HUMAN RESOURCES FOR HEALTH:
Conceptual Elements of the Post‐2015 Agenda
San Salvador, El Salvador
September 18‐19, 2013
OVERVIEW
•The Road Thus Far
•Results, Ongoing Issues & Lessons Learned
•Elements of the HRH Planning Process
•Cost Drivers, Politics & Collaboration
•UHC, PHC & HRH & the Reform Process
•Options to Build HRH Planning & Management Capacity
THEN
A Decade of Progress…
Joint Learning Initiative (2004)
NOW
WHO Research for UHC Toronto Call to Action (2005)
WHO World Health Report (2006) 2nd 20 HRH Goals Review Health Agenda for Americas (2007)
Global Health Alliance (2007) HRH PHC
20 Regional HRH Goals (2007‐2015)
Program Evaluation in HRH
UHC
HRH Data Management Project (2007) HRH Meeting San Salvador
1st 20 HRH Goals Review (2008‐2011)
Kampala Declaration (2008) WHO Global Code of Practice ( 2010)
Caribbean Road Map (2012‐2017)
3rd Global Forum on HRH
Health System Reform : Ongoing Issues
HRH
Supply
Distribution
Attrition
Education Alignment
Mix/Deployment
Working Conditions
Health/Safety
Governance/Management
Performance/Accountability
Planning/Data/Monitoring
GOVERNMENT
Economic Growth/Fiscal Constraint
Immigration/Emigration
Resource Competition
Public‐Private Sector Roles
Political Instability
Urbanization
Primary Health Care
Universal Health Coverage
POPULATION
Aging Population
Non‐Communicable Disease
Communicable Diseases
Ill‐Defined Needs
Social Expectations
Quality
Access
Poverty
HRH Planning Framework
Principles, Plans & Practices
HRH Planning Cycle
HRH Reform
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HRH Forecasting
H Health Workforce Productivity
Capacity
Development
Education & Training
Workforce Culture, Communications & Expectations
Supply & Mix
Outcomes
Workforce
Optimization
Workplace Support
Models of Care
Occupational Health & Safety
Stability of Workforce
Personnel Management
Practices
Efficiency in health services delivery
Innovation &
Support
Effectiveness of Patient Care, Health Outcomes & Population Health
Matching Competencies to Requirements
Provider Roles & Deployment
Mix, Numbers &
Distribution
Competency‐Based Deployment
Workforce Standards, Accountabilities, Assessment, Rewards and Continuing Development
Building Workforce Capacity
STAFF MANAGEMENT & SUPPORT
Job Satisfaction
Accountability
Leadership
Role of Technology
2015 2030
Nanotechnology…Robotics… Artificial Intelligence…Genome Sequencing…Gene Splicing...Singularity…
Health for All…Immortality (?)
Over‐Medicalization of Healthcare…
Non‐Communicable Diseases
Ape…Cro‐Magnon…Homo Erectus…Homo Sapiens…Homo Obesus
Non‐Communicable Diseases
NCD’s
Injuries
CD’s
NEEDS‐BASED PLANNING
UTILIZATION‐
BASED PLANNING
EFFECTIVE
DEMAND
HRH DEMAND
Unfilled Funded Posts
Chronic Vacancies/Turnover
Health Services Model/Coverage
Work‐Load Measurement
Caseload Complexity
Staff Mix
Deployment/FTEs Public‐Private Roles Wait‐Times Staff Targets/Ratios
Practitioner Demand
Patient Demand
Service Distance
Competencies/Training
Community/Family Comparative Health Care Cost Increases
UNIVERSAL HEALTH COVERAGE: Options, Capacities and Sustainability
Who’s covered, what’s covered and how’s it covered?
ADVANTAGES
UNIVERSAL HEALTH COVERAGE
‐Promotes PHC
‐Promotes collaboration
‐Promotes coordination
‐Defines partner accountability
‐Long‐term strategic vision
‐Innovative delivery models
‐Innovative funding models
‐Promotes cost control
‐Supports change management
‐Defines public‐private sectors
‐Defines needs, goals & targets
‐Consistent governance measures
‐Supports HRH policy development
‐Promotes community involvement
‐Requires political support
‐Continuity re service provision
‐Requires monitoring & evaluation
‐Intra‐governmental cooperation
‐Promotes system sustainability
‐Attracts donor funding
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CHALLENGES
Continuing public support
Higher public taxes
Political continuity
Greater demand; greater costs
Vagaries of fiscal support
Provider‐patient induced demand
“Work to rule” salaried employees
High system transition costs
Quality reduction in “free” system
Determination of “true” needs
Intra‐governmental fiscal support
Private‐public two‐tier pressures
Potential wait‐time increases
Health is labour‐intensive,
resource‐driven industry
Success requires PHC/HRH reform
Education system slow to respond
Possibly mismanagement backlash
re workforce instability and costs
New care model implementation
UHC
Co‐Dependent HRH
Common Goals & Principles
Mutually Supportive
HEALTH SYSTEM REFORM
ENABLERS// HRH
TOOLKIT
Political Support
‐Quality
Strategic Plans
Leadership
‐Fairness
Finance
‐Comprehensive
Governance
‐Equity
Legislation
‐Appropriate
Management
‐Access
Education
‐ Communications
Responsive
‐Capacity
Partnerships
‐Participatory
Technology
Info Systems
‐Sustainability
Research & KTE
UHC Policy
Programs
Operational Plans
Evaluation
PHC
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Supply
Primary Care
Productivity
Inter‐Sectoral Needs‐Based
Collaboration
Training
Health Promotion
Distribution
Illness Prevention
Retention
Rehab, Palliative,
Deployment
& Supportive Care Mix/Targets
Community Health/Safety Participation
Team‐Based
Info Access
Community‐
& Sharing
Based
Chronic Disease
Competency‐
Prevention and
Based
Management
Incentives &
Treating Acute &
Support Episodic Illness
Flexible Self‐Care Support
Accountable UHC
Efficiency
Quality
Fairness
Comprehensive
Collaborative
Equity
Appropriate
Accessibility
Responsive
Acceptable
Evidence‐Based
Needs‐Based
Participatory
Continuity
Consistent
Accountable
Affordability
Sustainability
BRAZIL : Lessons Learned
SUCCESSES
•Community nurse auxiliaries; decline in infant mortality, rise in immunization, partial alleviation of medical service bottlenecks
•Nurses lead PHC in poor neighbourhoods and rural areas in the northeast
•Decentralized management and community participation (Unified Health System)
•Health sector reform driven by civil sector and health professionals •Universal coverage with vaccination and prenatal care
•Expansion of HRH, pharmaceuticals and technology
•Infant mortality has decreased 5% annually over past three decades
CHALLENGES
•Strong commitment to PHC but reduction in overall government role
•Socio‐economic and regional disparities still large
•New health problems re urbanization
•System large & complex with administrative problems •Private sector role, chronic underfunding and urban service concentration
•Equity and sustainability concerns; care models not aligned with changing needs
•Quality care and patient safety remain issues; over‐medicalization of childbirth
•More rural HRH and local capacity needed to support health promotion activities
•Need stronger political support and financial re‐structuring
The Art of Managing Doubt
•Fiscal implications
•External development agencies
•Neighbours’ views & actions
•Election platform/promises
•Election cycle
•Cabinet position and promises
•Issue profile, quick wins
•Labour movements
•Public/lobby groups
•Media •Risks of inaction
•Internal‐external champions •Knowledge transfer & exchange
•Industry advisors
•Alignment with health plan/business plan
•Evidence‐based planning
Benefits of Collaboration
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Enhances communications, transparency of process & KTE
Enhances political and funding support & sustainability
Momentum through shared vision, plans, roles & accountabilities
Integrated & coordinated change management practices
Avoids duplication of effort & fragmented intervention Opportunities to share lessons learned & best practices
Combines resources for greater efficiencies and economies of scale
Opportunities for broader coordination of inter‐sectoral activities
Greater opportunities to implement & influence stakeholders
Enhance stability and reduce intra‐regional competition
Reduce vulnerability to changing global pressures
Post‐2015
HRH
UHC PHC
Options to Strengthen Regional HRH
Planning and Management Capacity
Planning
•MoH define and formally adopt a change management approach to HRH planning
•MoH formally adopt a “HRH in all health policy” strategy
•Develop HRH plans that link with health system plans and government business plans
•Expand HRH goals and targets to better support both PHC and UHC
•Modify MDG’s to include enablers regarding UHC, PHC , including HRH & fiscal targets
•Develop criteria for evidence‐based decision‐making and needs‐based planning
•Expand data systems to include indicators of workforce stability, deployment & mobility
•Link HRH to the delivery of health services and health system performance indicators
•Determine parameters of appropriate health care models and funding mechanisms
Partnerships
•Strengthen HRH planning processes by building formal planning partnerships with Education, other sub‐Regional Ministries of Health, inter‐Divisionally within the MoH and with the Observatory
•Lead an inter‐Divisional MoH team to administer first three planning principles above
•Redefine MoH linkages, roles & accountabilities within a change management approach
•Provide pro‐active leadership & identify champions in each HRH planning partnership
Options to Strengthen Regional
HRH Planning and Management
•UHC PHC
Strengthen the role of the Sub‐Regional Observatory to provide technical support to develop and standardize any or all of the following functions: clearing house for relevant HRH information; developing a framework for HRH planning, technology assessment,
professional regulation; information systems; coordinated training development (including centers of excellence); program evaluation; communications; research
pilots regarding HRH incentives and retention schemes; donor coordination; risk assessments; PHC model reviews; and facilitate planning and partner coordination. Finance
• Include fiscal plans and risk analysis with HRH strategies; coordinate EDP funding
Education
• Mandate social accountability of professional schools; alignment with health system needs; identify centers of excellence; and advance common core curricula development
Governance
• Develop standardized professional legislation to maximize public protection while minimizing any barriers to the innovative deployment of HRH in the PHC setting
Research
• Conduct research synthesis to determine best practices & conditions for success
• Develop knowledge transfer and exchange protocols to increase relevance & utility
• Include an evaluation component at the front‐end of all new HRH policies & programs
The HRH Planner’s Credo…
… Keep the Faith!