The World Bank and Health Professional Education Tim Evans, Director, Health Nutrition and Population, World Bank August MEPI Symposium, Kampala

Overview Beginning with the big picture – Health professional education and health systems The World Bank and health professional education – Past – Present – Future

World Health Report 2006 Critical shortage of health workers in 57 countries; 4.3 million more health workers needed to provide essential interventions.

Uganda by the numbers Source: Daily Monitor Tuesday August 6, 2013 and back of the envelope) Outflow of Doctors/year = 350 (200 migrate, 50 in between jobs, 50 on maternity leave, 50 retire) Inflow of Doctors/year = 350 (300 medical students graduate, 50 return from abroad) Outflow = Inflow!? – Is this what is needed in Uganda? – If not, what is needed? …Inflow 2x? 5x? > Outflow? – What needs to change in the medical education sector? – What needs to change elsewhere?

Systems Assessment!..

Working lifespan strategies

Pipeline to generate and recruit the health workforce

Provision Needs Demand Needs Labor market for health professionals Population Demand Provision Education system Health system Supply of health workforce Demand for health workforce Health education systems: right workers, right problems, right places

Educational Assessment Framework Institutional Governance& admission Infrastructure Finance Accreditation Information & Technology Instructional Curriculum Content Pedagogy Competencies Faculty Source: 5C Assessment Framework for Health Professional Education

Number of Health Professional Education Institutions over time ( ), by sector (public-private), in Bangladesh SectorPUBLICPRIVATE Medical College Nursing Diploma Nursing BSc Public Health Institute Source: 5C Situation Assessment of Health Professional Education in Bangladesh

Instructional Competency-driven Inter- & trans-prof educ IT-empowered Local-global Educational resources New professionalism Institutional Joint planning Academic systems Global networks Culture of critical inquiry Enabling Actions Reforms Align accreditation Strengthen global learning Enhance investments Mobilize leadership Goal Transformative & interdependent professional education for equity in health Goal Transformative & interdependent professional education for equity in health Recommendations

Essentials related to the World Bank “Development focus” Aims to eliminate avoidable poverty by 2030 Works in all sectors – Health, education, social protection, etc Three main financing mechanisms: – IBRD loans – IDA credits – Grants

Past Activities of the Bank Policy – Africa Ministers of Health/Education and Deans of Medical/Nursing Schools – Addis-Ababa 2001 Very few health professional education projects Education sector mostly primary education focus Investments in training as component of projects – Mostly in “in-service” training of health workers – Contributed to training of about 2.2 million health personnel over the last 35 years

Present Activities of the Bank Vietnam – Health Professional Education and Training for Health Systems Reform Indonesia - Health Professional Education Quality Project Liberia - Health Systems Strengthening Project Uganda - Health Systems Strengthening Project West and Central Africa - Higher Education Centers of Excellence Project (East Africa – Aga Khan and ADB Initiative)

Vietnam – Health Professional Education and Training for Health System Reform  Improve the Quality of Medical and Nursing Education  Quality Assurance System  Supportive measures to meet standards  Improve the Competencies and Coverage of PHC Teams Especially in Disadvantaged Areas  Retrain PHC Teams at the grass-root level  Train and send volunteer doctors to work in remote districts  Improve HRH Management and Database  Financing: IDA Credit: US $135 million; Vietnam Government $3 million

Indonesia Health Professional Education Quality Project Strengthen Policies and Procedures for Accreditation Certification of graduates with a national competency-based examination administered by independent evaluation center Results-based financing to medical schools as incentive to meet accreditation standards IBRD Loan $77.8 million

Liberia Health Systems Strengthening Project Component 2: Improving health worker competencies to address key health-related concerns at selected health facilities – Graduate Medical Residency Program in critical specialty areas (obs/gyn; surgery; peds; int med) – In-service training for mid-level cadres: uses teaching faculty from 2.1 to provide training to midwives, nurses and PAs Financing: IDA credit $4 million

Uganda Health Systems Strengthening Project Training of health workers – especially midwives but also post-graduate medical Leadership and management training for hospital administration and health services Financing: approx $7 million to training out of a total IDA Credit of $130 million

Africa Higher Education Centers of Excellence Project Build tertiary education centers of excellence and knowledge networks in STEM, health and agriculture Call for proposals July 2013 Eligibility: Universities from West and Central Africa Aims to fund 15 Centers of Excellence (approx $8 million/Center IDA Credit $130 million

Future Activities of the World Bank Recognizing health professional education institutions as central to health development – “Knowledge and innovation hubs of health systems” Linking to higher education – “the inter-sectoral imperative” Embracing local and global context – “no medical school is an island” Promoting better knowledge and know-how – “is scaling-up of midwifery education good value-for- money?” Working with partners!

Thank you