Human Resource for Health, Private Sector and UHC

Human Resource for Health, UHC and Private Sector

Harnessing and Aligning the Private Sector for Universal Health Coverage

Presented at Prince Mahidol Awards Ceremony Week

Paul Lalvani

Dean and Director

Empower School of Health

New Delhi, India

26 January, 2016

Ida Marie PantigStamp

2WHO HR4H vision 2020:

Universal coverage for access to quality health services,

particularly for the most vulnerable and excluded groups, with

improved patient and community health outcomes, through a

balanced distribution and efficient skill mix of a multi-professional,

motivated workforce able to prevent and manage a full range of

conditions and empower people and communities to manage their

own health needs as fully as possible

3Generalist medical practitioners

Specialist medical practitioners

Nursing professional

Midwifery professional

Traditional and complementary medicine professionals

Paramedical practitioner

Dentist

Pharmacist

Environmental and occupational health and hygiene professionals

Physiotherapist

Dieticians and nutritionists

Audiologists and speech therapists

Optometrists and ophthalmic opticians

Medical imaging and therapeutic equipment technicians

Medical and pathology laboratory technicians

Pharmaceutical technicians and assistants

Medical and dental prosthetic technicians

Nursing associate professionals

Midwifery associate professionals

Traditional and complementary medicine associate professionals

Dental assistants and therapists

Medical records and health information technicians

Community health workers

Dispensing optician

Physiotherapy technicians and assistant

Medical assistant

Environmental and occupational health inspectors and associates

Ambulance worker

Health associate professionals not elsewhere classified

Health care assistant

Home-based personal care worker

Personal care workers in health services not elsewhere classified

Health service manager

Health management personnel not elsewhere classified

Life science professionals

Social work and counselling professional

Non-health professionals not elsewhere classified

Life science technicians

Medical secretaries

Non-health technicians and associate professionals not elsewhere classified

Clerical support workers

Service and sales workers

Trades worker

Plant and machine operators and assemblers

Elementary occupations

Classification of Health Professionals

Health ProfessionalsHealth Associate

ProfessionalsPersonal Care Workers in

Health ServicesHealth Management and

Support Personnel

Source: WHO Health Workers Classification

International Standard Classification of Occupations (ISCO, 2008 revision)

5Challenges in HR for Health

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African Region 2.6 12 0.5 0.9

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9Examples of Imbalance in the Health Sector

Urban - Rural Imbalance:

Cambodia, 85% of the population reside in rural areas, yet only 13% of government health professionals work there

In Nepal, only 20% of rural physician posts are filled, compared with 96% in urban areas

Source: Health in Asia Pacific Chap 11.

Health Professional Imbalance

Greater numbers of physicians than nurses or midwives were registered in Bangladesh, India, Mongolia and Myanmar

Global average is twice as many nurses/midwives relative to physicians

10

Challenges faced by HR in health (In the Asia Pacific Region)

CRITICAL GAPS AND CHALLENGES

1. Cross-sectoral planning and policy alignment

2. Health sector financing and governance

3. HRH databases, information management systems and strategic plans

4. Workforce shortages and maldistribution

5. Implementation of HRH plans

6. Education and training

7. Informal health workers

8. Research, analysis, monitoring and evaluation

All these depend on good personnel management, appropriate career

structures, effective staff supervision and development, presence of adequate

support and good working conditions.


WHO HRH Action Framework

11

Cross-sectoral planning and policy alignment

Health workforce planning and policy alignment across sectors,

including health, education, finance and labour, are currently lacking in

many countries.

More attention must be spent on facilitating policy dialogue and joint decision-making across sectors with multiple stakeholders, including

all relevant ministries, the publicprivate service delivery sector, professional associations, nongovernmental and faith-based

organizations, consumers and communities, and technical and

donor partners.



12

Health sector financing and governance

HRH policies, plans and interventions call for strong political

commitment and sustained financial investments to support workforce

scaling up in areas of greatest need, i.e. employment costs and pre-

service education

Little has been done to increase health sector funding even though the consequences of inadequate investment are widely recognized.

As such, many countries are struggling to improve the recruitment, deployment, retention and performance of the health workforce.



13

HRH databases, information management systems and

strategic plans

In most lesser-resourced countries, databases and other data sources,

as well as HRH information management systems (IMS), even if they

exist, do not provide policy-makers and planners with the necessary

minimum data sets to enable full workforce analyses by gender, age,

location (rural or urban), ethnicity and expertise.

Governments have not completely or consistently identified health service priorities, or delineated the functions and staffing norms for

different facilities or services, further limiting the effectiveness of

workforce planning efforts.



14

Workforce shortages and maldistribution

Seriousness of the problems varies from country to country Overall, the Region has insufficient numbers of essential groups of

health personnel, including: qualified tutors/faculty for education and

training; mental health personnel; community-based nurses and

midwives and selected categories of medical specialists

Adequately trained health facility and equipment engineers and maintenance personnel; and, in the Pacific islands, local, low-cost

prosthetic makers.

All countries also have workforce distribution inequities with most health workers found in urban areas, leaving rural areas

underserved.



15

Implementation of HRH plans

Many countries have HRH plans in place to address workforce issues,

but the main challenge is in implementation

Even if HRH priorities are clearly delineated, there may still be inadequate strategic action planning and budgetary support to adequately address

urgent HRH needs.

Disconnects still exist between health services and educational and workforce planning, contributing to inefficiencies and misalignment in

training, deployment and uptake into the workforce.



16

Education and training

The standards and quality of education and training of health professionals remain below par in many countries

In many countries, there is no formal, credible system for educating allied health workers

Too many different kinds of professionals, too many people need to be educated and trained

In many lesser-resourced countries, the health workforce is ill-prepared to effectively respond to rapidly changing, complex health

systems, population health challenges, and the growing burden of

noncommunicable diseases

Faculty in lesser-resourced countries typically lack clinical expertise as well as formal preparation in education, teaching and learning



17

Informal health workers

The HRH challenges of the formal workforce apply to the informal workforce to an even greater extent, as many informal health

workers do not receive salaries or supervision, and are operating

below the radar If not managed or educated, or brought into the formal health

system, they can create more harm than good

Insufficient comparative and analytical data exist regarding their education, deployment, utilization, retention and effectiveness in the

region

Informal health workers have multiple titles and varying types and depth of training, studies and experience have shown that they can

play important roles in child survival, maternal health and

management of infectious diseases



18

Research, analysis, monitoring and evaluation

There is growing amount of analysis and research being undertaken throughout the region, which can inform policy development and

planning

More is needed to capture the unique characteristics of each country and its health workforce

. Research has been directed at better understanding the workforce

situation, and the underlying causes of particular problems.

There has been little investigation of the impact of interventions taken to resolve problems; however, in many countries, not enough

time has passed for such impacts to be felt, and resources for

monitoring or independent analysis are limited



19

Public-Private Partnerships for HR4H

20

Workforce Development Model

Demand driven skills in Health Sector

Education and Training

Public/ Private Partnership

Improved Workforce

Source: Public-Private Partnerships: lessons learned (USAID/Jordan, January 2009)

Oxford Policy Management

According to USAID early private sector engagement is an essential component to youth

employment programs as well as a critical contributor to programme sustainability

21

Case Study: NSDC, India

22

National Skills Development Corp., India

Launched by the Finance Minister "...There is a compelling need to launch a world-class skill

development programme in a mission mode that will address the challenge of imparting the

skills required by a growing economy. Both the structure and the leadership of the mission must

be such that the programme can be scaled up quickly to cover the whole country."

Mission:

Upgrade skills to international standards through significant industry involvement and develop necessary frameworks for standards, curriculum and quality assurance

Enhance, support and coordinate private sector initiatives for skill development through appropriate Public-Private Partnership (PPP) models; strive for significant operational and

financial involvement from the private sector

Play the role of a "market-maker" by bringing financing, particularly in sectors where market mechanisms are ineffective or missing

Prioritize initiatives that can have a multiplier or catalytic effect as opposed to one-off impact.

Source: NSDC

23

NSDC Case Study: Overview

A large part of its efforts are directed at skill development programmed in the unorganized sector

NSDC is actively promoting the involvement of employers through the establishment of Sector Skills Councils, and providing seed money to develop occupational standards and

competence-based curricula.

The differentiated focus for the 21 sectors under NSDCs purview and its understanding of their viability will make every sector attractive to private investment.

Source: NSDC

Oxford Policy Management

NSDC is a not-for-profit company set up by the Ministry of Finance,. It has an

equity base of Rs. 10 crore, of which the Government of India holds for 49%,

while the private sector has the balance 51%.

24

Healthcare Sector Skill Council (HSSC)

Healthcare Sector Skill Council is a unique Initiative of Confederation of Indian

Industry (CII), National Skills Development Corporation (NSDC) and Leading

Healthcare Industry Leaders, representing both public and private sector.

Source: HSSC

Objective: facilitating skilling of 4.8 million workforce in the Allied

Healthcare and Paramedics over the next 10 years

25

HSSC Role in Developing Vocational Education

in India for Allied Healthcare and Paramedics

Source: HSSC

Development of

National

Occupational

Standards

Development

of Appropriate

Courses &

Curriculum

Accreditation

& Affiliation of

Training Institutes

Assessment &

Certification for

Trainees

Establishment of a

Vibrant Labour-

Market Information

System & Placement

Support

Academy of

Excellence AWorld-class

Simulation

Centre

26

Case Study: UNAIDS, Empower

27

Case Study: UNAIDS and implementation by Empower School of Health

(ongoing)

Objective:

Develop and approach and establish a platform for scaleable assessment of HR capacity

Professional focus:

Health Procurement and Supply chain

Where:

Philippines, Pakistan and Indonesia Horizontal and vertical programs (HIV, TB, Malaria and RCH) Centre and the provinces

Approach:

Self assessment online tool, takes about 1 hour to complete and includes about 100 questions

28

Educational Qualifications

Work Experience

Soft Skills

Personal HR Profile

Domain

Competency

HR Competency Assessment

Use any platform to conduct assessmentFunders and Partners

29

Competency Finding (78 staff)

DOMAIN

30

Measuring Competency Level Performance

28%

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62%44%

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31

Analyse Competency Performance Results

Competency

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Work Experience

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32

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Overall FindingsSe

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Competency Performance (answering technical questions)Se

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s)

Sup

ply

co

mm

od

itie

s to

fac

ilit

ies

Man

age

re-p

ack

ing

of

pro

du

cts

Man

age

tran

spo

rt f

or

com

mo

dit

ies

Pro

vid

e in

form

atio

n a

nd

ad

vic

e to

th

e p

rod

uct

use

r /

pat

ien

t

Dis

pen

se o

r p

rovi

de

com

mo

dit

ies

to p

atie

nts

/ u

sers

Pro

per

ly u

se m

edic

al p

rod

uct

s ac

cord

ing

toin

tern

atio

nal

/ n

atio

nal

reg

ula

tio

ns

Rep

ort

pro

du

ct u

se /

co

nsu

mp

tio

n

Competency-wise AssessmentCompetency Performance

Weak

Average

Good

38

Module 1: Product Selection

Module 2: Quantification

Module 3: Procurement

Module 4: Inventory Management

Module 5: Quality Assurance

Module 6: Rational Use of Drugs

Design Your Own Modular Course

39

Customized UNDP PSM course (freely available)

40

HR in health is fraught with numerouse challenges

Lots of science to help us find the solutions, but more research needs to be done

Many governments are working on this and have developed HR4H plans

Many leading organizations working on thisWHO, ADB, World Bank, ILO, Academia

Private sector is getting engaged and collaborating with public sector and NGOs

Technology is acting as a game changer

Funds are available to help reform the sector

Conclusions

41

Vision: Saving lives by promoting universal access to quality-assured medicines

Our area of expertise is in Access to Medicines including procurement, supply chain,pharmaceutical management, regulatory and quality-assurance. Empower focuses on education,training, technical assistance and research.

Empower School of Health works across 30 countries in Africa and Asia

Thank you

EMPOWER PARTNERS, FUNDERS AND CLIENTS

Government

of Pakistan

Government

of Indonesia

Government

of Philippines

Ministry of Commerce, India

About Empower School of Health

Human Resource for Health, Private Sector and UHC

Documents

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