In 2013, while looking at national gaps in health coverage, the Government of Ethiopia and USAID identified an issue with the availability and quality of service delivery for the population in the under-served Oromia region. People had lost confidence in service delivery, as health facilities were frequently closed when citizens sought care.

Upon investigation, the source of the facilities’ closures was due to health workers’ need to travel as far as 700 kilometers to Addis Ababa - several times a month - to complete routine human resources (HR) activities, such as employment, transfer, professional license and salary and promotion confirmation letters. Due to insufficient HR capacity and limited knowledge and skills to complete these tasks locally, health workers had to spend their own time and money to make these trips, leaving health facilities unable to attend to patients while they were gone.

“It was a source of grievance for health workers and created a huge work burden on the HR staff at the Oromia Regional Health Bureau (ORHB). This was due to limited management capacity and few staff with limited knowledge,” says Habtamu Demissie, who leads human resource development in the ORHB.

To address this challenge, USAID worked with the Regional Civil Service Bureau to direct domestic resources to create, fill and fund more than 1,500 Human Resource Manager positions located in 316 district health offices and 504 health facilities throughout Oromia. The positions, which are permanent, are fully funded by the government. Furthermore, the minimum qualifications and work experience for these positions were revised and approved by the Regional Civil Service Bureau, thus aiding with the availability and quality of services.

Now, health staff can access support more readily, reducing time away from serving patients in the community. Additionally, these new positions have led to more timely recruitment and transfer of posts for health workers, which in turn improves their motivation and retention.

“The improved HR structure and increased level of staff have improved performance,” Habtamu says. The number of staff coming to ORHB with grievances has substantially decreased over the past four years. “More importantly, human resource management processes get out of the way of letting health workers do their jobs.” Interviews with health professionals showed that their satisfaction with HR support functions improved over the same period. USAID has also supported the Federal Ministry of Health and other regional health bureaus to improve HR staffing in Ethiopia, which will help to continue improving citizen satisfaction with health services.

By strengthening the Government of Ethiopia’s ability to manage and maintain skilled health workers, USAID has helped remove a barrier to citizens accessing quality health services. Now, the health system is more effective, and human resource managers contribute to enhanced efficiency, which results in increased access to services, both now and in the future. When USAID removes barriers to delivering care, we help governments improve service capacity and move toward self-reliance.

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