The fourth objective of the Global Strategy on Human Resources for Health: Workforce 2030 focused on strengthening availability of data on health workforce to guide stronger monitoring and overall accountability of strategies for health workforce.1
There were several proposed milestones for this objective that were to be achieved by 2020. Country governments were encouraged to make progress on the development and use of health workforce registries and to share data through avenues like the National Health Workforce Accounts.2 Bilateral and multilateral agencies were also requested to strengthen assessments of the health workforce and share available information.
When reported in full, the National Health Workforce Accounts include data on the number of active health workers in a country, such as details on their density, activity levels, demographic characteristics, and distribution. But there is far less data on health workers supported by bilateral or multilateral institutions, such as UN agencies, the Global Fund for AIDS, Tuberculosis, and Malaria, development banks, and global health initiatives such as the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).3 Staff supported by donors often bridge critical gaps to support delivery of essential or emergency services across countries, including targeted services for tuberculosis, malaria, and HIV. This has been further demonstrated during the COVID-19 pandemic, as countries have faced critical health workforce gaps in the context of the underlying global health worker shortage.4 Donor-supported health workers have been utilized to meet surge support needs for the pandemic response, including testing, community mobilization, and COVID-19 vaccination efforts.5
Due to the lack of standardized monitoring of health workforce activities across global health initiatives, it is difficult to fully quantify investments. Previous estimates of donor funding for human resources for health, based on available data, were estimated to be over $18.5 billion (2017 US dollars) between 1990 and 2016. 3
Data on the numbers, skill mixes, locations of work, and costs of donor-supported staff are important to better assess the totality of available workforce in countries and determine optimal utilization of workers in alignment with national strategic plans. This type of coordination is important for maximizing impact and long-term sustainability of health workforce investments. Knowing the full range of active health workers, where they are located, and associated expenditures is essential for mobilizing surge staffing efforts to respond to urgent needs and to plan for long-term workforce needs. It’s hard to plan for what you don’t know exists.
For a number of years, PEPFAR has increasingly placed focus on collection of data on the number of health workers supported and amount of expenditure, but this data has been historically incomplete and lacked sufficient detail to understand the range of staffing footprint and models of staffing supported to help achieve HIV service delivery targets. 6 , 7 , 8 PEPFAR has made substantive investment in additive health worker staffing to advance HIV service delivery and achieve UNAIDS 90-90-90 targets. In 2019, PEPFAR reported supporting over 290,000 workers at an expenditure of more than $921 million. 9 , 10 ,
More comprehensive data on health worker staffing and related expenditure, including location and types of services supported is needed to inform optimal staffing to achieve HIV program goals and to inform long-term sustainability of investment.
In 2020, the USAID Office of HIV/AIDS conducted a data collection exercise across a targeted subset of PEPFAR-supported countries. The exercise was intended to fill key health workforce staffing data gaps and inform more standardized PEPFAR reporting that would initiate in 2021. The details of this reporting exercise and implementation can be used as a case study on standardizing collection and utilizing data on health workers supported by donor funding and will be discussed in more detail in the following sections.