In Swaziland, a dwindling health workforce has been dealing with a heavy patient workload, providing care to the country’s high number of HIV-affected citizens and delivering services to meet other pressing needs. Health professionals have watched many of their colleagues move away from the public sector or migrate in search of better opportunities.

To address these challenges, the Ministry of Health and Social Welfare (MOHSW) urgently needed more information about its valuable human resources for health. “We didn’t know who was working where,” says Thembisile Khumalo, chief nursing officer at the MOHSW. No one had a complete picture of the number of staffed workers, their locations or the number of open positions.

Swaziland’s health sector includes government facilities as well as independent mission and private-sector hospitals and clinics. An existing Public Service database held records for MOHSW staff but did not include non-Ministry staff. Data accuracy was unreliable, and information was not being shared among decision-makers. Complicating matters, some former employees were never taken off the payroll and became "ghost workers," continuing to receive paychecks.

The Capacity Project worked with senior leaders of the MOHSW to develop a program of assistance. Strengthening the country’s human resources information systems (HRIS) quickly became a priority.

Following an assessment of the existing system, the Project organized the Swaziland HRIS Stakeholder Group. Members developed policy questions to determine the types of data and HRIS reports needed to produce the answers they sought. The top-priority policy questions addressed deployment, the incoming workforce, training, attrition and retention.

To get started and verify the existing HR data, Khumalo explains that the team “printed out the information for each department, for each facility. We sent them the information to check if it is correct for each health worker. So they submitted it back and we corrected the information.”

Next, Khumalo continues, “we developed the HRIS for the health sector. It includes the public service, the NGOs, missions and the private units—all the health workers. We have all their information. Also, we are able to trace all those people who have already left the Ministry. We found people who remained in the payroll for some time, as ghost workers, and we saved the money.”

Initial reports generated from the HRIS provided valuable input. The Lubombo Regional Health Management Team, for example, “said they'd had no idea about how heavily dependent their region was on mission nurses,” recalls Samuel Johnson, monitoring and evaluation advisor at the MOHSW. “They were very surprised to find that their ratio of nurses to population was the second highest in Swaziland. They were also shocked to discover a number of vacant posts that had slipped through the system and remained unfilled for years.”

At the MOHSW, staff used the new, accurate data to develop a Health Workforce Strategic Plan, analyze vacancies and fill gaps. Data are also being used to identify bottlenecks in the hiring process and deploy workers more efficiently.

The ultimate goal is to get the data into a complete system that links with other agencies. Khumalo notes that “we are intending to link the HRIS with the nursing council,” which holds detailed data from the private sector as well as the public sector. “The whole health system is to be linked together.”

The Capacity Project’s activities in Swaziland are continuing through the Southern Africa Human Capacity Development Coalition, a Capacity Project Associate Award led by IntraHealth International. An upcoming workshop on using data for decision-making will help leaders make the best use of their new system. “Now, with the information we have, we can tell who is working where,” says Khumalo. “It is helping us a lot in planning for the sector.”

[January 2008. To learn more about HRIS, see HRIS Strengthening.]

The Capacity Project, funded by the United States Agency for International Development (USAID) and implemented by IntraHealth International and partners (IMA, JHPIEGO, LATH, MSH, PATH, TRG), helps developing countries strengthen human resources for health to better respond to the challenges of implementing and sustaining quality health programs.