SEA-HSD-293 Distribution: Limited
Regional Consultation on Strategic Plan for Health Workforce Report of Regional Consultation Bali, Indonesia, 18 – 20 December 2006
Regional Office for South-East Asia New Delhi, May 2007
© World Health Organization 2007 This document is not issued to the general public, and all rights are reserved by the World Health Organization (WHO). The document may not be reviewed, abstracted, quoted, reproduced or translated, in part or in whole, without the prior written permission of WHO. No part of this document may be stored in a retrieval system or transmitted in any form or by any means – electronic, mechanical or other – without the prior written permission of WHO. The views expressed in documents by named authors are solely the responsibility of those authors.
Contents Page 1. 2. 3. 4. Introduction and background ........................................................................ 1 Inaugural session ........................................................................................... 2 Technical presentations................................................................................. 3 Outcomes of consultation ............................................................................. 7 Annexes 1. 2. 3. 4. List of participants ......................................................................................... 8 Programme ................................................................................................. 13 Inaugural address by Dr Samlee Plianbangchang Regional Director, WHO South-East Asia Region......................................... 16 Summary of country presentations .............................................................. 21
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1.
Introduction and background The need to have a competent, motivated health workforce in ensuring an efficient and effective health system is well recognized and documented. The World Health Report 2006 reflects the pivotal role played by the health workforce in achieving the health outcomes of countries and regions while highlighting the close correlation that exists between qualified health workers and key health outcomes. Most Member countries are well aware of the challenges they face with regard to the health workforce. In the recent past, there had been several progressive actions taken by countries of the World Health Organization’s South-East Asia (SEA) Region as well as the Regional Office to solve some of the important Human Resources for Health (HRH) problems confronting them. Member countries, as part of their preparations to the 59th Regional Committee meeting, which was held in Dhaka, Bangladesh in August 2006, were of the view that it would be timely for the Regional Office to take the initiative to develop a Regional Strategic Plan for Health Workforce Development, which was complied by the Regional Office. Taking into account the importance of problems related to the health workforce in the Region, a declaration was drawn at the 29th Health Ministers’ Meeting in Dhaka emphasizing the need to strengthen the health workforce in the Region and specifically entrusting the mandate of leadership of the same to the Regional Office. Following the declaration, the Regional Committee endorsed the resolution SEA/RC59/R6 on strengthening the health workforce in SouthEast Asia and the Regional Strategic Plan for Health Workforce Development. The Regional Committee requested the SEA Regional Office to take the initiative ahead by finalizing, through an inclusive consultation process, the development of a package of interventions and tools for strengthening the health workforce. This consultation was organized with the objectives listed below.
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General objective To finalize the Regional Strategic Plan for Health Workforce Development in the SEA Region.
Specific objectives (1) To review and discuss the existing challenges, problems and their causes in relation to the health workforce in Member Countries. To identify strategic activities based on the strategies already stated. To identify priority areas for technical assistance by the Regional Office in Health Workforce Development based on country expectations.
(2) (3)
The meeting brought together representatives from the Ministries of Health and of educational institutions of all member countries of the SEA Region. Other participants included representatives from regional networks, development partners, WHO/HQ, the Regional Office and the WHO Country Offices. List of participants and the programme are at annexes 1 and 2.
2.
Inaugural session Dr Samlee Plianbangchang, Regional Director for WHO’s South-East Asia Region, inaugurated the consultation. In his address, he emphasized the need to have a sustainable, efficient, effective and motivated health workforce for health service delivery in the Member countries of the Region. He also presented a brief outline of the problems and issues that are closely linked to the health workforce which are common among many countries of the Region, albeit in varying magnitude. Dr Samlee Plianbangchang highlighted the pressures on the health workforce that have emerged globally during the last two decades and are equally relevant to the South-East Asia Region. The need to have a dedicated health workforce to address the growing burden of chronic diseases which require a continuum of care, disease outbreaks such as
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Severe Acute Respiratory Syndrome ( SARS), avian influenza, and natural disasters such as earthquakes, the tsunami and floods, was stressed. He recalled the past action taken by the WHO Regional Office to facilitate the development of the health workforce in the Region and applauded the recent political commitment shown by Member countries in urging WHO to take the lead role in assisting Member countries in health workforce development. The full text of the Regional Director’s address is given in Annex 3. Dr Sultana Khanum, Director, Department of Health Systems Development at the Regional Office, explained the objectives of the consultation while providing a brief background of the events that led to the organization of the consultation. Dr Thushara Fernando, Operational Officer, introduced the participants. Dr Menaldi Rasmin, Dean, Faculty of Medicine, University of Indonesia, Jakarta was nominated as the Chairperson and Prof. P.H. Ananthanarayanan, Deputy Director-General, Directorate-General of Health Services, Ministry of Health and Family Welfare, Government of India, as the co-chairperson for the consultation.
3.
Technical presentations The presentations consisted of two technical presentations on Health Workforce Development – Global Perspective by Dr Manuel Dayrit, Director, HRH/HQ and Health Workforce Development – Regional Perspective by Dr Sultana Khanum, Director, HSD/SEARO. The technical presentations were followed by those made by country representatives on country health workforce situations. The country presentations were followed by a presentation made by Dr Thushara Fernando, HRH Focal Point, WHO/SEARO, on the Regional Strategic Plan for Health Workforce Development. He introduced the participants to the group activity scheduled for days two and three, which included a review and finalization of the activities of the Regional Strategic Plan that had already been endorsed by the 59th Regional Committee session. (1) Dr Manuel Dayrit , Director, HRH/HQ presented an overview of the global perspective on health workforce development. He defined the health workforce as those who are engaged in
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actions with the primary intent of enhancing health. Explaining the need to have an adequate, motivated and competent health workforce, he outlined the wide range of health problems today that stem from shortages and inequitable distribution of the workforce. The presentation stressed on the need for innovative approaches to overcome the global challenges to health workforce development while spelling out the potential threats that can thwart efforts to build capacity and the performance of health workforce. The presentation highlighted the HRH action framework building tools for an effective and sustainable health workforce. An introduction was also made on the 10-year ‘action plan’ specifying the strategic directions. The presentation was followed by a discussion in which issues raised by the participants on several subjects were further clarified. (2) The regional perspective on the health workforce was presented by Dr Sultana Khanum, Director, HSD/SEARO. In her presentation, she provided the working definition of the health workforce and cited examples to show that issues related to health workforce in the SEA Region are serious in comparison with those in many other Regions. She stressed that the current levels of availability of the health workforce are thoroughly inadequate when assessed against the burden of disease in the SEA Region. The limitations of data and information on the current health workforce situation such as non-availability of updated information, non-uniformity in classification of health workforce categories, lack of comprehensive data especially from the private health sector, and the lack of data on community healthcare workers were highlighted. Important health workforce related issues and the challenges the Region is facing on this front were elaborated. Dr Khanum reiterated that shortages and imbalances in terms of geography and skill-mix are major problems in the Region. She focused on the finding that a minimum critical mass of health-care workers is mandatory to meet the essential health interventions such as skilled assistance at child birth and immunization and that this is not available in many countries of the Region. Issues related to lack of adequate quality due to the non-availability of Page 4
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standardized educational facilities for pre-service and in-service training were discussed. Factors that demotivate the health workforce, including deficiency of skilled HRH managers, were also deliberated upon. Dr Khanum also said that at the 59th RC and the 29th HMM the highest level of political commitment was displayed by Member countries for the acceleration of the health workforce development in the SEA Region, and that the Regional Office is committed to take the initiative forward. (3) Country presentations All countries made short presentations highlighting the strengths and weaknesses of country health workforce situations and health workforce related problems and issues that they are facing today. The objectives of the presentations were to make participants more aware about the health workforce situation in Member countries which, in turn, will enable them to collectively contribute to the finalization of the Regional Strategic Plan while sharing their experiences on how their respective countries have taken action to address the challenges. At the end of the presentations, t he country situations were summarized and presented by Dr Prakin Suchaxaya, Regional Adviser on Nursing, SEARO. Important health workforce related problems and issues as raised by the country representatives are given in annex 4. (4) Following the presentations on country situations, Dr Thushara Fernando, STP/HRH, WHO/SEARO, made a brief presentation on the Regional Strategic Plan for Health Workforce Development. He outlined the background that led to the development of the Regional Strategic Plan, the envisaged vision, its mission and goals and the strategic objectives which have been categorized under three ‘key result’ areas. The guiding principles were explained and the 10 strategic areas were described. He explained the need to go through the activities that have already been listed under each strategic area in order to finalize the plan. Dr Fernando also described the circumstances that led to the identification of two additional strategic areas based on the discussions that took place at the 29th Health Ministers’ meeting and the 59th Regional Committee session. Page 5
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(5)
The discussions that took place on day one were recalled at the commencement of proceedings the following day. The objective of the group work which was organized in the morning session was to review the strategic areas that have been already identified in the plan and identify a set of strategic activities that need to be carried out under each strategic area. Participants paired into six subgroups, with each consisting of country participants, developmental partners and representatives of other organizations and country office focal points, review3e the strategic areas and activities already spelled out and made modifications based on the health workforce needs of the SouthEast Asia Region. The specific areas that needed WHO collaboration were identified and discussed by the participants. This discussion provided an opportunity for WHO to identify the priority areas for collaboration. Member countries requested SEARO to provide technical assistance in the following areas: Ø Ø Ø
Assisting countries to develop health workforce strategic plans and country-specific health workforce databases. Development of a regional health workforce database. Advocate on development and scaling up of the Community Based Health Workforce, especially the Community Health Care Workers. Improve quality assurance in training. Capacity building in HWF management.
Ø Ø
(6)
The second group work session was organized to provide an opportunity for participants to identify country-specific activities that could be initiated by respective countries in the immediate future. Country representatives and the Country Office focal points of respective countries identified these activities under relevant strategic areas and indicated the responsible organization, time-frame and the tentative budget required for their implementation. The countries furthe r identified how WHO can assist them to implement these activities in terms of technical and financial support.
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4.
Outcomes of consultation (1) The group arrived at a consensus that the strategic plan that has been endorsed by the 59th Regional Committee has been based on the needs of the health workforce, problems and issues prevailing among the Member countries in the Region. The Regional Strategic Plan for Health Workforce Development for the South-East Asia Region was finalized based on the inputs provided by the representatives of Member countries during the consultation. The revised version of the strategic plan has been readied for publication. The country representatives agreed that few priority activities need immediate implementation. The presence of WHO focal points from nine countries at this consultation provided an opportunity for constructive discussions on how WHO can assist the countries in implementing these priority activities immediately. The consultation also provided an opportunity to identify the areas that needed WHO collaboration and assistance for the year 2007. These inputs will used for the development of the SEARO HRH workplan for the 2008-2009 Biennium. The participants agreed that the proposed strategies and activities should form the basis for WHO country workplans for 2008-2009 and 2010-2011 bienniums in the area of HRH. Selected areas that could be addressed in the form of MultiCountry Activities (MCA) in the next biennium also became apparent. The countries agreed to incorporate some of these activities as MCAs for the next biennium plans based on the needs of countries.
(2)
(3)
(4)
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Annex 1
List of participants Bangladesh Mr Syed Mustafizur Rahman Joint Secretary (Administration) Ministry of Health and Family Welfare The People’s Republic of Bangladesh, Bangladesh Secretariat Dhaka Ph.: 00 880-2716-7282 Prof. Falah-uz Zaman Professor, Department of Community Medicine Bangladesh Medical College Hospital Dhaka Ph.: (Resi) 00 880 812 6586 Email: proffzamankhan@yahoo.com Dr Chencho Dorji, Director Royal Institute of Health Sciences Thimphu Ph: 975-2-322-031 Email: cdorji88@yahoo.com Ms Thinley Wangmo Senior Human Resource Assistant, HRD Ministry of Health Thimphu Ph: 975-2-322-602 Email: thinleywangmo@health.gov.bt
DPRK Dr Pak Song Chol Senior Official Department of Science and Education Ministry of Public Health Pyongyang Ph.:+850-2-381-7913/914 Mr Kim Yong Chol Interpreter Ministry of Public Health Pyongyang. Ph.:+850-2-381-7913/914
Bhutan Mr Jamtsho Deputy Chief Human Resource Division Ministry of Health Thimphu Ph: 975-23-23-953 Email: jamtshoyenten@health.gov.bt Mr Mindu Dorji Deputy Chief Human Resource Management Ministry of Health Thimphu Ph: 975-2-321314 Email: mindudorji@yahoo.com Mr Ugyen Wangchuk Human Resource Division Ministry of Health Thimphu Ph: 975-2-323-091 Email: uw@health.gov.bt
India Prof. P.H. Ananthanarayanan Deputy Director-General (M) Directorate-General of Health Services Ministry of Health and Family Welfare Government of India New Delhi Ph: 91-11-2306-3220 Email: phananthanarayanan@gmail.com, and ddgm@nb.nic.in
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Indonesia Dr Wisnu Hidayat Deputy Director of Structural and Management of Health Training Centre for Health Education and Training of Human Resources for Health Ministry of Health Jakarta Ph: 62-21-740-77-68 Email: hrwisnu@yahoo.com Mr. Sudung Nainggolan Deputy Director Continuing Education & Programme Evaluation and Reporting Center for Planning and Empowerment of HRH Board for the Development and Empowerment of HRH Ministry of Health Jakarta Ph: 62-21-722-6880 Email: sudungn@gmail.com Dr Menaldi Rasmin Dean, Faculty of Medicine University of Indonesia Jakarta Ph: 62-21-392 9651 Email: rasminm@fk.ui.ac.id
Myanmar Dr Than Oo Director (Administration) Department of Health Nay-pyi-taw Ph: 067-411-383 Email: diradm2@dms.gov.mm Dr Ye Win Director (Administration) Department of Medical Sciences, Nay-pyi-taw Ph: 067-411-024 Email: diradm2@dms.gov.mm
Nepal Dr Nirakar Man Shrestha Chief Specialist Policy, Planning and International Cooperation Division Ministry of Health and Population, Government of Nepal, Kathmandu Ph: 977-1-4262-862 Email: nirakar963@hotmail.com Mr Mahendra Prasad Shrestha Public Health Administrator Manpower Development Section, PPICD Ministry of Health and Population, Government of Nepal Kathmandu Ph: 977-1-4262-862 Email: mpkalpana@hotmail.com
Maldives Ms Aishath Ahmed Didi Assistant Lecturer Gr.1 Faculty of Health Sciences Ministry of Health Male Ph.: Mobile 00 960 964 3777 Email: aisha_aysha@hotmail.com Ms Aminath Rishfa Assistant Under Secretary Ministry of Health Male Ph: +00 960-333-7911 Email: rishfa@health.gov.mv
Sri Lanka Dr WMTB Wijekoon Director (Planning) Ministry of Healthcare and Nutrition Colombo Ph: 0094-011-267-4683 Email: wmtbw@health.gov.lk Dr H.R. Upali Indrasiri Provincial Director of Health Services, Western Province New Secretariat, Maligawatte, Colombo Ph: 094-011-243-7154 Email: pdhswp@sltnet.lk
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Thailand Dr Thinakorn Noree Researcher International Health Policy Program Bureau of Policy and Strategy Ministry of Public Health Bangkok Ph: 66-2-590-2396 Email: thinakorn@ihpp.thaigov.net Dr Nonglak Pagaiya, Sirindhorn College of Public Health Khon Kaen Ph:66-43-22-1770 ext. 170 Email: cnonglak@yahoo.com
ADB Prof. Nur Nasry Noor ADB Consultant – Jakarta Jakarta, Indonesia Ph: 62-21-522-6948 Email: nasrynoor@hotmail.com
ESCAP Mr Dae-won Choi Chief, Health and Development Section United Nations Economic and Social Commission for Asia and Pacific (ESCAP) Bangkok, Thailand Ph.: 66-2-288-1916 Email: daewon.choi@un.org
Timor-Leste Mr Feliciano da Costa Amaral Pinto SKp Permanent Secretary Ministry of Health Democratic Republic of Timor-Leste Dili Ph: +670-723-0090 Email: sp_saude@yahoo.com Mr Basilio Martins Pinto SKM Director Health Policy and Planning Ministry of Health Democratic Republic of Timor-Leste Dili Ph:+670-723-0142 Email: basiliomp67@yahoo.com
SEAPHEIN/APACPH Dr Phitaya Charupoonphol Dean and Associate Professor Faculty of Public Health Mahidol University Bangkok, Thailand Ph: 66-2-354-8527 Email: deanph@mahidol.ac.th Associate Prof Orawan Kaewboonchoo Deputy Dean International Relations and Training Faculty of Public Health Mahidol University, Bangkok, Thailand Ph.:66-2-354-8529 Email: phokb@mahidol.ac.th Dr Sipanee Sreesai Deputy Dean Student Affairs, Environment and Public Relations Mahidol University, Bangkok, Thailand Ph: 66-2-354-8525 Email: phssp@mahidol.ac.th
Other agencies AAAH Dr Piya Hanvoravongchai Coordinator Asia-Pacific Action Alliance on HRH (AAAH) Bangkok, Thailand Ph.:+66-2-590-2370 Email: coordinator@aaahrh.org
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GTZ Mrs Joyce Smith Team Leader for HR Development GTZ, Jakarta, Indonesia Ph: 62-21-720-7806 Email: j.smith_eposhrd@cbn.net.id
Ms Margareta Skold Human Resources for Health Focal Point WCO Myanmar Yangon Ph: 95-1-212-606/8/9/226-895 Email: skoldm@whomm@undp.org Dr Somchai Peerapakorn Human Resources for Health Focal Point WCO Thailand Bangkok Ph: +66-25-90-15-24 Email: somchai@searo.who.int Dr J. Erling L. Larsson Health Policy Adviser WCO Timor Leste Dili Ph: +670-728-7824 ® Email: larssone@searo.who.int Dr Agung Waluyo Human Resources for Health Focal Point WCO Indonesia Indonesia Ph: 62-21-520-43-49 Email: waluyoa@who.or.id
WHO Secretariat WCO HRH Focal Points Dr Khaled Hassan Medical Officer – Human Resources for Health WCO Bangladesh, Dhaka Ph: 861-4653 Email: hassank@searo.who.int Ms Rinji Om Human Resources for Health Focal Point WCO Bhutan Thimphu Ph: 975-23-22-864 Email: rinji@searo.who.int Dr Nagi M. Shafik Human Resources for Health Focal Point WCO DPR Korea Pyongyang Ph: +850-238-17-913 Email: shafikn@searo.who.int Mr Sunil Nandraj Human Resources for Health Focal Point WCO India New Delhi Ph: 91-11-230-61-955 Email: nandrajs@searo.who.int Dr Arvind Mathur Family and Community Health Focal Point WCO India New Delhi Ph: 91-11-230-61-955 Email: mathura@searo.who.int Dr PVR Kumarasiri Human Resources for Health Focal Point WCO Sri Lanka, Colombo Ph: 250-2345 Email: ranjithk@whosrilanka.org
WHO/SEARO & WHO/CO Indonesia Dr Georg Petersen WHO Representative to Indonesia Jakarta, Indonesia Ph: 62-21-520-43-49 Email: petersen@who.or.id Dr Sultana Khanum Director Department of Health Systems Development, WHO/SEARO, New Delhi Ph: 91-11-2330 9325 Email: khanums@searo.who.int Dr Thierry Mertens Special Representative of the Regional Director on Public Health Initiative, WHO/SEARO, New Delhi Ph: 91-11-23-30-94-26 Email: mertenst@searo.who.int
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WHO/HQ Dr Manuel M. Dayrit Director of Department of Human Resources for Health WHO/HQ Geneva Ph: 41-22-791-24-28 Email: dayritm@who.int
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Annex 2
Programme DAY 1, Monday, 18 Dec 2006 08:30 – 09:00 09:00 – 09:45 Registration of participants Inaugural session Ø Welcome remarks by Dr Nyoman Suteja, Head of Planning Division, Bali Provincial Health Office Ø Inaugural address by Dr Samlee Plianbangchang, Regional Director, WHO South-East Asia Region Ø Objectives of Consultation by Dr Sultana Khanum, Director, Department of Health Systems Development, WHO/SEARO Ø Introduction of participants by Dr Thushara Fernando, HRH Focal Point, Department of Health Systems Development, WHO/SEARO Ø Nomination of Chair, co-Chair and Rapporteur Ø Group photograph 09:45 – 10:15 10:15 – 10:20 Tea break Presentation on organization of the consultative meeting by Dr Sultana Khanum, Director, HSD, WHO/SEARO Health Workforce Development 10:20 – 10:45 Global perspective Ø Presentation by Dr Manuel Dayrit, Director, HRH, WHO/HQ (15 minutes) – followed by discussions 10:45 – 11:30 Regional perspective Ø Presentation by Dr Sultana Khanum, Director, HSD, WHO/SEARO – followed by discussions 11:30 – 12:30 Review of country situations: Ø Presentation of country situations – 15 minutes for each country – followed by discussions
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12:30 – 13:30 13:30 – 15:00
Lunch break Ø Presentation of country situations continued – followed by discussions
15:00 – 15:30 15:30 – 16:00
Tea break Ø Presentation of country situations continued – followed by discussions Presentation on “Regional Strategic Plan for Health Workforce Development”
16:00 – 17:00 19:00 – 21:0w
Ø Presentation by Dr Thushara Fernando, HRH Focal Point, WHO/SEARO Reception
DAY 2, Tuesday, 19 Dec 2006 08:30 – 10:15 Strategies Group work – Session 1 Ø The strategies will be discussed in four small groups and activities will be identified under each category (Reference Group Work Guidelines) 10:15– 10:45 10:45 – 12:15 12:15 – 13:30 13:30 – 15:30 15:30 – 16:00 16:00 – 17:00 Tea break Group work – Session 1 continued Lunch break Group presentations Tea break Country activities Group work – Session 2 Ø Identification of country-specific priority activities for immediate implementation (Reference: Group Work Guidelines).
DAY 3, Wednesday, 20 Dec 2006 08:30 – 09:30 09:30 – 10:00 Group work – Session 2 continued Tea break
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10:00 – 11:00
Groups presentations – AREAS OF WHO’S COLLABORATION Ø Identification of priority activities for WHO for immediate implementation Ø Presentation and discussion
11:00 – 12:00
12:00 – 12:30 12:30 – 13:30
Conclusion / closing session Lunch Break
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Annex 3
Inaugural address by Dr Samlee Plianbangchang Regional Director, WHO South-East Asia Region Dr I Ketut Subrata, Dr Sultana Khanum, Dr George Petersen, distinguished participants, honourable guests, ladies and gentlemen, With great pleasure, I welcome you all to this consultation. This morning, we will review and deliberate upon Regional Strategic Plan for the Development of the Health Workforce. Distinguished participants; The health workforce is the backbone of health systems, and is central to their effective operation. It is well documented that the health workforce is the key component of health development to achieve positive health outcomes of the population. The correlation between the performance of health workers and critical health indicators is well-recognized and proven beyond doubt. The issues relating to health workforce are common among many countries across the world. In absolute terms, the acute shortage of health workers also prevails in the South-East Asia Region. At the same time, consumers’ demands for more and better services have emerged globally over the last two decades. This is also equally relevant to the SEA Region. Health workers today have to address, among others, a growing burden of chronic disease, which requires a continuum of care. For this, they have to be particularly skilled in ambulatory and community care. Disease outbreaks and natural disasters have put to the preparedness of the health workforce to test. Health workers themselves are also adversely affected during the conflict and postconflict periods, either within or between countries. Their personal and family needs in this situation must also be taken care of. Furthermore, technological advances and growing consumer expectations affect the ways health care and services are perceived and practised. Adding to these, among others, are international trade agreements and the issues relating to intellectual property rights, which have a profound implication on Page 16
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the health of the public. Health professionals today need to clearly understand these trends and their implications. Ladies and gentlemen, Many actions have been taken by WHO in an effort to help Member States improve the situation relating to the health workforce. During the recent past, the World Health Assembly has adopted several resolutions that addressed many related issues. Furthermore, the Global Health Workforce Alliance was launched by WHO in May this year. This is one among many efforts to mobilize the support of key stakeholders in strengthening and developing the health workforce in countries. The WHO Regional Office for South-East Asia has also taken many initiatives to strengthen the health workforce in Member States. Among other important events was the landmark Calcutta Declaration adopted in 1999 at the Regional Conference on Public Health in South-East Asia. Despite all our efforts, the challenges of health workforce-related issues in the Region continue to prevail. In most countries, information on the various dimensions of the health workforce is inadequate at the national level. Comparatively, data are more complete on the types of services than on management aspects which determine the efficiency of service delivery. Data are also more comprehensive on service providers than on supporting staff, who also contribute to the efficiency and quality of services. Often, available data are limited to the public sector; and within this sector, focused heavily on doctors and nurses. Community-based health workers are often excluded from the headcount. These workers are the key p layers to contribute to the reduction of the disease burden the population. However, these data help highlight a few important health workforce-related problems that need urgent attention. Shortage of the health workforce is a critical concern almost everywhere. Many countries cannot meet the required threshold of doctors, nurses and midwives. According to one study, these staff members are needed at the ratio of at least 2.5 per 1,000 population in order to adequately provide essential health services. Below this level, the coverage of needed interventions to achieve the targets set under the MDGs will become very inadequate. The average figure in the SEA Region is estimated at 2.12, with the range in countries extending from 0.56 to 7.37. Europe and North America, with 21% of the world’s population, have 45%t of doctors and 61% of nurses. South-East Asia, with 26% of the world’s population, has only 20% of doctors and 8% of nurses. Page 17
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Furthermore, a gross imbalance in the distribution of health workers is common among countries, as well as within countries. This is especially so in the developing world. In most developing countries, there is a severe shortage of health staff in rural areas compared to urban. Training is geared towards the production of physicians and nurses, at the expenses of public health and management cadres. This situation creates a gross imbalance between institutional care and community care. The latter are particularly needed in developing countries where majority of the population lives in communities that have inadequate health-care institutions. The past emphasis laid on the development of a community-based health workforce is no longer visible. This is really a serious public health concern. Inadequate competency and skills of the health workers to meet the expected standards of care is another important challenge in the Region. Many of the training institutions also need to update or even reform their teaching methods and materials in order to effectively provide need-based and job-oriented education. Often, these institutions lack a system of assuring the quality of training. There are very few opportunities available in countries of the Region for continuing education of health staff. Incentive mechanisms need to be strengthened or even created to motivate and maintain the health workforce at high standards of performance. Management policies and practices need to be reformed to ensure efficient and effective development and deployment of health staff. These are essential elements for the management of health workers. Conducive working environment is needed to ensure fair management, equitable career advancement and personal development of health staff. Often, there is an increased attrition which adversely affects the production capacity of health workers. In some countries, measures to motivate staff to stay on the job – such as providing dual employment opportunities with the public and private sectors – have impacted government services negatively. There are many underlying causes for these issues; the inadequate production capacity and migration of skilled health professionals being among them. Adequate orientation in the areas of public health, quality of training programmes, and availability of facilities for continuing education are essential in our countries. These factors are important for health workers to acquire the required level of competency and skills. Effective management of the health workforce requires clear visions and robust policies and approaches with strong leaderships at all levels. Ladies and gentlemen, The Twenty-fourth Health Ministers’ Meeting and the Fifth-ninth session of the Regional Committee this year were landmarks in the development of the health Page 18
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workforce in South-East Asia. The honourable Ministers agreed that the unwavering and intensified political commitment was needed in facing the challenges in this area. The “Dhaka Declaration” was adopted at the end of the deliberations during the Health Ministers’ Meeting. This clearly reflects their commitment to push forward the agenda of health workforce development in the Region. The Declaration urged Member States to take several initiatives in this regard. The Fifth-ninth session of the WHO Regional Committee for South-East Asia adopted a resolution on strengthening the health workforce. The above declaration of Health Ministers and the resolution of the Regional Committee now serve as the principal guide for the countries in the SEA Region to take the initiative to ensure quality and adequacy of the health workforce. The draft Regional Strategic Plan for Health Workforce Development, presented to the Fifth-ninth session of the Regional Committee was also thereby endorsed. This consultation is being organized to revisit this strategic plan. During the course of our meeting, we will review the plan and identify the activities to be carried forward by both Member States and WHO. I hope that only realistic and practical activities are identified for action. Ladies and gentlemen, Before concluding, I would like to underline some important points in connection with the development of health workforce. Special attention should be paid to public health professionals and public health practitioners who can develop and implement public health programmes successfully. Public health programmes are those that place emphasis on health promotion and disease prevention and control, and serve directly and equally all communities in both rural and urban areas. These are also programmes that ensure equitable health-care services to all segments of the population. Equally important, our particular efforts should also be devoted to the strengthening and development of community-based health workers: the workers who can ensure reaching the unreached, the poor, the vulnerable and the marginalized. While the development of the health workforce is basically the responsibility of the health sector all stakeholders concerned should be actively engaged in it. These include educational institutions (which are often outside the health ministry’s jurisdiction), professional bodies and associations, civil society organizations, consumer groups and many more. Today health care needs a multidisciplinary health workforce with multisectoral perspectives. We need a health workforce with a high sense of social Page 19
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responsibility and commitment. Even more important, we need health workers of a high standard of ethics and moral value, who have a selfless commitment. Only the best interests of their clients and their people, the poor and the underprivileged in particular, should be foremost on their minds. Distinguished participants, It is still a long way to go in the development of the health workforce to ensure good health for all people, regardless of their socio-economic status. Let us face this challenge squarely together in the years to come. Let us hope that with our unwavering determination and commitment, we will be successful in pursuing this formidable but noble task. Finally, I wish you all fruitful deliberations and successful conclusions. And I wish all of you a very pleasant stay in Bali. Thank you
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Regional Consultation on Strategic Plan for Health Workforce
Annex 4
Summary of country presentations Priority health issues and challenges of SEAR countries Country Bangladesh Priority health issues and challenges of SEAR countries Ø Reducing maternal morbidity and mortality Ø Reducing morbidity and mortality of infants and children under five years of age Ø Reducing the burden of prevailing communicable diseases Ø Prevention of emerging non-communicable diseases. Ø Emergency Preparedness and Response to Natural Disaster. Bhutan Ø Achieving Millennium Development Goals Ø Improving quality and accessibility of health services Ø Improving promotive, preventive, curative and rehabilitative services Ø Enhancing traditional medicine services at all levels Ø Attaining sustainability and equity in health care delivery system DPR Korea Ø Control of tuberculosis and malaria Ø Control of other communicable diseases Ø Reducing burden of non-communicable diseases Ø Improving quality and coverage of maternal and child health services Ø Strengthening the mental health programme India Ø Expanding maternal health services Ø Reducing morbidity and mortality of infants and children under five years of age Ø Reducing the burden of prevailing communicable diseases Ø Controlling non-communicable diseases Indonesia Ø Enforcement and empowerment of community for healthy living Ø Improvement of community access to qualified health services Ø Improvement of surveillance system, monitoring and health information systems
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Country Maldives
Priority health issues and challenges of SEAR countries Ø Improving access to health services and medicines Ø Controlling communicable and non-communicable diseases Ø Improving quality of health care and services Ø Improving reproductive and maternal health services Ø Expanding child and adolescent health programmes Ø Introducing disaster and emergency preparedness and response Ø Strengthening ‘Dhivehibeys’ (Maldivian Traditional Medicine) and alternative forms of traditional medicines
Myanmar
Ø Controlling HIV/AIDS and related health and social problems Ø Control of malaria, TB and infectious diseases Ø Improving maternal and child health Ø School and youth health promotion Ø Prevention and control of non-communicable diseases Ø Development of HRH and Health Information Services
Nepal
Ø Promoting “Safe Motherhood” and family planning Ø Improving child health services Ø Controlling communicable and non-communicable diseases Ø Strengthening ambulatory patient services
Thailand
Ø Controlling HIV/AIDS and related health and social problems Ø Prevention and control of non communicable diseases Ø Preventing injuries
Timor Leste
Ø Improving maternal and child health Ø Prevention and control of communicable and non communicable diseases Ø Promoting a healthy environment Ø Health Promotion Programme
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Regional Consultation on Strategic Plan for Health Workforce
Current health workforce situation: Density of doctors, nurses and midwives Country Bangladesh Current health workforce situation: Doctors, nurses and midwives Ø Density of physicians – 2.2 per 10,000 population Ø Density of nurses – 1.1 per 10,000 population Ø Density of midwives – 1.8 per 10,000 population Bhutan Ø Density of physicians – 2.3 per 10,000 population Ø Density of nurses – 1.4 per 10,000 population DPR Korea Ø Density of physicians – 32 per 10,000 population Ø Density of nurses – 37 per 10,000 population Ø Density of midwives – 3 per 10,000 population Indonesia Ø Density of physicians – 2.4 : 10, 000 population Ø Density of nurses – 1.6 : 10,000 population Ø Density of midwives – 4.0 : 10,000 population Maldives Ø Density of physicians – 1.3 per 10 000 population Ø Density of nurses – 2.8 per 10 000 population Myanmar Ø Density of physicians – 3.6 per 10, 000 population Ø Density of nurses – 3.8 per 10, 000 population Nepal Ø Density of physicians – 2.1 per 10,000 population Ø Density of nurses and midwives – 2.2 per 10,000 population Thailand Ø Density of Physicians – 3 per 10,000 population Ø Density of Nurses – 15.3 per 10,000 population Timor-Leste Ø Density of physicians – 0.8 per 10,000 population Ø Density of nurses and midwives – 1.8 per 10,000 population
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Programmes/projects affected by health workforce related issues Country Bangladesh Programmes/projects affected by health workforce related issues Ø Maternal and child health programme Ø Immunization programme Ø HIV/AIDS control programme Ø Malaria control programme Ø Tuberculosis control programme Bhutan Ø Maternal and child health programme Ø Immunization programme Ø Vector control programme Ø STI/HIV/ AIDS control programme Ø Tuberculosis control programme Ø Water and sanitation programme DPR Korea Ø Maternal and child health programme Ø Primary health care programme Ø Communicable diseases control programme Ø Nurse/midwifery programmes Ø Mental heath programme India Ø Maternal and child health programme Ø Immunization programme Ø HIV/ AIDS control programme Ø Tuberculosis control programme Ø National Rural Health Mission Indonesia Ø Maternal and child health programme Ø Immunization programme Ø HIV/ AIDS control programme Ø Vector control/Malaria control programme Ø Tuberculosis control programme
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Regional Consultation on Strategic Plan for Health Workforce
Country Maldives
Programmes/projects affected by health workforce related issues Ø Maternal and child health programme Ø Immunization programme Ø HIV/STI/AIDS control programme Ø Tuberculosis control programme
Myanmar
Ø HIV/AIDS control programme Ø Maternal and child health Programme Ø Immunization programme Ø Malaria control programme Ø Tuberculosis control programme
Nepal
Ø Maternal and child health programme Ø Immunization programme Ø Malaria control programme Ø HIV/AIDS control programme Ø Tuberculosis control programme
Sri Lanka
Ø Non communicable diseases control programme Ø Maternal and child health programme Ø Elderly health care programmes Ø Quality of curative care services
Thailand
Ø National health security scheme (30 Baht scheme) Ø HIV/AIDS control programme Ø Provision of curative care services
Timor-Leste
Ø Mother and child health programme Ø Communicable diseases control programme Ø Non-communicable diseases control programme Ø Environment health programme Ø Health promotion (BCC)
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Current health workforce related issues and challenges Country Bangladesh Current health workforce related issues and challenges Ø Shortage: There is overall shortage of health workforce, especially in relation to nursing and allied health workforce Ø Maldistribution: The geographical distribution does not match the population density and health needs, especially in rural areas Ø HRH management: Low morale of service providers, resulting in low users satisfaction Ø Quality of training: Gap between health workforce education and the health needs and expectations of the people which needs to be bridged by improving quality of training Bhutan Ø Shortage of health workforce due to the increasing demand Ø Imbalanced skill-mix/inefficient competencies of health workforce Ø Lack of motivation/incentive mechanisms Ø Lack of safe and supportive working conditions DPR Korea Ø Insufficient number of specific categories such as nurses/midwives Ø Lack of the advanced knowledge and skills in health workers Ø Imbalanced skill mix/inefficient competencies of health workforce Ø Shortages of human resources in mental health and in communicable diseases control programme India Ø Health workforce shortage Ø Geographical maldistribution Ø Need to standardize the quality of training Indonesia Ø Shortages in terms of quantity Ø Geographical maldistribution leading to inequitable availability of service providers Ø The challenge in keeping pace with technological advancement Ø Lack of HRH management capacity across the country
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Regional Consultation on Strategic Plan for Health Workforce
Country Maldives
Current health workforce related issues and challenges Ø Shortages and skill-mix imbalances Ø High proportion of expatriates and their high turnover Ø The need to improve quality of training Ø Lack of staff development programmes
Myanmar
Ø Lack of health workforce data and information Ø Shortages of health workforce, especially shortage of trainers Ø Misdistribution of health workforce leading to skill-mix imbalances Ø Ineffective health workforce management
Nepal
Ø Weak health workforce management: Recruitment, deployment, retention, utilization and accountability Ø Shortages: Acute shortage of certain categories of health workforce Ø The need to improve training quality Ø Geographical imbalances
Sri Lanka
Ø Shortages especially of nurses and paramedical staff Ø Geographical imbalances Ø Lack of competencies Ø Ineffective health workforce management
Thailand
Ø Shortages of doctors, nurses Ø Maldistribution: geographical, public/private Ø Poor health-care provider – patient relationship
Timor-Leste
Ø Shortage of doctors and other auxiliary health personnel Ø Conflict of interest between health professionals Ø Misdistribution of health workforce Ø Lack of HRH management skills and capacity
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Causes of health workforce related problems Country Bangladesh Causes of health workforce related problems Ø Absence of a master plan for health workforce development Ø Lack of accreditation mechanisms covering all training/educational institutes. Ø Inadequate opportunities for in-service training and continuing education Ø Non-availability of career planning opportunities for health workforce Bhutan Ø Dhortage of training capacity within the country Ø Inadequate mechanisms to ensure proper deployment and equitable distribution Ø Inadequate resources to train, retrain and sustain health workforce DPR Korea Ø Inadequate capacity of training institutions Ø Increased turnover of health workers to other jobs Ø Inadequate opportunities for need based in-service training Ø Inadequate resources for health workforce development India Ø Lack of comprehensive information on health workforce, and Inadequate training capacity of some categories Ø Limited financial resources Ø Ineffective mechanism for equitable deployment Indonesia Ø Inadequate training capacity for certain categories Ø Lack of a comprehensive health workforce plan Ø Limited financial resources Ø Not having accreditation mechanisms for training/educational institutes Ø Inadequate opportunities for need-based in-service training Maldives Ø Geographical terrain mandating increased numbers of health workforce Ø Inadequate training capacity Ø High cost of training abroad Ø Lack of an effective mechanism for equitable deployment
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Regional Consultation on Strategic Plan for Health Workforce
Country Myanmar
Causes of health workforce related problems Ø Lack of information on health workforce Ø Inadequate training capacity of some categories Ø Lack of accreditation mechanisms of training institutions Ø Inadequate resources
Nepal
Ø Lack of a comprehensive Health Workforce development plan Ø Ineffective inter-ministerial and intersectoral coordination and collaboration Ø Inadequate emphasis on health workforce management Ø Insufficient incentives to work in the public sector, especially in the remote areas
Sri Lanka
Ø Shortage of training capacity for some categories Ø Ineffective deployment policies Ø Lack of information on health workforce Ø Inadequate opportunities for continuing education Ø Lack of emphasis on health workforce management
Thailand
Ø Increased health workforce demand Ø Limited production capacity of certain categories Ø More specialization trends Ø Increased contractual-based relationship between providers and patients Ø Increased consumers’ right causing heavy demand and higher standards
Timor-Leste
Ø Inadequate training capacity of some categories Ø Ineffective coordination among health professionals Ø shortage of infrastructure in rural areas Ø Lack of incentive mechanisms
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Major initiatives taken by countries to overcome HWF related issues Country Bangladesh Major initiatives taken by countries to overcome HWF related issues Ø Updating the Human Resource (HR) Strategy for the health, nutrition and population sector and development of human resource master plan Ø Strengthening HR information management system Ø Establishment of systematic continuing education programmes Ø Introducing quality assurance mechanism in health personnel training/education institutes Ø Orientation programme on health ethics, effective teaching and on best practices for managing of public health problems Ø Organizing local and external training for managers of the health service. Bhutan Ø Development of a Human Resource Strategic Plan Ø Ensuring adequate resource allocation/ mobilization Ø Strengthening institutional linkages and networking Ø Development of appropriate policy guidelines and a mechanism for motivating the health workforce Ø Ensuring sound professional competence development and creating conditions for life-long learning for health workers DPR Korea Ø Development of a strategic framework for health workforce development Ø Strengthening the capacity of nurses and midwives Ø Improving the method and quality for doctors in continuous education Ø Development of a specialist exchange programme with other countries India Ø Development of a health workforce for the Rural Health Mission Ø Development of a health workforce database
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Regional Consultation on Strategic Plan for Health Workforce
Country Indonesia
Major initiatives taken by countries to overcome HWF related issues Ø Development of a health workforce strategic plan Ø Development of a health workforce data-base Ø Developing a career development plan for health workforce Ø Initiating a certificate programme in recognition/accreditation
Maldives
Ø Reviewing of Health Master Plan and developing a health workforce strategy Ø Development of a systematic continuing education programme Ø Development of accreditation/certificate recognition programmes
Myanmar
Ø Development of a national health workforce plan Ø Development of a health workforce information system. Ø Development of accreditation systems for all training institutions Ø Development of a systematic continuing education programme Ø Introduction of effective Township Health System with smart leaders/managers in place
Nepal
Ø Introducing effective measures to deploy medical officers to remote and rural areas Ø Production of Medical Specialists and other health manpower within the country Ø Updating the incentives and motivational packages for HRH Ø Strengthening the Human Resource Information Center (HRIC)
Sri Lanka
Ø Development of a national health workforce strategic plan Ø Developing a health workforce data base. Ø Training of supervisors and managers on human resource management Ø Modifying duty lists and job descriptions of the health workforce Ø Improvement of training facilities at training institutes. Ø Instituting an accreditation system for training institutes of both the public and private sector.
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Country Thailand
Major initiatives taken by countries to overcome HWF related issues Ø Development of the National HRH Strategic Plan Ø Rural recruitment strategy: ODOD – one district, one doctor Ø OTON- one tumbon (sub-district), one nurse
Timor-Leste
Ø Development of a Health Workforce Plan 2005-2011 Ø Development of the Health Sector Strategic Plan 2007-2012 Ø Training of nurses as midwives Ø Developing a systematic continuous education programme for continuing improvement of health professionals
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