Addressing global health through the capacity building of health workers

1. Addressing global health through the capacity building of health workers Ministry of Health Indonesia Yogyakarta, October 3, 2019 Asia-Pacific Partnership on Health and Nutrition Improvement (APHNI)

3. 1. Three Dimensions 2. 3. Sumber : WHO

7. “All people everywhere will have access to a skilled, motivated and supported health worker, within a robust health system” This is the vision of the Global Health Workforce Alliance (GHWA), which was launched in 2006 as part of the response to the global HRH crisis, highlighted in the World Health Report 2006 - Working together for health (WHR 2006)

9. Global health challenges • Global shortage of health care workers and more are forecast • Inequitability of health workforce distribution (Urban and rural disparities) • Universal health coverage • Change in demographic and epidemiologic transition • Health care workforce migration • Health workforce ageing and replacement is a challenge • Skill mix balance • Human resource information system to meet the needs of decision-makers require • Leadership • Quality of health professional education and training

10. HEALTHY INDONESIA PROGRAMS

11. THE HEALTH DEVELOPMENT DIRECTION RPJMN I 2005 -2009 RPJMN II 2010-2014 RPJMN III 2015 -2019 RPJMN IV 2020 -2025 Health development directed to increase accessibility and quality of health care Community access for quality health care has been more steady Community access for quality health care has reached and equitable throughout Indonesia Community access for quality health care have been more developed and improved VISION: SELF RELIANCE AND EQUITY HEALTHY PEOPLE CURATIVE REHABILITATIVE PROMOTIVE - PREVENTIVE Direction of development of health efforts: moving towards from curative-rehabilitative to promotion, prevention according to the conditions and needs RPJMN: Medium-Term National Development Plan

12. Indonesia National Health System(Sistem Kesehatan Nasional) Health Management Human Rersources for Health (HRH) • Health Status • Financial protection Pharmacy, Medical Devices & Food Health efforts Research Community Empowerment Health Financing ( JKN ) (President Regulation 72/2012)

13. SUB SYSTEM : INDONESIA NATIONAL HEALTH SYSTEM (PRESIDENT REGULATION 72/2012) 1. Medical Care; 2. Health Research and Development; 3. Health Financing; 4. Human Resource for Health; 5. Pharmaceuitcal and Health Supplies and Food Control; 6. Health Management, information and Regulation; 7. Community empowerment.

14. PRESIDENT’S VISION AND MISSION TRISAKTI: Economic self-reliance, Political sovereignty, Personality in culture 9 PRIORITY AGENDA (NAWA CITA) 5th Agenda: Improving the quality of life of Indonesian People WORKING CABINET DEVELOPMENT NORM 3 DEVELOPMENT DIMENSION: HUMAN DEVELOPMENT, LEADING SECTORS, EQUALIZATION AND TERRITORIAL HEALTHY INDONESIA PROGRAM WORKING INDONESIA PROGRAM PROSPEROUS INDONESIA PROGRAM SMART INDONESIA PROGRAM STRATEGIC PLAN 2015-2019 HEALTH CARE STRENGTHENING HEALTH PARADIGM NATIONAL HEALTH INSURANCE HEALTHY FAMILY Remote Areas

15. 3 PILLARS HEALTHY INDONESIA • PROGRAM: • Health Care Access Improvement, esp. Primary Health Care • Optimalization of Referral System • Quality Improvement With Continuum of Care Approach and Health Risk Based Intervention • PROGRAM: • Health Mainstream in the development • Strengthening of Promotive and Preventive • Community empowerment. PILLAR 2 STRENGTHENING HEALTH CARE Middle-Long term Development Plan 2015 - 2019 PILLAR 1 HEALTHY PARADIGM • PROGRAM: • Expansion of Targets and Benefits • Cost System: Insurance with the principle of mutual cooperation • Quality control and cost control • Target: Beneficiaries & Non Beneficiaries • Membership  Healthy Indonesia Card PILLAR 3 NATIONAL HEALTH INSURANCE Healthy Family Approach

16. HEALTHY INDONESIA PROGRAMME MINISTERIAL STRATEGIC PLAN 2015 - 2019 • HEALTHCARE STRENGTHENING • Improving access, particularly at primary level • Referral system optimization • Quality improvement • Continuum of care throughout the life cycle • Health risk – based intervention • HEALTHY PARADIGM • Health mainstreaming in the development • Promotive – Preventive as the main pillar in health programmes • Community Empowerment • NATIONAL HEALTH INSURANCE (JKN) • Benefits • Financing system: insurance–gotong royong principle • Quality Control & Cost Control • Objects: Support Recipient and Non Support Recipient Subnational Govt + Central Govt Health Workforce

17. COMMUNITY BASED ACTIVITIES :HEALTHY FAMILY APPROACH PH CENTRES COMMUNITY EMPOWERMENT: Integrated Health Station, Integrated Elderly Health Station, NCD Prevention, Early Education Centres, School Health Units, etc Family Family Family Family Family Priority on promotive-preventive care, targeting families for continuum of care throughout the life cycle, through home visits

18. The Problem of HRH In Indonesia

19. Rolesofthe Agency for Development & Empowerment of HRH (BPPSDMK) (Regulation of Ministry of Health No 64 Year 2015)

20. ORGANIZATIONAL STRUCTURE BOARD FOR DEVELOPMENT & EMPOWERMENT HUMAN RESOURCES for HEALTH Board for Development & Empowerment Human Resources for Health Regulation of MoH No. 64 Year 2015: Organizaton & Work Procedure MoH Secreatariat Board for DEHR of Health Center for Planning & Utilization of HRH Training Center of HRH Education Center of HRH Center for Quality Improvement of HRH

21. HRH DEVELOPMENT & EMPOWERMENT CORE PROGRAMS

22. HRH DEVELOPMENT & EMPOWERMENT CORE PROGRAMS

23. OrganizationalChangestoaddress global health Can the healthsystem& structurerespond tothe challenge? CentralizationandIntegration=averticalprogrammefully integrated into overallhealthcareattheperipherallevel coordination supervision- Central Level • Managerialissues:management- evaluation – – – – Central Regional District Regional Level • Programme Delivery: District level – HealthFacilities: How the healthfacilitiesprovidetheentiresystem Note – Staff roles and functionsof eachlevelmust beclearly defined

24. HRH action framework country specific context including labourmarket Preparation & Planning Critical Success Factors Implement- ation Policy BETTER HEALTH SERVICES Equity Effectiveness Efficiency Accessibility Improved Health Workforce Outcomes inance F Leadersh BETTER HEALTH OUTCOMES i p HRM Systems Situation Analysis Partnership Education other health system components M&E World Health Organization Department of Human Resources for Health Geneva, Switzerland

25. ROLE OF MOH

26. ROLE OF MOH

27. ROLE OF MOH

28. ROLE OF MOH

29. HRH DEVELOPMENT STRATEGIES STRATEGY Regulation Improvement Increasing Quality of HRH Planning Increasing Quality of HRH Education and Training Increased utilization of HRH Coaching & Quality Control of HRH Empowerment Resourches Every people gains access to qualified healthcare professionals

30. TASK BPPSDMK • Controlling type • Controlling the amount • Quality control • Controlling the deployment HUMAN RESOURCHES FOR HEALTH Regulation, regulatory and other institutional support, improving the role of government Increased access to quality healthcare services

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32. ORGANIZATIONAL STRUCTURE TRAINING CENTER OF HRH Training Center of HRH Subdivision of Administration Division of Competency Analysis & Training Need Mapping Division of Training Development Division of Training Quality Developemnt Subdivision of Competensy Analysis Subdivision of Technical Training Development Subdivision of Training Acreditation Subdivision of Training Need mapping Subdivision of Functional Training Development Subdivision of Acreditation of Training Institution FUNCTIONAL GROUP

33. HRH TRAINING ( Ministry of Health_Indonesia ) • Training Routine • Pre-service (CPNS) • Leadership (PIM) • Health Team Haji Indonesia (TKHI) • Training for Special Programs • Doctor, dentist, midwife • Healty Archipelago Team Based (Nusantara Sehat) TYPES OF TRAINING • Training for Program Development • Management for Community Health Centers • Advocacy based surveillance • Internal control system • Health Promotion • Integrated Data-based Health Financing Planning • Training on Control, Prevention & Health Service for Cancer Disease • Training for Civil Servant (ASN) • Functional • Quarantine • Leadership • Procurement of Goods & Services • FinantialAdminitration Board for Development & Empowerment Human Resources for Health - MoH

34. C on c l us i on • HRHdevelopment is one of key aspects in Health/ Health Services Development , which is an importantpartof human development, therefore thisiscrucialforimprovingqualityof Indonesian human resourcesforeconomiccompetitiveness, therefore it is important for SDGs achievement; • RelatedtoSDGs, the HRH developmentisfocusedonimprovementqualityof HRH througheducationandtraining as well as theenhancingthedistributionthroughspecialprograms; • The Agency for Development & Empowerment of HRH has been implementing programs in HRH Development including Planning & Management of HRH, Education and Training as well as Quality Improvement of HRH

38. DEVELOPMENT PHASE RPJPN 2005 – 2025 (UU 17/ 2007 : National Long Term development plan of the Year 2005 – 2025) RPJMN 3 (2015 - 2019 RPJMN 4 (2020 – 2025) RPJMN 2 (2010 - 2014 RPJMN 2 (2010 - 2014 Rearranging the NKRI, establishing a safe, peaceful, fair and democratic Indonesia, with a better level of welfare To solidify development by emphasizing the development of an available economic competitive advantage, HR qualified, and IPTEK ability To be an independent, sustainable, fair and prosperous community through the development of a robust field with a strong economic structure based on competitive advantage Establishing the rearrangement of the NKRI, improving the quality of human resources, building IPTEK skills, strengthening the competitiveness of the economy

39. DIRECTION OF HEALTH DEVELOPMENT RPJMN IV (2020-2025 RPJMN III (2015-2019 RPJMN I (2005-2009 RPJMN II (2010-2014 Public access through quality health services has begun to steady Public access through quality health services has been more developed and increased Community health through quality health services has reached & evenly throughout Indonesia's Bangkes directed to increase access and quality of the health services VISION: A healthy society that is independent and fairness CURATIVE - REHABILITATIVE HEALTH PROMOTIVE-PREVENTION The direction of development of health and curative efforts move towards promotive, preventive according to conditions and needs

40. HR drives health systems Money Logistics Services Information Technology Individuals Communities Frontlinehealthworkers Drugs Available Motivated Skilled Supported 4

41. Towards comprehensive HRH: HRH vision, goal VISION Aworldwhereeverypersoneverywherehasaccesstoa motivatedandsupportedhealthworkerwhoisskilled and competent. GOAL Healthworkers atdifferentlevelsofthehealthsystemhavetheskills,knowledge,andattitudes (professionalcompetence)necessarytosuccessfullyimplementandsustaincomprehensive health servicesbased onNational HRH strategy. Asufficientnumber ofhealthworkersofallcategoriesis availableatall levelsofthehealthsystemwiththeneededsupportsystemstomotivatestafftouse theircompetencies toprovidequality health servicefortheentirepopulation accordingtotheirneeds.

42. What do we need in term of HRH? • Sufficient numbersof people(staff)in quantity and quality • Appropriatelytrainedstaff (knowledgeskills attitudes) • Appropriatedistribution (rightplaceat therighttime)

43. Current challengesin HRH • Overcoming Global Health • Policy, regulation and planning (Zerogrowth policy) • Migration(threats &opportunitiesofglobalization) • Labor market • Longtermneglect& under-fundingofHR • High turnover • Insufficient/ in adequate human capacity • Management and performance improvement • Education, training and research • HRH and priority health programs • Monitoring and evaluation

44. Insufficient/ inadequate Insufficient/ inadequate Humancapacity Humancapacity • Inadequateskills/ skillsimbalances • Lackofcommunicationbetweenhealth/programs planners andcolleges/universities • Lackofrefreshercourses&supervision • Lackofupdatedcurricula&trainingmethods • Unevendistribution • Labourmarket(workforcestructuralarrangements) • Externalmigration(braindrain) • InadequateHRplanning&management • Inadequatedeploymentpractices • Inflexiblecontractingarrangements • Internal(urban/rural) • –Resistanceto beallocatedto remote areas PoorHumanResourceplanning

45. Insufficient/ inadequate Humancapacity • Low staff numbers • Inadequateproduction(skills/ lengthy process) • Attrition/Highturn over • Expensive • Time consuming • Lack of planning&management –Inabilityto increaseposts(zerogrowth policy) • Competingsectorson limited pool of HR • •Public,Private & NGO's PoorHumanResourceplanning

46. Poormotivation • Under-skilled (inadequate/ infrequent training) • Unsupported/ lack of supervision • Poor work environment/ equipment/ tools • Poor careerstructure/ professional development • Underpaid • Overburdened/ high turn-over • Low morale • Sick or caringforsickfamily members PoorHumanResourcemanagement

47. Performance 1 Factors affecting capability: appropriatetraining, Factors increasing motivation: recognition, loveofwork, careerstructure, seeingresults, socialrespect adequate skills competencies, re-training, and updated knowledge Cando Capability Willdo Motivation Factors keeping you: salary,supervision, workingconditions, adequateworkload, etc.

48. QualityHR-No HRDstrategies • • • • • • • Emphasis Emphasis Emphasis on on on workshops& training number and intensity numbers trained courses of courses Inadequatetraining:curriculaoften not needs-based ResearchonHRmanagementvs."fancy science" No time (budget)forsupervisionandre-training Skillsdemandsof healthsector reformnotconsidered

49. HR quantity Unabletomatchstaffrequirements,health system & populationneeds • Healthworkforcehasbeenneglected • HRlowonHealth-policy agenda • UnderinvestmentinHR • PoorHRmanagement • Inadequateproductionof HR • HealthsectorreformdemandsonHR • disregarded • Contractualrestrictions- "Zerogrowth",cappedsalaries

50. Country comprehensivestrategy addressing global health • AssessHRNeeds • PositionneedswithinthecurrentSocialandHealthSystemcontext • Involvepartners(governments,technical,donors) • DesignappropriateHRdevelopment • Interventions: A twin-track approach • Address current health workforce crisis • Design medium to long term intervention: to ensure sustainability both in quality and quantity • Address/ ensurepolicysupport • Address gaps on the competencies of overseas health workers • Trained Health Workforce Exchange