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Human Resources for Health in South East Asia
Human Resources for Health in South East Asia
Human Resources for Health in South East Asia
Human Resources for Health in South East Asia
Human Resources for Health in South East Asia
Human Resources for Health in South East Asia
Human Resources for Health in South East Asia
Human Resources for Health in South East Asia
Human Resources for Health in South East Asia
Human Resources for Health in South East Asia
Human Resources for Health in South East Asia
Human Resources for Health in South East Asia
Human Resources for Health in South East Asia
Human Resources for Health in South East Asia
Human Resources for Health in South East Asia
Human Resources for Health in South East Asia
Human Resources for Health in South East Asia
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Human Resources for Health in South East Asia

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  • 1. Human Resources for Health in South East Asia:Challenges and Responses
    Churnrurtai Kanchanachitra
  • 2. Shortage and maldistribution
    Engagement in trade in health services
    Key Challenges
  • 3. Doctor and Nurse density (per 1,000)in South East Asia Region
    5 critical shortage countries
    210,000 gap
    Source: World Health Statistics 2009, country data for Indonesia, Thailand and Vietnam
  • 4. Under-five mortality and HRH density
    Calculated from World Health Statistics 2009
  • 5. Main factors leading to shortages
    Low production capacity
    70+576 doctors+nurses/year in Laos (need 4,484 doctors/nurses/midwives to meet the threshold of 2.28/1,000—7 years)
    290+410+398 doctors+nurses+midwives/year in Cambodia (need 12,592 to meet the threshold of 2.28/1,000—11 years)
    Low employment capacity
    About half of nurses graduated in Indonesia employed
  • 6. Gap ratio between highest and lowest province HRH densities in 4 countries
  • 7. Factors lead to maldistribution
    Distribution of health facility infrastructure
    Poor working and living conditions
    Opportunities to earn extra income in urban area
  • 8. Participation in Trade in Health Services
    Mode 2: Provide health care to foreign patients
    • Singapore, Thailand, Malaysia
    Mode 4: Movement of HRH across countries
    • Philippines, Indonesia
  • Foreign patients seeking health care
    Source: Ministry of Trade and Industry Singapore. The Healthcare Services Working Group
  • 9. Enabling factors for foreign patients seeking health care in SE Asia
    High quality medical services (JCI accredited hospitals--16 in Singapore, 11 in Thailand, six in Malaysia, three in Philippines and one each in Indonesia and Vietnam)
    Long queues and supply shortage in home countries
    Lower costs (A coronary bypass operation in the U.S. costs up to US$130,000 compared to less than $11,000 in Thailand and 16,500 in Singapore)
  • 10. Number of doctors and nurses working in OECD countries
    Migration Outlook: SOPEMI 2007, OECD Publishing
  • 11. Main destinations for Filipino nurses migration
    Source: POEA, 2009
  • 12. How the countries responded to the challenges
    Shortages
    Increase production quickly to compensate for the shortages but may compromise quality
    Up-graded assistant doctors to be doctor (Vietnam)
    Rotate high qualified staff to work in rural area (Vietnam)
    Role of private sector (Philippines and Indonesia)
    Skill-mix, professional mix, task shifting
    Point for consideration
    Quality VS quantity (in resource poor countries, scale up lower cadres may have to take into consideration—shorter time, lower costs)
    Employment opportunity for newly graduated
  • 13. How the countries responded to the challenges
    Maldistribution
    Incentive (financial and non-financial)
    Compulsory placement
    Rural recruitment for education
    Point for consideration
    Comprehensive strategies
    Sustainability
  • 14. Average Monthly income of doctors with different working experience in different settings, Thailand, 2010 ($US)
    Source: TinnakornNori
  • 15. Policy on trade in health services
    Policy to promote medical hub to encourage more patients to seek health care
    Impact on health care to the local people in term of require more HRH especially super-specialists
    Policy to promote export of HRH change from individual to bilateral and multilateral
    Studies are needed to assess on impact on health care to the local people
  • 16. Summary and Recommendations
    Challenges are similar to other countries in term of shortages and maldistribution
    Uniqueness is in the active engagement in trade in health services
    To cope with shortages in resource poor countries, scale up of lower cadres and apply task-shifting is a possible way
    Appropriate training is necessary to ensure quality
    Balance between trade and health has to take into account when develop policy on medical hub or export of HRH

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