Profile of training participants
Thirteen of the training participants were male and five were female. The median age of participants was 37, and their ages range between 25 and 56 years. With respect to institutional affiliations, 13 were based in health ministries, and five were located in public health training institutions. Looking at the educational background of the participants, half had clinical background and the other half had social science background (Psychology, Education, Sociology, and Administration). At the time of the study, of the 18 training participants, five left their home institutions to private or international agencies due to dissatisfaction about remuneration, work condition and career prospect. Detail information on career progression and capacity application experiences of training participants are presented at the end of text in Table 1.
Most graduates reported that they were able to apply their learning in the fields of management, research, training/teaching, policy development, and training material development. There was, however, diversity in the graduates’ ability, capacity and opportunity to apply newly developed skills and expertise. Clusters of factors across multiple levels emerged in the narratives of participants as influencing the contribution of training to organisational capacity development: relevance of newly acquired knowledge and skills set to role/position, and employer recognition in terms of being promoted to senior posts or being assigned challenging tasks; and motivation and retention of trained staff.
The sections to follow highlight patterns in the data under three interrelated themes of alignment of core competencies and role/position, employer recognition, and retention and turnover.
Alignment of core competencies and role/position
Fifteen trainees were located in departments at the health ministries or university where human resource management was one of the central foci. Three participants were enrolled in the programme with the understanding that they would transition to a more relevant position during or after the training. They were contract staff working in research projects affiliated with target departments in the universities. Two of them were later integrated into the departments as permanent academic staff with opportunities to teach HR-related courses. However, the other participant because of changes in leadership of the institution, he did not have the same support to enable the transition to a more appropriate position. For the majority of the participants, therefore, their role closely matched their acquired competencies and because they were located in institutions mandated to govern or train health professionals, they could make direct links between competencies and workplace demands.
One of the trainees, P3, took on a series of progressively senior posts in a health ministry, aligned to the competencies acquired in the programme, and this is what he has to say about his experience of applying the competencies.
[During training] I was working on HR [at the HR department in the health ministry] so whatever we learned… we would practice it. … [We] changed the administration and with the belief that the HR programme is important not just for the Ministry [at national level] but also for every region [sub-national level], we started developing a curriculum and started … the programme [a postgraduate programme in HRM in two local universities]. [P3]
Another trainee, P35, a lecturer at the university, has integrated his learning from the programme into his teaching and consultancy
I use all of them [training module materials] because [they] are related to the [subjects] I teach…. The [health workforce development module] … has very good examples of things that we can use simply in our context …. [Explaining further what enabled application of learning] I think it is especially because I am in an environment that I not only have to teach but I have to research, I end up using all the modules. I am also part of the [national] human resources observatory. Surely, I have been invited to be part of this because I am studying human resources development. [P35]
In addition to the relevance of the roles, recognition by the employer in the form of promotion or allocation of challenging assignments were found to enable capacity application.
Seniority was found to afford participants the opportunity to take on more challenging responsibilities, and space to implement their learning. A few of the participants held senior HR-related posts prior to being enrolled in the programme. One of these trainees, P14, was the head of HR in the health department at sub-national level. Informed by his learning and enabled by his senior position and associated network, he accomplished significant changes by decentralising HR departments, creating posts for HR managers at district level, ensuring qualified managers are recruited, and existing staff undergo training in newly initiated HR programmes in a local university.
[The] experience [from the programme] has increased my capacity a great deal. The project [restructuring] coincided with [my participation in] the HRD MPH. I have used my knowledge [from the programme] to make the most of this [restructuring] project. …You need vision to do anything. …While studying in the programme, I was able to realise all the gaps and weaknesses in the way we are doing things. HRH [department] is full of people who are transferred because of disciplinary reasons [and]who don’t understand the work. It was [considered as] a way of punishment. Until recently HR was not a place for professionals. … [The restructuring] is one of the success stories of HRH programme in [the country]. [P14]
The narratives show that the majority of participants advanced to progressively more senior positions upon joining the programme, either during the course of the programme or after its completion. This ranged from being officers (human resource/medical/research) to becoming senior leaders at sub-national or national levels in health ministries (cases in point are P3, P8, P15, P58, P59, P56, P37).
Training participants’ promotions to senior posts were reported to be recognition of their qualifications, core competencies, or improved contribution to their departments. One of the trainees, P58, was working as a health officer when she joined the programme. Her response shows that she was promoted to senior leadership position due to her improved contribution to the institution, which in turn opened further opportunities to contribute.
The division within which I was… it was somehow new. … I was the first person to get an opportunity to study. … [The training] programme equipped me with knowledge on how I can train health workers, [how] I can support them …. [Preparing] the strategic plan … I had to plan activities related to training, supervision, mentorship… all that. … [The modules] related to HRH development, planning and so on contributed to making me confident in my position [as a Director]. … I was like a pillar in my division. Because others were not [skilled enough] … I contributed a lot. I think that is why I was appointed as a Director. [P58]
P56 was a medical officer in a rural district hospital when he joined the programme. He then became director of the district hospital, and later he was promoted to a senior post at the health ministry. His response illuminates the mutually reinforcing relationship between recognition and application of competencies.
[W]hen I took [the directorship] position at the rural hospital … my predecessor was not very present…. I started establishing some mechanism of meeting people [regularly] … and involving them to propose solution…. I saw some changes in the way they manage. …I do have materials [from the training programme] on my computer and some books. … It helped me a lot…. I am doing [preparing] some procedure manual [focusing on integrating supportive supervision for the ministry] … I am leading development of [HR] policy for the whole [health] sector… I have been … engaging in leading the process of determining the staffing in health…. [and] leading the process of the HR sustainability … [and] the national health sector research agenda. [P56]
While such timeous recognition and creation of opportunities generated motivation, delayed employer recognition or lack of communication to this end reportedly led to frustration and lack of motivation in other cases. One of the trainees, P15, was an HR officer in a health department at sub-national level, and he was left frustrated by the absence of mobility to a more senior post or better financial package upon graduation. He expressed his annoyance:
… . That [lack of recognition or promotion] is disappointing. …. You can build their [staff] capacity, but after building capacity [if] you don’t give them anything ... that is ... inexplicable. [P15]
It took a while before this trainee got promoted to a position of head of HR in the provincial health department. Protracted administrative processes and poor communication led to turnover in the case of another participant, P57.
Retention and turnover
Thirteen of the participants stayed in their respective institution after graduation. However, five graduates across the countries left their institution to join international agencies, the private sector, or change career paths. An examination of the motives of participants reveals that a diverse set of intrinsic and extrinsic push and pull factors contributed to their decision to stay or leave: financial incentive, employer recognition (promotion or assignment of challenging responsibilities), career prospect, job security, family circumstances, external job holding opportunities, change in career path.
Four of the five participants (P8, P14, P39, and P57) who left their home institution had a clinical background. Two of them pursued clinical practice/study; the other two occupied management positions in international agencies.
The narratives of two of the training participants, P35 and P36, one based in university and another in a health ministry, illustrate the diversity of experiences and decisions regarding retention. The university-based trainee, P35, who was a junior lecturer, took on HR-focused teaching and consultancy responsibilities related to his core competency in HRH after enrolment in the training programme. He expressed disappointment at his inadequate salary, but he stated his resolve to stay in the institution.
I have to do consultancy to have [more] money … to take care of the family. It [consultancy] ends up [being a] big burden because I have to work, work, work. … I am still not thinking of leaving this public sector even though I am not satisfied with the salary because I still want to improve my academic career. [P35]
The trainee based in a health ministry, P36, was working as a junior manager in a public hospital when he joined the programme. He soon left the health ministry to join an international agency and, later, a private company. He cited dissatisfaction with his salary and career prospects as the main reasons for leaving.
I [left] to work for [an international agency] as a national HR manager [overseeing] administration and HR issues of 500 employees. After a year, I left the [international agency] to join a private company [as a head of the HR department] because I like to grow and get better opportunity to practice HR. I moved from ministry of health [to international agency] because of money. The pay [at MOH] was very, very low. My net pay at the NGO was double what I earned at ministry of health. When I moved [to the private company], it was almost double what I earned at the [international agency]. [P36]
The present analysis shows that while role relevance and seniority were enablers of capacity application, a closer look at the differences between the groups who left and those who stayed reveals no clear pattern based on role/position, or recognition (be it seniority or assignment of interesting tasks). There were also no country-specific patterns.