Health Workforce Development for Revisiting the PHC Approach

1. Health Workforce Development for Revisiting the PHC Approach Dr Thushara Fernando Technical Officer Health Systems Strengthening Department of Health Systems Development WHO SEARO

2. Presentation Outline • Health Workforce in SEAR • SEARO’s Action • PHC Approach and Health Challenges

3. Health Workforce in SEAR ■

4. Who are Health Workforce? All people engaged in actions whose primary intent is to enhance health Health Service Providers Managerial and Supportive staff +

5. Limitations of Health Workforce data and Information • Not regularly updated • No uniformity in classification of categories • Data limited to State Health Sector - Private Health Sector not adequately covered • Data concentrates on doctors and nurses - not on other categories • Community Healthcare Workers are usually not counted

6. HRH related problems and causes Shortages • Lack of HRH policies • Lack of norms and standards • Inadequate production capacity • Out-Migration Mal-distribution • Lack of HRH deployment policies • Lack of basic facilities • Migration • Over production of some categories Lack of competency & passion • inadequate pre-service training • Lack of public health orientation • Inadequate in service training • Lack of quality control mechanisms in training Ineffective management capacity • Shortage of managers • Week incentive systems • Week management policies and practices • Dual employment

7. HRH related problems and causes Shortages • Lack of HRH policies • Lack of norms and standards • Inadequate production capacity • Out-Migration Mal-distribution • Lack of HRH deployment policies • Lack of basic facilities • Migration • Over production of some categories Lack of competency & passion • inadequate pre-service training • Lack of public health orientation • Inadequate in service training • Lack of quality control mechanisms in training Ineffective management capacity • Shortage of managers • Week incentive systems • Week management policies and practices • Dual employment

9. Where are we in relation to this population norm? Number of (Doctors + Nurses + Midwives) per 1,000 population

10. HRH related problems and causes Shortages • Lack of HRH policies • Lack of norms and standards • Inadequate production capacity • Out-Migration Mal-distribution • Lack of HRH deployment policies • Lack of basic facilities • Migration • Over production of some categories Lack of competency & passion • inadequate pre-service training • Lack of public health orientation • Inadequate in service training • Lack of quality control mechanisms in training Ineffective management capacity • Shortage of managers • Week incentive systems • Week management policies and practices • Dual employment

11. SEA Countries: Doctors and Nurses per 1000 population

12. In-country Geographical Imbalances Doctors and Nurses

13. HRH related problems and causes Shortages • Lack of HRH policies • Lack of norms and standards • Inadequate production capacity • Out-Migration Mal-distribution • Lack of HRH deployment policies • Lack of basic facilities • Migration • Over production of some categories Lack of competency & passion • inadequate pre-service training • Lack of public health orientation • Inadequate in service training • Lack of quality control mechanisms in training Ineffective management capacity • Shortage of managers • Week incentive systems • Week management policies and practices • Dual employment

14. Competency of Health Workforce • Pre-service training is not geared to capture the challenges of service delivery • Need-based, job oriented training is not yet practices widely • There is an inadequacy of infrastructure and training equipment • Many training centres still use outdated teaching methods and materials • Quality assurance mechanisms are often lacking • Very few opportunities for continuing education.

15. HRH related problems and causes Shortages • Lack of HRH policies • Lack of norms and standards • Inadequate production capacity • Out-Migration Mal-distribution • Lack of HRH deployment policies • Lack of basic facilities • Migration • Over production of some categories Lack of competency & passion • inadequate pre-service training • Lack of public health orientation • Inadequate in service training • Lack of quality control mechanisms in training Ineffective management capacity • Shortage of managers • Week incentive systems • Week management policies and practices • Dual employment

16. Management Issues • Incentive systems are not very attractive • Management policies and practices are out dated and ineffective • The working environments are not appealing • Inadequate opportunities for career advancement and personal development • Health workforce demotivated • Often attrition is high and the productivity is low

17. SEARO’s Action

18. SEARO’s action RC Resolutions • Strengthen resource policies for health systems and development of appropriate HRH for PHC (SEA/RC30/R12-1977) • Training of voluntary health workers (SEA/RC29/R9-1976) • Community based orientation in medical education (SEA/RC29/R9/1976) and SEA/RC42/R5-1989)

19. SEARO’s action ctd. • The Calcutta Declaration on strengthening and reforming public health education, training and research 1999 • Development of accreditation guidelines for Public Health Institutes - 2002, • Support to International Executive Programme in Public Health - 2002 • Consultation on ‘Future Directions in Public Health – Calcutta and Beyond - 2003 • International Forum of South-East Asia Public Health Education Institutes Network (SEAPHEIN) - 2004 • Launching the South-East Asia Public Health Initiative 2004-2008 to assist the countries in strengthening public health

20. SEARO’s Response 2006 - 2007 • ‘Dhaka Declaration’, August 2006 • SEA / RC59 / R6: ‘Strengthening the Health workforce in South-East Asia’ • SEA / RC59 endorsed ‘SEA Regional Strategic Plan for Human Resource Development’ ∆ • SEA / RC60 / R 9 ‘ International migration of health personnel: A challenge for health systems in developing countries’

21. PHC Approach and Health Challenges

22. PHC Concepts • Universal coverage • Balanced mix of services • Quality of services • Community involvement • Intersectoral involvement Did we achieve PHC goals?

28. New millennium and new health challenges • Demographic transition • Epidemiological transition • Technological transition • Social transition • Increasing natural disasters and emergency situations • Privatization • Globalization

29. Moving forward… • The principles of PHC still remain valid • The need to strengthen Health Systems using PHC approach has been recognized • Existing Health Workforce problems as a system constrain has been highlighted regionally and globally: WHR 2006, RC Resolutions, Dhaka Declaration, Regional HWSP • The need to develop a sustainable community based health workforce has arisen as never before

30. ‘Revisiting Community Based Health Workers and Community Health Volunteers’ • Who are CBHW/CHV? • The origin and evolution • The role & need of CBHW & CHV in today’s context • Regional Strategic Directions for development of CBHW and CHV ∆

31. Community Based Health Worker all health workers part of the formal health organization undergone formal training spend substantial part of the working time actively reaching the community discharging services Community Health Volunteer members from communities undergone shorter training than professional workers predominantly involved in health promotion and prevention supported by the formal health system. Who are CBHW? CHV?

32. Regional Strategic Directions for development of CBHW and CHV ∆ • Three strategic Pillars • Nine Broad Strategic Actions

33. Thank You