THE WORLD HEALTH ORGANISATION EXPLORING THE USE OF THE WORLD HEALTH ORGANISATION HUMAN RESOURCES FOR HEALTH PROJECTION MODEL Peter Hornby KEELE UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

Changing Style Of Human Resource Planning Traditional H.R. Planning Staff roles and functions changing little, little attention to costs or efficiency Finance Limited H.R. Planning Staff numbers and mix determined or limited by finance Performance Driven H.R. Planning Staffing driven not simply by finance limits but also by demands for efficient use of resources KEELE UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

Purpose of Manpower- Human Resource – Work Force Planning To Achieve and Sustain : Right number of people In the right place with the right skills at the right time 1960’s Concept Right number of people In the right place with the right skills at the right time with the right attitudes and motivation 1970’s Concept Right number of people In the right place with the right skills at the right time with the right attitudes and motivation at the right cost 1980’s Concept Right number of people In the right place with the right skills at the right time with the right attitudes and motivation at the right cost doing the right work KEELE UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT 1990’s Concept

The ideal for the workforce (2000s concept), in human resource terms, is to have: The right number of people, With the right skills, In the right place, At the right time, With right attitudes/ commitment, Doing the right work, At the right cost, With the right productivity. This ideal is never achieved or at best minimally, because the workforce and the workforce environment is an extremely complex and dynamic system. KEELE UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

Classical View of Human Resource Planning Process Current Health Needs & Demands Existing Services Future Health Needs & Demands Future Health & Health Care Goals Leavers Current Staff Future Services Types of Staff Required Trained Staff Returning Projected Skill Mix New Graduates Total Staff Available In The Future Total Staff Needed In The Future Equal ? YES NO Change Goals, Services and/or Staff Requirements Change Type & Scale of Recruitment, Losses Affordable ? KEELE UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT NO YES Implement Plan

STAFF The Variables Impacting on Future Staff Requirements SERVICES POPULATION GROWTH AND CHANGE AVAILABLE FINANCE TECHNOLOGY CHANGE PUBLIC EXPECTATIONS STAFF REQUIREMENTS HEALTH PROBLEMS STAFF UTILISATION QUALITY STANDARDS SKILL MIX ORGANISATIONAL EFFICIENCY INDIVIDUAL PERFORMANCE KEELE UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

Conceptual Model - Linking Health Needs, Care Provision & the Health Workforce. FIRST STAGE --- Determine Current Situation Current Health Needs and Demands Current Demographic & Epidemiology patterns Health Services Current Share of National GNP Current Public Health Services Provided Current Socio- Economic Status of the population Current Service & HR Policies Current Public Sector Workforce Mix Current Size of the Private Health Sector Current Workforce Cost Creates foundation for second stage KEELE UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

Conceptual Model - Linking Health Needs, Care Provision & the Health Workforce. FIRST STAGE --- Determine Current Situation Current Health Needs and Demands Current Demographic & Epidemiology patterns Health Services Current Share of National GNP Current Public Health Services Provided Current Socio- Economic Status of the population Current Service & HR Policies Current Public Sector Workforce Mix Current Size of the Private Health Sector Current Workforce Cost SECOND STAGE –Develop The Service Plan Projected Changes in National GNP Projected Future Demographic & Epidemiology patterns Proposed Future Service Policies Future Socio- Economic Status of the population Future Health Needs & Demands Expected Future Share in National GNP Proposed Future Public Health Services Private Sector Expansion Provides Basis for Determining Future Workforce Requirements & Supply in Stage 3 KEELE UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

Conceptual Model - Linking Health Needs, Care Provision & the Health Workforce. Current Health Needs and Demands Current Demographic & Epidemiology patterns Health Services Current Share of National GNP Current Public Health Services Provided Current Socio- Economic Status of the population Current Service & HR Policies Current Public Sector Workforce Mix Current Size of the Private Health Sector Current Workforce Cost Projected Changes in National GNP Projected Future Demographic & Epidemiology patterns Proposed Future Service Policies Future Socio- Economic Status of the population Future Health Needs & Demands Expected Future Share in National GNP Proposed Future Public Health Services Private Sector Expansion Staffing Standards/Norms & Principles Projected Future Workforce Supply Available Financing for Workforce Human Resource Policies KEELE UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT Future Workforce Staffing Mix Projected Future Workforce Requirements

The model software actually incorporates three different There are an array of strategic HR projection models which include: THE WHO HRH PROJECTION MODEL (Hall) THE KEELE ZONAL HRH MODEL (Hornby) THE SMALL STATE/DISTRICT HRH MODEL (Dewdney) HEALTH SERVICE RESOURCE MODEL (UNDP in process) INTEGRATED HEALTH CARE TECHNOLOGY PACKAGE (IHTP) WHO SERVICE TARGETS/REPROFILING MODEL (FOR UK) The model software actually incorporates three different projection models; a ratio method model which is now rarely used, a service targets model for which few developing countries have the necessary data and which has been largely superceded by more sophisticated versions and a variant on the target method called the locations method based on institutional development. It is this method that is widely used in developing country situations The Keele model was developed to link electronically to the WHO model and provide a more detailed breakdown of staff requirements (note: maybe 400-500 job titles) and more local (district) strategic projections. It proved too cumbersome for districts but reasonable at zonal or regional level with grouped districts KEELE UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

Flexibility of WHO model inputs Models use individualized inputs regarding … Duration of projection (any number of years) Occupational categories used (up to 20 possible) Training intake and loss assumptions Post-graduation workforce loss assumptions including migration Geographic distribution variables (urban/rural) Economic, budget and demographic variables for age and gender Up to 7 types each of hospitals and ambulatory facilities in both public and private sectors Staff in non-clinical settings Staffing norms for different types of facilities All input/output tables electronically linked providing easy production of alternate scenarios KEELE UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

Model Data tables (Locations method) Data not Required (automatic) Data Required Topic Yes 1 DEMOGRAPHIC ESTIMATES AND ASSUMPTIONS Yes 2 EXISTING HEALTH WORKFORCE Yes 3 SUMMARY OF KEY PLANNING ASSUMPTIONS Yes 4 PUBLIC SECTOR INCOME ESTIMATES AND ASSUMPTIONS Yes 5 ECONOMIC FEASIBILITY TEST Yes 5a ECONO MIC FEASIBILITY TEST, PRIVATE SECTOR Yes 9 HOSPITAL REQUIREMENTS BY LOCATIONS METHOD 11 BASE YEAR & TARGET YEAR HOSPITAL STAFFING NORMS No 9a PRIVATE HOSPITAL REQUIREMENTS BY LOCATIONS METHOD Yes 11a BASE YEAR & TARGET YEAR PRIVATE HOSPITAL ST AFFING NORMS Yes 10 AMBULATORY FACILITIES BY THE LOCATIONS METHOD Yes Yes 12 BASE YEAR & TARGET YEAR CLINIC STAFFING NORMS Yes 10a PRIVATE AMBULATORY FACILITIES BY THE LOCATIONS METHOD Yes 13 BASE YEAR & TARGET YEAR PRIVATE CLINIC STAFFING NORMS Ye s 14 OTHER STAFF BY LOCATIONS METHOD 15 PROJECTION OF PRIVATE SECTOR STAFF AND SERVICES Yes 16 SUMMARY REQUIREMENTS BY LOCATIONS METHOD Yes 6 PROJECTED SUPPLY BASED ON TRAINING ASSUMPTIONS Yes 6a CALCULATING CHANGES BETWEEN BASE AND TARGET YE ARS No Yes 7 STUDENT ENROLMENT AND INSTRUCTOR ASSUMPTIONS No 17 SUPPLY - REQUIREMENTS COMPARISON BY LOCATIONS METHOD No 18 ECONOMIC FEASIBILITY OF LOCATIONS METHOD PROJECTION No 19 SUMMARY OF KEY DATA BY LOCATIONS METHOD 20 SUMMARY OF KE Y DATA IN ALTERNATE LANGUAGE No Yes 8 TEN - YEAR PROJECTION BY STOCK AND FLOW METHOD KEELE UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

Major model outputs HR requirements and supply projections Urban/ rural distribution of staff & services Number, size and staffing of all health sector facilities Test of economic feasibility for public sector staff and staff production feasibility for all health sector Intermediate year interpolation projections Summary statement of key indices of change sufficient to produce HRH plan document KEELE UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

AVAILABLE SUPPORT FOR THE MODEL The model itself is freely available from WHO Geneva on the tools website There is a very comprehensive manual but it has not been updated for new tables and is difficult to locate on the WHO website there is a short form manual from Keele which provides guidance on how to run the model and what data is required to complete the tables. It is freely available but not routinely distributed There is a manual from Keele which provides guidance on how to analyse and interpret input data in the model tables. It is freely available but not routinely distributed KEELE UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

Modelling and the Modelling process Issues: - participants in the projection making process lose track of the relationship between tables - the meaning of the numbers in the tables is often not understood among non-planners - the connection between health, HRH policy and growth proposals is only weakly made and applied in the model - there is frequently poor information on leavers - the estimates of staff costs is often very difficult to establish because of multiple funding sources - participants unused to visioning - original help tables now out of date and new types of help data required - the need for multiple iterations in the projection process is generally not recognised - difficult to find and maintain technical know-how within ministry – need external(in country) support KEELE UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

Fitting modelling into the Planning Process Issues: Operational environment becoming complicated with devolution of responsibilities in health sector reform. Data collection, processing & analysis difficult and time consuming. Service planning is sometimes not in place, sometimes mechanical or political & is always time consuming with little opportunity for testing resource (HR) implications. Little incentive for managers (although this is changing under new pressures for efficiency) to meet plan objectives. Planners not engaging with the Politics of planning Mechanisms for implementation often not In place. KEELE UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT