Strengthening Human Resources for Health to Achieve Epidemic Control: A Case Study of Democratic Republic of the Congo
Authors: Thurman Paul W. , Michaels-Strasser Susan , Lukusa Luc Ferdinand Kamanga , Ngulefac John , Lukeni Beatrice , Matumaini Serge , Assukulu Noe , Parmley Lauren , Zidana-Ndovi Sungani , Malele Faustin 
Published: July 2020

Abstract
Background The United States President’s Emergency Plan for AIDS Relief (PEPFAR) in Democratic Republic of the Congo (DRC) continues to fund a robust portfolio of programs aimed at achieving epidemic control in three provinces where 30 percent of people living with HIV/AIDS in the country reside. Challenges around human resources for health (HRH), including inadequate staffing and limited capacity, impede the delivery of quality HIV/AIDS services in DRC.Methods In partnership with the United States Health Resources and Services Administration (HRSA), PEPFAR, and DRC Ministry of Health (MoH), ICAP at Columbia University worked with 16 PEPFAR-identified high-priority health facilities (HFs) in DRC and developed HRH-specific interventions to address challenges in achieving 95-95-95 targets. These potential interventions were then prioritized for implementation using a collaborative, criteria-driven approach considering factors such as feasibility, viability, and time-to-impact. Through interviews at all 16 HFs, the joint teams developed an intervention framework, determined short-term priorities, and prepared to implement short-term HRH improvements to reach 95-95-95 targets across all HFs. Interviews used an adapted version of the PEPFAR HRH Rapid Assessment tool to capture key HRH information including staffing levels by type of clinical or administrative position, key barriers to achieving 95-95-95 targets, and perceptions of needed HRH-specific improvements. Results Site-level interviews occurred in April 2019, and the in-country team created a list of possible interventions across six domains: staffing, training, workplace environment, medical supplies and equipment, and monitoring and evaluation. Thirty-five interventions were hypothesized and prioritized into short, medium, and long-term priorities using a framework focused on desirability, feasibility, viability, and time-to-impact. Some interventions were applicable to all HFs while others applied only to selected HFs, the national MoH, or to implementation partners. Twelve interventions were selected as highest priority, and budget allocations and task planning were developed for each of the high-priority interventions. These high-priority interventions were then launched for implementation and evaluation within six months.Conclusions The supply and quality of HRH are critical to achieving epidemic control. This assessment delineated necessary interventions to address site-specific HRH barriers, HRH interventions focused on ensuring adequate staffing, optimal utilization of health workers, and strengthening health workers’ capacity to provide quality HIV/AIDS services to achieve epidemic control. Downstream tracking and reporting of key PEPFAR metrics, including key Monitoring, Evaluation, and Reporting (MER) indicators, will allow intervention teams to conduct program evaluations of key interventions and their impacts on PEPFAR targets.