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Transforming the Health Workforce in Support of Universal Health Coverage :

A global toolkit for evaluating health workforce education

Report of the 3rd Meeting 1–3 July 2014

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I A global toolkit for evaluating health workforce education

Contents

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . II

1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Day 1: proceedings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Opening session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Presentations on Day 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Day 2: proceedings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Group work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Discussion following group work on the ‘big rock’ items. . . . . . . . . . . . . . . . . . . . . . . . . . . 14Discussion following looking at the indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Day 3: proceedings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Criteria for selection of countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Discussions following this presentation about countries included: . . . . . . . . . . . . . . . . . . 18Discussion following Paul Worley’s presentation: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Discussion following groupwork on the Handbook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Annexes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Annex 1: Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Annex 2: List of participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Annex 3: WHA resolution 66.23 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Annex 4: Countries that signed up to Resolution WHA66.23 . . . . . . . . . . . . . . . . . . . . . . . 35

Annex 5: Recife Declaration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Annex 6: Recife HRH Commitment Countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Annex 7: Presentations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

II Transforming the Health Workforce in Support of Universal Health Coverage:

Executive Summary

This three day meeting focused on reaching agreement on which questions and indicators best fit the requirements of a global assessment toolkit, using the program logic model.

Addressing the degree to which the quantity, quality, skills mix and distribution of the health workforce (HWF) is appropriate and aligned to a country’s health context, burden of disease and health system is a global imperative. It is essential that the HWF is equipped with disciplinary knowledge, technical skills, profession-specific and generic competencies and attributes to ensure the centrality of patients and the population in the pursuit of equitable access to quality universal health coverage (UHC).

The literature has several examples that examine HWF education in the context of the needs of the population, social accountability and equity, including but not limited to: the World Health Report 2006: Working Together for Health; the Social Accountability Framework for Evaluation (SAFE) of Health Systems 2007; the WHO Global Health Workforce Alliance 2008: Scaling Up Saving Lives; the Lancet Commission 2010: Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World; the World Federation for Medical Education 2012: Basic Medical Education WFME Global Standards for Quality Improvement; the WHO Guidelines 2013: Transforming and Scaling up Health Professionals’ Education and Training; the Training for Health Equity Network (THENet) Evaluation Framework; and the WHO-UNESCO-FIP Education Initiative Needs-Based Education Model.

Evaluation of the outcomes of HWF education is complex. While the ultimate outcome is the health of the community the health worker serves, there are many variables that preclude analysis of direct relationships. The importance of developing reliable and valid evaluation tools, with continuous monitoring and evaluation of progress towards pre-determined HWF education goals is thus imperative.

Several reports from a diverse set of stakeholders ranging from the World Bank and the World Health Organisation (WHO) to especially constituted international Commissions, global forums and in-country health and education-related national plans speak to current HWF challenges, including but not limited to the quantity, quality, distribution, cost-effectiveness, and relevance of the HWF as well as the multi-stakeholder, trans-ministerial and educational institution leadership required to address them.

Despite these, the investment in the development of a capable, motivated and supported HWF remains low, there is a mismatch between supply and demand exacerbated by sub-optimal policy and regulatory frameworks as well as uncoordinated planning and budgeting at national, regional and international levels (WHO, 2006; http://www.who.int/workforcealliance/forum/2013/recife_declaration_13nov.pdf). Severe shortages across all cadres, marked maldistribution, gender imbalances and poor working environments between and within countries have reached crisis proportions with developing countries and remote and rural areas particularly disadvantaged as a result of emigration to developed countries and concentration in urban areas respectively (Crisp &

III A global toolkit for evaluating health workforce education

Chen, 2014 & WHO, 2010). There is a shortage of some 4.3 million physicians, nurses and midwives globally, approximately 57 low income countries have an insufficient health workforce to meet minimum needs, and several countries do not have medical schools, but are instead reliant on international graduates, thereby circumventing the WHO Global Code of Practice on the International Recruitment of Health Personnel (WHO, 2010 & WHO, 2006).

Program Logic Model

The program logic model was considered along with all of the indicators that had been discussed in December 2013 and in May 2014. The indicators were reviewed and added to which resulted in a total number of 747 suggested items. These were further reviewed and crystallized into 9 key indicators. Three major country level “traffic light” indicators were proposed based on the submitted key areas for inclusion and a total of 9 key indicators aimed at institutions, professional organizations etc., who are responsible for educating, training, accrediting courses and regulating the health workforce were identified.

The 9 key indicators were developed from WHA Resolution 66.23, the guidelines document on Transforming and Scaling Up Health Professional Education and Training, the Recife Declaration, policy briefs that accompanied the guidelines and other inputs from the group, with some adaptation to cater for important groups wider than health professionals.

1 A global toolkit for evaluating health workforce education

1. Introduction

The purpose of this third meeting of the Technical Working Group on Health Workforce Education Assessment Tools was to reach agreement on which questions and indicators best fit the requirements of a global assessment tool, using the program logic model. The draft protocol and handbook to accompany the tool, as well as a review of countries to begin phase 1 of the implementation, was also to be discussed and an approach agreed upon. The focus of the indicators is to be guided by the WHA Resolution 66.23 where Member States urged the WHO Secretariat:

� To develop a standard protocol and tool for assessment, which may be adapted to country context; � To support Member States as appropriate in using the protocol to conduct comprehensive assessments of the current situation in health workforce education

� To provide technical support to Member States in formulating and implementing evidence-based policies and strategies in order to strengthen and transform their health workforce education

� To consult regionally in order to review the country assessment findings and submit a report providing clear conclusions and recommendations, through the Executive Board, for consideration by the Seventieth World Health Assembly.

The Technical Working Group on Health Workforce Education Assessment Tools met on 1–3 July 2014 in order to agree on the following 6 objectives :1. To have a shared understanding of the consolidated program logic models.

2. To reach agreement on a final set of indicators for each of the Paired Domains.

3. To reach agreement on the questions for each of the Paired Domains.

4. To reach agreement on a draft Protocol and Handbook to accompany the tool.

5. To reach agreement on an outline of the pilot testing process.

6. To reach agreement on which countries to pilot the tool in first.

Twenty six Technical Working Group members, six non members, eighteen observers, five WHO staff members and one faciliator, participated in the meeting.

2 Transforming the Health Workforce in Support of Universal Health Coverage:

Day 1: proceedings

The meeting began with a welcome from Dr Erica Wheeler, on behalf of WHO.

Opening session

Professor Francisco George, Director General of the Portuguese NHS

Professor George began the opening session by stating that Portugal had achieved many health goals over the past 30 years. These are mainly in maternal and child health but also include all types of health care. The Portuguese national health system is doing well, despite the economic crisis in Portugal. In addition, the Portuguese national health plan until 2020 has recently been approved and was launched by the WHO Regional Director, Suzanne Jacob.

Professor João Lobo Antunes, Emeritus Professor, Faculty of Medicine, University of Lisbon, Council of State Member.

Professor Antunes, began by informing the group that he had been closely following this work. For him, education is not just a vocation but is his passion. He stressed the importance of the contribution of a health workforce to achieving a modernised health system in Portugal for the 21st Century. He mentioned that medicine had become more and more complex with the health workforce no longer dependent solely on doctors and nurses but rather a myriad of health workers. The emphasis of what it means to be healthy has changed. The goals of healthcare are much broader.

Health professionals today come from a variety of different backgrounds and there is a belief that those who are destined to work together should be reared together. All health professions have a common future. However new medicines and new health care demand new solutions. The complexity of health professionals’ roles is increasing and technology has driven medicine beyond its traditional area of concern and beyond its original definition. There is an increasing range of health professionals and health workers with an increasing range of skills, new work relationships, partnerships and relationships with the public. Change is necessary and long held beliefs cannot be a stumbling block. Health workers face moral challenges, new conditions, and a new approach to medical education is needed. Education needs to be transformative as young health workers will experience huge change in the next 25 years. The example of Portugal was cited where a new contract is being developed between medicine and the state and citizens to promote health literacy, personal health information and person centred models of care. Health education will inevitably need to change to achieve this. Competence and inter-disciplinary education is critical in meeting the challenges facing health workers.


Presentations on Day 1Dr Erica Wheeler, Technical Officer, Health Workforce Department, gave a presentation which included an overview of the overall project as well as the purpose of the meeting (see Annex 7)

Dr Wheeler reminded participants of the four tasks set for the technical group in WHA66.23.

FIGURE 1.

FOUR TASKS FOR THE TECHNICAL WORKING GROUP FROM WHA66.23

� To develop a standard protocol and tool for assessment, which may be adapted to country context

� To support member states as appropriate using the protocol to conduct comprehensive assessments of the current situation in health workforce education

� To provide technical support to member states in formulating an implementing evidence-based policies and strategies in order to strengthen and transform their health workforce education

� To consult regionally in order to review country assessment findings and submit a report providing clear conclusions and recommendations, through the Executive Board, for consideration by the Seventieth World Health Assembly

The overarching objective of the Group’s work was to develop a tool enable countries to measure their state of preparedness or readiness to prepare a workforce ready for the 21st century and to deliver a curriculum that reflects the social determinants of health. Achieving universal health coverage means not only training adequate numbers of workers but training the appropriate skill mix to meet the challenges of 21st century health and social care.

The aim is to develop key indicators and questions to enable countries to assess the status of the healthcare workforce and to transform it. The tool will be critical in implementing evidence-based polices and strategies. The tool has to be developed in a way that makes sense for participating countries, at various stages of development. The tool should be able to be adapted to different country requirements and WHO Regional offices will be involved to support countries.

Completing the tool will provide countries with a snapshot, a baseline, of their preparedness to meet the needs of universal health coverage and to identify what is needed to enable them to achieve universal health coverage. It will act as the basis for multi-sectoral dialogue towards transforming health workforce education. As countries complete the tool at regular intervals, it will also enable them to measure their progress towards transformational education.

Dr Wheeler stressed that the timeline for completion was tight and while the Group had already achieved a great deal: the Concept papers, a variety of internal papers and an embryonic interactive website had been set up, there was much to do.

Interactive website: the aim of this is to support the implementation of the tool, to provide a platform for case studies of good practice to be uploaded and shared with other countries, for Tweets, Facebook and other social media. http://whoeducationguidelines.org/


Professor Jan De Maeseneer, Head of the Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium, gave a presentation on ‘Learning and Assessing Person/Patient-centredness : Background and Practice’(see Annex 7).

Professor De Maeseneer stressed that patient satisfaction is an important determinant of the accessibility and value of the health care system and that training ‘change agents’ required new communication skills. As the gap in health outcomes widens, there is more need for training in reflective practice and respect for the spiritual dimensions of the patient. A key determinant in patient-centeredness is the approach of the doctor [health worker] to the patient: this fundamentally affects health outcomes and patient satisfaction. Health workers need to develop a new frame of reference: interpersonal aspects of care are key determinants of patient satisfaction. Patient value characteristics such as humaneness, being given sufficient time and information, being treated as individuals, being involved in decision making and mutual trust.

The ‘communication curriculum’ which enables health workers to develop these skills should be compulsory for every student, use small groups teaching methods, be contextualised and integrated, and reaffirmed in practice. There should be an emphasis on personal development and the social determinants of health from the start, and community oriented primary care: the ‘upstream’ causes of ill health. This shod be applied at all levels.

Professor Paul Worley, Dean of Medicine, Flinders University gave an initial presentation (which was subsequently revised) on the overall framework for the Toolkit which has been developed over the last several months. (see Annex 7)

Professor Worley stated that the task of the tool was to enable ministers of health to collaborate with the education sector. The product must :

� Be an intrinsic agent of change in countries and institutions. � Stand up to scrutiny: with a solid evidence base. � Be simple, attractive and make intuitive sense so that it is actually used by governments and supported by clinicians.

� Applicable to the various levels of interest in institutions, region, countries and globally. � Create new knowledge.

But having said that some of what goes into the tool is based on assumptions: not always evidenced and can represent leaps of faith. Instances when we can see the impact but the evidence isn’t there yet.

He outlined a possible ‘pitch’ to ministers to ‘sell’ the tool: � Do you want a health workforce education system that impacts positively on universal health coverage?

� Then you need to know if intermediate outcomes are being achieved. � And there’s more: we can provide you with an integrated series of transformational interventions that will identify and address the root causes that are hindering these outcomes: you need to involve more than the education sector to make this happen.

� The toolkit brings everything together.


The product outlined by Professor Worley was:1. A country level indicator evaluation tool for ministers of health with a guide to how to engage

with ministers of education, science, etc. » Building block indicators: things that have to be in place » Activity indicators » Outcome indicators » Impact indicators: to what extent if meet outcomes, what evidence that have impact?

The tool must be simple and allowing data to be collected: authentic and reliable.It needs to provide a snapshot of the current position and to be able to be repeated to measure progress. It must be able to link to data at the institutional and the regional level.Able to be aggregated globally by WHO: the more we can go for numbers the better.

2. A roadmap: the transformative engine

Indicators are linked to intersectoral programme logic models: identify the problem, who do you need to engage, how do you make an impact?

It includes the best global evidence base and provides sequenced activities to improve outcomes and impact.

Further optional questions to assist in broadening the scope of the transformation and gaining a finer grained understanding of progress: used to get more depth.

3. The bonus

A global and regional analysis of the data has the potential to create new knowledge, observe correlations between input, outputs and outcomes, a way of understanding required regional change

The research challenges (see Professor Worley’s presentation in Annex 7) � Health is all systems approach. � Ontology that includes bio psychosocial spiritual ontology. � Population health epistemology. � Evidence for effective models of care prioritised. � Evidence for effective models of education prioritised. � Translation evidence into health and education practice prioritised. � Evidence based creditable and quality improvement relevant to the reference population. � Challenging informing and monitoring the heath scene.

The health service challengeFrom a passive recipient of workforce and care characterised by relative crisis management to a generative health system, funded and supported to meet needs of the populations.

Are we concerned about: � Relevance of care. � Quality of care. � Active participation. � Training and development to have workforce and skills mix fit for purpose.


Education challengesMoving from informative to transformative: inclusive and innovative.

Integrated with health service and social systems.

How to move to: � Community engagement. � Social accountability. � Teamwork orientation. � Outcome focused for society and the professional.

The tool says to the minister of health � Collaboration is crucial. � Needs to be intersectoral approach leading to symbiotic outcomes. � Integrated systematic response is required. � We value what we measure: need to measure things we think are important.

The model has to be simple and to make intuitive sense. It must have integrity and to stand up to scrutiny: that’s what the underpinning logic model gives it.

Tools for government � Small number of core evaluation questions at each level. � More detailed questions. � Indication about who to collaborate with. � Thematic collaboration of activities between the three sectors.

Governments will get a visualization of the change process: picture for those who are more visual.Piloting will test the tool.

Key issues for the Technical Working Group � Put ourselves in the shoes of the ministers. � Understand the questions and options open to us. � Recognise the reality on the ground. � Global understanding of what works in own setting: evidence of what works in these sectors. � Review the problems, activities, outcomes and indicators with a specific sector hat on. � Address each with a research hat on, and education hat on and a service hat on.

Discussion following Professor Worley’s presentation :Several overarching comments on the presentation included :

� Concerns about the complexity of the model. � Many of the interactions in the model were between two sectors, education, research or service, whereas in reality there are many interactions between all three sectors.


� The key audience of the Ministry of Health was questioned. The model should be able to be taken up by institutions and thus be influenced by policy from the bottom up as well as the top down.

� It is important to explain our terms such as ‘training’ and ‘education’. � The WHO mandate implies a top down approach but a top down approach would also stimulate Member States into action.

� Readiness of Member States to implement this tool ? � The group was reminded of the focus of the WHA 66.23 resolution . � The health workforce education system has a responsibility to produce healthworkers who will work in rural areas. How will we know that education can contribute to this ? What evidence is there that shows what education systems should do to change the outcomes of the education system ?

� The questions of ‘champions’ for this intitative was raised. What commitment is there at government level to achieve UHC ? The need to think about the ‘champions’ on the ground and who can best move this forward : professional associations, regulatory bodies as well as Ministries.

� The proposed model needs to be more focused : Member States want a simple solution. � It needs to be aligned to existing policy and requests from WHO and also to Member States. � The group were reminded that the outcomes of Recife and the WHO transformative education guidelines.

During the afternoon on Day 1, the group chose to stay in plenary in order to discuss the Toolkit and get a better understanding of the Programme Logic Models presented earlier. There followed small group sessions where the participants were asked to identify indicators relating to each of the 6 Paired Domains.

DISCUSSIONKey discussion points included:• Theaccreditationsystemlooksattherelevanceofthecurriculumtopatients.• InAsia,theassessmentofthecurriculumisveryimportant.• Thepatient’sroleiscrucial.Itisimportantforstudentstounderstandtheroleofthepatient.• Person-centredcareisimportantbutwhatismissingisthetrainingofhealthworkerswho

can work seamlessly.• Suggestedquestionswhichcouldbeincludedinthetool,e.g.,‘Doesthecurriculuminvolve

assessement of students’ ability to communicate ?’ ‘Is patient-centred care part of the curriculum ?’ ‘Can students clearly articulate the role of the patient ?’ ‘Does the faculty understand it ?’

• Patient-centredcareisimportantintransformingtheworkforce.

• Ourgoalistodevelopsomethingthatisrightforeveryone’scontext,sowemustworkata level that is relevant to other cultures. We must differentiate between our own perspectives and what is best suited for specific regions. We can develop processes to help people form their own solutions.

• Thereisauniversalneedtobetreatedwithrespectandtobeheard.• Patientshavereportedthatdoctorsfailedtotaketheirspiritualneedsintoconsideration.

It is important to find ways to address these issues. How health workers treat their patients is critical.


• Doctors/care-providersneedtoconsidertheirpatients’spiritualneeds.• Thereisanestimatedlackof5-5millionhealthworkersglobally.• Therehasbeenalotofconcernabouttheneedforqualityhealthprofessionalswhoare

well-trained.• Itisimportanttobuildonthereadinessofcountriesandkeepmovingthisforward.• MinistriesofHealthdon’thavecompletecontroloverwherehealthprofessionalswork.• Notallthecountrieswillbeperformingwellwiththetool.Anevaluationtoolneedstobe

able to measure how well/badly countries are doing.• Ourtaskthisafternoonistosimplifythetool.• Inmanycountries,publicfundingisbeingusedinthehealthsystem.• Inlookingattheword‘transformative’,weneedtoidentifythecompetenciesthatare

being developed by education.• TheTransformativeEducationWHOGuidelineswas reflectedat our firstmeeting in

December 2013. It is important for us to be aspirational and not focus on what we can’t do.

• CountrieskeepaskingWHOforassistancesoitisimportantforustoidentifywhatsuite of indicators might help them to get to where they want to get to.

• Weneedtoremembercommunityhealthprovidersandmid-levelhealthMLHproviders.

The question was raised about the relationship between this work and other WHO/international initiatives such as the Recife Declaration on Human Resources for Health, Brazil 2013 : Human resources for universal health coverage: a template for eliciting commitments. This agreement applies “a ‘systems approach’ to human resources for health (HRH). This entails addressing capacity, management and working conditions as well as a solid understanding of the health labour markets dynamic that affect HRH production, deployment and absorption into the health system, retention, performance and motivations.” The Recife template “identifies systemic pathways of interventions along the Universal health Coverage Framework of AAAQ (availability, accessibility, affordability and quality). The advantage of the AAAQ model is that it offers a fitting matrix to systematize action, is easily understood by different stakeholders and actors and can serve as a bridge between HRH and UHC agenda.”

The proposed model needs to be more focused as Member States want a simple solution. It needs to be aligned to existing policy and requests from WHO and others to Member States.

It was also stressed that the model needs to accurately reflect the situation on the ground. Ministers focus on policy, they think short term, there is a complexity to their thinking that may not be reflected in the current model. The model needs to be clearer about policy relationships: the model assumes a direct relationship but this is not necessarily the case. The complexity of the model means that the predicative power decreases. Social accountability can be addressed at the local level rather than the national level as it is different to policy. A contextual curriculum is useful to respond to social dimensions.

The challenges of requesting and obtaining information were highlighted: it has proved difficult to obtain information from medical schools. Participants were generally worried that the complexity of the model and the information requested would reduce its efficacy. It is advisable to stick to a small number of questions.


We can learn from work by Sir Michael Marmot: ‘Evidence-based policy and policy -based evidence’, which influenced the UK government as they used the evidence he presented. We need to distil the critical components and communicate to someone who doesn’t know and doesn’t want to know. We need to demonstrate evidence. If it’s about UHC through producing health workers to provide care where it is needed, we will need to produce evidence. Communities are made up of people. Research shows if you recruit students form underserved areas and train them there, they stay in that area.

There is a need to recruit people and train them where they are going to be needed. It is a good idea to start at the community level then work upwards. It is essential for us to demonstrate that we have made progress towards the WHA66.23 resolution.

The issue of private funding for research and education was raised with the growth of private medical schools for example, and how WHO had little influence over them. The political economy needs to be taken into account, there are many of the current indicators over which ministers have no control. There has been an explosion of private universities over which the minister has no control. A key indicator could be: of the total workforce, how many work in the public sector only, how many in the private sector?

The tool needs to identify when policy elements are missing. Not all countries will be performing well: the tool needs to be able to reflect that (see the Recife Declaration about countries at different stages in Annex 5).

Our task is to focus on the indicators that are useful and can be collected. We may end up with 12 indicators, at the moment we have about 100.

For example, in the midwifery standards there are 12 or so domains which we could use as a basis. Al include community inputs: if al these were implemented we’d achieve UHC and transformative education. Accreditation tools already exist. We should use them.

� The question was also raised about what we mean by ‘transformative’ and whether it involves change?

� In supporting the needs of the people, what competencies are delivered? � What is the gap between what’s delivered and what’s needed? How are you going to measure that?

Transformative Education definititon(WHO): Sustainable expansion and reform of professionals’ education and training in order to achieve QQR of health professionals which in turn leads to strengthening of country health systems and improvement of population health outcomes.

The group were reminded that we need to think about where we’re going, to be aspirational and not be held back by what can’t be done or hasn’t been done. All countries are at different stages of development, therefore we need a suite of indicators. Having reviewed excellent tools and other work, this group is responsible for moving it forward.

It was suggested that case studies of transformation could also be included.


Day 2: proceedings

The focus on the second day’s proceedings was on the program logic model indicators.

There were questions about the overall purpose of the Toolkit (the assessment tool+ Protocol) and what it was aiming to achieve. If people don’t see the relevance of the questions they won’t use the tool. We need to push for a system to ask schools to reflect on what they’re doing to address UHC. Social accountability leads to UHC.

Following discussions, it was agreed that the group would identify what were some of the ‘Big Ticket’/’Big Rock’ items which the Toolkit should address. The group were reminded that the WHA66.23 resolution was the focus for their work. The aim being to strengthen and transform HRH, including the promotion of evidence-based recommendations, leading to improving the competency of the health workforce.

Program Logic Co-Facilitators were encouraged to get as many discrete indicators as possible.

What are the indicators ? They are a set of variables to measure change. We need to identify the change we want to see and then develop the appropriate questions. A good indicator should have face validity, specificity as well as being sensitive and measurable. They should also be adaptable to different countries.

How to deal with so many indicators :It was pointed out that in earlier discussions there were so many indicators that they could not all be discussed. If the group had a small number of overarching points they could look at the indicators to see how they fit into the framework. Research shows that the more specific the questions the less answerable they become. The tool should be less specific therefore more answerable, and useable, and cost effective.

How to identify a good education system:We need to identify the characteristics of a good education system: focus on what we’d like the education system to produce in terms of graduates with UHC skills. AAAQ elements must be reflected in the education characteristics of what is desired. The challenge to the public sector is to have a robust period of reflection among educational institutions to look at systems in order to improve them. They are weak at the moment, we can strengthen them through government reporting.The mission of the school should express social accountability.

Students should be motivated to take responsibility for their learning.Their education and training should respond to society’s needs. All elements of their education should relate to the context and community.

The group were also reminded that the Guidelines Plus document incorportated all of the documents which were previously mentioned into the new model.

It was suggested that we: 1. Consider the ‘big rocks/issues’ we want to change the [Recife framework was launched after the

WHA66.23 resolution], then


2. Identify the indicators that can measure this change we want to see.

We need to address how the workforce can to be trained to be fit for purpose.

FIGURE 2. SARAH LARKINS’ PRELIMINARY MODEL

Problem statement: Current health workforce education is failing to produce a health workforce that is equipped to meet the health needs of populations. A health workforce education assessment tool for use at country/national level is needed.

Section 1. Who do we serve and what are their needs? � We have a clear population profile including sociodemographic factors at national and local level

for the country (could be tick box answers – yes, comprehensive, yes, partial; no)

� Population health needs assessments have been performed. At national level, at local/community level. Role of community in defining health needs?

� We have mapped the health workforce competencies (or skillsets) required to meet population health needs

� We have an audit of existing health workforce in the country (including distribution and competencies)

� [Correlation of existing workforce distribution and competencies with population health needs to identify gaps.]

Section 2. How does health workforce education work in our country? � Which organisations have governance and policy responsibility for HWE?

» Ministry of Health, Ministry of Education, other

� Which organisations have funding responsibility for HWE?

� Audit of health workforce education institutions in the country (location, funding/governance and programs)

� What accreditation/regulation/licensure processes are in place for HWE in this country?

� What is the role (if any) of professional bodies in HWE? What about continuing professional development?

� What mechanisms are there for health workforce education institutions to link up with each other and health sector planners in this country? What about more broadly?

� What mechanisms are there for involving community in health workforce education planning in this country?

Section 3. How do we monitor what is done in HWE? � How do we allocate resources for HPE?

� Where do we educate our future health professionals?

� How do we recruit students?

� Who are the teachers? What is the role of community preceptors and community members in teaching?

� How do we ensure that the curricula align with priority health needs?

� How do we provide policy support for a teaching, research and service oriented health system?

� How do we monitor the extent to which research aligns with priority needs?

� How do we monitor the contribution of health workforce education institutions to service in the health sector?

Section 4. How effective is our health workforce education in terms of delivering a “fit-for-purpose” health workforce and delivering universal health care.

� Where are the graduates and what are they doing?

� How does this align with population and health sector needs?

� What change have we seen in the acceptability, accessibility, availability and quality of health services?

� What effect have we had on population health outcomes?


The group agreed to address the following key questions: � To what degree does our health workforce education deliver a fit for purpose health workforce? � What do we want to have in place to achieve the changes we want to see in order to achieve transformative UHC?

‘Big rock’ themes that emerged:1. Needs/planning

2. Governance/policy: intersectoral collaboration, accreditations, funding, alignment of systems and networks, community involvement

3. Curriculum

4. Students

5. Faculty

6. CPD, lifelong learning, career pathways

7. Impact of continuous improvement, involvement of local stakeholders

It was suggested that it would be useful to have a statement that captures these themes. It was noted that the tool was going to be an inspection and review process: if these main characteristics of the ‘big rocks’ were adhered to, then there was a good chance of achieving it. It was pointed out that existing accreditation systems and standards can meet many of these requirements: it’s political will that governs many of these things and makes them happen.

Group workUsing an ‘open space’ format, participants identified their individual Big Ticket/Big Rock items and posted their ideas onto large post-it notes, one idea per note. There were more than 150 post-it ideas created . These ideas were posted onto a wall and the group were invited to review the range of ideas generated and to self-organize these into key categories. There were further discussions about how to incorporate this information into the Toolkit.

A number of proposals were made about which assessment models needed to be incorporated into the final Toolkit. However, as there were no clear consensus, it was decided that the best course of action was to reformulate the Toolkit in order to incorporate the discussions during the meeting, and in particular to be informed by the WHO Guidelines document on Transformative Education. It was decided that Paul Worley and Julian Fisher would incorporate all of the ideas generated during the meeting and present this to the group on Day 3.


DISCUSSIONKey discussion points included:• Howmanyquestionswillthetoolhave?• WemustcontinuetoreferbacktoWHAResolution66.23asitstatesthechangethatthey

want us to achieve.• Indevelopingasetofvariables,whatarethechangeswewantintermsofhealthworkforce

education?• Onceweagreeonthechangesthatwewant,wecanthenidentifywhichindicatorswill

lead to those changes. • Wemustcomeupwithconcreteindicators.Agoodindicatorshouldbevalid,relevant,

sensitive and measurable.• Pilottestingwillallowustomodifytheseindicators.• Withsomanyindicators,it’sagreatchallengetodiscussthemall.• IntheUKithasbeenfoundthatthemorespecificquestionswerelessanswerable.Asa

result, it was concluded that the less specificity in questions makes them more answerable. Such thinking would also apply to this tool.

• ThecommentsaboutreferingbacktoWHAResolution66.23frameourtasknicelyasitalso focuses on what we want the educational systems to do to support UHC.

• We could strengthen the ability for governments to undertake self-reflection and toundertake an evaluation of institutions in terms of how well they support UHC.

• Contextisimportant.Weshouldaskschoolswhattheydoinaparticularsetofdomainsto support UHC.

• Itwouldbemoreusefulforthegrouptolookatwhetherthereareindicatorsmissing.Thiswas the purpose of the small group session on Day 1. Then as a group, we will all have the opportunity to state what we think are the priority indicators. Once we agree that we have all the indicators then we can do the Delphi Survey and then reduce the choice.

• DuringtheSecondTWGmeetinginMay2014,severalhourswerespentgoingthroughthe indicators.

• What dowewant to see changed? TheWHAResolution 66.23 reflects theWHOGuidelines. At what level are we doing this with this assessment tool? The Resolution talks about the Member States carrying out the assessment.

• WecarriedoutasimilarprojecttothisoneinWIPROseveralyearsago.Theprojectwasbeing carried out in four countries and we actually had to travel to each country and help them to identify the data.

• Itisnotpossibletohaveanassessmenttoolthatcoversalloftheindicators.WHO/EMROhas experience of designing a tool with 100 questions, however implementation yielded poor response levels.

• Whatarethe‘bigticket’itemsthatneedtobeaddressed?• WeshouldaddresstheworkfromGuidelinesPlusandcomeupwithsomequestions.

We should remember that all of those important documents were considered in informing until now. We have been guided by them until now.


• ThequestionisaboutlevelsoweshouldbelookingatMemberStatelevel.Fractalisationis useful but distracting.

• The‘bigticket’itemsfromWHAResolution66.23arethere.Nowwemustprioritizetheindicators and questions.

• Wewillhavetoconstructanaggregatedlistofindicators,thenwecanaddthebigticketitems to the flip charts. From there we can do the Delphi Survey.

• ThepurposeoftheDelphiSurveyistochoosethemostimportantindicators.• Itisimportantforgovernmentstomovequicklywiththistoolsoweneedtoworkasa

group and look at the indicators now.• Wehavelotsofindicatorsalready.Itseemsthatgovernments/MemberStatesarenot

interested in how schools work. We need to look at the big ticket items that are relevant for Member States.

• Thesearegoodsuggestions.Wehavepointsofreferences.Thosebigticketitemswouldnot be difficult to construct. There is some concern about eliminating important information in the Delphi Survey.

• WewillnotbeeliminatingindicatorsintheDelphiprocess,wewillbesimply choosing core indicators. Those indicators which do not become part of the core indicators will become questions.

• Isthegroupreadytoagreeonthekeyactivitiesintheprogrammelogicmodel?• IfweconsiderindicatorsasvariablesasDrSuwitsuggested,thenweneedtoidentify

which domains the indicators fall into. How to measure an indicator.• Itisbestforthegroupnottosplitintosmallgroupsatthisstage.Itmightbebetterto

reach agreement on the ‘big rocks’, as a whole group.

Discussion following group work on the ‘big rock’ items.

� Where do we place the big rocks? � How do we find the areas in the PLM which match the big ticket items? E.g. ‘this addresses accessibility…’

� The big ticket items must be included � Divide the big rock indicators into 4 groups:

1. Who do we serve the population and what are their needs? Needs Assessment

2. How does HWF education work in that country? Which organizations have funding responsibility? Accreditation processes? Mechanisms for HWF institutions to link up together?

3. How do we monitor what is done in HWF education? How to provide policy support?

4. How effective is HWF education in terms of delivery? » How effective are the graduates in delivering AAAQ service? (Availability, Accessibility,

Affordability, Quality) » What about the overlap of big ticket items ? » I see more confusion with these 4 ticket items. » As a group we must all take responsibility for this process. We all take responsibility for success

and failure. We have responded to all of your comments.


» Let’s think of the big ticket items and then classify them. » The AAAQ reflects the outcome. » At our 1st TWG meeting in December 2013, we agreed on the importance of choosing the

right questions. » We can use the AAAQ as an outline and select the big rocks which are already in the Resolution. » The big rocks are the changes you want to see.

Discussion following looking at the indicators � Aspects for the medical school curriculum are included. � WHA66.23 states ‘transforming health workforce education…’ It is important to look at how to encourage more health graduates to work in rural/underserved areas/not to leave the country. What can health workforce education contribute? How do we produce health workers who wish to work in their own countries?

� The tool should reflect the characteristics we think are important. � The activities are the indicators and these will bring about the desired change. � Let’s use the guidelines. � The big ideas are subsumed by government problems. � Can we condense all of these indicators? � There are plenty of accreditation definitions. � It is useful to look at accreditation. Do this represent agents of change? Does it reinforce a culture of quality?

� In Singapore, some medical schools are not accrediting their students in order to keep them in the country.

� The WHO guidelines were aimed at health professionals but we are considering all health workers.

Presentation by Jill Rogers on the Protocol and Handbook document (see Annex 7)

Protocol and Handbook

This will accompany the tool and together, will make up the Toolkit.

The following items were raised: � The distinction between a protocol and handbook was not entirely clear and it was suggested that all the content could be in a protocol.

� The content should be exciting and motivating. � It was noted that the intention of the whole exercise was not to compare the responses of countries but to capture their data. Countries themselves could use this data to improve their movement towards UHC.

� Although WHO will request that countries complete the tool, they cannot insist. � We need to be realistic about what can be done by WHO regional offices. � The small groups discussed their top ten ideas for getting buy-in from ministers to the tool.


Protocol

The aim of the Protocol is to set out the overall objectives of the initiative and show how the use of the tool will contribute towards UHC. It will provide the underpinning rationale of the tool. It will explain the design of the tool and the methodology.

Handbook

The aim of the handbook is to provide clear guidance on how to complete the assessment. It will use key terminology and standard terms. The importance of accuracy and honesty in the responses can not be underestimated. It will also include information about who to contact for support and guidance – it is agreed that this should be the role of the WHO country offices. It will explain how to use the data gained from the assessment to provide a snapshot of the situation in a particular country.

The protocol and handbook will be in a hard copy as well as electronic format.

Discussion following this presentation on the Protocol and Handbook � According to WHA Resolution 66.23, countries will use the tool results. � We need to be clear about the role of the WHO Regional offices. � WHO never intended to compare countries. We have simply agreed to pilot the tool.

Presentation by Dr Suwit Wibulpolprasert, Vice Chair, International Health Policy Program Foundation (IHPF), Health Intervention and Technology Assessment Foundation (HITAF), Ministry of Public Health, Nothaburi, Thailand

From Evidences to policy formulation, implementation and evaluation on Transformative HWF Education – The Thai Experience (see Annex 7)

It was stressed that: � WHO can use its social and intellectual capital to make recommendations. They can convince policy makers to make the necessary changes.

� Change cannot happen without leaders: need leaders with social capital � It is essential to meet with civil society, educators and others to develop a national strategy for health worker education.

Following this presentation, the day ended with small group work on developing ideas to get buy-in from governments and other key stakeholders when the Toolkit is being rolled out.


Day 3: proceedings

The final day began with a review of the progress of the meeting. It was agreed that the agenda for Day 3 would focus on :

� The selection of countries for pilot testing and implementation. � The paper produced for the meeting by Nadia Miniclier Cobb. � The revised Toolkit � The Handbook

Presentation by Sandra Pandi, Technical Officer, World Health Organization, Choosing countries for pilot testing and implementation (see Annex 7)

It was agreed that some countries were ready to go, whilst others would go at a slower pace. However we should be inclusive of all countries in all regions and invite them to be involved. We rely on them at the end of the day to provide us with the information. Perhaps refer to ‘staged implementation’ rather than piloting.

It was pointed out that if the purpose of the pilot is the refinement of the tool, then we need to be very clear about this. If it is refinement, we need a plan and criteria for those participating in the refinement.

Piloting

� The purpose of the pilot must be spelled out. � Need to decide if it is called a pilot or staged implementation. � Timescale needs to be clear. � Audience for the tool needs to be clear. � Stakeholders and those who implement it need to be clear. � Relationship to existing tool needs to be clear. � Will test the tool and improve it. � Will give feedback on the value of the questions.

Process:

Stage 1:countries takes part in the tool which then gives them � A profile of their progress toward UHC � An analysis of areas that could be improved � Guidance to either case studies of examples of work to follow, tools that they can use to change and develop

Stage 2: track countries’ progress towards achieving UHC


Criteria for selection of countries A number of additional criteria for the selection of countries were generated which included :

� Appropriate spread � Recife Declaration � Volunteers being available to assist. � Diversity of countries � Time for translation of the Toolkit � Level of country development � Commitment from the countries � Funding � Institutional Framework – centralised, decentralised, � The Resolution itself, WHA66.23 � Country readiness � Alpha and beta testing � Partnerships � Stage process

Discussions following this presentation about countries included:

� Important to add the Recife HRH commitment countries (see Annex 6) � What will the procedure be? Workshops to establish which countries are ready to begin with the tool? � Initial orientation and invitation to be involved should be given to all countries. � This is about the process. WHO will not tell a country what to do as WHO has to follow its norms. � The terms ‘alpha’ and ‘beta’ might be more suitable than ‘pilot’ in terms of testing the tool. � In terms of refining the tool, we will need to consider country preparedness.

Presentation by Professor Paul Worley, Dean of Medicine, Flinders University Global Evaluation Tool – To assist Ministers of Health to support Univesal Health Coverage Through Transformative HWF Education (see Annex 6)

A review of the original scheme was presented. This had included a review of the Recife document, Guidelines Plus and all the information generated by the group in their brainstorming on the previous day.

The aim of the tool was reiterated as being able to: � Meet the requirements of resolution WHA 66.23. � Build on existing WHO work in this field. � Link with existing evaluation tools: professional organisations. � Be an intrinsic agent of change. � Stand up to scrutiny. � Be simple, attractive and make intuitive sense so that it is used. � Applicable to fractal layers: from institutions to regions. � Create new knowledge


There is enormous interest in this topic which means that there is bound to be diversity as well as commonality. However, it is important to remember why we are doing this work.

The ‘Big Rocks’ represent the following :1. Faculty Development

2. Simulation

3. Career and Retention

4. National Standards (also known as Accreditation)

5. Governance and Planning

6. Curriculum and Community

7. Student Selection

8. Interprofessional Education

9. Life-long learning (CPD)

The plan was that the WHO secretariat would take the 747 items gathered from the brainstorming, including all the documents that have gone before, Guidelines Plus and all the earlier comments, and the indicators already generated and would cluster them under these headings. Field-testing during the pilot will then test the indicators and see which are core country indicators.

These ‘big rocks’ link with existing documents and frameworks.

The aspect of field testing is critical.

The country indicators sit above the big rocks.

Quality, Monitoring and Sustainability are above the ‘big rocks’ are each measured by a simple traffic light system: red, yellow, green. Countries could get a rapid response to their answers and could see if they were in the red, the yellow or the green zone in terms of achieving the different categories/indicators.

Quality

Is there a national framework for evaluation of quality of health workforce education that is relevant to universal health coverage for that country?

� Red: none/negligible � Yellow: exists but not relevant to UHC and/ or not utilised � Green: existing, relevant and utilised

Monitoring

A national approach to monitoring the progress towards UHC exists � Red: not prioritised � Yellow: data exist but not used in planning and quality assessment � Green: data used in planning


Sustainability

A national policy and commitment to funding health workforce education institutions and students to meet the quality standards

� Red: not prioritised � Yellow: partial commitment � Green: sustainable, sufficient and equitable

Discussion following Paul Worley’s presentation: � UHC is at the heart of the healthworker. � The success of healthcare is not about money but about the heart and commitment. � Patient-centred education is vital. � We need to include the Legal Framework in preparing this tool. � Accreditation is important but is not enough. � Retention and Motivation: It is important to give recognition to those students who worked well in rural areas under difficult circumstances. This gives health workers motivation.

� WHA64.9 Universal Health Coverage : adequate finance there. � Intersectoral partnerships : faculty development is there. � Institutional strengthening : is important and is in the building blocks. � It was suggested that these 9 ‘big rock’ headings presented by Paul should be renamed in order to differentiate this work from similar work that is being carried out.

� Let’s separate planning from policy. � Make the hierarchy explicit. � It is important to look at the work contracts of health workers as some of them have 4-hour contracts. Is is important to specify work contracts.

� This is an assessment tool and not an evaluation tool and should be relevant for crisis countries and developed countries.

� Rapid assessment tools are useful for countries (these cost less) and then a more comprehensive assessment can be carried out.

� The 747 statements are unweighted.

Paul stated that the 747 statements are a reflection of the comments and questions of the whole group.

Erica thanked Julian, Paul, A-J and Suwit and mentioned that although we would not use all of the 747 indicators, we would definitely use the key ones. Erica also stated the need to link to Resolution WHA66.23.

Erica also mentioned that we would not be able to go into all of the 747 items here and that the group must trust that this process is being undertaken accurately. Indeed it is a process of reducing the 747 indicators and processing this and then reflecting this back to the group.


Further comments: � We must state an overall vision for this work. � It is difficult to imagine the tool at this stage? What will be its format? � Jill and Erica are working on this. It will be done electronically for some and for others a paper copy using questions. We also plan do have a CD version for those without electricity. Also on a website.

� Countries will be answering questions which are linked to indicators. This is how we will know whether a country is doing something or not.

� How can we integrate this into a pyramid with UHC at the top end, the ‘traffic lights’ of Quality, Monitoring and Sustainability underneath that?

� We need to look at suggestions in the Global Commission Report, e.g. how is IT being used? � Pre-education must be considered before education.

Discussion following groupwork on the HandbookWhat would be helpful to have in the Handbook from the perspective of a country invited to complete the tool?

� There is confusion about the definition of a Handbook vs Protocol. Although WHA Resolution 66.23 refers to a Protocol, it should be integrated and form part of the package of the Toolkit.

� Provides hints on how to respond to the questions. � Evidence might contain several meanings. � The order of the questions should be user-friendly. � There should be a glossary with definitions. � Include case studies. � It should include information as to why people should carry out the tool. � The front page is important. � The timeline should be feasible. � Rapid response to get a quick start into the tool. � Should explain what the tool is about, why it is there and the benefits of completing it. � Very persuasive first pages are important. � Identify clear statements, resources, stakeholders. � What is the level of confidentiality? Who will carry it out? � There should be an introduction with a clear statement and purpose. � Clear instructions on how to complete the data gathering. � Simple language. � Guidance on the target audience. � Options on how to collect the data. � Helpline. � FAQ section. � Guidance on flexibility on how to meet country needs. � Clear information on how the data will be used once it is collected. � Use the process of collecting the data to guide the transformation.


� Regional workshops are a good idea. � Need to appropriately adapt the tool to a regional context. � It must define the problem, and also contain some background information including how the tool was developed.

� It should also state what it is NOT. It is not for comparison purposes. � It must emphasise health workers and not health professionals. � A Technical Support Helpline can provide a graph to plot responses. � It should have a list of definitions as well as a list of WHO Resolutions inside the Appendix. � It should promote assessment and evaluation. � Include examples of good practice. � WHO website on Transformative Education www.whoeducationguidelines@TE_guidelines

Next steps

� A small group will be set up to work with the 747 items and to develop them into a set of questions that would form the tool. Action: Erica and Sandra

� The small group’s proposals will then come back to the full group for comments and approval Action: Erica and Sandra

� In parallel work will begin on the Protocol: Action Jill � The schedule is still to go for piloting in October: Action Erica

Decisions to be made

� Detailed project plan to be prepared with parallel streams of work � Decide on the shape of the tool and the questions to be included � Decide on the countries to be invited to pilot � Agree the objectives and scope of the pilot work

Timeline

For the Toolkit (tool+handbook+protocol), we will form a small subgroup to go through the 747 indicators. We will need to take countries through the process. It must include the 9 areas as this is going to be the tool. A time line will be sent to to the TWG.

Erica introduced Professor Maria Machado, Clinical Director, Lisbon Central Hospital.

Presentation by Professor Maria Machado, Clinical Director, Lisbon Central Hospital.

What does transforming health workforce education mean at hospital level: past, present and challenges for the future. (see Annex 7)

Regarding the healthworkforce in Portugal, there is a shortage of nurses which is reflected in a low ratio of nurses to doctors. We must remember that there is no health without health workers.


The main challenges for the hospital were improved leadership, encouraging teamwork, developing management capabilities, improving communication skills between physicians, nurses and other workers, and achieving an effective skill mix. In her experience the ministry of health and the ministry of education do not communicate very much: data from different sources should be collected together for comparison.

The voice of patients is vital and so a Youth Council has been formed for teenagers with chronic conditions who discuss and inform the direction of health care. They meet twice a year.

Through interprofessional education, teamwork has improved and they are promoting the concept of mentoring.

What about administrators, managers etc who work in health? It is not just about doctors and nurses.We are too focused on medical doctors. In most countries, the nurse is the first point of contact.

Professor Henrique Martins, President, SPMS Parthilhados do Ministéro da Saúde, Lisbon, Portugal

‘What does the transformation of health workforce education mean to the NHS ?’ (See Annex 7)

There is a great need to change the health workforce.The health service in Portugal will have to change in order to adapt to those new health professionals being trained by education institutions. It means that we have to change the system. How do we convince the rest of the world of the importance of change? Patients are the only ones who can start the process of health care. Empowering patients is vital to this process of change.

The digital world is the only place where these people are treated the same. e.g. an IT System.

We must:1. Change communication.

2. Adopt a common language.

3. Change inappropriate information systems.

4. Change organization and group structures.

5. Change education and training.

6. Change incentive structures.

It is time to adopt a can-do attitude : if you don’t have a Handbook, use a Footbook ! Just do it. Sometimes nurses are paid 10x less than doctors. When you put different skill-mixes together, you get economies of scale.

We need: � New types of Deans. � The Ministry of Education to link to the Ministry of Health and form a Ministry of Well-Being. � In Portugal we need a governmental framework. � Healthcare education.


Professor Antonio Rendas, President, CRUP, Conselho Reitores Universidades e Politecnicos, Portugal

Cooperation Between Health and Education for a wealthier SNS

The Honorable Portuguese Minister of Health, Dr Paul Macedo, closed the meeting :Thank you to the Technical Working Group. This has been one of the top priorities for me for the past 3 years. One of the priorities was to focus on the career of health professionals. Physician specialists. One family doctor to each person listed is the goal of the Portuguese government. A better distribution of vacancies. We prepare monthly reports on health workforce. We have good expectations about this WHO project with its focus on Resolution WHA66.23. I was pleased to note from your agenda that Portugal is one of the first countries where the tools will be tested. Portugal is grateful to WHO for its support during this economic crisis. Congratulations on your progress during these 3 days.


Annexes

Annex 1: Agenda

TECHNICAL WORKING GROUP ONHEALTH WORKFORCE EDUCATION ASSESSMENT TOOLS

Third Meeting of the Technical Working Group (TWG) 1st to 3rd July 2014Lisbon, Portugal

Meeting Purpose:The purpose of this meeting is to bring members of the Technical Working Group on Health Workforce Education Assessment Tools together in order to reach agreement on which questions and indicators best fit the requirements for a global assessment tool using the programme logic model. The draft Protocol and Handbook to accompany the tool will also be reviewed as well as agreement on which countries to begin testing the tool in October 2014.

Desired Outcomes1. A shared understanding of the consolidated programme logic models

2. Agreement on a final set of Indicators for each of the Paired Domains.

3. Agreement on Questions for each of the Paired Domains.

4. Agreement on a draft Protocol and Handbook to accompany the tool.

5. Agreement on an outline pilot testing process.

6. Outline agreement on which countries to pilot the tool in first.


Day 1. Tuesday 1st July

Time Topic Speakers / Facilitators08:00 Registration

09 :00 The challenges faced by medical students in Portugal’

The importance of the health force for medicine in the 21st Century; the need for a culture of cooperation between health professional groups; education as a way for modernization of the health system in Portugal.

Professor Francisco George, Director General of the Portuguese NHS

Professor João Lobo Antunes Emeritus Professor Faculty of Medicine, University of Lisbon, Lisbon, Portugal. Council of State Member.

Welcome from TWG and context setting: Global and Regional perspectives.

Dr Erica Wheeler Technical Officer, WHO/HWF

Setting up for Success: Introductions, Working Agreements, Desired Outcomes for the Meeting.

Facilitator Mr Stevie Johnston, Interaction Institute for Social Change

11 :00 Coffee Break

11 :15 DESIRED OUTCOME 1: A shared understanding of the consolidated programme logic models.

Table & Plenary Discussions

Professor Paul Worely, Dean of Medicine Flinders University

13:00 Lunch Break

14:00 DESIRED OUTCOMES 2 &3: Agreement on a final set of Indicators for each of the Paired Domains. Agreement on Questions for each of the Paired Domains.

Table Discussions on ‘Paired Domains’

Table Facilitators & Co-facilitators

15:30 Coffee Break

DESIRED OUTCOMES 2 &3 discussions continued Table Facilitators & Co-facilitators

16 :45 Evaluation of Day 1 and Close What worked? What to change?

Facilitator Mr Stevie Johnston


Day 2. Wednesday 2nd July

Time Topic Speakers / Facilitators09:00 Start ups

Review Day OneAgenda for Day 2


DESIRED OUTCOMES 2 &3: Agreement on a final set of Indicators for each of the Paired Domains. Agreement on Questions for each of the Paired Domains.

Paired Domains WORLD CAFÉ

Table Facilitators &Co-facilitators

11:15 Coffee Break

11:30 DESIRED OUTCOME 4: Agreement on a draft Protocol and Handbook to accompany the tool.

Input on Protocol & Handbook Jill Rogers of Jill Rogers Associates

Input ‘From Evidence to Action’ Dr. Suwit Wibulpolprasert Vice Chair, International Health Policy Program Foundation (IHPF) Thailand:

Table discussion on the input.Plenary Feedback


13 :00 Lunch Break

DESIRED OUTCOME 4 contd.

Small groups to suggest best practice ideas that should be included for each element of the Handbook.


15:30 Coffee Break

15:45 DESIRED OUTCOME 2: Agreement on a final set of Indicators for each of the Paired Domains.

The Delphi Process

Sandra Pandi, Technical Officer, WHO/HWF

16:45 Evaluation of Day 2What worked? What to change?

Stevie Johnston


Day 3. Thursday 3rd July

Time Topic Speakers / Facilitators09:00 Start ups Facilitator Mr Stevie Johnston

DESIRED OUTCOME 2: Agreement on a final set of indicators for each of the domains.

Delphi Process


11:00 Coffee Break

11:15 DESIRED OUTCOME 5: Agreement on an outline pilot testing process

Proposal on the number of countries that a pilot should take place in.Table and Plenary discussion



11:30 DESIRED OUTCOME 6: Outline agreement on which countries to pilot the tool in first.Report out on process to date including criteria for selection.Questions for clarificationTable & Plenary discussionsPrioritisation Exercise



12:45 DESIRED OUTCOME 2: Agreement on final set of indicators for each Paired Domain

Delphi Process Feedback


13:00 Lunch Break

14:00 DESIRED OUTCOME 4: Agreement on a draft Protocol and Handbook to accompany the tool

Feedback from discussions on Day 2 and agreement on Protocol and Handbook.

Jill Rogers of Jill Rogers Associates

DESIRED OUTCOME 6: Outline agreement on which countries to pilot the tool in first.

Feedback on Prioritisation Process agreement on Country Selection



Review the ‘Parking Lot’ topics Facilitator Mr Stevie Johnston

Next steps in the development and implantation of the Health Workforce Education and Assessment Tools.


Evaluation Facilitator Mr Stevie Johnston

15:30 Coffee Break

15:45 What does transforming health workforce education mean in your work at the Central Hospital?‘What does the transformation of health workforce education mean to the Ministry of Health and what take home messages can you share on the implications on your area of work’?Coorperation Between Health and Education for a wealthier SNSClosing comments.

Professor Maria Machado, Clinical Director, Centro Hospitalar Lisboa Norte, Lisbon, Portugal Professor Henrique Martins, President, SPMS, Serviço Partilhados do Ministério da Saúde, Lisbon, PortugalProfessor Antonio Rendas, President, CRUP, Conselho Reitores Universidades e Politecnicos, PortugalDr. Paulo Macedo, Minister, Health Ministry Portuguese Government, Portugal

16:30 Close


TECHNICAL WORKING GROUP MEMBERS

BAILEY, RebeccaTeam LeaderHealth Workforce DevelopmentCapacityPlus, IntraHealth InternationalChapel Hill, [email protected]

BARRY, JeanNurse ConsultantInternational Council of NursesGenève, [email protected]

BERRY, SueAssociate ProfessorDivision of Clinical Sciences, Integrated Clinical LearningNorthern Ontario School of MedicineThunder Bay, [email protected]

BRUNO, Andreia FradinhoProject Coordinator and ResearcherInternational Pharmaceutical Federation (FIP)UCL School of PharmacyLisbon, [email protected]

BURDICK, WilliamAssociate Vice President for Education, Co-DirectorFoundation for Advancement of International Medical Education and Research (FAIMER Institute)Philadelphia, [email protected]

CHUENKONGKAEW, WanichaVice President for EducationDepartment of OphthalmologyMahidol UniversityBangkok, [email protected]

CLARK, ElisabethSenior LecturerFaculty of Health and Social WelfareOpen UniversityMilton Keynes, United [email protected]

CORDINA, MariaDepartment of Clinical Pharmacology and TherapeuticsUniversity of MaltaValletta, [email protected]

DE MAESENEER, JanHead of the DepartmentFamily Medicine and Primary HealthCareGhent UniversityGhent, [email protected]

DE ROODENBEKE, EricChief Executive OfficerInternational Hospital Federation (FIP)Route de Loëx 151Geneva, [email protected]; [email protected]

EISELÉ, Jean-LucExecutive DirectorFDI World Dental FederationGeneva, [email protected]

FISHER, JulianPeter L. Reichertz Institute for Medical InformaticsUniversity of BraunschweigInstitute of Technology and Hannover Medical SchoolHannover, [email protected]

Annex 2: List of participants


FLORES, WalterDirectorCenter for the Study of Equity and Governance in Health SystemsGuatemala City, [email protected]

GOIANA DA SILVA, FranciscoFaculty of MedicineUniversity of LisbonSanto TirsoLisbon, Portugal

GORDON, DavidVisiting ProfessorWorld Federation for Medical EducationUniversity of CopenhagenCopenhagen, [email protected]

GRANT, JanetDirector, Centre for Medical Education in ContextCenMEDIC& FAIMER Centre for Distance LearningThe Open University, UKLondon, United [email protected]

HARDEN, Ronald McGlashamGeneral SecretaryAssociation for Medical Education in Europe (AMEE)Dundee, United [email protected]

LARKINS, SarahAssociate Professor, General Practice and Rural MedicineSchool of Medicine and DentistryJames Cook UniversityTownsville Campus, [email protected]

LIU, HuapingSchool of NursingPeking Union Medical CollegeBeijing, [email protected]

MIDDLETON SOLOMON, Lyn ERegional Advisor NEPI and interim project directorICAP Global Nurse Capacity Development ProgramColumbia UniversityPietermaritzburg, South [email protected]

NEUSY, André-JacquesCEOTraining for Health Equity Network (THEnet)Baisy-Thy, [email protected]

PETRINI, MarciaProfessor and DeanWuhan UniversityWuhan, [email protected]

ROGERS, JillJill Rogers AssociatesCambridge, United [email protected]

SEWANKAMBO, NelsonPrincipal and Professor, MEPI Principal InvestigatorCollege of Health SciencesMakerere UniversityKampala, [email protected]

STRASSER, RogerDean and CEONorthern Ontario School of MedicineLakehead and Laurentian UniversitiesSudbury, [email protected]

TAINIJOKI-SEYER, JuliaWorld Medical AssociationFerney-Voltaire, [email protected]


WORLEY, PaulSchool of MedicineFlinders UniversityAdelaide, [email protected]; [email protected]

YOO, Il YoungProfessorCollege of NursingYonsei UniversitySeoul, South [email protected]

ZANGARO, GeorgeDirectorOffice of Performance ManagementUS Department of Health and Human Services (HRSA)Rockville,[email protected]

NON MEMBERS OF THE TECHNICAL WORKING GROUP

LEE, Maurice (attending on behalf of TWG member)Finance and Admin OfficerCentre for Health Sciences Training, Research and Development (CHESTRAD)London, United [email protected]

LUYBEN, Ans (attending on behalf of TWG member)Midwife, Independent International ConsultantCo-ChairInternational Confederation of Midwives’ Education Standing CommitteeChur, [email protected]@bluewin.ch

STRASSER, SarahAssociate Vice President Academics and Interprofessional PracticeHealth Sciences North(Former Associate Dean Northern Territory, Flinders University, Australia)Sudbury, Canada

THEODORAKIS, PavlosChief Executive OfficerAttica Mental Health Hospitals TrustKallithea, [email protected]

TUAZON, Josefina (attending on behalf of TWG member)Head, Research and Creative Writing ProgramFormer DeanUniversity of the Philippines College of NursingManila, [email protected]

WIBULPOLPRASERT, Suwit Vice ChairInternational Health Policy Program Foundation (IHPF)Health Intervention and Technology Assessment Foundation (HITAF)Ministry of Public HealthNothaburi, [email protected]

OBSERVERS

AGOSTINHO, SousaElected PresidentIFMSALisbon, [email protected] ALMEIDA SANTOS, Maria Antónia President of the Health CommissionPortuguese CongressLisbon, [email protected]


ANTUNES, João Lobo PresidentFaculty of MedicineUniversity of LisbonLisbon, [email protected]

BAPTISTA LEITE, Ricardo CongresmanPortuguese CongressLisbon, [email protected]

BELEZA, Alvaro Blood Unit DirectorCentro Hospitalar Lisboa NorteLisbon, [email protected]

BRANCO, Castelo DirectorUBI – Medical SchoolLisbon, [email protected]

CASTANHO, Miguel Vice-PresidentLisbon Faculty of MedicineLisbon, [email protected]

FONSECA, João Eurico DirectorBiobancoLisbon, [email protected]

GAIBINO, Nuno ProfessorCentro HospitalarLisbon, [email protected]

GEORGE, FranciscoDirectorDirecção Geral de SaúdeLisbon, [email protected]

MACHADO, Maria Clinical DirectorCentro Hospitalar Lisboa NorteLisbon, [email protected]

MARINHO, Rui ProfessorCentro Hospitalar Lisboa NorteLisbon, [email protected]

MARTINS, Henrique PresidentServiços Partilhados do Ministério da Saúde (SPMS)Lisbon, [email protected]

SARMENTO João, PHD studentEscola Nacional de Saúde PúblicaLisbon, [email protected]

SEQUEIRA, DuartePresidentPortuguese Nacional Medical Students FederationFaculty of Health Sciences, University of Beira InteriorCovilha, [email protected]

SENA E SILVA, FátimaHospital ManagerSurgery DepartmentCentro Hospitalar Lisboa OcidentalLisbon, [email protected]

SOUSA, NunoDirector of the Medical SchoolSchool of Health Sciences, University of MinhoBraga, [email protected]


SOUSA DIAS, Nuno DentistMundo a SorrirLisbon, [email protected]

FACILITATOR

JOHNSTON, Stevie Interaction Institute for Social ChangeBelfast, [email protected]

WHO STAFF - REGIONS

MAGZOUB, Mohi ElDinRegional AdviserHealth Professionals EducationWorld Health Organization for the Eastern Mediteranean RegionCairo, [email protected]

PAK, Tong CholRegional AdviserHuman Resources for Health and FellowshipsWorld Health Organisation Regional Office for South-East AsiaNew Delhi, [email protected]

PERFILIEVA, GalinaProgramme ManagerHuman Resources for Health and FellowshipsWorld Health Organisation Regional Office for EuropeCopenhagen, [email protected]

WHO STAFF – HEADQUARTERS

PANDI, SandraTechnical OfficerHealth Workforce DepartmentWorld Health OrganizationHeadquartersGeneva, [email protected]

WHEELER, EricaTechnical OfficerHealth Workforce DepartmentWorld Health OrganizationHeadquartersGeneva, [email protected]


Annex 3 : Resolution WHA66.23

Sixty-sixth world health assembly WHA66.23

Agenda item 17.3 27 May 2013

Transforming health workforce education in support of universal health coverage

The Sixty-sixth World Health Assembly,

� Recalling resolution WHA59.23 urging Member States to scale up health workforce production in response to the shortages of health workers that hamper the achievement of the internationally agreed health-related development goals, including those contained in the Millennium Declaration;

� Recognizing that a functioning health system with an adequate number and equitable distribution of committed and competent health workers at the primary health care level is fundamental to equitable access to health services as an important objective of universal health coverage, and was highlighted in The world health report 2006;1

� Recognizing also the need to provide adequate and reliable financial and non-financial incentives and an enabling and safe working environment for the retention of health workers in areas where they are most needed, especially in remote, hard-to-reach areas and urban slums, as recommended by WHO global guidelines;2

� Recalling resolution WHA64.9 on sustainable health financing structures and universal coverage, which, inter alia, urged Member States to continue, as appropriate, to invest in and strengthen the health delivery systems, in particular primary health care and services, and adequate human resources for health and health information systems, in order to ensure that all citizens have equitable access to health care and services;

� Concerned that in many countries, notably those in sub-Saharan Africa, there is inadequate capacity to train a sufficient number of health workers to provide the population with adequate service coverage;

� Recognizing the specific challenges of some Member States that have limited economy of scale in local health workforce education, their special needs, and the potential partnerships and collaboration with other Member States;

� Concerned also that the health workforce education challenge is global;

� Concerned further that demographic projections highlight the supply and distribution of the health workforce as issues of concern in the coming decades, irrespective of countries’ development status;

1 The world health report 2006: Working together for health. Geneva, World Health Organization, 2006.

2 Increasing access to health workers in remote and rural areas through improved retention, global policy recommendations, Geneva, World Health Organization, 2010.


Annex 4 : Countries that signed up to Resolution WHA66.23

Bangladesh

Bhutan

China

Democratic People’s Republic of Korea

India

Israel

Japan

Malaysia

Maldives

Nepal

Norway

Pakistan

Philippines

South Africa

Sri Lanka

Thailand

Timor-Leste

USA

Viet Nam

Senegal

UK

France


Annex 5 : Recife Declaration


ht tp: / /www.who. in t /workforceal l iance/forum/2013/hrh_commitments/en/

MEMBER STATES

AFRO

Benin

Burkina Faso

Burundi

Côte d’Ivoire

Ethiopia

Ghana

Guinea

Kenya

Liberia

Malawi

Mali

Mozambique

Nigeria

Senegal

South Sudan

Tanzania

Togo

Uganda

EMRO

Afghanistan

Djibouti

Egypt

Iran (Islamic Republic of)

Iraq

Kuwait

Lebanon

Libya

Oman

Pakistan

Somalia

Sudan

Yemen

EURO

Ireland

Republic of Moldova

SEARO

Bangladesh

Buthan

Democratic People’s Republic of Korea

Indonesia

Maldives

Myanmar

Nepal

Sri Lanka

PAHO

Argentina

Belize

Brazil

Chile

Colombia

Chile

Dominican Republic

Ecuador

El Salvador

Guatemala

Paraguay

Paraguay

Peru

Suriname

Uruguay

WPRO

Cambodia

Annex 6 : Recife HRH Commitment Countries


OTHER CONSTITUENCIES AND INSTITUTIONS

Palestinian Authorities

Institut Supérieur en Sciences Infirmières (ISSI), Democratic Republic of the Congo

Tanzanian Training Center For International Health

INTRAHEALTH

Peoples Health Movement

College of Physicians and Surgeons Pakistan

Health Services Academy (Hsa), Pakistan

COMISCA / Consejo de Ministros de Salud de Centroamerica y Republica Dominicana

Organismo Andino de Salud – Convenio Hipolito UNANUE

UNASUR / Grupo Técnico de Desarrollo de Recursos Humanos en Salud del Consejo de Salud Suramericano

Save the Children, India

AEMRN network (Afro-European Medical and Research Network)

AMREF

ANSWERS (India)

CHESTRAD

Community health workers

International Pharmaceutical Federation (FIP)

Health workers count

Health workers for all

Institute for Collaborative Development

International Nurses and Midwives

Midwives French Speaking Network

Swasti

The voices of women health workers in India THET

Wonca Working Party on Rural Practice

World Vision International


Annex 7 : presentations

Professor João Lobo Antunes, Emeritus Professor Faculty of Medicine, University of Lisbon, Lisbon, Portugal ; Council of State Member‘The importance of the health force for medicine in the 21st Century ; the need for a culture of cooperation between health professional groups, education as a way for modernization of the health system in Portugal.’

Professor Francisco George, Director-General, NHS, Portugal‘The challenges faced by medical students in Portugal’

Professor Henrique Martins, President, SPMS, Serviço Partilhados do Ministério da Saúde, Lisbon, Portugal

Jan De Maeseneer, Head of Department, Family Medicine and Primary HealthCare, Ghent University, Ghent, Belguim.

Learning and Assessing Person/Patient centeredness:

Background and Practice

Prof. Myriam Deveugele,MA, PhD, president European Association for Communication in Healthcare (EACH: www.each.eu)Prof. Jan De Maeseneer,MD, PhDGhent University (Belgium)

Lisboa, 01.07.14

Why is looking at person-provider interaction relevant?

*Macro-outcomes are related to what happens at NANO-MICRO and MESO-level.*Patient-satisfaction is an important determinant of the accesability,“value” and credibility of the system*Changing patterns (multi-morbidity, widening social gaps in health outcomes…) require new communication-skills*Training “change agents” requires new communicative skills*Training professional development , reflective practice and respect for spiritual and existential dimensions of the person/patient.


Person/Patient centeredness: evidence

Different views on the meaning: � Balint (1969): understanding the patient as a unique human being” � Byrne and Long (1976): a style of consulting where the doctor uses the patient’s knowledge and experience to guide the interaction.

� McWhinney (1989): the physician tries to enter the patient’s world, to see the illness through the patient’s eyes.

� Lipkin et al., 1984, Grol et al., 1990; Winefield et al., 1996: Giving information to patients and involving them in decision-making.

� Laine and Davidoff (1996): closely congruent with, and responsive to patients’ wants, needs and preferences.

Most comprehensive definition: Stewart, Brown, Weston, McWhinney, McWilliam and Freeman (1995a) six interconnecting components: 1. exploring both the disease and the illness experience;

2. understanding the whole person;

3. finding common ground regarding management;

4. incorporating prevention and health promotion;

5. enhancing the doctor–patient relationship;

6. ‘being realistic’ about personal limitations and issues such as the availability of time and resources.

Key dimensions :1. Biopsychosocial perspective: disorders are conceptualised at a number of interacting, hierarchical

levels (Engel 1980).

2. The ‘patient-as-person’ understanding of the patient as an idiosyncratic personality (Bower, 1998).

3. Sharing power and responsability person/patient-centered consultations reflect recognition of patients’ needs and preferences, encouraging the patient to voice ideas, listening, reflecting and offering collaboration (Byrne & Long, 1976).

4. The therapeutic alliance understanding of the goals and requirements of treatment.

5. The ‘doctor-as-person’ attention by the doctor to cues of the affective relationship as it develops between the parties, including self-awareness of emotional responses. Winefield et al. (1996)

� interpersonal aspects of care are key determinants of patient satisfaction.

Patients value highly: � doctors’ ‘humaneness’ (e.g. warmth, respect and empathy), � being given sufficient information and time, � being treated as individuals � being involved in decision-making � mutual trust

(Hall and Dornan, 1988, Baker, 1990, Williams and Calnan, 1991 and Wensing et al., 1998).

Person/Patient-centeredness is regarded as a proxy for the quality interpersonal aspects of care.


Consequences for building a communication curriculum. � skills based, theory driven � integrated and contextualised:

» with medical/nursing/….. skills » in every year of the education;

� small groups of 8 students maximum � rehearsed � compulsory for every student � assessed and remediated if necessary � reinforced in practice

Communication curriculum: � Year 1: generic skills (explorative techniques, dealing with emotions, listening skills…) and reframing into the medical context; reflection and feedback

� Year 2: a generic model of consultation (Calgary Cambridge) » exercise in an emotional context (new-born baby)

� Year 3 and 4: communication in difficult situations (shared decision making, breaking bad news, motivational interview, communication in diversity…)

� Year 5: integration with clinical skills � Ma-after-Ma: specific skills for the specialty

Assessment

Every year of the curriculum: � Year 1: theory and OSCE � Year 2; 3; 4; 5: OSCE � Ma-after-Ma: video assessment of real consultations

Principles � Starting from the skills the students master when entering medical/nursing… school-Rehearsal-4 to 5 training sessions of 1,5 hours every yearin small groups of 8 students, -teaching theory and research outcomes:

» for students: reduced to the minimum. » for trainers: maximal.

Important related areas: � personal professional development (small groups, 1 tutor, 6 years: 4 reflection-meetings every year) � social determinants of health � community oriented primary care (addressing upstream causes of ill health through intersectoral action for health)

� interaction with patient-groups and “learning from patients”


Learning methods

Health system - regulations - ...

Quality/competence of care

Perspective: Inter professional/workplace learning

CaregiverCaregiver

Patient

Learning Community

What could this contribute to the WHO - Assessment Tool? � Make clear that NANO-MICRO-MESO levels contribute to MACRO-OUTCOMES AND RELEVANCE. � Assess to what extent this is realized in the programs? � Demonstrate the relation with UHC (Universal Health Coverage), and the political relevance (e.g. contribution to “social cohesion”)

[email protected]


Professor Maria Céu Machado, Clinical Director, Centro Hospitalar, Lisboa Norte, Lisbon, Portugal.

What does transforming health workforce education mean at the Central Hospital structure? Past, present and challenges of the future. Third meeting WHO Technical Working Group on Health Workforce Education Assessment Tools INFARMED, Lisbon, Portugal, 1–3 July 2014

Maria Céu Machado, MD, [email protected]

Monitoring the Health Workforce in Portugal

3,8 physicians/1000 population » OECD average 3,1

° (overestimation - includes all doctors and not only those who are actually practicing)

5,7 nurses/1000 population » OECD average - 8,7 » EU-27 average - 7,9

1,3 pharmacists /1000 population » OECD average - 0,76

Data collected from OECD and EU sources, 2011

Past, present and challenges of the future

What does transforming health workforce education mean at the Central Hospital structure? � to engage the key academic and training institutions in this global movement to transform health workforce education and training in support of universal health coverage

NURSES TO DOCTORS RATIO

� Portugal 1.5

� EU-27 average 2.5

one of the lowest in developed countries


Health Workers

Health Professionals � career professionals specialized in the provision of health care:

» doctors, nurses, pharmacists, dentists and diagnostic and therapeutic technicians

Professionals Within the Health System � General workers that engage in tasks inherent to caring or the ones who despite not being producers of health are specialized in the understanding of the sector.

Health Professionals

All people engaged in the promotion, protection or improvement of the health of the population

Adams et al., 2003; Diallo et al., 2003

Hospital Santa Maria designed by Hermann Distel - 1938

� 1953 1300 bed Santa Maria Hospital and affiliated Medical School/University of Lisbon (FMUL) � 1968 Nurse School � 2004 Research - Institute of Molecular Medicine (IMM) � 2008 Centro Hospitalar Lisboa Norte - Merge HSM/HPV

» Lisbon Academic Medical Center (CHLN, FMUL, IMM)

Clinical organizationDepartments, ServicesIntegrated Centers

Department management � Medical Doctor – coordinator � Senior nurse � Manager

Departments � Surgery � Medicine � Heart � Torax

360º vision envolving the population as a whole and/or individually


� Neurosciences � Obstetrics � Pediatrics � MCDTs

Integrated Centers � Oncology � Trauma

Services � Anestesiology � Intensive Care � Emergency

Human Resources| 31 December 2013

CHALLENGES Effective Planning and ForecastingEmphasis on transformative, interprofessional education

Strategy on quality of health professionalsDevelop skills to meet citizens’ health needs considering epidemiological, demographic and socioeconomic population evolution

Systematic failures that compromise an effective use of healthLeadership, workforce selection, teamwork, skillmix and links between different levels of care

Healthcare assistants and informal caregivers are key co responsibles


� Joint approach between the Ministries of Education and of Health on planning the pre graduate level � Data collection and analysis in different sources should be collected and treated in a way that allows for comparison

� Focus on crosscutting generic competencies, such as leadership and management capabilities, and communication skills

� Bring together physicians, nurses and other health professionals to support teamwork � Promote Services/Departments Accreditation processes

2010 2011 2012 2013

N.º Ações

2013 N.ºAções 139

N.º Formandos 2466

N.º Horas 2388,5


ACSA Accreditation 2012-2014

Pediatrics, Pediatric Surgery and Neonatology

MODELO DE ACREDITAÇÃO AGENCIA DE CALIDAD SANITARIA DE ANDALUCÍA


Emphasis on transformative, interprofessional education

Department of Pediatrics

2012–2013 MD Nurses DTT PsicologHealthcare Assistents Administratives Total

Attendance Good Practices

na na na na 25,00% na 25,00%

Communication 0,00% 13,59% 0,00% 0,00% na 23,17% 10,43%

Patient safety 62,39% 31,69% na na na na 43,67%

Confidenciality, Privacity e data

protection

60,17% 59,78% 72,73% 62,50% 93,75% 60,98% 63,22%

Integrated management Biomedical waste

57,63% 84,78% 95,45% 81,25% 90,63% 71,95% 76,21%

Professional Risk 57,63% 60,87% 81,82% 62,50% 81,25% 34,15% 57,71%

Catastrophis, internal and external

emergencies

0% 0% 0% 0% 0% 0% 0%

Life basic support 10,17% 8,70% 0 0 0 0 18,87%

Prevention of nosocomial infection

61,21% 85,16% 86,36% 56,25% 90,63% 65,85% 74,89%

Drugs prescription and management

0% 0% na na na na 0,00%

More effective use of skillsTeamwork, Leadership and Accountability

� promote opportunities for inter-sectorial and multidisciplinary intervention, training and research � establish teams and team coordinators, independently � promote the development of the mentoring concept

» an experienced person assists another in developing specific skills and knowledge that will enhance the less-experienced person’s professional and personal growth

Pedro Barateiro, 2012


Professor Henrique Martins, President, SPMS, Serviço Partilhados do Ministério da Saúde, Lisbon, Portugal

What does the transformation of health workforce education means to the NHS?

What take home messages can you share on the implications of a multiprofessional educational

strategy

Henrique MG Martins, MD PhD Internal Medicine PhysicianProf of Mgt and Leadarship for health professionalsCEO of the Shared Services of the Ministry of Health

Changeconsensus or compromisecommunicationchoice or coercion

On organization:

‘Human beings tend to close out the outside. But effective organisations exist not to satisfy

themselves but to fill a customer need. Leaders have the duty to focus an organisation on

the outside in a way that continually refreshes what everyone is doing inside the company’

Peter Drucker

Medicine --web0.2


SERVUCTION


Eight-stage process

J. Kotter “Leading Change”

� Establishing a sense of urgency � Creating the guiding coalition � Developing a vision and strategy � Communicating the change vision � Empowering emplyoyees for broad-based action � Generating short-term wins � Consolidating gains and producing more change � Anchoring new approaches in the culture

Precipitating factors

Members’ felt need for change

Decisions/plans for instituting change

Implementation

Outcomes

Feedback (including evaluation)

Chance

Serendipity

Creativity

Learning

Intuition

Change Processes in Organisations

Resistance/Barriers

‘we don’t need to change � not sharing a compelling purpose & direction � disagreeing about the existence/causes of problems � ‘we won’t change’ � fear,resentment,vested interests,conflict over solutions � ‘we can’t change’ � lack of capacity,skills,leadership


Context is always important!

And health systems are some of the most complex at every level � policy � managerial � professional

mood

time

elation

shock

despair

defensive retreat

adaptation

acknowledgement

Stages of change

Diffusion Curve: General

Diff

usio

n of

Tec

hnol

ogy

Year

Innovators (2.5%)

2003

Early Adopters (13.5%)

Early Majority (34%)

Late Majority (34%)

Laggards (16%)

Everett Rogers, Diffusion of Innovations, 1995


Different Worlds, Different Cultures, Different taken for granted Assumptions

Stakeholders may inhabit different worlds and be guided by their own sets of assumptions and interpretation of what is right, feasible, and necessary

WHAT CAN “START THE PROCESS” ???

Empowered patients

Managing across different worlds

� Celebrating diversity and yet enhancing mutual understanding and respect � Developing common language or at least good translation capacity, with some bi- or tri- or multi-lingual capacity

� Alliances,cooperation and some boundaries as well as bridges � Persuasion, power, negotiation, trust….are all important

Inhibitions in structures, systems and institutions of an NHS to benefit from multiprofessional education

� Poor communication � Inappropriate information systems � Unchanged organisation and group structures � Unchanged education and training � Unchanged incentive structures � Unchanged performance and appraisal systems � Undeveloped professional leadership/role models

Individual Experience

Team/Group membership

Hospital

Health Authority

Region

Asthma


Why should professionals collaborate?

1. Spread risk and cost, combine insights to reduce uncertainty

2. Secure required combination of knowledge and skills not possessed by one party

3. Create economies of scale and scope or speed

4. Enable diversification especially for new activities

5. Often more desirable than a takeover or merger

6. Help develop ‘seamless networks’ important for users/clients/customers

7. Gain legitimacy, funds, other resources

NEW types of DEANS….

NEW Educational LEADERS---- (DON’T TALK MORE DO! )

Traditional leadership

Newleadership

Emergence

Cooperation

Trust

Competition

Control

Autonomy

Vigilance

Design


Tempered Radicals…

New Network Leadersdemonstrate accountability for their decisions and actions, concern with sustainability and cooperation, a desire to bring people together across traditional boundaries and effectiveness in convincing others to work together for a common purpose, and to build lasting working relationships.

2- D. Meyerson, ‘The Tempered Radicals’, Stanford Social Innovation Review 2.2 (2004): 14-23.

Boundary spanner’s Role - BackStage Leaders

� creating internal and external networks; � issue identification; � translating the knowledge back into the organizational culture; � influencing and educating internal and external stakeholders; � creating buy-in and support; � identifying internal senior-level champions.

NEW types of Ministers …

Of Health?

Of Education?

Of “PEOPLE WELLBEING”


Sandra Pandi, Technical Officer, World Health Organization

Choosing countries for implementation of the assessment tool

WHO Regions

African RegionAlgeria,

Angola

Benin,

Botswana,

Burkina Faso,

Burundi,

Cabo Verde,

Cameroon,

Central African Republic,

Chad,

Comoros (the),

Congo,

Côte d’Ivoire,

Democratic Republic of the Congo,

Equatorial Guinea,

Eritrea, Ethiopia,

Gabon, Gambia,

Ghana, Guinea,

Guinea-Bissau,

Kenya, Lesotho,

Liberia,

Madagascar,

Malawi,

Mali,

Mauritania,

Mauritius,

Mozambique,

Namibia,

Niger,

Nigeria,

Rwanda,

Sao Tome and Principe,

Senegal,

Seychelles,

Sierra Leone,

South Africa,

South Sudan,

Swaziland, Togo,

Uganda,

United Republic of Tanzania,

Zambia,

Zimbabwe

Region of the AmericasAntigua and Barbuda,

Argentina,

Bahamas (the),

Barbados,

Belize,

Bolivia (Plurinational State of),

Brazil,

Canada,

Chile,

Colombia,

Costa Rica,

Cuba,

Dominica,

Dominican Republic (the), Ecuador,

El Salvador,

Grenada,

Guatemala,

Guyana,

Haiti,

Honduras,

Jamaica,

Mexico,

Nicaragua,

Panama,

Paraguay,

Peru,

Saint Kitts and Nevis,

Saint Lucia,

Saint Vincent and the Grenadines,

Suriname,

Trinidad

Tobago,

United States of America, Uruguay,


Venezuela (Bolivarian Republic of)

South-East Asia RegionBangladesh,

Bhutan,

Democratic People’s Republic of Korea,

India,

Indonesia,

Maldives,

Myanmar,

Nepal,

Sri Lanka,

Thailand,

Timor-Leste

European RegionAlbania,

Andorra,

Armenia,

Austria,

Azerbaijan,

Belarus,

Belgium,

Bosnia and Herzegovina, Bulgaria,

Croatia,

Cyprus,

Czech Republic (the),

Denmark,

Estonia,

Finland,

France,

Georgia,

Germany,

Greece,

Hungary,

Iceland,

Ireland,

Israel,

Italy,

Kazakhstan,

Kyrgyzstan,

Latvia,

Lithuania,

Luxembourg,

Malta,

Monaco,

Montenegro,

Netherlands,

Norway,

Poland,

Portugal,

Republic of Moldova,

Romania,

Russian Federation,

San Marino,

Serbia,

Slovakia,

Slovenia,

Spain,

Sweden,

Switzerland,

Tajikistan,

The former Yugoslav Republic of Macedonia,

Turkey,

Turkmenistan,

Ukraine,

United Kingdom of Great Britain and

Northern Ireland (the),

Uzbekistan

East Mediterranean RegionAfghanistan,

Bahrain,

Djibouti,

Egypt,

Iran (Islamic Republic of), Iraq,

Jordan,

Kuwait,

Lebanon,

Libya,

Morocco,

Oman,

Pakistan,

Qatar,

Saudi Arabia,

Somalia,

Sudan,

Syrian Arab Republic,

Tunisia,

United Arab Emirates,

Yemen

Western Pacific RegionAustralia,

Brunei Darussalam, Cambodia,

China,

Cook Islands,

Fiji,

Japan,

Kiribati,

Lao People’s Democratic Republic,

Malaysia,

Marshall Islands,

Micronesia (Federated States of),

Mongolia,

Nauru,

New Zealand,

Niue,

Palau,

Papua New Guinea, Philippines,

Republic of Korea,

Samoa,

Singapore,

Solomon Islands,

Tonga,

Tuvalu,

Vanuatu,

Viet Nam


WHO 57 HRH Crisis Countries

2006 World Health Report www.who.int/whr/2006/whr06_en.pdf

The criteria used to classify them is based on the 2.3 health workers per 1000 people threshold of insufficient doctors, nurses and midwives + poorest health outcomes MDGs.

57 HRH Crisis Countries

African RegionAngola, Benin

Burkina Faso

Burundi, Cameroon

Central African Republic

Chad, Comoros

Congo, Côte d’Ivoire

Democratic

Republic of Congo

Equatorial Guinea

Eritrea. Gambia,

Ghana, Guinea

Guinea-Bissau

Kenya, Lesotho

Liberia, Madagascar

Malawi, Mali

Mauritania

Mozambique

Niger, Nigeria

Rwanda, Senegal

Sierra Leone

United Republic of Tanzania

Togo, Uganda

Zambia, Zimbabwe

Region of the AmericasEl Salvador

Haiti

Honduras

Nicaragua

Peru

South-East Asia RegionBangladesh

Bhutan

India

Indonesia

Nepal

Myanmar

East Mediterranean RegionAfghanistan

Djibouti

Iraq

Morocco

Pakistan

Somalia

Yemen

Western Pacific RegionCambodia

Lao People’s Democratic Republic

Papa New Guinea

What you told us…


Pacific+ Papua New Guinea

� WHO Collaborating Centre in Sydney, Australia

Ghana

Emmanuel Adjase and Nadia Cobb (from the TWG) have been working here as partners for 8 years.

Moldova

This is a country with a lot of migration; Rector of the Medical and Pharmaceutical university is ex-WHO Board, good links to WHO and well organized.

Kazakhstan

A medium-sized population; huge geographically so spread of workforce is difficult; well organized.

Nigeria

A key country in Africa in terms of population and disease burden; many schools (public and private); high level of outward migration.

DRC, Ethiopia, Zambia, Lesotho

NEPI is working in these countries

India, Philippines, Kenya, Ethiopia

are important countries in terms of total population and disease burden; many schools (public and private); wide range of innovation in education; strong WHO presence in Regional office; English speaking.

Cambodia, Laos, Mongolia, Phillipines, Vietnam

University of the Philippines has carried out previous work for South Asian countries for WHO and so could assist with the above countries.

Ethiopia

Good relationship with Tulane University and MOH

Brazil, Russia, India, China + South Africa

BRICS = 5 major emerging national economiesCurrently South Africa holds the chair of the BRICS group

Mozambique, Nepal, Pakistan,

Helpful UNICEF and/or WHO Country Offices


Myanmar

Good partnership with Myanmar Health and Development Consortium

Peru, Nicaragua

These countries have national resources and systems that can innovate.

Preparing for GAVI HSS funding Ready to address HRH issues

� Mozambique � Ethiopia � Nepal � Pakistan � Myanmar

Nursing Education Partnership Initative (NEPI)

An initiative developed to address the critical shortage of health care workers in sub-Saharan Africa by strengthening the quality and capacity of nurses and midwives throughout Africa.

Nursing Education Partnership Initiative (NEPI) countries

African Region Angola Partnership Framework

Botswana Partnership Framework

Democratic Republic of Congo Partnership Framework

Ethiopian Partnership Framework

Ghana Partnership Framework

Kenya Partnership Framework

Lesotho Partnership Framework

Malawi Partnership Framework

Mozambique Partnership Framework

Namibia Partnership Framework

Nigeria Partnership Framework

Rwanda Partnership Framework

South African Partnership Framework

Swaziland Partnership Framework

Tanzania Partnership Framework

Zambia Partnership Framework

Region of the AmericasCaribbean Regional Partnership Framework

Central American Region Partnership Framework

Dominican Republic Partnership Framework

Haiti Partnership Framework

European RegionUkraine Partnership Framework

Western Pacific RegionVietnam Partnership Framework


Medical Education Partnership Initiative (MEPI)

Network of 13 African institutions and partners in 12 countries

12 MEPI Countries

� Botswana � Ethiopia � Ghana � Kenya � Malawi � Mozambique � Nigeria � South Africa � Tanzania � Uganda � Zambia � Zimbabwe

Countries chosen for testing/implementation by TWG

African RegionSouth Africa (T)

Ghana (I)

Cameroon (I)

Central African Republic (I)

Eritrea (I)

Ethiopia (T)

Kenya (T)

Benin (I)

Burkina Faso (I)

Burundi (I)

Chad (I)

Congo (i)

Ghana (I)

Côte d’Ivoire (I)

Democratic Republic of Congo (I)

Djibouti (I)

Equatorial Guinea (I)

Gambia (I)

Guinea (I)

Guinea-Bissau (I)

Lesotho (I)

Liberia (I)

Madagascar (I)

Malawi (I)

Mali (I)

Mauritania (O)

Mozambique (I)Niger (I)

Nigeria (I)

Rwanda (I)

Senegal (I)

Sierra Leone (I)

South Africa (I)

United Republic of Tanzania (I)

Togo (I)

Uganda (I)

Zambia (I)Zimbabwe (I)

Region of the AmericasBrazil (T)

Honduras (I)

Nicaragua (I)

Peru (I)

Haiti (I)

USA (I)

El Salvador (I)

Nicaragua(T)

South-East Asia RegionBangladesh (I)

India (T)

Indonesia (I)

Myanmar (I)

Nepal (I)

European RegionGreece (I)

Portugal (I)

Russia (T)

UK (I)

Kazakhstan(I)

Moldova (I)

East Mediterranean RegionMorocco (I)

Yemen (I)

Western Pacific RegionCambodia (I)

China (T)

Philippines (T) (I)

Lao People’s Democratic Republic (I)

Papa New Guinea (I)

Mongolia (T)

Vietnam (I)


Jill Rogers, Jill Rogers Associates

Health workforce education assessment toolsThe protocol and handbookLisbon, 30 June – 3 July 2014

The challenge of communicating the idea Aim of the protocol Purpose of the handbook

• Clarity of purpose• Speak directly to key

stakeholders• Demonstrate accessibility• Effective design and interface• Recognisable branding and

design

• Set out the overall objectives of the initiative

• Show how the use of the tools will contribute to universal healthcare

• Provide the underpinning rationale for the tools

• Explain the design of the tools and underpinning methodology: the programme logic models

• Identify stakeholders and their roles

• Clear guidance about how to complete the tools

• Key terminology used and standard terms

• Importance of accuracy and honesty of responses

• Locating the information: existing data sets?

• Data protection: confidentiality of the data

• The use of and access to the data

‘Unless you have absolute clarity of what your brand stands for, everything else is irrelevant.’

Mark Baynes, CEO Kellogg

• Promote best practice in how the tools are used

• Demonstrate flexibility for individual country use

• Make sure countries apply the tools in as similar a way as possible

• Clarify stakeholders’ roles and responsibility for partnership working

• Demonstrate ‘what’s in it for us?’

• Who to ask for support and guidance: the role of the WHO Regional offices

• Use of data to provide a snapshot, baseline information, comparative data to lead to transformation

• Case studies to stimulate change

• Delivery of the protocol, handbook and tools: hard copy and/or electronic medium


Dr Erica Wheeler, Technical Officer, World Health Organization

“Transforming and Scaling Up Health Professional Education and Training”

Strengthening Health Systems for Health Professionals, Education

Dr Erica Wheeler, Department Of Health WorkforceWHO Headquarters, Geneva Switzerland 1st to 3rd July 2014,Lisbon, Portugal

The Purpose of the Presentation

1. Background

2. The purpose of the toolkit

3. Where we are now

4. Where we are heading

Policy framework for adapting 2006 WHO Report pipeline for generating and recruiting the health workforce; increasing complexity and interconnectedness

WHA 59.23: Rapid scaling up of health workforce production

2006 2011 2012 2013WHA 59.23: eHealth

WHA 64.6: Health workforce strengthening

WHA 64.7: Strengthening nursing and midwifery

WHA 64.9: Sustainable health financing structures and universal coverage

WHA 62.12: Primary health care, including health system strengthening

WHA 63.25: Improvement of health through safe and environmentally sound waste management

WHA 63.16: WHO Global Code of Practice on the International Recruitment of Health Personnel

Rio +20 Political Declaration

3rd Global Forum Recife Declaration

UN platform Health in post 2015 development agenda

WHA 65.8: Outcome of the World Conference on Social Determinants of Health

WHA 65.8: prevention and control of noncommunicable Diseases (UN political declaration)

Un resolution on Global Health and Foreign Policy

WHA 66.23: Transforming health workforce education in support of universal health coverage


Task of Technical Working Group on Health Workforce Education Assessment Tools, is the implementation of WHA66.23

To develop a standard protocol and tool for assessment, which may be adapted to country context;

To support Member States as appropriate in using the protocol to conduct comprehensive assessments of the current situation in health workforce education;

To provide technical support to Member States in formulating and implementing evidence-based policies and strategies in order to strengthen and transform their health workforce education;

To consult regionally in order to review the country assessment findings and submit a report providing clear conclusions and recommendations, through the Executive Board, for consideration by the Seventieth World Health Assembly (2017).

Adapting the 2006 WHO Report health workforce pipeline; achieving universal health coverage, a key outcome of health systems strengthening

WHA 66.23 Health workforce education in support of universal health coverage (2013)

The development process of the WHO Global Assessment and Evaluation Toolkit

The development of the WHO GAT has drawn upon and been informed by a number of tools1. WHO-UNESCO-FIP Education Initiative Development Team Needs-Based Education Model;

2. THE NET’s Social Accountability Operational Model;

3. WHO adapted 2006 pipeline to generate and recruit the health workforce;

4. Flinders et al; Social Accountability Framework for Evaluation of Health Systems.


WHO Global Assessment Tool for transforming health workforce education in support of Universal Health Coverage

Final tool should provide Member States with; � Baseline SNAPSHOT: Provide baseline to enable assessment/ evaluation of impact of transformative process in terms of supporting universal health coverage;

� Guide and inform transformation of health workforce education to provide a basis for multi-sectoral and multi-stakeholder dialogue at country (and institutional level);

� Commitment SNAPSHOT; Enable countries to manage change process, recognizing that this needs to be contextualized (at country level) and acknowledging the heterogeneity of influencers.

Determining variablesFor Service Delivery and Quality of Care

Determining variablesFor health workforce

education

Sustainable Workforce

Fit for Purpose to meet Reference

Population Health Needs

Determining variablesfor Research

Workforce servingthe needs of the

Reference Population

Evaluation: Measure and catalyze the degree of overlap between the three

worlds in support of UHC

Workforce education and

training informed by needs and inter-sectoral evidence for the Reference

Population


Toolkit and TE

� Concept paper (TWG) � Articles � Interactive website/ePlatform for dissemination and feedback of health workforce education and caters for input from anyone who visits, identifies visitors, allows blogs, tweets, links products associated with the guidelines and health workforce education issues. Updated with a map for uploading case studies, good practice in implementation of transformative education and 6 areas of focus.

http://[email protected]

Baseline snapshotCommitment snapshot for change process

� Agreed actions on determining variables in each domain by stakeholders, integrated within inter-sectoral action


Dr Suwit Wibulpolprasert, Vice Chair, International Health Policy Program Foundation (IHPF)

Health Intervention and Technology Assessment Foundation (HITAF), Ministry of Public Health, Nothaburi, Thailand.

From Evidences to policy formulation, implementation and evaluation on Transformative HWF education -

the Thai experience

Suwit Wibulpolprasert,

Co-chair of the Thai National Commission in moving the Strategic Plans for the Development of Health Workforce Education in the 21st Century (2014 - 2018)

July 2nd, 2014Infarmed, Lisbon, Portugal.

From Evidences to Decisions : the KT process

Policy brief/Guideline/media

The KT processes

Evidences

Communication

Advocacy

Assessments with appropriate tools

Implementaion of decisions

Policy decisions – financial, legal measures, etc.

Professionals’ practices

Public norm CS movements

Industrial production

of services n products

Researches

Reviewliteratures

AppropriatelyDigested

Knowledge

Actors’ decisions


From Evidences to Decisions - Dos and Don’ts

Dos:

� Clear/concrete evidences, goals and targets - policy briefs � Mobilize leaders and managers to drive the changes � Zun Wu – stakeholders analysis – win without fighting

Don’ts

� Expect too much from just token attempts – hard works � Be a single hero or heroine – collective efforts � Build too many enemies, do make friends/networks

Four years of regional and global movements

� Late 2010 – AAAH conference in Bali right before the commission’s report – sensitized with the issue – ‘find leaders’

� April 2011 – Hanoi meeting 5 countries network started – Bangladesh, China, India, Thailand and Vietnam

� Late 2011 – AAAH conference Cebu – finalized the tools � 2012-2013 – Assessment done in 5 countries – report launch October 28-30, 2014 at AAAH conference in Wei Hei China

� RC resolution September 2012 and WHA resolution May 2013 � Recife’s 3rd GF, PMAC Jan 2014 and Global strategies – WG2

“Triangle that move the mountain”

Prawase Wasi

“Tipping point”

Malcolm Gladwell

Knowledge generation & management

Social movement

Political/Policy linkages

Stickiness of the issue

Three groups of people

Conductive Environment


Hanoi meeting April 2011

Cebu meeting November 2011


Four years of movements in Thailand

� NHA (National Health Assembly) resolution December 2012 – multi-sectoral and public private/NGOs annual partnership forum based on National Health Act – ‘Triangle that moves the mountain’ - established mechanism to develop National Strategies

� February 2014 – IHA (Issue Based Health Assembly) resolution approved the national strategies (2014 to 2019) and further approved by the National Health Commission, chaired by the PM – appointment of a National Commission to drive the strategies

� PM appointed a National Commission to move the national strategies into real actions – multi-sectoral public/private

� An annual inter-professional transformative education conference will be convened from 2014-2019 – starts with ‘institutional reform’

� 4 subcommittees to drive the movements � Apply the WHO guideline in the works of the subcommittees � Momentum is increasing towards ‘tipping points’


Leadership Forum


Thai National Strategic plan

� Vision “Equitable and quality education towards competent and heart based HWF” � Objectives – Equity, Integration, Innovation, Responsiveness and Relevancy, and Humanistic health care

� Strategies – reform education policies, foster more cooperation, reform of management and administration, reform of curricula and learning process, knowledge management, networking

� Indicators – 8 broad indicators

Proposed 8 broad indicators

� Proportion of enrollments from urban and rural areas � Appropriate per head cost for an education program � Number of researches n innovations applicable to HWF education reform � The HWF has the competency relevant to the needs of HS and higher education standard � Attitude and commitment of graduates to work in rural setting � Proportion of graduates start their career in rural areas and their retention � Patient satisfaction and ethical and heart based services � Collaboration between producers and users of HWF with other partners


Professsor Paul Worley, Dean of Medicine, Flinders University

Global Evaluation ToolTo assist Ministers of Health to support Universal Health Coverage through Transformative HWF Education

The tool

� Meet the requirements of the WHA resolution � Build on existing WHO work in this field � Link with existing evaluation tools � Be an intrinsic agent of change � Stand up to scrutiny � Be simple, attractive and make intuitive sense so it is actually used � Applicable to fractal layers – institutions to regions to countries to global � Create new knowledge

The big rocks

Each Meso-level field has indicators that link to existing evaluation frameworks and tools

Faculty Development Simulation National

Standards

Student Selection

Curriculum &Community

Career &Retention

Life Long Learning

Governance & Planning

Interprofessional Education

The Country Indicators

Faculty Development Simulation National

Standards

Student Selection

Curriculum &Community

Career &Retention

Life Long Learning

Governance & Planning

Interprofessional Education

Quality Monitoring Sustainability


Quality

A national framework for evaluation of quality of HWF Education that is relevant to UHC for that country

Red – none or negligibleYellow – existing, but not relevant to UHC and/or not utilisedGreen – existing, relevant, and utilised

(Collaboration between Education and Research sectors)

Monitoring

A national approach to monitoring the progress towards UHC

Red – not prioritisedYellow – data exists but not used in planning and quality assessmentsGreen – data used in planning and quality assessments

(Collaboration between Health Service and Research sectors)

Sustainability

A national policy and commitment to financing HWF education institutions and students to meet the quality standards

Red – not prioritisedYellow – partial commitmentGreen – sustainable, sufficient and equitable

(Collaboration between Education and Health Service)

Health Service

Education

Sustainable Workforce Fit for Purpose to meet Health System needs

ResearchHealth Workforce and System fit for purpose to serve the needs of

the Reference Population

CatalyticEvaluation

Workforce Education high quality and informed by inter-sectoral evidence

for the Reference Population


Human rights based sustainable governance and planning

Health Service

Education

Sustainable

Research

Monitoring

CatalyticEvaluation

Quality

Global Evaluation Tool for Transformative Health Workforce

EducationSupporting Universal

Health Coverage

For more information, contact:World Health OrganizationDepartment of Health Workforce (HWF)Avenue Appia 201211 Geneva 27Switzerlandhttp://www.who.int/hrh/education/en/

transforming the health workforce in support of universal health … · transforming the health...

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