The Right to Health and Health Workforce Planning


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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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The Right to Health and Health Workforce Planning

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