Addressing the Human Resource in Health Crisis: Empowering the Private Not for Profit Health Trainin

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Addressing the Human Resource in Health Crisis
Empowering the Private Not for Profit Health
Training Institutions to Play their Role

• The Views and Experiences of Uganda Catholic
  Medical Bureau
• Presentation to the Christian Connections
  International Health
• 2006 Annual Conference
• May June, 2006
• Authors Marieke Verhallen, Daniele Giusti, Nancy
  Bolan.

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Structure of the Presentation (1)

• The Country Context
• Relevance of the Private Not for Profit Sector
  (PNFP)
• The Importance of Nurses and Midwives
• The Human Resources for Health Crisis
• The PNFP Research Development Question
• Findings
• Obstacles to Increasing Training Output
• Obstacles within the PNFP Sector
• Complex and Confused National Environment

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Structure of the Presentation (2)

• Conclusions and Priority Actions needed
• The Strategy to strengthen and empower the PNFP
  Health Training Institutions (HTI)
• The Partnership of the PNFP Health Training
  Institutions
• The Setback and the Alternative Strategy
• Results so far
• Recommendations

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Uganda in East Africa
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Context Uganda in Figures

• Population 27 million people
• Living below poverty line 38
• Infant Mortality Rate 88 / 1000
• Under five Mortality Rate 152 / 1000
• Maternal Mortality Rate 505 / 100,000 live
  births
• Life Years Lost
• due to preventable diseases 75

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Relevance PNFP Sector (1)

• Faith Based Organizations autonomous Civil
  Society Organizations
• Voluntary choice to contribute to Public Social
  Aims
• Essential cost effective services
• Percentage of Health Facilities in rural areas
  80
• 47 of hospitals in the country and
• 23 of Primary health care centers
• Overall 25 of the national health facilities
• 60 of the Nurse Training Schools
• National Coordination and Technical Support
• Medical Bureau per denomination

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Relevance PNFP Sector (2)

• Health Service output
• 30 of the national total
• Allocated budget
• 7 of the national budget (government and
  donors)
• Nurses Midwives graduated in 2005 60 of
  national total

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Present HR Problems in PNFP

• PNFP Shortage of Nurses and Midwives
• 1,843 36 of current norm (national 32)
• Annual Attrition rate nation
• PNFP 20 (national 3)
• In Nurse Training Schools shortage is relatively
  larger
• Main obstacle to recruitment Financial
• But this year PNFP shortage rapidly increasing
• Attrition in PNFP 25 in first quarter 2005!

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Importance of Nurses and Midwives

• Total current health work force 24,380
• Qualified Nurses and Midwives 8076 33
• Nursing Assistants (auxiliary nurses) 6345 26
• Nurses midwives in average hospital
• 60 of medical / clinical team
• In Primary Health Care Centers
• 80 of the team
• Many Additional the responsibilities in PHC
  centers

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The Human Resource Crisis

• National and International consensus
• Human Resources essential to attaining health
  outcomes
• Shortage of HR is THE OBSTACLE
• To achieve the Millennium Development Goals
  (MDGs)
• Health worker/population density needed
• 2.5 per 1000 people
• Increase in Nurses and Midwives needed 18,000
• PNFP 6,000
• NB Brain drain to developed countries
  accelerating
• 2005 200 nurses lost in one recruitment drive
• Training Capacity / Output will have to be
  increased

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Human Resource Crisis in Figures
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The PNFP Research and Development Question

• Initial question how to improve utilization of
  schools?
• Actual Question to be answered
• How can the PNFP HTI be enabled to assist in
  resolving the HR crisis?
• Research and development method Participatory
  Approach

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Findings Obstacles to Increasing Training Output

• Present training capacity inadequate
• Existing Curricula not adjusted to health needs
• Range of cadres trained too limited
• Entry criteria based on secondary school results
  continuously raised

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Findings Obstacles within PNFP Sector

• Lack of coordination and cooperation among the
  PNFP HTI
• No influence on national training policies,
  plans, nor programmes
• Loss of innovative capacity and daring

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Findings Complexity and Confusion at National
Level (1)

• Lack of Leadership
• Absence of HR Strategic plan
• Funding inadequate and inequitable
• Focus of Development Partners too narrow

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Findings Complexity and Confusion at National
Level (2)

• Who decides and who should decide?
• Existing Legislation The Professional Councils
• But MOES responsible for training?
• Entry criteria and curricula contradictory
  directives
• Academic and Professional Certification
  duplication of exams
• Regulation of professionals after entry into the
  system under developed

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An Example to Illustrate

• To improve PHC train a multipurpose nurse
• The Enrolled Comprehensive Nurse
• Decision taken in 2000 but still not fully
  implemented
• Reasons
• Curriculum developed by technical team MOES
  without effective consultation
• Nurses and Midwives Council never really endorsed
  it
• Unresolved dispute about the entry criteria
• Rural candidates cannot access the course
• Hospital managers hospital nursing not covered
• PHC center managers midwifery part inadequate
• Investment and recurrent costs proved too high

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Conclusions from the Findings

• Nurses and midwives form the backbone of the
  Ugandan health system
• To achieve the MDGs the number of nurses and
  midwives needs to be increased THREEFOLD
• Increasing training capacity is essential to
  increasing availability of HR
• The PNFP HTI have a large potential to increase
  the training output

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Priority Actions to Increase HR Availability

• National level clarify and strengthen Leadership
  and Planning
• PNFP HTI organize and strengthen themselves
• The Development Partners support both partners
  and joint development

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Preamble to Strengthening the PNFP HTI (1)

• Internal consensus PNFP Health Training
  Institutions need to be enabled to
• To respond to opportunities and threats in the
  external environment
• Build strong cohesion and unified voice
• To address the required huge increase in nurses
  and midwives
• Participate in national policy and planning
  process

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The Partnership of PNFP HTI (1)

• Choice of the PNFP HTI
• An Interdenominational Organization
• Legally established and recognized
• Formed and Governed by the member HTIs
• Taking charge themselves
• High level of participation and commitment
• Strong expression internal cohesion
• Employ professional capacity to support and
  enhance implementation

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The Partnership of PNFP HTI (2)

• Mission of the PNFP HTI
• To train an optimal range of health care staff of
  high professional and moral standard for the PNFP
  and national health care institutions
• Partnership Enhance attainment of HTIs mission
  through
• Internal coordination and cooperation
• External advocacy and cooperation
• Addressing common challenges

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The Setback

• When Constitution and Memorandum of Association
  ready to be signed by the Owners
• One denomination realizing the full extent of the
  plan requested to stay the process
• Decision
• Too early to set up a legal organization
• First exhaust existing structures and internal /
  external dialogue

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Alternative / Incremental Strategy

• Incremental step towards the Partnership
• The PNFP Medical Bureaux set-up a structure and
  capacity to support and represent their HTI
• A Participation Forum / Standing Committee
• Annual assembly of affiliated HTI
• HTI Training desk with a professional
  coordinator
• Mission, strategies, and objectives the same
• Per denomination
• One additional assignment
• Foster interdenominational dialogue and pursue
  the installation of the Partnership at later
  stage

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Results So Far (1)

• Externally
• Increased national awareness PNFP HTI capacity
  indispensable
• Move to include PNFP HTI in development of plans
• Increased interest Development Partners

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Results So Far (2)

• Internally
• Increased assertiveness of school teams and group
  
• Stronger cohesion among PNFP HTI
• Interdenominational cooperation accepted and
  pursued
• Innovations starting

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Recommendations

• For the PNFP HTI
• The key to contributing more effectively lies in
  united active participation and cooperation
• The structure and professional support should aim
  at empowering each HTI and the group as a whole

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Recommendations

• To address the HR Crisis effectively
• National and International Stakeholders have an
  interest in
• Fostering Public Private Not for Profit
  Partnership in training health workers
• Assuring adequate and equitable funding of
  training in all HTI

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Recommendations

• For CCIH participants
• The church health institutions represent a huge
  heritage that our forefathers left us
• As stewards
• We need to assure that we hand them over to those
  that come after us in better shape than they are
  now!
• We may not succeed if we follow the fashion of
  the day!