Special Article

Health Workforce Planning: Developing Expertise in Eastern Asia and the Pacific Islands

John Dewdney1, Lorraine Kerse2

(1) Visiting Fellow, Centre for Public Health, University of New South Wales, Sydney, Australia (E-mail address j.dewdney@unsw.edu.au).

(2) Regional Adviser in Human Resource Development, World Health Organization Western Pacific Region Office, Manila, Philippines

Abstract

Uncomfortably aware that several decades of talk about the need for health workforce planning in its Region had produced neither plans nor planning expertise, the WHO Western Pacific Regional Office (WPRO) embarked in the early 1990s on a project to develop both. The WHO Regional Training Centre in Sydney produced a training manual and a ‘do-it-yourself’ computer-based workforce planning workbook (the WPRO/RTC Model) which linked projected staffing requirements to training intakes and outputs, estimated future staffing and training costs and scheduled required inputs from external development assistance agencies. The workbook printout is a readable and easily understood 10-20 year workforce plan, incorporating both text and tables.

Introduced to national health authority representatives at a series of WPRO-supported inter-country workshops, the workbook generated both interest and enthusiasm, but not much ‘doing-it-yourself’. Follow-up in-country visits by consultants working with local planning staff led to the production of national workforce plans in all of the independent Pacific island countries, Cambodia and Viet Nam, and adaptation of the model in China for provincial and county level planning.

This paper reviews lessons learnt regarding getting decision-makers to recognise the nexus between workforce planning, overall health service development and operational policy; data collection and collation; moving beyond a simple personnel:population ratio approach; and adjusting the model to suit local circumstances. The project has identified some emerging and worrying trends in health workforce development. The need for consistent, sustained technical assistance which reflects long and wide experience in health service development and management is underlined. Lots of Talk, Little Action

Health workforce planning appeared frequently as an item on the agenda of the meetings of the WHO Western Pacific Region Committee in the 1970’s and 1980’s, nominees from the health authorities of Region’s member countries attended a succession of conferences and workshops on workforce planning, and consultants repeatedly recommended the preparation of health workforce plans - but despite all the talk, virtually nothing happened. Conspiring Imperatives

By the latter part of the eighties a number of factors conspired to underline the necessity for planning – the growing involvement of loaner-donor agencies in relatively large scale health service development projects; the desire to move more rapidly towards indigenous staffing of national health services; problems in the recruitment and payment of expatriate health personnel; the realisation in several of the Pacific island countries that their medical workforce was ageing and there were few national students in the training

2

pipeline; seduction of trained personnel from already under-staffed countries to more affluent neighbouring countries; the need to develop regional centres for the training of health personnel to work in countries too small to support in-country training institutions; over-production of some categories of personnel; and, of course, the universal problem of providing adequately staffed services to rural areas. Where are the Workforce Planners?

But a major stumbling block was the lack of workforce planning expertise and experience among the staff of the government health authorities in the Pacific island countries, and indeed among the staff of virtually all the health authorities of countries in the WHO Western Pacific Region. Although most of the health authorities did from time to produce national health plans covering, say, five to ten years of proposed activity, generally one of the weakest sections of those plans was that concerned with human resources.

Among the staff of most of the central health authorities in the region one could find a planning group or at least someone designated as a ‘Planning Officer’, perhaps with an MPH, MHA or similar degree. But neither their formal training nor attendance at workshops and seminars had prepared them to actually produce a workforce plan.

In discussions between WHO’s Western Pacific Regional Office (WPRO) in Manila and the Regional Training Centre (RTC) in Sydney it was agreed to embark upon a program to provide training aimed at producing people able to lead workforce planning activities and manage the formulation of workforce plans.

Two problems were soon recognised – one was the lack of appropriate training materials and the other was the absence of anything that could be regarded as an appropriate “model” workforce plan. “How to . . .” - the Birth of the WPRO/RTC Manual and Workbook

Two senior health service officials from Pacific island countries (PICs) were awarded fellowships to work for several months at the RTC in Sydney contributing to the production of a training manual – drawing on already published materials and examples from their own experience in human resource management in the small island countries. The manual was to be used both as a resource for conducting training courses and as a guide for “self study” by people with planning responsibilities.

But there were some reservations as to how successful a manual on conventional lines would be in actually getting plans written. One needs only to spend a short time in almost any health authority’s offices to come across copies, sometimes piles of copies, of manuals on a range of topics. Their dustiness attests to their infrequent use. And how would the manual relate to a model plan?

Furthermore, producing a workforce plan requires putting pen to paper and doing a lot of repetitive calculations – activities that by and large are not pursued with great enthusiasm in the PICs.

Fortunately in the early ’90s most of the government health authorities in the Western Pacific Region had been supplied with computers and there was considerable enthusiasm for making use of them. Why not write a model plan, combine it with instructions as to how to adapt the plan contents to one’s own situation and thus produce a workforce planning workbook? To make the whole thing easily useable, put it on a computer diskette. The planners then simply follow the instructions regarding consultation,

3

data collection and so on, enter their own data into the tables, modify the text in line with local detail and planning decisions – erase the instructions from the workbook diskette – and print out the plan as a readable document complete with text and tables. The WPRO/RTC Workbook

The workbook contents cover the main areas of concern to workforce planners working in developing countries and are presented in seven chapters:

1. Introduction 2. The Current Health Workforce 3. Training Programs and Training Issues 4. Planned Change - Workforce Requirements, Projections and Training Schedules 5. Workforce and Training Costs 6. External Support Needs and Priorities 7. Plan Implementation, Monitoring, Review and Evaluation Chapter sub-headings are shown in Exhibit 1. Because Microsoft Word was used in

writing the workbook, sub-headings may easily be added, deleted or re-arranged. Exhibit 1 The WPRO/RTC health workforce planning workbook – Table of contents. _____________________________________________________________________________ 1. Introduction 1.1 Purpose and use of the health workforce plan 1.1.1 Overall purpose 1.1.2 Specific uses of the plan 1.1.3 Plan review 1.2 The health care system 1.3 National health planning 1.4 National health workforce policy 1.5 Organisational arrangements for workforce planning 1.6 Health workforce data and information management 1.7 The planning context - assumptions relating to workforce planning 2. The Current Health Workforce 2.1 Introduction 2.2 The size, composition, deployment and productivity of the current MOH workforce 2.2.1 MOH posts and personnel 2.2.2 Gender and age distribution 2.2.3 Categories of MOH personnel

2.2.4 MOH staff salaries 2.2.5 MOH places of work 2.2.6 Geographical location of posts and personnel 2.2.7 Productivity of the MOH workforce

2.3 The private sector health workforce 2.4 Current staffing problems

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Exhibit 1 The WPRO/RTC health workforce planning workbook – Table of contents. (cont.) 3. Training Programs and Training Issues 3.1 Training policy and principles 3.2 Training responsibilities 3.3 Types, location and duration of training programs 3.4 Teaching/learning facilities 3.5 Curriculum development and approval 3.6 Recruitment and training of teaching personnel 3.7 Trainee recruitment, selection, retention and employment 3.8 Current training statistics 3.9 Current training issues 4. Planned change - workforce requirements, projections and training schedules 4.1 Introduction 4.2 Medical Officers - requirements, staffing and training 4.3 Nursing personnel - requirements, staffing and training 4.4 Pharmaceutical Service personnel - requirements, staffing and training 4.5 Dental Service personnel - requirements, staffing and training 4.6 Laboratory Service personnel - requirements, staffing and training 4.7 X-Ray Service personnel - requirements, staffing and training 4.8 Physiotherapy Service personnel - requirements, staffing and training 4.9 Nutrition Service personnel - requirements, staffing and training 4.10 Environmental Health Service personnel - requirements, staffing and training 4.11 Health Promotion and Health Education Service - requirements, staffing and

training 4.12 Other health personnel - requirements, staffing and training 5. Workforce and Training Costs 5.1 Costing the Health Workforce Plan 5.2 Estimated workforce costs 5.2.1 Salary costs 5.2.2 Other staff costs 5.3 Staff training costs 5.4 Costs summary 6. External Support Needs and Priorities 6.1 General principles 6.2 Support "Needs Schedule" 7. Plan Implementation, Monitoring, Review and Evaluation 7.1 Arrangements for adoption, implementation, monitoring, review and evaluation 7.2 Monitoring implementation 7.3 Review of the Health Workforce Plan 7.4 Plan evaluation

5

Each textual sub-section of each chapter contains an Activity - instructions as to how to complete that sub-section; and an EXAMPLE - a typical entry for that sub-section which the planners can modify to accommodate their own material. Exhibit 2 shows a typical extract from a page in the workbook Exhibit 2 Sample of activities and text examples from the WPRO/RTC Workbook. 1.4 National health workforce policy

There is at present no national health workforce policy document. However, the Public

Service Department has formulated policies applicable to the staffing of all government authorities. These include: • The average annual rate of growth in the total size of the public service workforce in

any five-year period must not exceed the average annual rate of population increase in that period.

• A non-citizen may be appointed to fill a Public Service post only if there is no adequately qualified Plananian citizen available to fill the post.

• Contracts for the employment of expatriate personnel will be for periods not exceeding three years.

• Public servants will retire on reaching their 60th birthday. In exceptional circumstances they may then be employed on a yearly contract basis, at a salary not exceeding the base rate for the grade in which they are to be employed under contract, or the base rate for the grade in which they were employed prior to retirement, whichever is the lower.

1.5 Organisational arrangements for workforce planning

The Director of Health Resources Planning, Development and Research (DHRPD&R)

coordinates all activities related to health workforce planning. The HRPD&R Division is responsible for the preparation of this draft national health workforce plan, and will act as the secretariat for the Workforce Planning Group.

The Workforce Planning Group is composed of the DHRPD&G, the Directors of Clinical Services, Preventive Health Services, Nursing and Administration and the Senior Health Research Officer.

ACTIVITY: Obtain any material containing statements regarding policy affecting the health workforce. Summarise the material. An example of an entry under this sub-heading is shown below, but your entry will almost certainly be different from this one. Enter your summary here as subsection 1.4 and delete this Activity box and the example

ACTIVITY: Enter here the organisational arrangements for the formulation of the health workforce plan. The paragraph below provides an example of an entry in this subsection. You will have to change it in order to describe the arrangements within your own health authority. Then delete this Activity box.

6

In preparing the draft workforce plan the planning group liaises closely with the heads of all divisions and units within the Ministry and with officers of outside agencies including the Public Service Department, the Department of Education and representatives of the health professional associations, international organisations and non-government organisations (NGOs).

Arrangements for obtaining endorsement of the health workforce plan and its subsequent regular review and rolling over are set out in Section 7 of this document.

In Chapter 4 the projection spreadsheets - one for each major category and sub-

category of health service personnel – show year-by-year throughout the planning period:

Required staffing Staff availability Training intakes and output Costs of salaries and training

Exhibit 3 demonstrates a typical spreadsheet. The spreadsheet templates were

prepared using Microsoft Excel and so rows and columns may be easily added or deleted and adjustments made to text, data and formulae as required. Each spreadsheet is accompanied by text explaining and summarising its content.

Exhibition 3 Sample spreadsheet, Chapter 4, WPRO/RTC Health Workforce planning Workbook.

Workforce Projection Sheet, MoH Planania, Registered Nurses

Staffing target: RN:population ratio of 1:550 to be reached in the year 2005 and then maintained thoughout the planning period. Assumptions: All Nursing School graduates enter MoH following graduation "'Intake other" includes people who left MoH employment (although they were not 55 years of age) but later re-enter MOH employment

Retirement at 60 years Deaths , invalidity etc - 1 per year Percentage RN "Exit -resignation" per year = 5 % Maximum new student intake 50 per year Percentage of new student intake not completing course or not entering MoH on graduation = 10%

Outcome: Target reached as planned 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Population at start of year 170,000 172,550 175,138 177,765 180,432 183,138 185,885 188,674 191,504 194,376 197,292 200,251 203,255Population growth rate % per year 1.5 %

Staff category: REGISTERED NURSE 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Required posts at start of year 271 281 291 301 311 321 332 343 348 353 359 364 370 Target population number per RN post 627 550 550 550 550 550 550

Staff in post at start of year 233 238 246 251 262 269 296 323 349 353 357 366 370 Population per employed RN at year start 730 725 712 708 689 681 628 584 549 551 553 547 549Intake from training 24 25 22 29 25 45 47 47 26 27 32 27 26Intake - extended beyond 60th birthday Intake - other 3 5 5 5 5 5 Total intake 27 30 27 34 30 50 47 47 26 27 32 27 26Exit - resignation 12 12 12 13 13 13 15 16 17 18 18 18 19Exit- retire - already 60+ 5 5 5 5 5 5 Exit - Retire at 60 4 4 4 4 4 4 4 4 4 4 4 4 4Exit - death/invalidity/etc 1 1 1 1 1 1 1 1 1 1 1 1 1 Total exits 22 22 22 23 23 23 20 21 22 23 23 23 24

Actual staff at year end 238 246 251 262 269 296 323 349 353 357 366 370 372 Required staff at year end 281 291 301 311 321 332 343 348 353 359 364 370 0

Students 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 New student intake 30 30 50 50 50 30 30 35 30 30 30 35 35Continuing students 50 52 57 73 93 93 73 53 58 58 53 53 58Total enrolment at start of year 80 82 107 123 143 123 103 88 88 88 83 88 93Graduates 25 22 29 25 45 47 47 26 27 32 27 26 26Other exits 3 3 5 5 5 3 3 4 3 3 3 4 4Continuing students 52 57 73 93 93 73 53 58 58 53 53 58 63

Workforce and training costs 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Staff salary cost P$ 10,000 2,355,000 2,420,000 2,485,000 2,565,000 2,655,000 2,825,000 3,095,000 3,360,000 3,510,000 3,550,000 3,615,000 3,680,000 3,710,000

Increase (decrease) on previous year 2.8 2.7 3.2 3.5 6.4 9.6 8.6 4.5 1.1 1.8 1.8 0.8Increase on 1998 salary cost 2.8 5.5 8.9 12.7 20.0 31.4 42.7 49.0 50.7 53.5 56.3 57.5Student salary cost P$

2,000 160,000 164,000 214,000 246,000 286,000 246,000 206,000 176,000 176,000 176,000 166,000 176,000 186,000Total staff and student salaries P$ 2,515,000 2,584,000 2,699,000 2,811,000 2,941,000 3,071,000 3,301,000 3,536,000 3,686,000 3,726,000 3,781,000 3,856,000 3,896,000% increase (decrease) on previous year 2.7 4.5 4.1 4.6 4.4 7.5 7.1 4.2 1.1 1.5 2.0 1.0% increase on 1998 salary cost 2.7 7.3 11.8 16.9 22.1 31.3 40.6 46.6 48.2 50.3 53.3 54.9

Workbook Workshops, 1995-1996 Workbook workshops represented a change from the typical health workforce

planning workshop pattern of participants’ self-introductions, country presentations, lectures, discussion of issues, group work and formulation of recommendations and conclusions. Here groups of planners from three to six countries spent one to two weeks of very intensive hands-on work getting to grips with the workbook-diskette content and its use as a planning tool, understanding the instructions, modifying text and feeding their own material into the workbook. They went home with a printout of the preliminary draft of their national health workforce plan.

Interest in the workbook widened beyond the PICs to other countries in the WHO Western Pacific Region. It was being realised that although designed for use in the small island countries, the workbook approach was applicable to health services covering much larger populations. Thus workshop participants came from 18 of the PICs, from the three countries of Indo-China and from five provinces of the Peoples Republic of China.

The workshops generated a high level of enthusiasm among the participants – it was difficult to get them to leave the computers at the end of the day, and for most of them work continued on into the night. The DIY phase 1996-1997

It had been hoped that the availability of the workbook and participation in the workbook workshops would themselves engender a Do-It-Yourself attitude among health service officials, with the health authorities going ahead to develop the preliminary draft plans into official documents.

Sadly, experience showed that a DIY approach would meet with but limited success.

Among the 18 PICs represented at the workbook workshops, only three developed, printed and adopted national health workforce plans.

In Cambodia the Ministry of Health completed a nation-wide data collection exercise, laying the foundation for further activity.

In the Chinese provinces parts of the workbook were translated and spreadsheets adapted for use at provincial and county level. In-country follow-ups and well formulated plans, 1997-2000

At the outset it had been proposed that the workshops would be followed up by a consultant making in-country visits to help planners and their employing authorities iron out planning problems and proceed to formulate and officially adopt national workforce plans. It was some time before funds for this follow up activity became available – and then somewhat slowly.

Over the period 1997-2000 funding permitted follow-up visits of two to four consultant-weeks duration to 13 of the 18 PICs represented at the workbook workshops. In all 13 countries the preliminary draft generated at the workshop has been developed into a well-formulated draft national health workforce plan – in some instances a final version adopted as the official national plan.

A first follow-up visit to Cambodia enabled the national data collection to be utilised in the formulation of the officially adopted First National Health Workforce Plan, and then in 1999 the first of what are hoped to be a continuing series of bi-ennial reviews of

9

the Plan was conducted. A follow-up visit was also paid to Viet Nam and the original draft plan amended to incorporate changes arising from shifts in policy regarding the training and employment of doctors and medical assistants. Formulating plans – the consultant’s role

Our experience reiterated that of others – it is generally not enough to provide health authority planners with planning tools and training in how to use them. There will be some instances where there is sufficient local drive and clout to go ahead – but it was interesting to note that in one of the three PICs where it appeared that the DIY approach worked, staff from the local WHO office played a key role; in another of these DIY PIC the Under-Secretary for Health was one of the people who helped in preparing the training manual; and in the third DIY PIC the Director of Health Services himself had attended a workbook workshop. In Cambodia again a member of the local WHO Office played a vital role in supporting national staff in data collection and developing the national plan.

For the majority of countries a follow-up visit by a consultant really started things moving in-country. Drawing on experience gained in a range of countries, the consultant was able to assist in resolving issues, suggest solutions, mediate differences and provide inputs in a number of areas, including: # The health service planning and workforce planning nexus

Perhaps because health service planning (e.g., formulation of a National Health Plan) typically occurs within a five-year time frame while workforce planning necessarily spans a longer period, there is a tendency for workforce planning to proceed more or less in vacuo with little relationship to the contents of the service development plan. This is less of a problem in the smaller countries where the central health authority may have only one planning officer – but in some of the larger authorities the linkage between these two planning areas needed strengthening. # Strained relations between stakeholders

Readers with some experience of working in government and other service agencies will be aware that relationships between agencies are not always characterised by sweetness and light. Typically several government and semi-government agencies are involved in the training and employment of health service personnel. In some of the countries visited relations between key stakeholding agencies were, to say the least, somewhat strained. The external consultant was in a position to bring the parties together on what was perceived as neutral ground, and in some instances a very cooperative inter-agency relationship replaced past suspicions, misunderstandings and rivalry. # Whose turf?

Within some health authorities there was disagreement as to where responsibility for health workforce planning should lie. The most common potential contenders for, or perhaps unwilling acceptors of, the job are a central planning unit, a human resources department, a training unit, or a personnel department if that is separate from the human resources department. Of course all of these, where they exist, should be involved in the formulation, monitoring and implementation of the workforce plan, and it is a matter for top level decision makers to allocate roles and responsibilities among them. Being outside

10

the local arena of conflict, the consultant was in a relatively good position from which to guide the decision makers and disputants towards an effective modus vivendi. # Government v. private sector workforce

In the majority of national health authorities involved in this planning project there has in the past been relatively little attention paid to the private sector health workforce. Matters relating to registration, regulation, training, continuing education, deployment and service activities of personnel in the non-government sector have usually been given little or no mention in national health plans, and receive scant, if any, attention in official annual reports. The external consultant can at least draw attention to the existence of this in some countries small, but everywhere increasingly important, component of the health care delivery system. It has to be said that, partly because of lack of information, it has not been possible to give it due consideration in the national health workforce plans so far developed. # Workforce data and databases

Despite numerous workshops, seminars, short-term (or longer) consultancies concerned with health service information systems, there is within many central health authorities a dearth of readily accessible, acceptably comprehensive, reasonably reliable and up-to-date information regarding approved staffing establishment, actual staff numbers and numbers of students progressing through the pre-service (and advanced training) pipelines.

Also, there appears to be among planners working in health service authorities, and indeed health service administrators generally, a widespread and ingrained mistrust of workforce data held by public service (civil service) authorities and centralised payroll operators.

Exhibit 4 presents an example of a simple Posts and Personnel database which has been used by one of us (JD) in several countries to provide information for the current situation analysis and a baseline for projection purposes. # The “How many . . . ” question

The formulation of a workforce plan of course involves many more people than simply the “planners”. Generally speaking one can convince the planners themselves that while in some situations a population:personnel or similar ratio taken from some source or other may be a starting point, there are other ways of determining the appropriate staffing for a particular service configuration. It may take some time to convince some of the other people involved in the planning process.

Exhibition 4 Example of post and personnel database

POST NO

DIVISION OCC

CAT

H/O

DESIGNATION OF POST

O/V

STAFF

NO

STATUS

CPTV

NAME

OTHER

NAMES

M/F

N/E

QUALIFICATION

QUAL DETAIL

DOB Age at

Age in

years

Due to

retire

DOJ DOP

SAL GR

GR STE

P

SALARY

P $pa SAL DATE

LOCATION

2 Administration ADM

O Administration Officer

O 102371

P GOLL

V F F N CERT COM

CERTIFICATE COMMER

CE ,1993

7-Aug-56

4/1/80

23.4 07-Aug-16

23-Aug-78

1-Jul-95

A08 2 10639

1-Jul-97

Head Office

# Administration ADM

O Assistant Stenographer In Charge

O 110092

P JAL O F N SC SCHOOL CERTIFICATE

5-Sep-59

4/1/80

20.3 05-Sep-19

#######

1-Jul-93

A07 4 9653 1-Jul-97

Head Office

3 Administration ADM

O Senior Administration Clerk

V Head Office

# Dental Services

DEN

H Dental Nurse /Therapist Clinical

O 110507

P JEGG

T G F N CERT DN

CERTIFICATE DENTAL NURSING

,1989

6-Apr-60

4/1/80

19.7 06-Apr-20

#######

1-Jul-97

L07 1 8756 1-Jul-97

Head Office

# Dental Services

DEN

H Dental Nurse /Therapist Public Health

O 110964

P SADE

R F N F5 ,CERT DN

CERTIFICATE DENTAL NURSING

,1991

14-Jul-69

4/1/80

10.5 14-Jul-29

#######

1-Jul-97

L06 1 7395 1-Jul-97

District C

# Dental Services

DEN

H Dental Technician V Head Office

# Dental Services

DEN

H Principal Dental Officer Clinical

O 110381

C EVE

V M E DIP DN DIPLOMA DENTAL NURSING

,1983

31-Sep-60

4/1/80

19.3 21-Sep-20

#######

1-Jul-97

SPG 1 23156

1-Jul-97

Head Office

12

# Finance ACC

O Accountant O 210266

P ZALL

N M N CERT FNM

CERTIFICATE FINANCIAL MANAGEMENT ,

1987

3-Dec-50

4/1/80

29.1 03-Dec-10

#######

1-Jul-93

A09 1 12015

1-Jul-97

Head Office

# Finance ACC

O Accounts Clerk O 210935

P EGE

V M N 22-Oct-76

4/1/80

3.2 22-Oct-36

#######

######

A01 5 2699 ######

Head Office

# Finance ACC

O Cashier O 210875

P VAR

T X M N SC ,F6 FORM 6 CERTIFIC

ATE ,1994

17-Jul-75

4/1/80

4.5 17-Jul-35

#######

1-0ct-

95

A03 1 4010 ######

Head Office

# Health Education &

Promotional Services

HEP

H Chief Health Educator

O 110211

P WAL

P U F N NZRN ,NZ GN, GDHED ,MHPED ,

BED

BACHELOR EDUCATI

ON ,1991

#######

4/1/80

23.4 16-Aug-16

#######

1-Jul-97

SPG 1 23156

1-Jul-97

Head Office

# Health Education &

Promotional Services

HEP

O Graphic Artist O 210865

C CETTY

T R M E 1-Nov-70

4/1/80

9.2 01-Nov-30

#######

1-Jul-

95

A05 2 6438 1-Jul-97

Head Office

# Health Education &

Promotional Services

HEP

H Health Educator Hospital

O 110091

P JAFF

R F N WSRN WESTERN SAMOA REGISTERED NURSE ,

1983

#######

4/1/80

20.4 14-Aug-19

#######

1-Jul-94

N03 3 7660 1-Jul-97

Head Office

# Health Inspectorate

HI H Environment Health Officer Occupational Health

O 110875

P JOLL

X M N CERT AHI

CERTIFICATE ASSISTANT HEALTH INSPECT

OR ,1984

#######

4/1/80

13.3 16-Sep-26

#######

1-Jul-90

A09 1 12015

1-Jul-97

Head Office

# Health HI H Environmental O 210 P PIL M M N 3- 4/1/ 5.3 03- #### 1- A01 6 2839 1- Head

13

Inspectorate Health Assistant Occupational Health

844 LER

Oct-74

80 Oct-34

### Jul-95

Jul-97

Office

# Health Inspectorate

HI H Field Assistant V Head Office

# Health Planning ,

Information &Research

HP H Chief Health Planner

O 110225

P LODE

T A B

M N CERT HI CERTIFICATE HEALTH INSPECTOR

#######

4/1/80

35.0 22-Dec-04

#######

1-Jul-94

A12 3 17780

1-Jul-97

Head Office

# Health Planning ,

Information &Research

HP O Computer Data Operator

O 210731

P VOSS

E F M N SC ,F6 FORM 6 CERTIFIC

ATE ,1991

#######

4/1/80

7.6 24-May-32

#######

1-Jul-96

A03 1 4010 1-Jul-97

Head Office

# Health Planning ,

Information &Research

HP H Health Resource Planning &Policy

Officer

O 210600

P QUADE

P Q F E DIP EH DIPLOMA ENVIRONMENTAL HEALTH ,

1992

#######

4/1/80

9.3 29-Sep-30

#######

1-Jul-90

A09 1 12015

1-Jul-97

Head Office

# Kitchen KN O Senior Cook O 110396

P VATE

L S F N #######

4/1/80

39.9 23-Jan-00

#######

1-Jul-84

A06 4 8193 1-Jul-97

National Hospital

# Laboratory Services

LAB

O Clerk Typist V National Hospital

# Laboratory Services

LAB

H Senior Laboratory Technician Public Health

O 210360

P IFE U M N BSC BIO ,MSC

MASTER SCIENCE ,

1994

21-Mar-66

4/1/80

13.8 21-Mar-26

#######

1-Jul-93

L11 1 15085

1-Jul-97

District A

# Laboratory Services

LAB

H Supervisor Laboratory Technologist Public Health

O 110153

P CATH

F M N CERT LTNG

CERTIFICATE LABORATORY TRAINING

3-Mar-40

4/1/80

39.8 03-Mar-00

#######

1-Jul-75

L10 1 13455

1-Jul-97

District B

# Management M H Director Clinical O 110 P SA H Q M N DSM , DIPLOM 4- 4/1/ 33.8 04- #### 1- CS1 4 3217 1- Head

14

GT Health Services 497 R MHA ,DIP DPH ,

DSM

A MEDICIN

E &SURGER

Y ,1979

Apr-46

80 Apr-06

### Jul-70

4 Jul-96

Office

# Management MGT

H Director General Of Health

O 110134

C CODE

A M N DSM ,FRACS

FELLOWSHIP ROYAL AUSTRALIAN COLLEGE OF SURGEO

NS ,1990

#######

4/1/80

38.5 26-Jun-01

#######

1-Jul-92

HED

3 41388

######

Head Office

# Management MGT

H Director of Administration

O 110111

P JULL

R M N CERT ACC

CERTIFICATE ACCOUNTING ,

1986

17-Oct-53

4/1/80

26.2 17-Oct-13

#######

1-Jul-92

SPG 5 27064

1-Jul-97

Head Office

# Management MGT

O Director of Finance O 110371

P WULL

P M E DIP PHI ,GDDAD ,

DIP HAD ,GDDAD

GRADUATE DIPLOMA DEVELOPMENT ADMINISTRATION ,

1989

2-Nov-44

4/1/80

35.2 02-Nov-04

#######

1-Jul-72

SPG 1 23156

######

Head Office

# Medical Records

MR H Senior Medical Records Clerk

O 210430

P MUN

T S M N SC ,F5 FORM 5 CERTIFIC

ATE ,1988

27-Jul-71

4/1/80

8.4 27-Jul-31

#######

1-Jul-90

A06 1 7395 6-Oct-97

National

Hospital

# Medical Services

MED

H Consultant Ophthalmologist

V National Hospital

# Medical Services

MED

H Consultant Specialist

V National

15

Hospital

# Medical Services

MED

H Medical Officer TB &Leprosy

O 110105

T JILL

H A M N DSM DIPLOMA MEDICIN

E &SURGER

Y ,1953

#######

4/1/80

49.8 28-Feb-90

#######

1-Jul-87

SPG 1 23156

1-Jul-96

Head Office

# Medical Services

MD

H Registrar O 210930

P SEGG

X M N #######

4/1/80

35.3 11-Sep-04

#######

1-Jul-89

SRG 3 18747

######

National

Hospital

# Medical Services

MED

H Senior Medical Officer

V National Hospital

# Ministerial Support

MIN

O First Secretary To Minister

V Head Office

# National Hospital Administration

HA O Administration Officer

O 110186

P MUNTER

R K F N 23-Oct-44

4/1/80

35.2 23-Oct-04

#######

1-Jul-92

A10 1 13455

1-Jul-97

Head Office

# National Hospital Administration

BME

H Bioeng Technician O 210779

P ZILLER

R M N TECH CERT

TECHNICIAN CERTIFIC

ATE ,1982

#######

4/1/80

19.6 27-May-20

#######

1-Jul-94

L07 3 9357 1-Jul-97

National Hospital

# Nursing Services

NUR

H Enrolled Nurse Community Health

O 210377

P JAFF

T F N #######

4/1/80

20.9 11-Feb-19

#######

1-Jul-93

A02 3 3332 1-Jul-96

National Hospital District

# Nursing Services

NUR

H Enrolled Nurse Student

O 210876

P BAK

G F N #######

4/1/80

2.0 20-Jan-38

#######

1-Jul-95

A02 3 3332 1-Jul-96

National Hospital

# Nursing Services

NUR

H Nurse Manager Community Health

O 110147

P DEGG

M D F N WSRN ,CERT MW

CERTIFICATE MIDWIFE

#######

4/1/80

37.3 21-Sep-02

#######

1-Jul-82

N05 2 10295

National Hospita

16

RY ,1982 l District

# Nursing Services

NUR

H Nurse Practitioner V District A

# Nursing Services

NUR

H Principal Nurse National Hospital

O 110212

P CEGG

B D F N NZRN ,NCC ,DIP

NUR ,CERT MFNM

CERTIFICATE MANAGEMENT FOR NURSE MANAGE

RS ,1993

#######

4/1/80

34.0 11-Jan-06

#######

1-Jul-96

N10 1 18747

1-Jul-96

Head Office

# Nursing Services

NUR

H Staff Nurse Community Health

O 110688

P BUN

C S F N WSRN WESTERN SAMOA REGISTE

RED NURSE ,

1971

27-Apr-48

4/1/80

31.7 27-Apr-08

#######

1-Jul-93

N03 2 7395 ######

District C

# Nursing Services

NUR

H Staff Nurse Hospital O 210946

P OZER

K U F N DIP NUR DIPLOMA NURSING

,1996

5-Sep-74

4/1/80

5.3 05-Sep-34

#######

######

N02 4 6668 ######

District C

# Nutrition D&N

H Community Health Worker

O 210681

P HAK

C T F N #######

4/1/80

15.4 16-Aug-24

#######

1-Jul-94

A04 1 5143 1-Jul-97

Head Office

# Nutrition D&N

H Nutrition Assistant O 110602

P USE

V F N 1-May-61

4/1/80

18.7 01-May-21

#######

1-Jul-90

A04 1 5143 1-Jul-97

Head Office

# Nutrition D&N

H Nutritionist O 210251

P HOSS

C F E UE ,WSRN

WESTERN SAMOA REGISTERED NURSE ,

1992

#######

4/1/80

11.3 26-Sep-28

#######

1-Jul-97

N03 1 7129 1-Jul-97

Head Office

# Pharmacy PH H Assistant O 210 P GE T F N SC ,F6 FORM 6 16- 4/1/ 17.5 16- #### 1- L03 1 4010 1- District

17

ARM

Pharmacist 367 NTLE

CERTIFICATE ,1981

Jul-62 80 Jul-22 ### Jul-97

Jul-97

B

# Pharmacy PHARM

H Chief Pharmacist O 210720

P PON

C M N BSC ,DIP PHAR ,

CERT REG

CERTIFICATE OF REGISTRATION ,

1993

2-Jun-59

4/1/80

20.6 02-Jun-19

#######

1-Jul-96

SPG 5 27064

######

Head Office

# Pharmacy PHARM

H Senior Pharmacist Assistant

V National Hospital

# Physiotheraphy

PHYS

H Physiotherapist V E National Hospital

# Physiotheraphy

PHYS

H Physiotherapy Aide O 210913

P TODD

C V M N #######

4/1/80

11.6 20-May-28

#######

1-Jul-96

A03 2 4195 1-Jul-97

National Hospital

# Physiotherapy PHYS

H Charge Physiotheraphist

O 110382

P ETE

Y F N DIP PHYSIO ,

CERT PHYSIO

CERTIFICATE

PHYSIOLOGY ,1967

26-Mar-43

4/1/80

36.8 26-Mar-03

#######

1-Jul-93

L13 1 18747

1-Jul-97

National Hospital

# Radiology RAD

H Assistant Radiographer General

O 110675

P JUN

O I F N F5 FORM 5 CERTIFIC

ATE ,1984

#######

4/1/80

13.6 16-May-26

#######

1-Jul-91

L07 1 8756 1-Jul-97

National Hospital

# Radiology RAD

H Dark Room Technician

O 210869

P ZAK

W X M N 6-Oct-68

4/1/80

11.2 06-Oct-28

#######

1-Jul-96

A03 1 4010 1-Jul-97

National Hospital

# Radiology RAD

H Radiographer General

O 110394

P VANG

U D M N SC SCHOOL CERTIFICATE

6-Nov-50

4/1/80

29.2 06-Nov-10

#######

1-Jul-89

L10 1 13455

1-Jul-97

National Hospital

# Radiology RAD

H X-ray Assistant General

V N National

18

Hospital

Notes:

OCC CAT=Occupational category ;H/O=Health personnel/Other personnel ;O/V=Post occupied/vacant ;

CPTV=Contract/Permanent/Temporary/Volunteer ;DOB=Date of birth ;DOJ=Date of joining DOH ;DOP=Date of Promotion ;SAL GR=Salary

grade ;GR STEP =Grade Step ;SAL DA

Emergent trends Over the years covered by the work reported here, there have been some important

changes in the thinking of some planners and senior decision-makers. Among the positive changes have been:

• Lengthening of the time scale recognised as appropriate and necessary for workforce planning – from a few years to upwards of ten years;

• growing concern regarding succession planning and interest in the use of succession planning charts; and

• increasing recognition of the need to be concerned with workload and productivity of health service personnel.

With the current movement towards decentralised management of health services the need to develop sub-national workforce plans (e.g., regional or district plans) is becoming recognised. There is a danger in some of the larger countries however that the necessity for consolidation of certain activities, such as pre-service and post-graduate training of most categories of health professionals, may be disregarded in the enthusiasm to shift activities away from central oversight and control.

Of concern to authorities in some of the smaller countries has been the movement of nurse training away from traditional hospital-based schools of nursing to university-based nurse education programs. One problem has been the reluctance of the higher performers among school leavers – those who can meet the educational standard required for university entrance do not want to enter nursing careers. A second concern is that university-program graduates will be particularly likely to be offered and to seek out-of-country jobs and so the already worrying emigration of trained nurses will increase. What has been learnt, and by whom? # Health authorities and their staff

Within the health authorities involved in the activities recounted here there has been developed a group of people who have acquired some appreciation of the complexities of workforce planning, some knowledge of the planning process and some skill in managing the process and in using some elementary planning tools to produce a well documented plan. The need for systematic review and revision of the plan is also generally recognised. # Other stakeholders

At least in some countries there has been increased awareness of the importance of participation in the health workforce planning process on the part of several stakeholders – and an awareness of how they may contribute to the planning process and its outcome. . # Proponents and promoters of health workforce planning

For those who seek to promote the practice of workforce planning several important lessons may be drawn.

The most important lesson from this exercise so far has been the demonstration that a sustained program of consistent training and follow-up using a relatively simple planning model built into a workbook format can lead to the production of well formulated workforce plans acceptable to and implementable by health service authorities.

20

Secondly, that a model developed primarily for use in countries with numerically very small populations can be usefully employed in countries with much larger populations.

Thirdly, that the workbook approach facilitates both the planning process and the production of the plan as a readable document readily understood by people with no previous workforce planning exposure – including high level health service officials and politicians.

Fourthly that repeated employment of a very small number of consultants covering a relatively large number of health authorities builds up and shares expertise within and between the authorities both effectively and relatively rapidly.

Fifthly, that if the momentum towards developing and systematically rolling over useful health workforce plans is to be maintained, a carefully designed and adequately funded continuing program of training and follow-up will be required. # The consultants

For the team at the Regional Training Centre who have been engaged throughout this project it has provided a unique opportunity to learn-through-involvement much about the development of planning tools, conducting a hands-on training program, and participating in and following up workforce planning activities in more than twenty national health authorities. The future and a postscript

The work reported here has extended over the best part of a decade. It could take as long again before health workforce planning is firmly established as an essential and on-going activity of all the health authorities covered so far. There will undoubtedly be a need for continuing consultant input both to these authorities and to others less advanced in terms of workforce planning commitment and expertise. The governments of developing countries expect such input to be funded by “donor and loaner” agencies.

By way of postscript it may be mentioned that the health workforce planning workbook has been and is being used in the development of workforce plans for a growing number of countries in Africa, Asia and the Caribbean, in addition to its use in the countries mentioned in the above report. Acknowledgement

The work reported in this paper has been supported by funds from the Western Pacific Regional Office of WHO, the University of New South Wales, Australia, the World Bank and AusAID. Selected Reports 1995-1999 1. Capelle DF, Dewdney J, Heine D, Jetnil A, Langidirk J, Riklon S. National Health

Workforce Plan, Republic of the Marshall Islands 1998-2020. Majuro, 1998. 2. Daniel R, Dewdney J, Ngari M, Rotem T, Short N, Sinclair H. Draft National Health

Workforce Plan, Cook Islands, 1998-2020. Rotorua, 1998. 3. Dewdney J. AusAID Papua-New Guinea Medical Officer, Nursing and Allied Health

Science Training Project – Health Workforce Planning – First Assignment Report, March 1996. Port Moresby, 1996.

21

4. Dewdney J. Report - WHO/RTC Health Workforce Planning Workshop, Port Vila, Vanuatu, October 1995. (Participants from Fiji, New Caledonia, Papua New Guinea, Solomon Islands, Tonga and Vanuatu). Sydney, 1996.

5. Dewdney J. Report - WHO/RTC Health Workforce Planning Workshop, Apia, Samoa, October 1995. (Participants from American Samoa, Cook Islands, Kiribati, Niue, Western Samoa, Tokelau and Tuvalu) Report. Sydney, 1996.

6. Dewdney J. Report - WHO/RTC Health Workforce Planning Workshop, Pohnpei, Federated States of Micronesia, November 1995. (Participants from Commonwealth of the Northern Mariana Islands, Republic of the Marshall Islands, Federated States of Micronesia, Nauru, Palau, State of Pohnpei ). Sydney, 1996.

7. Dewdney J. Report - WHO/RTC Health Workforce Planning Workshop, Hanoi, Viet Nam, February 1996. (Participants from Cambodia, Laos and Viet Nam). Sydney, 1996.

8. Dewdney J. AusAID Papua-New Guinea Medical Officer, Nursing and Allied Health Science Training Project – Health Workforce Planning – Second Assignment Report, July 1996. Port Moresby, 1996.

9. Dewdney J, Khuat TB, Nguyen ND, Nguyen ND, Phi VT, Rotem T. First Draft National Health Workforce Plan 1995-2015. Hanoi, 1996.

10. Dewdney J. Issues in Health Workforce Planning – Proceedings of the Inter-country Workshop, 22-26 July 1996. Sydney, Australia. Sydney, 1996.

11. Dewdney J. Fiji – Health Workforce Plan 1997-2012. Suva, 1997. 12. Dewdney J, Ueda M, Polloi J. Draft National Health Workforce Plan, Republic of

Palau, 1998-2020. Koror, 1998. 13. Dewdney J, Metai A, Rotaria A, Tenaua K. National Health Workforce Plan, Republic

of Kiribati, 1998-2020. Tarawa, 1998. 14. Dewdney J, Saili C, Ropati V, Schuster G. Draft National Health Workforce Plan,

Samoa, 1998-2020. Apia, 1998. 15. Dewdney J. AusAID Tonga Health Project – Health Workforce Planning – Progress

Report 1, February 1999. Nuku’alofa, 1999. 16. Dewdney J. AusAID Tonga Health Project – Health Workforce Planning – Progress

Report 2, July 1999. Nuku’alofa, 1999. 17. Dewdney J. Federated States of Micronesia – Draft Health Workforce Development

Plan, 2000-2019. Palikir, Pohnpei, 1999. 18. Dewdney J. Commonwealth of the Northern Mariana Islands – Draft Health Workforce

Plan, 2000-2015. Saipan, 1999. 19. Dewdney J, Eang MT, Hine B, Huong E, Phuong K, Soitheany N, Song PS. First

Biennial Review of the Health Workforce Development Plan, Kingdom of Cambodia, 1996-2005. Phnom Pehn, 1999.