Scalingup the stock of health workers: a review

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Scaling-up the stock of health workers a review

• Dussault, G., Fronteira, I., Prytherch H.,
• Dal Poz M., Ngoma D., Lunguzi J., Wyss K.
• Berkeley, April 4 2008
• commissioned by the International Centre for
  Human Resources in Nursing (ICHRN)

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Objective

• To take stock of the published and grey
  literature on the process of scaling-up the
  health workforce in low and middle income
  countries,
• Definition of scaling-up the health workforce
• Arguments to justify scaling-up
• Strategies/methods for scaling-up
• Conditions of success of scaling up the stock of
  HRH.

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Method

• Review of the literature on scaling-up of HRH
• Agreed list of key words and index terms
• 29 databases searched
• No time preset limit, but most documents from the
  mid-1990s onwards
• 254 documents presumed relevant another 20 were
  added as new information became available

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Method

• Abstracts reviewed by 2 a. to decide on
  inclusion. When no agreement, 3rd a. arbitrated
• Inclusion recommended if document addressed at
  least one of the following concept of
  scaling-up, justification, strategies and
  methods, lessons learned, costs,policy
  recommendations.
• 112 documents met the criterion
• Documents reviewed in depth by two a.
• Iterative process of production of report

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Why scaling-up is needed?

• Slow progress towards the MDGs
• Growing demand due increased availability of
  funds
• Global Health Initiatives find it difficult to
  deliver their programs

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What is scaling-up?

• Scaling-up the performance of health services
• Scaling-up resources needed to produce the
  services.
• Scaling-up the health workforce
• Scaling-up the stock of HRH
• Scaling up productivity

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Strategies to scale up the stock of health workers

• Augment the production of new workers
• Improve retention rates
• Recruit inactive and retired workers
• Import health workers.

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Examples

• Brazil (PROFAE)
• Malawi

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PROFAE The Professionalization of Health
Workers in Nursing

• 225 000 nursing workers without formal technical
  qualification complementary education to 90 000
  auxiliary nurses pedagogical training to 12 000
  nurses
• Initially planned for 2000/2004, extended to 2007
• Loan from IADB, National Treasury, Fundo de
  Amparo ao Trabalhador (Min. of Labour and
  Employment)
• UNESCO provided technical cooperation
• Cost estimated at US 370 million.

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PROFAE The Professionalization of Health
Workers in Nursing

• 218,244 students enrolled in the Auxiliary
  Nursing Course 207,844 graduated
• 82,029 enrolled in the Nursing Technician Course
  80,124 graduated
• 13,161 university nursing teachers trained

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PROFAE The Professionalization of Health
Workers in Nursing

• Competence Certification System
• Monitoring Market Signals in Nursing
• Strengthening and Modernization of Technical
  Schools Network 11 new schools, new programs
• Improvement of health care delivery quality
• Gains in self confidence of auxiliary nurses (we
  were nothing, we followed orders, now we can talk
  and discuss with other professionals).

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Response to the HRH crisis in Malawi

• 1 doctor/62,000 1 nurse/3,500
• Vacancy rates for nurses 67.7 for MoH and 53.2
  for CHAM (38 overall)
• Six-Year Emergency Pre-service Training Plan-2002
• Emergency Human Resource Program-2004
• Training gap (55)

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Response to the HRH crisis in Malawi

• Measures to improve working conditions pay and
  allowances, improvements in living conditions
• Increase in the numbers of hours worked (locum
  system, and through a relief system)
• 300 nurses recruited back
• Agreements with College of Medicine, College of
  Nursing and CHAM intake is being doubled

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Response to the HRH crisis in Malawi

• Initially, US27 million from donors (GTZ) and
  HIPC funds
• DFID and GFATM US95 million

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Response to the HRH crisis in Malawi

• HRD Policy
• Facilitate systematic training and staff
  development activities within the public health
  service
• Ensure that training and development are
  carefully planned, monitored, evaluated and
  sustained at all levels of health services
• Facilitate coordination of training efforts in
  order to eliminate waste of resources
• Strike a balance between the Ministrys and
  personal development needs
• Provide training programmes that meet
  international standards.
• Policy to apply to all health workers under the
  responsibility of the MoH and CHAM.

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Conditions of success

• Political commitment
• Strategic planning and management capacity
• Clear objectives and reliance on a mix of
  strategies
• Mobilization of stakeholders Advocacy amongst
  professional associations
• Sound information bases
• Continuous assessment of the effects of
  interventions
• Adequate financial resources (initial investment
  and recurrent expenditure)

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Who does what?

• Countries to formulate their own strategy
• Multiple actors involved government (finance,
  civil service, planning, education, health),
  professional associations and councils, unions,
  training institutions, users.
• Regional Human Resources for Health Observatories
• Financing and technical agencies and funds
  support observatories.

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End message

• Scaling up is not an objective in itself, but it
  may be a major component of any strategy towards
  achieving the objectives of the health policy