HRH Planning & Management in the Caribbean Region

Outline of Presentation • • • • • Goal of HRH Planning Scope and Components of the HRH Planning Process Highlights of the Caribbean Comparison Report Approach to HRH Capacity Development HRH Roadmap: Priorities for Action

Goal of HRH Planning “To achieve and maintain an optimal and stable supply and distribution of appropriately trained, deployed, supported and motivated health workforce, with the capacity to respond to current and future population health care needs in a way that maximizes efficiency and effectiveness while being affordable and sustainable…”

The History of HRH Planning

HRH Planning Context

Sustainable Health System Reform

Health Delivery CHANGE MANAGEMENT Human Resources Fiscal Support

Sustainable Health Workforce Planning Development

HRH

Management \ Policy / Education Finance / Partnership L Leadership

Workforce Development

Affordable Healthcare

Health System Outcomes

Health Expenditure & Outcomes

Ranking

(3) (1) (2) (4) (5) (3) (1) (2) (4) (4) (2) (4) (2) (2) (2) (3) (1) (3) (5) (5) (3) (3) (1) (1) (5) (5) (4) (4) (1) (5)

Equity in Healthcare Delivery

Equity for Healthcare Workers

Health System Cost Drivers

Technology Management

Application of Technology

Telemedicine

Primary Health Care Teams

HRH Task Shifting

Competency-Based Deployment

HRH Forecasting

HRH Forecasting

Recruitment & Retention

HRH Management & Development

Governance in Healthcare

Knowledge Translation & Exchange

Non-Communicable Diseases NCD’s Injuries CD’s

Non-Communicable Diseases

Lifestyle Risk Factors Policy Response - Primary Health Care - Public Health - Health Promotion/Disease Prevention - Health Education - Community Health Support WHAT ARE THE IMPLICATIONS FOR HUMAN RESOURCES FOR HEALTH PLANNING ?

Health Outcomes

HRH Reform

ISSUES:

Supply Demand Production Training Recruitment Retention Distribution Access Deployment Health/Safety Productivity Migration Management Payment Sustainability

Review of HRH in the Caribbean

Historical Trends

Only Dominica, Trinidad & Tobago and St. Lucia up in MD supply in last decade Others record a decline in physician numbers, the greatest in Jamaica Jamaica and Guyana greatest decline in RN numbers Jamaica and Grenada the highest health worker emigration Regional out-migration of 81% RNs and 53% MDs 78% employed in the public sector Specialists 17% of Dominica’s MD stock; 85% in Anguilla Trinidad & Tobago recruiting 450 RNs and 119 Medical Specialists Guyana 300 vacancies, 25% to 50% vacancy rates Possible surplus of health workers in Guyana in less than five years

Review of HRH in the Caribbean -

Regional Goals

8 of 11 countries achieve the minimum target of 25 per 10,000 population Jamaica and Belize 25% of goal; Montserrat & Barbados 3.3 times minimum target Only Belize and Grenada were 40 percent of MDs PHC physicians 5 of 9 countries achieved 90% of required PHC competencies & team coverage One RN for every MD achieved by all countries; Montserrat & Barbados 8.3 to 1

All countries had an HRH Unit, but the majority were one-person operations

80% of population growth occurring in urban areas Four countries reached target regarding staff inter-cultural competencies Jamaica, Dominica & St. Lucia reported upgrading staff skills and competencies Only four countries recruited PHC workers locally Only Barbados & Jamaica had adopted recruitment codes of practice No countries had achieved self-sufficiency in HRH

Review of HRH in the Caribbean -

Regional Goals

29% of health workers were in precarious, unprotected positions Six countries had worker health and safety practices in place Four countries had managers with appropriate competencies All countries had labor dispute mechanisms; 67% essential services legislation Six countries provided some inter-disciplinary training, the highest in Jamaica (73%) Only Jamaica & Barbados recruited students from under-serviced areas Only Barbados, Jamaica & Guyana have nursing attrition rates less than 20% Six countries have reached the target regarding health program accreditation -

Conclusions

About HALF the Regional Goals are well underway

Continuing support needed for data development, HRH planning capacity, ongoing skills development and workforce management and retention.

HRH Action Framework

HRH CAPACITY DEVELOPMENT & SUSTAINABILITY GOAL

: Optimal, Productive, Accessible, Responsive, Motivated & Stable Workforce

ENABLERS

Leadership Management Education/Training Curriculum Communications KTE Leg/Regulation Programs/Policies Stds/Guidelines Partnerships Finance/Incentives

CORE FUNCTIONS

Data Development Trend Monitoring Research & Analysis Supply & Distribution Needs Identification Cost-Benefit/Impact Strategic Planning Forecasting Evaluation

MoH LINKAGES

Primary Health Care Public Health Health Promotion RHA’s Finance Health Institutions Mental Health Health & Safety Health Information CNO / MOH Research & Planning

FACILITATION PARTICIPATION COORDINATION COLLABORATION PLANNING DEVELOPMENT IMPLEMENTATION EVALUATION MODIFICATION

Health Workforce Productivity

Capacity Development Workforce Optimization Workplace Support Outcomes

Education & Training Workforce Culture, Communications & Expectations Supply & Mix Models of Care Matching Competencies to Requirements Provider Roles & Deployment Mix, Numbers & Distribution Occupational Health & Safety Personnel Management Practices Innovation & Support Stability of Workforce Efficiency in health services delivery Effectiveness of Patient Care, Health Outcomes & Population Health

Roadmap: Priorities for Action

Governance

• • • • • • • HRH Database Development HRH Policy Inventory HRH Policy Brief Development (Online) Observatory Development Processes to Update & Disseminate Information Hiring Guidelines stipulating Public Health competencies MoH to draft new supporting HRH policies

• • • • • • • • HRH Roadmap: Priorities for Action

Education & Training

Build capacity & competencies to meet challenges of NCD’s Caribbean Learning Network courses in planning, evaluation and management CLN courses in online in-service training to work in inter professional teams Enroll HR Managers in online HRH Management courses Health staff will upgrade competencies as required CLN will begin process of course accreditation Ongoing commitment to staff training & capacity building Improved working conditions through better staff preparation