HUMAN RESOURCES FOR HEALTH: Conceptual Elements of the Post 2015 Agenda. San Salvador, El Salvador September 18 19, 2013

Transcription

1 HUMAN RESOURCES FOR HEALTH: Conceptual Elements of the Post 2015 Agenda San Salvador, El Salvador September 18 19, 2013

2 OVERVIEW The Road Thus Far Results, Ongoing Issues & Lessons Learned Elements of the HRH Planning Process Cost Drivers, Politics & Collaboration UHC, PHC & HRH & the Reform Process Options to Build HRH Planning & Management Capacity

3 THEN A Decade of Progress NOW Joint Learning Initiative (2004) WHO Research for UHC Toronto Call to Action (2005) WHO World Health Report (2006) 2 nd 20 HRH Goals Review Health Agenda for Americas (2007) Global Health Alliance (2007) HRH PHC 20 Regional HRH Goals ( ) HRH Data Management Project (2007) 1 st 20 HRH Goals Review ( ) Kampala Declaration (2008) WHO Global Code of Practice ( 2010) Caribbean Road Map ( ) UHC Program Evaluation in HRH HRH Meeting San Salvador 3 rd Global Forum on HRH

4 Health System Reform : Ongoing Issues HRH Supply Distribution Attrition Education Alignment Mix/Deployment Working Conditions Health/Safety Governance/Management Performance/Accountability Planning/Data/Monitoring GOVERNMENT Economic Growth/Fiscal Constraint Immigration/Emigration Resource Competition Public Private Sector Roles Political Instability Urbanization Primary Health Care Universal Health Coverage POPULATION Aging Population Non Communicable Disease Communicable Diseases Ill Defined Needs Social Expectations Quality Access Poverty

5 HRH Planning Framework Principles, Plans & Practices

6 HRH Planning Cycle

7 HRH Reform :

8 HRH Forecasting

9 H Health Workforce Productivity Capacity Development Workforce Optimization Workplace Support Outcomes Education & Training Workforce Culture, Communications & Expectations Supply & Mix Models of Care Matching Competencies to Requirements Provider Roles & Deployment Mix, Numbers & Distribution Occupational Health & Safety Personnel Management Practices Innovation & Support Stability of Workforce Efficiency in health services delivery Effectiveness of Patient Care, Health Outcomes & Population Health

10 Competency Based Deployment

11 Workforce Standards, Accountabilities, Assessment, Rewards and Continuing Development

12 Building Workforce Capacity

13 STAFF MANAGEMENT & SUPPORT Job Satisfaction Accountability Leadership

14 Role of Technology Nanotechnology Robotics Artificial Intelligence Genome Sequencing Gene Splicing...Singularity Health for All Immortality (?)

15 Over Medicalization of Healthcare

16 Non Communicable Diseases Ape Cro Magnon Homo Erectus Homo Sapiens Homo Obesus

17 Non Communicable Diseases NCD s Injuries CD s

18 NEEDS BASED PLANNING UTILIZATION BASED PLANNING EFFECTIVE DEMAND HRH DEMAND Unfilled Funded Posts Staff Mix Practitioner Demand Chronic Vacancies/Turnover Deployment/FTEs Patient Demand Health Services Model/Coverage Public Private Roles Service Distance Work Load Measurement Wait Times Competencies/Training Caseload Complexity Staff Targets/Ratios Community/Family

19 Comparative Health Care Cost Increases

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21 UNIVERSAL HEALTH COVERAGE: Options, Capacities and Sustainability Who s covered, what s covered and how s it covered?

22 ADVANTAGES UNIVERSAL HEALTH COVERAGE CHALLENGES Promotes PHC Promotes collaboration Promotes coordination Defines partner accountability Long term strategic vision Innovative delivery models Innovative funding models Promotes cost control Supports change management Defines public private sectors Defines needs, goals & targets Consistent governance measures Supports HRH policy development Promotes community involvement Requires political support Continuity re service provision Requires monitoring & evaluation Intra governmental cooperation Promotes system sustainability Attracts donor funding Continuing public support Higher public taxes Political continuity Greater demand; greater costs Vagaries of fiscal support Provider patient induced demand Work to rule salaried employees High system transition costs Quality reduction in free system Determination of true needs Intra governmental fiscal support Private public two tier pressures Potential wait time increases Health is labour intensive, resource driven industry Success requires PHC/HRH reform Education system slow to respond Possibly mismanagement backlash re workforce instability and costs New care model implementation

23 UHC Co Dependent Mutually Supportive HRH Common Goals & Principles

24 HEALTH SYSTEM REFORM ENABLERS// HRH PHC UHC TOOLKIT Political Support Quality Strategic Plans Fairness Leadership Comprehensive Finance Equity Governance Legislation Appropriate Management Access Education Communications Responsive Capacity Partnerships Participatory Technology Sustainability Info Systems Research UHC & KTE Policy Programs Operational Plans Evaluation Supply Productivity Needs Based Training Distribution Retention Deployment Mix/Targets Health/Safety Team Based Community Based Competency Based Incentives & Support Flexible Accountable Primary Care Inter Sectoral Collaboration Health Promotion Illness Prevention Rehab, Palliative, & Supportive Care Community Participation Info Access & Sharing Chronic Disease Prevention and Management Treating Acute & Episodic Illness Self Care Support Efficiency Quality Fairness Comprehensive Collaborative Equity Appropriate Accessibility Responsive Acceptable Evidence Based Needs Based Participatory Continuity Consistent Accountable Affordability Sustainability

25 BRAZIL : Lessons Learned SUCCESSES Community nurse auxiliaries; decline in infant mortality, rise in immunization, partial alleviation of medical service bottlenecks Nurses lead PHC in poor neighbourhoods and rural areas in the northeast Decentralized management and community participation (Unified Health System) Health sector reform driven by civil sector and health professionals Universal coverage with vaccination and prenatal care Expansion of HRH, pharmaceuticals and technology Infant mortality has decreased 5% annually over past three decades CHALLENGES Strong commitment to PHC but reduction in overall government role Socio economic and regional disparities still large New health problems re urbanization System large & complex with administrative problems Private sector role, chronic underfunding and urban service concentration Equity and sustainability concerns; care models not aligned with changing needs Quality care and patient safety remain issues; over medicalization of childbirth More rural HRH and local capacity needed to support health promotion activities Need stronger political support and financial re structuring

26 The Art of Managing Doubt Fiscal implications External development agencies Neighbours views & actions Election platform/promises Election cycle Cabinet position and promises Issue profile, quick wins Labour movements Public/lobby groups Media Risks of inaction Internal external champions Knowledge transfer & exchange Industry advisors Alignment with health plan/business plan Evidence based planning

27 Benefits of Collaboration Enhances communications, transparency of process & KTE Enhances political and funding support & sustainability Momentum through shared vision, plans, roles & accountabilities Integrated & coordinated change management practices Avoids duplication of effort & fragmented intervention Opportunities to share lessons learned & best practices Combines resources for greater efficiencies and economies of scale Opportunities for broader coordination of inter sectoral activities Greater opportunities to implement & influence stakeholders Enhance stability and reduce intra regional competition Reduce vulnerability to changing global pressures

28 Post 2015 UHC PHC HRH Options to Strengthen Regional HRH Planning and Management Capacity Planning MoH define and formally adopt a change management approach to HRH planning MoH formally adopt a HRH in all health policy strategy Develop HRH plans that link with health system plans and government business plans Expand HRH goals and targets to better support both PHC and UHC Modify MDG s to include enablers regarding UHC, PHC, including HRH & fiscal targets Develop criteria for evidence based decision making and needs based planning Expand data systems to include indicators of workforce stability, deployment & mobility Link HRH to the delivery of health services and health system performance indicators Determine parameters of appropriate health care models and funding mechanisms Partnerships Strengthen HRH planning processes by building formal planning partnerships with Education, other sub Regional Ministries of Health, inter Divisionally within the MoH and with the Observatory Lead an inter Divisional MoH team to administer first three planning principles above Redefine MoH linkages, roles & accountabilities within a change management approach Provide pro active leadership & identify champions in each HRH planning partnership

29 Options to Strengthen Regional HRH Planning and Management UHC Strengthen PHC the role of the Sub Regional Observatory to provide technical support to develop and standardize any or all of the following functions: clearing house for relevant HRH information; developing a framework for HRH planning, technology assessment, professional regulation; information systems; coordinated training development (including centers of excellence); program evaluation; communications; research pilots regarding HRH incentives and retention schemes; donor coordination; risk assessments; PHC model reviews; and facilitate planning and partner coordination. Finance Include fiscal plans and risk analysis with HRH strategies; coordinate EDP funding Education Mandate social accountability of professional schools; alignment with health system needs; identify centers of excellence; and advance common core curricula development Governance Develop standardized professional legislation to maximize public protection while minimizing any barriers to the innovative deployment of HRH in the PHC setting Research Conduct research synthesis to determine best practices & conditions for success Develop knowledge transfer and exchange protocols to increase relevance & utility Include an evaluation component at the front end of all new HRH policies & programs

30 The HRH Planner s Credo Keep the Faith!