To achieve the UNAIDS 95-95-95 targets, health facilities and community-based HIV service delivery points need to provide efficient, effective, and high-quality services to ensure that people living with HIV (PLHIV) know their status, receive antiretroviral therapy (ART), and achieve and main viral suppression. A key resource to achieve this goal, among other system factors, is the health workforce. Most low- and middle-income countries, though, experience many challenges when it comes to producing an adequate health workforce. These include, misallocation of new health workers, shortages of available health workers, and limited productivity and performance of the existing health workforce. Each of the 3 toolkits below address one of the above stated challenges, and can be used individually or in conjunction with one another.


Tool 1: A Guide for Efficient and Equitable HRH Staffing Allocation

The Government of Tanzania committed to gradually increasing the number of health care workers hired annually; however, insufficient funding has been a fundamental constraint for meeting this commitment. This tool has helped Tanzania to strategically focus on improving the efficient allocation of health workers to increase service coverage and improve outcomes.

In Oct 2014, Tanzania mandated the use of the WHO Workload Indicators of Staffing Needs (WISN) to build data driven HR plans. The method determines how many health workers of a particular type are required to cope with the workload of a given health facility, and assesses the workload pressure of the health workers in that facility Concurrently, USG funded the development of a Priority Optimization and Allocation Tool (POA) that takes WISN results and prioritizes health worker allocation based on strategic priorities, budget, and supply constraints. After assisting with implementation in seven regions, USG and partners realized the approach was unsustainable and unrealistic; it required manual data collection at each facility because many of the indicators were not accessible through the Health Management Information System (HMIS).

USG, through a PEPFAR supported private-public partnership, conducted a sensitivity analysis of WISN indicators and defined a subset that (1) comprised the majority of health worker time, and (2) could be found in the existing HMIS. The simplified WISN + POA methodology identifies the number of HRH needed at facilities based on their current performance, and prioritizes the highest burden facilities; thereby promoting equity of HRH allocation in a resource limited setting.

Tool 2: Estimating and Optimizing Human Resource Needs

Service providers have identified differentiated service delivery (DSD) models for clinically stable clients to provide HIV services through a client-centered approach that simplifies and adapts services across the HIV continuum of care. Differentiated care can reduce the burden on the health system and utilize available human resources more efficiently and effectively. This tool is a means to help plan for implementation of differenced care models based on HIV client caseload and the use of task sharing to increase efficiency among existing and proposed staff

The tool is intended for facility managers (site-level) and program planners (above-site, e.g., district, provincial, regional or national) to estimate and/or optimize human resource needs for different DSD scenarios, including:

  • Staffing needs for implementing one or a combination of HIV service delivery models.
  • Efficient ART task distribution among existing health workers to implement various DSD models.
  • Configuration of DSD and task-shifting/sharing (reassigning tasks from one health worker cadre/type to another) to reduce human resource imbalances (excesses or gaps).
  • Organization of site-level services to meet daily client needs: infrastructure, work hours and staffing.

Outputs from the tool enable users to make informed decisions for maximizing the use of the available workforce and to generate evidence for the need for additional human resources where appropriate.

Tool 3: Optimizing Health Worker Performance and Productivity

This toolkit focuses on workforce influences, as these are often the least understood and addressed. The toolkit provides a rapid, step-by-step process for addressing site-level, workforce-related barriers that contribute to HIV service delivery gaps. It also outlines additional tools that can be used to support further analysis and identify potential workforce interventions, many of which promote data use and quality improvement techniques.

The tools help:

  • Collect workforce-specific data and general data for analysis.
  • Analyze the underlying causes of the most common workforce problems observed in HIV service delivery programs, including health worker competency gaps, low staff engagement, poor allocation of tasks among staff, and inefficient workflow.
  • Identify interventions to address the causes of workforce problems.
  • Support intervention monitoring.

Case study examples highlight how the steps and tools can be applied throughout the toolkit.

The toolkit is accompanied by a slide deck and facilitator’s guide that can be customized and used by program leads to train colleagues and scale its use.


Tool 1

Standard Presentation on Simplified WISN Plus POA (ppt) [695 KB]

Tool 2

HOT4ART User Guide, English (pdf) [2 MB]

HOT4ART User Guide, French (pdf)  [2 MB]

HRH Optimization Tool for ART Service Delivery (xls)

HRH Optimization Tool for ART Service Delivery, French (xls)

Tool 3

Optimizing Health Worker Performance and Productivity to Achieve the 95 -95 -95 Targets: A Toolkit (pdf) [2 MB]

Toolkit Slides (ppt) [2 MB]

Facilitator Guide (pdf) [634 KB]


U.S. Department of State

The Lessons of 1989: Freedom and Our Future