Transcript HRH in times of economic crisis: challenges and opportunities

The impact of human resource
management on health
systems
[email protected]
HRH Management
• HRH Challenges
• HRH Dynamics
• Impact of recession
• HR Interventions
Common challenges:
Policy maker priorities
• How do we plan how many doctors, nurses, and
other health workers to educate, and employ?
• How can we improve recruitment, retention and
return?
• Which incentives are effective in motivating
doctors, nurses etc
• How can we determine and deploy the most effective
skill mix of doctors, nurses and other staff?
• How can we improve productivity of health workers?
• How do we maintain workload with reasonable
limits, for individuals and for teams of health
workers?
Common HRH Challenges
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Skills shortages
Geographic maldistribution
Fragmented planning
Education- employer linkages
Managing Staff Performance
Effective Skill mix
Migration
(Data; research/evaluation; informing policy)
Dynamics in Europe
• European health care labour markets are
dynamic- will change in response to
demographic change (ageing populations) ;
general economic conditions; -health sector
reform
• Accession- countries with relatively low paid
health professionals – outflow to established
“richer” EU countries? (Knock on effect to
East/ CIS?)
• Patient safety/ country level regulatory issues
• “Stocks and Flows” : Different data setsdifferent pictures
“Stocks and flows”
Joiners (“Flows”)
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From training
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international
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returners
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etc
Workforce
(“ Stock”)
Leavers (“flows”)
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retirement
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international
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non health
sector
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etc
“Flows”
(Maldistribution)
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FROM:
rural
“poor” districts
public sector
health sector
“poorer” countries
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TO
urban
“richer” districts
private sector
other sectors
“richer” countries
Distribution of physicians in the European Region
Physicians per 100000
P
<= 700
<= 580
<= 460
<= 340
Last
available
European Region
352.92
<= 220
No data
Min = 100
Source: WHO HFA database, 2007
Diversity in the European region
Health professionals / 100.000 population, 2002
Physicians
Nurses
Midwives
Pharmacists
European
Region
351.22
669.02
45.07
50.93
EU
343.56
708.26
35.95
77.54
Central Asian
Republics and
Kazakhstan
293.14
767.68
66.9
16.38
CIS
373.55
794.18
54.15
18.44
Lowest
118.54
245.15
11.30
3.03
(Albania)
(Turkey)
(Germany)
(Uzbekistan)
618.52
1856.91
122.77
204.31
(Italy)
(Ireland)
(Azerbaijan)
(Malta)
Highest
Source: WHO HFA database, 2007
Impact of recession/crisis
• “multidimensional and severe”(WHO,2009)
• Many European countries will be in economic
recession this year; employment decline most
evident in [export oriented] manufacturing,
finance, construction
• Countries with financial resources are funding
“stimulus” packages- those with limited
resources have less scope for fiscal
interventions
• Depreciation of national currencies in Central/
East / South East Europe (and UK) in
comparison to euro and $
Unemployment (%) 2008/2009,
selected countries [Source: WHO, 2009;EIU]
25
20
15
2008
2009
10
5
0
Albania Belgium
Czech
Germany Ireland
Latvia
Poland Romania
Serbia
Spain
UK
Recession: Impact on HRH
• Reduced demand for “new” HRH because of
funding constraints, and increased retention of
workers already working in health sector
• Labour cost reductions/ improved productivity=
skill mix changes, increased workload/ stress
• Pay “freezes” or pay reductions in health sector
• Increased pressure to migrate, but reduced job
opportunities in many countries
• Increase in unemployment/ underemployment of
health workers as supply increases and demand
reduces or stagnates
Policy options
• Establish “anti-crisis unit” in Ministry of Health: monitor
situation, explore strategic options, link to other
Ministries (particularly Ministry of Finance)
• Maintain/develop communication links with other
stakeholders (donors, professions, civil society, NGOs
etc)- “we are all in this together”
• Develop advocacy/ influence to protect health budgets
• Review HRH cost containment/ productivity options to
identify action with potential for positive impacts (assess
HRH impact)
• Review workforce planning and projections to assess if
oversupply of ”new “ staff
HRM Evidence Base
• about 30 studies examining links between
HRM and organisational performance:
• “Fit” : HRM must be aligned with
organisational context and objectives
• “Bundles” : co-ordinated HRM
interventions are more effective than
single interventions
• HRM can make a positive difference to
performance (Buchan, 2004)
References
• WHO (2009) Health in times of global
economic crisis: implications for the WHO
European region
• Buchan J (2004) What Difference Does
(Good) HRM make? Human Resources for
Health 2004:6
http://www.human-resourceshealth.com/content/pdf/1478-4491-2-6.pdf