© Sightsavers ` HUMAN RESOURCES FOR HEALTH AND THE GLOBAL HEALTH WORK FORCE ALLIANCE RONNIE GRAHAM, DIRECTOR, HUMAN RESOURCES FOR HEALTH, SIGHTSAVERS

© Sightsavers Health workers are the heart and soul of health systems. And yet, the world is faced with a chronic shortage - an estimated 4.2 million health workers are needed to bridge the gap, with 1.5 million needed in Africa alone. 57 countries are considered to be in crisis. The critical shortage is recognized as one of the most fundamental constraints to achieving progress on health and reaching health and development goals. 1. THE GLOBAL CRISIS

© Sightsavers 2006 Launch of World Health Report ‘Working Together for Health’ 2006 Launch of the GHWA – World Health Assembly, Geneva st Global Forum on HRH, Uganda – Kampala Declaration 2008Nigel Crisp ‘Scaling Up – Saving Lives’ 2009 Launch of Strategic Framework and CCF nd Global Forum, Thailand – membership exceeds Nigel Crisp & the APPG: ‘All The Talents: Changing Roles and Skill Mix of Health Workers’ 2012External Evaluation of GHWA 2. THE GLOBAL RESPONSE

© Sightsavers 3. What is the GHWA ? The Alliance is a global partnership, formed in 2006 as a joint platform for action on the health workforce crisis. Its members include governments, UN agencies, professional associations, NGOs, foundations, research and training institutions and the private sector. It serves as a catalyst for learning, dialogue, advocacy (HWAI) and joint action. It facilitates mechanisms to articulate link between investments and outcomes. It identifies strategic opportunities for advancing the global agenda. It supports regional networks and other alliances to strengthen collective action. It is not a funding mechanism !

© Sightsavers RESPONSE TO THE EVALUATION 1.Establish a specialist health worker sub-committee (eye health, dental, mental etc) 2. Prioritise advocacy opportunities at country level – particularly the CCF approach 3. Closer inter-sectoral collaboration between Ministries of Health and Education 4. Include HRH in post-MDG development framework 5. Focus on comprehensive, costed national HRH plans and include in health budgets 6. Strengthen the ‘voice’ of the health worker 7. Hold partners to account against commitments 8. Promote mHealth and on-line learning 9.Address overlapping mandate between GHWA and WHO HRH

© Sightsavers 36 out of 57 crisis countries 24% of the burden of disease 10% of the global population 1% of global health resources And only 3% of the global health work force 5. The Crisis in AFRICA

© Sightsavers Human resources are our most valuable asset. Yet many difficulties encountered in planning and training including issues of availability, distribution, competency, productivity, retention, CPD, equipment and supplies, cadre recognition and career development. 6.1 AVAILABILITY 6. THE EYE HEALTH WORK FORCE CRISIS IN AFRICA LEVELTYPEWHO RECOMMENDED RATIO NEEDSCURRENT ESTIMATE GAP TERTIARYOPHTHALMOLOGIST1/250,0004,0001,7002,300 SECONDARYALLIED EYE HEALTH PROFESSIONAL 1/100,00010,0004,0006,000 PRIMARYPEC1/10,000100,00010,00090,00 0

© Sightsavers Every table tells a story but also raises a new set of questions – what about urban-rural distribution, public-private, surgical-non- surgical etc. 6.2 DISTRIBUTION IN AFRICA POPULATION/ MILLIONS OPHTHALMOLOGISTSRATIO ANGLOPHONE 4231,1431/370,000 FRANCOPHONE /534,000 HORN OF AFRICA /834,000 LUSOPHONE 45351/1,275,000 TOTAL 8221,774

© Sightsavers 7.1 The HRH Action Framework (HAF) A simple but comprehensive technical framework to assist governments and managers to develop and implement strategies to achieve an effective and sustainable work force. Six Action Fields 1.HR Management Systems 2. Leadership 3. Partnership 4. Education 5. Finance 6. Policy Four Phases Situation analysis->Planning->Implementation->M&E 7. TOOLS AND GUIDELINES

© Sightsavers An important barrier to resolving the eye health workforce crisis is the lack of funding. Countries are seldom in a position to make the economic case for financial assistance. Selecting the wrong tool can lead to unnecessary costs, delayed policy decisions and wrong conclusions.. The tool has been applied in several countries and users found it useful to understand the scale of resources required. Sightsavers will now pilot in three countries in Africa. 7.2 COSTING THE EYE HEALTH WORKFORCE The OneHealth Tool was developed by a UN-World Bank Inter-agency Working Group and supports the costing, budgeting, financing and national strategy development with a focus on integrated planning and strengthening health systems. It combines the most useful components of different tools and is designed in a modular fashion allowing for programme specific costing.

© Sightsavers CCF is the process which brings together all key stakeholders in a country to develop and implement a comprehensive, evidence-based, HRH Plan. The HRH Unit in the MoH is the focal point. Duplication avoided and synergy enhanced. HReH becomes sustainable because it is embedded in the national health strategy. The CCF is a 5 phase process: 1. We start by suggesting an HReH sub-committee 2. Develop an HReH Situation Analysis 3. Develop an HReH Plan 4. Mobilise resources –domestic budgets and external partners 5. Implement and monitor 7.3 Country Coordination and Facilitation ‘ It is very unlikely that we will resolve the HRH crisis if each country or sector works in isolation’

© Sightsavers The training ‘pipeline’ can be long and while we can work to shorten it through such approaches as task sharing and curriculum review we are also now starting to see the kind of success which will impact on services for years to come. The key ‘take home’ message is that success is most often built around strong partnerships – between INGOs and with the Ministries of Health and Education. 8. BUILDING ON SUCCESS TRAINING PROGRAMMEPARTNERHIPSRESULTS East Africa – EACOSIGHTSAVERS AND lLftW30 ophthalmologists per year by 2015 West Africa - DESSOCBM & SIGHTSAVERS38 DOs since 2004 Africa -Schools of OptometryICEE + LftW, DIT, CBM SIGHTSAVERS From 7 schools in 2006 to 17 in 2012 Zambia -Chainama CollegeSIGHTSAVERS56 new AeHPs since 2008 Mozambique – Beira and Nampula SIGHTSAVERS, LftW, HELPAGE From 20 ‘technicos’ in 2011 to 109 by 2014

© Sightsavers Projected Outputs: Malawi Schools Of Optometry Two Success Stories

© Sightsavers P RIORITISE: Human Resources are our most valuable asset A LIGN: With other global health initiatives I NTEGRATE: Into mainstream health work force planning N ETWORK: Beyond eye health – AP/HRH, Regional Health Authorities, Development Banks, civil society health networks NO PAIN NO GAIN !!!! 9. OUR RESPONSE: STEP OUT OF THE BLINDNESS BOX