Challenges and opportunities of human resource management activities for neglected tropical diseases in Liberia.

People affected by skin neglected tropical diseases (NTDs) are best cared for by a motivated, well-directed, competent and well-resourced health workforce. There is limited evidence about performance management for health workforce relating to NTD tasks. We explored human resource management relating to skin NTDs, with a focus on performance management. We carried out qualitative and participatory research with health workers across health systems levels in Liberia to explore experiences of caring for people with skin NTDs and views on optimal human resource management (HRM) practices. We conducted key informant interviews with national health systems policymakers (16) and county health workers (32); in-depth interviews with health workers (36); focus group discussions with health workers (4); and photovoice with 15 community health assistants and community health promoters, purposively selected for maximum variation. All interviews and FGDs were transcribed and analysed using thematic framework approach. We found health workers often have strong intrinsic motivation to care for people affected by skin NTDs. However, this is undermined by weak HRM structures particularly in geographic areas where integrated services for NTDs requiring case management have not yet rolled out. The main challenges described include: limited awareness of NTD-related roles, and mental health support provision role, particularly at facility level, gaps in knowledge and skills (how to identify, diagnose and manage skin NTDs), irregular supervision and limited resources to deliver care. Our findings have informed collaborative development of a bundle of HRM approaches to strengthen performance of health workers caring for patients with skin NTDs, including participatory training informed by adult learning-based approaches, supportive supervision, provision of job tasks, NTD manual and related tools, essential resource provision for community health assistants and promoters (CHAs and CHPs) and non-cash awards.