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Odisha Development Conclave – Odisha 2016

Odisha Development Conclave – Odisha 2016. Session on Human Resources and Governance in Health Care. Human Resources for Health: Future Directions ------------------------------------------------------------------------------------- Prof. Sanjay Zodpey , MD, PhD

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Odisha Development Conclave – Odisha 2016

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  1. Odisha Development Conclave – Odisha 2016 Session on Human Resources and Governance in Health Care Human Resources for Health: Future Directions ------------------------------------------------------------------------------------- Prof. Sanjay Zodpey, MD, PhD Vice President – Academics, Public Health Foundation of India, New Delhi, Director – Indian Institute of Public Health, Delhi SZ_ODC_ODISHA_20092016

  2. Availability, competence and motivation of health workers is critical SZ_ODC_ODISHA_20092016

  3. Health systems are crux in designing, implementing and monitoring health programs and delivering quality health services A strong and vibrant health system is essential Yet, such systems are impossible without health workers who are the ultimate resource of health systems SZ_ODC_ODISHA_20092016

  4. A simple message: Health workers save lives! SZ_ODC_ODISHA_20092016

  5. HRH Scenario: Global, National, Provincial SZ_ODC_ODISHA_20092016

  6. Why do we need sufficient HRH? SZ_ODC_ODISHA_20092016

  7. Health workforce in the spotlight Source: Global Health Workforce Alliance and World Health Organization. 2013 SZ_ODC_ODISHA_20092016

  8. Health workforce in the spotlight Global shortage Source: Global Health Workforce Alliance and World Health Organization. 2013 SZ_ODC_ODISHA_20092016

  9. Global gap of health professionals is large and increasing every year A deficit of 7.2 million professional health workers in 2012 will rise to 12.9 millionby 2035 9 Source: Global Health Workforce Alliance and World Health Organization. 2013

  10. Health workforce is in the spotlight 10 Inequitable distribution Source: Global Health Workforce Alliance and World Health Organization. 2013

  11. Global Health Workforce Challenges • Health workforce shortage • Skill mix imbalance • Mal-distribution [and migration] • Negative work environments • Weak knowledge base *Reference: Chen L et al. Human resources for health: overcoming the crisis. Lancet 2004; 364: 1984–90 SZ_ODC_ODISHA_20092016

  12. HRH insufficiency in India HRH density (Doctor, Nurse and Midwife) – major India states (per 10,000 population) WHO threshold of 22.8 per 10,000 Considering only doctors, nurses and midwives, HRH density comes out to be 20.7 per 10,000 population Source: NSSO, 2011-12 SZ_ODC_ODISHA_20092016

  13. HRH insufficiency in India HRH density (Doctor, Nurse and Midwife) – major India states (per 10,000 population) WHO threshold of 22.8 per 10,000 National average close to WHO minimum threshold Considering only doctors, nurses and midwives, HRH density comes out to be 20.7 per 10,000 population Source: NSSO, 2011-12 SZ_ODC_ODISHA_20092016

  14. Dissecting India’s HRH insufficiency 14 Source: World Health Organization. The world health report: 2006: working together for health.. Rao KD, Bhatnagar A, Berman P. So many, yet few: Human resources for health in India. Human resources for health. 2012 Aug 13;10(1):1. Team Discussions

  15. HRH Response: Global and India SZ_ODC_ODISHA_20092016

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  17. Attraction • Increasing number of education institutes in Health • Engaging private sector in HRH HRH reforms in Employee life-cycle • Recruitment • Compulsory rural service for rural residents being pre-requisite for admission • Pre-condition of working in rural/tribal areas for PG admissions • Separation • Revision in service rules Employee life-cycle • Development • Pre-condition of working in rural/tribal areas for getting promotion • Task shifting • Creation of new cadres/courses • Retention • Monetary incentives related to HRH • Revision in service rules • Creation of new cadres/courses SZ_ODC_ODISHA_20092016

  18. HRH Reforms for addressing insufficiency: 8 Broad buckets SZ_ODC_ODISHA_20092016

  19. HRH Reforms for addressing insufficiency: 8 Broad buckets SZ_ODC_ODISHA_20092016

  20. Odisha HRH Plan and Progress: Appreciable efforts • Separate and dedicated unit for human resource management in health – State Human Resource Management Unit • Development of separate directorate of public health and directorate of nursing • Development of clinical and public health cadre • Restructuring of cadres for doctors and allied health staff • Recruitment of doctors through OPSC and ad-hoc both and posting through counselling SZ_ODC_ODISHA_20092016

  21. Odisha HRH Plan and Progress: Appreciable efforts • Policies for attraction and retention of doctors – Place based monetary incentives, 50% PG seats for in-service candidates, additional marks for PG entrance for working in hard to reach areas • Capacity building of in-service doctors for clinical and public health specialties • Commitment by government to recruit additional allied health staff in coming five years and their regularization after six years of service • NHM support for recruiting additional staff, capacity building and providing incentives SZ_ODC_ODISHA_20092016

  22. Odisha: Challenges for the future (some examples) • Production • Limited scope for increasing number of seats for doctors in existing institutions • Getting required number of faculties for new institutions in public sector • Maintaining quality of education in new institutions (both public and private) SZ_ODC_ODISHA_20092016

  23. Odisha: Challenges for the future (some examples) • Recruitment and posting • Ensuring continuation of service by doctors after recruitment and posting • Getting required number of applications for recruitment of allied health staff in certain districts (problem of coverage of primary and secondary education) • Inter-district variation in recruitment time for various allied health staff • Ensuring funds for salaries of additional allied health staff to be recruited over coming five years (Political economy of Department of Finance) SZ_ODC_ODISHA_20092016

  24. Odisha: Challenges for the future (some examples) • Attraction and retention • Incentives meant for attraction and retention may not ensure performance • High turn over of doctors in remote areas as they will enroll for PG courses • Uncertainty of employee response to strategies for attraction and retention SZ_ODC_ODISHA_20092016

  25. Advancing the HRH agenda: Future scope for Odisha SZ_ODC_ODISHA_20092016

  26. Review of HRH Reforms ü= Yes, ü= Partially, X= Needs additional documentation/ No +++ = easily implementable, ++ = moderately implementable, + = implementable with difficulty SZ_ODC_ODISHA_20092016

  27. Way Forward • Development of comprehensive HR policy so as to provide strategic direction • Development of clinical and public health cadres with improved career progression as well as accountability for doctors and allied health staff • Development of district hospital as an unit for production of health staff • DNB (degree) courses for producing specialist doctors • CPS (diploma) course for producing specialist doctors that can be posted at CHCs and sub-district hospitals • Courses for producing staff nurses, lab technicians, pharmacists, physiotherapists, hospital managers, and so on • Multi-skilling of existing staff such as LTs, AYUSH doctors, staff nurses, etc. • Development of web based dynamic system for human resource management • Monitoring, supervision and evaluation of HRM interventions done over a period of time – learning for future actions SZ_ODC_ODISHA_20092016

  28. SZ_ODC_ODISHA_20092016

  29. Thank you! SZ_ODC_ODISHA_20092016

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