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Lalitha Mendis, Indika Karunathilaka, and Hiranthi de Silva

INCENTIVES TO SUPPORT HUMAN RESOURCES FOR HEALTH (HRH), RETENTION, PRODUCTIVITY, AND EQUITABLE DISTRIBUTION. Lalitha Mendis, Indika Karunathilaka, and Hiranthi de Silva AAAH Conference, Bangkok, October 28-31 2006. Sri Lanka. Surface area 62,7 million sq km KM Population 19.2M

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Lalitha Mendis, Indika Karunathilaka, and Hiranthi de Silva

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  1. INCENTIVES TO SUPPORT HUMAN RESOURCES FOR HEALTH (HRH), RETENTION, PRODUCTIVITY, AND EQUITABLE DISTRIBUTION Lalitha Mendis, Indika Karunathilaka, and Hiranthi de Silva AAAH Conference, Bangkok, October 28-31 2006

  2. Sri Lanka • Surface area 62,7 million sq km KM • Population 19.2M • Health Budget 3.8% GDP • Health Indices • Life Expectancy 73 years • Infant Mortality/1000 live births 11.2 • Maternal Mortality /10,000 live births 1.9 • Under 5 yr mortality/1000 live births 16.3 Health Work force 100,000

  3. MAIN PROBLEMS RELATING TO HRH • Insufficient numbers in some categories • Maldistribution • Migration • International • Rural to urban • Public to private sector • Lack of clear health policy • Lack of proper management information system • Lack of modern management system

  4. As at 2006 & 2010 projection • 55.2 Drs per 100,000 population i.e. one Dr per 1811 people. • (By 2010 it should increase to 90.5 Drs per 100,000 i.e. I Dr per 1100 persons) • 4.3 specialists per 100,000 population i.e. One Sp per 23,000 persons • (By 2010 we should have 10.8 sp per 100,000; i.e. 1 sp per 9000 persons) • 2.8 GPs per 100,000 population i.e. GP per 35,000 persons. • 6.2 dentists per 100,000 pop. i.e. 1 dentist per 16,000 persons.

  5. DOCTORS PER 100,000 POPULATION Drs per 100,000 55.2 90.5 Sri lanka • Global average 170 / 100,000 population • South Asian average 40 + • Sri Lanka 55.2 • Bangladesh 23 • India 51 • Nepal 05 • Pakistan 66 • Malaysia 67.2

  6. Allied Health Professionals in SL, September 2002 Rate per 100,000 population Source : Annual Health Bulletin 2002 Medical Statistics Unit

  7. NURSES • Cadre 36,000 • Available 197000 • In Training 8000

  8. Undergraduate Medical Education Free 8 medical Schools ? Impending glut of doctors • Postgraduate Medical Education (PGIM) Compulsory year of overseas Training Both undergraduate and postgraduate medical education by Ministry of Higher Education

  9. Loss of Postgraduate Trainees who Qualified MD/MS from 1993 to 2000

  10. Training of Nurses and AHP • By Ministry of Health • Recently • 4 universities have begun BSc courses

  11. What Non Financial Incentives are possible to populate the provinces with HCWs that they need • Improve living conditions of housing, and accommodation • Schooling for children by ensuring places for children in closest & good urban schools (army has this arrangement) • Provide car loans and housing loans • Provide good working conditions that satisfy their professional conscious & good job satisfaction and enable them to use the skills that they have learned • Work out a credit and reward system for working in difficult areas

  12. What Non Financial Incentives are possible to populate the provinces with HCWs that they need • Limit the period spent in difficult areas to a minimum • Offer the incentives of recruitment in services to those in different areas as the understanding they will serve in that area for a specific period of time • The ministry could inspire more confidence in the system –that is worker friendly, efficient, non-political, fair and firm. • For this the ministry needs a good management information system. For lack of this and due to political manouvering some remain in urban areas for long period of time.

  13. INCREASING MOTIVATION AND PERFORMANCE • Performance based salary increments and promotions • Improve social prestige & image • Reward good worke.g. opportunities for post-basic training in country or overseas

  14. ADDRESSING THE HRH PROBLEM • ROLE OF MINISTRY OF HEALTH • Human Resource Unit in Ministry of health • Research the problem • Evidence based solutions • Clear and transparent policies POSSIBLE ROLE OF WHO AND GHWA Advocacy Fund Research

  15. Thank you

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