Assessing and Determining Capacity challenges in Health. Dr Lilian Dudley Health Systems Trust 13 October 2005

Transcription

1 Assessing and Determining Capacity challenges in Health Dr Lilian Dudley Health Systems Trust 13 October 2005

2 Definitions Human resources for health (HRH) persons engaged in any capacity in the production and delivery of health services. These persons may be paid or volunteer, with or without formal training for their functions, and in the public or private sector. HRH encompass all individuals engaged in the promotion, protection, or improvement of population health, including clinical and non-clinical workers. (JLI, 2004) Human resources development (HRD), as applied to human resources for health (HRH), includes the planning, production, and management of health personnel.

3 Policy Framework National Health Act, 2003 Establishes National Health Council to develop policy and guidelines for, and to monitor the provision, distribution, development, management and utilization of, human resources in the national health system. Human Resources Planning required by Provinces & Districts

4 Strategic Framework for HRH Plan (Aug 2005) Pillars proposed: Human Resource Policy and Planning Human Resource Production HRH Management / Leadership (Capacity Development) HR Information System HRH research Monitoring and Evaluation

5 Human Resources for Health, Overcoming the Crisis, JLI 2004 Global crisis in HRH HIV &AIDS Shortages, maldistribution of HRH and migration Chronic underinvestment in HRH Poor work environments Weak knowledge base on HRH Five pronged strategic approach Engaging stakeholders Planning human investments Managing performance Develop enabling policies Learning for improvement

6 SAHR 2005 HST commissions and conducts research in support of strengthening health systems, including human resource aspects SAHR produced annually by HST since 1995 This year theme on Human Resources Commissioning of chapters & research to experts Reviewing - Peer (Internal & External) - NDoH & PDoH

7 Main Users DoH national, provincial and district, municipalities and parliaments Academic institutions, NGOs, Corporate sector, international community including foreign missions Often accessed through the web (

8 Key HRH issues in SAHR International Context National Strategic priorities (2004-9) HR Policies Financing of HRH (incl projections for ART & PHC) Nursing profession HRH at District Hospitals HRH for District Health System Mid-level workers Community Health workers Information for HRH Chapter on Health and related indicators

9 International Context Focus on HRH a.r.o HIV &AIDS and MDG s SSA has lowest ratios of health workers to population HRD deficiencies Lack of planning results in recruitment from other countries Production not in keeping with needs (no.s, skills, PHC) Management poor resulting in low morale, and poor performance Migration Push & Pull factors Role of Nepad (Health strategy and HRD doc) Resolution on intnl recruitment and migration of HRH at WHA, May 2005

10 Review of 10 Point plan ( ) Backdrop of SA as developmental state. Balanced review with many things being achieved (e.g. smoking reduction, health act) and less success in other areas (e.g. HRH, TB, cervical cancer screening) HRH a critical constraint to achieving other targets 40% of PHC facilities have trained PHC nurses Recommendations a Politicians & managers communicate a vision/mission that resonates with front line health workers. Followed by clear operational strategies. a A programme of action that is developed with and that captures the imagination of implementers. a An effective governance and management system. a A critical mass of skilled and motivated health managers and health workers at all levels.

11 District Health System Health Act v positive and big step forward Challenges alack of clarity of assignment/delegation to LG acooperative governance ahow district health team will function ademotivation of health workers HR management needs attention asingle public service

12 Human Resources: District Hospitals & PHC Rural and scarce skills +ve feature. Needs PHC nurses included, also standardised definition of rural. Appropriate training & support of hospital managers required; balancing financial mgt with service care & quality. Recruitment and retention of professional staff (especially nurses and doctors) needs private sector approach. Strengthening community- based and mid-level health workers is needed; cooperation of all professional bodies and unions required. Continuing Education is an enormous but vital challenge that needs support and supervision to accompany it.

13 ART and PHC Financing and HR needs ART a Conditional grant funding (R325m) covers current 50,000 on ART. a By 2009, full coverage of 1, , cost will be R6.5b a HR requirements: 3100 doctors, 2300 nurses, 765 social workers, 765 dieticians, 2000 data capturers. PHC (2009) full package of services a Current 2.5 visits p.a. to increase to 3.85 a Current spending needs to double to R308 per person. a Translates into R13.5b required a If PHC continues in hospital OPDs an extra R4.5b a R1.8 billion needed for CHW programmes by 2009/10

14 Nursing During the period the growth in the no. of all nurses was < than increase in population growth. At same time increase in demand (HIV) & migration Production of new professional nurses declined from 2682 (1997) to 1553 (2003). Nursing colleges produce over 80% of all professional nurses. All universities together have total graduation of 400 p.a. (e.g. 3 universities in W.Cape produce 50 nurses p.a.) Over 40% of all professional nurses produced via bridging course

15 Nursing (Cont) Enrolled nurse training increased off low base. Private sector now producing more p.a. than public sector nursing colleges; (>90% of private in KZN & Gauteng). Private sector responsible for bulk of auxiliary nurse training (75%). This is concentrated in Gauteng and KZN (90%) Public Sector training also not equitably spread. Eastern Cape producing very few enrolled & auxiliary nurses

16 Mid-level Health Workers Pharmacists Assistants v successful case study but still challenges remain. Rehabilitation workers initially successful but then fizzled out for number of reasons. Dental assistants did not achieve goals. Ground prepared for medical assistants but number of outstanding issues (hospital/clinic; scope of practice vs nurses) All need full stakeholder buy-in & career planning

17 Information for HR PERSAL has primary function to manage salaries. Rest of info not accurate. Improve the completeness and accuracy of nonsalary information (e.g. staff establishment) on PERSAL to increase the use of information. Routine info system for HR mgt would create a culture of info & appreciation for importance of info. The Goals & Indicators for 2001/05, (NDOH) is good starting point for information requirements for HR management.

18 Indicators New NIDS will provide wide range of indicators from facility level to national. Population estimates below provincial level uncertain; district indicators (e.g. immunisation coverage) unreliable. Utilisation rates PHC steadily improving over past 5 years. Large amount of information on HR New section on MDGs. International comparisons difficult as different data sources used.

19 Research & Info Needs (Strategic Framework) Norms and Standards/ Staffing establishments/workload Availability and Distribution Impact of retention strategies incl. special allowances Health Education and Training Funding Interface between DOH & DOE Rethinking settings of training (AHC or DHS) Nursing education reform Continuing Professional Development

20 Research Agenda cont.. Career progression New Health Worker Cadres Role of CHW s Structures and systems for effective HRH planning and management Impact assessments of HRH planning

21 Summary Priority is for implementation of effective policies, planning and management of HRH, Which is informed and supported by research, reliable information systems and routine M&E in HRH