Human resources for health2010 25th june mph

Human Resources for Human Resources for HealthHealth

Dr. Nilar TinDr. Nilar Tin

A Rational approach to Health manpower A Rational approach to Health manpower planning (1978) Tom Hallplanning (1978) Tom Hall

2.2. Over half of the graduates of a ministry of health six-month training programme for environmental sanitation personnel were lost permanently to the health sector owing to failure by the ministry to create necessary jobs in time.

1. A newly expanded regional hospital system, completed at great cost with a foreign loan on which commercial interests are paid, stands unused for lack of nursing personnel.

3. Health authorities in the developing countries lament over the many physicians who emigrates following graduation, while at the same time citing with pride the high pass rate of these graduates in licensing examinations in developed countries.

4.4. Health and political authorities, Health and political authorities, in their desire to avoid in their desire to avoid providing rural communities with “second-class” health care, providing rural communities with “second-class” health care, oppose the use of non-professional personnel in such oppose the use of non-professional personnel in such areas, areas, hence ensuring that population will be without health hence ensuring that population will be without health care at all. care at all.

5. The gift by a developed country of a modern university hospital to a developing country has become a double liability to the recipient- a major drain on its health budget and a teaching facility inappropriate to local training needs.

6. One government agency has funded the development of a large number of training programmes for medical assistants (HA), while another in charge of reimbursements for health services under the social insurance system, has declined to approve payment for the services of these assistants working under medical supervision.

7. In order to cover the payroll of an overstaffed health system, the budgets for drugs, equipment, and maintenance of facilities have been cut to the point where the productivity of staff is severely compromised

8. Unwilling to jeopardize the “quality of care” by expanding its medical school capacity to meet its national needs, a country has ended up by relying on large numbers of immigrant physicians urgently needed in their home countries and ill-equipped to practise medicine in the host countries.

9. Over one third of the people in one continent are without medical care despite a reasonably good overall doctor: population ratio.

10. (42) new medical schools have opened in one country in 4 years.

The scope of Health Manpower ProcessThe scope of Health Manpower ProcessOverall aim: To ensure the manpower needed by the healthOverall aim: To ensure the manpower needed by the health

care delivery systemcare delivery system

Health MP PlanningHealth MP Planning Health MP Health MP ProductionProduction

Health MP Health MP ManagementManagement

GoalGoal To provide the To provide the framework within framework within which HMP process which HMP process takes placetakes place

To provide the To provide the manpower manpower requiredrequired

To optimize the To optimize the use of HMPuse of HMP

ObjectiveObjective To specify the no: of To specify the no: of teams and the teams and the composition needed composition needed to improve the level to improve the level of health up to a of health up to a proposed levelproposed level

To produce To produce xx people of people of yy types types

To determine To determine MP distribution MP distribution & productivity & productivity standards, standards, patterns of patterns of utilization &non utilization &non labour inputslabour inputs

The scope of Health Manpower ProcessThe scope of Health Manpower Process

Health MP PlanningHealth MP Planning Health MP Health MP ProductionProduction


StrategyStrategy -Regional (sub-national) -Regional (sub-national) planning and local planning and local programmingprogramming

-HMP project -HMP project formulationformulation

-Aggregation, -Aggregation, reconciliation and reconciliation and consolidationconsolidation

-Educational -Educational planning planning

-programming -programming educational educational objectives & objectives & teaching teaching methodsmethods

ReorganizationReorganization

-regionalization-regionalization

-integration of -integration of prevention and prevention and curecure

-country health -country health programming programming PHCPHC

-HMP project -HMP project managementmanagement

The scope of Health Manpower ProcessThe scope of Health Manpower ProcessHealth MP Health MP

PlanningPlanning

Health MP Health MP ProductionProduction


ActivitiesActivities -Planning and -Planning and programmingprogramming

-Coordination-Coordination

-Monitoring and -Monitoring and evaluating evaluating implementationimplementation

-Research and -Research and developmentdevelopment

-Recruitment -Recruitment campaigncampaign

-Definition of -Definition of admission admission procedures and procedures and syllabussyllabus

-Definition of -Definition of teaching methodsteaching methods

-Evaluation of -Evaluation of process and process and productsproducts

Establishment and Establishment and Implementation of:Implementation of:

-supervision system-supervision system

-referral system-referral system

-continuing education-continuing education

-recruitment & -recruitment & selection proceduresselection procedures

-career development -career development schemesschemes

-deployment of -deployment of manpowermanpower

-staffing patterns-staffing patterns

The scope of Health Manpower ProcessThe scope of Health Manpower Process

Health MP Health MP

PlanningPlanning

Health MP Health MP ProductionProduction


TargetsTargets XX health teams of health teams of YY composition in composition in operation by time operation by time TT

XX trained trained personnel of personnel of YY type by time type by time TT

XX units of service of units of service of specified quality specified quality delivered to defined delivered to defined populationpopulation

-coverage-coverage

HRH planning seeks to ensure that: -the right numbers of HRH are available -at the right place -at the right time -with the requisite skills and motivation to deliver health care to the population

Working together for Working together for health 2006health 2006

We have to work together to ensure access to a We have to work together to ensure access to a motivated, skilled, and supported health worker by motivated, skilled, and supported health worker by every person in every village. (LEE Jong-wook 2005)every person in every village. (LEE Jong-wook 2005)

WHO Region of America 10% global burden-has 37% WHO Region of America 10% global burden-has 37% of the world’s health workers spending more than 50% of the world’s health workers spending more than 50% of world’s health financing (Why?)of world’s health financing (Why?)

Africa Region -24% of burden but only 3% of health Africa Region -24% of burden but only 3% of health workers, less than 1% of world’s health expenditureworkers, less than 1% of world’s health expenditure

(Why?)(Why?)

Push & Pull FactorsPush & Pull Factors Push FactorsPush Factors

Endogenous Endogenous -- low remuneration levels low remuneration levels - work associated risks—TB,HIV/AIDS - work associated risks—TB,HIV/AIDS - inadequate HR plan with unrealistic - inadequate HR plan with unrealistic

workload workload - poor infrastructure- poor infrastructure- sub optimal conditions of work- sub optimal conditions of work- lack of further education and career ladder- lack of further education and career ladder- minimal or absent support and supervision - minimal or absent support and supervision

Exogenous Exogenous - - political insecuritypolitical insecurity - crime- crime

- taxation- taxation

Pull FactorsPull Factors - - aggressive recruitment by recipient countriesaggressive recruitment by recipient countries

- improved quality of life- improved quality of life- study and specialization opportunities- study and specialization opportunities- improved pay- improved pay

Working lifespan strategiesWorking lifespan strategies

ENTRY:ENTRY:

Preparing the workforcePreparing the workforce

PlanningPlanning

EducationEducation

RecruitmentRecruitment WORKFORCE:WORKFORCE: WORFORCE WORFORCE Enhancing worker performanceEnhancing worker performance PERFORMANCEPERFORMANCE

SupervisionSupervision AvailabilityAvailability

CompensationCompensation CompetenceCompetence

Systems supportsSystems supports ResponsivenessResponsiveness

Lifelong learningLifelong learning ProductivityProductivity

EXIT:EXIT:

ManagingManaging attritionattrition

Migration

Career choiceCareer choice

Health and safetyHealth and safety

RetirementRetirement

Entry-preparing the workforceEntry-preparing the workforce Building strong institutions:Building strong institutions:

For education is essential to secure no: and quality of health workers For education is essential to secure no: and quality of health workers required by health systemrequired by health system

The world’s 1600 medical schools, 6000 nursing schools, 375 School The world’s 1600 medical schools, 6000 nursing schools, 375 School of PH…need more schools of PH of PH…need more schools of PH

Shift of expectations of graduates from “know-all” to “know-how”Shift of expectations of graduates from “know-all” to “know-how” Teaching staff…also have to be competent, require training, career Teaching staff…also have to be competent, require training, career

incentives, credible supportincentives, credible support Telemedicine and distance education (pooling of resources and kn Telemedicine and distance education (pooling of resources and kn

mgt)mgt)

Assuring educational qualityAssuring educational quality Institutional accreditation and professional regulation (licensing, Institutional accreditation and professional regulation (licensing,

certification and registration)certification and registration) Too many private schools…benefits vs quality?Too many private schools…benefits vs quality?

Workforce Enhancing PerformanceWorkforce Enhancing Performance Supervision makes a big differenceSupervision makes a big difference

Supportive supervisionSupportive supervision Clear job descriptionClear job description Feedback on performanceFeedback on performance On the job trainingOn the job training

Fair and reliable compensationFair and reliable compensation Decent pay arrival on timeDecent pay arrival on time Financial incentiveFinancial incentive Non-financial incentive-study leave/child careNon-financial incentive-study leave/child care

Critical support systemsCritical support systems Lack in clean water, sanitation, adequate lightingLack in clean water, sanitation, adequate lighting VehiclesVehicles Drugs, working equipmentsDrugs, working equipments

Life long learningLife long learning Short term trainingShort term training Team work, sharing solutionsTeam work, sharing solutions

Exit: Managing migration and attritionExit: Managing migration and attrition Managing migration of health workersManaging migration of health workers

Should be planned migrationShould be planned migration Recipient countries should adopt responsible recruitment policy, treat Recipient countries should adopt responsible recruitment policy, treat

health workers fairly and consider entering into bilateral agreements-health workers fairly and consider entering into bilateral agreements-WHO Code of practice in recruiting health workforceWHO Code of practice in recruiting health workforce

Excessive internal migration can cause urban concentration and rural Excessive internal migration can cause urban concentration and rural neglectneglect

Keeping health work as a career of choice for womenKeeping health work as a career of choice for women Feminization-look into safety, protecting from violenceFeminization-look into safety, protecting from violence

Ensuring safe working environmentEnsuring safe working environment HIV/AIDS-outflow from workforce due to illness, disability and deathHIV/AIDS-outflow from workforce due to illness, disability and death Occupational hazardsOccupational hazards

Retirement planningRetirement planning Recruit retirees back to work force-improve their living conditionsRecruit retirees back to work force-improve their living conditions

Priority CountriesPriority Countries

The World Health Report 2006 identified The World Health Report 2006 identified 57 57 priority countriespriority countries that fell below the that fell below the threshold of 2.3 doctors, nurses and midwives threshold of 2.3 doctors, nurses and midwives for every 1000 people- the minimum number for every 1000 people- the minimum number generally considered necessary to deliver generally considered necessary to deliver essential health servicesessential health services

Africa, Asia, Central Americal, South America,Africa, Asia, Central Americal, South America, & Oceania& Oceania

Health Workforce 2008Health Workforce 2008

Health Workforce is defined as a stock of Health Workforce is defined as a stock of all people engaged in actions whose all people engaged in actions whose primary intent is to enhance healthprimary intent is to enhance health

HWF

Health care Provider

H. Management and SupportWorkers

Public Private

CBHV

NGO

Health Challenges for SEARHealth Challenges for SEAR

Emerging infectious diseases: SARS, AI, HIV, TB, Emerging infectious diseases: SARS, AI, HIV, TB, MalariaMalaria

Public Health Emergencies: natural disasters Public Health Emergencies: natural disasters requiring rapid response and disaster preparednessrequiring rapid response and disaster preparedness

Chronic non-communicable diseases requiring long Chronic non-communicable diseases requiring long term careterm care

Developments in biotechnology-advanced Developments in biotechnology-advanced diagnostic and curative facilities-require labour diagnostic and curative facilities-require labour intensive health care servicesintensive health care services

Rising patients’ expectations of health care deliveryRising patients’ expectations of health care delivery Health workforce shortagesHealth workforce shortages

Health Workforce (HWF) ChallengesHealth Workforce (HWF) Challenges Need for evidence based strategic HWF planningNeed for evidence based strategic HWF planning

Comprehensive data regarding HWF distribution, public, Comprehensive data regarding HWF distribution, public,

private, community, NGOs, partnersprivate, community, NGOs, partners

Imbalances in skills, geographic distribution, gender, optimal Imbalances in skills, geographic distribution, gender, optimal

skill-mixskill-mix

Relevance of training: pre-service, in-service training Relevance of training: pre-service, in-service training

directed to country health needs.directed to country health needs.

HWF recruitment, management, working environment, HWF recruitment, management, working environment,

financing, retention, exit/migration of HWFfinancing, retention, exit/migration of HWF

International and internal migration of health workforceInternational and internal migration of health workforce

WHO’s Response to HWF ProblemsWHO’s Response to HWF Problems

5959thth session of the Regional Committee: Dhaka session of the Regional Committee: Dhaka Declaration: Strengthening Health Workforce Declaration: Strengthening Health Workforce in countries of the SEA Region, 2007 in countries of the SEA Region, 2007

Regional Strategic Plan for HWF development in Regional Strategic Plan for HWF development in the SEA Regionthe SEA Region

WHO HQ-Regional-Country HWF data base WHO HQ-Regional-Country HWF data base harmonized with the country data baseharmonized with the country data base

Regional guidelines for HWF Strategic Plan Regional guidelines for HWF Strategic Plan

WHO Code of Practice on international WHO Code of Practice on international recruitment of HWF (2010 63recruitment of HWF (2010 63rdrd WHA) WHA)

Global Response to HWF ProblemsGlobal Response to HWF Problems

Global Health workforce Alliance GWHAGlobal Health workforce Alliance GWHA

2008 The Kampala Declaration and Agenda for 2008 The Kampala Declaration and Agenda for Global Action (1Global Action (1stst Global Health Forum in Global Health Forum in Uganda)Uganda)

To strengthen HWF at all levelsTo strengthen HWF at all levels To track progress in implementing the strategies To track progress in implementing the strategies

adoptedadopted To have access for all to skilled, motivated and To have access for all to skilled, motivated and

supported health workerssupported health workers

Rationale for Health Workforce Strategic Rationale for Health Workforce Strategic PlanningPlanning

1. 1. HWF ShortagesHWF Shortages

2. Lack of reliable, harmonized data on HWF 2. Lack of reliable, harmonized data on HWF

3. Resource Constraints3. Resource Constraints

4. Partnership development4. Partnership development

5. Requirements are diverse categories 5. Requirements are diverse categories HWF HWF

Health Workforce Health Workforce ImbalancesImbalances

HWF Density in SEAR HWF Density in SEAR (doc,nur,mw,dent,pharm,lab tech only)(doc,nur,mw,dent,pharm,lab tech only)

Density of Health Work Force in SEAR Countries

0 10 20 30 40 50 60 70 80 90

Bangladesh

Bhutan

DPRK

India

Indonesia

Maldives

Myanmar

Nepal

Sri Lanka

Thailand

Timor Leste

SEA Region

Total Health workers per 10 000 population

WHY do we need HWF Strategic Planning?WHY do we need HWF Strategic Planning?

““Strategic Planning for HWF”Strategic Planning for HWF”

Coordinated: multi factorial, multi-stakeholders Coordinated: multi factorial, multi-stakeholders involvementinvolvement

Systematic: time constraints, resource limitationsSystematic: time constraints, resource limitations

National HWF Policy approachNational HWF Policy approach

Partnership between national and international Partnership between national and international developmental partnersdevelopmental partners

Medium-term or long-term vision to achieve targetsMedium-term or long-term vision to achieve targets

The Strategic planning frameworkThe Strategic planning framework

The strategic framework consists of six steps which are:-The strategic framework consists of six steps which are:-

Health Workforce Situational analysisHealth Workforce Situational analysis

Problem Identification & PrioritizationProblem Identification & Prioritization

Projection of HWF Needs and Demands Projection of HWF Needs and Demands

HWF Policy Review and Identification of Strategic Areas HWF Policy Review and Identification of Strategic Areas

Formulating the Strategic PlanFormulating the Strategic Plan

Monitoring and EvaluationMonitoring and Evaluation

Health Workforce Strategic Planning FrameworkHealth Workforce Strategic Planning Framework

Six major factors influencing the entry, Six major factors influencing the entry, sustainability and exit from HWF IN HSsustainability and exit from HWF IN HS

Education and trainingEducation and training HWF ManagementHWF Management HWF FinancingHWF Financing HWF PolicyHWF Policy PartnershipsPartnerships LeadershipLeadership

1.Education/Training of HWF1.Education/Training of HWF Pre-service education/training; institutional capacity Pre-service education/training; institutional capacity

In-service education and training and capacity building. In-service education and training and capacity building.

Relevance of curricula to address country’s health needRelevance of curricula to address country’s health need

Inclusion of soft skillsInclusion of soft skills

Faculty development. Faculty development.

Accreditation system for internal and internal &external Accreditation system for internal and internal &external quality assurance mechanism. quality assurance mechanism.

Medical and Health professional education research for Medical and Health professional education research for innovations in education to address current HWF problems.innovations in education to address current HWF problems.

2.HWF management capacity2.HWF management capacity Density and distribution of HWF, with regard to Density and distribution of HWF, with regard to

equitable coverage, gender equity and relevance, equitable coverage, gender equity and relevance, appropriate skill mix appropriate skill mix

HWF information system, regular updating of HWF HWF information system, regular updating of HWF data including private sector and NGOs, health data including private sector and NGOs, health workforce in numbers, competencies and workforce in numbers, competencies and distribution distribution

Financing of HWF which consists of salary profile Financing of HWF which consists of salary profile of different categories of HWF, for different of different categories of HWF, for different geographic areas, different sectors, and geographic areas, different sectors, and

Incentive system for manning remote health Incentive system for manning remote health centers.centers.

2.HWF management capacity2.HWF management capacity HWF support for housing, healthcare, HWF support for housing, healthcare,

transportation and children’s education and transportation and children’s education and welfare, working environment supportive for welfare, working environment supportive for maximum performance; facilities and equipments, maximum performance; facilities and equipments, drugs, supplies and support staff. drugs, supplies and support staff.

Opportunities for promotion, personal and Opportunities for promotion, personal and professional development for HWF. professional development for HWF.

Data, information and causes for attrition, brain Data, information and causes for attrition, brain drain, migration pattern and presence of “ghost drain, migration pattern and presence of “ghost health workers” or absenteeism.health workers” or absenteeism.

3.HWF policy and regulations3.HWF policy and regulations Is there HWF policy reflected in the National Health Is there HWF policy reflected in the National Health

Policy of the country?Policy of the country?

Work load indicators and staffing needsWork load indicators and staffing needs

Deployment policies, recruitment policies, transfer, Deployment policies, recruitment policies, transfer, promotion, grievances, incentives including performance-promotion, grievances, incentives including performance-based incentives, and career advancement policies. based incentives, and career advancement policies.

HWF exit policy: pension and gratuity entitlements have HWF exit policy: pension and gratuity entitlements have to be taken into account.to be taken into account.

Regulations on ethical conduct, liability and quality Regulations on ethical conduct, liability and quality assurance mechanisms for the HWF, both in public and assurance mechanisms for the HWF, both in public and private sector.private sector.

3.HWF policy and regulations3.HWF policy and regulations

Relationship between HWF and Public Health Relationship between HWF and Public Health standard at different level of health facilities.standard at different level of health facilities.

Coordination with other related sector/departments.Coordination with other related sector/departments.

International code of conduct for recruitment of International code of conduct for recruitment of health professionalshealth professionals

4. HWF Financing4. HWF Financing Macroeconomic profiles:Macroeconomic profiles:

national health accounts and national health accounts and national health spending in relation to GDP, national health spending in relation to GDP, national budget for HRH development, national budget for HRH development, other sources of funding /spending for HRH other sources of funding /spending for HRH

Salary rates of different levels of HRH and other Salary rates of different levels of HRH and other entitlementsentitlements

Salary rates compared to bench marks in the Salary rates compared to bench marks in the other sectorsother sectors

4. HWF Financing4. HWF Financing Ratio of public to private out of pocket spending for Ratio of public to private out of pocket spending for

healthhealth

Health spending on non-salary financesHealth spending on non-salary finances

Multiple job holdings may result due to low salaries. Multiple job holdings may result due to low salaries.

Moon-lighting in the private sector is one strategy for Moon-lighting in the private sector is one strategy for HWF in the public sector to survive, however it can HWF in the public sector to survive, however it can lower the efficiency in the public sector. lower the efficiency in the public sector.

Supportive working environment with essential Supportive working environment with essential logistics logistics

5.HWF partnerships5.HWF partnerships Partnerships with international developmental Partnerships with international developmental

partners partners

Existences of co ordination mechanisms for Existences of co ordination mechanisms for international funds to align with national health international funds to align with national health priorities and effective scaling up of health workers priorities and effective scaling up of health workers training and education. training and education.

Partnerships with academic professional bodies for Partnerships with academic professional bodies for quality assurance and accreditation such as the quality assurance and accreditation such as the World Federation for Medical Education.World Federation for Medical Education.

Partnerships with the Global Health Workforce Partnerships with the Global Health Workforce Alliance and the Asia-Pacific Action Alliance of Alliance and the Asia-Pacific Action Alliance of Human Resources for Health Human Resources for Health

5.HWF partnerships5.HWF partnershipsHWF issues relating to international migration requires HWF issues relating to international migration requires policy dialogue with international organizations like ------policy dialogue with international organizations like ------

International Labour Organization (ILO), International Labour Organization (ILO), International Organization on Migration (IOM), International Organization on Migration (IOM), Organization for Economic Co operation and Organization for Economic Co operation and

Development (OECD), Development (OECD), Government to Government negotiations in ethical Government to Government negotiations in ethical

recruitment practices, and partnership building recruitment practices, and partnership building becomes important. becomes important.

Private-public partnerships Private-public partnerships not onlynot only for scale-up of for scale-up of disease-specific programs and community-based disease-specific programs and community-based health workforce training and education to improve health workforce training and education to improve coverage, but also for training and multi-skilling of HWFcoverage, but also for training and multi-skilling of HWF

6. HWF leadership6. HWF leadership

Leadership development for HWF Leadership development for HWF planning and management.planning and management.

Focal point for HWF, National Committee Focal point for HWF, National Committee for HWF development, for HWF development,

Multi-stake holder mechanism is in place Multi-stake holder mechanism is in place or not.or not.

Future Plan for working togetherFuture Plan for working together

Assist member countries to develop and Assist member countries to develop and implement CSP- HWFimplement CSP- HWF

Scaling up of training and education of all Scaling up of training and education of all categories of HWF inclusive of CBHW, CBHV. categories of HWF inclusive of CBHW, CBHV.

Innovative educational interventions: Innovative educational interventions: need based, need based, team-based, team-based, field-based curricula review, field-based curricula review, better co ordination between training and needbetter co ordination between training and need

Financial support to employ and deploy the Financial support to employ and deploy the trained workforcetrained workforce

Future Plan for working togetherFuture Plan for working together

HWF management capacity: HWF management capacity: for HWF recruitment and equitable for HWF recruitment and equitable

deployment, deployment, working conditions conducive for optimal HWF working conditions conducive for optimal HWF

performance, performance, supportive supervision, supportive supervision, incentive system for retention.incentive system for retention.

Pooling of Financial resources: Pooling of Financial resources: for long term investment on HWF for long term investment on HWF

development, development, harmonization and alignment of donors to harmonization and alignment of donors to

national priorities.national priorities.

Health System Strengthening by Health System Strengthening by PHC PHC

HWF is vital for health system HWF is vital for health system strengtheningstrengthening

CBHW & CBHV are vital to delivery of CBHW & CBHV are vital to delivery of health carehealth care

HWF development to strengthen Township HWF development to strengthen Township health system health system

Projection of HWF Needs and Demands Projection of HWF Needs and Demands Supply ForecastingSupply Forecasting

What numbers of HWF by category are available currently?What numbers of HWF by category are available currently?

What is the geographic distribution of different categories of What is the geographic distribution of different categories of HWF?HWF?

What is the attrition rate?What is the attrition rate?

Exit from HWF rate and pattern?Exit from HWF rate and pattern?

Rate of internal and external migration?Rate of internal and external migration?

Recruitments from other sources? Government –to –Recruitments from other sources? Government –to –government MOU for recruitment of HWF?government MOU for recruitment of HWF?

What categories need to be scaled-up training?What categories need to be scaled-up training?

Projection of HWF Needs and Demands Projection of HWF Needs and Demands Supply ForecastingSupply Forecasting

Is there institutional capacity for scaling up training without Is there institutional capacity for scaling up training without compromising the quality of output?compromising the quality of output?

What are the logistic support required and faculty needed What are the logistic support required and faculty needed for scaling up training?for scaling up training?

How long will it take to build institutional capacity to meet How long will it take to build institutional capacity to meet the needs?the needs?

How much financial support will we need to meet the How much financial support will we need to meet the supply costs?supply costs?

How do will fill the supply gap?How do will fill the supply gap?

Does the current HWF production policy support the Does the current HWF production policy support the proposed action to meet the supply needs? proposed action to meet the supply needs?

Projection of HWF Needs and Demands Projection of HWF Needs and Demands Demand ForecastingDemand Forecasting

There are two types of demand, one from the supplier of There are two types of demand, one from the supplier of health care side (public and private sector) and the other from health care side (public and private sector) and the other from patients or clients. patients or clients.

When carrying out a demand analyses there are many other When carrying out a demand analyses there are many other non-health factors that need consideration. non-health factors that need consideration. Economic growth of the country, Economic growth of the country, growth of the private health sector, growth of the private health sector, patients’ changing expectations are few factors that will shape up the patients’ changing expectations are few factors that will shape up the

countries health service demands. countries health service demands.

For example in a country with rapidly expanding economic For example in a country with rapidly expanding economic growth leading to rapid expansion of the private health sector, growth leading to rapid expansion of the private health sector, health trade and tourism, health trade and tourism, demands for health workers for the private sector demands for health workers for the private sector has to be taken into account, so that the public sector will be able to has to be taken into account, so that the public sector will be able to

attract and retain sufficient health personnel. attract and retain sufficient health personnel.


Demand ForecastingDemand Forecasting

What types of HWF do we need most for the What types of HWF do we need most for the functioning of the health system according to functioning of the health system according to findings of situation analysis?findings of situation analysis?

What tools will we use to project the need?What tools will we use to project the need?

What is the ideal (bench mark) and what is the What is the ideal (bench mark) and what is the current situation? current situation?


Demand ForecastingDemand Forecasting

What are the gaps for optimal function of the What are the gaps for optimal function of the health system?health system?

How do we fill the gaps? Scale-up How do we fill the gaps? Scale-up production/training or scale-up recruitment?production/training or scale-up recruitment?

How much financial support will we need to fill How much financial support will we need to fill the gap?the gap?

Does the current NHP support the proposed Does the current NHP support the proposed action to meet the demand of the health action to meet the demand of the health system? system?


Methods of HWF demand projection Methods of HWF demand projection There are many methods that have been developed There are many methods that have been developed

over time for health workforce demand projection of over time for health workforce demand projection of which some are basic and some requiring computer which some are basic and some requiring computer software applications. software applications.

The basic methods that have been continuously used The basic methods that have been continuously used for demand projection by many countries are:for demand projection by many countries are: HWF requirements based on the population ratiosHWF requirements based on the population ratios HWF requirements based on service demands HWF requirements based on service demands HWF requirements based on health system needs HWF requirements based on health system needs Work load indicators and staffing needs (WISN) Work load indicators and staffing needs (WISN) ““Soft PODD which is a Software Tool for Online Soft PODD which is a Software Tool for Online

Policy Diagnosis and Dialogue”. Policy Diagnosis and Dialogue”.

Health & Medicine

Human resources for health2010 25th june mph