1. The impact of human resource management on health systems jbuchan@qmu.ac.uk

2. HRH Management HRH Challenges HRH Dynamics Impact of recession HR Interventions

3. Common challenges: Policy maker priorities How do we plan how many doctors, nurses, and other health workers to educate, and employ? How can we improve recruitment, retention and return? Which incentives are effective in motivating doctors, nurses etc How can we determine and deploy the most effective skill mix of doctors, nurses and other staff? How can we improve productivity of health workers? How do we maintain workload with reasonable limits, for individuals and for teams of health workers?

4. Common HRH Challenges Skills shortages Geographic maldistribution Fragmented planning Education- employer linkages Managing Staff Performance Effective Skill mix Migration (Data; research/evaluation; informing policy)

5. Dynamics in Europe European health care labour markets are dynamic- will change in response to demographic change (ageing populations) ; general economic conditions; -health sector reform Accession- countries with relatively low paid health professionals – outflow to established “richer” EU countries? (Knock on effect to East/ CIS?) Patient safety/ country level regulatory issues “Stocks and Flows” : Different data sets- different pictures

6. “Stocks and flows”

7. “Flows” (Maldistribution) FROM: rural “poor” districts public sector health sector “poorer” countries TO urban “richer” districts private sector other sectors “richer” countries

8. P Distribution of physicians in the European Region Source: WHO HFA database, 2007

9. Diversity in the European region Health professionals / 100.000 population, 2002 Physicians NursesMidwivesPharmacists European Region 351.22669.0245.0750.93 EU 343.56708.2635.9577.54 Central Asian Republics and Kazakhstan 293.14767.6866.916.38 CIS 373.55794.1854.1518.44 Lowest 118.54 (Albania) 245.15 (Turkey) 11.30 (Germany) 3.03 (Uzbekistan) Highest 618.52 (Italy) 1856.91 (Ireland) 122.77 (Azerbaijan) 204.31 (Malta) Source: WHO HFA database, 2007

10. Impact of recession/crisis “multidimensional and severe”(WHO,2009) Many European countries will be in economic recession this year; employment decline most evident in [export oriented] manufacturing, finance, construction Countries with financial resources are funding “stimulus” packages- those with limited resources have less scope for fiscal interventions Depreciation of national currencies in Central/ East / South East Europe (and UK) in comparison to euro and $

11. Unemployment (%) 2008/2009, selected countries [Source: WHO, 2009;EIU]

12. Recession: Impact on HRH Reduced demand for “new” HRH because of funding constraints, and increased retention of workers already working in health sector Labour cost reductions/ improved productivity= skill mix changes, increased workload/ stress Pay “freezes” or pay reductions in health sector Increased pressure to migrate, but reduced job opportunities in many countries Increase in unemployment/ underemployment of health workers as supply increases and demand reduces or stagnates

13. Policy options Establish “anti-crisis unit” in Ministry of Health: monitor situation, explore strategic options, link to other Ministries (particularly Ministry of Finance) Maintain/develop communication links with other stakeholders (donors, professions, civil society, NGOs etc)- “we are all in this together” Develop advocacy/ influence to protect health budgets Review HRH cost containment/ productivity options to identify action with potential for positive impacts (assess HRH impact) Review workforce planning and projections to assess if oversupply of ”new “ staff

14. HRM Evidence Base about 30 studies examining links between HRM and organisational performance: “Fit” : HRM must be aligned with organisational context and objectives “Bundles” : co-ordinated HRM interventions are more effective than single interventions HRM can make a positive difference to performance (Buchan, 2004)

15. References WHO (2009) Health in times of global economic crisis: implications for the WHO European region Buchan J (2004) What Difference Does (Good) HRM make? Human Resources for Health 2004:6 http://www.human-resources- health.com/content/pdf/1478-4491-2-6.pdf