1. Human resources for malaria elimination Deyer Gopinath GMS Malaria Elimination Course 10 – 21 August 2015, Chiang Mai, Thailand

2. Issues currently Technical capacity within national programmes has declined in several GMS countries in recent years due to a number of factors: an ageing workforce, limited opportunities for high-level training increased staff attrition due to recruitment by partner agencies etc

3. Issues ahead As an elimination programme proceeds, the costs shift towards human resources, and, when the country is malaria free, towards general health services. Human resources required will appear to be disproportionate to the disease burden. Thus, after interruption of transmission, it is quite unrealistic to expect significant government/donor support particularly for HR.

4. Issues ahead The recruitment and maintenance of human resources (from the village volunteer to the programme manager) depends not only on commitment and financial allocations, but also on the capacity of the system to: plan and implement budgets, execute payments on schedule, and rapidly reallocate or mobilize funds to deal with unexpected events. Administrative disruptions can lead to malaria epidemics and derail elimination programmes

5. GMS Elimination: SUPPORTING ELEMENT 2. Strengthening the enabling environment Human resources must increase at all levels - for strong surveillance systems and high quality of all operations In addition to malaria/VBD staff, general public health staff may need to be tasked for surveillance and response, in which case they should be trained accordingly. Staff must be motivated and maintained until transmission is interrupted, and possibly thereafter, at least for some time. Capacity development at all levels of the health system appropriate to the implementing strategy

6. “Human resources must increase at all levels” 1995 – Sabah 5 year Action Plan Obtained 100 additional positions* By 2004, the proportion of cases investigated rose to 86.6% from 39.1% in 1992 * (1) major increases in vector control activity, (2) subsector outpost in remote areas; (3) more community involvement through VHV and (4) the implementation of case follow up & investigation procedures. Recruitment, training, placement

7. “Technical support and capacity-building”  Look ahead  Capacity development -regional, national and subnational levels. develop and regularly update HR development plans; maintain a core technical group of adequately trained professionals with the necessary epidemiological expertise to address the new elimination challenges; update knowledge and enhance the skills of specialized and general health staff ensure that training programmes are updated as necessary, should be oriented to tasks and problem solving and supported by regular supervision and needs-based refresher courses); and ensure that training increases the motivation of health staff to maintain their skills and competence and remain in service.

8. Need for training and technical collaboration: malaria elimination approaches, using WHO’s manuals and training materials, adapted to the epidemiology of GMS, allowing evolving country specifics information technology management of geographical information What will technology be in 2020? Smartphone to smart wrist watches?? QA for microscopy and RDTs;Allowing improvements in current diagnostics? entomological surveillance and vector-control QA. Urban malaria? Insecticide class?

9. Collaborative approaches in training advocacy and intersectoral collaboration; Skills on communication, how to conduct effective meeting/training/workshops, presentations, advocacy, effective dialogue with private sector - /non health sectors, developing a business case etc management of malaria in mobile and migrant populations Skills on PRA, ‘migrant friendly’ services, establishing intersectoral networks

10. “Developing a HR strategy” Addresses the country’s goal of malaria elimination, to include: HR assessment Staff inventory at all levels, Organogram, Job descriptions/ Terms of reference for all positions Staff motivation Recruitment, retention, training and professional development at all levels focused on recommended strategies/policies HR needs/gaps related to malaria elimination in a vertical program context and in an integrated program context. Strengthening pre-service education program to ensure graduates have the right knowledge and skills

11. Task shifting: defined as delegating tasks to existing or new cadres with either less training or narrowly tailored training a process of delegation whereby tasks are moved, where appropriate, to less specialized health workers. By reorganizing the workforce in this way, task shifting presents a viable solution for improving health care coverage by making more efficient use of the human resources already available and by quickly increasing capacity while training and retention programmes are expanded. Task shifting, skill mix, integration of tasks, task sharing; task rationalization…..

12. EXERCISE 1 In areas targeted for advanced control/reduction of transmission, assess how much malaria, select as an example, one province: 1.How great will be the demands on human resources (quantity and capacity) at different levels of the health system in that province [table if necessary]? What position/s would be most needed? 2.Do new people need to be recruited? Will it be possible to recruit as many as needed? How will you go about achieving this? 3.How will training and supervision be done? 4.Will these people be needed once elimination has been achieved? If not, what will happen to them? Suggested group: Lao PDR, Myanmar

13. EXERCISE 2 In areas targeted for elimination/POR, assess how much malaria, select as an example, one province: 1.How great will be the demands on human resources (quantity and capacity) at different levels of the health system in that province [table if necessary]? What position/s would be most needed? 2.Do new people need to be recruited? Will it be possible to recruit as many as needed? How will you go about achieving this? 3.How will training and supervision be done? How will you maintain motivation/interest? 4.Will these people be needed once elimination has been achieved? If not, what will happen to them? Suggested group: China, Viet Nam, Thailand, Cambodia