Human resources for health2010 25th june mph

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  • HWF education data: relating to existing training institutions, application rate to health professional institutions, student intake, output of health professionals by category by year (4).
    Identification of personnel and tasks is important for in-service education and training and capacity building.
    Existing health professional education: relevance of curricula to address country’s health needs, coordination between HWF production and utilization, frequency of curriculum review, update and revision.
    Inclusion of leadership, ethical conduct, altruism, commitment, personal and professional development programs, team work, partnership building and adoption of life long learning practices and existing system for continuing medical education in the curriculum.
    Existing facilities for personal and professional development of faculty.
    Existence of accreditation system for internal and external quality assurance.
    Medical and allied Health professional education research for innovations in education to address current HWF problems.
  • Density and distribution of HWF assessed against national bench marks and those mentioned in World health Report 2006.
    System to be put in place for regular updating of HWF data
    HWF distribution with regard to equitable coverage, gender equity and relevance, appropriate skill mix.
    Data regarding HWF in other sectors such as the private sector and NGOs, health workforce in numbers, competencies and distribution
    Financing of HWF which consists of salary profile of different categories of HWF, for different geographic areas, different sectors, and incentives for manning remote health centers.
    HWF support for housing, healthcare, transportation and children’s education and welfare, working environment supportive for maximum performance; facilities and equipments, drugs, supplies and support staff.
    HWF support for housing, family health care, transportation and children’s education.
    Opportunities for promotion, personal and professional development for HWF.
    Data, information and causes for attrition, brain drain, migration pattern and presence of “ghost health workers” or absenteeism.
  • Density and distribution of HWF assessed against national bench marks and those mentioned in World health Report 2006.
    System to be put in place for regular updating of HWF data
    HWF distribution with regard to equitable coverage, gender equity and relevance, appropriate skill mix.
    Data regarding HWF in other sectors such as the private sector and NGOs, health workforce in numbers, competencies and distribution
    Financing of HWF which consists of salary profile of different categories of HWF, for different geographic areas, different sectors, and incentives for manning remote health centers.
    HWF support for housing, healthcare, transportation and children’s education and welfare, working environment supportive for maximum performance; facilities and equipments, drugs, supplies and support staff.
    HWF support for housing, family health care, transportation and children’s education.
    Opportunities for promotion, personal and professional development for HWF.
    Data, information and causes for attrition, brain drain, migration pattern and presence of “ghost health workers” or absenteeism.
  • Is there HWF policy reflected in the National Health Policy of the country?
    Work load indicators and staffing needs for optimal allocation and deployment of staff according to population and patient loads, geographic area, functionally health services provided, at different levels (township /sub-district or village) according to facilities and financial support available (5).
    The existence of deployment policies, recruitment policies, transfer, promotion, grievances, incentives including performance-based incentives, and career advancement policies.
    HWF exit policy: pension and gratuity entitlements have to be taken into account.
    Regulations on ethical conduct, liability and quality assurance mechanisms for the HWF, both in public and private sector.
    Relationship between HWF and Public Health standard at different level of health facilities.
    Coordination with other related sector/departments.
  • Is there HWF policy reflected in the National Health Policy of the country?
    Work load indicators and staffing needs for optimal allocation and deployment of staff according to population and patient loads, geographic area, functionally health services provided, at different levels (township /sub-district or village) according to facilities and financial support available (5).
    The existence of deployment policies, recruitment policies, transfer, promotion, grievances, incentives including performance-based incentives, and career advancement policies.
    HWF exit policy: pension and gratuity entitlements have to be taken into account.
    Regulations on ethical conduct, liability and quality assurance mechanisms for the HWF, both in public and private sector.
    Relationship between HWF and Public Health standard at different level of health facilities.
    Coordination with other related sector/departments.
  • Macroeconomic profiles, national health accounts and national health spending in relation to GDP, national budget for HRH development, other sources of funding /spending for HRH (4).
    Salary rates of different levels of HRH and other entitlements
    Salary rates compared to bench marks in the other sectors
    Ratio of public to private out of pocket spending for health
    Health spending on non-salary finances: support children’ education, accommodation, transportation, etc
    Multiple job holdings may result due to low salaries. Moon-lighting in the private sector is one strategy for HWF in the public sector to survive, however it can lower the efficiency in the public sector.
    29. Supportive working environment with essential logistics
  • Macroeconomic profiles, national health accounts and national health spending in relation to GDP, national budget for HRH development, other sources of funding /spending for HRH (4).
    Salary rates of different levels of HRH and other entitlements
    Salary rates compared to bench marks in the other sectors
    Ratio of public to private out of pocket spending for health
    Health spending on non-salary finances: support children’ education, accommodation, transportation, etc
    Multiple job holdings may result due to low salaries. Moon-lighting in the private sector is one strategy for HWF in the public sector to survive, however it can lower the efficiency in the public sector.
    29. Supportive working environment with essential logistics
  • Partnerships with international developmental partners for sustainable long term investment in education and training of HWF.
    Existences of co ordination mechanisms for international funds to align with national health priorities and effective scaling up of health workers training and education.
    Partnerships with academic professional bodies for quality assurance and accreditation such as the World Federation for Medical Education.
    Partnerships with the Global Health Workforce Alliance and the Asia-Pacific Action Alliance of Human Resources for Health form a platform for technical co-operation and sharing of expertise in HRH development. HWF observatories are good ways to share information and case studies with regard to HWF development.
    HWF issues relating to international migration requires policy dialogue with international organizations like International Labour Organization (ILO), International Organization on Migration (IOM), Organization for Economic Co operation and Development (OECD), Government to Government negotiations in ethical recruitment practices, and partnership building becomes important.
    Private-public partnerships not only for scale-up of disease-specific programs and community-based health workforce training and education to improve coverage, but also for training and multi-skilling of HWF.
  • Partnerships with international developmental partners for sustainable long term investment in education and training of HWF.
    Existences of co ordination mechanisms for international funds to align with national health priorities and effective scaling up of health workers training and education.
    Partnerships with academic professional bodies for quality assurance and accreditation such as the World Federation for Medical Education.
    Partnerships with the Global Health Workforce Alliance and the Asia-Pacific Action Alliance of Human Resources for Health form a platform for technical co-operation and sharing of expertise in HRH development. HWF observatories are good ways to share information and case studies with regard to HWF development.
    HWF issues relating to international migration requires policy dialogue with international organizations like International Labour Organization (ILO), International Organization on Migration (IOM), Organization for Economic Co operation and Development (OECD), Government to Government negotiations in ethical recruitment practices, and partnership building becomes important.
    Private-public partnerships not only for scale-up of disease-specific programs and community-based health workforce training and education to improve coverage, but also for training and multi-skilling of HWF.
  • Human resources for health2010 25th june mph

    1. 1. Human Resources for Health Dr. Nilar Tin
    2. 2. A Rational approach to Health manpower planning (1978) Tom Hall 1. A newly expanded regional hospital system, completed at great cost with a foreign loan on which commercial interests are paid, stands unused for lack of nursing personnel. 2. Over half of the graduates of a ministry of health six-month training programme for environmental sanitation personnel were lost permanently to the health sector owing to failure by the ministry to create necessary jobs in time. 3. Health authorities in the developing countries lament over the many physicians who emigrates following graduation, while at the same time citing with pride the high pass rate of these graduates in licensing examinations in developed countries.
    3. 3. 4. Health and political authorities, in their desire to avoid providing rural communities with “second-class” health care, oppose the use of non-professional personnel in such areas, hence ensuring that population will be without health care at all. 5. The gift by a developed country of a modern university hospital to a developing country has become a double liability to the recipient- a major drain on its health budget and a teaching facility inappropriate to local training needs. 6. One government agency has funded the development of a large number of training programmes for medical assistants (HA), while another in charge of reimbursements for health services under the social insurance system, has declined to approve payment for the services of these assistants working under medical supervision.
    4. 4. 7. In order to cover the payroll of an overstaffed health system, the budgets for drugs, equipment, and maintenance of facilities have been cut to the point where the productivity of staff is severely compromised 8. Unwilling to jeopardize the “quality of care” by expanding its medical school capacity to meet its national needs, a country has ended up by relying on large numbers of immigrant physicians urgently needed in their home countries and ill-equipped to practise medicine in the host countries. 9. Over one third of the people in one continent are without medical care despite a reasonably good overall doctor: population ratio. 10. (42) new medical schools have opened in one country in 4 years.
    5. 5. The scope of Health Manpower Process Overall aim: To ensure the manpower needed by the health care delivery system Health MP Planning Health MP Production Goal To provide the framework within which HMP process takes place To provide the manpower required Objective To specify the no: of To produce x teams and the people of y types composition needed to improve the level of health up to a proposed level Health MP Management To optimize the use of HMP To determine MP distribution & productivity standards, patterns of utilization &non labour inputs
    6. 6. The scope of Health Manpower Process Health MP Planning Strategy Health MP Production -Regional (sub-national) -Educational planning and local planning programming -HMP project formulation -Aggregation, reconciliation and consolidation -programming educational objectives & teaching methods Health MP Management Reorganization -regionalization -integration of prevention and cure -country health programming PHC -HMP project management
    7. 7. The scope of Health Manpower Process Health MP Planning Activities -Planning and programming -Coordination -Monitoring and evaluating implementation -Research and development Health MP Production -Recruitment campaign Health MP Management Establishment and Implementation of: -supervision system -Definition of -referral system admission -continuing education procedures and -recruitment & syllabus selection procedures -career development -Definition of schemes teaching methods -deployment of manpower -Evaluation of -staffing patterns process and products
    8. 8. The scope of Health Manpower Process Health MP Planning Targets X health teams of Y composition in operation by time T Health MP Production X trained personnel of Y type by time T Health MP Management X units of service of specified quality delivered to defined population -coverage HRH planning seeks to ensure that: -the right numbers of HRH are available -at the right place -at the right time -with the requisite skills and motivation to deliver health care to the population
    9. 9. Working together for health 2006  We have to work together to ensure access to a motivated, skilled, and supported health worker by every person in every village. (LEE Jong-wook 2005)  WHO Region of America 10% global burden-has 37% of the world’s health workers spending more than 50% of world’s health financing (Why?)  Africa Region -24% of burden but only 3% of health workers, less than 1% of world’s health expenditure (Why?)
    10. 10. Push & Pull Factors  Push Factors    Endogenous Exogenous Pull Factors - low remuneration levels - work associated risks—TB,HIV/AIDS - inadequate HR plan with unrealistic workload - poor infrastructure - sub optimal conditions of work - lack of further education and career ladder - minimal or absent support and supervision - political insecurity - crime - taxation - aggressive recruitment by recipient countries - improved quality of life - study and specialization opportunities - improved pay
    11. 11. Working lifespan strategies ENTRY: Preparing the workforce Planning Education Recruitment WORKFORCE: Enhancing worker performance Supervision Compensation Systems supports Lifelong learning EXIT: Managing attrition Migration Career choice Health and safety Retirement WORFORCE PERFORMANCE Availability Competence Responsiveness Productivity
    12. 12. Entry-preparing the workforce  Building strong institutions:       For education is essential to secure no: and quality of health workers required by health system The world’s 1600 medical schools, 6000 nursing schools, 375 School of PH…need more schools of PH Shift of expectations of graduates from “know-all” to “know-how” Teaching staff…also have to be competent, require training, career incentives, credible support Telemedicine and distance education (pooling of resources and kn mgt) Assuring educational quality   Institutional accreditation and professional regulation (licensing, certification and registration) Too many private schools…benefits vs quality?
    13. 13. Workforce Enhancing Performance  Supervision makes a big difference      Fair and reliable compensation     Decent pay arrival on time Financial incentive Non-financial incentive-study leave/child care Critical support systems     Supportive supervision Clear job description Feedback on performance On the job training Lack in clean water, sanitation, adequate lighting Vehicles Drugs, working equipments Life long learning   Short term training Team work, sharing solutions
    14. 14. Exit: Managing migration and attrition  Managing migration of health workers     Keeping health work as a career of choice for women   Feminization-look into safety, protecting from violence Ensuring safe working environment    Should be planned migration Recipient countries should adopt responsible recruitment policy, treat health workers fairly and consider entering into bilateral agreementsWHO Code of practice in recruiting health workforce Excessive internal migration can cause urban concentration and rural neglect HIV/AIDS-outflow from workforce due to illness, disability and death Occupational hazards Retirement planning  Recruit retirees back to work force-improve their living conditions
    15. 15. Priority Countries The World Health Report 2006 identified 57 priority countries that fell below the threshold of 2.3 doctors, nurses and midwives for every 1000 people- the minimum number generally considered necessary to deliver essential health services  Africa, Asia, Central Americal, South America, & Oceania 
    16. 16. Health Workforce 2008  Health Workforce is defined as a stock of all people engaged in actions whose primary intent is to enhance health CBHV Public HWF Private NGO Health care Provider H. Management and Support Workers
    17. 17. Health Challenges for SEAR       Emerging infectious diseases: SARS, AI, HIV, TB, Malaria Public Health Emergencies: natural disasters requiring rapid response and disaster preparedness Chronic non-communicable diseases requiring long term care Developments in biotechnology-advanced diagnostic and curative facilities-require labour intensive health care services Rising patients’ expectations of health care delivery Health workforce shortages
    18. 18. Health Workforce (HWF) Challenges  Need for evidence based strategic HWF planning  Comprehensive data regarding HWF distribution, public, private, community, NGOs, partners  Imbalances in skills, geographic distribution, gender, optimal skill-mix  Relevance of training: pre-service, in-service training directed to country health needs.  HWF recruitment, management, working environment, financing, retention, exit/migration of HWF  International and internal migration of health workforce
    19. 19. WHO’s Response to HWF Problems  59th session of the Regional Committee: Dhaka Declaration: Strengthening Health Workforce in countries of the SEA Region, 2007  Regional Strategic Plan for HWF development in the SEA Region  WHO HQ-Regional-Country HWF data base harmonized with the country data base  Regional guidelines for HWF Strategic Plan  WHO Code of Practice on international recruitment of HWF (2010 63rd WHA)
    20. 20. Global Response to HWF Problems  Global Health workforce Alliance GWHA  2008 The Kampala Declaration and Agenda for Global Action (1st Global Health Forum in Uganda)  To strengthen HWF at all levels To track progress in implementing the strategies adopted To have access for all to skilled, motivated and supported health workers  
    21. 21. Rationale for Health Workforce Strategic Planning 1. HWF Shortages 2. Lack of reliable, harmonized data on HWF 3. Resource Constraints 4. Partnership development 5. Requirements are diverse categories HWF
    22. 22. Health Workforce Imbalances
    23. 23. HWF Density in SEAR (doc,nur,mw,dent,pharm,lab tech only) Density of Health Work Force in SEAR Countries SEA Region Timor Leste Thailand Sri Lanka Nepal Myanmar Maldives Indonesia India DPRK Bhutan Bangladesh 0 10 20 30 40 50 60 Total Health workers per 10 000 population 70 80 90
    24. 24. WHY do we need HWF Strategic Planning? “Strategic Planning for HWF”  Coordinated: multi factorial, multi-stakeholders involvement  Systematic: time constraints, resource limitations  National HWF Policy approach  Partnership between national and international developmental partners  Medium-term or long-term vision to achieve targets
    25. 25. The Strategic planning framework The strategic framework consists of six steps which are: Health Workforce Situational analysis  Problem Identification & Prioritization  Projection of HWF Needs and Demands  HWF Policy Review and Identification of Strategic Areas  Formulating the Strategic Plan  Monitoring and Evaluation
    26. 26. Health Workforce Strategic Planning Framework
    27. 27. Six major factors influencing the entry, sustainability and exit from HWF IN HS       Education and training HWF Management HWF Financing HWF Policy Partnerships Leadership
    28. 28. 1.Education/Training of HWF  Pre-service education/training; institutional capacity  In-service education and training and capacity building.  Relevance of curricula to address country’s health need  Inclusion of soft skills  Faculty development.  Accreditation system for internal and internal &external quality assurance mechanism.  Medical and Health professional education research for innovations in education to address current HWF problems.
    29. 29. 2.HWF management capacity  Density and distribution of HWF, with regard to equitable coverage, gender equity and relevance, appropriate skill mix  HWF information system, regular updating of HWF data including private sector and NGOs, health workforce in numbers, competencies and distribution  Financing of HWF which consists of salary profile of different categories of HWF, for different geographic areas, different sectors, and  Incentive system for manning remote health centers.
    30. 30. 2.HWF management capacity  HWF support for housing, healthcare, transportation and children’s education and welfare, working environment supportive for maximum performance; facilities and equipments, drugs, supplies and support staff.  Opportunities for promotion, personal and professional development for HWF.  Data, information and causes for attrition, brain drain, migration pattern and presence of “ghost health workers” or absenteeism.
    31. 31. 3.HWF policy and regulations  Is there HWF policy reflected in the National Health Policy of the country?  Work load indicators and staffing needs  Deployment policies, recruitment policies, transfer, promotion, grievances, incentives including performance-based incentives, and career advancement policies.  HWF exit policy: pension and gratuity entitlements have to be taken into account.  Regulations on ethical conduct, liability and quality assurance mechanisms for the HWF, both in public and private sector.
    32. 32. 3.HWF policy and regulations  Relationship between HWF and Public Health standard at different level of health facilities.  Coordination with other related sector/departments.  International code of conduct for recruitment of health professionals
    33. 33. 4. HWF Financing Macroeconomic profiles:      national health accounts and national health spending in relation to GDP, national budget for HRH development, other sources of funding /spending for HRH  Salary rates of different levels of HRH and other entitlements  Salary rates compared to bench marks in the other sectors
    34. 34. 4. HWF Financing  Ratio of public to private out of pocket spending for health  Health spending on non-salary finances  Multiple job holdings may result due to low salaries.  Moon-lighting in the private sector is one strategy for HWF in the public sector to survive, however it can lower the efficiency in the public sector.  Supportive working environment with essential logistics
    35. 35. 5.HWF partnerships  Partnerships with international developmental partners  Existences of co ordination mechanisms for international funds to align with national health priorities and effective scaling up of health workers training and education.  Partnerships with academic professional bodies for quality assurance and accreditation such as the World Federation for Medical Education.  Partnerships with the Global Health Workforce Alliance and the Asia-Pacific Action Alliance of Human Resources for Health
    36. 36. 5.HWF partnerships HWF issues relating to international migration requires policy dialogue with international organizations like -----     International Labour Organization (ILO), International Organization on Migration (IOM), Organization for Economic Co operation and Development (OECD), Government to Government negotiations in ethical recruitment practices, and partnership building becomes important. Private-public partnerships not only for scale-up of disease-specific programs and community-based health workforce training and education to improve coverage, but also for training and multi-skilling of HWF
    37. 37. 6. HWF leadership    Leadership development for HWF planning and management. Focal point for HWF, National Committee for HWF development, Multi-stake holder mechanism is in place or not.
    38. 38. Future Plan for working together  Assist member countries to develop and implement CSP- HWF  Scaling up of training and education of all categories of HWF inclusive of CBHW, CBHV.  Innovative educational interventions:  need based,  team-based,  field-based curricula review,  better co ordination between training and need  Financial support to employ and deploy the trained workforce
    39. 39. Future Plan for working together  HWF management capacity:  for HWF recruitment and equitable deployment,  working conditions conducive for optimal HWF performance,  supportive supervision,  incentive system for retention.  Pooling of Financial resources:  for long term investment on HWF development,  harmonization and alignment of donors to national priorities.
    40. 40. Health System Strengthening by PHC  HWF is vital for health system strengthening  CBHW & CBHV are vital to delivery of health care  HWF development to strengthen Township health system
    41. 41. Projection of HWF Needs and Demands Supply Forecasting  What numbers of HWF by category are available currently?  What is the geographic distribution of different categories of HWF?  What is the attrition rate?  Exit from HWF rate and pattern?  Rate of internal and external migration?  Recruitments from other sources? Government –to – government MOU for recruitment of HWF?  What categories need to be scaled-up training?
    42. 42. Projection of HWF Needs and Demands  Supply Forecasting Is there institutional capacity for scaling up training without compromising the quality of output?  What are the logistic support required and faculty needed for scaling up training?  How long will it take to build institutional capacity to meet the needs?  How much financial support will we need to meet the supply costs?  How do will fill the supply gap?  Does the current HWF production policy support the proposed action to meet the supply needs?
    43. 43. Projection of HWF Needs and Demands   Demand Forecasting There are two types of demand, one from the supplier of health care side (public and private sector) and the other from patients or clients. When carrying out a demand analyses there are many other non-health factors that need consideration.     Economic growth of the country, growth of the private health sector, patients’ changing expectations are few factors that will shape up the countries health service demands. For example in a country with rapidly expanding economic growth leading to rapid expansion of the private health sector,   health trade and tourism, demands for health workers for the private sector has to be taken into account, so that the public sector will be able to attract and retain sufficient health personnel.
    44. 44. Projection of HWF Needs and Demands Demand Forecasting  What types of HWF do we need most for the functioning of the health system according to findings of situation analysis?  What tools will we use to project the need?  What is the ideal (bench mark) and what is the current situation?
    45. 45. Projection of HWF Needs and Demands Demand Forecasting  What are the gaps for optimal function of the health system?  How do we fill the gaps? Scale-up production/training or scale-up recruitment?  How much financial support will we need to fill the gap?  Does the current NHP support the proposed action to meet the demand of the health system?
    46. 46. Projection of HWF Needs and Demands Methods of HWF demand projection  There are many methods that have been developed over time for health workforce demand projection of which some are basic and some requiring computer software applications.  The basic methods that have been continuously used for demand projection by many countries are:  HWF requirements based on the population ratios  HWF requirements based on service demands  HWF requirements based on health system needs  Work load indicators and staffing needs (WISN)  “Soft PODD which is a Software Tool for Online Policy Diagnosis and Dialogue”.

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