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Scaling up health workforce education and training to achieve the MDGs

Scaling up health workforce education and training to achieve the MDGs. Rebecca Bailey, MSPH, CEd Technical Officer , Health Workforce Education and Training Department of Human Resources for Health World Health Organization Geneva, Switzerland. The Case.

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Scaling up health workforce education and training to achieve the MDGs

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  1. Scaling up health workforce education and training to achieve the MDGs Rebecca Bailey, MSPH, CEd Technical Officer, Health Workforce Education and Training Department of Human Resources for Health World Health OrganizationGeneva, Switzerland

  2. The Case • You are the dean of Tegbar Medical School in a country with high HIV/AIDS prevalence. An evaluation shows that among the new graduates from your 5-year medical degree programme: • 1% are recruited to rural areas where 50% of the population resides • 90% require in-service training courses to bring them up to date with current health policies and clinical guidelines for HIV and AIDS • What should you do?

  3. Overview • HRH Strategy • Challenges • Progress • Discussion

  4. To ensure all people have equitable access to an adequately trained, competent, motivated and supported health workforce so they attain the highest possible level of health. Strategy of the WHO Human Resources for Health Team: 2010 to 2015* Vision Mission To enable WHO Member States to achieve their current and future health workforce development objectives through scientifically sound policy development approaches. • *Deadline for the MDGs

  5. Strategy: values Strategy is based on: • Commitment to Health-for-All and Primary Health Care • Working for social justice and equity • Working in partnership • Promoting a respectful working environment for health workers

  6. Strategic directions: three main lines of work • Providing strategic information for policy making, monitoring trends and assessing progress. • Promoting strategic investment in health workforce development. • Promoting innovative approaches to harmonize health workforce policies and programmes across the life-course of the population in an integrated way (e.g. beyond single health issues or specific cadres of personnel)

  7. Working lifespan strategies to build capacity and performance ENTRY:Preparing the workforce Planning Education Recruitment WORKFORCE PERFORMANCE WORKFORCE: Enhancing worker performance Supervision Compensation Systems support Lifelong learning Availability Competence Responsiveness Productivity EXIT:Managing attrition Migration Career choice Health and safety Retirement Source: WHO (2006). The World Health Report 2006 – Working Together for Health.Geneva, World Health Organization

  8. A complex issue in a complex environment ENTRY:Preparing the workforce Planning Education Recruitment WORKFORCE: Enhancing worker performance Supervision Compensation Systems support Lifelong learning WORKFORCE PERFORMANCE Availability Competence Responsiveness Productivity EXIT:Managing attrition Migration Career choice Health and safety Retirement World Bank WHO Development partners Ministry of finance GAVI The Global Fund PEPFAR Ministry of labour Ministry of higher education Civil service commission Professional associations Ministry of health Health workers Ministry of transport Populations/communities Ministry of public administration

  9. Reaching universal coverage with priority health interventions Overarching health workforce goal: • The right people • At the right places and time • With the right competencies, and • the right resources and support.

  10. Health workforce is critical for achieving the health-related MDGs MDGs Interventions Health Workforce ART ORT PMTCT ACTs Nutrition TBT etc. MDG 4, 5 and 6 targets for children, pregnant women, persons with AIDS, TB and malaria Health Workforce

  11. Why the “bottleneck”? General challenges: Workforce planning Information about the workforce Numbers of health workers Distribution (urban/rural) Competence/performance Migration and attrition Working conditions (workload, pay, resources) Career paths Investment, financing and fiscal policies (e.g. salary caps in civil service sector) Education-specific challenges: Recruitment and selection Exponential growth of information to cover Rapidly changing environment in which graduates will practice (e.g. technology, policy, guidelines) Infrastructure (classrooms, laboratories, clinical practice sites) Instructors/teachers/preceptors Resistance to change Links between education, health and labor sectors

  12. Country priorities as reflected in 30 GFATM round 5 health system strengthening proposals Human resources

  13. Positive correlation between health worker density and intervention coverage Source: WHO (2006). The World Health Report 2006 – Working Together for Health. Geneva, World Health Organization

  14. Critical shortages and poor distribution of health workers Distribution of the global health workforce Source: WHO (2006). The World Health Report 2006 – Working Together for Health. Geneva, World Health Organization Critical shortages in 57 countries, 36 of which are in sub-Saharan Africa

  15. The same countries are making slow progress towards the health-related MDGs Maternal mortality ratio per 100 000 live births in 2000 Source: WHO (2005). The World Health Report 2005 – Make Every Mother and Child Count. Geneva, World Health Organization

  16. Inequitable distribution and imbalances Rural/urban distribution of health workers

  17. Common causes of health workforce shortages from country to country ENTRY: Preparing the workforce Limited data and information about the current workforce Poor planning (cadres, numbers, distribution) Insufficient budgets and capacity for education and training Curricula not based on health needs and not competency-based WORKFORCE: Recruit and retain Fiscal policies (wage spending caps) Limited budgets for remuneration Poor working conditions Poor career structures Lack of supportive supervision Poor integration with the private sector EXIT: Managing attrition • Migration (outward and within) • Illness and death • Change of occupation • Retirement

  18. Current capacity to produce the 4.3 million additional health workers needed % increase of HCP required Total HCP schools NA 1750 98% 362 119% 1889 50% 1440 40% 1388 139% 354

  19. Disparities in medical schools and graduates

  20. Pipeline to generate and recruitthe health workforce Quality Quality - Teachers Attract Retain EducateTrain Certify RecruitDeployRetain LIFE-LONG LEARNING………………………………………………

  21. WHR2006: Ten-year plan of action

  22. Moving human resources for healthup the global health agenda WHA Resolution 48.8 on reorienting medical education and medical practice for health (1995) 1995 1996 / 2001 / 2004 2005 2006 2007 2008 WHA Resolution 54.12 on strengthening nursing and midwifery(2001) WHA Resolution 57.19 on international migrationof health personnel (2004) World Health Report 2006, Working together for health GHWA Task Force on Scaling up Education and Training of Health Workers, March 2007 Global Forumon Human Resources for Health, March 2008 produced the Kampala Declaration and Agenda for Global Action WHA Resolution 59.23 on rapid scaling up of health workforce production WHA Resolution 49.1 on strengthening nursing and midwifery (1996) WHA Resolution 58.17 on international migrationof health personnel (2005) Task force report on scaling up education and training launched, May 2008 WHA Resolution 59.27 on strengthening nursing and midwifery Global Health Workforce Alliance (GHWA)

  23. Scaling-up the health workforce (Financial crisis events)

  24. Task Force on Scaling up Education and Training • Recommends urgent implementation of new strategies to address acute shortages of health workers • Vision for the future • National road map • Types of health workers to scale up • Building strong education and training systems • International action needed • The cost • Measuring success • Country case studies • Recommendations www.ghwa.org

  25. Critical success factors Education and training Strategies Scale-up outcomes Chronic disease management Health outcomes MDG 5 MDG 4 MDG 6 Source: Scaling Up, Saving Lives. World Health Organization and Global Health Workforce Alliance, 2008

  26. Building strong education and training systems Guiding principles: • Address country health needs and embed education and training in the health system; • Increase equity and efficiencies of scale of health service delivery through innovative curriculum design and delivery (e.g. distributed, distance, on-the-job learning, case based?) • Enhance quality through leadership and collaboration (e.g. twinning, consortia)

  27. Education systems: proposed strategies 1 • Reduce attrition among students and teachers, and improve accessibility • Integrate pre-service and in-service education and training (links with services) • Develop common educational platforms for different types of health workers (e.g. team based) • Move learning to the community, using modular education and action learning • Increase use of information and communication technologies • Improve education through quality assurance programmes

  28. Education systems: proposed strategies 2 • Build institutional capacity by: • expanding teaching capacity (e.g. teachers from services) • fostering twinning and partnerships • maximizing impact through regional approaches, and • harnessing public-private partnerships

  29. IMCI strengthening pre-service education

  30. Transformative Scale Up • More health workers, but not the same • Education and training within the context of primary health care renewal, that is: • Needs based • Problem based • Community based • Public health based • Team based • Socially accountable • Linked to services and systems • Dynamic – responding to new policies, technologies, technical guidelines, etc. • Never the same lecture twice!

  31. Spare slides

  32. HRH Action Framework country specific context including labour market Preparation & Planning Critical Success Factors Policy BETTER HEALTH SERVICES EquityEffectivenessEfficiencyAccessibility Leadership Finance Improved Health Workforce Outcomes H R M Systems BETTER HEALTH OUTCOMES Situation analysis Implement-ation Partnership Education other healthsystemcomponents M & E

  33. Link the education, labour and health services markets Source: WHO (2006). The World Health Report 2006 – Working Together for Health. Geneva, World Health Organization

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