- Role of Retention Strategies Health Systems Development, 9 th General Assembly, International Agency for the Prevention of Blindness, Hyderabad, India, 17 – 20 Sept Prof. Kayode ODUSOTE Prof. Kayode ODUSOTE

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 Ophthalmologists 1: 250,000  Cataract Surgeons (1:250,000)  Ophthalmic Assistants/ON 1:100,000  Optometrists/Refractionists 1:50,000  Community/PEC Workers 1:5,000  Ophthalmic Equip. Technicians ??  Managers & Administrative Personnel 100% of 3 o and 50% of 2 o PERSONNEL IN EYE CARE by HREH in WA - Role of Retention Intervention Strategies

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 Inadequate number of all categories of health professionals.  Mal-distribution of available staff.  Inappropriate mix of health workers.  Poor performance associated with poor motivation. 13 HREH in WA - Role of Retention Intervention Strategies

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 Living conditions ◦ Housing ◦ Infrastructure – roads, water, electricity, telephone ◦ School for children, work for spouse  Opportunities for Career Progression  Work Environment ◦ In Eye Health – lack of facilities for specialized care.  Professional Development and isolation  Opportunity Cost. HREH in WA - Role of Retention Intervention Strategies 21

 Financial incentives – rural allowance, etc ◦ main issue is sustainability  Enhanced career progression – ◦ reduced length of service for promotion to next grade  Hire Purchase facilities for car purchase ◦ less effective with high cost of new vehicles and lower cost of imported used cars. HREH in WA - Role of Retention Intervention Strategies 22

 Compulsory rural service ◦ effect is only short-term and does not make for sustained retention  Bonding for sponsored training ◦ Difficult to police sometimes, effect is short-term and requires other packages for long-term retention.  Priority for further training or overseas trips ◦ dependent on volume of available sponsorships.  Decentralized recruitment ◦ works in a situation of adequate supply and no vacancies in the major cities/ HREH in WA - Role of Retention Intervention Strategies 23

TRAINING Intervention Potential for Effectiveness Students from rural backgroundsPos Health Professional schools outside major cities Prb Clinical rotations in rural areas during studiesPrb Curricula that reflect rural health issuesNL Continuous professional development for rural health workers Pos (if) HREH in WA - Role of Retention Intervention Strategies 24 Key: Def – Definite Pos – Possible Prb – Probable NL – Not likely

REGULATION Intervention Potential for Effectiveness Enhance scope of PracticePos Different types of health workersDef Compulsory serviceDef Subsidized education for return of service Def HREH in WA - Role of Retention Intervention Strategies 25 Key: Def – Definite Pos – Possible Prb – Probable NL – Not likely

FINANCIAL INCENTIVES Intervention Potential for Effectiveness Appropriate financial incentivesDef (but) HREH in WA - Role of Retention Intervention Strategies 26 Key: Def – Definite Pos – Possible Prb – Probable NL – Not likely

PROFESSIONAL AND PERSONAL SUPPORT Intervention Potential for Effectiveness Better living conditionsPos Safe and supportive working conditionsPrb Outreach supportPrb Career development programmesPos (if) Professional NetworksNL Public recognition measuresPrb HREH in WA - Role of Retention Intervention Strategies 27 Key: Def – Definite Pos – Possible Prb – Probable NL – Not likely

 By 2020 –  By 2020 – Every person, everywhere, should have access to a well-trained and well- motivated specialized eye health worker within 50 km and a well- trained and well-motivated primary eye care worker within 5 km of where he/she lives. HREH in WA - Role of Retention Intervention Strategies 28

 We need retention strategies to achieve the new goal, but ◦ No single intervention works for all situations and for all categories. ◦ Package of financial and non-financial incentives have better chances of success.  Eye Health remains low in priority of governments in WA and so is Human Resources for Eye Health.  We appreciate the support of the IAPB family and would continue to depend on this support for the development of HREH in WA at least until 2015 and possibly beyond. HREH in WA - Role of Retention Intervention Strategies 29

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