Human Resources for Health in the Asia – Pacific
An AusAID Initiative
John Hall
Associate Professor
Director
Human Resources for Health Knowledge Hub
Background
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Continuing High Burden of Disease in developing countries – some indictors
(MMR & NMR) not changing, health disparities.
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Have the interventions (preventive & treatment) to achieve the Millennium
Development Goals, but Health Systems in many developing countries are
very weak.
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Health System:
– Facilities & Equipment (Hospitals, Health Centres).
– Health Information Systems.
– Human Resources – Doctors, Nurses, Midwives, Pharmacists, Dentist,
Allied Health, Managers, Planners.
– Finance.
– Policies – evidence based.
WHO: World Health Report 2006
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
Skilled Birth Attendant at Birth
World Health Report 2005: Making Every Mother & Child Count.
Critical shortages and maldistribution 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
World Health Report 2005: Making Every Mother & Child
Count.
Estimated global shortage of 4.3 million
health workers
Global health workforce, by density
Source: WHO (2006). The World Health Report 2006 – Working Together for Health. Geneva, World Health Organization
Distribution of health workers by level of health
expenditure and burden of disease, by WHO region
Disparities in medical schools and graduates
Human Resources for Health
Global “CRISIS”
• Human Resources for Health are central
to Health Systems Strengthening and
achieving the Millennium Development
Goals.
Human Resources for Health
Global “CRISIS”
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Shortage all forms of health workers.
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Distribution of health workers – rural vs urban, high disease burden vs low
disease burden countries, accessing reproductive HS, public vs private.
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Health worker retention, migration – incentives.
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Quality & standards – initial training, in-service training, mix of skills, who
sets & maintains standards.
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Leadership & Management - low capacity – planning, managing.
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2.5 health workers (including doctors, nurses and midwives) per 1000
people to achieve MDGs.
Asante, Dewdney & Hall 2009
Strategic Direction
Long Term
Equity in access to primary health care services;
improve the health and wellbeing of people in the
Asia-Pacific region – MDGs
Medium Term
A significantly increased number of countries with strong
national HRH Strategic Plans and management capacity,
and stronger workforce policies and regulations;
Short Term
Growing literature and body of knowledge; and
better country access to HRH intelligence information, communications, and knowledge.
Convening & Partnerships
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Links to the other Knowledge
Hubs
Australian Health Workforce
Institute
Australian Researchers
WPRO & SEARO
Asian-Pacific Action Alliance on
Human Resources for Health
(AAAH)
The Pacific Human Resources
for Health Alliance (PHRHA)
HRH Forum in PNG & Timor
Leste, Indonesia
Global HRH Networks
HRH Hub@UNSW - 2009 Work Plan
Three Work Outputs (Products):
1.
Human Resources for Health priority country maps.
2.
Strengthening Health Leadership and Management Capacity in
Asia-Pacific Region
3.
Evidence informed community-based (CB) maternal, newborn
and reproductive care (MNRC) staffing
(Establishment of a HRH Knowledge Repository)
2008 – extensive consultation process with stakeholders
Product 2 –
Leadership & Management
Background
Critical importance of health
leadership and management:
 Weak leadership and management a
recognised obstacle to scaling up priority
services and achieving MDGs.
 Effective leadership and management
critical for making the best use of our scarce
health resources. Calls for additional
investment in health but to what effect?
 Decentralization of health systems
impacting on leadership and management
capacities especially at sub-national level.
Leadership and management
strengthening efforts
 Long history of substantial investment in
management training involving a range of
agencies yet with limited returns
 Recent studies stress moving beyond training
and taking a holistic approach to strengthening
capacity
 Limited evidence on what approaches work
and in what contexts especially in resource poor
settings
Product Objectives
 Critically review frameworks and approaches for
assessing and strengthening health leadership and
management capacity.
 Undertake a situation analysis of issues affecting health
leadership and management capacity in the Asia-Pacific
region.
 Develop policy options for strengthening leadership and
management capacity especially at the sub-national level.
 Build partnerships and disseminate at appropriate fora the
policy options for strengthening leadership and
management capacity in the region and beyond.
Discussion Paper: Some Key Issues
• Systematic reviews of leadership and management
development are largely from individualistic, Western and
corporate perspectives
• Health leadership and management literature has largely
focused on competency models particularly looking to the
NHS in the United Kingdom
• There is a need for developing an evidence base for
strengthening health leadership and management capacity
grounded in the diverse cultural and political contexts of
countries in Asia Pacific region and that are meaningful to
health priorities and current capacity development
approaches and policy directions
• Determining useful framework/s approaches supports the
development of that evidence base
Criteria for Analysis of
Frameworks/Approaches
Key Criteria
Issue for Consideration
Currency
Was it developed between 2000 – 2009?
Credibility
Did it originate from a credible source?
Focus and
approach
What level of management is the focus and
what are the underlying assumptions?
Relevance and
adaptability
Is the framework appropriate to lower and
middle income countries? To the Asia
Pacific region?
Strength of
evidence base
How was the framework developed?
Application and
testability
Where has the framework been used?
Usability
How easy is it to use?
Evaluation
Has the framework been evaluated and if
so..?
Sample of Summary Profile of Frameworks
Frameworks
Profile
WHO MAKER (Managers taking Action
based on Knowledge and Effective use of
resources to achieve results)
Developed in international fora; focuses on sub-national
management level at the system; holistic and shifts
strengthening to assessing range of interrelated factors;
only applied in Africa; underpins SEARO’s strategic plan
for health management strengthening (2007)
HRH Action Framework (HAF)
Focuses on the whole health system; developed and
supported by Global Health Workforce Alliance, United
States Agency for International Development, and WHO;
leadership and management embedded within key
components; framework and indicators currently under
refinement; WPRO strategic plan for health system
strengthening draws on this framework
Leadership Development Program (LDP)
by Management Sciences for Health
Training based framework; individual focus; applied
largely in Central and South America; evaluated and
promoted in that region
UNDP Capacity Development Framework
Nested approach focuses on environment, organisation
and individual capacity; uses highly consultative and
participative approach to strengthening capacity; to be
country led and based on sensitive situational analysis;
indicators currently in draft form
Findings from the situation
analysis
Some key issues affecting leadership and management capacity in
the region
 Competency - clinician managers with limited training in management
 Difficulty of managing clinically trained professionals (doctors & nurses)
by non-clinician managers (e.g. health extension officers in PNG)
 Inadequate supervision and mentoring of local managers
 Inadequate incentives for health workers in underserved areas
 Poor management information systems
And therefore what?
Three potential follow up products:
1. Case studies of best health leadership and
management practices in selected countries.
2. Building the evidence base for evaluated incentives
for health worker retention in underserved areas.
3. Models for appropriate training of manager at
different levels in health systems.
Product 3 –
Evidence Based HRH Practice in
Maternal Neonatal Reproductive Health
at Community Level
Rationale
• Maternal, newborn and
reproductive health is a
priority area
• HRH at community level
are poorly understood
• Lack of knowledge & little
dissemination
• Need to understand
lessons learned
Objectives
• Increase the quality of knowledge on effective
community based MNRC HR practices
• Improve stakeholder access to high knowledge
of evidence informed community based MNRC HR
• Engage collaboratively with a range of
Australian, regional and international
professionals, organisations and networks to
stimulate dialogue on community based MNRC
staffing and policy issues
• Increase stakeholder involvement in
participatory processes
Approach
Literature
Review
Narrative
Synthesis
Collaborative
process
Peer Review &
consultation
Peer Review &
consultation
Discussion
paper
2 Focused
workshops
Content
analysis
(template)
Stakeholder
consultation
Policy
options paper
Mapping
of 10
countries
Review Methods
15
bibliographic
Databases
4 journals
2 Meta indexes
22 Websites
Electronic
Gateways &
networks
315
2
75
161
6
Citation
tracking
560 full text papers,
reports, book chapters,
reports, news articles,
discussion feeds etc
Following up
on references
Minus
duplicates
808
documents
assessed
75 very useful
234 useful
309 in final
review
518 not useful
Findings
• Lessons learned: Professionalization of
community midwifery cadre, community
mobilisation, approach to TBAs
• Scaling up: Emphasis on increasing SBA
coverage, increasing the role of CHWs,
expanding education and training
• Barriers & supportive strategies: lack of
evidence and regard for complexity
• Tools for assessing HR effectiveness:
performance focused
BUILDING A HRH ELECTRONIC
GATEWAY
Rationale
• Knowledge generation &
dissemination is a core function of
the AusAID funded Knowledge Hubs
• A number of knowledge resources on
health, health systems and HRH do
currently exist.
• Key of the elements of our system:
– Focus on the Asia-Pacific region
– Focus on user-generated content and
interactivity
– Collation and dissemination of grey
literature
Objectives
• Provide an environment where state of the art HRH
knowledge can be accessed, shared and debated by decision
makers, researchers and health practitioners in the Asia
Pacific region in order to stimulate evidence informed HRH
policy (and practice) transformation.
• Provide infrastructure for the generation, management and
dissemination of current knowledge on HRH, which will build
capacity in partner institutions in Asia and the Pacific and
support the engagement of Australian agencies in the region.
• Web-based environment for resource storage, discovery,
and dissemination, as well as communication between users
of the system.
Keywords
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Socio-cultural issues (gender, culture, access/equity etc.)
Geo-political context (fragile states, post-conflict etc.)
Work environment (health of workforce, culture, morale etc.)
Education and training
Legal & ethical issues (regulation, professional standards)
Economics and finance
Policy and planning
Roles and functions of health workforce
Information systems and technology
Advocacy
Deployment and distribution
Employment arrangements (outsourcing, career structure)
Leadership and management
Governance
Health sector reform
Resource types
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Planning and policy documentation
Conference / workshop papers
Images and media
Blogs and wiki’s
Online networks, Communities of Practice,
coalitions, alliances
• Theses
• Journal papers
HRH Hub@UNSW - 2009 Work Plan
Three Work Outputs (Products):
1.
Human Resources for Health priority country maps.
2.
Strengthening Health Leadership and Management Capacity in
Asia-Pacific Region
3.
Evidence informed community-based (CB) maternal, newborn
and reproductive care (MNRC) staffing
(Establishment of a HRH Knowledge Repository)
2008 – extensive consultation process with stakeholders
HRH Hub@UNSW
• Principal Investigators – Anthony Zwi, Anna Whelan, Rohan
Jayasuria, Alan Hodgkinson, Daniel Tarantola, Lois Myer, John
Dewdney, Richard Taylor.
• Director – John Hall.
• Hub Strategic Partnerships & Convening Roll – Michele Vanderlanh
Smith.
• Manager – Vanessa Traynor.
• Research Fellows – Angela Dawson, Augustine (Kojo) Asante.
• Project Officer/Research Assistants – Lisa Thompson, Tara Howes,
David Taylor
• Administration Officer – Angela McLoughlin.
Thankyou