Global Perspectives on the Health Workforce Manuel M. Dayrit MD, MSc Director Department of Human Resources for Health.

Global Perspectives on the Health Workforce

Global Perspectives on the Health Workforce

Manuel M. Dayrit MD, MScDirector

Department of Human Resources for Health

Manuel M. Dayrit MD, MScDirector

Department of Human Resources for Health

Global Perspectives on the Health Workforce2 |

Healthworkerssavelives.


What is the health workforce?What is the health workforce?

“People engaged in actions whose primary intent is to enhance health”

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


Health workers save lives … but we need enough of themHealth workers save lives … but we need enough of them

Proportion of health workers per population

Pro

bab

ility

of

surv

ival

Low High

Low

High

Maternal Survival

Child Survival

Infant Survival



Why build the health workforce?Why build the health workforce?

“We have to work together to ensure access to a motivated, skilled, and supported health worker by every person in every village everywhere.”

Dr LEE Jong-wook, late Director-General World Health Organization


There are shortages of health workers worldwide

Distribution of the global health workforce



Causes of shortages vary from country to countryCauses of shortages vary from country to country

health workforce not a priority

poor HRH planning

insufficient HRH production

migration

unjustified control of HRH production by professional organizations

death from HIV/AIDS


Many African health workers migrateMany African health workers migrate

Dr. Alain Maxime Mouanga Psychiatrist, Democratic Republic of Congo


Percentage of doctors trained in African countries but now working abroad Percentage of doctors trained in African countries but now working abroad

0 10 20 30 40 50 60

Sao Tome and Principe

Guinea Bissau

South Africa

Ghana

Ethiopia


WHO regions

0

5

10

15

20

25

30

35

0 5 10 15 20 25 30 35 40 45

% of global workforce

% o

f g

lob

al b

urd

en

of

dis

ease

Africa

South-East Asia

Eastern Mediterranean

Western Pacific

Europe Americas

Inequities in health workforce distributionInequities in health workforce distribution



Health Workforce Crisis in Sub-Saharan AfricaHealth Workforce Crisis in Sub-Saharan Africa

Africa's burden of disease: 25%

Percentage of the world's health workers in Africa: 1.3%


Loss of health workers due to HIV/AIDSLoss of health workers due to HIV/AIDS

Zambia:- 1980: 2 nurses out of 1000 died- 2001: 27 nurses out of 1000 died

Botswana: - 1999─2005: 17% of health workforce died

- 1999─2010: 40% of health workforce will die (projection if no action is taken)

HIV prevalence = 15% up to 33 % loss of health workers in 10 years


What must be done to lower maternal mortality?

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

Maternal mortality ratio per 100 000 live births in 2000


Investment HRHDevelopment

Better HealthOutcomes

We need innovative approachesWe need innovative approaches


We must build “capacity” or “potential” just like a batteryWe must build “capacity” or “potential” just like a battery

or

or


Working lifespan strategies to build capacity and performanceWorking lifespan strategies to build capacity and performance


WORKFORCE PERFORMANCE

AvailabilityCompetenceResponsivenessProductivity

WORKFORCE:Enhancing worker

performance

SupervisionCompensation

Systems supportLifelong learning

ENTRY:Preparing the

workforce

PlanningEducation

Recruitment

EXIT:Managing attrition

MigrationCareer choice

Health and safetyRetirement


What can defeat efforts to build capacity and performance?What can defeat efforts to build capacity and performance?

migration of health workers

lack of managerial capacity to retain and support them

HIV/AIDS

pull factors from developed countries

unintended negative effects of health system reform, e.g. decentralization


Unsafe workplaces push health workers to leave

Primary health care nurse, South Africa

"Our personal safety is not guaranteed. Patients are harassing us and shouting at us. They have guns ..."



Percentage of foreign-trained doctors in nine industrialized countriesPercentage of foreign-trained doctors in nine industrialized countries

Proportion and number of foreign trained doctors in selected countries

0% 10% 20% 30% 40%

New-Zealand

United Kingdom

United States

Canada

Australia

Finland

Germany

France

Portugal 1,258

11,269

17,318

213,331

13,620

11,122

1,003

2,832

69,813


Challenges to performance improvement vary across sectorsChallenges to performance improvement vary across sectors

Transaction intensity )decision process complexity(

Source: Capacity building in Africa: an OED evaluation of World Bank support. World bank, 2005


Promoting multiple strategies to improve retention in ThailandPromoting multiple strategies to improve retention in Thailand

Bangkok vs. Rural Northeast(Doctor to Population Ratio)

Regulatory: compulsory contract of 3 years of public work after graduation

Economic: rural development project and financial incentives

Education: rural recruitment and training in rural health facilities; development of community medicine

Managerial: personnel management

Social: movement for rural development

Source: S. Wibulpolprasert, 2003

Strategies that worked:


Will Filipino health workers return-migrate?Will Filipino health workers return-migrate?


Link the education, labour and health services marketsLink the education, labour and health services markets



Go to CD-Rom / Internet [http://www.capacityproject.org/framework/]

HRH Action Frameworktools for an effective and sustainable health workforceHRH Action Frameworktools for an effective and sustainable health workforce

BETTER HEALTH

SERVICES Equity

EffectivenessEfficiency

Accessibility

BETTER HEALTH

OUTCOMES

other healthsystem

components

country specific context

including labour market

Improved Health

Workforce Outcomes

Situation analysis

Preparation & Planning

Implement-ation

M & E

Policy

Leadership

Partnership Education

FinanceH R M

Systems

Critical Success Factors


Ten-year action planTen-year action plan

2006 2010 2015

Immediate Mid-point Decade

Strategies and plans for countries available

Implementation and evaluation of plans on-stream

New cycle of planning and implementation started

Investment in education increased

Workforce capacity improved in numbers and types

Improved health outcomes Country leadership

Best-practices in management shared

Country knowledge base expanded

National capacity strengthened

High political priority among global stakeholders stimulated

High political priority enhanced

High political priority sustained

Harmonized donor practices Increased/sustained resource flows/managed migration

Country support sustained Global solidarity

Shared best practices Global knowledge base expanded

Powerful knowledge base in use


Strategic directions 2006-2015 (WHO 11th Global Programme of Work)Strategic directions 2006-2015 (WHO 11th Global Programme of Work)

Strengthen coordination and harmonization of human resources policies across service

delivery channels and levels of the health systems as well as across sectors and improve

partnerships with private providers, nongovernmental organizations, and community

partners.

Adapt the skill-mix of health workers to ensure adequate distribution geographically and by

specialty, including matching the skills and competences of graduates of health professional

institutions with specific national priorities and health care needs.

Enhance the enabling environment to increase motivation, effectiveness and retention of

workforce at national level (addressing the incentive barriers for recruiting, retaining and

motivating staff - salaries, career structure, working conditions, etc.).

Develop realistic and long-term global and regional solutions to manage the outflows of

workforces, including meeting the requirements of national health systems and respecting

the rights of individuals to cross national boundaries.


FOR THE IMMEDIATE ATTENTION OF THE DELEGATES OF THE UN HIGH LEVEL DIALOGUE ON MIGRATION AND DEVELOPMENT

A number of preliminary recommendations came out of our discussions including:

• A Global Code of Practice should be adopted which builds on lessons from existing Codes such as the Commonwealth Code of Practice. A Global Code should serve as a basis for further bilateral and multilateral agreements.

• The 57 countries identified by the WHO with critical shortages of health workers should be the focal point of immediate international action with respect to short-term and long-term solutions.

• All countries should have a comprehensive health workforce strategy for addressing the demand for health services and attaining self-sufficiency.

• Developing countries should focus on retention strategies and working conditions to encourage health workers to stay in their country of origin and remain in the health care profession.


• Governments should develop policies which allow health workers to move between sending and receiving countries and contribute to the development of both.

• The skills of members of diasporas should be harnessed and managed to contribute to development and health care needs in developing countries.

• Significant increases in spending on health care are needed in developing countries requiring the support of international financial institutions which in some cases still place restrictive ceilings on social spending.

• The role of other cadres of health workers including mid-level providers, community health workers and other substitute workers to address the health workers crises and in supporting national health systems should be explored further.

• A Global Observatory for data collection on health worker mobility should be established.

FOR THE IMMEDIATE ATTENTION OF THE DELEGATES OF THE UN HIGH LEVEL DIALOGUE ON MIGRATION AND DEVELOPMENT


"There is a tide in the affairs of (wo)men

Which, taken at the flood, leads on to fortune;

Omitted, all the voyage of their life

Is bound in shallows and in miseries.

On such a full sea are we now afloat;

And we must take the current when it serves,

Or lose the ventures before us. "William Shakespeare, Julius Caesar


Health workers save lives.

Support them.

Educate them.

Love them.

Don't leave them.

Or they'll leave you…

That's not a threat.

That's not a promise.

It's already a fact of life.

Global Perspectives on the Health Workforce Manuel M. Dayrit MD, MSc Director Department of Human Resources for Health.

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