Education and training

1. Education and training

2. Most Common Issue Isolation of Training Institutions from the developments in the Health Services

3. Training Institutions • Lack of clarity of roles between Ministries of Health and Education in relation to Health Personnel Education

4. HR Production • Training must be related to market needs • Planned continuing education to strengthen capacity in clinical skills and leadership/management

5. International Issues re Competency of Health Workforce • Pre-service training is not geared to capture the challenges of service delivery • Need-based, job oriented training is not yet practiced widely • There is an inadequacy of infrastructure and training equipment • Many training centres still use outdated teaching methods and materials • Quality assurance mechanisms are often lacking • Very few opportunities for continuing education. (Source: WHO SEARO Regional HRD Meeting Bali 2006)

6. Competency Issues - continued • Teacher student ratios (1: 8-10 FTE) not adhered to • In sufficient number of clinical teachers • Weak educational planning • Weak links with the health facilities where clinical practice teaching takes place • Insufficient sites with sufficient practice cases • Political pressure to increase intakes reduced quality • Focus on hospital practice rather than community health.

7. Competency Issues • Focus on the total length of the training instead of the total hours required for training during that total period

8. Clinical Teaching • Clinical Teachers as a category in health facilities • Clarifying links with hospitals and health facilities for clinical practice • Clinical Practice sites not overloaded by students from both governmental and private training institutions simultaneously

10. Planning Intakes Linking intakes for training to target recruitment from underserved areas Training Female health workers – e.g will unmarried young midwives be acceptable to the community where they are posted on graduation?

11. Private Training Institutions • Who regulates the standards to be achieved in private institutions? • Does MOH employ graduates from private training or do they train for export? • Do private Training schools utilise teachers from Governmental training schools?

12. Continuing Education

13. Objectives • To increase and maintain professional competence • To orient existing health workers in changes and updating on new approaches to patient care and changes in treatment protocols • To contribute to professional development of health workers

14. Issues related to continuing Education • In the absence of a functioning HR system, Continuing Education is unplanned and unlinked to professional development (e.g. Somaliland) • Continuing Education is perceived as a source of income and totally unrelated to professional development • Many people attend training which is not relevant to their job descriptions or have been trained many times in the same topic. • Ad hoc approaches by donors , vertical programmes and NGOs is given to government health workers without any connection to the HR and health system • Relevant teachers from training institutions not included in continuing education to ensure they are aware of new approaches and changes in treatment protocols.

15. Possible Strategies • All agencies and departments planning training of government health workers provide training plans and coordinate with the relevant HR responsible at the relevant level • Details of all who attended training courses is provided to the HR focal units to be entered in the HR personnel records or HRMIS • Standardization of specific training modules which are accredited • Clear job descriptions so selection of participants in training is relevant to their job.

16. DEPLOYMENT, RECRUITMENT, RETENTION AND MOTIVATION ISSUES

17. Biggest problems • Health workers are people but in the absence of good HR systems which have appropriate HR Information and planning systems they become regarded as numbers to be moved around like chess pieces on a chess board.

18. Practical Issues • Salaries /survival • Schooling for their children • Want to stay in areas where there is an opportunity for private practice /higher income • Unwilling to be posted to rural areas where they have no connections • Rural -> urban drift

19. Incentives • Financial Incentives – will get people to go to where you want it doesn’t keep them there or make them work!! • Non Financial Incentives Are better at motivating staff . e.g. • Supportive Supervision • Career Development • Recognition • Clear roles and functions • Training for the job they have to do.

20. Recruitment • Should have the right training and experience for the job they have to do • Should have clear job descriptions • Should have clear lines of supervision You cannot undertake staff assessment on a health worker who has no job description and is having to undertake work for which they have not been trained!!!!

21. Possible strategies • Targeted recruitment of students for pre-service training from underserved areas • Social contracts with communities so that those students return to their communities after training

22. Organizational Strategy Human Resource Strategy Rewards selection performance appraisal development Strategic integration model Source: Devanna et al 1984

23. MoH Policy and Planning Health Service Delivery Programmes Hospital Management HR Task Force Civil Service Authority MoH Finance Dept Ministry of Finance Civil Service authority Donors Provincial /district Authorities Training NGOs and IOs Grants management Civil Service Authority M HR Financing Provincial HR Liaison HR Policy and Planning HR Department HR Management system HR Production Licensing and quality MOH HMIS M&E Quality of Services Grants Management Civil Service Authority Training Institutes Min of Higher Education Civil Service Authority IOs and NGOs Examination Board Training (NGO and IO) Health Professional Councils Civil Service Authority

24. MOH HR Focal unit MOH finance Dept Local government All PHO departments Relevant Provincial Local Government Departments MOH HR Focal Unit MOH Policy and Planning Unit District HR Departments Local government Training Institutes HR Finance Provincial HR Liaison HR Policy and Planning Provincial HR Department HR Information HR Production Licensing and Quality District HR departmt Health facilities Professional Assoc Local government CSC Provincial and regional Training Institutions MOH HRD Focal Unit District and Provincial in-service programs MOH HRD Professional Councils

25. IMHR takes time! • Cannot be achieved in a short time • Requires a common understanding by all stakeholders • Should be addressed utilising existing opportunities and focusing on a few priorities at a time whilst keeping the overall IMHR goal in view • Requires sound practical Operational Policies to underpin it.

26. Above all it requires COMMUNICATION