G. ElzingaWHO, Geneva14 - 02 - 2005

Who cares?

Life Expectancy: Advancing and Slipping

Differences in health

increase within countries

and between countries.

WHY CAN’T W

E COPE?

HEALTH WORKFORCE PROBLEM

Joint Learning Initiative

Diagnosis (The Lancet, 27-11-2004)

Global Health Workforce cannot

cope with global health crisis;

SSA hit hardest

The Glue of the Health System

migration

training

Sky full of HRH “challenges”

V&Hdilemma’s

productivity over-burdening

workconditions quality

distribution

number

honorarium

manage-ment

HIV/AIDS

statuscarrierperspective

PROVIDING HEALTH IN POVERTY

Program of

prevention and/or care

interventions to

controla

specific health-

problem.

V

Infrastructure of prevention - and care services to cope with the prevailing health problems.

H

VH

V

HVertical-horizontal indeveloping countries

Vertical-horizontal indeveloped countries

Program Macrostructure

MEIS

PC

Vintervention

strategymonitoring en

evaluation

preventionand/or care

Differences between countries (polio)

MEIS

PC

MEIS

PC

MEIS

PC

General health services

Differences between programspolio

MEIS

PC

TB

MEIS

PC

3x5

MEIS

PC

malaria

MEIS

PCGeneral health services

Vertical programs: who is doing what?

Intervention Strategy

Monitoring/ Surveillance

Prevention/care

international

national

HRH required

district

facility

HRH dilemma ?

V H

HRH synergy !

&

RESEARCH CONTRIBUTIONS TO HEALTH WORKFORCE STRENGTHENING

Health systems and workforces are ‘man-made’

Research outcomes depend more on time and place than those of biomedical research.

However, research is not second rate: Relevance: crucial to reach health outcomes and

cost contaiment Intellectually: methodology often quite

demanding because of complexities

SPECIFIC

GENERIC

2 VALUABLE ‘RESEARCH’ LAYERS

SPECIFIC

POLICYCYCLE

analysis

M&E planning

implementation

LEARNING FROM RESEARCH

GENERIC

POLICYCYCLE

a

p

i.

m&e

POLICYCYCLE

a

p

i.

m&e

POLICYCYCLE

a

p

i.

m&e

POLICYCYCLE

a

p

i.

m&ePOLICYCYCLE

a

p

i.

m&ePOLICYCYCLE

a

p

i.

m&e

POLICYCYCLE

a

p

i.

m&e

POLICYCYCLE

a

p

i.

m&e

POLICYCYCLE

a

p

i.

m&e POLICYCYCLE

a

p

i.

m&e

BY RELATINGDIFFERENCES TO

OUTCOMES

GENERIC

POLICYCYCLE

a

p

i.

m&e

POLICYCYCLE

a

p

i.

m&e

POLICYCYCLE

a

p

i.

m&e

POLICYCYCLE

a

p

i.

m&ePOLICYCYCLE

a

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i.

m&ePOLICYCYCLE

a

p

i.

m&e

POLICYCYCLE

a

p

i.

m&e

POLICYCYCLE

a

p

i.

m&e

POLICYCYCLE

a

p

i.

m&e POLICYCYCLE

a

p

i.

m&e

socio-political contexthealth systemhealth workforceHRHTB/HIV

socio-political context

health system

health workforce

HRHTB/HIV

ROLE OF HRHTB/HIV RESEARCH

supporter

facilitator

contributor

participator

stimulator

initiatorPriorities?

PC

IS MESimplification• less time/patient• lower cadres

Time/Cost-effectiveness(of intervention(s) and system)• less time/patient• more work satisfaction

HIV/AIDS&TB

Optimisation(Integration; IT ?)• less time• higher quality

“INITIATOR” PRIORITIES

socio-political context

health system

health workforce

HRHTB/HIV

ROLE OF HRHTB/HIV RESEARCH

initiator

participator

stimulator

contributor

facilitator

supporterPriorities?

Policy truths

Economic growth cu

res povert

yHealth Care is a cost not a profit

Thus, keep health expenditure low!

Social realitiesPoor populations havehigh disease burdens They therefore need

more health serviceswhile they can infact afford less.

Health belowa critical state tends

to deteriorateHIV/AIDS & TB/HIV

can push health below thatcritical state, causinglife expectancy to fall,

the labor force to falter, and social costs to sore!

EXAMPLES OF “SUPPORTER” PRIORITIES

WHAT REALISTIC INTERVENTIONS CAN COUNTER

MIGRATION OF HEALTH WORKERS?

WHEN DOES HEALTH CARE CHANGE FROM COST TO INVESTMENT?

Thank you

Worker density by region

socio-political context

health system

health workforce

HRHTB/HIV

ROLE OF HRHTB/HIV RESEARCH

initiator

participator

stimulator

contributor

facilitator

supporter

Priorities?

Community Referral Centre

“ESSENTIAL PRIMARY CARE” FUNCTION

AVAILABLE 1 PER ?000ACCESSIBLE < .. HOURSAFFORDABLE < . . % INCOME

Tuberculosis

M&C health

Malaria

HIV-AIDS

POLICYCYCLE

analysis

M&E planning

implement.

• Cost-effectiveness calculations of approach.

• Methodology to determine availability,

accessibility, affordability of EPF

• Controlled study of cost- and time

effectiveness of approach.

• Etc.

“PARTICIPATOR” PRIORITIES

MDG’s countries

donors High level forum WHO

Worldbank NGO’s

UNDP Post JLI ILO

Technical agencies Foundations

ILOPost JLI

Foundations

MDG’s countries

donors High level forum WHO

Worldbank NGO’s

UNDP

Technical agencies

THANK YOU

ed. & tr.

community

global policies

population health

need supplyhealth workforce

h e a l t h s y s t e m

national policies

demand

HIV-AIDSMigration

Een HRH dilemma ?

burden of disease is higher in

poor environments

V+ development requires adequate

general health services

H+