Human Resources for Health in South East Asia:Challenges and Responses<br />Churnrurtai Kanchanachitra<br />
Shortage and maldistribution<br />Engagement in trade in health services<br />Key Challenges<br />
Doctor and Nurse density (per 1,000)in South East Asia Region<br />5 critical shortage countries<br />210,000 gap<br />Sou...
Under-five mortality and HRH density<br />Calculated from World Health Statistics 2009<br />
Main factors leading to shortages<br />Low production capacity <br />70+576 doctors+nurses/year in Laos (need 4,484 doctor...
Gap ratio between highest and lowest province HRH densities in 4 countries<br />
Factors lead to maldistribution<br />Distribution of health facility infrastructure<br />Poor working and living condition...
Participation in Trade in Health Services<br />Mode 2: Provide health care to foreign patients<br /><ul><li>Singapore, Tha...
Enabling factors for foreign patients seeking health care in SE Asia<br />High quality medical services (JCI accredited ho...
Number of doctors and nurses working in OECD countries<br />Migration Outlook: SOPEMI 2007, OECD Publishing<br />
Main destinations for Filipino nurses migration<br />Source: POEA, 2009<br />
How the countries responded to the challenges<br />Shortages<br />Increase production quickly to compensate for the shorta...
How the countries responded to the challenges<br />Maldistribution<br />Incentive (financial and non-financial)<br />Compu...
Average Monthly income of doctors with different working experience in different settings, Thailand, 2010 ($US)<br />Sourc...
Policy on trade in health services<br />Policy to promote medical hub to encourage more patients to seek health care<br />...
Summary and Recommendations<br />Challenges are similar to other countries in term of shortages and maldistribution<br />U...
Human Resources for Health in South East Asia
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Human Resources for Health in South East Asia

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