Human resource development (HRD) is a key element in overall health systems development. The quality of service delivery, including of interventions for comprehensive TB control, depends to a large extent upon adequate numbers of staff and their performance, supported by the availability of sufficient facilities, equipment, drugs and other commodities. The performance of personnel depends on various factors such as motivation, training, supervision, salaries and working conditions, all of which require carefully formulated and implemented health workforce policies.

Health workforce development for TB control is concerned with the different functions involved in planning, managing and supporting the professional development of the health workforce for comprehensive TB control within overall health workforce development. The strength and sustainability of NTPs depend on timely, adequate and ongoing recruitment, training, deployment, motivation and management of health workers to ensure that the Stop TB Strategy can be implemented in the context of national guidelines.

There is today a substantial shortage of health workers to meet global health needs. However, shortages are not universal or even uniform across low-income countries or even within countries. An inadequate skills mix, distributional imbalances, unfilled vacancies and poor working conditions exacerbate the problem. This shortage is in many places a major constraint to achieving the health-related MDGs.

The long-term goal for HRD for comprehensive TB control is to reach and sustain a situation where:

• health workers at different levels of the health system have the skills, knowledge and attitudes (professional competence) necessary to successfully implement and sustain comprehensive TB control services based on the Stop TB Strategy;
• a sufficient number of health workers of all categories involved in comprehensive TB control are available at all levels of the health system, with the needed support systems to motivate staff to use their competencies to provide high-quality TB services for the entire population according to their needs.

Effective strategies provide the road map for achieving and sustaining the goal for HRD for comprehensive TB control, enhancing the performance of the health system, even under difficult circumstances. Such strategies include, but are not limited to, the list below. These strategies apply to all countries/areas. However, depending on the country-specific situation, the activities planned under each strategy will differ. The key strategies and implementation approaches are:

• contributing to overall workforce planning and policy development;
• organizing in-service training (clinical, laboratory and managerial) for all health workers involved in TB control, including private providers engaged in programme activities:

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  initial training in all aspects of basic DOTS implementation for existing staff and new recruits at all levels;

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  initial training on TB/HIV and MDR-TB;

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  retraining (major performance problems that may be addressed through, for example, a formal training course);

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  on-the-job or refresher training (minor performance problems that may be addressed during a supervisory visit);

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  continued education (to build skills and knowledge);

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  training/orientation of all public and private providers;

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  advanced training on management aspects (health financing, leadership/governance, business planning, organizational development);

• strengthening preservice training (basic training) for physicians, nurses, laboratory technicians and other health workers involved in the implementation of TB control;
• engaging in strategic partnerships for health workforce development for comprehensive TB control with, for example:

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  training divisions/institutions;

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  other in-service training programmes, e.g. HIV;

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  ministry of education and other relevant ministries;

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  professional associations;

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  private sector including NGOs;

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  bilateral and international organizations;

• contributing to integrated personnel management systems at all levels to foster adequate workforce planning, recruitment, hiring, deployment and retention;
• monitoring and supervising health worker performance:

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  to detect and remedy performance deficiencies;

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  to identify new staff in need of training;

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  to identify additional staff needs.

To ensure a comprehensive approach to the HRD challenge, all action fields and phases of the action cycle will eventually need to be addressed. However, based on a particular area of need or NTP responsibility, any action field or phase may be selected for in-depth analysis and planning.

Table 17.1¹ describes the role and functions for different aspects of HRD for comprehensive TB control, based on the action framework. To enable these functions to be carried out within the NTP, programmes should establish the organizational structure at the central level. This includes, but is not limited to:

TABLE 17.1

ROLE AND FUNCTIONS OF NATIONAL TUBERCULOSIS CONTROL PROGRAMMES (NTPS) FOR HUMAN RESOURCE DEVELOPMENT (HRD).

• assigning a dedicated focal person for HR in the NTP. In larger countries, this corresponds to a full time job. A focal point may also be needed at state/provincial level;
• appointing an HR coordination group with representatives from training institutions, health workers, concerned professional organizations, and other disease control programmes;
• determining the roles and functions of HR management at subnational levels.

The table indicates the guiding principles; the overall structure and situation will vary from country to country. HRD functions within the NTP are carried out in close collaboration and coordination with the overall HRH department to ensure optimal efficiency and results. This should also ensure that HRD activities within the NTP are in harmony with the overall HRH policies of the ministry of health, and ensure that the NTP HRD plans are integral parts of overall HRH plans.

NTPs need to develop and support strategic approaches to staffing, competence development and creation of an enabling environment for all staff involved in the implementation of TB control, based on the outline above, as well as coordinating their efforts with overall health workforce development. HR plans should be integral parts of the two types of plans previously described: the strategic medium-term plan and the annual implementation plan.

The strategic plan focuses on long-term direction and provides overall guidance for implementation and financing to ensure the achievement of the goal of an adequate, competent and performing health workforce. It provides guidance for the annual implementation plans.

The annual implementation plan should be short term, tactical, focused, feasible and measurable. It should include short-term objectives and activities needed to progress towards the goal of an adequate and competent workforce.

International organizations support national TB HRD by providing technical and financial assistance, developing generic training modules and manuals, and organizing international training courses.