• Step 1: Ensure an adequate supply of health workers

    An adequate supply of human resources for health on a national and subnational level is a foundation for implementing interventions intended to improve availability of effective PHC services. Training, recruiting, and deploying an appropriately sized and adequately trained workforce is discussed in greater detail in the Workforce module (forthcoming). However, an adequate supply of competent providers is only a first step towards achieving high-quality, available, and effective services.4

    Step 2: Ensure that trained and competent PHC providers are available to patients

    The presence of an appropriate number of providers is of limited benefit if providers are absent from their planned shifts or if service delivery is structured in such a way that patients are unable to access a skilled provider at convenient times. Patients can only receive high-quality care from competent providers if those providers are present in facilities or communities and trained in the relevant care. If provider absenteeism is driven by facility-level factors such as inadequate supervision, poor remuneration, a sense of ineffectiveness due to poor training or inadequate supplies, or a lack of professional development, improving provider motivation may concurrently address provider availability.

    Even with the availability of large numbers of health workers, inadequately trained and skilled providers will likely not contribute to improving either individual or population-level health outcomes. Frontline primary care service delivery is a highly complex task, requiring the ability to diagnose and manage a wide range of possible illnesses in undifferentiated patients presenting at the first contact point with the health system. Additionally, providers health workers require appropriate and comprehensive training in prevention and promotion to engage with individuals and communities to promote health and wellbeing and address risk factors. Competency at these tasks requires substantial experience and training that often goes beyond typical academic degree-based educational programs, requiring post-graduate experience and supervision. It is this comprehensive set of skills effectively applied in community settings that are likely to be responsible, at least in part, for overall improvements in morbidity and mortality.

    Step 3: Ensure respect and safe practices throughout

    There are some overlaps between provider competence and patient-provider respect and trust. Experiential quality of care – measured from the patient perspective – may influence patient choice and utilization of primary care facilities.  Competence and safety have similar overlaps – a system staffed with a workforce without the necessary clinical competency will most certainly perform poorly on safety.  Safety includes not only provider knowledge in safe diagnostic, prescribing, and procedural practices, but also accessibility to the necessary supplies and equipment for a provider to perform his or her job.

Relevant resources

Many tools and resources focused on the availability of effective PHC services have been created over the last decade. Below is an interactive resource that provides the most useful documents within the context of our defined scope of provider competence, provider availability, provider motivation, patient-provider respect and trust, and safety.
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  • Patient-provider respect and trust
  • Monitoring and evaluation
  • Provider motivation
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  • Infectious disease
  • COVID-19
  • Resilience of health systems
  • Responsiveness to people
  • Fragile and conflict affected settings

Citizen monitoring to promote the right to healthcare and accountability Center for Health and Social Justice, 2015

This case study series highlights examples of how communities have come together to negotiate higher-quality services from the state, leveraging on core strategies of participation, transparency, and accountability. Specifically, these case studies describe how colleagues in the Community of Practioners on Accountability and Social Health conceptualized, organized, and implemented these processes to enable practitioners to adopt similar practices in their health systems.
Tags: Patient-provider respect and trust, Monitoring and evaluation

Costing of Health Services for Provider Payment: A Practical Manual JLN, 2014

This manual provides practical, step by step guidance on what stakeholders can do to address challenges related to costing for provider payment in LMICs. Stakeholders can adapt and apply the tools and templates and policy options to improve provider payment policy processes in their context. It is accompanied by an online training course.
Tags: Provider motivation

Global Standards for Post Graduate Medicine Education WONCA, 2016

This document provides a set of global standards for postgraduate family medicine education. While countries will need to adapt these global standards to their local environment and local needs, they may be used by institutions and education programs to support quality improvement in family medicine postgraduate education, including self-assessment and program quality improvement; new program development; peer review; and recognition and accreditation.
Tags: Provider competence

Global Strategy on Human Resources for Health: Workforce 2030 WHO, 2016

This resource from the Global Health Workforce Alliance outlines a policy agenda for member states on how to drive progress toward a global strategy on human resources for health for all. The agenda is organized into four objectives, under which countries can find a series of intersectoral policy options for taking action and milestones to help assess progress toward each objective. In particular, the agenda includes recommendations for how to build the institutional capacity and strengthen data to optimize the health workforce and accelerate progress towards UHC and the SDGs.
Tags: Provider availability, Provider competence, Provider motivation, Private and multisectoral engagement, UHC

Guideline on health policy and system support to optimize community health worker programmes WHO, 2018

This guideline was developed to provide countries with the best global evidence on optimizing community health workers programs as part of a comprehensive PHC workforce. It contains practical guidance on how to effectively improve the design, implementation, performance, and evaluation of community health worker programs. In particular, it details policy and system enablers required to strengthen education, deployment, performance, and integration into the broader health system.
Tags: Patient-provider respect and trust, Provider availability, Provider competence, Provider motivation, Safety

Guidlines to implement supportive supervision PATH, 2003

These guidelines were developed to build the capacity of health workers to effectively provide safe and cost-effective immunizations. Identifying supportive supervisions as a high priority and critical gap in immunization training and management, these guidelines serve to help national managers and country staff understand and implement supportive supervision methodologies to improve immunization programs.
Tags: Provider competence, Infectious disease

Health Workers: Building and Motivating the Workforce Breman et al., 2006

This chapter of the Disease Control Priorities in Developing Countries (DCP2) report focuses on building and motivating the health workforce. It highlights cost-effective interventions based on in-depth analyis of health systems and health outcomes, using the results of this research to propose context-sensitive policy recommendations for improving health workforce development and motivation.
Tags: Provider availability, Provider competence, Provider motivation

Holding Health Workers Accountable: Governance Approaches to Reducing Absenteeism IntraHealth International, 2012

This technical brief addresses challenges to health worker accountability and strategies to improve motivation and accountability issues, country policies, and absenteeism. It landscapes common underlying issues to provider accountability and motivation as well as governance measures that stakeholders can implement to drive improvements.
Tags: Provider availability, COVID-19

How do different types of provider affect access to effective and affordable healthcare during and after crises? ReBUILD Consortium, 2017

This policy brief summarizes the key characteristics of different types of healthcare providers and their role in crisis-affected settings. Specifically, it highlights the range of services they offer and discusses possible interventions to improve their motivation and competence and ultimately increase access to effective and affordable healthcare during and after crises.
Tags: Provider availability, Resilience of health systems, Responsiveness to people, Fragile and conflict affected settings

Increasing access to health workers in remote and rural areas through improved retention: Global policy recommendations WHO, 2010

To support the recruitment, deployment, and retention of workforce in remote and rural areas, this document outlines a series of 16 evidence-based recommendations. It also provides guidance for policymakers on how to choose and implement the most appropriate interventions for their context and how to monitor and evaluate impact over time.
Tags: Provider availability, Provider competence, Provider motivation, Monitoring and evaluation

IFC's IQ-Healthcare Tool International Finance Corporation

IFC's Improving Quality (IQ) - Healthcare Tool responds to global gaps in health care competence by providing health providers with a diagnostic tool to identify quality gaps and cost-efficient solutions, aiming to improve patient safety, align practices with global quality standards, and build safe health infrastructure. The tool operates at the network-wide and single-facility level and focuses on eight core areas related to direct health service operations and improving operating practices related to ethics and family rights, governance and leadership, facilities management, general safety, and human resources.
Tags: Provider competence, Safety, COVID-19

Key Steps for Creating Patient and Family Advisory Councils in CPC Practices National Partnership for Women and Families, 2013

This guideline outlines a set of recommendations that primary care practices can use to establish a patient and family advisory council for the first time or enhance councils aleady in place. These recommendations are intended to help patients, families, and providers take the steps needed to work together on procedures, processes, and quality improvement strategies to achieve higher-quality care.
Tags: Patient-provider respect and trust, Responsiveness to people

Means, Motives and Opportunity: determinants of community health worker performance John et al., 2020

"This article presents a framework to help practitioners and researchers diagnose the constraints to performance of CHWs and guide programmatic and policy responses. The Means, Motives and Opportunity (MMO) framework has been adapted from the SaniFOAM framework used to identify the determinants of sanitation behaviours. It is based on three interdependent and interacting domains: means (whether an individual is capable of performing), motives (whether an individual wants to perform) and opportunity (whether the individual has the chance to perform)."
Tags: Provider motivation

Measuring the Competence of Healthcare Providers USAID, 2001

"This paper provides a framework for understanding the key factors that affect provider competence. Different methods for measuring competence are discussed, as are criteria for selecting measurement methods. Also, evidence from various research studies on measuring the effectiveness of different assessment techniques is presented."
Tags: Provider competence

OpenWHO WHO, 2020

"OpenWHO is WHO’s new interactive, web-based, knowledge-transfer platform offering online courses to improve the response to health emergencies. OpenWHO enables the Organization and its key partners to transfer life-saving knowledge to large numbers of frontline responders."
Tags: Provider competence, COVID-19, Resilience of health systems

Operations Manual for Delivery of HIV Prevention, Care and Treatment at Primary Health Centres in High-Prevalence, Resource-Constrained Settings: Chapter 9 Human Resources WHO, 2008

This Operations Manual provides operational guidance on delivering integrated, high-quality HIV services at the health center level. The manual provides health center teams with curated learning and job aids on best practices for delivering high-quality HIV and essential primary care services. Chapter 9: Human Resources is particularly salient for this module and provides actionable information on ensuring provider availablity, motivation, competence, and safety.
Tags: Provider availability, Provider competence, Provider motivation, Patient-provider respect and trust, Safety, Infectious disease

Patient Safety Essentials Toolkit IHI

IHI's Patient Safety Essentials Toolkit includes nine tools to help organizations improve teamwork and communication, understand underlying issues that can cause errors, and create and maintain reliable safety systems. Each tool offers a short description, instructions, and example, and a blank template that can be adapted to the safety work of different organizations.
Tags: Safety

Patient Safety Page WHO

This webpage curates informations related to patient safety, with links to relevant tools and resources. It guides users through key topics important for patient safety including policies and strategies, medcication without harm, education and training, patient engagement, and other technical topics.
Tags: Safety, Patient-provider respect and trust

Technical series on safer PHC WHO, 2016

"The Technical Series on Safer Primary Care is a series of nine monographs, which explore the magnitude and nature of harm in the primary care setting from a number of different angles and provide some possible solutions and practical next steps for improving safety. Each monograph describes the scope, approach, potential solutions, practical next steps, concluding remarks, and then provides links to online toolkits and manuals to provide practical suggestions for countries and organizations that have committed to moving forward this agenda."
Tags: Safety

The Labour market for human resources for health in low- and middle-income countries WHO, 2012

This paper intends to introduce human resource practitioners with little or no economic training to the terms and tools of labor market analysis. By connecting labor market principles to tangible LMIC experience, it enables practitioners to understand labor markets in health and how to apply these concepts to address a variety of workforce challenges, including workforce shortages, ghost workers, and unfilled posts.
Tags: Provider availability, COVID-19

The Practical Approach to Care Kits (PACK) Programme Knowledge and Translation Unit, 2020

"The Practical Approach to Care Kit (PACK) is a health systems improvement programme designed to support the work of primary care health workers in underserved communities strengthen the health services in which they work and thereby achieve the best possible patient outcomes." It comprsises 4 pillars: a clinical decision support tool, a training program, measures to strengthen health systems, and monitoring and evaluation tools.
Tags: Provider competence, Monitoring and evaluation, COVID-19

UpToDate UpToDate, 2020

UpToDate is a leading digital evidence-based clinical resource that gives providers the informational tools they need to improve care. 30 Providers can use UpToDate to immediately access medical education resources, including evidence-based clinical knowledge and actionable recommendations for effective diagnosis and treatment. To ensure that the resource aligns with current evidence, standards, and guidelines, the resource is continuously updated and authored by world experts in all clinical fields.
Tags: Provider competence

PHCPI is a partnership dedicated to transforming the global state of primary health care, beginning with better measurement. While the content on this website represents the position of the partnership a whole, it does not necessarily reflect the official policy or position of any partner organization.​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​

References:

  1. Kak N, Burkhalter B, Cooper M. Measuring the Competence of Healthcare Providers. Qual Assur. 2001;2(1):1–28.
  2. Franco LM, Bennett S, Kanfer R. Health sector reform and public sector health worker motivation: a conceptual framework. Soc Sci Med. 2002;54(8):1255–66.
  3. Patient safety. World Health Organization.
  4. Cometto G, Witter S. Tackling health workforce challenges to universal health coverage: setting targets and measuring progress. Bull World Health Organ. 2013 Nov;91(11):881–5.