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AFRO Library Cataloguing in Publication Data,Policies and Plans for Human Resources for Health. Guidelines for Countries in the WHO African Region. 1 World Health Organization,2 Human Resources for Health. 3 Health policies,ISBN 92 9 023 104 1XXXX NLM Classification XXXX. WHO Regional Office for Africa 2006, Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of. Protocol 2 of the Universal Copyright Convention All rights reserved Copies of this publication may be obtained from. the Publication and Language Services Unit WHO Regional Office for Africa P O Box 6 Brazzaville Republic of. Congo Tel 47 241 39100 Fax 47 241 39507 E mail afrobooks afro who int Requests for permission to. reproduce or translate this publication whether for sale or for non commercial distribution should be sent to the. same address, The designations employed and the presentation of the material in this publication do not imply the expression of any.
opinion whatsoever on the part of the World Health Organization concerning the legal status of any country territory. city or area or of its authorities or concerning the delimitation of its frontiers or boundaries Dotted lines on maps. represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or. recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in. this publication However the published material is being distributed without warranty of any kind either express or. implied The responsibility for the interpretation and use of the material lies with the reader In no event shall the World. Health Organization or its Regional Office for Africa be liable for damages arising from its use. Printed in,Acknowledgements,Abbreviations,Introduction. Part I Situation Analysis of Human Resources for Health. Chapter 1 Undertaking a Situation Analysis,1 1 Background. 1 2 Process for conducting a situation analysis, 1 3 Proposed outline for a situation analysis report. Part II Policy Development for Human Resources for Health. Chapter 2 Policy Formulation for Human Resources for Health. 2 1 Defining a human resources for health policy,2 2 Objectives and content. 2 3 Financing,2 4 Policy content, 2 5 Proposed process of policy formulation and development.
Part III Developing a Plan for Human Resources for Health. Chapter 3 Developing a Comprehensive Strategic Plan for HRH. 3 1 Introduction,3 2 What and why of an HRH strategic plan. 3 3 Human resources planning approaches methods models and scenarios. 3 4 Education training and development of HRH,3 5 HRH management. 3 6 HRH research at country level,3 7 Components and content of HRH strategic plan. 3 8 Process of development of HRH strategic plan,Chapter 4 Conclusion. References, The Regional Strategy for the Development of Human Resources for Health was.
adopted by the WHO Regional Committee for Africa at its forty eighth session in. 1998 while its acceleration document was adopted at the Committee s fifty. second session in 2002 These were concrete steps taken towards advocating for a. comprehensive approach to the development and implementation of human. resources for health in Member States Interactions with countries have been. continued in order to support a holistic approach However experience has. shown that governments have different kinds of HRH policies strategies and. plans even when they are within the overall context of national health policies. and strategies, This document provides guidance on the process with proposals of content for. three basic HRH documents situation analysis policy and strategic plan. These guidelines are intended for use by Ministry of Health officials responsible. for human resources development as well as others in relevant ministries and. It is hoped that these guidelines will be used for the review and development of. human resource situation analysis policies and plans and will be adapted as. necessary by each Member country in the WHO African Region Further. guidelines on other human resources management tools including human. resources information systems will be shared with Member countries when. Dr Rufaro R Chatora,Former Director, Division of Health Systems and Services Development. WHO Regional Office for Africa,Acknowledgements, These guidelines have been prepared with significant contributions made by. various staff members of the Human Resources for Health Development. Programme in the Division of Health Systems and Services Development. WHO Regional Office for Africa Valuable inputs were also received from. colleagues in other programmes within the division and outside which were. used to enrich the content of this document,Abbreviations. HR human resources,HRD human resource development,HRH human resources for health.
HRHM human resources for health management,HRM human resource management. HRHSP human resources for health strategic plan,HRIS human resource information system. ICU intensive care unit,MoH Ministry of Health,MTEF medium term expenditure framework. NHIS national health information system,NHP national health policy. NHSP national health strategic plan,PRSP Poverty Reduction Strategy Paper.
WHO World Health Organization,WHO HQ World Health Organization headquarters. INTRODUCTION,Human resource development issues, Health work is broadly defined to include not only technical skills and expertise. directly responsible for creating and sustaining health but also the skills needed. in support systems and the linkages that facilitate the application of technical. skills1 The health sector is not only labour intensive but it also depends on a. precise application of the knowledge and skills of its workforce to ensure patient. security and health The World Health Organization WHO continues to. develop tools and guidelines to improve the development and management of. human resources for health HRH in Member countries. The crucial role of HRH in health systems has not been fully appreciated until. recently Many health programmes have consistently experienced shortages of. suitable health personnel as one of the major constraints in not accomplishing. intended objectives This has been noted especially in developing countries. which have the highest disease burden and where the Millennium Development. Goals MDGs seem to be beyond reach It is now accepted that HRH is not only. strategic capital but also the most important resource for the performance of the. health system It is also recognized that HRH is an integral part of the health. system linked with health services provision and performance of health service. providers in a relationship of mutual dependence2,Challenges for the African Region. The WHO African Region seems to have the bulk of the problems in the way of. HRH development and management It faces extreme pressure in major areas. such as producing the required number of key health cadres and utilizing them. and managing them in such a way that they remain motivated to serve in their. respective countries The high turnover of skilled health personnel in the form of. migration and brain drain is the order of the day in many African countries. Some of the pull factors encouraging migration of health workers from their. countries include better remuneration better working conditions opportunities. for postgraduate education and training education for their children and better. standards of living The push factors are the absence of most or all of the. aforementioned pull factors in their home countries However while all this is. WHO 2003 The People Who Work for Our Health Placing Health Workers at the Heart of Health Services Delivery. Division of Health Systems and Services Development Regional Office for Africa. WHO 2002 Human Resources for Health Developing Policy Options for Change Discussion Paper Draft Geneva. generally known by most governments an up to date comprehensive HRH. situation is rarely known and documented in these countries3. While it is acknowledged that most of the problems faced by the countries are. due to limited resources at their disposal the lack of efficient management. systems is also responsible for this situation Thus there are still many things. that can be done to reverse the trend by using the available resources judiciously. such as making an accurate assessment of the HRH situation policy. development and drawing up a comprehensive plan for its implementation. In an attempt to create a regional perspective on human resources for health. development Member States of the WHO African Region adopted the Regional. Strategy for the Development of Human Resources for Health during the forty. eighth session of the WHO Regional Committee for Africa in 19984 Meanwhile. concern about the slow implementation of this strategy was raised As a result. the fifty second session of the Regional Committee in 2002 endorsed a. document for accelerating the implementation of the strategy with i greater. emphasis on consistent implementation of policies and strategies ii relevant. education and training and iii resolving management issues of brain drain and. retention of professional personnel among others at country level5. With human resource issues gaining momentum at the regional and. international levels increased activity is expected at country level However the. challenges highlighted above as well as weak human resource development. departments high turnover and skeletal staff affects the strategic planning and. implementation of HRH development,Status of HRH policies and plans. Most Member countries have human resource policies and plans in one form or. another either as part of national health policy and strategies or as stand alone. documents Their comprehensiveness varies as many of these are not based on. exhaustive situation analysis About half of the countries in the WHO African. Region are reviewing or developing their HRH policies strategies and plans for. more comprehensiveness and thoroughness in order to respond to current. challenges, Planning and implementation have had limited success due to several factors.
which include insufficient balance between the plan and the planning process. Awases M et al 2004 Migration of Health Professionals in Six Countries A Synthesis Report WHO Brazzaville. 4 WHO 1998 Regional strategy for the development of human resources for health Report of the Regional Director. AFR RC 48 10, WHO 2003 Human Resources for Health Accelerating Implementation of the Regional Strategy Report of the Regional Director. AFR RC 52 13, i e how the plan was prepared lack of access to and use of planning methods. and tools suitable for solving problems found in many developing countries lack. of appropriate and accurate data and information such as that related to. workforce supply annual attrition rates private sector data service outputs and. staff productivity low levels of involvement of stakeholders in the planning. process and insufficient advocacy to attract resources for implementation It is. therefore critical that the situation of HRH development in a country is properly. and thoroughly documented as the initial step before drawing up a policy and a. Purpose of guidelines, The aim of these guidelines is to support Member countries in human resource. development assessment of HRH the situation and policy and plan formulation. with a view to achieving a level of comprehensiveness and consistency at. country level The guidelines will discuss the HRH process make situation. analysis and suggest policy and plan development in the context of overall. national health policies and strategies These guidelines explain how to. formulate develop and review the HRH situation policies and plans with the. flexibility necessary for each country This may not be the only way to develop. policies and plans but a good way has been suggested as to how to proceed. Preparation of these guidelines has been influenced by country and regional. experiences gained over a period of time, The primary target group for these guidelines includes HRH managers in. ministries of health and other ministries such as Education Planning and. Finance health facilities and civil or public service agencies dealing with HRH. The three main outputs the situation the policy and the plan though closely. related are distinct so that they will be discussed in three separate sections for. Situation Analysis of Human Resources for Health,UNDERTAKING A SITUATION ANALYSIS.
1 1 Background, In many African countries the current status of health workers in terms of their. numbers and categories patterns of distribution patterns of practice and. attrition rates is not well documented Consequently measures taken to improve. the HRH situation are not necessarily responsive For instance it may be more. prudent to reduce the number of certain basic cadres being trained and instead. focus on reorienting the existing ones to improve their skill levels increasing. their remunerations and improving their motivation and retention. Comprehensive identification description and analysis of the HRH situation are. essential They form the basis upon which a policy or a plan can be developed or. reviewed They also provide a baseline from which measurements can be made. as to whether the situation has improved or not, General health situation analyses do not always contain all the pertinent details. of human resources for health This is due to the fact that many health systems. are still very weak and are yet to pay adequate attention to HRH development. issues especially the strategic management aspects6 However the health. related Millennium Development Goals MDGs have acknowledged that unless. something drastic is done to avert the HRH crisis in Africa it is highly unlikely. that these goals will be attained7 Even without accurate and updated. information being available on health workers by country what is evident is that. there are absolute and relative shortages of health workers in places where they. are needed the most Whether it is scaling up the provision of antiretrovirals. ARVs for HIV AIDS treatment or providing skilled attendants for maternal. services the major challenge is making available suitably qualified staff in. sufficient quantities to support these services, Undertaking and documenting a comprehensive situation analysis for health. workers within the context of service delivery will provide evidence on how the. availability of appropriate quality and quantity of health workers can improve. delivery of health services in the context of the targets set by national health. programmes, Martinez J and Martineau T 1998 Rethinking human resources an agenda for the millennium Health Policy and. Planning Journal Volume 13 4 page 345 348, WHO 2005 Health and the Millennium Development Goals Keep the Promise page 34 Geneva.
Diagram 1 Process for undertaking HRH situation analysis. Set up a multi Assign tasks,sectoral team responsibilities. health finance develop work,public service plan and. education schedule,Planning etc,Update review Collect data and. the HR status information,document from existing,documents and. key informants,Widely Compile and,disseminate the analyse findings.
report and use it into draft report,for developing. policy and plan,Finalise the Obtain feed,report and back from. publish print stakeholders,1 2 Process for conducting a situation analysis. There are some basic steps to be followed when conducting a situation analysis. for human resources for health at country level These are discussed below. Set up a multidisciplinary team, The multidisciplinary team should be intersectoral and should include staff from. the human resources department within MoH and other key stakeholders within. and outside the ministry It should include staff form other ministries such as. Education Finance and Planning as well as accreditation and examination. bodies professional associations public services and training institutions. The chairperson of the team should be a senior person who can provide guidance. on issues to be dealt with in this process The chairperson should also have good. contacts with relevant departments ministries and institutions. Assign tasks and responsibilities, The terms of reference for each task should be clarified and understood by all.
What needs to de done and how and the estimated time frame are necessary to. know Preparatory steps should be discussed Sufficient time and budget for the. exercise need to be provided to allow for a smooth process and timely results. Adequate time and commitment by all team members is necessary to achieve. good results, The team will clarify further the terms of reference assignment of tasks and. deadlines to be set A workplan and schedules are developed at this stage and. suggestions sought and decisions taken on who else could be co opted for. specific tasks and assignments,Collection of data, Identification of what data and information are to be collected and means of. collection and analysis should be determined and agreed upon At times there. may be a need to conduct some rapid surveys due to lack of routine data and. information Some of the possible sources would include the national health. information system national staff databases of public service commission or. Ministry of Planning training institutions accreditation or licensing authorities. survey reports and others A generic tool for data collection is given at Annex 1. which can be adapted in order to generate specific questionnaires to expand on. data collected as explained below,Data and information include. a Demographic profile of the country its geography population education. levels etc, b Political profile on the level of commitment valuing of HRH security and. stability policies affecting human resource availability and performance. c Economic profile on health financing such as proportion of the budget for. health in general and HRH development in particular including the concept. of real wages profile of salaries of health workers and pay related issues and. macroeconomic profiles, d Epidemiological profile listing priority health problems and issues to be.
tackled including essential health packages health priority programmes. e Organization of health system institutional capacity for development and. management of health workers employment status of trained health workers. including that of retired personnel in view of severe shortages of health. f Structure of Ministry of Health strategic planning and implementation of. HRH issues policy and planning education training development. management of HR research and regulation of HRH professionals. g Numbers and profiles of health workers available and gaps identified by. category in the health sector both public and private status of the entire. health sector by category government private non profit and for profit. organizations, h Distribution profile of health workers by category age population. geographical area region province district and health facility vis vis the. set standards, i Planning and production of staff staff projections versus actual numbers. trained current staffing norms and standards practised with reference to. models of projecting staff requirements and workload analysis providing a. rationale and objective base for the estimated number. j Attrition levels brain drain migration public to private sector those. working outside the health sector though trained in health professions etc. k Availability of education training and professional development for key. health cadres public and private training institutions teaching capacities. inservice training and development facilities evaluation and relevance of. training programmes etc The basis on which graduates are trained training. needs assessment plans health system requirements etc. l Availability of HRH information to help in decision making. comprehensiveness of available human resource information system HRIS. its accessibility to users for planning and decision making and the technology. used i e computerized or largely manual and whether it is linked to the main. health information system,Review and analysis of data. Reviewing and analysing data are important steps for accessing documents. available with various departments government agencies as well as private. institutions The existing documentation should be assessed to confirm the HRH. status in the country,Some key documents to be looked for are. a The national health policy document and national health strategic or. development plan which provide the context of HRH some countries have. national development plans that contain portions on health. b Specific documents on HRH policy and planning including availability of. database s on HRH, c Documentation on projections of HRH requirements based on health system.
delivery needs, d Capacities of institutions to train different cadres of health workers. e Distribution patterns of all health and health related cadres throughout the. f Attrition rates by cadre analysed by reason pattern or trends including. geographical biases prevailing in the country such as rural versus urban. g Remuneration packages in public and private sectors due to the nature of the. subject specific names and sources may be omitted to protect confidentiality. h Any other related documentation e g motivation studies if available brain. drain studies evaluation reports of training programmes censuses labour. surveys etc, The contents of the aforementioned documents need to be analysed and gaps if. any in the information identified before going to the next step. Focus group discussions and interviews with key informants. Key informants that need to be interviewed for obtaining further information. should be identified to validate existing information and to complete missing. information and data before analysis A schedule of appointments with. informants should be confirmed Depending on the number of informants to be. interviewed there may be need to divide the group into smaller teams and. strategize an approach to get maximum results For example some informants. can be put on a panel to discuss specific topics Key informants could include. a Senior policy makers and decision makers in Ministry of Health and other. ministries relevant to health trainers of various cadres line managers at. various levels of the health system including health facilities schools and. training colleges all these should include both public and private. stakeholders including religious groups and NGOs, b Professional bodies associations councils etc dealing with certification. examinations licensing ethics and standards, c Community leaders and consumers of services mothers youths elderly. care givers etc, d Health workers from different levels and areas of country.

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