Presentation by Dr' Anthony A Sandi'

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Human Resource Policy and the Overall HRH Status
in MoHS in Sierra Leone.

• Presentation by Dr. Anthony A Sandi.
• Director, Human Resources for Health, Ministry of
  Health and Sanitation.

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SIERRA LEONE-THE LAND OF GOLD AND
DIAMOND.
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OBJECTIVE OF THE PRESENTATION.

• TO SHOW CLEARLY AND OBJECTIVELY
• 1) An overview of the Health System in Sierra
  Leone.
• 2) HR-Policy in line with General Civil Service
  Policy and Decentralization.
• 3) HRH-Status i.e Number-in-Post and Actual
  Number Required).
• 4) Health Training Institutions and Health
  Professional
• Training.
• 5) Stop-Gap Measures put in place by Government.
• 6) Recommended Solutions to Government.

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Health System Organisation In Sierra Leone

• The Health Care Delivery in Sierra Leone is a
  three tier system
• a) Primary Health Care (CHC,CHP,MCHP)
• b) Secondary Health Care (District Hospitals)
• c) Tertiary Health Care (Regional and
  Specialized
• Hospitals)
• d) The system is interlinked through a referral
  system.

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Basic Country Profile and some Health
Indices.

• Pop.5M.
• 2. MMR1,300/100,000 Live Births.
• 3. IMR170/1,000.
• 4. U5sMR265/1,000 Live Births.
• 5. HIV Prevalence1.5

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Some common and Killer Diseases.

• Malaria (Responsible for 33 Deaths among
  Infants).
• Measles.
• ARI.
• Diarrhea.
• Malnutrition though not a disease but is a
  significant contributor to Infant Morbidity and
  Mortality.

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HR-Policy-I.

• I) Before the Public Sector Reforms now going
  on in Sierra Leone,
• a) Strategic Policy making in HR was the
  prerogative of the Establishment Secretary who
  reports to Secretary to Cabinet who is Head of
  the Civil Service.
• b) Then, MoHS as a line Ministry was
  responsible for policy implementation.

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HR-Policy I (cont).

• c) The Establishment Secretary was responsible
  for creating and controlling staff establishment
  and positions, recruitment, appointment,
  discipline and retirement.
• d) The Public Service Commission (PSC) was and
  still is responsible for conducting recruitment
  and promotion interviews.

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HRH-Policy.

• With Major Health Sector Reforms going
  on
• I. HRH- Policy is now developed and intends to
  address the following
• It regulates and directs HR-Management, Planning,
  Development, Utilization and Monitoring within
  MoHS.
• It responds to contemporary challenges and
  developments including the high attrition rate
  and advancement in medical technology.
• MoHS now recommends Staff Recruitment, Promotion
  and retirement.

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HRH-Policy Vision.

• 1. By the year 2015, MoHS, provided the HR-Plan
  is strictly and comprehensively implemented,
  shall have in place adequately well-managed,
  efficient and motivated Human Resources for
  Health capable of providing equitable access and
  distribution of services leading to a healthy and
  productive Sierra Leone.

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HRH-Policy Values.

• I. HR-Policy is based on the following values
• a) Quality and Cost Effectiveness in Human
  Resource Development is based on client needs and
  set norms and standards.
• Professional conduct and performance standards
• are oriented towards the client.
• c) Efficiency and effectiveness in delivery of
  quality health care services.
• d) Transparency and fairness in all principles
  and practices of Human Resources Management and
  Development.

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HRH-Policy Values (cont).

• f) Equality of access to managerial and
  leadership positions based on merit and relevant
  qualifications.
• g) Decentralized implementation of the HRH-
  policy and strategy in accordance with the
  national health decentralization strategy and
• h) Broad involvement and participation of all
  relevant stakeholders.

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HRH-Policy Objectives.

• The objectives of this policy are to
• 1. Provide a focused and detailed policy
  direction on issues of HRH Management including
  planning, production and motivation that will
  ensure quality service delivery
• 2. Provide policy direction on HRH education and
  training of the required competencies/cadres
  based on service delivery requirements in optimal
  quantities and quality.

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HRH-Policy Objectives (cont).

• 3. Promote research into HRH interventions to
  provide evidence base for the improvement of
  service delivery and
• 4. Form a basis for the review of the
  implementation of the HRH-Strategic plan to
  address contemporary challenges affecting HR
  within the decentralized system.

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Challenges of HRH-Policy and
Decentralization.

• There is a Local Government Decentralization Act
  published in 2004.
• The act paves the way for the devolution of
  authority and responsibility from the central to
  District Councils.
• In this act, there is a section which gives
  HRM-Responsibilities to Local Government Service
  Commission.

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HEALTH CARE FINANCING.

• 1. The Total Annual Government Budget for Health
  in 2007 was US 12 Million.
• 2. For 2008,it is US 9 Million.
• 3. This Budget is for all Technical Programmes
  and Tertiary Health Care Services.
• 4. Budget for Primary and Secondary Health Care
  has been devolved to Local Government

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Health Care Financing (cont).

• 5. HRH consumes about 30 of Annual Budget,
  which is by 30 40 below the Average Rate of
  most Countries in Africa.
• 6. This budget also includes personnel emoluments
  and other HR-Aspects such as Training.
• 7. However, some appreciable Financial
  Contributions are made by Development Partners
  like World Bank, EU, ADB, IDB, WHO, UNICEF, DFID,
  GLOBAL FUND etc.

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Health W/Force Attrition and Causes.

• The drastic movement of Health Workers away from
  the MoHS to either Private, NGOs, FBOs, or
  UN-Agencies, within or outside the country is due
  to several factors (Push and Pull Factors).
• In view of the above, I will give the actual
  HR-Strength in MoHS.

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Stock of Med. Personnel in MoHS.

• CADRE199320032005..2006..2008Pr/SecVAC...GA
  P
• M.Os.20373...67.7578..30.300.236.
• Paed...16..4..3...3......3...4...17.
  ..12.
• Dentists......15.............6..8........8....
  ..8..3....20...12.
• O/Gyn........23.............6......8........7...
  ...8...4...15.8.
• P/H.Sp...58....30...19...22...24...6...
  30..9.
• Surg/Sp.....13......7.6........8..5....7
  30.....22.

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Stock of Medical Personnel (cont).

• CADRE.1993..20032005...2006...2008Pr/Sec.V
  AC......GAP.
• Phy/Sp..5........6......1.......5........4.10...
  .30......23.
• M/W132111.98..87..8730....300...113
• SRN.....625.266..184202....355.85...600...375

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Personnel/Population Ratio.

• MO/GP.146,296.
• Paediatrician.1714,285.
• Obs/Gyn....1416,666.
• M/Wives.......142,734.
• Surgeon.1416,666.
• RN.111,363.
• Phy. Specialist...135,714.

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Reasons for Attrition in MoHS.

• Poor conditions of service (Low Salaries, Poor
  Work Environmental Conditions, Lack of or
  Inadequate Basic Working Equipment, Lack of or
  inadequate Staff Quarters).
• Poor Career Path and therefore Poor Career
  Progression.
• Inadequate Training Opportunities because of
  inadequate Funds.

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Reasons for Attrition-cont.

• 6. Slow promotion of Personnel.
• 7. Bureaucratic Recruitment and Absorption
  Processes within the Civil Service.
• 8. Death as a Natural Cause.
• 9. Retirement either Voluntary or attainment
  of statutory retirement age of 60 Years.
• 10. Migration for better economic opportunities.

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Health Professional Training. I

• Sierra Leone has two Universities University of
  Sierra Leone and Njala University.
• Professional training is largely with the
  Ministry of Education.
• For now, there is only 1 Medical School (COMAHS)
  under USL, established in 1988 and trains

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Health Professional Training by COMAHS (USL)
II.

• Cadre...Course..D/tion.Intake...Output.
• M.Os...MBBS....78 Yrs...40.............5.
• Pharm..B.Pharm.5 Yrs...20.........7.
• RNs.B.Sc4.Yrs... 6.6.
• RNs.....Dip..3Yrs...75...60.
• CHNCert.2 ½ Yrs..80...75.
• P/Tech..Cert3 Yrs..75...........70.
• L/Tech..Dip.2 Yrs..15...15.

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Professional Training by Njala UniversityNat.Sch.
of Midwifery III.

• Cadre...Course..D/tion..In-TakeOutput.
• P/H..B.Sc..4Yrs20..(On-Going).
• P/H..MPH.2Yrs24..(On-Going).
• CHOs..HND.4Yrs....30...25.
• EHOs..HND.4Yrs....30...25.
• RNs.Dip...3Yrs40...35.
• SECHN...Cert..2½Yrs.40...35.
• M/Wives..Cert..1 ½.Yrs40.35.

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Other Health Professional Training Institutions
(cont).

• I. Other Nursing Training Institutions are
• 1. Eastern Polytech in Eastern Region of S/L.
• 2. Northern Polytech in Northern Region of S/L
• 3. Military Nursing Training School in F/Town.
• 4. 4-FBOs Nursing Training Schools.

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Stop-Gap Measures (cont).

• South-South Doctors are presently in Country as
  follows
• a) 10- Doctors from Cuba and Nigeria are
  presently serving in the Country.
• b) About 50 more South-South Doctors are yet to
  come.
• 2. HR-Division has reviewed existing Schemes of
  Service and has developed new ones for newly
  Established Posts to ensure Career Path and
  Progression, which serve as a motivation factor

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Stop Gap Measures (cont).

• 3. Government has endorsed an increase in the
  following allowances
• a) Housing allowances.
• b) Hard-to-Go or Remote Area Allowances.
• Leave Allowances.
• Separation Allowances for Married Couples.
• Medical Allowances.
• Transportation Allowances.

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Ways of achieving Attraction and Retention.

• Ensure Continuous Education to improve Personnel
  Skills, Competencies and Career Development.
• 2. Development Partners to help with
  expatriates to strengthen Capacity Back-Up.
• 3. To strengthen PPP in order to enhance full
  Partnership Commitment and Participation in
  Service Provision.

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Proposed Solutions (cont).

• Government to approve and authorize the enactment
  of Medical and Health Services Commission to
  facilitate Staff recruitment, absorption and
  promotion.
• Government to approve and authorize the removal
  of Health Personnel from the general Civil
  Service Salary Scale to a separate one like
  Teachers and Judiciary.

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Proposed Solutions (cont).

• Provide Housing Scheme.
• Advocacy with the West African Colleges of
  Surgeon and Physicians to accredit selected
  Hospitals to facilitate Specialist Training.
• 3. Most importantly, improve general conditions
  of service.

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CONCLUSION.

• No matter the range of influx of Financial
  Resources into a system in order to improve that
  system, no matter the implementation of carefully
  tailored, tested and proven policies, a positive
  impact will never be realized without having a
  well trained, well managed and a well motivated
  workforce in place.
• THANK YOU FOR YOUR ATTENTION.