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?