The 6 th AAAH Annual Conference 2011 Focal Point Reports on Country Information

Transcription

1 The 6 th AAAH Annual Conference 2011 Focal Point Reports on Country Information Country SRI LANKA Name of Focal Point (or representative) DR. Sarath Samarage Please answer the following questions or indicate X in appropriate box [ ] 1. Please fill in the matrix regarding the trend on HRH in your country in the last 5 years HRH indicators Total medical doctors 10,505 11,598 12,195 13,720 14,589 % in private 3.2 New medical graduates 933 % graduated from private medical schools 59* Total nurse personnel 20,197 20,912 24,459 26,351 27,494 % in private New nurse graduates % graduated from private nursing schools Doctor per 1,000 pop : total Doctor per 1,000 pop: capital city Doctor per 1,000 pop: outside capital city Nurse per 1,000 pop : total Nurse per 1,000 pop: capital city Nurse per 1,000 pop: outside capital city Midwife per 1,000 pop : total Midwife per 1,000 pop: capital city Midwife per 1,000 pop: outside capital city * Graduates Trained overseas 2. Does your country have a plan to achieve universal health coverage (UHC)? [ ] No [X] Yes; if yes please indicate a. The target year: 2016 b. Is there any HRD plan to support UHC in your country [X] Yes [ ] No

2 3. Please provide a brief on HRH plan (within 1,000 words) in your country in the last 5 years regarding HRH production, HRH distribution, HRH education, policies on rural retention and other important issues? Sri Lanka s health sector is facing a number of human resource challenges that are influencing effective delivery of services. There is a continuous mismatch of demand and supply of human resources over the years, which has resulted in maldistribution and shortages. These are further complicated by the disease burden and demographic changes. Although there are the discrepancies between numbers, types, functions, distribution, and quality of health workers, the Sri Lanka health system over the years has been performing well when compared to other developing countries. However the human resource issues it faces need to be resolved quickly, if it were to show any further improvement in its service delivery. Strengthening of the Human Resources for Health (HRH) in both public and private sector has been emphasized as one of major activity to be undertaken in the implementation of the Heath Master Plan (HMP) Though developing a Human resources strategic plan has ranked low in the past in the agenda of the Ministry of Health, the need for such a plan has been emphasized in many forums recently. Some attempts have been made in the past to produce HRH plans. The latter has not materialized as either the HRH issues were not addressed in a systematic manner, or the plans that have been formulated are divorced from the development of the overall health system. Relatively weak areas in the management of HRH are the fragmented nature of functions relating to HRH in the Ministry of Health, a sketchy database on HRH at information division of the Ministry, weak planning capacities throughout the system and the many gaps between policies and local implementation. A task force and a working group were appointed by the Secretary of Health to carry out this task of developing a strategic plan that would address the issues affecting HRH. This activity was conducted in collaboration with the World Health Organization (WHO). In the process of developing the plan the working group organized several consultations which included discussions on HRH issues relevant to decentralization, private sector involvement and HRH in underserved areas. Several consultations were also made with the trade unions and professional associations as well as with the senior staff of the National Ministry of Health and Provincial Ministries of Health. The HRH Strategic Plan is based on a thorough situation analysis (Section 1: Situation Analysis), followed by examination of the scale of the problem and the underlying causes and the effects on the delivery of health services. (Section 2: Analysis of issues and challenges in Human resources for Health). Based on the analysis, a draft strategic framework consisting of guiding principles, vision and mission statements and a set of strategic objectives were developed.(section 3: Formulation of Strategic Plan). The Strategic Plan was formulated around 7 interrelated objectives organized around three functional areas. (Section 4: Strategic Plan). The main document sets out strategies, outcomes and broad activities for 2009 to 2018 to address the human resources problems in the health sector in three functional areas namely HRH planning, HRH production and HRH management. Most of the activities will be implemented within the timeframe of national Health Master Plan (HMP). The main focus of the strategic plan is to strengthen human resource planning, production and management capacities at all levels. It aims at establishing a coordinated approach to Human Resource Planning, ensuring a trained, motivated and equitably distributed staff and at improving productivity and performance of health workers for provision of a service of high quality.

3 4. Please describe the 3 most important enabling factors and 3 barriers on HRH development in your country? Enabling Factors 1) Government Policy Mahinda Chinthana Vision for a new Sri Lanka. A Ten Year Horizon Development Framework is the government policy document describing the 10 year development strategy of the government. Health is mentioned under the section Ensuring good health. The current problems relevant to HRD are referred to in this document as: absence of a realistic approved cadre, imbalance in the recruitment and production of different categories of staff, geographic inequity, imbalances in deployment and a disparity between expected job performance and training, including quality of training. It is noteworthy that the same issues for HRD that have persisted over several decades have been documented in various policy documents though no concrete action has followed. Barriers 1) Lack of Coordination HMP has identified a separate profile for Human Resources for Health. HMP development commenced in 2003 and took approximately 3 1/2 yrs for completion. A key observation is that there is no overall human resources policy and development plan existing in the country and this was attributed mainly due to the lack of an organization / key unit with responsibility at the national level, which could take the initiative and lead this matter. The type of organization envisaged was a central Human Resource Unit or Department within the Ministry of Health, to coordinate various human resource functions. However action has been taken on the commitment to produce 15,000 nurses as mentioned in the Governments policy statement (Mahinda Chinthana 2005).Whether this was based on any rational calculation of actual need is not clear. However this statement shows the political will to produce a category of staff that is in short supply. In the policy document, HRD is given prominence in that the need for improving the doctor: patient ratio is mentioned. The policy favours more recruitment of doctors but emphasizes that deployment should be to the rural areas. The document mentions that the intake of medical students will be increased. The need to increase the number of specialist doctors is also emphasized. The policy recommends the award of more scholarships in order to increase the number of specialists. The need to increase availability of residential facilities for doctors is identified and this will improve the availability of doctors to rural and difficult areas. 2) Incentives 2) Poor Motivation

4 Enabling Factors The following incentives apply to health cadres, depending on the type of staff and their service minutes. -Leave for training Paid leave for selected job oriented training -Government sponsorship for training courses -Low interest loans: distress loans; car loans; duty free concessions -Concessions to work in difficult areas: Staff sent to the Northern and Eastern Provinces are able transfer out after one year to a better station. -Risk allowance this is variable and at times not in force Barriers Salaries and incentives are important for motivation of staff. The main motivators next to salary and incentives are recognized as training, recognition and responsibility. Training benefits can be seen as a main motivating factor if the general conditions and benefits as stated in the respective service minutes apply. The general acceptance of being in the Health service also may be a perceived motivation. However training benefits are not universally followed in a way that staff and the organization can benefit. This has become a de motivating factor. Performance management in the form of supervision, performance appraisals, and appropriate job descriptions have an influence on motivation. The performance management activities have to be improved upon to influence staff motivation. 3) Development Partners and HRH networks Development partners have been involved in many programs related to human resources development. Among the development partners are WHO, UNDP, World Bank, ADB, UNICEF, UNFPA and ILO. Exploration through networking is required. The recent collaborations with the Asia Pacific Action Alliance on Human Resources for Health (AAAH) is important. It is a regional partnership mechanism established in response to international recognition of the need for global and regional action to strengthen country capacity for HRH planning and management. AAAH training workshop on regional guidelines for country strategic planning of HRH was held recently in Manila Phillipines where two Sri Lankan staff members participated. 3) Labour relations The role of Trade unions as an influencing factor in determining HRH needs is evident. The role played by the medical professional bodies also needs to be explored. Discussions that involve trade unions, professional bodies and how their roles are viewed by HRH planners and decision makers are important. Trade unions continue to exert a significant influence on HRH managerial decision making process. Recruitment and deployment, salary structures have been the most significant areas of influence. Trade unions involvement also has influenced HR developments, particularly on supply and training for the private sector. The private sector is currently almost entirely dependent on Government training and supply of HRH. Trade unions oppose any private involvement in training such as establishment of private medical and nursing schools. They have also voiced their opposition to some of private degree programs. A recent conference in Sri Lanka highlighted the impact of Globalization on HRH and took stock of national developments of member countries in strengthening HRH.

5 5. As a country focal point, please describe role or activities which you have involved in HR planning and management in your country? (for instance, conduct research, policy uptake, etc.) As the Director Organization Development ( ) of the Management Development & Planning Unit of the Ministry of Health Sri Lanka, I was actively involved in the HR Planning & HR Development Activities. (Productivity improvement programs, Health Master Plan Development, District Health Planning / Development of Performance Indicators under the World Bank Health Sector development Project.) As the Deputy Director General of Health Services(Planning) ( ) of the Ministry of Health, I initiated the development of a HRH Strategic Plan for Sri Lanka and led the Strategic Plan Development process. Development of Job Descriptions for key positions in the ministry and developing performance plans. Establishing provincial and district Planning Units and capacity building. As the National Consultant at the WHO Country Office I am actively involved in HRD activities. Coordinator of the External Review Team of the National Institute of Health Sciences (National Training & Research Centre for PHC Health Workforce). This institute is being developed to be a WHO Collaborating Centre. Attended several WHO SEARO Regional Meetings on HRH and Planning Peer Review Meetings. Resource Person for the WHO Global learning Program on National Health Policies, Strategies and Plans. Post Graduate Training in Medical Administration As a member of the Board of Study in Medical Administration, Visiting Lecturer and an Examiner for the MSc and MD in Medical Administration Courses, Supervision of postgraduate research dissertations and theses. Member of the LANKAPHEIN (Sri Lanka Public Health Educational Institutes Network) President of the College of Medical Administrators of Sri Lanka. Consultant to the IOM / MoH / Migration Health Secretariat Actively involved in Research on In-bound, out-bound, internal migration and families left behind, Member of the National Task Force on Migration Health, Development of a Migration Health Policy. 6. Please describe how AAAH conferences/activities have contributed to HR planning and management in your country? Sri Lanka is one of the founding member countries of the Asia Pacific Action Alliance for Human Resources for Health, which was initiated in 2005 and also, Sri Lanka happens to be one of the priority countries out of the 15 member countries. Two Medical Officers (Management Development & Planning Unit -01, Education, Training & Research Unit 01) of the Ministry of Health participated in the AAAH Training Workshop on HRH Strategic Planning in the Philippines in As a follow-up Sri Lanka has initiated many activities under Human Resource (HR) Planning, HR Development and management. The AAAH Training Workshop gave the necessary stimulus and the capacity to the Ministry of Health in undertaking the development of the HR strategic Plan. AAAH has played a very positive catalytic role in the HRH development in Sri Lanka in recent times. Sri Lanka also hosted the 3 rd AAAH Conference in October AAAH Conferences have helped Sri Lanka to create an interest on Human Resources Development and Research among key stakeholders from the Ministry of Health, Universities and Private Sector, and also develop capacity through participation at the conferences and training workshops organized by the AAAH. Sri Lanka has been identified as a priority country by AAAH, and already a proposal has been submitted to receive AAAH support to strengthen HRH Development work in Sri Lanka.