Title: Addressing the Human Resource in Health Crisis: Empowering the Private Not for Profit Health Training Institutions to Play their Role
1Addressing the Human Resource in Health Crisis
Empowering the Private Not for Profit Health
Training Institutions to Play their Role
- The Views and Experiences of Uganda Catholic
Medical Bureau - Presentation to the Christian Connections
International Health - 2006 Annual Conference
- May June, 2006
- Authors Marieke Verhallen, Daniele Giusti, Nancy
Bolan.
2Structure of the Presentation (1)
- The Country Context
- Relevance of the Private Not for Profit Sector
(PNFP) - The Importance of Nurses and Midwives
- The Human Resources for Health Crisis
- The PNFP Research Development Question
- Findings
- Obstacles to Increasing Training Output
- Obstacles within the PNFP Sector
- Complex and Confused National Environment
3Structure of the Presentation (2)
- Conclusions and Priority Actions needed
- The Strategy to strengthen and empower the PNFP
Health Training Institutions (HTI) - The Partnership of the PNFP Health Training
Institutions - The Setback and the Alternative Strategy
- Results so far
- Recommendations
4Uganda in East Africa
5Context Uganda in Figures
- Population 27 million people
- Living below poverty line 38
- Infant Mortality Rate 88 / 1000
- Under five Mortality Rate 152 / 1000
- Maternal Mortality Rate 505 / 100,000 live
births - Life Years Lost
- due to preventable diseases 75
6Relevance PNFP Sector (1)
- Faith Based Organizations autonomous Civil
Society Organizations - Voluntary choice to contribute to Public Social
Aims - Essential cost effective services
- Percentage of Health Facilities in rural areas
80 - 47 of hospitals in the country and
- 23 of Primary health care centers
- Overall 25 of the national health facilities
- 60 of the Nurse Training Schools
- National Coordination and Technical Support
- Medical Bureau per denomination
7Relevance PNFP Sector (2)
- Health Service output
- 30 of the national total
- Allocated budget
- 7 of the national budget (government and
donors) - Nurses Midwives graduated in 2005 60 of
national total
8Present HR Problems in PNFP
- PNFP Shortage of Nurses and Midwives
- 1,843 36 of current norm (national 32)
- Annual Attrition rate nation
- PNFP 20 (national 3)
- In Nurse Training Schools shortage is relatively
larger - Main obstacle to recruitment Financial
- But this year PNFP shortage rapidly increasing
- Attrition in PNFP 25 in first quarter 2005!
9Importance of Nurses and Midwives
- Total current health work force 24,380
- Qualified Nurses and Midwives 8076 33
- Nursing Assistants (auxiliary nurses) 6345 26
- Nurses midwives in average hospital
- 60 of medical / clinical team
- In Primary Health Care Centers
- 80 of the team
- Many Additional the responsibilities in PHC
centers
10The Human Resource Crisis
- National and International consensus
- Human Resources essential to attaining health
outcomes - Shortage of HR is THE OBSTACLE
- To achieve the Millennium Development Goals
(MDGs) - Health worker/population density needed
- 2.5 per 1000 people
- Increase in Nurses and Midwives needed 18,000
- PNFP 6,000
- NB Brain drain to developed countries
accelerating - 2005 200 nurses lost in one recruitment drive
- Training Capacity / Output will have to be
increased
11Human Resource Crisis in Figures
Present available Present shortage New required New shortage
HR/pop density 0.8 / 1000 4,909 2.5 / 1000 43,120
Nurses midwives - Including Nurse Assistants 0.5 / 1000 0.7 / 1000 3,715 1.5 / 1000 21,714
PNFP NM 2,829 1,843 7,843
Nr of NM training places 1600 - 1800 3500 - 4000
12The PNFP Research and Development Question
- Initial question how to improve utilization of
schools? - Actual Question to be answered
- How can the PNFP HTI be enabled to assist in
resolving the HR crisis? - Research and development method Participatory
Approach
13Findings Obstacles to Increasing Training Output
- Present training capacity inadequate
- Existing Curricula not adjusted to health needs
- Range of cadres trained too limited
- Entry criteria based on secondary school results
continuously raised
14Findings Obstacles within PNFP Sector
- Lack of coordination and cooperation among the
PNFP HTI - No influence on national training policies,
plans, nor programmes - Loss of innovative capacity and daring
15Findings Complexity and Confusion at National
Level (1)
- Lack of Leadership
- Absence of HR Strategic plan
- Funding inadequate and inequitable
- Focus of Development Partners too narrow
16Findings Complexity and Confusion at National
Level (2)
- Who decides and who should decide?
- Existing Legislation The Professional Councils
- But MOES responsible for training?
- Entry criteria and curricula contradictory
directives - Academic and Professional Certification
duplication of exams - Regulation of professionals after entry into the
system under developed
17An Example to Illustrate
- To improve PHC train a multipurpose nurse
- The Enrolled Comprehensive Nurse
- Decision taken in 2000 but still not fully
implemented - Reasons
- Curriculum developed by technical team MOES
without effective consultation - Nurses and Midwives Council never really endorsed
it - Unresolved dispute about the entry criteria
- Rural candidates cannot access the course
- Hospital managers hospital nursing not covered
- PHC center managers midwifery part inadequate
- Investment and recurrent costs proved too high
18Conclusions from the Findings
- Nurses and midwives form the backbone of the
Ugandan health system - To achieve the MDGs the number of nurses and
midwives needs to be increased THREEFOLD - Increasing training capacity is essential to
increasing availability of HR - The PNFP HTI have a large potential to increase
the training output
19Priority Actions to Increase HR Availability
- National level clarify and strengthen Leadership
and Planning - PNFP HTI organize and strengthen themselves
- The Development Partners support both partners
and joint development
20Preamble to Strengthening the PNFP HTI (1)
- Internal consensus PNFP Health Training
Institutions need to be enabled to - To respond to opportunities and threats in the
external environment - Build strong cohesion and unified voice
- To address the required huge increase in nurses
and midwives - Participate in national policy and planning
process
21The Partnership of PNFP HTI (1)
- Choice of the PNFP HTI
- An Interdenominational Organization
- Legally established and recognized
- Formed and Governed by the member HTIs
- Taking charge themselves
- High level of participation and commitment
- Strong expression internal cohesion
- Employ professional capacity to support and
enhance implementation
22The Partnership of PNFP HTI (2)
- Mission of the PNFP HTI
- To train an optimal range of health care staff of
high professional and moral standard for the PNFP
and national health care institutions - Partnership Enhance attainment of HTIs mission
through - Internal coordination and cooperation
- External advocacy and cooperation
- Addressing common challenges
23The Setback
- When Constitution and Memorandum of Association
ready to be signed by the Owners - One denomination realizing the full extent of the
plan requested to stay the process - Decision
- Too early to set up a legal organization
- First exhaust existing structures and internal /
external dialogue
24Alternative / Incremental Strategy
- Incremental step towards the Partnership
- The PNFP Medical Bureaux set-up a structure and
capacity to support and represent their HTI - A Participation Forum / Standing Committee
- Annual assembly of affiliated HTI
- HTI Training desk with a professional
coordinator - Mission, strategies, and objectives the same
- Per denomination
- One additional assignment
- Foster interdenominational dialogue and pursue
the installation of the Partnership at later
stage
25Results So Far (1)
- Externally
- Increased national awareness PNFP HTI capacity
indispensable - Move to include PNFP HTI in development of plans
- Increased interest Development Partners
26Results So Far (2)
- Internally
- Increased assertiveness of school teams and group
- Stronger cohesion among PNFP HTI
- Interdenominational cooperation accepted and
pursued - Innovations starting
27Recommendations
- For the PNFP HTI
- The key to contributing more effectively lies in
united active participation and cooperation - The structure and professional support should aim
at empowering each HTI and the group as a whole
28Recommendations
- To address the HR Crisis effectively
- National and International Stakeholders have an
interest in - Fostering Public Private Not for Profit
Partnership in training health workers - Assuring adequate and equitable funding of
training in all HTI
29Recommendations
- For CCIH participants
- The church health institutions represent a huge
heritage that our forefathers left us - As stewards
- We need to assure that we hand them over to those
that come after us in better shape than they are
now! - We may not succeed if we follow the fashion of
the day!