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IMPROVING AVAILABILITY, DISTRIBUTION AND EFFICIENCY OF HUMAN RESOURCES FOR HEALTH

IMPROVING AVAILABILITY, DISTRIBUTION AND EFFICIENCY OF HUMAN RESOURCES FOR HEALTH. Dr M. EKEKE MONONO Regional Adviser Health Policies and Service Delivery WHO/AFRO. Insert Presenting Organisation’s Logo. Outline. 2 .0 Background.

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IMPROVING AVAILABILITY, DISTRIBUTION AND EFFICIENCY OF HUMAN RESOURCES FOR HEALTH

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  1. IMPROVING AVAILABILITY, DISTRIBUTION AND EFFICIENCY OF HUMAN RESOURCES FOR HEALTH Dr M. EKEKE MONONO Regional Adviser Health Policies and Service Delivery WHO/AFRO Insert Presenting Organisation’s Logo

  2. Outline

  3. 2.0 Background

  4. Objective to improve availability, distribution and efficiency of HRH • The objective to improve the availability, the distribution and performance of the health care workforce is to have: • The right number of Health workers • With the right skills • In the right place • At the right time • With the right attitude • Doing the right work • At the right cost • With the right work output

  5. HRH Stock in the countries with HRH shortages in the African Region (2005-2010

  6. Density of doctors, nurses and midwives per 1,000 population in African Region (2005-2010) Density >2.3 Density: 1-2 Density: 0.5-0.9 Density: < 0.5

  7. Tunisia Algeria Mali Senegal Mauritania Niger Cape Verde Chad Sudan Eritrea Gambia Burkina Faso Guinea Nigeria Guinea Bissau Benin Ethiopia Ghana Cote d'Ivoire CentralAfricanRepublic Sierra Leone Liberia Cameroon Togo Uganda Kenya Congo Sao Tome & Principe Democratic Republic of Congo Gabon Rwanda Equatorial Guinea Burundi Density greater than 2.3 health workers / 1,000 pop (10 countries) Seychelles United Republic of Tanzania Comoros Density lower than 2.3/1000pop and greater than 1/1000 pop ( 8 Countries) Angola Malawi Zambia Madagascar Atlantic Ocean Zimbabwe Mauritius Namibia Density lower tha 1/1000pop and greater than 0.5/1000 pop (16 countries) Botswana Mozambique Swaziland South Africa Lesotho Indian Ocean Health Workforce to population ratios in Africa Density lower than 0.5/1000 pop (13 countries)

  8. 3.0 Key Points

  9. Challenges to improve the availability, the distribution and performance of the health care workforce Three main challenges related to the distribution and performance of the health care workforce : Absolute and relative shortages and scarcity of some categories of Health Care Workers Inequitable/ maldistribution of Health Care Workers Sub-optimal utilization of the available Health care workers

  10. Shortage and scarcity of Health Care Workers • In Africa, the shortage of health care workers constitutes the primary challenge in the distribution and performance of the available health care workers . • Main reasons contributing to the situation: • Underinvestment in human resource for health, • High workloads, • Difficult working and living conditions • Inadequate remuneration • Lack of critical supplies, equipment and materials • inefficient management & regulation

  11. In addition to economic factors, professional considerations also play an important role in the decision of many available health care workers to migrate. • These factors lead to low entry levels into and high exit rates from the health profession.

  12. Shortage and scarcity of Health Care Workers in Africa

  13. Maldistributionof Health care workers • Widening imbalances and inequalities in the availability of health care workers undermine the provision of fair and universal health care. Most of the countries are unable to make available appropriately skilled health workers in the right numbers where they are needed • Intra-sectoral movement: health care workers leave the public sector in favour of the better-resourced and, often, better-managed private sector establishments

  14. Maldistribution of healthworkers • Internal migration results in asymmetric geographic distribution of health care workers and availability of health services within a country with a high level of concentration in urban areas rather than distribution according to disease patterns and care needs • Inadequate utilization, retention and performance of the available health workforce

  15. Percentage of urban and rural health workforce by category in the African Region (2005)

  16. Distribution of health care cadres among sectors in the African Region (2005)

  17. 4.0 Implications and Relevance for Nigeria

  18. Regional distribution of health workers in Nigeria (2007) • According to the 2007 HRH country profile of Nigeria, the geographical distribution of health workers in Nigeria is uneven, with fewer health workers in less developed areas. • There is concentration of health workers in urban areas, tertiary health care, curative and certainparts of the country. • The uneven distribution of health workers is greater in some category of workers ,with specialist physicians being the most unevenly distributed • Community health workers have been produced in significant numbers but need to be more equitably distributed, especially in the rural areas.

  19. Bridging Health Workforce Gaps to achieve Universal Health Coverage Population without access to well performing health workers Universal access to quality health workforce Performing HRH Productivity gaps: require systems support, enabling management, adequate incentives. Quality HRH Quality gaps:require enhanced pre-service and in-service training, effective regulation, supportive supervision. Equitably distributed HRH Distribution gaps: require incentives for retention in under-served areas. Available HRH Numbers and skills mix gaps: require adequate planning and investment Population access to health workforce Figure : Human resources for health and UHC (adaptation from Tanahashi framework on evaluating health systems)

  20. Addressing shortage & scarcity of health professionals • Increasing the number of entrants into the Health Workforce • Increasing investment in education of health care workers • Making the health care profession more attractive • Reducing Attrition from the Health Workforce • Address gender equality in the health workforce • Improve standards of health and safety in the workplace • Improve management of the existing health workforce • Develop evidence based retention strategies • Task shifting • Delegation of tasks to middle level and lower level cadres (with adequate training, close supervision and as a temporary measure )

  21. Addressing inequality of distribution of health professionals • Strengthening leadership and governance capacity of the health workforceto harness all that is required to make available appropriately skilled and high-performing health workers in the right quantity where they are needed. • Optimizing the utilization, retention and performance of the available health workforce. This involves the development and implementation of mechanisms for equitable, rational distribution, enabling working environment ; • Improving health workforce information and evidence to improve decision-making. This includes strengthening HRH information systems and HRH observatories

  22. 5.0 Recommended Actions

  23. Recommended Actions (5/1) Introduce effective recruitment and deployment policies and practices that promote rational utilization of health workers through updating of norms for better management in order to minimize ad-hoc and haphazard solutions. Introduce measures to improve the working conditions, remuneration and living environment of health workers in collaboration with ministries that manage public sector employment across sectors; and implement HRH performance management systems.

  24. Recommended Actions (5/2) • Promote and implement sustainable and effective retention mechanisms including attraction of workers to rural areas; assure the safety of workers; increase salaries and introduce special allowances for staff working in difficult circumstances. • Implement the global code of practice on the international recruitment of health personnel (as agreed in the WHA),including attraction of workers from the diaspora

  25. Recommended actions(5/3) 5. Strengthen and/or introduce innovative approaches for professional practice such as the use of telemedicine, e-learning, micro-surgery techniques and outsourcing of services. 6. Use the context of strengthening referral systems to deploy skilled health care workers for UHC at different levels of the system 7. Strengthen HRH information systems and HRH observatories for evidence based policy dialogue

  26. 6.0 Summary

  27. Summary • Strengthening HRH governance & leadership at all levels for effective planning and implementation • Optimal utilization of the available health care workers • Implementing evidence based retention strategies • Implementing performance management systems • Determining appropriate skill mix of health teams • Scaling up production of determined gaps of specific categories that are in short supply • Strengthening HRH evidence and Observatories for informed policy and planning

  28. THANK YOU

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