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`HUMAN RESOURCES FOR HEALTH

AND THE

GLOBAL HEALTH WORK FORCE ALLIANCE

RONNIE GRAHAM,

DIRECTOR, HUMAN RESOURCES FOR HEALTH, SIGHTSAVERS

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Health workers are the heart and soul of health systems. And yet, the world is faced with a chronic shortage - an estimated 4.2 million health workers are needed to bridge the gap, with 1.5 million needed in Africa alone.

57 countries are considered to be in crisis.

The critical shortage is recognized as one of the most fundamental constraints to achieving progress on health and reaching health and development goals.

1. THE GLOBAL CRISIS

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2006 Launch of World Health Report ‘Working Together for Health’

2006 Launch of the GHWA – World Health Assembly, Geneva

2008 1st Global Forum on HRH, Uganda – Kampala Declaration

2008 Nigel Crisp ‘Scaling Up – Saving Lives’

2009 Launch of Strategic Framework and CCF

2011 2nd Global Forum, Thailand – membership exceeds 300

2012 Nigel Crisp & the APPG: ‘All The Talents: Changing Roles and Skill Mix of Health Workers’

2012 External Evaluation of GHWA

2. THE GLOBAL RESPONSE

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3. What is the GHWA ?

• The Alliance is a global partnership, formed in 2006 as a joint platform for action on the health workforce crisis. Its members include governments, UN agencies, professional associations, NGOs, foundations, research and training institutions and the private sector.

• It serves as a catalyst for learning, dialogue, advocacy (HWAI) and joint action.

• It facilitates mechanisms to articulate link between investments and outcomes.

• It identifies strategic opportunities for advancing the global agenda.

• It supports regional networks and other alliances to strengthen collective action.

• It is not a funding mechanism !

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RESPONSE TO THE EVALUATION

1.Establish a specialist health worker sub-committee (eye health, dental, mental etc)

2. Prioritise advocacy opportunities at country level – particularly the CCF approach

3. Closer inter-sectoral collaboration between Ministries of Health and Education

4. Include HRH in post-MDG development framework

5. Focus on comprehensive, costed national HRH plans and include in health budgets

6. Strengthen the ‘voice’ of the health worker

7. Hold partners to account against commitments

8. Promote mHealth and on-line learning

9.Address overlapping mandate between GHWA and WHO HRH

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36 out of 57 crisis countries

24% of the burden of disease

10% of the global population

1% of global health resources

And only 3% of the global health work force

5. The Crisis in AFRICA

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Human resources are our most valuable asset.

Yet many difficulties encountered in planning and training including issues of availability, distribution, competency, productivity, retention, CPD, equipment and supplies, cadre recognition and career development.

6.1 AVAILABILITY

6. THE EYE HEALTH WORK FORCE CRISIS IN AFRICA

LEVEL TYPE WHO RECOMMENDED

RATIO

NEEDS CURRENT ESTIMATE

GAP

TERTIARY OPHTHALMOLOGIST 1/250,000 4,000 1,700 2,300

SECONDARY ALLIED EYE HEALTH PROFESSIONAL

1/100,000 10,000 4,000 6,000

PRIMARY PEC 1/10,000 100,000 10,000 90,000

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Every table tells a story but also raises a new set of questions – what about urban-rural distribution, public-private, surgical-non-surgical etc.

6.2 DISTRIBUTION IN AFRICA

POPULATION/MILLIONS

OPHTHALMOLOGISTS RATIO

ANGLOPHONE 423 1,143 1/370,000

FRANCOPHONE 256 479 1/534,000HORN OF AFRICA 98 118 1/834,000

LUSOPHONE 45 35 1/1,275,000TOTAL 822 1,774

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7.1 The HRH Action Framework (HAF)A simple but comprehensive technical framework to assist governments and

managers to develop and implement strategies to achieve an effective and

sustainable work force.

Six Action Fields1.HR Management Systems2. Leadership3. Partnership4. Education5. Finance6. Policy

Four Phases

Situation analysis->Planning->Implementation->M&E

7. TOOLS AND GUIDELINES

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• An important barrier to resolving the eye health workforce crisis is the lack of funding.

• Countries are seldom in a position to make the economic case for financial assistance.

• Selecting the wrong tool can lead to unnecessary costs, delayed policy decisions and wrong conclusions.

.

The tool has been applied in several countries and users found it useful to understand the scale of resources required. Sightsavers will now pilot in three countries in Africa.

7.2 COSTING THE EYE HEALTH WORKFORCE

The OneHealth Tool was developed by a UN-World Bank Inter-agency Working Group and supports the costing, budgeting, financing and national strategy development with a focus on integrated planning and strengthening health systems. It combines the most useful components of different tools and is designed in a modular fashion allowing for programme specific costing.

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CCF is the process which brings together all key

stakeholders in a country to develop and implement

a comprehensive, evidence-based, HRH Plan.

• The HRH Unit in the MoH is the focal point.• Duplication avoided and synergy enhanced.• HReH becomes sustainable because it is

embedded in the national health strategy.

The CCF is a 5 phase process:

1. We start by suggesting an HReH sub-committee

2. Develop an HReH Situation Analysis

3. Develop an HReH Plan

4. Mobilise resources –domestic budgets and external partners

5. Implement and monitor

7.3 Country Coordination and Facilitation ‘It is very unlikely that we will resolve the HRH crisis if each country or sector works in isolation’

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The training ‘pipeline’ can be long and while we can work to shorten it through such approaches as task sharing and curriculum review we are also now starting to see the kind of success which will impact on services for years to come.

The key ‘take home’ message is that success is most often built around strong partnerships – between INGOs and with the Ministries of Health and Education.

8. BUILDING ON SUCCESS

TRAINING PROGRAMME PARTNERHIPS RESULTS

East Africa – EACO SIGHTSAVERS AND lLftW 30 ophthalmologists per year by 2015

West Africa - DESSO CBM & SIGHTSAVERS 38 DOs since 2004

Africa -Schools of Optometry ICEE + LftW, DIT, CBM SIGHTSAVERS

From 7 schools in 2006 to 17 in 2012

Zambia -Chainama College SIGHTSAVERS 56 new AeHPs since 2008

Mozambique – Beira and Nampula

SIGHTSAVERS, LftW, HELPAGE

From 20 ‘technicos’ in 2011 to 109 by 2014

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Projected Outputs: Malawi Schools• Of Optometry

Two Success Stories

22

358,239

44,122

898,955

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

1,000,000

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Cumulative number of community selectedmembers trained as CDDs (1999-2009)

•Cumulative = previous year trained/retrained + newly trained in year being reported

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PRIORITISE: Human Resources are our most valuable asset

ALIGN: With other global health initiatives

INTEGRATE: Into mainstream health work force planning

NETWORK: Beyond eye health – AP/HRH, Regional Health Authorities, Development Banks, civil society health networks

NO PAIN...................................NO GAIN !!!!

9. OUR RESPONSE: STEP OUT OF THE BLINDNESS BOX