13th Canadian Conference on International Health

1
Global to Local The Human Resource Dilemma
13th Canadian Conference on International Health
2
Global Proportions
3
World Workforce Health Status The Global
Picture
From JLI 2004.
4
Projected Nursing Shortfalls in Developed
Countries A Danger for Poor Source Countries?
.
Derived from data at - http//www.state.gov/s/gac/
rl/or/29737.htm (October 2004)
5
(No Transcript)
6
The Health Worker Density Index (HRH index)

• 1. A composite index
• density of physicians, nurses, midwives per
  1,000 population,
• reflects the overall level of health workers in
  each country.
• 2. A density of 2.5 workers per 1,000
• - a threshold of worker density necessary
  to attain adequate coverage of some essential
  health interventions and core MDG-related health
  services.

7
Health Workforce Density and Need
HWF per density Total Workforce/Total
Population X 1000 Optimal HWF density per 1000
Total Population X 2.5 /1000
8
Balancing Health Worker Ratios
9
About HR numbers alone?
10
(No Transcript)
11
HRH Index Higher in the countries where U5MR
increased
12
Under-five mortality in Sri Lanka(Good Health at
low numbers low cost)
13
Numerical Approach

• Valuable for advocacy
• Prompted debate discussion
• Stimulated policy review

14
Many Edges of the African crisis
15
Production Output versus Absorptive
Capacity(School of Health Technology)
16
What can improve HW performance?
17
Total Health Expenditure per capita (US ) in
the African Region
18
Analysis of Capital Expenditure
19
Analysis of Recurrent Expenditure
20
NATIONAL HEALTH SYSTEM PARTNERS IN DISARRAY!!!
Private Sector - International NGOs/PVOs
Private Sector - Facilities
Private Sector - Mission Hospitals
21
Between the tiers - Fragmentation
Tertiary Support

• Unclear structure
• functions linkages
• Systematic
• analysis of needs
• response capacity
• inadequate
• Mainly relate on priority
• disease or programs

1st Referral
Health Center (1st Contact)
Home/Community Based Care
22
Overall Systems Performance of the Health System
African Countries(Ranking among the 191 member
states of WHR 2000)
23
Who cares?
24
Global Momentum
HL Forum I Geneva
JLI Report
HL Forum II Abuja
Oslo Consultation
Transitional WG
Africa Commission Report
G8 Summit Gleneagles
Asia Network Bangkok
UNGA Summit
PAHO Observatory Toronto
HL Forum III Paris
World Health Report World Health Day
WHA
25
African Leadership Partnership
2004
WHA Resolution 1
African Union Summit, Abuja
2005
African Health Ministers mtg -Maputo
WHA Resolution 2
ACOSHED-NEPAD Regional Dialogue
African Stakeholder Consultation, Brazaville
WAHO Consultation, Ougadougou
AU Conference of African Ministers of Health -
Gabaronne
African Platform on HRH
2006
African HRH Observatory
Planning and Learning mtg - Akure
Solidarity with the African Health Workforce
26
High Level Political Commitment
There is a need to address the issue of Health
Systems Strengthening and its Human Resources in
Health component. In this respect, countries
should develop costed national human resources
development and deployment plans, including
revised packages and incentives, especially for
working in disadvantaged areas and revitalize
Primary Health Care. Conference African Union
Ministers of Health 2005
27
Evolving and Robust Response
28
A Conceptual Framework
Financing Options (Budget allocation, grants
loans, community financing)
Infrastructure Equipment
Human Resources
Actions from related sectors
Finance Public Administration
Education Agriculture Environment
Drugs, Supplies Quality Mgt
Health Systems Output (Equity, Efficiency
Quality)
Outcome ( Health Status, Mortality
Morbidity)
29
Optimizing Service Southern African Capacity
Initiative
30
SACI- Focus Diagram
31
Solidarity with the African Health Workforce!
32
A Civil Society Led Partnership Response

• African Council for Sustainable Health
  Development (ACOSHED)
• Centre for Health Sciences Training, Research and
  Development (CHESTRAD), Nigeria
• Ethiopian Public Health Association (EPHA),
  Ethiopia
• Health Systems Trust, South Africa
• African Medical Research Foundation, Kenya
• EQUINET, South Africa,
• WAHO, SADC
• NEPAD, WHO-AFRO, UNDP-SACI
• University of Western Cape, South Africa
• Physicians for Human Rights, USA
• Global Health Workforce Alliance, Swizerland
• UK Faculty of Public Health, UK
• African Countries Nigeria, Ethiopia, Swaziland,
  Uganda, South Africa, Namibia

33
Key Program Themes

• Action, Learning and Practice Sites on Human
  Resources for Health
• The mid cadre and Community Health Workforce
• African Health Systems Review
• Leadership Development for Human Resources and
  Health Systems
• Policy Dialogues, Advocacy Knowledge Management
• Performance Evaluation and Impact Assessment

34
Canadians on Board!
35
What can you contribute?

• Research there is still a lot we dont know
• Fiscal space expansion and management
• Bold, purposeful, sustained and innovative
  investment like The Ivermectin Promise
• Respect the Paris Declaration
• Ownership, alignment, harmonization and
  coordination
• Leadership for HR and HSS in Africa
• Capacity building

36
THANK YOU!
Lola Dare Executive Secretary African Council for
Sustainable Development (ACOSHED)
16th October 2006