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Increasing access to health workers in rural and remote areas through improved retention

Report of the third expert group meeting

25–26 November 2009, Hanoi, Viet Nam

Increasing access to health workers in rural and remote areas through improved retention Report of the third expert group meeting

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Table of contents

Introduction ................................................................................................................................. 2 Revised draft recommendations .................................................................................................. 2 A. Education............................................................................................................................... 3 B. Regulatory interventions........................................................................................................ 4 C. Financing ............................................................................................................................... 5 D. Working environment and management ............................................................................... 6 E. Social and spiritual motivation .............................................................................................. 7 New timeline ............................................................................................................................... 9 Research agenda........................................................................................................................ 10 GRADE and outcomes.............................................................................................................. 10 “How to” guide ......................................................................................................................... 12 Tools for costing and evaluation ............................................................................................... 13 The next meeting....................................................................................................................... 13 Annex 1: Provisional agenda.................................................................................................... 14 Annex 2: List of participants.................................................................................................... 15


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Introduction On 2 February 2009, WHO launched a new programme to increase access to health workers in remote and rural areas through improved retention. The programme is an integral part of WHO’s renewed efforts to strengthen health systems through a primary health care approach.

The recommendations are being developed by a group of more than 30 international experts on health workforce rural retention. Since February 2009 the full Expert Group and the core expert group have met on four occasions.

This report presents highlights of the discussions from the third full expert group meeting which took place in Hanoi 25–26 November 2009 immediately after the close of the annual conference of the Asia Pacific Action Alliance on Human Resources for Health (AAAH), jointly organized by AAAH and WHO. The agenda, list of presentations, and list of participants can be found in Annex 1, 2 and 3 respectively.

Jean-Marc Braichet and Manuel Dayrit chaired the meeting. In their opening remarks they emphasized that the main purpose of the meeting was to redraft the recommendations in light of the feedback from the three-day joint AAAH/WHO conference. They urged the experts to capture what they had learnt from hearing country experiences with implementing rural retention policies. The other objectives of the expert meeting were to review the timeline for the development of the recommendations, work on the grade tables, discuss the “how to” guide, and decide on the date for the next and final meeting of the expert group.

Given that retention is high on the agenda of many countries and that there is much expectation surrounding the publication of these recommendations, it is important to use whatever evidence is available, conclude as soon as possible, and move forward with implementing the policy. The time to act is now. However, there is also a need to strengthen the evidence and do more research so that when the group re-convenes in a few years to update the recommendations, much more will be known about what works and what doesn’t work and why.

After their opening remarks a decision was taken to depart from the proposed agenda and to move directly into smaller working groups to revise the recommendations.

Revised draft recommendations This section presents the revised recommendations that resulted from the group work during the expert meeting, followed by highlights of some of the comments that were made after each set of recommendations was presented. It is worth noting that the recommendations still need to be written in one consistent style and that more work needs to be done on the preamble, commentary and evidence sections that accompany each recommendation. Small writing teams have been formed and are taking this work forward.

For the most part the draft recommendations were well received at the AAAH/WHO conference. However, two significant changes were suggested. One was to rewrite the section on financial incentives. The other was to create a new section to address factors related to social and spiritual motivation of health workers in remote and rural areas. It was argued that this should be a separate set of recommendations because it addresses a discrete set of intrinsic factors related to issues of health worker isolation and dissatisfaction. Although there will be little in the way of quantitative evidence for this section, several case studies and other qualitative evidence can be used to support the recommendations.


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Overarching comments on the draft document

• Be clear from the outset about the scope of the recommendations. Some obvious things need to be stated such as: “policy-makers need to have a wide variety of policies to choose from” and “these recommendations are only one part of much broader national health plans that cover all components of a health system”.

• The scope of the recommendations needs to be global and broad enough to allow countries to adapt them to their own context.

• The group could make a recommendation about the type and quality of evidence and research it would find most useful.

• A preamble is needed before each section.

• The document still places too much emphasis on doctors and nurses.

• Consider shifting the orientation of the document towards the needs of the community. A social accountability approach could be a useful perspective for organizing the recommendations.

• The terminology has to be consistent throughout the document (it isn’t in the current draft) and some terms need to be defined.

• Consider using “underserved” instead of “rural” or “remote and rural”; “dual practice” rather than “private practice” and “non-state sector” instead of “private sector”

• Cross-cutting issues such as gender need to be discussed before the recommendations as they are the philosophy or soul of these recommendations.

• The recommendations are moving beyond the evidence base to expert opinion and wisdom, which is a positive development.

A. Education Revised recommendations A1. Health professions education programmes should target admission of students from rural backgrounds so as to increase the likelihood of graduates practicing in rural areas.

A2. Health professional schools and training centres should also be located in remote and rural areas as this has been shown to increase recruitment and retention in these areas.

A3. Health professional schools should institute community experiences and clinical rotations in rural or underserved areas as these have a positive influence on recruitment of health professionals to rural areas.

A4a. Health professional curricula should include rural health issues, primary health care, team building, supervision and training skills so as to improve competencies to work in rural areas and enhance interest in working in these areas. A4b. As most rural health care is primary care and most rural practitioners are generalists, curricula should have a generalist orientation to increase the likelihood of producing health workers for rural practice.

A5a. Continuous professional development programmes should be designed to meet the needs of rural practitioners within the local context so as to support rural recruitment and retention of health professionals.


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A5b. Opportunities for career and academic development should be accessible to rural health professionals without a requirement to leave the rural context.

Selected comments

• A2 is still not clear – putting a university in a rural area is a very expensive proposition.

• Concern over last statement in that having an extra training requirement in rural health may in fact be a barrier that puts people off. Perhaps “specific training” is better than “extra training”.

• There is evidence of the impact of having schools in rural settings and the benefits of creating infrastructure in rural areas.

• Need to make clear that the location of a school and the recruitment of students to that school are very strongly linked.

• There is a contradiction between two recommendations: one emphasizes the fact that everyone who is trained has the skills for rural areas, but the other says it is a specialty (other experts commented that this was not an inherent contradiction and that the two can coexist).

B. Regulatory interventions Revised recommendations B1. As a recruitment measure, compulsory service can be introduced in order to improve geographical distribution of the health workforce, for the duration of the placement in an underserved area.

B2. Compulsory service together with additional benefits such as social support, continuing education and remuneration, will increase the likelihood of retaining health professionals in underserved areas.

B3. Recognition and regulation to support an enhanced and safe scope of practice can improve access to health services and job satisfaction/retention of health workers in underserved areas.

B4. The facilitation and regulation of limited private practice can contribute to improved retention of health workers in underserved areas.

Selected comments

• Consider moving issues that need to be looked at in the task-shifting process to the commentary section.

• The WFHPA has a statement on what task shifting is, which needs to be aligned with this issue.

• B2 should include "beyond the initial compulsory service period" and address the issue of enforcement.

• Reword B3: perhaps “Regulation to support enhanced and safe scope of practice" or consider using “avoiding rigid scope of practice" instead of “changed scope of practice” so a rural health worker can do a variety of things if necessary.

• Be wary of “creeping credentialism”—credentials and regulatory processes for every aspect of providing care restricts what a health worker in a rural area can do.


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• B3 is about health workers being responsive towards the needs of the community they serve and ensuring that health workers are working together as a team to meet those needs with flexibility as to who does what. There is justification for expanded scope of practice, which is different from task shifting i.e. “changed scope of practice”.

C. Financing Revised recommendations C1. Financial incentives, whether monetary or non-monetary, are likely to improve retention only if the proposed amount of these incentives is large enough to create a net benefit for rural and remote service.

C2. Policy-makers should carefully cost out incentive packages and identify sources of financing to ensure sustainability (this point could be moved to the implementation section).

C3. Policy-makers need to balance the need to target specific cadres where shortages are highest with perceived equity issues among other cadres or professions.

C4. In designing financial incentives, policy-makers should carefully consider how feasible it is – politically and legally—to provide financial incentives only to health workers.

C5. Investment finance can be provided to those individual health workers who would like to set up health services in rural and remote areas (this recommendation is relevant only in places that have sufficient patient demand and should focus only on licensed health workers).

Selected comments

• There is the risk that C1 will be side-tracked by performance. It means that a health worker is only eligible to receive the incentive if he or she goes to that place and stays there.

• In C1 it would be better to use “financial and non-financial incentives” or “direct and indirect financial incentives”.

• Given C2’s importance, it should stay in this section and then be repeated in the implementation section.

• C3 needs to be clarified as reads like it is more about planning than a recommendation.

• C4 should include a discussion on the broader issues of integration and the destabilizing effect of vertical programmes. For example, donor funds sometimes pay higher salaries for health workers. It should also address harmonization looking at all financial incentives provided in that country.

• Perhaps something more specific should be said about financing reforms and performance-based pay schemes.

• Can these recommendations piggy-back on financing reforms to strengthen financial incentives?

• The implementation section or the “how to” guide will go into more detail on the importance of the financing context in a country but still need a general statement on financing context in this section.

• C5 needs to clarify that it does not actually mean setting up private practice i.e. it could be an NGO or a private provider that is fully publicly funded.

• C5 raises equity issues – in Africa the majority of service providers are non-licensed. Be careful not to encourage more inequities by saying “where there is sufficient demand”. Is it “sufficient need” rather than demand?


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D. Working environment and management Revised recommendations D1. Improving the physical working environment, which includes safe working conditions, maintenance of facilities, access to technologies, supplies, drugs, can reduce the workload, improve performance and increase retention of health works. In addition, supportive living conditions, such as access to water, sanitation, housing, cell phone support, education facilities for children, working opportunities for family, social/cultural opportunities, and community engagement, can improve motivation and retention to work in underserved areas, such as rural or remote.

D2. Human resource management (HRM) systems should function effectively at both central and decentralized levels. HRM processes must ensure the employment of the right staff at the right place (including deployment policies, contract mechanism, payroll, recruitment), support the professional development of staff, and ensure the existence of proper job description and performance appraisal. HRM personnel themselves should have the necessary training and orientation to the essential public health functions.

D3. Supporting the development of professional/specialists networks, rural professional associations, setting up a system of remote contact through telemedicine, creating viable career path can improve morale, status and can reduce feelings of professional isolation.

D4. Attention should be given to identifying and implementing service delivery models which are effective in maximizing the contribution of health workers to underserved areas.

Selected comments

• Even though there are overlaps it was agreed that D1 should be divided into two separate recommendations: one on living conditions and one on working conditions. Much of the description in D1 can move to the commentary section.

• All levels have a role to play in these recommendations – local, regional, national – but need to start at the local level.

• Need to be clear that the focus of the recommendation is on the human resource aspect and not a broader high-level discussion.

• The way D4 is phrased at present makes it about service delivery. D4 could fit with reorienting how health services function to work better for the health workers in those underserved areas i.e. reword to read: “What models of effective service delivery would best provide health workers to underserved areas”.

• Outreach services can be considered as a retention strategy as long as they have regular contact with the community. Health workers do not have to be permanently in a place to provide health services and retention does not only apply to health workers who live and work in the community.

• It may be more cost-effective to have temporary but frequent coverage of rural areas rather than long-term health workers in place.


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E. Social and spiritual motivation New recommendations E1. Develop effective strategies to integrate newly arrived health professionals and their families into the community. This will help motivate the health worker to serve the community, build community recognition and respect for the health worker, and address issues of social isolation.

E2. Establish awards at different levels (country, regional, international), use various media and communication strategies (e.g. publish stories of rural health workers) to raise awareness of the value and importance of rural health workers.

E3. Ensure all health students graduate with confidence to work in remote and rural areas (e.g. through appropriate curriculum, rural exposure).

E4. Lift the profile of rural health workers as an entity (e.g. rural health as a specialty, establishing chairs/professors of rural health, rural health workforce organizations, rural health journals, publications, rural health days, etc).

Some experts were not convinced of the need for a separate category and thought the recommendations in E could be integrated into the other four sections that already exist (especially management). However, more experts were of the opinion that it should be a stand alone set of recommendations, except for E3 which should move to education. The team that drafted the recommendations is in the process of gathering evidence and writing the preamble and commentary sections.

The figure below was presented during the AAAH/WHO conference in support of making this a separate set of recommendations.

Education Financial

Exte

rnal

soc

io-

econ

omic

refo

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Regulatory

Working environm

ent

Committedspirit


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Ian Cooper presented the diagram below from a study showing the significant influence of values and other intrinsic factors on health workers’ decision to work in rural areas.

Source: adapted from Couper et al, Influences on the choice of health professionals to practice in rural areas S Afr Med J 2007; 97: 1082–1086.

Selected comments

• Change title to "community support and other social interventions" or to a title that encapsulates social relationships and values.

• These actions are relevant for a wide variety of nongovernmental stakeholders — who are the recommendations directed towards?

• These recommendations are directed at raising awareness and the profile of rural health workers. This should be the first thing to do when discussing rural health and so could come first in the recommendations.

• E2 and E4 are linked to awareness raising, advocacy and recognition. E1 could be in management section and E3 could be integrated in education.

• The commentary section should explicitly acknowledge that several of the recommendations are cross-cutting.

Origin, values

Facilitating factors

Context

Reinforcing factors

Going rural

Staying factors


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New timeline The expert group and the Secretariat remain committed to publishing the recommendations as fast as possible. However, given the requirements of the Guidelines Review Committee (GRC), having the full document edited, translated, designed and printed in time for the World Health Assembly (WHA) in May 2010 may not be feasible. It was agreed to postpone the official launch until September–October, possibly around the Regional Committees of WHO. The plan now is to present a synopsis of the final recommendations in a technical briefing during the WHA, and to use this also as an opportunity to advertise for the later launch. This new timeline will allow sufficient time for the GRC to provide feedback and final approval.

It was noted that a thematic workshop should be held in the African region (and perhaps in Latin America) sometime in 2010 to raise awareness and get buy-in from stakeholders in countries in these regions (i.e. to hold some events in places other than Geneva and Asia). Using pilots in countries to feed into the process and piggy-backing on related forums are two other ways to actively promote the recommendations.

PROPOSED TIMELINE

2011

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March or A

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April or M

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June Editing & Final text

July & A

ug. Layout, design & translation

May W

HA

63: Tech. briefing / synopsis

Aug/S

eptember --printing

End S

ept. AA

AH

Conf. Indonesia

Report back

Early Oct. R

egional Com

mittee

Launch ?

January 2ndG

lobal HR

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BK

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Code of practice

JAN

UA

RY –

DR

AFT TO

PE

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VIE

W

▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼ ▼

Retention guidelines


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Research agenda Selected comments

• Along with the recommendations the expert group needs to put forward a clear research agenda.

• Monitoring and evaluation will help steer the research agenda.

• In addition to the special theme issue in the WHO Bulletin in May 2010 (which could be an opportunity to promote the research agenda), links should be made with the HRH research conference in Brazil in June 2010 and the global symposium on health systems research in Switzerland in November 2010.

• Some generic research tools need to be developed.

• We must be weary of re-inventing the wheel. In 2004 both the Joint Learning Initiative and a meeting in Cape Town, South Africa established a broad HRH global research agenda. What has happened in the past five years? Where is the progress?

• We have identified research gaps and how to fill those gaps. The priority now is to develop practical tools and policy instruments to pilot these recommendations.

• Given the many research gaps we must be careful in terms of what kind of research we recommend. The focus should be on research in developing countries.

• WFHPA and IHF are engaged in related research through the positive practice environment campaign.

• The interventions we are recommending are not new. We should focus on trying to find better ways for countries and institutions in countries to document their retention strategies. The development of tools to do this is more important than a research agenda.

• At end of the day we want to know whether these recommendations make a difference and that requires the use of control groups for comparison. The multicountry study approach is a good way forward.

GRADE and outcomes This session of the meeting was devoted to the GRADE tables and measuring outcomes. The expert group can make recommendations based on thee types of evidence, which will be presented in the document as three sets of tables:

1. Evidence tables with descriptive studies and qualitative evaluations

2. Evidence tables with surveys of factors affecting the decisions of health workers to relocate to, stay in or leave rural areas

3. Evidence tables with quantitative data from evaluations.

The GRC is only concerned with quantitative studies. Grading the quality of the evidence (with high, moderate, low, very low) and the strength of the recommendation (strong or weak) only relates to quantitative data.


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The experts were asked to consider several questions:

• What outcomes would policy-makers most like to know in order to feel confident in implementing this recommendation?

• How do we word outcomes in a way that is clear for policy-makers?

• How and where is best to account for indirect outcomes?

• How confident are we in our recommendations based on the summaries of the evidence we have included, balanced with how confident are we in our recommendations based on our expert experience and knowledge of “what works” in countries?

The following are some examples of the output and outcome indicators that need to accompany each recommendation.

Recommendation: Targeted admission of students from rural backgrounds to medical schools and other health professional training institutions increases the chance of graduates practicing in rural areas.

Indicators:

• Number of students from rural background or from underrepresented groups retained in rural/remote/underserved area.

• Number of students from rural background or from underrepresented groups currently practising in rural/remote/underserved area (at time of the study).

• Number of students from rural background or from underrepresented groups reporting their intention to practice in rural/remote/underserved area.

Recommendation: Health professional schools and training centres should also be located in rural and remote areas as this has shown to increase recruitment in these areas.

Indicator: % of training institution seats located in rural areas.

Recommendation: As a recruitment measure, compulsory services can be introduced in order to improve geographical distribution of the health workforce for the duration of the placement in an underserved area.

Indicators:

• Uptake rate of compulsory service (target levels??)

• Survival rate during compulsory service

• % of total compulsory service placements that are allocated to underserved areas

• Retention rate after compulsory service.

Selected comments

• Output or process indicators of a particular intervention are irrelevant. It is important to clearly define the outcomes, as effects of a single intervention, or of a combination of interventions, that are complementary.

• Context counts in assessing evidence, even for quantitative data. Randomized control trials provide generic information that is not context specific and doesn’t really apply to small community settings.

• For the indicators, start with the end in mind: the right numbers in the right places with the right skills. This is the point of transfer between the research agenda and government policy.


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• Suggest the grading moves to the end of the document. Why would we include weak recommendations?

• What do countries need to do to get results—that should be the focus. Governments need to start collecting data in order to know what is working and not working. We want to help countries to collect data that make sense for their purposes. As a group we may over-estimate our ability to influence and measure what we are putting out there.

• Research needs to be operational and useful to the monitoring of these recommendations. The monitoring and evaluation framework that has been developed clarifies exactly where we are trying to get to.

• Expand on the indicators in the evaluation paper that has been submitted to the WHO Bulletin and move towards developing some sort of tool.

“How to” guide Choosing the most appropriate interventions is section 4 of the draft document. An examination of the external factors that may present either opportunities or threats still needs to be done. We also need to consider the attributes of these strategies and possible unintended consequences.

These recommendations are not starting from scratch but are building on what is already being done in the area of rural retention. Some retention strategies may not have a positive impact on other areas of the health workforce. For example, incentives can create tensions among those who are not included. Promoting health workers purely based on length of service in rural areas rather than perhaps on the quality of their work can lead to other problems.

Within bundles of interventions we are looking for complementarity. For example, promoting rural schools located in rural areas must be linked with selected admission of students from rural areas. To facilitate the process of bundling we can present the benefits and the costs of certain interventions, but ultimately it will be up to decision-makers in countries to choose which recommendations they want to implement.

Selected comments

• Need to be very explicit about the linkages between the different policies and wary of the “bundled” phrase. This is not just a random amalgamation of certain strategies. In addition, the success of some policies is contingent upon others already being in place.

• Include a section that annotates and explains how to use all these recommendations in real life.

• The commentary for each recommendation needs to highlight the linkages with other recommendations and to say what success is contingent upon.

• There is never enough time to discuss the “how to” guide and this is what is most important for countries.


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Tools for costing and evaluation Selected comments

• In terms of the costing and M&E tools, both need to be further developed, linked to research and piloted in different countries. Field testing and using the tools is the best way to improve them.

• The M&E tool makes a lot of sense and is extremely useful for evaluating the recommendations as it immediately throws up the questions that need to be asked. But as many of the interventions are not new (they have been used for decades), some of the questions will have to be adapted.

• There is some disconnect in the figure between outputs and outcomes. Is impact part of outcome? Should we be talking about “indicators of outcomes”?

• Outcomes = indirect effects of the interventions. Outputs = direct effects of the interventions. Impact = the final result of the intervention. This links to the debate on the attribution of effects and the fact that it is often impossible to directly or easily attribute an outcome or impact to a specific intervention.

The next meeting A small majority favoured 4–5 February 2010 for the final meeting of the full expert group, which is supposed to finalize the recommendations. The Secretariat acknowledges that it is always difficult to find a date suitable for everyone, but kindly requests all experts try to attend.


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Annex 1: Provisional agenda

Wednesday, 25 November 2009 Chair: Manuel M. Dayrit

14:00 Session I – Review of feedback from the conference

Welcome and opening remarks Jean-Marc Braichet

Plenary discussion and feedback from the conference

14:30 Session II – Revising the recommendations

14:30 Introduction to grading of evidence Carmen Dolea/Laura Stormont

15:00 Discussion to refine recommendations and elaborate upon benefits, values and risks for each recommendation Education (Ray Pong) Regulatory (Seble Frehywot)

16:00 Coffee break)

16:30 Session II – Revising the recommendations (continued)

Discussion to refine recommendations and elaborate upon benefits, values and risks for each recommendation Financial (Aly Sy/Marko Vujicic) Management, environmental and social support (Jim Buchan)

17:30 How to revise the grading tables and proposals for the research agenda Carmen Dolea/Laura Stormont

18:00 End of day one

Thursday, 26 November 2009 09:00 Session I II – “How to” guide – taking recommendations to

countries

09:00 Discussion on choice of interventions and implementations (criteria) Tim Martineau

09:30 Plenary discussion to refine the following tools Tools for costing (Pascal Zurn) Tools for evaluation (Luis Huicho/Carmen Dolea)

10:30 Coffee break

11:00 Session IV – Next steps

Presentation and moderated discussion Next steps and timeline (Jean-Marc Braichet) Identification of pilot countries Expert group meeting in January/February

12:30 Closing remarks Manuel M. Dayrit


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Annex 2: List of participants

Technical advisers Dr Omolade Alao Head Health Systems Organisation Urmel Nord Pas-de-Calais 4 Avenue Foch 59420 Lille France

Tel: +33 320 142 217 (direct) Fax: +33 320 149 331 E-mail: [email protected]

Dr Ethel Grace Allen Young Consultant Specialist in Healthcare Management & Pharmaceutical Services 21 West Armour Heights Kingston 8 Jamaica

Tel: +876 969 7212 (direct) Fax: E-mail: [email protected]

Prof James Buchan Professor Health Sciences Queen Margaret University Edinburgh EH27 6UU United Kingdom

Tel: +44 131 474 0000 Fax: +44 131 317 3605 E-mail: [email protected]

Dr Laurence Codjia Technical Officer Global Health Workforce Alliance 20 Avenue Appia 1211 Geneva Switzerland


Prof Ian Couper Director, Centr for Rural Health Faculty of Health Sciences University of the Witwatersrand 0216 Hartbeespoort North West South Africa

Tel: +27 11 7172062 (direct) Fax: +27 11 7172558 E-mail: [email protected]

Mr Eric de Roodenbeke Directeur Général /CEO International Hospital Federation Immeuble JB Say 13 Chemin du Levant 01210 Ferney-Voltaire France

Tel: +33 450 426000 (main) Fax: +33 450 426001 E-mail: [email protected]


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Mr Sabado Nicolau Girardi Rio de Janeiro, 2251 Apartamento 601 Lourde Belo Horizonte MG Brazil

Tel: +5531 3409 9688 Fax: E-mail: [email protected]

Prof Armando Guerra Vilanova National Director Human Resources Cuban Health Ministry M260 E/19 and 21 Vedado Revolution Ciudad de la Habana Cuba

Tel: +537 838 2546 (main) Fax: E-mail: [email protected]

Mme Nicole Hanssen Directrice des Programmes Santé Sud 200 Bd National, Le Gyptis Bàt. N 13003 Marseille France

Tel: +33 4 91 95 63 45 (main) Fax: + 33 4 91 95 68 05 E-mail: [email protected]

Prof. Luis Huicho Professor of Paediatrics Peadiatrics Universidad Peruana Cayetano Heredia Batallon Libres de Trujillo 227 LI33 Lima Peru

Tel: +511 3721 461 Fax: +511 431 4013 E-mail: [email protected]

Dr Scholastika Iipinge Senior Lecturer Nursing and Public Health Univeristy of Namibia/EQUINET 136 Gemini Street, Dorado Park, ext 1 9000 Windhoek Khomas Region Namibia

Tel: +264 61 206 3111(main) Fax: +264 61 206 3320 E-mail: [email protected]

Ms Hortence Afoue Kouame Deputy Director Human Resources Direction Ministry of Health Public Hygiene of Côte d'Ivoire Cedex 1 06 Abidjan Côte d'Ivoire

Tel: +225 203 32 4726 (direct) Fax: +225 20 324193 E-mail: [email protected]


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Mr Tim Martineau Senior lecturer in Human Resource Management International Health Group Liverpool School of Tropical medicine Pembroke Pl Liverpool Merseyside L3 5QA United Kingdom


Ms Joanne McManus Consultant 105 Howard Street Oxford OX4 3AZ United Kingdom


Mr Hilary Mwale Human Resource Advisor, Independent Consultant Manda Hill (postbox address) Great East Road 10101 Lusaka Zambia


Dr Thinakorn Noree Researcher International Health Policy Program Ministry of Public Health Tiwanon Road 11000 Nonthaburi Thailand


Dr Raymond Pong Research Director and Professor Centre for Rural land Northern Health Research Laurentian University Ramsey Lake Road Sudbury Ontario P3E 2C6 Canada


Prof. Steve J. Reid Director Centre for Rural Health University of KwaZulu-Natal Nelson R Mandela School of Medicine, 5th floor, Congella 4013 Durban KwaZulu-Natal South Africa


Dr Julia Seyer Medical Advisor The World Medical Association 13 Chemin du Levant 01212 Ferney Voltaire France

Tel: +33 450 407575 (main) Fax: +33 450 40 5937 E-mail: [email protected]


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Prof Roger Strasser Dean Northern Ontario School of Medicine Lakehead and Laurentian Universities 935 Ramsey Lake Road Sudbury Ontario P3E 2C6 Canada

Tel: +1 705 671 3874 (main) Fax: +1 705 671 3830 E-mail: [email protected]

Ms Karin Straume Chief County Medical Officer Health and Social Affairs County Covernor of Finnmark Statens hus 9815 Vadsoe Norway


Mr Aly Boury Sy Senior Economist (Health) AFTHE The World Bank Boulevard de la Revolution SORAS Building Kigali Rwanda

Tel: +250 591 312 (direct) Fax: E-mail: [email protected]

Mr Pawit Vanichanon Director Langu District Hospital Hat Yai Satun province 9110 Thailand

Tel: +66 74 77 35 63 6 Fax: +66 74 77 35 62 E-mail: [email protected]

Mr Marko Vujicic Senior Health Economist Health, Nutrition and Population World Bank MSN. G7-701 1818 H Street NW Washington D.C. 20433 United States of America

Tel: +1 202 473 1000 (main) Fax: + 202 522 3234 E-mail: [email protected]

Dr Kim Webber Chief Executive Officer Rural Health Workforce Australia Suite 1, level 6 10 Queens Road Melbourne Victoria 3004 Australia

Tel: Fax: E-mail: [email protected]


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Dr Junhua Zhang Assistant Director-General Human Resources for Health Development Centre Ministry of Health 3 Huogiying Road Haidian District 100097 Beijing China


WHO staff

Dr Walid Abubaker Technical Officer Human Resources for Health WHO Regional Office for the Eastern Mediterranean 1 Abdul Razzak al Sanhouri 11371 Nasr City Cairo Egypt


Dr Magdalena Awases HRH Adviser WHO Intercountry Support Team/ESA WHO Regional Office for Africa Parienyatwa Hospital 86 Enterprise Road, Highlands Harare Zimbabwe


Dr Karin Bergstrom Technical Officer Stop TB World Health Organization 20 Avenue Appia 1211 Geneva Switzerland


Dr Jean-Marc Braichet Coordinator, HMR Human Resources for Health World Health Organization 20 Avenue Appia 1211 Geneva Switzerland


Ms Amel Chaouachi Technical Assistant Human Resources for Health World Health Organization 20 Avenue Appia 1211 Geneva Switzerland



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Dr Manuel M. Dayrit Director Human Resources for Health World Health Organization 20 Avenue Appia 1211 Geneva Switzerland


Dr Fatoumata Binta T. Diallo Madame le Représentant de l'OMS Bamako Mali

Tel: +223 20224683 Fax: +223 20222335 E-mail: [email protected]

Dr Carmen Dolea Technical Officer, HMR Human Resources for Health World Health Organization 20 Avenue Appia 1211 Geneva Switzerland


Dr Delanyo Dovlo Health Systems Adviser Health System Governance and Service Delivery World Health Organization 20 Avenue Appia 1211 Geneva Switzerland

Tel: +41 22 791 1465 (direct) Fax: +41 22 791 4153 E-mail: [email protected]

Mr Varatharajan Durairaj Health Economist Health Systems and Financing World Health Organization 20 Avenue Appia 1211 Geneva Switzerland

Tel: +41 22 791 2387 Fax: E-mail: [email protected]

Mr Benjamin Fouquet Communication Officer Human Resources for Health World Health Organization 20 Avenue Appia 1211 Geneva Switzerland

Tel: +41 22 791 Fax: +41 22 791 4747 E-mail: [email protected]

Ms Laure Garanger CC Viet Nam World Health Organization Hanoi Viet Nam

Tel: +84 94 306 75 11 Fax: E-mail: [email protected]


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Mrs Annette Mwansa Nkowane Technical Officer, HPN Human Resources for Health World Health Organization 20 Avenue Appia 1211 Geneva Switzerland


Ms Valerie Novarina Secretary, HMR Human Resources for Health World Health Organization 20 Avenue Appia 1211 Geneva Switzerland


Dr Jean-Marc Olivé The WHO Representative in the Socialist Republic of Viet Nam 10000 Hanoi Viet Nam


Dr Martins Ovberedjo HRH Adviser Human Resources for Health World Health Organization Country Office Tanzania Luthuli Road Dar es Salaam United Republic of Tanzania


Ms Laura Stormont Technical Officer Human Resources for Health World Health Organization 20 Avenue Appia 1211 Geneva Switzerland

Tel: +41 22 791 2940 Fax: E-mail: [email protected]

Ms Gillian Weightman Administration Assistant Human Resources for Health World Health Organization 20 Avenue Appia 1211 Geneva Switzerland


Dr Pascal Zurn Health Economist, HMR Human Resources for Health World Health Organization 20 Avenue Appia 1211 Geneva Switzerland


increasing access to health workers in rural and remote ... · health professions education...

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