18
Workforce, Training, and Education Emmanuel Ameh, Lars Hagander, Caris Grimes, Nivaldo Alonso, Eunice Derivoir Merisier, Nyengo Mkandawire, Adam Lantz, Hampus Holmer, Johanna Riesel The Lancet Commission on Global S Thursday, June 19, 2014 1

Workforce, Training, and Education

  • Upload
    eliora

  • View
    24

  • Download
    0

Embed Size (px)

DESCRIPTION

The Lancet Commission on Global Surgery. Workforce, Training, and Education. Emmanuel Ameh , Lars Hagander , Caris Grimes, Nivaldo Alonso, Eunice Derivoir Merisier , Nyengo Mkandawire , Adam Lantz, Hampus Holmer , Johanna Riesel. Thursday, June 19, 2014. - PowerPoint PPT Presentation

Citation preview

Page 1: Workforce, Training, and Education

1

Workforce, Training, and Education

Emmanuel Ameh, Lars Hagander, Caris Grimes, Nivaldo Alonso, Eunice Derivoir Merisier, Nyengo Mkandawire, Adam Lantz, Hampus Holmer, Johanna Riesel

The Lancet Commission on Global Surgery

Thursday, June 19, 2014

Page 2: Workforce, Training, and Education

2

Defining the Surgical Workforce

• The health workforce: “All people engaged in actions whose primary intent is to enhance health” (WHO)

• Providing Surgical care is providing a surgical TEAM– Health care executives, managers, leaders– Surgical/Obstetric providers– Anesthetic Providers – perioperative care providers – nurses and trained theater staff– Technical support staff– Radiologists, pathologists– High income country personnel– Community Health Workers

Page 3: Workforce, Training, and Education

3

Handbook on Monitoring and Evaluation of Human

Resources for Health (WHO, 2009)

Working Lifespan Framework

Page 4: Workforce, Training, and Education

4

Workforce: Defining the Current State

• WHO defines health workforce crisis as <2.5 healthworkers/1000 population

• 57 countries in health workforce “crisis”• Little is known about surgical workforce due to

lack of published data• WTE group is collecting data on current state

Page 5: Workforce, Training, and Education

5

Surgical Provider (S, A, O) Density by workforce crisis

Page 6: Workforce, Training, and Education

6

Surgical Provider (S, A, O) Density by World Bank Income Status

HIC

U-M

IC

L-M

IC LIC

HIC

U-M

IC

L-M

IC LIC

HIC

U-M

IC

L-M

IC LIC

HIC

U-M

IC

L-M

IC LIC

Surgeons Anesthesiologists Obstetricians Total surgical work-force

0

10

20

30

40

50

60

70

80

90

100

36.5 35.3

8.9

0.2

13.9 12.6

6.6

0.2

16.6

11.3

0.6 0.2

65.3

60.5

34.1

0.8

Num

ber o

f pro

vide

rs p

er 1

00,0

00 p

opul

ation

Page 7: Workforce, Training, and Education

7

Entry to the Workforce

– Training should reflect the needs of the population– Training curriculum must be updated regularly so

as to match the changing needs of the populations – Emphasize Core Competencies

• Minimal required skill set• Many different ways to train the surgical

provider– Accreditation– Retraining of current surgical providers – Innovative approaches

• Free, online courses • E-learning, e-mentoring, telementoring

– Response to Deficit of Surgical Providers • Task Sharers/Mid-level providers• Visiting surgeons from other

countries/Missionary Surgeons/PAACS

Page 8: Workforce, Training, and Education

8

Task Sharing• Several Countries have adopted the use of “Mid-

Level Providers” or “Non-Physician Clinicians” to address the surgical workforce shortage

• Benefits: shorter training, less expensive, increased workforce numbers in surgery, anesthesia, OBGYN

• Controversy: supervision, quality assurance, difficult decision making, detracting from training of surgeons, appropriate terminology

• Consensus statement to be circulated

Page 9: Workforce, Training, and Education

9

Exit from the Workforce• Migration

– To other countries– Public to Private Sector– Surgical to Nonsurgical Specialties– To Charitable and NGO sector– Rural to urban

• Lack of access to training, infrastructure, remuneration, career opportunities

• International policies to reduce recruitment

• Partnerships with HIC

Page 10: Workforce, Training, and Education

10

Percent Surgical Workforce trained in LIC working in HIC

Switzerland

Slovak republic

Estonia

Austria

Norway

Sweden

Slovenia

Israel

New Zealand

Ireland

Canada

United Kingdom

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% 14.0% 16.0%

0.5%

0,.%

0.8%

1.0%

1.1%

1.4%

6.5%

7.6%

8.4%

9.5%

13.2%

15.6%

SurgeonsAnesthesiologistsObstetricians

Page 11: Workforce, Training, and Education

11

Performance and Quality• Patients should have access to

basic surgical/anaesthteic/obstetric skills within 2 hours

• Optimum number of surgeons/100,000 population

• M&E e.g. M&M• CME – local and

international/partnerships• Maintenance of certification

• Local • High income country

certification

Page 12: Workforce, Training, and Education

12

Possible Workforce Metrics

Surgical Workforce (SAO) Density (#SAO/100,000 Population)

Distribution of Surgical Workforce (SAO) (#people within 2 hours of surgical care/population)

Proportion of Surgical Workforce (# of SAO/Total National Physician Workforce)

Page 13: Workforce, Training, and Education

13

Primary Research Topics• HIC Benchmarking and Immigration of the Surgical Workforce • The Global workforce project – in 63 countries• MOH survey – sent across the world to report exact number of Surgeons,

Anesthetists, and OBGYN. • Assessing Surgical Workforce Density via the WHO Situational Analysis Tool

in 53 countries• Investigating Training Modules for Surgeons and Anesthetists. • Current requirements (based on estimates of need) to close the gap

between surgical providers and access to basic surgical/anesthetic/obstetric skills within 2 hours

• Likely future requirements (projections of population growth and likely need)

• Teaching Cases: CURE Hydrocephalus, Teaching Laparoscopy in Mongolia

Page 14: Workforce, Training, and Education

14

Key Findings• There is a dearth of data about the true size of the surgical

workforce• Many factors contribute to the current situation of the

surgical workforce• Access to educational Materials and research are limited

in many LMICs• Due to migration factors, current surgical and anesthetic

trainees lack access to available, skilled educators• Developing procedures/treatments based on a

population’s needs is important and may be applicable to other populations around the world

Page 15: Workforce, Training, and Education

15

Recommendations• Overall

– Increased Investment– Improved Training– Better human resources management

• Ministries of Health– Development of Technical capacity to monitor health workforce– Define current situation for their country/gather relevant data– Develop surgical workforce plans to ensure access to basic surgical care within 2

hours – Ensure quality assurance of surgical training, including task sharing– Increased access to fast, affordable internet

• HIC partnerships/NGO’s Charitable Sector– Responsibility not to drain local sector– Train local providers including increased access to eucational and research resources

• Train local providers to be local trainers/educators

Page 16: Workforce, Training, and Education

16

Thank You

Comments?

Page 17: Workforce, Training, and Education

17

The number of major operations* per surgeon and obstetrician, and per anesthesiologist, by World Bank income category**

• Boxes show interquartile range, center point and numeric value shows median value and whiskers indicate maximum and minimum number.• * Data source: Weiser TG, Regenbogen SE, Thompson KD, et al. An estimation of the global volume of surgery: a modelling strategy based on available data.

Lancet. 2008;372:139-44.• ** HIC = High-income (GNI pc $12,616 or more); U-MIC = upper middle income countries ($4,086 - $12,615); L-MIC = lower middle income countries ($1,036

- $4,085); LIC = low income ($1,035 or less)

HIC U-MIC L-MIC LIC0

500

1000

1500

2000

2500

3000

3500

4000

4500

664240

1,017

780

Num

ber o

f maj

or o

pera

tions

per

ane

sthe

siol

ogis

t

HIC U-MIC L-MIC LIC0

100

200

300

400

500

600

700

155

73

236

251

Num

ber o

f maj

or o

pera

itons

per

sur

geon

and

obs

tetr

icia

n

Page 18: Workforce, Training, and Education

18

Surgical Workforce Crisis