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Published byGladys O’Brien’ Modified over 9 years ago
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The Global Crisis Global shortage of nurses & other health professionals Migration of nurses & doctors to developed countries Impact on delivery of care & health outcomes Undermines Africa’s effort to achieve Millennium Development Goals
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Major Studies & Publications Joint Learning Initiative (JLI) World Health Report 2006 –Extended the JLI report –Additional data
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The Glue of the Health System
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The Health Worker Density Index (HRH index) 1. A composite index 2. A density of 2.5 workers per 1,000 -- a threshold to cover essential health interventions & core MDG-related health services. 3. Sub-Saharan Africa need 1 million additional health workers.
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Association between Mortality & Health Worker Density
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Health Worker Density Comparisons by World’s Regions From: JLI 2004.
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Numerical Approach Valuable for advocacy Prompted debate & discussion Stimulated policy review
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Systematic Analysis: Back to basics 1. Task analysis –Identify needed skills & competence –Design training & apprenticeship –Review job descriptions / deployment 2, Managing migration –Dimensions & determinants –Amelioration 3. Balanced investment in health systems
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HOME / COMMUNITY Home based care Community based care Information exchange Technology transfer. PRIMARY CARE FACILITY Basic health care Referral.... FIRST REFERRAL HOSPITAL Complicated cases: Emergency Obstetric care Severe malaria Life-threatening illnesses...... SECOND / THIRD REFERRAL HOSPITALS Specialist care: Internal Medicine Paediatrcis Surgery Obstetrics
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PUSH PULL
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Higher income Better working environment Security Low income Unpaid salaries Shortage of drugs, etc Poor logistic support Loyalty to nation Family ties Social & other interests
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Managing Migration Realistic national human resource policy Gather data & monitor trends Tackle ‘push’ factors Negotiate managed migration Make most effective use of health workers Note: the large amount of funds repatriated by African workers
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Amelioration of PUSH factors Financial incentives –Realistic salaries in terms of local realities –Regular payment of salaries. Allowances & pensions Non-financial incentives –Improving working environment –More efficient management of services Consultations accredited representatives of: –Health workers –Civil society
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Balanced investment in the health system Mismanaged, malfunctioning health systems ‘Sick System Syndrome’ Staff salaries - high percentage of recurrent budget (60-80%) Infrastructure, supplies, logistics, etc. inadequate Vertical programmes fragment health systems
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Strengthening Health Care Units PHYSICAL Infrastructure Equipment Maintenance MANAGEMENT Evidence Procurement/Distribution Human resources Financing RELATIONSHIPS Stewardship Development partners Health education Community mobilisation Dare & Reeler, 2005
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Training Obstetricians in Ghana PeriodTrained Working in Ghana To 1989 UK 303 1989-2006 Ghana 3837 Can other nations adopt lessons learnt?
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Training manual Developed in Ghana Translated to French, Spanish, Vietnamese, Russian, etc. Used in 30 countries
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