Finalization of HRH Commitment of Bangladesh (November 3, 2013) Human Resource Management Unit

1. Seminar Third Global Forum on Human Resources for Health:Foundation for Universal Health Coverage and the post-2015 development agenda Finalization of HRH Commitment of Bangladesh (November 3, 2013) Human Resource Management Unit Ministry of Health and Family Welfare

2. “Health Workers for All and All for Health Workers”A brief introduction • The Global Health Workforce Alliance (GHWA) was born in 2006, during the 59th World Health Assembly in Geneva. • a common platform to address health workforce crisis • a partnership of national governments, civil society, international agencies, finance institutions, researchers, educators and professional associations to identify and advocate for solutions. • With a vision of “all people everywhere will have access to a skilled, motivated and supported health worker, within a robust health system”. HRM Unit, MOHFW

3. From Kampala to Recife “Action on the Health Workforce Time for Action” (Kampala Declaration and Agenda for Global Action) Kampala 2008 Bangkok 2011 From Kampala to Bangkok: Reviewing Progress Renewing Commitments Developed global HRH roadmap Human Resources for Health:Foundation for Universal Health Coverage and the post-2015 development agenda Increased investment, sustained leadership and the adoption of effective HRH policies Recife 2013 build a foundation for UHC through strengthening HRH & elicit the commitment HRM Unit, MOHFW

4. Third Forum objectives & outcomes Objectives: • Elicit and announce new tangible HRH commitments • Update the HRH agenda to make it relevant to the current global health policy discourse including: • a push to accelerate progress towards attaining the MDGs • promoting universal health coverage • identifying post-2015 health development priorities Expected outcomes include: • New HRH commitments from governments, DPs and other stakeholders • Greater accountability to track, monitor and report on commitments • Clearer links established between the HRH agenda and • MDGs, • universal health coverage, • social determinants of health, • Rio+20 process and the post-2015 development agenda. Source: http://www.who.int/workforcealliance/forum/2013/3gf_objectives/en/index.html HRM Unit, MOHFW

5. GHWA’s call for HRH Commitment • Identify suitable HRH commitment pathways for the governments to develop HRH commitment consistent with national health strategies, plans and priorities. • Identify country-specific HRH commitments accompanied by global commitments which will be captured in a global declaration to be adopted at the Forum. • GWHA Prepared a draft template as guideline to fill in with country level HRH commitment pathways. Source: http://www.who.int/workforcealliance/forum/2013/3gf_objectives/en/index.html HRM Unit, MOHFW

6. Background of the call • Increased recognition of central role of HRH towards health MDGs and UHC • JLI Report (2004) and WHR (2006) identified HRH challenges and prospective solutions • Launching of GHWA and 2 Global Forums (2008, 2011) added political momentum for HRH • Adoption of WHO Global Code of Practice on International Recruitment of Health Personnel (the WHO Code) • HRH-specific commitments of UN Global strategy for women’s and Children’s health (2010) • Recognition of HRH in the UN General Assembly resolution on UHC (2012) • Need to apply a “systems approach” to HRH • Need to address capacity, management and working conditions, as well as a solid understanding of the health labour markets dynamics that affect HRH production, deployment, absorption into the health system, retention, performance and motivation Source: http://www.who.int/workforcealliance/en/ accessed on October 22 2013 HRM Unit, MOHFW

7. HRH Framework towards UHC • Systemic pathways of interventions along the Universal Health Coverage Framework of AAAQ (availability, accessibility, acceptability and quality) Source: http://www.who.int/workforcealliance/en/ accessed on October 22 2013 HRM Unit, MOHFW

8. Template for HRH commitment pathways HRM Unit, MOHFW

9. Drafting HRH Commitment of Bangladesh The state of human resources for health in Bangladesh: Post 2008 development and current challenges towards universal health coverage

10. Government’s commitments towards UHC HRM Unit, MOHFW

11. Post 2008 development – HRH Policy and Plan(Instruments for implementation) • Perspective Plan of Bangladesh 2010-2021 • National Health Policy- 2011 • Strategic Plan for Health, Population & Nutrition Sector Development Program (HPNSDP) 2011-2016 • Program Implementation Plan (PIP) for HPNSDP 2011-2016 • Bangladesh Health Workforce Strategy 2008/2009 • Operational Plan for Human Resource Management of Ministry of health & Family Welfare 2011-16. • Health Care Financing Strategy 2012-2032 HRM Unit, MOHFW

12. Major progresses in HRH 2009-2012 • Strengthening Upazilla Health Services into 3 level i.e. Community Clinic (CC), Union Health & Family Welfare Centers (UHFWC), Upazilla Health Complex (UHC). • Establishment of 1 CC for every 6000 population and around 13,000 CC has been established all over the country and recruitment of 13600 community health care provider (CHCP). • Steps taken to establish 1 UHFWC for every Union. New 200 UHFWCs constructed. Total 276 31Beded UHCs have been transformed into 50 Bedded UHC and 3 into 100 Bedded. UHC. • Number of Govt. Hospital increased from 568 to 592. • Number of Non-Govt. Hospital increased from 2,155 to 3,190. • No. of Govt Medical & Dental College increased from 20 to 31, Non-Govt from 52 to 72. • No. of Govt. Nursing College & Institutes 34 to 53, Non-govt. from 34 to 107 • About 5,728 Medical Doctors and around 6000 Nurses were recruited. • About 2,169 new health cadre posts were created and 1,763 other posts were created. • Additional 7000 medical doctor, 4000 Nurses and 3000 Midwifes are under recruitment process. Source: http://www.pmo.gov.bd/index.php?option=com_content&task=blogcategory&id=158&Itemid=398 HRM Unit, MOHFW

13. Current Stock & Trends: Health worker population ratio Source: GOB HRH Country Profile, 2013 HRM Unit, MOHFW

14. Density of HW/1000 in 2012 and 2003 HRM Unit, MOHFW Source: GOB HRH Country Profile, 2013

15. From Kampala to Recife: Case of BangladeshRegistered health professionals 2008-2012 Source: GOB HRH Country Profile, 2013 HRM Unit, MOHFW

16. Status of major health indicator Source: MOHFW, APR 2013 HRM Unit, MOHFW

17. Health MDGs: Bangladesh Current Status Source: GOB Planning Commission, 2013 HRM Unit, MOHFW

18. Major HRH issues and challenges: Generating commitmentsReference: Bangladesh Health Workforce Strategy 2003, 2008/09, National Health Policy 2011, Vision 2021, HPNSDP 2011-2016, PIP of HPNSDP 2011-2016, MOHFW APR 2009, 2012 and 2013, World Health Report 2006 Governance and management • Lack of good governance and accountability (best practices) of HRM functions such as recruitment, promotion, transfers and postings • Centralized HR planning and management with minimum people’s participation (stakeholders) • Lack of public private partnership on HRH issues • Mal-distribution (e.g. skewed HRH concentration in urban areas) • Inefficient Performance management systems (e.g. backdated, inefficient, and manipulated performance management systems with minimum linkage with organizational mission and vision) • Fragmented HRIS (which hinders evidence based policy making, planning and management) Production & supply • Shortages of skilled Health workforce (e.g. Bangladesh is one of the 57th severe health workforce shortage countries) • Skill-mix imbalance (e.g. more doctor than nurse, med assistant, technologists) Financing Inadequate resources allocation for HRH management and research. Quality • Lack of coordination and regulation of GO, NGOs and private sector HRH initiatives (in both production and employment generation) • Weak accreditation framework of production MOHFW of Bangladesh is proclaiming its commitment at the occasion of the 3rd global forum on HRH for • “Improving the processes of production, recruitment, deployment, development and retention of the health workforce in close collaboration with the public and private sectors for reasonably balanced distribution of each type of workforce in optimum number to meet the health needs of each specific population group of the country.” HRM Unit, MOHFW

19. Priority HRH objectives • Develop a need-based comprehensive Human Resource Plan • i.e. focusing on scaling up the production and deployment of each type of health workforce; • Strengthening HRM functions across the ministry and its directorates; • Develop responsive and effective policies/ processes for staff recruitment, deployment, development and retention including incentives for working in remote/hard to reach areas. • Enhance continuing education of the teaching staff to support quality education and training of the health workforce; • Give special attention to improving production capacity of nurses, midwives, MTs, MAs, FWVs, birth attendants and community health workers • Establish a formal and effective accreditation system for medical education and health care institutions/facilities irrespective of public, private and NGO sectors; • Scale up the Individual Performance Management System (IPMS) and expand its application to the Organization Performance Management System (OPMS); • Improve the role, function, organization and effectiveness of current Human Resource Functions across the Ministry and Directorates; • Establish effective and functional HR systems at the national level and health facilities /organizations at the local level. Source: Bangladesh Health Workforce Strategy 2008/2009 HRM Unit, MOHFW

20. Immediate HRH Targets and timeframe 1. Targets related to Overall planning and coordination: • National assessment of the capacity of public and private pre-service training institutions completed to determine the HR gap by categories - developed by Mid- 2014 and utilized by Mid- 2016 (Information source/s: progress report) • HR Projection - developed by Mid- 2014 and utilized by Mid- 2016 (Information source/s: progress report) • HR Planning -developed by Mid- 2014 and implemented by Mid- 2016 (Information source/s: progress report) • Strengthening HR Management Functions across the MOHFW- Initiated by April 2014 and Recommendations by 2014 • Policy on introducing incentive packages (initiatedby Mid- 2014 and pilot for introducing incentive packages implemented by Mid- 2016 (Information source/s: progress report) • Central Human Resources Information System (HRIS) with MOHFW- Requirement analysis and specification of the system finalized by Mid 2014 and Systems design finalized by Mid 2016(Information source/s: progress report) HRM Unit, MOHFW Source: PIP of HPNSDP 2011-2016

21. Immediate HRH Targets and timeframe (cont…) 2. Targets related to health professional recruitment: • Review and update Recruitment rules for (a) Health, (b) Non-medical, (c) Family Planning and (d) Nursing cadres – revised b, d by Mid- 2014 and a, c by Mid- 2016 • Review and update the Job description for (a), (b), (c) and (d) - updated and oriented for implementation by 2016 • Action plan has been designed and stakeholder consultations are put into place to generate evidence for developing an incentive package (Information source/s: progress report) • Incentive package has been developed with costing analysis and utilization plan approved by the ministry. (Information source/s: Final report) • Central framework of the HRIS is developed in consultation with relevant directorate and professional bodies. (Information source/s: progress report and related documents) • Prototyping with specific data entry has been done and communication channels are established and functioning. (Information source/s: final/notification report)

22. Thank you!!Question and comments? HRM Unit, MOHFW