Annual Health Forum 2007 Reorientation of the Health Workforce for future challengers Primary Health Care Workforce Dr Abhaya Tissera

Annual Health Forum 2007 Primary Health Care ‘essential health care …..made universally accessible to individuals and families in the community…..it forms an integral part both of the country’s health system, of which it is the central function and main focus, and of the overall social and economic development of the community. (WHO International Conference on PHC, Alma Ata 1978)

Annual Health Forum 2007 Primary health care workforce Medical Officer of Health and the team First point of peoples contact with the Health Service, Bring health care as close as possible to where people live and work.

Annual Health Forum 2007 Challengers Changing concept of health Developing new technology Epidemiological transitions Demographic transitions Changing health care priorities The way health system doing its business Changing social and cultural values

Annual Health Forum 2007 Changing concept of health and health care PeriodIdeology of healthCompetencies 19 th centuryBiomedical modellegislations and sanitary reforms Early 1970sHealth Field – life styleHealth education Late 1970sSocial model of health PHC concept Community participation Empowerment 1986 onwardOttawa Charter for HP Bangkok Charter for HP Advocacy Partnership building

Annual Health Forum 2007 Epidemiological and demographic transitions Demographic transition Increasing aging population, and youths and adolescents healthy aging, youth counseling, community based disability management Epidemiological transition Changing disease pattern from CD to NCDs community based interventions management of NCDs at PHC level

Annual Health Forum 2007 Changing health care priorities: new areas… Health care for aging population Youths and adolescents health Prevention and management of major non communicable disease, New emerging diseases Health care in natural disasters

Annual Health Forum 2007 Changing health care priorities: more funds.. Country Cooperate Strategy - WHO Component of HSDP project - World Bank Component of EBM study – JICA

Annual Health Forum 2007 The new approaches for health care Integrated Non-Communicable Disease Prevention community interventions –The active participation of families and communities, – pooling and sharing resources to ensure integrated preventions. –The identification of leaders, organized groups and institutions. –The development of strategic coalitions and alliances ( PHA Canada, 2007)

Annual Health Forum 2007 Changing social and cultural values people’s choice for place of delivery has been changed from ‘home’ to ‘institution’ more and more mothers are now seeking services of GPs/institutions for immunization of their children Home Visits by FHWs vs Home Care by private health agency

Annual Health Forum 2007 Competency profiles Technical competencies Non technical competencies –Community participation –Advocacy –Communication –Developing partnership –Facilitating group dynamics –Change management –Organizing community groups

Annual Health Forum 2007 Response to challengers 1.District Health System DHO system 2.Increasing numbers but preserving existing job categories allocating less number of populations per FHW and assigning new tasks ??assigning new tasks will dilute the present core functions 3. Adding new disciplines, job categories

Annual Health Forum 2007 What can we do in the future ? 1.In response to the challengers, adding new areas of work and new approaches at the PHC level is inevitable 2.That mean, adding new sets of competencies,both technical and non technical, at the PHC level. 3.Executing non-technical competencies need more time and energy. 4.Therefore ‘packing’ all competencies required to face the challenges into one ‘box’ may be impossible.

Annual Health Forum 2007 What can we do in the future ? Adding new disciplines or new categories of workers Change the way of doing business such as –networking, –partnership building and –out sourcing –???Accountability –??? Quality of work

Annual Health Forum 2007 National Occupational Standards ‘evidence of the quality of the human resources, that is competencies of the PHC worker, assessed against a set of agreed criteria for the best practice (Liz Rolls, 1999). Example the National Occupational Standards for Health Promotion and Care what is happening now, what is considered good practice, what is not happening now- but should be happening and what can be anticipated in future (Care Sector Consortium, 1997, p7).