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Human Resources for Primary health Care

Human Resources for Primary health Care. Adetokunbo O. Lucas, MD. The Global Crisis. Global shortage of nurses & other health professionals Migration of nurses & doctors to developed countries Impact on delivery of care & health outcomes

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Human Resources for Primary health Care

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  1. Human Resources for Primary health Care Adetokunbo O. Lucas, MD

  2. The Global Crisis • Global shortage of nurses & other health professionals • Migration of nurses & doctors to developed countries • Impact on delivery of care & health outcomes • Undermines Africa’s effort to achieve Millennium Development Goals

  3. Major Studies & Publications • Joint Learning Initiative (JLI) • World Health Report 2006 • Extended the JLI report • Additional data

  4. The Glue of the Health System

  5. The Health Worker Density Index (HRH index) 1. A composite index 2. A density of 2.5 workers per 1,000 -- a threshold to cover essential health interventions & core MDG-related health services. 3. Sub-Saharan Africa need 1 million additional health workers.

  6. Association between Mortality & Health Worker Density

  7. Health Worker Density Comparisons by World’s Regions From: JLI 2004.

  8. Is the density of the workforce the main determinant of : > Delivery of health care > Health outcomes?

  9. Numerical Approach • Valuable for advocacy • Prompted debate & discussion • Stimulated policy review

  10. Systematic Analysis: Back to basics 1. Task analysis • Identify needed skills & competence • Design training & apprenticeship • Review job descriptions / deployment 2, Managing migration • Dimensions & determinants • Amelioration 3. Balanced investment in health systems

  11. . . . Primary Health Care . . .

  12. PUSH PULL Anchor

  13. Higher income • Better working environment • Security • Low income • Unpaid salaries • Shortage of drugs, etc • Poor logistic support • Loyalty to nation • Family ties • Social & other interests

  14. Managing Migration • Realistic national human resource policy • Gather data & monitor trends • Tackle ‘push’ factors • Negotiate managed migration • Make most effective use of health workers • Note: the large amount of funds repatriated by African workers

  15. Amelioration of PUSH factors • Financial incentives • Realistic salaries in terms of local realities • Regular payment of salaries. Allowances & pensions • Non-financial incentives • Improving working environment • More efficient management of services • Consultations accredited representatives of: • Health workers • Civil society

  16. Balanced investment in the health system Mismanaged, malfunctioning health systems ‘Sick System Syndrome’ • Staff salaries - high percentage of recurrent budget (60-80%) • Infrastructure, supplies, logistics, etc. inadequate • Vertical programmes fragment health systems

  17. Strengthening Health Care Units Dare & Reeler, 2005

  18. Training Obstetricians in Ghana Can other nations adopt lessons learnt?

  19. Training manual • Developed in Ghana • Translated to French, Spanish, Vietnamese, Russian, etc. • Used in 30 countries

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