Plus ups: Human resources for HIV/AIDS service delivery remains a key challenge, particularly as relates to the number of available staff and their skills. USG Uganda has been working to address HR issues through improvement of MIS systems and assessing and piloting recruitment and retention schemes. Further efforts are needed to work with the Ministry of Local Government in addition to the central mechanisms to improve ownership, accountability and viable solutions to address staffing shortages.

As with many other sub-Saharan African countries, Uganda is experiencing shortages of healthcare workers. The Mid-Term Review of the Health Sector Strategic Plan identifies the lack of trained health personnel, staffing imbalances and the HRM infrastructure as critical constraints to scaling up services. The most fundamental constraint seems to be inadequate capacity in all sectors to perform the necessary Human Resource Management (HRM) functions. There have been several assessments that have been done recently, and there has been dedicated HRH improvement work going on in Uganda for the past 7-8 years. Key stakeholders in this effort include the MoH, the MoES, District Service Commissions, the PNFP Medical Bureaus, etc. Development Cooperation Ireland, the EU, DANIDA, the USG and various cooperating agencies are collaborating to build capacity in HRM for Health. Keeping this context in mind, the aim of the Capacity project strategy is identify gaps not being treated by others and to develop a proposed work plan based on these gaps. This work plan includes objectives and activities that "fit in" and make critical contributions given the other HRH projects underway.

The goal is to provide support for the strengthening of strategic, data-based HR management, leadership, and decision-making at the central and district levels. This will help to enable Uganda to meet its health care needs and respond to health challenges such as HIV/AIDS and TB. To achieve this overall goal, the Capacity Project will focus on the following interventions during the planning period: 1) Mature Human Resource Information System (HRIS) Complete an HRIS that can be used to track health worker training, certification and licensure; managing and deploying personnel; and long-term health workforce modeling and planning. The integrated HRIS database will link the data from the four health professional councils developed with Capacity Project support (training, registration and licensure of health professionals) to extant data sources such as, the existing HMIS data , HR data (currently paper based), PPO (payroll), Health Service Commission, local government, and district HR data (where internet connection available). Where HR data are available, a link will be made with the three faith-based bureaus, and other PNFP data, in collaboration with PPPH Office. This system will allow the various ministries to be able to plan for training of health professions, recruit, hire and pay health workers, manage the existing health labor force, and make projections for the future labor force needs. 2)Improved HR management and retention strategies (non-conflict regions) Based upon the results from the MOH/HRDD Human Resources Symposium (April 2006) Action Plan and the Capacity Project retention study (July -Sept 2006), develop interventions in several rural and urban districts to improve retention and management of health care workers. Depending on the number of districts selected and the extent of funding, seed money would be use to design and test some of the following interventions with a scale up plan. a.Strengthen supportive supervision skills at the facility level. b.Improve performance appraisal system so staff are permitted to see their performance appraisal, can set goals for the next year, and performance driven promotions. A career ladder is available for the staff. c.Continue to strengthen human resources leadership and management at HRDD. d.Develop results oriented management strategies so that staff understand how they contribute to the organization's performance and are involved in developing the future direction for the organization and assessing process to meet goals. e.Test different strategies to improve performance, productivity, staff motivation and satisfaction. f.Improve working conditions at facility, e.g. supplies, staffing, communication. g.Improve quality of life circumstances for health workers, such as, access to transportation, housing, education for children, loans for cars and housing, communication etc. 3)Improved HR management and retention strategies in conflict areas Based upon the results from the MOH/HRDD Human Resources Symposium (April 2006) Action Plan and the Capacity Project retention study (July -Sept 2006), develop interventions for improving retention and management of health care workers in conflict and non conflict areas of Uganda. Seed money will be used to design and test some of the following interventions, and develop a plan for scale-up. Involve the community in recognition of the importance of health workers and collaborate with community leaders in developing strategies. Protect health workers from gender-based violence.

Develop supportive supervision skills that targets needs of health workers in conflict areas. Involve staff in setting organizational performance targets for results oriented management and specific to needs in conflict areas. Facilitate communication between the health facilities in conflict areas and central government. Could involve ongoing medical expertise between teaching facilities and conflict areas via internet. Ensure safety of health workers during transportation to the health facility and while at work. Develop stress relief strategies. Communication strategies for line ministries, profession bodies, and training institutions Communication strategies and communication channels will be developed and identifies between line ministries: MoH, MOES, and Ministry of Public Service (MOPS); and between the govt line ministries, various professional Councils, and the private Not for Profit Sector. This will be in collaboration with the European Union/DHRH. Effort will be made to ensure laws for higher education are consistent across the ministries. Communication strategies between Central MOH and Districts Improve communication between the districts and central government. Have conference calls, instant messenger times set up so the managers and staff in the districts can communicate regularly with the central ministry staff to improve communication in a decentralized environment. This will be tested in the 20 districts that already have an internet connection between the district and central MOH. Implement workplace safety guidelines Funds permitting, the project will implement workplace safety guidelines developed with support from Capacity Project at the facility level in collaboration with the national ministerial committee to improve workplace safety. Conduct five regional workshops to implement guidelines and follow-up with staff in selected districts through-out year to ensure facility level implementation.

*P.U.: support to MoH and Prof orgs the 2 areas of establishing a mature HRIS that can be used to track the different cadres of health workers, and improve the HR management and retention. The HRIS system will allow the various ministries and professional bodies to plan for training of health professions, certification and licensure; recruit and deployment of personnel, hire and pay health workers, manage the existing health labor force, and do long-term health workforce modelling and planning. The program will be used to design and test interventions for improving retention and management of the health workers in rural and conflict districts in northern Uganda. interventions include improvement in the performance appraisal system, strengthening HR leadership and management at the MoH, development of results oriented management strategies with staff involvement, and testing different strategies to improve performance, productivity, staff motivation and satisfaction like improving working conditions at work place, and improving quality of life circumstances such as, access to transportation, housing, education for children, loans for cars and housing, and communication.