Abstract
BackgroundTo address the shortage of health information personnel within Botswana, an innovative human resources approach was taken. University graduates without training or experience in health information or health sciences were hired and provided with on-the-job training and mentoring to create a new cadre of health worker: the district Monitoring and Evaluation (M&E) Officer. This article describes the early outcomes, achievements, and challenges from this initiative.MethodsData were collected from the district M&E Officers over a 2-year period and included a skills assessment at baseline and 12 months, pre- and post-training tests, interviews during stakeholder site visits, a survey of achievements, focus group discussions, and an attrition assessment.ResultsAn average of 2.7 mentoring visits were conducted for M&E Officers in each district. There were five training sessions over 18 months. Knowledge scores significantly increased (p < 0.05) during the three trainings in which pre/post tests were administered. Over 1 year, there were significant improvements (p < 0.05) in self-rated skills related to computer literacy, checking data validity, implementing data quality procedures, using data to support program planning, proposing indicators, and writing M&E reports. Out of the 34 district M&E Officers interviewed during site visits, most were conducting facility visits to review data (27/34; 79%), comparing data sets over time (31/34; 91%), backing up data (32/34; 94%), and analyzing data (32/34; 94%). Common challenges included late facility reports (28/34; 82%), lack of transportation (22/34; 65%), inaccurate facility reports (10/34; 29%), and colleagues’ misunderstanding of M&E (10/34; 29%). Six posts were vacated in the first year (6/51; 12%). A total of 49 Officers completed the achievements survey; of these, common accomplishments related to improvements in data management (35/49; 71%), data quality (31/49; 63%), data use (29/49; 59%), and capacity development (26/49; 53%).ConclusionsThe development of a cadre of district M&E Officers has contributed positively to the health information system in Botswana. In the absence of tertiary training related to health information, on-the-job training and mentoring of university graduates can be an effective approach for developing a new professional cadre of M&E expertise and for strengthening capacity within a national health system.
Highlights
To address the shortage of health information personnel within Botswana, an innovative human resources approach was taken
The data were collected from the district Monitoring and Evaluation (M&E) Officers over a 2-year period (Table 1) and included a skills assessment at the beginning of the cadre’s tenure and after 12 months, pre- and post-training tests, interviews during stakeholder site visits, a survey focusing on achievements, focus group discussions, and an attrition assessment
While there were 51 district M&E Officers hired at the outset, the number of occupied positions varied over the course of the project as some Officers left during the course of implementation while others were recruited into the cadre
Summary
Many low- and middle-income countries experience critical shortages of health workers and imbalances in the mix of skills within the health workforce [1,2], a challenge exacerbated by the HIV/AIDS epidemic [3]. This widely recognized global health problem impedes efforts to reach overall health goals [4,5]. To maintain a wellfunctioning health system, health care providers need to be complemented by nonclinical personnel with additional relevant skills [5] This includes health workers who monitor and evaluate health program performance to ensure effective and efficient implementation. The World Health Organization has identified health information systems as one of the six core components or “building blocks” of a health system [8]
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