Health workforce education and development and Human Resource in the health sector.
- 1. Health workforce education & development and Human Resource in the health sector” Dr. Elsie Kiguli-Malwadde Director Health Workforce Education and development African Centre for Global Health and Social development (ACHEST) Hon Assoc Prof,Makerere University 1st African Biomedical Scientists' Conference 2nd March 2019
- 2. Outline • Health System • Shortage • Education and training • Governance and planning ( management) • Migration and Retention • Challenges • Research • Recommendations
- 3. Components of a Health System Health System Services delivery Health Workforce Health Information Finances Leadership and Governance Supplies, Meds, Technologies
- 4. Health Workforce • Single most important input into the health system. • It is the resource that puts all other resources into motion
- 5. "To ensure access to a motivated, skilled & supported health worker by every person, in every village, everywhere." Dr LEE Jong-wook, 1945-2006 WHO Director-General Health Workers for All and All for Health Workers
- 6. Health Workforce Densities • Require adequate density of the health workforce (Doctors, Nurses and Midwives, Biomedical Scientists etc) to population to assure skilled attendance • According to 2006 WHO report, Uganda is among the 36 countries with critical shortage
- 7. Disease burden Vs HWF Physician Workforce
- 8. Education: Critical entry point • Train and retain • Education Institutions are factories: good factory = good product; bad factory = bad product • Synchronize- HWF education and training with the health service system.
- 9. History • The growth of HPE in Sub-Saharan Africa -the growth of bacteria inoculated into a culture medium. • Now in the 3rd Phase Prof Monekosso, G.L. Lag phase ACCELERATION PHASE EXPONENTIAL PHASE DECLINE PHASE STATIONARY PHASE Death Phase
- 10. Medical Education Partnership Initiative • 130 million project funded by the US government • 13 schools in 12 countries in SSA • Network of 40 regional partners, health and education ministries • 30 U.S Collaborators.
- 11. 5 MEPI AIMS/Outcomes Increasing the numbers and quality of HCWs trained CAPACITY#1 Retaining HCWs over time and in areas where they are most needed #2 RETENTION Supporting regionally relevant research #3 RESEARCH Sustainability of the programs #4 SUSTAINABILITY Creating communities of Practice #5 COMMUNITIES OF PRACTICE
- 12. Required Competencies: Fit For Purpose(FFP) • Prepared to work where services are most needed: selection process, attitudes, socially accountable • Able to respond to health needs of community: training in real life situations in community • Able to deliver quality care with available (limited) resources. (Achieving the most with available resources.) • Clinical excellence as foundation for teaching and research. • Able to be a leader, manager , teacher mentor, and change agent: Continuous self directed learners • Effective communicators: problem based learning, practice based learning
- 13. Quality Assurance • Strong Regulatory Bodies • Strict and Independent Accreditation • Strong Professional Associations • Supportive Supervision • Educated Demand- Evidence based • Self Assessment
- 14. Health Workforce Regulatory Framework • Uganda has laws, policies and regulations governing manpower development. • However current policy and legal instruments not sufficient to mitigate -ve impact of HRH distribution & migration. • A particular gap in the policy landscape is the absence of any instruments regulating the mobility of health personnel Relevant Policies on Health Workforce • National Health Policy 2010, • Human Resources for health Policy 2006, • Human resources for Health Strategic plan 2005/2006 – 2019/2020,
- 15. Health workforce migration Trends in Uganda • Between 2010 and 2015, 265 GPs got LOGS out of a total of 2,915 to migrate from Uganda, giving an attrition rate of 9% per annum. • In 2018 alone indication is that from Jan to Aug, close to 167 Medical and Dental practitioners left the country • 89% of migrating GPs were below 40 years of age, showing that younger GPs were more likely to migrate • Approx net loss of 10% of the health workforce migrated over a five year period 2010-15
- 16. HRH Leadership and Governance • Planning • Recruitment (entry) Employment retention departure • Welfare (live and work in dignity in the communities they serve)
- 17. Challenges • Production and competencies • Insufficient financial resources • Absenteeism • Job satisfaction and compensation • Attitude • Cumbersome recruitment exercise • Ceiling on Recruitment
- 18. Policy Options • Expand education and training capacity • Improve retention • Enhance workforce integration (Attracting those who have left the workforce) • Adapting a more efficient skills mix • Improving productivity (linking performance with reward) • Conducive working environment (tools. medicines e.t.c)
- 19. Recommendations • Need for a New HWF Strategy/Policy • Streamlined MOH management structures for monitoring, (HSC, DSC, recentralization of recruitment) • Linking education to health systems(Service) • Updating the staff norms • Improve conditions of service
- 20. Role of Biomedical scientists • bio-medical scientists take part in various aspects of biomedical science – health professional training and medical education – health care delivery – biomedical basic science research.
- 21. Researchers • LMIC invest 1% GDP in Research • Challenges – Insufficient funding – Lack of political support – Few trained researchers – Absence of supporting research environment – Inadequate Infrastructure – Donor driven research – Inability to publish
- 22. Conclusion • Right Track • Dialogue • Dissent • Team work
- 23. Conclusion • Health Professions Education in Africa is in the exponential phase • Expand education, research and training capacity • Quality Versus Quantity=Balance • Improve retention • Fund Research and Research Training at Health Professions’ Schools • Encourage researchers to publish their work.