Review of human resources for health (HRH) related activities in the Bank

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Review of human resources for health (HRH)
related activities in the Banks portfolio of
Latin America and the Caribbean

Christoph KurowskiBrinnon GarrettThe LAC HNP
TeamPAHO
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LAC health workers on strike
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Overview

1. Shortcomings in health workforce performance
   common themes
2. The root of performance shortcomings
3. HRH in the LAC portfolio
4. Reflections from Task Team Leaders
5. Summary and conclusions

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Whats wrong with the health labor force in LAC?
Health workforce performance levers (macro and
micro)
Health system performance
Health workforce performance

• Imbalances
• Low productivity
• Skill mix

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Skill mix
Region Nurse per physician ratio
Africa 5.5
East Asia and Pacific 4.5
Europe and Central Asia 2.4
South Asia 2.3
Latin America Caribbean 1.9
Latin America 0.4
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At the root of shortcomings Health system
characteristics
Health system performance
Health workforce performance
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At the root of shortcomings Health system
characteristics contd.

• Health system characteristics
• Vertically segmented
• Segments fragmented (e.g. decentralization)
• Within segments varying contract systems

• Workforce implications
• Highly segmented labor market
• Regulation and management challenges
• Multi-employment
• Varying incentive environments

• Performance implications
• Availability and quality imbalances between and
  within segments
• Tensions between and within segments

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At the root of shortcomings the political
economy
Quick transition in administrations and health
authorities
Health workforce performance levers (macro and
micro)
Health workforce performance
Labor unions
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HRH in the LAC portfolio
HRH or workforce issues explicitly recognized 9 47
Project supports research to understand HRH and workforce issues 3 47
Project addresses in one or another way HRH issues 47 47
Project includes subcomponent to leverage health workforce performance 7 47
Project includes component to leverage health workforce performance 2 47
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What activities do Bank projects support?

• Training (47)

• HRH performance management
• Remuneration (9)
• Non-monetary incentives (6)
• Job descriptions (6)
• Career development (5)
• Performance benchmarking (4)
• Licensing (2)
• HR MIS (2)

• Physical work environment (38)

• Strategic workforce
• management
• Planning (11)
• Legislation (5)
• Medical education (4)

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HRH in the LAC lending portfolio
Million US
Training Specific interventions Others
410 (7.7) 250 (4.7) 4,680 (87.6)
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Reflections from task team leaders

• All Task Team Leaders are aware of HRH issues
• The majority considers workforce performance a
  serious constraint to health system performance
• HRH issues are always part of the dialogue with
  clients
• Commonly, the Bank and stakeholders other than
  governments bring up HRH issues

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Reflections from task team leaders contd.

• HRH issues are less frequently addressed in
  projects than they are part of the policy
  dialogue
• TTLs engage primarily with MoHs that do have
  limited leverage over health labor issues
• Governments are reluctant to address issues and
  political feasibility is the major concern (e.g.
  labor unions)
• Some TTLs believe their technical expertise is
  insufficient to pursue an effective dialogue
• HRH activities in projects are limited to
  training that
• promises political visibility without rocking
  the boat

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Summary

• Significant health workforce performance
  shortcomings are a major limitation to health
  system performance
• Certain health system characteristics typical for
  the region are not conducive for optimal
  workforce performance
• Health workforce performance limitations are a
  major concern of stakeholders, however are rarely
  addressed in reform efforts and projects
• Policies and other mechanisms to improve
  workforce performance are often considered not
  politically feasible
• Among performance levers, the Bank supports
  primarily short-term training of health workers
• Within Bank projects, there is a trend towards
  more comprehensive approaches

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Conclusions

• Reform projects need to acknowledge the
  importance of HRH
• Consider reform implications on workforce
  performance
• Address workforce performance shortcomings
• The Bank needs to engage more broadly with
  relevant national stakeholders, probably most
  effectively, in a multi-sector approach
• The Bank, in collaboration with regional and
  global partners, needs to strengthen its
  technical expertise in order to engage more
  effectively in policy dialogues with clients