Lead Health Specialist Raising the Profile of Laboratory Professionals East Africa Public Health Laboratory Networking Project MIRIAM SCHNEIDMAN Lead Health Specialist WORLD BANK African Society for Laboratory Medicine Cape Town, December 2, 2012

OVERVIEW OF PRESENTATION Why are laboratory workers critical? What factors influence the labor market for laboratory workers? What kind of policies can enhance their career prospects and performance?

Why are laboratory workers critical? Appropriately trained and qualified laboratory personnel are critical to well functioning laboratory systems that provide high quality, timely, and reproducible results both for clinical care and public health functions Laboratory workers play a particularly key role in resource constrained settings which depend heavily on manual testing Laboratory workers are the backbone of quality diagnostics

A vicious cycle Laboratory profession is undervalued Production of additional lab personnel is modest Insufficient numbers and low level qualifications Low wages and poor career structures Poor work environments , inaccurate results Clinicians lose confidence in laboratory services, use presumptive diagnoses Laboratory workers become demotivated Constrained supply, sluggish demand, relatively low wages

What factors influence the labor market for laboratory workers? SUPPLY Current pool of different cadres of laboratory personnel in public and private sectors and those who are unemployed Annual number of graduates from pre-service training institutes Continuing professional development courses Labor mobility which is linked to job satisfaction and alternative employment opportunities DEMAND Government policies and strategies which promote or impede the recruitment, deployment, retention and recognition Private sector polices and practices (salaries, benefits, incentives, work conditions) Practitioner practices, including extent to which clinicians and public health officials value and use laboratory services

What are the broad trends in Africa? Relative scarcity and skewed distribution of highly qualified laboratory personnel with certificate holders dominating the labor market Predominantly male and moderately young labor force; females overrepresented in the lower cadres Strong demand for pre-service training but institutions constrained by inadequate space, and shortage of tutors Limited labor mobility for majority of laboratory workers in light of low qualifications, poor absorption of graduates, and limited availability of alternative employment opportunities

What are the broad trends in Africa? Government policies and strategies to structure the laboratory profession have been modest Registration and regulation not systematic Expansion of degree programs is slow Clear pathways for career development and structured promotional opportunities are inadequate Private sector institutions offer better working conditions, more attractive salary and benefit packages and innovative incentive schemes yet absorb few graduates Views and attitudes of clinicians adversely affect the demand for the services of laboratory workers “They cook results, so we treat based on clinical presentation” -Job descriptions not standardized -Salary structures are not consistent -Policies to promote task shifting remain modest - Staffing norms are non existent or not enforced

Policies and practices to enhance career prospects and performance Pre Service Training Explore different options for expanding pre-service training to produce new graduates (public sector; private sector; regional approaches) Upgrade current pool of laboratory workers by expanding degree programs Shift towards competency based curricula endorsed by regulatory bodies In Service Promote innovative retraining strategies (work place based mentorship, rotational deployment, e-learning, flexible hours for training) Adopt clear and transparent criteria for selecting trainees Pursue joint training of laboratory and clinical staff Career Development Develop clear career paths with well defined promotion prospects Rationalize job descriptions Explore feasibility of task shifting for simple tests Engage civil service officials to discuss capacity to absorb graduates

Policies and practices to enhance career prospects and performance Government Policies Ensure that lab professionals becomes an integral part of national HR planning Improve registration of laboratory workers Incorporate lab workers in performance review and recognition schemes Regulatory & Representative Bodies Strengthen national regulatory bodies to monitor quality and ensure governance Promote use of national and regional accreditation bodies Make representative bodies more effective Operational Research Scale up research to better understand factors which influence the demand and supply of laboratory workers Determine the effects of HR strategies on recruitment and retention Explore reasons for gender imbalance in higher laboratory cadres

Breaking the cycle is critical to enhancing performance of laboratory workers Laboratories are mainstreamed in health systems agenda Production of lab personnel and in service training are expanded Larger pool of qualified laboratory workers who are integral part of health system Clear career paths and improved remuneration Laboratory workers are more motivated better recognized, and more performant Confidence in laboratory services is restored

Acknowledgements Russell Dacombe Jane Carter Martin Matu EAPHLN Team Consultant Team HRH Bank Colleagues

Laboratory profession is undervalued Box #1 A vicious cycle Laboratory profession is undervalued Production of additional lab personnel is modest Insufficient numbers and low level qualifications Poor career structures and low wages Inadequate work environments Clinicians lose confidence in laboratory services, use presumptive diagnoses Laboratory workers become demotivated

Laboratories are mainstreamed in health systems agenda Box #11 A Virtuous cycle Laboratories are mainstreamed in health systems agenda Production of lab personnel and in service training are expanded Larger pool of qualified laboratory workers who are integral part of health system Clear career paths and improved remuneration Laboratory workers are more motivated better recognized, and more performant Confidence in laboratory services is restored