HREH SESSION

Adidja AMANI, MD MPH

HReH focal person at Sightsavers

The Outline of the HReH session?

where we have come from

where we are right now

where we want to go

Expectations of CDs…

ZAMBIA MOZAMB. UGANDA S. SUDAN KENYA MALAWI

Learning on how

other countries are

ensuring that the

staff trained are

retained in the

programme areas

Know better the

work in progress

An update on where

we are with the

implementation of

the HReH strategy Have more insight

into the support for

Training

Learn more on the

organizational

strategy for HRD

Detailed HReH plan

for Sightsavers

learning of

possibilities of

bonding the staff

from MOH on the

training

programmes

Find synergies to

continue to develop

HR in Mozambique

Funding

opportunities for

HReH, especially the

more costly

infrastructure

development for

training institutions.

Information on

Training institution

for orthopist

training

institutions, the

minimal

requirements for

entry and the

tuition fees

Learn from the

experience of others

how they have dealt

with some of the

problems facing

HReH in Kenya

Detailed advocacy

strategy for

government support

towards HReH

Development

learning from

others in general

Advocacy

component – what

is the level of

influence HReH

Priorities on the way

forward.

Information on

optometrist

training

institutions, the

minimal

requirements for

entry and the

tuition fees

Funding opportunities

for HReH

ADVOCACY

Update on the

HReH strategy

FUNDING/

support for

training

Learning from

others

At the end of this session, CDs will be able to:

1. Be at ease with the various tools

2. take forward its own unique

strategy to address the HReH crisis

3. design a framework plan for HReH

section of the new CSP

4. give constructive feedback on the

toolkit

“Silver bullet” question

Where would you aim if you had only one

bullet? And why?

THE EYE HEALTH WORKFORCE

CRISIS IN AFRICA: A SYSTEMIC ISSUE

Adidja AMANI, MD MPH

HReH focal person at Sightsavers

OUTLINE

The health worker in the health system

What is the Current situation of HReH in ECSA?

Why is the (eye) health workforce in crisis?

Who are the health workers?

health workers : all people engaged in actions whose

primary intent is to enhance health (WHO, 2006)

www.who.int/whr/2006/06_chap1_en.pdf‎

health workers : all people engaged in the promotion,

protection or improvement of the health of the

population (Adams et al., 2003: 276; Diallo et al., 2003)

Why are eye health workers equally important?

Outreach services, hospitals are only as good as the people who staff them

Eye health is overwhelmingly worker-dependent

The only route to reach better eye health is through eye health workers. They are no shortcuts

Medical equipment, supplies, facilities, and medication will be wasted, without a trained workforce

HReH are the ultimate resource in health because they manage and synchronize all other health resources, including financing, technology, information, etc.

Eye health workforce crisis must be addressed to achieve

stronger health systems,

universal access to health services, and

greater improvements in actual health outcomes.

It is the health worker who glues these inputs together into a

functioning health system

the health worker,

the most neglected

yet most essential

building block of

effective health

systems

increase in the density of qualified health workers has a positive impact on health

outcomes. However, most African countries that have a high disease burden continue

to face severe shortages of health workers

The power of the health worker

The eye health workforce crisis in Africa – WHY?

Africa has the most severe health workforce shortage in the world.

Of the 57 countries identified as facing HRH crisis (health workforce density ratio below 2.3 per 1000 population), 36 are in the African Region (The World Health Report 2006 )

ROOT CAUSES:

Two decades of health sector ‘mis-reforms’ treated health workers as a cost burden, not an asset: structural adjustment policies, health reforms imposed ceilings on staff numbers and salaries while capping investment in higher education and training.

most donor projects shy away from investing in people for the long term

Tendency to finance technical assistance and short-term training

the workforce, commanding the largest share of the budget, is the least strategically planned and managed resource of most health systems.

The impetus….

We have to work together to ensure access to a motivated, skilled, and supported health worker by every person in every village everywhere.” LEE Jong-wook , November 2005

02

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Source: WHO/Global Atlas

Health Worker Density in Sub-Saharan Africa

Severe shortage of eye health workers – Linguistics zones …

POP.

MILLIONS

OPHTHALMOLOGISTS RATIO ArHPs Ratio

ANGLOPHONE 432 1,137 1/380,000 2,751 1/157,000

FRANCOPHONE 262 492 1/532,000 1,745 1/150,000

HORN OF AFRICA 100 118 1/847,000 188 1/627,000

LUSOPHONE 46 35 1/1,275,000 88 1/522,727

TOTAL 841 1,786 1/470,000 4,772 1/176,000

© Sightsavers

How many exactly? Health pyramid

LEVEL TYPE DESIRED RATIO

(Default targets)

NEEDS CURRENT

ESTIMATE

GAP

TERTIARY OPHTHALMOLOGIST 1/250,000 4,000 1,786 2,214

SECONDARY ALLIED EYE HEALTH

PROFESSIONALS

1/100,000 10,000 5,000 5,000

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

If densities of doctors across urban and rural areas were similar, the points (one point represents one country) would all be close to the “equality line”. Densities are much higher in urban areas, explaining why all points are above the “equality line”.

Guinea

Mauritania

Chad

Mali

DRC

Ethiopia

Mozambique

Sudan

Uganda

Senegal

Niger

Rwanda

Kenya

0

0.5

1

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3

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Number of doctors for 10,000 persons (RURAL areas)

Densities of doctors across urban and rural areasin 13 countries

Many reasons for crumbling eye health system…

Policy dialogue among line ministries, stakeholders and partners remains limited

Investment in HReH in most countries is generally inadequate

The resources mobilized internally are not enough for production and employment

Few countries have developed or implemented policies and strategies for retention and good performance of available health workers

The current output of HReH does not meet the requirements for delivering quality eye health

The capacity to generate, analyse and use HReH data for policy-making is still inadequate

Data on the exact numbers and skill mix remains fragmented

skewed geographical distribution rural/urban areas

inappropriate skill mix and migration of skilled eye health workers.

Many reasons for crumbling eye health systems…

• No agreement on cadres: job, registration

• Too few applicants for some cadres, V2020 targets not met e.g: Uganda

• Career paths lacking e.g: Malawi

• Unsuitable placements after graduation

• No funding, eye health not a MoH priority e.g: Mozambique

• Areas without training institutions e.g: South Sudan

• Equipment supply and repair e.g: Zambia

• No link between ophthalmology training programmes and mid-level eye care training programmes (thus, disconnect between HR availability and needs in the field)

By cadres..

Ophthalmologists – All-rounders or sub-specialists – or both ?

Optometrists – Public or private – or both. Role of OTs ?

Cat. Surgeons – Most heavily contested

ONs – Degree or competency based ?

OCOs – Backbone ?– task sharing ?

OMAs – Is it worth continuing with them ?

PEC – Health seeking behaviour or outreach ?

CEHWs – Vertical or integrated ?

Challenges in HReH Development identified by CDs

ZAMBIA MOZAMBIQUE UGANDA S. SUDAN KENYA MALAWI Addressed?/6

Shortage of Human

Resource training of Ophthalmic HR

Inadequate

numbers and skill

mix.

No Training institutions for

Ophthalmologist

Interesting middle level

medical personnel in taking

up eye-health as an area of

specialization;

Government funding for

training of eye health

professionals

5

Inadequate

infrastructure for eye

health

leakage of existent

Ophthalmic HR to private

sector and NGO’s

Urban-rural

disparities Few ophthalmologists

Increasing the numbers of

different cadres of eye-

health workers

Inadequate capacity of

training institutions, e.g.

Malawi College of Health

Sciences

3

Very Inadequate

consumables

right composition of the

Ophthalmic Team (new

cadres)

Insufficient training

capacity or lack of

it for some cadres

No sub-specialist in

Ophthalmologist

Inadequate numbers of Eye

health workers versus V2020

requirements

3

Delayed

implementation of

eye health structure

by the government

V2020 National Plan

Low attraction and

retention of health

workers with the

right skill mix

The mid-level cadres within the

country have not yet been

included into the Public

Services remuneration grading

system

Equitable distribution of

eye-health workers

countrywide Unclear career path for eye

care cadres 3

Inadequate transport MoH budget line for

ophthalmology

Unpopularity of

ophthalmologists

among graduate

medical doctors

The infrastructure for eye care

services inadequate

Lack of basic eye health

equipment in district hospitals 1

Half full

Half

empty

The extent to which Eyehealth is mentioned in National Health &HRH Plans

Not Mentioned Limited Moderate Eye-Health is a listed focus area

Health HRH Health HRH Health HRH Health HRH

Gambia

Kenya

Moz.

Kenya Gambia

Mali

Moz Nigeria

Tanzania

Uganda

Zambia

Malawi Nigeria

Zambia Sierra Leone

Sth Africa

Benin

Burkina

Sierra Leone

Sth Africa

Zimbabwe

Cameroon

Malawi Cameroon

Ghana

Liberia

Mali

Sierra Leone

Tanzania

Uganda

Zimbabwe

It is important to note that limited or no mention of eye-care in the National Plan is not necessarily

reflective of countries level of engagement with the Ministry of Health

Eye-health mentioned in National Health and HRH plans

0123456789

Not Known No Mentionin Plan

Limitedmention in

Plan

Moderatemention in

Plan

Focus Area inPlan

Health Plan

HRH plan

Key messages:

a production challenge

an underutilization challenge

a distributional challenge:the rural-urban dimension,

region, income, sector (public/private for-profit/ private not-for-profit or a mix of these)

a performance challenge, refers to the fact that the quality of the work performed by health care professionals

a financing challenge

Don’t forget….

patient

Adequate HR:

Numbers

Skills

Competencies

Minimum Infrastructure

Services Delivery

Regular & Adequate Supply of Essential

Medicines & Supplies

National & Nation-wide

Strategy

Guidelines & Protocols

Service

Status

Salary

Satisfaction

Stability

Security

Adidja AMANI, MD MPH

HRH focal person, SIGHTSAVERS

SIGHTSAVERS’ STRATEGIC RESPONSE to the Human Resources for Eye Health Crisis in

Africa

Strategic alignment externally…..

Strategic alignment Internally…

Nigel Crisp,

the inspirer

Caroline Harper,

The Commissioner

Ronnie Graham, HRH Director

10-Year Strategy to respond to the HReH Crisis in Africa

RECAP….

Eye health is on a unique journey in Africa…

From sight restoration through prevention of blindness to eye health

From vertical/parallel approaches to HSS

From disease control to comprehensive eye health

From top-down to bottom-up

From INGO led to government led

the process of strengthening the eye health work force from a specific historical situation, characterised by:

Fragmentation

Weak evidence base

Donor dependence

Disease specific focus

Dominance of tertiary/curative thinking

SHIFT….

Eye health strategy meeting-21-23 November2012

From: To:

× Focusing on blindness and disease control Focusing on comprehensive eye health

× Building capacity for individual projects Building capacity to meet national needs

× Being a fragmented eye health sector Being a united and collaborative eye health

sector

× Having programmes led by INGOs Having programmes led and owned by

governments

× Emphasising programme implementation Emphasising advocacy – to change the systemic

barriers to effective HReH

× Working in isolation from other health sectors Working beyond the ‘usual suspects’ to engage

with wider health and HRH initiatives.

× Taking a ‘vertical’ approach, with

programmes focused solely on eye health

Taking comprehensive approach, with attention to

strengthening the whole health system

The Vision

Vision:

All people in Sub-Saharan Africa experience good

health and reduced morbidity – through access to a

comprehensive, high quality and sustainable eye health

workforce as part of strong national health systems.

Vision: All people in Sub-Saharan Africa experience good health and reduced morbidity – through access to a comprehensive, high quality and sustainable eye health

workforce as part of strong national health systems.

Goal: To contribute to achieving a comprehensive, high quality and sustainable

eye health workforce in Sightsavers-supported countries and more widely in Sub-Saharan Africa by 2022.

Objective 1: The right number

Objective 2: The right quality

Objective 3: The right training

Objective 4: The right balance

To support 24 countries in Sub-Saharan Africa to

achieve their national targets

for the eye health workforce by 2022

- as an integral part of strong

national systems for human

resources for health.

To support countries where

Sightsavers works to address the key

challenges that limit the provision

of appropriate, accessible and

high quality services by the

eye health workforce.

To strengthen national and

regional training institutions and

systems to ensure the appropriate

scale, quality and responsiveness of

the eye health workforce.

To accelerate investment in

Francophone and Lusaphone countries –

addressing their specific needs and

shortages and contributing to

significant progress towards

their national targets for the eye health workforce.

Objective 1: To support 24 countries in Sub-Saharan Africa to achieve their national targets for the eye

health workforce - as an integral part of strong national systems for HRH

In each of the 16 countries where Sightsavers works:

1. national situation analysis on HReH to identify key gaps in the eye health workforce and

interventions to address them.

2. Contribute to the Development of a costed national HReH plan to address the key gaps in the eye

health workforce

3. integration of the national HReH plan into the HRD through the CCF

4. advocacy to the government and other key national stakeholders to fully resource and implement the

national HReH plan.

At regional and global levels: advocacy and resource mobilisation among donors and other key stakeholders to secure fund to

implement national HReH plans.

© Sightsavers

Priority 1: The number of the eye health workforce address existing shortfalls in number of eye health workers at all levels

include the scaling-up and strengthening of:

–Ophthalmologists and sub-specialists.

–Optometrists.

–Allied Eye Health Professionals.

–Primary and Community-Level Eye Health Workers.

Priority 2: The quality of the eye health workforce

to address the range of issues that affect the quality and impact of the eye health workforce–

task-sharing, incentives and accreditation – are made within the context of overall national strategies for

HRH and HSS

Objective 2: To support countries where Sightsavers works to address the key challenges that limit

the provision of appropriate, accessible and high quality services by the eye health workers

– national situation analysis to identify and prioritise the key limits affecting the eye

health workforce

– Advocacy to the government and other key national stakeholders to address the

key limitations wider national HRH plans.

At regional and global levels:

– Conduct and compilation of research of ‘what works’

– regional and global advocacy to multi-lateral and bi-lateral stakeholders to

integrate HReH issues within broader HRH strategies

– partnership with all relevant stakeholders

Objective 3: To strengthen national and regional training institutions and systems to ensure the

appropriate scale, quality and responsiveness of the eye health workforce.

Strengthening specialist training institutions and systems for HReH

Situation analysis to identify and prioritise gaps in specialist training institutions and systems for eye health workers;

mapping of institutions, stakeholders, policies and facilities. Development of a national plan to respond to the priority gaps in specialist training

institutions and systems for eye health workers

Advocacy to the government and other key national stakeholders to address the priority gaps

Mainstreaming eye health into training systems for other health workers

:

– focusing on identifying and addressing gaps in relation to the integration of eye health into general HRH training institutions and systems

© Sightsavers

severe shortages in eye health training institutions which are under-

funded ,under-subscribed, short-staffed, lack of equipment, etc

a need to work with the education sector more broadly to ensure that

HReH training and planning is systems-based.

will also require the strengthening of eye health training within the

training of general health workers.

CPD remain largely uncoordinated, partial and under-resourced

The training of the eye health workers

Objective 4: To accelerate investment in Francophone and Lusophone countries – addressing their

specific needs and shortages and contributing to significant progress towards their national

targets for the eye health workforce

Francophone or Lusophone region or group of countries:

Situation analysis to identify and prioritise the specific challenges affecting the investment

imbalance in the eye health workforce= Francophone strategic plan available

Development of an action plan to address the specific challenges.

Building of strategic regional alliances and build awareness and action on the imbalance.

Building of capacity of Sightsavers own country offices, on strategic advocacy

At the regional and global levels:

Implementation of intensive advocacy within regional institutions (such as AP/HRH, RHA,

AFDB, AU ,WHO and GHWA to address the investment imbalance

Acceleration of resource mobilisation from international donors

How can we achieve these 4 objectives ?

By cadre – work with WHO, professional bodies,

By country – CCF process, HAF, HSS, country strategies

By institution – engage, evaluate, invest

Through advocacy – Influencing different domains

GLOBAL: GHWA, WHO, IHP+, G8 etc

REGIONAL: WHO-Afro, AP/HRH, AfDB, RHAs

NATIONAL: HRH Departments, MoH, MoE, MoF

With partners – strengthen our work with HRH Departments, civil

society

© Sightsavers

Levels

Sightsavers strategic approaches

District

Country

Regional

Global

Demonstrate scalable cost-effective approaches. The HR of eye health-specific projects to

providing models and action to address the national HReH crisis within the context of wider

action on HRH and health systems strengthening.

Ensure high quality programmes based on evidence

Develop effective partnerships. By collaborating with stakeholders in both the eye health and

mainstream health sectors at all levels: GHWA, HRD/MOH AP/HRH

Develop effective and joined-up advocacy by emphasising strategic advocacy to ensure pro-

HReH policies within the context of action on wider HRH and health systems strengthening.

Establish strong strategic networks and alliances by taking a leadership role, mobilising

coalitions and ensuring synergies with other like-minded stakeholders from all sectors.

Gather and disseminate sound research and evidence by collaborating with others and

maximise our own evaluations to identify and share evidence of ‘what works’ in HReH.

Mobilise significant additional resources

Use resources strategically and efficiently. emphasise financial sustainability

Our added-value…. organisational strategy and priority. Sightsavers frames its attention to HReH within a

comprehensive organisational strategy that emphasises HSS and the building of national, government-d responses

A progressive approach. moved ‘out of the blindness box’ to address comprehensive eye health and HReH within the context of wider strategies for HRH and HSS

Emphasis on scalability and cost-efficiency. Sightsavers emphasises the identification of models and approaches to address the HReH crisis that can be scaled-up

A ‘seat at the table’. Sightsavers is actively involved with key mechanisms and advocacy opportunities to address the overall HRH and HReH crisis CCF at country level

Research, innovation and good practice through research and learning from recent evaluations

Working in partnership. strategic partnerships with key stakeholders at the global level (such as WHO, IAPB and the GHWA), at regional level (AP/HRH, the WHO Afro, African Health Observatory) and at national level with MOH/e

© Sightsavers

Strategy needs to be country specific, rooted into a critical analysis of the real constraints rather than in generic advocacy

Ensure that support truly contributes to sustain national efforts to develop an adequate health workforce

Align our work with national government plans rather than developing parallel systems- not silo programs

Partner with MOH and MOE in all the countries

Make better investment decisions

Expand our research work, so we are confident that we speak not just with conviction but on the basis of hard evidence

The toolkit

FROM SYSTEMIC PROBLEMS

TO SYSTEMIC SOLUTIONS

Target audience

Target audience: CD, PM,Pos.. Other stakeholders

(NGO community, Ministries of Health and

Education

Country Directors are in a unique position to make

THE DIFFERENCE

1- Country Coordination and Facilitation

2- Rural and Remote areas Retention

3- The Onehealth tool

4- HRH Action Framework

5- Planning Checklist

6- Country Actions

47

Some homework to do beforehand … 48

Does the country have a strategy or plan for HR? Is it updated?

Does the country have a HRD or management unit within the MoH?

Does the existing staff correspond to the target staffing levels?

What kinds of tools/methods of planning are used by MOH?

Does an established cycle exist for planning, implementation and

evaluation in the health sector?

Which stakeholders should be involved in the development of the

HReH plan and which ones should be consulted?

HReH analysis of the situation

aims to ensure that policy positions are informed by

concrete evidence gathered either from programme

work on the ground, or through reviews of literature

that is available

A good test for determining whether you’ve identified

a truly systemic problem is to ask yourself “Why?” at

least five times. Such a series of questions forces you

to keep going until you reach the truly systemic cause.

CCF is documented in some countries… 51

Several published Case studies on CCF... 52

Eritrea

Indonesia

Nepal

Nigeria Pakistan

Sudan

Zambia,

Zimbabwe

etc

Stakeholder HRH Position Power

Governmental

Ministry of Health Increased HRH production, higher wages, more training High

Ministry of Health (sub-national level):

hospital/clinic managers

HRH stock, wage bill, tenure, training Medium

Ministry of Education Higher HRH production / some pre-service training Medium

Ministry of Finance; Ministry of Planning Limit wage bill for HRH High

Civil Service Agency Limit wage bill and restrict HRH to public sector rules High

Local governments HRH stock / wage bill and/or employment (sub-national) Low

Non-governmental

Professional associations / unions

(Physicians, nurses, pharmacists, etc.)

Limit HRH production, increase wage bill, restrict non-

professional roles

Medium to High

NGOs (national/international) HRH production, stock, wage bill, tenure, training Low

International institutions (donor, technical

assistance agencies)

Increase HRH production and wage bill, special interest in

HRH for specific disease programs

Medium to high

Media Report on conflict and poor performance; often ignore reform

proposals

Low to medium

EDUCATION FINANCIAL

INCENTIVES PROFESSIONAL

SUPPORT

• Supportive

supervision and

mentoring

•Implement

appropriate

outreach

activities

•

•Senior posts in

rural areas

•Support

professional

network

54

Why Planning HReH?

Planning means building a bridge from where you are now to where you want

to be when you have achieved the objective before you

HWs are not fungible, optional, or immediately available on demand

The function of planning meets the group’s need to accomplish its task by

answering the question how. But the ‘how’ question soon leads to ‘When does

this or that have to happen?’ and ‘Who does what?’

Because of limited resources, it is important to accurately estimate the number

of health workers required to meet the eye health care needs, as this will help

governments and donors make prudent health systems spending decisions

HReH planning 57

Clarify the purpose of the planning and how it contributes to the HReH strategy

Plan the planning: external expertise needed? Which stakeholders involved?

Agree on the methods for determining the numbers and types of staff

Identify data required and collect from existing databases

Analyses Supply: audit of the existing staff and anticipate flows in and out

Identify tools for analysis

Analyse the data and develop projections, Present findings to key stakeholders;

agree on targets and explore strategies for achieving it

Establish indicators for monitoring and evaluation and reporting mechanisms

Incorporate into the wider HR strategy

6- ADVOCACY TOOL FOR HReH ?

systems are unlikely to change to accommodate eye health, So we need to change to be accommodated by health systems

Neglecting the workforce wastes all other resources

In order to be effective, the advocacy will target the right audiences, using appropriate forums and relevant channels and delivery mechanisms

HWs is one of the best investments, with considerable returns on investments in the health, education, and economic sectors.

Key advocacy messages

Possible advocacy research priorities….

TOPIC PURPOSE Determine economic evaluation of eyecare

interventions in comparison to other competing

health burdens: cataract – age related , refractive

errors , childhood cataract , trachoma (i.e. 60-

70% of global blindness; all ages & both

genders)

To provide data for advocacy through demonstrating the economic

& social rationale for increasing resources to strengthening national

eyecare programmes

Determine total costs & benefits of investing in

eyecare, i.e. positive economic rates of return

To demonstrate that investing in eyecare is a good investment from

a national development perspective

Determine the benefits of eyecare To provide government & donors reassurance that their investment

has positively changed lives & impacted the MDGs

Document examples of sustainable eyecare To demonstrate to donors & governments that eyecare programmes

have the potential to be sustainable

Document examples of successful programmes To demonstrate to donors & governments that eyecare programmes

have the potential to be successful in terms of the attributes of

health systems

59

Step 1: Analysis of the situation

Step 2: Planning

Step 3 : Integration and resource mobilization

Step 4: Implementation

Step: M&E

6- COUNTRIES ACTIONS

HRH 10 Year strategy meeting, Nairobi October 2012

60

In Saudi Arabia, sentences are read from right to left and not from left

to right so people read the advert in the opposite direction.

Lesson – No matter how smart an idea may be, it must take into

consideration the context of the culture and understanding of the

target audience

.

• Sale of Coke was dwindling in a Saudi Arabian Town

• Weeks later, sales became worse as everyone started avoiding coke

KEY MESSAGES….

We have these support documents- We must follow through.

We must maintain clear communication with Human

Resources Director in MoH,

The more we stay in our comfort zone the less confident we

are about stepping out of it

Convincing policymakers to take action requires evidence-

based information, strategic thinking, strong advocacy

skills, and persistence

“That is tedious, I am just going to do it my way, because that way lay confusion, chaos and inefficiency”

63

It is important to have sound processes!

“Changing Gear - A

time of Challenge”

“The processes are there for

a reason and we need to

follow them”

PUTTING EYE HEALTH WORKERS FIRST

“BUSINESS AS USUAL” WILL NOT DO

Adidja Amani, MD MPH

Every country, should have a workforce plan shaped to

its situation and crafted to address its health needs

the response must be inclusive, engaging all relevant stakeholders, including non health and nongovernmental groups.

Strengthening the health workforce is a shared challenge that demands commonly developed solutions—a mutual responsibility of all.

Crafting a workforce to meet national health needs requires sustained efforts over time—it cannot be a fleeting fad.

Country-based and country-led strategies constitute the

primary engine for driving workforce development.

No country is an island in workforce development

The cost of inaction is unmistakable

the response must be country-based and country-led—because all global initiatives must be implemented, planned, and owned in specific national settings

Technical approaches alone will not do, because adequate financing, strong leadership, and political commitment are necessary.

the principal lever for strategic action is national

Eye health Workforce development demands building a

strong action coalition across all stakeholders

Health workers must be at the center

collaboration must reach beyond the health sector to finance, education, and other ministries and beyond government to academic leaders, professional associations, labour unions, educational institutions, and nongovernmental

All must be involved in setting national goals, designing strategies, drawing up plans, and implementing policies and programs

Good data, invariably scarce where needed most, are essential to inform and guide such efforts

Will have to restock the shelves….

All countries should develop national eye health

workforce strategic plans fully integrated in

National HRH plans to guide enhanced investments

in HReH as the core component of strengthening

national eye health systems

Each country develops its country plan through local consultation, a participatory process which includes consultation with al l stakeholders

Ensure availabil ity of credible evidence and strategic intell igence on HReH availabil ity and flow

Beyond quantitative targets, geographic distr ibution, gender composition, minimum standards, competency frameworks and other aspects related to wider management practices

Develop ef fective and joined-up advocacy

Focus pol icy actions and investment decisions where they are most required

Strengthen HReH coordination mechanisms to facil itate pol icy dialogue

Develop and implement costed HRH strategies and plans as an integral component of national health strategies;

Attainable and real istic objectives considering the financial constraints faced by low -income countries

SOME ASPECTS THAT SHOULD BE

REFLECTED IN THE CSP

“SILVER BULLET” QUESTION : WHERE WOULD YOU AIM IN

HREH DEVELOPMENT IF YOU HAD ONLY ONE BULLET?