Situational Analysis-HReH-GB-DRAFT ZERO

DRAFT ZERO, 04 Nov 2013

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ANALYSIS OF THE SITUATION OF HUMAN

RESOURCES FOR EYE HEALTH

GUINEA BISSAU


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ACKNOWLEDGEMENTS

This report was prepared by Dr. Adidja Amani. I thank Aliou Tandia, Victor Caperuto and

Joao Soares for their support. I we owe a special word of thanks to Victor and Joaes for

their administrative support, for leading and hosting the assessment ,for providing

vehicles and contact with the stakeholders . We also thank all those who agreed to

participate in interviews

Disclaimer: An initial disclaimer that deserves mention upfront is related with the quality

and availability of the data used in the preparation of this report. The reader should be

warned that in many occasions the necessary information was either not available, or

when available was of limited quality and usefulness.


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I. TABLE OF CONTENTS


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LIST OF ACRONYMS

CONAEGUIB Confederação Nacional das Associações Estudantis da Guiné Bissau

(CONAEGUIB

DRHAS Direção de Recursos Humanos e Administração da em Saúde (Directorate for Human Resources and Management for Health)

ENS Escola Nacional de Saúde (National School of Health)

HRH Human Resources for Health

PNDRHS

Plano Nacional de Desenvolvimento de Recursos Humanos em Saúde

(National Plan for Development of Human Resources for Health)

PNDS Plano Nacional de Desenvolvimento Sanitário,

PNSV Programa Nacional de Saude Visuel

WAHO West Africa Health Organization

CSR Cataract Surgical Rate

HRH Human Resources for Health

HReH Human Resources for eye Health

IAPB International Agency for the Prevention of Blindness

PALP Países Africanos de Língua Portuguesa

TI Training Institution


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II. BACKGROUND:

Geography and demography

Guinea-Bissau, officially the Republic of Guinea-Bissau, is a situated on the

west coast of sub-Saharan. The country comprises territory on the mainland and a

number of islands (archipelago of Bijagós) (CIA, fact book, 2013). Guinea - Bissau is

situated on the West Coast of Africa and shares borders with Senegal, Guinea

Conakry and the Atlantic Ocean. The country is divided into 8 regions Bafata,

Biombo, Bissau, Bolama, Cacheu, Gabu, Oio, Quinara and Tombali. The population

of Guinea-Bissau is estimated at 1,533,000 (World Development Report, 2013,

RGPH 2009). 63.3% of the population is under 25 years of age.

Economic, social and political context

The economy is heavily dependent on cashew nut sub sector which represent

about 60 % of GDP. Politically, Guinea-Bissau went through periods of civil wars.it

has been facing political instability and recurrent violence, as reflected in repeated

coups d’état and armed conflict.The social situation is still precarious. Guinea-Bissau

has a very low score on the worldwide Human Development Index (HDI) (The World

Bank, 2013) and ranks 176th out of 185 countries surveyed in the 2013 report. The

average life expectancy is 45.8 years, according to the United Nations Development

Programme (UNDP, 2011) and 66% of the population lives on less than 2US dollars

per day.

The national poverty reduction strategy (DENARP, 2010) priority intervention areas

are peace and political stability, strengthening of the health service delivery system,

and education among others.

Education

The government adopted the Education Sector Policy Paper for 2009 to 2020. The

overall illiteracy rate is 58%, but that of women is 72%. Public expenditure devoted

to education is very low at 11.5% (UNESCO, 2013), less than half of the African

average of 22.6, and at the bottom end of the range.

There are 4 universities in Guinea-Bissau: Universidade Colinas de Boé,

Universidade Lusófona and Universidade Jean Piaget and Universidade Amílcar


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Cabral. Universidade Amílcar Cabral is Guinea Bissau's first University and it is

the only which offers degrees in general medicine. It is a public university .After 7

years, of training, graduates receive the Medicina general, which is equivalent to

MD. So far, all postgraduate studies must be undertaken abroad. The Faculty of

Medicine is supported by bilateral cooperation, by the Republic of Cuba. The Amilcar

Cabral University was suspended by the government in 2008 for 3 years and has

now re-opened.Students pay enrolment and tuition fees and teachers are paid using

primarily these collected resources. Enrolment fee is approximately US$ 20 and

tuition fee is US$ 300 per year per student. Despite the presence of these

universities medical doctors seeking to specialize must go abroad, typically to Cuba,

Portugal, Russia and neighbouring African countries.

An overview of the health system

According to the National Health Development Programme 2008-2017 (Plano

Nacional de Desenvolvimento Sanitário, or PNDS) Public health care structures in

Guinea-Bissau are divided into three levels, primary, secondary, and tertiary. There

are 11 health regions (MOH, 2013). The National Health Programs are as follows:

anti-Malaria Program, National Program to Combat AIDS, National Visual Health

Program, National Program to Combat Leprosy and Tuberculosi, Expanded Program

on Immunization (EPI) and National Family Health Program.In 2006, 5% of the

State’s general budget went to the Ministry of Public Health and 1,22% of the GDP

was spent on health (AHWO, 2009).

According to the RAAB conducted in 2010, Avoidable causes of blindness (92.9%)

are much higher than the VISION 2020 estimate of 85%. According to the same

RAAB report, only 28% of people needing cataract surgery were operated (Oye,

RAAB 2010) .The first two most important barriers to cataract surgery uptake were

linked to the available services for cataract operation and accessibility. In 2013, the

cataract surgical rate is 78 % (PNSV, 2013). There were 7 nurses and 1 doctor for

every 10,000 inhabitants in Guinea-Bissau in 2007, according to a country profile for

Guinea-Bissau produced in 2010 by the Africa Health Workforce Observatory

(AHWO). From 1998-2008 there was only one ophthalmologist in the country. The

health services system depends heavily on external aid to support the health budget

(Fronteira, Dussault, 2010).


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Table..: Evolution over 10 years of the number of health workers and hospitals in Guinea Bissau source: Direcção de Estatística, Direcção de Higene e de Epidemologia. * include 40 Cubans doctors

Studies conducted in Portuguese speaking African countries regarding the

health workforce crisis are scanty. In April 2010, the WHO health workforce

observatory published the first comprehensive overview of the health workforce in

Portuguese speaking African countries. The report was followed by the publication of

the situational analysis on human resources for health of the PALP (Fronteira and

Dussault, 2010). The results highlighted a huge deficit of the general health

workforce. Prior to this work, WHO-Afro performed in 2006 an assessment of the

training of professional health workers which highlighted some challenges including

(i) high migration rate(ii) high dependency on foreign countries for training (iii) ageing

of specialized health workers and (iv) excessive dependency on foreign physicians.

These three studies allowed a general understanding of the situation of health

workers, however none have focused specifically on understanding the eye health

workforce1 . Sound initial situation analysis is crucial to identifying the important

contextual variables that influence eye health workforce development.

Research question -Rationale Fundamental questions regarding the development of the eye health workforce in

other to achieve VISION 2020 goal in PALP remain largely unanswered. There is a

need to generate evidence to deepen the appreciation of the status of the eye health

workforce in these countries through a comprehensive analysis of the situation that

will answer the following questions

1Eye health workers in this document refer to all cadres in eye health as defined by Vision 2020. They are: Ophthalmologist, Cataract

Surgeons, Ophthalmic Medical Officer, Ophthalmic Nurse , Community Ophthalmic Nurse, Optometrists, Optometrist Technician,

Refractionists, Optical Technician, Eye Instrument Technician, Eye Care Programme Manager and Low Vision Worker

GUINEE-

BISSAU 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Physicians 74 85 73 73 82 102 120 165* 165* 188* 188*

Nurses 1164 1176 1167 1158 1164 1164 1164 1164 1164 912 998

National hospitals 1 1 1 1 1 1 1 1 1 1 1

Regional hospital 7 7 7 7 7 7 7 1 7 7 7

Sectorialhospital 26 26 26 26 26 26 26 26 26 26 26

Health centers 371 371 371 371 371 371 371 371 371 371 371

Clinics 3 3 3 3 5 5 5 5 5 5 5

Health expenditure 8.70% 7.70% 5.00% 6.60%


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• What is the current situation of eye health workers in Guinea Bissau?

• Which effective interventions are required for the development of the eye

health workforce in other to achieve vision 2020 goal in Guinea Bissau ?

OBJECTIVES

Through a comprehensive analysis of the situation we shall specifically:

1. Analyse the human resources for health policies, strategies and practices in

Guinea Bissau that affect eye health workers

2. Determine the reasons for migration of the eye health workers and factors

that might motivate them to remain in their respective countries

3. Identify opportunities and recommend appropriate strategies and policies to

develop the eye health workforce.

III. METHODS

This study was conducted with an aim to review existing national HRH related

policies, plans, guidelines and strategies, identify gaps and make recommendation

This study was conducted in 2 days.

a) Ethical approval

Ethical approval for this work was sought and obtained from the participants . The

research participants were explicitly explained about the objectives and methods of

the study, benefits of the study was explained. Use of study findings was clarified to

the research participants. Written informed consent from the participants was

obtained prior to commencing the interviews.

b) Data collection methodology

Phase 1: We searched MEDLINE from 1963 to 2013. Search terms were

“ophthalmologists”, “eye health”, “training”, “guinea Bissau”. We also searched

websites of organisations working to improve health-worker performance, reference

lists from identified reports. Some documents and data were identified later through

direct contact with the Ministries of Health, Education and Public service


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Phase 2: The second phase involved the designing and administration of a

semi-structured questionnaire as a data collection tool for gathering information. The

questionnaires were field-tested in Benin in July 2012. After minor revisions, it was

used to assess the Human resources for eye health in Guinea Bissau.

Pre-field-trip: The stakeholders were contacted by the representation os Sightsavers

in Guinea Bissau. Identified institutions were contacted and informed about the

study. Prior to the interviews, the researchers explained the objectives and

approaches of the study to each person being interviewed. The full list of the

interviewees is in the annex.

Phase 3: The third phase comprised field work. The assessment team was

led by the HRH focal point of Sightsvers. The team consisted of 3 people from

Sightsavers office in Guinea Bissau. According to the pre-set calendar, field

constraints, or the workload of informants approached, some of them were not

available and thus their direct collaborators had to give us the information we were

looking for. Due to time constraints and the urgency of the mission , In-country data

collection was conducted in 2 days: 1 working day (Friday the 25 October ) and on

the week end (Saturday 26 October 2013) with interviews of key informants at the

national level. And these dates clashed with the swearing ceremony for military

were all the authorities have to attend.

The In-depth interviews with stakeholders lasted 60 to 120 minutes depending

on each case. We interviewed 9 individuals from Ministries, training institutions,

hospital and health staff involved in the delivery of eye care services. The sampling

procedure was not intended to be statistically representative for the whole country,

but to provide insights from the key decision according to the objectives of the study.

The list of those interviewed is given in Annex

Phase4: in the fourth phase information collected with the questionnaires was

entered into a database involved an analysis and interpretation of the study findings.

The answers from the different questionnaires were analysed and a draft report was

prepared that will be shared with all the stakeholders who were interviewed.

IV. RESULTS


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The analysis of the situation will follow the HRH Action framework components

promoted by the World Health Organization (WHO) and the Global Health Workforce

Alliance(GHWA) that is HRH leadership, management, policy, finance and

partnership. Qualitative findings are illustrated using quotations translated verbatim

from Portuguese to English, the original language of the interview. Each quotation is

followed by precise information on the respondent’s sex and professional title

Respondent characteristics

9 respondents effectively participated in the study, 4 males and 5 females. The

female were respectively at the policy level within the Ministry of Health, the Ministry

of Public service and Head of training institution. There was one eye health worker

(ophthalmologist) in the sample.

The quantity , the mix and distribution vis a vis vision 2020 targets

There are overall 4 ophthalmologists in the country with 3 in Bissau and 1 in the

region of Farim. 25 out of the 44 (56% ) eye health workers in Guinea Bissau are

female . Their training was supported for some by faith–based organizations and for

the recent one by Sightsavers. The latter is then national trachoma coordinator

trained in Nigeria with Sightsavers support. With the exception of Dr. Meno, the

national eye care coordinator who was trained in Russia, the majority of the cadres

were trained in Africa particularly in Nigeria and the Gambia. They are currently 2

cataract surgeons in training in the Gambia. All cadres including cataract surgeons

and optometrists are recognised by the authorities and systematically integrated as

civil servant upon their return.

Category of Eye Health Worker

Currently available (total)

Number Required

GAP

Ophthalmic Nurses/ Ophthalmic Medical Assistants

6 16 10

Cataract Surgeons 9 10 1

Ophthalmologists 4 7 3

Optometrists 8 33 25


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Optometric Assistants 0 127 127

Ophthalmic Equipment Technicians

2 6 4

Programme Managers 1 1 0

Community Ophthalmic Nurses

15 326 311

Optical workshop Technicians

1 3 2

Low vision specialist no data no data

Total 46 529 483

Table: National eye health workforce of Guinea Bissau source: Ministry of Health, Direction of Human resources, data collected on February 2013. Ref. annex for disaggregated data by cadre, by service delivery level and geographic area

HUMAN RESOURCE MANAGEMENT SYSTEM

Effective HRH management generally requires an information system that provides

reliable data to plan for necessary staff, train, appraise staff performance, and

provide salaries and incentives for their retention

The Human resource capacity of the Directorate of human resources include 9 staff

that manage the 2,000 workers in the health sector (DRHAS, 2013)

The existence of a costed HRH strategic plan that is not being implemented because

of the lack of funding (DRHAS, 2013)

HREH PLANNING/PROJECTIONS

According to the projection of National Human resources development plan 2008-

2016, the Ministry of Health plan to train 20 ophthalmology technicians, 8

Optometrists and 10 cataract surgeons by the end of 2016. There are no data for

ophthalmologists. These projections are not in coherence with vision 2020

requirements.

There is also natural attrition of the workforce to retirement, resignation and death

that was not addressed with the planning of the current workforce.

The ratio of eye care cadres to the population as well as distribution: However there

is a better distribution of the eye health mid-level workers. All the health regions have

at leat one eye health works in charge of the eye health unit.


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RETENTION AND THE BRAIN DRAIN PHENOMENON

There are regional disparities with respect to the distribution of health professionals.

In the region of Bolama Island where there is only one doctor working in the region

(MOH, 2013) .

“Retention of human resources is one of the chronic problems of health systems

especially in remote area”

(Maria Aramata Injai, Directora dos servico de Recursos Humanos e Administração

da Saúde)

The brain drain of health workers was not perceived as a current problem. It was

acknowledge that the phenomenon of massive migration happened during the civil

war of 1998 but it is not anymore an issue.

HRH Financing

There is a weak government financial capacity. Despite the small progress made in

mobilizing domestic resources, the country is still dependent on foreign aid to finance

public expenditure .The proportion of the budget allocated for human resources for

health and eye health is not clear and could not be obatined. Although Guinea-

Bissau signed the Abuja Declaration in 2000, by which African states committed

themselves to spend 15% of their annual national budgets on health, this country’s

budget allocation to was 4% in 2007 (WHO, 2011). The human resources directorate

currently has no funding, no budget line. There is no specific budget allocated to the

HR department. The minister centralizes the budget and can allocate according to

the need. Almost all recurrent expenditure is on salaries, leaving little room for

manoeuvre in relation to other expenditure.

The payment of salaries to health workers has often been subject to delay. When

paid the salaries is not attractive. For a medical doctor, it is 170,000-180,000 XOF

(£217.0- £230.0/month) and XOF 59,000 (~£76) for mid-level health workers

(DRHAS, 2013). When there is a top up by the INGOs it is within XOF 40,000-

100,000 XOF/ Month. Community eye health workers are recognized but do neither


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are civil servant nor do they receive a salary. However they are incentivize if there is

any specific tasks.

HRIS

The collection systems include information on eye care staff however there is no

technical expertise in that area. Availability of systems and capacity for the

collection, integration and analysis of HRH data and information

HRH PLANNING

There is a mismatch between the staffs projections versus the actual numbers

trained. There is no reference to the model for projecting staff . It is not clear what

was the rational and objective base for the estimated numbers.

HRH Policy

Health workers are managed through a complex system involving 3 ministries: The

Training institutions. A soon as they graduate the MoH ensure that the list of

graduates is sent to the Ministry of Public Service for approval. Then the list os sent

to the Ministry of Finance for salary purposes. The process take 9-12 months before

he graduates perceived their first salary.

In the ministry of public service , there is no written procedure for the management

of data that includes collection, preservation, cleaning, quality control, analysis and

presentation of data is implemented throughout the country Existence of up-to-date

HRH policies in place; evidence that HRH policies are actually used or implemented

RECRUITMENT POLICY

The recruitment of health workers is done centrally at the Ministry of Public Health in

collaboration with the Ministry of Public Service and the Ministry of Finance. The

recruitment is systematic for all graduates however there is no planning document

for recruitment. It is done on an ad hoc basis following the government policy, rules

and regulations.. The age limit to get into public service is 50 years. 100% of health

workers whether trained in Guinea-Bissau or abroad have been recruited by the

Ministry of Health.


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However, there is a long pipeline (9-12 months) between the graduation and their

integration as civil servant. Training institutions in public sector are autonomous and

formulate their own recruitment policy and rule, which are approved by the

government. The private academic institutions have more liberal policy of

recruitment.

CAREER PROGRESSION

Any Promotion or career progression of civil servant has been suspended since

2012. There is no instrument for evaluating the performance of health workers.

However at the Ministry of Public service a new career progression scheme is being

developed but there is no capacity to finalize it or to mobilize resources for its

implementation. The evidence from the data collected showed that health workers

were expressed much dissatisfaction with the salary they received.

IN-SERVICE AND CONTINUOUS TRAINING

In-service training in the public sector is not coordinated. It responds to the needs of

different programmes and services and the regional health directorates, and

depends on the availability of funds from donors. Currently there is a request of 4

medical doctors who wish to specialize in ophthalmology but here are currently

scholarship available.

Education

During the field visit on Friday 25 October, the teachers and students have been on

strikes for 19 days. This strike is planned for 60 days (CONAEGUIB,2013). The

main reason is the dissatisfactions with the non-payment of teachers’ salaries for the

past 10 months.

PRE-SERVICE EDUCATION

There is one nursing school and one medical school in Guinea Bissau. There are no

eye health training institutions in the country

The existence of a domestic residency training program is considered as an

important aspect of a country’s medical education system and prospects for

physicians’ retention. The director is from guinea Bissau, the 2 vice rectors that are

from Cuba. The training of medical students is done at Universidade Amílcar Cabral,

the Guinea Bissau's first University. The school was re-opened in 2006 after being


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closed for 10 years that during the civil war of 1996. Since its reopening 2 batch of

medical doctors graduated. The intake 10 to 15 students/year. The first batch

graduated in 2011 with 88 medical doctors and in 2012 with 37 medical doctors

among them only 5 females ( MoH, 2013). In medical schools, the ratio male to

female is almost 1to 8, while in nursing the school , there is a feminization of the

graduates . in 2010 it was 1 male for 2 female, in 2011 2.3 for 1.

The main factor of dissatisfaction of student in nursing school was related to the poor

quality of support systems (library, computers, laboratories) and the heavy load (and

poor organization) of formal teaching hours. The cost of training for a nurse is

approximately XOF 360,000 (~£461) for the 3 years of training.

CURRICULUM

Since 2009, the curriculum used in nursing school is the harmonized West African

Health Organisation (WAHO) curriculum - but which still has a huge Portuguese

influence.

Year of graduation 2009 2010 2011 2012 Total

Medical school Universidade Amílcar

0 0 88 37 125

Nursing school, Escola Nacionale de saude

no data 657 556 338 1551

Total 657 644 375 1676

Table.. Numbers of graduates in the health field in Guinea Bissau per year

PARTNERSHIP

To effectively respond to national health goals, relevant government sectors must

have a shared vision and a readiness to play their part.

The main development partners of Guinea-Bissau are the European Union

(EU) together with European bilateral donors, Economic Community of West

African States (ECOWAS) and West Africa Economic Monetary Union

(WAEMU), West Africa Development Bank (BOAD) the African Development

Bank (AfDB), United Nations agencies, UNFPA and WHO


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Cuba's assistance in international health. Cuban professors have helped to

found medical schools in Guinea Bissau and the Cuban government provides

the human resources which trains up the local population

Other INGOs , specifically CBM who recently trained 3 Cataract surgeons ,

Instituto de Higiene e Medicina Tropical (Institute of Hygiene and Tropical

Medicine) of the Universidade Nova de Lisboa (technical support)

There is quasi no information about the for-profit health care sector which

appears to be underdeveloped. None of the respondents mentioned the

private sector as a supporter.

Leadership

Human resource for health development is said to be a priority in the country as

there is (i) a directorate in charge of their development, (ii) a policy document of

human resources for health, (iii) a systematic recruitment of eye health workers

trained (iv) with a regular salary . However, the country ownership is insufficient as

75% of the respondents failed to make reference to themselves as potential

supporters in any project to develop the eye health workforce in GB.

There is also a limited institutional capacity and human resources in the country

(Ministry of Public service and health ) for successfully planning and implementing

development policies and programs;

V. CONSTRAINTS AND THE CHALLENGES IN EYE HEALTH

WORKFORCE DEVELOPMENT

Guinea Bissau been described as a stage on a continuum where the risk of

destabilization remain with a cycles of peace and war, security threat is an important

concern for all. Several constraints might be envisioned for the development of the

eye health workforce.

ON LEADERSHIP


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Almost all the interviewees mentioned the international partners to best

support any HRH initiative. They didn’t see themselves primarily as potential

supporters, that might lead to low ownership of any program if started

Pressure to restore and repair public services to meet emergency needs

frequently diverts attention from long-term issues such as policy development

and reform

ON FINANCING

There is a plan for the development of HRH, but it faces major challenges in

implementation. The financial structures in which to raise local revenue are

damaged and the likelihood to attract foreign investment is low.

Inefficient resource allocation. There is no public budget for eye care and the

budget cycle suffers from malfunctions in all of its phases. The current budget

is allocated on a contingency basis and there is no budget breakdown

department of the MoH. It is imperative that the budget present an

expenditure breakdown. This would help assess the real situation in the

sector as well as contribute to introduce more transparency and credibility into

the budget process.

The payment of salaries to health workers has often been subject to delay,

and morale is said to be poor. The In Guinea-Bissau, where the starting

monthly salary of a public sector doctor was US$ 320,

ON EDUCATION

Heavy dependency on foreign staff (the Cubans). 100% of teaching staff in

medical school are Cubans. Ways must be identified to make Guinean

resources sustainable, including building up a medical teaching faculty

Difficulties with the supply of electricity are among the greatest obstacles to

economic and social development in Guinea-Bissau. Only 5.7% of the

population has access to electricity (World Bank. 2012.)

Government concentrate on educational institutions and training, while

neglecting others aspects of human resources development.

OPPORTUNITIES


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The assessment indicates that, despite all the setbacks, some progress have

recently been achieved in specific aspects of education and health sectors amid

social tensions and disputes with unions

There is close tied and collaboration between the national eye care

coordination and the human resources for health department

Health appears to receive more priority from the government. While teachers

are on strike, the salaries of health workers are paid on a regular basis.

Guinea Bissau is member of WAHO, the health branch of the Economic

Community of West African States (ECOWAS), who works to improve health

in the region by harmonizing policies and pooling resources.

Guinea Bissau is also member of CPLP and PALP

Faculty development highlighted by the Human Resources Development

Strategy (2007) and Action Plan by focusing on the production of health

personnel in close collaboration with the Oswaldo Cruz Foundation (Brazil)

which will train the faculty.

LIMITATIONS AND CONSTRAINTS

This situational analysis faced a number of important constraints some of which

were expected; others proved more challenging than anticipated. The fact that it

was during the period of the swearing ceremony of militaries, we were not able to

meet with the Dean of Medical School as well as the official of the Ministry of

Finance as they were to attend this official ceremony.

No electricity, we spent half of the time of this situational analysis in the dark at

both schools and were not able to print documents

Obtaining key documentation proved challenging as no single organization had a

comprehensive set or sense of what should be available. Those contacted were

encouraged to send any additional thoughts and documents by email but none

were received. If it had been possible to start contacting stakeholders more than


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two weeks before the field visit began, some of the above limitations might have

been reduced / mitigated.

I. CONCLUSION AND RECOMMENDATIONS

There is a plan for the development of HRH, but it faces major challenges in

implementation.

The human resources for health policies that affect the general health

workforce are the same that affect the eye health workforce. However there

no training programs for eye health workers in country

There is no public budget for eye care and the budget cycle suffers from

malfunctions in all of its phases. The current budget is allocated on a

contingency basis and there is no budget breakdown department of the MoH.

There is a low satisfaction. The starting monthly salary of a public sector

doctor was US$ 320

migration/brain drain is said not to be an issue in the country .it has been the

case in the past due to the civil war of 1998 and a better motivation will be

done through reducing the pipeline , better working conditions, increased of

salary and payment of salaries on time

Regionalizing area of training of ophthalmologists. It was suggested that a

partnership with Angola and Cape Verde be established in other to developed

are of speciality and subspecialty in more developed countries like cape

verde, which will circumvent the 1 year language requirement in the Gambia

or Nigeria and the prohibitive cost of being trained in Portugal or Brazil,

enhance the south to south collaboration for sustainable results

it is essential to contribute to “life support”—to pay civil servants’ salaries and

reduce the chances of a resumption of conflict

The new human resources strategy and action plan in the health sector

should be effectively used to create linkages between planning, production

and deployment of personnel.


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Overcoming the deficit of skills emerges as a necessary condition for the

success of Public administration. The capacity building of civil servant

authorities in preparing planning and policy documents is essential .

Political instability remains a persistent risk to the continuity and consistent

implementation of actions envisaged in the HRDP.

REFERENCES

1. The World Fact book CIA Mapshttps://www.cia.gov/library/publications/the-

world-factbook/geos/pu.html accessed 1st November 2013

2. Human Resources for Health Country Profile Guinea-Bissau, 2010

3. HRDP Human Resources Development Plan 2008-2016

4. Global Health Observatory (GHO) Guinea-Bissau: country profiles

http://www.who.int/gho/countries/gnb.pdf

5. Cláudia Conceição, Joana Sousa Ribeiro, Joel Pereira and Gilles Dussault.

Portugal Mobility of Health Professionals. Associação para o

Desenvolvimento da Medicina Tropical Instituto de Higiene e Medicina

Tropical Universidade Nova de Lisboa December 2011

http://www.mohprof.eu/LIVE/DATA/National_reports/national_report_Portugal.pdf

6. RGPH. 3rd General Census of Population and Housing (RGPH) 2009 in

Guinea-Bissau http://www.stat-guinebissau.com/

7. Guinea-Bissau Country Profile: Human Development Indicators

http://hdrstats.undp.org/en/countries/profiles/GNB.html accessed the 30th October

2013

8. Dussault G, Fronteira I. Análise dos recursos humanos da saúde (RHS) nos

países africanos de língua oficial portuguesa (PALOP) (The situation of the

health workforce in the PALOPS), WHO, Human Resources for Health

Observer Series, no 2, Geneva (ISBN 978 92 4 859907 1); 2010. Available at

http://www.who.int/hrh/resources/observer2/en/index.html

https://www.cia.gov/library/publications/the-world-factbook/geos/pu.html

https://www.cia.gov/library/publications/the-world-factbook/geos/pu.html

http://www.who.int/gho/countries/gnb.pdf

http://www.mohprof.eu/LIVE/DATA/National_reports/national_report_Portugal.pdf

http://www.stat-guinebissau.com/

http://hdrstats.undp.org/en/countries/profiles/GNB.html

http://www.who.int/hrh/resources/observer2/en/index.html


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9. WHO (2012) Global Health Observatory Data Repository: World Health

Statistics - Health Workforce;

http://apps.who.int/gho/data/node.main.67?lang=en

10. World health report 2006. Working together for health. Geneva, World Health

Organization, 2006.

11. WHO (2013) Global Health Expenditure Database (GHED);

http://bit.ly/SRlTPy

12. Documento de Estratégia Nacional de Redução da Pobreza. Adopted 2005.

Corrected version published 2005. See: http://www.stat-

guinebissau.com/denarp/denarp.pdf.

13. 20 Fronteira I, Ferrinho F, Dussault G, Ferrinho P. Avaliação final da

Implementação e Execução do Plano Nacional de Desenvolvimento Sanitário

2003-2007 da República da Guiné Bissau. Associação para o

Desenvolvimento e Cooperação Garcia de Orta, 2007.

14. Ferrinho et al.: The training and professional expectations of medical students

in Angola, Guinea-Bissau and Mozambique. Human Resources for Health

2011 9:9.

15. EFA Country Profile Guinea Bissau UNESCO, 2012

http://www.unesco.org/new/fileadmin/MULTIMEDIA/FIELD/Dakar/pdf/EFA%20cou

ntry%20profile%202012%20%20%20-%20Guinea%20Bissau_01.pdf accessed on the 2

November 2013

16. Three-year Plan for the Development of Education: 2011 - 2013 Carta de

Política Sectorial, a policy document

17. World Bank. 2012. PPIAF assistance in the Republic of Guinea-Bissau.

Public-Private Infrastructure Advisory Facility (PPIAF). Washington D.C. : The

Worldbank. http://documents.worldbank.org/curated/en/2012/08/17518648/ppiaf-assistance-

republic-guinea-bissau

18. WHO (2013) Global Health Expenditure Database

http://apps.who.int/gho/data/node.main.67?lang=en

http://bit.ly/SRlTPy

http://www.unesco.org/new/fileadmin/MULTIMEDIA/FIELD/Dakar/pdf/EFA%20country%20profile%202012%20%20%20-%20Guinea%20Bissau_01.pdf

http://www.unesco.org/new/fileadmin/MULTIMEDIA/FIELD/Dakar/pdf/EFA%20country%20profile%202012%20%20%20-%20Guinea%20Bissau_01.pdf

http://documents.worldbank.org/curated/en/2012/08/17518648/ppiaf-assistance-republic-guinea-bissau

http://documents.worldbank.org/curated/en/2012/08/17518648/ppiaf-assistance-republic-guinea-bissau


22

19. Research, 6(1), 97-113.Fronteira & Dussault, Human Resources in the Heath

Sector of Portuguese-speaking Afrian Countries, Reciis, Vol. 4, No. 1, 2010

RECIIS – R. Eletr. de Com. Inf. Inov. Saúde. Rio de Janeiro, v.4, n.1, p.71-78,

Jan., 2010

VI. ANNEX

Annex 1: Human resources for health requirements Source : HRDP, Ministry of Health


23

ANNEXE .. : Roster of eye health workers in Guinea Bissau as February 2013 source,

Human resource department and National eye care program, Ministry of Health


24

ANNEX ..:


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Three-year Plan for the Development of Education: 2011 – 2013 Source: Republic of Guinea-Bissau Ministry of National Education, Culture, Science, Youth and Sports

ANNEX..... LIBRARY AT ESCOLAR NACIONAL DE SAUDE

Documents

Situational Analysis-HReH-GB-DRAFT ZERO