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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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Presentation Transcript

The global crisis
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


Major studies publications
Major Studies & Publications

  • Joint Learning Initiative (JLI)

  • World Health Report 2006

    • Extended the JLI report

    • Additional data



The health worker density index hrh index
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.




Human resources for primary health care

Is the density of the workforce

the main determinant of :

> Delivery of health care

> Health outcomes?


Numerical approach
Numerical Approach

  • Valuable for advocacy

  • Prompted debate & discussion

  • Stimulated policy review


Systematic analysis back to basics
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


Human resources for primary health care

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Primary Health Care

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Human resources for primary health care

PUSH

PULL

Anchor


Human resources for primary health care

  • Low income

  • Unpaid salaries

  • Shortage of drugs, etc

  • Poor logistic support

  • Loyalty to nation

  • Family ties

  • Social & other interests


Managing migration
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


Amelioration of push factors
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


Balanced investment in the health system
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


Human resources for primary health care

Strengthening Health Care Units

Dare & Reeler, 2005


Human resources for primary health care

Training Obstetricians in Ghana

Can other nations adopt lessons learnt?


Human resources for primary health care

  • Training manual

  • Developed in Ghana

  • Translated to French, Spanish, Vietnamese, Russian, etc.

  • Used in 30 countries