1.
Human Resources for
Health (HRH): from theory
to practice
Dr Stefaan Van Bastelaere
Senior Health Expert

2.
The global context of HRH
Components of a crisis :
• World Health Organisation 2006
• African countries = 24% of disease burden | 3% of health professionals | 1% means
• Kampala declaration 2008 - First world forum on HRH
• Global shortage estimate 4 million
• US estimate for 2020 : gap of 100,000 physicians | 1,000,000 nurses | 250,000 other
health professionals
• Systematic underproduction in some countries
• Systematic overproduction in other countries
• Poor or absent HR planning
• Poor or absent HR Monitoring & Evaluation
• Resistance to change (task-shifting, task-sharing)
• Little attention paid to clinical activities
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3.
Migration
• as old as mankind
• not the cause, but the solution
Drivers for migration
• stick
• stay
• push
• pull
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The global context of HRH

4.
Components of a solution :
• Comprehensive HRH policies and management
Source: WHO 2006
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The global context of HRH

5.
Components of a solution :
• 2010 : Code of practice on international recruitment,
World Health Assembly
• 2012 : Belgian HRH Charter
• Reducing push forces – strengthen stick factors :
Self esteem!
Better connectivity : telemedicine
Results-Based Finance – Performance-Based Finance:
motivation strategy
Improving housing and working conditions…
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The global context of HRH

6.
The Belgian HRH Charter
5 strategic result areas
 RA 1 : Partnership and harmonization
 RA 2 : HRH policies and development plan
 RA 3 : Training
 RA 4 : Recruitment policies
 RA 5 : In Belgium
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7.
RA 1 : Partnership and harmonisation
• Federal Public Service Foreign Affairs
 Embassies do political and policy dialogue
 Long-term vision : predictability of programs 4-5 years
• BTC interventions fully embedded in local institutions
 Ministries of Health, Ministries of Education, Hospitals, Districts or local
health systems
 Universities or local schools
 Local steering bodies
• BTC actively participating in Sector-Wide Approach
 Development of “Compact”
 Health sector cluster groups, HRH Working Group
 Joint sector reviews
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From theory to practice :
implementing the charter

8.
RA 2 : HRH policies and development plans
• Support HR department of Health
Ministries
• Support development and
implementation of HRH plans (Rwanda,
Burundi, Niger, DR Congo,
Mozambique, Senegal) respecting
values :
 Equity
 Gender
 Sound geographic distribution
September 2013 European Congress on Tropical Medicine and International Health 8
From theory to practice :
implementing the charter

9.
Improve professional motivation
• Performance-Based Financing
(Rwanda, Burundi)
• Better professional environment :
 Investing in communication ICT
 Better equipment
 Housing
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RA 2 : HRH policies and development plans
From theory to practice :
implementing the charter

10.
Performance-Based Financing as motivational factor
• 85-95 % of delivered services compliant to quality standards
• Substantial topping up of the salaries
Figure 7: Quality of services achievement in group 1
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RA 2 : HRH policies and development plans
From theory to practice :
implementing the charter

11.
RA 3 : Training
Support development of capacities by strengthening
professional education in partner countries
• Nursing schools : paramedical public schools in Burundi and
Rwanda being upgraded, new curriculum developed,
motivation of teaching staff
• Undergraduate and postgraduate trainings
 National University of Rwanda
• Internship, training of District Medical Officers
• Capacity-building program for hospital management teams in
South Africa
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From theory to practice :
implementing the charter

12.
• Scholarship programs in all our partner countries
• Shift from „individual scholarships‟ to an integrated
„institutional capacity development program‟
• Individual scholarships (before 2012)
o Beneficiaries: individuals
o Sectors: all
o Based on individual training needs
o No follow-up
o Nationwide
o Yearly agreement between partner states
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RA 3 : Training
From theory to practice :
implementing the charter

13.
Institutional capacity development plans (as from 2012)
• Beneficiaries: geographical consistency
• In line with HRH planning of partner countries and institutional
capacity development plans
• Sector-specific: in „concentration‟ sector (health, education,
agriculture, infrastructure)
• Priority to local and regional training institutes
• Minimum 4 years‟ duration
• Special focus on: Partnership with international partners (Institute for
Tropical Medicine…) | Sandwiched approaches | Distance learning | Gender
balanced
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RA 3 : Training
From theory to practice :
implementing the charter

14.
RA 4 : Recruitment
• Respect the WHO “Code of Practice”
 Right to migrate, circulation of competences ?
o BTC employed international experts without restrictions on nationality (Niger,
Burundi, Senegal, Peru, Cameroun, DR Congo…)
• Compensate for negative consequences
 Only possible in partner countries
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From theory to practice :
implementing the charter

15.
RA 5 : In Belgium
• Inform and raise awareness
 Charter signed and available on intranet
 Information on partner country HRH plans on healthpl@form
 Participation in HRH WG of Because-Health,
 Collaboration on HRH issues with different NGO‟s
• Collaboration with diaspora and universities
 IOM
 Contracts with almost all Belgian universities
• Capitalise and share knowledge
 https://intranet.btcctb.org/claroline/
 www.be-causehealth.be/en/themes-and-working-groups/human-
resources-for-health
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From theory to practice :
implementing the charter

16.
Conclusions
Development agencies can make a difference
 Work on planning, production and monitoring
 Influence on push and stick factors
Harmonisation and coordination under a
national consensus is key
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