Collecting dust on the shelf: How can we ensure human resources for health strategic plans get implemented?

The development of strategic plans is encouraged for strengthened health governance in low- and middle-income countries. Detailed strategic plans specific to human resources for health (HRH) are critical to the development and retention of the health workforce to meet population health needs. The USAID-funded Health Systems 20/20 Project assessed 21 countries to determine whether they had a HRH policy or strategic plan that outlined goals and priorities for the health workforce, and what the level of implementation was. Using these findings, we piloted a process for strengthening the implementation of HRH strategic plans in Lesotho. In ten of the 21 countries examined, HRH strategic plans existed, and outlined a rationalized process for health workforce training, recruitment, and deployment. However, every country reported key elements of the strategies languished unimplemented. Lesotho had a five-year HRH strategic plan, retention plan, and nursing sector plan. As with most country strategies assessed, Lesotho's plans were ambitious, with limited detail on specific activities and associated costs. With the Ministry of Health (MOH) and Human Resources Alliance for Africa, we piloted a standardized process for translating strategic plans into realistic implementation plans. Stakeholders were led through a structured prioritization exercise to develop a shortened list of priority strategies and corresponding implementation activities. MOH staff was trained to establish detailed cost estimates for all activities, and the detailed, costed priorities were successfully used to mobilize resources for implementation. Findings from the assessment and pilot will assist countries seeking to increase the implementation of HRH strategic plans.