How To Pass A Postgraduate Certificate In Human Resources For Health Management

Transcription

1 HEALTH SERVICES ACADEMY ISLAMABAD Post Graduate certificate in Human Resources for Health Management Summary Report Dr Abdul Majeed, Instructor-HRH 2011 HEALTH SERVICES ACADEMY Ministry of Health Government of Pakistan Collaboration of Queen Margaret University, Edinburgh & German International Cooperation (GIZ), Pakistan

2 TABLE OF CONTENT LIST OF ABBREVIATIONS Background: Introduction: Aim of the Course: Objectives of the Course: Course Coordinators: Module Descriptions: Module-I (Code: NM-251)... 8 Aims:... 8 Objectives:... 8 Content: Module-II (Code: NM-252):... 9 Aim:... 9 Objectives: Content: Module-III (Code: NM-253): Aim: Objectives: Content: Induction, Matriculation and Inauguration: Facilitators: Learning and Assessment: Participants: Personal Academic Tutors (PAT): Class Representation: Attendance Summary: Result of PG Cert HRH, 2011: Students Feedback annexes ANNEX-I: PERSONAL ACADEMIC TUTOR (PAT) LIST ANNEX-II:CONTACT DETAILS OF HRH STUDENTS Photo gallery: H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 2

3 LIST OF TABLES & FIGURES LIST OF TABLES: Table 1: Locality of the students LIST OF FIGURES: Figure 1: Province wise Distribution of Studnents H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 3

4 LIST OF ABBREVIATIONS HRH PG Cert WHO UK SCOTCAT HSA QMU PMDC PNC WISN LHW PIMS Human Resources for Health Post Graduate Certificate World Health Organization United Kingdom Scottish Credit Accumulation and Transfer Health Services Academy Queen Margaret University Pakistan Medical and Dental Council Pakistan Nursing Council Workload Indicators of Staffing Need Lady Health Worker Pakistan Institute of Medical Sciences H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 4

5 1. BACKGROUND: There is increasing evidence of a strong correlation between the density of human resources for health (HRH) in a country and health outcomes of the population. But many countries lack the right numbers of health workers in the right places to deliver essential health interventions, such as immunization and skilled attendance at delivery. There are various causes of these shortages and imbalances; which include limited production capacity as a result of years of poor planning and underinvestment in health education and training institutions. Often, training outputs are poorly aligned with the health needs of the population. There are also "push" and "pull" factors that affect workforce retention and may encourage health service providers to leave their workplaces, including those related to unsatisfactory working conditions, poor remuneration and career opportunities, and other labour market pressures. In particular, the international migration of large numbers of health workers further weakens the already fragile health systems in many low and middle income countries. Underlying all this is the inability of national HRH information systems to generate adequate and timely data to inform evidence-based decision making for policies and programmes. The 2006 World Health Report identified 57 countries facing a health workforce crisis. Each of these countries has fewer than 23 health workers (doctors, nurses, midwives) per 10,000 people - the minimum required to achieve an 80% coverage rate for deliveries by skilled birth attendants or for measles immunization. The World Health Report 2006 working together for health contains an expert assessment of the current crisis in the global health workforce and ambitious proposals to tackle it over the next ten years, starting immediately. The report reveals an estimated shortage of almost 4.3 million doctors, midwives, nurses and support workers worldwide. Pakistan is one of the 57 countries that have been identified by World Health Organization as facing a crisis in Human Resources in Health (HRH). The WHO strategy for addressing the global health workforce crisis (the World Health Report 2006) describes WHO's vision and approaches to ensure that all people have equitable access to an adequately trained, skilled and supportive health workforce, in order to attain the highest possible level of health. H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 5

6 2. INTRODUCTION: Postgraduate Certificate in Human Resources for Health Management (PG Cert HRH) is a new course being offered at Health Services Academy (HSA), Islamabad in collaboration with the Queen Margaret University (QMU), Edinburgh and German International Cooperation (GIZ), Pakistan. This is a UK post-graduate qualification offered here in Pakistan which is a new venture not only in Pakistan but in this whole region. The course welcomes participants from many different places from within and beyond Pakistan. 3. AIM OF THE COURSE: The overall aim of this course is to enable its graduates to contribute to shaping national and local policies and organizational practices which will improve the planning, development and management of human resources as a key component of well functioning health systems and directly contribute to ensuring a competent, responsive and productive health workforce. Specially, this programme will give students the opportunity to: Undertake study of human resources in health at a more advanced level than has been previously available but in a relevant national and local context. Develop specialist competencies in the planning, production and management of human resources. Strengthen the evidence base for workforce planning, management and production both locally and nationally. Place human resource strengthening at the centre of health systems improvement. Positively influence the attainment of strategic development goals and targets. Impact positively on the continuing health workforce crisis. Advance a beginning career in human resources for health management. H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 6

7 4. OBJECTIVES OF THE COURSE: On completion of the course, participants should be able to: Recognise the key factors and forces shaping the needs and deployment of human resources in health systems and the contribution a health workforce makes to health and well being among different populations. Recognise and justify the value of human resources to health service organizations and act as an employee champion and advocate at senior management levels. Develop quality Human Resource policies and track their implementation. Contribute to positive organizational development, safe working environments and effective change leadership. Forecast human resource needs and develop short, medium and long range plans for health service organizations to meet those needs. Enable high quality employee development and learning initiatives to meet existing or future training needs in health systems. Ensure organizational compliance with local employment legislation and professional regulation frameworks. Create and manage performance management systems and work with other to manage individual performance issues. Recruit and retain suitably qualified and motivated staff; ensure departments have adequate personnel to meet service demands; provide applicants with realistic job and organizational previews. Administer organizations compensation and benefits systems efficiently. Communicate effectively with staff and senior management. Manage Human Resource information systems including: acquire, clean and analyse HR data and information; critically evaluate HR data; and to synthesise HR information into clear reports, posters and oral presentations. H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 7

8 5. COURSE COORDINATORS: Overall course leader for this PG Cert HRH was Ms Jean Robson from Queen Margaret University Edinburgh. She was responsible for the overall conduct of the course. However the course coordinator at Health Services Academy was Dr Sabrina Zaka. She was the first point of contact regarding the course. Ms Jean Robson and Dr Sabrina worked in close coordination for the smooth running of the course. 6. MODULE DESCRIPTIONS: This is a modular programme of study with the taught Postgraduate Certificate component extending over one 15-week semester, from middle of January to the end of April. This programme comprises of three modules. Each single module carries 20 SCOTCAT credit points at M level. Successful completion of 3 modules will accumulate the necessary 60 credit points to enable participants to qualify for the award of Postgraduate Certificate in Human Resources for Health (PG Cert HRH). 6.1 Module-I (Code: NM-251) First Module comprised of 20 credits, extending over two weeks time period, from 17 th January to 28 th January Aims: The aim of this module was to review the consequences of a systemic failure to address human resource issues in health systems and health care organizations at local, national and even global level. Participants were supposed to learn to take a strategic view of the human resource management, how human resource functions operate in health care organizations and how to develop and properly implement human resource policy and strategy. Objectives: The objectives of the module were; 1. Take a lead role in integrating human resource strategies and initiatives into the strategic plans of health care organization. 2. Prepare health human resource profiles for use in planning activities at local, regional or national level. H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 8

9 3. Using databases and other data sources identify staff flows, migration from and into the workforce, source of supply and recruitment, and service provision gaps at local, regional or national level. 4. Identify suitable strategic options and directions for health human resource planners based on agreed international standards. 5. Develop quality HR policies and track compliance with local employment policies and regulations. 6. Monitor information about staff in post through an HR information system, and produce regular monitoring reports. 7. Show leadership when engaging with process analysis and redesign, and facilitating positive and smooth change processes. Content: Content used in this module was; The global workforce crisis Country and district workforce profiles Understanding and measuring staff flows: migration, exits, main sources of supply Retaining health staff: why and how How do incentives work in the labour market? Strategic HRM roles and functions in health care organizations HRH Action Framework HR Policy Professional regulation Employment legislation 6.2 Module-II (Code: NM-252): The second Module also comprised of 20 credits, extending over two weeks time period, from 7 th February to 18 th February Aim: The aim of this module was to prepare participants to advance their competence in preparing workforce plans at National, regional and organizational level. Participants aimed to become familiar and competent with the various planning tools and models available to health planners, and be able to prepare high quality workforce plans based H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 9

10 on quantitative and qualitative approaches. The module was practical in orientation, offering students multiple opportunities to use different tools, software and techniques. Objectives: The objectives of the module were; 1. Use concepts of supply and demand to calculate workforce projections based on different planning scenarios. 2. Use key workforce planning tools including WISN, Birth Rate plus etc. 3. Undertake a re-profiling exercise for local health services 4. Prepare and monitor Workforce Plans. Content: Content used in this module was; 1. Workforce planning process 2. Work study Methods 3. Demand and supply side issues impacting on plans 4. Workload based methods WISN, Birth Rate plus, Dewdney etc 5. Facility based methods Skill mix, task shifting, re-profiling, ratio etc 6. HR metrics 7. Data and information needed for workforce planning 8. Data Collection and management 6.3 Module-III (Code: NM-253): The third Module also comprised of 20 credits, extending over two weeks time period, from 28 th February to 11 th March Aim: The aim of third module was to examine the theories and processes of managing and mobilising the health workforce to achieve service improvement from the standpoint of the mid-level health manager, including management issues such as recruitment, retention, staff development, performance issues and the difficult and sensitive skills of handling grievances and negotiations. The module was strong on skill development and practice. H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 10

11 Objectives: The objectives of the module were; 1. Draw on key concepts from motivation theories to explain performance issues including underperformance, dissatisfaction, poor work environments, team failure, and unplanned exits. 2. Use relevant techniques to recruit, select and retain talented and motivated staff and work with other managers to achieve this. 3. Create and/or manage effective performance management systems for health service organisations and health workers. 4. Identify organisational & individual training needs and match these to training opportunities. 5. Enable the health service organisation to deliver or contract out effective personal and professional development programmes to the entire workforce. 6. Communicate effectively to the workforce and help other managers to improve internal communications within the organisation. 7. Create or support a positive working environment for all grades of health staff. Content: Content used in this module was; 1. The nature of HRM in health organisations 2. Using recruitment procedures, tools and functions; selection panels and good interview techniques; 3. Retention functions and procedures; 4. Staff appraisal functions and how to do them well 5. Preparing job related documents (e.g job descriptions) 6. Job analysis studies 7. Organizing and conducting job evaluation exercises 8. Understanding motivation in the workforce 9. Performance management techniques 10. Facilitative supervision techniques 11. New training and staff development techniques 12. HTI audit 13. Training need assessments 14. Training Evaluations H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 11

12 7. INDUCTION, MATRICULATION AND INAUGURATION: Induction and Matriculation of the selected candidates for the course was conducted on 15th and 16th of January A brief introduction about the course was given by the course leader, Ms Jean Robson. Dr Saira Tariq, Instructor-HSA, gave a brief orientation presentation about Health Services Academy to all the newly inducted students of PG Cert HRH. Then the students were matriculated with QMU for the said course. The course was started on 17 th January 2011, after a formal Inauguration ceremony at Health Services Academy attended by the Federal Minister of Health, Executive Director, HSA, Representatives from QMU, GIZ & USAID at Health Services Academy. 8. FACILITATORS: For this course, teaching was mainly done by the facilitators from Queen Margaret University. However, few of the facilitation were also done by the core and adjunct faculty members of Health Services Academy. Name of facilitators who contributed in teaching PG cert HRH, included; Ms Jean Robson (QMU) Ms Marilyn McDonagh (QMU) Ms Joyce Smith (QMU) Dr Assad Hafeez (HSA Core faculty) Dr Saira Tariq (HSA Core faculty) Dr Fatima Bajwa (HSA Core Faculty) General Usmani (External Facilitator-AFPGMI/Army Medical College) Dr Zulfiqar Khan (External Facilitator-WHO) Dr Suhail Hashmi (External Facilitator-PMDC) Dr Arshad Chandio (External Facilitator-LHW Program) Ms Nuzhat Sultana (External Facilitator-Shifa International Hospital) Ms Humaira Gul (External Facilitator-PIMS hospital) Dr Jahanzeb Aurakzai (External Facilitator-PIMS Hospital) Dr Azhar (External Facilitator-Pakistan Red Crescent Society) Dr Zahid Larek (External Facilitator-PIMS Hospital) Mr Lundy Keo (External Facilitator-GIZ) Mr Uzair Malik (External Facilitator-Shifa International Hospital) Dr Nadeem (External Facilitator-PMDC) Ms Nighat Durrani (External Facilitator-PNC) Ms Zara Ladhani (External Facilitator-PNC) H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 12

13 9. LEARNING AND ASSESSMENT: The method of study used is called blended learning. This means that the course was made up of a number of components, including self-tests, class-based learning, readings, videos, virtual learning environment (WebCT), small student led group work and practical field exercises. This involved the students in becoming an active learner, taking responsibility for motivating yourself, pacing their studies and managing their workload. The students were expected to actively participate in the discussions, debates and activities in both the face to face sessions and also the on-line discussions through the use of WebCT. The students were expected to be able to cope with increased independent learning and to use their tutor as a resource rather than a provider of knowledge. To keep the teaching process interactive, interesting, understandable and effective; multi-methods were used. For example; Study Pack Multimedia presentations Use of Flip Charts Use of white board Zopp cards Group work & Presentations Field Visits Exercises Assessment strategies included both formative and summative. Assessment is academically challenging and facilitates the application of reflective skills, critical analysis and reasoned decision making. This was achieved through the use of varied strategies such as oral and poster presentations, written assignments, reports, attendance in the class and active participation during group work and class discussions. Every participant was provided with two books (Student Handbook & Module 1 Study Pack). Continuous electric supply was ensured to avoid any un-necessary delay and interruptions resulting in wastage of time during the course of study. H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 13

14 10. PARTICIPANTS: The Senior and Mid-Level managers of both Public and Private sector attended the course. The faculty and students of HSA who want to build their career in HRH were also enrolled in the course. A parliamentary Secretary for Health and Member National Assembly has also attended the PG Cert HRH. The programme is expected to develop special competencies in the management of Human resources amongst the students. The course will also contribute in research and knowledge production in the field of HRH. A total of 25 students mainly comprising of male (72%) were registered with QMU for the PG certificate HRH course. The students had liberty to register themselves as full time or part time. The full time student had to attend all the three modules in the same year. While part time students can complete the program within three years. 20 students were registered as full time while five students were registered as part time. For module-i (NM-251) & module-iii (NM-253), 23 students were registered while 21 students were registered for module-ii (NM-252). Students from different provinces of the country attended the course (shown in table & graph below) TABLE 1: LOCALITY OF THE STUDENTS S.No Domicile No. Of Students %age 1. KPK AJK Punjab Sindh Balochistan 1 4 Total 25 H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 14

15 FIGURE 1: PROVINCE WISE DISTRIBUTION OF STUDNENTS 4% 12% 16% 44% KPK AJK Punjab Sindh Balochistan 24% 11. PERSONAL ACADEMIC TUTORS (PAT): Every student was allocated a Personal Academic Tutor who was there to support them through learning on the programme. The students discussed issues relating to their studies on the programme with their PATs. The PATs also offered pastoral care in times of stress and assisted them in claiming extenuating circumstances. The list of PAT is as under (Details Annexed) 1. Dr Saira Tariq (HSA) 2. Dr Fatima Bajwa (HSA) 3. Dr Majid Shahzad (HSA) 4. Dr Abdul Majeed (HSA) H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 15

16 12. CLASS REPRESENTATION: As per criteria of QMU & HSA, two representatives from the class were elected through voting system. All the class members participated in voting for their representatives. Dr Shahzad Faisal was elected as the Class Representative while Dr Shefa Haider was elected as Deputy Class Representative by the class. 13. ATTENDANCE SUMMARY: Levels of students attendance during the HRH course have been the focus of HSA and QMU interest. So attendance record was maintained for each student throughout the course. Attendance for each student was recorded twice a day (morning & evening session). During the attendance analysis it was found that majority (90%) of the students had had very few recorded periods of absence, which is very encouraging especially when the students comprise of elected members of national assembly and senior level managers. The attendance percentage was highest for module-ii (NM-252). No students had less than 50% attendance for module-iii (NM-253). It was also observed that method for recording the attendance was not well organised so the possibilities of human errors could not be ruled out in recording the attendance during classes. 14. RESULT OF PG CERT HRH, 2011: Total seventeen students have successfully earned Post Graduate Certificate in HRH from Queen Margaret University. Three out of twenty full time registered students are required to re-submit their assignments by August, For the Part time students, four out of five students (80%) have successfully cleared their respective modules. One part time student will also have to re-submit the assignment by August, STUDENTS FEEDBACK Each student was asked to fill a module evaluation form at the end of each module for their feedback. Likert scale was used for the feedback from students. Analysis of the feedback was done using SPSS version 16. The results of feedback are discussed in detail below. H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 16

17 15.1. LEARNING OBJECTIVES WERE ACHIEVED: Most of the students agreed persistently over the all three modules that learning objectives for each module were successfully achieved. However responses for the second (NM-252) module were inconsistent with the other two modules. Perhaps this may be because a lot of calculations (WISN, Aberdeen, birth rate plus, Dewdney etc) were involved in the second module, which were not easy for the students CLASSES WERE GENERALLY WELL PREPARED AND ORGANIZED Majority of the students reported that classes were well prepared and organized during the whole PG cert course. Similar problem is noticed for module II (NM-252) in which some students disagreed ADEQUATE HELP WAS AVAILABLE WHEN NEEDED Majority of the student agreed that adequate help was available when needed in all the three modules. However percentage for the response strongly agree decreased over the subsequent module PACE OF MODULE As whole students were comfortable with the pace of the module, however for module-iii (NM-253) students found the pace fast COURSE WORK Students found second module (NM-252) as most difficult one amongst all the three modules. This may be again due to the same reason of numerous calculations were involved in this particular module. Fortunately none of the student found any of the modules far too difficult. It is also noticeable that no student considered any module far too easy. This depicts that the curriculum for the PG cert is well prepared taking the students capabilities in consideration AMOUNT OF COURSE WORK REQUIRED Most of the students reported that amount of the course work required was neither too little nor too much. However according to 47% of the students the course work for module-iii was much which should be taken in to consideration FEED BACK ON PROGRESS Feed back on progress of module-i and module-iii was reported good by majority of students, however progress for module-ii (NM-252) was not reported as good by majority of the students. H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 17

18 15.8. LIBRARY RESOURCES The students had varied experiences with library resources in all the three modules of PG certificate; however majority of the students reported neither good nor poor. Overall students were not comfortable with library resources IT RESOURCES IT resources area was found to be the most concerned area by the students during all the three modules, perhaps because of their poor background/previous knowledge regarding IT OVER ALL THE MODULE WAS The overall impression of the students about all the three modules was encouraging as majority of the participants found the course interesting. The least interesting module in PG cert HRH was module-ii (NM-252) in which 21% of students reported the module as either boring or extremely boring. The students were also asked to fill any comments and observations regarding the each module in four main categories; THREE KEY THINGS LEARNED: Most of the students stated that during first module (NM-251) they learnt the importance of HRH, problem analysis and improvement in personal skills. Few students mentioned specific topics from the course contents which they learnt during the course duration. During Module-II (NM-252), according to the students they learnt Workforce planning, WISN and other planning tools. While in the last module (NM-253) the students said that they learnt performance appraisal, Job analysis, writing and re-designing job descriptions, motivation and training need assessment THREE THINGS LIKED: Majority of the students appreciated the teaching methodology and the facilitation provided by the facilitators during their stay at HSA for all the three modules of PG cert HRH. The students also liked the classroom environment, group work, practical work and content of the course of all the three modules. H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 18

19 THREE THINGS THAT COULD BE IMPROVED: Better IT/internet resources and Accommodation were the top most points mentioned by the students which need improvement. Cleanliness of hostel and cafeteria was another concern of students. The students also showed some concern about the handouts, like the handouts should be provided prior to the lecture and should be with large font size. Few students were of the view that the timing for group work should be increased. Scholarship issues, mechanism for feedback after each session and quality of the external facilitators were some other areas highlighted by the students to be looked into. During first module (NM-251) the students mentioned that there should be some time spared for tea break after the first session which was adjusted by the module coordinators for the rest of two modules. For Module-II (NM-252) the student demanded for more time to understand the planning tools and calculation (WISN, Aberdeen etc). The students also stated that all the students should be given equal time and each students should be involved during the calculations. For module-iii (NM-253), the major concern of the students was about the external facilitators. According the students they have bossy attitude in the classroom COMMENTS FOR FACILITATORS: All most all the students highly appreciated the facilitators regarding their competency, cooperation, support and encouragement. According to the students the facilitators are mature, hardworking, punctual and friendly however according to the one of the student the facilitators from HSA were too busy in other issues. H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 19

20 Dr Abdul Majeed Dr Fatima Bajwa Mr Majid Shahzad Dr Saira Tariq Post Graduate certificate in Human Resources for Health Management ANNEXES ANNEX-I: PERSONAL ACADEMIC TUTOR (PAT) LIST Personal Academic Tutor (PAT) S.No. Name of the Students Name of PAT 1 Mohammad Naeem 2 Syed Hafeez Ahmed 3 Khawaja Aftab Ahmed 4 Muhammad Kashif Rajput 5 Amna Chishti 6 Farzana Andaleeb 1 Mahreen Bhutto 2 Ejaz Sahu 3 Siraj Mohammod 4 Shefa Haider Sawal 5 Mariyam Sarfraz 6 Kamran Ajaib 1 Jehanzab Khan Aurakzai 2 Irum Kamran 3 Imran Inayat 4 Aftab Hussain 5 Masood Ahmed Bukhari 6 Anisa Afridi 1 Sher Mohammad 2 Mushtaq Khan 3 Ramesh Kumar 4 Faisal Shahzad 5 Farhat Shaheen 6 Bilal Zafar H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 20

21 ANNEX-II: CONTACT DETAILS OF HRH STUDENTS Contact Details of HRH Students (2011) S.# Name of the Students Address 1 Abdul Majeed amjaffar@hotmail.com 2 Amna Chishti amna@hsa.edu.pk 3 Anisa Afridi anisaafridi@yahoo.com 4 Muhammad Kashif Rajput drkashif@hsa.edu.pk 5 Siraj Mohammod drsiraj1@hotmail.com 6 Mushtaq Khan drmushtaq692@yahoo.com 7 Kamran Ajaib mohammad.kamran@giz.de 8 Mohammad Naeem naeemphsa@yahoo.com 9 Ejaz Sahu dr.ejaz@hsa.edu.pk 10 Faisal Shahzad faishahzad@gmail.com 11 Farhat Shaheen farhat_7@hotmail.com 12 Imran Inayat imran@hsa.edu.pk 13 Jehanzab Khan Aurakzai draurakzai@gmail.com 14 Khawaja Aftab Ahmed drkhaftab@hotmail.com 15 Mariyam Sarfraz mariyam@gmail.com 16 Mahreen Bhutto bhuttomahreen@yahoo.com 17 Masood Ahmed Bukhari mabukhari26@yahoo.com 18 Syed Hafeez Ahmed hafeezjee99@yahoo.com 19 Sher Mohammad shermohamad@hotmail.com 20 Aftab Hussain draftab@hotmail.com 21 Farzana Andaleeb farzana.fatima2000@yahoo.com 22 Shefa Haider dshefa@gmail.com 23 Ramesh Kumar ramesh@hsa.edu.pk 24 Bilal Zafar bilal024@hotmail.com 25 Irum Kamran irum.kamran@giz.de H u m a n R e s o u r c e s f o r H e a l t h U n i t, H S A Page 21