Human Resources Policy

Islamic Republic of Afghanistan Ministry of Public Health Human Resources Policy Kabul 2006 National Human Resources Policy Page 1

Contents Pages Glossary of Terms 3 List of Acronyms 3 Background to HR Policy Development 4 Goal of HR Policy 4 Principles of HR Policy 4 Governance of HR 5 Role of MoPH General Directorate of HR 6 Coordination 6 Policy Development 7 Planning 7 Production 7 Specialist Categories of Health Workers 9 Admission Policy to Health Professional Institutions 10 Accreditation of health Professional Training Programs 11 Certification and Licensing of Health Personnel 11 Continuing Professional Education 12 Human Resources Management 12 Human Resources Financing 13 Health Professionals Providing Private Practice 14 NGO s Contracted to Provide Health Services 14 National Human Resources Policy Page 2

Glossary of Terms Used Accreditation Certification Licensure The process of external quality review which is applied to training institutions and or programs to assess the quality. It measures the institution and or program against agreed-upon standards thereby assuring that they meet the national agreed upon standards. Acknowledgement of those quality standards has been met. (e.g. certificate issued to indicate successful completion of a course of study having achieved the required levels of competence The approval given to an individual professional practitioner once minimal requirements have been met. This is obtained through examination (e.g. Testing and Certification Board Examinations) or through graduation from an accredited training institution. List of Acronyms HR BPHS EPHS MOPH MOHE CSC MOWSA MOF NGO Human Resources Basic Package of Health Services Essential Package of Health Services Ministry of Public Health Ministry of Higher Education Civil Service Commission Ministry of Work and Social Affairs Ministry of Finance Non Governmental Organization National Human Resources Policy Page 3

Background to HR Policy Development The process of development of HR Policy commenced in 2002 with general HR statements being included in the first overall Health Policy document developed at that time. A more detailed HR policy was developed in 2003 which amplified and extended the initial general HR policy statements and also supported the Basic Package of Health Services (BPHS) which was being developed at that time. Since 2003 there have been many rapid developments within the health system, including the development of the Essential Package of Hospital Services (EPHS). The approach to development of Human Resources for Health has changed to encompass a comprehensive approach. Goal of the Policy The goal of the human resources (HR) policy is to ensure the appropriate production and availability of suitably qualified, appropriately skilled and motivated human resources for health. These human resources should be of pre-defined disciplines that are appropriate for provision of the defined Basic Package of Health Services (BPHS), the Essential Package of Hospital Services (EPHS) and other health services which are of acceptable quality at affordable cost to the community. They also need to be equitably distributed. Principles of the Human Resources Policy 1. The Ministry of Public Health (MOPH) recognizes that human resources are the backbone for national development. It considers appropriately trained and distributed human resources for health critical to the provision of health care and the performance of the health system in Afghanistan. 2. The Ministry recognizes the importance of increasing the number of female health care workers in the health workforce to address the health needs of women and children. 3. The Ministry recognizes that appropriate development and continuous learning of health personnel is basic to the effective functioning of the health system. It sees professional growth as essential to the wellbeing of the employees of the Ministry. 4. The Ministry recognizes the need to develop a comprehensive, coordinated and adequately funded national plan for human resources development in collaboration with its main partners. These are the Ministry of Higher Education (MOHE), the Civil Service Commission (CSC), the Ministry of Work and Social Affairs (MOWSA), the Ministry of Finance (MOF), Ministry of Rural Rehabilitation & Development (MRRD), Development Partners, universities and other training institutes and those who support the provision of health care services. National Human Resources Policy Page 4

5. The Ministry governs the process of human resources development and management for health. It encourages the development of a supportive work environment that contributes to these principles and goals and encourages other ministries who employ health workers to adhere to its principles and goals 6. The Ministry s human resources policies are designed to establish a firm foundation which is a first stage towards future achievement of regional and international levels of health professional education. Governance of Human Resources 1. The General Directorate of Human Resources at the central level in the MOPH is charged with the responsibility for all aspects of a comprehensive approach to human resources for health. This includes policy, planning, recruitment, training, licensing, deployment, supervision, management and financing in relation to all officially recognized categories of health personnel who work in EPHS/BPHS and other health facilities. 2. Curricula for all types of in-service training and pre-service education for health professions shall be standardized at the national level by specialist working groups under the supervision of the Director of Training and Development which will include relevant partners from clinical services, MOHE and NGOs. They will be endorsed by the General Directorate of Human Resources until such time that a National Health Professions Council is established. All groups involved in the education and training of health care workers will be required to follow these curricula. 3. Civil Service classification and pay scales shall be established through a joint CSC/MOPH initiative to reflect the training and skills of all categories of health personnel and be in accordance with market-driven rates and will support career development. This initiative will be closely linked to the MOPH National Salary Policy. 4. Posts will be established by the MOPH based upon the organizational structures of the MoPH and the staffing requirements as identified within the Basic Package of Health Services (BPHS) and the Essential Package of Hospital Services (EPHS). The creation of posts aims to ensure an appropriate distribution of health personnel to reduce the disparity in health service provision, and to meet the community s needs. These staffing levels will apply to all MoPH facilities, whether directly staffed by civil servants or NGO grantee staff. 5. In the absence of an independent National Health Professionals Council, a semiautonomous National Testing and Certification Board is charged with the responsibility to establish processes for testing and certification of all categories of health professionals, identify equivalencies and ensure that health workers are registered to practice at a level commensurate with their knowledge and skills. This process is a pre-cursor to development of a National Health Professional Licensing System. National Human Resources Policy Page 5

6. A system of Health Professional Registration has been established by the MoPH in the absence of a National Health Professions Council. All health professionals are required to register with the General Directorate of Human Resources, be recorded in the national health workers database and receive an official identification number. If required by the National Testing and Licensing Board they must undergo a testing and licensing process. 7. An independent National Health Professions Council will be established to regulate the practice of the different categories of health professionals. It will oversee the work of individual professional councils and accreditation boards (e.g. the Midwifery Accreditation Board) to register and accredit health professions education and training institutes to ensure quality of educational programs and to license health practitioners in order to protect the public from unsafe practices. Role of the Ministry of Public Health General Directorate of Human Resources 1. The General Directorate of Human Resources (GD HR) shall support the overall mission and goals of the MoPH in Afghanistan as outlined in the National Policy 2005-2009. 2. The GD HR is responsible to ensure that an effective and affordable workforce is appropriately trained, licensed and equitably distributed to deliver the essential health services as defined in the BPHS and EPHS to reduce inequities in all aspects of health in Afghanistan covering all sectors delivering health services. 3. The GD HR shall implement a comprehensive approach to HR through close collaboration with all other General Directorates in the MoPH. It acts as the focal point to coordinate all HR related activities. 4. The GD HR shall implement the MoPH s Human Resources for Health Policies. It shall monitor the implementation of these policies and regularly evaluate the need to propose further policy developments as necessary to meet the changing health care needs. Coordination The MoPH recognizes the importance of coordination of all the components of Human Resources Development to ensure an appropriate, clear and effective approach to addressing the major HR issues in Afghanistan. The General Directorate of Human Resources will undertake a strong role to ensure that all aspects of Human Resources Development are coordinated with all departments within the MoPH, the MoHE and all other relevant ministries, training institutions, donors and relevant agencies to ensure that all health worker training both pre-service and postgraduate produces graduates who meet the needs of the MoPH defined health services.. This will ensure common HR standards and strategies throughout Afghanistan National Human Resources Policy Page 6

Policy Development Human resources policies will be reviewed and revised as necessary on a bi-annual basis. This will ensure that human resource for health policies remain appropriate to the needs of the health services during a period of rapid change. This process will be undertaken by the General Directorate of Human Resources in collaboration with the General Directorate of Policy and Planning. Rules and regulations related to this policy shall be developed and endorsed by the General Directorate of Human Resources. Planning The Genral Directorate of Human Resources has the main responsibility for all aspects of health workforce planning. It will work collaboratively with the General Directorate of Policy and Planning, the Training Institutions and all relevant MoPH Departments to ensure that workforce and capacity building plans support overall health service planning. Workforce planning will be undertaken utilizing appropriate up-to-date workforce planning methodology based upon workload indicators to determine more accurately the national health workforce requirements. Production 1. The MoPH recognizes 14 basic categories of health workers as the only categories trained in Afghanistan. Tables 1 and 2 list these categories. Table 1. Health Workers Trained by the Ministry of Higher Education Category Length of Training Doctors/General Medical Practitioners 7 years Dentist/Stomatologist 6 years Pharmacist 1 4 years All categories trained by MoPH are regarded to be at registered level. The term registered is not specified in the professional title with the exception of nurses which in accordance with the international nomenclature are termed Registered Nurse or RN. The entry requirements for each category is specified in the relevant sub-policy Table 2. Health Workers Trained by Ministry of Public Health Category Length of Training Registered Nurse 3 years Midwife 2 years 2 Community Midwife 3 18 months 4 (continuous) Laboratory Technician 2 years 5 Radiography Technician 2 years 1 Based on the curriculum of this category, they can be employed as clinical pathologists and medical technologists in health facilities as well. 2 Midwifery training is conducted in two 9 month academic years (plus holidays) 3 Community Midwives are trained by NGOs, on behalf of the MOPH. Diplomas are issued by the IHS. 4 Community Midwifery training is conducted in an 18 month continuous program. The job description and thus the content is essentially the same as for midwifery. Those community midwives who can not be considered as graduates of 12 class will be recruited as contracted employee of MoPH called "Ajeer". 5 Laboratory Technician training is currently 3 years but will be reduced to 2 years National Human Resources Policy Page 7

Pharmacy Technician 2 years 6 Physiotherapy Technician 2 years 7 Orthopedic Technician 2 years Dental Prosthetic Technician 2 years Ophthalmic Technician 8 3 years Vaccinators 3 months The further integration of vertical programs into the comprehensive health delivery system may result in other categories being included in the future on the basis of level of integration. Other proposed categories to be trained in the future include: Dental Hygienist Environmental Hygienist/Sanitarian Biomedical Technician 2. The MoPH recognizes 3 additional health worker categories which are no longer trained in Afghanistan. They are: Feldsher Dentist/ Dental Technicians trained in IHS for 3 years; replaced by Dental Prosthetic Technician Darkroom Assistant Feldshers should be encouraged to work in rural and underserved areas, and are eligible to apply for entry to training for specialist technical and nursing posts (e.g. Operating Theatre Technician, Anaesthetic Technician, Psychiatric Nursing, Intensive Care Nursing.) when such training courses are established. Feldshers can only occupy nursing posts on a temporary basis, in the event of no registered nursed being available. 3. The following titles will be used to identify those health workers, who were previously trained outside recognized training institutions and need to be tested and certified.. Dental skilled worker Pharmacy skilled worker/compounder Nursing skilled worker Midwifery skilled worker Microscopist or Skilled laboratory worker X-ray skilled worker Physiotherapy Skilled Worker Environmental Skilled Worker 4. The category of Community Health Worker, whilst not employed directly by the MoPH, is recognized by the MoPH provided they are trained following a standard curriculum recognized by the MOPH. This category will work collaboratively with 6 Pharmacy Technician training is currently 3 years but will be reduced to 2 years 7 Physiotherapy technician training is currently 2 years, but is proposed to be extended to 4 years 8 Ophthalmic technicians are trained by NGOs, on behalf of the MOPH. Diplomas are issued by the IHS. National Human Resources Policy Page 8

health staff in health posts and health centers to support health service delivery to their communities. Specialist Categories of Health Workers The following clinical specializations are recognized by the MoPH to work in Afghanistan. These categories are based upon the BPHS and EPHS staffing categories. Table 3. Specialist Categories Recognized by the MoPH Medical Specialists Nursing Specialists Allied Specialist Surgeon (covering all Operating Theatre surgical sub-specialties) Technician Anesthesiologist Obstetrician/ Gynecologist Pediatrician Internal Medicine Psychiatrist Ophthalmologist Cardiologist Orthopedics Radiologist (medical imaging including X-ray and ultrasound) ENT Dermatologist General/Family Practitioner (Recommended) Anesthetic Technician (Recommended) Pediatric Nurse (Recommended) Psychiatric Nurses (Recommended) CCU Nurses (Recommended) Community Nurse (Recommended) Midwife/ Community Midwife Psychologist Orthopedic Technicians) Further strategic workforce planning will be undertaken to identify any further clinical specialist categories required. This will be based on health service needs utilizing on relevant health information and will take into account available resources to conduct quality training. ( resources include, available qualified specialist teachers who can train to regional standards, appropriate clinical supervision, sufficient clinical practice sites with high patient volume, adequate funding ) 5. Revision of the system of training medical specialists will be utilized to identify existing gaps in the current specialist training systems and to develop strategies to improves and strengthen the training systems. 6 Non Governmental Organizations (NGOs) shall use the national standardized curricula in preparing health care personnel. They shall not prepare categories of health care providers that are not approved by the General Directorate of Human Resources at the MoPH. All NGO-supported programs must be accredited by the National Human Resources Policy Page 9

relevant Accreditation Board or Council. Those that are operating outside the regulatory structures for preparation of health care workers will be ordered to close. 7. Private Training Institutions can only be permitted to train any categories of health workers if they are accredited by the relevant Board or Council and with the agreement of the General Directorate of Human Resources at the MoPH. Accreditation is dependant upon use of the national curriculum and adherence to predetermined standards of educational quality. Admission Policy to Health Professional Institutions 1. Admission Mechanisms shall be strengthened and regulations established by General Directorate of Human Resources to ensure appropriate selection of students into nursing, midwifery and allied health educational institutions. This means: The number of students to be admitted annually to approved health science schools will be based on the capacity and financial, clinical and physical resources available. In order to achieve quality graduates with appropriate levels of clinical practice, this will initially require a reduction in the number of students and health professions schools. The MoPH will work closely with MOHE to ensure that projected intakes to study medicine, dentistry and pharmacy are related to MoPH projected workforce needs as well as the capacity and financial, clinical and physical resources available. In the case of medicine this will require a considerable reduction in the number of students to be admitted due to an oversupply of medical doctors. The MoPH s target of delivering health services by equitably deployed health workers means that there is no longer a guarantee of employment by the MoPH for graduates from all governmental and non-governmental health professional schools and institutes, particularly if the graduates refuse postings offered to them by the MoPH. Targeted recruitment of students from specific areas of the country to match the expansion of health services delivery to rural and underserved areas. The GD of HR will establish a mechanism for determining the number of seats in nursing, midwifery and allied health classes/programs. This will include a mechanism for reserving seats for students from surrounding provinces and recruitment of these students so as to increase appropriate rural/provincial enrollment and deployment. Students entering through targeted recruitment must have achieved the required scores in the concur examinations. Providing opportunities for a higher female enrollment in all educational institutions throughout the country. This will facilitate a more balanced geographical coverage, well distributed human resources and provision of health services mainly by women to women. National Human Resources Policy Page 10

Admission into the institutes that prepare nurses, midwives and allied health personnel shall be based upon criteria determined by the MOPH. Students will be required to have a minimum acceptable score on the national concur exam, previously declared interest in the field of study, proof of residence in geographically underserved areas and readiness to serve in their assigned post. Students who have not gained admission to their preferred faculty and come unwillingly to the Institute of Health Sciences will not be granted admission. Accreditation of Health Professional Training Programmes 1. Semi autonomous accreditation boards will be established to ensure that all health professional training programs meet the educational and technical standards of quality required by the MoPH. A Midwifery Education Accreditation Board has already been established. Training programs which do not meet the defined standards will not be accredited by the MoPH. They will be informed of the areas which require attention in order to achieve the required standards and the period of time in which they must meet those standards. If they fail to meet the standards they will be required to cease training and close. The MoPH will not certify the graduates from these courses as meeting the minimum accepted standards of competence. 2. The linkages of these semi autonomous accreditation boards with the future National Health Professionals Council will be delineated at the time of establishment of the council. Certification and Licensing of Health Personnel 1. The General Directorate of Human Resources, in collaboration with the National Testing and Certification Board and the HR Taskforce, (until such time as a National Health Professions Council is established) shall determine the rules, regulations and procedures for licensing health personnel. It shall establish the minimum educational requirements for health professionals and criteria for continued licensure and registration of health professionals in the country. (Once the registration of health workers is complete and the requisites for establishing a licensing system are in place, the National Testing and Certification Board will become part of an independent national licensing authority) 2. The General Directorate of Human Resources at the MoPH in collaboration with the National Testing and Certification Board shall be responsible for designing, managing and sustaining the system of testing certification and licensing of Afghan health workers until such time that a National Health Professions Council is established in the country. National Human Resources Policy Page 11

3. Health personnel shall be certified and licensed as a practitioner of their defined category after they have successfully completed a recognized program of study and graduated from an accredited health professional educational institution or passed the MoPH testing and certification examinations. 4. Foreign health workers of all categories recruited to work in Afghanistan must register with the General Directorate of Human Resources and produce appropriate documentation of their certification as a health worker. The General Directorate may validate their qualifications with the appropriate licensing authorities in their country of origin and where deemed necessary may require individual health workers to sit for the MoPH Testing and Certification Examinations. Continuing Professional Education 1. All health workers will be required to undertake continuing education which is directly related to their current position and which supports strengthening of their work performance and contributes to their career development 2. Locally conducted in-service training will follow standardized training modules based on the BPHS, EPHS and other health services which are recognized by the General Directorate of HR. 3. Selection of candidates for attendance at overseas meetings and training courses will utilize a transparent and merit based selection process for dealing with allocation of international fellowships. 4. MoPH staff in provinces who meet the required criteria will have equal access to national and international training opportunities as staff at central level. Where possible priority will be given to those serving in the most remote rural areas, including those working for NGO Grantees who provide health services on behalf of MOPH, providing they meet the criteria for entry to such training programs. 5. All results of continuing health professional education will be entered in the National Human Resources Database. The database will be used as a planning tool to support appropriate allocation of training opportunities. Human Resources Management 1. The General Directorate of Human Resources is responsible for developing job descriptions for all categories of health personnel, which will be based on MoPH structure and functions. Each health worker will be provided with a copy of his/her job description. 2. The National Health Professional Registration system requires that all health personnel shall register with the General Directorate of Human Resources. Their National Human Resources Policy Page 12

professional details are entered in the MOPH HR Database and they will be issued with a National Human Resources Identification Card which provides a record of their unique ID number. 3. The General Directorate of Human Resources, in collaboration with the CSC, will administer a comprehensive human resources management system. This system is designed to achieve a higher level of institutional and clinical performance development. 4. Staff development strategies will include a comprehensive job evaluation and pay and grading system which provide career structures for each profession, together with appropriate capacity building programs. 5. Linkages will be strengthened between the General Directorate of Human Resources and the provinces by the placement of a Provincial Human Resources Officer in each province. This officer will function as a member of the Provincial Public Health Management Team and will work closely with the General Directorate of Human Resources to implement the MOPH Human Resources Management Policies and Strategies at province level. 6. The General Directorate of HR will work with CSC to develop strategies to support retention of health professionals under the MOPH and improve and secure their wellbeing. Human Resources Financing 1. The General Directorate of Human Resources will work closely with the General Directorate of Policy and Planning and the General Directorate of Administration and Finance to ensure that there is adequate financial support to implement the MoPH human resource strategies. 2. In collaboration with the Civil Service Commission, the General Directorate of Human Resources will establish a pay and grading system for the defined MoPH civil service staffing establishment based on the BPHS and EPHS and which is linked to the MOPH National Salary Policy 3. NGO grantees contracted to implement basic health services will be required to observe MoPH defined salary and incentive levels. 4. The General Directorate of Human Resources will strengthen the capacity of the Institutes of Health Sciences to develop appropriate development and recurrent budgets to ensure production of the defined quality of nurses, midwives and allied health workers. 5. The General Directorate of Human Resources will be responsible for developing budgets to support national continuing education plans. National Human Resources Policy Page 13

Health Professionals Providing Private Practice 1. All health professionals, both national and international, employed in private health facilities or providing private practice must register with the GD of HR and undertake Testing and Licensure, if required, in order to obtain licensure. 2. A committee comprising of representation from General Directorate of Human Resources, Medical Legislation Unit of GD of Policy and Planning and GD Curative Medicine will establish a system to monitor HR aspects of private practice to ensure that it is in line with the MOPH policies related to private practice. NGO s contracted to Provide Health Services NGO s contracted to provide health services on behalf of the MoPH will be required to adhere to the MoPH HR policies. National Human Resources Policy Page 14