Non-financial incentives to support HRH retention, productivity and equitable distribution

1. The First Conference of The Asia Pacific Action Alliance on Human Resources for Health October 28th to 30th 2006 Bangkok, Thailand Non-financial incentives to support HRH retention, productivity and equitable distribution Francisco Campos Ministry of Health, Brazil

2. Some important information about National Health System (SUS): • Universal, equitable and holistic system included in the Constitution. • Decentralized and socially controlled system. • Provides comprehensive and free medical care to the whole population. • 82% coverage of influenza vaccination for elderly, rotavirus vaccination provided by SUS, improvements in health outcomes. • Is a global reference for STD/AIDS – free public antiretroviral therapy • 72,000 hearth surgeries • 132 million high-complexity procedures • 12,000 organ transplants

3. Family Health Strategy (FHS) • Implemented in 84% of municipalities/counties (+/- 5,000) • 26K teams (1 physician, 1 dentist, 1 nurse, 1-2 aux. nurse, 6 CHW) • Coverage: 50% of the Brazilian population  • 86M people

4. HFP strategy is growing up… Target and actual number of family health teams – Brazil, 1994 –2005 FONTE: SIAB - Sistema de Informação da Atenção Básica

5. FHP strategy is growing up… Target and actual population coverage by the family health teams – Brazil, 1994 –2005 (x 1.000.000 hab.) FONTE: SIAB - Sistema de Informação da Atenção Básica

6. 1998 1999 2000 2001 2003 2004 2005* The rate of change Actual coverage: % of population by the health family teams – Brazil, 1998 –2005 0% 0 a 25% 25 a 50% 50 a 75% 75 a 100% FONTE: SIAB - Sistema de Informação da Atenção Básica

7. Population: coverage 2005 0% 0 a 25% 25 a 50% 50 a 75% 75 a 100%

8. Family Health Program: Main Challenges (1) URBAN AREAS: Despite positive difference of salaries, professionals are reluctant to join FHP, due to “lack of prestige” (2) RURAL AREAS: A former federal program encouraging professionals to go to inner cities has failed. Professionals alleged lack of support (second opinion and continuous education) as the main reason for leaving

9. IMPROVING SELF-CONFIDENCE AND “PRESTIGE” OF FHT • New professionals joining this area: • MOH supports multi professional and Medical Residences in PHC (1K residents in 30 academic programs funded by MOH: US$15K/resident) • Incentives to research and doctoral thesis in PHC – management and clinical guidelines and “consensus” • Former specialists hired by NHS as FHT members: • Incentives to Specialization in Family Health by academic institutions (2K specialists/year in 40 programs: US$3K/sp) • Training Platform upgrade: from on-site courses to combined model including distance learning • Belo Horizonte as role model: 1K professionals specialized in 2 years.

10. ADDRESSING THE CHALLENGES IN URBAN AREAS • MOH has commissioned all the teaching capacity, but it is still insufficient to prepare 26K professionals. • Multi Centric Network, to develop shared technologies, exchanges, technical cooperation, knowledge management, clearinghouse and guidelines, … • Incentives to academia and professional associations to scale-up supply of specialized training in FHP, both as traditional on-site offer and Distance Learning (and combinations).

11. SYNERGIC PARALEL TRACKS: • Assurance that FHT is a trustful and reliable policy and not merely a wishful thinking, a transitory commitment of a specific government or political party. It is a permanent state policy and it won’t change. • Mass media communication: Assuring confidence in FHT as gatekeepers and responsible for improvements in health. Research institute find strong popular support towards this policy. • Huge financial incentives to M/D/N schools to change their curricula to tackle social and epidemiological needs (PRO-SAÚDE).

12. CHALLENGE 2: RURAL AND REMOTE AREAS: TELE-HEALTH • TELEHEALTH comprises assistance and education components • Initial figure: It is possible to save 1:100 in direct and indirect costs (deployments, bad use of scarce resources, unnecessary examinations and prescriptions, work absenteeism). • Institutional partnership: MOH, MOE, Communications, Science and Technology, Defense, Academia, Professional Organizations • MOH joined the National Network of Research to bring hi-speed internet to all health centers (official protocol signed 4 days ago by 3 Ministers) • PHC network will merge the UH already set University Hospital network.

13. TELE HEALTH OBJECTIVES • To organize a system of consultancy and second opinion • To promote the use of tele-education health services (training, practical qualification, and evaluation of professional competencies) • To promote the digital inclusion of Primary Health professionals

14. R N P B A C K B O N E

15. Regions of implementation 8 Poles  800 sites 2.400 teams  10.000.000 people

16. Infrastructure of the Pole (University Hospitals)

17. Remote site technology (800 Units / FTH)

18. Ministry of Health Secretariat of Management of Education and Work in Health Francisco Campos www.saude.gov.br/sgtes francisco.campos@saude.gov.br