Using A Multi-Criteria Method for the Recruitment and Deployment of Health Human Resources to Strengthen the Health System in Central African Republic

Abstract

Background Effective human resources for health (HRH) planning is essential for achieving Sustainable Development Goal 3, particularly in a country like the Central African Republic (CAR) where significant HRH shortages hinder health system performance. This article discusses the use of a multi-criteria approach to objectively recruit and deploy HRH in the CAR. Methods This was a documentary analysis conducted between October 2023 – January 2024, with a multi-criteria approach used to inform HRH recruitment and deployment. First, HRH distribution by professional category was assessed at facility level, with results aggregated to determine distribution at health district (HD) level. Next, key indicators influencing HRH need were analyzed by HD, with weights assigned proportionally to the indicator value in each HD. Priority scores were then computed, with a score of 01 assigned to the HD with the highest indicator value, and other HDs scored relative to it. A gap analysis comparing available HRH to national standards was then performed, with the difference (gap score) indicating the number of vacancies per HRH category. Finally, a need index was calculated from the product of the gap and priority scores, and the HRH allocation ratio per HD derived by dividing its need index by the total need index across all HDs. Results Health Region 6 (HR6) had the highest need index while HR7 had the lowest. The highest indices were observed in the Bamingui-Bangoran HD for physicians (2.56), state-registered nurses (8.68) and health assistants (7.85); the Kouango-Grimari HD for midwives (3.86); the Bangassou HD for birth attendants (1.0), and the Haut-Mbomou HD for senior laboratory technicians (0.5). Overall, 130 local and 10 international HRH were recruited and deployed to 35HDs across 05 HRs, with HR6 (47/130), HR3 (33/130) and HR2 (22/130) receiving the majority. At HD level, the Bangassou HD received the most HRH (13/130). Conclusions The use of a multi-criteria approach to inform HRH recruitment and deployment in the CAR proved to be an objective method to addressing the country’s HRH challenges. This underscores the need for targeted recruitment and deployment to meet HRH needs and ensure equitable distribution across the country.