iHRIS: Where Are We Now?
Global health workforce issues have only recently received focused attention in the field of international development. In 2006, the World Health Organization identified 57 countries that had a health workforce crisis, defined as having less than 2.3 doctors, nurses, and midwives per thousand population. That same year, while working on the Capacity Project, we visited some of these health workforce crisis countries to see what tools and technologies countries were using to address their health workforce needs.
What did we find? Essentially, nothing. Data on health workers were inaccurate or unavailable, making health workforce planning impossible. Ministries of health and professional councils such as those that license nurses used paper-based systems to track health workers. Their files filled many volumes or shelves, even whole shipping containers. Often, records were missing or misfiled. Tracking down one worker’s record could take days. Aggregating information, such as the total number of health workers available to deploy in the country, took weeks to compile.
The countries we visited expressed a great need for a computerized human resources information system (HRIS) to quickly access, aggregate, and analyze the health workforce data they needed to make good decisions. Comprehensive HR information systems did exist, of course, often as part of large enterprise systems, but they were far too costly. These countries needed a system that could be installed at a low cost, could be easily customized to meet their particular needs, and would evolve as their needs did.
In response, we worked with these countries to develop iHRIS: free and open health workforce information software. In 2007, after nearly two years of design and development, we released the initial products in our iHRIS Suite: iHRIS Manage and iHRIS Qualify. We rolled out the first versions of the iHRIS software in Rwanda and Uganda that same year. iHRIS Manage was designed to help ministries of health deploy and track health workers. iHRIS Qualify enabled professional councils to manage the licensing and certification requirements of a health worker cadre, such as nurses. One year later, we added iHRIS Plan, workforce planning and modeling software, to the suite.
Today, 12 countries across Africa and Asia are using iHRIS to manage more than 475,000 health workers. Six other countries in the Caribbean, Central America, and Asia are actively planning to roll out the software this year. iHRIS has been translated into 13 languages. Governments use the data that iHRIS provides to inform strategic plans, remove ghost workers”—those who are no longer working but remain on the payroll—from the system, and strengthen health service delivery. iHRIS is laying a strong foundation for country understanding of and investment in solving health workforce challenges. We recently released a major new update to the iHRIS Suite, available for download from our newly redesigned website at www.ihris.org.
What’s next for iHRIS? We want to transform the suite from a human resources information system to a human resources management system. iHRIS does a great job of collecting, aggregating, and reporting health worker data for decision-making and planning purposes, but as countries are developing strong databases of health worker records, they need more effective ways of taking actions on these records. The next iteration will support efforts to make HR management actions more efficient and consistent across the health system.
A robust HR management system, as we envision iHRIS becoming, would enable HR managers to streamline the critical process of deploying health workers where they are most needed. Managers could use the system to identify vacancies, approve new positions, post job openings, make employment offers, and place health workers in districts and facilities. They could better support their workers by managing promotions, leave, benefits, retirement, and disciplinary actions. As managers use the system on a daily basis, they will ensure that health worker data are more accurate and up-to-date, which as a side effect will strengthen reporting and planning even more.
We are also planning new additions to the suite. We will soon release iHRIS Retain, a tool for planning and costing retention interventions, and we are actively looking at ways iHRIS can better support preservice and in-service training of the health workforce. We will share more news about these products as they evolve.
While we’re excited about how far iHRIS has come in five years, we’re even more excited imagining where we’re going. It all comes down to our core principle of supporting the health worker. Without the health worker, there is no health care. Health systems can either be a boon or a burden in their support of health workers. Our software is designed to strengthen health systems support of health workers, letting them get on with their all-important work: providing care.