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?

Richard Scheffler and Brent Fulton, UC Berkeley

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  • Building Capacities: Policy, Advocacy: Scheffler & Fulton

    1. 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. 2. Overview of Presentation <ul><li>Health workforce shortages in SSA in 2015 </li></ul><ul><li>Wage bill to eliminate the shortages </li></ul><ul><li>Full cost to eliminate shortages </li></ul><ul><li>Discussion and policy implications </li></ul>
    3. 3. Co-Authors <ul><li>Richard M. Scheffler, PhD </li></ul><ul><li>Distinguished Professor of Health Economics & Public Policy </li></ul><ul><li>Director, Global Center for Health Economics and Policy Research </li></ul><ul><li>University of California, Berkeley </li></ul><ul><li>Chris Brown Mahoney, PhD </li></ul><ul><li>National Institute of Mental Health Post-doctoral Scholar </li></ul><ul><li>Global Center for Health Economics and Policy Research </li></ul><ul><li>University of California, Berkeley </li></ul><ul><li>Mario R. Dal Poz, MD, PhD, MSc </li></ul><ul><li>Coordinator, Human Resources for Health </li></ul><ul><li>World Health Organization </li></ul><ul><li>Alexander S. Preker, MD, PhD </li></ul><ul><li>Head, Health Investment Policy and Lead Economist </li></ul><ul><li>The World Bank </li></ul>
    4. 4. Research Papers <ul><ul><li>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. </li></ul></ul><ul><ul><ul><li>Available at: http://www.who.int/bulletin/volumes/86/7/07-046474.pdf </li></ul></ul></ul><ul><ul><li>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). </li></ul></ul>
    5. 5. Methodology for Doctors <ul><li>Forecast future need and demand for physicians in 2015: </li></ul><ul><ul><li>Needs-based model (WHO): Number of physicians required to achieve 80% coverage of births by a skilled attendant </li></ul></ul><ul><ul><li>Demand-based model: GNI as key indicator of health spending </li></ul></ul><ul><li>Project supply: what will be the future supply of physicians if current trends continued? </li></ul>
    6. 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. 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. 8. Methodology for Nurses and Midwives <ul><li>Need </li></ul><ul><ul><li>2.28 workers per 1,000 population (WHO, 2006) </li></ul></ul><ul><ul><li>0.55 doctors (Scheffler et al., 2008) </li></ul></ul><ul><ul><li>1.73 nurses and midwives </li></ul></ul><ul><li>Supply </li></ul><ul><ul><li>Doctors </li></ul></ul><ul><ul><li>Apply combined nurse-to-doctor and midwife-to-doctor ratio </li></ul></ul><ul><li>Shortage = Need – Supply </li></ul>
    9. 9. Health-worker shortage in 2015 (31 African countries) *Preliminary results. Do not cite.
    10. 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. 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. 12. Overview of Presentation <ul><li>Health workforce shortages in SSA in 2015 </li></ul><ul><li>Wage bill to eliminate the shortages </li></ul><ul><li>Full cost to eliminate shortages </li></ul><ul><li>Discussion and policy implications </li></ul>
    13. 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. 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. 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. 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. 17. Overview of Presentation <ul><li>Health workforce shortages in SSA in 2015 </li></ul><ul><li>Wage bill to eliminate the shortages </li></ul><ul><li>Full cost to eliminate shortages </li></ul><ul><li>Discussion and policy implications </li></ul>
    18. 18. Full Cost to Scale Up <ul><li>Wage bill for doctors, nurses, and midwives ($2.6 bn) </li></ul><ul><li>Other recurring costs ($16.4 bn) </li></ul><ul><ul><li>Wage bill for other health workers and support staff </li></ul></ul><ul><ul><li>Funds for supplies, pharmaceuticals, equipment, and facilities </li></ul></ul><ul><li>Training costs ($2.6 bn / year) </li></ul>*Preliminary results. Do not cite.
    19. 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. 20. Overview of Presentation <ul><li>Health workforce shortages in SSA in 2015 </li></ul><ul><li>Wage bill to eliminate the shortages </li></ul><ul><li>Full cost to eliminate shortages </li></ul><ul><li>Discussion and policy implications </li></ul>
    21. 21. Discussion and Policy Implications <ul><li>Productivity improvements--3% per year reduces shortage from 792,000 to 575,000 </li></ul><ul><li>Worker incentives, both monetary and non-monetary </li></ul><ul><li>Skill mix </li></ul><ul><li>Training capacity and partnerships </li></ul>
    22. 22. Skill Mix Analysis
    23. 23. Questions? End of Presentation
    24. 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. 25. Supply projection <ul><li>ln(physicians per 1,000 population t ) = α 0 + α 1 *Year t + ε t </li></ul><ul><li>Where ε t is a random disturbance term </li></ul><ul><li>and </li></ul><ul><li>T = {1980,…,2001} </li></ul>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. 26. Needs-based model projection <ul><li>arcsine(percent coverage) = β 0 + β 1 * ln(physicians per 1,000 population i,t ) + μ i + η t + δ i,t </li></ul><ul><li>Where </li></ul><ul><li>μ i + = Country fixed effect </li></ul><ul><li>η t = Time fixed effect </li></ul><ul><li>δ i,t = Random disturbance term </li></ul>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. 27. Demand-based model projection <ul><li>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 </li></ul><ul><li>Where </li></ul><ul><li>μ i reflects a vector of country fixed effects </li></ul><ul><li>ζ i,t is a random disturbance term </li></ul>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. 28. Shortage Calculation for Mozambique (workers per 1,000 population) <ul><li>Doctors need minus supply: </li></ul><ul><ul><li>0.55 – 0.01 = 0.54 </li></ul></ul><ul><li>Nurse & midwife need minus supply: </li></ul><ul><ul><li>1.73 – 0.14 = 1.59 </li></ul></ul><ul><li>Total need minus supply: </li></ul><ul><ul><li>2.28 – 0.15 = 2.13 </li></ul></ul>*Preliminary results. Do not cite.*
    29. 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. 30. Summary of Findings for Africa <ul><li>Over 30 countries with projected doctor shortages in 2015 </li></ul><ul><li>Shortage totals 257,000 doctors </li></ul><ul><ul><li>Needs-based demand: 369,000 </li></ul></ul><ul><ul><li>Projected supply: 112,000 </li></ul></ul>
    31. 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. 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. 33. Scenario A: wage bill savings from increasing nurse & midwife-to-doctor ratio by 50 percent *Preliminary results. Do not cite.*

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