Pam McQuide Senior Workforce Planning and Policy Advisor Capacity Project

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 27, 2006 Pam 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. Evidence of the Current Health Crisis: Life Expectancy – Advancing and Slipping

4. Health Care Workers Do Influence Health Outcomes: More workers, fewer deaths

6. 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

7. Worker Density by Region – Huge Disparities

8. Distribution of health workers by level of healthexpenditure and burden of disease, by WHO region World Health Report, 2006

9. Working Lifespan Strategies – Determining the Stock of Healthcare Workers World Health Report, 2006

10. Workforce Pyramid

11. The HRH Crisis in Africa: A Case Study

12. 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

13. MigrationCarousel

14. 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 • Transfer of learning from education/training is often poor due to limited follow-up and supervision

15. 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 • 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

16. Some Final Causes… • Vertical, or categorical, programs and/or funding • Although is the same worker who provides multiple services, programs/funding are not integrated • 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.

17. The Healthcare Worker Crisis… • Any questions so far: • Have we missed any HRH issues? • Of the issues we’ve discussed, which do you think is the most important? Why?

18. 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!!!

19. Some Solutions • Establish HRIS and use the data for decision-making (Rwanda, Uganda, Swaziland) • Contracting of additional workers (Kenya, Namibia) • Creating new cadres of workers, including volunteers, youth, lay workers (Lesotho, Namibia) • Task shifting/job realignment (Rwanda, Zambia, etc.)

20. More Solutions • Improve recruitment and retention through improved salaries, work conditions (Malawi) • Provide supportive supervision • Get good retention data, context specific reasons for turnover (Uganda) • Improve HR management systems so they support and assist the worker (job descriptions, performance-based evaluations, etc.) • Incentives • Especially to keep workers in hardship posts (Zambia) • Non-financial incentives may be key (Uganda)

21. More Solutions • Align pre-service education with the country’s health priorities (many countries) • Make sure pre-service education focuses on skills development rather than just knowledge transfer (many) • Develop national education and training plans • Accredit institutions and/or certify providers (Afghanistan, Rwanda) • Community-based education (Afghanistan)

22. Overcoming Crisis • Country Leadership • Strategic plan and management • Investing in education • Managing for performance • Harmonization funding, diseases • Enabling fiscal policies • International reinforcement • Managing labor migration • HRH friendly donor policies • Building knowledge base

23. 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 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