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Global, Regional and Local Challenges in Human Resources for Health

Global, Regional and Local Challenges in Human Resources for Health. Bruce Fried, PhD Department of Health Policy & Administration University of North Carolina at Chapel Hil May 28, 2008. Where does the health workforce fit into health system goals?. The Health Workforce and Health Outcomes.

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Global, Regional and Local Challenges in Human Resources for Health

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  1. Global, Regional and Local Challenges in Human Resources for Health Bruce Fried, PhD Department of Health Policy & Administration University of North Carolina at Chapel Hil May 28, 2008

  2. Where does the health workforce fit into health system goals?

  3. The Health Workforce and Health Outcomes Source: Human Resources for Health: Overcoming the Crisis. Global Equity Initiative, Harvard University, 2005.

  4. One Major Issue: Lack of Human Resources

  5. A Global View of Disparities in Supply From: JLI 2004.

  6. Health Worker Density and Mortality Source: Anand & Baernighausen- 2004 (JLI)

  7. Shortages and Global Maldistribution Ratios do not tell the whole story, but they do communicate compelling message. Source: Buchan J & Calman L. International Council of Nurses, 2004.

  8. Another perspective on disparities in the healthcare workforce: The burden of disease in Africa Source: Addressing Africa’s Health Workforce Issues: An Avenue for Action., 2004.

  9. Projection of health workforce in Africa based on current trends Current health workforce shortages in Africa will worsen in coming years. Source: Addressing Africa’s Health Workforce Issues: An Avenue for Action., 2004.

  10. Zambia Staff Attrition: Jan. 2003 – June 2004 Source: Dovlo D. “Human Resources for Health Situation Report: A Summary of International Fact-Finding on HRH.” High Level Forum-2004, Abuja, 2004. Zambia Country Case Study 2004

  11. The Case of Physicians Evidence of the loss of human capital

  12. Who benefits from physician mobility? In the U.S., 25.0% of all physicians in the US workforce are international medical graduates. In the U.K., 75.2% of IMGs are from lower-income countries Source: Mullan, 2005

  13. Highlights: Physicians trained in India account for: 4.9% of the U.S. physician workforce 10.9% of the U.K. physician 4.0% of the Australian physician workforce South Africa provides: 2.6% of Canadian physician workforce 2.3% of the Australian physician workforce 1.4% of the U.K. physician workforce Source: Mullan, 2005

  14. But the problems go beyond numbers.

  15. The Impacts of HIV/AIDS on the Health Workforce in Africa • Significant increase in workload • Attrition due to death from HIV/AIDS • death of nurses represents almost 40% of the annual output from training in 2 countries • Low productivity due to absenteeism, illness & burnout • Need for new, techniques-Palliative, Counseling • Deterrent to new entrants into nursing - perceived risk • Paradox – Higher demand for health workers but lower supply • Protecting the provider Source: Dovlo D. “Human Resources for Health Situation Report: A Summary of International Fact-Finding on HRH.” High Level Forum-2004, Abuja, 2004.

  16. Multiple driving forces and multiple workforce challenges

  17. Driving Forces Health needs Demographics Disease Burden Epidemics Health Systems Financing Technology Consumer Preferences Context Education Public Sector Reforms Globalization Workforce Challenges Shortages and Maldistribution Training and skill-mix imbalances Poor human resources management practices Poorly resourced systems Low job satisfaction and poor working conditions (include safety concerns) Failure of past public policy initiatives Lack of professional development and promotional opportunities Little or no involvement in decision making Lack of respect and lack of support Stress and overwork

  18. Regional Issues • Developed countries: aging population, aging nurse workforce, shrinking recruitment pool • Developing countries: low supply, emigration and “push” factors, HIV/AIDS

  19. Possible Solutions

  20. Invest in Human Capital • Improve earnings, career opportunities, and working conditions • Make more efficient use of personnel through improved geographic distribution • Mandatory service • Multiple incentives

  21. Dealing with Shortages • Increase compensation • Recruitment and retention bonuses • Retraining incentives to re-skill professionals in skill areas in short supply • Increase education intakes - more training • Increase use of foreign providers • Using technology to expand capacity (telemedicine) • Use substitute providers

  22. Dealing with Maldistribution • Expand opportunities for education in under-served areas • Geographic mobility incentives • Mandatory service

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