Human Resources for Health

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Human Resources for Health

• AN INGHO PERSPECTIVE
• FROM THE FRONT LINES OF
• FRAGILE STATES
• Stephen TomlinVP for Program Policy
  PlanningInternational Medical Corps Los
  Angeles, California
• UNIVERSITY OF CALIFORNIA, BERKELEY
• SCHOOL OF PUBLIC HEALTH
• GLOBAL HEALTH WORKFORCE CONFERENCE
• April 4-5, 2008

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THE INTERNATIONAL SYSTEM FOR RESPONSE AND
TRANSITION

• INGOs
• INTERNATIONAL ORGANIZATIONS
• UN AGENCIES
• GOVERNMENT DONORS
• MILITARY
• PRIVATE DONORS

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Diversity of INGO Sector
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INTERNATIONAL MEDICAL CORPS

• established as a private, voluntary,
  nonpolitical, nonsectarian organization in Los
  Angeles,1984.
• mission is to improve the quality of life for
  vulnerable populations through health
  interventions and related activities that build
  local capacity.
• currently works in 23 countries.
• FY2008 budget is 138 m.

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IMC Around the World
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FRAGILE STATES

• Fragile states are unable or unwilling to harness
  domestic and international resources for poverty
  reduction
• Comprise 48 countries
• 1,150 million people
• 19 of the worlds population

• Biggest challenge to any significant improvement
  in global health, as well as any progress towards
  the achievement of MDGs, are in difficult
  environments comprised of fragile states - or
  weak states or failing states
• Excluding those of India and China, the
  populations of these countries comprise more than
  50 of those living in absolute poverty around
  the world. 

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Fragile States Comprise

• 1/3 (2835) of all those living in absolute
  poverty in developing countries.
• 1 in 3 people undernourished.
• 1/3 of all children (3246) living in developing
  countries who are not receiving a primary
  education.
• Nearly 1/2 of all children (4151) dying before
  their fifth birthday each year in developing
  countries.
• 1/3 (3344) of all maternal deaths in developing
  countries each year.
• 1/3 (3444) of all those living with HIV/AIDS in
  developing countries.
• 1/3 (2735) of all those living without
  sustainable access to safe drinking water in
  developing countries.

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• Africa
• Angola, Burkina Faso, Burundi, Cameroon, Central
  African Rep, Rep of Congo, Cote dIvoire,
  Djibouti, DRC, Eritrea, Ethiopia, The Gambia.
  Guinea, Guinea-Bissau, Lesotho, Liberia,
  Madagascar, Mali, Mauritania, Niger, Nigeria,
  Rwanda, Senegal, Sierra Leone, Somalia, Sudan,
  Togo, Uganda Zimbabwe
• Asia
• Afghanistan, Azerbaijan, Bhutan, Cambodia,
  Indonesia,  Kyrgyz Republic, Lao PDR, Myanmar,
  Nepal, Pakistan, Papua New Guinea, Tajikistan,
  Timor-Leste, Uzbekistan. Vietnam, Rep of Yemen
• Other
• Serbia and Montenegro, Haiti

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Typical IMC Level of Activity In The Health
Sector
Ministry of Health
For profit hospitals
Charitable hospitals
doctors
Tertiary referral hospital
doctors
doctors
Primary Care
doctors
Charitable hospitals
doctors
Provincial Hosp
doctors
Charitable hospitals
District Hosp
clinics
Health Center
Health Post
clinics
Community Health Workers
clinics
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IMC Partners
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IMC Focus Areas
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IMC Flagship Initiatives

• Training health care providers in fragile states
• Health and well-being of women
• Integration of mental health services into
  primary health care
• Building local capacity for risk reduction and
  rapid response to emergencies
• Very interested in applied research that will
  facilitate the mobilization of multi-year funding
  initiatives for health sector human resource
  development

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Evidence-based Research Can Bridge the Gap
Between Humanitarian and Development
Humanitarian v.
Developmental

• IMC operates in most countries for prolonged
  periods
• IMC attempts to work with existing state
  providers
• IMC seeks engagement with State systems since
  this provides most potential for scaling up
• IMC views primary health to be the easiest sector
  in which to engage with the state directly.

• IMC interventions in Fragile States span a range
  of needs
• IMC links communities to formal healthcare
  provision to scale up surveillance and preventive
  healthcare
• IMC is rarely ever invited to participate in high
  level planning processes
• Need-based curriculum development, often in
  isolation

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Evidence-based Research Can Bridge the Gap
Between Humanitarian and Development
Humanitarian v.
Developmental (2)

• IMC s training activities are rarely capitalized
  upon. They could provide models for improving
  service delivery.
• IMC is not aware of any independent evaluation of
  the extent to which INGO programs contribute to
  pro-poor government systems.
• IMC project funding is often on very short
  relief cycles, usually between 6-12 mos.

• Development of state capacity requires more
  predictable, longer-term funding mechanisms tied
  to more inclusive planning
• IMC is challenged in securing funds for
  transitional environments
• IMC does not view Consolidated Appeals as
  inclusive mechanisms for raising resources

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LESSONS LEARNED - Effective Interventions

• Focus on building capacity at all levels
• Dependant on intl alliances and partnerships
• Incorporate long term vision
• Coordinated strategically/
• Good Humanitarian Donorship Initiative
• Include INGOs at the high-policy table
• Coordinated tactically/
• Cluster approach
• Security is coordinated and managed at all levels

• Information sharing through HIS is facilitated
• Multi-sectoral
• Logistic systems are robust
• Partner with local NGOs / CBOs
• Communities are mobilized
• Services are integrated
• Engage with State systems
• Incorporate quality assurance systems

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IMC al Jeer clinic, Nyala, South Darfur, Sudan
MCH, Daru Clinic, Sierra Leone
Rabia Balki Hospital for Women, Kabul
AE Training, Nasiriyah Hospital, Iraq
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Livelihoods Micro-Finance Activities Linked to
Health Worker Support
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stomlin_at_imcworldwide.org www.imcworldwide.org