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

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


1
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
2
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.

3
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
4
Distribution of health workers by level of
health expenditure and burden of disease, by WHO
region
World Health Report, 2006
5
Working Lifespan Strategies Determining the
Stock of Healthcare Workers
World Health Report, 2006
6
The HRH Crisis in Africa A Case Study
7
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

8
Migration Carousel
9
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

10
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)

11
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

12
The Healthcare Worker Crisis…
  • Any questions so far
  • Have we missed any HRH issues?

13
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!!!

14
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 )

15
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

16
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

17
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
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