Leadership (f)or participation?

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Leadership (f)or participation?

• Development policies
• on Human Resources for Health
• from Alma Ata until today
• by Maren Bredehorst, MPH
• International Conference global gerecht
  gesund
• Forum V, Workshop Health workers Ethical
  Aspects and Dimensions
• Berlin, 17-16 September, 2010

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Introduction
Historical perspective on development policies
in health and their implications for Human
Resources for Health (HRH) Example Republic of
Malawi
Focus on the concepts of leadership,
professionalism and community participation con
tradictions of underlying principles?
challenges and options for health
professionals / experts?
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Human Resources for Health policies in Malawi
(1964-1993, Banda-era)

• post-independence manpower and facilities
• under-five clinics 1973-75
• Primary Health Care 1978(pilot paid PHC
  workers then turn to volunteers / Health
  Surveillance Assistants)

• Increased sensitivity for workforce profile
  (skills) and management in 1986-95 National
  Health Plan
• College of Medicine 1991, emphasis on community
  health

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Human Resources for Health policies in Malawi
(1994-present, multi-party system)

• HIV/AIDS increasing workload and health worker
  attrition
• attempts at strategic HR planning
• Academic training Bachelor and Master
  programmes but no formal career paths
• Health Sector-Wide Approach with Human Resources
  Emergency Plan
• Global Fund applications(incl. Health Systems
  Strenthening)

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Volunteering and professionalism
Alma Ata Declaration incorporates both a)
spirit of self-reliance and self-determination
participation community health workers b)
train existing health cadres for PHC
implementationdevelop a scientific base

• Malawis Health Surveillance Assistants
  ambivalent role, core cadre for service delivery
  in communities
• Professional view Who regulates and supervises
  increasing numbers of volunteers and auxiliaries?
  (Dräger et al. 2006)

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Leadership concepts in health

• shift from social dimension of PHC (Flahault
  1986)towards capacity development / governance /
  stewardship
• good practice principles for leadersHealth
  outcomes, Evidence-based, Aligned, Long-term,
  Transformational, Harmonized (WHO 2007)
• leaders as brokers for PHC and moderators of
  political processes
• participation as transparent processes,
  empowerment of health professionals(WHO 2008)

WHR 2008 Primary Health Care now more than
ever
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Challenges and options for health professionals
/ experts
Approach to health needs vs. rights - from
professionally-led to user-led initiatives? -
empowerment? Professionalisation
organizational vs. occupational- third logic
besides market and bureaucracy- collective
action under the global aid regime? Knowledge
systems standardisation vs. openness-
information needs of development institutions-
social research for alternative knowledge /
value systems
Rappaport (1981) Evetts (2006)Escobar (1995)
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Conclusion
Leadership and community participation (and their
link) have often been neglected in HRH policies
Participation should be established as a value /
principle in the process of professionalisation
in Public Health Reflective practice is
required Political nature of health has to be
recognised by all stakeholders, at all levels
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- Thank you for your kind attention! -
References Dräger S, Gedik G, Dal Poz MR (2006)
Health workforce issues and the Global Fund to
fight AIDS, Tuberculosis and Malaria. Human
Resources for Health 423 Escobar A (1995)
Encountering Development. The making and Unmaking
of the Third World. Princeton University
Press Evetts J (2006) Short Note The Sociology
of Professional Groups New Directions. Current
Sociology 54 133 Flahault D, Roemer MI (1984)
Leadership for Primary Health Care. Levels,
functions and requirements based on twelve case
studies. WHO, Geneva Rappaport J (1981) In Praise
of Paradox. A Social Policy of Empowerment over
Prevention. American Journal of Community
Psychology 9 (1) 1-25 WHO (2008) World Health
Report 2008 Primary Health care now more than
ever. WHO, Geneva WHO (2007) Towards better
leadership and management in health.
WHO/HSS/healthsystems 2007.3 Photos M.
Bredehorst 2009 Map and flag of Malawi
www.wikipedia.org