MSH HQ- BB Presentation- Shelemo_ew edits (3)
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The document describes Ethiopia's human resources for health challenges, including an inadequate and imbalanced health workforce, poor motivation and retention of health workers, and weak human resource management systems. It outlines the Strengthening Human Resources for Health project's efforts to improve HRM capacity through a discover, design, deliver approach. This included conducting HRM assessments, developing action plans to address gaps, implementing interventions like expanding HRM roles and training, and strengthening HR data and planning systems. The project achieved results such as creating over 1,100 new HR positions and training HR staff, but further work is still needed to professionalize HRM and improve workforce issues in Ethiopia.
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MSH HQ- BB Presentation- Shelemo_ew edits (3)
- 1. Improving Human Resource Management Capacity in the Ethiopian Public Health Sector Shelemo Shawula (MD, MPH) Senior HRH Management Advisor Strengthening HRH Project Addis Ababa, Ethiopia
- 2. Objectives • Describe Ethiopia’s Human Resources for Health (HRH) challenges, the underlying causes & factors, and the HRH Project profile • Highlight the process of Discovering, Designing and Delivering HRM Capacity improvement • Discuss next steps and the way forward for HRH project
- 3. Significance of Human Resources in Health “Sufficient number of qualified and motivated health workers is a backbone to achieve our health program goals. The fact is we always have fewer health workers than we need, often inadequately trained and unmotivated. We also fail to appreciate and meet the needs of available staff. Now the time has come to put the first thing first, with support from HRH project.” (Deputy Director for Regional Health Bureau, January 2013) 3
- 4. Projected Tends of Global Health Workforce Deficit 4 Trends of deficits in Health Care Providers: in Millions Source: Global Health Workforce Alliance
- 6. 6 • Inadequate number of health workers • Imbalances in skill mix and geographic distribution • poorly motivated • High attrition rates • Inadequate number of health workers • Imbalances in skill mix and geographic distribution • poorly motivated • High attrition rates • Underinvestment in education and training • Weak human resources management • Decentralization with no proper institutional capacity building • Underinvestment in education and training • Weak human resources management • Decentralization with no proper institutional capacity building •Inadequate institutional capacity of Universities/Colleges •Little or no attention to HRM. •Inadequate HRM structure, staffing, plan and budget •Weak Human Resources Information System (HRIS) •Inadequate institutional capacity of Universities/Colleges •Little or no attention to HRM. •Inadequate HRM structure, staffing, plan and budget •Weak Human Resources Information System (HRIS) Characteristics of HRH Challenges in Ethiopia
- 7. Strengthening Human Resources for Health (HRH) Project Key Result Areas 7
- 8. IR 1: Improved HRM Capacity Discover Design Deliver 8 • Strengthening the human resource management system, policies and practices at all levels of health system
- 9. Discover • Conducted HRM Capacity Assessment – A two-day facilitated process with institution (self-assessment, priority setting, and action planning ) – Brought together 15-20 multi- disciplinary team – Guided by MSH’s HRM Rapid Assessment Tool for Health Organizations (3rd Edition), 5 Broad Areas & 20 Sub-themes • HRM Capacity Assessments were conducted with 15 Institutions 9
- 10. Design • Reviewing of the challenges identified and underlying cause(s) • Agreeing the priority areas and level 10 • What works? (international & national evidence) • What is feasible in the specific setting? • What can actually be implemented? (short-term, medium and long- term) •Identifying key interventions •Developing plans of actions
- 11. Planned Activities HRM Staff and Budget • Increase the number of HR positions at all levels • Conduct HRM training needs assessments and HRM In- service Training • Prepare budget plan with HR activity plan and secure approval from senior management team HR Plan • Review and Finalize National HRH Strategic Plan and adapt the HRH Strategic Plan to the Regions • Develop the planning skills of HR staff in order for them to forecast the staffing needs • Build capacity of hospitals, Woredas and health science colleges to develop staffing plans HR Data • Update the existing HR data collection tools • Train HR staff on data collection, analysis and data use • Strengthen HRIS reporting mechanism 11
- 12. Strengths of HRM RAT Process • Created opportunities for the organizations to discover their strengths and gaps • Involved senior staff from non-HR functions and they were able to appreciate how strong HRM would contribute to strong health programs • Culminated with agreed plan of actions with each organization as basis for capacity improvement • Involved senior management team of the organization throughout the process 12
- 13. Strengths of HRM RAT Process (2) “….. I have attended many trainings and workshops of several days’ duration over the last few years. But I have not gained as much I have from this two-day activity…” (Deputy Director, Civil Service Commission Bureau, Tigray Region) 13 The Obelisk of Axum, Tigray (1,700-years-old, 24 m tall and 160 tones heavy)
- 14. Deliver: Implementation and achievements • Existing HR structure revised and 1,100 new HR positions created (in 11 Regional health bureaus) • HRM In-service training provided to 424 HR managers and staff (national & regional levels) • Strengthened HR management functions (updated job descriptions and recruitment guidelines, developed orientation manuals, supported HRIS data collection and entry etc. ) • Ongoing support is underway to strengthen HR planning the Ministry and regions 14
- 15. Deliver: Implementation and achievements (2) • National Retention study conducted (first-ever in African countries) • New national regulations were put in place for health workforce licensing and management • Increased partnership between the ministries of health, civil service and finance for HRH is in place -- National and Regional HRH Forums • Curriculum developed and modules writing completed to launch Master Degree HRH Management 15
- 16. Way forward • Professionalize HRM functions at all levels • Build upon the gains to improve workforce availability, distribution, motivation and retention • Design and implement work climate improvement programs in the health facilities • Strengthen designing, equitable delivery and evaluation of in-service training for health workers • Strengthen systems and practices for performance management, feedback and support at all levels 16
- 17. Thank You for Attention! Q & A 17
Editor's Notes
- Fact of the matter: shortage, inadequate qualifications and experience, low motivation and high turn over as MD working in the health Center, MD in a referral hospital, HIV/AIDS program Coordinator and RHB staff. But also HR was critical factor for successful implementation of Child Survival and Health Systems performance Improvement in Ethiopia. Little or no improvement: situation is still similar or remained the same in many cases a decade and half (15 Yrs) after my employment in the public health sector Public health sector: government-owned and run- national, regional, zonal and district health systems
- Objectives
- Health workforce shortage and imbalances are Global Phenomena where 4million additional health workforce were need globally when World Health Report was released in 2006. This projection has tripled and additional 12 m health workforce is required by 2030 (as presented during 3rd Global HRH Conference in Recife, Brazil) But situation not the same across the globe. Africa is hard hit by the crisis. According to WHO 2.3 doctors, Nurses and midwives/1000 population required to achieve 80% coverage with skilled birth attendance (to reduce maternal, newborn and infant mortality). But 57 countries have health workforce density less than 2.3/1000. Ethiopia was one of the 57 countries with HRH crisis. (WHR, 2006). When WHR published, the country had only one-third of the bench mark density. Nearly a decade after, the figure has not doubled? Why?
- √ HRH project is USAID funded five-year (2012 – 2017) bilateral project designed to support the efforts of the Government in meeting the HSDP and HRH strategy. It is the first major undertaking to address HRH challenges- stated above ((Shortage in Health work force, un balanced urban-rural, public-private sector distributions, unmotivated, underperforming, not supported, posted and forgotten) in the country. √ Goal: to improve health outcomes for all Ethiopians (with emphasis on the reduction of infectious disease and gender-focused disparities in maternal and newborn mortality) through improved availability, distribution and management of health work force through out the country √ (as you can see from the Logos): HRH is implemented by Jhpiego, MSH, OU, EMA and EAA. MSH leads on improved HRM Management: the systems, the policy f(for recruitment, deployment, performance management, training and development) and practices Scope 33 Universities, 43 Health Science Colleges, FMoH, FMHACA, 11 Regional Health Bureaus, 100 Zones and 860 districts. PLUS EMA, EAA
- Goal: strengthening the human resource management system, policies and practices at Federal Ministry of Health, Zonal Health Departments and Woreda/Sub city Health Offices levels We improve HRM capacity through a comprehensive approach: discovering, design and deliver Discover: current capacity and the gaps through participatory organizational capacity assessment- entirely new approach for the government health system. Jointly with the government offices/institutions we have identified HRM needs and gaps in the system, policies and practices by conducting HRM Rapid Assessment Tool. We conducted RM RAT with 15 Institutions: FMoH, FMHACA, 11 RHBs, EMA and EAA. Besides Rapid situation Assessment (1), project’s baseline assessment (1), employees’ satisfaction surveys (12), Staff exit interview (7), HRHM In-service training (13). The assessments have created several opportunities for leaning, consensus building and planning to address challenges discovered Design: HRM Systems, policies and practice Guidelines. Client-centered participatory planning- practical, need-based, proven interventions, adapted to local context Delivering: implement plan of actions. Implementation of the planned interventions with training, mentorship and technical support from HRH Management staff
- √ Conducted HRM Capacity Assessment 15 Institutions ( FMoH, 11 RHBs, FMHACA, 2 Professional Associations )- reports for each HRM Capacity Assessment and Synthesis report was written and shared with each institution, Jhpiego and USAID/E. HRM RAT is a sought after tool from MSH √ Guided by HRM RAT: 5 Broad Areas (and 20 Components ( √ Brings together multi-disciplinary team: Brings together about 15-20 staff from each institution- within health sector and civil service commissions. Both HR and non-HR staff were involved. The first ever such meeting at national and regional levels where HR issues are systematically reviewed/discussed. Led HR staff (managers/leaders) and give recognition for HR staff √ Brings together multi-disciplinary team ( HR and non-HR staff): first-ever meeting led by HR Process-give recognition for HR staff
- Participatory, self-reflections Involved non-HR functions, truly multi-disciplinary team approach, where non-HR staff were able to appreciate the HR contributions to successful implementation of health programs. First-ever process for HR staff to lead such an assessment Action plan: Planned actions are part of the annual work plan and a framework for technical support by HRH Project Involved senior management team of the organization in planning from the beginning and that Support and increased commitment staff has increased the prospect of implementing of the actions
- √ Existing HR structures reviewed and 1100 new HR positions were created at regional and local levels √ Technical support provided to strengthen HR planning at national and 11 regional health bureaus √ Regional health bureaus supported to strengthen HR management functions (update job descriptions, recruitment and orientation, HRIS data collection and entry, etc. ) √ Employee job satisfaction surveys were conducted at FMoH and 9 RHBs (complement with information from employee exit interviews conducted in 11 RHBs) √ Supporting introduction of standard National Licensure Exam for health professionals; √ Supported development of National Scope of Practice for health workers (15 cadres) √ Guidelines and tools developed to orient staff to labor law proclamations and civil service codes at national and regional level √ Multi-sectoral HRH Forum established at the Ministry and 10 (out of 11 Regional Health Bureaus) to improve partnership and collaboration for imprfoved HRM √ HRHM In-service training provided to 424 HR managers and staff (national and regional levels)
- √ Guidelines and tools developed to orient staff to labor law proclamations and civil service codes at national and regional level √ Multi-sectoral HRH Forum established at the Ministry and 10 (out of 11 Regional Health Bureaus) to improve partnership and collaboration for imprfoved HRM √ HRHM In-service training provided to 424 HR managers and staff (national and regional levels)