Human Resources for Health:Human Resources for Health:Strategies for Crisis and SustainabilityStrategies for Crisis and Sustainability

Report: Joint Learning Initiative

International Medical Workforce CollaborativeMayflower Hotel, Washington DC, October 8, 2004

DemandDemand

CoordinationCoordination

SupplySupply

Priority Priority DiseasesDiseases

InnovationsInnovations

AfricaAfrica

HistoryHistory

JLI Working GroupsJLI Working Groups

Consultations/WorkshopsConsultations/Workshops

New York City, USA

Cambridge, MA, USA

Brasilia, Brazil

Stockholm, Sweden

Kaunas, LithuaniaLondon, UK

Oxford, UK

Barcelona, Spain

Cape Town, South Africa

Mombassa, Kenya

Pattaya, Thailand

Rajendrapur, Bangladesh

Arusha, Tanzania

Addis-Ababa, Ethiopia

Acra, Ghana

Amsterdam, Netherlands

Naarden,Netherlands

Veyrier-du-Lac,France

Bellagio, Italy

Zagreb, Croatia

Tblisi, Georgia

JLI DisseminationJLI Dissemination

•• JLI Strategy ReportJLI Strategy Report

•• Working GroupWorking GroupCommissioned papers >50Commissioned papers >50Reports Reports –– History, Africa, Demand, SupplyHistory, Africa, Demand, Supply

•• JournalsJournalsLancet, Bulletin WHO, American JournalLancet, Bulletin WHO, American Journalof Public Health, Human Resources Journalof Public Health, Human Resources Journal

•• WebsiteWebsite““globalhealthtrustglobalhealthtrust.org.org””

PartnersPartners

JLI Strategy ReportJLI Strategy Report

•• Power of Health Worker (1)Power of Health Worker (1)-- Health crisis and fragile systemsHealth crisis and fragile systems-- Fresh opportunitiesFresh opportunities-- HRH essentiality and neglectHRH essentiality and neglect

•• Workforce StrategiesWorkforce Strategies-- Community actions (2)Community actions (2)-- Country strategies (3)Country strategies (3)-- Global responsibilities (4)Global responsibilities (4)

•• Imperative for Action (5)Imperative for Action (5)

Health CrisisHealth Crisis

35

45

55

65

75

85

1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002Year

Life

Exp

ecta

ncy

(yea

rs)

JapanJapan

Denmark

Russia

Haiti

Zimbabwe

Zambia

Why Human Resources?Why Human Resources?

•• New ForcesNew Forces-- Triple threat HIV/AIDSTriple threat HIV/AIDS-- Medical migrationMedical migration-- Neglect and underNeglect and under--investmentinvestment

•• HRH Drives Health SystemsHRH Drives Health Systems-- History accelerating health progressHistory accelerating health progress-- Active agents health changeActive agents health change-- Spearhead and glue health systemSpearhead and glue health system-- Half to threeHalf to three--quarters health budgetquarters health budget

Productionof Health

Inflow

Education In-migration

RetirementDisability/DeathOut-migration

Outflow

CoverageMotivationCompetence

StocksStocks--FlowsFlows

Stock Stock Health WorkersHealth Workers

Migration: Migration: ““CarouselCarousel”” South AfricaSouth Africa

Dumont and Meyer 2004 p128Dumont & Meyer 2004

Worker Density by RegionWorker Density by Region

2.3

2.6

4.2

6.9

8.7

9.9

10.3

0.8

0 2 4 6 8 10 12

Euro p e

N o rt h A me r ic a

W e s t e rn P ac if ic

M id d le Ea s t

G lo b a l

S &C e nt ra l A me r ic a

A s ia

S ub - S aharan A f r ic a

Workers per 1,000 population

Worker Density and GDPWorker Density and GDP

Uganda

EthiopiaGabon

CameroonSierra Leone

IndiaZambia

ThailandCongo, Rep. China Botswana

South AfricaRomania United KingdomTajikistan Philippines

Kyrgyz RepublicRussian Federation United States

BelarusNorway

12.

55

15

1000 5000 10000 50000GDP per capita, PPP (current international $) 2001 WDI

Hea

lth W

orke

r Den

sity

per

100

0

Worker Density and Worker Density and Service CoverageService Coverage

0 .5 1.0 1.5 2.0 2.5 3.0 3.5 4.0

Cov

erag

e (%

) 80

40

60

100

20

Skilled Birth Attendance

Measles Immunization

Health Worker Density (per 1,000)

Worker Density and MortalityWorker Density and Mortality

0

1

2

3

4

5

6

7

8

9

0 1 2 3 4 5

Density (workers per 1,000, log)

Mor

talit

y (p

er 1

,000

, log

)

Maternal

Infant

Under-5

Worker Density and MortalityWorker Density and Mortality

Uganda

Sierra Leone

India ZambiaThailand

Malaysia Brazil BotswanaMexico South Africa

United Kingdom

Russian FederationUnited States

Norway

12.

55

15

1.8 5 10 25 100Child Mortality Rate (Under Five)

Hea

lth W

orkf

orce

Den

sity

(per

1,0

00 P

op)

Country ClustersCountry Clusters

(3) Moderate Density(3) Moderate Density 44 Countries

(5) High Density(5) High Density(Low Mortality)(Low Mortality)

35 Countries

(2) Low Density(2) Low Density32 Countries

(1) Low Density(1) Low Density(High Mortality)(High Mortality)

43 Countries

(4) High Density (4) High Density

36 Countries

Hig

hM

idLo

wWor

kfor

ce D

ensit

yW

orkf

orce

Den

sity

Child MortalityChild MortalityLow High

Global Shortages

ChallengesChallenges

Skill Mix Imbalances

Negative Work Environment

Maldistribution and Migration

Weak Knowledge Base

What Should be Done?What Should be Done?

•• NationalNational

CuttingCutting--edge actionedge action

•• CommunityCommunity

Ultimate focusUltimate focus

•• GlobalGlobal

Interdependence and reinforcementInterdependence and reinforcement

Country StrategiesCountry Strategies

Stakeholders

UniversityTraining Institutions

SUPPLY

MOBILITY

DEMAND

GovernmentsPrivate commercial

NGOs

GovernmentsInternational Organizations

Personal/FamilyProfessional assoc

“NON-GOVERNMENTAL”

DONORS AND AGENCIES

•Numeric adequacy•Skill mix• Social outreach

Coverage:Social-Physical

•Competitive remuneration•Work environment•Systems support

Motivation:Systems Supported

•Education for skills•Training and learning•Leadership and

entrepreneurship

Competence:Training-Learning

Quality and Responsiveness

Efficiency & Effectiveness

Equitable Access

Managing for PerformanceManaging for PerformanceHuman Resource Human Resource

ActionsActionsWorkforce Workforce ObjectivesObjectives

Health System Health System PerformancePerformance

PopulationPopulationHealthHealth

Health Health OutcomesOutcomes

Community ActionsCommunity Actions

FrontlineFrontlineworkersworkers

MobilizingMobilizingfor crisisfor crisis

BuildingBuildingsustainablesustainable

systemssystems

Global Responsibility

KnowledgeKnowledge

FinancingFinancing

MigrationMigration

40%40%10%10%

Investing in Country Investing in Country Strategy/CapacityStrategy/Capacity

$400 Million$400 Million

ODA for ODA for HealthHealth

$10 Billion$10 Billion

SalariesSalariesTrainingTraining

Technical AssistanceTechnical Assistance

$4 Billion$4 Billion

Regional/Global Regional/Global ReinforcementReinforcement

$40 Million$40 Million

10%10%

Investing in Investing in WorkforceWorkforce

Decade for Human ResourcesDecade for Human Resources

GovernmentAgenciesDonors

Initiatives

Strengthening Workforce for Sustainable Systems

Mobilizing Workers to Combat Crisis

Building the Knowledge Base

Implications for USA/OECD?Implications for USA/OECD?

•• Isolationism option?Isolationism option?•• Foreign professionals significantForeign professionals significant

(360,000 foreign(360,000 foreign--trained; 23% of 1.5 m)trained; 23% of 1.5 m)•• Why importation?Why importation?

(demography, (demography, epidemiologyepidemiology, technology,, technology,family structure, client preference)family structure, client preference)

•• Why not selfWhy not self--sufficiency in USA?sufficiency in USA?(opportunity, inequity)(opportunity, inequity)

•• US workforce in interdependent world?US workforce in interdependent world?