UNFPA/EBCOG International Session at the 25th European Congress Human Resources for Universal Access to SRH in EECA Countries: Achievements and Challenges ADVANCING WOMEN’S HEALTH IN EASTERN EUROPE AND CENTRAL ASIA  UNFPA/EBCOG International Session at the 25th European Congress Turkey, May 17-21 Dr. Tamar Khomasuridze, SRH Regional Adviser, UNFPA EECARO Setting the Stage: Family Planning in the context of new 2030 agenda: achievements, challenges and opportunities

Human Resources for Universal Access to SRH and realisation of RRs Achievements since 2000: Births attended by skilled health personnel: close to 100% Availability and quality: antenatal care and FP services Improved standards, guidelines and protocols Improved education curriculums and training opportunities Access to international resources for capacity building and knowledge management Access to advanced equipment and technologies - Highest density of physicians (per 1000 population)

The overarching themes to accelerate the progress in EECA Universal access to SRH (focus on human rights, vulnerable groups, unmet needs) Shifting the focus from curative to preventive services Fostering programmatic and policy linkages and supporting integration of services Integrated, client oriented services at the PHC level Task-shifting What are the critical overarching themes in EECA?

Human resources for delivering 6 key components of SRH at PHC level Improving antenatal, perinatal, postpartum and neonatal care Providing high-quality services for family planning, including infertility services Preventing unsafe abortion Combating sexually transmitted infection (STI), including HIV, reproductive tract infections (RTIs) and cervical cancer Promoting sexual health Increasing capacity for strengthening research and programme development

HRH Action Framework Human resources (HR) are one of the most important components determining performance of public health system. For assessing the different dimentions of the HRH, we use the HRH Action Framework, introduced by WHO. The HRH Action Framework diagram (at left) includes six clickable Action Fields (HR Management Systems, Leadership, Partnership, Finance, Education and Policy) and four clickable Phases (Situational Analysis, Planning, Implementation and Monitoring & Evaluation). 

Addressing the proportion between physicians and midwives/nurces, HR Management Systems Personnel systems: weaknesses in workforce planning (including staffing norms), recruitment, hiring and deployment Work environment and conditions: gaps in workplace safety, gender equity, job satisfaction and career development HR information system: lack of accurate data required for planning, training, appraising and supporting the workforce Performance management: no systems for performance appraisal, supervision and productivity. Addressing the proportion between physicians and midwives/nurces, Advocating for task-sharing and task- shifting; Improving the systems and tools for recruitment and performance appraisal

Leadership Few champions and advocates for SRHR Weak leadership and management skills Capacity to lead multi-sector and sector-wide collaboration Professional associations to provide leadership amongst their constituencies. Strengthen managerial and leadership capacities Introduce the systems and practices of acknowledgment, Strengthen the role, capacities and networking of professional associations.

Support to intersectoral cooperation, Partnership Weak mechanisms and processes for multi-stakeholder cooperation (inter-ministerial committees, health worker advisory groups, observatories, donor coordination groups). Weak Public-private partnerships Poor community involvement in care and governance of health services. Support to intersectoral cooperation, Catalyse Public-private partnerships Encourage communities

Finance Salaries and allowances for service providers Weak capacities in budgeting and projecting HRH requirements including salaries, allowances, education, incentive packages, etc. Limited data on HRH expenditures (e.g., National Health Accounts, etc.) Advocate for introduction of efficient costing and budgeting methodologies in accordance to new SRH standards and guidelines Advocate for linking the salaries and allowances with job descriptions and performance

Education Challenges in: Pre-service education curriculums: addressing all SRH components In-service training opportunities (e.g., distance and blended, continuing education) Capacity of training institutions Training of community health workers and non-formal care providers. Supporting the capacity building of national training institutions, Introducing new training standards and comprehensive programmes in pre and post diploma education systems; New approaches for continuity and sustainability of trainings (online platforms, self assessment tools etc)

Support the participation and capacity building Policy Challenges in: Professional standards, licensing and accreditation Authorized scopes of practice for health cadres Political, social and financial decisions and choices that impact HRH Employment law and rules for civil service and other employers. Support the participation and capacity building of midwives and nurses. Updating the SRH standards and guidelines in accordance to international best practices Participate in the policy development and implementation!

Global and regional strategies: human resources for SRH Optimize performance, quality and impact of the health workforce through evidence-informed policies on human resources for health, Align investment in human resources for health with the current and future needs of the population and health systems, Build the capacity of institutions at subnational, national, regional and global levels for effective public policy stewardship, leadership and governance of actions Strengthen the systems and tools for data on human resources for health for better monitoring and accountability Launched in 2016; In May 2014, the Sixty-seventh World Health Assembly adopted resolution WHA67.24 on Follow-up of the Recife Political Declaration on Human Resources for Health: renewed commitments towards universal health coverage. In paragraph 4 of that resolution, Member States requested the Director-General of the World Health Organization (WHO) to develop and submit a new global strategy for human resources for health (HRH) for consideration by the Sixty-ninth World Health Assembly. The Global Strategy on Human Resources for Health: Workforce 2030 is primarily aimed at planners and policy-makers of WHO Member States, but its contents are of value to all relevant stakeholders in the health workforce area, including public and private sector employers, professional associations, education and training institutions, labour unions, bilateral and multilateral development partners, international organizations, and civil society.

Thank you!