1 world health organization, geneva identifying human resources information needs for art programmes...

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World Health Organization, Geneva

Identifying human resources information needs for ART programmes

World Health Organization

Human Resources for Health

Department of Health Service Provision

Norbert Dreesch

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There is a crisis in HR which stems from . . .

• …years of neglect of the significance of investing properly in human resources development

• … lack of incentives in many countries to work in the services (low pay, low working conditions, low morale)

• … sense of powerlessness amongst service staff in high-burden HIV/AIDS countries

• AGAINST THIS BACKGROUND: TREMENDOUS HR DEVELOPMENT NEEDS FOR ART

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HR issues countries are struggling with - 1:

• HRH constraints to absorbing new resources and expanding good practices

• Inadequate numbers and skills of providers affect quality of performance, ability to deliver services to the poor and other disadvantaged populations

• Imbalances in the health workforce (geographic, gender, and other)

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HR issues countries are struggling with - 2:

• Migration and retention of health workers • Impacts of specific diseases and other risk factors for

health care providers• Weak congruency between education for health care

providers and achievement of coverage • Lack of coordination between external donors' and

countries’ policies towards HRH development

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• Currently no universally accepted classification of service providers to whom distinct ART skills could be assigned

• Out-migration, low morale and poor retention capacity• Difficulty to count the extent of FTE contributions by private

clinics, treatment NGOs, employers, research and public sector in ART care flow

• Problems of accuracy of staff figures at aggregate levels, both public and private

• Lack of HR development plans

HIV/AIDS specific HR issues countries are struggling with - 3:

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20

40

60

80

100

Perc

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1990 1996 1998 2000

Staff deaths due to HIV/AIDS in Tanzania

Impact of HIV/AIDS on staffingImpact of HIV/AIDS on staffingImpact of HIV/AIDS on staffingImpact of HIV/AIDS on staffing

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The challenges - 1:

• ART is a new, labour-intensive intervention• Little to no knowledge about ART treatment systems• Quality systems are needed• Core treatment unit, tasks, FTEs, and skills training

needs have to be defined for different national settings and conditions

• It is not yet clear to which extent and what level of staff clinical tasks can be transferred

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The challenges - 2:

• Demand for ART is high, capacity to deliver is low:– demand cumulative– chronic care needs

• Success may create recipe for failure: increasing coverage will need to be matched by increased numbers of ART skilled staff

• But: some countries severely affected by staff losses due to HIV/AIDS

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At facility level, we need to know - 1:

• The level of current staff types and their time utilization• All leave and average morbidity and staff loss experience • The baseline skills currently available amongst different

service providers• Additional FTE needs based on the national ART model

and coverage goals• The training needs having to be achieved prior to scaling up

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At facility level, we need to know - 2:

• The phasing pattern to insure skills, supplies, and equipment function in a quality care environment when going to scale

• The care flow best suited to available skills• The optimal mix of task distributions:

– referral facilities– staff in the care flow

• ART task distribution between service providers/community members

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At national/regional level we need to know or define - 1:

• The intended ART coverage goals for the next 5 years• The current and future production of training institutions for different types

of service providers• The responsiveness of education and training to changing needs for

different services• Staff internal and external migration, geographical imbalances of staff

distribution within country• The rate of attrition of service providers for the next years to come (as a

result of age, disease (e.g. HIV/SARS), labour market dynamics, otherwise)

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At national/regional level we need to know or define - 2:

• The impact of treating service staff with ARVs on staff productivity and replacement needs

• Incentives and motivational factors to work in the health services, assessment of possibility to re-hire staff who left the service, retention strategies

• The capacity of existing personnel records systems to provide accurate data on staff

• Administrative/personnel systems’ flexibility to reflect new skills mix in revised staff grading and remuneration systems

• Impact of existing constraints to public sector scale up due to lending institution agreements

• Impact of international/regional recruitment policies

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In conclusion, there are huge strategic information needs:

• Generic: more attention needed internationally to support identification of health systems/HR development needs for scaling up ART

• Specific to HIV in high-burden countries:– impact on HR– country-specific models

• Difficult to imagine how countries will be able to deliver quality ART if support is not given to identify the information necessary for HR planning.

1 world health organization, geneva identifying human resources information needs for art programmes...

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