Scaling up health workforce education and training to achieve the MDGs

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Scaling up health workforce education and
training to achieve the MDGs
Rebecca Bailey, MSPH, CEd Technical Officer,
Health Workforce Education and Training Department
of Human Resources for Health World Health
OrganizationGeneva, Switzerland
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The Case

• You are the dean of Tegbar Medical School in a
  country with high HIV/AIDS prevalence. An
  evaluation shows that among the new graduates
  from your 5-year medical degree programme
• 1 are recruited to rural areas where 50 of the
  population resides
• 90 require in-service training courses to bring
  them up to date with current health policies and
  clinical guidelines for HIV and AIDS
• What should you do?

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Overview

• HRH Strategy
• Challenges
• Progress
• Discussion

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Strategy of the WHO Human Resources for Health
Team 2010 to 2015
Vision

• To ensure all people have equitable access to an
  adequately trained, competent, motivated and
  supported health workforce so they attain the
  highest possible level of health.

Mission
To enable WHO Member States to achieve their
current and future health workforce development
objectives through scientifically sound policy
development approaches.
Deadline for the MDGs
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Strategy values

• Strategy is based on
• Commitment to Health-for-All and Primary Health
  Care
• Working for social justice and equity
• Working in partnership
• Promoting a respectful working environment for
  health workers

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Strategic directions three main lines of work

• Providing strategic information for policy
  making, monitoring trends and assessing progress.
• Promoting strategic investment in health
  workforce development.
• Promoting innovative approaches to harmonize
  health workforce policies and programmes across
  the life-course of the population in an
  integrated way (e.g. beyond single health issues
  or specific cadres of personnel)

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Working lifespan strategies to build capacity and
performance
ENTRYPreparing the workforce Planning Education
Recruitment
WORKFORCE PERFORMANCE
WORKFORCE Enhancing worker performance Supervisi
on Compensation Systems support Lifelong learning
Availability Competence Responsiveness Productivit
y
EXITManaging attrition Migration Career
choice Health and safety Retirement
Source WHO (2006). The World Health Report 2006
Working Together for Health. Geneva, World
Health Organization
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A complex issue in a complex environment
World Bank
WHO
Development partners
Ministry of finance
GAVI
The Global Fund
PEPFAR
Ministry of labour
Ministry of higher education
Civil service commission
Professional associations
Ministry of health
Health workers
Ministry of transport
Populations/communities
Ministry of public administration
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Reaching universal coverage with priority health
interventions

• Overarching health workforce goal
• The right people
• At the right places and time
• With the right competencies, and
• the right resources and support.

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Health workforce is critical for achieving the
health-related MDGs

• MDGs

Interventions
Health Workforce
ART ORT PMTCT ACTs Nutrition TBT etc.
MDG 4, 5 and 6 targets for children, pregnant
women, persons with AIDS, TB and malaria
Health Workforce
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Why the bottleneck?

• General challenges
• Workforce planning
• Information about the workforce
• Numbers of health workers
• Distribution (urban/rural)
• Competence/performance
• Migration and attrition
• Working conditions (workload, pay, resources)
• Career paths
• Investment, financing and fiscal policies (e.g.
  salary caps in civil service sector)

• Education-specific challenges
• Recruitment and selection
• Exponential growth of information to cover
• Rapidly changing environment in which graduates
  will practice (e.g. technology, policy,
  guidelines)
• Infrastructure (classrooms, laboratories,
  clinical practice sites)
• Instructors/teachers/preceptors
• Resistance to change
• Links between education, health and labor sectors

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Country priorities as reflected in 30 GFATM round
5 health system strengthening proposals
Human resources
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Positive correlation between health worker
density and intervention coverage
Source WHO (2006). The World Health Report 2006
Working Together for Health. Geneva, World
Health Organization
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Critical shortages and poor distribution of
health workers
Distribution of the global health workforce
Source WHO (2006). The World Health Report 2006
Working Together for Health. Geneva, World
Health Organization
Critical shortages in 57 countries, 36 of which
are in sub-Saharan Africa
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The same countries are making slow progress
towards the health-related MDGs
Maternal mortality ratio per 100 000 live births
in 2000
Source WHO (2005). The World Health Report 2005
Make Every Mother and Child Count. Geneva,
World Health Organization
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Inequitable distribution and imbalances

• Rural/urban distribution of health workers

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Common causes of health workforce shortages from
country to country

• ENTRY
• Preparing the workforce
• Limited data and information about the current
  workforce
• Poor planning (cadres, numbers, distribution)
• Insufficient budgets and capacity for education
  and training
• Curricula not based on health needs and not
  competency-based

• WORKFORCE
• Recruit and retain
• Fiscal policies (wage spending caps)
• Limited budgets for remuneration
• Poor working conditions
• Poor career structures
• Lack of supportive supervision
• Poor integration with the private sector

• EXIT
• Managing attrition
• Migration (outward and within)
• Illness and death
• Change of occupation
• Retirement

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Current capacity to produce the 4.3 million
additional health workers needed
NA 1750
98 362
119 1889
50 1440
40 1388
139 354
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Disparities in medical schools and graduates
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Pipeline to generate and recruitthe health
workforce
Attract Retain Educate Train Certify
Recruit Deploy Retain
LIFE-LONG LEARNING

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WHR2006 Ten-year plan of action
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Moving human resources for health up the global
health agenda
1995
1996
/ 2001 /
2005
2006
2007
2008
2004

• WHA Resolution 48.8 on reorienting medical
  education and medical practice for health (1995)

WHA Resolution 54.12 on strengthening nursing and
midwifery (2001)
WHA Resolution 57.19 on international migration
of health personnel (2004)
World Health Report 2006, Working together for
health
GHWA Task Force on Scaling up Education and
Training of Health Workers, March 2007
Global Forum on Human Resources for Health, March
2008 produced the Kampala Declaration and Agenda
for Global Action
WHA Resolution 59.23 on rapid scaling up of
health workforce production
WHA Resolution 49.1 on strengthening nursing and
midwifery (1996)
WHA Resolution 58.17 on international migration
of health personnel (2005)
Task force report on scaling up education and
training launched, May 2008
WHA Resolution 59.27 on strengthening nursing and
midwifery
Global Health Workforce Alliance (GHWA)
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Scaling-up the health workforce
(Financial crisis events)
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Task Force on Scaling up Education and Training

• Recommends urgent implementation of new
  strategies to address acute shortages of health
  workers
• Vision for the future
• National road map
• Types of health workers to scale up
• Building strong education and training systems
• International action needed
• The cost
• Measuring success
• Country case studies
• Recommendations

www.ghwa.org
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Critical success factors
Education and training
Strategies
Scale-up outcomes
Chronic disease management
Health outcomes
MDG 5
MDG 4
MDG 6
Source Scaling Up, Saving Lives. World Health
Organization and Global Health Workforce
Alliance, 2008
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Building strong education and training systems

• Guiding principles
• Address country health needs and embed education
  and training in the health system
• Increase equity and efficiencies of scale of
  health service delivery through innovative
  curriculum design and delivery (e.g. distributed,
  distance, on-the-job learning, case based?)
• Enhance quality through leadership and
  collaboration (e.g. twinning, consortia)

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Education systems proposed strategies 1

• Reduce attrition among students and teachers, and
  improve accessibility
• Integrate pre-service and in-service education
  and training (links with services)
• Develop common educational platforms for
  different types of health workers (e.g. team
  based)
• Move learning to the community, using modular
  education and action learning
• Increase use of information and communication
  technologies
• Improve education through quality assurance
  programmes

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Education systems proposed strategies 2

• Build institutional capacity by
• expanding teaching capacity (e.g. teachers from
  services)
• fostering twinning and partnerships
• maximizing impact through regional approaches,
  and
• harnessing public-private partnerships

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IMCI strengthening pre-service education
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Transformative Scale Up

• More health workers, but not the same
• Education and training within the context of
  primary health care renewal, that is
• Needs based
• Problem based
• Community based
• Public health based
• Team based
• Socially accountable
• Linked to services and systems
• Dynamic responding to new policies,
  technologies, technical guidelines, etc.
• Never the same lecture twice!

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Spare slides
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HRH Action Framework
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Link the education, labour and health services
markets
Source WHO (2006). The World Health Report 2006
Working Together for Health. Geneva, World
Health Organization