World Health Report 2006

Health workforce is important Health system : 3 M Health system : 3 M Man * Man * Money Money Material/Technology Material/Technology Note * : Shortage

Health Workers

Global health workforce’s situation Amount : Shortage, Need-based sufficiency Amount : Shortage, Need-based sufficiency Distribution : Density, Migration Distribution : Density, Migration Diversity : Gender/Tribe/Age Diversity : Gender/Tribe/Age Skill mix Skill mix Public-private mix Public-private mix

Forces driving the workforce

Responding to urgent health needs High priority services : MDGs High priority services : MDGs Burden of chronic diseases and injuries Burden of chronic diseases and injuries Natural disasters and outbreaks Natural disasters and outbreaks Working in conflict and post conflict environments Working in conflict and post conflict environments

Challenges: MDGs MDGs Epidemics of in-service training Epidemics of in-service training Overburdened district staff Overburdened district staff Two tiers of salaries Two tiers of salariesSolutions: Strategy 2.1 Scale up workforce planning Strategy 2.1 Scale up workforce planning Strategy 2.2 Capitalize on synergies across priority programme Strategy 2.2 Capitalize on synergies across priority programme Strategy 2.3 Simplify services and delegate appropriately Strategy 2.3 Simplify services and delegate appropriately Strategy 2.4 Secure the health and safety of health workers Strategy 2.4 Secure the health and safety of health workers

Challenges: Preparing the workforce for the growing burden of chronic diseases and injuries Preparing the workforce for the growing burden of chronic diseases and injuries New paradigms of care require a workforce response New paradigms of care require a workforce responseSolutions: Strategy 2.5 Deploy towards a continuum of care Strategy 2.5 Deploy towards a continuum of care Strategy 2.6 Foster collaboration Strategy 2.6 Foster collaboration Strategy 2.7 Promote continuous learning for patient safety Strategy 2.7 Promote continuous learning for patient safety

Optimal mix of health services Self-care Informal community care Health services through primary health care Community health services Health services in general hospitals Long-stay facilities and specialist services

Challenges: Mobilizing for emergency needs: natural disasters and outbreaks Mobilizing for emergency needs: natural disasters and outbreaks Preparedness plans can help Preparedness plans can helpSolutions: Strategy 2.8 Take a “command and control” approach Strategy 2.8 Take a “command and control” approach Strategy 2.9 Help remove sector boundaries Strategy 2.9 Help remove sector boundaries Strategy 2.10 Train appropriate health staff for emergency response Strategy 2.10 Train appropriate health staff for emergency response Strategy 2.11 Develop an emergency deployment strategy for different kinds of health workers Strategy 2.11 Develop an emergency deployment strategy for different kinds of health workers Strategy 2.12 Ensure adequate support for front- line workers Strategy 2.12 Ensure adequate support for front- line workers

Challenge: Working in conflict and post-conflict environments Working in conflict and post-conflict environmentsSolutions: Strategy 2.13 Obtain and maintain strategic information Strategy 2.13 Obtain and maintain strategic information Strategy 2.14 Invest in advanced planning and focused interventions Strategy 2.14 Invest in advanced planning and focused interventions Strategy 2.15 Protect what works Strategy 2.15 Protect what works Strategy 2.16 Repair and prepare Strategy 2.16 Repair and prepare Strategy 2.17 Rehabilitate when stability begins Strategy 2.17 Rehabilitate when stability begins

Preparing the health workforce Preparing the health workforce Working lifespan strategies

Getting the mix right: challenges to health workforce production

Pipeline to generate and recruit the health workforce

Functions of health educational institutions to generate the health workforce

Relationship of education, labour and health services markets with human resources

Making the most of existing health workers

Human resource indicators to assess health workforce performance

Levers to influence the four dimensions of health workforce performance

Exit routes from the health workforce

Managing exits from the workforce Migration Migration External migration External migration Source country Source country Receiving country Receiving country Internal migration Internal migration Retirement Retirement

External migration; Source country strategies Strategy 5.1 Adjust training to need and demands Strategy 5.1 Adjust training to need and demands Strategy 5.2 Improve local conditions Strategy 5.2 Improve local conditions

External migration; Receiving country strategies Strategy 5.3 Ensure fair treatment of migrant workers Strategy 5.3 Ensure fair treatment of migrant workers Strategy 5.4 Adopt responsible recruitment policies Strategy 5.4 Adopt responsible recruitment policies Strategy 5.5 Provide support to human resources in source countries Strategy 5.5 Provide support to human resources in source countries

External migration; International instruments Strategy 5.6 Develop and implement tactics against violence Strategy 5.6 Develop and implement tactics against violence Strategy 5.7 Initiate and reinforce a safe work environment Strategy 5.7 Initiate and reinforce a safe work environment

Internal migration; Challenge: Change of occupation or work status Change of occupation or work statusSolutions: Choosing a reduced work week Choosing a reduced work week Strategy 5.8 Accommodate workers’ needs and expectations Strategy 5.8 Accommodate workers’ needs and expectations

Internal migration; Challenge: Health workers not employed in their field Health workers not employed in their fieldSolution: Strategy 5.9 Target health workers outside the health sector Strategy 5.9 Target health workers outside the health sector

Internal migration; Challenge: Absentees and ghost workers Absentees and ghost workersSolution: Strategy 5.10 Keep track of the workforce Strategy 5.10 Keep track of the workforce

Retirement;Challenges: Retirement rates and the risk of shortages Retirement rates and the risk of shortages Health workforce ageing Health workforce ageingSolution: Strategy 5.11 Develop the capacity and policy tools to manage retirement Strategy 5.11 Develop the capacity and policy tools to manage retirement The need for knowledge transfer The need for knowledge transfer Strategy 5.12 Develop succession planning Strategy 5.12 Develop succession planning

Formulating national health workforce strategies Building trust and managing expectations Fair and cooperative governing Strong leadership Strengthening strategic intelligence Investing in workforce institutions

Organizations influencing the behavior of health workers and the health institutions Professional organizations: Self regulations of entry And market rules through Codes of ethics, sanctions, Training, role models Institutional regulators: Administrative measures, funding mechanisms, employment and contracts managed by state, social health insurance or similar institutions The behavior of health care institutions and health workers Civil society organizations: Protection of the interest of citizens by: empowering users, functioning as watchdogs, setting policy agenda

The country strategies 1. Build national strategies out of concrete action points that cover management of entry, workforce and exit as well as: building or rebuilding trust; multi-stakeholder management of the regulatory environment; and leadership capacities.

The country strategies 2. Pay attention to the process. The choices to be made may be difficult and controversial: it is essential to ensure procedural fairness by being inclusive and transparent, but with the courage to arbitrate when vested interests are taking over.

The country strategies 3. Strengthen strategic intelligence, focusing on: (i) understanding the extent and nature of health workforce problems; (ii) evaluating what is being done and determining what can be done; (iii) identifying the political drivers that led to the current situation; (iv) understanding workers’ viewpoints and anticipating their possible reactions to change.

The country strategies 4. Build the country’s health workforce institutional capacity, with a focus on regulation, leadership and strategic information, including: (i) analysis and evaluation of microinnovations (ii) scenario building and planning for the future

Working together for health, within and across countries Country Leadership Country Leadership Global Sodality Global Sodality

Ten-year plan of action

Global stakeholder alliance