jim campbell: fish & chips or caviar. bellagio center, feb 05, 2014
DESCRIPTION
Colombia University (USA) and Public Health Foundation India hosted a 3-day conference at the Rockefeller Foundation's Bellagio Center, titled "On the move: studying and addressing health systems postings and transfers in LMICs". This presentation raised questions on the types of research that would elicit new perspectives and information on health systems posting and transfers.TRANSCRIPT
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Bellagio: health systems postings and transfers in LMICs
“Fish & chips or caviar?” Deep dive: What kind of research for the
future?
On the move: studying and addressing health systems postings and transfers in
LMICs.
Colombia University-PHFIRockefeller Foundation, Bellagio, Italy
05 February, 2014
Jim CampbellDirector, ICS Integrare, Barcelona, Spain
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Bellagio: health systems postings and transfers in LMICs
#OverlyHonestMethods
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Bellagio: health systems postings and transfers in LMICs
Framing the research – what’s the narrative?
• Right to health
• MDGs
• Post-2015
• Universal Health Coverage
• Healthy Life for All
• Equity / Social justice / “Just health” (Daniels)
• Effective coverage
• “80 x 40”
• “mission consistency”
• Positionality
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Bellagio: health systems postings and transfers in LMICs
Time to “rethink and improve”
“The foundations for a strong and effective health workforce for the future are being corroded in front of our very eyes by failing to match today’s supply of professionals with the demands of tomorrow’s populations.
To prevent this happening, we must rethink and improve how we teach, train, deploy and pay health workers so that their impact can widen.”
Dr. Marie-Paule Kieny, WHO Assistant Director-General for Health Systems and Innovation. November, 2013.
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Bellagio: health systems postings and transfers in LMICs
Framing the research – where’s the HRH entry point?
• International?
– Global strategy on HRH for post-2015
– KD + AGA
– WHO Advisory Committee
– Global Code of Practice
– Recife Declaration
• Regional?
• National?
• Sub-national? – the geography of HRH and equity?
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Bellagio: health systems postings and transfers in LMICs
Do we have basic data?
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Bellagio: health systems postings and transfers in LMICs
Labour markets?
Healthcare education and training
High School graduates (male/female)
Qualified healthcare workers
UnemployedEmployedExits
Public
Other
Private
Health sector
‘potential supply’
‘participation’
‘supply’
Source: adapted from Vujicic and Zurn, 2006
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Bellagio: health systems postings and transfers in LMICs
Effective coverage?
Sources: adapted from Tanahashi 1978; Campbell 2012; Speciale 2014
Target population who do not contact services
Availability CoveragePeople for whom service is available
Target Population
Accessibility CoveragePeople who can use service
Acceptability CoveragePeople willing to use the service
Contact CoveragePeople who use the service
Effective CoveragePeople who receive effective care
Service Delivery Goal
Pro
cess
of
serv
ice
pro
visi
on
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Bellagio: health systems postings and transfers in LMICs
Drivers of change?
Source: Campbell et al 2013
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Bellagio: health systems postings and transfers in LMICs
Metrics perspective?
• Descriptive “evidence”
– Stock- ✓
– Distribution- ✓
– Performance- ✓
– Wage bill- ✓
– Roles and responsibilities - ✓
– Financing - ✓
– Political economy analysis - ✓
– Posting & Transfers - ✓
• Quantitative “evidence”
– Turnover rates -✗
– Retention rates -✗
– Stability index-✗
– Survival rates -✗
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Bellagio: health systems postings and transfers in LMICs
Midwifery workforce: National context and challenges
12.0+
11.0
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0
Pro
fess
ion
al h
ealt
h w
ork
ers
/ 1
,00
0 p
op
ula
tio
n (W
HO
20
13
)
Year
2.3
3.5
5.6
2013 2015 2020 2025 2030
89
57POPULATION GROWTH
(96% urban)
?
How to “bend the curve” for midwifery workforce UP-wards?
..improve quality care + quality care provider?
..who’s looking out for the poor and vulnerable?
..address rural/urban + socio-economic equity?
NEEDS a DECADE OF WORKFORCE INNOVATION Demands political solutions not “quick fixes”!!
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Bellagio: health systems postings and transfers in LMICs
A research question resulting:
'What is the appropriate midwifery workforce, and how is it best deployed, to equitably deliver essential MNH interventions at
scale and quality, and what (including costs) needs to be put into place to achieve universal access?'
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Bellagio: health systems postings and transfers in LMICs
What if? Labour markets + effective coverage + UHC + metrics
Source: de Sousa et al 2013
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Bellagio: health systems postings and transfers in LMICs
What kind of research for the future?
In addition, EBDM context:– scale (present and future)– the geography of HRH– disaggregation– 80 x 40 challenge– workforce science and
surveillance• stability• survival• turnover• retention• attrition
– counterfactual + consequence– IPOOI (results chain)– return on investment
Schaaf & Freedman (2013):• emic approach & nuances• ‘unwritten rules’• public policy & interests• power & agency• complexity