Where Have All the Workers Gone The extent of the global healthcare worker shortage, why workers are

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Where Have All the Workers Gone?The extent of
the global healthcare worker shortage, why
workers are leaving and some strategies for
addressing the crisis.
USAID Mini-University October 5, 2007
Pamela McQuide Senior Workforce Planning and
Policy Advisor Capacity Project
Lois Schaefer Senior Technical Advisor for HCD
GH/PRH/SDI
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Before We Get Started

• What do you think are the two most important
  reasons for the shortage of healthcare workers?
• Discuss briefly with the people immediately
  around you.
• See if you can agree on two reasons.

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Workforce Density to Meet the MDGs

• 2.5 health workers needed/1000 population to meet
  MDGs (which do not directly address FP/RH)
• 57 countries critical shortage
• 36 are in sub-Saharan Africa
• Additional 2.4 million professionals needed
  globally
• Sub-Saharan Africa has the largest relative need
  needs an increase of 140

World Health Report, 2006
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Distribution of health workers by level of
healthexpenditure and burden of disease, by WHO
region
World Health Report, 2006
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Working Lifespan Strategies Determining the
Stock of Healthcare Workers
World Health Report, 2006
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The HRH Crisis in Africa A Case Study
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The HRH Crisis in Africa is Due to

• Lack of information on the current workforce
• Limited recruitment into health professions and
  the public sector
• Poor retention of workers
• Forced early retirement
• Reduction in workforce as part of civil service
  or health sector reform
• Voluntary separation from public sector
• Sickness and death, mainly due to HIV/AIDS
• migration

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Migration Carousel
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The HRH Crisis is also due to

• Weak pre-service and in-service systems
• Pre-service education does not adequately prepare
  workers as disease burden shifts
• In-service training systems are not up to the
  challenge of filling the pre-service gaps
• In-service training to wrong providers and
  limited understanding of who has been trained
• Transfer of learning from education/training is
  often poor due to limited follow-up and
  supervision

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Its also due to

• Inappropriate alignment of the workforce
• Workers are overburdened with tasks that could be
  performed by others
• Rigid scopes of practice that unnecessarily block
  appropriate workers from providing specific
  services (e.g. ARTs by MDs)
• Focus on development of more expensive cadres
  relative to the disease burden.
• doctors vs nurses/midwives vs community workers
• Maldistribution of workers
• Urban vs rural
• Health workers in non-clinical positions (NGOs
  and MOH)

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Some Final Causes

• Weak, ill-positioned Human Resources Units in MOH
  
• No one to lead, advocate for the right human
  resources across the various ministries,
  finances, or mentor
• inadequate performance support systems/weak human
  resource management systems
• Non-existent or weak human resource systems that
  often politicize recruitment, deployment and
  promotion.
• Many human resource or personnel functions do not
  have the policy support they need.
• Vertical, or categorical, programs and/or funding
• Although the same worker provides multiple
  services, programs/funding are not integrated

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The Healthcare Worker Crisis

• Any questions so far
• Have we missed any HRH issues?

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So What Can Be Done?

• The traditional approach to addressing human
  resources issues has been..TRAINING.
• But we now know that TRAINING IS NOT ENOUGH!!!

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Some Solutions

• Strengthen Human Resources Units in MOH
• Establish HRIS and use the data for
  decision-making (Rwanda/Uganda/Swaziland))
• Contracting of additional workers and
  streamlining recruitment processes (Kenya,
  Namibia)
• Creating new cadres of workers, including
  volunteers, youth, lay workers (Uganda)
• Task shifting/job realignment (Ghana )

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More Solutions

• Improve recruitment and retention based upon data
  (Uganda, Malawi)
• Provide supportive supervision
• Productivity (Tanzania)
• Strengthen professional associations and councils
• Improve HR management systems
• Offer financial and non-financial incentives

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More Solutions

• Align pre-service education with health
  priorities ensuring skills development and
  knowledge transfer
• Develop national education and training plans
• Develop rational standards for licensure linked
  to continuing education
• Use innovative teaching strategies for
  pre-service and inservices (Kenya)
• Sustainability focused solutions

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Vision for the Future

• That health care workers will be in the right
  place at the right time doing the right thing
• A balanced hydraulic between the public sector,
  NGO and the private sector and RH/FP, HIV/AIDS,
  and other health priorities
• That communities and families are involved in the
  process of defining critical areas and approaches
• Overall health sector is strengthened and
  sustained