(HRH_CURR) Number of health worker full-time equivalents who are working on any HIV-related activities

Export Indicator

Number of health worker full-time equivalents who are working on any HIV-related activities
What it measures

Many countries experience HRH shortages and/or imbalances by population density (e.g., HRH shortages in rural areas) that are not related to population health needs, including HIV epidemiology; addressing density and distribution of HRH is important in increasing access to HIV services.

In many PEPFAR countries, there are overall shortages of HRH, particularly in rural and remote areas, leading to insufficient numbers of health workers according to internationally recommended levels (2.3 doctors, nurses, midwives/1,000 population). There are also countries where there is large overproduction of health workers, with medical unemployment in urban areas, and at the same time with shortages in rural areas.

Furthermore, different types of health workers receive different types and amounts of support that may vary by geographic location, cadre, workload, and other factors. Understanding the ways in which different cadres are supported is important for mobilizing differential models of service delivery under different circumstances.

This indicator measures the person-time that PEPFAR-supported health workers contribute to providing HIV services at facility and community sites. It allows us to track our level of support and continuously calibrate it based on impact. It also allows us, over time, to measure the transition from PEPFAR support to host country support.

Definition

For this indicator, health workers who receive any type of support from PEPFAR, including monetary (i.e., salary, overtime, stipends) and non-monetary support should be counted.

Monetary:

PEPFAR monetary support includes any monetary contribution toward a total salary and stipend payments.

Non-monetary support includes health workers who are not receiving salary or stipend, but do receive any type of non-currency support for which PEPFAR incurs an expense and that enables a health worker to perform additional HIV-related services. Examples include but are not limited to: mobile phone credits/air time, general modes of transportation such as a bicycle or motorbike, credits for transportation such a bus tokens or cards, job aids or equipment that can be used outside of HIV or in other jobs (such as in private practice), or other in-kind support. Do not include receiving in-service training, receiving routine supportive supervision, clinical mentoring, or any activities as part of continuous quality improvement.

This indicator is the number of full-time equivalent positions (FTE) working on HIV (“HIV FTE”), defined as the time spent on HIV that is supported by the PEPFAR partner, as a proportion of the full-time work week. Calculate part-time positions working exclusively on HIV, or full-time positions working on several areas including HIV and other illnesses, as fractions. However, do not count any amount of time health workers are already spending on HIV-related services that would happen without PEPFAR support. Only count the hours that are worked in exchange for monetary or non-monetary compensation from a PEFPAR implementing mechanism. Full time equivalency hours should be the standard listed in the cadre’s scheme of service and/or Ministry of Health guidelines. The methodology for calculating this is consistent with Expenditure Analysis (EA) Guidance.

- For example, four PEPFAR-supported health workers who each work on average 25% of the work week (independent of variations in the hours worked per week by each worker) on HIV would contribute 1.0 FTE.

- PEPFAR may support a doctor’s full salary who works full-time with time distributed among five communities – you would then allocate her time as 0.2 FTEs per site. This would also apply to workers who split their time between community and facility. Only count the year in which PEPFAR expended resources to provide the support; for example, providing a bike for a community worker would only be counted the year the bike was received.

 

Rationale

Number of health worker full-time equivalents who are working on any HIV-related activities i.e. prevention, treatment and other HIV support and are receiving any type of support from PEPFAR at facility sites, community sites, and at the above-site level.

Numerator

Not applicable: This indicator is neither a numerator nor a denominator.

Method of measurement

Data on total numbers of positions or FTEs supported should be tracked by implementing partner’s record-keeping systems, for example, personnel databases, human resources records, and financial records that show salary or stipend payments, including information on non-monetary support to volunteers. Leverage the same records and systems partners already use to report dollar amounts for EA reporting, to identify PEPFAR support of HRH. Hours worked on HIV may be estimated using staff work-week scheduling calendars and HIV clinic/lab opening hours, and speaking with facility in-charges. For community sites, hours worked on HIV can be estimated using average beneficiary consultation times, and average number of consultations.

For non-monetary supported personnel, partners should cross-reference expense reports and registers against the cadre types who received the corresponding non-monetary benefits. For example, receipts showing transportation allowances were provided to attend meetings could be cross-referenced with the attendance listed in the minutes for community lay workers. Facility and community workers are reported by IM, Site ID, facility and community site affiliation, and cadre type. All PEPFAR-supported workers at the facility and community should be reported.

We recommend that PEPFAR implementing partners following these steps:

1) Identify all facility and community sites where you work.

2) Identify and count the number of health workers (individuals) you support at each site.

3) Group these health workers into their most appropriate, mutually exclusive cadre (doctor, nurse, lay counselor, lab technician).

4) List all types of monetary and non-monetary support that were provided to health workers at any of those sites in the current fiscal year (as incentive or compensation for time spent on HIV services at those sites).

5) Assign those types of support to the health workers identified on your site lists.

Create a matrix of supported health workers by cadre and support type

6) Further split the health workers into sub-groups based on the most appropriate mutually exclusive type of PEPFAR support. (*Assign FTE to the “highest” category - Non-monetary support should be reported if you provide only non-monetary support, with no salary or stipend

7) Calculate the FTE: Hours per week that this mechanism supports for HIV-related services at this site / Hours in a full-time work week

Repeat this separately for the three types of support:

8) Take the average FTE for each cadre

9) Add up the total FTE within each broader cadre category (clinical, clinical support, management, loy, social service, other)

10) Enter this amount in DATIM in the corresponding box for cadre category – support type.

Above-site support may include Ministry of Health or other government staff who work at the district or provincial level, or at the national level, including Ministry of Health office, National Reference Laboratories, or at national research centers not otherwise providing HIV services directly to beneficiaries.

How to calculate annual total:

Fill out disaggregated data entry form first, annual total will auto-calculate from disaggregates. Data should capture health workers for whom PEPFAR provided support in the same reporting period (fiscal year), and who have not been transitioned by the end of the fiscal year. Unfilled positions or vacancies should not be included.

Measurement frequency

Annual: Data should be reported in the fourth quarter of the year from retrospective review of HRH and expenditure systems or records. We recommend using the HRH inventory tool, which facilitates FTE calculations by further breaking out the broad cadre categories into more specific cadre types (such as doctors, nurses, lab technicians, etc.).

Disaggregation

Disaggregate Groups

By cadre category (For facility and community level)

1. Clinical

2.Clinical support

3. Management

4. Social service

5. Lay

6. Other

Description of Disaggregate

1. Clinical workers are those who provide a direct clinical service to clients: (Clinical professionals, including doctors, nurses, midwives, clinical officers, medical and nursing assistants, auxiliary nurses, auxiliary midwives, testing and counseling providers. They should have completed a diploma or certificate program according to a standardized or accredited curriculum and support or substitute for university-trained professionals.)

2. Clinical Support workers are those who support clinical services at the site but do not directly provide services to clients: (Pharmacists, medical technologists, laboratorians, lab and pharmacy technicians)

3. Management workers are those who provide support to the site for administrative needs but not directly provide services to clients: (Facility administrators, human resource managers, monitoring and evaluation advisors, epidemiologists and other professional staff critical to health service delivery and program support.)

4. Social Service workers are those who have advanced training in social services and provide services directly to clients: Social service workers including social workers, child and youth development workers, social welfare assistants.

5. Lay workers are those who have non-clinical training and provide services directly to clients: (Health workers who provide important services for the continuum of care within facilities and/or communities. These include (but are not limited to) adherence support, mother mentors, cough monitors, expert clients, lay counselors, peer educators, community health workers and other community-based cadres )

6. Other – workers who do not fit into any of the categories above. For all categories of workers, please provide description of specific cadres in the narrative when reporting.

By cadre category (for above-site)

1.1. Management central level

1.2. Management (subnational unit)

1.3. Faculty

1.4. Epi/surveillance

1.5. Other

Description of Disaggregate

1.1. Management central level are those staff supporting management functions at national level. Examples may be development and implementation of policies, guidelines, quality standards, health or HIV budgeting and financing. The work of these staff have a national scope and affect all (or multiple) districts or regions.

1.2. Management sub-national unit are those staff supporting management functions for one geographic area at the sub-nationallevel. Examples may include district-level health planning and coordination, district-level quality improvement, training or mentoring (e.g. district health office, provincial coordinating authority)

1.3.Faculty (Tutors and Trainers) are those staff working at pre-service institutions and training centers/departments.

1.4. Epi/Surveillance staff are those collecting and/or analyzing HIV epidemiologic data at the above site level. This may include making national or district-level estimates of PLHIV or key populations, incidence modeling, ANC or sentinel surveillance, integrated behavioral and biological surveys, drug resistance estimates.

1.5. Other types of staff not covered by the above categories.

By site-level cadre and by type of support provided by PEPFAR to the staff

2.1.Salaried staff

2.2. Staff receiving Stipends

2.3. Staff receiving nonmonetary support

Description of Disaggregate

For each cadre category supported by PEPFAR at the site level, further disaggregate the HIV FTE by the type of support provided by PEPFAR. The total HIV FTE should equal the sum of the HIV FTE by three types of support. Do not disaggregate above-site cadre category FTE by type of support.

2.1. Salary – Total number of HIV FTE positions for which PEPFAR is providing any level of financial support toward their regular salary. Include all HIV FTE (all person-time spent on HIV) if any amount of salary support is provided, even if they also receive support from sources other than PEPFAR. This represents the total FTE that are “touched” by PEPFAR salary support. PEPFAR salary support is any ongoing monetary contribution bench marked toward a total salary which is benchmarked toward, a government salary scale or international salary standard). A salary is characterized by being disbursed at regularly scheduled intervals in expected denominations.

2.2. Stipend – Total number of HIV FTE positions for which PEPFAR does not provide salary support but does provide monetary payments in connection with the provision of HIV services. Stipend payments are not necessarily disbursed in regularly scheduled intervals, and are not necessarily commensurate with, nor benchmarked toward, a government salary scale or international salary standard. These include one-time reimbursements for expenses connected to travel or training (per diems); and supplementary payments, for example, for overtime worked due to HIV case burden. Payment could be made at regular intervals depending on agreement.

2.3. Non-monetary only – Total number of HIV FTE positions for which PEPFAR provides only non-monetary support. Report if PEPFAR provides only non-monetary forms of support that do not involve currency, in connection with or in support of the provision of HIV services. These include mobile phone credits, meals, general modes of transportation like bicycle or motorbike, job aids or equipment that can be used outside of HIV or in other jobs (such as in private practice), or other in-kind support. Include volunteers who work on HIV and receive only non-monetary support from PEPFAR.

Further information

MER 1.0 to 2.0 Change

HRH_CURR was previously reported at the facility site and community site levels by type of cadre and type of support. Above site workers are now included in this indicator. Added new types of staffing support (Salaried staff, Staff receiving Stipends, Staff receiving non-monetary support).

PEPFAR Support definition

no additional requirements needed

DREAMS SNU Specific Guidance

no additional requirements needed