National Human Resources for Health Strategic Plan 2016-2025.

Sep 2016
National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
TABLE OF CONTENTS
ACKNOWLEDGEMENT ..................................................................................................................................................................................5
FOREWORD ........................................................................................................................................................................................................6
ACRONYMS .........................................................................................................................................................................................................7
EXECUTIVE SUMMARY ....................................................................................................................................................................................9
Country’s Human Resources for Health (HRH) Context ...................................................................................................................9
Strategic Challenges and Issues ................................................................................................................................................................ 10
The Strategic Plan (SP)................................................................................................................................................................................ 11
Health Workforce Stock and Demands ................................................................................................................................................ 12
Organization of the Strategic Plan document ....................................................................................................................................... 13
STRATEGIC PLAN MAP (SUMMARY) ....................................................................................................................................................... 14
CHAPTER 1:BACKGROUND AND INTRODUCTION ...................................................................................................................... 15
1.1. DEMOGRAPHIC AND SOCIO ECONOMIC PROFILE .......................................................................................................... 16
1.2. GOVERNANCE AND ADMINISTRATION ................................................................................................................................ 16
1.2. ETHIOPIA HEALTH STATUS .......................................................................................................................................................... 17
1.3. POLICY AND PLANNING CONTEXT ....................................................................................................................................... 17
1.4. RATIONALE FOR THE HRH STRATEGIC PLAN ..................................................................................................................... 20
CHAPTER 2:SITUATIONAL ANALYSIS OF HRH IN ETHIOPIA ................................................................................................. 22
2.1. HRH LEADERSHIP AND GOVERNANCE .................................................................................................................................. 23
2.2. HUMAN RESOURCES MANAGEMENT ...................................................................................................................................... 24
2.3. HEALTH WORKFORCE EDUCATION AND TRAINING .................................................................................................... 25
2.4. HEALTH WORKFORCE DENSITY AND DISTRIBUTION .................................................................................................... 28
2.5. HRH POLICY AND LEGISLATION ............................................................................................................................................... 29
2.6. PARTNERSHIPS FOR HRH .............................................................................................................................................................. 35
CHAPTER 3:STRATEGIC DIRECTION ................................................................................................................................................ 35
3.1. VISION, GOAL AND OBJECTIVES ................................................................................................................................... 36
3.2. GUIDING PRINCIPLES ......................................................................................................................................................... 37
CHAPTER 4:STRATEGIC PLAN OUTCOMES, OBJECTIVES AND ACTIONS............................................................................. 38
OUTCOME 1: HRH LEGISLATION, PLANNING AND PARTNERSHIP STRENGTHENED ............................................... 39
OUTCOME 2: HEALTH WORKFORCE EDUCATION AND TRAINING CAPACITY
AND REGULATION IMPROVED .......................................................................................................................................................... 42
OUTCOME 3: HRH LEADERSHIP, GOVERNANCE AND HUMAN RESOURCES MANAGEMENT CAPACITY
AND PRACTICES ARE STRENGTHENED .......................................................................................................................................... 44
OUTCOME 4: UTILIZATION, RETENTION AND PERFORMANCE OF AVAILABLE HEALTH WORKFORCE
OPTIMIZED .................................................................................................................................................................................................. 46

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
CHAPTER 5:IMPLEMENTING THE HRH STRATEGIC PLAN ............................................................................................................ 48
5.1. THE IMPLEMENTATION APPROACHES .................................................................................................................................... 49
5.2. IMPLEMENTATION MATRIX AND TIMELINES........................................................................................................................ 51
Outcome 1: HRH legislation, Information, Planning and Partnership Strengthened at all Levels ........................................... 51
Outcome 2: Health Workforce education and training capacity and Regulation improved .................................................... 56
Outcome 3: HRH leadership, governance and management capacity and practices are strengthened ................................ 61
Outcome 4: Utilization, retention and performance of the available health workforce optimized. ...................................... 62
CHAPTER 6: MONITORING AND EVALUATION............................................................................................................................... 65
6.1. MONITORING AND EVALUATION: INDICATORS AND MATRIX ................................................................................ 66
6.2. Comprehensive M&E Matrix ............................................................................................................................................................. 68
6.3. MONITORING AND EVALUATION: APPROACHES ............................................................................................................ 68
Annex A............................................................................................................................................................................................................... 70
CHAPTER 7: PROJECTIONS AND COSTING ....................................................................................................................................... 70
A1. HEALTH FACILITY SCALE UP AND PROJECTIONS OF HEALTH WORKFORCE ...................................................... 70
1.1. HEALTH FACILITY SCALE UP PLAN ........................................................................................................................................... 70
1.2. EXISTING STAFFING STANDARD FOR HEALTH FACILITIES ........................................................................................... 71
1.3. BASELINE STOCK AND PROJECTIONS .................................................................................................................................... 78
A2. COSTING THE HRH STRATEGIC PLAN ......................................................................................................................................... 82
A2.1. SALARIES AND BENEFITS OF HEALTH WORKFORCE .................................................................................................... 82
A2.2. Training and Capacity Development............................................................................................................................................ 82
ANNEX B: MISCELLANEOUS INFORMATION ..................................................................................................................................... 85
B1. THE STOCK AND DENSITY OF HEALTH PROFESSIONAL IN 2015 ..................................................................................... 85
B3. Detailed Costing ...................................................................................................................................................................................... 104
Annex B3. A COMPREHENSIVE MONITORING AND EVALUATION MATRIX ...................................................................... 106

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
ACKNOWLEDGEMENT

The current National Human Resources for Health (HRH) Strategic Plan (SP) is the result of a
collaborative effort between the Federal Ministry of Health, Regional Health Bureaus and relevant
sectors of government; academic institutions, professional associations and development partners
among others. The Ministry of Health would like to acknowledge a number of people whose
contributions were essential to the preparation of this strategic document. We wish to thank first Dr.
Wendemagegn Enbiale, former Director of Human Resources Development and Administration
Directorate of the Ministry of Health who started the process of HRH Strategic Planning and Dr.
Getachew Tollera, Director of Human Resources Development and Administration Directorate of the
Ministry of Health who oversaw and guided the revisions for finalization of the strategic plan. Without
their leadership and commitment, this document could have not been finalized. Ato Mohammed
Hussein Abaseko, Technical Advisor from Ministry of Health deserves a special mention for his
immense contribution to the strategic planning as a member of the team and putting extra efforts to
bring the document to its completion.

The acknowledgement is extended to the USAID funded Strengthening Human Resources for Health
Project implemented by Jhpiego with its partners Management Sciences for Health (MSH). The project
provided technical and financial support throughout Strategic Planning Process. A particular
recognition goes to Dr. Shelemo Shawula Kachara, Senior HRH Management Advisor for HRH
Project, a member and secretary of HRH Strategic Plan team who worked very hard in the HRH
strategic planning process.

The Ministry of Health would like to extend its gratitude to the stakeholders and individuals who have
participated in the consultative workshop to review and finalize the Strategic Plan. The consultation
workshop brought together experts from various departments of Ministry of Health, Federal
Hospitals, Ministry of Education, Education strategy Agency, Federal TVET, HERQA, FMHACA,
Universities and Regional Health Science Colleges, Health Professional Associations, and development
partners. This group of senior health and management experts generated valuable comments and
brought unique perspectives that have enriched and significantly improved the Strategic Plan. Thanks
are extended to Ato Kahsu Bekuretsion of Ministry of Health who shared his knowledge on
OneHealth Tool for Costing the Strategic Plan.

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
FOREWORD

Over the last decade or so, Ethiopia has made unparalleled expansion of tertiary education facilities.
The health sector, in close collaboration with the education sector, has implemented a step-wise
expansion in enrollment and training of various health science disciplines. The focus of successive
health sector development programs has been to build a robust primary health care. Therefore, the
development of human resource for health (HRH) has prioritized training of cadres fit for primary
health care purpose. This, by and large, has been successfully implemented and helped our country
make good progress in addressing priority health problems.

While additional investments need to be made to further strengthen the primary health care platform,
we need to embark on training of health workforce for secondary and tertiary care as well. As the
economy of the country continues to grow at impressive pace, the likelihood that our country will
join the middle income category by 2025 is very high. This economic growth coupled with rapid
urbanization and change in lifestyle will result in triple burden of disease; a rise in non-communicable
diseases, injury and trauma, and communicable diseases. This calls for prudent HRH planning to ready
the health system address these existing and emerging health challenges. This, Human Resources for
Health Strategic Plan 2016-2025, have been prepared in order to guide production, recruitment,
deployment and performance support for health workforce in the sector.

The HRH strategic plan is aligned with the Health Sector Transformation Plan and Country’s become
a low middle income country by 2035; the World Health Organization’s road map for scaling up
human resources for Health for improved health services delivery in Africa Regions 2012-2025 and
National Health Policy and Strategies, among others. Our experience in Ethiopia underscored the
policy direction, leadership and understanding of a balance between urgent and practical actions are
guided by clear policy framework. On the other hand, we faced with several challenges in quality of
training and education of health workforce, human resources leadership, governance and management
systems and practices. This strategic plan is aimed to guide short-term and medium range human
resources planning, development and management in the health sector to overcome these challenges.

Finally, across all nations, a stronger and collaborative way of working is needed to develop human
resource for health to deliver quality health services towards achieving Sustainable Development
Goals. We are committed to learn from other countries in the process of implementation of the
strategic plan and will document and share our experience.

_____________________________________
Dr. Kesete-Birhan Admasu
Minister of Health
The Federal Democratic Republic of Ethiopia.

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
 ACRONYMS

AHWO Africa Health Workforce Observatory

BPR Business Process Reengineering
BSC Balanced Score Card
CAR Contraceptive Acceptance Rate
CoC Certificate of Competency
CPD Continued Professional Development
CPR Contraceptive Prevalence Rate
CSA Central Statistics Authority
DHRDA Directorate of Human Resources Development and Administration
DHFPL Directorate of Health Facilities and Professionals Licensing
FMHACA Food Medicine and Health Care Administration and Control Authority
GDP Gross Domestic Product
GP General Practitioner
HERQA Higher Education Relevance and Quality Agency
HEW Health Extension Worker
HIT Health Information Technician
HIV Human Immunodeficiency Virus
HMIS Health Management Information System
HO Health Officer
HR Human Resource
HRH Human Resource for Health
HRM Human Resource Management
HRIS Human Resource Information System
HSDP Health Sector Development program
HSTP Health Sector Transformation Plan
ICT Information Communication Technology
IESO Integrated Emergency Surgical Officers
IST In-service training
MDG Millennium Development Goals
M&E Monitoring and Evaluation
MoH Ministry of Health
MoU Memorandum of Understanding
NHA National Health Account

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
NGO Non-Governmental Organization
PHCU Primary Health Care Unit
PPP Purchasing Power Parity; Public-Private Partnership
PSE Pre-Service Education
RHB Regional Health Bureau
SNNPR Southern Nations, Nationalities and Peoples Region
SP Strategic Plan
TVET Technical and Vocational Education and Training
USAID United States Agency for International Development
WHO World Health Organization
WISN Workload Indicator for Staffing Need

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
EXECUTIVE SUMMARY

COUNTRY’S HUMAN RESOURCES FOR HEALTH (HRH) CONTEXT

Ethiopia has achieved a considerable expansion in primary health care services in the last decade with
massive scale up of health infrastructure, health workforce development and deployment, improved
availability of equipment and essential medical supplies, and increased responsiveness to the population
health need.
Given the country’s emphasis on expanding primary healthcare services, there was a focus on growing
the low and mid-level health workforce. The effort to increase mid-level health workers gathered
momentum in 2003 when the government introduced the health extension program, Ethiopia’s
flagship program. This policy prioritization of massively expanding the primary care health workforce
was translated into concrete targets and strategic initiatives that were included in the successive
health sector development programs III and IV implemented from 2007-2015.
A human resources for health situation analysis conducted in 2015/2016showed that the human
resources development and management targets set out in the HSDP-IV were achieved through
sustained expansion of health workers’, including an increased number of education and training
programs for various cadres of health professionals. For example, between 2009 and 2014/15:

• The number of medical schools has increased from 7 to 35 (28 Public and 7 Private)
• Annual enrollment in medical students has increased from 200 to 4,000.
• The number of physicians in the country has increased from 1,540to 5,372.
• Midwifery teaching institutions have also increased from 23 to 49.
• The number of midwives increased from 1,270 in 2009 to 11,349

Apart from these selected health professionals, overall health professionals to population ratio
increased from 0.84 per 1000 in 2010 1 to 1.5 per 1000 in 2016 2.This is remarkable progress for a 5
year period. If the current pace is sustained, Ethiopia will be able to meet the minimum threshold of
health professionals to population ratio of 2.3 per 1000 population, the 2025 bench mark set by the
World Health Organization (WHO), for Sub-Saharan Africa.

1
WHO (2010): Human Resources for Health Country Profile Ethiopia. Africa Health Workforce Observatory. 2010
2
MoH (2015): Routine HRIS data, 2015
National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
STRATEGIC CHALLENGES AND ISSUES
Despite the remarkable achievements stated above, the following are some of the remaining
challenges of HRH in Ethiopia:
• Quality of health workers’ education and training: rapid expansion of health workers education
and training was not matched with essential inputs such as well qualified faculty members,
skills lab materials, library and resource centers as well as practical training facilities. Thus
quality of training, and graduates has become a major focus of the human resources
development for the health sector.
• Geographical distribution and professional skills mix: Despite the improvement in number of
health workers nationally, there are critical shortages of some health profession; furthermore,
improvements are needed for equitable distribution of health workers particularly in remote
and rural areas. This is one of the major challenges to achieve universal health service
coverage.
• Human Resources Management (HRM): despite significant achievements in health professionals
training, recruitment and deployment, other HRM functions remained largely traditional with
focus on routine personnel administration tasks instead of playing strategic role in health
sector transformation. HRM structure and staffing levels are inadequate. HRM capacity is
generally weak with special needs at decentralized district levels. The targets related to health
workforce motivation and retention have not shown significant improvements despite the
incentives implemented by Federal Ministry of Health (FMoH) and Regional Health Bureaus
(RHBs).
• Human Resources Information System (HRIS): The national HRIS system has not been effectively
utilized to collect and manage HR information and data. As a result, there is a lack of up-to-
date data for planning and evidence-based management decision-making.
• Health Workforce Regulation: structures and institutions for health workforce regulation have
been established. However, the capacity of these institutions is not well developed, and
requires additional investments.
To comprehensively address the HRH challenges, seven strategic issues were identified. These include:
• Existence of weak leadership and governance for HRH at various levels of the health system
• Poor quality of health workforce education and training
• Underdeveloped human resources management systems and practices
• Weak HR information system and evidence-driven HRH planning
• Insufficient financial resources for HR development and management
National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
 • Weak interagency coordination for HRH development and management
• Weak HRH regulatory capacity

THE STRATEGIC PLAN (SP)

• The development and strategic direction of this plan was guided by the
Ministry of Health HRH vision, goal, objectives and guiding principles.
• The vision of HRH is to have an adequate number of well qualified,
committed, compassionate, respectful and caring health workers
contributing to the health sector vision of Ethiopia.
• The Strategic goal of the HRH SP is to ensure availability of an
adequate number of well qualified health professionals with an appropriate
mix of skills; equitably distributed, motivated, retained and perform well
to achieve universal access to health care in Ethiopia.
• The Objectives of the SP are organized into four outcome areas.
These outcomes will address the strategic issues identified during the
situational analysis. The four outcomes include:
• HRH policy, planning and partnership strengthened at all levels;

• Quantity, Quality and equitable deployment and distribution of the

health workforce;

• Leadership, governance and human resources management capacity

and practices improved at all levels of the health system

• Attraction and retention of health professionals including measures for

improving their commitment, distribution, performance, remuneration
and their working and living conditions.
Strategic objectives were identified to achieve each outcome area - thus, a total of fourteen (14)
strategic objectives have been included in the plan. Several strategic actions/interventions have been
developed to achieve each strategic objective, and a timeline for implementation was agreed upon.
Implementation plan matrices were developed for actions under each strategic outcome and
objectives (Chapter 5). Monitoring and evaluation activities and matrices have also been incorporated
into the SP (Chapter 6).
National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
HEALTH WORKFORCE STOCK AND DEMANDS
• HR demand was projected based on estimated population-based health facility expansion. The
total health workforce in the base year (2016) was 219,542 out of which 150,534 (68%) were
health professionals of various categories working in the health facilities and management
structures. By applying the population standards (population served by) for various categories
of health facilities such as Health Post, Health Center, Primary Hospital, General Hospital and
Tertiary hospitals, the number of health facilities required were estimated for the planning
period. The staffing needs of those health facilities were estimated by applying the minimum
staffing standards developed by the Food, Medicine and Healthcare Administration and
Control Authority (FMHACA) in 2012 for these categories of public health facilities, and
experts’ consensus for other health professional categories that were not included in the
FMHACA staffing norms.
• Based on the projection, the number of health professionals of various categories will
progressively increase to 248,538 by 2020 and 374,368 by 2025. The numeric changes for
some of the key health professional categories include:
• General medical practitioners will increase to 9,836 by 2020 and 15,676 by 2025
• Nurses (all categories), will increase to 85,580 by 2020, and 127,299 by 2025
• Midwives (all categories) will increase to 19,620 by 2020 and 29,686 by 2025
• Anesthesia professionals (all categories including anesthesiologists and anesthesia
specialists) will increase to 3,284 by 2020 and 5,769 by 2025
• In addition, there will be a total of 95,488 management/administrative and support staff by
2020 and this number will increase to 139,652 by 2025. The proportion of health
professionals will remain between 68-73% of the total health workforce.
• These projections need to be updated regularly as more evidence becomes available that
reflects both the feasibility of this projected increase in the health workforce, and the changing
health care needs. This will be accomplished with the help of the monitoring and evaluation
procedures included in this SP.

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
ORGANIZATION OF THE STRATEGIC PLAN
DOCUMENT
This document is organized into seven chapters. The First Chapter- Introduction and Backgrounds,
describes the country’sdemographic and socio-economic profile, key health status indicators, policy
and planning context, and rationale and process of HRH SP development. The Second Chapter- HRH
Situation Analysis- outlines the results of the situational analysis in major HRH thematic areas:
leadership and governance, education and training with quality and regulation, HR management and
performance, HR information, financing HRH and partnership and collaboration. Chapter 3-Strategic
Direction- summarizes the strategic direction of the SP including vision, objectives, guiding principles
and strategic plan outcomes, and strategic objectives. The chapter also contains a schematic
summarizing the SP. Chapter 4- Outcomes, Strategic Objectives and Actions- is the heart of the
strategic plan and includes the four outcome areas. Under each outcome, there are strategic
objectives with strategic actions. Chapter 5- Strategic Implementation Plan- articulates approaches of
implementing and coordinating the SP across implementation levels and sectors. It also outlines the
implementation timelines for the different strategic actions between 2016 and 2025. Chapter 6:
Monitoring and evaluation Framework provides an overview of the monitoring approach and key
indicators, baselines and targets for each outcome area. Chapter 7: Projections, Costing and Budget-
highlights the health workforce needs and the estimated costs/budget required to implement the SP.

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
STRATEGIC PLAN MAP (SUMMARY)

The Vision of HRH SP is to have an adequate number of well qualified, committed, compassionate, respectful and caring health workers
Vision
contributing to the health sector vision of Ethiopia.

Strategic Goal The Strategic goal of the HRH SP is to ensure availability of an adequate number of well qualified health professionals with an appropriate
mix of skills; equitably distributed, motivated, retained and perform well to achieve universal access to health care in Ethiopia.

Health workforce
HRH regulation, planning Leadership, governance and
Strategic education and training Availability, retention and performance of the
and partnership HRM capacity and practices
Outcomes capacity and health workforce optimized
strengthened strengthened
regulation improved

Develop and implement

appropriate HRH standards,
Improve quality of
guidelines and legislative
pre-service education
frameworks
and training for the
health workforce
Establish a comprehensive
Improve health worker recruitment and
Human Resources
Strengthen in-service deployment at all levels
Information System (HRIS) Strengthen HRH leadership
training and
and strengthen data use for and governance structures
continuing Reduce inequity in geographic distribution and
decision-making and capacity at all levels
Strategic professional skill mix of health care workers
Objectives development for the
Strengthen HRH Planning at Strengthen HRM capacity
health workforce Enhance staff motivation and retention
all levels and practices at all levels
Strengthen Improve health workforce performance and
Create a gender
accreditation, productivity
responsive workforce
licensing and
regulation of training
Engage with diverse
institutions and health
stakeholders and partners
professionals
on national HRH dialogue
and actions

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
CHAPTER 1:

BACKGROUND AND INTRODUCTION

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016 15
 1.1. DEMOGRAPHIC AND SOCIO ECONOMIC PROFILE

Ethiopia is an ancient African country with over 80 ethnic groups and a rich cultural heritage. It is a
developing country with an estimated annual per capita income of USD 1432 (PPP) 3. The population is
growing at an annual rate of 2.6% and the 2016 projected population was 92.4 in 2016 4, with approximately
74.5 million living and working in rural areas.
TABLE 1.1. KEY DEMOGRAPHIC, SOCIO-ECONOMIC AND HEALTH INDICATORS

Basic Indicators Levels Data Sources

Demographic Indicators

Projected Total population (millions), 2016 92.4

Central Statistics Authority of

Urbanized population (%), 2016 18.3 Ethiopia. Population Projection
2014-2017.
Population Annual Growth rate (%), 2016 2.6 http://www.csa.gov.et/ Accessed
on April 26, 2016

Life expectancy at birth (years), 2012 63

Economic Indicators

GDP per capita (US$), 2013 $630 2013/2014 (UNDP) 5

Gross National Income, 2014 $550 The World Bank 6

Population below international poverty line of US$1.25 per day (%),

22% HSTP 2015/16-2019/20
(in 2015)

Public spending as a % of GDP (2007-2011) allocated to: health 2.6

UNICEF, December 2013
http://www.unicef.org/infobycou
Public spending as a % of GDP (2008-2010) allocated to: education 4.7
ntry/ethiopia_statistics.thml#0
Accessed on September 2, 2016
Total adult literacy rate (%); 2008-2012 39

1.2. GOVERNANCE AND ADMINISTRATION

The 1994 Constitution of the country introduced a federal government structure composed of nine
Regional States: Tigray, Afar, Amhara, Oromia, Somali, Beninshangul-Gumuz, Southern Nations, Nationalities
and Peoples Region (SNNPR), Gambella and Harari, and two City Administrations: Addis Ababa and Dire

3
The World Bank. Ethiopia Economic Indicators, 2015. Accessed from http://www.tradingeconomics.com/ethiopia/indicators On 1May 2016
4
Central Statistics Authority (Ethiopia). Available on http://www.csa.gov.et/ accessed on 27 November 2015.
5
Ethiopia Quarterly Key Economic and Social Indicators produced by the Policy Advisory Unit, UNDP Ethiopia
http://www.undp.org/content/dam/ethiopia/docs/Ethiopia-Key%20Economic%20Indicators-%202015%20No-2.pdf
6
Bankhttp://data.worldbank.org/country/ethiopia
16 National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
Dawa. The National Regional States and City Administrations are further sub-divided into 82 Zones and 934
Woredas (districts) 7, which are the basic decentralized administrative units representing 100,000 people
governed by an administrative council composed of elected members. Health care provision in Ethiopia is
predominately public and it is through this decentralized structure that national health initiatives are
implemented.

1.2. ETHIOPIA HEALTH STATUS

Ethiopia has made significant improvements in many health indicators. The country has reduced under-five
mortality by two-thirds from the 1990 baseline, meeting the Millennium Development Goal (MDG) target
three years ahead of the schedule; new HIV infections have gone down by more than 90%, and there has
been no generalized malaria epidemic in more than 8 years. The number of malaria cases and death due to
malaria has dropped by 67% and 48% respectively8. Recent reports have also shown that Ethiopia has
reduced maternal mortality by 72%, and the Contraceptive Prevalence Rate (CPR) increased from 29% in
2011 to 42% in 2014. These great successes are mainly due to well-coordinated, extensive efforts and
intensive investment of the government, partners and the community at large to strengthen and expand the
primary health care. Table 1.2 below includes the status of some of the key health indices:

TABLE 1.2. KEY HEALTH INDICATORS

Health Indicators Level Data Sources

Households that have access to an improved

54.5% Ethiopia Mini DHS 2014
source of drinking water.

Contraceptive acceptance rate among married MoH Annual Performance

69.9%
women Report, 2015

59 per 1000 live births Countdown 2015 9

Under-5 mortality rate (U5MR), 2012 (Gross)
204 (1990)

42.94 per 1000 live Countdown 20159

Infant mortality rate (under 1), 2012
births 121 (1990)

15.4% (63.0% urban

Institutional delivery Ethiopia Mini DHS 2014
versus 10.4% rural).

353 maternal deaths per

Maternal mortality ratio WHO MMR estimate 2015
100,000 live births

Source: Ethiopia Demographic Health survey, 2011; HSDP Annual Performance Report (2012/2013)
UNICEF, December 2013. http://www.unicef.org/infobycountry/ethiopia_statistics.html#0

1.3. POLICY AND PLANNING CONTEXT

7
HRH Project (2016): Improving HRM in Ethiopia for improved health services delivery and health outcomes. Compiled from 11 Regional Health
Bureau Reports. April 2016. Addis Ababa. Unpublished Regional Reports
8
HSDP-IV Woreda-Based Health Sector Annual Core Plan EFY 2007 (2014/2015), page 1, MOH, 2014. Addis Ababa
9
http://www.countdown2015mnch.org/documents/2015Report/Ethiopia_2015.pdf
National Human Resources for Health Strategic Plan 2016-2025. Sep 2016 17
 • Several policy and planning documents at the national and regional level bear influence on the HRH
situation of the country. As a result, development of the HRH Strategic plan was based on a number
of policy and planning documents including the Ethiopian Health Policy (1993), Health Sector
Transformation Plan (2015– 2020) and Visioning Ethiopia’s Path Towards Universal Health Coverage
Through Primary Health Care - Visioning 2035 (March 2014), among others.

1.3.1. Health Policy of Ethiopia

The Health Policy of the transitional government of Ethiopia, 1993 makes a number of recommendations
regarding HRH. These recommendations include: Training of community based frontline and middle level
health workers up to the appropriate professional standards and recruitment and training of these
categories at regional and local levels. It also stipulates the training of trainers (ToT) for managerial and
supportive categories of workers to support the health service objectives, development of appropriate
continuing education for all categories of workers in the health sector, and development of career structure
and incentive mechanisms for all categories of HRH

1.3.2. HRH commitment for universal health coverage

The Federal Democratic Republic of Ethiopia constitution emphasizes equitable access to public services.
The country renewed its commitment to ensure Universal Health Coverage for its population during the
third Global HRH Forum held in Recife, Brazil (November 2013). Two broad commitments were:

• Scale-up quality pre-service education of HRH focusing on those cadres in critical

shortage by expanding education for health workers to meet 100 % of the staffing standard,
considering the skill mix in all primary health care facilities, improving quality of health professionals
education by implementing program level accreditation in both public and private training
institutions, and improving quality of health professionals education by instituting a competency-
based pre-licensure system for all health workers by 2017.
• Improve human resources for health planning and management capacity by strengthening
pre-service and in-service training of human resources for health managers

1.3.3. Pre-service education

Pre-service education in the country is governed by the Higher Education Proclamation No.650/2009 and
Technical and Vocational Education and Training (TVET) proclamation No.391/2004. The higher education
proclamation emphasizes institutional transformation, legal frameworks for critical issues of relevance and
quality, and governance of expanding higher education among others. The TVET proclamation emphasizes
production of a competent younger generation workforce for various industries through technical and
vocational education and training system.

1.3.4. Regulatory policy frameworks

18 National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
The Higher Education Relevance and Quality Agency (HERQA) and FMHACA regulate health workforce
development and professional practices. The two agencies were established by the Proclamation No.
351/2003 and 661/2009, respectively.

HERQAs mandate is to ensure relevance and quality of pre-service education and training in higher
educational institutions in the country. FMHACA’s mandate is to avert health problems due to substandard
health institutions, incompetent and unethical health professionals, poor environmental health and
communicable diseases among others.

1.3.5. National in-service (IST) directive and implementation guideline

This directive aims at facilitating the delivery of standardized IST courses by local training institutions. The
directive also defines the roles and responsibilities of various stakeholders including MoH, FMHACA, RHBs,
Zonal Health Departments, local IST Institutions and Health Professional associations.

The purpose of the National IST Implementation Guideline is to promote and guide standardization and
institutionalization of IST in the health sector in Ethiopia. The guideline aims at ensuring that in-service
trainings are need based, standardized, institutionalized, and that an updated in-service training database is
available at all levels.

1.3.6. Public Service and Human Resources Policies

Human Resources Development (HRD) and management in the health sector is governed by Public Service
and HR Development Proclamations and other relevant policy and legal frameworks at national and regional
levels. Accordingly, Proclamation No. 515/2007 is the major policy framework for HRD and administration
at the national level. The regional governments have adapted this proclamation to reflect their local context
and applied it to HR development and management functions.

1.3.7. Health Sector Transformation Plan 2015/16-2019/20

Human resources for the health sector is one of the major capacity building strategic objectives (CB 2) of
the Health Sector Transformation Plan (HSTP) 2015/16-2019/2020 10. This strategic objective entails human
resources planning, development and management.

Human resources management focuses on recruitment as per the need, deployment of staff, performance
management and motivation. It also includes leadership development, promoting women in leadership
positions and community capacity development. One of the main focuses of this strategic objective is to
promote patient-centered, respectful and compassionate care by all health professionals. This requires
multifaceted interventions starting from recruiting students who have the drive and motivation to be health
professionals, to continuously encouraging health science students to reflect on what it means to be a health
professional and inspiring practicing health professionals to demonstrate commitment to their country,
people and care for their patients. CB2 HSTP targets are summarized in Table 1.3, below:
TABLE 1.3: SUMMARY OF HRH COMPONENTS OF HSTP (2015/16-2019/20)

Result CB2 Improve development and management of human resources for health

10
Health Sector Transformation Plan (HSTP) EFY 2008-2012 (2015/2016-2019/2020). Ministry of Health. Addis Ababa
National Human Resources for Health Strategic Plan 2016-2025. Sep 2016 19
 • An adequate number of competent, motivated and committed health
Outcome
professionals are available to provide health care to all Ethiopians

• Strengthened national agenda of developing compassionate, respectful and caring

Key Components health professionals
• Strengthened HRH strategy and planning at all levels
• Increased enrollment and improved quality of pre-service training

• Scale up training and development of health professionals based on health needs

taking into account current stock, demand, supply, skill mix and distribution in
public and private sectors, as well as local and global labor markets.
• Maintain and improve competence of the health workforce through effective,
Strategic Initiatives
efficient and sustainable continuing professional development.
• Provide support for quality audits of all existing pre-service training programs.
• Strengthen linkages between health science training institutions and the industry
• Establish twinning between national/international health science training
institutions

• Train adequate number of health workers with appropriate skill mix

• Enhance human resources management practice including motivation and
retention schemes
• Strengthen Human Resources Information System (HRIS)
• Enhance gender mainstreaming capacity of the health workforce
Strategic Actions
• Reduce inequity in geographic distribution, skill and gender mix of health care
workers.
• Implement Continuing Professional Development
• Enhance Motivation and retention.
• Enhance performance and productivity

• Increase stock of health workforce (disaggregated by cadres and regions) from

Performance
the current 0.8/1000 to 1.6/1000 11
Measures
• Reduce staff attrition rate from 6.6% to 4%.

1.4. RATIONALE FOR THE HRH STRATEGIC PLAN

The MOH recognizes that successful implementation of the various health programs and reform initiatives is
dependent on the availability of an adequate number of well qualified, and equitably distributed, clinical,
public health and administrative personnel in the health sector. The HRH SP was developed to meet health
service demands of the Ethiopian population. Below are the main reasons for the development of the HRH
strategic Plan:

1.4.1. Reflect HSTP Priorities and Targets

11
Health workforce density in 2016 was 1.63/1000 as opposed to HSTP’s 2020 target of 1.6/1000. The HSTP target was lower due to lack of
accurate HR data at that time. However, the density will reach 2.3/1000 by 2020.
20 National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
This is the most important bench mark for the HRH SP as the HSTP aspires to provide equitable and quality
health services to all Ethiopians. HRH is a major strategic objective in the HSTP 2015/16-2019/2020. In
addition, the HSTP requires investment in HRH across all strategic objectives. This HRH strategic plan
elaborates the high-level HRH investments indicated in the HSTP.
1.4.2. Align with Visioning Ethiopia’s Path Towards Universal Health Coverage Through Primary Health
Care

The visioning document was developed to pave Ethiopia’s path towards Universal Health Coverage through
Primary Health Care. The document that was produced in March 2014 identifies six strategic areas that
highlight priority areas for continued investment to improve primary care. These include: (1) empowering
the community to play a significant role in the health sector, (2) strengthening primary health care units
(PHCU) within the larger health sector, (3) ensuring a robust Human Resources Development system that is
commensurate with socio economic development of the country as a Lower Middle Income Country by
2025 and a Middle Income country by 2035, (4) engaging the private sector in support of the MOH vision,
(5) developing sustainable financing mechanisms and (6) developing institutional capacity to be responsive to
changing economic, social, environmental, technical, and epidemiologic contexts. These strategies were
informed by an in-depth situational analysis conducted in 2012, which documented successes and continued
challenges faced by the health sector. Each strategic area is supported by sub-strategies that offer more
specific recommendations. All of the above strategies are relevant to this HRH SP.

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016 21
 CH

CHAPTER 2:
SITUATIONAL ANALYSIS OF HRH IN
ETHIOPIA

22 National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
This section describes the existing HRH situation in Ethiopia based on the situational analysis d in 2016.
Information is provided for seven thematic areas: leadership and governance, health workforce density and
distribution, education and training, human resources management, HRH policy and legislation, and
partnership and collaboration for HRH.

2.1. HRH LEADERSHIP AND GOVERNANCE

There are designated HR leadership and governance structures in the health sector at national and regional
levels. These include the Directorate of HR Development and Administration (DHRDA) at the national
level, and the HR Development and Administration Support Process at RHBs. In addition, there are health
professionals’ regulatory agencies at national and regional levels. The Ministry of Public Service and Human
Resource Development, and Regional Bureaus of Public Service and Human Resource Development, are also
involved in HRH decision making.

The DHRDA at national level is responsible for HRH planning, oversight of pre-service education, in-service
training and continued professional development; recruitment and deployment of graduates from various
universities as well as personnel administration. The directorate also serves as a liaison between the Ministry
of Education and the Ministry of Public Service and Human Resource Development. The directorate also
conducts assessments to guide HRH planning and management. The Directorate for Health Facility and
Health Professionals Licensing of the Food, Medicine and Health Care Administration and Control Agency
(FMHACA) and its regulatory work processes in the RHBs are responsible for registration and
licensing/relicensing of health professionals.

The Human Resources Development and Administration Support Process (HRDA SP) is responsible for
HRH planning, recruitment, deployment and personnel administration functions at RHBs. However, this
structure is embedded into the Public Service and HR Development Pool at Zonal and District Health
Offices in many Regions. Health centers and Hospitals have HR staff within Administration and finance
functions.

The existing HR governance and leadership challenges include lack of dedicated HR structures at zonal,
woreda and health facility levels (in many regions). Where the organizational structure exists, the number,
educational qualification and experience of HR staff is inadequate to effectively lead and govern HRH in the
sector. As a result, HRH decisions are subjected to weak governance and leadership practices such as
incomplete HRH planning, inadequate HR development and management; lack of transparency,
accountability and good governance. The human resource budget is also limited to staff salaries with no or
insufficient budget to address other HR functions such as workforce motivation, retention and performance
support; training and capacity building for HR staff and improvement of the work environment.

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016 23
 2.2. HUMAN RESOURCES MANAGEMENT
2.2.1. Workforce planning

The DHRDA at the Federal Ministry of Health and HRDA Support process in the RHBs are responsible for
health workforce planning at national and regional levels, respectively. The workforce planning has been
guided by successive health sector development plans (HSDPs), the current HSTP and annual HR
operational plans. In the absence of a national HRH Strategic plan, workforce demand is determined by
health facility staffing standards/norms developed by FMHACA and approved in 2012. The staffing standards
for the health management structures at national, regional and local levels are determined by the number of
positions approved by the Public Service and HR Development during health sector business process
reengineering (BPR). The staffing standards are applied to estimate the number, professional categories and
minimum position requirements for the workforce planning.

Existing challenges with workforce planning include a weak human resources information system (HRIS) to
generate accurate and timely data for comprehensive health workforce planning, lack of dedicated HR
structures at lower levels, shortages of skilled staff, weak performance planning systems and practices,
insufficient budget and lack of a robust monitoring and evaluation system for forecasting and projection of
workforce demand and supply. Following the BPR, more flexible staffing standards that were developed by
the MoH and/or RHBs are used to deploy health workers to various health facilities. The number of active
positions for health care workers is guided by perceived workload at local levels such as health centers or
hospitals. However, the challenges with this approach include a variation in workload among the same
category of health facilities, the fact that minimum staffing standards are not based on a realistic workload,
but rather the current work load which is based on existing health worker shortages, and the fact that most
woredas do not plan their workforce based on realistic workload, which in turn impacts the budget
allocation for woreda health offices and health facilities.

2.2.2. Recruitment, Deployment, Motivation and Retention of Health Workers

Under the current decentralized system, RHBs and Woreda Health Offices have mandates to plan, identify
and fill vacant positions. This gives the lower administrative units in each region a sense of ownership, and
increases efficiency and accountability. It is critical to improve HR management systems, capacity and
practices for efficient recruitment, deployment, motivation and retention of health workforce.

Most Woreda health office HR functions are managed under the Public Service and HR Development Pool
System where a single structure coordinates HR issues of the health sector along with other sectors. As a
result, HRH does not receive sufficient attention for planning, recruitment, deployment, motivation and
retention. For optimum functioning, the woreda health office management requires negotiation and
management capacity to request and secure financial resources to recruit an adequate number of health
workers with the appropriate skills mix.
Though the MoH and RHBs are implementing various incentive packages for health professionals, the
existing schemes are not consistently implemented in all regions and health facilities, and are not provided
for all health workers, thus contributing to high attrition rates. Well-designed and systematic incentive
schemes that include financial and non-financial packages need to be implemented for all health professional
categories.

24 National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
2.2.3. Performance Management

Performance management in the health sector is a collaborative effort of the Ministry of Public Service and
HR Development and theMOH. The former develops performance management systems, implementation
guidelines and standard operating procedures, while the MOH puts these into practice.

The Ethiopian Public Service has implemented several reform initiatives over the past few years, including
decentralizing decision making to the woreda level, implementing business process reengineering (BPR), and
introducing the Balanced Score Card (BSC). The focus of all these reform efforts is to improve performance
management systems and practices that are responsive to civil servant needs, improve access to health
services, empower communities and create a culture of measuring and rewarding performance. However,
BSC is not fully implemented, and regions required additional support to do so. As a result, promotion
decisions are still based on years of work experience rather than performance-based measures. This affects
staff morale, performance and retention.

2.2.4. HRIS, Monitoring and Evaluation

Accurate and timely HRH information is essential to support HR planning and management. The MOH
introduced HRIS in 2009 to facilitate routine data collection and management. However, the system has not
been fully functional at various levels and has failed to produce comprehensive national HR information.
Underlying factors affecting the functionality of the HRIS is a lack of dedicated HR structures and staff, lack
of ownership, inadequate supplies of computers and HRIS software, limited capacity to manage HRIS
functions and insufficient budget allocated for HRIS among others. Thus, there is a need to strengthen and
scale up the HRIS to all levels of health administration, health facilities and training institutions.

2.3. HEALTH WORKFORCE EDUCATION AND TRAINING

2.3.1. Pre-service Education

The government of Ethiopia has invested in expansion of health professionals’ education and training
capacity to achieve the MDG and SDG health related goals including Universal Health Coverage. To facilitate
the expansion, the government has determined the ratio of intake between natural science and social
science to be 70/30. This decision favors the enrolment of more health science students. The overall
expansion of public universities and colleges has contributed to a significant increase in the availability of
most categories of health workers. Annual enrollment of health science students in public higher education
institutions reached close to 23,000 by 2015/2016. An additional 16,000 health science students were under
training in private higher education institutions in 2015/2016.

The number of universities that provide medical education has also increased from 5 in 2003 to 35 in 2016
(28 public and 7 private). Out of 37 public universities available to date, 34 have been providing four or
more health science programs. Annual intake of medical students in public universities has increased by
more than 20-fold from 152 in 2000 and to 3,537 in 2015/2016. There are more than 16,000medical
students enrolled as of 2015/2016 (compared to its baseline level 1,462 in 2008/2009).

Similarly, teaching institutions providing midwifery training have increased from 23 in 2009 to 49 in
2015/2016.

Training of Integrated Emergency Surgical Officers (IESO), is one of the task shifting programs to address the
shortages of surgeons and obstetricians. The program was started in 2009 in 3 universities and 10 affiliated

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016 25
 sites with an annual intake of 43 students, with the aim of providing them with training leading to MSc in
Emergency Surgery. The program was scaled up in 2014 to 11 universities and 42 affiliated hospitals with an
annual intake of 240 students. By the end of 2015, a total of 252 emergency officers had completed the
training and been deployed to health facilities. To increase access to anesthesia services, the MoH trained
and deployed 96 Level-V nurse anesthetists and 50 degree-level anesthesia graduates by 2013/2014 12. In
2015/2016, the total number of anesthesia professionals had reached 87513.

According to the WHO benchmark for Sub-Saharan Africa, the nurse to population ratio should be 1 per
5,000. Ethiopia has achieved a nurse to population ratio of 1 per 2,132 people by 2015/2016. To improve the
quality of nursing services in hospitals and to strengthen motivation and retention of the diploma-level
nursing workforce, nursing specialty training programs at a bachelors’ degree level were started in
2014/2015 (these include neonatal, surgical, pediatrics, emergency and critical, and operation room nursing) .

The health extension program, the flagship health program of the country, has trained and deployed 42,336
health extension workers 14since its inception in 2003. To strengthen pre-hospital emergency services
throughout the country, an Emergency Medical Technicians (EMT) training program was started in and has
trained 353. The plan is to train and deploy at least 3 EMTs per ambulance.

• These achievements are remarkable, and have resulted in successfully increasing the health
workforce. Concerns, however, remain regarding the quality of training, as the rapid expansion has
strained existing teaching and learning resources, and greatly increased the student to faculty ratio.
To address these concerns, most higher education institutions have established a health educational
quality assurance office, but the attention given to quality has to be improved. Quality assurance
structures need to be cascaded to the lowest academic units including health science programs.
Higher education institutions also need well-developed policies, procedures, guidelines and tools for
internal quality assurance.
2.3.2. In-Service Training and Continuing Professional Development

• In-service training (IST) and continuing professional development (CPD) are important functions to
support competence, motivation and retention, and improved performance of health professionals.
If linked to health professionals’ licensing, need-based IST and CPD can help to support career
progression and staff motivation that in turn strengthen institutional capacity to deliver quality of
health care.
• In this regard, the MOH issued a directive and guidelines to support standardization and
institutionalization of IST in January 2014. Subsequently, a year later, 35 IST centers were
established and equipped to facilitate the implementation of standardized IST. Challenges related to

12 Ibid #12
13 MoH (2016). Human Resources Development and Administration Directorate. Draft HR data for the country. Data was collected
from September- November 2015 and compilation Completed in May 2016. Unpublished Report (see Annex B, Table B1.2 of this
document for the details)
14 MoH (2015): Health and Health Related Indicators. Version 1. 2008 E.C.
26 National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
 standardization and institutionalization of IST include lack of a focal person to coordinate IST
activities at the regional level, limited ownership for planning and budget allocation for IST activities
at all levels, and limited capacity to enforce implementation according to the directive and guideline.
• Similarly, a CPD directive and implementation guideline was developed and approved –
implementation of these documents are pending further review.

2.3.3. Quality Assurance and Regulation of Health Education

Accreditation

Accreditation is a mandatory requirement for higher education institutions in Ethiopia, and is managed by
the Higher Education Relevance and Quality Agency (HERQA). Institutions and programs are subject to
accreditation every three years.
Though HERQA is actively working to accredit private health education institutions, the agency is not yet
fully engaged in regular accreditation of public health science education institutions.

Quality Audit

HERQA carries out institutional quality audits of all higher education institutions to ensure the
appropriateness and effectiveness of each institution’s approach to quality, its systems of accountability and
its internal review mechanisms. HERQA has audited and produced reports for almost half of the health
education institutions in the country. Internal quality assurance audits are expected to be carried out by the
higher education institutions themselves. To guide this effort, HERQA, the MOH and universities developed
national internal quality assurance implementation guideline and seven program level quality
assurance standards for medicine, health officers, nursing, midwifery, medical laboratory, pharmacy and
anesthesia.
Once the higher education institutions have completed the institutional or program level quality audit, they
are expected to submit results to HERQA for reaccreditation. However, HERQA has not implemented
regular reaccreditation for higher education institutions which has resulted in noncompliance to the outlined
quality audit requirements by higher education institutions.
Certification and Licensing

Graduates who have successfully completed the TVET level training program have to take a National
Qualifying Examination, which was developed based on Ethiopian occupational standard (EOS) and used as a
criterion for licensing. Since 2011, the Certificate of Competence is provided to the graduates who
successfully pass the National Qualifying Examination.

However, there was no similar certification program for graduates from the university level trainings. The
MOH developed and piloted a National Licensing Examination for first degree graduates from higher
institutions, to measure graduates’ competence before professional registration and licensing. The exam was
first administered in 2015 and a total of 10,000 graduates took the examination in 2015/2016. The result of
national licensing examination is systematically analyzed to use as an input to improve quality of health

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016 27
 professionals’ education. Current challenges with the National Licensing Examination are a lack of legal
backing as directives and guideline is not finalized.

2.4. HEALTH WORKFORCE DENSITY AND DISTRIBUTION

2.4.1. Health Workforce Density

The study done in 2010 by the African Health Workforce Observatory (AHWO) found that the health
worker density for all categories has been on the upward trend rising from 0.64 per 1000 population in
2003-2004 to 0.84 per 1000 population in 2008-2009. The upward trend of health workforce availability was
maintained between 2010 and 2015 where the total stock of health care workers in 2015/2016 was150, 534
giving the health worker density of 1.63 for 1,000 populations 15(See Table B1.1 for details).
In 2015/2016, there were a total of 68,084 medical doctors, nurses and midwives in the country providing
health care. This gives a density of 0.74 per 1000 population compared to the WHO bench mark of 2.3
doctors, nurses and midwives per 1000 population for Sub-Saharan Africa. The shortage of key health
workers has persisted due to low training output and out-migration, particularly for physicians. Table 2.1
shows the stock in 2015/2016.

TABLE 2.1: HRH STOCK AND DENSITY

Health Workforce Density in 2015/2016

Ethiopia International
Indicators
Density 2016 Bench Mark

Total Health professionals per 1000 population (HWs density) (all

1.63 per 1000 Not available
categories)

2.3 per 1000

Doctors, Nurses and midwives 0.8 per 1000
(WHO)

Physician to population ratio 1 per 17,720 16 1 per 10, 000

Nurse to population ratio 1 per 2,132 1 per 5,000

Midwife to population ratio 1 per 8,200 1 per 5000

SOURCE: MOH, ROUTINE HRIS DATA JULY 2016.N.B. THE FIGURES SHOW PUBLIC SECTOR HEALTH WORKFORCE ONLY

2.4.2. Health Workforce Regional Distribution

The distribution of available health professionals has been highly variable and unequal between urban and
rural settings, between regions, and within regions. Some of the main reasons are accessibility of basic

15 MoH (2016). Human Resources Development and Administration Directorate. Draft HR data for the country. Data was collected from
September- November 2015 and compilation Completed in May 2016. Unpublished Report (see Annex B, Table B1.2 of this document for the
details)
16 MoH (2015)> Annual Performance Report
28 National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
services (road, electricity, telephone, water, education). Rural and hard-to-reach areas are particularly
underserved.

In the last 5 years, there were initiatives to decrease inter and intra-region inequality of health worker
distribution. These initiatives included expansion of health care professionals’ training institutions (pre-
service) in all regions, improved health workers recruitment and deployment based on local needs,
compulsory service schemes, and improving financial and non-financial incentives for those who work in
hard to reach areas. The current health workforce density and regional distribution is depicted in the figure
below:

Health Professionals per 1000 population in Ethiopia

(in 2013 and 2016)
4.50
4.03
4.00
3.40
3.50
2.99
3.00 2.70 2.60
2.50 2.17 2.30
2.06
2.00 1.80
1.50 1.54 1.63
1.30 1.40 1.36
1.50 1.20
0.97 1.04 0.90 0.99 0.97
1.00 0.76 0.83

0.50 0.32
0.00
Tigray Afar Amhara Oromia Somali B-G SNNP Gamb Harari AA DD National
2013 2016

Sources: Strengthening Human Resources for Health (HRH) Project Baseline Survey (May, 2013) and Ministry of Health, HR
Data (July 2016).

2.5. HRH POLICY AND LEGISLATION

2.5.1. Legislation on Planning of HRH

Ethiopia’s legislative requirements for HR planning fall under Article 12 of the Civil Service Proclamation
No.515/2007. According to this proclamation the MoH is responsible for preparing and implementing short,
medium and long term HRH plans for the health sector.
2.5.2. Legislation on Professional Practice and Responsibility

Legislation on professional practice is critical for the regulation of health professionals as it defines the
minimum requirements for registration and licensing, delineates scopes of practice, and sets standards for
education, ethics, and competent practices. FMHACA has the mandate to regulate human resources for
health is given as per proclamation No.661/2009. Regulation No. 76/2002 and some profession specific
codes of ethics are also in place to guide professional practice. With leadership from the regulatory body of
the MOH, FMHACA, an ethical code of conduct has recently been developed in collaboration with
professional associations though it has not yet been approved.
National Human Resources for Health Strategic Plan 2016-2025. Sep 2016 29
 2.5.3. Legislation on Education and Training

The Ministry of Education is mandated to assist in the development and implementation of higher education
law. The Higher Education Proclamation No.650/2009 governs the existing legislation on the education of
health professionals, which is applicable to all public and private institutions. This proclamation requires all
public higher education institutions to be established by Regulation of the Council of Ministers or regional
regulations. In addition, provisions governing accreditation of private institutions are found under the same
law in Articles 74 and 75, which gives this power to HERQA.

TVET level health science training programs are accredited and regulated by national TVET proclamation
No.391/2004 which gives mandate to TVET agency for the training programs regulation and standardization.

2.5.4. Legislation on HRH Management

Health professionals are civil servants governed by laws and regulations that govern civil service schemes in
the country. The policy and legislative framework concerning HR management is currently addressed in the
civil Service Proclamation number 515/2007, federal civil servants Disciplinary and Grievance Procedure No.
77/2002 and other directives and operational guidelines.

A career development qualification framework for each health professionals’ category was developed by the
MOH and approved by the Ministry of Public service and Human Resource development as indicated in the
national health professional career structure guideline. However, the career structure has not been updated
since 2012 nor is it inclusive of the newly emerged health professionals’ categories.

2.5.5. Legislation on Research and Development of HRH

The existing legislation in Ethiopia concerning health related research is the Ethiopian Public Health Institute
(EPHI) Establishment Regulation 4/1996. This Research Institute was established to conduct research on the
causes and spread of diseases, nutrition, traditional medicines and medical practices and thereby inform
activities to improve the health status of the country, and contribute to the development of health science
and technology. In addition, the Higher Education Proclamation (No. 650/2009) states that one of the
objectives of higher education institutions is to promote and conduct research consistent with the country’s
priority needs. However, Human Resource for Health related operational research that address the
challenges in health workforce development and administration do not get the necessary attention.

30 National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
2.6. PARTNERSHIPS FOR HRH

2.6.1 Private Health Science Training Institutions

The Government of Ethiopia recognizes the contribution of development partners and the private sector to
the country’s socio-economic development including achieving health goals for its population. The private
sector, including both for profit and not-for profit, is an important player in the health and social welfare
functions. The private sector in Ethiopia is involved in a broad range of functions which include training,
service delivery and research. As a result, Public Private Partnerships (PPP) are taking root, though they are
not yet institutionalized in a comprehensive manner. Important emerging trends worth noting include the
questionable quality of the health professional training in the private schools and a growing migration of the
skilled workforce from the public to the private sector. Anecdotal evidence suggests that health
professionals join the private sector due to salaries and benefits that are higher than government
remuneration packages. This creates a labor market opportunity for the health professionals while increasing
the health workforce shortage in the public sector and affecting service delivery and management for the
underserved.

The private sector is contributing to HRH development through pre-service education. A close working
relationship between the MoH/RHBs and health facilities and the private sector training institutions is critical
for successful training programs. Involving the private sector in health sector human resources planning is a
critical first step to develop a strong framework and foundation for collaboration.

2.6.2 Health Professional Associations

Professional associations can play essential roles in HR development and management through pre-service
education, in-service training and continued professional development, health professionals’ ethics and
regulation as well as workforce motivation and retention. In the past few years, Associations have been
involved in health professionals’ training standard development, curriculum designing and review, in-service
training and professional regulation/ethical practices. However, the engagement of Associations in HRH
development and regulation is not yet fully aligned with the roles and responsibilities MoH and the
associations.

2.6.3 Development Partners

Development partners play a significant role in human resources development and management in the health
sector in Ethiopia. They provide technical, financial and material support for pre-service education and in-
service training of health professionals. However, this support is driven by disease-specific programs. As a
result, they have not sufficiently addressed comprehensive HR development and management efforts in the
National Human Resources for Health Strategic Plan 2016-2025. Sep 2016 31
 health sector. In addition, interagency collaboration at the MoH and RHBs have not fully leveraged the
existing potential of development partners for HR in the sector.

2.7. STRATEGIC ISSUES

The following strategic issues were identified as priorities to be addressed:

• Existence of weak leadership and governance for HRH at various levels of health
system: Health sector work requires not only technical skills and expertise
directly responsible for sustaining health but also the skills needed in support
systems and the linkages that facilitate the application of technical skills. The
health sector has a critical gap in effective human resources managers who
have the capacity and motivation to assess HRH needs, and develop relevant
policies, strategies and operational guidelines to ensure health workforce
planning, development, recruitment and equitable distribution, career
development, motivation, retention and performance.
• Poor quality of health workforce education and training: the increased investment
in expansion of health professional teaching institutions is already showing
results in the exponential increase in numbers of graduating health
professionals. However, the rapid expansion has resulted in challenges with
ensuring the quality of health sciences education and training in both public and
private training institutions.
• Underdeveloped human resources management systems and practices: The various
civil service reforms have led to some positive results in the utilization,
retention and performance of the available health workforce in improving
coverage, equity in access, quality and efficiency of health services. Despite this
progress, retaining skilled health workers with the appropriate skill mix in

32 National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
 remote areas remains a major challenge due to low salaries, and non-
conducive working conditions and living environment.
• Weak HR information system and evidence-driven HRH planning: there is lack of
comprehensive HR information to inform evidence-based management and
policy decision making. Additionally, the capacity to analyze, disseminate and
use available HR information is also not sufficiently developed at all levels.
Documentation of best practices and human resources related research is also
not well developed.
• Insufficient financial resources for HR development and management: There is
limited budget for HR functions including salary and benefits, motivation and
retention, performance management, and office supplies and equipment. There
are also several challenges related to allocation of available budget for HR
development functions such as in-service training and continued professional
development within an institution.

• Weak interagency coordination for HRH development and management: In the

recent years efforts have been made to increase the involvement of
government ministries and agencies, RHBs, development partners, professional
associations and private health professional training institutions in HRH policy
and planning efforts. However, the level of alignment and harmonization is at
its infancy. Competing interests within and between the stakeholders and
development partners coupled with insufficient harmonization and alignment of
the efforts has increased fragmentation and duplication of efforts in health
workforce education, training and distribution.
• Weak HRH regulatory capacity: A comprehensive health workforce regulation
system that includes licensure, accreditation and certification, development of
standards and scope of practice is mandatory to ensure public protection and
efficient use of the health workforce. HERQA and FMHACA were established

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016 33
 to oversee quality of pre-service education and health professionals’
registration, licensing and regulation. However, there capacity of these entities
to ensure the quality of education and professional practices is not well
developed.

34 National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
CHAPTER 3:
STRATEGIC DIRECTION

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016 35
 The strategic direction of this plan has been guided by the Ministry of Health HRH vision, goal, objectives
and guiding principles outlined below.

3.1. VISION, GOAL AND OBJECTIVES

Vision
The vision of HRH is to have an adequate number of well qualified, committed, compassionate, respectful
and caring health workers contributing to the health sector vision of Ethiopia.

Strategic Goal

The Strategic goal of the HRH SP is to ensure availability of an adequate number of well qualified health
professionals with an appropriate mix of skills; equitably distributed, motivated, retained and perform well to
achieve universal access to health care in Ethiopia.

Strategic Objectives

Strategic Outcomes Strategic objectives

• Develop and implement appropriate HRH standards, guidelines and

legislative frameworks
• Establish a comprehensive Human Resources Information System
HRH regulation, planning and partnership
(HRIS) and strengthen data use for decision-making
strengthened
• Strengthen HRH Planning at all levels
• Create a gender responsive workforce
• Engage with diverse partners and stakeholders on national HRH
dialogue and actions

• Improve quality of pre-service education and training for the health

workforce
Health workforce education and training • Strengthen in-service training and continuing professional development
capacity and regulation improved for the health workforce
• Strengthen accreditation, licensing and regulation of training institutions
and health professionals

• Improve HRH leadership and governance structures and capacity at all

Leadership, governance and HRM capacity and
levels
practices are strengthened
• Strengthen HRM capacity and practices at all levels

• Improve health worker recruitment and deployment at all levels

• Reduce inequity in geographic distribution and skill mix of health care
Availability, retention and performance of the
workers
health workforce optimized
• Enhance staff motivation and retention
• Improve health workforce performance and productivity

36 National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
3.2. GUIDING PRINCIPLES

This strategic plan is guided by the following principles:

Principle Explanation

Country’s commitment To support actions that contribute to a sustainable health workforce

National HRH strategies should be harmonized with the relevant components of the health
System linkage
system and primary health care principles

Donor alignment Donor support should be coordinated and aligned with country HRH plans

Equity, accessibility and To ensure that all people, in all places, have access to skilled health workers who are
accountability equipped, motivated and supported

Results-oriented HRH strategies and actions aimed at achieving measurable outcomes

Multispectral engagement Involve all sectors and stakeholders including the community to build the health workforce

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016 37
CHAPTER 4:

STRATEGIC PLAN OUTCOMES,

OBJECTIVES AND ACTIONS

38 National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
OUTCOME 1: HRH LEGISLATION, PLANNING AND PARTNERSHIP
STRENGTHENED

This outcome addresses interventions aimed at strengthening HRH legislation and planning at the federal and
regional level so as to improve the HRH profile in respect to staffing, skills, distribution, retention and
performance. These interventions fall under the following five Strategic Objectives:

SO 1.1: Develop and implement appropriate HRH standards, guidelines and Legislative Frameworks
SO 1.2: Establish a comprehensive Human Resources Information System (HRIS) and strengthen data use
for decision-making
SO 1.3: Strengthen HRH Planning at all Levels
SO 1.4: Create a Gender Responsive and Healthy workforce
SO1.5: Engage diverse partners in National HRH dialogue and actions

SO 1.1: Develop and Implement Appropriate HRH Standards, Guidelines and Legislative
Frameworks

The following strategic Actions will be undertaken to support Strategic Objective 1.1

Strategic actions
3.2.1. Develop and implement across-the-board and profession-specific laws/code of ethics for all
health professions.
3.2.2. Apply relevant legislation to improve quality of pre-service education and in-service training.
3.2.3. Develop legislation and guidelines to support confidentiality and appropriate use of personal
information in HRH databases
3.2.4. Develop memorandums of understanding/guidelines on ethical recruitment and employment
of health professionals with major recipients countries
3.2.5. Improve availability and utilization of various HR legislation, procedures and guidelines

SO 1.2: Strengthen Human Resources Information system (HRIS) and Data use for decision-
making

A robust system to collect, organize and disseminate HR data from diverse geographical locations needs to be
put in place to generate current HRH information, and the capacity and motivation of health leaders and
managers should be developed to enhance evidence-based decision making. The following strategic actions will
support the establishment of a comprehensive HRIS:
National Human Resources for Health Strategic Plan 2016-2025. Sep 2016 39
Strategic Actions
1.2.1. Conduct functional assessment of existing HR information systems and develop plan of action
1.2.2. Strengthen human resources information systems (HRIS) for improved collection, storage, analysis and
use of health workers data.
1.2.3. Establish and/or strengthen national, sub regional and regional health workforce observatories.
1.2.4. Improve the infrastructure and increase availability of various equipment for HRIS
1.2.5. Assign staff to manage HRIS at various levels of the health system administration
1.2.6. Train system managers and HR staff to use the HRIS
1.2.7. Integrate the HRIS into the MOH’s data-warehouse (or existing HMIS)
1.2.8. Encourage use of HRIS for decision making by availing customized reports to stakeholders
1.2.9. Produce policy briefs on success stories in evidence-based HRH problem solving
1.2.10. Increase investment in HRH research capacity and disseminate results to all stakeholders to identify
health workforce requirements, trends and the effectiveness of interventions.
1.2.11. Explore, document and disseminate HRH related best practices at global, national and regional levels
1.2.12. Develop indicators for monitoring and evaluation of the health workforce within national health
services.

SO1.3: Strengthen HRH Planning at all Levels

The HRH planning capacity at the federal, regional and facility level has been very limited. This plan proposes
the following strategic actions to improve HRH planning.

Strategic Actions
1.3.1. Strengthen the planning capacity of the MoH and RHBs through knowledge and skill development
1.3.2. Develop annual HRH operational plans at federal and regional levels based on the National HRH
Strategic Plan
1.3.3. Institute an integrated monitoring and evaluation system that involves all relevant stakeholders.
1.3.4. Review and regularly update the Federal HRH strategic plan
1.3.5. Forge partnerships with government agencies, development partners and other stakeholders to
mobilize resources to support the development, implementation and review of HRH plans
1.3.6. Train facility managers and heads on methods of determining staffing needs such as Workload
Indicator for Staffing Need (WISN)
1.3.7. Update the national HRH requirement every five years using sound HRH projection methods

40 National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
SO 1.4: Create a Gender Responsive and Healthy workforce

It is imperative that Ethiopia invests in creating a gender balanced, responsive and healthy workforce to attract
and retain high performing health workers. This strategic objective will be supported by the following
strategic actions:

Strategic Actions
1.4.1. Build the capacity of health mangers and policy makers on gender analysis and integration as an
essential component of HRH program design, implementation and review
1.4.2. Create gender units/departments and recruit gender officers/focal persons at regional, health facility
levels as well as in training institutions
1.4.3. Provide support to public and private health professionals’ training institutions
1.4.4. Set gender equity indicators and targets, particularly for higher/senior level (leadership) positions and
training institutions
1.4.5. Introduce mechanisms that support gender equity including affirmative action
1.4.6. Introduce comprehensive occupational safety and health (OSH) programs including structures and
staffing
1.4.7. Ensure all health workers have access to HIV and wellness workplace programs.

SO 1.5: Engage diverse partners in National HRH Dialogue and actions

The development and implementation of the HRH Strategic plan is a collaborative endeavor that involves
different stakeholders. Actors other than the public sector also play important roles in shaping the HRH
agenda of the country. In Ethiopia, there are a number of private institutions that provide training of health
workers and also provide health services. The following strategic actions will support the effective engagement
of the private sector in the planning and management of the health workforce.

Strategic Actions

1.5.1. Develop the capacity of the MOH to track, negotiate, align, harmonize and coordinate
stakeholder/partner activities
1.5.2. Expand and strengthen HRH coordination mechanisms for all relevant stakeholders and partners in
order to facilitate policy dialogue on the HRH agenda at national, regional and local levels
1.5.3. Develop and/or strengthen appropriate public/private partnerships to ensure coherence of and
support for HRH plans
1.5.4. Facilitate South-South and North-South technical cooperation in HRH
1.5.5. Commit to predictable long-term aid flow to HRH in keeping with aid effectiveness agendas, and
invest in priority areas such as the production and employment of health workers to ensure
sustainable impact
National Human Resources for Health Strategic Plan 2016-2025. Sep 2016 41
1.5.6. Include diverse partners (health professional associations, NGOs, private, donors) in the HRH
Working Groups at the Federal and regional levels
1.5.7. Develop a common code of conduct governing the mobility of health workers between public and
private sector institutions
1.5.8. Introduce approaches for resource sharing between public and private institutions as it relates to HRH
(Service delivery and training)
1.5.9. Encourage the private sector to invest in the health sector and institute an incentive mechanism to
attract private health providers to disadvantaged areas or population groups

OUTCOME 2: HEALTH WORKFORCE EDUCATION AND TRAINING

CAPACITY AND REGULATION IMPROVED

This outcome addresses the issue of production of an adequate number of health workers with the right skill
mix, by creating a system for ensuring competency and continuous quality improvement of the health
workforce. It also addressing the issue of ensuring that after deployment, health workers have access to
quality and relevant in-service training and continuous professional development. Outcome 2 will be achieved
through the following strategic objectives:

SO 2.1: Strengthen Pre-Service education for the health workforce

SO 2.2: Strengthen In-Service Training and Continuing Professional Development for the health
workforce
SO2.3: Strengthen accreditation and regulation of training institutions and health professionals

SO 2.1: Strengthen Pre-Service Education for Health Workforce

The aim of this strategic objective is to increase the output, quality and relevance of priority cadres and hence
support improved staffing levels and increase the health worker to population density towards WHO
recommendations of 2.3 per 1000. The specific strategic actions are:

Strategic Actions
2.1.1 Support a shift to evidence-based curriculum and education models including but not limited to
outcomes-based, integrated, community-oriented, and active learning.
2.1.2 Reform existing undergraduate and post-graduate training programs into competency-based trainings
2.1.3 Establish a system to nurture public service ethics, professional values and social accountability in
health science students to create compassionate, respectful, and caring workforce.
2.1.4 Build the capacity of problem-based innovative medical education programs to continue training
physicians from a pool of bachelor of science holders
2.1.5 Develop and implement strategies to increase annual health professionals enrolment and output for
health cadres in critically short supply in line with MoH projections
2.1.6 Produce appropriate professionals for Emergency Medical Services consisting of Physician, Emergency
and Critical Care Nurses, Emergency Surgical Officer and Emergency Medical Technicians
2.1.7 Expand clinical specialty and subspecialty training programs and substantially increase the enrolment
capacity of training institutions
2.1.8 Produce family health teams to transform the household services of the Health Extension Program
(family physician, family health nurse, family midwife and other professionals)
42 National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
2.1.9 Introduce and scale-up nurse specialty training programs
2.1.10 Establish centres of excellence for pre-service training for various professional areas in all universities
2.1.11 Provide support for quality audits for all existing pre-service training programs (in public and private
institutions) to develop and implement evidence-based quality improvement interventions
2.1.12 Establish Health Science Education Development Centers in all public and private higher education
institutions with health programs to lead and coordinate internal quality assurance
2.1.13 Establish networking of practicum sites (public, private and affiliates) for quality health professional
training
2.1.14 Enhance capacity of higher education leadership to provide sustained support for health professionals’
training
2.1.15 Increase the number and capacity of faculty for improved quality of health professionals’ training
2.1.16 Strengthen the infrastructure for effective teaching by establishing skills labs, availing simulators,
providing information and communications technology (ICT) support, etc.
2.1.17 Increase awareness and skills of health care professional graduates in gender mainstreaming in the
health sector
2.1.18 Establish Alumni offices to support teaching-learning programs
2.1.19 Improve national and international networking and collaboration among the pre-service education
institutions
2.1.20 Establish platforms for collaborations among universities and regional health science colleges

SO 2.2: Strengthen In-Service Training and Continuing Professional Development for Health
Workforce
To support Strategic Objective 2.2, the following strategic actions are proposed:

Strategic actions
2.2.1. Develop need-based annual IST plans at national, regional, woreda, health facility and health training
institutions.
2.2.2. Ensure standardization and institutionalization of in-service trainings.
2.2.3. Support the establishment of in-service training centres with appropriate geographical coverage.
2.2.4. Establish ICT platforms to support delivery and management of in-service trainings.
2.2.5. Implement continuing professional development (CPD) programs linked to career advancement and
re-licensure to practice
2.2.6. Engage professional associations, academia and the private sector in providing CPD.
2.2.7. Create a system for regular communication between pre-service and in-service training programs
2.2.8. Establish and maintain a functional IST database that interfaces with HRIS at all levels

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016 43
SO2.3: Strengthen accreditation and regulation of education and training institutions and
health professionals

Health workers are expected to provide quality health care services to the community. Their competency and
compliance will be ensured through strengthened accreditation and licensing systems and practices.
Accreditation will be applied to public and private pre-service training institutions, in-service training centers,
practicum sites, training programs and in-service training materials. Graduates from the accredited institutions
and training programs will sit for National Licensing Examinations, and get registered and licensed to practice
by meeting required professional standards. The strategic actions are:

Strategic Actions

2.3.1 Establish and/or strengthen the capacity of national, sub regional and regional regulatory bodies to
harmonize practices and regulation between professions and across countries.
2.3.2 Promote the establishment of professional and regulatory bodies to support enforcement of laws and
regulations where they do not exist.
2.3.3 Strengthen the capacities of regulatory bodies to perform their roles of HRH accreditation and
regulation at national, sub regional and regional levels.
2.3.4 Support enforcement of HERQA accreditation and quality standards at all public and private health
sciences educational institutions
2.3.5 Conduct quality audits of existing pre-service training programs to develop and implement evidence-
based quality improvement interventions
2.3.6 Define and regularly update the scopes of practice for all health professionals and monitor compliance
2.3.7 Establish and enforce licensing examination to measure competence of new graduates for safe and
effective practice prior to entry to the health workforce
2.3.8 Establish database for accreditation of CPD providers, in-service training and National Licensing
Examination Centres.
2.3.9 Strengthen capacity of the regulatory agency for effective regulation of health professionals’ practices
2.3.10 Strengthen the capacities of national and regional professional associations such as public health,
medical, dental, pharmaceutical, nursing and midwifery associations.
2.3.11 Enforce further the regulation that seeks to minimize the adverse impact of uncontrolled
commercialization of health services delivery.

OUTCOME 3: HRH LEADERSHIP, GOVERNANCE AND HUMAN

RESOURCES MANAGEMENT CAPACITY AND PRACTICES ARE
STRENGTHENED
This outcome will be achieved through the implementation of the following strategic objectives:

SO 3.1: Improve HRH leadership and governance structure and capacity at all levels
SO 3.2: Strengthen HRM Function and Practices at MOH and Other levels

44 National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
SO 3.1: Improve HRH leadership and governance structure and capacity at all levels

This strategic objective aims to harness all that is required to make available appropriately skilled and high-
performing health workers in the right quantity where they are needed. This objective is required to increase
the domestic investment for sustainable financing of national health workforce plans including recruitment, and
to strengthen HRH management and leadership capacities. Strategic actions to achieve improved governance
and leadership are as follows:

Strategic Actions

3.1.1. Conduct assessments and identify gaps in leadership and governance for HRH at all levels
3.1.2. Develop leadership and governance structures at decentralized health levels
3.1.3. Strengthen institutional leadership and governance capacities at all levels 17
3.1.4. Develop, regularly update and implement comprehensive national HRH strategic plans reflecting the
road map in the context of broader health plans and the macroeconomic situation in the country
3.1.5. Increase domestic (public and private) investment in health workforce development and
administration
3.1.6. Improve effectiveness and efficient use of health-related resources to progress towards sufficient
and sustainable financing for HRH at national, regional and local levels
3.1.7. Ensure financial sustainability for HRH in collaboration with other relevant ministries, partners and
stakeholders including the community.
3.1.8. Carry out advocacy with and engage political leaders and relevant stakeholders in HRH policy and
legislation processes at country, regional and sub-regional levels

SO 3.2: Strengthen the HRM system and practices at MOH and Other levels

This strategic objective aims at creating a health workplace in which staff are supported to function optimally.
This objective will be achieved through the following strategic actions:

Strategic Actions

3.2.1. Professionalize the human resources development and administration function at all levels
3.2.2. Provide continuous HRM training to HR staff and line managers at all levels
3.2.3. Conduct periodic job analysis in order to regularly update HRH categories
3.2.4. Review and improve the implementation of a performance-based evaluation system

17Includingthe HRH units at Ministry of Health, RHBs, Woredas and health facilities, regulatory agencies and other sectors responsible for employment
and transfer of health workers.

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016 45
OUTCOME 4: UTILIZATION, RETENTION AND PERFORMANCE OF
AVAILABLE HEALTH WORKFORCE OPTIMIZED
This outcome will be achieved through the following strategic objectives:

SO 4.1: Improve health worker recruitment and deployment at all levels

SO 4.2: Reduce inequity in geographic distribution and skill mix of health care workers
SO 4.3: Enhance staff motivation and retention
SO 4.4: Enhance performance and productivity

SO 4.1: Improve Health Workers Recruitment and Deployment

It is expected that staffing requirements will be reviewed at appropriate intervals to reflect any major changes
in service standards, disease burden, workload, public expectation or other factors that have significant impact
on the health care delivery system. This HRH strategic plan aims at increasing the health professionals’ density
from the existing level of 1.5 to 2.3 per 1,000 populations by 2025. This will be achieved through the
implementation of the following strategic actions.

Strategic Actions

4.1.1. Optimize health workforce deployment to address equity of distribution and enhance performance
4.1.2. Strengthen orientation programs for newly recruited staff to provide them with clear roles and
expectations, guidelines, adequate work processes, and a suitable work environment.
4.1.3. Develop tools to support effective selection and recruitment including electronic recruitment (e-
recruitment)
4.1.4. Strengthen recruitment for scarce health professionals from outside sources such as the diaspora,
volunteers and retirees.

SO 4.2: Reduce inequity in geographic distribution and skills mix of health Workers

Health workforce geographic inequity and skills mix will be addressed through the following strategic actions.

Strategic Actions

4.2.1. Implement special support initiatives and enroll students from disadvantaged communities and remote
areas.
4.2.2. Build capacity of RHBS and woredas to identify locally appropriate factors that affect workforce
attraction and retention, develop strategies, and plan to recruit and deploy health professionals in
hard-to-reach geographic areas
4.2.3. Develop tailored remuneration and incentive packages in hard-to-reach areas (link with motivation
and retention)
4.2.4. Enforcing minimum compulsory public service to address shortages of health professionals and
inequity in geographic distribution
46 National Human Resources for Health Strategic Plan 2016-2025. Sep 2016
4.2.5. Develop a comprehensive strategy to raise awareness, change attitudes and increase commitment of
the health workforce to serve communities
4.2.6. Regularly review the needs and develop strategies/actions for task shifting to address critical shortage
of health professionals

SO 4.3: Enhance staff motivation and retention

Health workforce motivation and retention will be enhanced by implementing the following strategic actions:

Strategic Actions:

4.3.1 Design appropriate financial and non-financial motivation and retention incentives at all levels.
4.3.2 Create conducive work climate to enhance workforce retention and productivity
4.3.3 Increase opportunities for professional development and promotion
4.3.4 Undertake regular review of career structures for all health professionals
4.3.5 Conduct regular motivation and retention studies to assess the extent of the retention problem and
design motivation and retention mechanisms

SO 4.4: Enhance performance and productivity of health workforce

A competent and productive health workforce is very important to improve health outcomes of the Ethiopian
population. Health workers need to be trained and supported to plan for and meet performance expectations.
The strengthening of a system for participatory performance assessment, planning and improvement is a
critical component of this strategic Objective. The following strategic actions will be implemented to enhance
health workforce performance and productivity.

Strategic Actions:

4.4.1. Strengthen regular performance planning, monitoring and improvement programs for health care
workers at all levels
4.4.2. Conduct comprehensive work climate assessments and develop improvement programs at all levels of
health system
4.4.3. Conduct regular supportive supervision, mentorship and regular feedback at all levels
4.4.4. Strengthen the link between health professionals’ performance, professional development and career
promotion
4.4.5. Conduct regular productivity surveys for evidence-based decisions

National Human Resources for Health Strategic Plan 2016-2025. Sep 2016 47
 CHAPTER 5:
IMPLEMENTING THE HRH STRATEGIC
PLAN

48 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
5.1. THE IMPLEMENTATION APPROACHES

5.1.1. Coordination Mechanisms

The implementation of this HRH SP will require the support of multiple stakeholders at all levels. It is
therefore critical to establish coordinating mechanisms such as HRH working groups at the national and sub-
national levels.

The MOH will play an overall leadership role at the national level and support the development of regional
and facility level HRH strategic plans. Furthermore, detailed annual HRH work plans will be developed and
periodic review of the implementation of the HRH strategic plan will be conducted in order to continuously
refine the HRH needs of the health sector.

Key stakeholders involved in the implementation of HRH SP include:

 Ministry of Health
 Ministry of Education (MOE)
 HERQA
 Federal and regional TVET FMHACA
 Ethiopian Public Health Research
Institute
 Ministry of Public Service and HR
Development
 Ministry of Finance and Economic
Cooperation
 Health Sciences Education and Training
Institutions
 Regional Health Bureaus/Woreda
Health Offices/Health Facilities
 Health Professional Associations
 Private Sector
 Development Partners

National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 The implementation framework and key roles of each stakeholder is shown in the table below

Implementing
Roles and Responsibilities
Sector/Organization

• Provide overall leadership in the implementation of the SP

• Support regions in the development of their HRH plans
• Oversee monitoring and evaluation of the plan
MoH, FMHACA
• Registration, licensing and regulation of health facilities and professionals
• Provide support in HRH Operational planning
• Participate in performance management

• Job classification, grading and salary scale

• Regular review, development and dissemination of HRM legislation,
operational guidelines and procedure manuals
Ministry of Public Service and HR
• Strengthening performance management and reward for staff motivation and
Development
productivity
• Review and approve HR staffing standards; recruitment and deployment of
health workforce

• Develop and implement educational and training policies and strategies for
health workforce development
• Provide Pre-service education and training
MoE, Universities and HERQA
• Accreditation of Health Sciences Education Institutions and Programs
• Conduct quality audits of Health Training Institutions and recommend
improvement interventions

Regional Health Bureaus and • Recruitment and management of staff

Woreda Health Offices • Licensing of lower level health workers

Health Facilities • Day-to-day management of staff

• Provide accredited CPD courses and in-service training

• Participate in the development of curricula, quality improvement standards;
accreditation and quality audit visits; and development and implementation of
Health Professional associations
National Licensing Examinations
• Development and enforcement of professional codes of conduct
• Promotion of compassionate, respectful and caring professional practices

• Training of health workers

Private Sector
• Recruitment and management of health workers

50 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
5.2. IMPLEMENTATION MATRIX AND TIMELINES

The table below provides the implementation Matrix of the HRH Strategic Plan.

OUTCOME 1: HRH LEGISLATION, INFORMATION, PLANNING AND PARTNERSHIP STRENGTHENED AT ALL LEVELS
Implementation
Timeline
Strategic Objective Strategic Actions

2016/17

2018/19

2020/21

2022/23

2024/25
1.1.1 Develop and implement across-the-board and profession-specific laws/code of ethics for all
health profession

1.1.2 Apply relevant legislation to improve quality of pre-service education and in-service training.
SO 1.1: Develop and
implement an
appropriate HRH 1.1.3 Develop legislation and guidelines to support confidentiality and appropriate use of personal
standards, guidelines and information in HRH databases
legislative frameworks

1.1.4 Develop memorandums of understanding/guidelines on ethical recruitment and employment of

health professionals with major recipient countries/organizations

1.1.5 Improve availability and utilization of various HR legislation, procedures and guidelines

1.2.1. Conduct functional assessment of existing HR information systems and develop plan of action
SO1.2. Establish
Comprehensive, HRIS
1.2.2. Strengthen human resources information systems (HRIS) for improved collection, storage, analysis
and Strengthen Data use
and use of health workers data
for decision-making

1.2.3. Establish and/or strengthen national, sub regional and regional health workforce observatories.

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 51
 Implementation
Timeline
Strategic Objective Strategic Actions

2016/17

2018/19

2020/21

2022/23

2024/25
1.2.4. Improve the infrastructure and increase availability of various equipment for HRIS

1.2.5. Assign staff to manage HRIS at various levels of health system administration

1.2.6. Train system managers and HR staff to use the HRIS

1.2.7. Integrate the HRIS into the MOH’s data-warehouse (or existing HMIS)

1.2.8. Encourage use of HRIS for decision making by availing customized reports to stakeholders

1.2.9. Produce policy briefs on success stories in evidence-based HRH problem solving.

1.2.10. Increase investment in HRH research capacity and disseminate results to all stakeholders to
identify health workforce requirements, trends and the effectiveness of interventions

1.2.11. Explore, document and disseminate HRH related best practices at global, national and regional
levels

1.2.12. Develop indicators for monitoring and evaluation of the health workforce within national
health services.

1.2.13. Strengthen the planning capacity of the MoH and RHBs through knowledge and skill development
SO 1.3: Strengthen HRH
Planning at all Levels
1.2.14. Develop annual HRH operational plans at federal and regional levels based on the National

52 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Implementation
Timeline
Strategic Objective Strategic Actions

2016/17

2018/19

2020/21

2022/23

2024/25
HRH Strategic Plan

1.2.15. Institute an integrated monitoring and evaluation system that involves all relevant stakeholders

1.3.1. Review and regularly update the Federal HRH strategic plan

1.3.2. Forge partnerships with government agencies, development partners and other stakeholders to
mobilize resources to support the development, implementation and review of HRH plans

1.3.3. Train facility managers and heads on methods of determining staffing needs such as Workload
Indicator for Staffing Need (WISN)

1.3.4. Update the national HRH requirement every five years using sound HRH projection methods

1.4.1. Build the capacity of health mangers and policy makers on gender analysis and integration as an
essential component of HRH program design, implementation and review

SO 1.4: Create a Gender

Responsive and Healthy 1.4.2. Create a gender unit/department and recruit gender officers/focal persons at regional, health
workforce facility levels as well as in training institutions

1.4.3. Provide support to public and private health professionals’ training institution

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 53
 Implementation
Timeline
Strategic Objective Strategic Actions

2016/17

2018/19

2020/21

2022/23

2024/25
1.4.4. Set gender equity indicators and targets, particularly for leadership positions and training
institutions

1.4.5. Introduce mechanisms that support gender equity including affirmative action

1.4.6. Introduce comprehensive occupational safety and health (OSH) programs including structures
and staffing

1.4.7. Ensure all health workers have access to HIV and wellness workplace programs.

1.5.1. Develop the capacity of ministries of health to track, negotiate, align, harmonize and coordinate
stakeholder/partner activities.

1.5.2. Expand and strengthen HRH coordination mechanisms for all relevant stakeholders and partners
in order to facilitate policy dialogue on the HRH agenda at national, regional and local levels
SO 1.5: Engage in
diverse partners for
national HRH dialogue 1.5.3. Develop and/or strengthen appropriate public/private partnerships to ensure coherence of and
and actions support for HRH plans

1.5.4. Facilitate South-South and North-South technical cooperation in HRH.

1.5.5. Commit to predictable long-term aid flow to HRH in keeping with aid effectiveness agendas, and
invest in priority areas such as the production and employment of health workers to ensure
sustainable impact.

54 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Implementation
Timeline
Strategic Objective Strategic Actions

2016/17

2018/19

2020/21

2022/23

2024/25
1.5.6. Include diverse partners (NGOs, private, donors) in the HRH Working Groups at the Federal
and regional levels

1.5.7. Develop a common code of conduct governing the mobility of health workers between public
and private sector institutions.

1.5.8. Introduce approaches for resource sharing between public and private institutions as relates to
HRH (Service delivery and training)

1.5.9. Encourage the private sector to invest in the health sector and institute an incentive mechanism
to attract private health providers to disadvantaged areas or population groups.

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 55
 OUTCOME 2: HEALTH WORKFORCE EDUCATION AND TRAINING CAPACITY AND REGULATION IMPROVED
Implementation Timeline

Strategic
Strategic actions
Objective

2016/17

2018/19

2020/21

2022/23

2024/25
2.1.1 Support shift to evidence-based curriculum and education models including but not limited to outcomes-
based, integrated, community-oriented, and active learning

2.1.2 Reform existing undergraduate and post-graduate training programs into competency-based trainings

2.1.3 Establish a system to nurture public service ethics, professional values and social accountability in health
science students to create compassionate, respectful, and caring workforce
SO 2.1:
Strengthen
Pre-Service 2.1.4 Build the capacity of problem-based innovative medical education programs to continue training physicians
training of the from a pool of BSC holders
health
workforce

2.1.5 Develop and implement strategies to increase annual health professionals enrolment and output for health
cadres in critically short supply in line with MoH projections

2.1.6 Produce appropriate professionals for Emergency Medical Services consisting of Physician, Emergency and
Critical Care Nurses, Emergency Surgical Officer and Emergency Medical Technicians

2.1.7 Expand clinical specialty and subspecialty training programs and substantially increase the enrolment capacity
of training institutions

56 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Implementation Timeline

Strategic
Strategic actions
Objective

2016/17

2018/19

2020/21

2022/23

2024/25
2.1.8 Produce family health team to transform household services as part of the Health Extension Program (family
physician, family health nurse, family midwife and other professionals

2.1.9 Introduce and scale-up nurse specialty training programs

2.1.10 Establish centres of excellence for pre-service training for various professional areas in all universities

2.1.11 Provide support for quality audits for all existing pre-service training programs (in public and private
institutions) to develop and implement evidence-based quality improvement intervention

2.1.12 Establish Health Science Education Development Center in all public and private higher education institutions
with health programs to lead and coordinate internal quality assurance

2.1.13 Establish networking of practicum sites (public, private and affiliates) for quality health professional training

2.1.14 Enhance capacity of higher education leadership to provide sustained support for health professionals’
training

2.1.15 Improve the number and build capacity of faculty for improved quality of health professionals’ training

2.1.16 Strengthen the infrastructure for effective teaching by establishing skills labs, availing simulators, ICT etc.

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 57
 Implementation Timeline

Strategic
Strategic actions
Objective

2016/17

2018/19

2020/21

2022/23

2024/25
2.1.17 Increase awareness and skills of health care professional graduates in gender mainstreaming in health sector

2.1.18 Establish Alumni offices to support teaching-learning programs

2.1.19 Improve national and international networking and collaboration among the pre-service education
institutions

2.1.20 Establish platforms for collaboration between universities and regional health science colleges

2.2.1 Develop need-based annual IST plans at national, regional, woreda, health facility and health training
institutions
SO
2.2:Strengthen
2.2.2 Ensure standardization and institutionalization of in-service trainings
in-service
training and
continued
2.2.3 Support the establishment of in-service training centres with appropriate geographical coverage.
professional
development
for health
2.2.4 Establish ICT platforms to support delivery and management of in-service trainings.
workforce

2.2.5 Implement continuing professional development (CPD) programs linked to career advancement and re-
licensure to practice

58 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Implementation Timeline

Strategic
Strategic actions
Objective

2016/17

2018/19

2020/21

2022/23

2024/25
2.2.6 Engage professional associations, academia and the private sector in providing CPD.

2.2.7 Create a system for regular communication between pre-service and in-service training programs

2.2.8 Establish and maintain a functional IST database/interface with HRIS/ at all levels

2.3.1 Establish and/or strengthen the capacity of national, sub regional and regional regulatory bodies to
harmonize practices and regulation between professions and across countries.

2.3.2 Promote the establishment of professional and regulatory bodies to support enforcement of laws and
regulations where they do not exist.
SO 2.3: Expand
the Capacity of
Health 2.3.3 Strengthen the capacities of regulatory bodies to perform their roles of HRH accreditation and regulation
Training at national, sub regional and regional levels
Facilities

2.3.4 Support enforcement of HERQA accreditation and quality standards at all public and private health
sciences educational institutions

2.3.5 Conduct quality audits of existing pre-service training programs to develop and implement evidence-based
quality improvement interventions

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 59
 Implementation Timeline

Strategic
Strategic actions
Objective

2016/17

2018/19

2020/21

2022/23

2024/25
2.3.6 Define and regularly update the scopes of practice for all health professionals and monitor compliance

2.3.7 Establish and enforce licensing examination to measure competence of new graduates for safe and
effective practice prior to entry to the health workforce

2.3.8 Establish database for accreditation of CPD providers, in-service training and National Licensing
Examination Centres.

2.3.9 Strengthen capacity of the regulatory agency for effective regulation of health professionals’ practices

2.3.10 Strengthen the capacities of national and regional professional associations such as public health, medical,
dental, pharmaceutical, nursing and midwifery associations

2.3.11 Enforce further the regulation that seeks to minimize the adverse impact of uncontrolled
commercialization of health services delivery.

60 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
OUTCOME 3: HRH LEADERSHIP, GOVERNANCE AND MANAGEMENT CAPACITY AND PRACTICES ARE STRENGTHENED

Implementation Timeline

Strategic
Strategic actions
Objective

2016/17

2018/19

2020/21

2022/23

2024/25
3.1.1. Conduct assessments and identify gaps in leadership and governance for HRH at all levels

3.1.2. Develop leadership and governance structures at decentralized health levels

3.1.3. Strengthen institutional leadership and governance capacities at all levels

SO 3.1: Improve
HRH leadership and 3.1.4. Develop, regularly update and implement comprehensive national HRH strategic plans
governance reflecting the road map in the context of broader health plans and the macroeconomic
structure and situation
capacity at all levels
3.1.5. Increase domestic (public and private) investment in health workforce development and
administration

3.1.6. Improve effectiveness and efficient use of health-related resources to progress towards
sufficient and sustainable financing for HRH at national, regional and local levels

3.1.7. Ensure financial sustainability for HRH in collaboration with other relevant ministries,
partners and stakeholders including the community.

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 61
 3.1.8. Carry out advocacy with and engage top political leaders and relevant stakeholders in
HRH policy and legislation processes at country, regional and sub-regional levels

3.3.1. Professionalize the human resources development and administration function at all levels

SO 3.2: Strengthen 3.3.2. Provide need-based HRM training to HR staff and line managers at all levels
the HRM functions
at all levels
3.3.3. Conduct periodic job analysis in order to regularly update HRH categories

3.3.4. Review and improve the implementation of a performance-based evaluation system

OUTCOME 4: UTILIZATION, RETENTION AND PERFORMANCE OF THE AVAILABLE HEALTH WORKFORCE OPTIMIZED.
Implementation Timeline

2016/17

2018/19

2020/21

2022/23

2024/25
Strategic Objective Strategic Actions

4.1.1. Optimize health workforce deployment to address equity of distribution and

enhance performance

SO 4.1: Improve Health

Worker Recruitment and 4.1.2. Strengthen orientation programs for newly recruited staff to provide them with
Deployment for Higher clear roles and expectations, guidelines, adequate work processes, and a suitable
Staffing Levels work environment

4.1.3. Develop tools to support effective selection and recruitment including e-

recruitment

62 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Implementation Timeline

2016/17

2018/19

2020/21

2022/23

2024/25
Strategic Objective Strategic Actions

4.1.4. Strengthen system to recruit for scarce health professionals from outside sources
such as diaspora, volunteers and retirees.

4.2.1. Implement a special support initiative and enroll students from disadvantaged
communities and remote areas.

4.2.2. Build capacity of RHBs and woredas to identify locally appropriate factors that affect
workforce attraction and retention, develop strategies and plan to recruit and deploy
health professionals to hard-to-reach areas

4.2.3. Develop tailored remuneration and incentive packages in hard-to-reach areas (link
SO 4.2: Reduce Inequity in with motivation and retention)
Geographic Distribution and
skills mix of health Workers
4.2.4. Enforcing minimum compulsory public service to address shortages of health
professionals and geographic distribution

4.2.5. Develop a comprehensive strategy to raise awareness, change attitudes and increase
commitment of the health workforce to serve communities

4.2.6. Regularly review the needs and develop strategies/actions for task shifting to
address critical shortage of health professionals

SO 4.3: Enhance Staff 4.3.1 Design appropriate financial and non-financial motivation and retention incentives at
Motivation and Retention all levels.

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 63
 Implementation Timeline

2016/17

2018/19

2020/21

2022/23

2024/25
Strategic Objective Strategic Actions

4.3.2 Create conducive work climate to enhance workforce stability and productivity

4.3.3 Increase opportunities for professional development and promotion

4.3.4 Undertake regular review of career structures for all health professionals

4.3.5 Conduct regular motivation and retention studies to assess the extent of the
retention problem and design motivation and retention mechanisms

4.4.1. Strengthen regular performance planning, monitoring and improvement programs

for health care workers at all levels

4.4.2. Conduct comprehensive work climate assessments and develop improvement

SO 4.4: Enhance performance programs at all levels of health system
and productivity of Health
Workforce including improved
professionalism and 4.4.3. Conduct regular supportive supervision, mentorship and regular feedback at all
compassion to clients levels

4.4.4. Strengthen the link between health professionals’ performance, professional

development and career promotion

4.4.5. Conduct regular productivity surveys for evidence-based decisions

64 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
CHAPTER 6:
MONITORING AND EVALUATION

National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 6.1. MONITORING AND EVALUATION: INDICATORS AND MATRIX
Monitoring and evaluating the status and needs of the health workforce is a required to document progress in
implementing the HRH SP against its planned targets. A well-developed monitoring and evaluation plan should
contain indicators, baseline and performance targets, timeline, data sources and data collection tools; data
analysis and a dissemination plan.
Many HRH Strategic Plan M&E indicators were identified from published sources, mainly, Handbook on
monitoring and evaluation of human resources for health (2009) 18 developed by the World Health
Organization in collaboration with The World Bank and USAID, Health and Health Related Indicators and
Health Sector Transformation Plan (HSTP) by Federal Ministry of Health Ethiopia and The Compendium of
HRH M&E Indicators by USAID-funded CapacityPLUS Project 19. However, data on most of these indicators is
not available to determine the baseline value and set performance targets over the years. As a result, only
seven (7) indicators were selected, as summarized in Table 6.1.
Table 6.1. Monitoring and Evaluation Indicators for HRH SP

Performance

level to measure

Measurement
Target

Frequency of
Appropriate

(2015/16)
Baseline
Indicator 20 Descriptions Calculations Type

2020

2025
Numerator: Total
Health number of health
Professionals Total number of Professionals in 1.6 21
Impact

Density health public sector National

Annual 1.5 3
(Per 1000 professionals per Regional
population) 1000 population Denominator: Total 2.4 229
population of the
same countryX1000

Distribution of
N: Number of
HRH by
physicians, nurses
Output

occupation, National
Skills mix and midwives 23 Annual 44.7% 24 50% 50%
specialization or Regional
D: Total number of
other skill-related
health workers
characteristic

18
WHO (2009). Handbook on monitoring and evaluation of human resources for health: with special applications for low- and middle-income
countries / edited by Mario R Dal Poz … [et al].
19
Ibid #16
20 Ibid #17
21 Also a target in HSTP
22 Based on current projection
23 (or other categories of health service providers)
24MoH (2016): National Human Resources Data. May 2016 (Submission 4)
66 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Performance

level to measure

Measurement
Target

Frequency of
Appropriate

(2015/16)
Baseline
Type
Indicator 20 Descriptions Calculations

2020

2025
N: Number of
Distribution of health workers in
HRH by rural areas (or
geographical other

Output
Geographic National
location epidemiological, Annual N/A TBD TBD
distribution Regional
(Workforce administrative or
Density by the economic region)
Regions) D:Total number of
health workers

N: Number of
female (or male)
Output
Gender Distribution of National 45% 25
health Workers Annual 1:1 1:1
distribution HRH by sex Regional (F)
D: Total number of
health workers

N: Number of
graduates of health
Workforce professions
Ratio of entry to
Output

production or education National

the health Annual 38% 26 45% 26%
generation institutions in the Regional
workforce
ratio last year
D: Total number of
health workers

N: Number of
health workers who
Workforce Proportion exits left the active labor
Output

National
loss (attrition) from the health force in the last Annual 6.6 27 4 4
Regional
rate workforce year
D: Total number of
health workers

25 WHO (2010): Africa Health Workforce Observatory. Ethiopia Country Profile

26 An estimated number of 20,000 health professionals had entered the workforce every year between 2009 and2015. Based on the
projections an estimated number of 22,000 health professionals will enter the workforce between 2016 and 2020 while this number
will be 17,000 between 2021 and 2025.
27
Source: Health Sector Transformation Plan (2015/2016-2019/2020). However, based on the current projection it will reach 2.4 by 2020 and 3 by
2025
National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Performance

level to measure

Measurement
Target

Frequency of
Appropriate

(2015/16)
Baseline
Type
Indicator 20 Descriptions Calculations

2020

2025
N: Specific tasks
performed over a
given period (e.g.
ambulatory visits,
immunizations,
Relative number surgeries) by a given National

Output
Provider of specific tasks health service Regional
Annual N/A TBD TBD
productivity performed among provider Health
health workers D: Total number of Facility
specific tasks
performed over the
same period among
all health service
providers

These general indicators can provide valuable information on the number, placements (urban/rural, primary vs.
secondary facilities and management structures), professional qualifications (categories), and levels of
specialization and inter-professional proportion of the health workforce. Data on many of these general
indicators are available and relatively easy to measure annually by collecting HR data from the regional and
sub-regional levels.

On the other hand, the indicators can be measured at all levels of health system. However, for simplicity and
to avoid delays in decision-making, they should only be monitored at national and regional levels.

6.2. COMPREHENSIVE M&E MATRIX

Several HRH indicators could be selected from the sources referenced above, in line with the four strategic
outcomes and 14 Strategic Objectives contained in this National HRH Strategic Plan. However, it was found
to be extremely difficult to find appropriate data to determine baseline performance and set targets over the
years. To avoid the misunderstanding that National HRH SP is monitored/evaluated only by very few
indicators, several indicators were identified based on the strategic outcomes (strategic objective and actions)
and monitoring and evaluation matrix was developed (Annex B3).

6.3. MONITORING AND EVALUATION: APPROACHES

68 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
In addition to identifying suitable M&E indicators, a clear and systematic process should be in place to support
the practice. Thus, the MOH will set up mechanisms to continuously monitor the implementation of this SP
including the following:

• The MOH will create appropriate organizational structure, deploy staff and provide necessary training
in M&E of HR development and management in health sector.
• Conduct quarterly, semi-annual and annual assessments, supportive supervision and review meetings
at national and sub-national levels
• Design and conduct a formal mid-term evaluation of the plan in 2020; and an end term evaluation of
the plan will be carried out in 2025
• Commission special studies such as the retention study to track outcome and impact level HRH
indicators
• Disseminate the M&E findings to key stakeholders

National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 ANNEX A
CHAPTER 7: PROJECTIONS AND COSTING

A1. HEALTH FACILITY SCALE UP AND PROJECTIONS OF HEALTH

WORKFORCE
1.1. HEALTH FACILITY SCALE UP PLAN28
One of the major assumptions for health workforce projection is the pace of expansion of health facilities.
Based on the population norm approach (the health facility to population standard of the country), the
expected number of public health facilities by the year 2020 and 2025 was calculated and shown in Table
A1.1.
TABLE A1.1. POPULATION-BASED HEALTH FACILITIES EXPANSION IN 2015, 2020 AND 2025

End-line
Baseline year (2015) Mid-term (2020)
Standard

(2025)

Population Population
Population 90,142,000
102,486,220 116,520484

Functional Health Facilities as December 2015

Health Post 1:5,000 29 16,477 30 21,741 29,130

Health Center (Total) 1:25,000 3,542 31 3,792 4,224

Primary Hospital 1:100,000 153 32 820 874

General Hospital 1:1,500,000 54 102 117

Specialized Referral Hospital 1:5,000,000 20 26 33

Population Profile (2015: Urban=15,324,192 R=74,818,116; 2020: U= 20,497,244, R=81,988,796; 2025: U=29,130, 122, R=87,390, 365)

28
the population norm approach has been used in the One Health Tool (OHT)
29 The standard is 3000-5000 pple/HP; 15,000-25,000 for rural setting and assumed 40,000 pple/ HC in the urban settings; 60,000-100,000 pple/PH;
1,000,000-1,500,000 pple/GH and 3,500,000-5,000,000 pple/SH
30
MoH Annual Performance Report 2015
31
MoH Annual Performance Report 2015, Functional Health Centers as of 2015
32
Data on the number and categories of the hospitals came from Annual HR and Infrastructure Data collected by USAID-funded HRH Project.
Data collected between October and November 2015. All hospitals were functional at the time of data collection. Based on the population size and
standard, there should have been 748 Primary Hospitals by 2015. However, only 153 were functional and affects the actual number of PH is 2020
and 2025

70 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
The progress towards the proposed facility scale-up plan should be periodically reviewed as this will affect
the HR plan and training. Furthermore, based on the available stock and distribution of health professionals,
regular reviews and decisions should be made to strike a balance between task shifting and conventional
training categories.

The current projection is based on the assumption that there will be a full realization of the health facility
expansion plan. However, this might overestimate the HR requirement and distort the HR plan related to
training and deploying the health professional categories specifically designed to address local need through
innovative approaches such as Integrated Emergency Surgical Officers (IESO) and Health Officers (HO).

1.2. EXISTING STAFFING STANDARD FOR HEALTH FACILITIES

The existing staffing minimum norms/standards developed by FMHACA were reviewed and summarized as
a basis for the projection of health workforce needed during the development of the National HRH SP.
While the availability of the health workforce in the conventional (standard) HRH categories will continue
to improve over the period of this strategic plan, there will also be a continued investment in task shifting.
As the HRH landscape continues to improve, the health service packages that will be delivered through the
primary health care facilities will also be expanded. Therefore, highly trained health professionals such as
general practitioners, nurses, midwives, laboratory technologists, pharmacists and family physicians will be
deployed to the primary health care facilities. Similarly, health facility standards and staffing requirements
will be regularly reviewed. Table A1.3 shows existing staffing standards developed by FMHACA guidelines,
while other categories were also included and optimum numbers were estimated based on expert opinion.

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 71
 TABLE A1.3. MINIMUM STAFFING STANDARDS FOR THE GOVERNMENT-OWNED HEALTH
FACILITIES (BY FMAHACA)

Health Post

Specialized
Hospital

Hospital

Hospital
Primary

General
Center
Health
Occupational Group

Doctors and specialists

General Medical Practitioner 0 1 4 18 36

General Surgeon 0 0 0 3 5

Cardiothoracic Surgeon 0 0 0 0 1

Endocrine Surgeon 0 0 0 0 1

Gastrointestinal Surgeon 0 0 0 0 1

Maxiofacial Surgeon 0 0 0 0 1

Neurosurgeon 0 0 0 0 1

Pediatric Cardiac Surgeon 0 0 0 0 1

Pediatric Surgeon 0 0 0 0 1

Plastic & Reconstructive Surgeon 0 0 0 0 1

Transplant Surgeon 0 0 0 0 1

Emergency Medicine Specialist 0 0 0 0 1

Urosurgeon 0 0 0 0 1

Urologist 0 0 0 0 1

Vascular Surgeon 0 0 0 0 1

Forensic Medicine 0 0 0 0 2

Dermatopathologist 0 0 0 1 1

Dermatovenerologist 0 0 0 1 1

Family Physician 0 0 1 2 0

Internist 0 0 0 2 5

72 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Health Post

Specialized
Hospital

Hospital

Hospital
Primary

General
Center
Health
Occupational Group

Adult Endocrinologist 0 0 0 0 1

Adult Interventional Cardiologist 0 0 0 0 1

Cardiologist 0 0 0 1 2

Gastroenterologist 0 0 0 1 2

Hematologist 0 0 0 0 1

Infectious Disease Specialist 0 0 0 0 1

Intensivist 0 0 0 0 1

Nephrologist 0 0 0 1 2

Neurologist 0 0 0 1 3

Oncologist 0 0 0 2 3

Pulmonologist 0 0 0 0 1

Obstetrics and Gynecology Specialist 0 0 0 3 5

Oby/Gynecologists & Gynecologic Oncologist 0 0 0 0 1

Ob/Gynecologists and Perinatologist 0 0 0 1 1

Ob/Gynecologists and Urogynaecologist 0 0 0 0 1

Ophthalmologist 0 0 0 2 4

Cornea Specialist 0 0 0 0 1

Glaucoma Specialist 0 0 0 0 1

Pediatric Ophthalmologist 0 0 0 0 1

Retina Specialist 0 0 0 0 1

Optometrist 0 0 0 0 1

Orthopedic Surgeon 0 0 0 2 5

Pathologist 0 0 0 1 3

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 73
 Health Post

Specialized
Hospital

Hospital

Hospital
Primary

General
Center
Health
Occupational Group

Pediatrician 0 0 0 2 5

Pediatric Endocrinologist 0 0 0 0 1

Pediatric Hematologist 0 0 0 0 1

Pediatric Intensivist 0 0 0 0 1

Pediatric Neonatologist 0 0 0 0 1

Pediatric Nephrologist 0 0 0 0 1

Pediatric Neurologist 0 0 0 0 1

Pediatric Oncologist 0 0 0 0 1

Pediatric Cardiologist 0 0 0 0 1

Pediatric Endocrinologist 0 0 0 0 1

Radiologist 0 0 0 1 3

Clinical Psychologist 0 0 0 0 1

Psychiatrist 0 0 0 1 2

Addiction Psychiatrist 0 0 0 0 1

Child and Adolescent Psychiatrist 0 0 0 0 1

ENT Specialist 0 0 0 1 1

Medical Physicist 0 0 0 0 1

Dental Surgeon 0 0 0 1 3

Non-Physician Clinicians

IESO MSc 0 0 2 0 0

Health Officer BSc 0 2 4 0 0

Nurses

74 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Health Post

Specialized
Hospital

Hospital

Hospital
Primary

General
Center
Health
Occupational Group

Nurse MSc 0 0 0 1 3

Nurse professional 0 0 3 47 81

Family Health Nurse professionals 0 2 5 0 0

Neonatal nurse professional 0 0 0 4 8

Emergency & Critical care nurse professional 0 0 0 6 12

OR Nurse Professionals 0 0 2 10 24

Pediatrics Nurse professionals 0 1 2 10 24

Surgical Nurse professions 0 0 1 10 24

Oncology nurse professional 0 0 0 8 15

Geriatric Nurse Professionals 0 0 0 0 1

Nurse Diploma/Level IV 0 5 20 49 89

Midwives

Midwife professionals 0 1 2 8 16

Midwife Diploma/Level IV 0 2 4 10 10

Mental Health

Mental Health MSc 0 0 0 1 0

Clinical Psychologist MSc 0 0 0 1 1

Psychiatry Professionals BSc 0 0 1 4 8

Ophthalmic

Optometry Professionals BSc 0 0 0 1 1

Ophthalmic Nurse professionals BSc 0 0 1 1 0

Cataract surgery professionals BSc 0 0 1 0 0

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 75
 Health Post

Specialized
Hospital

Hospital

Hospital
Primary

General
Center
Health
Occupational Group

Dental

Dental professionals (BSc) 0 0 2 3 6

Dental Hygienist/Therapist (Diploma/Level IV) 0 1 0 0 0

Laboratory

Medical Laboratory technologist MSc 0 0 0 0 1

Medical Laboratory technology professionals 0 1 4 4 12

Medical Laboratory technicians Diploma/Level IV 0 2 3 20 10

Pharmacy

Clinical Pharmacy MSc 0 0 0 0 1

Radio-pharmacist (MSc) 0 0 0 0 1

Clinical Pharmacy professionals 0 0 2 7 10

Pharmacy technicians Diploma/Level IV 0 2 4 8 8

Physiotherapy and Rehabilitation

Physiotherapy MSc 0 0 0 0 1

Physiotherapy professionals 0 0 0 2 4

Prosthetics-Orthotics Professional 0 0 0 2 4

Prosthetics-Orthotics technician 0 0 0 4 2

Human Nutrition

Dietician/Human Nutrition MSc 0 0 0 0 1

Dietician/Human Nutrition Professionals 0 0 1 2 2

Radiography

Medical Radiography technology (MSc) 0 0 0 0 1

76 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Health Post

Specialized
Hospital

Hospital

Hospital
Primary

General
Center
Health
Occupational Group

Medical Radiography technology professional 0 0 1 2 4

Medical Radiography technician Diploma/Level IV

0 0 2 0 0

Audiometery

Audiometery Professional BSc 0 0 0 1 2

Audiometery Technician level IV 0 0 1 1 2

Speech & Language Pathology Professional 0 0 0 1 1

Health Extension

Health extension Worker (Rural) Level III & IV 2 0 0 0 0

Health extension worker (Urban) Level IV 0 16 0 0 0

Ambulance Paramedics

Emergency Medical Technicians Level III & IV 0 0 3 3 3

Other Health care workers

Environmental Health /Occupational health professionals 0 0 1 2 4

Social worker 0 0 0 2 2

Epidemiologist 0 0 0 0 0

Field Epidemiology MSc 0 0 0 0 0

Health Service managers (MPH) 0 0 0 1 1

Public Health MPH 0 0 0 0 0

M&E MSc 0 0 0 0 0

Health Informatics MSC 0 0 0 0 0

Health Informatics BSC 0 0 0 1 1

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 77
 Health Post

Specialized
Hospital

Hospital

Hospital
Primary

General
Center
Health
Occupational Group

Health Information Technician (HIT) level IV 0 1 2 4 8

Biomedical Engineers BSc 0 0 0 2 2

Biomedical Technician Diploma/Level IV 0 0 1 4 8

Mortuary theaterTechnician Level IV 0 0 0 2 4

Sterilization Technician Level IV 0 0 1 4 8

Maintenance technicians 0 1 2 5 10

Compliance Handling Officer 0 1 1 2 2

Reception/Archive 0 2 4 8 12

Runner and porter 0 0 2 4 8

Cleaners 1 5 15 30 40

HR Officers 0 2 5 10 15

Internal Auditors 0 0 0 1 1

Finance Officer /Accountant 0 1 2 4 6

Security/Guard 1 4 8 20 30

Gardener 0 1 2 6 10

1.3. BASELINE STOCK AND PROJECTIONS

The baseline health workforce data for the strategic plan was collected from all health facilities and
management structures in all National Regional States (9), 2 City Government as well as the Federal
Agencies, hospitals and institutions. In the base year (2016), the total health workforce was 211,678 out of
which 142,657 (68%) were health professionals of various categories. See Table B1.1, in the annex B,
below for details.

Population-based health facility projection was conducted and staffing needs of those health facilities were
developed based on population to health facility standards. Examples of population to health facility are
number of people estimated to access health services from a given health facility. For example, 1 health

78 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
post serves 3000-5000 people while 1 rural health centre serves 15,000-25,000 people 33. See Table A1.1.,
above for the total numbers of health facilities in 2015, 2020 and 2025, based on the country’s population
size for the corresponding years.

Subsequently, staffing needs were projected based on the MINIMUM staffing standards (Norms) for various
categories of public sector health facilities developed by FMHACA in 2012 (Table A1.3). For those
professional categories that were not included in the existing staffing standards (e.g. various categories of
medical subspecialties), experts’ opinion was used to estimate staffing needs by taking into account the
epidemiological and demographic trends in the coming decade from the base year (2015/2016).

The result of the HRH projection shows that the number of health professionals will progressively increase
to 233,422 by 2020 and 353,454 by 2025. The estimated health workforce by 2020 and 2025 is summarized
in the Table A1.4 below.

TABLE A1.4: THE EXISTING WORKFORCE AND PROJECTIONS FOR 2020 AND 2025

Projections
Actual number of
Professional Categories health workforce at
Base Year (2016) Mid-term End line
(2020) 2025

Medical Doctors, Specialists and subspecialists 5,411 14,684 24,101

Non-physician Clinicians (BSC & MSC) 9,746 14,144 21,850

Nurses (all categories) 50,604 85,580 127,299

Midwives 12,069 19,620 29,868

Mental Health Professionals 369 2,160 3,796

Ophthalmic and optometry 343 976 3,181

Dental 270 6,576 10,017

Medical Laboratory 8,870 15,076 23,375

Pharmacy 9,582 14,040 21,608

Anesthesia (all categories) 875 3,284 5,769

Physiotherapy and Rehabilitation 193 764 1,299

Dietician/Human Nutrition N/A 128 216

33
1 Urban Health Center to 40,000 people; 1Primary Hospital Serves 60,000-100,000; 1 General Hospital 1million to 1.5 million; 1 Specialized
Hospital services 3.5million to 5million people

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 79
 Medical Radiography 681 3,352 5,886

Audiometery N/A 1,124 1,940

Health Extension Workers (rural and urban) 42,310 49,186 61,586

Emergency Medical Technicians 353 2,724 4,821

Biomedical Engineering /Technology 224 1,036 1,823

Environmental Health, and Occupational Health

2,615 5,668 8,377
and safety Professionals

Health Informatics/Information technician 3,271 5,884 13,147

Public Health Professionals (all Categories) 336 1,484 2,538

Health Promotion & Public Health professionals

2,252 908 1,607
(all levels and categories)

Health Related/Health science Professionals 160 160 264

Total Number of Health Professionals 150,534 248,558 374,388

Administrative and support staffs

69,021 95,488 139,652
(Diploma,BSC,MSC)

Grand Total 219,555 344,046 514,020

Project Populations (2016) 92,486,008 102,486,220 116,520,486

Health Professionals Density (per 1000

1.63 2.43 3.21
population)

All Health Workforce/1000 (including admin

2.37 3.37 4.26
&support)

• The above table shows cumulative number summarized by the professional categories while Table
B1.5 contained detailed projections by professional Categories. Based on this table, the numeric
changes for some of the key health professional categories include:
• General medical practitioners will increase to 7,376 by 2020 and 15,676 by 2025
• Nurses (all categories), will increase to 85,580 by 2020, and 127,299 by 2025
• Midwives (all categories) will increase to 19,620 by 2020 and 29,686 by 2025
• Anesthesia professionals (all categories including anesthesiologists and anesthesia specialists)
will increase to 3,284 by 2020 and 5,769 by 2025

80 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
• In addition there will be a total of 96,346 management/administrative and support staff by 2020 and
this number will increase to 122,162 by 2025. The proportion of health professionals will remain
between 68-73% of the total health workforce. However, these projections need to be updated
regularly as more evidence becomes available that reflects both the feasibility of implementing the
SP and the changing health care needs. This will be accomplished with the help of the built-in
monitoring and evaluation procedures.

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 81
 A2. COSTING THE HRH STRATEGIC PLAN
• The National HRH SP was costed by using the HRH Module of the OneHealth Tool 34. Major cost
categories 1. Salary, Benefits and Incentives 2. Training and Capacity Development 3. HRH Program
Management/Operational Costs. Operational costs were also divided into HRH-specific operational
costs, training of HR staff, supervision and performance management, policy and planning among
others. Table A2.1 and Annex Table B2.1 show major and detailed costing, respectively.

A2.1. SALARIES AND BENEFITS OF HEALTH WORKFORCE

• Salary and benefits were estimated based on the assumption that the facilities’ scale up will proceed
as planned, and all the new and existing facilities will be staffed as per the minimum staffing
standard. This approach may potentially lead to overestimation of costs of salary and benefit as the
HRH requirement on which the cost estimation is based exceeds the HRH availability. Thus, it is
not generally useful to estimate a 10 years’ cost related to salary, rather it suffices to estimate the
yearly increase of the cost related to salaries and benefits. It is important to review the available
fiscal space –not just for the HR component but the overall flow of resources to the health sector
as HR is just one input.

A2.2. TRAINING AND CAPACITY DEVELOPMENT

• This category includes the costs for in-service training (IST) and continued professional
development (CPD). IST/CPD costs are estimated by calculating 10% of the current annual salary of
each category of HRH towards IST/CPD. In addition, IST/CPD for HR staff at national, regional and
local levels were estimated and included under program specific operational costs. On the other
hand, pre-service education costs are largely covered by the education sector and including this
into the cost estimate might unnecessarily inflate the overall cost on health sector. However, pre-
service education inputs from the health sector for such areas of training conducted by regional
health science colleges and hospital based residency programs should be estimated. Major costs
under this category include cost of establishing learning resource center (ICT + minor renovation),
faculty development (IST), establishing/strengthening quality assurance (QA) units, QA Training,
enhancing skill labs, availing e-readers (tablets) and post graduate training on medical education and
effective teaching. These elements were not specifically estimated as it requires extensive baseline
data and was therefore not included in this summary.

34
World Health Organization (WHO). OneHealthTool. Accessed from www.who.int/choice/onehealthtool/en/ .August 20/2016

82 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
Table A2.1: Major components and sub-components for HRH Strategic Plan budget
estimation

Year 2017-2020 2021-2025

Cost Category 1: Salaries, benefits and incentives

Health Facilities

Salaries 111,323,618,098.74 382,790,498,936.30

Benefits 11,566,207,883.81 41,601,638,192.49

Incentives 11,779,804,601.00 37,750,329,927.01

Total at Health Facility 134,669,630,584.03 462,142,467,055.81

Administrative Levels (Districts, Regional and National)

Salaries 3,719,331,577.80 9,005,631,298.79

Benefits 386,022,644.42 977,755,196.75

Incentives 0.00 0.00

Total Admin Levels 4,105,354,222.23 9,983,386,495.54

Total Salaries, Benefits and Incentives (at all levels) 138,774,984,806.25 472,125,853,551.35

Cost Category 2: Training and Capacity Development

2.1. In-service Training/CPD 9,546,347,412.77 26,091,577,348.30

2.2. Pre-service education N/A N/A

Total Training 9,546,347,412.77 26,091,577,348.30

Cost Category 3: HR Administration/Operational

3.1. HR staff (Program-specific HR personnel) costs 8,956,505,608.72 17,406,138,149.50

3.2. Training and CPD for HR Staff 95,216,014.81 185,043,495.77

3.3. Supportive Supervision (planning, coordination, 170,841.38 332,014.00

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 83
 visits)

3.4. Miscellaneous /Other Costs 35 134,686,434.70 261,750,596.89

Total HR Admin/ Operational 9,186,578,899.61 17,853,264,256.00

Grand Total: HRH Costs 157,507,911,118.62 516,070,695,156.20

35
Development and implementation of HR policy and procedures, design and review HR strategy and operational plans, HRH situation assessments
etc

84 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
ANNEX B: MISCELLANEOUS INFORMATION

B1. THE STOCK AND DENSITY OF HEALTH PROFESSIONAL IN 2015

In July 2016, the total health workforce (health professionals and management/support staff) was 210,640. Out of
the total, 142,657 were health professionals working in various health facilities and management structures. Table
B1.1, below shows the number, regional distribution and health professionals’ density (per1000 population) at
regional and national level in 2016. However, these figures show only the public sector health workers as data was
lacking for the private and non-government sectors.
TABLE A2.1: MAJOR COMPONENTS AND SUB-COMPONENTS FOR HRH STRATEGIC PLAN BUDGET
ESTIMATION 36

Ben-Gum

Gambella

Diredawa
Amhara

Oromia

SNNPR
Somali

Harari

Grand
Ababa
Tigrai

Addis

Total
Afar

142,657
27841

42888

27153

Health
9200

2731

4785

2594

1452

8783

1036
934
Professionals

92,486,008
21,053,520

34,738,308

18,737,633

3,368,563
5,158,112

1,789,549

5,579,183

457,914
947,408

421,070

234,747
Population

HP per 1000
1.8

1.5

1.3

1.2

0.9

2.7

1.4

3.4

4.0

2.6

2.3

1.5
Population
12,289

15,573

12,357

69,021
4,314

2,180

1,060

1,128

6,115
486

739

529

Other staffs**

Total Health
211,678
13,514

40,130

58,461

39,510

14,898
4,911

5,845

3,722

1,938

1,673

1,565

Workforce
by Region

*Total of RHBs, Federal Agencies, Hospitals and Institutions, Teaching Hospitals

** Supportive and administrative staffs (diploma, BSC, MSC

36
Data was collected from September- November 2015 and compilation Completed in July 2016
National Human Resources for Health Strategic Plan 2016-2025. September, 2016 85
TABLE B1.2 DETAILED PROJECTION OF HEALTH PROFESSIONALS DEMANDS OF HEALTH FACILITY EXPANSION, 2020 AND 2025

Health Post Staffing Standards

Specialized
Occupational Group Total Number Required by level [ (Estimated Total Health Total Number Required by level Total Health

Primary
Hospital

Hospital

Hospital
General
Health
Center
Number of HF of Each Category) X (Staffing Professionals [(Estimated Number of HF of Each Category) X Professionals
Standard)] (2020) (Staffing Standard)] (2025)

Year 2020 2025

116,520,486
Projected Population 102,486,220

Health Facility Categories HP HC PH GH SH HP HC PH GH SH

Estimated Number of health facilities by category ,612 820 68 20 24,969 6,554 1457 117 33 9,836
20,497

Medical Doctor Professionals (GP, Specialists and subspecialists)

General Medical
0 1 4 18 36 0 4,612 3,280 1,224 720 9,836 0 6,554 5,828 2106 1188 15,676
Practitioner

Dermatopathologist 0 0 0 1 1 0 0 - 68 20 88 0 0 - 117 33 150

Dermatovenerologist 0 0 0 1 1 0 0 - 68 20 88 0 0 - 117 33 150

Emergency/Critical care
0 0 0 1 2 0 0 - 68 40 108 0 0 - 117 66 183
medicine SP.

ENT Specialist 0 0 0 1 2 0 0 - 68 40 108 0 0 - 117 66 183

86 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Staffing Standards

Health Post

Specialized
Occupational Group Total Number Required by level [ (Estimated Total Health Total Number Required by level Total Health

Primary
Hospital

Hospital

Hospital
General
Health
Center
Number of HF of Each Category) X (Staffing Professionals [(Estimated Number of HF of Each Category) X Professionals
Standard)] (2020) (Staffing Standard)] (2025)

Year 2020 2025

116,520,486
Projected Population 102,486,220

Health Facility Categories HP HC PH GH SH HP HC PH GH SH

Family Physician 0 0 1 2 0 0 0 820 136 0 956 0 0 1,457 234 0 1,691

Forensic medicine 0 0 0 0 2 0 0 - - 40 40 0 0 - 0 66 66

Anesthesiologist 0 0 0 1 2 0 0 - 68 40 108 0 0 - 117 66 183

General Surgeon 0 0 0 3 5 - - 0 204 100 304 - - - 585 165 750

Cardiothoracic Surgeon 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Endocrine Surgeon 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Gastrointestinal Surgeon 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Maxiofacial Surgeon 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Neurosurgeon 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Pediatric Cardiac
0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33
Surgeon

Pediatric Surgeon 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 87
 Staffing Standards

Health Post

Specialized
Occupational Group Total Number Required by level [ (Estimated Total Health Total Number Required by level Total Health

Primary
Hospital

Hospital

Hospital
General
Health
Center
Number of HF of Each Category) X (Staffing Professionals [(Estimated Number of HF of Each Category) X Professionals
Standard)] (2020) (Staffing Standard)] (2025)

Year 2020 2025

116,520,486
Projected Population 102,486,220

Health Facility Categories HP HC PH GH SH HP HC PH GH SH

Plastic & Reconstructive

0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33
Surgeon

Transplant Surgeon 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Urosugeon 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Vascular Surgeon 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Trauma Surgeon 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Internist 0 0 1 1 2 0 0 820 68 40 928 0 0 1,457 117 66 1,640

Geriatric Medicine
0 0 0 1 1 0 0 - 68 20 88 0 0 - 117 33 150
Specialist

Adult Endocrinologist 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Adult Interventional
0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33
Cardiologist

Cardiologist 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

88 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Staffing Standards

Health Post

Specialized
Occupational Group Total Number Required by level [ (Estimated Total Health Total Number Required by level Total Health

Primary
Hospital

Hospital

Hospital
General
Health
Center
Number of HF of Each Category) X (Staffing Professionals [(Estimated Number of HF of Each Category) X Professionals
Standard)] (2020) (Staffing Standard)] (2025)

Year 2020 2025

116,520,486
Projected Population 102,486,220

Health Facility Categories HP HC PH GH SH HP HC PH GH SH

Endocrinologist 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Gastroenterologist 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Hematologist 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Infectious Disease
0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33
Specialist

Intensivist 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Nephrologist 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Neurologist 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Oncologist 0 0 0 1 1 0 0 - 68 20 88 0 0 - 0 33 33

Pulmonologist 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Interventional Radiation
0 0 0 0 3 0 0 - - 60 60 0 0 - 0 99 99
Therapist

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 89
 Staffing Standards

Health Post

Specialized
Occupational Group Total Number Required by level [ (Estimated Total Health Total Number Required by level Total Health

Primary
Hospital

Hospital

Hospital
General
Health
Center
Number of HF of Each Category) X (Staffing Professionals [(Estimated Number of HF of Each Category) X Professionals
Standard)] (2020) (Staffing Standard)] (2025)

Year 2020 2025

116,520,486
Projected Population 102,486,220

Health Facility Categories HP HC PH GH SH HP HC PH GH SH

Obstetrics and
0 0 0 2 2 0 0 0 136 40 176 0 0 - 234 66 300
Gynecology Specialist

Oby/Gynaecologist &
0 0 0 0 2 0 0 - - 40 40 0 0 - 0 66 66
Oncologist

Ob/Gyn and
0 0 0 0 2 0 0 - - 40 40 0 0 - 0 66 66
Perinatologist

Ob/Gyn and
0 0 0 0 2 0 0 - - 40 40 0 0 - 0 66 66
Urogynacologist

Ophthalmologist 0 0 0 1 1 0 0 - 68 20 88 0 0 - 117 33 150

Cornea Specialist 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Glaucoma Specialist 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Pediatric
0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33
Ophthalmologist

Retina Specialist 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

90 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Staffing Standards

Health Post

Specialized
Occupational Group Total Number Required by level [ (Estimated Total Health Total Number Required by level Total Health

Primary
Hospital

Hospital

Hospital
General
Health
Center
Number of HF of Each Category) X (Staffing Professionals [(Estimated Number of HF of Each Category) X Professionals
Standard)] (2020) (Staffing Standard)] (2025)

Year 2020 2025

116,520,486
Projected Population 102,486,220

Health Facility Categories HP HC PH GH SH HP HC PH GH SH

Orthopedic Surgeon 0 0 0 1 2 0 0 - 68 40 108 0 0 - 117 66 183

Pathologist 0 0 0 1 1 0 0 - 68 20 88 0 0 - 117 33 150

Pediatrician 0 0 0 1 3 0 0 - 68 60 128 0 0 - 117 99 216

Pediatric Endocrinologist 0 0 0 0 2 0 0 - - 40 40 0 0 - 0 66 66

Pediatric Hematologist 0 0 0 0 2 0 0 - - 40 40 0 0 - 0 66 66

Pediatric Intensivist 0 0 0 0 2 0 0 - - 40 40 0 0 - 0 66 66

Pediatric Neonatologist 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Pediatric Nephrologist 0 0 0 0 2 0 0 - - 40 40 0 0 - 0 66 66

Pediatric Neurologist 0 0 0 0 2 0 0 - - 40 40 0 0 - 0 66 66

Pediatric Oncologist 0 0 0 0 2 0 0 - - 40 40 0 0 - 0 66 66

Pediatric Cardiologist 0 0 0 0 2 0 0 - - 40 40 0 0 - 0 66 66

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 91
 Staffing Standards

Health Post

Specialized
Occupational Group Total Number Required by level [ (Estimated Total Health Total Number Required by level Total Health

Primary
Hospital

Hospital

Hospital
General
Health
Center
Number of HF of Each Category) X (Staffing Professionals [(Estimated Number of HF of Each Category) X Professionals
Standard)] (2020) (Staffing Standard)] (2025)

Year 2020 2025

116,520,486
Projected Population 102,486,220

Health Facility Categories HP HC PH GH SH HP HC PH GH SH

Addiction Psychiatrist 0 0 0 0 2 0 0 - - 40 40 0 0 - 0 66 66

Child and Adolescent

0 0 0 0 2 0 0 - - 40 40 0 0 - 0 66 66
Psychiatrist

Radiologist 0 0 0 2 0 0 - - 40 40 0 0 - 0 66 66

Dental Surgeon 0 0 0 2 4 0 0 - 136 80 216 0 0 - 234 132 366

Subtotal 0 4,612 4,920 2,652 2,500 14, 684 - 6,554 8,742 4,680 4,125 24,101

Non-physician Clinicians

Health Officer 0 2 4 0 0 0 9,224 3,280 - 0 12,504 0 3,108 5,828 0 0 18,936

Emergency Surgical
0 0 2 0 0 0 0 1,640 - 0 1,640 0 0 2,914 0 0 2,914
Officer ( MSC)

Subtotal 14,144 21,850

Nurses (all Categories)

92 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Staffing Standards

Health Post

Specialized
Occupational Group Total Number Required by level [ (Estimated Total Health Total Number Required by level Total Health

Primary
Hospital

Hospital

Hospital
General
Health
Center
Number of HF of Each Category) X (Staffing Professionals [(Estimated Number of HF of Each Category) X Professionals
Standard)] (2020) (Staffing Standard)] (2025)

Year 2020 2025

116,520,486
Projected Population 102,486,220

Health Facility Categories HP HC PH GH SH HP HC PH GH SH

Nurse MSc 0 0 0 1 3 0 - - 68 60 128 0 - - 117 99 216

Nurse Professional (BSc) 0 0 5 48 81 0 - 4,100 3,264 1620 8,984 0 - 7,285 5616 2673 15,574

Intensive care nurse

0 0 0 4 8 0 0 - 272 160 432 0 0 - 468 264 732
professional

Neonatology Nurse
0 0 3 1 2 0 0 2,460 8 40 2,568 0 0 4,371 117 66 4,554
Professionals

OR Nurse Professional 0 0 2 10 24 0 0 1,640 680 480 2,800 0 0 2,914 1170 792 4,876

Pediatrics Nurse
0 0 2 10 20 0 0 8,200 680 400 9,280 0 0 2,914 1170 660 4,744
Professional

Emergency & Critical

0 0 0 6 12 0 0 - 408 240 648 0 0 - 702 45 747
Care Nurse Professional

Family Nurse
0 2 5 0 0 - 9,224 4,100 - 0 13,324 - 13,108 7,285 0 0 20,393
Professional

Surgical Nurse
0 0 1 10 24 - - 820 680 480 1,980 - - 1,457 1170 792 3,419
Professional
National Human Resources for Health Strategic Plan 2016-2025. September, 2016 93
 Staffing Standards

Health Post

Specialized
Occupational Group Total Number Required by level [ (Estimated Total Health Total Number Required by level Total Health

Primary
Hospital

Hospital

Hospital
General
Health
Center
Number of HF of Each Category) X (Staffing Professionals [(Estimated Number of HF of Each Category) X Professionals
Standard)] (2020) (Staffing Standard)] (2025)

Year 2020 2025

116,520,486
Projected Population 102,486,220

Health Facility Categories HP HC PH GH SH HP HC PH GH SH

Oncology nurse
0 0 0 8 15 - - - 544 300 844 0 0 - 936 495 1,431
professional

Geriatric nurse
0 0 0 0 1 - 20 20 0 0 - 0 33 33
Professional - - -

Nurse Diploma 0 5 20 49 89 0 23,060 16,400 3,332 1780 44,572 0 32,770 29,140 5733 2937 70,580

Subtotal - 32,284 37,720 9,996 5,580 85,580 - 45,878 55,366 17,199 8,856 127,299

Midwives - -

Midwife Diploma (Level

0 2 4 0 0 0 9,224 3,280 - 0 12,504 0 3,108 5,828 0 0 18,936
IV)

Midwife professionals 0 1 2 8 16 0 4,612 1,640 544 320 7,116 0 ,554 2,914 936 528 10,932

Subtotal 19,620 29,868

Mental Health

94 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Staffing Standards

Health Post

Specialized
Occupational Group Total Number Required by level [ (Estimated Total Health Total Number Required by level Total Health

Primary
Hospital

Hospital

Hospital
General
Health
Center
Number of HF of Each Category) X (Staffing Professionals [(Estimated Number of HF of Each Category) X Professionals
Standard)] (2020) (Staffing Standard)] (2025)

Year 2020 2025

116,520,486
Projected Population 102,486,220

Health Facility Categories HP HC PH GH SH HP HC PH GH SH

Mental Health MSC 0 0 1 0 0 - - 820 - 0 820 - 1,457 0 0 1,457

-

Psychiatry Professional
0 0 1 4 8 0 - 820 272 160 1,252 0 1,457 468 264 2,189
(nurse) -

Clinical Psychologist 0 0 0 1 1 0 0 - 68 20 88 0 0 - 117 33 150

Subtotal - - 1,640 340 180 2,160 - - 2,914 585 297 3,796

Ophthalmic

Ophthalmic Nurse
0 0 1 1 0 0 - 820 68 0 888 0 1,457 117 0 1,574
Professional -

Optometry Professional 0 0 0 1 1 0 0 - 68 20 88 0 0 - 117 33 150

Cataract Surgery
0 0 1 0 0 0 0 - - 0 - 0 0 1,457 0 0 1,457
Professional

Subtotal 0 0 820 136 20 976 0 0 2914 234 33 3,181

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 95
 Staffing Standards

Health Post

Specialized
Occupational Group Total Number Required by level [ (Estimated Total Health Total Number Required by level Total Health

Primary
Hospital

Hospital

Hospital
General
Health
Center
Number of HF of Each Category) X (Staffing Professionals [(Estimated Number of HF of Each Category) X Professionals
Standard)] (2020) (Staffing Standard)] (2025)

Year 2020 2025

116,520,486
Projected Population 102,486,220

Health Facility Categories HP HC PH GH SH HP HC PH GH SH

Dental

Dental professionals 0 0 2 3 6 0 0 120 1,964 0 0 2,914 351 198 3,463

1,640 204

Dental
Hygienist/Therapist 0 1 0 0 0 0 4,612 - - 0 4,612 0 6,554 - 0 0 6,554
(Level IV)

Subtotal 6,576 10,017

Medical Laboratory - -

Medical Laboratory
0 0 0 1 1 0 - - 68 20 88 0 - - 117 33 150
Technologist (MSc)

Medical Laboratory
0 1 2 8 12 0 4,612 1,640 544 240 7,036 0 2,914 936 396 10,800
Professionals 6,554

Medical Laboratory
Technician(Diploma/Leve 0 1 3 10 10 0 4,612 2,460 680 200 7,952 0 6,554 4,371 1170 330 12,425
l IV)

96 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Staffing Standards

Health Post

Specialized
Occupational Group Total Number Required by level [ (Estimated Total Health Total Number Required by level Total Health

Primary
Hospital

Hospital

Hospital
General
Health
Center
Number of HF of Each Category) X (Staffing Professionals [(Estimated Number of HF of Each Category) X Professionals
Standard)] (2020) (Staffing Standard)] (2025)

Year 2020 2025

116,520,486
Projected Population 102,486,220

Health Facility Categories HP HC PH GH SH HP HC PH GH SH

Subtotal 0 9,224 4,100 1,292 460 15,076 - 13,108 7,285 2,223 759 23,375

Pharmacy

Clinical Pharmacy, MSc 0 0 0 0 1 0 - - - 20 20 0 - - 0 33 33

Radio pharmacist (MSc) 0 0 0 0 1 - - - - 20 20 - - - 0 33 33

Clinical Pharmacy
0 0 1 7 10 - 200 1,496 - 1,457 819 330 2,606
Professional - 820 476 -

Pharmacy Technician 0 2 4 0 0 0 9,224 3,280 - 0 12,504 0 13,108 5,828 0 0 18,936

Radio-pharmacist 0 0 0 0 4 0 0 - - 0 - 0 0 - 0 0 -

Subtotal - 9,224 4,100 476 240 14,040 - 13,108 7,285 819 396 21,608

Anesthesia Professionals

Anesthetist-Diploma
0 0 2 0 0 0 0 1,640 - 0 1,640 0 0 2,914 0 0 2,914
(Nurse)

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 97
 Staffing Standards

Health Post

Specialized
Occupational Group Total Number Required by level [ (Estimated Total Health Total Number Required by level Total Health

Primary
Hospital

Hospital

Hospital
General
Health
Center
Number of HF of Each Category) X (Staffing Professionals [(Estimated Number of HF of Each Category) X Professionals
Standard)] (2020) (Staffing Standard)] (2025)

Year 2020 2025

116,520,486
Projected Population 102,486,220

Health Facility Categories HP HC PH GH SH HP HC PH GH SH

Anesthesia Professional
0 0 1 6 10 0 0 820 408 200 1,428 0 0 1,457 702 330 2,489
(BSc)

Anesthesia Professional
0 0 0 2 4 0 0 - 136 80 216 0 0 - 234 132 366
(MSc)

Subtotal 0 0 2460 544 280 3,284 0 0 4371 936 462 5,769

Physiotherapy and
Rehabilitation

Physiotherapy (MSc) 0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

Physiotherapy
0 0 0 2 4 - - - 136 80 216 - - - 234 132 366
professionals

Prosthetics-Orthotics
0 0 0 2 4 - 0 - 80 216 - 0 - 234 132 366
Professional 136

Prosthetics-Orthotics
0 0 0 4 2 0 0 - 272 40 312 0 0 - 468 66 534
Technician

Subtotal 0 0 0 544 220 764 0 0 0 936 363 1,299

98 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Staffing Standards

Health Post

Specialized
Occupational Group Total Number Required by level [ (Estimated Total Health Total Number Required by level Total Health

Primary
Hospital

Hospital

Hospital
General
Health
Center
Number of HF of Each Category) X (Staffing Professionals [(Estimated Number of HF of Each Category) X Professionals
Standard)] (2020) (Staffing Standard)] (2025)

Year 2020 2025

116,520,486
Projected Population 102,486,220

Health Facility Categories HP HC PH GH SH HP HC PH GH SH

Dietician/Human
Nutrition

Dietician/Human
0 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33
Nutrition MSC

Dietician/Human
0 0 0 1 2 0 0 - 68 40 108 0 0 - 117 66 183
Nutrition Professional

Subtotal 0 0 0 68 60 128 0 0 0 117 99 216

Medical Radiography

Medical Radiography
0 0 0 1 2 0 0 - 68 40 108 0 0 - 117 66 183
Technologist (MSc)

Medical radiography
0 0 1 8 12 0 0 820 544 240 1,604 0 0 1,457 936 396 2,789
Professional

Medical Radiography
0 0 2 0 0 0 0 1,640 - 0 1,640 0 0 2,914 0 0 2,914
Technician (Dip.Level IV)

Subtotal 0 0 2,460 612 280 3,352 - - 4,371 1,053 462 5,886

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 99
 Staffing Standards

Health Post

Specialized
Occupational Group Total Number Required by level [ (Estimated Total Health Total Number Required by level Total Health

Primary
Hospital

Hospital

Hospital
General
Health
Center
Number of HF of Each Category) X (Staffing Professionals [(Estimated Number of HF of Each Category) X Professionals
Standard)] (2020) (Staffing Standard)] (2025)

Year 2020 2025

116,520,486
Projected Population 102,486,220

Health Facility Categories HP HC PH GH SH HP HC PH GH SH

Audiometery and Speech

Therapy

Audiometry
0 0 0 1 2 - 0 68 40 108 - - 117 150
professionals (BSc) - - 33

Audiometery Technician
0 0 1 1 2 0 0 820 68 40 928 - 117 1,640
(Level IV) - 1,457 66

Speech and language

0 0 0 1 1 0 0 0 68 20 88 - - 117 150
pathology professional - 33

Subtotal - - 820 204 100 1,124 - - 1,457 351 132 1,940

Health Extension
Workers

Health Extension
2 0 0 0 0 0 0 40,994 0 - 0 0 49,938
Workers (Rural) 40,994 - - 49,938

Health Extension
0 16 0 0 0 - 8,192 - - 0 8,192 - - 0 0 11,648
Workers (Urban) 11,648

Subtotal 49,186 61,586

100 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Staffing Standards

Health Post

Specialized
Occupational Group Total Number Required by level [ (Estimated Total Health Total Number Required by level Total Health

Primary
Hospital

Hospital

Hospital
General
Health
Center
Number of HF of Each Category) X (Staffing Professionals [(Estimated Number of HF of Each Category) X Professionals
Standard)] (2020) (Staffing Standard)] (2025)

Year 2020 2025

116,520,486
Projected Population 102,486,220

Health Facility Categories HP HC PH GH SH HP HC PH GH SH

40,994

Emergency Medical
Technicians

Emergency Medical
0 0 3 3 3 0 - 2,460 204 60 2,724 0 - 4,371 351 99 4,821
Technicians

Environmental Health, and Occupational Health and safety Professionals

Occupational Health &

0 0 0 0 3 0 0 - - 60 60 0 0 - 0 99 99
Safety Professional

Environmental Health
0 1 1 2 2 0 4,612 820 136 40 5,608 0 6,554 1,457 234 66 8,311
Professional

Subtotal 5,668 8,410

Health Information
Professionals

Health Informatics 0 0 0 1 0 0 - - 20 20 0 0 - 0 33 33

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 101
 Staffing Standards

Health Post

Specialized
Occupational Group Total Number Required by level [ (Estimated Total Health Total Number Required by level Total Health

Primary
Hospital

Hospital

Hospital
General
Health
Center
Number of HF of Each Category) X (Staffing Professionals [(Estimated Number of HF of Each Category) X Professionals
Standard)] (2020) (Staffing Standard)] (2025)

Year 2020 2025

116,520,486
Projected Population 102,486,220

Health Facility Categories HP HC PH GH SH HP HC PH GH SH

Specialist

Health Information
0 1 2 4 8 0 4,612 820 272 160 5,864 0 6,554 5,828 468 264 13,114
Professionals/Technician

Subtotal 5,884 13,147

Public Health
Professionals

Health Care and Service

0 0 0 0 1 0 0 20 20 0 0 - 0 33 33
managers - -

Public Health Specialist

0 0 0 0 1 0 0 20 20 0 0 - 0 33 33
Generalist - -

Field Epidemiologist
536 865
(MSC)

Chief Executive Officer

0 0 1 1 1 0 0 820 68 20 908 0 0 117 33 1,607
(CEO) 1,457

Subtotal 1,484 2,538

102 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Staffing Standards

Health Post

Specialized
Occupational Group Total Number Required by level [ (Estimated Total Health Total Number Required by level Total Health

Primary
Hospital

Hospital

Hospital
General
Health
Center
Number of HF of Each Category) X (Staffing Professionals [(Estimated Number of HF of Each Category) X Professionals
Standard)] (2020) (Staffing Standard)] (2025)

Year 2020 2025

116,520,486
Projected Population 102,486,220

Health Facility Categories HP HC PH GH SH HP HC PH GH SH

Health related/health sciences Professionals

Medical Physicist 0 0 0 0 4 0 0 - - 80 80 0 0 - 0 132 132

Nuclear Medicine
0 0 0 0 4 0 - - 80 80 0 0 - 0 132 132
Technician -

Subtotal 160 264

Biomedical
Engineers/tech

Biomedical
0 0 2 3 4 0 0 1,640 204 80 1,924 0 0 351 132 3,397
Engineers/tech 2,914

Subtotal 1,924 3,397

Subtotal (Health
248,538 374,368
Professionals)

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 103
B3. DETAILED COSTING

Year 2017 2018 2019 2020 2021 2022 2023 2024 2025 Total

Health
Facilities

Salaries 17,056,109,369.68 23,010,055,018.60 30,626,559,941.40 40,630,893,769.06 49,891,357,348.02 60,929,166,224.98 74,086,817,960.69 89,706,234,406.59 108,176,922,996.03 494,114,117,035.04

Benefits 1,739,721,935.19 2,370,429,711.76 3,186,504,866.46 4,269,551,370.39 5,295,000,988.04 6,531,030,599.78 8,020,663,894.75 9,808,575,174.43 11,946,367,535.49 53,167,846,076.30

Incentives 1,796,761,842.71 2,454,410,415.84 3,258,529,776.19 4,270,102,566.74 5,185,247,536.13 6,222,986,087.21 7,397,829,689.84 8,724,388,001.58 10,219,878,612.26 49,530,134,528.49

Total at Health
20,592,593,147.59 27,834,895,146.20 37,071,594,584.05 49,170,547,706.19 60,371,605,872.19 73,683,182,911.97 89,505,311,545.27 108,239,197,582.60 130,343,169,143.78 596,812,097,639.83
Facility

Administration :
Districts Level

Salaries 292,036,117.33 351,775,025.49 422,671,160.66 511,036,748.15 581,125,438.16 660,826,792.01 751,459,186.53 854,521,813.96 971,719,480.75 5,397,171,763.03

Benefits 29,790,604.33 36,243,416.05 43,983,330.47 53,710,475.83 61,687,636.26 70,849,576.53 81,372,261.91 93,457,792.31 107,338,283.81 578,433,377.51

Incentives 0 0 0 0 0 0 0 0 0 0

Total District levels 321,826,721.66 388,018,441.54 466,654,491.13 564,747,223.98 642,813,074.43 731,676,368.54 832,831,448.44 947,979,606.27 1,079,057,764.56 5,975,605,140.55

104 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
Administration:
Regional Level

Salaries 360,715,800.99 434,503,825.24 522,072,980.80 631,219,972.50 717,791,791.73 816,236,935.96 928,183,831.73 1,055,484,244.25 1,200,243,908.35 6,666,453,291.54

Benefits 36,796,618.86 44,766,972.57 54,327,123.73 66,341,853.49 76,195,045.09 87,511,647.47 100,509,008.62 115,436,757.35 132,581,597.71 714,466,624.89

Incentives 0 0 0 0 0 0 0 0 0 0

Total Regional 397,512,419.85 479,270,797.81 576,400,104.53 697,561,825.99 793,986,836.81 903,748,583.43 1,028,692,840.35 1,170,921,001.60 1,332,825,506.05 7,380,919,916.43

Administration:
National Levels

Salaries 35,784,395.65 43,104,451.63 51,791,648.86 62,619,450.49 71,207,708.12 80,973,845.29 92,079,408.17 104,708,099.00 119,068,814.78 661,337,822.00

Benefits 3,650,366.20 4,441,055.96 5,389,459.75 6,581,367.18 7,558,841.70 8,681,492.21 9,970,880.46 11,451,770.58 13,152,604.73 70,877,838.77

Incentives 0 0 0 0 0 0 0 0 0 0

Total National 39,434,761.85 47,545,507.59 57,181,108.61 69,200,817.67 78,766,549.83 89,655,337.50 102,050,288.63 116,159,869.58 132,221,419.51 732,215,660.78

Total Salaries,
Benefits, Incentives 21,351,367,050.95 28,749,729,893.14 38,171,830,288.33 50,502,057,573.83 61,887,172,333.26 75,408,263,201.44 91,468,886,122.70 110,474,258,060.05 132,887,273,833.89 610,900,838,357.59
(at all levels)

Training

In-service Training 1,609,061,661.01 2,058,853,927.54 2,601,094,087.64 3,277,337,736.59 3,824,589,268.84 4,440,216,685.75 5,133,778,048.59 5,911,806,026.46 6,781,187,318.65 35,637,924,761.07

Pre-service
0 0 0 0 0 0 0 0 0 0
education

Total Training 1,609,061,661.01 2,058,853,927.54 2,601,094,087.64 3,277,337,736.59 3,824,589,268.84 4,440,216,685.75 5,133,778,048.59 5,911,806,026.46 6,781,187,318.65 35,637,924,761.07

HR
Administration/Oper
ational

Program-specific HR 1,801,532,407.07 2,066,717,977.40 2,364,991,212.52 2,723,264,011.74 2,949,294,924.71 3,194,086,403.46 3,459,195,574.95 3,746,308,807.67 4,057,252,438.71 26,362,643,758.22

Training 19,151,971.07 21,971,141.22 25,142,064.12 28,950,838.39 31,353,757.98 33,956,119.89 36,774,477.85 39,826,759.51 43,132,380.55 280,259,510.58

Supervision 34,363.43 39,421.73 45,111.16 51,945.06 56,256.50 60,925.79 65,982.63 71,459.18 77,390.30 502,855.77

General Prog. Mgt 0 0 0 0 0 0 0 0 0 0

Other Costs 27,091,143.30 31,078,959.59 35,564,342.66 40,951,989.15 44,351,004.25 48,032,137.60 52,018,805.02 56,336,365.83 61,012,284.20 396,437,031.59
National Human Resources for Health Strategic Plan 2016-2025. September, 2016 105
Total HR
Administration/Oper 1,847,809,884.88 2,119,807,499.93 2,425,742,730.46 2,793,218,784.33 3,025,055,943.43 3,276,135,586.74 3,548,054,840.44 3,842,543,392.19 4,161,474,493.75 27,039,843,156.16
ational

Grand Total: HRH

24,808,238,596.84 32,928,391,320.62 43,198,667,106.42 56,572,614,094.75 68,736,817,545.53 83,124,615,473.93 100,150,719,011.73 120,228,607,478.71 143,829,935,646.29 673,578,606,274.82
Costs

ANNEX B3. A COMPREHENSIVE MONITORING AND EVALUATION MATRIX

A comprehensive framework, that also includes the basic HRH indicators, and selected indicators per outcome areas are necessary to
monitor the progress of HRH interventions as laid in the strategic plan. The tables below give the indicators, baselines and performance
targets for the HRH strategic plan. The 2025 targets will be set later based on evaluation findings and any changes in the focus of the plan in
later years.

Outcome 1 Indicators: HRH Policy, Planning and partnership Strengthened at all levels

Performance
Base Relevant level
Targets Frequency
Indicators Description Method of Calculation Year for the indicator Source of Data
Measurement
(2015) Measurement
2020 2025

Outcome 1: HRH Policy, Planning and partnership strengthened

Strategic Objective 1.1: Develop and implement an appropriate HRH standards, guidelines and Legislative Frameworks

Presence of a current,
comprehensive,
Interviews at
strategic national HRH
M o H level;
plan to outline policies, Every 5
National HRH plan Yes/No 1 N/A N/A MoH observations
laws, and regulations for Years
&documentation
the health work force in
review
alignment with country
needs

106 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Performance
Base Relevant level
Targets Frequency
Indicators Description Method of Calculation Year for the indicator Source of Data
Measurement
(2015) Measurement
2020 2025

Number (%) of Numerator: Regional

Regional Health Health Bureaus who have Supportive
Bureaus/City HRH SP in place
Regional HRH SP 7 11 Regional Supervision and Annual
Governments who have 0
Denominator: All RHBs review meetings
a comprehensive HRH
SP in place (11)

% of HR Support
Process (Units) with
access to Civil Service
proclamation and
%of HR Support other relevant policy Numerator: No. of HR HRIS,
Process who have all and procedure Support Process with
manuals that cover a access to detailed HR MoH, RHBs, Periodic
HR policy and
wide range of staffing manual for current job Zonal and Assessments
Procedure Manuals in
norms, including work N/A TBD TBD Woreda levels, during Annual
place
ethics, leave and rest, Health Facility Supportive
(Disaggregated by the safety, career Denominator: Total no. of Supervision or
(All)
RHB, Zones/Woredas development, HR Support Process other regular
and Health Facilities) workplace violence Assessed x100 surveys
and gender
discrimination,
grievance processes,
and terms of service

%ofhealthworkerswithcl % of health workers with Numerator:No.ofhealthwo

All Levels Semi-
inical/servicemanuals,g access to updated rkerswithreadyaccesstocli
annual/Annua
uidelines,and/orprotoco manuals,guidelines,and nical/servicemanuals,guid

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 107
 Performance
Base Relevant level
Targets Frequency
Indicators Description Method of Calculation Year for the indicator Source of Data
Measurement
(2015) Measurement
2020 2025

lsavailable protocolsthatorientandg elines,orprotocolsforcurre l

uidetheircurrentclinical/s ntjob
ervicefunctions,andareb Denominator:Totalno.ofhe
asedonaccepted(e.g.,W althworkersinterviewedx1
HO)bestpractices 00

SO 1.2: Strengthen HRH Planning at all Levels

Numerator: No. of health

workers (by cadre) HRIS
Total numbers of skilled
Stock(and density)of Denominator: Total Surveys and
health workers relative MoH and RHBs Annual
HRH population(in country, populationc
to population
region, or district) ensus
x10,000population

Vacancy rates Numerator: Total no.of

% of HRH unfilled HRH positions by
(Disaggregated by positions that level All Levels HRIS Annual
management levels have not been
and health facility filled Denominator: Total no.of
levels) positions by level

SO 1.3:Create a Gender Responsive and Healthy workforce

108 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Performance
Base Relevant level
Targets Frequency
Indicators Description Method of Calculation Year for the indicator Source of Data
Measurement
(2015) Measurement
2020 2025

Numerator: No.of
female(or male)
Sex distribution of healthworkers
% of HRH by sex All levels HRIS Annual
healthworkers
Denominator: Total no.of
health workers x 100

SO1.4: Engage diverse partners in National HRH Dialogue

Existence or extent to
which a partnership of
country-level HRH
stakeholders (e.g.,
Structured
Existence or stakeholder leadership
strength of an Yes/No (for existence) interviews at
group or technical
HRH stakeholder government/Mini Semi-annual
working group)
leadership group MoH and RHBs stry of Health (RHBs),
operates, meets
Ordinal scale (1-10), level; Annual (MoH)
(e.g. National and regularly, enacts policy
capacity/quality documentation
Regional HRH Forum) or makes policy
review
recommendations to
senior management
within the Ministry of
Health

SO 2.1: Strengthen Pre-Service education for health workforce

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 109
 Performance
Base Relevant level
Targets Frequency
Indicators Description Method of Calculation Year for the indicator Source of Data
Measurement
(2015) Measurement
2020 2025

Numerator: No.of dropout

%ofstudents(byschool,c students(by Schoolrecords,n
adre,gender,socioecono characteristics) ationalMinistryof
School attrition miccharacteristics,reaso
Denominator: Total no.of Health,Ministryof
(dropout)rate n)whodrop out from
students who Educationregistri
school by end of first
registered/startedprogram es
and last program year 37
x100

SO 2.2: Strengthen In-Service Training and Continuing Professional Development for health workforce

%ofhealthworkerswhoh
avereceivedin- Numerator: No. of health
servicetraining(allforms) workers receiving in-
service training HRIS,
basedonperformanceas
documentation
In-service training sessments,taskanalysis, Denominator:Totalno.ofhe All levels
review, facility
ordevelopmentneedsatl althworkersbyposition,cad assessments
eastonceevery3- re,andfacility/workplacex1
5years,bycadre,location 00
,andtypeoftraining

SO2.3: Strengthen accreditation and regulation of training institutions and health professionals

37“Reason”includesfailuretopass,personal/family,absenteeism,etc.

110 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Performance
Base Relevant level
Targets Frequency
Indicators Description Method of Calculation Year for the indicator Source of Data
Measurement
(2015) Measurement
2020 2025

HRIS,recordsfro
mprofessionallic
Numerator:No.ofcertified/li ensingbodies,fro
%ofhealthworkersprofes censedhealthprofessional
Registration and mHRHinformatio
sionallycertified/licensed s(bycharacteristics)
licensure of health MoH and RHBs nsystems(Minist
,percadre,nationality,an
workers Denominator: Total ryofHealth,
dothercharacteristics
number of health workers private/NGOs/fai
th-based
organizations)

SO 3.1: Strengthen the HRM Function and Practices at MOH and Other levels

Numerator: No of HR
% of HR Leaders with Bachelor’s
Professionalizing HR Leaders/Managers who or Master’s Degree HRIS, Annual
Leadership (HRM have Bachelor/Master’s
Denominator: Total Data Collection
Function) Degree in HRH
Management 38 Number of HR
Leadership Positions

SO 3.2: Establish a Comprehensive, Sector-Wide Human Resources Information System (HRIS) and Strengthen Data use for decision-making

38Example, MPH in HRH Management or Equivalent

National Human Resources for Health Strategic Plan 2016-2025. September, 2016 111
 Performance
Base Relevant level
Targets Frequency
Indicators Description Method of Calculation Year for the indicator Source of Data
Measurement
(2015) Measurement
2020 2025

Extent to which the

government has an
information system that
collects and maintains
data on public sector
staffing vacancies, Structured
staffing needs, and interview,
Existence of a human employment actions Yes/NO for existence
document
resources information (e.g., deployments, Ordinal scale (1-10), for review,
system (HRIS) transfers, promotions, quality/capacity of HRIS observation
leave, disciplinary
actions, performance
evaluations, exits) and
status of health workers
within the country by
cadre, region, and
facility

SO 4.1: Improve health worker recruitment and deployment at all levels

Extent to which health Special

workforce recruitment interviews (with
Effectiveness (and strategies exist and are applicants and
transparency) of health implemented to attract National/Region recently Annual
qualified graduates and Ordinal scale (1-10)
workforce recruitment al employed (index)
strategies professionals to fill workers),
vacant health worker document
positions (especially in review
rural, remote, and

112 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Performance
Base Relevant level
Targets Frequency
Indicators Description Method of Calculation Year for the indicator Source of Data
Measurement
(2015) Measurement
2020 2025

underserved areas) and

utilize standard and
transparent practices
including equal
opportunity

Special
interviews (with
Average number of applicants and
Efficiency of days an employee Mean value in terms of National recently Annual
recruitment spends to complete the days spent /Regional employed (index)
hiring process 39 workers),
document
review

SO 4.2: Reduce inequity in geographic distribution and skill mix of health care Workers

Number or Numerator:No.ofhealthwo Semi-

Geographical Percent of health rkersinruralareas(orbyoth annual
ercharacteristics) National and ®
Distribution of health workers by HRIS
Regional
workforce administrative Denominator:Total no.of
region health workers 40
Annual

39
as measured by the time spent by a health professional applicant between the first day of his/her application and the date s/he receives the first salary
40 Foranillustrative viewoftheway theindicatorisconstructed,seeAppendixB, pages28-29.
National Human Resources for Health Strategic Plan 2016-2025. September, 2016 113
 Performance
Base Relevant level
Targets Frequency
Indicators Description Method of Calculation Year for the indicator Source of Data
Measurement
(2015) Measurement
2020 2025

Breakdowns by age (N)

groups/cadre/sector(e.g.,
(Also: by Sub-
public,private)
region,
rural/urban)

Numerator:Numberofphys
DistributionofHRHbyocc icians,nursesandmidwive
upation,specialization,or s(orothercategoriesofhealt Census, surveys,
Skills mix hserviceproviders) Regional Annual
otherskill- routine records(HRIS)
relatedcharacteristic Denominator: Total
number of health workers

SO 4.3: Enhance staff motivation and retention

Numerator:No.ofworkers
whohaveworkedintheinstit HRIS,
%ofworkerswhohavebe utionandwhohavereceive document
enrecognizedfortheirwor dany form of recognition
%of workers who have review (e.g.
k(e.g.,employeeofthemo or incentive National,
received any form of payroll survey),
nth),orhavereceivedince Regional, Local Annual
incentive from Denominator:Totalno.ofhe interview with
ntives,e.g.,training,good levels
employer althworkerswhohavework health workers
s,allowances,timeoff,oro
edintheinstitution(bypositi in the health
therforms
on,cadre,andfacility/workp facilities
lace)x100

114 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
 Performance
Base Relevant level
Targets Frequency
Indicators Description Method of Calculation Year for the indicator Source of Data
Measurement
(2015) Measurement
2020 2025

%
ofhealthworkerswh Numerator:No.ofhealthwo
ohavebeensupervi rkerswhoreceivedatleasto
%of health workers nesupportivesupervisionvi
sedinlastsixmonth
who have received sitinlastsixmonths HRIS, facility
swheresupervisorh National,
supportive assessments/sur Semi-annual
asprovidedsupport Regional, Local
supervision 41in last six Denominator: Total no.of veys
ivesupervision
months health workers
interviewed/assessed
x100

SO 4.4: Enhance performance and productivity

Numerator:No.ofspecificc
onsultations/servicesperfo
rmedoveragivenperiod(e.
Ratio of
g.,out-
consultations/services National, Facility/healthwo
Provider productivity patientorambulatoryvisits,i
to health worker costs Regional, Health rkersurveys;time Annual
(output index) mmunizations,surgeries)b
or defined period of Facility -motionstudies
yagiven/allhealthworkers
time, per facility
Denominator: Total
number of working hours
of health worker(s)

41
Definition:Supportivesupervisionindexconsiderswhetherthesupervisoraddressedworkerphysical,information,anddevelopmentneeds;assessedperformancetostandards/jobdescription,
and managed performance problems; updated knowledge and skills
National Human Resources for Health Strategic Plan 2016-2025. September, 2016 115
 Performance
Base Relevant level
Targets Frequency
Indicators Description Method of Calculation Year for the indicator Source of Data
Measurement
(2015) Measurement
2020 2025

Composite
indicator(index) made of
National, Special studies:
Average quality of care (illustrative):10greeting;
Regional, observations(thir Semi-annual
Quality of care index by cadre, facility type, history-
d-party mystery or Annual
region taking;examinations;expla Health Facility clients)
nations;finalizationandfoll
ow-up

116 National Human Resources for Health Strategic Plan 2016-2025. September, 2016
National Human Resources for Health Strategic Plan 2016-2025. September, 2016 117
118 National Human Resources for Health Strategic Plan 2016-2025. September, 2016