THE ROLE OF HEATLH CARE PROVIDER ORGANISATIONS, GOVERNMENT AND DONORS IN HUMAN RESOURCE DEVELOPMENT,

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THE ROLE OF HEATLH CARE PROVIDER ORGANISATIONS,
GOVERNMENT AND DONORS IN HUMAN RESOURCE
DEVELOPMENT, MANAGEMENT AND RETENTION

• INTERNATIONAL HEALTH WORKFORCE CONFERENCE ON A
  CALL FOR ACTION ENSURING
• GLOBAL HUMAN RESOURCES FOR HEALTH
• CICG GENEVA, SWITZERLAND
• 22 23 March, 2007
• O. Mokopakgosi
• Ministry of Health, Botswana

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COUNTRY PROFILE

• Botswana is a landlocked country with a
• total land area of 582,000 square kilometres
• population of 1,680,863 million people
• semi arid climate low rainfall high
  temperatures
• stable economic growth

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HEALTH CARE SYSTEM
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STAFFING SITUATION
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HEALTH FINANCING
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HRH Challenges in the Health Sector

• Staff shortages is of two folds
• - Requirement vs Establishment (needs based)
• - Establishment vs Actual staff in place
  (vacancy levels)
• Mainly attributed to
• - inappropriate HRH planning
• - lack of proper training and recruitment
  strategies
• - high competition (locally, regionally,
  internationally)
• - inavailability of critical skills from the
  global market
• - phasing out of middle level health workers

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HRH Challenges in the Health Sector

• Staff migration from
• Public to private
• Rural to urban centres
• Developing to developed countries
• Out of health professions
• Scenario - where majority of professionals in the
  private sector are serving population minority
  and few professionals in public service are
  serving the population majority.
• Hard hit areas are severely underserved.

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HRH Challenges in the Health Sector

• Staff migration is driven by both the pull and
  push factors, including
• Low salary levels comparatively/low entry points
  given lengthy training period for some cadres
• unclear career paths/slow progression ladder
• Highly skilled workforce driven health systems
• Poor working conditions
• High workload resulting staff burnout
• Imbalances of infrastructure and HRH
• Separation of spouses/children
• Inadequate accommodation
• Lack of appreciation of scarce skills/exceptionali
  ties
• Lack of managerial and administrative skills
• Lack of authority at district level/centralised
  decision making

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HRH Challenges in the Health Sector

• Low staff production
• Limited training capacity locally and placement
  externally. This may be in terms of physical
  space and/or shortage of lecturers
• Limited base where trainees are selected
• Stringent selection/entry requirement in science
  based courses
• Budgetary constraints to support
• Training strategies
• Recruitment strategies

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HRH Challenges in the Health Sector

• Poor HRH Information Systems
• Limited capacity to monitor HRH trends for
  decision making and planning purposes.
• Unreliable base to guide decisions
• Limited capacity for HRH research
• Lack of proper health service planning
• To guide HRH policy and plan development

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POSSIBLE SOLUTIONS

• Integrated Workforce Planning Capacity
• Aligning HRH planning with Service Delivery
  
• approaches and needs
• Need to develop good capacity for health
  workforce planning at national and district
  levels/devolve power
• Need to develop good leadership capacity within
  the public health system to foster supervision
  and utilisation and equitable distribution
• Understanding international markets and their
  impact on local and regional spheres
• Establish good relationship between policy
  planners and statutory councils governing health
  professionals

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POSSIBLE SOLUTIONS

• Strengthening RHR Information Systems to support
  planning and decision making
• Information systems on health workforce
  established at national level
• availability of accurate timely information
• to systematically analyse trends, develop
  perspectives, define response strategies
• Encouraging HRH Research
• Need to invest at country level in information
  technology systems

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POSSIBLE SOLUTIONS

• Scaling up HRH Production
• Strategic investment in the health professions
  education and training
• Training plans must be linked/aligned to needs
  (physical space, trainers, curricula)
• Train staff on leadership of national workforce
  planning and management
• Introduce and train middle level health workers
• Explore and establish centres of excellence and
  twinning programmes

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POSSIBLE SOLUTIONS

• Improved Working Conditions
• Additional incentives to support remuneration
  packages (monetary non monetary)
• Special allowances for hard hit areas, education,
  accommodation, communication, etc
• Career structures paths within the public
  health sector must be developed and responsive to
  challenges
• Consideration for scarce skills pay devt.
  structures for the health sector
• Allowing public servants to work part-time during
  their off duty
• Introduce staff support programmes wellness,
  motivation, stress, etc

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POSSIBLE SOLUTIONS

• Staff Migration
• Improved competitive remuneration
• Appropriate resources (infrastructure) to enable
  relevant skilled professionals to do their job
• Set up mentorship systems especially for rural
  areas
• Exchanges/placement within the region for both
  academic and clinical purposes (identify
  establish best practices)
• Encourage exchange of technical expertise within
  the ministries of health, both regionally and
  abroad

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POSSIBLE SOLUTIONS

• Staff Migration
• Explore ways of how professionals in diaspora
  could assist their countries of origin
• Offer part-time sabbatical-for working privately
  during off duty (in academic or clinical
  settings)
• Offer professionals working abroad opportunities
  to come work at local facilities on a regular
  basis
• Encourage local health professionals working for
  international research institutions to conduct
  their research studies at home

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Conclusion

• Possible limitations to successful implementation
  of various policy interventions are dependent on
  the economic performance of member states
  political issues in some countries
• Managing the human resources at hand is the first
  and foremost step towards attracting and
  retaining the health workforce to promote equity
  and access to health care
• Collaborative approach and the involvement of
  health care providers is an opportunity for
  success in exploring possible options to
  addressing HRH crisis

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THANK YOU AND GOD BLESS YOU