HUMAN RESOURCES Essential Elements of HRD International Perspectives Joyce Smith, HRD Specialist
What is the health workforce? “People engaged in actions whose primary intent is to enhance health” Source: WHO (2006). The World Health Report 2006 – Working Together for Health. Geneva, World Health Organization
What is Human Resources Development? • Activities that aim to improve the capacity and quality of the workforce, employee relations, equal opportunities and staff motivation.
What is the target of good HRM? • To get the right people, with the right qualifications, in the right place at the right time at a cost that can be afforded by the community and the health system
Fact HR consumes 60-80% of the health Budget BUT Gets the least attention!!!!
Health workers save lives … but we need enough of them Source: WHO (2006). The World Health Report 2006 – Working Together for Health. Geneva, World Health Organization
FACT • Well trained competent health workers save lives • Poorly trained health workers working beyond the scope of practice for which they are trained can KILL
Essential Elements of HRD • HR POLICY • HR PLANNING • HR PRODUCTION • HR MANAGEMENT • PERSONNEL MANAGEMENT • PERFORMANCE MANAGEMENT • HR FINANCING
No guarantee of successful production of staff Comprehensive approach No guarantee of staff trained to implement policies and plans Training has limited outcome If unlinked to Policies, plans and management POLICY PLANNING TRAINING MANAGEMENT (Personnel) FINANCING
Managing HR Systems • Traditionally HR functions have been splintered within Ministries • Need Highly Placed HRD focal unit in Ministries to CO-ORDINATEall HR functions with all technical and administrative units • Need High Level Political Commitment • Need HR focal units at provincial/decentralized level • Need strong advocacy to promote HR strategies effectively
Common HR Issues • Maldistribution • Low morale /Motivation • Low salaries – quantity v quality • Poor management • Poor career prospects • Lack of coordination between Education and Health • Low quality of production
HRH related problems and causes (WHO-SEARO) Shortages Lack of HRH policies Lack of norms and standards Inadequate production capacity Out-Migration Mal-distribution Lack of HRH deployment policies Lack of basic facilities Migration Over production of some categories Lack of competency inadequate pre-service training Lack of public health orientation Inadequate in-service training Lack of quality control mechanisms in training Ineffective management capacity Shortage of managers Week incentive systems Weak management policies and practices Dual employment
Causes of shortages vary from country to country • health workforce not a priority • poor HRH planning • insufficient HRH production • migration • unjustified control of HRH production by professional organizations • death from HIV/AIDS • (Source: WHO Geneva- Presentation SEARO Regional HR Meeting Bali 2006)
Health Services Delivery SystemRole of Central level (MoH) • Centralised System • Determining policy • Setting standards – service and professional • direct service provider • Stewardship with contracting • Decentralised System • Determining policy • Setting minimum service standards • Setting minimum standards of professional competencies • Stewardship
Know what Human Resources you have! • Effective information systems are a basis for planning • Core information fields must cover both Quantitative and Qualitative data • Issues of who accesses what and for what purpose.
Manage Your Human Resources! Personnel Management • Job classification • Recruitment • Hiring, transfer & promotion • Compensation, benefits & incentives • Discipline, grievance & termination • Policy Manuals • Union & Professional Assoc relations • Compliance with Labour Laws
Manage your Human Resources! Performance Management • Job Descriptions • Supportive Supervision • Performance Planning and Evaluation • Motivation
Impact of Fragile Environmentson HR • HR affected by transition particularly where there is conflict or instability • Can be migrations both internal and external • Diminishment of workforce can lead to poorly planned over production of particular cadres to meet immediate needs • Destruction or degradation of training institutes • Ad hoc training to meet immediate needs
HR Dilemmas in Fragile Environments • Employ Everyone? • A smaller better paid workforce that works longer hours? • Emergency approach v Development Approach
Key issues to be addressed • Identifying available staff • Developing HRH management structures at all levels • Clarifying HRH roles and responsibilities • Establishing health worker equivalencies and upgrading skills • Supporting civil service redevelopment • Widely disseminating information re HRH strategies and the benefits to the public
HR Planning • Is initially based on a Guesstimate on the approximate numbers of staff in different types of facilities often based on international norms which require readaptation • Eventually must move to more appropriate workforce planning methodology within the context of IMHR e.g. WISN which can be used to provide evidence for more appropriate staffing levels and more effective distribution of staff
HR Planning -cont • Linking recruitment for pre-service training to actual needs.
Redevelopment of HR takes TIME • This is not always understood by donors who are locked into short funding cycles Emphasis on Quantity rather than Quality
It is quick to project and plan the quantity of health workers you require ? How long does it take to develop the quality of those numbers
HR management capacity at Provincial and Districts • This is frequently overlooked • HR structure should be developed for these levels which is linked to central level
Afghanistan Structure of HRD Department of MoPH - 2004 Testing and Certification Board Institute of Health Sciences International Meeting and Fellowship Board MoHED KMI+ Medical Schools HR Director Personnel and Employment Section Provincial HRD Liaison Planning and Information Section Training and Development Section Direct Links Functional Links Technical Links Collaborative Links
Afghan Poem گرندانی که ندانی توکی خرک خویش به منزل برسانی If you don’t know that you don’t know you will not be able to reach to the destination گربدانی که ندانی تونیز خرک خویش به منزل برسانی If you know that you don’t know you will be able to reach to the destination
Establishing a HR Focal Unit at Central, Regional and District levels • HR functions are generally splintered throughout a Ministry or Regional Health Office • The functions are unlinked and result in wasted effort, duplication and inefficient use of scarce resources • The role of a HR focal unit, placed at an appropriately high level is to COORDINATE the HR functions and establish linkages.
HR Financing Provincial HR Liaison HR Policy and Planning HR Directorate HR Management system HR Production Licensing and quality
HR Finance Provincial HR Liaison HR Policy and Planning Provincial HR Department HR Information HR Production Licensing and Quality