1. Country Coordination and Facilitation 04 May 2010 San Salvador Hirotsugu Aiga, MPH, PhD Coordinator, GHWA secretariat

2. 2 Outline of presentation Background & introduction Part 1 Country coordination and facilitation Part 2 Way forward Part 3

3. 3 Background & introduction Part 1

4. 4 Countries with a critical HRH shortage Part 1 [Source] WHO. (2006). World Health Report 2006. WHO: Geneva. Of 57 crisis countries, 5 are in Latin America.

5. 5 Vision: access for all to a skilled, motivated, and supported health worker as part of a functioning health system. What is GHWA? Part 1 Mission: mobilize all stakeholders to collaboratively advocate and take appropriate actions to achieve access for all to skilled and motivated health workers, with a focus on the 57 countries in crisis. Stakeholders: 258 Alliance Members and 29 Alliance Partners, representing developing and developed countries, health professional organizations, academia, NGOs and the private sector.

6. 6 1. Africa Public Health Alliance 2. African Christian Health Association (ACHA) 3. African Medical and Research Foundation 4. Asia Pacific Action Alliance on Human Resources for Health 5. Bill & Melinda Gates Foundation 6. Duke University 7. East, Central, and Southern African (ECSA) Health Community 8. Federal Ministry for Economic Cooperation and Development, Germany 9. French Development Agency - Agence Française de Développement 10. Health and Life Sciences Partnership 11. International Council of Nurses 12. International Hospital Federation 13. Intrahealth International, Inc. 14. Irish Aid - Department of Foreign Affairs, Ireland 15. Japan International Cooperation Agency (JICA) 16. Norwegian Agency for Development Cooperation (NORAD) 17. Physicians for Human Rights 18. Realizing Rights – The Ethical Globalization Initiative 19. Results for Development Institute 20. The Canadian International Development Agency (CIDA) 21. The College of Surgeons of East, Central, & Southern Africa (COSECSA) 22. The UK Department for International Development (DFID) 23. The United States Agency for International Development (USAID) 24. Tropical Health and Education Trust 25. Uganda National Association of Community & Occupational Health 26. University of Ottawa - Université d'Ottawa 27. World Health Organization (WHO) 28. World Health Professions Alliance 29. World Medical Association 29 GHWA partners Part 1 + 258 GHWA members

7. 7 Core functions of GHWA Part 1 Convening all stakeholders => regional meeting, technical working groups, task forces, consultations, etc. Advocating for keeping HRH issues high on the global agenda => High level commitment at G8 2008 and 2009, Global forum on HRH Brokering knowledge => country profile, technical tools, community of practice, etc. Three core functions “ABC”:

8. 8 : Kampala Declaration & Agenda for Global Action Part 1 1.Building coherent national and global leadership for HW solution 2.Scaling up education and training 3.Managing pressures of the international health workforce market and its impact on migration 4.Retaining an effective, responsive and equitably distributed health workforce 5.Securing additional and more productive investment in the health workforce 6.Ensuring capacity for an informed response based on evidence and joint learning

9. 9 Country coordination and facilitation (CCF) Part 2

10. 10 Why? Part 2 Quantity: Pre-service training Quality: In-service training Professional dev’t Recruitment Deployment & distribution Migration & retention Accreditation Social recognition (1) MOH (4) MOL (5) MOFA (2) MOE =>Education (3) MOF => Investment (6) Health professional association (7) Private sector (1) MOH (4) Civil society (5) NGO HRH as a complex polyhedron

11. 11 What is “Country Coordination and Facilitation” (CCF)? Part 2 Transparency => All the stakeholders share the information and decision making process CCF is the process which brings all the key stakeholders in the country to develop and implement a comprehensive evidence-based HRH plan Ownership => All the stakeholders share the roles and responsibility Comprehensive solution => All the stakeholders work together as a multi-sectoral team Maximizing existing mechanism => Reinforce the existing HRH committee, if there is.

12. 12 Develop & implement costed HRH plan National HRH Committee [ Country level ] [ Regional level ] Flow of the CCF process Part 2 [ Global level ] Ministry of Health Ministry of Education Ministry of Labor Health Prof Association Ministry of Finance Civil society Private sector............ GHWA secretariat STEP1 CCF regional mtg =>sensitization Local institution STEP 3 CCF national trg STEP 4 Coaching & mentoring STEP 6 Facilitation & acceleration GHWA partner in country: Multi-/bi-lateral agency STEP 5 CCF facilitation guidance [ Note ] STEP 2 and STEP 5 will be undertaken as a combined sessions. Regional institution STEP 2 CCF regional TOT

13. 13 GHWA partner (eg, PAHO, USAID, WB….) Facilitation & acceleration National HRH Committee Consultation CCF process in the country Part 2 Supervision & Coaching Local institution

14. 14 Expected outcome of CCF Part 2 [Outcome 1] Preparation of HRH country profile [Outcome 2] Development of comprehensive costed HRH plan [Outcome 3] Implementation of comprehensive costed HRH plan [Outcome 4] M&E of implementation of comprehensive costed HRH plan National HRH Committee throughout the processes & outcome

15. 15 Way forward Part 3

16. 16 Lessons learned from other regions Part 3 1. Inadequate dialogues between stakeholders => Information was not adequately shared between the sectors 2. In particular, health professional associations are not adequately involved. => involvement of non-state stakeholders is key. 3. Stakeholders’ involvement had been limited to validation of HRH strategy and plan. => they would like themselves to be more involved.

17. 17 Then, the CCF process starts 5. Request for CCF support from GHWA, if needed 4. Identify local institute & the Alliance partner 3. Discuss how the HRH costed plan should be 2. Think about organizing national HRH committee ? Way forward, to start CCF Part 3 1.Open a dialogue between key stakeholders

18. Thanks for your attention. Let us work together! Contact: Hirotsugu AigaLaurence Codjia Coordinator, GHWATechnical Officer, GHWA Email: aigah@who.intEmail: codjial@who.int Phone: +81-22-791-2450Phone: +81-22-791-2360 aigah@who.intcodjial@who.intaigah@who.intcodjial@who.int http://www.who.int/workforcealliance/en/

19. 19 Distribution of health workers by level of health expenditure and burden of disease, by WHO regions Countries with a critical HRH shortage Part 1

20. 20 Involve them in implementing, monitoring, and evaluating the HRH plan [ Step 5 ] Involve them in HRH committee and technical working group for developing, evidence-based HRH plan [ Step 4 ] Organize meetings to share information on HRH situation to show how it is beneficial for them [ Step 3 ] Identify key stakeholders on HRH- related issues at country level [ Step 2 ] Flow of the CCF process Part 2 Convene a regional meeting as a kickoff [ Step 1 ]

21. 21 CCF is the process which brings all the key stakeholders in the country to develop and implement a comprehensive evidence-based HRH plan What is “Country Coordination and Facilitation” (CCF)? Part 2 In-country partnership involves all the key stakeholders, => ministries of health, education, labor, and finance; private sector; health professional associations; NGOs: and development agencies/ GHWA partners, etc. CCF provides guidance for accelerating country actions for resolving the health workforce crisis.