Transcript Third Global Forum on Human Resources for Health

Seminar
Third Global Forum on Human Resources for Health:
Foundation for Universal Health Coverage and the post-2015
development agenda
Finalization of HRH Commitment of Bangladesh
(November 3, 2013)
Human Resource Management Unit
Ministry of Health and Family Welfare
“Health Workers for All and All for Health Workers”
A brief introduction
• The Global Health Workforce Alliance (GHWA) was born in 2006,
during the 59th World Health Assembly in Geneva.
– a common platform to address health workforce crisis
– a partnership of national governments, civil society, international
agencies, finance institutions, researchers, educators and professional
associations to identify and advocate for solutions.
– With a vision of “all people everywhere will have access to a skilled,
motivated and supported health worker, within a robust health system”.
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From Kampala to Recife
“Action on the Health
Workforce Time for Action”
(Kampala
Declaration
Agenda for Global Action)
Kampala
and
2008
From Kampala to Bangkok:
Reviewing Progress Renewing
Commitments
Developed global HRH
roadmap
Bangkok
2011
Increased investment, sustained
leadership and the adoption of
effective HRH policies
Recife
2013
build a foundation for UHC
through strengthening HRH &
elicit the commitment
HRM Unit, MOHFW
Human Resources for Health:
Foundation for Universal Health
Coverage and the post-2015
development agenda
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Third Forum objectives & outcomes
Objectives:
1)
2)
Elicit and announce new tangible HRH commitments
Update the HRH agenda to make it relevant to the current global
health policy discourse including:
– a push to accelerate progress towards attaining the MDGs
– promoting universal health coverage
– identifying post-2015 health development priorities
Expected outcomes include:
• New HRH commitments from governments, DPs and other stakeholders
• Greater accountability to track, monitor and report on commitments
• Clearer links established between the HRH agenda and
–
–
–
–
MDGs,
universal health coverage,
social determinants of health,
Rio+20 process and the post-2015 development agenda.
Source: http://www.who.int/workforcealliance/forum/2013/3gf_objectives/en/index.html
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GHWA’s call for HRH Commitment
1. Identify suitable HRH commitment pathways for the
governments to develop HRH commitment consistent with
national health strategies, plans and priorities.
2. Identify country-specific HRH commitments accompanied by
global commitments which will be captured in a global
declaration to be adopted at the Forum.
• GWHA Prepared a draft template as guideline to fill in with
country level HRH commitment pathways.
Source: http://www.who.int/workforcealliance/forum/2013/3gf_objectives/en/index.html
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Background of the call
• Increased recognition of central role of HRH towards health MDGs and UHC
• JLI Report (2004) and WHR (2006) identified HRH challenges and
prospective solutions
• Launching of GHWA and 2 Global Forums (2008, 2011) added political
momentum for HRH
• Adoption of WHO Global Code of Practice on International Recruitment of
Health Personnel (the WHO Code)
• HRH-specific commitments of UN Global strategy for women’s and
Children’s health (2010)
• Recognition of HRH in the UN General Assembly resolution on UHC (2012)
• Need to apply a “systems approach” to HRH
• Need to address capacity, management and working conditions, as well as a
solid understanding of the health labour markets dynamics that affect HRH
production, deployment, absorption into the health system, retention,
performance and motivation
Source: http://www.who.int/workforcealliance/en/ accessed on October 22 2013
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HRH Framework towards UHC
• Systemic pathways of interventions along the Universal Health
Coverage Framework of AAAQ (availability, accessibility,
acceptability and quality)
AAAQ (availability, accessibility, acceptability and quality)
Availability: functioning health care facilities; health workers, goods, services
and programmes in sufficient quantity;
Accessibility: health facilities, health workers, goods and services accessible
to everyone; this entails four overlapping dimensions: non-discrimination,
physical accessibility, economic accessibility (affordability), information
accessibility;
Acceptability: health facilities, health workers, goods and services must be
respectful and culturally appropriate, as well as sensitive to gender and life cycle
requirements;
Quality: health facilities, goods and services provided by health workers must
be scientifically and medically appropriate and of good quality
HRM Unit, MOHFW
Source: http://www.who.int/workforcealliance/en/ accessed on October 22 2013
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Template for HRH commitment pathways
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Drafting HRH Commitment of Bangladesh
The state of human resources for health in
Bangladesh:
Post 2008 development and current challenges
towards universal health coverage
Government’s commitments towards UHC
Indicators/Sources Commitments
Constitution of
Bangladesh
Government of Bangladesh (GOB) is obligated to “ensure provision of basic
necessities of life including medical care to its citizens (Article 15(a)) and to raise
the level of nutrition and to improve public health (Article 18 (1))”.
Perspective Plan of
Bangladesh 20102021: Making Vision
2021 A Reality
“By 2021, the war against poverty will have been won, the country will have
crossed the middle income threshold, with the basic needs of the population
ensured, their basic rights respected, when everyone is adequately fed, clothed
and housed, and have access to health care”.
Vision of Ministry of
Health & Family
Welfare
“to create conditions whereby the people of Bangladesh have the opportunity
to reach and maintain the highest attainable level of people health…”
National Health
Policy 2011
“…To attain sound health of the entire population it is necessary to ensure
equity in health care access, equality in gender and ensure services for the
marginalized population and people with disability. Improved health care
services is essential to reduce poverty”
Strategic Plan for
HPNSDP 2011-2016
“To ensure quality and equitable health care for all citizens in Bangladesh by
improving access to and utilization of health, population and nutrition services.”
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Post 2008 development – HRH Policy and Plan
(Instruments for implementation)
• Perspective Plan of Bangladesh 2010-2021
• National Health Policy- 2011
• Strategic Plan for Health, Population & Nutrition Sector
Development Program (HPNSDP) 2011-2016
• Program Implementation Plan (PIP) for HPNSDP 2011-2016
• Bangladesh Health Workforce Strategy 2008/2009
• Operational Plan for Human Resource Management of Ministry
of health & Family Welfare 2011-16.
• Health Care Financing Strategy 2012-2032
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HRM Unit, MOHFW
Major progresses in HRH 2009-2012
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•
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Strengthening Upazilla Health Services into 3 level i.e. Community Clinic (CC),
Union Health & Family Welfare Centers (UHFWC), Upazilla Health Complex (UHC).
Establishment of 1 CC for every 6000 population and around 13,000 CC has been
established all over the country and recruitment of 13600 community health care
provider (CHCP).
Steps taken to establish 1 UHFWC for every Union. New 200 UHFWCs constructed.
Total 276
31Beded UHCs have been transformed into 50 Bedded UHC and 3 into 100
Bedded. UHC.
Number of Govt. Hospital increased from 568 to 592.
Number of Non-Govt. Hospital increased from 2,155 to 3,190.
No. of Govt Medical & Dental College increased from 20 to 31, Non-Govt from 52
to 72.
No. of Govt. Nursing College & Institutes 34 to 53, Non-govt. from 34 to 107
About 5,728 Medical Doctors and around 6000 Nurses were recruited.
About 2,169 new health cadre posts were created and 1,763 other posts were
created.
Additional 7000 medical doctor, 4000 Nurses and 3000 Midwifes are under
recruitment process.
HRM Unit, MOHFW
Source: http://www.pmo.gov.bd/index.php?option=com_content&task=blogcategory&id=158&Itemid=398
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Current Stock & Trends: Health worker population ratio
Category (Registered)
Year 2012
Year 2003
Number
HW Per 1000
Number
HW Per 1000
MBBS Physician
60413
0.404
36223
0.279
Medical Assistant
9036
0.060
5894
0.045
Dentist (BDS)
5170
0.035
1563
0.012
Pharmacist (B Pharm + Diploma)
12199
0.081
10259
0.070
Pharmacy Assistant/Technician
52505
0.350
24985
0.192
Nurse-midwife** Professionals
30680
0.204
18393
0.141
Medical Technologist
13096
0.087
1806
0.013
73838
0.493
54424
0.418
2776
0.019
1287
0.010
23477
0.157
14400
0.111
Community Health Workers
(Public
Sector)
Ayurvedic & Unani
(BUMS, BAMS &
Diploma) Physician
Homeopathy
(BHMS
&
Diploma)
Physician
Source: GOB HRH Country Profile, 2013
HRM Unit, MOHFW
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Density of HW/1000 in 2012 and 2003
0.6
0.493
0.5
0.418
0.404
0.4
0.3
0.35
0.279
0.192
0.2
0.1
0.204
0.157
0.141
0.06
0.045
0.0810.07
0.035
0.012
0.111
0.087
2012
2003
0.013
0.0190.01
0
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Source: GOB HRH Country Profile, 2013
From Kampala to Recife: Case of Bangladesh
Registered health professionals 2008-2012
80000
70000
60000
50000
40000
30000
20000
10000
0
HRM Unit, MOHFW
2012
2008
Source: GOB HRH Country Profile, 2013
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Status of major health indicator
Source: MOHFW, APR 2013
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Health MDGs: Bangladesh Current Status
Major Goals, targets & indicators
Base year
1990/91
Current
status
Goal 4: Reduce child mortality
Goal will be met
Target 4.1: Under-five mortality rate (per 1,000 live births)
146
53 (BDHS 2011)
44 (SVRS 2011)
48
Goal met
4.2 Infant mortality rate (per 1000 Live births)
92
31
On track
4.3 Proportion of 1 year-old children immunized against
measles, %
54
43 (BDHS 2011)
35 (SVRS 2011)
87.5 (BDHS 2011)
100
On track
Goal 5: Improved maternal health
Goal will be met
5.1 Maternal mortality ratio (100,000 Live Births)
574
209 (SVRS 2011)
194 (BMMS 2010)
143
On track
5.2 Proportion of births attended by skilled health personnel,
%
5.0
31.7
50
Need attention
5.3 Contraceptive prevalence rate, %
39.7
61.2 (BDHS 2011)
72
Need attention
5.5 Antenatal care coverage (at least one visit), %
27.5 (93/94)
67.7 (BDHS 2011)
100
Need attention
5.6 Unmet need for family planning, %
21.6 (93/94)
13.5 (BDHS 2011)
7.6
Need attention
Goal 6: Combat HIV/AIDS, malaria and other diseases
Goal will be met
(BDHS 2011)
Source: GOB Planning Commission, 2013
HRM Unit, MOHFW
Target / Remarks
2015
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Major HRH issues and challenges: Generating commitments
Reference: Bangladesh Health Workforce Strategy 2003, 2008/09, National Health Policy 2011, Vision 2021, HPNSDP 20112016, PIP of HPNSDP 2011-2016, MOHFW APR 2009, 2012 and 2013, World Health Report 2006
Governance and management
•
Lack of good governance and accountability (best practices) of HRM functions such as recruitment, promotion, transfers and postings
•
Centralized HR planning and management with minimum people’s participation (stakeholders)
•
Lack of public private partnership on HRH issues
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Mal-distribution (e.g. skewed HRH concentration in urban areas)
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Inefficient Performance management systems (e.g. backdated, inefficient, and manipulated performance management systems with
minimum linkage with organizational mission and vision)
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Fragmented HRIS (which hinders evidence based policy making, planning and management)
Production & supply
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Shortages of skilled Health workforce (e.g. Bangladesh is one of the 57 th severe health workforce shortage countries)
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Skill-mix imbalance (e.g. more doctor than nurse, med assistant, technologists)
Financing
Inadequate resources allocation for HRH management and research.
Quality
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Lack of coordination and regulation of GO, NGOs and private sector HRH initiatives (in both production and employment generation)
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Weak accreditation framework of production
MOHFW of Bangladesh is proclaiming its commitment at the occasion of the 3rd global forum on HRH for
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“Improving the processes of production, recruitment, deployment, development and retention of the health workforce in close
collaboration with the public and private sectors for reasonably balanced distribution of each type of workforce in optimum number to
meet the health needs of each specific population group of the country.”
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HRM Unit, MOHFW
Priority HRH objectives
•
Develop a need-based comprehensive Human Resource Plan
– i.e. focusing on scaling up the production and deployment of each type of health
workforce;
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Strengthening HRM functions across the ministry and its directorates;
Develop responsive and effective policies/ processes for staff recruitment,
deployment, development and retention including incentives for working in
remote/hard to reach areas.
Enhance continuing education of the teaching staff to support quality education
and training of the health workforce;
Give special attention to improving production capacity of nurses, midwives, MTs,
MAs, FWVs, birth attendants and community health workers
Establish a formal and effective accreditation system for medical education and
health care institutions/facilities irrespective of public, private and NGO sectors;
Scale up the Individual Performance Management System (IPMS) and expand its
application to the Organization Performance Management System (OPMS);
Improve the role, function, organization and effectiveness of current Human
Resource Functions across the Ministry and Directorates;
Establish effective and functional HR systems at the national level and health
facilities /organizations at the local level.
Source: Bangladesh Health Workforce Strategy 2008/2009
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HRM Unit, MOHFW
Immediate HRH Targets and timeframe
1. Targets related to Overall planning and coordination:
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National assessment of the capacity of public and private pre-service training institutions
completed to determine the HR gap by categories - developed by Mid- 2014 and utilized by Mid2016 (Information source/s: progress report)
HR Projection - developed by Mid- 2014 and utilized by Mid- 2016 (Information source/s:
progress report)
HR Planning -developed by Mid- 2014 and implemented by Mid- 2016 (Information source/s:
progress report)
Strengthening HR Management Functions across the MOHFW- Initiated by April 2014 and
Recommendations by 2014
Policy on introducing incentive packages (initiated by Mid- 2014 and pilot for introducing
incentive packages implemented by Mid- 2016 (Information source/s: progress report)
Central Human Resources Information System (HRIS) with MOHFW- Requirement analysis and
specification of the system finalized by Mid 2014 and Systems design finalized by Mid 2016
(Information source/s: progress report)
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HRM Unit, MOHFW
Source: PIP of HPNSDP 2011-2016
Immediate HRH Targets and timeframe (cont…)
2. Targets related to health professional recruitment:
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Review and update Recruitment rules for (a) Health, (b) Non-medical, (c) Family
Planning and (d) Nursing cadres – revised b, d by Mid- 2014 and a, c by Mid- 2016
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Review and update the Job description for (a), (b), (c) and (d) - updated and
oriented for implementation by 2016
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Action plan has been designed and stakeholder consultations are put into place
to generate evidence for developing an incentive package (Information source/s:
progress report)
•
Incentive package has been developed with costing analysis and utilization plan
approved by the ministry. (Information source/s: Final report)
Central framework of the HRIS is developed in consultation with relevant
directorate and professional bodies. (Information source/s: progress report and
related documents)
Prototyping with specific data entry has been done and communication channels
are established and functioning. (Information source/s: final/notification report)
•
•
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Thank you!!
Question and comments?
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HRM Unit, MOHFW