Historically pre-computerisation Human Resources Information was collected kept in two differing ways:
- Manual Personnel Records which were kept in Personnel Offices and which actually contained ALL the information required regarding health workers comprising of upward of 40 data variables. Updating these manual personnel records was the task of a number of basic level clerks. Whilst these records contained all information, it was impossible to answer queries without manually going through all relevant records and undertaking a manual tally (e.g How many health workers have been trained in triage or EPI or Malaria). This could take weeks to months dependant on the question asked, and how large the number of health workers to be surveyed.
- A Head Count taken usually as a result of survey of health workers nationally, regionally or provincially. This data, comprising of only 3 to 4 variables, is included in the Health Management Information System (HMIS) and is used together with health worker/population ratios or fixed facility staffing to plan the workforce. All the evidence now shows that this type of planning is not guaranteeing a well distributed, appropriately qualified or motivates Whilst this can yield quantitative information it cannot provide any qualitative information on the workforce. It can frequently be misleading as actual qualifications are not verified nor the experience and training of each health worker. In post-conflict environments the reported headcounts can vary greatly and what is reported by a community as a doctor may be a nurse or even a community health worker who has stayed and served a community and is regarded as a “doctor”. Huge sums are spent in these “headcounts” of the workforce that in essence only take questionable and inaccurate “snapshots” of the workforce at a particular moment in time.
These two approaches arose due to the 1960’s Personnel and Training Approach to HR (see Blog …..A longitudinal history of failure) and are I believe a reason why it remains difficult to implement an Integrated HR Systems Approach.
Accurate quantitative and qualitative HR information is the heart of effectively implementing any HR system and guarantee effective delivery of the required health care deliver system.
Ok, so we have a manual HR records system and planning but we are in the computer age what is the reality on the ground in HR. Firstly staff in HR Offices and Departments that manage the manual personnel records system generally lack computer literacy. Health Planning Departments who are involved in planning are computer literate and consider that they should control HR Information.
There are many parties who require HR Information, amongst which are :
- Civil Service Administration which deals with administrative side of personnel, e.g. job classification, eschelon level, family allowances, salary level, salary increments which only deals with some sections of the entire fields of the manual personnel record but not all.
- Health Planners, who require 3-4 fields related to a health worker e.g. category, place of work, gender etc that are contained in the HMIS. This is unrelated to administration, payroll, training, experience etc. However Health Planners who are mainly trained in epidemiology consider that they should “control” HR information.
- Clinical /Technical programmes who want to know who is working on their vertical disease programmes and who they have trained and frequently who they are paying financial incentives to . They are NOT interested in career progress or quality management but take a quantitative approach to this.
- Directorates of HRD who have to deal with both the quantitative and qualitative aspects of the ENTIRE workforce.
In fact all the required HR data fields to meet everyone’s needs are contained in the old manual personnel records. Given the currently available software and the ability to import and export data it would appear to be a simple matter to
- identify an appropriate software that is compatible with many others. (e.g. Access is good for small numbers of personnel records and can be imported into SQL which is designed for larger data management)
- incorporate all the data fields that are normally contained in the Manual personnel Record
- Identify if any of the relevant parties who require HR data require any extra fields which can be added or if they are already contained in other databases and are required for comprehensive HR management can be imported into the HR Database
- Identify what data fields are contained in the now computerised HR database are required by other parties or departments ( e.g. HMIS requires approximately 3-4 fields)
- Each health worker if they do not have a unique identification number (e.g national ID card number or such) will require allocation of a unique registration number which the health worker is aware of.
- Enter the data from the manual personnel record system so each manual record is now computerised then validate the data with the Health workers to check that the records are up to date.
- ENSURE THAT THERE IS A SYSTEM OF REGULAR REPORTING (AS THERE WAS WITH THE MANUAL RECORDS) TO ENSURE THAT RECORDS ARE CONTINUALLY UPDATED AND THAT IF LINKED TO OTHER DATABASES SUCH AS HMIS AND TRAINING DATABASES THAT THERE IS REGULAR IMPORT/EXPORT OF THE RELEVANT DATA FIELDS.
- REMEMBER THAT WITH ALL THE IMPORT AND EXPORT OF DATA CARE MUST BE TAKEN TO ENSURE AS MUCH CONFIDENTIALITY OF PERSONNEL RECORDS AS POSSIBLE.
OK, if you think this is beginning to sound like HR Information systems for Dummies, remember, there is no rocket science here only practical common sense! HR information Systems are basically simple and straightforward.
So if it is so straight forward then why does it go so wrong and why is there so much conflict and controversy over this area?
In my considerable years of experience in working in HRD within Ministries of Health the main reasons can be summarised as:
- Too many vested interests.….information is power and many departments/ directorates in Ministries want to control the information thus putting them in the position of the most power and influence. As I have said earlier in this blog HR Planning units and Directorates who are computer literate consider that they should control HR information without actually understanding what HR information is required for comprehensive HR Management that addresses both quantitative and qualitative aspects. HR directorates frequently are staffed by minor civil servants that are not computer literate and if the approach to HR in their ministry remains as “personnel and training” they are not in strong enough position to fight the HR data battle. They follow the administrative requirements of Civil Service Authority.
- Individual departments/directorates developing ad hoc databases to meet their own needs that do not link or are compatible with other related databases
- Donor Agencies importing their own database models that may or may not be useful or compatible with what is required in a Ministry and are not easily adaptable. This approach is often undertaken by short term consultants who are working to short time cycles and have insufficient time to get to know the local situation and do not use nationals to manage the system after they leave.
- Personality Clashes. We are after all dealing with humans and frequently competition between department heads can retard implementation
- Lack of understanding. Managers frequently do not understand databases (just as they generally do not understand HR!). They want to own a database without understanding it. This results in conflict and retards utilisation, regular updating and maintenance of the system as well as preventing import/export of data.
- Trying to develop combined Health and HR information systems. This is the biggest problem encountered. Health Information (HMIS) is complex and problematic, HR Information HR-MIS is very straightforward. the combining of these stems from the concept that Health Planners control everything. Trying to combine the two results in HR being subsumed and the HR part of the Health information system quite frankly in most cases being pretty useless for comprehensive HR Planning and management. The straightforward nature of HR-MISs can be undertaken in much less time than a HMIS and work on collection and verification of HR data can at times be delayed for a year or more waiting for HMIS. All this when actually all HMIS only requires approximately 3 to 4 data fields out of the more than 40 data fields of a HR-MIS or a manual personnel record…. in this case HR is retarded and its development downgraded.
- Head counts. Donors are always willing to fund surveys (head counts) of the workforce. Managers and Politicians love doing head counts so they can quote Numbers no matter how tenuous or inaccurate. The amount of money spent on “head counts” would be better spent on supporting the development of a computerised personnel records system which then be validated.
What are the Solutions??
- It is essential that managers and senior policy level understand the basic principles of a database and how it can help them base their management decisions on accurate credible data. It can answer their questions and if a database cannot generate a report to answer their question then it is possible to link the relevant fields or add another data filed so that the question can be answered. If the senior managers understand then they will support the maintenance and running of the HR-MIS
- Do NOT try to develop combined HR and Health Information systems. They should be developed separately using compatible software that allows export/import of relevant data fields.
- Employ a young IT trained person who has experience in working with and developing databases. this person can either design the database and/or train staff in management and maintenance of the system and make the necessary adjustments and linkage of data fields to answer questions from managers. REMEMBER if a HR database contains all the normal data fields of a manual personnel record it can answer most of the queries as long as the data fields are linked in the right way. If it doesn’t answer a query then get your young IT person to look at how the fields are linked and he/she can identify if there are more fields needed or purely needs adjustment to the linkages.
- Discuss with all relevant users of HR data to identify their needs and then ensure that the relevant data fields are included and are correctly linked. Once they realise that they will have access to the data they require then this will go along way to prevent conflict and blockages.
- Use national IT experts, they will invariably be young and they don’t have to be health personnel. You need a national IT expert to train national clerical staff who now do the manual data entry to do computer data entry and they can trouble shoot and ensure safety of data and the HR-MIS
- Stop wasting money on head counts. These are purely “snapshots” of a short period in time and of no use for managing the workforce. Use the money more effectively to establish a computerised HR-MIS that is sustainable. It can still produce the ‘Numbers” but is much much more.
I will follow up this blog with examples of what worked and what didn’t in a Part 2. within a few weeks.
