Primary Health Care and Human Resources for Health: An Overview by 46GDQVw

VIEWS: 4 PAGES: 33

									  Scaling up health workforce
education and training to achieve
           the MDGs



                  Rebecca Bailey, MSPH, CEd
      Technical Officer, Health Workforce Education and Training
             Department of Human Resources for Health
                      World Health Organization
                          Geneva, Switzerland
                                       The Case

   You are the dean of Tegbar Medical School in a country
    with high HIV/AIDS prevalence. An evaluation shows that
    among the new graduates from your 5-year medical
    degree programme:
     – 1% are recruited to rural areas where 50% of the
        population resides
     – 90% require in-service training courses to bring them
        up to date with current health policies and clinical
        guidelines for HIV and AIDS

   What should you do?


       TITLE from VIEW and SLIDE MASTER | 27 July 2006
2 | Department of Human Resources for Health (HRH)   |   7 December 2009
                                       Overview


   HRH Strategy

   Challenges

   Progress

   Discussion



       TITLE from VIEW and SLIDE MASTER | 27 July 2006
3 | Department of Human Resources for Health (HRH)   |   7 December 2009
   Strategy of the WHO Human Resources for
          Health Team: 2010 to 2015*


    To ensure all people have equitable access to an
    adequately trained, competent, motivated and
    supported health workforce so they attain the highest
    possible level of health.



                            To enable WHO Member States to achieve their
                            current and future health workforce development
                            objectives through scientifically sound policy
                            development approaches.

*Deadline for the MDGs

         TITLE from VIEW and SLIDE MASTER | 27 July 2006
  4 | Department of Human Resources for Health (HRH)   |   7 December 2009
                              Strategy: values

Strategy is based on:

   Commitment to Health-for-All and Primary Health Care

   Working for social justice and equity

   Working in partnership

   Promoting a respectful working environment for health
    workers




       TITLE from VIEW and SLIDE MASTER | 27 July 2006
5 | Department of Human Resources for Health (HRH)   |   7 December 2009
                      Strategic directions:
                    three main lines of work
   Providing strategic information for policy making,
    monitoring trends and assessing progress.

   Promoting strategic investment in health workforce
    development.

   Promoting innovative approaches to harmonize health
    workforce policies and programmes across the life-course
    of the population in an integrated way (e.g. beyond single
    health issues or specific cadres of personnel)




       TITLE from VIEW and SLIDE MASTER | 27 July 2006
6 | Department of Human Resources for Health (HRH)   |   7 December 2009
Working lifespan strategies to build capacity
             and performance

                  ENTRY:
               Preparing the
                 workforce
                  Planning                                                              WORKFORCE PERFORMANCE
                 Education
                Recruitment                   WORKFORCE:
                                             Enhancing worker                               Availability
                                               performance                                  Competence
                                                 Supervision
                                                                                            Responsiveness
                                               Compensation
                                              Systems support                               Productivity
                                              Lifelong learning
                   EXIT:
            Managing attrition
                Migration
              Career choice
             Health and safety
               Retirement
                                                Source: WHO (2006). The World Health Report 2006 – Working Together for Health.
                                                Geneva, World Health Organization




         TITLE from VIEW and SLIDE MASTER | 27 July 2006
  7 | Department of Human Resources for Health (HRH)   |   7 December 2009
A complex issue in a complex environment

             Ministry of                    Development                 World Bank            WHO
              finance                         partners
                                                                                                 GAVI
                               ENTRY:
                            Preparing the                    PEPFAR            The Global Fund
   Ministry of                workforce
    labour
                               Planning                   WORKFORCE:
                               Education                  Enhancing worker          WORKFORCE PERFORMANCE
                              Recruitment                   performance               Availability
  Ministry of higher
                                                              Supervision             Competence
     education                                              Compensation
                                                           Systems support            Responsiveness
                                 EXIT:
                           Managing attrition
                                                           Lifelong learning          Productivity
   Civil service              Migration
   commission               Career choice                       Ministry of               Professional
                           Health and safety                                              associations
                             Retirement
                                                                 health

         Ministry of                                                      Health
                                     Ministry of public                                      Populations/
         transport                                                        workers
                                      administration                                         communities

        TITLE from VIEW and SLIDE MASTER | 27 July 2006
 8 | Department of Human Resources for Health (HRH)   |   7 December 2009
        Reaching universal coverage with
          priority health interventions

Overarching health workforce goal:
 The right people

 At the right places and time

 With the right competencies, and

 the right resources and support.




       TITLE from VIEW and SLIDE MASTER | 27 July 2006
9 | Department of Human Resources for Health (HRH)   |   7 December 2009
Health workforce is critical for achieving the
          health-related MDGs
Interventions                                                                MDGs

                                           Health
ART                                       Workforce                          MDG 4, 5
ORT                                                                          and 6 targets
                                                                             for children,
PMTCT
                                                                             pregnant
ACTs                                                                         women,
Nutrition                                                                    persons with
TBT                                                                          AIDS, TB and
                                           Health                            malaria
 etc.
                                          Workforce




         TITLE from VIEW and SLIDE MASTER | 27 July 2006
 10 | Department of Human Resources for Health (HRH)   |   7 December 2009
                        Why the “bottleneck”?

General challenges:                                       Education-specific challenges:
 Workforce planning                                       Recruitment and selection
 Information about the workforce                          Exponential growth of information to
 Numbers of health workers                                  cover
 Distribution (urban/rural)                               Rapidly changing environment in

 Competence/performance
                                                             which graduates will practice (e.g.
                                                             technology, policy, guidelines)
 Migration and attrition
                                                           Infrastructure (classrooms,
 Working conditions (workload, pay,
                                                             laboratories, clinical practice sites)
  resources)
                                                           Instructors/teachers/preceptors
 Career paths
                                                           Resistance to change
 Investment, financing and fiscal
                                                           Links between education, health
  policies (e.g. salary caps in civil
  service sector)                                            and labor sectors




       TITLE from VIEW and SLIDE MASTER | 27 July 2006
11 | Department of Human Resources for Health (HRH)   |   7 December 2009
Country priorities as reflected in 30 GFATM round
   5 health system strengthening proposals

Human resources




         TITLE from VIEW and SLIDE MASTER | 27 July 2006
 12 | Department of Human Resources for Health (HRH)   |   7 December 2009
   Positive correlation between health worker
       density and intervention coverage




                    Source: WHO (2006). The World Health Report 2006 – Working Together for Health. Geneva, World Health Organization


        TITLE from VIEW and SLIDE MASTER | 27 July 2006
13 | Department of Human Resources for Health (HRH)             |   7 December 2009
   Critical shortages and poor distribution of
                  health workers
                         Distribution of the global health workforce




                         Source: WHO (2006). The World Health Report 2006 – Working Together for Health. Geneva, World Health Organization

Critical shortages in 57 countries, 36 of which are in sub-Saharan Africa

            TITLE from VIEW and SLIDE MASTER | 27 July 2006
    14 | Department of Human Resources for Health (HRH)              |   7 December 2009
The same countries are making slow progress
      towards the health-related MDGs
              Maternal mortality ratio per 100 000 live births in 2000




                    Source: WHO (2005). The World Health Report 2005 – Make Every Mother and Child Count. Geneva, World Health Organization



        TITLE from VIEW and SLIDE MASTER | 27 July 2006
15 | Department of Human Resources for Health (HRH)             |   7 December 2009
  Inequitable distribution and imbalances

             Rural/urban distribution of health workers




        TITLE from VIEW and SLIDE MASTER | 27 July 2006
16 | Department of Human Resources for Health (HRH)   |   7 December 2009
Common causes of health workforce shortages
         from country to country

                      ENTRY:
              Preparing the workforce
  • Limited data and information about the current
    workforce
  • Poor planning (cadres, numbers, distribution)
  • Insufficient budgets and capacity for education and                             WORKFORCE:
    training                                                                       Recruit and retain
  • Curricula not based on health needs and not
                                                                         •   Fiscal policies (wage spending
    competency-based                                                         caps)
                                                                         •   Limited budgets for remuneration
                                                                         •   Poor working conditions
                                                                         •   Poor career structures
                                                                         •   Lack of supportive supervision
                              EXIT:                                      •   Poor integration with the private
                         Managing attrition                                  sector
              •   Migration (outward and within)
              •   Illness and death
              •   Change of occupation
              •   Retirement




        TITLE from VIEW and SLIDE MASTER | 27 July 2006
17 | Department of Human Resources for Health (HRH)       |   7 December 2009
    Current capacity to produce the 4.3 million
        additional health workers needed


                                            NA
                                           1750
                                                                                   %
                                                 98%
                                                 362 119%
                40%                                                          50%
                                                     1889
                                              139%                          1440
               1388
                                              354



          % increase of HCP required

          Total HCP schools

        TITLE from VIEW and SLIDE MASTER | 27 July 2006
18 | Department of Human Resources for Health (HRH)   |   7 December 2009
                Disparities in medical schools and
                             graduates




        TITLE from VIEW and SLIDE MASTER | 27 July 2006
19 | Department of Human Resources for Health (HRH)   |   7 December 2009
            Pipeline to generate and recruit
                  the health workforce
  Attract      Retain      Educate        Train Certify             Recruit     Deploy Retain

                  Quality                                                     Quality




                                                             - Teachers




            LIFE-LONG LEARNING………………………………………………

        TITLE from VIEW and SLIDE MASTER | 27 July 2006
20 | Department of Human Resources for Health (HRH)   |   7 December 2009
       WHR2006: Ten-year plan of action




        TITLE from VIEW and SLIDE MASTER | 27 July 2006
21 | Department of Human Resources for Health (HRH)   |   7 December 2009
         Moving human resources for health up
               the global health agenda

1995    1996       /   2001    /      2004     2005               2006            2007             2008
WHA Resolution      WHA               WHA                    World Health     GHWA Task        Global Forum
48.8 on             Resolution        Resolution             Report 2006,     Force on         on Human
reorienting         54.12 on          57.19 on               Working          Scaling up       Resources for
medical             strengthening     international          together for     Education and    Health, March
education and       nursing and       migration of           health           Training of      2008 produced
medical             midwifery         health                 WHA Resolution   Health           the Kampala
practice for        (2001)            personnel              59.23 on rapid   Workers, March   Declaration
health (1995)                         (2004)                 scaling up of    2007             and Agenda
                                                             health                            for Global
WHA Resolution                        WHA Resolution                                           Action
                                                             workforce
49.1 on
                                      58.17 on               production
strengthening
                                      international          WHA Resolution                    Task force
nursing and
                                      migration of           59.27 on                          report on
midwifery
                                      health                 strengthening                     scaling up
(1996)
                                      personnel              nursing and                       education and
                                      (2005)                 midwifery                         training
                                                             Global Health                     launched, May
                                                             Workforce                         2008
                                                             Alliance
                                                             (GHWA)

         TITLE from VIEW and SLIDE MASTER | 27 July 2006
 22 | Department of Human Resources for Health (HRH)   |   7 December 2009
Scaling-up the health workforce
                                              (Financial crisis events)
               2006-2007                      2008                             2009                            2010 (prospective, indicative)

 January                                         Task shifting guidelines                                        Code of practice
                                                                                                                   (migration)

 March-April      World Health Report 2006      GHWA Forum, Kampala             WHO-PEPFAR Meeting             Retention guidelines
                                                 Launch of online community       HRH and GHIs
                                                  for education and training

 May              WHA 59.23 (scale-up)          Launch of report Task           Japanese govt. pledge to       Country work
                  WHA 59.27 (Nursing and         Force Scaling-up Education       create 100,000 health           MDG5 scale-up
                   Midwifery)                     and Training                     workers in Africa               midwives
                  GHWA launch

 June                                                                             Positive synergies             Interprofessional
                                                                                  Launch of Educational           education
                                                                                   Consortium for HRH,            Observatories (national
                                                                                   South Africa/ Rwanda/           and global)
                                                                                   Mozambique

 September                                       Commission on Social            HRH Handbook on
                                                  Determinants for Health          monitoring and evaluation
                                                  Report
                                                 WHR2008 - PHC Reform

 October                                                                          WHO-PEPFAR meeting
                                                                                   Scale-up
                                                                                   education(140,000 new
                                                                                   health workers)


           TITLE from VIEW and SLIDE MASTER | 27 July 2006
23 | Department of Human Resources for Health (HRH)                |   7 December 2009
Task Force on Scaling up Education and
               Training
          Recommends urgent implementation of
           new strategies to address acute shortages
           of health workers
             – Vision for the future
             – National road map
             – Types of health workers to scale up
             – Building strong education and
                training systems
             – International action needed
             – The cost
             – Measuring success
             – Country case studies
             – Recommendations
                                                                            www.ghwa.org

         TITLE from VIEW and SLIDE MASTER | 27 July 2006
24 | Department of Human Resources for Health (HRH)   |   7 December 2009
                                                    Critical success factors
         Political commitment                             Workforce planning                         Enabling environment
   Sustained government involvement and           Commitment to short- and long-term         Good information systems for health
    support                                         workforce planning                          workforce and education
   Collaboration around country-led health        Commitment to produce appropriately        Effective management and leadership
    plan                                            trained health workers to meet needs       Labour market capacity and policy to
   Significant financial investment               Significant expansion of pre-service        absorb and sustain additional health
                                                    education                                   workers




                                                    Education and training
                             Quick wins                               Medium term                            Longer term
Strategies       E.g. reduce student and teacher           E.g. systematic curriculum reform,     E.g. integrated in-service education
                 attrition, maximize use of existing       use of improvement collaboratives,     and training, build new educational
                 infrastructure and technology,            create regional resource centres,      institutions, better knowledge
                 increase teacher numbers                  better public-private provider mix     management, more regional
                                                                                                  partnerships
Scale-up
outcomes         More community health workers             More mid-level cadres                  More high-level cadres




                           Health outcomes                                                                   Chronic
                                                                                                MDG 5        disease
                                                                                    MDG 4                    management
                                                                       MDG 6
           TITLE from VIEW and SLIDE MASTER | 27 July 2006
25 | DepartmentSaving Lives. World Health Organization and Global Health7 December 2009
 Source: Scaling Up,
                     of Human Resources for Health (HRH) | Workforce Alliance, 2008
    Building strong education and training
                   systems
Guiding principles:

    Address country health needs and embed education and
     training in the health system;

    Increase equity and efficiencies of scale of health service
     delivery through innovative curriculum design and
     delivery (e.g. distributed, distance, on-the-job learning,
     case based?)

    Enhance quality through leadership and collaboration
     (e.g. twinning, consortia)


        TITLE from VIEW and SLIDE MASTER | 27 July 2006
26 | Department of Human Resources for Health (HRH)   |   7 December 2009
Education systems: proposed strategies 1

1. Reduce attrition among students and teachers, and
   improve accessibility
2. Integrate pre-service and in-service education and training
   (links with services)
3. Develop common educational platforms for different types
   of health workers (e.g. team based)
4. Move learning to the community, using modular education
   and action learning
5. Increase use of information and communication
   technologies
6. Improve education through quality assurance programmes

        TITLE from VIEW and SLIDE MASTER | 27 July 2006
27 | Department of Human Resources for Health (HRH)   |   7 December 2009
Education systems: proposed strategies 2

7. Build institutional capacity by:
    – expanding teaching capacity (e.g. teachers from
       services)
    – fostering twinning and partnerships
    – maximizing impact through regional approaches, and
    – harnessing public-private partnerships




        TITLE from VIEW and SLIDE MASTER | 27 July 2006
28 | Department of Human Resources for Health (HRH)   |   7 December 2009
IMCI strengthening pre-service education




        TITLE from VIEW and SLIDE MASTER | 27 July 2006
29 | Department of Human Resources for Health (HRH)   |   7 December 2009
                    Transformative Scale Up

   More health workers, but not the same

   Education and training within the context of
    primary health care renewal, that is:
     – Needs based
     – Problem based
     – Community based
     – Public health based
     – Team based
     – Socially accountable
     – Linked to services and systems
     – Dynamic – responding to new policies,
        technologies, technical guidelines, etc.

   Never the same lecture twice!

        TITLE from VIEW and SLIDE MASTER | 27 July 2006
30 | Department of Human Resources for Health (HRH)   |   7 December 2009
                                    Spare slides




        TITLE from VIEW and SLIDE MASTER | 27 July 2006
31 | Department of Human Resources for Health (HRH)   |   7 December 2009
                          HRH Action Framework

                         Preparation                                        country
                         & Planning                                     specific context
                                                 Critical
                                                                           including
                                                 Success                 labour market
                                                 Factors
                           Policy
                                                                                               BETTER
                                                                                               HEALTH
             Leadership                Finance                      Improved                  SERVICES        BETTER
Situation                  HRM                                       Health                      Equity       HEALTH
                                                  Implement-
analysis                  Systems                                   Workforce                Effectiveness   OUTCOMES
                                                     ation
                                                                    Outcomes                   Efficiency
                                                                                             Accessibility
                 Partnership Education


                                                                              other health
                           M&E                                                  system
                                                                              components




            TITLE from VIEW and SLIDE MASTER | 27 July 2006
  32 | Department of Human Resources for Health (HRH)   |   7 December 2009
    Link the education, labour and health
              services markets




Source: WHO (2006). The World Health Report 2006 – Working Together for Health. Geneva, World Health Organization

        TITLE from VIEW and SLIDE MASTER | 27 July 2006
33 | Department of Human Resources for Health (HRH)     |   7 December 2009

								
To top