Strengthening human resource in
health and nursing in a multi-sectorial
engagement to
achieve Universal Health Coverage
3rd Global Forum on Human Resources for Health (HRH)
13 November 2013, Recife, Brazil
Dr. Mario Roberto Dal Poz, Profe
HRH situation: twofold agenda
Unfinished agenda
Maldistribution
Skill imbalances
Low productivity
Low salaries
Poor work environments
Weak knowledge base
Labour flexibility
Lack of social protection
Unmanaged migration
Growing shortages
Epidemiological transition
Increasing role of private sector
New challenges
owing importance of HRH in the political agenda
rowing
2006: World Health
Report
2006 – Wold Health Assembly Resolutions
- Accelerated training to increase the availability of health
personnel
- Strengthening the nursing and midwifery
Joint
ng
ve (JLI)
t
Establishment of Global Health
orce Alliance
African union: health strategy
Recognition by global health initiatives, such as GF
GAVI, PEPFAR, that human resources and health
systems represent a bottleneck to achieve their goa
obal Forums on Human Resources for Hea
008 (March), Kampala, Uganda, approximately
1500 participants: Kampala Declaration e
Agenda for Global Action.
011 (January), Bangkok, Thailand, together
with “Prince Mahidol Award Conference”:
approximately 1000 participants.
013 (November), Recife, Brasil
Global commitments
Other
WHA Resolutions
 Strengthening nursing and
midwifery
(2003 & 2011)
 Declaration and Agenda for Glob
Action, Kampala, 2008 (endorse
by G8)
 Strengthening human resources
for health
(2004 & 2011)
 Outcome Statement of the Seco
Global Forum on Human
Resources for Health
Bangkok, 2011
 Scaling up Health Workforce
Production
(2006)
 PEPFAR II (Target of training an
retaining at least 140,000 health
care professionals and
paraprofessionals)
 WHO Global Code of Practice
on the International
Recruitment of Health
Personnel
(2010)
 Japan's health worker training
commitment (Training 100,000
people as health workers in Afric
over the next 5 years)

……………
o, now we know a bit more about some of the challenges .
 Numbers, skill mix
 Staffing in the most disadvantaged areas
 Migration of health personnel
 Retention and incentives
 Funding and productivity
 Government health spending and health workers payment
 HRH information systems
 Management and planning systems and tools
ut, health workers’ concerns are still o
the basics …
Low salaries
Poor terms and conditions - housing, schooling, lack of
tools to do the job
Professional isolation
Posted and forgotten
Lack opportunities for promotion and professional
development
till not much evidence of what works a
Still
scale …..
Job regrading
Salary supplements / incentives
Remote area incentives
Car/housing loans
Decentralise recruitment & management
Contract out recruitment
Bonding – compulsory community service
Retention strategies set
Flexible working
Career progression opportunity ……….
kewise, not much on best practice (con
Rethinking the workforce skills mix - mid level workers
Task shifting: where and how to move forward ?
Pay for Performance: how? ethics concerns? quality?
Investment in training institutions in rural areas?
Build centres of excellence ?
Still much talk of training for export
………….
nsity of health workers and service coverage:
ld mortality (by province, Vietnam)
# Efficiency?
# Skill-mix?
# Quality?
Current investment in HRH
Most investment in training;
– Pre-service; often outdated model
– In service: main salary supplement, often doubtful impact;
disrupts service delivery
Still little on HRH planning, recruitment and deployment
processes, HR information systems
Very little on retention
A major challenge: the global economic/financial crisis is not over ...
HRH issues / agenda 1/2
Planning / forecasting for long-term, coordinated with national healt
plans (Europe, OECD, Asia, AL)
Bringing together service delivery, financing and HRH
Hot topics:
– Scaling up and improving the quality of training/education
– Migration management and monitoring
– Health workforce inequalities
– Health labour market dynamics: analysis & policy options
– Regulation of education and practice / regulatory framework
– Task shifting ...
HRH issues / agenda 2/2
 Long-term funding / impact of financial crisis
 Alignment and harmonization of donors and international
organizations, with national policies - IHP + / "accountability"
 Greater involvement of governments in the costs
 A greater emphasis on results (P4P?)
 Increased participation of non-state actors in training and
service delivery
 Information systems
Many thanks
Muito obrigado
Muchas gracias