Lessons For Developing Winning GF Proposals To Support Human Resource Strengthening The Health Systems Strengthening through the AAAH Global Fund Round.

Lessons For Developing Winning GF Lessons For Developing Winning GF Proposals To Support Human Proposals To Support Human

Resource StrengtheningResource Strengthening

The Health Systems Strengthening The Health Systems Strengthening through the AAAH Global Fund Round 7 through the AAAH Global Fund Round 7

WorkshopWorkshop8-10 May 20078-10 May 2007

Anne Martin-Staple PhDAnne Martin-Staple PhDPresident and Chief EconomistPresident and Chief Economist

Health Strategies International LLCHealth Strategies International LLC

WHO, Global Health Atlas

Introduction

– Round 5: Malawi Supported resource shortfall (US$65.4m) for Six-Year HR Emergency Plan and HIV/AIDS HR Model

– Round 6: Zambia proposal to support Health Sector HR Planning and Finance Model and Malaria Scale-up HR Model

Key points for winning Key points for winning proposalsproposalsWINNING THEME: GF should strengthen NOT WINNING THEME: GF should strengthen NOT

weaken public and civil society health weaken public and civil society health sectorsector

1.1. Include health system strengthening Include health system strengthening

2.2. Technically sound and quantifiedTechnically sound and quantified

3.3. Link HR activities to disease goals Link HR activities to disease goals

4.4. Provide comprehensive strategiesProvide comprehensive strategies

55.. Resource envelop, gaps and cost sharing Resource envelop, gaps and cost sharing

STEPS TO WINNING STEPS TO WINNING PROPOSALSPROPOSALS

1.1. Assess health sector workforce shortfall Assess health sector workforce shortfall 2.2. Assess staffing requirements and shortfall for Assess staffing requirements and shortfall for

disease-specific interventions i.e. HIV/AIDS/ART, disease-specific interventions i.e. HIV/AIDS/ART, malariamalaria

3.3. Analyzing labor market issuesAnalyzing labor market issues4.4. Develop a mix of integrated, costed strategies to Develop a mix of integrated, costed strategies to

meet HR shortfall meet HR shortfall 5.5. Mobilize political commitment and resources to Mobilize political commitment and resources to

meet HR targetsmeet HR targets6.6. Develop operational plans to implement Develop operational plans to implement

recruitment, retention and training strategiesrecruitment, retention and training strategies


STEP 1: Critical HR Shortfall

Cadre MoH target cadre for Malawi

Current number in post

Current vacancies

% of actual staff to target

Physicians 433 139 294 32Nurses 8440 4717 3723 56Clinical Officers 1405 942 463 67Medical Assistants

1500 718 782 48

Laboratory Technicians

507 251 256 50

Pharmo Techs 285 93 192 50Environmental Health Officers

1662 304 1358 18

STEP 2: HR Crisis Threatens STEP 2: HR Crisis Threatens disease-specific programsdisease-specific programs• Rapid expansion of programs (HIV/AIDS, Rapid expansion of programs (HIV/AIDS,

EHP, TB, Malaria, ART) with no EHP, TB, Malaria, ART) with no proportional expansion of workforce puts proportional expansion of workforce puts critical drain on health sectors critical drain on health sectors

• HR crisis threatens effective scale-up of HR crisis threatens effective scale-up of disease specific programs especially in disease specific programs especially in rural areasrural areas

• HR crisis threaten sustainability of HR crisis threaten sustainability of programsprograms


HIV/AIDS driving HR demand

Cadre

Physicians 10Nurses 3401Clinical Officers 689Medical Assistants 500Laboratory Supervision + Assistants 386Pharmacists + Assistants 344Environmental Health Officers 10

Total 5340

HR REQUIREMENTS FOR HIV/AIDS (2005-2010)


The 6-Year Plan Gap that tied the proposal to HIV/AIDS services

• Health Surveillance assistants (HSAs) (4200 including 1000 PWAs)

• Other cadres: doctors, nurses, COs, counselors

• Tutor career development• Training institution support

Zambia: Ensuring malaria scale-upZambia: Ensuring malaria scale-upin context of overall MoH HR Goal:in context of overall MoH HR Goal:

To determine the level of public sector and civil service HR effort required to carry out effective malaria scale-up and associated financial costs

• Develop a HR Finance Model with a mix of costed strategies to meet MoH workforce targets in 4-years

• Develop malaria specific HR Finance Model to determine staffing LOE and cost for scale-up

• Promote increased role of private sector (e.g. CHAZ) and civil society for malariascale-up


STEP 3: Analyzing Labor Market Issues

1. Poor retention of existing staff

2. Inadequate trained labour supply

3. Inequitable staffing distribution


Push Factors

• Poor pay and benefits• Poor working conditions• Delayed payment• Lack of incentive schemes/career

development • Personal security• Poor supervision and management • Poor HR infrastructure• Poor living conditions: housing• High transport costs


Pull Factor: Brain Drain

• To countries with greater financial rewards, improved working conditions, opportunities for further training

• To private sector• NGO and research projects


Inadequate Trained Labor Supply

• Training institutions have inadequate output

• Due to the lack of qualified health workers, recruitment outside of the country is required


Inequitable distribution

• 97% and 94% of COs and RNs in urban areas

• High vacancies at under-served rural areas

• 10 districts without a MOH doctor• 4 districts have no doctor• 6 districts have nursing vacancies over

70%


STEP 4: Defining costed strategies for meeting

HR targets1. Determine HR shortfall and

targets by cadre2. Estimate the cost of mix of

synergetic strategies 3. Develop HR finance model 4. Examine finance implications:5. Determine resource envelop6. Estimate resource mobilisation

targets


Training

Institution CadreCurrent

Enrollment

Required Capacity

Expansion

College of Medicine Physicians 175 305

Kammuzu School of Nursing & CHA of

MalawiNurses 1218 590

Malawi College of Helath Sciences

Technicians 1048 452


Training: Estimating the costs of Expanding Institutional Capacity

– Capital costs for classrooms, dormitories, and labs

– Salary costs for newly hired tutors and staff– Staff recruitment and training costs (overseas

PhD programs)– Increase in operating costs as enrolment

expands

$63 million estimated over 6 years


OUTPUTS FROM BUILDING TRAINING CAPACITY

Summary Results for Expanded Training Capacity for MoH Staff*

2003 2005 2006 2007 2008 2009 2010

Entering students 1000 1,042 1,315 1,530 1,620 1,620 1,620Graduates 750 842 1,002 1,228 1,399 1,451 1,534Recruited 250 250 250 225 160 65# Trained out of the country 0 4 4 4 4 4Total entering service 1,055 1,229 1,357 1,483 1,470 1,458# In post 7,327 8,382 9,611 10,968 12,451 13,921 15,379Vacancies 7,647 6,592 5,363 4,006 2,523 1,053 -405Target 14,974 14,974 14,974 14,974 14,974 14,974 14,974

*Physicians, nurses, nurse technicians, clinical officers, medical assistants, laboratory technicians, pharmacy technicians, radiography technicians, dental therapists, environmental health officers.


STEP 5: Finances Mobilized

Six-Year Emergency HR ProgrammeTotal programme cost = US$272 million

•US$210M = Recruitment and retention

•US$62 M = Training Capacity

Donor financing – US$182MGap = US$90MRequested = US$65.4M


Staff retention improves

• “The number of resignation letters from nurses has reduced from six per month to almost none”

• “Before the remuneration supplement in April, we were having more than 120 nurses going to the UK,”….. Although they are working in harsh conditions, we have seen the improvements in their morale.”

• Malawi Health Minister Hetherwick Ntaba , January 2006


Thank you

Dr. Anne Martin-StaplePresident, Health Strategies

International(anne.staple@hsinternational)

Lessons For Developing Winning GF Proposals To Support Human Resource Strengthening The Health Systems Strengthening through the AAAH Global Fund Round.

Documents

hr model slide

hr targets

hr demand slide

health sectors hr crisis

health sector hr planning

hivaids hr model

critical hr shortfall

global health atlas