is responsible for the training of almost 70 % of the professional nursing cadres in community, medical and surgical nursing. Nazarene College of Nursing on the other hand accounts for the remaining 30 % of professional registered nursing cadres; and Good Shepherd Nursing School is responsible for the training of the Nursing Assistants cadre with an output of 40 per year. There are no training facilities for the rehabilitation therapists, radiographers, laboratory technicians.

SAHCD will strengthen PST to increase the supply of new skilled health workers (nurses) in consultation with PST institutions, the Nursing Council, and MOH, to finalize ongoing upgrading of nursing certificate courses to diploma level and increasing intake in the diploma and degree programs. Good Shepherd and Nazarene Nursing College will be the priority. The support will be finalization of curriculum development, renovation of infrastructure and faculty salary support. The finalization of the Task Shifting support through WHO is a strategic area of support for PEPFAR because it impacts on all funded program areas. SAHCD will advocate for the development of guidelines to support to avoid the long policy development process. GOKS and other funding partners who can support infrastructural needs will be consulted.

Support for In-service Training (IST) Continuous Professional Development (CPD) will be supported by conducting a Training Needs Assessment and a HCW Skills Audit at all levels; supporting the MOH Training Unit to develop a Master Training Plan and Training Information Management Systems (TIMS); and strengthening MOH's coordination and standardization of training activities to ensure efficient use of available training resources and avoid duplication of activities. Advocacy and support will be provided to MOH and PST/IST institutions to develop a Continuing Education Strategy, with advocacy to regulatory councils and MOH to accredit selected IST courses.

The capacity of community health workers (CHWs) to deliver HIV related services will be strengthened by supporting: implementation of Supervision Manual through a Training of Trainers (TOT) for CHW supervisors (national and regional); standardization and printing of training curricula; training, advocacy for accreditation and standardizing the work and remuneration of various CHWs cadres; and the promotion of quality control for CHW service delivery and job outputs through supportive supervision systems.

The need for qualified Social Workers in Swaziland is huge. Through SAHCD, support will be provided to modify the DSW organizational structure that was developed when the department was part of the MOH. DSW is now housed within the Deputy Prime Minister's Office with additional functions, including disaster management and management of the education grants for orphans and vulnerable children. Based on the new structure, the Social Welfare Policy and DSW Strategic Plan, a HR Capacity Gap Analysis will be conducted to assess the Department's skills gap. Training for recently recruited Para-social workers is a priority for the department and SAHCD will provide TA support in developing a program in-country modeled from what has been done in the region (Malawi). Increasing the number of specialized (degree-trained) Social Workers is important because there are so few qualified Social Workers in Swaziland and tremendous demand for their services. SAHCD will also provide support in certification and accreditation of programs currently underway and funded by UNICEF to train CHWs in psychosocial support.

Leadership Development Program Building on previous leadership development (LDP) programs targeted at lower level managers, SAHCD will strengthen the governance and stewardship role of the MOH to create a conducive policy environment for improved health workforce outcomes. MOH capacity will be developed in leadership, governance and management at middle and senior levels. The virtual learning programs (HRH and Strategic Plan) and the accredited FPD/Yale Management course will be utilized. The capacity of local Institutions (SIMPA, Mananga, IDM and ESAMI) will be built via capacity building workshops on MSH tools (MOST, HRMRA, and Consulting for Results tools) to further develop leadership, governance and management skills.