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G. Elzinga WHO, Geneva 14 - 02 - 2005

G. Elzinga WHO, Geneva 14 - 02 - 2005. Who cares?. Life Expectancy: Advancing and Slipping. Differences in health increase within countries and between countries. WHY CAN’T WE COPE?. HEALTH WORKFORCE PROBLEM. Joint Learning Initiative. Diagnosis (The Lancet, 27-11-2004).

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G. Elzinga WHO, Geneva 14 - 02 - 2005

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  1. G. Elzinga WHO, Geneva 14 - 02 - 2005

  2. Who cares?

  3. Life Expectancy: Advancing and Slipping

  4. Differences in health increase within countries and between countries. WHY CAN’T WE COPE?

  5. HEALTH WORKFORCE PROBLEM

  6. Joint Learning Initiative Diagnosis (The Lancet, 27-11-2004) Global Health Workforce cannot cope with global health crisis; SSA hit hardest

  7. The Glue of the Health System

  8. Sky full of HRH “challenges” distribution HIV/AIDS work conditions quality V&H dilemma’s honorarium training manage- ment migration productivity over- burdening status carrier perspective number

  9. PROVIDING HEALTH IN POVERTY

  10. V Program of prevention and/or care interventions to control a specific health-problem. H Infrastructure of prevention - and care services to cope with the prevailing health problems.

  11. V Vertical-horizontal in developing countries H V Vertical-horizontal in developed countries H

  12. Program Macrostructure IS ME PC V intervention strategy monitoring en evaluation prevention and/or care

  13. IS IS IS ME ME ME PC PC PC Differences between countries (polio) General health services

  14. polio TB 3x5 IS ME IS ME malaria IS ME IS ME PC PC PC PC Differences between programs General health services

  15. Vertical programs: who is doing what? international Intervention Strategy Monitoring/ Surveillance Prevention/care national district facility HRH required

  16. V & H HRH dilemma ? HRH synergy !

  17. RESEARCH CONTRIBUTIONS TO HEALTH WORKFORCE STRENGTHENING

  18. Health systems and workforces are ‘man-made’ THUS: • Research outcomes depend more on time and place than those of biomedical research. • However, research is not second rate: • Relevance: crucial to reach health outcomes and cost contaiment • Intellectually: methodology often quite demanding because of complexities

  19. 2 VALUABLE ‘RESEARCH’ LAYERS SPECIFIC GENERIC

  20. analysis M&E planning implementation SPECIFIC POLICY CYCLE

  21. a a a a a a a a a POLICY CYCLE POLICY CYCLE POLICY CYCLE POLICY CYCLE POLICY CYCLE POLICY CYCLE POLICY CYCLE POLICY CYCLE POLICY CYCLE m&e m&e m&e m&e m&e m&e m&e m&e m&e p p p p p p p p p a POLICY CYCLE m&e p i. i. i. i. i. i. i. i. i. i. GENERIC LEARNING FROM RESEARCH

  22. a a a POLICY CYCLE POLICY CYCLE POLICY CYCLE a POLICY CYCLE m&e m&e p m&e p p a a POLICY CYCLE POLICY CYCLE i. i. i. m&e p m&e p a POLICY CYCLE a POLICY CYCLE m&e p i. i. m&e p m&e p a a POLICY CYCLE POLICY CYCLE i. i. m&e p m&e p i. i. i. GENERIC BY RELATING DIFFERENCES TO OUTCOMES

  23. socio-political context health system health workforce HRHTB/HIV

  24. initiator stimulator participator contributor facilitator supporter ROLE OF HRHTB/HIV RESEARCH Priorities? HRHTB/HIV health workforce health system socio-political context

  25. “INITIATOR” PRIORITIES • Optimisation • (Integration; IT ?) • less time • higher quality • Simplification • less time/patient • lower cadres IS ME HIV/AIDS & TB PC • Time/Cost-effectiveness • (of intervention(s) and system) • less time/patient • more work satisfaction

  26. ROLE OF HRHTB/HIV RESEARCH initiator HRHTB/HIV stimulator participator health workforce contributor health system facilitator supporter Priorities? socio-political context

  27. Policy truths Economic growth cures poverty Health Care is a cost not a profit Thus, keep health expenditure low!

  28. Social realities Poor populations have high disease burdens They therefore need more health services while they can in fact afford less. Health below a critical state tends to deteriorate HIV/AIDS & TB/HIV can push health below that critical state, causing life expectancy to fall, the labor force to falter, and social costs to sore!

  29. EXAMPLES OF “SUPPORTER” PRIORITIES WHEN DOES HEALTH CARE CHANGE FROM COST TO INVESTMENT? WHAT REALISTIC INTERVENTIONS CAN COUNTER MIGRATION OF HEALTH WORKERS?

  30. Thank you

  31. Worker density by region

  32. ROLE OF HRHTB/HIV RESEARCH initiator Priorities? HRHTB/HIV stimulator participator health workforce contributor health system facilitator supporter socio-political context

  33. “ESSENTIAL PRIMARY CARE” FUNCTION Malaria Community Referral Centre M&C health HIV-AIDS Tuberculosis AVAILABLE 1 PER ?000 ACCESSIBLE < .. HOURS AFFORDABLE < . . % INCOME

  34. analysis POLICY CYCLE M&E planning implement. “PARTICIPATOR” PRIORITIES • Cost-effectiveness calculations of approach. • Methodology to determine availability, • accessibility, affordability of EPF • Controlled study of cost- and time • effectiveness of approach. • Etc.

  35. Technical agencies Foundations UNDP Post JLI ILO Worldbank NGO’s donors High level forum WHO MDG’s countries

  36. Technical agencies Foundations UNDP Post JLI ILO THANK YOU Worldbank NGO’s donors High level forum WHO MDG’s countries

  37. national policies demand ed. & tr. HIV-AIDS Migration global policies h e a l t h s y s t e m supply need health workforce population health community

  38. H+ development requires adequate general health services V+ burden of disease is higher in poor environments Een HRH dilemma ?

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