As we work toward ending the global HIV epidemic by the year 2030, optimizing the health workforce has never been more important. PEPFAR 3.0 directs investment to target regions and services to achieve epidemic control. Yet, as countries strive to achieve more with less, what activities and approaches will best support and enable increased utilization of the existing health workforce to deliver and sustain quality HIV/AIDS services?
A recent investigation explores a relationship that has long been appreciated by health practitioners, if rarely studied: an engaged health workforce is more productive, stays on the job longer, and provides better care.
With support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), USAID ASSIST undertook a mixed methods study to explore the factors that contribute to an engaged health care worker providing HIV care in Tanzania. We developed and validated a health worker survey to assess engagement and found four characteristics associated with health worker engagement:
- Being a change agent: proactive, focused on improvement, being a team player
- Job satisfaction: having pride in one’s work, employee trust, relationships
- Being accountable: understanding of job expectations, answerable to responsibilities
- Delivering equitable and client-centered care: respectful care delivered to all patients
We also identified factors that influenced engagement:
- Perceived support from immediate supervisor
- Perceive adequacy of competencies to perform assigned tasks
- Perceived adequacy of inputs in the health facility
Qualitative data, however, present a more complex picture of these factors. Support from supervisors was not limited to on-the-job guidance and feedback, but support of the worker as a whole. For example, one respondent appreciated that her supervisor did not put her on night shifts when she was late in her pregnancy. Additionally, support was not limited to immediate supervisors; encouragement and feedback from colleagues and patients was motivating. Interview respondents also shared that inadequate supplies did increase their dissatisfaction with their work.
This research, and the accompanying validated tools, offer insight into how to engage health workers to achieve better patient outcomes and reach HIV goals. As we enter into a new era of HIV response under the Sustainable Development Goals and continued PEPFAR 3.0 Agenda, our mixed methods research points to the importance of compassion and support for improving health worker engagement and better HIV care.
This work also highlights the opportunities for more direct focus on human resources for health at the facility level as aligned with the approach outlined in the PEPFAR HRH Strategy. It provides further evidence for the importance of focus on the health workforce to achieve an AIDS-Free Generation.