Annexure Xi Health Workforce Strategicplan 2012 2017-Books Pdf

Annexure XI Health Workforce StrategicPlan 2012 2017
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Table of Contents,Foreword Error Bookmark not defined. Acronyms 3,1 INTRODUCTION TO POLICY 4,1 1 AIM OF HRH POLICY 4. 1 2 THE HRH POLICY CONTEXT 4, 1 3 MILESTONES TOWARDS DETERMINING STRATEGIC DIRECTIONS FOR THE. HEALTH WORKFORCE Error Bookmark not defined,1 4 THE MYANMAR VISION FOR HEALTH DEVELOPMENT 6. 1 5 SITUATIONAL ANALYSIS 6,2 GOAL AND OBJECTIVES OF HWF STRATEGY 9.
3 GUIDING PRINCIPLES 10,4 THE FOUR PILLARS OF THE POLICY 11. 4 1 STRENGTHENING LEADERSHIP AND MANAGEMENT OF HRH 11. 4 1 1 Development of policy and plans on human resources for health 11. 4 1 2 Human resource management 11, 4 1 3 Development of legislation on human resources for health 11. 4 1 4 Monitoring 12, 4 1 5 Coordination of national human resource efforts 12. 4 1 6 Coordination of development partner support 12. 4 1 7 Duties and responsibilities of the stakeholder units 13. 4 1 8 Targets for 2012 2016 Error Bookmark not defined. 4 2 IMPROVING AVAILABILITY OF HUMAN RESOURCES FOR HEALTH 15. 4 2 1 Workforce size and characteristics 15,4 2 2 Classification of categories of staff 16. 4 2 3 Staff mix 17,4 2 4 Staff distribution 18,4 2 5 Staff performance and motivation 19.
4 2 6 Remuneration 19,4 2 7 Targets for 2012 2016 20. 4 3 IMPROVING QUALITY OF HUMAN RESOURCES FOR HEALTH 20. 4 3 1 Education and training 20,4 3 2 Professional competence 21. 4 3 3 Certification and licensing 22,4 3 4 Targets for 2012 2016 22. 4 4 ENSURING EQUITY IN HUMAN RESOURCES FOR HEALTH 23. 4 4 1 Monitoring equity Issues in HRH 23,4 4 2 Equal opportunities framework 23. 4 4 3 Affirmative action strategies 23, 4 4 4 Cultural acceptability of health services 24.
4 4 5 Targets for 2012 2016 24,References and Annexes Error Bookmark not defined. AMW Auxiliary Midwives,ASEAN Association of South East Asian Nations. BHS Basic Health Staff,CBO Community Based Organisations. CHW Community Health Workers,DPO Development Policy Options. GOM Government of Myanmar,HRD Human Resource Development.
HRH Human Resources for Health,HWF Health Workforce. HWFM Health Workforce Management Division,INGO International Non Government Organisations. MDG Millennium Development Goals, MNPED Ministry of National Planning and Economic Development. MOD Ministry of Defence,MOF Ministry of Finance,MOH Ministry of Health. MOL Ministry of Labour,NGO Non Government Organisations.
PHC Primary Health Care,PhD Doctorate of Philosophy. PHS Public Health Supervisors,UCSB Union Civil Service Board. WHO World Health Organization,Health Workforce Strategic Plan 2012 2017. 1 INTRODUCTION TO POLICY,1 1 AIM OF HRH POLICY, The Health Workforce Strategic Plan drafted by the Myanmar Ministry of Health MOH in. extensive consultation with key stakeholders is designed to guide the development of. Human Resources for Health HRH to meet the challenges facing the Myanmar health. system The strategy aims to ensure that the health system has adequate quantity and mix. of competent and committed health professionals at managerial and technical levels who. could be deployed where and when needed to serve the people of Myanmar. The HRH Policy is underpinned by an analytical review of the challenges inherent in the. Myanmar demographic socio economic health and human resource situation The review. entitled Myanmar Country Profile is attached,1 2 THE HRH POLICY CONTEXT.
Various government policies plans and strategies provide a policy context for human. resources for health, High level consultation on Development Policy Options DPO for Myanmar held in Nay Pyi. Taw in Feb 2012 placed health at the centre of poverty reduction and highlighted the. importance of developing a reliable HRH database strategic plan including a Rural. Human Resource Plan The meeting also stressed the need to clearly define roles and. responsibilities for all categories of the health workforce HWF and to explore strategic. options for attraction and retention of skilled HRH in rural areas especially midwives. The current National Health Plan 2011 2016 highlights the importance of developing a. comprehensive National Strategic Plan for Health Human Resource to strengthen health. systems through effective health human resource planning development and management. The National Health Plan 2011 2016 stipulates the urgency of developing a five years. National health Workforce Strategic Plan with emphasis on compiling information concerning. HR supply demand and critical gaps in both the public and private sectors through a. collaborative process involving all relevant stakeholders. The Nay Pyi Taw Accord for Effective Development Cooperation adopted in February 2013. stresses the aspiration of the Government for a people centred socio economic development. in cooperation with international partners to strengthen national capacity and skill. development to reduce incidence of poverty and achieve the Millennium Development. Goals by 2015, A national multi sectoral consultation convened in Nay Pyi Taw in November 2012. assessed the health system capabilities towards Universal Health coverage UHC and. reasserted the critical role of human resources for health in attaining UHC The meeting. confirmed the following actions for strengthening the health system. Other relevant policies include the Myanmar Vision 2030 Rural Health Development Plan. 2001 2006 Hospital Upgrading Plan 2001 2002 2005 2006 and various laws including. Myanmar Medical Council Law 2000, Dental and Oral Medicine Council Law 1989 revised in 2011. Nursing and Midwifery Law 1990 amended in 2002, The Law Relating to Private Health Care Services 2007. Public Health Law 1972,National Drug Law 1992,Traditional Medical Council Law 2000.
Myanmar Maternal and Child Welfare Association Law 1990 revised 2010. Myanmar Medical and Allied Degrees Act in process, Prevention and Control of Communicable Diseases Law 1995 revised 2011. In addition The Government of Myanmar GOM initiated various activities in recent years to. promote effective deployment of HRH including, Operational studies on the deployment of staff in remote areas and functional. analysis of their performance with particular reference to motivation and retention of. midwives in hard to reach rural areas, Provision of financial incentives per diems for staff in twenty pilot townships with. villages in hard to reach areas for to integrate outreach activities. Hardship allowances for health workers serving in hard to reach areas and. Recruitment and training of volunteer health workers Auxiliary Midwives AMW and. Community Health Workers CHW,1 4 THE MYANMAR VISION FOR HEALTH DEVELOPMENT. The objectives of the Myanmar Health Vision 2030 are. To uplift the Health Status of the people, To make communicable diseases no longer public health problems aiming towards.
total eradication or elimination and also to reduce the magnitude of other health. To foresee emerging diseases and potential health problems and make. necessary arrangements for the control, To ensure universal coverage of health services for the entire nation. To train and produce all categories of human resources for health within the country. To modernise Myanmar traditional medicine and to encourage more extensive. utilisation, To develop medical research and health research up to the international standard. To ensure availability in sufficient quantity of quality essential medicine and. traditional medicine within the country, To develop a health system in keeping with changing political economic. social and environmental situation and changing technology. The Vision for the Health Workforce Strategy is to. Achieve comprehensive health benefits by providing universal coverage of quality and. equitable health services through a financially sustainable health system with an adequate. competent and productive health workforce that is responsive to changing health needs. especially of remote and rural populations,1 5 SITUATIONAL ANALYSIS. Background, The Republic of the Union of Myanmar is a developing country in the midst of a political.
social and economic transition The nation is facing major challenges in every sphere of. development and particularly in the provision of quality health and education With a. population of around 59 1 million people spread across 680 000 square kilometres most of. whom live in rural areas with limited access to health care services Myanmar is required to. strengthen its health system and ensure equitable and effective services to its people. Government expenditure on health care has increased but is still very low Correspondingly. in spite of recent improvement in health status health indicators are still weak compared to. other countries in the region and beyond Mortality rates are improving as is life expectancy. but there are still many challenges The country is in an epidemiological transition with non. communicable diseases on the rise as well as significant prevalence of infectious diseases. Current health personnel stock levels and distribution. It is estimated in 2010 11 there were 88 975 health workers including 26 435 medical. practitioners 25 544 nurses and 19 556 midwives Together this equalled to 1 49 health. workers doctors nurses and midwives per 1 000 people well below the WHO minimum. recommended threshold of 2 3 health workers considered necessary to support the. achievement of the Millennium Development Goals MDG Furthermore not all these health. workers are public servants and those who are are not necessarily employed by the. Ministry of Health as the Ministries of Labour and Defence have employed large numbers of. health workers, The health workforce has a high proportion of women with almost 75 female health. workers There is an even spread of health workers in urban and rural areas However only. 34 of the Myanmar people live in urban areas Furthermore health facilities in the rural. areas are mostly staffed with lesser qualified Basic Health Staff BHS health assistants. midwives public health supervisors lady health visitors and community health workers who. require further training and logistical support, Due to the limited data on the private sector it is difficult to estimate the availability and. deployment of health personnel and ascertain the true state of HRH in Myanmar It is known. however that the private sector is playing an increasingly important role in Myanmar health. system and that it is essential to understand its contribution and regulate its involvement. Main HRH issues, Human Resource Development HRD has been identified as a major priority to promote. quality and accessibility of health service in Myanmar Human Resource challenges include. shortages of qualified human resources inappropriate balance and mix of skills inequitable. distribution difficulties in rural deployment and retention and lack of appropriate incentives. and support to engender motivation and retention of health workers in remote areas. Basic health staffs are responsible for providing health services to approximately 70 of the. population largely in rural areas These workers face many challenges in their effort to reach. out to the remote villages with meagre resources and support Accessibility to health care is. hampered by health worker shortages particularly in rural and remote areas near the. borders high levels of private financing of health services security issues poor. infrastructure and transport lack of equipment resources and drugs cultural and language. difficulties and geographic isolation, In view of these constraints not surprisingly there has been a focus on extending the. coverage and access to services through production of a larger quantity of health personnel. without sufficient emphasis on the quality of the services provided Furthermore production. and recruitment of health workers are often not well synchronised with excess number of. doctors relative to recruitment quota and lack of nursing personnel to fill vacancies in rural. areas Pre service education is also affected by inadequate funding and infrastructure which. in turn affects the capacity of the institutions to offer quality programs. In the absence of a focal point unit department in the Ministry of Health to coordinate all. aspects of HRH HRH planning management and production are not sufficiently aligned and. impact on the efficiency and effectiveness of health personnel development and deployment. Underpinning many of the difficulties associated with HRD is the insufficient investment and. allocation of resources for improving all aspects of HRH production and deployment. On balance Myanmar faces immense challenges in improving the health situation Rural. areas are particularly disadvantaged with severe shortages of health workers services. equipment resources and infrastructure Revenue from gas exports are increasing and the. lifting of sanctions in recent years has potential to enable increase health funding and with it. improve the health outcomes for the people of Myanmar. Summary of HRH issues that need to be addressed, Insufficient capacity and lack of coordination for planning managing and monitoring.
the health workforce, Inadequate HRH information systems to inform HRH policy formulation and. operational decision making particularly with regard to the deployment of staff in the. private sector, Insufficient capacity and resources to implement a systematic regulatory framework. to ensure adherence to institutional quality standards and competence of health. personnel to provide quality services, Insufficient engagement of development partners in formulation and delivery of. coordinated support and investments particularly in continuing education at the grass. root levels, Shortages of qualified health workers particularly in rural and remote areas. Workforce recruitment quotas that fail to respond to the staffing requirements of the. health system, Inadequate financial arrangement for support of education intuitions and professional.
bodies to enable quality production of health personnel. Deficiencies in the quality of education and training of health workers particularly. weak professional practical and clinical skills, Imbalance in skills mix and distribution of health workers. Lack of clarity about functional responsibilities scope of services required. competencies and supervision arrangements in different settings. Low motivation and performance of health workers at all levels. Insufficient salaries to meet basic living costs and low incentives. Insufficient human resource budget linked to inadequate financing of the sector. 2 GOAL AND OBJECTIVES OF HWF STRATEGY,The goal of the HWF Strategy is. To develop an effective health workforce that can meet the challenges facing the Myanmar. health system ensuring that competent and committed personnel managerial and technical. appropriate in quantity and quality are deployed where and when needed to adequately. serve all the people of Myanmar,The objectives of the Health Workforce policy are. 1 To strengthen the leadership and management of human resources for health. 2 To ensure availability and deployment of adequate number and mix of suitably qualified. health workers at all levels of the health system, 3 To ensure availability of a competent and motivated health workforce through improved. training and supervision, 4 To ensure efficiency quality and acceptability of the health workforce through attention.
to equity issues,3 GUIDING PRINCIPLES,The HWF Strategic plan will be. 1 Responsive to the priority health needs of the population. 2 Sustainable and instrumental to the attainment of universal coverage of health services. 3 Focused on priorities set by the Millennium Development Goals. 4 Responsive to the socio economic and cultural context of the country. 5 Sensitive to issues of equity particularly from the perspective of gender and the needs of. people living in remote and hard to reach areas, 6 Cognisant of the need to protect and promote diversity within the workforce. 7 Consistent with best evidence with reference to the Association of South East Asian. Nations ASEAN and global health policy, 8 Flexible and enabling adaptation to changing circumstances. 9 Developed through wide consultation within and outside the health sector. 4 THE FOUR PILLARS OF THE POLICY, The HRH policy is based on four key pillars in line with the development objectives. 4 1 STRENGTHENING LEADERSHIP AND MANAGEMENT OF HRH. Strengthening of HRH leadership and management capacity at all levels of the health. system is essential for effective performance and transparent governance. The MOH has charged the Department of Medical Science Department of Health and. Department of Health Planning to act as focal points in their respective areas of. responsibility to provide leadership in the implementation of policies and strategic directions. for human resources for health, 4 1 1 Development of policy and plans on human resources for health.
The Department of Medical Science is charged with the responsibility to formulate policy and. monitor all aspects of education and training of the health workforce across the country The. Department of Health Planning is responsible for developing and implementing the HWF. Strategic Plan to guide adjustments in the national workforce size staff distribution staff mix. and staff performance The development of a HRH unit under the MOH will need to include. representatives from all relevant departments It is proposed this new HRH unit should be. called the Health Workforce Management Division HWFM The HWFM should report. directly to the Union Minister of Health to ensure active involvement and mobilization of all. sections of the MOH and beyond It needs to have designated full time staff with adequate. authority and expertise to manage HRH effectively,4 1 2 Human resource management. The MOH through the HWFM in close coordination with the Union Civil Service Board. other Ministries health authorities at Regional and District levels and other agencies and. councils will provide leadership and technical capacity for effective management of human. resources at all levels with particular reference to. a Determining staff requirements types staffing levels and mix. b Reviewing roles allocation of responsibilities delegations accountabilities. c Developing policies to ensure healthy and safe working conditions and environments. d Providing induction training re skilling and supervision support. e Facilitating work teams and supportive networks, f Setting standard performance targets and indicators. g Enhancing management of staff performance including documentation using. standard appraisal templates, h Give incentives and promote staff who have high levels of productivity. i Managing separation and retirement of staff,j Monitoring equal opportunities commitments. k Manage and facilitate information sharing with the private sector in a confidential and. secure manner, 4 1 3 Development of legislation on human resources for health.
The MOH will formulate regulations and laws concerning HRH by. a Compiling an inventory of Health System Legislation policies and guidelines and. analysing for consistency and compliance with the HRH framework. b Drafting modifications of inconsistent legislation policies and guidelines. c Determining where additional supporting legislation policies or guidelines are. required to ensure HRH can provide effective and efficient services and. d Drafting and enacting legislation which clearly delineates the conditions. requirements and mechanisms for the accreditation of training programmes and. licensing of health professionals, e Ensuring that the Health Professions Council is strengthened and adequately. resourced to play a major role in regulating and managing the quality of the health. professions,4 1 4 Monitoring, The MOH will develop and maintain an information system on health personnel to inform. policy and enable effective management of HRH, The MOH will ensure that the HWF strategic plan support the production and employment of. staff required to address public health priorities in the framework of a comprehensive PHC. approach including strategies for,a Maternal mortality reduction. b Improving child survival, c Improving nutrition status and disaster and epidemic preparedness.
The MOH will monitor human resources recruitment deployment career progression and. retention to ensure compliance with the HRH policy directions including commitment to. equity and equal opportunities, The MOH will establish capacity and or commission relevant institutions for the conduct of. operational research concerning HRH issues to support evidence based decision making. The MOH will establish mechanism s that will allow the voices of health sector staff to be. heard on key issues that affect their performance and motivation. 4 1 5 Coordination of national human resource efforts. The MOH will strengthen coordination among all HRH stakeholders and promote their. participation to ensure that HRH development strategies are acceptable feasible and. sustainable In particular the MOH will, a Review the roles of and coordination among authorities with responsibility for policy. formulation and implementation concerning employment of staff and vocational and. higher education in the health sector, b Monitor and regulate the development of health services provided by the private. health sector and ensure that they are well aligned with national health priorities. 4 1 6 Coordination of development partner support, The MOH will coordinate development partner support for HR issues in line with the national. HWF strategic plan, The MOH will ensure that donor support complies with the principles of aid effectiveness.
This requires donor support to be designed from the outset to be. a Focused on the priority activities of the MOH,b Evidence based effective health and health care. c Sustainable after initial development support,d Co ordinated to avoid duplication. e Consistent with operating procedures clinical protocols and reporting. 4 1 7 Duties and responsibilities of the stakeholder units. The proposed Health Workforce Management Division will be designated as the focal point. for the implementation and monitoring of the HRH strategy The performance of this role. entails many responsibilities focused on planning and management of human resource for. health including, Formulating and regularly updating a Strategic Health Workforce Plan. Informing officials at all levels about the Health Workforce Plan. Directing adjustments in the national workforce size staff distribution staff mix and. staff duties and responsibilities mandated by the HWF plan. Regularly updating projections of future national health workforce requirements. Developing and implementing strategies for recruitment and deployment of staff in. remote and hard to reach areas, Developing long term strategies to promote the recruitment and retention of specific. groups to the health workforce candidates from disadvantaged areas who may not. meet recruitment requirements without targeted support. Building capacity for and promoting effective management of human resources in. close coordination with central agencies and health authorities at regional district. and township levels, Contributing to the formulation of regulations and laws concerning HRH by.
o Compiling an inventory of Health System Legislation policies and guidelines. and analysing for consistency and compliance with the HWF strategy. o Determining where additional supporting legislation policies or guidelines are. required to ensure HRH can provide effective and efficient services. Developing and maintaining an information system on health personnel to inform. policy and enable effective management of HRH, Monitoring the implementation of the HRH strategy to ensure that it supports the. production and employment of staff required to address public health priorities with. particular reference to the implementation of strategies that target attainment of the. MDG poverty infant and maternal mortality, Monitoring human resources recruitment deployment career progression and. retention to ensure compliance with the HWF strategy including equal opportunities. commitments, The Department of Medical Science was designated as the focal point for all aspects of. production of the health workforce including oversight and regulation of all education and. training institutions and continuous support for the professional development of managerial. and technical health staff including, Formulate policies and provide strategic direction for the development of health. professional education, Monitor the health services staffing requirements to ensure adequate supply of.
human resources with appropriate competencies and attributes. Maintain and utilize data from the Human Resource Management Information. System concerning professional development and in service training of health. Review changing and emerging duties and responsibilities of health personnel to. ensure relevance of education programs to current requirements. Maintain close liaison with Ministry of Education and other education authorities. concerning policy and operational matters associated with the operation of the. training institutions and programs for the health professions. Review and implement legal frameworks for regulation and monitoring of training. institutions, Cooperate with the Professional Councils in the development of mechanism for. accreditation of training institutions and national licensing exam to verify professional. competence of graduates, Monitor outcomes of institutional accreditation and national exit exam results and. consider strategies to address deficiencies in the future. Monitor and promote complementary contribution of the public and private sectors to. health profession education, Review efficient and effective use of Educational Development resources to promote. quality of education, Monitor development partner collaboration with training institutions and promote. harmonization of efforts in line with MOH priorities. Commission operational studies to inform policy and program implementation for. quality production of the health workforce, Advocate and mobilize support for the development of education institutions and.
programs for the health professions, Monitor the development and use of quality standards for education institutions to. ensure quality of programs efficient use of resources and transparent and effective. management systems, Monitor the strengthening of education and training institutions with particular. reference to,o Curriculum development, o Teacher training and educational development activities. o Availability and use of learning resources and materials. o Institutional arrangements for clinical practice. o Availability and use of clinical settings for learning. o Improvement of school facilities and dormitories. o Acquisition and maintenance of equipment, Monitor and regulate students enrolment into training institutions to ensure intakes. are consistent with service requirements and institutional capacity to provide quality. Formulate long term strategies to promote enrolment in training institutions of. students from rural remote and disadvantaged areas who may not meet entry. requirements without targeted support, Guide the preparation of strategic and operational development plans of training.
institutions to ensure adherence to policy and efficient and equitable allocation of. Monitor and promote development and implementation of in service training program. for professional and technical staff, Overseeing development and implementation of continuing professional development. training programs for senior managers and leaders,4 1 8 Targets for 2012 2016. The priority targets for strengthening leadership and management systems for HRH. Review and adjust Terms of Reference for all the Departments and entities. involved with HRH, Establish a focal point unit department for HRH planning and management in. Review and adjust a legal framework to regulate the production and. deployment of health personnel, Develop leadership and management systems to strengthen planning and. management of HRH at all levels, Develop and maintain Health Personnel Information System.
Develop and maintain tools for the projection of staff production and. recruitment requirement, Review staffing standards and adjust targets based on consultation and. Develop an evaluation and monitoring framework to ensure quality and. effective use of resources, Establish mechanisms for information sharing coordination and consultation. within the Ministry the public sector at large the private sector and. development partners, 4 2 IMPROVING AVAILABILITY OF HUMAN RESOURCES FOR HEALTH. 4 2 1 Workforce size and characteristics, The MOH will determine and implement affordable and sustainable staffing norms that. reflect service requirements and promote effective use of scarce resources within a Primary. Health Care PHC conceptual framework to respond to users needs. The MOH in consultation with health services providers will identify gaps in staffing. according to agreed staff norms and set priorities for resolving imbalances in staff. distribution and skill mix with reference to, a Implementation of essential services based on PHC principles and practices.
b Compliance with the MOH policies concerning roles and functions of health facilities. at all levels of the health system including needs based specialist hospitals. c Consistent with the scope of services of health personnel and laws and regulations.

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