Nonglak Pagaiya and Sanya Sriratana

1
Planning for health workforce for primary care
services in 2 provinces in the Northeast Thailand

• Nonglak Pagaiya and Sanya Sriratana
• International Health Policy program

2
Presentation outline

• Why are-based HWF planning
• Objectives
• Results
• Policy implication

3
Health Service System
Center of Excellence
Prov/ reg hosp (100)
RURAL
District hosp 50,000 (83)
Health centre 5,000 (100)
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1. Context/ factors effecting HWF demand

• Change in demo./ epidemiology
• Elderly increase up to 10 , 15 in 10 yrs
• Increase in chronic diseases
• Increase in accident/ emergency
• Reform
• universal coverage, increase utilisation
• civil service reform, limit number of HRH
• existence of organization promoting health
  promotion

5
Health workforce (HWF) problems

• Mismatch between Supply and Demand
• Mal-distribution, rural vs urban

supply
Demand
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Limitations of HWF planning

• Contextual changes, effecting HFW
• Inadequate evidence-based information
• Emphasize on number rather than quality and
  planning process, limited stakeholders
• Lack of area-based planning, not related to local
  needs
• Plan for each professional separately
• Methods for planning is limited to population
  ratio

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2. Objectives and Approach

• to assess the health workforce supply and demand
  and to develop recommendations to redress the
  mismatch between health workforce supply and
  demand.
• Approaches
• Develop the HFW forecasting model
• Collect baseline information
• Assess supply and demand (requirement)
• Develop recommendations for HFW planning

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Baseline data for HWF forecasting Model

• Model assess HFW requirement base on health needs
  and health demand approach
• Population by age group
• Sickness and service utilization by age group
• Health facilities
• HWF, number, distribution, loss rate and gain
  rate
• Productivity and staffing norm

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Population by age group
Community setting
Facility setting
1? care
Com. care
HFW
HFW
2? care
HFW
HFW
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3. Results
1) Sickness and service utilization at primary
care (Curative and rehabilitation at health
centers)
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2) Baseline data of 2 provinces
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Community HWF Supply
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3) HWF supply (2? care)Ubon
24
11
11
20
3
2
14
HWF supply (1? care) Ubon
1
5
2
21
5
1
15
(5) HWF supply (2 ? care) KK
27
12
11
7
7
2
16
(5) HWF supply (1 ? care) KK
2
4
3
2
2
1
17
Service provision and task-shifting
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HFW requirements Ubon
19
HFW requirements KK
20
Community HWF supply and requirements
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4. Summary

• HWF problems
• Shortage of doctors, nurses and PT
• Surplus of dental personnel, if not well job
  allocation
• Inequitable distribution, esp primary vs
  secondary care
• Retention in rural, esp, primary care

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Recommendations

• Area-based planning with HFW mechanism at local
  and national level
• Increase production, particularly
• Local recruitment, regional training and hometown
  placement esp, nurses, PT
• Increase production of auxialies, i.e., PT
  auxiliaries and plan for their career path
• Appropriate task-shifting
• Doctors and nurses curative
• Nurses and public health prevention
• Public health and nurse vs VHV and community HWF

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Recommendation (cont)

• 4. Shift from curative care to health promotion
  and prevention at community levels
• 5. Strengthen community health workforce, esp,
  VHV , aged care providers and other volunteers
• 6. Consider appropriate incentives (financial and
  non-financial) to attract and retain doctors,
  nurses, PH and PT at rural.
• 7. Strengthen effective referal system btw health
  centers and hospital including sharing resources