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Global, Regional and Local Challenges in Human Resources for Health. Bruce Fried, PhD Department of Health Policy & Administration University of North Carolina at Chapel Hil May 28, 2008. Where does the health workforce fit into health system goals?. The Health Workforce and Health Outcomes.

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Global, Regional and Local Challenges in Human Resources for Health


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global regional and local challenges in human resources for health

Global, Regional and Local Challenges in Human Resources for Health

Bruce Fried, PhD

Department of Health Policy & Administration

University of North Carolina at Chapel Hil

May 28, 2008

the health workforce and health outcomes
The Health Workforce and Health Outcomes

Source: Human Resources for Health: Overcoming the Crisis. Global Equity Initiative, Harvard University, 2005.

slide6

Health Worker Density and Mortality

Source: Anand & Baernighausen- 2004 (JLI)

slide7

Shortages and Global Maldistribution

Ratios do not tell the whole story, but they do communicate compelling message.

Source: Buchan J & Calman L. International Council of Nurses, 2004.

slide9

Another perspective on disparities in the healthcare workforce:

The burden of disease in Africa

Source: Addressing Africa’s Health Workforce Issues: An Avenue for Action., 2004.

slide10

Projection of health workforce in Africa based on current trends

Current health workforce shortages in Africa will worsen in coming years.

Source: Addressing Africa’s Health Workforce Issues: An Avenue for Action., 2004.

zambia staff attrition jan 2003 june 2004
Zambia Staff Attrition: Jan. 2003 – June 2004

Source: Dovlo D. “Human Resources for Health Situation Report: A Summary of International Fact-Finding on HRH.” High Level Forum-2004, Abuja, 2004.

Zambia Country Case Study 2004

the case of physicians

The Case of Physicians

Evidence of the loss of human capital

slide13

Who benefits from physician mobility?

In the U.S., 25.0% of all physicians in the US workforce are international medical graduates.

In the U.K., 75.2% of IMGs are from lower-income countries

Source: Mullan, 2005

slide14

Highlights:

Physicians trained in India account for:

4.9% of the U.S. physician workforce

10.9% of the U.K. physician

4.0% of the Australian physician workforce

South Africa provides:

2.6% of Canadian physician workforce

2.3% of the Australian physician workforce

1.4% of the U.K. physician workforce

Source: Mullan, 2005

the impacts of hiv aids on the health workforce in africa
The Impacts of HIV/AIDS on the Health Workforce in Africa
  • Significant increase in workload
  • Attrition due to death from HIV/AIDS
    • death of nurses represents almost 40% of the annual output from training in 2 countries
  • Low productivity due to absenteeism, illness & burnout
  • Need for new, techniques-Palliative, Counseling
  • Deterrent to new entrants into nursing - perceived risk
  • Paradox – Higher demand for health workers but lower supply
  • Protecting the provider

Source: Dovlo D. “Human Resources for Health Situation Report: A Summary of International Fact-Finding on HRH.” High Level Forum-2004, Abuja, 2004.

slide18
Driving Forces

Health needs

Demographics

Disease Burden

Epidemics

Health Systems

Financing

Technology

Consumer Preferences

Context

Education

Public Sector Reforms

Globalization

Workforce Challenges

Shortages and Maldistribution

Training and skill-mix imbalances

Poor human resources management practices

Poorly resourced systems

Low job satisfaction and poor working conditions (include safety concerns)

Failure of past public policy initiatives

Lack of professional development and promotional opportunities

Little or no involvement in decision making

Lack of respect and lack of support

Stress and overwork

regional issues
Regional Issues
  • Developed countries: aging population, aging nurse workforce, shrinking recruitment pool
  • Developing countries: low supply, emigration and “push” factors, HIV/AIDS
invest in human capital
Invest in Human Capital
  • Improve earnings, career opportunities, and working conditions
  • Make more efficient use of personnel through improved geographic distribution
    • Mandatory service
    • Multiple incentives
dealing with shortages
Dealing with Shortages
  • Increase compensation
  • Recruitment and retention bonuses
  • Retraining incentives to re-skill professionals in skill areas in short supply
  • Increase education intakes - more training
  • Increase use of foreign providers
  • Using technology to expand capacity (telemedicine)
  • Use substitute providers
dealing with maldistribution
Dealing with Maldistribution
  • Expand opportunities for education in under-served areas
  • Geographic mobility incentives
  • Mandatory service