1. 1 Managing Human Resources for Health in Lithuania Jonas Bartlingas Head of Health Care Resources Management Division Head of Health Care Resources Management Division Ministry of Health Republic of Lithuania Second Policy Dialogue in the Baltic Countries on Human Resources for Health WHO, Regional Office for Europe European Observatory on Health Systems ands Policies 26-27 September 2005, VILNIUS

2. 2 Health Care Resources  Material resources  The property of the LNHS executive and managing bodies  Any other property, assigned by laws for ensuring of the LNHS activities  Financial resources  Funds of compulsory Health insurance  Human Resource for Health  Databases of information concerning health care

3. 3 Human Resource for Health  Health care specialists  Other workers, who work in team or have equal work facilities  :  Health care specialists:  Sectorial directives of EU  General directives of EU

4. 4 Effects to Managing HRH  working conditions  payment systems  financial and non-financial incentives  organization of staff in the health sector  composition of health care teams  career pathways  employment conditions of staff in the health sector  retention  parties involved in negotiations determining working conditions  (innovative) mechanisms to monitor staff performance and outcomes of health care  New challenges in Managing HRH after EU enlargement

5. 5 Working conditions  Lithuanian Trade Code  working conditions - agreement employee / employer  they can not be worse to employee, then it is determined by legal acts  Working hours  Annual leave  Workload  Payment systems

6. 6 Working conditions  Working hours  Trade Code – 40, except some condition  For Health workers - max 39.  36 blood, immediate care, physiatrist, TB, infections diseases  33 echoscope  30 radiology, pathology  Annual leave  Trade Code – 28 - 56 calendar days,  For Health workers min. 35, max 42 days  Trade load in HCI is under agreement trade union / employer  Payment systems are under agreement trade union / employer

7. 7 Organization of structure Primary care Primary family care  State HCI  Privacy HCI Contracts with SSF

8. 8 Organization of structure Primary care Primary family care  State HCI  Privacy HCI Contracts with SSF

9. 9 Composition of HC teams Primary care  Family medicine  Family doctor (GPD) and Team of doctors (internist, pediatrician, gynecologist, surgeon)

10. 10 Composition of HC teams Primary care  Family medicine and population

11. 11 Composition of HC teams Primary care Primary care  Dentists  Psychiatrist

12. 12 Parties involved in negotiations determining working conditions  Patient organizations  Specialists organizations  Trade unions of employees  Organizations of employers  Institutes/universities ( as scientific potential )

13. 13 Implementation of EU Acquis into Lithuanian law Republic of Lithuania implemented all obligations and transferred requirements of sector and general based directives to Lithuania laws and legal acts: There were added/changed acts There were added/changed acts There were admitted acts on recognition of EU diploma There were admitted acts on recognition of EU diploma Improvement of programs Improvement of programs Notification of “conformity dates” Notification of “conformity dates” Certification of nationally acquired professional qualifications Certification of nationally acquired professional qualifications

14. 14 Implementation of EU Acquis into Lithuanian law Improvement of programs in the training of doctors, dentists, nurses, midwives, pharmacists  Most alteration was in training of doctors  reduced primary residency to internship (undergraduate training)  Associated secondary and tertiary residency to residentship (postgraduate training)  Training programs of dentists, pharmacists, nurses, midwives were revised according to experts recommendations on requirements of directives:  Dentist’s professional title “stomatologas” to “odontologas”  Theoretical course in college study program of nurse is separated from practical training  Restart training of midwives after secondary education, also have 18 months training after graduating as nurse

15. 15 After Accession: Certification of nationally acquired professional qualifications From 1991 study program “comply” with directive 93/16/EEC, only one diploma From 1993 diploma with certificate accompanying qualification - “profesinės kvalifikacijos pažymėjimas” of “medicinos gydytojas” (1994) 1993 General practice (family medicine) Dates of conformity in specialized medicine differ according to specialization: 1994 Anesthesiology and reanimation, Ophthalmology, Otorhinolaryngology 1995 Gynecology-obstetrics 2005 Orthopaedics and traumatology, Physical medicine and rehabilitation, Clinical laboratory, Pathology 2006 Psychiatry, Radiology, Child and adolescent psychiatry Dates of conformity Medicine

16. 16 After Accession: Certification of nationally acquired professional qualifications Internal medicine from 2007: 2006 Allergology and clinical immunology, Occupational medicine, Dermatovenerology, Endocrinology, Gastroenterology, Geriatrics, Hematology, Infectious diseases, Cardiology, Nephrology, Neurology, Pulmonology, Onco-radiotherapy, Rheumatology Or all diplomas in above mentioned specializations after qualified in internal medicine (program 2 years) General surgery from 2005 2005 Neurosurgery, Urology, Abdominal surgery, Vascular surgery, Thoracic surgery, Children surgery, Plastic surgery from 2005 Or all diplomas in above mentioned specializations after qualified in general surgery (program 2 years) Dates of conformity

17. 17 After Accession: Certification of nationally acquired professional qualifications Nurses  All university diploma  College diploma from 2003 Midwives  College diploma from 2007 without nurse diploma  If training separate by from nurse training  College diploma from 2005 with college nurse diploma  If there is additional training after nurse training Dates of conformity

18. 18 After Accession: Certification of nationally acquired professional qualifications Dentists  University diploma  Comply with directive from 1991  From 1993 diploma with certificate accompanying qualification - “profesinės kvalifikacijos pažymėjimas” of “bendrosios praktikos gydytojas stomatologas” (1994) Specialization in dentistry - from 2004 year comply with directive Dates of conformity

19. 19 Managing of migration Certification of nationally acquired professional qualifications  Diploma  Certificate of conformity  Certificate of conformity – change of denomination  Certificate of acquired rights  Certificate of special – acquired rights  Certificate of good standing

20. 20 EC DIRECTIVES: HORIZONTAL AND SECTORAL BASED APPROACHES  General System Directives (for allied health professionals) - 89/48/EEC; - 92/51/EEC; - 99/42/EC.  Specific (Sector-based) Directives (“Health Directives”) - Doctors’ : 93/16/EEC, - Dentists’ : 78/686/EEC, 78/687/EEC; - Nurses’: 77/452/EEC, 77/453/EEC; - Midwives’: 80/154/EEC, 80/155/EEC; - Pharmacists’: 85/432/EEC, 85/433/EEC;  New - On the recognition of professional qualifications 2005/36/EC

21. 21 A VOLUNTARY EUROPEAN CERTIFICATE OF GOOD STANDING  Name  Professional ID Number  Date of Birth  Date and Description of Primary Medical Qualification  Qualification of Specialization  Registered address  Registration status

22. 22 A VOLUNTARY EUROPEAN CERTIFICATE OF GOOD STANDING  Name (the applicants nationality, including any dual nationality status, and details of any changes or additions to nationality)  Professional ID Number (the applicants official and unique identification number as issued to them by the regulatory authority)  Date of Birth (day, month and year of birth)  Date and Description of Primary Medical Qualification (the date of qualification and name of the relevant qualification held)  Qualification of Specialization(details of the healthcare profession if not explicitly stated elsewhere. Details of the registered specialty held by the individual)  Registered address (the place of current practice of the individual or the individual’s registered address)  Registration status (details of the nature of the registration held e.g. full, temporary, subject to conditions etc and the reason, the duration of sanctions where available)

23. 23 Upsurge in migration Dynamic In period of 8 months of 2004 1 st May – 31 st December were issued certificates for 467 applicants: 298 doctors 298 doctors 75 dentists 75 dentists 84 nurses 84 nurses In period of 8 months of 2005 1 st January– 31 st August 2005 were issued certificates for 422 applicants: 264 doctors 264 doctors 51 dentists 51 dentists 101 nurses 101 nurses 6 midwifes 6 midwifes

24. 24 Upsurge in migration Dynamic

25. 25 Upsurge in migration Absolute numbers of professionals and applicants

26. 26 Upsurge in migration Absolute numbers of professionals and applicants

27. 27 Upsurge in migration Absolute numbers of professionals and applicants

28. 28 Upsurge in migration Absolute numbers of professionals and applicants

29. 29 Upsurge in migration Percentage of professionals and applicants

30. 30