KEY ELEMENTS OF THE HEALTHCARE SYSTEM

1. KEY ELEMENTS OF THE HEALTHCARE SYSTEM • Demand • Government • Payers • Private sector • Donors/ NGOs • Reimbursement • Taxes • Providers • Patients • Addressing the HRH problem will require resolving issues on both the supply and demand side in the context of a dynamic healthcare system • Incentives • Donations • Nurses, pharmacists, other HRH* • Doctors* • HIV/AIDS • Other infectious diseases • Public health administrators • Preventive and routine • User fees • Hospitals • Districts and DMCs • Maternal, child health • Pharmaceutical companies • Medical suppliers • Supply * Public and private Source: Team analysis

2. Productivity • Training • Retention • Utilization • Regulatory • Elements of HRH demand • Elements of HRH supply • HRH equilibrium • For any given geographic area and time period, this will be the total output based on the supply of appropriately skilled, deployed and motivated HRH and the actual demand (i.e. not latent demand) - - - - FRAMEWORK TO ANALYZE THE HRH PROBLEM • Access • Healthcare need • Total HRH educated and trained • Licensure, certification or registration • Hiring for public • Establish for private • Leave health sector (whole or in part) • Afford-ability • Distance • Ancillary costs • Incentives • Disease burden • Awareness of need for care x x • Financing • Output per HRH (limited by poor placement, lack of supplies, etc.) • Public (e.g. government) • Private (e.g. donors) Source: Team analysis

3. Productivity • Training • Retention • Utilization • Regulatory • Elements of HRH demand • Elements of HRH supply • HRH equilibrium • Adequate supply of appropriately skilled, deployed and motivated HRH to meet patient demand KEY BARRIERS TO EXPANSION OF HRH • PRELIMINARY Lack of community health workers High costs and associated costs Low attractiveness of health sector Poor country planning Poor country planning Low standard of care Low salaries (1/2) • Access • Healthcare need Inadequate training output Poor human resource management (HRM) Fiscal freezes vis-à-vis other sectors Donor preference and earmarking Poor facilities management • Financing Low salaries (2/2) • In addition, low enabling environment • Limited, though growing global cooperation • Lack of knowledge and tools Source: Literature survey, team analysis