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The Right to Health and Health Workforce Planning


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Overview: …

Refresher on health workforce crisis
Right to health overview
Value of human rights approach to health workforce planning
Human rights and health workforce planning
What you can do

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  • 1. The Right to Health and Health Workforce Planning By Eric A. Friedman Physicians for Human Rights Physicians for Human Rights National Student Conference Providence, RI, Jan. 31-Feb. 1, 2009 [Contact:]
  • 2. Overview
    • Refresher on health workforce crisis
    • Right to health overview
    • Value of human rights approach to health workforce planning
    • Human rights and health workforce planning
    • What you can do
  • 3. Overview of health workforce crisis
    • Africa has 24% of the world’s disease burden, but only 3% of the world’s health workers
    • WHO has identified 57 countries with severe shortages, including 36 in sub-Saharan Africa
      • Shortage is 4.3 million health workers total, 1.5 million in Africa
  • 4. Nurses, midwives, and physicians per 100,000 population
  • 5. Beyond numbers
    • Severe internal inequities, underserved rural areas
    • Poor management and lack of regular, supportive supervision
    • Lack of medicines and supplies
    • Unsafe working conditions
    • Mistreatment of patients
  • 6. Health workforce solutions
      • Beyond the health system (addressing economy, political situation, corruption, etc.)
      • Health system investments
        • Medicines, supplies, equipment, facility infrastructure
        • Logistic systems, referral systems, financial management, etc.
        • Infection prevention and control (e.g., gloves)
      • Health worker-specific investments:
        • Financial and non-financial incentives
        • Massive scale-up of pre-service training
        • Continuing professional development
        • Comprehensive health and HIV/AIDS services
        • Health workforce management
      • Policy changes
        • Mid-level and community health workers
        • Retirement age
  • 7. Right to health overview
  • 8. Right to health (1)
    • States “recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. ” – International Covenant on Economic, Social and Cultural Rights, article 12
    • Further defined in General Comment 14 of the Committee on Economic, Social and Cultural Rights
    • Health services, goods, and facilities must be accessible, available, acceptable, and of good quality
    • Obligation to respect, protect, and fulfill right
  • 9. Right to health (2)
    • State must spend “maximum of its available resources” towards fulfilling this and other rights
    • States must progressively realize this right
      • “ continuing obligation to move as expeditiously and effectively as possible towards the full realization of” the right
    • Minimum “core obligations” that states must meet now
      • Equitable distribution of health goods, services, and facilities
      • Non-discriminatory access
      • To adopt and implement a national public health strategy
  • 10. Value of human rights approach to health workforce planning
  • 11. A necessary combination
    • Technical considerations + Human rights
    • = Skilled, motivated, equipped, supported health workforce for everyone
  • 12. Value of human rights approach
    • Guides what plan aims to achieve
      • Health services must be accessible to everyone
    • Emphasizes certain areas
    • Adds additional aspects
  • 13. Right to health and health workforce planning
  • 14. Elements
    • Accountability
    • Participation
    • Equity and non-discrimination
    • Comprehensiveness
    • Funding
    • Quality
    • Sustainability & human rights education
  • 15. Guiding goals: Accountability to commitments (1)
    • Health workforce plan as accountability mechanism
      • Accountability to right to health, universal access HIV and other to health services, Millennium Development Goals
      • If you don’t plan for a sufficient health workforce, you won’t get one
      • Reality: Many countries developing policies, few with comprehensive, costed plans
      • Not all plans aimed at achieving goals
        • Uganda scenarios: Business as Usual v. Health for People
  • 16. Guiding goals: Accountability to commitments (2)
    • Goals
      • Meet commitments – suggest what is achievable with maximum of available resources and progressive realization
        • Progressive realization: “continuing obligation to move as expeditiously and effectively as possible towards the full realization….”
      • Near term: Essential health care to be available to all
        • “ Minimum basket” concept
      • Build towards health care at all levels accessible to all
    • How measure?
      • One approach: Determine number of health workers by considering level of coverage needed to meet goals, which workers, and how long for each activity
  • 17. Adding emphasis: Participation
    • Recognized that needs to be more than Ministry of Health involved in developing plan, but…
    • Who is involved?
    • How are they involved?
  • 18. Adding emphasis: Participation diverse perspectives
    • Health consumers
    • Health workers
    • Poor and rural populations
    • Home caregivers
    • Women
    • Youth and elderly
    • People living with HIV/AIDS
    • People with disabilities
  • 19. Adding emphasis: Features of participation
    • Resources are dedicated to participation
    • People meaningfully informed and opinions respected
    • Possibilities
      • Inclusive team leading plan development
      • Community and national forums open to all
      • Consultations with NGOs and health worker groups
      • Opportunities for written input
    • Continued participation in monitoring and evaluating plan implementation
  • 20. Adding emphasis: Benefits of participation
    • Ondo State, Nigeria
    • Asked health workers their needs
    • 62%: Equipment, supplies, medicines
    • Government responded
    • Proportion of nurses serving in rural areas 28% > 66% (3 years)
  • 21. Added emphasis: Equitable distribution (1)
    • Equitable distribution and emphasis on needs of marginalized and vulnerable populations central to right to health
    • Requires using all levers to improve distribution and reach underserved
  • 22. Added emphasis: Equitable distribution (2)
    • Incentives
      • Zambia: more than 70 physicians on 3-year contract in rural areas receive:
        • hardship allowance
        • accommodation allowance
        • education allowance for children
        • eligibility/funding for post-graduate training
        • eligibility for a loan
      • Expanding to nurse tutors, nurses, clinical officers, more
    • Basic infrastructure
      • Ondo State, Nigeria
      • Zambia to receive support from GAVI to bring clean water and power to rural health facilities
  • 23. Added emphasis: Equitable distribution (3)
    • Education
      • Recruitment from rural areas
      • Scholarships to serve in rural areas
      • Training in primary health care
      • Service in rural areas
    • Skills mix
      • Who is most likely to serve in rural areas?
  • 24. Additional aspects: Countering health worker discrimination (1)
    • “ Clinic staff were reluctant to test me because they didn’t think older people like myself were at risk.” – 62-year old South African grandmother, HIV-positive
    • “ Unfortunately the nurse I met knew that I was HIV positive; she refused to touch my wound and gave me the bandage to stop the bleeding myself.” – HIV/AIDS patient, Nigeria
    • “ Governments tell drug users to act responsibly and not to infect others, but the clinics shut the doors in the faces of those seeking to take care of themselves.” – Open Society Institute
  • 25. Additional aspects: Countering health worker discrimination (2)
    • Proper information and training (pre-service and in-service)
    • Clear policies against discrimination
    • Management and leadership sensitized to dangers of discrimination and lack of respect for patients
    • Avenues of redress for patients
    • Protective equipment (universal precautions)
  • 26. Additional aspects: Human rights education for health workers
    • Human rights training for health workers
      • Own practice
      • Advocacy
      • Policymaking
    • “ A deep understanding of human rights compels one to stand in solidarity with marginalized groups who suffer discrimination in terms of access to healthcare service delivery. ” – Physician, Niger State, Nigeria
    • “ Human rights education changes your perception from seeing medicine as an employment – where you can make some money – to a service to humanity.” – Medical Student, Kampala, Uganda
  • 27. Additional aspects: Dissemination of plan
    • Government accountable to people
    • Should publicly disseminate plan (and key aspects)
    • Translate into local languages
    • Educate people on rights and entitlements under the plan
  • 28. What you can do
  • 29. Steps taken so far
    • PHR published The Right to Health and Health Workforce Planning: A Guide for Government Officials, NGOs, Health Workers and Development Partners (2008)
    • Broad distribution
    • Turning guide into more user-friendly indicators
    • Seeking to have indicators part of Global Health Workforce Alliance (GHWA) monitoring and evaluation process of country actions
      • GHWA is international partnership addressing health workforce crisis
    • Seeking to have Guide part of standard package of tools to assist countries in developing health workforce plans
  • 30. How you can help
    • Share health workforce planning guide
    • Potential project
      • Review health workforce plans
      • Analyze plans based on right to health and health workforce indicators
      • Please let me know if you would be interested ( [email_address] )
  • 31. PEPFAR and health workers
    • PEPFAR reauthorization
      • Train and support the retention of at least 140,000 new health professionals and paraprofessionals
      • Help countries achieve 2.3 doctors/nurses/midwives per 1,000 population and strengthen primary health care
      • Support national health strategy, advance safe working conditions, promote codes of conduct on ethical recruitment
  • 32. In-district PEPFAR meetings on health workers
    • Law sets stage, now need successful implementation
    • In-district meetings
      • Appropriations!!! – Overall foreign aid, PEPFAR
      • Ensure that PEPFAR does train and retain at least 140,000 new health workers
      • Help countries develop and fully implement rights-based, needs-based health workforce strategies
      • Establish policy to enable (at the least) all health workers in PEPFAR-supported programs to have access to HIV and other health services and safe working conditions
        • Train on respecting rights and dignity of all patients
    • New health worker legislation?
  • 33. Health care and safety for health workers
    • Right to access health care, right to safe working conditions
    • Improves retention
    • Petition to have PEPFAR establish policy ensuring health care and safety for all health workers in its programs
    • Material for endorsements: yours, friends and colleagues, professors, deans, organizations, universities