Transcript Slide 1

CHA 2009 C0NFERENCE HELD IN
KAMPALA UGANADA
CHAG HRH STAUDY REPORT
PRESENTED
BY
PHILIBERT KANKYE
BERNARD C. BOTWE
TITLE OF STUDY
• An Assessment of the Impact of
Government Human Resources for
Health (HRH) Policies on Network
Members of the Christian Health
Association of Ghana
• February 2008
• Philibert Kankye, CHAG
• Peter Yeboah, CHAG
• Bernard C. Botwe, CHAG
OUTLINE OF PRESENTATION
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INTRODUCTION
BACKGROUND OF STUDY
PROBLEM STATEMENT
STUDY OBJECTIVES
METHODOLOGY
POLICY OBJECTIVES
POLICIES AND STRATEGIES
POLICY IMPLEMENTATION
FINDINGS
CONCLUSIONS
RECOMMENDATIONS
LESSONS
NEXT STEPS
INTRODUCTION
• The Ministry of Health (MOH) and Christian Health
Association of Ghana (CHAG) have maintained
operational relationships since the establishment of
CHAG in 1967
• In 1975 the government commissioned Adibo Committee
to study the role of mission health facilities in Ghana.
• The Committee recommended that Government should
sun-vent CHAG Facilities to enable them to pay salaries.
• This recommendation led to a strengthened relationship
between the government and CHAG.
INTRODUCTION CONT.
• This relationship was further evidenced in
the signing of a Memorandum of
Understanding (MOU) and Administrative
Instructions (AI) in 2003. The objectives
of which are:
– To provide a framework to formalize the
working arrangement between the parties
– To ensure accountability and transparency in
the working relationship.
INTRODUCTION CONT.
• In the MOU,
• CHAG agreed to adopt the HRH policies outlined
by the MOH and to submit its human resource
needs to the MOH for support.
• For its part,
• the MOH agreed to facilitate the equitable
distribution of health professionals among its
agencies including CHAG.
INTRODUCTION CONT.
• Health professionals from training
institutions shall be proportionately
allocated to CHAG institutions through
negotiation or based on needs.
• Staff placement and deployment in
CHAG institutions shall be in accordance
with MOH guidelines and norms.
• CHAG training institutions shall receive
support from the MOH like all MOH
training institutions.
INTRODUCTION CONT.
• The MOH shall provide fellowships to
CHAG in line with the approved Human
Resource plans and budgets
BACKGROUND OF STUDY
• In 2002, the MOH launched an HRH policy
intended to facilitate the development and
retention of a highly trained and motivated
workforce with skills appropriate to
implement the health sector’s Program of
Work (POW).
BACKGROUND OF STUDY CONT.
• Christian Health Association of Ghana
(CHAG), in the broader scheme of things,
subscribed to both the HRH policy and the
five-year POW as covenant in the
Memorandum of Understanding (MOU)
and Administrative Instructions (AI).
• The implementation of the policy reached
its final year in 2006.
BACKGROUND OF STUDY CONT.
• As a major stakeholder in the health sector,
CHAG conducted this study to assess the extent
to which the policy impacted the health service
delivery of its network members.
• The outcome of the study will be used to guide
the development of future HR policy options and
to strengthen CHAG’s capacity to remain a key
partner in the health service delivery throughout
the country.
PROBLEM STATEMENT
• The health sector reform initiatives in
Ghana recognized HRH as the most crucial
aspect of the delivery of efficient and cost
effective health care
• The reforms also addressed the issue of
increased participation of private providers
in health care delivery from 35% to 50%
by 2010,
PROBLEM STATEMENT
• The operations of CHAG network members
continue to be affected by the HRH policy
direction of the MOH and its implementing
agency, Ghana Health Service (GHS).
• HR inequities still exist between GHS and CHAG
member institutions at all levels.
This phenomenon is further compounded by a
number of factors.
Internal brain drain:
• CHAG staff continue to resign their post to join
GHS.
Uneven staff distribution:
Newly qualified and existing skilled professionals
are also distributed to the disadvantage of the
PROBLEM STATEMENT
Career development:
• the exclusion of CHAG network members where opportunities do
exist.
Policy implementation gaps:
• CHAG in its policy document, CHAG continues to be adversely
affected by implementation structures and processes.
Latent competition:
Underlying the above developments is the seemingly hostile attitude
of public health professionals toward those in private sector,
especially CHAG.
There are serious challenges and inequality gaps in HRH that work
against CHAG.
STUDY OBJECTIVES
• To assess MOH HRH policy/program
implementation and impact on CHAG’s HR
capacity.
• To provide HR policy options to strengthen
CHAG’s capacity to engage the MOH,
stakeholders and other partners in HR
development and maintenance.
METHODOLOGY
• Document Reviews - from published and
unpublished sources.
• Primary data was collected with the use of
questionnaires, interviews and focus group
discussions with key informants.
GOVERNMENT HRH POLICY
OBJECTIVES
The objectives of the HRH policy are:
• To provide a strategic basis for human resource
development, deployment and compensation
• To ensure coherence between national/MOH policies and
HR policies and strategies
• To ensure improved performance of the health sector
workforce
• To depict the extent and impact of the brain drain on the
health sector and the country as a whole, and strategies
to mitigate these effects.
HRH POLICIES AND STRATEGIES
• Policy 1: The MOH will ensure high
quality training for all categories of staff.
Strategies include:
• Continuing to train increasing numbers of
high quality professionals
• Restructuring training programs
• Coordinating in-service training programs
• Coordinating fellowships to ensure that
awards are based on national needs, and
to ensure equity in the distribution of
awards.
Policy 2: The MOH will ensure
equitable distribution of health
professionals to benefit deprived areas.
Strategies:
• Paying rural allowance (30% and 50% of
basic salary to doctors and other staff
respectively) to rural area health staff
• Providing staff with viable housing
ownership schemes
• Encouraging mission/NGO hospitals to run
more satellite clinics in the rural areas
where they operate.
Policy 3: The MOH will ensure
retention of trained staff.
Strategies:
• Providing career development avenues by increasing
opportunities for further training, attendance of
conferences and updates; providing access to fellowships
for eligible staff of all categories at all levels; and
encouraging, supporting and recognizing essential nonclinical programs.
• Reviewing salaries of all health staff by consolidating
basic salaries and ADHA [Additional Duty Hours
Allowance] with an appropriate top-up
• Providing non-salary incentives by providing saloon
cars/year for health staff; and providing housing
units/year to health sector workers.
Policy 4: The MOH will ensure
efficiency in human resource
management.
• Developing and implementing a continuous performance
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management system to replace the current appraisal
system
Decentralizing HR management to teaching hospitals,
regional and district directorate levels with clear lines of
responsibility and authority
Promoting interview at agency level except for very
senior staff
Training and employing a new cadre of staff as health
care assistants to take care of non-technical duties
Training and employing nurse prescribers and dispensary
technologists.
Policy 5: The MOH will foster close partnerships
with other MDAs, private and nongovernmental
providers to improve access to health care.
Strategies
• Encouraging and supporting legitimate
institutions to train health professionals
• Providing human resources
• Providing interest-free vehicles for
institutional use.
POLICY IMPLEMENTATION
• The MOH developed the policy to run
concurrently with the second five-year
POW, spanning 2002-2006.
• There was, however, no action plan
• No system of monitoring and evaluation to
guide the implementation.
• Nevertheless, the policy was implemented
somehow
ACHIEVEMNTS
• There were minimal achievements in the implementation
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of the HR policy.
These include the following:
• Training of health professionals:
• There has been significant expansion of all existing
health training institutions to accommodate increase
intake of students.
• Twenty-eight new training institutions were set up
• 21 of these by the MOH, six by the private sector and
one by CHAG.
• These new training institutions include the Ghana
College of Physicians and Surgeons
ACHIEVEMENTS CONT.
• New programs for direct entry into
midwifery, health assistants (clinical) and
a diploma in community health nursing
were introduced. This period of expansion
resulted in an increase of 50% in
admissions into the Health Training
Institutions and a 20% increase in intake
into all the universities.
ACHIEVEMENTS CONT.
• HR retention measures. A number of
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schemes were simultaneously implemented with
the ultimate objective of curbing the brain drain.
These include:
Vehicle Hire Purchase scheme (VHPS): This
scheme was instituted to provide affordable
private ownership of vehicles for Health Staff by
monthly deductions over a longer period of time.
Thus, the scheme led to the procurement and
distribution of 1,082 saloon cars for health
workers at all levels and for categories of staff.
ACHIEVEMENTS CONT.
• Additional Duty Hours Allowance (ADHA):
Subsequent to Health Workers agitations for better
remuneration packages, the MOH instituted the ADHA
policy in 1999 with 3 objectives:
• To recognize and remunerate health workers for any
hours performed over and above the normal 8 hour per
day or 40 hours per week respectively.
• To ensure a 24-hour cover by all health delivery points in
the country.
• To motivate health workers for higher performance. This
was expected to restore and sustain public confidence in
the health sector’s capacity for quality health service
delivery.The massive enhancement of salaries of health
workers with the consolidation of ADHA into the basic
ACHIEVEMENTS CONT.
• Deprived Area Incentives Allowance (DAIA):
• The DAIA was intended to target critical health staff
(Doctors, Nurses/Midwives, Pharmacists) working in
disadvantaged and underprivileged areas of the country.
The designation of deprived area status was the
exclusive responsibility of the Ministry of Local
Government that had the added duty of administering
the DAIA to eligible health staff.
• Deployment strategy:
• A ministerial committee for posting of health
professionals was formed to ensure the equitable
distribution of staff among providers including CHAG.
Also, a number of policy guidelines were developed to
guide the management of the existing stock of staff at
all levels.
FINDINGS
• POSITIVE IMPACT
• High staff retention rates
• Increased workforce productivity in-spite
of low staff numbers
• Increased motivation as a result of
enhanced salaries
• Increased professional and technical skills
for service delivery
FINDINGS CONT.
• POSITIVE IMPACT
• Increased infrastructural investment in
nursing training schools
• Increased production of nurses to fill the
vacancies
• and increase in the ratio of professional to
nonprofessional nursing staff in hospitals.
FINDINGS CONT.
• ADVERSE IMPACT
• Perverse incentives to overstay at
workplace due to pecuniary gains other
than service delivery to patients.
• Low morale of some staff due to
inequitable allocation of the HR incentive
packages
• enabled its staff to receive more money.
FINDINGS CONT.
• ADVERSE IMPACT
• Apathy in the case of some staff who felt
marginalized.
• Internal migration of CHAG staff to GHS
due its relaxed implementation of the
ADHA, which
CONCLUSIONS
• QUOTES FROM RESPONDENTS
• “It tended to lower morale because of the
inequities in quantum size between what
CHAG staff got and staff in Ghana Health
Service.”
• “It bred mistrust, enmity as a result of its
inbuilt exclusionist principle at the facility
level initially.”
CONCLUSIONS CONT.
• “The policy came to kill the spirit of
sacrifice in the mission institutions
and we are now struggling to
resuscitate it.”
• came “to disturb the peace in the
mission hospital environment.”
RECOMMENDATIONS
• CHAG should develop a common HRH strategy
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for adoption by all members.
CHAG should adopt an HR transfer policy that
will institutionalize or facilitate staff transfers
and deployment amongst CMIs and across
denominational lines. This would ensure
equitable allocation and rational utilization of
scarce human resources within the CHAG
fraternity.
CHAG should develop a separate incentive
package for its network members that will be
equitable and linked to performance.
RECOMMENDATIONS CONT.
• CHAG Staff that return from further training
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and who do not fit well in their old places of
work should be deployed within the CHAG
instead of losing them to either Ghana Health
Service or other organizations.
CHAs should analyze the impact of government
HR policies on thier staff, evolve own HR
strategies and implementation plans, and
gather and use evidence for engagement with
their Ministries of Health.
LESSIONS FOR CHAG
• CHAG was unable to maximize the opportunities
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created by the MOH’s HRH policy for lack of
effective participation.
CHAG’s commitment to the MOU in relation to
HR made it possible for CHAG network members
to benefit from the policy, especially with
regards
– the equitable distribution of the newly trained health
professionals
– incentive packages to motivate and the ability to
retain health staff
– the infrastructural expansion of their nurses’ training
colleges
LESSIONS FOR CHAG CONT.
• Improved relationship between CHAG and
the MOH in the area of HR production
• CHAG needs to develop its own HR policy
and strategy document that would feed
into the national policy and strategic
document in future
LESSIONS FOR CHAs
• The experience of CHAG indicates that
• Government HR policies directly affect Christian
Health Associations in Africa (CHAs).
• There is perennial problem of inequitable
allocation of resources to the disfavour of CHAs.
• Staff working with CHAs often feel marginalized
when their counterparts in government receive
preferential treatments, incentives and
advantages that are not readily available at
CHAs facilities.
LESSIONS FOR CHAs
• Given the insightful preliminary findings of
this study, CHAs are highly encouraged to
conduct a similar study into the impact of
government policies on their network
members. It would enable them to identify
key issues around which they engage their
respective Ministries of Health in a
constructive dialogue to find pragmatic
solutions to HR challenges in their
countries and throughout Africa.
ACKNOWLEDGEMENT
• CHAG is very grateful to the following:
– Charles Franzen, and
– Craig Hafner, of IMA World Health,
for failitaing the funding of the research;
– Capacity Project and
– USAID for financing the study
– The heads of CHAG Institutions for participating in
the rearch
– The staff of CHAG Secretariat for assisting in the
retrieval of relevant documents
ACKNOWLEDGEMENT
• BIG THANKS TO MIKE OF THE CHA
PLATFORM FOR HELPING ME OUT LAST
NIGHT.
• THIS PRESENTATION WOULD NOT HAVE
BEEN POSSIBLE WITHOUT HIM
• THE END!!!
• THANKS
• YE DA MO ASE
• BARKA YAGA
• ASANTE SANA
• MERCI