Charles Godue Unit of Human Resources for Health, PAHO/WHO

1. Charles GodueUnit of Human Resources for Health, PAHO/WHO The network of observatories of human resources for health: the experience of the Americas Asia-Pacific Action Alliance on Human Resources for Health 28-31 October 2006

2. The Region of the Americas • 48 countries and territories • 4 main languages • Total population 2000: 833,112,000 • Total Physicians and Nurses: 5,197,200 • The US represents 68% of total # of physicians and nurses (>3.5m) • Important disparities between countries and within countries

3. The Region of the Americas • In 2000, over 163 million people resided in areas where the human resources density was below the minimum target of 25 per 10,000 • In the 15 countries where the health human resources density ratio is below 25, it would take approximately 128,000 additional doctors and nurses to reach that level

4. In the Region of the Americas • Physician supply in urban areas is eight to ten times higher than it is in rural areas • Nurses outnumber 3 to 1 in North America, but doctors outnumber nurses 3 to 1 in many Latin American countries

5. In the Region of the Americas • Roughly three quarters of the countries and territories of the Americas have experienced a net loss with respect to migration of their health human resources • Haiti, with the lowest physician to population ratio in the Americas, has a physician emigration rate almost 12 times higher than Cuba, with one of the highest ratio in the world • The gap between countries with high and low densities of health workers continues to grow

6. However, some radical experiences of scaling up human resources are taking place • Escuela Latinoamericana de Medicina, La Havana, Cuba, 1998. This year first cohort to graduate, 1501 students from 20 countries • Venezuela: scaling up the production of doctors, nurses and allied health professionals; Mision Barrio Adentro: more than 20,000 doctors and nurses from Cuba; large number of professors

7. The context of the initiative of the Observatories • Summit of the Americas, 1995: PAHO is given the responsibility to monitor health sector reforms in the Region • Costa Rica, 1997: Human Resources as a key component of health sector reforms • Chile, 1999: launching of the initiative of the Observatory of Human Resources for Health • Public Health in the Americas, the Essential Public Health Functions and the question of the PHWF

8. Objectives of the Initiative • Raise awareness on the importance of human resources issues • Monitor the impact and implications of Health Sector Reforms on human resources • Promote the production / utilization of information and knowledge for analyzing problems, define priorities and identify effective HRH interventions • Promote sharing of experiences and networking between countries on HRH policies

9. Observatory of Human Resources in Health Priority issues and policies Interests of stakeholders Evidence

10. Observatory of Human Resources in Health EVIDENCE FOR DECISION-MAKING HRH Steering Role Policy Planning Regulation Education Management HRH Core Data Set Comparative Studies Case Studies Intercountry Cooperation Information Clearinghouse Training Institutional Development Direct Technical Cooperation National Interinstitution Intersectoral Groups ANALYSIS BARGAINING AGREEMENT HRH STRATEGIC INTERVENTIONS ARGENTINA, BELIZE, BOLIVIA, BRAZIL, CANADA, CHILE, COLOMBIA, COSTA RICA, CUBA, DOMINICAN REPUBLIC, ECUADOR, EL SALVADOR, JAMAICA,MEXICO, NICARAGUA, PANAMA, PARAGUAY, PERU, SAINT. LUCIA, URUGUAY, VENEZUELA

11. Main strategies of the Initiative • Country based: build on existing country dynamics and actors (there is to be an interest) • Minimum of formality; high organizational flexibility to accommodate diversity, political contexts • Empower, strengthen the capacity of HRH Units of the Ministries of Health • Be responsive when technical assistance was required • Provide visibility to the countries’ policy initiatives and a forum for discussion through the annual meeting of the Observatories

12. Organization models • Models of organization would vary from one country to the other, according to existing institutional arrangements and leadership • MOH always involved • Associations of education institutions, professional associations, interdisciplinary groups, NGOs, others • The Brazilian model network of observatories • PWR: active supportive role

16. Initial results of the initiative • Launched in 1999 with 9 countries; in 2005, 23 countries were involved in the initiative • Development of a community of professionals engaged in HRD policy • Significant production: national profiles of HRH, special topics • www.observatoriorh.org

17. The initiative gets a new momentum • Breaking point: the VI Regional Meeting, Brasilia, 2004: the network becomes a “ movement” • Interest in developing a regional agenda • Creation of a coordinating committee (CAN, BRA, JAM, PER, MEX) • Regional consultation on critical challenges and national capacities to meet them • The Regional Meeting acquires a new role

18. The VIII Regional Meeting of the Observatories, Toronto, Canada • 28 countries, 11 international organizations • HR policies as a strategic component of health systems policies; participation of 8 deputy ministers of health • Main outputs: a common platform for action, an advocacy instrument, a vision for the next 10 years

19. “The Call to Action aims to mobilize institutional actors, both national and international, of the health sector and other relevant sectors and civil society, to collectively strengthen the human resources for health through policies and interventions, in order to achieve the Millennium Development Goals and according to the national health priorities to provide access to quality health services for all the peoples of the Americas by the year 2015”

20. The approach: cooperation between countries • Toronto Call to Action: commitment by Member States for plans of action with long term objectives (10 years), indicators, monitoring system • Scaling up technical cooperation between countries within a multilateral framework: the contributions of Canada and Brazil • Leadership development for HRH policy: creating a learning community with the teams developing the action plans

21. VIII Regional Meeting of the Observatories of Human Resources for Health, Lima, Peru, 20-22 November 2006 Designed as a “peer-review” process of national action plans by subregions Definition of needs for technical cooperation Participation of the MOH of the Andean Region Participation of African Countries

22. From advocacy to action • 2007: regional plan of action and cooperation strategy 2007-2015 • Regional meeting will take place every 2 years • Will focus on monitoring progress, identifying bottle necks, designing short term (2 years) initiatives (work plans) • The concept of “observatory”: more specialized function of research, production of information, monitoring of progress

23. Key messages • The network is inclusive, country-based, but with basic rules and commitments • Minimum regional governing structure • The involvement of stakeholders within countries and the cooperation between countries favor continuity of policy • Importance of linking the technical and the political aspects, HR discussions at the highest level of decision making

24. Key messages • Creating a “community” of learning and practice • Availability and continuity of technical support; personalized relations and cooperation, trust

25. Thank you

26. Plan decenal de RRHH Centroamérica TALLER SUBREGIONAL Definición de Planes Decenales de Recursos Humanos Copán Ruinas, Honduras 23 al 25 de Agosto de 2006

27. 5 critical challenges • Policies and long-term plans for the adaptation of the workforce to the changes in health systems and the health conditions of the population • Equitable distribution of health workers • Effective regulation of the migration and displacements of health workers • Promotion of healthy work environments and commitment to the institutional mission to guarantee quality health services • Mechanisms and interaction between training institutions and health services