The Health Workforce Strategy for strengthening health service

1
The Health Workforce Strategyfor strengthening
health service

• Dr Percy Mahlathi
• Deputy Director General
• National Department of Health

2
Introduction

• HRH as a complex suite of strategies with the
  potential to strengthen a health system,
  including organizational and individual
  performance and job satisfaction, is not commonly
  understood (Bryson)
• Many lessons learnt globally but paradoxically
  there is little information in literature on how
  HRH policies and strategies relate to government
  and health sector reforms (Biscoe)

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Systemic challenges

• Concept of HRH as mainly being admin rather
  than management, planning, research and policy
  for the present and future workforce
• Focal area for crystallising debates,
  internalising research in order to focus on
  workforce solutions
• Role of professional councils broader than
  registration and quality assurance for todays
  cadre
• Coordination of planning for the workforce
  mamoth and complex but necessarily a hybrid of
  decentralised and centralised requiring
  reaction and responsiveness at all levels
• Resource constraints shortages impact on
  labour relations giving rise to tensions between
  professionalism and unionism

4
Systemic challenges

• Planning loci frequently separate financial,
  infrastructure, personnel planning rarely done
  together in many organisations (resulting in
  phenomenon of unfunded posts)
• Academic collaboration on supply training
  issues and differentiation rare colleges, HEIs,
  research organisations research agendas rarely
  policy grounded
• Oversight of key interventions require evidence
  and information systems which are rarely
  integrated
• Management, leadership ethics issues
• Messaging and communication of policy e.g.
  nursing qualifications being viewed as equal to
  nursing reform
• Governance of key instruments and agencies of
  policy e.g. statutory councils State funded
  research bodies

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Institutional challenges

• Capacity for planning and review
• Information management its use for
  decision-making
• Data credibility issues
• Opportunities for sharing best practice
  diminished due to service burden
• Research interest and agenda sacrificed
• Fragmentation narrow programmatic way of
  approaching resources
• Broader socio-economic and development priorities
  underpinning policy direction
• not solely an HRH challenge

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Policy Planning challenges

• Loci not totally integrated
• Harmonisation e.g. education assistance
• Information knowledge management crowded out
  the preserve of the few therefore technical
  capacity and capability compromised hence
  reliance on established resource persons and a
  few in the system
• Inconsistent application of agreed policy
• Implementation and public perception skewed
• Management and leadership of process versus
  content a problem especially in terms of
  experience of officials, managers
• M and E systems not always well developed
  regarding outputs and outcomes

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Programme challenges

• Nursing reform planning and implementation
• Harmonised inputs on global debates
• Promoting health sciences for young people
• Monitoring and evaluation of interventions
• Demand assessment for health services training
• OSD implementation measuring returns
• Impact assessment of all training interventions
  especially management and leadership ones
• Context sensitive norms development for
  facilities in the light of national and
  provincial competencies
• Strengthening systemic CPD for the professions
• Convincing professional councils and other
  stakeholders to respond to national HRD
  priorities.

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Some Key Global Trends (1)

• Economic globalization and integration
• Technology and its impact on health
• Notion of a public good privatization
• Ensuring sustainable development
• Emerging new work systems
• Health driven workforce planning efforts
• Harmonisation of health sciences education
  training

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Some Key Global Trends (2)

• Shift from personnel administration to
  strategically focused HRH efforts
• Changes in leadership style from bureaucracy to
  entrepreneurship
• Changes in organizational culture from risk
  averse bureaucracies to innovative and effective
  organizations
• Collective global efforts at managing migration
  of professionals

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Compounding Global Challenges

• Keeping abreast with new health knowledge and its
  implications, from the explosion of knowledge in
  the genetic field to communicable and
  non-communicable diseases
• Paradox of growing resistance of infectious
  diseases to antibiotics and the potential for
  uncontrollable epidemics

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Where do we start?

• Appropriate health workforce planning
• Understand our health professionals and manage
  them better
• Manage better the limited resources we have as a
  country
• Create conducive work environments that encourage
  life-long learning
• Invest appropriately in various aspects of health
  system

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Role of Professionals

• Health professionals in clinical field represent
  the technical core of health services
• They take responsibility for life death
  decisions
• They play major role in resource allocation
  (rationing of care through utilisation if not
  allowed direct influence)
• They are responsible for innovation
• Quality of care rests mostly on their shoulders
• Non-health trained professions also critical in
  health service delivery

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Certain difficulties arise when the people to be
organized are professionals. In order
tounderstand these difficulties, it is necessary
to understand the nature of professionals, how
their expertise and values act as driving forces,
what informational inputs they work on, how they
interpret and make decisions, and what controls
they respond toWeick, K.E. and McDaniel, R.R.
(1989)
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Interventions

• Improve quality of managers (technical expertise
  people skills)
• Improve understanding of professionalism the
  health professions
• Improve provision of tools of trade
• Improve areas like accommodation, communications,
  libraries etc
• Make professionals feel appreciated
• Professionals must in return appreciate
  communities they serve

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Strategic Approaches

• National HRH Planning
• Focus efforts of all stakeholders on workforce
  issues
• Build strengthen administrative capacity
  (planning, development management)
• Build academic capacity (quantum orientation)
  by boosting production (linked to demands on
  health system)
• Leverage on international relations

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Operational Issues

• Create better working environments
• Create new retention mechanisms
• Expand choices of professional development in
  public service
• Demand a good ROI from professionals
• Direct better public investment in health
• Improve capacity of education institutions (all
  facets)
• Strengthen retain management expertise

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Actions

• Attend to remuneration issues of professionals
• Statutory Councils strengthening HRH plans for
  relevant professions
• Engagement of academic institutions / bodies to
  address national production issues
• Developing a Health Professions Information
  System (record, track define)
• Management development
• Foreign workforce management

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Project Work 1 (on-course planned)

• Determination of cost of training
• Audit of public nursing colleges with a purpose
  of expanding production
• Development of HRH indicators
• Context specific norming
• Specialist production and academic leadership
  development (CMSA)
• Revitalisation of Clinical Research (ASSAF)
• Interface between service training platforms

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Project Work 2(on-course planned)

• Expansion of mid-level health professions
• Harmonisation of regulation of certain categories
  e.g. oral health
• Regional collaboration on regulation of the
  health professions (statutory councils)

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Review HRH Planning Framework of 2006
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Finally.

• Encourage black professionals to flock into
  academia and research
• Support transformation especially at academic
  institutions
• Ensure that communities look after health assets
  all kinds of infrastructure
• Attention to moral fibre of society
• Attention to concept of professionalism
  associated values (critical - see next slide)

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Although the art of healing is the most noble of
all arts, yet because of the ignorance of both
its professors and of their rash critics, it has
fallen at this time into the least repute of them
all Hippocrates