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Building Capacities: Policy, Advocacy: Scheffler & Fulton

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Evidence based Estimates of Health care Professional Shortages: What can Africa afford and what else can be done? …

Evidence based Estimates of Health care Professional Shortages: What can Africa afford and what else can be done?

Richard Scheffler and Brent Fulton, UC Berkeley

Published in: Education, Economy & Finance

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    • 1. Brent D. Fulton, PhD Global Center for Health Economics and Policy Research* School of Public Health, University of California, Berkeley *A Pan American Health Organization/World Health Organization Collaborating Center on Health Workforce Economics Research 18 th Annual Global Health Education Consortium Conference & 7 th Annual Western Regional International Health Conference Transcending Global Health Barriers: Education & Action University of Washington April 4, 2009 Estimates of Sub-Saharan Africa Health Care Professional Shortages in 2015: What Can Be Done at What Cost
    • 2. Overview of Presentation
      • Health workforce shortages in SSA in 2015
      • Wage bill to eliminate the shortages
      • Full cost to eliminate shortages
      • Discussion and policy implications
    • 3. Co-Authors
      • Richard M. Scheffler, PhD
      • Distinguished Professor of Health Economics & Public Policy
      • Director, Global Center for Health Economics and Policy Research
      • University of California, Berkeley
      • Chris Brown Mahoney, PhD
      • National Institute of Mental Health Post-doctoral Scholar
      • Global Center for Health Economics and Policy Research
      • University of California, Berkeley
      • Mario R. Dal Poz, MD, PhD, MSc
      • Coordinator, Human Resources for Health
      • World Health Organization
      • Alexander S. Preker, MD, PhD
      • Head, Health Investment Policy and Lead Economist
      • The World Bank
    • 4. Research Papers
        • Scheffler RM, Liu JX, Kinfu Y, Dal Poz MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” The Bulletin of the World Health Organization 2008, 86:516-523.
          • Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf
        • Scheffler RM, Mahoney CB, Fulton BD, Dal Poz MR, Preker AS. “Estimates of Sub-Saharan Africa Health Care Professional Shortages in 2015: What Can Be Done at What Cost?” (submitted for publication).
    • 5. Methodology for Doctors
      • Forecast future need and demand for physicians in 2015:
        • Needs-based model (WHO): Number of physicians required to achieve 80% coverage of births by a skilled attendant
        • Demand-based model: GNI as key indicator of health spending
      • Project supply: what will be the future supply of physicians if current trends continued?
    • 6. Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization . Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf
    • 7. Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization . Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf
    • 8. Methodology for Nurses and Midwives
      • Need
        • 2.28 workers per 1,000 population (WHO, 2006)
        • 0.55 doctors (Scheffler et al., 2008)
        • 1.73 nurses and midwives
      • Supply
        • Doctors
        • Apply combined nurse-to-doctor and midwife-to-doctor ratio
      • Shortage = Need – Supply
    • 9. Health-worker shortage in 2015 (31 African countries) *Preliminary results. Do not cite.
    • 10. Health worker shortage in 2015 (countries with largest projected shortage per 1,000 population) Note: Total is based on non-rounded numbers. Preliminary results. Do not cite. Need: 0.55 1.73 2.28
    • 11. Health worker shortage in 2015 (cont.) (countries with largest projected shortage per 1,000 population) Note: *Negative number represents a surplus. Total is based on non-rounded numbers. Preliminary results. Do not cite. Need: 0.55 1.73 2.28
    • 12. Overview of Presentation
      • Health workforce shortages in SSA in 2015
      • Wage bill to eliminate the shortages
      • Full cost to eliminate shortages
      • Discussion and policy implications
    • 13. Monthly Wage Statistics in Africa ($US 2007) Source: Occupational Wages around the World (OWW) Database Doctors ($) Nurses ($) Doctor-to-Nurse Ratio Average 522 333 1.8 Median 423 272 1.7 Minimum 33 18 1.0 Maximum 1,779 1,129 5.0
    • 14. Annual wage bill required to remove health worker shortage in Africa for 2015 Note: Numbers are based on rounded numbers. Preliminary results. Do not cite.
    • 15. Annual wage bill required to remove health worker shortage in Africa for 2015 (millions $US 2007) Source: 2003 Government Health Budget, World Health Report 2006 Note: Total is based on non-rounded numbers. Preliminary results. Do not cite.
    • 16. Annual wage bill required to remove health worker shortage in Africa for 2015 (millions $US 2007) ( cont.) Note: *Negative amount represents a surplus. Total is based on non-rounded numbers. Preliminary results. Do not cite.
    • 17. Overview of Presentation
      • Health workforce shortages in SSA in 2015
      • Wage bill to eliminate the shortages
      • Full cost to eliminate shortages
      • Discussion and policy implications
    • 18. Full Cost to Scale Up
      • Wage bill for doctors, nurses, and midwives ($2.6 bn)
      • Other recurring costs ($16.4 bn)
        • Wage bill for other health workers and support staff
        • Funds for supplies, pharmaceuticals, equipment, and facilities
      • Training costs ($2.6 bn / year)
      *Preliminary results. Do not cite.
    • 19. Full Cost to Scale Up in Context Sources: Authors’ analysis, World Health Report 2006, and Effective Aid Better Heath (2008) *Preliminary results. Do not cite.
    • 20. Overview of Presentation
      • Health workforce shortages in SSA in 2015
      • Wage bill to eliminate the shortages
      • Full cost to eliminate shortages
      • Discussion and policy implications
    • 21. Discussion and Policy Implications
      • Productivity improvements--3% per year reduces shortage from 792,000 to 575,000
      • Worker incentives, both monetary and non-monetary
      • Skill mix
      • Training capacity and partnerships
    • 22. Skill Mix Analysis
    • 23. Questions? End of Presentation
    • 24. Conceptual Framework Demand Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization. Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf
    • 25. Supply projection
      • ln(physicians per 1,000 population t ) = α 0 + α 1 *Year t + ε t
      • Where ε t is a random disturbance term
      • and
      • T = {1980,…,2001}
      Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization. Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf
    • 26. Needs-based model projection
      • arcsine(percent coverage) = β 0 + β 1 * ln(physicians per 1,000 population i,t ) + μ i + η t + δ i,t
      • Where
      • μ i + = Country fixed effect
      • η t = Time fixed effect
      • δ i,t = Random disturbance term
      Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization. Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf
    • 27. Demand-based model projection
      • ln(physicians per 1,000 population i,t ) = γ 0 + γ 1 *ln(GNP per capita i,t-5 )+ γ 2 *IncomeDummy i + μ i + ζ i,t
      • Where
      • μ i reflects a vector of country fixed effects
      • ζ i,t is a random disturbance term
      Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization. Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf
    • 28. Shortage Calculation for Mozambique (workers per 1,000 population)
      • Doctors need minus supply:
        • 0.55 – 0.01 = 0.54
      • Nurse & midwife need minus supply:
        • 1.73 – 0.14 = 1.59
      • Total need minus supply:
        • 2.28 – 0.15 = 2.13
      *Preliminary results. Do not cite.*
    • 29. Number of countries with projected shortages of doctors Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization . Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf Note: A country was defined to have a shortage if the projected supply of physicians met less than 80% of the projected demand or need.
    • 30. Summary of Findings for Africa
      • Over 30 countries with projected doctor shortages in 2015
      • Shortage totals 257,000 doctors
        • Needs-based demand: 369,000
        • Projected supply: 112,000
    • 31. Doctor Shortages in Africa in 2015 Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization . Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf
    • 32. Doctor Shortages in Africa in 2015 (cont.) Scheffler, RM, Liu, JX, Kinfu, Y, Dal Poz, MR. “Forecasting the Global Shortages of Physicians: An Economic- and Needs-based Approach.” April 2008, The Bulletin of the World Health Organization . Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf Countries with no doctor shortages: Botswana, Congo, Namibia, Mauritius, South Africa and Algeria
    • 33. Scenario A: wage bill savings from increasing nurse & midwife-to-doctor ratio by 50 percent *Preliminary results. Do not cite.*