3rd Global Forum on Human Resources for Health (HRH)13 November 2013, Recife, Brazil

Strengthening human resource in health and nursing in a multi-sectorial

engagement toachieve Universal Health Coverage

Strengthening human resource in health and nursing in a multi-sectorial

engagement toachieve Universal Health Coverage

Dr. Mario Roberto Dal Poz, Profe

io R Dal Poz 13/11/2013

HRH situation: twofold agendaHRH situation: twofold agenda

MaldistributionSkill imbalancesLow productivity

Low salariesPoor work environmentsWeak knowledge base

Labour flexibilityLack of social protectionUnmanaged migration

Growing shortagesEpidemiological transition

Increasing role of private sector

Unfinished agenda

New challenges

io R Dal Poz 13/11/2013

rowing importance of HRH in the political agendaowing importance of HRH in the political agenda

Joint ng ve (JLI) t

2006: World Health Report

African union: health strategy

Recognition by global health initiatives, such as GFGAVI, PEPFAR, that human resources and health systems represent a bottleneck to achieve their goa

Establishment of Global Health orce Alliance

2006 – Wold Health Assembly Resolutions- Accelerated training to increase the availability of health personnel- Strengthening the nursing and midwifery

io R Dal Poz 13/11/2013

obal Forums on Human Resources for Heaobal Forums on Human Resources for Hea

008 (March), Kampala, Uganda, approximately 1500 participants: Kampala Declaration e Agenda for Global Action.

011 (January), Bangkok, Thailand, together with “Prince Mahidol Award Conference”: approximately 1000 participants.

013 (November), Recife, Brasil

io R Dal Poz 13/11/2013

Global commitmentsGlobal commitmentsWHA Resolutions

Strengthening nursing and midwifery(2003 & 2011)

Strengthening human resources for health(2004 & 2011)

Scaling up Health Workforce Production(2006)

WHO Global Code of Practice on the International Recruitment of Health Personnel(2010)

Other Declaration and Agenda for Glob

Action, Kampala, 2008 (endorseby G8)

Outcome Statement of the SecoGlobal Forum on Human Resources for HealthBangkok, 2011

PEPFAR II (Target of training anretaining at least 140,000 healthcare professionals and paraprofessionals)

Japan's health worker training commitment (Training 100,000 people as health workers in Africover the next 5 years)

……………

io R Dal Poz 13/11/2013

o, now we know a bit more about some of the challenges .o, now we know a bit more about some of the challenges .

Numbers, skill mix Staffing in the most disadvantaged areas Migration of health personnel Retention and incentives Funding and productivity Government health spending and health workers payment HRH information systems Management and planning systems and tools

io R Dal Poz 13/11/2013

ut, health workers’ concerns are still othe basics …

ut, health workers’ concerns are still othe basics …

Low salaries

Poor terms and conditions - housing, schooling, lack of tools to do the job

Professional isolation

Posted and forgotten

Lack opportunities for promotion and professional development

io R Dal Poz 13/11/2013

Still not much evidence of what works ascale …..

till not much evidence of what works ascale …..

Job regrading

Salary supplements / incentives

Remote area incentives

Car/housing loans

Decentralise recruitment & management

Contract out recruitment

Bonding – compulsory community service

Retention strategies set

Flexible working

Career progression opportunity ……….

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kewise, not much on best practice (conkewise, not much on best practice (con

Rethinking the workforce skills mix - mid level workers

Task shifting: where and how to move forward ?

Pay for Performance: how? ethics concerns? quality?

Investment in training institutions in rural areas?

Build centres of excellence ?

Still much talk of training for export

………….

io R Dal Poz 13/11/2013

nsity of health workers and service coverage:ld mortality (by province, Vietnam)

nsity of health workers and service coverage:ld mortality (by province, Vietnam)

# Efficiency?# Skill-mix?# Quality?

io R Dal Poz 13/11/2013

Current investment in HRHCurrent investment in HRH

Most investment in training; – Pre-service; often outdated model– In service: main salary supplement, often doubtful impact;

disrupts service delivery

Still little on HRH planning, recruitment and deployment processes, HR information systems

Very little on retention

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A major challenge: the global economic/financial crisis is not over . major challenge: the global economic/financial crisis is not over ..

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HRH issues / agenda 1/2HRH issues / agenda 1/2

Planning / forecasting for long-term, coordinated with national healtplans (Europe, OECD, Asia, AL)Bringing together service delivery, financing and HRHHot topics:

– Scaling up and improving the quality of training/education– Migration management and monitoring– Health workforce inequalities– Health labour market dynamics: analysis & policy options– Regulation of education and practice / regulatory framework– Task shifting ...

io R Dal Poz 13/11/2013

HRH issues / agenda 2/2HRH issues / agenda 2/2

Long-term funding / impact of financial crisis Alignment and harmonization of donors and international

organizations, with national policies - IHP + / "accountability" Greater involvement of governments in the costs A greater emphasis on results (P4P?) Increased participation of non-state actors in training and

service delivery Information systems

io R Dal Poz 13/11/2013

Many thanksMuito obrigadoMuchas gracias

www obsnetims org br