report on and assessment of the human resources...

Report on and assessment of the human resources

management system, including activities undertaken to

strengthen the system and recommendations for use in

other regions

USAID/Peru/Health Policy

Contract No. GHS-I-10-07-00003-00

December 15, 2013

Prepared for:

Armando Cotrina, COR

USAID/Peru Health Office

Av. Encalada s/n

Lima - Peru

Submitted by:

Abt Associates Inc.

4550 Montgomery

Avenue

Suite 800 North

Bethesda, MD 20814

This document has been drafted by the USAID|PERU|Health Policy Project, financed by the

United States Agency for International Development (USAID) under contract #GHS-I-10-07-

00003-00.

The author’s views expressed in this publication do not necessarily reflect the views of the

United States Agency for International Development or the United States government.

Policies, regulations and programmatic actions regarding human resources for health GHS-I-10-07-00003-00

Abt Associates Inc. Table of Contents ▌pg. i

Table of Contents

Acronyms ....................................................................................................................................... iv

Executive Summary ...................................................................................................................... vi

Introduction .................................................................................................................................... 1

1. Legal and conceptual framework for the development of Human Resources

Management System in health institutions .................................................................................. 3

1.1 SERVIR and Civil Service Reform ............................................................................. 3

1.1.1 Background of the civil service in Peru[2] .................................................... 3

1.1.2 The Civil Service Law ................................................................................... 4

1.2 Ministry of Health: Proposal on Human Resources Management System for Health

Institutions.............................................................................................................................. 6

1.2.1 HHR policy and strategic planning ................................................................ 7

1.2.2 Work organization ......................................................................................... 8

1.2.3 Employment management ............................................................................. 9

1.2.4 Performance management ........................................................................... 10

1.2.5 Development and training management ...................................................... 10

1.2.6 Compensation management ......................................................................... 11

1.2.7 Managing human and social relations ......................................................... 11

2. Assessment of the Human Resources Management System ........................................... 13

2.1 Performance Evaluation of the Entire HRMS in Health Institutions ......................... 13

2.1.1 Tools and methodologies to assess HRMS implementation ........................ 13

2.1.2 Human Resources Management System in SMT-RHD .............................. 15

2.1.3 Human Resources Management System in other regions ........................... 18

2.2 HHR Policy and Strategic Planning: Progress........................................................... 22

2.2.1 Results of the assessment in San Martin Regional Health Directorate ........ 22

2.2.2 Results of the assessment in other regions .................................................. 28

2.3 Work Organization: Progress .................................................................................... 31



2.4 Employment Management: Progress ......................................................................... 36


Abt Associates Inc. Table of Contents ▌pg. ii



2.5 Performance Management: Progress ......................................................................... 44



2.6 Development and Training Management: Progress .................................................. 50



2.7 Compensation Management: Progress ...................................................................... 56

2.7.1 Results of the assessment in SMT-RHD ..................................................... 56


2.8 Managing Human and Labor Relations: Progress ..................................................... 62



3. Activities undertaken to strengthen the HRMS in health institutions .......................... 69

3.1 Activities undertaken to estimate staffing needs ....................................................... 69

3.2 Activities undertaken to define job profiles............................................................... 75

3.3 Activities undertaken to define managerial competencies ........................................ 80

3.4 Activities undertaken to design salary scales ............................................................ 82

3.5 Activities undertaken to develop competencies at micronetwork level..................... 84

3.6 Activities undertaken to assess management performance........................................ 86

3.6.1 Performance evaluation method .................................................................. 87

3.6.2 Performance evaluation implementation ..................................................... 88

3.6.3 Competencies evaluation definition and criteria ......................................... 89

3.6.4 Analysis of results obtained in the evaluation of goals attained and

competencies ............................................................................................................. 89

3.7 Activities undertaken to improve recruit and selection processes ............................. 90

4. Conclusions ....................................................................................................................... 100

5. Recommendations to implement the HRMS at regional level ..................................... 102

6. References ......................................................................................................................... 103


Abt Associates Inc. Table of Contents ▌pg. iii

7. Annex ................................................................................................................................ 104

7.1 Questionnaire to assess the implementation of the HRMS in health institutions .... 104

7.2 Qualitative assessment of HRMS conducted by PARSALUD II in 4 Regions ....... 138

7.3 SMT-RHD: HHR regional policies ......................................................................... 140

7.4 National agenda for research in HHR ...................................................................... 141

7.5 ASEGURA software for HHR requirements calculations ....................................... 143

7.6 Using the spreadsheet to facilitate calculations ....................................................... 144

7.7 Survey to determine the available working time in the first-level-of-care .............. 155

7.8 Detailed table of "available working time" for health facilities .............................. 159

7.9 Available working time to provide PEAS in first-level-of-care health facilities..... 160

7.10 Ministry of health: General competencies for the health sector .................... 161

7.11 CONEAU: Managerial competencies for health professionals ..................... 163

7.12 Human resources management competencies ............................................... 164

7.13 Transversal managerial competencies ........................................................... 167


Abt Associates Inc. Acronyms ▌pg. iv

Acronyms

AETA Asignación Extraordinaria por Trabajo Asistencial / Extraordinary Assignment

for Health Care Work

CAFAE Comité de Administración del Fondo de Asistencia y Estímulo / Management

Committees for the Stimulus and Assistance Fund

CAS Contrato administrativo de servicios / Administrative services contract

CAP Cuadro de asignación de personal / Staffing Table

CDC Competencies Development Centers

CGP Civil service managers

CLAS Comités Locales de Administración de Salud / Health Administration Local

Committees

CONEAU Consejo de evaluación, acreditación y certificación de la calidad de la

educación superior universitaria / Council for the Quality of Professional

Education

CTS Compensación por Tiempo de Servicios / Compensation for time of service

DGGDRH Department of Human Resources Development Management

DIRESA Dirección Regional de Salud / Region Health Directorate

DL Legislative Decree

HP Health Policy

HR Human resources

HHR Health human resources

HRMS Human Resources Management System

ILO International Labour Organization

JNE National Jury of Elections

LMEP Ley marco del empleo público / Framework law for public employment

MAPRO Manual de procesos / Procedures Manual

MOF Manual of Organizations and Functions

MoF Ministry of Finance

MoH Ministry of Health

PAHO Pan American Health Organization

PAP Presupuesto analítico de personal / Staff budget

PARSALUD II Programa de Apoyo a la Reforma del Sector Salud / Program for Health

Reform Support

PCM Presidency of the Council of Ministers

PDP Personal Development Plan

PEAS Plan esencial de aseguramiento universal / Essential package

PLAME Planilla mensual de pagos / Monthly payroll

RG Regional governments


Abt Associates Inc. Acronyms ▌pg. v

RHD Regional health directorate

RIT Reglamento interno de trabajo / Internal rules

RNSDD Registro Nacional de Sanciones de Destitución y Despido / National Registry

of Sanctions and Dismissals

ROF Regulation of Organization and Functions

SERUMS Servicio Rural y Urbano Marginal en Salud / Civil Health Service in Rural and

Marginal Urban Areas

SERVIR National Civil Service Authority

SMT-RHD San Martin Regional Health Directorate

TA Technical Assistance

UE Unidades ejecutoras de presupuesto / Budget spending units

UHI Universal health insurance

UNDP United Nations Development Programme

USAID United States Agency for International Development

WHO World Health Organization

WISN Workload Indicators of Staffing Need


Abt Associates Inc. Executive Summary ▌pg. vi

Executive Summary

In June 2008, the National Civil Service Authority (SERVIR) was created as the leading agency in

managing the Human Resources Management System for public institutions. Complementarily,

the Ministry of Health defined a basic structure for this system to be implemented in health

institutions. This structure contains seven components or sub-systems with 29 processes.

Based on this structure, the Health Policy (HP) project designed a tool to assess the level of

implementation for all 29 processes at the regional level. This assessment instrument was applied

to Cajamarca and San Martin regional health directorates, and as results collected by the

Program to Support Health Reform (PARSALUD II) in 4 additional regions.

Evidence from these six regions confirms that human resource offices only perform administrative

activities related to monitoring staff attendance; recruiting, selection and hiring; managing

payrolls; and relations with unions. Almost no progress was seen in the performance evaluation

and planning components, while some modest progress was observed in processes related to

organization of work; capacity development; and management of human and social relations. The

few processes that are developing display technical shortcomings. The challenge is to make

these offices move away from personnel administration towards a more comprehensive human

resource management approach.

The poor performance of human resource offices is mainly due to the fact that these offices are

staffed with non-professional personnel who are not trained in human resource management.

Additionally, offices are not able to take on new responsibilities under the regulatory framework of

the human resources management system. Another difficulty related to the management of

human resources is the variety of personnel policies, many of which are duplicates of or are in

conflict with other policies. This confusion over policies prevents processes from being carried out

according to norms; causes frequent staff turnover; contributes to a lack of clarity in team member

roles and the lack of a responsible part for managing processes; engenders the existence of

various remunerative norms that provoke dissatisfaction and inequity; and impedes the creation of

reliable human resources information to formulate sound decisions. Additionally, not all processes

are managed by a single organizational unit.

A key factor in this situation is that the health authorities do not give much importance to human

resource management. In some cases, authorities have designated untrained employees as

heads of human resources offices. In another case, authorities have hired a lawyer to manage the

office to have a legal advisor to manage institutional relationships with unions.

For the health sector, the lack of a proper human resource planning process generates that

specific human resource needs to meet the population’s health needs are unknown. The lack of

job profiles favours selection processes that are based on subjective criteria rather than the needs

of the position. Recruitment and selection processes are carried out without taking into account

key regulatory aspects such as adequate dissemination for competitive recruitment; and objective

assessment of the candidates. The lack of objective performance assessments based on job

profiles generates that staff do not know if what they are doing is right. Lack of performance

incentives generates a lack of motivation. The lack of a fair and equitable salary scale not only

generates dissatisfaction but also results in a shortage of human resources where they are

needed most.

To tackle these problems, USAID has contributed to the design and validation of tools aimed at

the implementation of key processes for managing health human resources. The tools designed

include the following:

Methodology and tools to define human resource requirements at the first level of care.

Methodology and tools for the design of job profiles.


Abt Associates Inc. Executive Summary ▌pg. vii

Methodology for the design of labor competencies and performance standards.

Methodology and tools for designing salary scales for staff recruitment at the first level of

care.

Methodology and tools for competency development for health personnel responsible for the

growth and development of children under five years through the implementation of

competency development centers at the first level of care.

Methodology and flowcharts for recruitment, selection and hiring processes based on job

profiles.

Methodology and tools for evaluating the performance of health network managers.

Implementing these tools at the regional level depends fundamentally on whether regional

authorities understand the link between improvement in health indicators and the performance of

health human resources. Improving organizational performance depends on how many human

resources are required for the achievement of regional health goals and the individual

performance of each health worker.

To improve individual performance, it is necessary to define what is expected of each health

worker; measure the performance gap; implement incentive mechanisms for good performance or

capacity building programs; and establish an appropriate working environment.

This report presents detailed information about the results of the human resources management

system assessment as well as an explanation of the tools that were designed and implemented to

strengthen the system.


Abt Associates Inc. Introduction ▌pg. 1

Introduction

The enactment of Legislative Decree (DL) 1023 in June 2008 created the National Civil Service

Authority (Autoridad Nacional del Servicio Civil - SERVIR) as the governing body of the Human

Resources Management System (HRMS). The Presidency of the Council of Ministers

(Presidencia del Consejo de Ministros – PCM) confers SERVIR with the legal power and national

authority to improve public administration by strengthening the civil service at national scope.

The HRMS provides, develops and implements government policies related to the civil service,

including the rules, principles, resources, methods, procedures and techniques used by all public

sector entities in the management of human resources (HR).

The HRMS is composed of:

a) SERVIR, which formulates civil service national policy, governs the system and resolves

disputes.

b) State-level human resources offices, or those acting in their place, which are responsible for

implementing the rules, principles, methods, procedures and techniques of the system as part

of the decentralization process.

According to DL 1023, the system comprises the following processes:

Planning of HR policies

Work organization

Employment management

Performance management

Compensation management

Development management and training

Managing relationships

Resolution of disputes

In addition, Article Six of Law No. 30057[1], the Civil Service Law passed in July 2013,

establishes the following functions for the HR office in public institutions:

a) Executes and implements arrangements, guidelines and management tools provided by

SERVIR and the respective public institution.

b) Develops guidelines and policies for the development of the personnel management plan and

the optimal functioning of the HRMS, including the application of indicators.

c) Supervises, develops and implements continuous improvement initiatives in the processes

that comprise the HRMS.

d) Conducts research as well as quantitative and qualitative analysis of staff provision, according

to institutional needs.

e) Manages job profiles.

f) Manages and updates, in the scope of its competence, the National Registry of Civil Service

Personnel (Registro Nacional de Personas del Servicio Civil) and the National Registry of

Dismissal and Sanctions (Registro Nacional de Sanciones de Destitución y Despido –

RNSDD).

g) Other functions that are established through regulations by the governing body of the system.


Abt Associates Inc. Introduction ▌pg. 2

Through this framework, the Ministry of Health (MoH) proposes a scheme to support health

institutions in the implementation of a system for health human resources (HHR).

This report presents the current operating status of the HRMS in six regional health directorates;

activities that have been developed to strengthen HRMS implementation in health institutions; and

recommendations to improve implementation and replicate successes in other regions.


Abt Associates Inc. Legal and conceptual framework for HRMS ▌pg. 3

1. Legal and conceptual framework for the development of Human

Resources Management System in health institutions

This chapter delineates the legal framework governing HRMS implementation in public institutions

and the HRMS structure, which was designed by the MoH for health institutions nationwide.

1.1 SERVIR and Civil Service Reform

1.1.1 Background of the civil service in Peru[2]

The civil service in Peru has been characterized as very complex with large deficits in planning

and organization capacity. Most especially, however, the civil service has been criticized for

lacking a clear authority to conduct the processes required to satisfy workers’ needs and improve

performance.

Most of the obstacles toward achieving a just and equitable civil service are related to the

coexistence of different working regimes, distortions in remunerative schemes, temporary

contracts, the lack of a governing body, and most especially the lack of a national civil service

policy.

There have been various reform processes over the past 20 years, including the following:

a) In 1990, the reform process was characterized by downsizing and the redefinition of the

state’s role in HR issues. The following initiatives illustrate this process: reducing staff

through incentives to resign; closing entry into the civil service; creating a private activity

labor regime (DL 728); contracting "non-personnel services" to prevent the entry of

permanent staff; hiring senior officials from UNDP and the Management Support Fund;

and creating alternative mechanisms to increase worker incomes such as the

Management Committees for the Stimulus and Assistance Fund (Comités de

Administración del Fondo de Asistencia y Estímulo - CAFAE).

b) In 1995, the reform process concentrated on modernizing the state and encouraging the

flexibility of administrative systems. However, the process lacked political support, and

progress was limited to the enactment of the following laws: Law of State Procurements

(Ley de Contrataciones del Estado); Diplomatic Service Law; and the law that prohibits

recruitment and employment in case of kinship.

c) In 2000, the reform process sought to overcome citizens’ distrust of public institutions

through the creation of spaces for dialogue. A new process of decentralization was

initiated in 2002, and the “Framework Law for Public Employment (Ley Marco del Empleo

Público - LMEP) was enacted in 2004.

d) In 2008, the current civil service reform process started. At the outset, there were 500 civil

service regulations, more than 102 salary scales in 82 public institutions, over 400 rules to

regulate payment of public employees, and more than 198 remunerative and non-

remunerative types of payments. The Peruvian state employed approximately 1,300,000

public servants, and each year 42,000 new employees were being hired without a clear

purpose or need. SERVIR was created at this time1 as the administrative governing body

for HRM and responsible for civil service development. Several of the laws related to civil

service reform[2] are shown in the following table:

1 DL 1023



Table 1: Problems that are trying to be solved by new civil service laws.

Problem Proposal Law

Lack of governing body in HRM Creation and implementation of SERVIR DL 1023

Lack of formal recruitment for highly

qualified professionals

Creation and regulation of the Public Managers

Corps

DL 1024

Lack of a performance assessment

system

Permanent evaluation:

To train underperforming workers

To recognize and reward efficient workers

To have qualified staff

DLDL 1025

Lack of training programs and policies Approval of training procedures and a training

fund

DL 1025

Limitations in rationalizing staff

especially in regions and

municipalities

Establishment of a special regime that allows local

and regional governments to implement

comprehensive modernization processes

DL 1026

SOURCE: SERVIR

These regulations have been integrated into one law, which will regulate incorporation, retention,

promotion and termination of civil servants.

1.1.2 The Civil Service Law

After several attempts to improve civil service in Perú, Law No. 30057[1], the Civil Service Law,

was enacted on July 4, 2013 to establish a unique regime for individuals who are employed by the

government and are responsible for its management, the exercise of its authority, and the

provision of services.

According to the rule, the guiding principles of the civil service according to the law are: general

interest; effectiveness and efficiency; equal opportunity; merit; budgetary provision; legal and

regulatory expertise; transparency; management accountability; probity and public ethics;

flexibility; and protection against the arbitrary end of the civil service.

Civil servants in public entities will be classified by the following groups when the law is

implemented:

a) Public Official: Political representative or political office representative who exercises

government functions in state organizations. Directs a unit and approves policies and

standards.

Public officials are classified as:

Public official from a direct and universal election (president, vice president,

congressmen, regional councilors, mayors, aldermen)

Public official whose designation and removal is regulated (ombudsman;

comptroller general of the republic; public prosecutor; chairman of the supreme

court; president of the National Jury of Elections (JNE); and rectors and vice

rectors of public universities, among others)

Public official whose designation and removal is based on trust (ministers; vice

ministers; general manager of regional government; and municipal manager).

They must have higher education or experience and meet the job profile

requirements.

b) Public Directors: Civil servant who runs a body, program or special project. Admission is

by open competition based on merit and fulfillment of the respective job profile. Public

directors can remain in their position for three years renewable up to two terms depending



on the fulfillment of annual goals. Their performance evaluations are based on

compliance with goals. Only 20% of public directors can have the status of “trusted

servants”2 .

c) Career civil servant: Civil servant with functions directly related to compliance of key

substantive functions. This is a unique and integrated system, which does not include

officers; public officials; trusted officials; or complementary activities civil servants. These

positions are not filled on a temporary basis. Hiring is done by open or public competition

based on merit, fulfilling the respective job profile.

d) Complementary activities civil servant: Civil servant with functions indirectly related to

compliance of key substantive functions. Hiring is done by open competition based on

merit, fulfilling the respective job profile. They can be hired through a contract for an

indefinite period or a fixed-term contract.

This law also reaffirms the organization of the civil service through the Administrative System of

Human Resource Management, which includes SERVIR, the HR offices of public institutions and

the Civil Service Tribunal.

HR offices or those serving in their stead are responsible for the HRM and have the following

functions:

a) Implements HR management guidelines provided by SERVIR and its unit.

b) Designs guidelines and policies for the development of a “people management plan” and

the optimal functioning of the HRMS, including the application of indicators.

c) Supervises, develops and implements continuous improvement initiatives in the HRMS.

d) Analyzes quantitative and qualitative staffing according to institutional needs.

e) Manages job profiles.

f) Maintains the National Registry of Civil Service Personnel and the National Registry of

Sanctions and Dismissals (RNSDD).

Major criticisms of the law originate from the workers union, which believes:

1. The law creates a new labor regime in the state.

2. The law did not collect the opinions of workers, who are directly involved.

3. The law restricts union rights and eliminates collective negotiation as well as the right to

strike and join a union.

4. Assessments would bring mass dismissals of workers, affecting labor stability.

5. It is unknown whether civil service salaries will be better.

6. The ability to relax the rules facilitates dismissal.

7. The law eliminates special assignments and subsidies.

Since passage of the law, the workers union has organized strikes

and mobilizations against implementation of the law, arguing that the

2 The law defines "trusted servant" (cargo de confianza) as a civil servant who is part of the direct and

immediate environment of public officials or public directors, and whose tenure in the civil service is

subject to the confidence of the person who supervises him. The number of trusted servants in no one

case should be greater than 5% of total posts provided by the institution, with a minimum of two and a

maximum of 50, with the head of the unit determining the location of trusted servants.

"There is a great fear that the law

can generate massive layoffs, but

we have repeatedly clarified that

this reform cannot be compared

with that made in the nineties.”

Nancy Laos, Minister of Labor,

July 31st, 2013.



law eliminates work stability. The Minister of Labor has appeased labor unions by proposing a

series of "locks" to ensure stability required for state workers.

Encouragingly, a survey conducted between June 7-8, 2013[3] by a renowned polling company

produced the following results:

84% of the population agrees with meritocracy as the core of the reform, and 88%

supported annual evaluations of public servants.

74% approve the termination of personnel who has received negative performance

evaluations for two consecutive years.

36% have heard of this reform. Among this group, 56% approve of it. Support increases

to 78% after the components of the reform are fully explained.

According to the law, the new labor regime is meritocratic: hiring is carried out by publicized,

competitive examination, and job retention and promotion are secured through evaluations.

Perhaps the greatest error in rollout of the law was the lack of discussion to explain the scope of

the new law.

Regarding collective negotiation, the law states the following: “Collective rights of civil servants

are specified in Convention 151 of the International Labour Organization (ILO) and the

Constitution of Peru”. The law also stipulates that the right to strike is exercised after the failure of

any mechanisms for negotiation, and if workers decide to use this right, they must give 15 days of

advance notice to allow time for hiring temporary staff to ensure the provision of minimum

services.

The law does not explicitly mention dismissal as a result of evaluations. The law says that a

worker who receives a negative review, specifically "performance under observation", should be

trained; if the result of a second evaluation is again "performance under observation", the rating

will become “unsatisfactory”. However, the law does not state what will happen with employees

who receive “disapproving”.

There is currently no information on the contents of the law’s regulations. Meanwhile, union

protests continue.

1.2 Ministry of Health: Proposal on Human Resources Management

System for Health Institutions

Under the legal framework established by SERVIR and according to the Civil Service Law, public

institutions must implement their HRMS. To facilitate its implementation, the MoH has developed

a proposal for the structure of HRMS which defines subsystems, processes and functions.

The expected results of HRMS implementation in health institutions are:

a) Adequate health workers properly situated and properly performing their duties.

b) Attract and retain competent staff.

The following inputs are necessary to implement HRMS in health institutions:

a) Health policies and strategies to align staff performance.

b) Models of health care, management and health services organization to define

competency profiles, HR allocation, and HR compensation, among others.

c) Health service portfolios to define individual goals.

d) Civil Service Law as a legal framework for HRMS implementation.



e) Regulation of organization and functions (ROF) to define job profiles, recruitment,

assessment, etc.

The following graph displays this structure:

Graphic 1: HRMS in health institutions: MoH proposed structure.

II. Work

Organization

Job profiles

Identification

of labor

competencies

Job Rating

III. Employment

Management

Recruitment,

selection,

incorporation

and induction

Staff mobidity

Disciplinary

process

Staff retirement

and retirement

VI. Development

Management

Career progression

Capacity building

Teaching &Service

Regulation

I. HHR Policy and Strategic PlanningHR needs, Strategies to cover HR gap

VII. Managing humanand social relationshipsOrganizational Climate and Culture; Labor relation; Workplace health, safety and

welfare.

V. Compensation

Management

Salary scales

Payroll

Benefits, bonuses,

pensions

Incentives

Health Policy

Strategies

HealthcareModel

Management Model

OrganizationalModel

Healthserviceportfolio

Civil,ServiceLaw

ROF

IV. Performance

Management

Performance

planning

Supervision

Performance

evaluation

Feedback

Plans for

Individual

performance

improvement

Having

adequate

workers,

placed in

appropriate

places, doing

well what they

have to do.

Attract and

retain

competent staff

The following subsections explain the operational definitions of each process within the HRMS for

health institutions.

1.2.1 HHR policy and strategic planning

This subsystem is primarily responsible for HRM alignment to national and regional policies;

national health strategies; and the comprehensive care model. It also enables coordination

among all HRM processes to ensure suitable and competent workers where they are needed.

The processes involved in this subsystem are:

HHR policies and strategies. This process consists of developing HRM policies and strategies

that will attract and retain competent staff.

Operational research development. It is necessary to have evidence in order to define policies

and strategies for HR management and development that are relevant and cost-effective. This

process seeks to promote research studies focused on factors that will attract and retain

competent staff as well as research to support HR policy design.

HHR information management. To ensure proper management, it is necessary to have reliable

and update-to-date HHR information at both the institutional and sectoral levels. HR observatories

are an excellent mechanism to maintain HHR quantitative information, and information system

records or specific databases, including staff competencies, performance evaluations, and

incentives, complement quantitative information. All information must be updated to allow

informed HRM decisions.

HHR management control. This process is aimed at supporting health managers at different

levels, as well as those responsible for other subsystems, in monitoring HRM indicators,



analyzing results and defining necessary corrective measures. It also includes annual evaluations

of HRMS processes and manager performance.

HHR strategic planning. This process includes all actions related to quantitative and qualitative

HHR requirements and needs at all levels in the short, medium and long term at both institutional

and sectoral levels. This process also addresses necessary actions to fill the HHR gap. HHR

planning should be closely linked and coordinated with national and regional health policies;

institutional strategies; and health provision approaches (e.g. the family health care model).

Challenges to the planning process include high internal and external migration of health workers

as well as high staff turnover.

HHR financing. This process includes the necessary actions to ensure a sufficient budget to

provide adequate HHR for proper health facility operation.

1.2.2 Work organization

This subsystem exists to optimize HHR working capacity by specifying the content of functions,

activities and tasks, as well as the staff qualifications to achieve them.

The main goal of this subsystem is to establish a set of policies and standards regarding work

specialization that forms the "job"; the job profile includes a work description, including objectives,

relationships, roles, responsibilities and working conditions; and the position requirements,

including educational background, experience and competencies. As an additional part of the job

profile, competency profiles articulate staff abilities in regard to institutional objectives, goals and

organizational culture.


Job profile design. Based on the "general functions" established in the institutional ROF, each

organizational unit designs its positions and the specific functions of each position. The functions

of each position are outlined in the Manual of Organization and Functions (MOF). Based on the

MOF, each unit defines its "job profile", which has two major components:

Job description: Defines the characteristics of the job, including the job title; location within the

organization; relationships with other positions, including supervisory, managerial, and

collaborative roles; purpose; functions to be performed; and working conditions (e.g physical

such as equipment; normative, as the regulatory framework to be used) for good job

performance.

Job analysis: This refers to the characteristics of ideal job candidate in relation to the job

requirements. This section establishes required academic training, experience, knowledge

and skills.

Identification of labor competencies. This process identifies specific and general competencies

for each position.

Job rating. This process analyzes and compares the contents of jobs to define their relative

importance within the organization; place them in hierarchical order as the basis of the

remuneration system; and aid in the development of career plans within health institutions. Job

design alone is not enough to trigger HRM processes and it is also necessary to rank and value

jobs in relation to their importance within the organization. The position must be assessed and not

the person who occupies it.



1.2.3 Employment management

Employment management seeks to establish a set of policies and standards to optimize inflows,

movement and exit of staff in health care organizations. These policies and standards should be

based on job profiles and competencies established by the employer and should foster the

achievement of sectoral health objectives.


Recruitment. This process allows health care organizations, based on HHR needs identified in

the planning process, to attract candidates to participate in selection processes. The recruitment

process uses internal (within the organization) or external sources.

Selection. In this process, the institution examines whether candidates meet the job

requirements, which are described in the job profile, and then selects the candidate who has the

necessary skills for successful performance. This process also involves the formation of selection

committees and defines the criteria, standards, procedures and tools for evaluating candidates in

the selection process.

Incorporation. This process formalizes the entry of the selected candidate into health

organizations and establishes the characteristics, conditions, restrictions and penalties related to

employment. This process includes compliance with standards for each of the modalities of

incorporation (stable or contracted) and the definition of the duties and rights of HHR.

Induction. This is a general orientation process prior to the start of work activity. This process

provides basic information about the institution, including norms, policies and organizational

characteristics; explains the nature of the position; and indicates requisite functions and roles. In

addition, the new employee receives relevant information to help achieve satisfactory

performance.

Staff mobility. This process defines workplace assignment changes that HHR can perform both

inside and outside health institutions. These changes balance the needs identified in the target

unit and the availability of the worker (in the origin institutional source) as well as the worker's own

need, under current regulations. The regulation defines the types of workplace assignment

change, displacement criteria, and administrative procedures to be followed for each type of

mobility.

Management of personnel files, control of attendance. This process consists of conservation,

renovation, veracity and legality of the documents maintained by institution staff, as well as

compliance with rules for the submission of affidavits. It also includes the management and

control of the working day, permissions, holidays, leave, etc.

Administration of disciplinary process. In this process, the institution determines the level of

staff responsibility in certain administrative acts, including compliance with disciplinary procedures

in accordance with applicable regulations; the classification of fault; the design of internal rules

(reglamento interno de trabajo - RIT); and the registration and updating of the RNSDD.

Staff termination and retirement. In this process, the institution regulates the term of

employment between staff and the institution. In compliance with labor rights and under current

regulations, disengagement may be voluntary or involuntary. There are currently several forms of

disengagement: resignation, removal, dismissal, and termination, among others. This process

includes the enforcement of laws on the causes for dismissal; termination of employment

procedures and requirements; and standards and criteria for the termination of employment.



1.2.4 Performance management

The performance management subsystem aligns the strategy of the institution with the individual

objectives of HHR to continuously improve staff performance and hence institutional performance.

Performance evaluation is part of performance management, which allows each member of the

institution to know at all times specific employee expectations in terms of quantitative and

qualitative attributes for a given period. The aim of the evaluation is to establish strategies for

solving performance problems motivate employees and encourage personal development.

The performance management subsystem defines and measures competency standards and

performance targets to be achieved by health personnel in order to promote and maintain the

highest possible level of performance based on recognition of merit, ability and equal

opportunities.

Performance management is mainly aimed at establishing a set of policies and rules regarding

standards of competence and performance goals of health workers.Achievement of these goals is

linked to various incentive and personal development mechanisms, which promote continuous

improvement processes in HHR and, consequently, in health institutions.


Performance planning. This consists of defining competencies, standards and individual

performance goals to be achieved in line with institutional priorities, strategies and objectives.

This process also includes the definition of the methodology for performance evaluation as well as

the design of the necessary assessment tools for an objective measurement of staff competence

and compliance with established performance goals.

Supervision. This consists of continuous and systematic support to health workers to improve

their performance based on the observation that immediate supervisors do to promote continuous

improvement of skills. This process is also driven by leaders.

Performance evaluation. This consists of an objective and transparent measurement of health

staff skills and institutional goals obtained during a defined time period and following a predefined

methodology. Results should be compared to competency standards and goals established in the

performance planning process.

Feedback and design of plans for individual performance improvement. In this process,

plans are designed for individual performance improvement based on results from the

performance evaluation. Leaders define performance objectives for each employee in the

following year.

1.2.5 Development and training management

The development and training management subsystem defines practices to encourage

professional and job development opportunities by providing learning opportunities as well as

career path planning within the organization.


Labor advancement (promotion and career path). This process is responsible for the policies

and procedures governing HHR promotion and occupational group change within an institution. It

also manages the assumption of duties and responsibilities of greater difficulty or complexity in

comparison to the previous level. The labor process includes both horizontal progression, which is

a progression in degree, category, or step that can be established without shifting the workplace

or occupational group to which the worker belongs; and vertical progression, which is promotion

within the structure of the organization to a higher level.



Capacity building. This process is responsible for providing tools and resources to facilitate

individual and collective learning and further develop staff labor competencies. The term "labor

competency" refers to the knowledge and skills demonstrated at work and reflect the worker's

contribution to the objectives of the organization.

Regulation of the teaching - service process. This process involves a set of actions needed to

articulate HHR training and education activities within health services. The teaching and service

provision relationship refers to the simultaneous occurrence of health service provision and

specialized educational opportunities for health personnel in health facilities. The dual nature of

these training areas requires the regulation and enforcement of standards to ensure the quality of

both health and education services.

1.2.6 Compensation management

Compensation management relates to remuneration provided by the organization in return for

work done.

Compensation can take several different forms: pay or base salary, which is a fixed amount that is

paid hourly or monthly; monetary and non-monetary incentives related to performance

recognition; and benefits, which are established by law and serve as additional payments

awarded by the institution.


Design of salary scales. This process defines salary scales based on job profile and job

classification by levels.

Management of payroll and salaries. This process manages compliance with the rules and

procedures which establish and maintain fair and equitable salary structures in the organization.

In this process, the organization defines the remunerative and non-remunerative compensation as

well as electronic payroll management: monthly payroll (Planilla Mensual de Pagos - PLAME);

registration of labor information (Registro de información laboral – T Registro); and social benefits

settlement, such as compensation for time of service (Compensación por Tiempo de Servicios -

CTS), gratuities and bonuses. This process also involves the regular registration of income, both

on the dependent category (fifth category) and the independent category (fourth category).

Administration of benefits and bonuses. This process administers extra-pay benefits including

holidays, life insurance, subsidized transportation, subsidized food and health insurance.

Incentive management. This process enforces the rules and instruments that are established

and applied by the institution to recognize worker achievements. This recognition has no

permanent wage effects and can be monetary and non-monetary.

Pension management. This process manages the recognition and granting of pensions; survival

verification; and the application of legislation for pension payment.

1.2.7 Managing human and social relations

This subsystem seeks to regulate and harmonize interactions between individuals, focusing on

the collective dimension. It includes policies and practices related to organizational climate; labor

relations; social welfare; and safety at work.

This subsystem supports all of the subsystems mentioned above and guarantees conditions

conducive to satisfactory productivity and performance.




Management of the organizational climate and culture. This process is aimed at maintaining

or improving the perception of collective satisfaction. Organizational climate is defined as the set

of qualities, attributes or relatively permanent properties of a particular work environment, which

are perceived, felt or experienced by workers who make up the organization. The organizational

climate influences individual behavior.

Management of labor relations. This process governs relations between the head of an

organization and social partners, including unions and associations, which represent workers or

group of workers. This process also involves collective negotiation of wages and working

conditions to appropriately manage conflicts.

Workplace health, safety and welfare. This process includes two groups of activities:

Social welfare: This activity affects the quality of life of staff and their extended family and

fosters a peaceful and enjoyable workplace experience. Social welfare programs include the

promotion of sports activities; event celebrations; cafe or restaurant services; educational

support; financial services; daycare; and care for elderly people, among others.

Health and safety at work: This activity refers to a set of rules; procedures; and technical,

educational, medical and psychological measures to protect employees’ physical and mental

integrity. These measures prevent health risks inherent to job tasks and the physical working

environment. This activity also seeks to diagnose and prevent occupational diseases based

on the study of two variables: man and his work environment.


Abt Associates Inc. Assessment of the Human Resources Management System ▌pg. 13

2. Assessment of the Human Resources Management System

In 2012, the Program for Health Reform Support (Programa de Apoyo a la Reforma del Sector

Salud – PARSALUD II) led the development of a technical report entitled "Developing a Health

Model for Decentralized Regional HRMS: Ayacucho, Cajamarca, Cusco, Huanuco and Ucayali

and their Respective Action Plans"[4]. This document includes a diagnosis of HRMS performance

at various levels of management, including the Regional Health Directorate (RHD), networks,

micro-networks and hospitals. Both PARSALUD II and the project developed the HRMS

diagnosis, which was based on the HRMS structure as defined by the MoH. To gather the

information, PARSALUD II designed a survey for examining each of the subsystems defined by

the MOH.

The project reviewed PARSALUD II’s survey and incorporated the latest developments in the

HRMS structure. The project also worked with the MoH to expand the survey to examine all

processes involved in the HRMS.

In this chapter, the methodology developed by the project to gather information in San Martin

Regional Health Directorate (SMT-RHD) will be presented. In addition, the results of the survey

conducted in SMT-RHD for each of the HRMS processes will also be presented.

Based on the PARSALUD II technical report, a comparative chart was compiled to display each

subsystem’s operations in regions where PARSALUD II works.

Since the instruments used by PARSALUD II and the project are different, the results are not

comparable. Given this, the project gathered information from Cajamarca using the instruments

applied in San Martin to compare results obtained. This comparison is presented in a table

showing the performance of HRMS in these two regions.

2.1 Performance Evaluation of the Entire HRMS in Health Institutions

2.1.1 Tools and methodologies to assess HRMS implementation

In order to gather the necessary information to determine the level of HRMS implementation, the

project employed the following tools, which were developed by the USAID Peru Health Policy

Project:

a) A list of questions for each of the processes in each HRMS subsystem3.

The questionnaire consists of several closed questions whose answers are YES or NO. The

following are several examples:

3 See the questionaire in Annex 7.1



1. Does your institution have human resources management and development policies? ( ) YES ( ) NO

If the answer is yes, please answer the following questions. Otherwise, skip to the next section. 2. Are the human resources management and development approved?

( ) YES ( ) NO

……

Do you have the specifics of at least 60% of job the profiles for the following levels written down?

Question N°

Level 60% of job profiles

YES NO

1 Regional Health Directorate

2 Network

3 Operational Office

4 Micro-network

……

There are also open questions that allow qualitative information or more specific information,

including the following examples:

According to the current ROF, which governing bodies are involved in estimating human resource

requirements and design staffing plans in your institution?

Level Is involved? In case of participating

YES NO Name of the responsible body Specific function

RHD

Network

Micro-network

In relation to the selection process conducted during the past year, provide the following information:

Month # Days to publicize the

vacancy

Results of selection process

Achieved Invalid Process with

objections

……

b) A spreadsheet to record the answers of every closed question.

The spreadsheet immediately allows the aggregation of results into tables and graphs for

easy analysis. Additionally, each question has been weighted according to its strategic

importance in proper HRMS functioning.

The project used the following ratings to analyze the results:

High development: > 80% complete

Moderate development: 40% - 80% complete



Little Development: <40% complete

The processes considered in the analysis were identified by the MoH as important to include.

Table 2: Key processes for each HRMS subsystem in health institutions.

Subsystem Key Processes

HHR policy and strategic planning Policies and strategies for HHR management and development

Development of operational research

HHR information management

HHR management control

HHR strategic planning

HHR financing

Work organization Design of job profiles

Identification of labor competencies

Job rating

Employment management Recruitment, selection, incorporation and induction

Staff mobility

Management of personnel files, control of attendance

Administration of disciplinary process

Staff termination and retirement

Development and training management Labor advancement (promotion and career path)

Capacity building

Regulation of the teaching-service process

Performance management Performance planning

Supervision

Performance evaluation

Feedback and design of plans for individual performance

improvement

Compensation management Design of salary scales

Management of payroll and salaries

Administration of benefits and bonuses

Incentive management

Pension management

Managing human and social relations Management of the organizational climate and culture

Management of labor relations

Workplace health, safety and welfare

To gather information on the implementation of the HRMS in SMT-RHD, the director of the HR

Management Directorate developed a workshop for responsible parties of HRM processes at

different organizational levels.

Working groups were formed to analyze each subsystem. The project made a conceptual

presentation of the processes in each subsystem for each working group to facilitate

understanding of survey questions.

2.1.2 Human Resources Management System in SMT-RHD

The new organizational structure of SMT-RHD[5] has considered the functioning of two normative

units, which must maintain close coordination, to lead HRMS implementation:



Human Resource Management and Development Directorate (HRM Directorate) - This body

executes exclusive regulatory functions in HHR management and is primarily responsible for

the following subsystems: policy and planning; work organization; performance management;

development and training management; and some processes related to compensation and

labor relations management.

Operations Directorate – This body manages regulatory functions for all administrative

systems, including personnel administration. It is primarily responsible for the job

management subsystem and some processes of compensation and labor relations

management.

The implementing units of HRMS are:

Health networks, which are responsible for implementing the processes regulated by the

HRM Directorate.

Operations Offices, which are responsible for implementing the processes regulated by the

Operations Directorate.

These inter-relationships are presented in the following graph:

Graphic 2: Staff of the Human Resources Management and Development Directorate:

Number of workers by labor regimen, San Martin 2013.

HRMS Governing at regional level

Responsible for HR development processes

Responsible for personnel administration processes

No

Regional Health Directorate

Office of Sectoral Legal

Consulting

Office of Planning and

Health

Intelligence

Comprehensive Health Direction

Department of Regulation and Control in Health Sector

Directorate of Human Resource Development

Operations Management -Health

Operations Offices (05)

Health Networks

Management (10)

Hospitals and Regional Services

Administrative Management Unit

Budget Management Unit

Referential Hospital Tarapoto

Referential Laboratory

Blood Bank

Regional Management of Social Development

REGIONALGENERAL MANAGEMENT

Regional Office of Planning and Busget

Regional Office of Legal Consulting

Regional Office of Regional Defense ad Disaster Risk Management

Regional Office of Administration

Persons Management Office

Accounting and Treasury Office

Logistics Office

Estate Control Office

Office of information Technology

Normative Units Implementing Units

SOURCE: SMT technical report



The new ROF is currently under implementation so the region’s units are not fully deploying their

functions. As of July 2013, the HRM Directorate only has five employees, including four

professionals and one technician; two of the professionals have permanent positions, while the

other staff members were hired through an administrative services contract (Contrato

Administrativo de Servicios – CAS)[6]. The quantity and composition of staff members is

insufficient to lead, regulate, monitor and control the implementation of HRM processes.

Table 3: HRM Directorate staff: Number of workers by labor regimen, San Martin 2013.

Occupational group Total 276

Regimen

728

Regimen CAS

Full-time

independ

ent

contracto

r

Other

Professional 4 2 0 2 0 0

Administrative Technician 1 0 0 1 0 0

Administrative Assistant 0 0 0 0 0 0

TOTAL 5 2 0 3 0 0


Listed below are results from the diagnostic tools.

Graphic 3: Results for each subsystem, San Martin 2013.

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Sub-System: HHR Policy and Strategic Planning

Sub-System: Work Organization

Sub-system: Employment Management

Sub-System: Development and

Training Management

Sub-System: Performance Management

Sub-System: Compensation Management

Sub-System: Managing human and social

relations

San Martin: HRMS in Health Institutions

SOURCE: SMT technical report[7]



Table 4: Results for each subsystem, San Martin 2013.

Human Resource Management System % complete Result

Subsystem: HHR policy and strategic planning 65.0% Moderate development

Subsystem: Work organization 32.0% Low development

Subsystem: Employment management 37.5% Low development

Subsystem: Development and training management 62.2% Moderate development

Subsystem: Performance management 14.0% Low development

Subsystem: Compensation management 57.7% Moderate development

Subsystem: Managing human and social relations 64.3% Moderate development

HUMAN RESOURCE MANAGEMENT SYSTEM 47.5% Moderate development


Table 4 shows that SMT-RHD has, on average, achieved a 48% progress rate in HRMS

implementation.

The subsystems that are more developed include HHR policy and strategic planning; managing

human and social relations; and development and training management. On the opposite end, the

performance management subsystem is the least developed.

2.1.3 Human Resources Management System in other regions

Graphic 4: Results for each subsystem, Cajamarca 2013.

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Sub-System: HHR Policy and Strategic Planning

Sub-System: Work Organization

Sub-system: Employment Management

Sub-System: Development and

Training Management

Sub-System: Performance Management

Sub-System: Compensation Management

Sub-System: Managing human and social

relations

Cajamarca HRMS

SOURCE: Cajamarca technical report



Table 5: Results for each subsystem, Cajamarca 2013.

Human Resources Management System % completed Result

HHR policy and strategic planning 48.0% Moderate development

Work organization 10.0% Little development

Employment management 35.0% Little development

Development and training management 29.6% Little development

Performance management 1.8% Little development

Compensation management 57.7% Moderate development

Managing human and social relations 21.4% Little development

Human Resources Management System 29.1% Little development


Table 5 shows that Cajamarca has not reached optimal levels for proper HRM. The weaker

subsystems include performance management; work organization; and management of human

relations. These weaknesses are concerning since these subsystems are integral to achieving the

objectives, goals and outcomes of the health care model in the region.

Regional management documents are outdated and are not aligned with the decentralization

process, much less with the current care model. Given this situation, processes within the HR

policy and strategic planning subsystem have not been developed.

Comparative chart

The project created a table of results obtained by PARSALUD II from Ucayali, Cusco, Ucayali,

Cajamarca and Huánuco to compare RHD performance on HRMS implementation. Other results

from Cajamarca and San Martin, which were obtained by applying diagnostic tools designed by

the project, are also included to make additional comparisons.

Analysis of some processes has not been considered in the PARSALUD II evaluation because

the information is too qualitative.

To elaborate this matrix, the project examined information from the PARSALUD II technical

report4 to compare the results and formulated the following conclusions:

All PARSALUD II RHDs, with the exception of Ucayali which shows little development in all

subsystems, show the same results in each of the subsystems.

PARSALUD II survey does not cover all processes in its analysis.

The project’s survey explores in greater detail HRMS processes. Comparing Cajamarca

results from both surveys, differences in application, analysis and results are apparent.

By comparing San Martin and Cajamarca performance with the application of HP project

survey, better results are apparent in San Martin in all the subsystems.

4 See the results of qualitative assessmemnt in PARSALUD regions in Annex 7.2



Table 6: Comparative table of HRMS level of implementation in six regions.

N.c.= Not considered in PARSALUD II assessment; N.i.= No information

HRMS Ucayali * Cusco * Huanuco

*

Cajamarc

a*

Ayacuc

ho * San Martín **

Cajamarca

**

HHR policy and strategic planning

65% Moderate 48%

Modera

te

Policies and strategies for HHR

management and development N.c. N.c. N.c. N.c. N.c. 73% Moderate 0% Little

Development of operational

research N.c. N.c. N.c. N.c. N.c. 0% Little 0% Little

HHR information management Little Little Little Little Little 76% Moderate 90% High


N.c. N.c. N.c. N.c. N.c. 0% Little 50%

Moderat

e

HHR strategic planning Little Little Little Little Little 82% High 57%

Moderat

e

HHR financing

N.c. N.c. N.c. N.c. N.c.

100

% High 86% High

Work organization 32% Little 10% Little

Design of job profiles Little Moderate Moderate Moderate

Moderat

e 38% Little 18% Little

Identification of labor competencies Little Moderate Moderate Moderate

Moderat

e 38% Little 0% Little

Job rating N.c. N.c. N.c. N.c. N.c. 10% Little 0% Little

Employment management 37% Little 36% Little

Recruitment, selection,

incorporation and induction Little High High High High 38% Little 38% Little

Staff mobility N.i. N.i. N.i. N.i. N.i. 0% Little 0% Little

Management of staff files and

attendance control N.c. N.c. N.c. N.c. N.c. 40% Moderate 25% Little

Administration of disciplinary

process

N.c. N.c. N.c. N.c. N.c. 43% Moderate 43%

Moderat

e

Staff termination and retirement Little Little Little Little Little 0% Little 67%

Moderat

e

Development and training

management 60% Medium 30% Little

Labor advancement (promotion and

career path) Little Moderate Moderate Moderate

Moderat

e 76% Moderate 19% Little

Capacity building Little Little Little Little Little 58% Moderate 40% Little

Regulation of the teaching & service

process

N.c. N.c. N.c. N.c. N.c. 35% Little 30% Little

Performance management 14% Little 2% Little

Performance planning Little Little Little Little Little 16% Little 12% Little

Supervision Little Little Little Little Little 0% Little 0% Little

Performance evaluation Little Little Little Little Little 22% Little 0% Little

Feedback and design of plans for

individual performance improvement

N.c. N.c. N.c. N.c. N.c. 0% Little 0% Little



HRMS Ucayali * Cusco * Huanuco

*

Cajamarc

a*

Ayacuc

ho * San Martín **

Cajamarca

**

Compensation management 61% Moderate 58%

Modera

te

Design of salary scales Little Little Little Little Little 63% Moderate 41%

Moderat

e

Management of payroll and salaries Little Little Little Little Little

100

% High

100

% High

Administration of benefits and

bonuses Little Little Little Little Little

100

% High

100

% High

Incentive management Little Little Little Little Little 44% Moderate 56%

Moderat

e

Pension management Little Little Little Little Little

100

% High

100

% High

Managing human and social

relations 70% Moderate 21% Little

Workplace health, safety and

welfare Little Little Little Little Little 63% Moderate 34% Little

Management of labor relations N.i. Moderate Moderate Moderate

Moderat

e

100

% High 22% Little

Management of the organizational

climate and culture Little Little Little Little Little 69% Moderate 29% Little

HUMAN RESOURCES

MANAGEMENT SYSTEM

48% Moderate 29% Little

SOURCE: (*) PARSALUD II technical report. (**) HP project assessment.


Abt Associates Inc. Assessment of HRMS ▌pg. 22

2.2 HHR Policy and Strategic Planning: Progress

2.2.1 Results of the assessment in San Martin Regional Health Directorate

The following graph shows the results of five of the processes that are within this subsystem.

On average, implementation of this subsystem is 65% completed, which indicates “moderate

development”.

It has been noted that some processes are not working, including development of operational

research and HHR management control.

According to what was reported, HHR financing is functioning adequately.

Graphic 5: San Martin HHR policy and strategic planning: Results by key processes.

0%10%20%30%40%50%60%70%80%90%

100%

Policies and Strategies for

HHR Management …

Development of

operational research


HHR

Management Control

HHR Strategic Planning

HHR Financing

San Martin: HHR Policy and Strategic Planning




Table 7: San Martin HHR policy and strategic planning: Results by key processes.

KEY PROCESSES Expected

result

Obtained

result

%

Complete Result


management and development 26 19 73% Moderate development

Development of operational research 4 0 0% Little development

HHR information management 21 16 76% Moderate development

HHR management control 14 0 0% Little development

HHR strategic planning 28 23 82% High development

HHR financing 7 7 100% High development

Average 100 65 65% Moderate development


Below are key findings for each of the processes within this subsystem:

Formulation of policies and strategies for management and HHR development

This process shows 73% success, mainly due to the following developments:

The HRM directorate is responsible for developing HR policies for the SMT region.

In October 2008, SMT-RHD led the signing of a memorandum of commitment to all

institutions in the regional health system approving a set of regional policies for HHR

management and development. These policies are aimed at improving the performance of

HR and working conditions to "have adequate health workers properly situated, properly

performing their duties". Currently, these policies are not approved.5

The USAID Peru Health Policy Project is working closely with the SMT-RHD management

team to implement these policies.

Progress and specific advances are presented in the following table:

Table 8: San Martin human resources regional policies: Progress.

Policy Progress Ongoing

Policy 3. - HHR strategic planning

based on actual needs to properly

allocate HHR according to

demographic, cultural and

epidemiological profiles of the

region, highlighting health

priorities of excluded populations.

Methodology to determine HR

requirements and gaps for the first level

of care.

Determination of HR needs at micro-

network level for the short, medium and

long term.

Strategies to fill the gaps.

Institutional planning system for

HHR.

Policy 6. - Implementation of a

new regulatory framework based

on labor competency profiles;

compensation and incentive

systems; recruitment and staffing

processes; applying public career

promotion; and considering rights,

duties, gender equity and respect

for diversity.

Baseline assessment of HRMS

functioning in SMT-RHD.

Contributions to the MoH proposal of

designing a decentralized management

system in HHR in the context of

SERVIR.

Job profiles of RHD units.

Job profiles of networks.

Job profiles for first level of care.

Recruitment and selection

processes based on job profiles.

Definition of non-monetary

incentives.

5 See HHR regional policies in Annex 7.3



Policy Progress Ongoing

Salary scale for staff employed in first-

level-of-care facilities.

Policy 2. - Managing training

processes linked to institutional

development projects using the

“Continuing Education in Health”

(Educación Permanente en Salud

– EPS) and competencies

approach to strengthen job

performance, characterized by

respect for rights, gender equity

and cultural relevance of the

population.

Definition of RHD management

competencies to assume functions

transferred in the decentralization

process.

Definition of managerial competencies

for networks.

Proposal for job performance

evaluation of network management

teams based on job competencies.

Implement a job performance

evaluation system of network

management teams based on

individual goals and job

competencies.


Despite advances in the design and implementation of regional HR policies, problems that have

been encountered in this process are outlined in the following table:

Table 9: Constraints in the formulation of policies and strategies for HHR management and

development. San Martin, 2013.

Problem Constraints Consequences Proposal for

improvement

HR policies have not been

approved.

Designed policies have nothing

explicitly related to health and

safety at work.

There are aspects of designed

policies which are not yet

implemented, including skills

development; motivation and

incentives; and workplace

health, safety and welfare.

Changes in regional authorities

slow the approval process.

This aspect was not prioritized

at the outset due to lack of

information and awareness

regarding its importance.

Lack of a policy framework and

competent teams to design

policy implementation

strategies.

Lack of a regulatory

framework for HHR

actions in RHD.

Administrative

sanctions for failure to

comply.

Review and update

policies to bring into

alignment with Civil

Service Law.


The Civil Service Law includes the following statement to describe one function of the HR office or

corresponding body:

"Develop guidelines and policies for the development of a personnel management plan and the

optimal functioning of the HRM, including the application of performance indicators."

Development of operational research

Unfortunately, this process has not progressed, despite the existence of a national research

agenda for HHR problems for 2011-2014, which was approved on March 18, 2011 by ministerial

resolution.6

Problems encountered during this process are included in the table below.

6 See the national agenda for HHR research in Annex 7.4



Table 10: Constraints in the development of operational research. San Martin, 2013.


improvement

Neither HRH

investigations nor a

diagnostic assessment

of the HRH situation in

the region have been

carried out.

The lack of research and

diagnostics is mainly due to

the lack of a responsible party

to promote this work. The

diagnosis is not taken into

account when making

decisions.

Authorities do not give due

importance to this process.

HRM directorate has little

capacity for HRM: staff must

assume multiple roles and

cannot specialize in research

issues.

Due to the lack of research, there

is no evidence to support the need

for policies and strategies to

improve HRM and staff

performance.

Based on HRMS

diagnosis, identify

research topics to

be co-financed with

the central level.



Progress in this process is 76%, which is deemed “moderate development”.

According to current ROF, the HRM directorate is responsible for maintaining HR information. To

accomplish this, the institution employs official reporting systems to record information on HR

employment.

Key informants report that they use the information from these systems to make decisions.

The weaknesses identified in this process are included in the following table.

Table 11: Constraints in HHR information management. San Martin, 2013.


improvement

Current information

systems do not register

non-remunerative items;

staff attendance,

tardiness and absences;

public tenders; current

allocation of each

worker; or personnel

files.

They use MEF reporting

applications (payroll system,

SIGA), but this data is

insufficient for decision

making and comprehensive

analysis.

This is because the RHD

does not define the type of

information they need for

relevant and timely decisions.

Insufficient information is

recorded to make decisions.

By not knowing the allocation of

workers, health networks are

hiring staff where they are not

needed. Operational units do

not report to the RHD about

public tenders they perform.

Define HRM issues to

monitor at all levels.

Develop reporting

systems; flow charts;

and collation and

analysis of required

information.



No progress has been achieved in this process.

According to the current ROF, there is no party responsible for this process although it is noted as an important function of HR offices in the Civil Service Law.



"Develop guidelines and policies for the development of people management plan and the optimal HRM functioning, including the application of performance indicators."

The weaknesses identified in this process are included in the table below.

Table 12: Constraints in HHR management control. San Martin, 2013.


improvement

A responsible party has

not been defined to

manage this key

function, which is

explicitly mentioned in

the Civil Service Law.

Indicators for HRM have

not been defined.

RHD does not perceive

the need to monitor HRM

indicators.

Due importance is not

given to this process.

Insufficient staff to

implement HRM

processes, and current

staff must execute

multiple roles and cannot

specialize.

RHD and operational units

do not measure progress

in HRMS implementation

in order to improve them.

Form an ad hoc

committee to define

indicators and

procedures for

collecting, recording,

measuring and

periodically analyzing

results.

Strengthen capacities of

the committee to monitor

indicators.


The HP project survey tool defines a set of HRM indicators that can be reviewed to establish a

HRMS monitoring plan in SMT-RHD.

PROPOSED INDICATORS OF HUMAN RESOURCE MANAGEMENT

% of micro-networks that have HR needs estimation

% of units that have job profiles7

% of contracts signed after a meritocratic selection process

% of vacancies that have been published on the website of the Ministry of Labor

% of recruitment and selection processes that have been made based on job profiles

% of training conducted on the basis of a performance gap

% of workers who have agreed output targets

% of workers who have been assessed by competencies

% of workers who have been hired in remote areas, based on an attractive pay scale

HHR strategic planning

Progress in this process is 82%, which is deemed “high development”.

This high level of achievement is based on the following actions:

According to the current ROF, the HRM directorate is responsible for this process.

Last year, the RHD made calculations of HHR requirements and needs at the first level of

care.

7 The standard suggested to be fulfilled is at least 80%.



To estimate HHR needs, SMT-RHD considered population growth; an increase in functions;

expected increase in production; effective demand projections; and health service use

projections.

To make accurate calculations, SMT-RHD used a spreadsheet prepared by the project and

an application designed by the MoH. The MoH application includes the same criteria as the

project spreadsheet.

According to key informants, these results are used for hiring purposes to justify the need for

an increased budget and request more Civil Health Service in Rural and Marginal Urban

Areas (Servicio Rural y Urbano Marginal en Salud - SERUMS) positions.

SMT-RHD has a staffing plan for the medium term. Unfortunately, recent staff turnover in the

RHD management team has delayed the plan’s revision by the new team. Additionally, the

HRM directorate has insufficient staff to perform all assigned tasks.

The weaknesses identified in this process are included in the table below.

Table 13: Constraints in HHR strategic planning. San Martin, 2013.


improvement

In spite of having a

party responsible for

estimating HR needs

and an application to

calculate needs, there

is no updated

information on current

staffing.

The MoH has provided an

application to facilitate

accurate calculations.

Micro-networks do not

regularly report information on

staff allocation and levels

because they are not required

to do so. Additionally, there is

no mechanism to allow this

information to flow from the

bottom up, at least quarterly.

HR gaps cannot be

estimated due to

unreliable information on

current staffing.

High risk of overstaffing

or misallocation.

Develop a staff

information mechanism

to periodically flow from

the bottom up to identify

needs; this mechanism

could be included in the

MOF that is being

designed.


According to the Civil Service Law, all HRM offices in the public sector must execute the following

function:

"Study and analyze the quantitative and qualitative staffing of public institutions according to institutional needs."

HHR financing

Progress in this process is 100%, which is deemed “high development”.

This level of achievement is due to the following actions:

There is a body responsible for managing this process.

According to key informants, last year the SMT-RHD estimated HHR funding needs and

generated calculations based on the number of unfilled positions of contracted staff under

CAS mode; HR needs evaluation; implementing units’ requirements; and the historical

budget.

The SMT-RHD designed proposals to finance hospitals and SERUMS staff.



2.2.2 Results of the assessment in other regions

The following table shows the consolidated results from the evaluation prepared by PARSALUD

II.

Table 14: HHR policy and strategic planning: Performance in four regions at different

levels.

Institution Ucayali Cusco Huánuco Ayacucho

RHD No HRM plan, so

HRM is reactive.

HRM office activities

are focused on a

short-term

administrative

aspects instead of

integrated HRM .

Personnel files are

incomplete.

RHD has an HR

management plan

but has insufficient

information.

RHD has developed

HHR gap analysis

based on the MoH’s

Health Information

System (HIS) but

did not consider

qualitative

information.

HRM office

activities are

focused on short-

term administrative

aspects instead of

integrated HRM.

Poor allocation of

computing

resources. No

systematic updating

of information in

personnel files.

No HRM plan, so

HRM is reactive.


are focused on short-

term administrative

aspects instead of

integrated HR

management.

Personnel files are

incomplete.

No HRM plan, so

HRM is reactive.


are focused on

short-term

administrative

aspects instead of

integrated HRM.

Personnel files are

incomplete.

Network No HRM plan, so

HRM is reactive.


are focused on

short-term

administrative

aspects instead of

integrated HR

management.

Personnel files are

incomplete.

No HRM plan, so

HRM is reactive.

Poor allocation of

computing

resources.

No systematic

updating of

information in

personnel files.

No HRM plan, so

HRM is reactive.



term administrative

aspects instead of

integrated HR

management.

Personnel files are

incomplete.

No HRM plan, so

HRM is reactive.


are focused on

short-term

administrative

aspects instead of

integrated HR

management.

Personnel files are

incomplete.

Micro-

network

No HRM plan, so

HRM is reactive.


are focused on

short-term

administrative

aspects instead of

integrated HR

management.

Personnel files are

incomplete. There is

a notable shortage

of HR in the HRM

office.

No HRM plan, so

HRM is reactive.

No HRM plan, so

HRM is reactive.



term administrative

aspects instead of

integrated HR

management.

Personnel files are

incomplete.

No HRM plan, so

HRM is reactive.


are focused on

short-term

administrative

aspects instead of

integrated HR

management.

Personnel files are

incomplete.




Hospital Has an incomplete

HRM plan.


are focused on

short-term

administrative

aspects instead of

integrated HR

management.

Personnel files are

incomplete.

No HRM plan.

Poor allocation of

computing

resources.

No systematic

updating of

information in

personnel files.

No HRM plan, so

HRM is reactive.



term administrative

aspects instead of

integrated HR

management.

Personnel files are

incomplete.

No HRM plan, so

HRM is reactive.


are focused on

short-term

administrative

aspects instead of

integrated HR

management.

Personnel files are

incomplete.

SOURCE: PARSALUD II technical report

PARSALUD II qualitative information shows poor development in the HHR policy and planning

subsystem, especially in the capacity to determine HHR requirements and manage HHR

information.

Regarding Cajamarca RHD, the project will present the results of the assessment using HP

project methodology and instruments.

Graphic 6: Cajamarca HHR policy and strategic planning: Results by key processes.

0%10%20%30%40%50%60%70%80%90%

100%

Policies and Strategies for HHR Management and

Development

Development of operational

research


HHR Management Control

HHR Strategic Planning

HHR Financing

Cajamarca: HHR Policy and Strategic Planning




Table 15: Cajamarca HHR policy and strategic planning: Results by key processes.


result

Obtained

result

%

Complete Result


management and development 26 0 0% Little development

Development of operational research 4 0 0% Little development

HHR information management 21 19 90% High development

HHR management control 14 7 50% Moderate development

HHR strategic planning 28 16 57% Moderate development

HHR financing 7 6 86% High development



The table below presents the findings for each of the processes in this sSubsystem.

Table 16: Constraints in HHR policy and strategic planning. Cajamarca, 2013.

Key Process Problem Constraint Consequences Proposal for

improvement

Policies and

strategies for

HHR

management and

development

Lack of HRM policies and

strategies.

Some authorities do

not know the scope of

HR planning while

others show a lack of

interest. In addition,

the MoH does not

provide TA to help

regions develop

HRM.

Personnel

disorganized.

Lack of interest

and institutional

commitment to the

objectives.

Formulate a

comprehensive proposal

for HRM with TA from the

MoH.

Development of

operational

research

Operational research is

conducted in an isolated

manner with little

monitoring of RHD.

There is no research

unit in the Cajamarca

RHD to promote and

monitor the

development of

research.

Lack of research

hinders progress

of health sector

development in

Cajamarca.

Create a research unit

with competent staff.

HHR information

management

Cajamarca has a matrix

that identifies the

allocation of health

personnel in each

service.

There is a

responsible party in

each health network

to monitor the

availability of staff in

health facilities.

The availability of

information about

the location of HR

facilitates the

identification of

HHR gaps.

Specify in detail some

aspects of the actual and

current location of staff,

as well as the temporary

movement to other

facilities.

HHR

management

control

Absent or weak HRM

control.

HR offices in health

networks have little

support from RHD

and do not have

access to training.

These offices do not

exercise their

authority in HRM.

Staff do not fulfill

their duties and

are sometimes

absent or

unavailable.

HR offices must exercise

greater control, authority

and respect for the rules

of HHR control.

HHR strategic

planning

Lack of HHR strategic

planning.

Recently, some HHR

plans are being

implemented.

Cajamarca RHD has

Unavailability of

appropriate staff

in the right place.

Implementation and

strengthening of an

adequate HHR strategic

plan.




improvement

defined HR gaps.

There is a plan of

action to close HHR

gaps, among other

issues related to HR

planning.

HHR financing Cajamarca RHD has

sufficient budget to

ensure staff salaries, but

there are old debts to be

paid from the arbitrary

and non-technical

distribution of staff

bonuses and incentives

granted by the state.

No constraints

reported.

Personnel receive

remuneration

according to work

assignment.

Continuous monitoring of

budget availability, and

design of a proper

financial plan to include

budget needs of both

stable and hired staff.


2.3 Work Organization: Progress


The following graph shows the results of three processes included in this subsystem.

On average, this entire subsystem has only achieved a 32% progress rate, which is deemed “little

development”.

In general, all processes have increased but with "little development".

According to key informants, processes exhibiting slight improvements are associated with job

profiles definitions and competencies design.

Graphic 7: San Martin work organization: Results by key processes.

0%

20%

40%

60%

80%

100%

Design of jobs

profiles

Identification of

labor competencies

Job rating

San Martin: Work Organization




Table 17: San Martin work organization: Results by key processes.


result

Obtained

result

%

Complete Result

Design of job profiles 56 21 38% Little development

Identification of labor competencies 24 9 38% Little development

Job rating 20 2 10% Little development

Average 100 32 32% Little development


More specific findings on each of the processes are listed below.

Design of job profiles

This process shows a 38% achievement rate due to the following developments, among others:

Technical team members have utilized the following documents: Staffing Table 2013 (Cuadro

de Asignación de Personal – CAP); MOF 2006; and Staff Budget 2012 (Presupuesto Analítico

de Personal – PAP).

According to CAP 2013, the number of stable staff is less than the number authorized in the

CAP. However, the total number of workers, both stable and hired, exceeds the quantity

allocated in the CAP. Therefore, contracted staff exceeds the authorized number.

Job profiles have been created for 60% of the positions in SMT-RHD organizational units.

To design the specific functions of each position, the SMT technical team referenced the opinion

of experts and general functions established in the ROF. To define the position requirements, the

team considered the regional labor market situation, the complexity of the functions and the

importance of the position. However, designed job profiles have not yet been officially approved.

Despite advances in this process, problems have been encountered and are summarized in the

table below.

Table 18: Constraints in the design of job profiles. San Martin, 2013.


improvement

SMT-RHD has not

assigned the task of job

profile design to a

specific group in the

institution. The ROF also

does not specify a

responsible party for this

task.

The design of job

profiles is not based on

the Procedures Manual

(Manual de procesos –

MAPRO) because SMT-

RHD does have not one.

There is an institutional

MOF from 2006 that

does not correspond to

the current

organizational structure;

Since stripping the National

Institute of Public

Administration (INAP) of its

role as HRMS policy maker,

there has been a loss of

interest in following HRMS

regulations. With the entrance

of SERVIR, regulations are

being reviewed and important

tasks are being identified,

including job profile design.

Lack of awareness of the

importance in managing

MAPRO, which identifies all

procedures for operational

management of the

organization. These

procedures present the

functional tasks for specific

The lack of job profiles

and unclear technical job

requirements negatively

affects the recruitment

process.

Remuneration is linked to

the person and not to the

specific profile.

The disuse of MAPRO

results in overlapping

functions, shared

responsibilities and

duplicate subordinated

functions.

Due to the outdated MOF,

workers have no effective

responsibility for the tasks

performed.

Assign this process to

an appropriate party.

Appoint a committee to

develop and

institutionalize

MAPRO.

Appoint a commission

to assume

development of a MOF

aligned to ROF and

CAP.




improvement

specific roles are

outdated.

positions.

A new ROF necessitates

amending other documents,

including MOF, CAP, PAP,

MAPRO, and job profiles.


The Civil Service Law explicitly states the HR office or corresponding body should perform the

following function[1]:

"Manage Job Profiles."

Identification of labor competencies

This process has reached a 38% achievement rate, due largely to SMT-RHD progress since

January 2013 in designing competency profiles for the first level of care as well as for managerial

and administrative positions. In designing the profiles, the technical team is referencing the

Competencies Dictionary and MoH-designed competencies and consulting with experts.


table below.

Table 19: Constraints in the identification of labor competencies. San Martin, 2013.


improvement

There is no party

responsible for defining

the competency profile

since the current ROF

does not consider the

subject.

HRM based on

competencies is not well

developed in the public

sector, which could

contribute to

implementation failure in

the regional governments.

Weakly designed job

profiles without including

competencies would result

in hiring people without

identifying their skills.

Hire an external consultant

to apply competency

profiles in HRMS

processes.


Job rating

This process has achieved a 10% progress rate due mostly to the development of job profile assessment processes at the micro-network level.


table below.



Table 20: Constraints in job rating. San Martin, 2013.


improvement

In the current ROF, there

is no party responsible for

assessing job profiles.

Lack of awareness as to

the importance of

evaluating job positions to

design equitable salary

scales and career plans.

Compensation could not be

assigned in a fair and

equitable manner.

Demotivated staff could

weaken institutional

achievements.

Assign a person or

appoint a committee to

be responsible for

assessing job profiles

and rating.




II.

Table 21: Work organization: Performance in four regions at different levels.


RHD Has updated

management

records but poorly

defined in some

cases.

Possesses all

management

records but with

incomplete

information.

Has designed CAS

job profiles.

RHD refers to

having designed

competencies, but

they only define

knowledge which is

part of a

competency.

Has management

documents

developed in 2006.

Has management

documents

developed in 2006.

Network Networks either do

not possess

management

documents or they

are outdated.

Functions and

responsibilities are

not uniform among

networks.

Possesses all

management

documents but with

incomplete

information.

Have developed

models to design

MOF at network

level.

They use Cusco

RHD job profiles to

hire network staff.

All networks have

management

documents, but they

are outdated.

Functions and


not uniform among

networks.

All networks have

management

documents, but they

are outdated.

Functions and


not uniform among

networks.

Micro-

network

Micro-networks

either do not

possess

management

documents or have

outdated versions.

Functions and


not uniform among

micro-networks.

Micro–networks

either do not

possess

management

documents or have

outdated versions.

Functions and


not uniform among

micro-networks.

Micro–networks

either do not

possess

management

documents or have

outdated versions.

Functions and


not uniform among

micro-networks.

Micro–networks

either do not

possess

management

documents or have

outdated versions.

Functions and


not uniform among

micro-networks.




Hospital Hospitals either do

not possess

management

documents or have

outdated versions.

Not all hospitals

have the entire

range of

management

documents, but if

they do, these

documents do not

contain complete

information.

The majority uses

Cusco RHD hired

staff job profiles.

All have

management

documents.

All have

management

documents.


PARSALUD II qualitative information shows poor development in the design of job profiles.

Additionally, all regions have outdated management documents.

Regarding Cajamarca RHD, the results of the project’s assessment using HP project

methodology and instruments are below.

Graphic 8: Cajamarca work organization: Results by key processes.

0%

20%

40%

60%

80%

100%

Design of jobs

profiles

Identification

of labor

competencies

Job rating

Cajamarca: Work Organization


Table 22: Cajamarca work organization: Results by key processes.


result

Obtained

result

%

Complete Result

Design of job profiles 56 10 18% Little development

Identification of labor competencies 24 0 0% Little development

Job rating 20 0 0% Little development





Findings for each of the processes in this subsystem are presented in the table below.

Table 23: Constraints in work organization. Cajamarca, 2013.


improvement

Design of job

profiles

There is no

responsible party to

assume job profile

design in the

institution, but they

have the following

management

documents: CAP

2013, MOF 2009

and PAP 2013.

No specialist has

been identified who

can assume this

role within the

institution. It is also

likely that the

institution does not

have the budget to

hire an external

specialist.

Recruitment does

not meet job

technical

requirements.

Due to the lack of

job profiles,

remuneration is

often linked to a

person and not to

the specific job

profile.

Assign a


develop job profiles

for the Cajamarca

RHD and

decentralized

bodies.

Identification of

labor

competencies

Have not been

developed nor

implemented.

Lack of competent

team.

Assign a


develop labor

competencies for

the Cajamarca RHD

and decentralized

bodies.

Job rating Have not been

developed nor

implemented.

Lack of competent

team.

Assign a


rate posts for the

Cajamarca RHD

and decentralized

bodies.


While this is the most important subsystem, it is also the least developed. Staff has not developed

the technical skills needed to perform this function. Management documents are outdated, and

functions are not defined in the current HRM framework.

2.4 Employment Management: Progress

The following graph presents the results of the five processes that are involved in this subsystem.

On average, the subsystem only achieved a 37% progress rate, which is deemed “little

development”.

In general, most processes have made some progress. According to information provided by key

informants, however, there are processes that have achieved no development, including staff

mobility as well as staff termination and retirement.




Graphic 9: San Martin employment management: Results by key processes.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Recruitment,

Selection, Incorporation and

Induction

Staff mobility


attendance control

Administration of

disciplinary process


San Martin: Employment Management

SOURCE: SMT Technical Report

Table 24: San Martin employment management: Results by key processes.


result

Obtained

result

%

Complete Result

Recruitment, selection, incorporation

and induction 60 23 38% Little development

Staff mobility 3 0 0% Little development

Management of staff files, attendance

control 20 8 40%

Moderate

development

Administration of disciplinary process 14 6 43%

Moderate

development

Staff termination and retirement 3 0 0% Little development



Finding for each process in this subsystem are presented below.

Recruitment, selection, incorporation and induction

This process shows achieved a 38% progress rate due to the following developments, among others:

There is a responsible party for managing staff recruitment, selection, incorporation and

induction. However, in some cases there is no one responsible for the development of each

process.

Key informants said that evaluation instruments in the most recent selection process were

only used to fulfill the minimum requirements of current regulations. These evaluation tools



included curriculum evaluation; personal interview; and knowledge and psychological test

scores.

Despite advances in this process, problems have been encountered and are summarized in the following table.

Table 25: Constraints in recruitment, selection, incorporation and induction. San Martin,

2013.


improvement

Despite having a

responsible party for

managing recruitment,

selection, incorporation

and induction of staff,

CAS hiring processes

conducted last year lack

the use of job profiles,

terms of reference,

functions worksheets,

and budgetary

certification8.

Affidavits from hired

candidates are not

verified during the

recruitment and

selection process.

Hired staff does not

receive appropriate

instruction because

there is no responsible

party to inform them of

policies, rules, roles,

goals, vision, mission

and institutional values.

Lack of administrative

procedures in personnel

administration.

There are no visible leaders

to take responsibility for

executing these processes.

The local labor market is tight,

and there is a poor

understanding of these

processes.

Salary scale is not

competitive to attract skilled

personnel with HRM

knowledge.

Frequent personnel turnover

results in the accumulation of

records pending verification

and interferes with daily

tasks.

Lack of awareness regarding

the importance of the

induction process as a tool for

strengthening organizational

learning.

Absence of qualified

personnel and sound

knowledge of HRM

procedures generate

mediocre management

results, and an error prone

environment that has high

civil and criminal liability.

The working environment

deteriorates as a result of

staff who do not fit the job

profile, standards or

requirements; this can

cause a rise in unmet

demands.

The cost to the state to

recruit unqualified

personnel is high because

turnover is more likely.

This creates further costs

in time and money to carry

out a new recruitment and

selection process.

Design a directive to

establish procedures and

responsibilities for the

different processes of

recruitment. This directive

must be supported by the

correct contract file that

includes the standardized

job profile of the post to be

hired, as well as the budget

certification to guarantee

remunerative payment

without neglecting

transparency and

information dissemination

established by current

regulations.

Designate a responsible

party to develop an

induction program with the

person responsible for

institutional image

management.


The Civil Service Law explicitly states the following as a function of HR offices or the

corresponding body[1]:

“The selection process is a mechanism to join a group of public managers, career civil servants,

and public servants from complementary activities. It selects the best people for the job on the

basis of merit, competence and transparency, ensuring equal access to public service."

Staff mobility

This process has achieved little to no progress.

8 It means "ensure availability of budgetary provision to compromise expenditure for the respective

fiscal year".



The problems encountered in this process are presented in the table below.

Table 26: Constraints in staff mobility. San Martín, 2013.

Problem Constraints Consequences Proposal for improvement

Staff shifting is made

according to personal

needs rather than

institutional

Lack of knowledge of

rules governing staff

mobility.

Shifting of staff does not

satisfy the needs of the

original or destination

position.

Develop and approve internal

job regulation (Reglamento

Interno de Trabajo – RIT) to

clarify and specify all the

necessary tasks to implement

institutional policies and

procedures.


Management of staff files and attendance control

This process has achieved a 40% progress rate mostly due to SMT-RHD selection of a person responsible for updating information regarding staff files and a person responsible for attendance control records.

Despite advances in this process, problems have been encountered and are summarized in the table below.

Table 27: Constraints in management of staff files, attendance control. San Martin, 2013.


improvement

The filing of staff information

is not done through a digital

recording system which would

facilitate and expedite the

organization of information on

recruited staff.

A digital attendance control

system is in use, but

physicians do not record

attendance in the way agreed

to by the medical union.

Physicians also disregard the

rules requiring a public

servant to record attendance

in order to maintain payment

of their salaries.

Failure to implement

software for the digital

recording system may

stem from insufficient

budget or poor familiarity

with modern devices.

In health institutions, it is

critical to establish

physician attendance

controls. Physicians are

the only workers exempt

from signing attendance

control records

according to an

administrative

resolution.

Failure to evaluate staff

in a timely manner can

interfere with efficient

decision making.

Implementation of a

comprehensive

administrative system of

personnel control and

records, which includes all

personnel administration

processes.


Administration of disciplinary process

This process has achieved a 43% progress rate due to SMT-RHD designation of a responsible party to manage disciplinary proceedings. The SMT-RHD has also created a permanent commission to manage administrative processes; the commission’s decisions are inherently supported by a resolution.

Despite advances in this process, problems have been encountered and are summarized in the table below.



Table 28: Constraints in administration of disciplinary process. San Martin, 2013.


improvement

SMT-RHD has neither

developed nor approved

RIT, which identifies the

rights and obligations of

the public servant.

They do not maintain an

updated record to report

dismissals and dismissal

sanctions to the National

Registry of Sanctions

(RNSDD).

Lack of knowledge

regarding regulations or

insufficient staff to develop

regulations and internal

policies.

Lack of knowledge

regarding current

regulations administered by

SERVIR to develop an

updated record of the

RNSDD.

Disoriented personnel

unable to exercise their

rights and duties as well as

a weak governing body to

apply normative standards.

Failure to maintain updated

records for SERVIR would

result in state entities hiring

unfit personnel. In the case

of health professionals, this

[the hiring of unfit

personnel] could cause

irreparable damage: poor

decision making could

negatively affect public

health.

Develop internal

regulations by hiring a

consultant or assigning a

manager to lead the

development of

management regulations.


individual or party to

manage registration,

dismissals and dismissal

sanctions for prompt

reporting to SERVIR.



This process has achieved little to no progress.

The problems encountered are listed in the following table.

Table 29: Constraints in staff termination and retirement. San Martin, 2013.


improvement

There is no responsible

party to manage the

process of

disengagement in order

to effectively manage

staff termination in a

timely manner.

Lack of knowledge

regarding HRM processes

and lack of verification of

data that generates

unjustified regular expenses

(payments to dead

workers).

Inappropriate payment of

remunerative obligations,

which could possibly

generate administrative,

civil and criminal penalties.

Implement a

comprehensive

administrative staff system

with detailed information

on all types of

disengagement according

to labor rules and

contracts. Alternatively, a

responsible party should

be assigned for the sole

purpose of managing all

types of employment

termination.




II.



Table 30: Employment Management: Performance in four regions at different levels.


RHD RHD publicizes

CAS vacancies to

recruit but does not

record information

about the

recruitment

processes.

Incomplete use of

selection tools.

There is no system

to register the real

destination of HR.

Lack of a

permanent

selection

committee.

RHD utilizes job

profiles in selection

process and has a

permanent

selection

committee.

RHD does not

systematize CAS

selection

processes.

There is no system


destination of HR.

RHD publicizes CAS

vacancies to recruit

but does not record

information about the

recruitment

processes.

Incomplete use of

selection tools.

There is no system


destination of HR.

Lack of a permanent

selection committee.

RHD publicizes CAS

vacancies to recruit but

does not record

information about the

recruitment processes.

Incomplete use of

selection tools.

There is no system to

register the real

destination of HR.

Lack of a permanent

selection committee.

Network Networks publicize

CAS vacancies to

recruit but do not

record information

about the

recruitment

processes.

Incomplete use of

selection tools.

There is no system


destination of HR.

Lack of a

permanent

selection

committee.

Networks publicize

CAS vacancies to

recruit.

Utilize job profiles

in selection

process.

Have a permanent

selection

committee.

Insufficiently

systematized CAS

selection

processes.

There is no system


destination of HR.

Networks publicize

CAS vacancies to

recruit.

Use of selection

tools as well as

recording and

storage of

examinations do not

occur uniformly

among networks.

All networks lack

permanent selection

committees.

All networks provide

induction programs

for new staff.

Networks publicize CAS

vacancies to recruit.

Use of selection tools as

well as recording and

storage of examinations

do not occur uniformly

among networks.

Lack of permanent

selection committees.

Always conduct

induction programs.

Micro-

network

Micro-networks do

not publicize CAS

vacancies.

Micro-networks do

not publicize CAS

vacancies.

Micro-networks do

not publicize CAS

vacancies.


publicize CAS

vacancies.

Hospital Hospitals do not

publicize CAS

vacancies.

Selection tool

usage is not

standardized.

Formation of

permanent

selection

committees is not

uniform.

Hospitals use job

profiles in selection

processes.

They have a

permanent

selection

committee.

There is no system


destination of HR.

All entities publicize

CAS vacancies.

There are no

permanent selection

committees.

There is no

uniformity in the use

of criteria and

selection

instruments.

Always provide

induction programs.

All entities publicize

CAS vacancies.

There are no permanent

selection committees.

Always conduct

induction programs.


PARSALUD II qualitative information shows incomplete development of recruitment and selection

processes.



Regarding Cajamarca RHD, the project will present the results of the assessment using HP

project methodology and instruments.

Graphic 10: Cajamarca employment management: Results by key processes.

0%10%20%30%40%50%60%70%80%90%

100%

Recruitment,

Selection, Incorporation and Induction

Staff mobility

Management of

staff files and attendance

control

Administration of disciplinary

process


Cajamarca: Employment Management


Table 31: Cajamarca employment management: Results by key processes.


result

Obtained

result

%

Complete

Level of

developme

nt

Recruitment, selection, incorporation

and induction 60 23 38% Little

Staff mobility 3 0 0% Little


attendance control 20 5 25% Little

Administration of disciplinary process 14 6 43% Moderate

Staff termination and retirement 3 2 67% Moderate

Average 100 36 36% Little


The findings for each of the processes in this subsystem are included in the following table.



Table 32: Constraints in employment management. Cajamarca, 2013.


improvement

Recruitment,

selection,

incorporation and

induction

Cajamarca RHD

has a permanent

selection

committee.

Lack of

knowledge

regarding

implementation of

the recruitment

process required

by law.

To reduce time in

selection process,

Cajamarca RHD

eliminates some

important procedures.

Contract inadequate

staff due to

inappropriate

recruitment; staff

selection does not

fit the job profile.

Standardize the

recruitment and

selection processes

to include

standardized job

profiles based on

current regulations.

Staff mobility There is an

evaluation

committee for

mobilization

(displacement) of

staff within the

organization, but

there is no control

or monitoring of

other staff,

especially health

facility staff.

Lack of interest

among health

networks in managing

mobility of health

facility staff based on

current regulations.

There is no real

information about

personnel

allocation.

Frequent absence

of staff in health

facilities.

Implement a staff

attendance and

mobility control

system.

Management of

staff files and

attendance control

Poor management

of health

personnel files

and records.

Poor management

of attendance

records.

Poor definition of

functions for

personnel file control.

Lack of staff

commitment to

register attendance.

There is no


monitor attendance

and retention in

health facilities and

networks.

Staff files with

incorrect

information.

Frequent absence

of staff in health

facilities.

Form a party

responsible for

managing files and

records.

Implement an

attendance control

system in health

facilities.

Administration of

disciplinary

process

Disciplinary

process

commissions

unfamiliar with

rights and

obligations of

public servants.

Disciplinary

process

unnecessarily

extended.

Lack of trained

personnel to manage

processes and

current regulations on

disciplinary process.

Statute of limitations

on faults.

Commissions must

be properly staffed

with qualified

personnel who are

familiar with labor

regulations and

administrative

procedures.

Staff termination

and retirement

Current processes

are incomplete

and not based on

current

regulations.

Lack of knowledge

regarding the legal

basis of personnel

administration

processes.

Staff termination

and retirement

without technical

and legal support.

Designate a


manage all types of

employment

terminations.




2.5 Performance Management: Progress

The following graph shows results of the four processes that are involved in this subsystem.

On average, this entire subsystem only achieved a 14% progress rate, which is deemed “little

development”.

The supervision process as well as the feedback and design of plans for individual performance

improvement process achieved little to no development.

According to key informants, the performance evaluation process is the most developed within the

performance management subsystem despite having a progress rate of 22%.


Graphic 11: San Martin performance management: Results by key processes.

0%

50%

100%Performance Planning

Supervision

Performance Evaluation

Feedback and design of

plans for individual performance improvement

San Martin: Performance Management


Table 33: San Martin performance management: Results by key processes.


result

Obtained

result

%

Complete Result

Performance planning 25 4 16% Little development

Supervision 16 0 0% Little development

Performance evaluation 45 10 22% Little development


individual performance improvement 14 0 0% Little development



Findings for each of the processes in this subsystem are listed below.

Performance planning

This process has achieved a 16% progress rate due to the following developments, among others:



There is a responsible party for the planning, organization and implementation of a

performance evaluation process for the institution.

The current ROF indicates that this function is the responsibility of the HRM directorate in the

SMT-RHD.

The SMT-RHD plans to implement staff performance this year to replace subjective

assessment, which does not reflect the true performance and expected results of each

worker.


table below.

Table 34: Constraints in performance planning. San Martin, 2013.


improvement

Although there is a body

responsible for planning,

organizing, implementing

and evaluating staff

performance evaluations,

there is no methodology

or evaluation plan. In spite

of this, the SMT-RHD

conducted staff

performance evaluations.

There is no methodology

for establishing individual

performance goals.

Evaluations are conducted

only to meet administrative

requirements in order to

avoid sanctions from the

government comptroller.

Lack of knowledge in

managing staff performance

evaluations.

Staff is evaluated but

without considering the

attainment of

institutional goals.

Retain institutional staff

with apparently good

performance while in

reality staff may not be

achieving performance

goals.

Develop methodologies and

management tools to

measure job performance in

order to contribute to the

achievement of institutional

goals.

Develop a policy that

defines the standards of job

competence at the

individual level within the

framework of RHD policies

and including identification

of performance goals for

each unit.


The Civil Service Law explicitly states the following as a function of the HR office or

corresponding body[1]:

“Be responsible for assessments to be made by the organization and in the manner established by SERVIR ".

"Public managers, career civil servants and related-activity public servants are subject to performance

evaluation."

Supervision

This process has achieved a 0% progress rating, which is deemed “poor development”.

The problems encountered are summarized in the following table.



Table 35: Constraints in supervision. San Martin, 2013.


improvement


party to manage, monitor,

coach or mentor. In the

current ROF, this process is

not defined.

There are no methods or

instruments to provide TA

to staff.

RHD does not develop

coaching, supervision or

mentoring activities.

Managers do not realize the

importance of standardizing

and developing tools and

methodologies to

accompany staff

performance.

Errors and wasted time,

which affects achievement

of individual goals.

Confused and

demotivated staff feels

uncommitted and

uninvolved in their jobs

and duties, which

prevents attainment of



party to develop

methodology and

management tools to

guide staff performance.


Performance evaluation

This process has achieved a 22% progress rate due to the following developments, among others:

There is a responsible party for planning, organizing and implementing staff performance

evaluations for SMT-RHD organizational units and its decentralized bodies.

The current ROF indicates that this function is the responsibility of the HRM directorate.

Last year, the SMT-RHD conducted a performance evaluation but only for staff hired in CAS

mode. Results were used to dismiss contract workers with poor scores.


following table.

Table 36: Constraints in performance evaluation. San Martin, 2013.


improvement

There is a responsible

party according to the

current ROF, but there is

no person in charge of

organizing and monitoring

the staff performance

evaluation process.

Methodology and

management tools to

define the staff

performance evaluation

process have not been

developed or approved.

A non-technical staff

performance evaluation for

CAS staff took place,

reflecting only the

fulfillment of routine

administrative obligations.

RHD has not identified a

specialist within the

current staff who can

assume this role.

The institution does not

have the budget to hire an

external specialist.

Subjective evaluation that

does not reflect the

performance

achievements of each

worker.

SMT-RHD will assume

administrative

responsibility for the

failure to implement the

mandatory provisions of

the Civil Service Law

regarding a

comprehensive,

systematic, continuous,

demonstrable and

objective assessment

process.

Designate a party

responsible for organizing

and monitoring an objective

staff performance

evaluation process.

Develop methodology and

management tools to

develop a performance

evaluation in line with





Feedback and design of plans for individual performance improvement

This process has achieved a 0% progress rate.

The problems encountered are summarized in the following table.

Table 37: Constraints in feedback and design of plans for individual performance

improvement. San Martin, 2013.


improvement

There is no party with

direct responsibility for

processing feedback

and designing plans to

improve individual staff

performance; the current

ROF also does not

specify a party for these

duties.

Through performance

feedback, heads of

organizational units perform

appropriate actions to

improve staff performance.

HHR with poor

performance, making the

same mistakes indefinitely.


party to manage the

feedback process and

design plans to improve

individual staff performance

for all SMT-RHD

organizational units and its

decentralized bodies.




II.

Table 38: Performance management: Results in four regions at different levels.


RHD RHD conducts

performance

evaluations using

the instrument

provided by the MoH

but does not put the

results to practical

use.

RHD does not

conduct

performance

evaluations.

RHD conducts

performance

evaluations using

the instrument

provided by the MoH



use.

RHD conducts

performance

evaluations using

the instrument

provided by the MoH



use.

Network RHD conducts

performance

evaluations using

the instrument

provided by the MoH



use.

RHD conducts

performance

evaluations using

the instrument

provided by the MoH



use.

All the networks,

except Leoncio

Prado, conduct

performance

evaluations using

the instrument

provided by the MoH



use.

Only Puquio and

Huamaga networks

conduct

performance

evaluations using

the instrument

provided by the

MoH.

However, these

networks do not put


use.

Micro-

network

Micro-networks do

not conduct

performance

evaluations.

Micro-networks do

not conduct

performance

evaluations.

Micro-networks do

not conduct

performance

evaluations.

Micro-networks do

not conduct

performance

evaluations.

Hospital Hospitals rarely

conduct

performance

Hospitals conduct

performance

evaluations for staff

Hospitals conduct

performance

evaluations for staff

Hospitals do not

conduct

performance




evaluations. When

they do, they utilize

MoH instruments but

do not put the


use.

hired on the 276

legal regime and

CAS. Administrative

and health care staff

are evaluated

utilizing MoH

instruments but do

not put the results to

practical use.

hired on the 276

legal regime and

CAS. Administrative

and health care staff

are evaluated

utilizing MOH

instruments but do

not put the results to

practical use.

evaluations.


PARSALUD II qualitative information shows that RHD, networks and hospitals develop

performance evaluation; however, these evaluations are subjective and are not linked to

individual goals. Additionally, evaluation results are not used to improve performance, and there is

no feedback to employees.

Regarding Cajamarca RHD, the project presents the results of the assessment using HP project

methodology and instruments below.

Graphic 12: Cajamarca performance management: Results by key processes.

0%

20%

40%

60%

80%

100%Performance Planning

Supervision

Performance

Evaluation

Feedback and design of plans for individual

performance improvement

Cajamarca: Performance Management

Table 39: Cajamarca performance management: Results by key processes.


result

Obtained

result

%

Complete Result

Performance planning 25 3 12% Little development

Supervision 16 0 0% Little development

Performance evaluation 45 0 0% Little development


individual performance improvement 14 0 0% Little development


SOURCE: Cajamarca Technical Report

Findings from each of the processes in this subsystem are presented below.



Table 40: Constraints in performance management. Cajamarca, 2013.


improvement

Performance

planning

There is no

responsible party

for objectively

managing, planning,

organizing,

implementing,

monitoring and

evaluating staff

performance using

a comprehensive,

systematic and

continuous

assessment.

Lack of knowledge

regarding the

importance of design

tools and instruments

for an objective

performance

evaluation.

Subjective

performance

assessment.

Designate a party

responsible for

planning

performance

evaluations at all

levels.

Supervision Has not been

developed nor

implemented.

Lack of knowledge

regarding the

importance of guiding

staff in the

performance of its

duties and functions.

Staff making the

same mistakes,

repeatedly, without

technical assistance

to correct them.

Train managers in

strategies to guide

staff to improve

performance,

through coaching,

mentoring and

supervision.

Performance

evaluation

A management tool

has not been

developed or

approved to define

the methodology to

develop the staff

performance

evaluation process.

Lack of knowledge

regarding the

importance of

developing

methodologies and

management tools to

objectively organize

and implement staff

performance

evaluations.

Health staff

performance

evaluation processes

have been executed

at the health facility

level but only to meet

an administrative

need.

Health facility staff

with apparently

good performance

ratings but

demonstrates

minimum

achievement in

institutional and

individual goals.

Designate a party

responsible for

organizing and

monitoring the staff

performance

evaluation process.

Develop a

management tool to

measure the

effectiveness and

efficiency of

administrative and

health care staff for

Cajamarca RHD

units.

Feedback and

design of plans

for individual

performance

improvement

Has not been

developed nor

implemented.

Lack of knowledge

regarding the

importance of

providing feedback

after a performance

evaluation process.

Workers without

plans to help them

improve

performance

Train managers to

provide feedback to

their workers and

design individual

plans to improve

performance.




2.6 Development and Training Management: Progress


The following graph shows results of the three processes in this subsystem.

On average, this subsystem has achieved a 60% progress rate, deemed “medium development”.

The teaching-service process has progressed the least.

According to information provided by participants, the process with the greatest level of progress

is labor advancement.

Graphic 13: San Martin development and training management: Results by key processes.

0%

20%

40%

60%

80%

100%

Labor advancement (Promotion and

Career Path)

Capacity BuildingRegulation of the

Teaching & Service process

San Martin: Development and Training Management


Table 41: San Martin development and training management: Results by key processes.


result

Obtained

result

%

Complete Result


career path) 35 27 76% Moderate development

Capacity building 47 27 58% Moderate development


process 19 7 35% Little development



Findings for each of the processes in this subsystem are listed below.

Labor advancement (promotion and career path)

This process has achieved a 76% progress rate (Development Environment) due to the following

reasons:



Key informants report that the RHD has designed a promotion policy that has not been

approved or disclosed to workers.

They have designated a responsible party for this process within the HRM directorate.

The promotion policy takes into account personnel file information, including professional

background required, years of service, trainings, performance evaluations, and absence of

disciplinary offenses; interviews; knowledge test; knowledge required for new position;

experience in the public sector; recommendations of previous employers; and opinion of

current supervisor.

The RHD states that decisions related to promotion are not susceptible to political influence.

Despite progress, problems have been encountered and are summarized in the following table.

Table 42: Constraints in labor advancement. San Martin, 2013.


improvement

RHD does not have a

standing committee to select

staff to be promoted.

RHD does not review

technical documents

produced by the candidate.

RHD does not assess

whether the applicant has

knowledge and skills in public

management or conflict

management.

Lack of clear procedures to

evaluate candidates.

RHD technical team does

not have requisite

knowledge or skills to carry

out a fair and transparent

evaluation of applicants.

The promotion process

is discredited.

Assess the effectiveness

of policy implementation,

incorporate improvements

and manage its approval.

Strengthen capacities of


improve development of

the policy.


Capacity building

This process achieved a 58% progress rate, which is deemed “moderate development”, due to

the following developments:

The SMT-RHD has a methodology to lead staff capacity development, which was provided by

the MoH.

The SMT-RHD has a responsible party for staff training processes.

The SMT-RHD has organized the following educational interventions: short courses,

workshops, lectures, and internships in regional hospitals and Lima hospitals.

To identify training needs, the responsible party takes into account institutional objectives and

goals; regional health priorities; MoH training offers; regional educational institution training

offers; institutional requests; and direct requests from workers.

To select training participants, the RHD takes into account the functions of the position and

the request from an immediate supervisor.

Salaried and contract staff can participate in trainings.

The unit responsible for training mainly deals with logistic details, including: announcing

training opportunities; facilitating audiovisual media, managing refreshments, preparing the

training room, providing teaching materials, and evaluating acquired knowledge.



Despite these advances, problems occurred and are summarized in the following table.

Table 43: Constraints in capacity building. San Martin, 2013.


improvement

SMT-RHD does not have a

regional policy for training

activities.

SMT-RHD does not know

how much is invested in

training.

Each unit develops its own

training activities and does

not report to the RHD training

unit.

Training activities do not take

place in locations similar to

the workplace.

First-level-of-care staff does

not perform internships at

first-level-of-care facilities.

RHD does not coordinate the

development of training

activities with universities.

When identifying staff training

needs and selecting staff to

train, RHD does not take into

account the results of

knowledge and performance

evaluations, or the previous

training record of the worker

(to avoid duplication).

There are no objective criteria

to select participants. The

responsible party is not

developing essential

functions, including

identifying staff training

needs; TA to network

regarding training

management; controlling

training attendance;

assessing teacher

performance; evaluating skills

according to each position;

evaluating training impact;

and evaluating training

funding.

The understaffed HR unit

manages multiple

activities, which do not

allow it to develop a

regional training policy

and strategies.

Each unit manages its

training financing.

There are no training

venues in first-level-of-

care facilities.

Logistics absorb time and

attention of training unit.

No performance

evaluations are conducted

to identify training needs.

Poor ability to manage

training activities.

Staff performance is not as

expected.

Trained workers are not

always the most in need.

RHD training unit is not

recognized as a TA unit in

training management.

RHD does not know the total

investment made in training

activities, although it

considers that the investment

made does not significantly

improve the quality of care.

Strengthen capacities

in training

management at all

levels.

Design standards,

guidelines and tools to

improve training

activities.

Design training

programs and

internships in places

similar to the working

environment of

trainees.

Develop strategies to

create internship

opportunities in first-

level-of-care facilities

to train first-level-of-

care workers.

Establish a

mechanism to

centralize information

regarding training

activities and

associated financing.


Regulation of teaching - service process

This process achieved a 35% progress rate, deemed ”little development”, mainly because the

RHD has signed agreements with training institutions for undergraduate and graduate students in

medicine; undergraduate students in nursing and midwifery; and students in technical institutes.

The problems encountered are included in the following table.



Table 44: Constraints in regulation of teaching - service process. San Martin, 2013.


improvement

SMT-RHD does not have

criteria to qualify "teaching

hospitals". Teaching

hospitals are not

accredited.


a Pre-degree Regional

Committee (Comité

Regional de Pregrado en

Salud - COREPRES)

officially established and

running.

RHD does not keep

records of all students

who were trained in health

institutions in the region.


party to manage

agreements with training

institutions.

No regional rules related

to the operation of

teaching hospitals.

Do not know in detail the

national regulations of

COREPRES.

RHD does not understand

the need for or importance

of this information.

Patients' rights are not

respected in teaching

hospitals.

The quality of training is not

satisfactory and not in line

with national regulations.

Training institutions do not

meet the commitments set out

in the agreements, which are

also outdated.

Training institutions use

health facilities to train their

students, but health

institutions receive nothing in

return. For example, RHD

employees could participate

in courses offered by

universities but are currently

not able to.

Revise the existing

legislation regarding

COREPRES and

teaching hospitals.

Revise existing

agreements and design

an advantageous

proposal for RHD.


party to manage

agreements.

Schedule an internship

at the MoH to train party

responsible for

agreements in all related

regulations.




II.

Table 45: Development and training management: Performance in four regions at different

levels.


RHD RHD performs

promotion processes

for stable staff

(administrative and

care staff).

Training activities are

guided by the range of

courses and not by

specific need or

demand. Courses are

primarily in public

health rather than

public management.

Develop promotion

processes for stable

staff based on

document review.


arbitrarily oriented

rather than guided by

needs.

Trainings focus on

professional staff.

Main topic in trainings

is public health.

There are restrictions

in training contract

staff.

Develop promotion

processes for all

stable staff.

Trainings are

conducted based on

supply, not demand.

RHD prioritizes public

health issues and

public management.

RHD designs and

implements its own

training courses.

No promotion

process.

Training programs

are based on supply.

RHD designs and

implements its own

training courses.

Network Some networks do

promotion processes

for stable staff, mainly

care staff.

Trainings focus on

public health issues.


Perform promotion

processes for stable

staff based on

document review.

Trainings are

conducted based on

supply rather than

Huánuco network is

the only one that has

performed promotions

for stable staff.

All networks train

both stable and

contract staff.

Only Huanta network

performs promotion

process.

Trainings are carried

out for both stable

and contract staff.

Trainings only




guided by a supply

approach.

Trainees do not apply

what they have

learned.

One network stated

restrictions in training

hired staff.

demand.

Trainings focus on

professional staff and

public health issues.

There are restrictions

to train hired staff.

All networks prioritize

public health issues in

trainings.

Only Huánuco and

Leoncio Prado

networks include

governance issues in

trainings.

prioritize public health

issues.

Each network is

responsible for

designing and

implementing training

activities.

Micro-

network


execute promotion

and training

processes.

Micro-networks do

not execute

promotion and

training processes.

Micro-networks do

not execute

promotion and

training processes.

Micro-networks do

not execute

promotion and

training processes.

Hospital Hospitals perform

promotion processes

for stable staff focused

on care staff.

Training is led by

supply rather than

demand.

One hospital uses

training plan

guidelines.

Some hospitals

restrict trainings to

hired staff.

Hospitals perform

promotion processes

for permanent staff, in

some cases through

a systematic process

but usually based on

document review.

Training is led by

supply rather than

demand.

Trainings focus on

professional staff and

on general public

health issues instead

of institutional

governance.

No restrictions in

training hired

personnel.

All hospitals develop

promotion processes,

primarily for stable

staff who perform

clinical work.

Hospitals train both

stable and hired staff.

All hospitals provide

training in public

health topics but not

in governance.

Each hospital is

responsible for

designing and


activities.

Contracted staff

finances their own

training.

Hospitals do not

conduct promotions

or training processes.

Each hospital is

responsible for

designing and


activities.


The results of the HRMS performance evaluation conducted by the management team of

Cajamarca RHD are shown below.

More specifically, the following graph shows results from the three processes in this subsystem.

On average, the entire subsystem has achieved a 31% progress rate, which is deemed “little

development”.



Graphic 14: Cajamarca development and training management: Results by key processes.


Table 46: Cajamarca development and training management: Results by key processes.


result

Obtained

result

%

Complete Result


career path) 35 7 19% Little development

Capacity building 47 19 40% Little development


process 19 6 30% Little development



Findings for each of the processes in this subsystem are included in the table below.

Table 47: Constraints in development and training management. Cajamarca, 2013.


improvement

Labor

advancement

(promotion and

career path)

RHD does not

have regional

policies to

promote staff.

RHD managers do

not show interest in

promoting staff

advancement and

progression.

MoH does not have

adequate public

policies to promote

staff; as a result,

regions have not

received the proper

TA and guidance in

this issue.

Health personnel

unmotivated with

lack of institutional

commitment.

Design a proposal

for a regional policy

to promote HHR.

Capacity building Lack of a single

regional plan to

Weak RHD

stewardship to lead

Health personnel

unmotivated,

Design a regional

training proposal




improvement

train and build

health staff

capacity.

and manage


RHD units do not

coordinate their


Weak institutional

commitment to joint

work, which would

include agreed

targets and

complementary

activities.

without minimum

competencies.

Poor health care

services, both in

quantity and quality.

Population

unsatisfied with

health service

provision.

with appropriate

methodologies and

institutional training

objectives that are

mandatory for all

units.

Regulation of the

teaching - service

process

Poor capacity to

manage these

activities.

Weak regulatory

processes for

teaching in health

services.

Lack of a party

responsible for

managing teaching-

service process.

Graduates of health

training institutions

do not meet the

minimum

requirements to

work in health

services nor do they

have the necessary

skills to work in rural

areas of Cajamarca.

Generate capacities

of the party

responsible for

managing the

teaching - service

process.

Design a plan to

monitor signed

agreements

between the RHD

and universities.


2.7 Compensation Management: Progress

2.7.1 Results of the assessment in SMT-RHD

The graph below presents results from the five processes in this subsystem.

On average, the subsystem achieved a 67% progress rate, which is deemed “moderate

development”.

Processes related to the payment of salaries, bonuses and pensions are fully developed with a

100% progress rate. The directorate of operations and the operation offices are responsible for

these processes.

On the other hand, SMT-RHD has achieved ”moderate development” in the management of

incentives and the design of a pay scale; the HRM directorate is responsible for implementing

these processes.



Graphic 15: San Martin compensation management: Results by key processes.

0%

20%

40%

60%

80%

100%

Design of Salary

Scales

Management of

Payroll and Salaries


bonuses

Incentive

Management

Pensions

Management

San Martin: Compensation Management


Table 48: San Martin compensation management: Results by key processes.


result

Obtained

result

%

Complete Result

Design of salary scales 56 35 63% Moderate development

Management of payroll and salaries 4 4 100% High development

Administration of benefits and bonuses 2 2 100% High development

Incentive management 32 14 44% Moderate development

Pension management 6 6 100% High development



Findings for each of the processes in this subsystem are summarized below.

Design of salary scales

This process has achieved a 63% progress rate, which is deemed “moderate development”, due

to the following developments, among others:

Utilizing HP project TA, SMT-RHD designed and approved a salary scale to hire staff working

in first-level-of-care facilities. This approval resolution defines mechanisms for implementation

and maintenance.

The approved salary scale incorporates the following criteria: level of development (rurality)

and poverty in health facility location; distance from Tarapoto to health facility; furthest village

still within its jurisdiction.

Rioja network used the approved pay scale to hire physicians. This network is also in the

process of implementing the new scale for new contract hires.



Despite these advances, problems have been encountered and are summarized in the table

below.

Table 49: Constraints in the design of salary scales. San Martin, 2013.


improvement

Absence of a responsible

party to lead the design of

salary scales for all RHD

staff.


pay scales for managers,

professionals and

technicians from

administrative areas.

Each budgetary execution

unit autonomously defines

hired staff salaries without

referencing RHD regulation

and control.

Low wages in remote and

underdeveloped areas

affect recruitment and

retention of health

personnel.

Technical team members

trained in the design of

salary scales have been

moved to other positions.

SMT-RHD has not yet

analyzed the budget to

approve implementation of

the pay scale next year.

Salary scale directive

includes a variable

remunerative component

linked to performance but

has not yet defined its

implementation.

The pay scale does not

consider position hierarchy

or length of service as

criteria.

SMT-RHD pay scale does

not have a corresponding

policy to promote hiring staff

as part of a career plan

framework.

SMT-RHD has not identified the

importance of monitoring the

existing pay scale nor are they

exploring the need for other

scales.

The new technical team does

not know how to apply the

methodology to estimate other

pay scales.

Mechanisms to implement the

pay scale in all networks have

not been defined.

SMT-RHD management team

has not allocated time to plan

implementation of the scale.

Hired staff is unsatisfied

and perceives that the

wage assignment is not

fair and equitable.

Current wages do not

attract and retain health

personnel where needed.

Health professional

positions go permanently

unfilled in remote areas

because of low wages.

Designate and train a


manage all aspects of

the pay scale.

Design other pay scales

where required.


Management of payroll and salaries

This process has achieved a 100% progress rate, deemed “high development”, due to

the following developments, among others:

The SMT-RHD has an exclusive division responsible for managing payroll.



Payrolls and pensions are kept up-to-date. This is mainly because there are mandatory

national regulations, as well as software which need to be regularly updated so that staff can

receive timely payment of their salaries.

Administration of benefits and bonuses

This process has also achieved a 100% progress rate, which is deemed “high development”.

Like the previous process, the registration of benefits and bonuses is mandatory and is monitored

by the Ministry of Economy and Finance (MoF).

Operations offices are responsible for this process.

Additional bonuses in the form of AETA (Extraordinary Assignment for Health Care Work) are

distributed among professionals and technicians working in health care. Each type of professional

group and technicians receives 22 AETAs.

Bonuses to officers and managers are provided through CAFAE. Technicians in administrative

positions receive bonuses through SUB-CAFAE.

Incentive management

This process has achieved a 44% progress rate, which is deemed “moderate development”, due

to the following developments, among others:

While operations offices are responsible for managing monetary incentives, the SMT-RHD

has not assigned a responsible party to define non-monetary incentives.

Key informants report that the RHD has approved institutional regulations for the

implementation of monetary and non-monetary incentives.

The SMT-RHD has assigned monetary incentives to work teams and not to individuals.

Despite the lack of a responsible party to manage non-monetary incentives, SMT-RHD has

granted several, including public recognition of achievement of corporate goals; secretaries

receiving training courses; days off; baskets of food; uniforms; and organization of internal

sports championships.

Despite these advances, problems have been encountered and are included in the following

table.

Table 50: Constraints in incentive management. San Martin, 2013.

Problem Constraints Consequences Proposal for improvement

SMT-RHD has not

designated a


manage non-monetary

incentives.

Last year, SMT-RHD did

not provide incentives to

individuals and did not

take into account the

results of performance

evaluations. Moreover,

workers are not all able

to receive incentives.

HRM directorate is

understaffed.


mechanisms to measure

and evaluate individual

results.

SMT-RHD does not know

what kind of incentives are

desirable to staff.

Poor staff motivation

and commitment in

achieving institutional

goals.

Designate and train a responsible

party to develop incentive

programs.

Conduct operational research to

identify the type of incentives that

staff wants, at all levels, whether

health care staff or administrative

personnel.

Implement a performance

evaluation system with individual

goals.




Pension management

This process has achieved a 100% progress rate, which is deemed “high development”.

Like previous processes, the registration of pensions is also mandatory and is monitored by the

MEF.

Operations offices are responsible for administering pensions. There is an approved regulation for

handling them, and pensions are awarded according to the current regulation.



II.

Table 51: Compensation management: Performance in four regions at different levels.


RHD RHD does not have

a pay scale for hired

staff; wages are set

on a case-by-case

basis.

RHD does not have


staff.

RHD does not have



on a case-by-case

basis.

RHD does not have a pay

scale for hired staff;

wages are set on a case-

by-case basis.

Network One network has a

pay scale for hired

staff based on stable

staff salaries.

Some networks

have a pay scale for

hired staff.

RHD does not have



on a case-by-case

basis.

Only the San Miguel

network has designed a

pay scale for hired staff

based on the stable staff

remuneration structure.

Micro-

network

Micro-networks do

not have pay scale

for hired staff; wages

are set on a case-

by-case basis.

Micro-networks are

not involved in

remunerative issues.

Wages and salaries

of micro-networks

are defined by

network or RHD.

Micro-networks are

not involved in

remunerative issues.

Wages and salaries

of micro-networks

are defined by

network or RHD.

Micro-networks are not

involved in remunerative

issues. Wages and

salaries of micro-networks

are defined by network or

RHD.

Hospital Hospitals do not


hired staff; wages

are set on a case-

by-case basis.

Hospitals do not


hired staff; wages

are set on a case-

by-case basis.

Only Tingo Maria

hospital has created

pay scales for hired

staff based on the

remuneration

received by

permanent staff.

Hospitals do not have a

pay scale for hired staff;

wages are set on a case-

by-case basis.


In general, PARSALUD regions do not have specific pay scales for hired staff. Every

remuneration concept is linked to an official that manages each one of them (pensions, benefits,

bonuses and monetary incentives). Every remuneration concept must be updated on a permanent

basis because staff payment depends on the timeliness and accuracy of this information.

The results from the HRMS performance evaluation conducted by the Cajamarca RHD

management team are shown below.

More specifically, the following graph shows the results from the five processes in this subsystem.

On average, the subsystem achieved a 53% progress rate with some processes achieving a

100% progress rate.



Graphic 15: Cajamarca compensation management: Results by key processes.

0%

20%

40%

60%

80%

100%

Design of Salary

Scales

Management of Payroll and

Salaries


bonuses

Incentive

Management

Pensions Management

Cajamarca: Compensation Management


Table 52: Cajamarca compensation management: Results by key processes.


result

Obtained

result

%

Complete Result

Design of salary scales 56 23 41% Moderate development

Management of payroll and salaries 4 4 100% High development


bonuses 2 2 100% High development

Incentive management 32 18 56% Moderate development

Pension management 6 6 100% High development



Findings for each of the processes in this subsystem are summarized in the following table.

Table 53: Constraints in compensation management. Cajamarca, 2013.


improvement

Design of salary

scales

Regional authorities

have not

established an

appropriate regional

salary structure.

The decentralization

of functions from

the MoH to regional

authorities has not

been accompanied

by a transfer of

knowledge and

skills.

Cajamarca RHD has

kept the wage

structure defined by

the MoH for several

years.

Set a salary scale

according to local

conditions and

needs.

Management of

payroll and

salaries

No significant

problems were

reported.

Payroll payment is

guaranteed for

stable staff in

Wages are paid on

time in the face of

strong administrative

Monitor all

procedures.




improvement

institutional budgets

(the so called

ordinary resources.)

sanctions.

Administration

of benefits and

bonuses

No significant

problems were

reported.

Benefits are

guaranteed for

stable staff in


(the so called

ordinary resources).

Benefits are paid on

time in the face of


sanctions.

Monitor all

procedures.

Incentive

management

There is no

incentive policy.

Cajamarca RHD is

not authorized to

use institutional

budget to grant

incentives.

Decentralization

process was not

accompanied by

adequate budgetary

support.

Lack of incentives

inhibits staff

commitment to

achieve institutional

goals.

Design an

incentive policy for

health staff,

according to local

realities and staff

needs.

Pursue research

to target

incentives that

can motivate staff

to perform well.

Pension

management

No significant

problems were

reported.

Pensions are

guaranteed for

stable staff in


(the so called

ordinary resources).

Pensions are paid on

time in the face of


sanctions.

Monitor all

procedures.


2.8 Managing Human and Labor Relations: Progress


The following graph shows results from the three processes in this subsystem. On average, this

subsystem achieved a 70% progress rate, which is deemed “moderate development”. The

management labor relations process has achieved more progress than other processes.

Graphic 15: San Martin managing human and social relations: Results by key processes.

0%

20%

40%

60%

80%

100%

Management of the Organizational

Climate and Culture



San Martin: Managing human and social relations




Table 54: San Martin managing human and social relations: Results by key processes.


result

Obtained

result

%

Complete Result


climate and culture 32 20 63%

Moderate

development

Management of labor relations 9 9 100% High development

Workplace health, safety and welfare 59 41 69% Moderate

development

Average 100 70 70% Moderate

development


Findings from each of the processes in this subsystem are summarized below.

Management of the organizational climate and culture

This process achieved a 63% progress rate, which is deemed “moderate development” due to the

following developments:

The SMT-RHD has designated a responsible party to manage organizational climate and

culture in the HRM directorate.

The SMT-RHD has methodology and tools to assess organizational climate; with these tools,

they have assessed the organizational climate this year.

The assessment of the organizational climate has received support from the highest levels

within the institution and at least 90% of workers.

Despite these advances, problems have been encountered and are summarized in the following

table.

Table 55: Constraints in the management of the organizational climate and culture. San

Martin, 2013.


improvement

The results of organizational

climate assessment9 have not

yet been analyzed.

No plans have been made to

improve the working

environment.

No immediate action was taken

within 30 days of the

assessment.

The team responsible has not

defined whether the results will

SMT-RHD has done only

one phase of the

organizational climate

management, which is the

assessment.

The team in charge has not

yet organized meetings to

discuss the results.

The delay in analysis

could magnify existing

problems, and

dissatisfaction could

grow.

Arrange meetings to

discuss the results and

propose plans to improve

the organizational climate.

9 The assessment of organizational climate is a snapshot that measures employe perception of

organizational factors; rules; procedures; standards of productivity; management style; communication;

interpersonal relationships; motivators; and leadership. These factors characterize the organization and

influence employee behavior.




improvement

be used to review and improve

policies and practices of HRM.



This process has achieved a 100% progress rate, which is deemed “high development”.

The project isolated the following positive developments in this process:

The HRM directorate is responsible for managing this process.

Over 75% of staff is unionized.

Doctor, nurse and midwife unions meet monthly to discuss issues related to the health staff

on duty and job stability.

Administrative and technical staff unions meet at the request of the union leadership to

discuss problems about health staff on duty and job stability.

Key informants describe the relationship between trade unions and RHD authorities as

"good".

The latest negotiation between the union and the authorities has left both parties satisfied,

and both sides are fulfilling all agreements and commitments.

In 2012, the medical strike lasted 72 days.

Relations among RHD members, networks and health facilities are generally good. However,

relations within operations offices are rated as "poor" due to a lack of communication.

The most common causes of labor disputes include salaries, union struggles and internal

rivalries.

Mechanisms used to solve conflicts include negotiating with unions, direct negotiations with

the aggrieved, and negotiations with the immediate boss.


This process has achieved a 60% progress rate, which is deemed “high development”, due to the

following advances:

The HRM directorate is responsible for managing this process.

There are social welfare programs but only in hospitals and mostly for the elderly. Hospitals

plan and organize social welfare activities.

This year, the RHD is organizing the regional olympics as a social welfare activity.

Hospitals have planned social welfare activities including the celebration of national and

regional public holidays; staff birthday celebrations; the institution’s anniversary celebration;

and the organization of sports competitions.

The control and regulation directorate is responsible for health and safety at work.

There are approved rules, policies and programs to manage health and safety at work.

The SMT-RHD plans activities for health and safety at work.



The scheduled activities on health and safety at work include fumigation of workplaces;

provision of protective equipment for epidemics; occupational disease screening campaigns;

vaccination campaigns; and an infrastructure assessment by Civil Defense.

Despite these advances, problems have been encountered and are summarized in the following

table.

Table 56: Constraints in workplace health, safety and welfare. San Martin, 2013.


improvement

The SMT-RHD has not

scheduled other social

welfare activities aside

from the olympics.

Workers do not have a

cafeteria or restaurant;

cash loan services;

financial support for

trainings; a nursery; an

elderly club; travel

arrangements.

Workers do not have

health insurance in case

of accident or illness.

The HRM directorate has

limited staff to perform these

tasks.

RHD has not conducted a

study to identify employee

needs.

RHD has not evaluated the

institutions’ ability to provide

for these needs.

The responsible team is not

familiar with the Health and

Safety at Work Law.

Welfare activities should

generate greater

companionship to reduce

internal conflicts and

improve relationships.

The institution could be

penalized for not applying

health and safety

measures.

Conduct a study to identify

workers’ needs in order to

improve work performance.

The team responsible

should review the Health

and Safety at Work Law

enacted by the Ministry of

Labor and then implement

its provision.




II.

Table 57: Managing human and social relations: Performance in four regions at different

levels.


RHD Human relations are

good despite the

absence of labor

climate studies.

The most frequent

cause of conflict is

remuneration.

The RHD does not

conduct staff welfare

programs or health

and safety at work

activities.

Human relations are

good despite the

absence of labor

climate studies.

The cause of

conflicts is

remuneration.

The RHD does not

conduct

occupational safety

programs.

Human relations are

bad due to internal

rivalry between

health care staff and

administrative staff;

remunerative

differences are also

a problem.

There have been

isolated technical

initiatives to assess

the work

environment, but

with little application

of the results.

Programs for

welfare, health and

safety at work focus

both on providing

protective equipment

for diseases and

There is no

information on

human relations.

The most frequent

causes of conflicts

are internal rivalries

and remuneration.

No welfare and

safety at work

programs.




accidents as well as

holiday celebrations.

Network Human relations are

good despite the

absence of labor

climate studies.

The most frequent


remuneration.

Networks do not

conduct staff welfare

programs or health

and safety at work

activities.

Human relations in

some networks are

good and in others

bad.

The most frequent

cause of labor

disputes is

remuneration.

Conflict resolution is

managed by the

union.

Human relations are

good except in the

Leoncio Prado

Network, where they

are bad.

None of the

networks provide

welfare and safety at

work programs.

Human relations are

classified as bad.

The most frequent

causes of labor

disputes include

salaries, internal

rivalries and conflicts

generated by

unions.

No records exist

regarding

information on


work programs.

Micro-

network

Human relations are

good despite the

absence of labor

climate studies.

The most frequent


remuneration.

Micro-networks do

not keep records of


work programs.

No information on

the analysis of social

and human relations

or welfare and safety

at work programs.

No information on


and human relations


at work programs.

No information on


and human relations


at work programs.

Hospital Human relations are

generally good to

very good despite

the absence of labor

climate studies,

The most frequent


remuneration.

Only one hospital

keeps a record of


work programs.

Human relations are

in some cases good

and in other cases

bad.

The most frequent

cause of labor

disputes is

remuneration.

Conflict resolution is

managed by the

union.

Some hospitals run

occupational safety

programs.

Staff at all hospitals

believes that human

relations are bad.

The most frequent

causes of conflict

are compensation

and internal rivalries.

Only Hermilio

Valdizán hospital

provides social

welfare programs,

as well as sterile and

safe equipment for

customer service.

Human relations in

general are

evaluated as good,

despite the absence

of labor climate

studies.

Welfare programs

are aimed at the

supply of sterile and

safe equipment for

customer service.


In general, PARSALUD regions do not have specific activities to assure health and safety at work.

Results from the HRMS performance evaluation conducted by the Cajamarca RHD management

team are presented below.

The following graph shows results from the five processes in this subsystem. On average, the

subsystem achieved a 30% progress rate.



Graphic 16: Cajamarca managing human and social relations: Results by key processes.

0%

20%

40%

60%

80%

100%

Management of the Organizational

Climate and

Culture



Cajamarca: Managing human and social relations


Table 58: Cajamarca managing human and social relations: Results by key processes.


result

Obtained

result

%

Complete Result


climate and culture 32 11 34% Little development

Management of labor relations 9 2 22% Little development

Workplace health, safety and welfare 59 17 29% Little development



The findings for each of the processes in this subsystem are included in the following table.

Table 59: Constraints in managing human and social relations. Cajamarca, 2013.


improvement

Management of

the

organizational

climate and

culture

Cajamarca RHD

has made little

progress in

organizational

climate

management.

This is evident on a

daily basis: a large

number of

employees are

unhappy and lack

commitment to


Managers show

little interest in

improving

organizational

climate among

workers.

Weak health

outcomes; poor

achievement of

institutional goals

and objectives; and

population

dissatisfied with

health care

services.

Strengthen HR in

the institution.

Implement an

organizational

climate study to

establish a baseline

and develop

mechanisms to

solve problems.

Management of

labor relations

Management of

labor relations is

Little interest in

strengthening labor

Staff weakly

committed to

Design and

implement an




improvement

weak. relations. Sporadic

activities without

clear objectives.

achieving

institutional goals

and objectives.

institutional plan for

improving labor

relations. RHD

authorities must be

present and monitor

this plan.

Workplace

health, safety

and welfare

Processes to

ensure staff welfare

and safety at work

are

underdeveloped.

Authorities show

little interest in this

subject.

Occupational

diseases and

frequent absences

due to occupational

diseases.

Design and

implement an

institutional plan for

welfare and safety

at work with the

participation of all

appropriate offices

and organizational

units.



Abt Associates Inc. Activities undertaken to strenghen the HRMS in health institutions ▌pg. 69

3. Activities undertaken to strengthen the HRMS in health

institutions

3.1 Activities undertaken to estimate staffing needs

To implement universal health insurance (UHI) at the national level, it necessary to assure the

availability and proper allocation of HHR with the necessary competencies to provide quality

health care services. The first step in this process is estimating the HHR requirements needed

to provide the UHI “essential package” (Plan Esencial de Aseguramiento Universal - PEAS) and

cover the HHR gap to assure quality care under UHI.

One of the main problems at the national level is the scarcity of health professionals at the first

level of care. To rectify this issue, one of the HP project’s main activities was designing a

proposal to estimate HHR requirements at the micro-network level.

The MoH and HP project designed and validated methodology for one region, and this

experience was scaled up to the national level. The HP project and MoH supported the

following activities:

Bibliographic review of methods to identify HHR needs. The project decided to use tools

proposed by WISN (Workload Indicators of Staffing Need)[8] as its main reference.

Human resources software review which are applying at the regional level. The project

specifically reviewed software that manages the centralized registry of payrolls and public

sector HR data, which is administered by the Ministry of Finance (MoF); more specifically,

the project looked at the level of reliability, data timeliness, and the level of analysis at the

point of data entry. HP project regions keep updated information through software that

registers HHR data except staff recruited for Health Administration Local Committees

(CLAS - Comités Locales de Administración de Salud); CAS hired staff; displacements; and

actual HR allocation. All regions must report using MoF software, but they do not analyze

the data.

Bibliographic review of approaches in estimating HR requirements for the first level of care.

The project analyzed three main approaches[9, 10]:

- Needs-based: converts projected service needs to personnel requirements using

productivity norms and professional judgment.

- Utilization-based (or demand-based): estimates future requirements based on current

level of service utilization.

- Health workforce to population ratio: specifies desired worker-to-population ratio.

To meet the health needs and services determined by PEAS and to address population

health needs using a mix of HHR, the project selected the needs-based approach.

The methodology used within this approach is based on a a bottom-up process: data is

collected from each health facility and is consolidated by the micro-network; data from all

micro-networks is consolidated at the network level and then further consolidated at the

RHD level.

Established a formula to calculate HR requirements. This calculation must be done for each

type of HHR.



Formula:

HHR requirement

=

Total quantity of time (hours) required to produce PEAS procedures

Standard of available working time per health worker per year x

dispersion index

Calculated the numerator. The project reviewed and validated ASEGURA10

software, which

determines the number of hours required to provide each PEAS procedure linked with a

specific health staff category and a specific unit time (activity standard or activity time)11

at

the national level12

. In order to validate ASEGURA usefulness in HR calculations at the

regional and network level, the HP project and the MoH organized a workshop with Callao

RHD and Lima Ciudad RHD. The main conclusion from the workshop was the need to

make adjustments in ASEGURA, which was designed to perform financial analysis at the

national level. In order to define the total number of procedures necessary to provide PEAS

at the regional and local level for a given population, ASEGURA needs to be flexible when

considering local incidence of priority diseases; determining the type of procedures actually

performed by health staff within networks according to PEAS procedures and the actual

operational capacity of health facilities; considering the regional and local population

structure which is different from the structure at the national level; and considering current

health care norms to calculate activity standards.

In order to make calculations and include adjustments in ASEGURA, the project designed a

spreadsheet13

. Another option considered was the design of an HR module within

ASEGURA, but at that moment ASEGURA was being reviewed and updated.

The spreadsheet has the following advantages:

o It is based on the probability of occurrence of cases (for healthy and ill conditions)

by age group for a given population.

o For each case, the spreadsheet defines all the procedures involved based on

current health care standards.

o For each procedure, it establishes the HHR types involved and the time spent by

each HR type to perform a procedure based on current health care standards.

o It considers the effective time that will be available to provide health care (that is

discounting administrative, training, vacations time, among other issues).

o Allows adjustment according to current and potential health portfolio in the short

and medium term.

o Allows calculation of the HR requirements adjusted for the conditions of the district

in which the health facility is located.

o It considers the current HR allocation in each health facility to determine the gap

that must be covered.

10 Software designed by Partherships for Health Reform plus (PHRplus) project to estimate PEAS cost

at the national level.

11 How much time on average a case should take each staff category, while working to acceptable

professional standards. (WISN, page 5.)

12 See ASEGURA software in Annex 7.5.

13 See procedures to use spreadsheet in Annex 7.6.



o Facilitates the design of charts and graphs, which allow for better analysis of HR

allocation within the micro-network.

Calculated the denominator. The project used the WISN method as a technical reference

point: WISN is based on actual work and is useful for calculating both current and future

HHR requirements. More specifically, it is based on working time, components of work and

activity standards. For our purposes, the project identified indicators related to time spent at

work and other components, including time to directly provide services, vacations, sick

leave, holidays, training, local travel, and administrative burden. On this basis the project

gathered the relevant information in the field. The project provided technical assistance to

the MoH team to design and develop the research project using these indicators. The

research was executed in Ayacucho RHD to determine the time available to solely perform

PEAS procedures. This research project was financed by the MoH. Additionally, the HP

project, along with technical teams from Ucayali and San Martin RHD, conducted interviews

to determine the available working time to provide PEAS at the first level of care14

.

Research results were, in some cases, absolutely unacceptable: in several networks, health

workers spend more than 50% of their time doing activities other than providing health care

services. One conclusion from this research study is that there is a need to define “activity

standard”: how much time on average a case should take each staff category while working

to acceptable professional standards and standards related to distribution of health

providers’ time. It is not acceptable that health workers, who are hired to provide health care

services, spend more than 80% of their time doing other activities. If RHDs do not properly

organize and control staff time distribution, they will always have HR gaps.

Given these results, the SMT-RHD defined standards for the available working time for

each type of health facility at the first level of care15

.

The MoH analyzed results obtained in Ayacucho, San Martin and Ucayali, and determined a

national standard for the available working time needed to provide PEAS.

Table 60: Ministry of Health: Percentage distribution of the workload, by occupational

group for the first level of care.

Occupational group Workload

To provide

PEAS Other

activities Total

Physician 82% 18% 100%

Dentist 94% 6% 100%

Nurse 74% 26% 100%

Psychologist 73% 27% 100%

Midwife 72% 28% 100%

Medical technologist - radiology 94% 6% 100%

Medical technologist - laboratory 94% 6% 100%

Nutritionist 90% 10% 100%

14 See the survey in Annex 7.7.

15 See a detailed table in Annex 7.8 and a summary table in Annex 7.9.



Occupational group Workload

To provide

PEAS Other

activities Total

Social worker 90% 10% 100%

Technician in radiology 94% 6% 100%

Technician in laboratory 94% 6% 100%

Technician in laboratory 72% 28% 100%

SOURCE: USAID Peru|Health Policy Reform project and the Ministry of Health, 2012.

Calculated the dispersion index. Since expected health worker performance is different in

rural and urban settings, it is important to determine a “rural” index to adjust calculations

based on the conditions of the location. Due to the diversity of clusters with different levels

of population density and local development in Peru, it was necessary to define an index

that adjusts HR requirement calculations. The HP project and the MoH developed a study to

determine the “rural” index for each district nationwide[11]. Based on this study and after

many workshops with RHD, the MoH used one of the components from the “rural” index

(population density) and defined a dispersion index for all districts in the country. The

dispersion index has only two clusters: “dispersed population” and “no dispersed

population”. From this, the MoH defined a “productivity index” to adjust HR requirement

calculations.

Table 61: Ministry of Health: Productivity index according to dispersion index.

Type of district according to dispersion index Productivity index

District with dispersed population 0.75

District with no dispersed population 1

SOURCE: Technical Guide No. 001-MINSA/DGRH-V.01 Guide methodology for calculating

HR gaps in health care services at the first level of care, page 8[12].

Table 62: Ministry of Health: Productivity index according to rural index.

Type of district according to rural index Productivity index

Highly rural 0.50

Rural 0.63

Intermediate 0.75

Urban 0.88

Highly urban 1.00

SOURCE: USAID|Peru |Politicas en Salud project[11].

Determined the formula to calculate HHR gap. Once HR requirements were defined, the

next step was to calculate the HR gap by comparing the difference between current and

required staff in order to identify understaffed or overstaffed networks. The formula to

estimate the HHR gap is:

HHR gap = Current staffing – HHR requirements



Current staffing. Aside from determining HHR requirements, it is necessary to determine

current staffing by network in order to calculate the gap. The main difficulties in estimating

the HHR gap were related to staff turnover as well as the lack of reliable information

regarding the actual location of health staff. It took more than six months to collect current

staff information in Ayacucho, Ucayali and the SMT-RHD; once consolidated, this

information proved to be completely outdated.

The SMT-RHD decided to organize a workshop with all the micro-networks; each micro-

network prepared the required information, which was consolidated during the course of the

workshop. While productive, organizing a workshop whenever RHDs need this type of

information is expensive and inefficient. A mechanism is needed to oblige all micro-

networks periodically send information about the current staffing at each facility to its

respective network; networks would then send this information to the RHD for regional

consolidation and analysis. The micro-network is the only source of this kind of information;

without this information, any estimation is completely arbitrary.

The following table displays an example of the results which could be obtained automatically

with the application of the spreadsheet to calculate HR staffing needs.

Table 63: Huallaga network: HHR staffing needs, SMT-RHD, 2012.

Physician Dentist Nurse Psychologist Midwife Biologist

Lab

Tech Technician

Sacanche micro-network

(7,782 inhabitants)

HHR requirements (A) 2.67 0.40 11.22 0.26 3.23 0.17 0.30 2.15

Current staffing (B) 4.00 1.00 5.00 1.00 4.00 0.00 1.00 10.00

HHR gap (B - A) 1.33 0.60 -6.22 0.74 0.77 -0.17 0.70 7.85

Workload ratio (B/A) 1.50 2.49 0.45 3.87 1.24 0.00 3.30 4.65

Health workforce to

population ratio

(B/hab*10000) 5.07 1.27 6.34 1.27 5.07 0.00 1.27 12.69

Saposoa micro-network

(19,875 inhabitants)



HHR gap (B - A) 0.46 -2.66 -20.09 -1.49 1.54 -1.97 -1.29 26.03

Workload ratio (B/A) 1.05 0.27 0.33 0.40 1.16 0.00 0.61 2.45

Health workforce to

population ratio

(B/hab*10000) 5.03 0.50 5.03 0.50 5.53 0.00 1.01 22.14

HUALLAGA NETWORK

(27,757 inhabitants)



HHR gap (B - A) 1.79 -2.06 -26.30 -0.74 2.31 -2.14 -0.60 33.88

Workload ratio (B/A) 1.15 0.49 0.36 0.73 1.18 - 0.83 2.68

Health workforce to

population ratio

(B/hab*10000) 5.04 0.72 5.40 0.72 5.40 0.00 1.08 19.45



SOURCE: SMT-RHD technical report on HHR gap[13].

Analyzed results. The analysis is based on three calculations using two variables: HHR

requirements obtained through ASEGURA plus adjustments for location conditions; and

current staffing obtained directly from micro-networks until a comprehensive HHR

information system is implemented.

o HHR gap: Comparing the difference between current and required staffing levels to

identify which locations are understaffed or overstaffed. In the table above, the

negative numbers in red indicate understaffed positions. For example, in Huallaga

network there is a severe shortage of nurses, especially in the Saposoa micro-

network. This information could prove useful if Huallaga network has additional

funds to hire health workers: the priority would be to hire nurses in Saposoa micro-

network instead of technicians, which is a currently overstaffed position.

o Workload ratio (the WISN ratio)[8]: Dividing current staffing by HR requirements as

a proxy measure to assess the pressure that health workers experience in their

daily work. Values over “1” indicate overstaffed; values below “1” indicate

understaffed. For example, if a heath facility has four physicians and needs only

two, the workload ratio is two; this means that two doctors are working for every

one that is needed. Conversely, if a heath facility has two physicians and needs

four, the workload ratio is 0.5, which means that one doctor has the workload of two

doctors. In Huallaga network, nurses have the lowest workload ratio, which means

that they have the highest actual workload and feel the most pressure of all

workers.

o The availability of HHR measured by the ratio of professionals per 10,000

inhabitants: Dividing the current staffing by the total population. According to the

Pan American Health Organization (PAHO), there are usually 10 physicians, 10

nurses, and five midwives per 10,000 inhabitants in developing countries. To

compare, Huallaga network has five physicians and five nurses per 10,000

inhabitants; this is 50% less than the average. There are 5.4 midwives per 10,000,

which is slightly more than the average. Accordingly, there would be no need to hire

additional midwives in this network.

The HHR shortage is severe in remote and rural areas mainly due to low wages and poor

working conditions, as well as low connectivity in most of the micro-networks which

prevents regular professional development.

Defined strategies to cover the gap. With these results, the project discussed a set of

strategies to gradually bridge the gap:

o Improve working conditions, especially in remote and rural areas.

o Establish mechanisms to monitor the appropriate use of staff time.

o Distribution of tasks or “task shifting”.

o Improve equipment to shorten working time.

o Define health facility opening hours according to population needs to increase

productivity.

The project worked with Ayacucho RHD to implement task shifting at the network level.

Preliminary results from task shifting show that at the operational level, where the scarcity of

physicians is high, nurses and midwives are performing some medical procedures. In

Ayacucho, nurses and midwives are teaming up to share tasks that have traditionally

belonged to only one of them. Task shifting resulted in a decrease in the average number of

working hours for doctors and nurses, as well as an increase the average number of

working hours for midwives. After task shifting, the overall gap of health staff changed.

Some networks have a gap in midwives instead of being overstaffed, and fewer networks



are overstaffed in general. This is evidence that the redistribution of tasks as a result of task

shifting allows the efficient use of scarce resources such as doctors and nurses.

Based on this methodology, the MoH designed an application to perform these calculations,

and the project provided TA to support application in Ayacucho. Additionally, the HP project

worked with the MoH to design the “Methodology Guide to Calculate HHR Gaps for the

First-Level-of-Care”, which is being approved through a ministerial resolution for national-

level implementation.

3.2 Activities undertaken to define job profiles

The National Civil Service Authority (SERVIR), which directs the HRMS, states that the

classification and organization of employment positions is the starting point for the

implementation of a HRMS. To promote this idea, SERVIR developed a technical paper entitled

"A Methodological Guide for the Development of Job Profiles” to facilitate the correct

construction of job profiles by human resource managers[14].

Within this framework, job profiles serve as a tool of HR management in providing structured

information regarding the location of a position within an organizational structure, the position’s

purpose and its main functions. A job profile also includes the requirements and demands of the

job to clarify expectations and performance standards.

Based on the importance of the job profile, SERVIR and the HP project developed two macro-

regional workshops to disseminate methodology for designing profiles.

The methodology, in line with the conceptual framework established by SERVIR, identified a

number of procedures to be accomplished before the design of a job profile[15]:

Review of institutional policy documents (ROF, MOF, CAP)

Define the criterion that determines positions and their functions based on one of the

following three approaches: systems approach, process approach, or function focused.

Development of a matrix to define functions for each of the positions.

Preliminary Job profile design

- Determining functions within the matrix of job functions.

- Assessing job functions.

- Identifying essential job functions.

- Identifying position requirements.

- Identifying skills and competencies required for the position.

The Ayacucho RHD technical team, with technical assistance from the HP project, developed

job profiles for the Ayacucho Executive Office of Management and Human Resource

Development; these job profiles are listed below and detailed in the HP project technical paper,

entitled "Staff Jobs Profiles for the Executive Office of Management and Human Resource

Development”[16].



Table 64: Job profiles for the Ayacucho RHD.

Organizational Unit Proposed Positions

Executive Office of

Management and Human

Resource Development

Executive director for HRM and development in health

Head of the HR planning unit

Head of employment management unit

Head of job design and performance management unit

Head of pensions and other benefits unit

Responsible for social welfare and incentives

Responsible for payroll and salary scale

Head of occupational health and organizational climate unit

Responsible for personnel data and record keeping

Responsible for attendance control

Responsible for SERUMS

SOURCE: USAID Peru Health Policy project and Ayacucho RHD.

The HP project continues to support and provide technical assistance to the Ayacucho RHD in

designing job profiles for staff who provide primary health care services. More specifically, the

project is working to identify and systematize technical information that has been validated by

representatives of networks and micro-networks.

The methodology developed by the HP project for job profile development dictates that defining

"health professional” positions is a first step in the process and should be guided by Law No

23536 and its regulations (DS No 0019 - 83-PCM). Based on this, health professionals include

the following groups: surgeons, dental surgeons, obstetricians, nurses, biologists,

psychologists, social workers, and pharmacists. The HP project also considers nursing

technicians to be important components of the health team. Having specified professional

health groups, the following three points are important in the development of job profiles and are

included in the HP project document entitled "First-Level-of-Care Job Profiles"[17]:

Point 1: Finding information on the functions of each occupational group by category within

each first level of care including I-2, I-3, and I-4.

Point 2: Confirmation of job functions through expert judgment (regional workshop).

Point 3: Job profile description for first-level-of-care staff.

The Ayacucho RHD technical team designed job profiles for the following first-level-of-care

personnel:

Table 65: First-level-of-care personnel job profiles for the Ayacucho RHD.

Health Facility

Categories Proposed Positions

I-2

Medical care I-2

Nursing care I-2

Obstetrical care I-2

Nursing technician I-2

I-3 Medical care I-3

Nursing care I-3





Responsible del Pharmacy Services I-3

Responsible for Nutritional Services I-3

Responsible for Social Services I-3

I-4 Medical care I-4

Nursing care I-4



Dental surgeon (primary care)

Psychological care (primary care)

Laboratory supervisor (primary care)

Responsible for Pharmacy Services I-4

Responsible for Nutritional ServicesI-4

Responsible for Social Services I-4

SOURCE: USAID Peru Health Policy project and Ayacucho RHD.

In addition, the HP project provided TA to the SMT-RHD in the analysis of a new organizational

structure and, more specifically, in the definition of specific functions; job descriptions and

analysis; and job profiles.

Taking into account SMT-RHD priorities, the following tables summarize organizational units

and corresponding job profiles[15]:

Table 66: Regional Health Directorate of San Martin.


DIRECTORATE OF HUMAN RESOURCES

DEVELOPMENT

Director

Institutional organizational development specialist

RRHH sector management specialist

Work management specialist

Performance development and evaluation specialist

DIRECTORATE OF OPERATIONS Director

Unit chief

Budget management specialist

Administrative support specialist (decentralized operations)

Logistics management and control specialist

Internal administrative management specialist

OFFICE OF STRATEGIC SECTOR

PLANNING Office chief

Budget and finance specialist

Planning specialist

Project investment specialist

Organization and quality assurance specialist




OFFICE OF HEALTH INTELLIGENCE

Epidemic Control, Emergency,

Disaster Prevention Unit

Information Research and Analysis

Management Unit

Office chief

Unit chief

Epidemiological surveillance specialist

Epidemics, emergencies and disaster specialist in

charge

Unit chief

Investigation specialist

Information management specialist

Communications specialist

Documentation specialist

OFFICE OF LEGAL COUNSEL

Office chief

Regulation and supervision specialist

Judicial processes and administration specialist

DIRECTORATE OF HEALTH SECTOR

REGULATION AND AUDIT

Health Sector Regulatory Unit

Health Sector Audit Unit

Director

Unit chief

Environmental health specialist

Unit chief

Public and private services inspector specialist

Pharmaceutical establishments inspector specialist

Basic sanitation inspector specialist

Food hygiene inspector specialist

Ecology and environmental protection inspector

specialist

DIRECTORATE OF COMPREHENSIVE

HEALTH

Individual and Family Health Unit

Public Health and Environment Unit

Drug and Health Services

Management Unit

Director

Coordinator of comprehensive health

Individual and family health unit chief

Youth and adult life stage specialist

Senior adult life stage specialist

Public health and environment unit chief

Health promotion specialist

Technical unit chief

Organizational and services management specialist

SOURCE: USAID Peru Health Policy project and SMT-RHD.



Table 67: Office of Operations - Health (OOH).


OFFICE OF OPERATIONS Office chief

ADMINISTRATIVE MANAGEMENT

UNIT

Unit chief

Personnel manager

Accounting manager

Treasurer

BUDGET MANAGEMENT UNIT

Unit chief

Budget management unit chief


Table 68: Health Network.


Health Network Director

OFFICE OF HEALTH PLANNING

AND INTELLIGENCE

Office chief

Planning specialist

Epidemiology specialist

OFFICE OF SANITARY

MANAGEMENT

Office chief

Organization and health services management specialist

Human resource management specialist

DIRECTORATE OF INDIVIDUAL

HEALTH Director

Immunization and child specialist

Food and nutrition specialist

DIRECTORATE OF COLLECTIVE

HEALTH MANAGEMENT Director

Health promotion and community participation specialist

Occupational health specialist

OFFICE OF ADMINISTRATIVE

LIAISON MANAGEMENT Office chief

Personnel administration assistant

Logistics and control assistant

SOURCE: USAID Peru Health Policy project and SMT- RHD.



Table 69: Job profiles for the health micro-network: First-level-of-care staff.


Micro-network Medical care I-2

Nursing care I-2



Medical care I-3

Nursing care I-3



Medical care I-4

Nursing care I-4



Dental surgeon (primary care)

Psychological care (primary care)

Laboratory supervisor (primary care)


The HP project’s TA was instrumental in the development of job profiles at the regional health

directorate level and has contributed to the improvement of the HRMS in the following ways:

- Regarding the recruitment and selection process, job profiles provide information that can help define the types of media and notices necessary to attract the largest number of candidates.

- Job profiles facilitate the induction process of orientating a new employee within the organizational structure; clarifying relationships with other positions and organizational units; and outlining objectives and duties.

- Training processes are better oriented for the development of Personal Development Plan (PDP).

- In the performance evaluation process, updated job profiles are helpful in defining personal skills or competencies to be monitored through performance evaluations.

- Job profiles also support decision making regarding displacement decisions, designation, rotation, temporary assignments and staffing redeployment.

In recent years, SERVIR has been developing actions within the most urgent aspects identified

to initiate civil service reform as a mandatory by the human resources office, or in lieu thereof,

as stated in Article 6 of Law No 30057.

During the course of the year, there have been a series of regulatory changes regarding HRM in

health institutions nationwide. Specifically, it is now mandatory for health care institutions to

possess updated job profiles in compliance with administrative regulations and requirements.

HP project participation in organizing and structuring Ayacucho HRD and SMT-HRD job profiles

has provided both a valuable experience and a considerable advantage for both regions as

other regions work towards adapting to current regulations for HRM in health institutions.

3.3 Activities undertaken to define managerial competencies

According to the ILO[18], job competencies are divided into general and specific competencies.

General competencies can be described as corporative, generic, organizational, core, and



value-based; all members of an organization must possess these competencies. Specific

competencies can be described as technical or functional aspects; each worker in an

organization performs a set of functions and must demonstrate competency in the proper

performance of those functions. The capabilities linked to the employee's functions are "specific

competencies".

USAID projects provided TA to the MoH in the conceptual and methodological framework to

define general competencies. Using this framework, the MoH defined the following general

competencies for the health sector16

:

1. Ethical commitment

2. Respect for life, people and environment

3. Communication based on cultural diversity

4. Teamwork

5. Ability to organize and plan

These general competencies must be a part of the job profiles for each posotion in all public

health organizations. Accordingly, the HP project provided TA to help design job profiles in the

Ayacucho RHD and the SMT-RHD, and these competencies have been included in all job

profiles.

The Council for the Quality of Professional Education (Consejo de evaluación, acreditación, y

certificación de la calidad de la educación superior universitaria – CONEAU) is in the process of

defining managerial competencies for all health professions. CONEAU is responsible for

working with professional associations and training institutions in the definition of professional

competencies. There is consensus among health professional associations that all health

professionals perform healthcare, training, management and research actions, focusing on their

daily activities in one of them. In April 2013, CONEAU officially formed a special committee

responsible for designing managerial competencies, which will be used in the mandatory

professional certification process. In 201217

, CONEAU designed a proposal related to

managerial competencies and in 2013 CONEAU submitted the proposal to the special

committee for review, but this committee has yet to convene.

As part of the decentralization process, a new set of functions was transferred from the MoH to

regional health directorates. To support this change, the HP project provided assistance to the

SMT-RHD in the definition of specific managerial competencies for each of the new functions

through the creation of a competencies dictionary18

. This dictionary has been used in the

definition of specific managerial competencies in Ayacucho and SMT.

The Ayacucho RHD asked the HP project for TA in the design of HR job profiles. Using the

SMT-RHD managerial competencies dictionary, the Ayacucho management team identified

specific competencies necessary for HR management19

and then assigned specific

competencies to appropriate job profiles.

To define job profiles and develop performance evaluations for managers at the SMT-RHD

network level, the HP project supported technical teams at the network level in defining two

types of managerial competencies: transversal, which are common to all management

positions, and specific, which are related to the specific functions of the position. For specific

managerial competencies, the HP project utilized the managerial competencies dictionary,

which contains 86 specific competencies. Managers at the network level used this dictionary to

prioritize three competencies that are specific to each position and included them in respective

16 See MoH general competencies in Annex 7.10. 17 See CONEAU managerial competencies in Annex 7.11. 18 See Managerial competencies dictionary in Annex 7.12. 19 See HRM competencies in Annex 7.13.



job profiles. For transversal competencies, the HP project provided a list of 14 competencies20

determined by a bibliographic search of the most common managerial competencies. Based on

this list, network managers defined four competencies to be included in job profiles for all

managerial positions and in performance assessments for network managers.

The four transversal managerial competencies include:

1. Maintain a satisfactory organizational climate

2. Lead, mobilize and inspire teams

3. Maintain good interpersonal relationships

4. Use resources with a high sense of responsibility

3.4 Activities undertaken to design salary scales

One problem in the health sector is the shortage of human resources, especially at first-level-of-

care facilities. One cause of this problem is the inability to attract and retain qualified staff,

mainly in health facilities located in remote and excluded areas; unfortunately, these areas also

have a greater need for health care services. More broadly, while the level of development and

connectivity plays roles in attracting and retaining health care professionals, wages are even

more strongly linked to hiring and retention.

Given this, RHDs should set fair and equitable salaries for hiring staff, especially since more

than 50% of the health workforce is contracted by a variety of regimes.

Graph 17: Health professionals by labor condition, MoH and regional governments, 2012.

SOURCE: MoH – HHR Observatory

The main problem in setting a regional salary scale for health staff is the lack of governance

from RHDs due to the existence of “budget spending units” (unidades ejecutoras de

presupuesto – UE). These units have the authority to define the number of staff hired and

respective salaries without considering technical criteria. This autonomy generates internal

20 See Transversal managerial competencies in Annex 7.14.



inequality, dissatisfaction and demotivation among health workers since two or more health

professionals doing the same job receive different wages. Additionally, local governments as

well as public and private donors can hire health personnel and offer a different salary: this

means that professionals working in the same health facility performing the same functions earn

different wages.

To define a fair and equitable salary scale in hiring health personnel at first-level-of-care

facilities, the HP project worked with Ayacucho, Ucayali and SMT RHDs to define methodology

and tools to set salary scales according to specific characteristics and regional needs[19].

In February 2012, two directives were approved in Ayacucho: a regional directive approving

salaries for first-level-of-care personnel hired by CAS and a second-level-of–care personnel

hired by CAS21

. In Ayacucho, the wage scale is being implemented in all UE. The RHD team

used the methodology to design salary scales for hospitals and RHD workers; they also used

the wage scale to establish the 2013 budget.

In Ucayali, the HP project provided TA to define criteria and respective weights in order to value

job positions and define a salary scale for each micro-network. The salary scale was applied in

the recruitment and selection process in some networks, but there was no regional resolution to

approve its use in all networks.

In SMT, the project presented its experiences from Ucayali and Ayacucho in the design of pay

scales for the first level of care. Regional authorities were interested in this methodology

because it allows them to consider different contexts and factors. Using this background

information, the management team defined four factors to be considered in the SMT pay scale

as well as the relative weight and importance of each factor. The team also defined the

following characteristics: separate pay scales for medical and non-medical health professionals

and technicians; and a pay scale for each health facility.

With these guidelines, the project designed SMT-RHD pay scales that were then approved through directorial resolution. Factors and their respective weights are shown in the table below.

Table 69: Criteria and weights

Level of

development

Accessibility: Distance from

Tarapoto Level of poverty

Time spent to get to remote

communities

A. Most rural 50 A. More than 8 hrs 65 A. Quintile I

and II

30 A. More than 6 hrs 36

B. Rural 40 B. 2 to 8 hrs 55 B. Quintile III 25 B. 3 to 6 hrs 30

C. Intermediate 35 C. 15 minutes to 2 hrs 40 C. Quintile IV 20 C. 30 minutes to 3 hrs 25

D. Urban 30 D. Less than 15 minutes 35 D. Quintile V 15 D. Less than 30

minutes

20

21 Regional Directive N. 001-2012-GRA/GG-GRDS-RHD-DEGRRHH and Regional Directive N.

002-2012-GRA/GG-GRDS-RHD-DEGRRHH.



3.5 Activities undertaken to develop competencies at micronetwork

level

One of the challenges faced by all RHDs is reducing maternal mortality and child malnutrition.

Achieving this depends not only on the availability of equipment but also on the availability of

competent health workers to provide quality health care. Accordingly, it is important to identify

and confront issues related to HHR management and development, including the following[20]:

Limited development of competencies among health workforce.

High turnover of trained staff.

Reduced or inexistent access to training activities for health personnel in remote areas

Poor coordination between RHDs and training institutions resulting in health professionals

who are not responsive to regional health needs Training programs conducted in settings

which are different from actual work environments

Performance evaluations are not competency-based

Health personnel are poorly motivated and not committed to the goals and strategies of

their respective institutions

To manage these issues, USAID provided TA to regional governments to implement regional

HHR policies and improve health worker competencies related to the provision of quality health

services to mothers and children. As part of this TA, Huanuco, Pasco and Junin RHDs

cooperated in the development of a conceptual, methodological and instrumental framework for

a "Competencies Development System", which includes the implementation of competencies

development centers (CDC). Huanuco RHD was the only institution that implemented all

aspects of the system, including the opening of three CDCs in Amarilis, Margos and Acomayo.

The objective of a CDC is to generate and strengthen labor competencies among RHD health

workers at the network and micro-network level with the involvement of local government,

training institutions and professional associations. These centers are part of an in-service

training strategy to foster the development of competencies in locations similar to actual

workplace settings.

Stages of CDC implementation are shown in the graph below.



Graphic 18: Stages in CDC implementation

Design and approval of job competencies,

performance standards

and evaluation tools

Identifying potential

internship sites

Qualification of micro-networks

as CDC

Training program design

Certification of workers trained

Continous supervision of

certified workers

Training program

development

Implementation of competencies

development centerCDC

Supervision of workers trained in their workplace

E

V

A

L

U

A

C

I

O

N

Source: USAID Health Policy Initiative. Mejorando Las Competencias Laborales en el Ámbito Local. 2009:

31.

USAID TA achieved the following results in 2009[21]:

CDCs institutionalized in Huanuco, Junin and Pasco regions with the assistance of the

regional government’s social development management department as well as RHDs and

local governments.

Labor competencies designed, validated and approved for antenatal care; growth and

development monitoring (control de crecimiento y desarrollo – CRED); training nutritional

sessions; care of women in labor and immediate postpartum; and vertical birth.

Non-monetary incentives granted by local governments and civil society to reward

competent HHR from San Luis de Shuaro and Pichanaki micro-networks in Junin RHD.

Official recognition of competency evaluation committees in Huanuco, Cusco, Junin and

Ucayali.

Official recognition of CDC qualification committees in Huanuco, Cusco, Junin and Ucayali.

Official recognition of CDC tutors.

Evaluation of the following competencies: CRED in Huanuco, Junin and Pasco;

demonstration sessions for the preparation of food with local products in Junin; and

antenatal care in Pasco and Junin.

Official recognition of CDCs in Huanuco for CRED; Junin for antenatal care and nutritional

demonstration sessions; Ayacucho for antenatal care; Cusco for vertical birth; Pasco for

antenatal care; and Ucayali for antenatal care.



92 health workers were trained at a CDC through an internship.

Six health workers trained at a CDC have received supervisory visits.

Achievements in Huanuco in this short time frame were mainly due to USAID TA; strong support

from the regional government’s social development manager; the involvement of the University

of Huanuco’s School of Nursing; and most especially the commitment of networks’ technical

team.

A year into CDC implementation in Huanuco, regional and RHD authorities changed, and CDCs

were left without technical and political support. However, two CDCs in Amarilis and Acomayo

are still operating today.

The HP project visited these two centers to interview health authorities and tutors to determine

how the centers have managed to continue operating. The visit yielded the following findings:

All tutors were recognized as certified and competent in CRED through regional resolutions.

Many tutors were also employed as teachers in regional universities, and the health facility

was incorporated into the university as a teaching center.

Mothers attending these health facilities, easily recognized if they are attended by a trained

in the CDC, of another who was not involved in the internship at the CDC, and not allowed

to be attended by untrained personnel. This causes the staff has not been trained ask to

participate in the internship at the CDC.

Health workers from other health networks claimed to be trained at the CDC.

The local government supports the maintenance of equipment and materials for early

stimulation.

This program will be implemented in SMT health networks.

3.6 Activities undertaken to assess management performance

A performance assessment consists of identifying, measuring and managing human

performance in organizations. Identification is based on jobs analyses and intends to determine

which work areas should be studied when their performance is being measured. Measurement

is the core of an evaluation system and seeks to determine how performance compares with

certain objective parameters. Management is the focal point of any assessment system and to

realize the full human potential of an organization it should be orientated towards the future

rather than focus on examining past activity[22].

The regulatory framework defines performance evaluation as a mandatory, comprehensive,

systematic, continuous and demonstrable set of staff activities, skills and performance

measures to meeting goals and objectives. Senior management and human resources, or the

latter’s designees, are responsible for ensuring assessments are carried out in the time and

manner established by SERVIR.

All evaluation processes are subject to the following minimum requirements:

Performance factors measured should be related to job functions, which are clearly defined

in the job profiles of the organization.

Performance is based on factors related to measurable and verifiable targets.

Prior to the evaluation, the worker must be aware of the procedures, factors or goals which

are evaluated.

Evaluations are conducted on an annual basis.



A worker who does not participate in the evaluation process on his own accord, for justified

reasons such as illness, receives a disapproving score, since the performance evaluation is

mandatory for all employees.

All performance evaluations must conform to institutional characteristics, and services provided

correspond to the position types in an organization.

SERVIR considers the following two types of evaluation as complementary. The first type of

evaluation is a measurement of competence that identifies the gap between optimal skills and

current skills to identify training needs. The second type of evaluation aims to measure goal

achievement and identify staff contribution towards achieving organizational goals as well as

areas where adjustments are required to improve performance.

Due to the approval in previous months of new regulations for the civil service and the

administration of performance evaluation, the HP Project has conducted workshops with the

SMT-RHD management team to develop a management tool that allows them to identify

training needs. Additionally, the management tool would also verify and qualify achievements

according to individual institutional goals programmed into the duties’ performance required by

each position. The objective is to provide the SMT-RHD with a tool to measure the evolution of

employee work performance in order to continuously improve institutional management.

3.6.1 Performance evaluation method

The evaluation method developed and proposed by the HP Project ensures that criteria and

practices allow distinguishing performance differences that exist between people in the service

of SMT-RHD. The performance evaluation consists of two parts:

a. Results Evaluation – This component measures the performance of position functions

and/or processes. These functions, including essential and general functions, as well as

position processes, are clearly defined in position profiles for each organizational unit of

the SMT-RHD.

b. Competency Assessment – This component measures general work competencies

which have been identified and approved for all health sector staff and are contained

within the MoH publication "Work Competencies for Improving the Performance of

Health Human Resources".

The following graphs demonstrate the two components of a performance evaluation.

Graphic 19: Results Evaluation



Graphic 20: Competency Evaluation

3.6.2 Performance evaluation implementation

The implementation of performance evaluations for SMT-RHD staff contains two components:

a) Competency measurements to examine position abilities, skills and attitudes takes

place through a 360° evaluation in which the criteria and parameters for each evaluator,

including self, supervisor, subordinate, peer and client, are required to measure the

competencies established by position type, as shown in the graph below.

b) Completion of essential job functions. To achieve strategic and institutional objectives,

in which essential functions need to be identified, processed, displayed and valued on

levels established by SMT-RHD organizational unit leaders.



Graphic 21: 360° Competency Assessment

3.6.3 Competencies evaluation definition and criteria

The following general competencies were selected by the SMT-RHD technical team while the

definitions and evaluation criteria were established by the MoH[23].

ETHICAL

COMMITMENT

The health worker demonstrates responsible attitudes

and service actions in response to service needs

based on principles and values, the common good,

human dignity and the right to health.

Works for the common good, with honesty and

confidentiality.

Completes his/her work quickly and with quality.

ORGANIZATION

AND PLANNING

CAPACITY

The health worker organizes his/her goals, objectives,

resources, roles, activities and tasks to achieve better

health and social transformation results working within

health guidelines and policies.

Identifies, organizes his/her goals, objectives,

functions, activities, tasks and options through

an established plan.

Works in a planned manner to achieve strategic

results, in a set time frame, building towards

future progress.

TEAMWORK The health worker cooperates and collaborates;

integrating into trans disciplinary teams to achieve

organizational objectives and quality care services in

community health.

Participates in obtaining common goals,

respecting different opinions and avoiding

competition.

Supports team members principally by sharing

information, knowledge and resources.

3.6.4 Analysis of results obtained in the evaluation of goals attained and

competencies

Once the performance evaluation is completed, the SMT-RHD Directorate of Human Resources

processes the information in a format entitled "Analysis of Results Obtained", as shown below,

to determine the gap between expected and observed results. The “Problem Statement”

section highlights factors which caused the gap, analyzes the problem and identifies causes.

The format also shows proposed corrective actions in the short- and medium-term for each

evaluated category.



Graphic 22: Analysis of the results obtained

3.7 Activities undertaken to improve recruit and selection processes

The recruitment and staff selection sub-processes are defined in the employment management

system and framed by the HRM system. These processes are intended to include highly

competent persons within varying organization work areas through transparent and efficient

processes, where merit, suitability and non-discrimination are central elements of its execution.

At present there are irregularities in the implementation of HRM processes (selection, training,

evaluation, mobility, separation, compensation and incentives) depending on labor

arrangements. For example, in most public sector institutions there is no application of merit

and performance principles for either recently hired or long term staff or towards service

retention and no monitoring mechanisms both selection and design processes of job profiles.

Selection tends to be based on the characteristics of the person to be chosen rather than those

required for the position.

Following the analysis for estimating health human resource gaps at all SMT-RHD networks and

micro-networks, the project performed in January 2013, a baseline evaluation of staff

recruitment and selection processes. The analysis took as observation samples the budget

execution units at San Martin (U.E. 400) and Alto Mayo (U.E. 401), both of them in San Martin

RHD. The purpose of the study was to describe the recruitment process in force, so as to allow

the identification of improvement options in the context of the modernization of the human

resource management system.

Tools used in the baseline evaluation were: questionnaires (items research), interview guides

and check lists. Steps from the recruitment and selection process that were evaluated are:

preparatory stage, recruitment stage, selection stage, contract signing stage. The organic units

which participated in this evaluation are mentioned in table 64:



Table 70: Base Evaluation: Participants

U.E 400 U.E 401 SMT-RHD

Office of Resource

Administration

Office of Human

Resources

Office of Planning

Office of Resource

Administration

Office of Human Resources

Office of Planning

Directorate of the Office of

Administration

Executive Office of Institutional

Development and Quality

Office of Strategic Planning

SOURCE: USAID|Peru|Health Policy project

Results of assessment are shown in the table 71 below:

Table 71: Results of baseline evaluation of recruitment and selection processes at San

Martin RHD. January, 2013

Issues assessed U.E. 400 U.E. 401 Comment / recommendation

Preparatory Stage

No workers in the area of human resources 5 3 HRM unit understaffed and under

qualified

Incumbent officer for recruitment and selection No No Appointment of the incumbent

Job profiles availability No No Development and standardization of

job profiles

Competitive salary scale definition and

implementation

Scale defined but

not implemented

Scale defined but

not implemented

Implementation plan needs to be

defined and deployed

Estimation of human resources gaps Yes Yes Link recruitment process to gaps

identified

Triggers to staff recruitment process

Memo/Micro-

Networks

Reports/Networks

and Micro-networks

Define and standardize forms and

define formal parties

Recruitment Stage

Use of institutional web page Sometimes No Publication is mandatory

Ministry of Labor Portal (website) No No Publication is mandatory

Other recruitment methods Hospitals murals Hospitals murals Utilize any method that attracts the

largest pool of candidates

Publication duration 5 days 3 days Use time frame indicated in current

regulations

Selection Stage

Selection committee nomination Yes Yes Recommended composition: at least

one representative of HR area and

one from the user area

No of committee members 8 5 Standardized criteria

Evaluation of CV and personal interview Yes Yes Required by law

Other evaluations Psychological

plus knowledge

evaluation

Psychological

Evaluation

Structured evaluation instruments

should be utilized

Publication of evaluation results on institution

website

No No Publication is mandatory

SOURCE: USAID|Peru|Health Policy project



The assessment performed in San Martin RHD revealed that the highest percentage of health

workers in health facilities and micro-networks were hired under CAS modality.

With that information in mind San Martin RHD requested the project advance a proposal to set

policies and procedures for the recruitment and selection of staff. Within this proposal also had

to be defined powers, responsibilities, obligations and terms of the organizational units involved

in the process, according to regulations and the reality and potential of the region. Particularly,

SERVIR regulation for the recruitment procedure were taken into consideration (see graphic

66).

Graphic 23: Macro process: administrative services contracting - CAS

During 2013, the project conducted workshops with the technical team of San Martin RHD to

build the recruitment process proposal. As a consequence San Martin RHD Director and his

management team approved the general process flowchart for recruitment. This process is

described below (Graphic 24).

Preparation Stage: This stage starts the recruitment process, and includes the approval of

recruitment requirements to be part of the job announcement. The administrative

management unit (UGA) is the body responsible for administrative services contracts within

health office operations, hereinafter OOS.

Process initialization:

a. The user area sends the administrative service requirement to the immediate supervisor

in their organization. In San Martin RHD, through the Directorate of Health Management,

where an assessment has to be made as related to estimates of human resource

requirements.

b. All networks forward to their Health Operations Office their approved human resource

requirements, within a schedule timetable. OOS budget execution unit evaluates networks

requirements based on budget availability.

c. Budget execution unit forwards the requirement along with their certified budget proposal

to the health network.

d. The health network forwards the requirement to San Martin RHD-Directorate of Human

Resources Development. This instance assesses the requirement according to stated

regional health priorities.



e. Directorate of Human Resources Development responds to the health network to

authorize and commence the recruitment process through the Directorate of Health

Management.

The Directorate of Health Management cannot start the recruitment process unless it has the

following documents: institutional requirement, terms of reference and budget certification by

budget execution unit. It may be necessary to develop or adjust the job profile of the desired

personnel to be hired. However, if there is already a job profile, it has to be reviewed and

updated according to the functions and competencies required.

For facilitating this process, the project defined a methodology for defining job profiles, providing

a framework for developing job profiles in health provision and health management

positions[15].



Graphic 24: Preparation Stage flowchart



Recruitment Stage. During this stage, dissemination is started in order to inform vacancies

available, according to institutional needs. Dissemination must comply with current regulations

for recruitment procedures. In the case of San Martin RHD, health networks are entitled to

utilize additional dissemination media for attaining recruitment objectives. Minimum media to be

used are:

a. National Employment Service of the Ministry of Labor www.empleosperu.gob.pe/

b. National Internet Portal http://www.peru.gob.pe/

c. Institution web portal http://www.diressanmartin.gob.pe/web/

This process is described below (Graphic 25).

The MoH web portal as supplementary dissemination media

This tool is currently unavailable for informing on vacancies availability. However, it has been

considered by the project as a valuable tool based on the following facts:

a. It facilitates of the tracking and monitoring of jobs demands nationwide, since it can

concentrate institutional, local and regional offers in each region

b. It could serve as a specialized broadcasting tool nationwide within the health sector.

http://www.empleosperu.gob.pe/

http://www.peru.gob.pe/

http://www.diressanmartin.gob.pe/web/



Graphic 25: Recruitment Stage



Selection Stage. This stage comprises the objective assessment of applicants who meet the

conditions required by the area user. Assessments required by law are curriculum evaluation

and interviews. In San Martin RHD, additional mechanisms are used by health networks, such

as psychological evaluations, knowledge assessments, etc. to suit the characteristics of the

vacancy service area.

a) Curriculum Evaluation: It involves the analysis, review and compliance checking with

the minimum position requirements in terms of education, training and/or expertise,

experience and skills (mandatory).

b) Personal Interview: This technique allows the evaluator to meet and evaluate the

applicant during the recruitment process (mandatory). Personal interview includes the

following elements:

- Presentation and development: Appropriate personal bearing and ease of

communication in conveying ideas.

- Attitude and qualities: Applicant behavior and expression, both verbal and nonverbal,

manifested during the conduct of the interview.

- Knowledge and analytical skills: Ability to respond to hypothetical and diverse workplace

scenarios related to the job as well as actual work situations.

This process is described below (Graphic 26).



Graphic 26: Selection Stage


Abt Associates Inc. Activities undertaken to strengthen HRMS ▌pg. 99

To create the final technical document proposal for SMT-RHD hiring, the HP project must have all job profiles including competencies of staff to be hired for SMT-RHD.

The HP Project’s technical paper[24] proposes processes and activities to conduct recruitments is

based on existing national and regional norms corresponding to its scope.



4. Conclusions

Based on the results of HRMS assessment in six RHDs, the following can be concluded:

1. In general, there is poor development in the implementation of HRMS processes at the regional

level; only SMT-RHD shows moderate development at 48% towards goals.

2. The performance management component shows the lowest level of development in all assessed

RHDs, including SMT-RHD. The employment management component shows a high level of

development in four RHDs.

3. These results are due to a clear lack of delineation of regulatory functions in RHDs regarding

HRM, which must be explicitly stated in the manual of operations and functions (MOF). RHDs

have not designated responsible parties for many of the HRM processes. HRMS components are

not in the same organizational unit which makes it difficult to implement as a whole system with

components and processes interrelated and interdependent, under a single person. Additionally,

in many RHDs the heads of HR offices are non-professional staff members and have not been

trained in HRM. The number of personnel working in HR offices is insufficient to perform all HRM

processes well.

4. Processes that have reached more than 50% implementation are mostly related to compliance

with the requirements of higher authorities such as the MEF, which requires regular information

reporting.

5. Regarding the planning component, there is an absence of operational research to support

formulation of HHR policies and strategies as well as monitoring and control of HRM indicators.

There have been significant advances in the design of HR policies, which must be reviewed and

updated. A national guideline to estimate HHR needs for the first level of care was designed and

validated; it is currently being approved by MoH. This guideline incorporates tools and

methodologies which were validated and applied by the HP project in Ucayali, Ayacucho and San

Martin.

6. For the work organization component, all RHDs show some progress in relation to the design of

managerial documents such as ROF, MOF, CAP and PAP. However, there have been few

advances in the development of procedure manuals for relevant processes. SERVIR, which is the

national authority for HRMS, has defined a methodology for the design of job profiles, and it has

been validated and applied by the HP project in Ayacucho and San Martin.

7. In the employment management component, the processes performed to date have not met all

the regulatory requirements for conducting a recruitment process. For example, most of the

contract files do not include standardized job profiles or the respective budget certification which

specifies and guarantees remunerative payment. Additionally, dissemination required by current

regulations is not being executed. Staff recruited as a result of this process does not receive the

appropriate induction because there is no responsible party to inform them of policy, rules, roles,

goals, vision, mission and values of the institution. This situation places new staff in institutional

limbo, creating conditions where personnel do not identify with institutional goals.

8. In the performance management component, despite having an organizational unit responsible

for the process, there is no designated person to manage this process. Additionally, a

management tool has not been developed or approved defining the methodology to evaluate the

performance of institution staff.



9. The development management component demonstrates a poor level of implementation. Despite

having a promotion policy for stable staff, it is not being implemented. This policy needs to be

revised and improved to serve as a reference for more transparent and meritocratic processes.

Regarding capacity building, some regions have restrictions in training hired staff; in these

regions, training activities focus on professional staff.

10. Regarding the compensation management component, only SMT-RHD and Ayacucho have

salary scales for all first-level-of-care facilities. The scales are approved but have not yet been

implemented at the regional level in the case of SMT-RHD.

11. For the management of human and social relations component, there have been advances in

management of labor relations but slightly less progress in developing processes related to

organizational climate and culture as well as workplace health, safety and welfare.


Abt Associates Inc. Recommendations to implemente the HRMS at regional level ▌pg. 102

5. Recommendations to implement the HRMS at regional level

1. Diagnose the level of implementation of HRMS at different levels of management. Based on the

results, define critical processes to further develop improvement processes. It is important to

define whether the deficiency in the implementation of critical processes is due to deficiencies in

staff skills or lack of a standard.

2. Establish an organizational structure for HR offices that allows implementing all HRMS processes

by assigning each process to a particular party who is responsible for a defined position in the

new structure.

3. Define job profiles for the head of the HR office and all units established by the new structure.

4. Build the capacity of the HR office´s technical team through a specific program in management of

HRM tools and standards, according to the job profile defined, ensuring permanence of trained

personnel.

5. Strengthen HR offices at the regional and network level with competent and sufficient staff to

implement key HRMS processes and fulfill basic functions of the HR office.

6. Identify indicators for monitoring the implementation of HRMS at the RHD level.

7. Design, adapt or adopt documents or technical tools to improve the management of a given HRM

process. The HP project has designed and validated a HRM toolkit which can be used or adapted

according to the specific environment.

8. Design, adapt or adopt rules or policies when the proper functioning of a process requires the

approval of a regional standard.

9. Establish a workshop among the regional bodies that are involved with HRMS implementation.

Employ regional government HR Offices and the RHD HR Office to analyze the results obtained

in evaluating HRMS, and define improvement plans for the proper functioning of these processes

in accordance with SERVIR provisions.


Abt Associates Inc. References ▌pg. 103

6. References

1. Ley del Servicio Civil, in Ley 30057 2013, Congreso de la República: Perú.

2. SERVIR, El Servicio Civil Peruano; Antecedentes, Marco Normativo Actual y Desafíos Para

La Reforma. 2012, Autoridad Nacional del Servicio Civil: Lima.

3. Ipsos, Evaluación de la Reforma del Servicio Civil. 2013: Lima.

4. Villanueva, C., Elaborar un modelo de gestión descentralizado de recursos humanos en

salud para las regiones: Ayacucho, Cajamarca, Cusco, Huánuco y Ucayali y los planes de

intervención respectivos. 2012, MINSA: Perú.

5. GORESAM, Ordenanza Regional N° 003-2013-GRSM/CR, in OR 003-2013-GRSM/CR.

2013: Región San Martín.

6. Nivel de implementación del sistema de gestión de recursos humanos de la DIRES San

Martín. 2013, Dirección de Desarrollo de RR.HH. de la DIRESA San Martín.

7. Informe de sistemas de gestión de RR.HH. de la DIRESA Cajamarca.

8. Workload Indicators of Staffing Need (Software Manual). 2010, World Health Organization:

Ginebra.

9. Dreesch, N., An approach to estimating human resource requirements to achieve the

Millenium Development Goals. 2013, Oxford University England.

10. An overview of human resources for health (HRH) Projection Models. 2008, USAID: North

Carolina.

11. Alvarez, C., Cálculo de índice de ruralidad para todos los distritos del Perú. 2012: Lima.

12. Guía de metodología de cálculo de las brechas de recursos humanos en salud para los

servicios asistenciales del primer nivel de atención, in Guía Técnica N° 001-MINSA/DGRH-

V.01, MINSA: Lima.

13. Cálculo de brecha de recursos humanos y propuesta de asignación de dotación del equipo

básico para el primer nivel de atención. 2013, Dirección Regional de Salud de San Martín:

Lima.

14. SERVIR, Guía metodológica para la elaboración de perfiles de puestos en las entidades

públicas. 2012: Lima.

15. Perfiles de puestos de la DIRESA San Martín y sus órganos desconcentrados. 2013, HP: San

Martín.

16. Perfiles de puestos para el personal de la dirección ejecutiva de gestión y desarrollo de

recursos humanos. 2012, HP: Ayacucho.

17. Perfiles de puestos para el personal asistencial del primer nivel de atención, HP: DIRESA

Ayacucho.

18. OIT, Diseñar un modelo integtral y dinámico de gestión de recursos humanos por

competencias. 2006, Centro Internacional de Formación de la OIT: Turín.

19. Chiavenato, I., Gestión del Talento Humano. Mc Graw-Hill ed. 2009, México D.F.

20. USAID, Mejorando las competencias laborales en el ámbito local. 2009, USAID | Iniciativa

de Políticas en Salud Lima.

21. USAID, Desarrollo de recursos humanos en salud; Sistema de Desarrollo de Competencias.

2009, USAID | Iniciativa de Políticas en Salud: Lima.

22. WHO, Working together for health - The World Health Report 2006. 2006, World Health

Organization: Ginebra.

23. MINSA, Competencias laborales para la mejora del desempeño de los recursos humanos en

salud. 2011, MINSA - Dirección General de Gestión del Desarrollo de Recursos Humanos:

Lima.

24. Directiva que regula el procedimiento de contratación del personal bajo el régimen especial

laboral de contrato administrativo de servicios - CAS de la Dirección Regional de Salud de

San Martín - Propuesta, HP project.


Abt Associates Inc. Annex ▌pg. 104

7. Annex

7.1 Questionnaire to assess the implementation of the HRMS in health

institutions

SISTEMA DE GESTIÓN DE RECURSOS HUMANOS EN INSTITUCIONES DE SALUD

La finalidad de este instrumento es conocer cuál es el nivel de avance en la implementación de los procesos de

la gestión de recursos humanos. Para ello, sírvase responder las preguntas que se formulan a continuación.

Esperamos que las respuestas se acerquen lo más posible con la realidad de su institución, de tal forma que se

puedan identificar las áreas que son necesarias fortalecer.

El instrumento consta de preguntas cerradas donde usted puede marcar la o las alternativas que más se

acerquen a la realidad de su institución. También hay preguntas abiertas donde se espera que pueda ampliar la

información proporcionada en las preguntas cerradas.

Se agradece de antemano su colaboración.

A continuación, sírvase llenar la siguiente información

GESTIÓN Y DESARROLLO DE RECURSOS HUMANOS

Nombre de la institución:

_____________________________________________________________________________

1. En su institución ¿Existe una instancia responsable de la gestión y desarrollo de recursos humanos en

salud? ( ) SI ( ) NO

¿Cuál es el nombre de la unidad responsable de la gestión de recursos humanos en su institución? _______________________________________________________________________________

2. ¿Cuál es la ubicación de la unidad de recursos humanos en su institución? ( ) Órgano de Asesoría ( ) Órgano de Línea ( ) Órgano de Apoyo ( ) No existe, se encuentra dentro de otra

Unidad

3. ¿Cuántas personas trabajan en esta unidad?

Grupo ocupacional

TOTAL

Número de personas por régimen laboral

Régimen 276

Régimen 728

CAS Locador a

tiempo completo

Otro

Profesionales

Técnicos

Otros

TOTAL

POLÍTICA Y PLANIFICACION ESTRATÉGICA DE RECURSOS HUMANOS EN SALUD Cuestionario Formulación de Políticas y estrategias de Gestión y Desarrollo de Recursos Humanos



1. En su institución ¿Existe una instancia responsable de la formulación y evaluación de políticas de recursos humanos en salud?

( ) SI ( ) NO De acuerdo con su ROF vigente, ¿Cuáles son las instancias que participan en el diseño y evaluación de las políticas de recursos humanos en su institución?

Nivel

¿Participa? En caso de que participe

SI NO Nombre de la unidad

responsable Función específica

En DIRESA

En la Red

En la MR

2. ¿Cuenta con Políticas de Gestión y Desarrollo de Recursos Humanos?

( ) SI ( ) NO Si la respuesta ha sido afirmativa, favor responder las siguientes preguntas. En caso contrario, pasar a la siguiente Sección.

3. ¿Las Políticas de Gestión y Desarrollo de Recursos Humanos están aprobadas? ( ) SI ( ) NO

¿Cuándo han sido aprobadas? ______________________________________

El diseño de las Políticas de Recursos Humanos ha tomado en cuenta los siguientes procesos: (Si es posible, pedir las políticas y revisar)

N° Pregunta SI NO

4. Planificación de Recursos Humanos

5. Desarrollo de competencias

6. Evaluación del desempeño

7. Motivación e Incentivos

8. Salud y Seguridad en el Trabajo

9. Selección en base al mérito

10. Perfiles de puestos y competencias

11. Agentes comunitarios en salud

Otros; Especificar:

Otros; Especificar:

12. ¿Las políticas aprobadas han tenido algún nivel de implementación?

( ) SI ( ) NO

Si la respuesta a la pegunta anterior ha sido afirmativa, ¿Qué aspectos de la política han sido implementadas?

N° Pregunta SI NO

13. Planificación de Recursos Humanos

14. Desarrollo de competencias

15. Evaluación del desempeño

16. Motivación e Incentivos

17. Salud y Seguridad en el Trabajo

18. Selección en base al mérito

19. Perfiles de puestos y competencias

20. Políticas de Remuneraciones

Otros; Especificar:

Otros; Especificar:



Desarrollo de investigaciones operativas 21. ¿Han desarrollado algún tipo de investigación relacionada con la gestión de recursos humanos?

( ) SI ( ) NO

Si la respuesta a la pegunta anterior ha sido afirmativa, ¿Qué investigaciones han desarrollado? _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

22. ¿Cuentan con un diagnóstico situacional de los recursos humanos en su Región? ( ) SI ( ) NO

Organización y administración de la información en recursos humanos en salud 23. En su institución ¿Existe una instancia responsable de mantener actualizada la información relacionada con

los recursos humanos en salud? ( ) SI ( ) NO

De acuerdo con su ROF vigente, ¿Cuáles son las instancias que participan en la gestión de la información de recursos humanos en su institución?

Nivel




En DIRESA

En la Red

En la MR

24. ¿Cuenta con algún sistema de información sobre recursos humanos?

( ) SI ( ) NO

Si la respuesta a la pegunta anterior ha sido afirmativa, marcar con una “X” el tipo de información que se registra en cada aplicativo, software o base de datos de recursos humanos que utilizan en su institución.

Información de RRHH que se registra

Nombre del aplicativo / software / base de datos

Planillas

SIGA …….. …….. ……..

25. Nombre completo de todos los trabajadores

26. Número de plazas ocupadas

27. Número de plazas previstas

28. Número de plazas previstas y presupuestadas sin ocupar

29. Conceptos remunerativos

30. Conceptos no remunerativos

31. Gastos en planilla

32. Asistencia/Tardanzas/Faltas

33. Personas por regímenes laborales

34. Personas por unidad orgánica

35. Personas por grupo ocupacional

36. Concursos públicos realizados

37. Ubicación actual del trabajador

38. Legajo de servidores

39. Servidores por especialidad

40. Tipo de desplazamientos

Otro: ___________________________________

Otro: ___________________________________

Otro: ___________________________________



41. Los aplicativos que utilizan ¿le ayudan a tomar las decisiones que necesita? ( ) SI ( ) NO

Control en la Gestión de recursos humanos en salud 42. En su institución ¿Existe una instancia responsable del monitoreo de indicadores de gestión de recursos

humanos en salud? ( ) SI ( ) NO

De acuerdo con su ROF vigente, ¿Cuáles son las instancias que participan en el monitoreo de indicadores de gestión de recursos humanos en su institución?

Nivel




En DIRESA

En la Red

En la MR

43. ¿En el último año han definido los indicadores de gestión de recursos humanos en su institución?

( ) SI ( ) NO Si la respuesta ha sido afirmativa, favor responder las siguientes preguntas. ¿Qué indicadores de gestión de recursos humanos han definido? (puede marcar más de 1)

N° Pregunta SI NO

44. % de MR que cuentan con la estimación de necesidades de RRHH

45. % de instancias que cuentan con el 80% de perfiles de puestos

46. % de contratos suscritos después de un proceso de selección meritocrático

47. % de convocatorias que han sido publicadas en la web del MINTRA

48. % de procesos de reclutamiento y selección que se han realizado en base a perfiles

49. % de capacitaciones realizadas en base a la brecha en el desempeño

50. % de trabajadores que cuentan con metas de producción concertadas

51. % de trabajadores que han sido evaluados por competencias

52. % de trabajadores que han sido contratados en zonas alejadas, en base a una escala salarial atractiva.

Otros; Especificar:

Otros; Especificar:

53. ¿Han realizado la medición de los indicadores de monitoreo de la gestión de recursos humanos en su

institución. ( ) SI ( ) NO

Planificación estratégica de Recursos Humanos 54. En su institución ¿Existe una instancia responsable de la planificación de recursos humanos en salud?

( ) SI ( ) NO De acuerdo con su ROF vigente, ¿Cuáles son las instancias que participan en la estimación de requerimientos de recursos humanos y en el diseño de los planes de dotación en su institución?

Nivel




En DIRESA

En la Red



En la MR

55. ¿En el último año han realizado estimaciones de requerimientos y necesidades de recursos humanos en su

institución? ( ) SI ( ) NO

Si la respuesta ha sido afirmativa, favor responder las siguientes preguntas.

¿Qué criterio han usado para definir los requerimientos de recursos humanos? (puede marcar más de 1)

N° Pregunta SI NO

56. Plazas del CAP no cubierto

57. Crecimiento vegetativo de la población

58. Aumento de funciones

59. Aumento de la producción

60. Proyecciones de demanda

61. Proyecciones de uso de servicios

62. Ratio de la OMS

Otros; Especificar:

Otros; Especificar:

63. ¿Cuentan con algún aplicativo para las estimaciones de requerimientos de recursos humanos?

( ) SI ( ) NO

64. ¿Han podido contar de manera inmediata, con información actualizada acerca de la dotación actual de recursos humanos y su situación laboral?

( ) SI ( ) NO Si la respuesta es NO, indique ¿Por qué? __________________________________________ _________________________________________________________________________

65. ¿Han utilizado el estudio de brechas o de necesidades de recursos humanos para tomar alguna decisión? ( ) SI ( ) NO

Si la respuesta es afirmativa, ¿En qué han utilizado esta información de necesidades de recursos humanos?

N° Pregunta SI NO

66. Para las nuevas contrataciones

67. Para sustentar más presupuesto

68. Para redistribuir personal

69. Para solicitar mas SERUMS

Otros; Especificar:

Otros; Especificar:

70. ¿En base a esta información, han elaborado su Plan de dotación para el corto, mediano y largo plazo?

( ) SI ( ) NO Si la respuesta es NO, indique ¿Por qué? __________________________________________

Financiamiento de Recursos Humanos 71. En su institución ¿Existe una instancia responsable de estimar las necesidades de financiamiento de

recursos humanos en salud para la Región? ( ) SI ( ) NO



De acuerdo con su ROF vigente, ¿Cuáles son las instancias que participan en la estimación de las necesidades de financiamiento de recursos humanos en salud para la Región?

Nivel




En DIRESA

En la Red

En la MR

72. ¿En el último año han realizado estimaciones de necesidades de financiamiento para los recursos humanos

en salud para la Región? ( ) SI ( ) NO


¿Qué criterio han usado para definir los requerimientos de financiamiento de recursos humanos? (puede marcar más de 1)

N° Pregunta SI NO

73. Plazas del CAP no cubierto

74. Estudio de necesidades de RRHH

75. Requerimientos de las unidades ejecutoras

76. Presupuesto histórico

Otros; Especificar:

Otros; Especificar:

COMENTARIO ACERCA DE LA ORGANIZACIÓN Y FUNCIONAMIENTO DEL SUB SISTEMA DE POLÍTICA Y PLANIFICACIÓN ESTRATÉGICA DE RECURSOS HUMANOS:

ORGANIZACIÓN DEL TRABAJO

Cuestionario

Diseño de perfiles de puestos de trabajo 1. ¿Existe una instancia responsable del diseño de los perfiles de puestos en su institución?

( ) SI ( ) NO De acuerdo con el ROF vigente, ¿Quién o quiénes son las instancias que participan en el diseño de las competencias?

Nivel

¿Existe responsable?

En caso de que exista



En DIRESA



Nivel





En la Red

En la MR

Para el diseño de perfiles de puestos, deben tomarse como referencia los documentos de gestión en materia de recursos humanos, al respecto, llene el siguiente cuadro:

N° Documento

¿Existe al menos en el 80% de las

unidades orgánicas?

En caso de que exista, responda lo que ocurre en la mayoría de los casos

SI NO Año de

aprobación Año de última modificación

# de modificaciones en los últimos 3 años

2. 1 CAP

3. 2 MOF

4. 3 MAPRO

5. 4 PAP

En relación al CAP, marque lo que corresponda para su institución:

( ) El número de personas nombradas trabajando es exactamente igual al número de personas consignadas en el CAP

( ) El número de personas nombradas trabajando es mayor al número de personas consignadas en el CAP

( ) El número de personas nombradas trabajando es menor al número de personas consignadas en el CAP

( ) El número de personas trabajando (nombradas y contratadas) es exactamente igual al número de personas consignadas en el CAP

( ) El número de personas trabajando (nombradas y contratadas) es mayor al número de personas consignadas en el CAP

( ) El número de personas trabajando (nombradas y contratadas) es menor al número de personas consignadas en el CAP

Para el documento CAP más avanzado y completo, marque el contenido

N° Pregunta SI NO

6. Puestos ocupados

7. Puestos previstos

8. Cargos de confianza

9. Puestos por grupo ocupacional

10. Puestos del personal CAS

Otros; Especificar:

Para el documento MOF más avanzado y completo, marque el contenido

N° Pregunta SI NO

11. Funciones específicas del puesto

12. Conocimientos requeridos

13. Experiencia previa

Otros; Especificar:

Para el documento MAPRO más avanzado y completo, marque el contenido

N° Pregunta SI NO

14. Procesos desarrollados

15. Responsables de cada proceso



N° Pregunta SI NO

16. Metas por procesos

17. Metas por persona

Otros; Especificar:

Para el documento PAP más avanzado y completo, marque el contenido

N° Pregunta SI NO

18. Monto de Ingresos por servidor

19. Clasificación de conceptos remunerativos

20. Clasificación conceptos no remunerativos

21. Frecuencia de otorgamiento de conceptos salariales

Otros; Especificar:

22. ¿En el último año han diseñado perfiles de puestos en alguna unidad orgánica?

( ) SI ( ) NO Si la respuesta ha sido afirmativa, favor responder las siguientes preguntas. En caso contrario, pase a la siguiente sección. ¿Cuentan con al menos el 60% de perfiles para los puesto de los siguientes niveles?

N° Nivel 60% de perfiles

SI NO

23. DIRESA

24. Red

25. Oficina de Operaciones

26. MR

¿Qué han tomado como referencia para definir las funciones específicas de los puestos?

N° Pregunta SI NO

27. Las funciones vigentes del MOF

28. Las funciones descritas en los TDR

29. Opinión de expertos

30. Perfil de competencias

31. Las funciones generales del ROF

32. Un análisis de procesos

Otros; Especificar:

Otros; Especificar:

¿Qué han tomado como referencia para definir los requisitos para los puestos?

N° Pregunta SI NO

33. La situación del mercado laboral regional

34. La situación del mercado laboral nacional

35. La situación laboral de los trabajadores actuales

36. La complejidad de las funciones

37. La importancia del puesto

Otros; Especificar:

Otros; Especificar:



38. ¿Los perfiles de puestos diseñados, tienen algún tipo de aprobación oficial? ( ) SI, ¿Cuál? _______________________ ( ) NO

39. ¿Han utilizado los perfiles de puestos diseñados para tomar algún tipo de decisión?

( ) SI ( ) NO, ¿Por qué? ___________________________________ ¿En qué han utilizado los perfiles de puestos diseñados?

N° Pregunta SI NO

40. Para los procesos de reclutamiento

41. Para los procesos de selección

42. Para los procesos de capacitación

43. Para definir las compensaciones

44. Para la evaluación del desempeño

45. Para los ascensos

Otros; Especificar:

Otros; Especificar:

Identificación de competencias 46. ¿Existe una instancia responsable de definir el perfil de competencias en su institución?

( ) SI ( ) NO De acuerdo con el ROF vigente, ¿Quién o quiénes son las instancias que participan en el diseño de las competencias?

Nivel





En DIRESA

En la Red

En la MR

47. ¿En el último año han diseñado perfiles de competencias en alguna unidad orgánica?

( ) SI ( ) NO Si la respuesta ha sido afirmativa, favor responder las siguientes preguntas. ¿Cuentan con al menos el 60% de perfiles para los puesto de los siguientes niveles?

N° Nivel 60% de perfiles

SI NO

48. Asistencial

49. Gerencial o Directivo

50. Administrativo

¿Qué herramientas han usado para definir las competencias?

N° Pregunta SI NO

51. Diccionario de competencias

52. Las competencias del MINSA

53. Las competencias de los colegios profesionales

54. Las competencias definidas por otras instituciones similares

55. Análisis Funcional

56. Análisis Conductual

57. Consulta a expertos



N° Pregunta SI NO

Otros; Especificar:

Otros; Especificar:

58. ¿Las competencias definidas, tienen algún tipo de aprobación oficial? ( ) SI, ¿Cuál? ___________________ ( ) NO

59. ¿Han utilizado las competencias diseñadas para tomar algún tipo de decisión?

( ) SI ( ) NO, ¿Por qué? ____________________________________

¿En qué han utilizado las competencias definidas?

N° Pregunta SI NO

60. Como parte de los perfiles de puestos

61. Para la evaluación de candidatos en los procesos de selección

62. Para definir los contenidos de la capacitación

63. Para definir la línea de carrera

64. Para la evaluación del desempeño

65. Para definir las compensaciones

Otros; Especificar:

Valoración de puestos de trabajo 66. ¿Existe una instancia responsable de valorar los puestos de trabajo en su institución?

( ) SI ( ) NO De acuerdo con el ROF vigente, ¿Quién o quiénes son las instancias que participan en la valoración de los puestos de trabajo?

Nivel





En DIRESA

En la Red

En la MR

67. ¿En el último año han desarrollado algún proceso de valoración de puestos de trabajo?

( ) SI ( ) NO Si la respuesta ha sido afirmativa, favor responder las siguientes preguntas. La valoración de puestos realizada, han sido para los puestos en los siguientes niveles:

N° Nivel SI NO

68. DIRESA

69. Red

70. Oficina de Operaciones

71. MR

¿Qué criterios han usado para definir las competencias?

N° Pregunta SI NO

72. El perfil del puesto: Jerarquía, formación, experiencia

73. Presupuesto bajo responsabilidad



N° Pregunta SI NO

74. Cantidad de personal bajo responsabilidad

75. Ubicación geográfica del puesto

76. Carga de trabajo del puesto

77. Condiciones de desarrollo del lugar donde se ubica el puesto

78. Nivel de pobreza del lugar donde se ubica el puesto

Otros; Especificar:

Otros; Especificar:

79. ¿Han utilizado la valoración del puesto para tomar algún tipo de decisión? ( ) SI ( ) NO, ¿Por qué? ______________________________________

¿En qué han utilizado la valoración del puesto realizada?

N° Pregunta SI NO

80. Para definir la línea de carrera

81. Para definir el salario

82. Para distribuir el personal

83. Para definir los incentivos

Otros; Especificar:

Otros; Especificar:

COMENTARIO ACERCA DE LA ORGANIZACIÓN Y FUNCIONAMIENTO DEL SUB SISTEMA DE ORGANIZACIÓN DEL TRABAJO:

GESTIÓN DEL EMPLEO

Cuestionario

Reclutamiento, Selección, Incorporación e Inducción

1. ¿Cuentan con una instancia responsable de administrar los procesos de reclutamiento, selección, incorporación e inducción de personal?

( ) SI ( ) NO De acuerdo con el ROF vigente ¿Quién es la instancia responsable de administrar los procesos de reclutamiento, selección, incorporación e inducción de personal?

Nivel

¿Existe? En caso de que exista



En DIRESA

En la Red

En la MR



2. ¿En el último año han realizado procesos de reclutamiento y selección en su institución? ( ) SI ( ) NO

En el último proceso de contratación ¿Cómo han SUSTENTADO la necesidad de contratación de personal?

N° Pregunta SI NO

3. Existencia de plazas del CAP no cubiertas

4. Incremento en el presupuesto

5. Requerimiento del área usuaria

6. En base a un estudio de brechas

7. Este tipo de decisiones no tiene influencia política

8. Por aumento de la producción

Otros; Especificar:

En la fase preparatoria de los procesos de contratación de CAS realizados el año pasado, han contado con lo siguiente: (puede marcar más de 1)

N° Pregunta SI NO

9. El requerimiento realizado por el área usuaria.

10. Perfil del puesto

11. Términos de Referencia

12. Hoja de funciones

13. Existencia de la disponibilidad en la Certificación Presupuestaria

Otros; Especificar:

En relación al Reclutamiento, en el último concurso de plazas, ¿qué medios de difusión han utilizado?

N° Pregunta SI NO

14. Radio local

15. Televisión local

16. Periódicos locales

17. Mural de la entidad

18. Página web de la institución

19. Servicio Nacional del Empleo del MINTRA

Otros; Especificar:

En relación a los concursos realizados durante el año pasado, llenar la siguiente información

2012 Mes

# días de difusión del concurso

Resultado

Concurso culminado

Concurso desierto

Concurso impugnad

o

Plazas concursadas:

Mes

# Plazas concursadas Tipo y # de plazas asistenciales concursadas

Directivas

Asistenciales

Administrativos

A B C D E



A= Médico; B=Enfermera; C=Obstetra; D=Técnico; E= Otro

En relación a las plazas ocupadas

Mes

# Plazas contratadas Tipo y # de plazas asistenciales contratadas

Directivas

Asistenciales

Administrativos

A B C D E


20. ¿Existe una Comisión permanente de Procesos de Selección?

( ) SI ( ) NO

21. El último proceso de convocatoria realizado, ¿Fue comunicado a la Red CIL PROEMPLEO? ( ) SI ( ) NO

Si la respuesta es afirmativo: ¿Con cuántos días de anticipación se cursó dicha información a la Red CIL PROEMPLEO? _____ días.

22. ¿En el último proceso de convocatoria de personal, cualquiera sea la modalidad, han consultado el Registro Nacional de Sanciones de Destitución y Despido (RNSDD), para verificar si alguno de los candidatos se encuentra inhabilitado para ejercer función pública?

( ) SI ( ) NO

En el último proceso de selección realizado, utilizaron los siguientes instrumentos de evaluación: (puede marcar más de 1)

N° Pregunta SI NO

23. Lista de chequeo para evaluar CV

24. Guía de entrevistas

25. Examen de conocimientos

26. Presentación de un caso

27. Examen psicológico

28. Prueba psicotécnica

29. Evaluación de competencias

Otros; Especificar:

Otros; Especificar:

En el último proceso de selección realizado, la puntuación se realizó sobre los siguientes aspectos: (puede marcar más de 1)

N° Pregunta SI NO

30. Formación

31. Capacitación

32. Experiencia laboral

33. Competencias

34. Entrevista personal

35. Conocimientos

Otros; Especificar:

Otros; Especificar:

36. ¿Tiene un sistema para archivar y llevar el registro de todos los procesos de selección realizados?

( ) SI ( ) NO

¿Qué tipo de información de los procesos de selección está archivada? (puede marcar más de 1)



N° Pregunta SI NO

37. Bases del concurso

38. Solicitudes recibidas

39. Resultado de las evaluaciones

40. Impugnaciones

41. Actas del Comité de Concurso

Otros; Especificar:

Otros; Especificar:

42. En el último proceso de contratación, ¿Han realizado la inducción al nuevo personal incorporado?

( ) SI ( ) NO En el último proceso de contratación, ¿Quién ha sido la unidad responsable de la inducción al nuevo personal?

( ) Director de la DIRESA ( ) Jefe del Área usuaria ( ) Jefe de la Red ( ) Un trabajador del área usuaria ( ) Jefe de la MR ( ) Otros; Especificar: ____________

En el último proceso de inducción, ¿Qué temas se han abordado?

N° Pregunta SI NO

43. Misión, Visión y Valores de la institución

44. Políticas regionales de salud

45. Políticas y estrategias sanitarias institucionales

46. Reglamento Interno de Trabajo (RIT)

47. Funciones Generales de la unidad orgánica

48. Funciones específicas del puesto

49. Procesos claves que se desarrollan

50. Metas de desempeño esperadas

Otros; Especificar:

51. El último proceso de inducción duró en promedio de 3 días a 1 semana a tiempo completo

( ) SI ( ) NO Desplazamiento o movilidad del personal 52. ¿Cuentan con un responsable de mantener actualizada la información de los desplazamientos del

personal? ( ) SI ( ) NO

De acuerdo con el ROF vigente ¿Quién es la instancia responsable de autorizar el desplazamiento del personal?

Nivel




En DIRESA

En la Red

En la MR

53. ¿Cuentan con un sistema que permita mantener actualizada la información de los desplazamientos del


En el 2011 y 2012, ¿cuánto personal ha sido destacado fuera de la institución?

Año # total de personal

# total de personal

# de destaques por grupo ocupacional # destaques

por plaza



movilizado destacado asistencial

Directivo Asistencial

Administrativo

A B C D E

2011

2012

2013


Administración de legajos y declaraciones juradas; control de asistencia y permanencia

54. ¿Cuentan con un responsable de mantener la actualización de la información del legajo?

( ) SI ( ) NO De acuerdo con el ROF vigente ¿Quién es la instancia responsable del mantenimiento del legajo de personal?

Nivel




En DIRESA

En la Red

En la MR

55. ¿Cuentan con algún sistema para registrar la información del personal, como por ejemplo un legajo de



¿Qué información del trabajador contiene el legajo de personal?

N° Pregunta SI NO

56. Datos personales (nombre, edad, sexo, etc.)

57. Régimen laboral al que pertenece

58. Registro de amonestaciones o sanciones

59. Informes de evaluaciones de desempeño

60. Registro de las faltas o tardanzas

61. Capacitaciones recibidas

62. Incentivos recibidos

Otros; Especificar: __________

63. ¿ El año pasado han realizado la actualización de la información del legajo?

( ) SI ( ) NO

¿Cuándo realizaron la última actualización de la información del legajo? ( ) El mes pasado ( ) El año pasado ( ) Hace 6 meses ( ) No se realiza

En relación al Control de Asistencia y permanencia: 64. ¿Cuentan con un responsable del Control de Asistencia y permanencia del personal?

( ) SI ( ) NO De acuerdo con el ROF vigente ¿Quién es la instancia responsable del Control de Asistencia y permanencia del personal?

Nivel




En DIRESA

En la Red

En la MR



N° Pregunta SI NO

65. ¿Cuentan con un sistema confiable de control de asistencia del personal, que no sea el Cuaderno de asistencia?

Si la respuesta es SI, ¿Cuál?

66. ¿Todos marcan su asistencia? Si la respuesta es NO, ¿Quiénes no marcan y por qué?

67. ¿Tienen alguna Resolución donde se señala el personal que no está obligado a registrar su asistencia?

Si la respuesta es NO, ¿Por qué?

Administración de procesos disciplinarios 68. ¿Cuentan con un responsable de administrar los procesos disciplinarios en su institución?

( ) SI ( ) NO

De acuerdo con el ROF vigente ¿Quién es la instancia responsable de administrar los procesos disciplinarios en su institución?

Nivel




En DIRESA

En la Red

En la MR

En relación al Reglamento interno de Trabajo (RIT):

N° Pregunta SI NO

69. ¿Cuentan con un RIT? ¿Cuándo fue diseñado? __________

70. ¿El RIT está aprobado? ¿Cuándo fue aprobado? ______________

71. ¿El RIT es conocido por el personal? ¿Cómo se ha difundido____________________

72. ¿El RIT ha sido entregado al nuevo personal contratado en el último proceso?


73. ¿Tiene ejemplares del RIT disponibles en este momento?


En relación a los Procesos Disciplinarios:

N° Pregunta SI NO

74. ¿Cuentan con una Comisión de Procesos Administrativos Disciplinarios?


75. ¿Han realizado procesos disciplinarios el 2012?

¿Cuántos procesos disciplinarios han desarrollado en el 2012?

76. ¿Todos los fallos formales de la Comisión de procesos administrativos del 2012 cuentan con Resolución?


77. ¿Mantienen un registro actualizado de los expedientes de Procesos Administrativo?


78.

Mantiene actualizado el Registro Nacional de Sanciones de Destitución y Despido (RNSDD), con el registro oportuno de las sanciones y todos los demás actos relacionados como la modificación, suspensión o anulación, según corresponda




Desvinculación del personal 79. ¿Cuentan con un responsable de administrar los procesos de desvinculación del personal?

( ) SI ( ) NO

De acuerdo con el ROF vigente ¿Quién es la instancia responsable de administrar los procesos de desvinculación del personal?

Nivel




En DIRESA

En la Red

En la MR

80. ¿Cuentan con un sistema que permita mantener actualizada la información de los procesos de

desvinculación del personal por régimen laboral y grupo ocupacional? ( ) SI ( ) NO

En el periodo 2010-2012, ¿cuántos casos de desvinculación por régimen laboral han ocurrido?

Tipos de desvinculación laboral

2010 2011 2012

DL 276

DL 728

CAS DL 276

DL 728

CAS DL 276

DL 728

CAS

Fallecimiento

Renuncia

Despido

Destitución por falta grave

Invalidez permanente

Jubilación

Término del contrato

COMENTARIO ACERCA DE LA ORGANIZACIÓN Y FUNCIONAMIENTO DEL SUB SISTEMA DE GESTION DEL EMPLEO:

GESTIÓN DEL DESEMPEÑO Cuestionario

Planificación del desempeño

1. ¿Cuentan con un responsable de planificar, organizar, implementar y evaluar los procesos de evaluación el desempeño del personal de su institución?

( ) SI ( ) NO De acuerdo con el ROF vigente ¿Quién es la instancia responsable de planificar y organizar los procesos de evaluación el desempeño del personal de su institución?

Nivel




En DIRESA

En la Red



En la MR

En relación a las metas de rendimiento

N° Pregunta SI NO

2. ¿Cuentan con una metodología definida para establecer las metas de rendimiento individual?

3. ¿Cuentan con una metodología definida para establecer las metas de rendimiento grupal?

4. El año pasado y durante el presente año, ¿Han establecido metas de rendimiento de manera concertada, para algún grupo ocupacional?

5. ¿Tienen planificado realizar la estimación de las metas de rendimiento para este año?

En relación a la metodología e instrumentos para evaluar el desempeño del personal

N° Pregunta SI NO

6. ¿Cuentan con una metodología definida para evaluar el desempeño del personal?

7. ¿Cuentan con una metodología aprobada oficialmente para evaluar el desempeño del personal?

8. ¿Cuentan con instrumentos para evaluar de manera objetiva el desempeño del personal?

9. ¿Tienen planificado realizar la evaluación del desempeño del personal durante el presente año?

10. En el último año han elaborado un plan para la evaluación del desempeño del personal de su institución?

( ) SI ( ) NO Acompañamiento

11. ¿Cuentan con un responsable de planificar, organizar, implementar y evaluar los procesos de supervisión, coaching o mentoring en su institución?

( ) SI ( ) NO De acuerdo con el ROF vigente ¿Quién es la instancia responsable de planificar y organizar los procesos de supervisión, coaching o mentoring de su institución?

Nivel




En DIRESA

En la Red

En la MR

En relación al acompañamiento del personal:

N° Pregunta SI NO

12. ¿Cuentan con una metodología e instrumentos definidos para que los jefes de unidades puedan realizar el acompañamiento a su personal?

13. La metodología definida para que los jefes de unidades puedan realizar el acompañamiento a su personal, ¿está aprobada?

14. ¿Cuentan con algún mecanismo para registrar los procesos de acompañamiento que realizan los jefes de unidades orgánicas? (Por ejemplo: Informes de supervisión)

15. ¿En el último año los jefes de unidades orgánicas han reportado la ejecución de actividades de

acompañamiento al personal para mejorar su desempeño? ( ) SI ( ) NO




N° Pregunta SI NO

16. Los reportes o informes del acompañamiento registran los problemas en el desempeño encontrados

17. Los reportes o informes del acompañamiento registran las medidas correctivas adoptadas

18. Los reportes o informes del acompañamiento registran la fecha de la próxima visita

19. Los reportes o informes del acompañamiento son firmados por el personal visitado

Evaluación del desempeño

20. ¿Cuentan con un responsable de organizar y monitorear los procesos de evaluación de desempeño en su institución?

( ) SI ( ) NO De acuerdo con el ROF vigente ¿Quién es la instancia responsable de organizar y monitorear los procesos de evaluación de desempeño en su institución?

Nivel




En DIRESA

En la Red

En la MR

En relación a la evaluación del desempeño:

N° Pregunta SI NO

21. Las unidades orgánicas de su institución programan evaluaciones de desempeño a su personal

22. ¿Cuentan con algún mecanismo para registrar los procesos de evaluación del desempeño que realizan los jefes de unidades orgánicas?

23. ¿En el último año los jefes de unidades orgánicas han realizado procesos de evaluación de desempeño?

( ) SI ( ) NO Si la respuesta ha sido afirmativa, favor responder las siguientes preguntas.

N° Pregunta SI NO

24. Los jefes de unidades orgánicas han usado los perfiles de puestos para diseñar los instrumentos para evaluar el desempeño del personal a su cargo.

25. Los jefes de unidades orgánicas han establecido las metas de rendimiento del personal a su cargo, de manera concertada

26. Los jefes de las unidades orgánicas han definido los estándares de desempeño esperados en el personal a su cargo

27. Los jefes de las unidades orgánicas han definido los indicadores de desempeño en base a las funciones del puesto

28. Los jefes de las unidades orgánicas han definido las preguntas para evaluar conocimientos en base a la información del perfil del puesto

29. Los trabajadores son informados con anticipación sobre la evaluación

30. Los trabajadores son informados sobre los temas a ser evaluados

31. Los trabajadores son informados sobre los instrumentos de evaluación

32. Los trabajadores son informados sobre los mecanismos de impugnación

33. Los trabajadores son informados sobre las consecuencias de la evaluación

34. Han realizado la evaluación de conocimientos específicos para el puesto



N° Pregunta SI NO

35. Han realizado la evaluación de conocimientos generales para el puesto

36. Han realizado la medición de las metas de producción del personal

37. Han realizado la medición de las competencias específicas del puesto

38. La evaluación del desempeño es realizada por un agente externo a la unidad orgánica (par o superior)

39. La evaluación del desempeño se realiza semestralmente

Las evaluaciones de desempeño se realizan preferentemente a personal:

N° Nivel SI NO


41. Profesionales asistenciales

42. Técnicos asistenciales

43. Profesionales administrativos

44. Técnicos administrativos

45. Personal nombrado

46. Personal contratado bajo cualquier modalidad

47. ¿Han utilizado los resultados de la evaluación del desempeño para tomar algún tipo de decisión?

( ) SI ( ) NO, ¿Por qué? ______________________________________

¿En qué han utilizado los resultados de la evaluación del desempeño?

N° Pregunta SI NO

48. Para definir los contenidos de la capacitación

49. Para definir la promoción y los ascensos

50. Para definir las compensaciones (incentivos monetarios o no monetarios)

Otros; Especificar:

Otros; Especificar:

Retroalimentación y Diseño de planes de mejora del desempeño individual

51. ¿Cuentan con un responsable de asegurase que el personal evaluado reciba la retroalimentación y diseñe con su jefe los planes de mejora de su desempeño?

( ) SI ( ) NO De acuerdo con el ROF vigente ¿Quién es la instancia responsable de asegurase que el personal evaluado reciba la retroalimentación y diseñe con su jefe los planes de mejora de su desempeño?

Nivel




En DIRESA

En la Red

En la MR

52. ¿Cuentan con algún mecanismo para registrar los procesos de retroalimentación del desempeño que

realizan los jefes de unidades orgánicas? ( ) SI ( ) NO

53. ¿En el último año los jefes de unidades orgánicas han realizado la retroalimentación al personal evaluado?




N° Pregunta SI NO

54. Se entregan los resultados de la evaluación del desempeño al evaluado

55. Se otorga algún tipo de certificación al personal que ha demostrado ser competente en la evaluación del desempeño

56. Como resultado de la medición de las metas de desempeño, se reformulan las metas operativas para la siguiente evaluación.

57. En base a los resultados de la evaluación se formulan planes de mejora con el evaluado

¿Considera que existen problemas para desarrollar los procesos de evaluación de desempeño en su institución?

( ) SI ( ) NO ¿Cuáles son las principales dificultades que existen para desarrollar procesos de evaluación de desempeño basado en metas de rendimiento y en competencias en su institución?

Problemas SI NO

Poco apoyo por parte de la alta dirección

Poco apoyo por parte de los evaluados

Uso casi nulo de los resultados de la evaluación por parte de los jefes inmediatos

Desconocimiento sobre herramientas de diseño y aplicación referidos a la evaluación de desempeño

No se entiende la importancia de la evaluación para mejorar el desempeño

El personal asocia la evaluación con despidos

Las evaluaciones de desempeño tradicionales son subjetivas y desmotivan al personal

El personal no acepta ser evaluado por temor a los resultados

Otro

COMENTARIO ACERCA DE LA ORGANIZACIÓN Y FUNCIONAMIENTO DE LA GESTIÓN DEL DESEMPEÑO:

GESTIÓN DEL DESARROLLO Y LA CAPACITACIÓN

Cuestionario

Progresión laboral (Promoción y Carrera) En relación a los ascensos del personal

N° Pregunta SI NO

1. ¿Han diseñado una política de ascensos?

2. ¿Esta política está aprobada? Si la respuesta es SI, ¿Cuándo ha sido

aprobada?_______

3. ¿Esta política es conocida por todos?

4. ¿Cuentan con un responsable de administrar los procesos de promoción y ascenso del personal?



( ) SI ( ) NO De acuerdo con el ROF vigente ¿Quién es la instancia responsable de administrar los procesos de promoción y ascenso del personal?

Nivel




En DIRESA

En la Red

En la MR

5. ¿En el último año han realizado procesos de promoción o ascenso al personal de su institución?

( ) SI ( ) NO Solo si la respuesta es afirmativa conteste las siguientes preguntas; caso contrario, pase directamente a la sección “Desarrollo de Capacidades”. La promoción y/o ascensos en los últimos 5 años se han realizado tomando en cuenta lo siguiente.

N° Pregunta SI NO

6. Años de servicio

7. Evaluaciones de desempeño

8. Mediante concurso de mérito

9. Evaluación del legajo

10. Este tipo de decisiones no tienen ninguna influencia política

Otros; Especificar:

Otros; Especificar:

Indicar la cantidad de ascensos ocurridos el 2012, por régimen laboral y grupo ocupacional.

Grupo ocupacional de

origen

Régimen laboral Total

276 728 CAS

Funcionarios

Directivos

Profesionales

Apoyo

Total

11. ¿Existe una comisión permanente para los procesos de selección de personal a promover?

( ) SI ( ) NO Marcar los instrumentos que se utilizan para seleccionar al personal a promover.

N° Pregunta SI NO

12. Entrevistas

13. Exámenes de conocimientos

14. Dinámicas grupales

15. Proyectos/ensayos/documentos de investigación

Otros; Especificar:

Otros; Especificar:

Sobre la difusión del concurso, marcar las que se han utilizado en los últimos 2 años:

N° Pregunta SI NO

16. Son publicados con anticipación

17. Se estipula el cargo y las funciones



N° Pregunta SI NO

18. Se definen los requisitos para postular

19. Se define el cronograma del concurso

20. Se difunden los resultados

21. Se difunden los ganadores del concurso

22. Se definen las modalidades de impugnación


Otros; Especificar:

Otros; Especificar:

Marcar los criterios que se evalúan para promover al personal:

N° Pregunta SI NO

24. Conocimientos sobre funciones que realizará

25. Conocimientos sobre gestión pública

26. Liderazgo

27. Comunicación

28. Trabajo en equipo

29. No haber cometido faltas disciplinarias

30. Resultados de evaluación de desempeño

31. Experiencia en el sector público

32. Experiencia en las funciones que realizará

33. Recomendaciones

34. Nivel profesional adquirido

35. Manejo de conflictos

36. Participación en capacitaciones

37. Opinión del jefe inmediato superior


Otros; Especificar:

Otros; Especificar:

Desarrollo de Capacidades

En relación a las actividades de capacitación

N° Pregunta SI NO

39. ¿Han diseñado una política de capacitación?

40. ¿Esta política está aprobada? Si la respuesta es SI, ¿Cuándo ha sido

aprobada?_______

41. ¿Esta política es conocida por todos?

42. ¿Cuentan con una guía metodológica para el desarrollo de capacidades?

Si la respuesta es SI, ¿esta Guía es la proporcionada por el MINSA? SI___ NO___

43. ¿Cuentan con un responsable de administrar los procesos de capacitación del personal?

( ) SI ( ) NO De acuerdo con el ROF vigente ¿Quién es la instancia responsable de administrar los procesos de capacitación del personal?

Nivel ¿Existe? En caso de que exista





En DIRESA

En la Red

En la MR

44. ¿En el último año han realizado procesos de capacitación al personal de su institución?

( ) SI ( ) NO Solo si la respuesta es afirmativa conteste las siguientes preguntas.

¿Qué tipo de intervenciones educativas han desarrollado en su institución, en el último año?

N° Pregunta SI NO

45. Cursos cortos

46. Charlas

47. Pasantías en sedes del I Nivel

48. Pasantías en Hospitales regionales

49. Pasantías en Hospitales de Lima

50. Diplomados coordinados con una universidad

51. Talleres de capacitación

Otros; Especificar:

Indicar la cantidad de personas que han sido capacitadas el 2012, por régimen laboral y grupo ocupacional.

Grupo ocupacional

Régimen laboral Total

276 728 CAS

Funcionarios

Directivos

Profesionales

Apoyo

Total

Indicar los tres (03) temas que con más frecuencia han sido considerados en la capacitación de cada grupo ocupacional.

Grupo ocupacional

Temas más frecuentes en las actividades de capacitación

Funcionarios

a) b) c)

Directivos

a) b) c)

Profesionales

a) b) c)

Apoyo

a) b) c)

Marcar los criterios que se han tomado en cuenta para identificar las necesidades de capacitación del personal de su institución:

N° Pregunta SI NO

52. Los objetivos/metas de la entidad

53. Las prioridades sanitarias regionales

54. Las oferta de capacitación del MINSA

55. Las ofertas de capacitación de instituciones regionales

56. Resultados evaluaciones de conocimientos

57. Resultados de evaluaciones de desempeño



N° Pregunta SI NO

58. Lineamientos del Plan de Capacitaciones

59. Sugerencia de otras instancias (redes, DIRESA, etc.)

60. Pedidos específicos de las áreas

61. Pedido directo de los trabajadores

Otros; Especificar:

Marcar los criterios que se utilizan para seleccionar al personal de su institución que participará en una capacitación.

N° Pregunta SI NO

62. El Perfil del puesto

63. Requerimiento de inmediato superior

64. Resultados de evaluaciones de desempeño (brecha de competencias)

65. Lineamientos del Plan de Capacitación

66. Recomendación otra instancia (microrredes, redes, DIRESA, etc.)

67. Ser personal nombrado de la entidad

68. Que no haya recibido capacitación en el mismo tema


Otros; Especificar:

70. ¿El personal contratado CAS, NO tiene ninguna restricción para recibir capacitaciones? ( ) SI ( ) NO

Marcar los roles y funciones que actualmente cumple la oficina de recursos humanos en los procesos de capacitación al personal de su institución.

N° Pregunta SI NO

71. Identificar las necesidades de capacitación del personal

72. Elaborar el Plan de Capacitación de la DIRES

73. Asesorar a las redes en el diseño de los planes de capacitación

74. Informar sobre oportunidades de capacitación

75. Facilitar los medios audiovisuales

76. Gestionar los refrigerios

77. Facilitar el local o aula de capacitación

78. Entregar materiales de enseñanza

79. Monitorear asistencia a las capacitaciones

80. Monitorear el desempeño de los docentes

81. Evaluar los conocimientos adquiridos

82. Evaluar la aplicación de conocimientos en sus funciones

83. Evaluar el impacto de las capacitaciones

84. Evaluar el financiamiento de las capacitaciones

Otros; Especificar:

Regulación Docencia - Servicio

En relación a las sedes docentes



N° Pregunta SI NO

85. ¿Cuentan con criterios para calificar a las sedes docentes?


86. ¿Estos criterios están aprobados? Si la respuesta es SI, ¿Cuándo ha sido

aprobada?_______

87. ¿Cuentan con convenios con instituciones formadoras?


88. Tienen un Comité Regional de Pregrado (COREPRES) conformado oficialmente?


89. El COREPRES se reúne al menos una vez al año?


90. ¿Cuentan con un sistema de información o de registro de todos los estudiantes que se forman en su institución?


91. ¿Todas las sedes docentes de su ámbito se encuentran acreditadas?


92. ¿Cuentan con un responsable de administrar los convenios docencia servicio?


De acuerdo con el ROF vigente ¿Quién es la instancia responsable de administrar los convenios con las instituciones formadoras?

Nivel




En DIRESA

En la Red

En la MR

93. ¿En el último año han suscrito convenios con instituciones formadoras?

( ) SI ( ) NO Solo si la respuesta es afirmativa conteste las siguientes preguntas.

¿Para qué tipo de formación tienen actualmente convenios vigentes?

N° Pregunta SI NO

94. Pre grado en Medicina

95. Post Grado en Medicina

96. Pre Grado en Enfermería

97. Pre grado en Obstetricia

98. Prácticas de institutos tecnológicos

Otros; Especificar:

COMENTARIO ACERCA DE LA ORGANIZACIÓN Y FUNCIONAMIENTO DEL SUB SISTEMA DE GESTION DEL DESARROLLO Y LA CAPACITACIÓN:



GESTIÓN DE LA COMPENSACIÓN

Cuestionario Diseño de estructuras salariales

1. ¿Cuentan con un responsable de diseñar, implementar y monitorear las escalas salariales de su institución? ( ) SI ( ) NO

De acuerdo con el ROF vigente ¿Quién es la instancia responsable de diseñar, implementar y monitorear las escalas salariales de su institución?

Nivel




En DIRESA

En la Red

En la MR

2. En el último año han elaborado alguna escala salarial?

( ) SI ( ) NO

Si la respuesta es afirmativa, responda las siguientes preguntas: 3. ¿La escala salarial está aprobada?

( ) SI ( ) NO Las escalas salariales han sido diseñadas para personal:

N° Nivel SI NO


5. Profesionales asistenciales

6. Técnicos asistenciales

7. Profesionales administrativos

8. Técnicos administrativos

9. Personal nombrado

10. Personal contratado bajo cualquier modalidad

Las escalas salariales han sido diseñadas para personal que trabaja en:

N° Nivel SI NO

11. DIRESA

12. Redes

13. Microrredes

14. ¿Cuenta con una metodología para diseñar escalas salariales?

( ) SI ( ) NO

15. ¿Cuenta con normas para el cumplimiento y mantenimiento de la escala salarial aprobada? ( ) SI ( ) NO

El diseño de la escala salarial aprobada ha tomado en cuenta lo siguiente:

N° Pregunta SI NO

16. La valoración previa de los puestos de trabajo

17. Los perfiles de puestos

18. Más de 1 criterio

19. La disponibilidad presupuestal

20. Incorpora un componente variable ligado al desempeño



N° Pregunta SI NO

21. La escala salarial pública

22. Las funciones que realiza el puesto

23. La jerarquía del puesto que ostenta

24. La antigüedad en el puesto

25. La zona geográfica donde se ubica el puesto

26. El grupo ocupacional al que pertenece

Otro

27. ¿Han utilizado la escala salarial aprobada para tomar algún tipo de decisión?

( ) SI ( ) NO, ¿Por qué? ____________________________________

¿En qué han utilizado la escala salarial aprobada?

N° Pregunta SI NO

28. Para los nuevos contratos

29. Acompaña los ascensos del personal

30. Para definir una línea de carrera

Otro

Administración de salarios o Gestión de la Planilla

31. ¿Cuentan con un responsable de administrar los salarios y las planillas del personal en su institución? ( ) SI ( ) NO

De acuerdo con el ROF vigente ¿Quién es la instancia responsable de administrar los salarios y las planillas del personal en su institución?

Nivel




En DIRESA

En la Red

En la MR

32. ¿ La planilla de pagos de remuneraciones y pensiones está actualizada)

( ) SI ( ) NO Administración de beneficios y bonificaciones 33. ¿Cuentan con un responsable de administrar los beneficios y bonificaciones del personal de su institución?

( ) SI ( ) NO De acuerdo con el ROF vigente ¿Quién es la instancia responsable de administrar los beneficios y bonificaciones del personal de su institución?

Nivel




En DIRESA

En la Red

En la MR

¿Quiénes reciben AETAS en su institución?

Nivel SI NO Si es “SI” ¿cuántas?

Gerencial o Directivo



Nivel SI NO Si es “SI” ¿cuántas?

Profesionales asistenciales

Técnicos asistenciales

Profesionales administrativos

Técnicos administrativos

Personal nombrado

Personal contratado bajo cualquier modalidad

Administración de Incentivos 34. ¿Cuentan con un responsable de la administración de los incentivos monetarios?

( ) SI ( ) NO De acuerdo con el ROF vigente ¿Quién es la instancia responsable de la administración de los incentivos monetarios?

Nivel




En DIRESA

En la Red

En la MR

35. ¿Cuentan con un responsable de la administración de los incentivos no monetarios?

( ) SI ( ) NO

36. ¿Cuentan con normas o políticas aprobadas para la aplicación de incentivos? ( ) SI ( ) NO

37. ¿En el último año han otorgado incentivos monetarios?


N° Pregunta SI NO

38. Los incentivos que se otorgan se hacen de acuerdo a los resultados de la evaluación del desempeño

39. Todos los trabajadores tienen la oportunidad de recibir incentivos monetarios

40. Los incentivos monetarios son individuales

41. Los incentivos monetarios son grupales

42. ¿En el último año han otorgado incentivos no monetarios?


N° Pregunta SI NO

43. Los incentivos que se otorgan se hacen de acuerdo a los resultados de la evaluación del desempeño

44. Otras instituciones participan en el otorgamiento de incentivos no monetarios

¿Qué tipo de incentivos no monetarios aplican en su institución?

N° Pregunta SI NO

45. Reconocer públicamente los logros que ha conseguido una Red, MR o EESS y cómo ello contribuye a los logros de la DIRES en general.

46. El “trabajador del mes”

47. Un curso de capacitación



N° Pregunta SI NO

48. Financiar un paseo con la familia

49. Días libres

Otro

Administración de Pensiones 50. ¿Cuentan con un responsable de administrar las pensiones del personal?

( ) SI ( ) NO De acuerdo con el ROF vigente ¿Quién es la instancia responsable de administrar las pensiones del personal?

Nivel




En DIRESA

En la Red

En la MR

51. ¿Cuentan con una norma o directiva aprobada para administrar las pensiones del personal?

( ) SI ( ) NO

52. ¿Todas las pensiones se otorgan de acuerdo a la norma vigente? ( ) SI ( ) NO

COMENTARIO ACERCA DE LA ORGANIZACIÓN Y FUNCIONAMIENTO DE LA GESTIÓN DE LA COMPENSACIÓN:

GESTIÓN DE LAS RELACIONES HUMANAS Y SOCIALES Cuestionario Gestión del Clima Organizacional 1. ¿Cuentan con un responsable de la gestión del clima organizacional de su institución?

( ) SI ( ) NO De acuerdo con el ROF vigente ¿Quién es la instancia responsable de la gestión del clima organizacional de su institución?

Nivel




En DIRESA

En la Red

En la MR

En relación al clima organizacional

N° Pregunta SI NO

2. ¿Cuentan con una metodología definida para medir el clima organizacional?



N° Pregunta SI NO

3. ¿Cuentan con los instrumentos para medir el clima organizacional?

4. ¿Tienen planificado realizar la medición del clima organizacional para este año?

5. El año pasado han realizado la medición del clima organizacional?

( ) SI ( ) NO Si la respuesta a la pregunta anterior es afirmativa, responda las siguientes preguntas:

N° Pregunta SI NO

6. La medición del clima laboral ha contado con el apoyo de la máxima autoridad de la institución

7. La medición del clima laboral ha contado con la participación de al menos el 80% de los trabajadores

8. Los resultados de la medición han sido analizados con los trabajadores

9. Se han elaborado planes para mejorar el clima laboral

10. Se han tomado acciones inmediatas en un lapso no mayor a 30 días de la medición del clima laboral

11. Los resultados se tienen en cuenta para la revisión y mejora de las políticas y prácticas de la gestión de recursos humanos.

Gestión de las Relaciones Laborales 12. ¿Cuentan con un responsable de la gestión de las relaciones laborales en su institución?

( ) SI ( ) NO De acuerdo con el ROF vigente ¿Quién es la instancia responsable de la gestión de las relaciones laborales en su institución?

Nivel




En DIRESA

En la Red

En la MR

13. ¿Existen servidores que pertenecen a alguna organización sindical?

( ) SI ( ) NO ¿Cuántos trabajadores están sindicalizados?

Menos del 25% del personal

Entre el 26 al 50% del personal

Entre el 51 al 75% del personal

Más del 75% del personal

¿Con cuánta frecuencia se reúnen los sindicatos?

Grupo ocupacional Anual Mensual Trimestral Semestral A pedido

del sindicato

Ante acontecimientos

relevantes

Médicos

Enfermeras

Obstetras

Personal administrativo

Personal Técnico

General

Otros: ____________



¿Cuáles son los temas que se discuten con más frecuencia con los sindicatos?

Grupo ocupacional Salarios Bienestar

social Movilidad Funciones Ascensos Evaluación

Otro

Médicos

Enfermeras

Obstetras


Personal Técnico

General

Otros: __________

¿Cómo califica la relación entre los sindicatos y las autoridades de la institución?

Niveles Muy

buena Buena Mala

Muy mala

Médicos

Enfermeras

Obstetras


Personal Técnico

General

Otros: ___________________

14. ¿En el último año se han realizado negociaciones con los sindicatos que han dejado satisfechas a todas las

partes involucradas? ( ) SI ( ) NO

¿Cuántos días de huelga en total han tenido en año pasado?

Grupo ocupacional N° total de días

Médicos

Enfermeras

Obstetras


Personal Técnico

General

Otros: __________________________

¿Cómo califica en promedio las relaciones laborales en los diferentes niveles?

Niveles Muy

buena Buena Mala

Muy mala

DIRESA

Redes

Establecimientos de salud

¿Cuáles son las causas más frecuentes de conflictos laborales?

Grupo ocupacional SI NO

Remuneraciones

Luchas sindicales

Rivalidades internas

Otro




Otro

¿Cuáles son los mecanismos de solución de conflictos que mas se han usado en la institución el año pasado?


Negociaciones con el sindicato

Negociaciones directas con los agraviados

Negociaciones con los jefes inmediatos superiores

Otro

Otro

Bienestar y Seguridad en el Trabajo 15. ¿Cuentan con un responsable de gerenciar los procesos de bienestar de persona?

( ) SI ( ) NO De acuerdo con el ROF vigente ¿Quién es la instancia responsable de gerenciar los procesos de bienestar de personal?

Nivel




En DIRESA

En la Red

En la MR

16. ¿Existen programas de bienestar social en su institución?

( ) SI ( ) NO 17. ¿Planifican actividades de bienestar social en su institución?

( ) SI ( ) NO 18. ¿Se cumplen las actividades programadas de bienestar social en su institución?

( ) SI ( ) NO Si la respuesta a la pregunta anterior es afirmativa, ¿qué tipo de actividades se programan?

N° Pregunta SI NO

19. Celebraciones de feriados oficiales

20. Celebraciones de feriados regionales

21. Celebraciones de cumpleaños

22. Celebraciones de aniversario de la entidad

23. Organización de campeonatos deportivos

24. Servicio de cafetería o restaurante

25. Servicios de préstamos de dinero

26. Apoyo financiero para capacitaciones

27. Guardería

28. Club de la tercera edad

29. Organización de viajes

30. Organización de hinkanas

31. Organización de paseos con la familia

Otro

Otro

32. ¿Cuentan con un responsable de gerenciar los procesos de salud y seguridad en el trabajo?

( ) SI ( ) NO



De acuerdo con el ROF vigente ¿Quién es la instancia responsable de gerenciar los procesos de salud y seguridad en el trabajo?

Nivel




En DIRESA

En la Red

En la MR

33. ¿Existen normas o políticas aprobadas de salud y seguridad en el trabajo en su institución?

( ) SI ( ) NO

34. ¿Existen programas de salud y seguridad en el trabajo en su institución? ( ) SI ( ) NO

35. ¿Planifican actividades de salud y seguridad en el trabajo en su institución?

( ) SI ( ) NO 36. ¿Se cumplen las actividades programadas de salud y seguridad en el trabajo en su institución?

( ) SI ( ) NO Si la respuesta a la pregunta anterior es afirmativa, ¿qué tipo de actividades se programan?

N° Pregunta SI NO

37. Fumigación de los lugares de trabajo

38. Provisión de equipamiento protector de enfermedades, epidemias, etc.

39. Otorgamiento de seguros de salud ante accidentes o epidemias

40. Campañas de despistaje de enfermedades ocupacionales

41. Campañas de vacunación

42. Evaluaciones de defensa civil

Otros

Otros

Otros

COMENTARIO ACERCA DE LA ORGANIZACIÓN Y FUNCIONAMIENTO DE LA GESTIÓN DE LAS RELACIONES LABORALES:



7.2 Qualitative assessment of HRMS conducted by PARSALUD II in 4

Regions

PARSALUD: Human Resources Management System in Ucayali RHD


PARSALUD: Human Resources Management System in Cusco RHD




PARSALUD: Human Resources Management System in Huanuco RHD


Human Resources Management System in Ayacucho RHD




PARSALUD: Human Resources Management System in Cajamarca RHD


7.3 SMT-RHD: HHR regional policies

Below are 7 formulated policy guidelines, the same that are aligned to the national policy for HHR management and development.

Lineamiento de Política 1.- Formación de los RHUS basado en el Modelo de Atención

Integral de Salud, el perfil epidemiológico y sociocultural de la población, acorde a las

necesidades regionales, locales bajo el marco de la descentralización.

Lineamiento de Política 2.- Gestión de procesos de capacitación articulados a proyectos

de desarrollo institucional, utilizando la Educación Permanente de la Salud y el enfoque de

competencias para fortalecer el desempeño laboral, caracterizado por el respeto a los

derechos, la equidad de género y la pertinencia cultural de la población.

Lineamiento de Política 3.- Planificación estratégica de RHUS, sustentada en la

información de necesidades reales de distribución y ubicación adecuada de RHUS, acorde

al perfil demográfico, sociocultural y epidemiológico de la región, destacando las prioridades

sanitarias de la población más excluida.

Lineamiento de Política 4.- Gestión de RHUS a nivel regional, que asegure servicios de

calidad, generando la participación activa del personal en las innovaciones

organizacionales y la toma de decisiones para conciliar las necesidades de la población,

los requerimientos básicos de los servicios de salud y las necesidades de los RHUS.



Lineamiento de Política 5.- Valoración y reconocimiento del trabajo de los agentes

comunitarios de salud como aliados estratégicos en las acciones preventivo-promocionales

del sistema de salud.

Lineamiento de Política 6.- Aplicación de un nuevo marco normativo laboral consensuado

con los RHUS, en base a perfiles ocupacionales por competencias con un sistema de

compensación e incentivos; y procesos adecuados de reclutamiento, selección del

personal, que aplique la promoción en la carrera pública considerando los derechos y

deberes, la equidad de género, y el respeto a la diversidad.

Lineamiento de Política 7.- Generar condiciones de trabajo, orientadas por relaciones

laborales que promuevan ambientes de trabajo saludables, contribuyan a fortalecer los

valores organizacionales, la calidad de las personas, y el aseguramiento de servicios de

calidad a la población.

7.4 National agenda for research in HHR

Resolución Ministerial 212-2010-MINSA

SE RESUELVE:

Artículo 1º.- Aprobar la Agenda Nacional de investigación para conocer los problemas de

los Recursos Humanos en Salud, para el periodo 2011-2014, que a continuación se

señalan:

1. Articulación de la formación en pregrado de los recursos humanos en salud con las

necesidades de salud del país.

2. Capacidades del docente y estudiante para el uso y aplicación de las tecnologías de

información y comunicación en el proceso de enseñanza aprendizaje en la formación en

pregrado de los recursos humanos en Salud

3. Capacidades pedagógicas, metodología y estilos de aprendizaje durante la formación

del estudiante de pregrado en escenarios comunitarios.

4. Necesidades de las regiones en la formación de recursos humanos en salud en

estudios de postgrado y especialización según niveles de atención.

5. Impacto de las experiencias en la formación y logro de competencias de los recursos

humanos en salud en especialización y postgrado.

6. Evaluación de la formación e investigación en postgrado y segunda especialización en

salud en respuesta a las necesidades y problemas sanitarios del país.

7. Determinación de brechas de recursos humanos por niveles de atención para el

aseguramiento en salud.

8. Análisis de procesos en el marco de la implementación del plan esencial de

aseguramiento en salud con énfasis en el estudio de tiempos y movimientos para la

dotación de recursos humanos.



9. Análisis y formulación de estrategias de financiamiento para la contratación de recursos

humanos en el marco del aseguramiento universal en salud.

10. Perfil de competencias asistenciales y gerenciales, para la atención primaria de salud

con enfoque de interculturalidad del personal existente en el equipo básico de salud.

11. Motivación e incentivos para desarrollar la atención primaria de salud en el primer nivel

de atención.

12. Impacto de los agentes comunitarios en salud y estrategias de integración en atención

primaria de salud.

13. Desarrollo de capacidades en base a competencias que respondan a las necesidades y

objetivos institucionales y sectoriales.

14. Determinantes que influyen en el desarrollo laboral.

15. Ética y valores personales en la gestión de recursos humanos en salud.

16. Evaluación de experiencias exitosas nacionales e internacionales para la retención de

profesionales de salud.

17. Evaluación del impacto económico y sanitario de la migración interna de profesionales

de salud.

18. Dinámica y factores asociados a la movilización interna de los profesionales del sector

salud.

19. Prevalencia e incidencia de la exposición, enfermedades y accidentes ocupacionales.

20. Estado de la implementación de las normas y organización de los servicios para la

gestión de la salud y seguridad del trabajo.

21. Factores de riesgo ergonómicos y psicosociales.

22. Estudio de incentivos laborales.

23. Estudio de ética y funcionamiento.

24. Inequidad entre servidores y funcionarios de la salud.

25. Acceso a cargos públicos, impacto en el clima laboral y prestación de los servicios de

salud.

26. Comparación de la jerarquía organizacional en los establecimientos de salud en relación

a cargos y puestos.

27. Marco legal en materia laboral.

28. Identificar las competencias gerenciales a nivel regional para la gestión de recursos

humanos y la gestión sanitaria regional.

29. Identificar y analizar las políticas/normas nacionales de recursos humanos que deben

actualizarse al nuevo contexto regional.

30. Determinar la situación de las unidades orgánicas o sus equivalentes de gestión de

recursos humanos en las regiones.



7.5 ASEGURA software for HHR requirements calculations

Startup screen

Screen: Time required for various medical procedures by type of HHR – First level of care

(hours)

This screen displays the total number of medical procedures established by PEAS for the

first level of care (132) and respective Current Procedural Terminology (CPT) codes22. The

22 The Current Procedural Terminology (CPT) is a medical code set maintained by the American Medical

Association (AMA) through the CPT editorial panel. The CPT code set (copyright protected by the AMA)

http://en.wikipedia.org/wiki/Medical_coding

http://en.wikipedia.org/wiki/American_Medical_Association

http://en.wikipedia.org/wiki/American_Medical_Association



"N°" column corresponds to the total number of procedures for a given population. The next

set of columns represents each type of HR and the total hours they spend on each

procedure based on activity standards23 set by the MoH. The last row displays the sum of all

hours for each HR type in delivering the PEAS package.

7.6 Using the spreadsheet to facilitate calculations

This annex contains the procedure manual created with the Ayacucho RHD to facilitate

calculations at the micro-network level. The manual was not approved due to RHD authority

turnover.

PROCEDIMIENTO PARA DETERMINAR LA BRECHA DE RECURSOS HUMANOS EN

SALUD PARA EL PRIMER NIVEL DE ATENCION

I. FINALIDAD. La presente directiva tiene la finalidad de contribuir con mejorar la calidad

de atención de los servicios de salud del primer nivel de atención mediante la dotación

adecuada de recursos humanos en salud, distribuidos en lugares adecuados.

II. OBJETIVOS:

a. General. Lograr que los servicios de salud del primer nivel de atención cuenten

con recursos humanos adecuados en cantidad y calidad, que permitan satisfacer

las necesidades de salud de la población ayacuchana.

b. Específicos. La presente directiva permitirá a los jefes de Redes y micro-redes

tomar decisiones relacionadas con:

Establecer la cantidad requerida del personal de salud para atender a la

población que está bajo su responsabilidad y territorio.

Mejorar la ubicación del personal con que ya cuenta en los servicios de salud.

Distribuir y asignar tareas, que permitan aprovechar de manera óptima el tiempo

del personal para producir las atenciones requeridas,

Comparar el esfuerzo y presión laboral a los que está sometido el personal de los

establecimientos, dado que los desequilibrios se pueden manifestar como

sobrecarga o distención laborales.

Distribuir mejor el tiempo disponible del personal para la producción de los

servicios de salud.

describes medical, surgical, and diagnostic services and is designed to communicate uniform information about

medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for

administrative, financial, and analytical purposes.

23 The average amount of time a case should take each staff category to complete in compliance with acceptable

professional standards (WISN, page 5).



III. ÁMBITO DE APLICACIÓN. Lo establecido en la presente Directiva es de aplicación y

cumplimiento obligatorio de las Unidades Ejecutoras de Salud del ámbito de

competencia de la Dirección Regional de Salud de la Región Ayacucho.

IV. BASE LEGAL

a. Ley Nº 27680.- Aprueba reforma constitucional del Capítulo XIV del Título IV, sobre

descentralización.

b. Ley Nº 27783, Ley de Bases de la Descentralización.

c. Ley Nº 26842, Ley General del Salud.

d. Ley Nº 27867, Ley Orgánica de Gobiernos Regionales.

e. Ley Nº 28411, Ley General del Sistema Nacional de Presupuesto Público, Título III,

“Normas complementarias para la gestión presupuestaria”.

f. D.S. Nº 064-2004-PCM, “Plan Nacional para la superación de la Pobreza”

g. Decreto Legislativo Nº 1057 y su Reglamento aprobado por D.S. Nº 075-2008-PCM,

modificado por D.S. Nº 065-2011-2011-PCM.

h. Ordenanza Regional Nº 059-2005 que aprueba las Políticas Regionales de RRHH.

i. Reglamento de Organización y Funciones de la DIRESA

j. Lineamientos Generales de Política Regional de Gestión y Desarrollo del Potencial

Humano en Salud

V. DISPOSICIONES GENERALES.

a. Principios y valores: El Personal Administrativo de la Dirección Regional de Salud

Ayacucho se rige bajo los Valores y Principios siguientes:

i. Calidad. La Calidad es un enfoque que compromete a todo servidor y a todo nivel

operacional, entendido como satisfacción del usuario, que puede evidenciarse a

través de tres dimensiones: dimensión técnica, dimensión humada y la calidad

del entorno.

ii. Cumplimiento. Es un valor realizable solo si se cumple tres condiciones: que los

objetivos institucionales sean verificables; que las tareas y responsabilidades

sean explicitas; y que los niveles de autoridad sean respetadas.

iii. Seriedad. Basada en el principio de honestidad en nuestras relaciones con el

usuario externo, el usuario interno y los proveedores.

iv. Eficiencia. Enfocada al uso optimo de los recursos.

b. Objetivos institucionales: El personal Administrativo de la Dirección Regional de

Salud Ayacucho desempeña un rol para el logro de los siguientes objetivos

institucionales:

i. Reducir la Desnutrición Infantil.

ii. Evitar la Mortalidad Materna Neonatal.

c. Estrategias institucionales: Son estrategias de la Dirección Regional de Salud

Ayacucho:

i. Estrategia Sanitaria Articulado Nutricional.

ii. Estrategia Sanitaria Materno Neonatal

iii. Estrategia Sanitaria TBC/HIV – Enfermedades Transmisibles.

iv. Estrategia Sanitaria Metaxénicas y Zoonóticas.

v. Estrategia Sanitaria No Transmisibles.



vi. Estrategia Sanitaria Control de Cáncer de Cuello Uterino.

d. Políticas. La presente Directiva se implementa en el marco de los Lineamientos

Generales de Política Regional de Gestión y Desarrollo del Potencial Humano en

Salud. Donde su Política 2 establece: “Planificación estratégica de recursos humanos,

para su distribución equitativa, de acuerdo al MAIS, el perfil demográfico, socio

cultural y epidemiológico de la Región, cautelando las condiciones de trabajo del

personal de salud”. La Dirección Regional de Salud es responsable de la

planificación territorial de los recursos, en coordinación con las unidades

desconcentradas. La elaboración de la presente directiva responde al siguiente marco

conceptual:

e. Marco conceptual:

Planificación de recursos humanos en salud: De acuerdo con la OMS la planificación

de RRHH en Salud consiste en la “Estimación del número de personas y los tipos de

conocimientos, habilidades y actitudes que requieren para alcanzar objetivos

sanitarios predeterminados y una determinada situación de salud”. El Ministerio de

Salud ha definido una propuesta de Sistema de Gestión Descentralizada de RRHH en

Salud, donde un primer subsistema está relacionado con la Planificación de RRHH. El

Objeto del Subsistema de Planificación de Recursos Humanos, involucra la definición

de necesidades, cuantitativas y cualitativas de recursos humanos a corto, medio y

largo plazo; contrastadas con las capacidades internas; así como las acciones que

deben emprenderse para cubrir la brecha identificada. La planificación de recursos

humanos comprende programar las necesidades de recursos humanos de la

organización y establecer los pasos necesarios para satisfacer esas necesidades.

Esta planificación es el primer paso de toda gestión efectiva de los recursos humanos.

El desafío de este subsistema es lidiar con la migración interna y externa de los

trabajadores de salud, así como la alta rotación del personal fundamentalmente la

falta de información. Resulta difícil hacer proyecciones en estos escenarios. La

planificación de los recursos humanos en salud debe estar estrechamente vinculada y

articulada con las políticas y estrategias institucionales, con el modelo de atención de

salud, el modelo de gestión, el modelo de organización de los servicios de salud,

entre otros. En este subsistema se plantean las siguientes interrogantes:

- ¿Hasta qué punto la capacidad de planificar las necesidades de recursos humanos

repercute en el desempeño de los mismos?

- ¿Se encuentran las personas adecuadas en los puestos adecuados?

- ¿Podemos pronosticar las exigencias actuales y futuras de recursos humanos?

- ¿Sabemos cómo y dónde identificar a las personas que poseen las aptitudes

necesarias para satisfacer esas necesidades?

- ¿Podemos vincular la misión y metas organizacionales con la planificación de

recursos humanos?

Los procesos principales que se desarrollan en este subsistema son:

Gestión de la información de recursos humanos: Un aspecto importante e

imprescindible para una adecuada planificación de recursos humanos y para el

cálculo de los requerimientos institucionales de recursos humanos es contar con



información actualizada y confiable acerca de la cantidad y distribución de recursos

humanos en las diferentes unidades de la institución.

Diseño de políticas y planes para cubrir la brecha de recursos humanos en

salud: Para cubrir la brecha de recursos humanos en salud es necesario realizar un

análisis cuantitativo y cualitativo de necesidades de recursos humanos; un análisis de

la disponibilidad de recursos humanos; la definición de la brecha de recursos

humanos para la definición de estrategias que permitan cubrir la brecha identificada.

Las funciones principales del Subsistema de Planificación de RRHH en salud son:

Mantener actualizada la información de recursos humanos de la institución. Identificar

las necesidades de incorporación de personal en base a los planes y estrategias

institucionales. Diseñar estrategias, planes y políticas destinadas a cubrir las

necesidades de recursos humanos.

f. Enfoques. Se definen varios enfoques para determinar la dotación de RRHH en

Salud. Entre los tres principales más utilizados más utilizados son:

i. Basado en las necesidades de salud. Permite estimar necesidades futuras de RHUS

con base en necesidades de servicios de salud, ajustados por diversos criterios.

Satisface las necesidades de salud. Es lógico, consistente e independiente a la

utilización actual de servicios de salud, pero requiere de normas o estándares de

producción.

ii. Basado en la utilización futura de servicios de salud. Este enfoque proyecta

requerimientos futuros basados en el uso actual de los servicios de salud. Existen

pocos cambios en los ratios de utilización de una población específica. resultan ser

alcanzables financieramente sin embargo es una proyección del status quo cuyo

supuestos, inexactos, pueden ocasionar errores de cálculo por que no toma en

cuenta el nivel de acceso a servicios de salud.

iii. Basado en coeficientes de población. Proporción entre trabajadores de salud y

población. fácil de aplicar y entender, pero no permite explorar interacciones entre:

mezcla, distribución, productividad, resultados.

La selección de un enfoque dependerá de la disponibilidad de información confiable,

del nivel de decisión y del problema o restricción en la gestión de recursos humanos

que se pretende resolver.

g. Metodología. La metodología para la estimación de la dotación de recursos humanos

en salud desde la Micro red está basado en las necesidades de salud, con las

siguientes características:

1. Se basa en la estimación de la probabilidad de ocurrencia de casos, por grupo

etáreo, para una población determinada.

2. Para cada caso y sus respectivas variantes, se definen los procedimientos

asistenciales involucrados, en base a las normas vigentes.

3. Para cada procedimiento se establecen los tipos de RRHH que intervienen y el

tiempo que dedica cada uno de ellos a cada procedimiento, basado en las

normas vigentes.

4. Toma en cuenta el tiempo realmente disponible para la prestación

5. Permite ajustes de acuerdo a la capacidad resolutiva actual y potencial en el

corto plazo



6. Permite calcular los requerimientos de recursos humanos ajustado en función

al nivel de ruralidad del distrito donde se ubican los establecimientos de salud.

7. Permite introducir la cantidad actual de recursos humanos en el

establecimiento de salud, para determinar la brecha que es necesario cubrir.

8. Permite contar con cuadros finales de análisis que permiten una mejor

asignación de los recursos humanos al interior de la microrred.

La metodología para el análisis de necesidades de recursos humanos en salud

desde la microrred comprende los factores que intervienen entre la disponibilidad

de recursos y la producción de servicios. Los cuales están relacionados con:

a. La productividad de los recursos humanos y su rendimiento

b. El tiempo realmente utilizado en la prestación de servicios de salud

c. La distribución de la carga de trabajo

d. La accesibilidad geográfica para la asignación territorial.

VI. DISPOSICIONES ESPECÍFICAS:

Para realizar los cálculos de dotación de recursos humanos en salud para el primer nivel de

atención, cada microrred contará con un aplicativo en excell. Las hojas de cálculo

destinadas para la estimación tienen tres partes:

(i) La parte superior para introducir los datos;

(ii) La parte intermedia, para el procesamiento automáticamente de los datos

relacionados con:

El listado de los procedimientos asistenciales por tipo de establecimiento de salud.

Las fórmulas que calculan automáticamente la cantidad de procedimientos en un

año, en base a la población asignada.

Las fórmulas que calculan automáticamente los tiempos que cada proveedor

destina al total de procedimientos.

(iii) La parte inferior, para mostrar los resultados.



I. PARTE SUPERIOR

Para el ingreso de datos

II. PARTE

INTERMEDIA

Para el procesamiento de

datos ingresados.

III. PARTE INFERIOR

Para mostrar los resulta-

dos

Ingreso de datos: Cada responsable en la microrred deberá introducir los datos

relacionados con cada uno de los establecimientos de salud de la MR, para ello deberá

llenar los espacios que se encuentran en color rosado.

Cada establecimiento de salud tiene una hoja de cálculo donde se ingresarán sus datos.

SOLO DEBERÁ LLENARSE LA INFORMACIÓN QUE SE DETALLA A CONTINUACIÓN. A

continuación se detalla el tipo de información a llenar.

a. Datos Generales: Esta información permitirá identificar la unidad de análisis. Los

datos que se ingresen en los campos respectivos, permanecerán a lo largo del

análisis.

Ejemplo:

DIRESA Ayacucho

RED Cora Cora

MR Cora Cora

EESS CS Pacapausa

b. Población asignada: En este campo, se deberá colocar la población total de la

unidad de análisis.



Ejemplo:

Población 1,737

c. Datos de los proveedores: Para cada uno de los tipos de proveedores de servicios

asistenciales de salud, se deberá consignar la siguiente información:

a. Horas disponibles para la prestación del paquete básico de atención.- Se

refiere al tiempo que debe destinar el proveedor en el año, para la prestación

de los servicios de salud individual. En el caso del ejemplo que coloca líneas

abajo, de las 1800 horas que tiene el médico al año, solo destina 1346 horas

para los procedimientos establecidos, el resto del tiempo lo dedica a sus

vacaciones, capacitación, tareas administrativas, etc.. Estos tiempos serán

asignados por la DIRESA, dependiendo del tipo de establecimiento de salud.

b. Dotación actual de recursos humanos.- Aquí se consignará la cantidad de

personal por tipo de grupo ocupacional que se encuentra laborando en el

establecimiento de salud al momento de realizar la estimación de la dotación

de recursos humanos. Por ejemplo, no considerar al personal destacado.

c. Remuneración anual - Personal contratado (nuevos soles).- Deberán

consignar la remuneración anual, según lo establecido en la directiva vigente

de la escala salarial para el personal contratado.

d. Remuneración anual - Personal nombrado (nuevos soles).- Deberán

consignar la remuneración anual, según lo establecido en las planillas del

personal nombrado.

Ejemplo:

Médico

CirujanoEnfermera Obstetra

Horas disponibles para la prestación del paquete básico de atención 1346 1322 1322

Dotación actual de recursos humanos 2 2 2

Remuneración anual - Personal contratado (nuevos soles) 38,400.00 19,200.00 19,200.00

Remuneración anual - Personal nombrado (nuevos soles) 50,671.72 25,689.04 25,689.04

d. Índice de ajuste de productividad por ruralidad: En este recuadro deberán colocar

los índices de ajustes establecidos para cada uno de los establecimientos de salud,

los mismos que se encuentran en el Anexo 1 de esta directiva24. Esta información

será permanentemente revisada por la DIRESA y su actualización será distribuida

en la directiva correspondiente.

Ejemplo:

Ïndice de ajuste de productividad por ruralidad 0.63

24 Alvarez, Carmela. “Calculo de Indice de Ruralidad para todos los distritos del Perú”. Para el proyecto

USAID/Perú/ Políticas en Salud. Febrero 2012.



Resultados a nivel del establecimiento de salud: Una vez que se han ingresado los

datos, los resultados aparecerán automáticamente al final de la hoja de cálculo respectiva.

Los resultados que aparecerán son los siguientes:

Ejemplo:

TOTAL DE HORAS NECESARIAS 804.60 3,028.85 942.06

Médico


RRHH NECESARIOS SIN AJUSTE 0.60 2.29 0.71

RRHH AJUSTADOS POR RURALIDAD 0.95 3.64 1.13

DOTACIÓN ACTUAL 2.00 2.00 2.00

BRECHA DE RRHH SIN AJUSTE -1.40 0.29 -1.29

BRECHA DE RRHH CON AJUSTE -1.05 1.64 -0.87

a. Total de horas necesarias: Lo que aparece es el total de horas al año que se requiere

para la prestación de todos los procedimientos, por cada tipo de proveedor. En el

ejemplo que se muestra a continuación, se requiere un total de 804.6 horas del Médico

Cirujano para todas las atenciones previstas.

b. RRHH necesarios sin ajuste: Se efiere al número de RRHH que se requiere para

realizar todos los procedimientos establecidos para la población asignada. Esta

cantidad resulta de dividir el “Total de horas necesarias” entre la cantidad de “Horas

disponibles para la prestación del paquete básico de atención”. En el ejemplo que se

muestra, se requieren 804.6 horas del Médico que divididas entre las 1346 horas

disponibles, nos dan 0.60 médicos.

c. RRHH ajustados por ruralidad: La cantidad de “RRHH necesarios sin ajuste” se divide

entre el “Índice de ajuste de productividad por ruralidad” para tener una nueva

estimación de requerimientos de RRHH ajustados por el nivel de ruralidad del distrito

donde se ubica el establecimiento de salud. En el ejemplo que se muestra, los 0.6

médicos que se necesitan, se dividen entre 0.63 que es su índice de ajuste por

ruralidad, y sale una nueva estimación: 0.95 médicos.

d. Dotación actual: Es una copia de la información introducida en la parte superior de la

hoja de cálculo.

e. Brecha de RRHH sin ajuste: Resulta de realizar la resta de “RRHH necesarios sin

ajuste” menos la “dotación actual”. En el ejemplo, el EESS necesita 0.6 médicos y tiene

2 médicos, lo que significa que tiene una sobredotación de 1.40 médicos (sale en

negativo). Si se observa el caso de las enfermeras, se requieren 2.29 enfermeras y se

tienen 2, por lo que faltan 0.29 enfermeras.

f. Brecha de RRHH con ajuste: Resulta de realizar la resta de “RRHH necesarios con

ajuste” menos la “dotación actual”. En el ejemplo, el EESS necesita 0.95 médicos

ajustados por ruralidad y tiene 2 médicos, lo que significa que tiene una sobredotación

de 1.05 médicos (sale en negativo). Si se observa el caso de las enfermeras, se

requieren 3.64 enfermeras (con el ajuste)y se tienen 2, por lo que faltan 1.64

enfermeras.

g. Información complementaria: Conociendo la brecha por cubrir y la remuneración

anual, se puede obtener el costo de cubrir la brecha.



Ejemplo:

COSTO PARA CUBRIR LA BRECHA SIN AJUSTE

Con personal contratado -53,845.62 5,589.40 -24,717.99

Con personal nombrado -53,263.99 42,045.00 -22,320.73

COSTO PARA CUBRIR LA BRECHA CON AJUSTE

Con personal contratado -40,364.47 31,424.45 -16,682.53

Con personal nombrado -53,263.99 42,045.00 -22,320.73

h. Resultados a nivel de la microrred: Un visión global de la situación de dotación de

recursos humanos a nivel de la MR se observa en la hoja de cálculo “Comparativo”,

donde se puede observar de manera integrada la infomación de todos los EESS de la

MR.

La matriz que se observará contiene la columna EESS donde están todos los EESS

de esa MR, con sus respectivas poblaciones. Para cada grupo ocupacional, se

tienen los siguientes indicadores:

- RRHH necesarios ajustados por ruralidad (A).

- Dotación actual (B)

- Brecha de RRHH (A-B)

- Ratio de carga laboral (B/A): Es un indicador para la gestión de RRHH que nos

mide la magnitud de la carga de trabajo que tiene el prestador. Lo deseado es

que el resultado sea “1”; un número mayor a “1” indica “sobredotación”, un

número menor a “1” indica “sobrecarga de trabajo”; mientras mas cerca de “0”

mayor sobrecarga. Por ejemplo, los 2 médicos del PS Chaviña realizan el trabajo

que debe ser realizado por solo 1 médico (0.95), lo que da un ratio de carga

laboral de 2.11, al ser mayor a “1” indica que hay “sobredotación de médicos en

PS Chaviña”. En el caso de las enfermeras, las 2 que están actualmente en el

CS Chaviña están cargado el trabajo que deberían realizar las casi 4 enfermeras

que se necesitan, lo que da un ratio de carga laboal de 0.55, al ser menor a “1”

indica que hay “sobrecarga”.

- Ratio x 10000 habitantes (B/pob*10000): Es un indicador que es útil para

poblaciones grandes, pero que no ayuda mucho para las poblaciones pequeñas

que existen a nivel de EESS.

Nota: Se mantiene este indicador, ya que estas matrices pued ser usadas a nivel

de Redes y DIRESA.

Ejemplo:



EESS PoblaciónMédico


RRHH necesarios ajustados por ruralidad (A) 0.95 3.64 1.13

Dotación actual (B) 2.00 2.00 2.00

BRECHA DE RRHH (A-B) -1.05 1.64 -0.87

Ratio de carga de trabajo (B/A) 2.11 0.55 1.77

Ratio x 10,000 habitantes (B/Pob *10000) 8.12 8.12 8.12



BRECHA DE RRHH (A-B) -0.70 1.13 0.35





BRECHA DE RRHH (A-B) -0.44 1.16 -0.33





BRECHA DE RRHH (A-B) 1.18 13.34 0.18



PS Calpamayo

PS Sancos

608

1,461

MR Cora Cora 11,158

PS Chaviña 2,463

Análisis de la información:

En la hoja de cálculo “Gráficos” se encontrarán un conjunto de tablas y gráficos que

permitirán analizar la información relacionada con la distribución de los RRHH entre los

EESS de la MR.

Las últimas tablas resumen todos los cálculos realizados y permiten tomar decisiones.

Ejemplo: MR Cora Cora

Grupo ocupacional

Población EESS

RRHH

necesarios

ajustados por

ruralidad (A)

Dotación

actual (B)

BRECHA DE

RRHH (A-B)

Problema en

gestión de

RRHH

Ratio de

carga de

trabajo (B/A)

Presión en la

carga Laboral

1,737 CS Pacapausa 0.67 0 1 escasez 0.00 alta

1,087 PS Aycara 0.35 0 0 escasez 0.00 alta

682 PS Ccasaccahua 0.22 0 0 escasez 0.00 alta

655 PS Muchapampa 0.21 0 0 escasez 0.00 alta

682 PS San Marcos 0.22 0 0 escasez 0.00 alta

728 PS San Francisco de Rivacayco 0.35 0 0 escasez 0.00 alta

566 PS Ccochani 0.27 0 0 escasez 0.00 alta

409 PS Upahuacho 0.20 0 0 escasez 0.00 alta

450 PS Sansaycca 0.22 0 0 escasez 0.00 alta

1,699 PS Chaquipampa 0.65 0 1 escasez 0.00 alta

2,463 PS Chaviña 0.95 2 -1 sobredotación 2.11 no hay sobrecarga

608 PS Calpamayo 0.30 1 -1 sobredotación 3.39 no hay sobrecarga

1,461 PS Sancos 0.56 1 0 sobredotación 1.78 no hay sobrecarga

13,227 Total de la MR 5.18 4 2 escasez 0.77 alta

Médico Cirujano

El análisis de esta tabla debe realizarse a nivel de la MR. Por ejemplo, esta MR requiere

5.18 médicos, es decir 6 médicos. La pregunta es ¿Dónde asigno a estos 6 médicos?. Si

solo analizo las cantidades puedo decir que requiero colocar médicos en los 6 EESS con

cifras mayores, pero debo tomar en cuenta otras variables como:

- Ubicación del EESS

- Tipo de contrato del personal.

- Nivel de producción del EESS.

La siguiente tabla muestra cómo se modifican los resultados con la reasignación.



DECISIÓNGrupo ocupacional

Población EESS

RRHH

necesarios

ajustados por

ruralidad (A)

Dotación

actual (B)

BRECHA DE

RRHH (A-B)

Problema en

gestión de

RRHH

Ratio de

carga de

trabajo (B/A)

Presión en la

carga Laboral

1,737 CS Pacapausa 1 0 1 escasez 0.00 alta

1,087 PS Aycara 1 0 1 escasez 0.00 alta

682 PS Ccasaccahua 0 0 0 normal #¡DIV/0! #¡DIV/0!

655 PS Muchapampa 0 0 0 normal #¡DIV/0! #¡DIV/0!

682 PS San Marcos 0 0 0 normal #¡DIV/0! #¡DIV/0!

728 PS San Francisco de Rivacayco 1 0 1 escasez 0.00 alta

566 PS Ccochani 0 0 0 normal #¡DIV/0! #¡DIV/0!

409 PS Upahuacho 0 0 0 normal #¡DIV/0! #¡DIV/0!

450 PS Sansaycca 0 0 0 normal #¡DIV/0! #¡DIV/0!

1,699 PS Chaquipampa 1 0 1 escasez 0.00 alta

2,463 PS Chaviña 1 2 -1 sobredotación 2.00 no hay sobrecarga

608 PS Calpamayo 0 1 -1 sobredotación #¡DIV/0! #¡DIV/0!

1,461 PS Sancos 1 1 0 normal 1.00 normal

13,227 Total de la MR 6 4 3 escasez 0.67 alta

Médico Cirujano

Las unidades ejecutoras deberán tomar en cuenta estas matrices para la determinación de

las brechas de RRHH a nivel de MR y EESS, así como para determinar la asignación de

RRHH a nivel de MR.

Es importante que antes de llenar la información, se GRABE el archivo de trabajo con un

nombre diferente. Cada vez que deseen hacer un nuevo cálculo, pueden usar la matriz en

blanco y grabarla con el nombre que más convenga.

VII. RESPONSABILIDADES:

DIRESA:

a) Como autoridad sanitaria en la Región le corresponde la implementación, el

monitoreo, el control y la evaluación del cumplimiento de la presente directiva.

b) Brindar asistencia técnica a las unidades ejecutoras para el correcto cumplimiento

de la presente directiva.

RED/UNIDAD EJECUTORA:

a) Aplicar y ejecutar lo dispuesto en la presente directiva de acuerdo a sus

competencias.

b) Informar a la DIRESA la aplicación de la presente directiva, de manera trimestral.

c) Informar a la DIRESA acerca del uso de los resultados de la matriz de cálculo, cada

vez que realicen contrataciones de personal para el primer nivel de atención.

d) Participar en la reuniones de monitoreo y evaluación de la presente directiva, las

mismas que serán convocadas por la DIRESA.

VIII. Disposiciones Finales.

Disponer que la DIRESA Ayacucho realice una primera evaluación a los tres meses de

haberse aplicado el cálculo de la dotación de RRHH en el primer nivel de atención y si el

caso amerite, proponer los ajustes que se considere necesarios.



7.7 Survey to determine the available working time in the first-level-of-care

ENCUESTA

DISPONIBILIDAD DE TIEMPO EN EL PRIMER NIVEL DE ATENCION

La presente encuesta es anónima e individual, su información será muy útil para la dotación de

RRHH en la región. Por favor, completar toda la información solicitada con la mayor veracidad

posible.

SUS RESPUESTAS MÁRQUELAS CON UNA “X”, ó ESCRÍBALAS EN LOS ESPACIOS

SUBRAYADOS

SECCION N° 1: DATOS GENERALES DE ESTABLECIMIENTO DE SALUD

Localidad y Distrito:

Nombre del Establecimiento:

Categoría del Establecimiento:

Microrred a la que pertenece:

1. ¿Qué cargo desempeña?

( ) Médico ( ) Enfermera ( ) Obstetra

( ) Cirujano dentista ( ) Psicólogo ( ) Biólogo

( ) Nutricionista ( ) Tecnólogo Médico: Laboratorio ( ) Tecnólogo Médico: Radiología

( ) Tecnólogo Médico: Terapia Física ( ) Técnico Laboratorio ( ) Técnico Enfermería

( ) Otro: _______________________________________

2. ¿Cuál es su condición laboral?

( ) Nombrado ( ) Contratado ___________________________

Especifique modalidad

( ) SERUMS

N° de Encuesta:



3. ¿Cuántas horas al mes está usted contratado?

(Oficialmente el personal nombrado labora 150 horas al mes)

( ) 150 horas ( ) Otro ¿Cuántas horas? ______ ( ) No sabe

SECCION N° 2: AUSENCIAS PREVISTAS Y NO PREVISTAS

4. Cuántos días de vacaciones tiene usted en el año?

( ) 15 días ( ) 30 días ( ) Otro ______días ( ) No tiene vacaciones

5. Durante los meses comprendidos entre octubre del 2011 a marzo del 2012, ha participado

usted en capacitaciones dentro de los días laborables?

( ) Si ( ) No (Si la respuesta es “No” pase a la pregunta 6)

Nombre de la Capacitación

¿Cuántas horas duró

la capacitación?

¿Cuántas horas

empleó en viajar de

ida y regreso?

1.

2.

3.

4.

Sub total horas

Total horas

6. ¿Cuáles son las fiestas o celebraciones regionales y locales cuyos días no son laborables

en su establecimiento? (No considerar los feriados nacionales oficiales, semana santa,

fiestas patrias, fiestas navideñas, otros)

Nombre de la Celebración NO Laborable Nº de días

1. Fiesta patronal

2. Aniversario del Establecimiento



Nombre de la Celebración NO Laborable Nº de días

3. Otra:______________________________

4. Otra: _____________________________

5. Otra: _____________________________

Total días

6. Durante los meses comprendidos entre octubre del 2011 a marzo del 2012, ¿sufrió algún

imprevisto que lo obligó a ausentarse de su lugar de Establecimiento de Salud?


7. ¿Cuál fue el motivo de dicho imprevisto que lo obligó a ausentarse?

Motivo Nº de días

( ) Enfermedad

( ) Imprevisto personal o familiar

( ) Fallecimiento de un familiar

( ) Conflicto o huelga

( ) Otros motivos (por favor especifique):

________________________________________

SECCION N° 3: SALUD AMBIENTAL

8. Durante los meses comprendidos entre enero a marzo del 2012, ¿Usted ha realizado o

participado en actividades de salud ambiental, dentro del establecimiento?


9. Durante los meses comprendidos entre enero a marzo del 2012, ¿Cuántas salidas y

cuántas horas le ha dedicado a las actividades de salud ambiental?

Actividades Extramurales Nº de salidas

realizas

Nº de horas promedio

utilizado en cada salida

Total

horas

Charlas a la comunidad

Fumigaciones



Actividades Extramurales Nº de salidas

realizas

Nº de horas promedio

utilizado en cada salida

Total

horas

Control de la calidad del agua

Otras: __________________________

Otras: __________________________

Total horas

SECCION N° 4: LABOR ADMINISTRATIVA O DE GESTION

10. ¿Usted realiza actividades administrati

11. vas o de gestión o participa en actividades o reuniones de relacionadas con la

administración o gestión del establecimiento?

( ) Si ( ) No (Si la respuesta es “No” usted ha culminado la encuesta, muchas gracias)

12. ¿cuántas actividades administrativas o de gestión realiza aproximadamente en un mes?

Actividades de Gestión ó Administrativas

Nº de veces al

mes

Nº horas promedio

que utiliza en cada

actividad

Total

horas

Coordinaciones con actores locales

(autoridades, representantes, funcionarios de

otras instituciones)

Participación en la elaboración de planes

estratégicos, operativos, presupuesto, etc.

Trámites administrativos (cuadro de

necesidades, requerimientos, seguimiento a

trámites administrativo, etc.)

Elaboración de informes de: gestión,

capacitación, evaluaciones, supervisiones, etc.)

Codificación, llenado y registro de reportes e

información estadística

Actividades de monitoreo y/o evaluación del

establecimiento

Otra: ___________________________

Total horas

Muchas gracias!



7.8 Detailed table of "available working time" for health facilities

This table corresponds to health facilities type I-4

Grupo OcupacionalCondición

laboral

Hras totales

anuales

Días de

vacaciones al

año

# total de

horas de

vacaciones al

año

Hrs anuales

de

capacitación

N° total de

días de

celebraciones

N° total de

horas de

celebraciones

N° total de

días de

imprevistos

N° horas de

días de

imprevistos

N° total de

horas de

actividades

administrativ

as

TOTAL DE

HORAS NO

DISPONIBLES

TOTAL DE

HORAS

DISPONIBLES

PARA LA

PRESTACION

% de tiempo

disponible

para NO PEAS

Total de

horas

disponibles

para NO PEAS

Total de

horas

disponibles

para PEAS

% tiempo

disponible

PEAS

Médico Nombrado 1800 25 150 18 2 12 1 6 22 208 1,592 10% 159.2 1,433 80%

Contratado 1800 15 90 18 2 12 1 6 22 148 1,652 10% 165.2 1,487 83%

Enfermera Nombrado 1800 25 150 30 2 12 1 6 22 220 1,580 15% 237 1,343 75%

Contratado 1800 15 90 18 2 12 1 6 22 148 1,652 15% 247.8 1,404 78%

Odontólogo Nombrado 1800 25 150 12 2 12 1 6 22 202 1,598 1% 15.98 1,582 88%

Contratado 1800 15 90 12 2 12 1 6 22 142 1,658 1% 16.58 1,641 91%

Obstetra Nombrado 1800 25 150 18 2 12 1 6 22 208 1,592 5% 79.6 1,512 84%

Contratado 1800 15 90 12 2 12 1 6 22 142 1,658 5% 82.9 1,575 88%

Tecnólogo Médico Nombrado 1800 25 150 6 2 12 1 6 22 196 1,604 1% 16.04 1,588 88%

Radiología Contratado 1800 15 90 0 2 12 1 6 22 130 1,670 1% 16.7 1,653 92%


Laboratorio Contratado 1800 15 90 0 2 12 1 6 22 130 1,670 1% 16.7 1,653 92%


Rehabilitación Contratado 1800 15 90 0 2 12 1 6 22 130 1,670 1% 16.7 1,653 92%

Psicólogo Nombrado 1800 25 150 12 2 12 1 6 22 202 1,598 20% 319.6 1,278 71%

Contratado 1800 15 90 12 2 12 1 6 22 142 1,658 20% 331.6 1,326 74%Biologo Nombrado 1800 25 150 6 2 12 1 6 22 196 1,604 20% 320.8 1,283 71%

Contratado 1800 15 90 0 2 12 1 6 22 130 1,670 20% 334 1,336 74%

Nutricionista Nombrado 1800 25 150 12 2 12 1 6 22 202 1,598 5% 79.9 1,518 84%

Contratado 1800 15 90 0 2 12 1 6 22 130 1,670 5% 83.5 1,587 88%

Trabajadora Social Nombrado 1800 25 150 6 2 12 1 6 22 196 1,604 80% 1283.2 321 18%

Contratado 1800 15 90 0 2 12 1 6 22 130 1,670 80% 1336 334 19%

Técnico Laborat. Nombrado 1800 25 150 12 2 12 1 6 22 202 1,598 1% 15.98 1,582 88%

Contratado 1800 15 90 12 2 12 1 6 22 142 1,658 1% 16.58 1,641 91%

Técnico Radiolog. Nombrado 1800 25 150 0 2 12 1 6 22 190 1,610 1% 16.1 1,594 89%

Contratado 1800 15 90 6 2 12 1 6 22 136 1,664 1% 16.64 1,647 92%

Fisioterapista Nombrado 1800 25 150 0 2 12 1 6 22 190 1,610 1% 16.1 1,594 89%

Contratado 1800 15 90 6 2 12 1 6 22 136 1,664 1% 16.64 1,647 92%

Técnico Enferm. Nombrado 1800 25 150 6 2 12 1 6 22 196 1,604 15% 240.6 1,363 76%

Contratado 1800 15 90 6 2 12 1 6 22 136 1,664 15% 249.6 1,414 79%



7.9 Available working time to provide PEAS in first-level-of-care health facilities

CategoríaSituación

laboral

Médico

Cirujano

Cirujano

DentistaEnfermera Psicólogo Obstetra

TM -

Radiología

TM -

Laboratorio

TM -

Terapia

física

Biólogo NutricionistaTrabajador

Social

Tco.

Radiología

Tco.

Laboratorio

Fisioterapis

ta

Servidor

Tco./Aux

Nombrado 1,453 1,610 1,362 1,301 1,533 1,610 1,610 1,610 1,301 1,545 325 1,616 1,043 1,616 896

Contratado 1,507 1,675 1,423 1,354 1,596 1,675 1,675 1,675 1,354 1,607 338 1,675 1,109 1,675 947

% hras PEAS

contratado 84% 93% 79% 75% 89% 93% 93% 93% 75% 89% 19% 93% 62% 93% 53%

Nombrado 1,453 1,327 1,119 1,072 1,262 1,327 1,327 1,327 1,072 1,273 268 1,180 1,174 1,616 1,382

Contratado 1,507 1,392 1,180 1,125 1,324 1,392 1,392 1,392 1,125 1,336 281 1,675 1,234 1,675 1,059

% hras PEAS

contratado 84% 77% 66% 62% 74% 77% 77% 77% 62% 74% 16% 93% 69% 93% 59%

Nombrado 1,433 1,451 1,231 1,173 1,387 1,457 1,457 1,457 1,178 1,398 294 1,180 1,168 1,180 1,008

Contratado 1,487 1,511 1,292 1,221 1,450 1,523 1,523 1,523 1,230 1,461 308 1,239 1,228 1,239 1,059

% hras PEAS

contratado 83% 84% 72% 68% 81% 85% 85% 85% 68% 81% 17% 69% 68% 69% 59%

Nombrado 1,433 1,582 1,343 1,278 1,512 1,588 1,582 1,588 1,283 1,518 321 1,594 1,582 1,594 1,363

Contratado 1486.8 1641.42 1404.2 1326.4 1575.1 1653.3 1653.3 1653.3 1336 1586.5 334 1647.36 1641.42 1647.36 1414.4

% hras PEAS

contratado 83% 91% 78% 74% 88% 92% 92% 92% 74% 88% 19% 92% 91% 92% 79%

I-1

I-2

I-3

I-4



7.10 Ministry of health: General competencies for the health sector

FORMULACION DE LAS COMPETENCIAS LABORALES GENERICAS DEL SECTOR SALUD25

La formulación e identificación de las competencias laborales genéricas tiene como

ejes orientadores al propósito clave del sector salud y los objetivos sectoriales (plan

concertado de salud), la que permite responder a cuáles son las competencias

laborales genéricas que todo trabajador del sector salud debe saber hacer para el

cumplimiento de las funciones encomendadas. A continuación se presenta a manera

de esquema el propósito clave, los objetivos del sector y las competencias genéricas

laborales del sector salud.

IDENTIFICACIÓN Y DEFINICIÓN DE LAS COMPETENCIAS GENÉRICAS LABORALES Para el logro del propósito clave y los objetivos del sector, todos los trabajadores del sector salud deberán tener las siguientes competencias genéricas laborales las que se complementaran con las competencias específicas.

25 Extraído de: “Competencias Laborales para la mejora del desempeño de los Recursos Humanos en

Salud”/Ministerio de Salud. Dirección General de Gestión del Desarrollo de Recursos Humanos en Salud. Dirección de Gestión del Trabajo en Salud – Lima: Ministerio de Salud; 2011.177 pág.; ilus.; tab. – (Serie Documentos Técnicos Normativos de Recursos Humanos en Salud; 2)



1. Compromiso ético

Los trabajadores del sector salud demuestran actitudes y acciones de servicio

responsable, sustentado en principios y valores de justicia, bien común, dignidad de la

persona y el derecho a la salud, en respuesta a las necesidades que la sociedad le

demanda.

Criterios de evaluación del desempeño

Trabaja por el bien común, con honestidad, confidencialidad.

Cumple su trabajo con oportunidad y calidad

2. Respeto por la vida, las personas y el ambiente

Los trabajadores de la salud practican la convivencia en armonía con todas las formas

de vida, con la construcción de una sociedad más humanizada, la defensa y

preservación de la biodiversidad.


Participa defendiendo la importancia de la vida humana y otras formas de vida.

Es consciente de ser parte de una sociedad que requiere mejores condiciones

de salud propiciando la Participación social y el capital social.

3. Trabajo en equipo

Los trabajadores del sector salud cooperan y colaboran, integrándose en equipos

transdisciplinarios, para el logro de objetivos organizacionales y de la calidad de la

atención de los servicios de salud y comunidad.


Participa con otros en la obtención de metas comunes, respetando diferentes

opiniones y evitando competir.

Apoya a los integrantes del equipo compartiendo principalmente información,

conocimiento y recursos.

4. Comunicación en base a interculturalidad

Los trabajadores del sector salud se comunican asertivamente entre ellos y con la

población, mediante mensajes que incorporan patrones culturales, lingüísticos y

sociales, propiciando la inclusión social e identidad con los servicios de salud.


Escucha y expresa sus mensajes (información, ideas, opiniones) con

cordialidad y pertinencia.



Genera y mantiene un flujo de comunicación incorporando patrones culturales,

lingüísticos y sociales

5. Capacidad de organización y planificación

Los trabajadores del sector salud organizan sus metas, objetivos, recursos, funciones,

actividades y tareas, para lograr resultados de mejora de la salud y transformación

social, en el marco de lineamientos y políticas de salud.


Identifica, organiza sus metas, objetivos, funciones, actividades, tareas y

recursos a través de un plan.

Trabaja planificadamente para el logro de resultados estratégicos, en un

horizonte de tiempo sostenido, construyendo situaciones futuras.

7.11 CONEAU: Managerial competencies for health professionals

MAPA FUNCIONAL DE LAS COMPETENCIAS DEL PROFESIONAL EN SALUD EN

GESTION

FUNCION CLAVE UNIDAD DE

COMPETENCIA ELEMENTO DE COMPETENCIA

Gestionar las

organizaciones

sanitarias y las

entidades formadoras

de profesionales en

salud, en el ámbito de

competencia

profesional y según

normatividad vigente.

1. Planificar las actividades

de una organización

sanitaria y entidades

formadoras, según


Elaborar el análisis situacional del ámbito de acción de una

organización sanitaria ó entidad formadora.

Elaborar el plan estratégico, plan operativo y otros

documentos de gestión de una organización sanitaria ó

entidad formadora.

Determinar las necesidades de recursos humanos,

materiales y financieros de una organización sanitaria ó

entidad formadora, de acuerdo a lo planificado.

2. Organizar el

funcionamiento de una

organización sanitaria y

entidades formadoras,

según normas vigentes

Aprobar los procesos de gestión sanitaria o académica a su

cargo, según norma vigente.

Elaborar los flujogramas de los procesos de gestión sanitaria

o académica.

Determinar la necesidad y funciones del personal a su cargo

según normatividad vigente.

Aprobar los programas de adquisición y mantenimiento de

equipos e insumos.

3. Dirigir el funcionamiento

de de una organización


formadoras, según

Liderar el equipo de gestión aplicando principios y valores

éticos.

Utilizar herramientas de gestión pertinentes para la oportuna



FUNCION CLAVE UNIDAD DE

COMPETENCIA ELEMENTO DE COMPETENCIA

normas vigentes toma de decisiones.

Implementar planes y procesos de mejora continua de la

calidad.

4. Controlar los servicios de

de una organización


formadoras, según


Monitorear el cumplimiento de procesos y metas establecidas

en el plan operativo y otros documentos de gestión.

Supervisar el desempeño del talento humano a su cargo.

Evaluar los resultados de plan estratégico y plan operativo,

aplicando medidas preventivas y acciones correctivas.

Fuente: CONEAU

7.12 Human resources management competencies

COMPETENCIAS PARA LA GESTION DE RECURSOS HUMANOS

PROPOSITO PRINCIPAL DE LOS GESTORES DE RECURSOS HUMANOS: Contar con

personal competente, motivado, distribuido en lugares adecuados, haciendo bien lo que tiene

que hacer, en base a las necesidades de salud de la Región Ayacucho.

FUNCIONES CLAVES COMPETENCIAS

PLANIFICACIÓN

Definir los

requerimientos de

recursos humanos y la

dotación adecuada de

recursos humanos

Diseñar directivas, formatos, matrices para el acopio de información de RH

Controlar la implementación y cumplimiento de la normatividad del acopio de la

información regional de RH

Mantener actualizada la base de datos del inventario regional del personal de salud

Estimar las necesidades de RHUS para todos los niveles de atención de acuerdo a las

prioridades sanitarias regionales y locales

Estimar la brecha de recursos humanos de acuerdo a las políticas institucionales

vigentes

Elaborar el diagnóstico de RHUS tomando en cuenta las necesidades tanto de la

formación como de la prestación

Diseñar planes y estrategias para cubrir la brecha de RHUS

ORGANIZACION DEL

TRABAJO

Describir y clasificar

los puestos de trabajo;

define los requisitos y

competencias para

ocuparlos, así como

registra la distribución

del personal en la

organización.

Elaborar los perfiles de puesto de acuerdo a los objetivos institucionales

Elaborar el Cuadro de Asignación de Personal de acuerdo a las necesidades

organizacionales vigentes

Elaborar directivas y normas acerca de perfiles de competencias de acuerdo al marco

normativo vigente

Diseñar los perfiles de competencias de acuerdo a las directivas vigentes

Brindar asistencia técnica para el diseño de los perfiles de competencias de acuerdo a

las necesidades organizacionales

Diseñar los estándares de desempeño laboral de acuerdo a las competencias definidas

GESTIÓN DEL

EMPLEO

Implementar políticas y

prácticas de RRHH

vinculadas al ingreso,

movimiento y salida del

personal.

Desarrollar estudios de mercado de la Oferta y Demanda laboral

Diseñar procesos de reclutamiento de personal de acuerdo a las necesidades

institucionales

Elaborar las bases del proceso de reclutamiento y selección del personal

Evaluar los expedientes de candidatos para verificar requisitos de acuerdo al perfil

Diseñar instrumentos para evaluar candidatos de acuerdo a los perfiles de puesto y

competencias definidos.

Elaborar el documento del contrato en base al informe de resultados de la selección

Realizar la inducción a los nuevos trabajadores de acuerdo a los procedimientos




establecidos

Formular políticas y procedimientos que regulan los procesos de desplazamiento

horizontal y vertical del personal, de acuerdo al desempeño del personal, a los años de

permanencia en el puesto, a la progresión desde zonas de menor a mayor desarrollo.

Evaluar y emitir opinión de las solicitudes de desplazamiento en función a las

necesidades

Elaborar el reglamento interno de trabajo

Evaluar expedientes de procesos administrativos de acuerdo a la normatividad vigente.

Realizar el control de asistencia y permanencia de acuerdo a la normatividad vigente

Mantener el legajo del personal actualizado hasta el último año.

Diseñar directivas de desvinculación del personal de acuerdo a la normatividad vigente

Evaluar expedientes para la desvinculación laboral en base a la normatividad vigente

GESTIÓN DEL

DESEMPEÑO

Mejorar el desempeño

del personal y alinearlo

a los valores y

estrategias de la

organización.

Establecer metas de rendimiento conforme a criterios técnicos, de manera concertada y

de acuerdo con las necesidades institucionales

Diseñar procedimientos de evaluación de competencias de acuerdo a la evidencia

nacional o internacional exitosas

Elaborar instrumentos de evaluación de competencias de acuerdo a la normatividad

vigente o evidencia internacional y nacional exitosa

Elaborar el plan de supervisión del desempeño de acuerdo a las brechas de competencia

identificadas

Diseñar los instrumentos de supervisión en función a los objetivos y estándares de

desempeño.

Supervisar el desempeño en el marco de los estándares diseñados para el puesto laboral

Elaborar el informe final de la supervisión conforme a las brechas identificadas

Realizar actividades de reflexión de la práctica diaria para la mejora del desempeño en el

servicio

Elaborar reportes de monitoreo de rendimiento y desempeño del personal de salud de

acuerdo a cumplimiento del Plan de Desempeño

Seleccionar evaluadores del desempeño de acuerdo a los estándares vigentes

Evaluar las metas de rendimiento de acuerdo a los procedimientos establecidos

Certificar a los trabajadores en base a las competencias adquiridas y demostradas

Administrar el portafolio individual de evidencias de acuerdo a las evaluaciones y

certificaciones

Implementar de manera concertada planes individuales de mejora del rendimiento en

función a las brechas encontradas

Elaborar planes de mejora del desempeño en base a los planes de mejora del

rendimiento laboral

GESTION DE LA

COMPENSACION

Definir políticas y

prácticas retributivas,

monetarias y no

monetarias, y el

ordenamiento de las

remuneraciones,

prestaciones e

incentivos por

rendimiento.

Definir una escala salarial equitativa y justa de acuerdo a las políticas institucionales

vigentes

Controlar el cumplimiento de la aplicación de la escala salarial en todos los niveles

Organizar la información de la planilla de pagos, remuneraciones y pensiones según

niveles y grupos profesionales (administrativos y asistenciales)

Definir beneficios extrasalariales y salariales por trabajo extrahorario de acuerdo a la

normatividad vigente

Diseñar políticas de incentivos monetarias y no monetarias para retener al personal

competente de acuerdo a la evaluación del desempeño

Diseñar documentos de reconocimiento al personal de acuerdo a la normatividad vigente

GESTION DEL

DESARROLLO

Definir políticas y

prácticas orientadas a

favorecer el desarrollo

profesional y laboral de

Diseñar políticas para el cambio de grupo ocupacional y ascensos, de acuerdo a

competencias y mérito

Diseñar líneas de carrera en base al mérito, tiempo de permanencia y competencias para

el cargo

Elaborar directivas para la implementación de las líneas de carrera para todos los grupos

ocupacionales, en todos los niveles institucionales (incluye definiciones de cargos)




las personas de

acuerdo a sus

aptitudes,

proporcionando

espacios de

aprendizaje y líneas de

carrera de acuerdo a la

dinámica y estructura

organizativa.

Elaborar el diagnóstico de identificación de brechas de competencias y necesidades de

capacitación de acuerdo a las prioridades institucionales

Elaborar el plan de desarrollo de capacidades en base al diagnóstico de brechas de

competencias y necesidades de desarrollo

Elaborar programas de capacitación de acuerdo a la normatividad vigente

Diseñar estrategias comunicacionales para la socialización de las directivas sobre

intervenciones educativas

Elaborar el informe de evaluación de los programas y planes de desarrollo de

competencias de acuerdo a normatividad vigente

Evaluar los procesos de gestión de la capacitación de acuerdo a la normatividad vigente

Diseñar planes de desarrollo de sedes docentes de acuerdo al Plan de Desarrollo de

Capacidades

Calificar las sedes docentes de acuerdo a las normas vigentes

Elaborar el informe de acreditación de la sede docente calificada de acuerdo a la norma

vigente

Elaborar convenios marco y específicos con instituciones de formación conforme al

marco normativo y legal vigente

Diseñar normas para la regulación de los programas de docencia-servicio (pregrado,

internado, SERUMS/SECIGRA y segunda especialización en concordancia con las

políticas institucionales

Gerenciar los programas de docencia-servicio (pregrado, internado, SERUMS/SECIGRA

y segunda especialización en concordancia con las políticas institucionales

GESTIÓN DE

RELACIONES

HUMANAS

Regular y armonizar

las interacciones entre

los individuos, con

énfasis en su

dimensión colectiva, y

la organización, en

base a políticas y

prácticas vinculadas al

clima laboral, las

relaciones laborales y

el bienestar.

Diseñar políticas de desarrollo organizacional de acuerdo a las necesidades

institucionales

Elaborar diagnósticos del clima organizacional de acuerdo a la normatividad vigente

Elaborar planes de mejora del clima organizacional de acuerdo al diagnóstico

Gestionar la implementación de las acciones de mejora del clima laboral conforme al plan

Investigar los conflictos laborales de acuerdo a las necesidades de La organización

Formular estrategias para la resolución de conflictos laborales de acuerdo a las

necesidades de la organización, el trabajador y los usuarios

Definir los canales de comunicación y negociación entre los directivos y trabajadores de

acuerdo a la política institucional

Gestionar la implementación de las estrategias de resolución de conflicto conforme a la

políticas institucional

Diseñar programas de bienestar social de acuerdo a la normatividad vigente

Diseñar políticas, directivas y planes para la gestión de la seguridad en el trabajo (incluye

control y vigilancia) conforme a la normatividad vigente

GESTION DEL

SISTEMA

Alimentar y

retroalimentar a los

demás subsistemas.

Alinear los

subsistemas a la

misión, objetivos y

estrategias de la

organización

Diseñar indicadores de gestión de RHUS de acuerdo a las necesidades institucionales

Monitorear los indicadores de gestión de RHUS de acuerdo a los planes y políticas de

gestión institucional

Diseñar el plan estratégico para la gestión y desarrollo de recursos humanos, en el marco

de las políticas sectoriales y la legislación vigente.

Diseñar políticas de gestión del desarrollo de los RHUS (institucionales y sectoriales) de

acuerdo a las necesidades institucionales y sectoriales

Diseñar el plan operativo de la unidad de recursos humanos de acuerdo con los planes

estratégicos vigentes

Diseñar el presupuesto de la unidad de recursos humanos de acuerdo con los planes

operativos vigentes

Diseñar el modelo de gestión de recursos humanos por competencias apropiados a la

organización institucional

Gerenciar los procesos de la elaboración, administración y uso de la información de

recursos humanos institucionales (y sectoriales) de acuerdo al marco normativo y

necesidades institucionales

Elaborar el Presupuesto Analítico de Personal de acuerdo a la normatividad vigente




Elaborar reportes financieros y presupuestales de Personal conforme a criterios técnicos,

administrativos y gerenciales

Elaborar propuestas y recomendaciones al planeamiento y presupuesto institucional de

acuerdo a las conclusiones del análisis

Diseñar ROF, MOF CAP y PAP en base a la normatividad vigente

Elaborar los documentos de gestión de la unidad de RRHH de la organización

7.13 Transversal managerial competencies

En este anexo se presenta la revisión bibliográfica realizada acerca de competencias

gerenciales, especialmente para el sector salud:

Modelos de competencias gerenciales

A continuación se presenta los diferentes modelos de competencias encontrados en la

bibliografía.

Si bien, tenemos el enunciado de la competencia, es necesario establecer una

definición operacional de las mismas para facilitar su mejor comprensión y por

consiguiente su evaluación.

Competencias directivas (Hooghiemstra, 1992)

a) Razonamiento estratégico

b) Liderazgo para el cambio

c) Gestión de las relaciones

Competencias gerenciales (Bethell-Fox 1992)

a) Desarrollo de personas

b) Dirección de personas

c) Trabajo en equipo y cooperación

d) Liderazgo interna

Competencias gerenciales genéricas (Richard Boyayzis, 1982)

a) Competencias de logro de metas y objetivos

Orientación eficiente

Proactividad

Diagnosticar a través de conceptos

Crear impacto

b) Competencias de liderazgo

Confianza en sí mismo

Manejo adecuado de la comunicación oral

Pensamiento lógico

Conceptualización

c) Competencias de recursos humanos

Uso de poder de socialización

Actitud positiva

Manejo de grupos

Autovaloración de certeza



d) Competencias de dirigir subordinados

Desarrollo de otros

Uso de poder unilateral

Espontaneidad

e) Competencias de madurez

Control en sí mismo

Percepción objetiva

Resistencia y adaptabilidad

Construcción de una filiación

Competencias gerenciales genéricas (Lyle Spencer y Signe Spencer, 1993)

a) Orientación a logros o resultados: Orden y precisión, Iniciativa, Búsqueda de

Información y Pensamiento Analítico o Conceptualización

b) Ayuda y servicio a personas: Capacidad para relaciones interpersonales,

Orientación al usuario.

c) Impacto e influencia: Conciencia organizacional, Construcción de relaciones.

d) Dirección: Desarrollo de otros; Decisión, asertividad y uso adecuado de poder.

e) Cognición: Pensamiento analítico, pensamiento conceptual.

f) Madurez personal: Control de sí mismo, confianza en sí mismo, flexibilidad,

compromiso organizacional.

Competencias directivas (modelo inglés)

a) Dar propósito y dirección

b) Producir impacto personal

c) Pensar estratégicamente

d) Conseguir lo mejor de las personas

e) Aprender a mejorar

f) Centrarse en el servicio

Competencias directivas (modelo canadiense)

a) Intelectual (capacidad cognitiva, creatividad)

b) Construcción de futuro (visión)

c) Gestión (gestión para la acción, comprensión organizacional, trabajo en equipo,

asociación)

d) Relacional (relaciones interpersonales, comunicación)

e) Personal (la vitalidad y resistencia al stress; ética y valores; personalidad;

flexibilidad; autoconfianza; conocimiento de sistemas, políticas y programas de

gobierno).

Competencias directivas fundamentales (modelo brasilero)

a) Compromiso con los resultados (de la organización bajo su autoridad y del

gobierno en su conjunto), con el impacto de las acciones y el uso responsable

de los recursos públicos

b) Ayuda a definir claramente la misión de la institución que dirige, sus estrategias

y prioridades, y estar preparado para ejercer una supervisión permanente de

las acciones hacia la misión, estrategias y prioridades definidas.

c) Liderar con el ejemplo y conducir el cambio en la organización pública para

alcanzar mayores niveles de desempeño institucional: dar el foco y dirección a



los cambios organizativos y el ejercicio constante de comunicación con todos

los participantes

d) Practicar, promover y recoger el alto desempeño de todos los empleados

e) Desarrollar el interés real por los recursos humanos, finanzas y tecnología

f) Ayudar a preparar la transición de gobierno.

Competencias Gerenciales en Salud (American College of Health care Executives, 2010)

a) Comunicación y Gestión de las Relaciones

Gestión de las relaciones

Destrezas de comunicación

Facilitación y negociación

b) Liderazgo

Destrezas de liderazgo

Cultura y Clima organizacional

Comunicación de la visión

Gestión del cambio

c) Profesionalismo

Rendición de cuentas personal y profesional

Desarrollo profesional y aprendizaje para la vida

Contribución a la comunidad y la profesión

d) Conocimiento del sistema de salud

Sistemas y Organizaciones de salud

Personal de salud

Perspectiva del paciente

Comunidad y medio ambiente

e) Destrezas y conocimientos gerenciales

Gestión General

Gerencia financiera

Gestión de RRHH

Dinámica organizacional y gobernanza

Planeamiento estratégico y marketing

Gestión de la información

Gestión del riesgo

Mejoramiento de la calidad.

Competencias nucleares26 en salud pública (Center for health policy, Columbia

University)

a) Dimensiones comunitarias

b) Planeamiento y gestión financiera

c) Pensamiento sistémico y liderazgo

d) Desarrollo de políticas / planeamiento de programas

e) Evaluación analítica

f) Ciencias básicas de salud pública

26 Nucleares o Core: Representan un set de destrezas, conocimientos y actitudes necesarias para la

práctica de la salud pública aplicada por personal de primera línea; personal de alto nivel; y gerentes y

supervisores Las competencias se han definido en términos generales para que puedan aplicarse

ampliamente a todos los programas, muestra aquellas competencias que son comunes a todos los

residentes de medicina preventiva (American College of Preventive Medicine)



g) Competencias culturales

h) Comunicación

Competencias gerenciales transversales

En base a la revisión bibliográfica realizada, se definieron las competencias que eran

comunes a los modelos analizados, definiéndose 14 competencias gerenciales que

sirvieron de referencia para que los equipos de gestión de las redes de salud de la

DIRES San Martín identificaran sus competencias gerenciales transversales.

Listado de las 14 competencias gerenciales transversales

1. Lead, mobilize and inspire teams

2. Communicate messages verbally or in writing

3. Help others to solve problems

4. Maintain good interpersonal relationships

5. Develop the potential of others

6. Build a vision

7. Lead people to achieve results, goals and objectives

8. Locate, attract and retain the right people in the right job

9. Use resources responsibly

10. Manage finances efficiently

11. Negotiate

12. Maintain a satisfactory organizational climate

13. Manage change

14. Implement plans, policies and programs in health.



CUADRO COMPARATIVO DE LOS DIFERENTES MODELOS DE COMPETENCIAS GERENCIALES

Competencias Gerenciales

Genéricas Hooghiemstra

Bethell-

Fox Boyaysis Spencer

Modelo

inglés

Modelo

canadiense

Modelo

brasilero

Modelo

español

para la

gestión

local

ACHCE CHP Total

Liderazgo 1 1 1 1 1 1 1 7

Comunicación / Ayuda y servicio

a otros: Relaciones

interpersonales, orientación al

usuario 1 1 1 1 1 1 6

Dirigir subordinados; Desarrollo

de personas, uso de poder. 1 1 1 2 1 6

Impacto e influencia: Gestión de

relaciones, conciencia

organizacional 1 1 1 1 1 1 6

Competencias de madurez /otras

competencias: Control en sí

mismo, percepción objetiva,

resistencia y adaptabilidad,

construcción de filiación.

Confianza en sí mismo,

compromiso organizacional.

Aprender a mejorar. Ética y

valores, personalidad. 1 1 1 1 1 5

Pensamiento estratégico,

Construcción de futuro (visión) 1 1 1 1 1 5

Orientación al logro de

resultados, metas y objetivos 1 1 1 3

Dirección de personas, recursos

humanos 1 1 1 3

Trabajo en equipo y cooperación 1 1 1 3

Cognición: Pensamiento

analítico, pensamiento

conceptual / Evaluación analítica 1 1 1 3



Competencias Gerenciales

Genéricas Hooghiemstra

Bethell-

Fox Boyaysis Spencer

Modelo

inglés

Modelo

canadiense

Modelo

brasilero

Modelo

español

para la

gestión

local

ACHCE CHP Total

Gestión para la acción /

Destrezas gerenciales 1 1 2

Conocimiento de sistemas,

políticas y programas de gobierno

/ Pensamiento sistémico 1 1 2

Uso responsable de recursos

/Gestión financiera 1 1 2

Iniciativa 1 1

Comprensión del entorno político 1 1

Ayudar a preparar la transición de

gobierno 1 1

Facilitación y negociación 1 1

Cultura y Clima organizacional 1 1

Gestión del cambio 1 1

Profesionalismo 1 1

Conocimiento del sistema de

salud 1 1

Dimensiones comunitarias /

competencias culturales 1 1

Desarrollo de políticas /

planeamiento de programas 1 1

Ciencias básicas de salud

pública 1 1

TOTAL 3 4 5 6 6 8 7 7 9 9

ACHE: American College of Health Care Executives

CHP: Center for Health Policy, Columbia University

report on and assessment of the human resources...

Documents