3 Questions with Hanan Zaidah: Fighting “Brain Drain” in Jordan’s Health Sector


Hanan Zaidah is an expert in organizational development and institutional transformation with 20 years of experience. She currently serves as project director for the Human Resources for Health in 2030 (HRH2030) activity in Jordan. Prior to HRH2030, she worked as organizational development program manager for USAID/Jordan’s Strengthening Family Planning Project.

Global health leaders have consistently identified motivation and retention of health workers as hurdles to achieving the vision of universal health coverage. In its strategic plan, the Jordan Ministry of Health suggests that 2.7 percent of doctors and 6.8 percent of nurses leave the country every year. What issues do you believe have the most impact on health worker retention in Jordan?

Retention factors in Jordan are undoubtedly country-specific; significant numbers of health workers are moving to the Gulf countries. This migration is motivated by several things, including higher compensation and better working conditions. The perception is that Jordan’s public health sector, with its limited resources, cannot compete with the Gulf. Also, the Syrian refugee influx and the increase in the Jordanian population have not been accompanied with expanding services to meet the increasing demand. This compounds the problem by creating a stressful environment for public sector health workers who face increased workloads and reduced morale.

In Jordan evidence suggests that there is a fair amount of “brain drain” that occurs when health workers in the public sector move to the private sector. What strategies might the public sector employ to combat this phenomenon?

Though based on anecdotal data, lack of professional development opportunities and performance management issues are core factors that are widely blamed for workers leaving the public sector to work in the private sector. The Ministry of Health should consider the implementation of a fair and equitable performance management system, which could potentially reduce annual turnover of physicians from 2.7 to 2 percent. Such an approach would create the opportunity for a more supportive work environment, linking supervision to career advancement and promotion, re-licensure, certification, and continuing professional development. The Ministry of Health could also review and approach the financial incentive system for employees, while exploring a non-financial incentive system.

In support of the Ministry of Health, the HRH2030 activity in Jordan is conducting research that will conclusively identify factors impacting health worker motivation and retention. The results will inform actions to improve the ministry’s performance management, opportunities for professional development, and incentive systems. Specifically, we are helping the ministry establish a supportive supervision system for its primary health care facilities and introducing the use of performance appraisal tools. We are also exploring a web-based professional and medical educational program with Arizona State University that would provide unique self-learning opportunities for health workers seeking certification or further career development.

Retention of female staff, especially in Jordan’s remote areas, has been identified as a challenge. What is the HRH2030 activity in Jordan doing to attract female health workers to rural areas and to keep them there?

Anecdotal information from Ministry of Health officials points to poor working conditions, noncompetitive pay, lack of incentives, limited training and career development opportunities, and unclear deployment procedures as factors contributing to low enrollment and retention of female health workers, especially in rural areas. Social barriers are also believed to play a role. Rural areas, for example, tend to be more conservative, and schools there don’t offer the same quality of education as those in urban areas. For the worker and for her family, this makes a difference.

HRH2030 is conducting research to help Jordan’s public health sector gain a clearer understanding of the driving forces and constraints that affect enrollment and retention of female workers in the Ministry of Health system. This understanding can be used as a guide for policies and possible interventions related to recruitment, distribution, retention, and motivation of the female health workforce. A potential strategy is the previously mentioned web-based medical and nursing educational program. While the entire health workforce can benefit, such a program would present an exceptional opportunity for women to fit their learning and career development around their work and home lives.

HRH2030 supports countries in developing the sufficient, fit-for-purpose and fit-to-practice health workforce needed to end preventable child and maternal deaths (EPCMD), achieve an AIDS-free generation (AFG), protect communities from infectious diseases (PCID), achieve the Global Health Security Agenda (GHSA), and reach the goals of Family Planning 2020 (FP2020). The program is funded by USAID and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).

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The Refugee Crisis Presents a Global Challenge to the Health Workforce


“No one is going home soon,” stated the moderator at a recent Society for International Development-Washington panel discussion about the global refugee crisis. This simple observation drives home the reality that governments, aid organizations, and refugees themselves have confronted around the world for nearly five years. It is a reality that has more recently entered mainstream media and one that continues to confound. 19.6 million refugees — people — worldwide need the essentials, including...

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20 Years of Evolution in Human Resources for Health


The 69th World Health Assembly presents a significant milestone for those of us who work in human resources for health (HRH): HRH has finally been recognized as a foundational principle in reaching world health goals. More so now than at any other point in history, the public health community is devoting significant attention and effort to making sure that the right health worker is in the right place, with the right skills and motivation, to provide high-quality service in order to reach...

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Multidimensional Approaches Are Needed to Achieve Global Health Goals


Last year, the 17 Sustainable Development Goals (SDGs) and their 169 targets were presented as part of an integrated and indivisible framework that builds on the Millennium Development Goals (MDGs), including completing what the MDGs did not achieve. The SDGs were created to continue the focus on key development priorities - such as poverty eradication, health, education, food security, and nutrition - while also expanding into a wider range of economic, social, and environmental objectives. The...

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Now Is the Time: Let's End TB in Ukraine


By Kartlos Kankadze, Mariia Dolynska, and Viktoriia Gultai The theme of World TB Day this year, "Unite to End TB," reflects the World Health Organization's (WHO's) End TB Strategy, which recently replaced the Stop TB Strategy and corresponds to the UN Sustainable Development Goals (SDGs). End TB sets an ambitious agenda between now and 2035, targeting a 95 percent reduction in number of TB-related deaths, 90 percent reduction in TB incidence rate, and zero families facing catastrophic costs due...

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In Focus: Saving Mothers' Lives in Zambia


In this photo from 2014, a "change champion" in Zambia discusses how to ensure a safe pregnancy and delivery with mothers. USAID's Communications Support for Health (CSH) project engaged 350 chiefs and headmen through its change champion approach within its successful Mothers Alive campaign, which was designed to increase demand for and uptake of facility-based maternal health services to prevent deaths and complications related to pregnancy and birth. As part of the campaign, these traditional...

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Why "Family Planning" Is a Useful Concept


I used to deride the term “family planning.” I saw it as a sort of euphemism used to skirt around controversial aspects of in sexual and reproductive health. The term particularly bothered me when used in regard to adolescent sexual and reproductive health (ASRH) because it seemed like an attempt to hide the fact that, in many places many young people have non-marital sex. I thought that it ignored adolescents’ lived realities and stymied holistic solutions for healthy productive lives. (Please...

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When There Is No Money to Hire More: Helping HIV/AIDS Health Care Workers to Be as Productive as They Can Be


We need to face facts: In many developing countries, there simply isn’t any money to hire more health care workers. According to WHO there is a global shortage of more than 7 million health care workers; 83 countries fall below WHO’s basic recommendation on of 23 health care providers per 10,000 population. By 2035, that shortage is expected to grow to almost 13 million. The situation is even worse for HIV/AIDS care providers. According to research conducted by the President’s Emergency Plan for...

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Reflection on APHA 2015: Preparing Health Systems for Policy Change


The theme of this year’s American Public Health Association (APHA) Annual Meeting, hosted in Chicago, was “Health in All Policies” (HiAP). This theme emphasized the need for policymakers in all sectors to recognize that environments where we live, work, and attend school have serious implications on health outcomes. Julián Castro, the U.S. Secretary of Housing and Urban Development, spoke movingly on this topic when recounting the moment when, as mayor of San Antonio, he realized the impact...

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Safe Love: Breaking Taboos About Sex in Zambia


By Melissa Rickman and Andrew Johnson Can social and behavior change communications (SBCC) actually influence people’s behavior in the real world? The results of USAID’s “Safe Love” HIV Prevention Campaign in Zambia suggest that they can, even when it comes to taboo subjects like sex. The campaign’s outcome evaluation also underscores the power of good storytelling that resonates with real people and their daily lives. In Zambia, years of safe-sex public service announcements had done little to...

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Know Your SDGs: Your Guide to What the U.N. Is Doing This Weekend


Today, the United Nations Sustainable Development Summit opens in New York. More than 150 world leaders are expected to gather there to adopt the proposed Sustainable Development Goals (SDGs), an ambitious document meant to define the world’s development agenda for the next 15 years. With 17 goals and 169 individual targets, the SDGs are more numerous and complex than their predecessor, the Millennium Development Goals (MDGs), adopted in 2000. But they are hugely important, both individually and...

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Human Centered-Design: Why Asking the Right Questions is Critical in International Development


A few years back, I was involved in designing a health promotion and education campaign to help diabetes and hypertension patients take better control of their health in the Caribbean and Latin America. In Jamaica, I asked my audience a series of questions about their body mass index (BMI) and their blood pressure. In the middle of the conversation, one participant stopped me and made the following remarks: “Sir, why are you so focused on our BMI and blood pressure? We know that we are fat...

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We Can’t Achieve Health Goals for Women Without Women Leaders


For months we have been talking about and planning for the "post-2015 era." Now it is just around the corner, with the Sustainable Development Goals (SDGs) ready to be adopted in September. While discussion thus far has been oriented on the agreement and its parameters, focus is now shifting to the means of implementation. With the structure of the SDGs now clear, the differences between the Millennium Development Goals (MDGs) and the SDGs are now apparent too. For instance, the SDGs more than...

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Progress and Perseverance: Reflections on World Population Day


World Population Day (July 11) is a time for us as development professionals to celebrate and take stock of our accomplishments, of which there have been many. At the same time, it is important to recognize the challenges that lie ahead. For me, health is a basic human right, as well as one of the key indicators of a country’s development progress. On the global level, progress across several health indicators has been noteworthy since the first World Population Day was observed in 1989. Maternal...

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3 Questions with Doris Youngs on Health Care Delivery in Rwanda


Doris Youngs leads the USAID Rwanda Family Health Project, working closely with local and international partners to the quality of service delivery in HIV, maternal health, child and newborn health, malaria, nutrition, and hygiene in 20 out of 30 districts in Rwanda. Doris is a senior program director, chief of party, and public health practitioner with more than 20 years of experience, who has worked on health programs in more than 35 countries in Africa, Asia, and the Middle East. Q. While some...

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How Do We Measure Success in Health in the Post-2015 Agenda?


As we move ever-closer to defining shared health goals for post-2015 development agenda, we must also take the time to stop and think about assessing our progress. What does success look like? And how will we measure it? The World Bank, USAID, and World Health Organization, with support from the Bill & Melinda Gates Foundation, have embarked on an important strategy to construct a common agenda to improve and sustain country accountability systems for health results in the post-2015 era. This...

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Are Complex Global Health Partnerships Worth It? In Peru, a Resounding “Yes.”


This week at the World Health Assembly in Geneva, the Global Health Council, FSG and Chemonics hosted a session addressing the question: Are Complex Global Health Partnerships Worth It? Before the audience got comfortable and the speakers took their seats at the front table, I noticed Peru’s Minister of Health, Dr. Anibal Veláquez Valdivia, had joined us, and felt a jolt of excitement. I had worked extensively on the Peru Quality Healthcare (QHC) program—a five-year initiative that emphasized...

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The Power of Partnership in Global Health


This week, as you all may know, Chemonics is currently attending the World Health Assembly in Geneva, Switzerland. What you may not know is that Chemonics is but one organization of more than 50 being represented in the Global Health Council’s delegation, which is only a small fraction of the United States’ contingency, which is but one of the 194 country delegations expected to contribute to critical annual dialogue around global health policy. And this year is not a typical WHA year. This year,...

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The Ripple Effect of Better Data in the Fight Against AIDS


When I first started my career in public health and supply chain management back in the early 90s, HIV/AIDS was practically a death sentence. Antiretroviral therapy (ART) was still in its early stages, and weak supply chains across the developing world meant that existing drugs for HIV and opportunistic infections were beyond reach for millions in poverty. Working as a pharmaceutical technologist in Kenya, I saw the impact of weak supply chains on the job when I had to turn my clients away...

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My Route to a Career in Public Health


“Reflect on the time you realized you wanted to work in public health…” This was one of the requests of Joyce Gaufin, president of the American Public Health Association, during November’s APHA 142nd Annual Meeting & Expo, held in New Orleans, Louisiana. What an appropriate question to ask a room filled with thousands of public health professionals. What a pointed question, it felt like, for me personally, as I returned to my home state – this time, representing Chemonics International among...

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