HRH COMMITMENTS

Third Global Forum on Human Resources for Health

10 – 13 November 2013 Recife, Brazil

HRH COMMITMENTS

Rising to the grand challenge of human resources for

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Table of contents

MEMBER STATES _____________________________________________________________________________________________________ 4

AFRO ______________________________________________________________________________________________________________________ 5 BENIN _______________________________________________________________________________________________________________________________ 5 BURKINA FASO _______________________________________________________________________________________________________________________ 11 BURUNDI ___________________________________________________________________________________________________________________________ 15 COTE D’IVOIRE _______________________________________________________________________________________________________________________ 18 ETHIOPIA ___________________________________________________________________________________________________________________________ 23 GHANA _____________________________________________________________________________________________________________________________ 25 GUINEE _____________________________________________________________________________________________________________________________ 26 LIBERIA _____________________________________________________________________________________________________________________________ 30 MALAWI ____________________________________________________________________________________________________________________________ 31 MALI _______________________________________________________________________________________________________________________________ 33 MOÇAMBIQUE _______________________________________________________________________________________________________________________ 35 NIGERIA ____________________________________________________________________________________________________________________________ 37 SENEGAL ____________________________________________________________________________________________________________________________ 42 SOUTH SUDAN _______________________________________________________________________________________________________________________ 45 TANZANIA (Republic of) ________________________________________________________________________________________________________________ 48 TOGO ______________________________________________________________________________________________________________________________ 50 UGANDA ____________________________________________________________________________________________________________________________ 60

EMRO_____________________________________________________________________________________________________________________ 62 AFGHANISTAN _______________________________________________________________________________________________________________________ 62 DJIBOUTI ____________________________________________________________________________________________________________________________ 65 EGYPT ______________________________________________________________________________________________________________________________ 68 Iran (Islamic Republic of) _______________________________________________________________________________________________________________ 71 IRAQ _______________________________________________________________________________________________________________________________ 84 LEBANON ___________________________________________________________________________________________________________________________ 87 LIBYA _______________________________________________________________________________________________________________________________ 91 OMAN ______________________________________________________________________________________________________________________________ 94

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PAKISTAN ___________________________________________________________________________________________________________________________ 96 SOMALIA___________________________________________________________________________________________________________________________ 100 SUDAN ____________________________________________________________________________________________________________________________ 103 YEMEN ____________________________________________________________________________________________________________________________ 106

EURO ____________________________________________________________________________________________________________________ 108 IRELAND ___________________________________________________________________________________________________________________________ 108 REPUBLIC OF MOLDOVA_______________________________________________________________________________________________________________ 111

PAHO ____________________________________________________________________________________________________________________ 113 REPÙBLICA ARGENTINA _______________________________________________________________________________________________________________ 113 BELIZE _____________________________________________________________________________________________________________________________ 134 CHILE _____________________________________________________________________________________________________________________________ 136 COLOMBIA _________________________________________________________________________________________________________________________ 138 ECUADOR __________________________________________________________________________________________________________________________ 139 EL SALVADOR _______________________________________________________________________________________________________________________ 141 GUATEMALA ________________________________________________________________________________________________________________________ 145 HAITI ______________________________________________________________________________________________________________________________ 152 PANAMÁ ___________________________________________________________________________________________________________________________ 156 PARAGUAY _________________________________________________________________________________________________________________________ 158 PERU ______________________________________________________________________________________________________________________________ 160 REPUBLICA DOMINICANA______________________________________________________________________________________________________________ 161 SURINAME Ministry of Health / Diakonessen Hospital _______________________________________________________________________________________ 163 URGUGUAY _________________________________________________________________________________________________________________________ 164

SEARO ___________________________________________________________________________________________________________________ 166 BANGLADESH _______________________________________________________________________________________________________________________ 166 BHUTAN ___________________________________________________________________________________________________________________________ 169 INDONESIA _________________________________________________________________________________________________________________________ 172 MALDIVES __________________________________________________________________________________________________________________________ 175 MYANMAR _________________________________________________________________________________________________________________________ 178 NEPAL _____________________________________________________________________________________________________________________________ 181 SRI LANKA __________________________________________________________________________________________________________________________ 184

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WPRO ___________________________________________________________________________________________________________________ 185 CAMBODIA _________________________________________________________________________________________________________________________ 185

OTHERS INSTITUTIONS ______________________________________________________________________________________________ 188 AEMRN Network (Afro-European Medical and Research Network) _____________________________________________________________________________ 189 AMREF ____________________________________________________________________________________________________________________________ 191 ANSWERS (India) ____________________________________________________________________________________________________________________ 194 CHESTRAD__________________________________________________________________________________________________________________________ 196 College Of Physicians And Surgeons Pakistan ______________________________________________________________________________________________ 198 Community Health Workers ____________________________________________________________________________________________________________ 200 Health Services Academy (HSA), Pakistan _________________________________________________________________________________________________ 204 Health Workers Count ________________________________________________________________________________________________________________ 206 Health Workers For All ________________________________________________________________________________________________________________ 207 Institute for Collaborative Development __________________________________________________________________________________________________ 209 Institut Supérieur En Sciences Infirmières (ISSI)_____________________________________________________________________________________________ 210 International Nurses and Midwives ______________________________________________________________________________________________________ 212 IntraHealth International ______________________________________________________________________________________________________________ 213 International Pharmaceutical Federation (FIP) _____________________________________________________________________________________________ 215 COMISCA __________________________________________________________________________________________________________________________ 219 ORGANISMO ANDINO DE SALUD – CONVENIO HIPOLITO UNANUE _____________________________________________________________________________ 221 UNASUR ___________________________________________________________________________________________________________________________ 223 PALESTINIAN AUTHORITIES ____________________________________________________________________________________________________________ 226 Réseau des sages-femmes francophones / Midwives French Speaking Network: __________________________________________________________________ 230 Save the Children, India _______________________________________________________________________________________________________________ 240 SWASTI ____________________________________________________________________________________________________________________________ 242 Tanzanian Training Centre For International Health _________________________________________________________________________________________ 243 The Voices Of Women Health Workers In India _____________________________________________________________________________________________ 244 THET ______________________________________________________________________________________________________________________________ 248 UN RC, KUWAIT _____________________________________________________________________________________________________________________ 252 WONCA WORKING PARTY ON RURAL PRACTICE ____________________________________________________________________________________________ 254 WORLD VISION INTERNATIONAL ________________________________________________________________________________________________________ 255

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MEMBER STATES

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Voies d’engagements en matière de RHS BENIN

1) Quelles sont les actions – voies en matière de ressources humaines pour la santé (RHS) sur lesquels votre pays/institution peut s’engager?

Les femmes au Bénin courent plus le risque de décéder entre 15 et 49 ans, en raison de la mortalité maternelle liée aux complications de l’accouchement1. Chaque jour environ 4 femmes meurent des complications de la grossesse, de l’accouchement et des suites de couches. La mortalité néonatale stagne autour de 38 décès pour 1.000 naissances vivantes depuis plusieurs décennies2. Le ratio de mortalité infantile publié en 2006 était 32 pour mille enfants3.

Afin d’améliorer la couverture des soins et par ricochet les indicateurs de santé, le Bénin adhère à l’aspiration d’une couverture universelle en santé (CUS). Le gouvernement du Bénin a engagé le processus de mise en œuvre du Régime d’Assurance Maladie Universelle (RAMU) dans le but d’améliorer l’accessibilité financière des populations. En même temps, le Financement Basé sur les Résultats (FBR) a été adopté dans le cadre de la mise en œuvre d’une gestion axée sur les résultats et un renforcement de la performance du système sanitaire.

Les ressources humaines de la santé (RHS) disponibles et accessibles sur tout le territoire sont une condition nécessaire pour offrir des services de santé de qualité à la population et pour assurer une couverture sanitaire universelle pour la population. L’atteinte de l’objectif d’extension de la couverture de la population, des services offerts et d’amélioration de leur qualité dépend en réalité, dans une large mesure des RHS qui sont disponibles et géographiquement accessibles, et qui répondent mieux aux souhaits, besoins et demande des populations, en fournissant des services acceptables et d’une bonne qualité. Des mesures rigoureuses doivent être prises pour améliorer la situation des RHS afin d’avancer vers une CUS et assurer une offre en adéquation avec les besoins de la population. Il s’agit d’un investissement: les personnels de santé4 sont le moyen à travers lequel il est possible d’atteindre une CUS.

Les RHS figurent en bonne place dans les divers documents d’orientation, de politiques et de stratégies de développement au Bénin tels que les Objectifs du Millénaire pour le Développement (OMD), les Orientations Stratégiques de Développement du Bénin, ainsi que le Plan National de Développement Sanitaire (PNDS), et le Plan Stratégique de Développement des Ressources Humaines du Secteur Santé (PSDRHSS) qui couvre une période de dix ans (2009-2018). Ce dernier document est en cours d’être traduit dans un plan triennal d'action 2014-2016 de développement des ressources humaines du secteur sante (PTDRHS).

L’engagement

Afin de commencer l’opérationnalisation du Plan Triennal de Développement des RHS et de mettre en œuvre des interventions à haut impact en rapport avec la disponibilité, l’accessibilité, l’acceptabilité et la qualité des RHSMNI, le Ministère de la Santé au Bénin s’engage à organiser un Forum National avec tous les Ministères, parties prenantes et partenaires clés, pour aborder un dialogue politique de haut niveau en vue d’une sélection des activités concrètes, chiffrées, faisables sur le plan économique, politique, socio-culturel et institutionnel, et à haut impact pour améliorer la disponibilité, l’accessibilité, l’acceptabilité et la qualité des RHSMNI et afin d’atteindre les aspirations d’une extension de la couverture de la population et de réduire la mortalité maternelle, infantile et néonatale au 1 Profil en ressources humaines en santé, mars 2011. 2 Evaluation des besoins en soins obstétricaux et néonatals d’urgence au Bénin, septembre 2011. 3 Enquête Démographique et de Santé, 20006. 4Y compris l’organisation les systèmes dans lesquels ils fonctionnent, de façon qu’ils sont disponibles en quantité et qualité suffisantes, et qu’ils sont motivés d’être performants.

AFRO

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Bénin. L’engagement du Gouvernement est que ces politiques, une fois acceptées, seront mises en œuvre afin que les RHS soient allouées de façon plus équitable sur toute l’étendue du territoire national.

Les propositions

En plus des activités en cours, comme le lancement d’un recrutement de 1012 prestataires en octobre 2013 et les activités de mis à l’échelle du FBR, le Ministère de la Santé propose aux parties prenantes, acteurs et partenaires dans le domaine de la santé maternelle et infantile ; la CUS ; les RHS ; et le FBR les interventions suivantes:

- Amélioration de la disponibilité

A1. Recrutement des RHSMNI en 2014 et 2015

Bien que le Gouvernement du Bénin ait entrepris assez d’efforts pour augmenter le recrutement des RHS, par exemple à travers les recrutements des agents sur les fonds mesures sociales et le recrutement de 1012 Agents Permanents de l’Etat en octobre 2013, l’effectif en RHSMNI qualifiées n’évolue pas au même rythme que la croissance de la population.

Un recrutement d’au moins 775 RHSMNI jusqu’en 2018 par an sera nécessaire pour assurer une évolution de l’effectif à la mesure de l’évolution de la population, mais il faudra ajouter en plus le recrutement de 1602 sages-femmes (SF), 1547 infirmiers diplômés d’Etat (IDE), 467 médecins généralistes (MG), 112 gynécologues (GYN) et 145 pédiatres (PED) pour combler le gap en personnel qualifié. La proposition est de recruter en 2014 350 SF, 300 IDE, 100 MG, 15 GYN et 15 PED et en 2015 200 SF, 200 IDE, 50 MG, 10 GYN et 10 PED, soit par un recrutement annuel de 625 RHSMNI. Cela réduira l’écart entre l’offre et les besoins de 50% en zone rural et va couter 2 043 296 051 francs CFA

A2. Reconversion des aides-soignantes (AS) et infirmiers brevetés (IB) en infirmiers diplômés d’Etat / sages-femmes (IDE/SF) à travers le concours professionnel

Les ressources financières pour les RHSMNI travaillant dans le secteur public sont limitées par un plafond du budget de l’Etat pour les fonctionnaires de l’Etat (un plafond de 35% a été convenu entre les gouvernements de l’UEMOA). Pour cette raison-là, il est prévu que les possibilités pour augmenter le recrutement des agents de l’Etat seront limitées et qu’il sera nécessaire d’entreprendre des mesures additionnelles pour combler l’écart entre l’offre et les besoins en RHSMNI. Le Bénin possède actuellement un effectif de presque 6,000 aides-soignantes (AS), dont 2030 Agents Permanent de l’Etat - APE et d’environ 1,500 infirmiers brevetés (IB), dont 388 APE. Ces catégories professionnelles ne sont pas considérées comme « personnel qualifié », mais en raison de la pénurie en RHSMNI, ils fournissent le paquet de services à la population cible au niveau de base de la pyramide sanitaire (certaines maternités des zones défavorisées gérer par des AS). il est proposé d’assurer une reconversion d’AS et d’IB en IDE/SF sur la base des critères relatifs au niveau de formation initiale et aux expériences à travers le concours professionnel. Par an, 125 AS et IB pourraient devenir des contractuels sur poste après une formation de courte durée : 3 mois de formation théorique et 9 mois de stage pratique, à l’issu d’un test de sélection. Cette expérience a déjà été menée en 2005..Actuellement les IB ont le droit de devenir IDE/SF selon les textes existants, ce qui n’est pas le cas pour les AS. Cela réduira l’écart entre l’offre et les besoins de 4%. Quant aux couts, il s’agit : (i) une augmentation de la charge salariale annuelle de 15 495 375 francs CFA; (ii) les coûts liées à l’amélioration

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de la capacité d’accueil des institutions de formation (sous la coordination de l’INMES) ; et (iii) les couts de formation des AS/IB.

A3. Contractualisation de 154 prestataires qualifiées par les collectivités, avec le Fonds d’Appui au Développement des Communes (FADeC) et l’implication des mairies par une agence autonome

Le Fonds d’Appui au Développement des Communes (FADeC) est un mécanisme budgétaire d’allocation de dotations de fonctionnement et d’investissement au profit des communes. L’intervention proposée est de stimuler les collectivités à recruter des sages-femmes (SF), infirmiers diplômes d’Etat (IDE), médecins généralistes (MG), techniciens de laboratoire (TL), anesthésistes-réanimateurs (AR) (jeunes sans emploi ou retraités) à travers le « recrutement des prestataires » financé par les fonds FADeC. L’implication d’une agence indépendante (comme l’Agence Nationale de Promotion de l'Emploi, ANPE) est recommandée pour appuyer les Communes dans la gestion de contrats et afin d’éviter des problèmes de reversement et les pressions syndicalistes. Les mairies seront responsables du recrutement de la compétence des nouvelles recrues à leur poste de travail. Cela réduira l’écart entre l’offre et les besoins de 4,25%. Quant aux couts, il s’agit : (i) les salaires payés à travers les fonds FADeC – 203 351 500 francs CFA ; (ii) les couts liées aux services fournit par l’agence autonome – 24 000 000 francs CFA; (iii) les couts pour un renforcement des compétences des mairies – 69 300 000 francs CFA.

- Amélioration de l’accessibilité des RHSMNI dans les zones défavorisées

B1. Introduire dans les zones pilotes « Financement Basé sur les Résultats » (FBR) une différenciation des paiements et les motivations non-financières basées sur les résultats (formation, responsabilisation) pour les zones défavorisées.

Actuellement le Gouvernement béninois est en train de réaliser une couverture totale du pays pour l’approche FBR dans le cadre de la plate-forme RSS et avec l’appui de la Banque Mondiale (BM), de la Coopération Technique Belge (CTB), le Fonds Mondial, et UNICEF. Un des risques est que les résultats (en particulier une amélioration de la quantité des services fournis) soient plus faciles à atteindre dans les zones urbaines, ce qui pourrait rendre les zones urbaines encore plus attrayantes.la conséquence d’une telle situation sera l’augmentation du déséquilibre dans la répartition des RHSMNI entre les milieux urbains et ruraux. Or, dans le contexte actuel, en 2014, le Bénin connaitra :

- une insuffisance de 1,600 SFE, dont 1,500 dans les zones rurales ; - une insuffisance de 1,500 IDE, dont 1,400 dans les zones rurales ; - une insuffisance de 470 MG, dont 320 dans les zones rurales ; - une insuffisance de 110 GYN, dont 100 dans les zones rurales ; - une insuffisance de 150 PED, dont 90 dans les zones rurales.

L’approche FBR, à travers une différenciation des paiements par résultat (prix unitaires) et les motivations non-financières basées sur les résultats (formation, responsabilisation, gestion de carrière) pour les zones défavorisées a un grand potentiel pour attirer et fidéliser les prestataires en zones défavorisées afin de réduire le déséquilibre énorme entre la couverture des besoins en RHSMNI dans les zones urbaines et rurales/ défavorisées. Il s’agit de définir des zones défavorisées et de développer un paquet incitatif pour les RHS travaillant sur la base de FBR dans les zones desservies avec bon rapport coûts/impact/efficacité, basé sur les preuves

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B2. Définir un paquet incitatif pour les RHS dans les zones desservies avec bon rapport couts/impact/efficacité, basé sur les preuves.

Il s’agit d’une étude au niveau opérationnel sur ce qui (de)motive le plus (si une telle étude n’est pas encore menée). De cette façon on peut définir un paquet incitatif pour les RHS dans les zones desservies avec bon rapport couts/impact/efficacité, basé sur les preuves. Le paquet pourrait contenir par exemple un logement ; une garantie de l’Etat pour la banque pour acheter une maison ; l’électricité à la maison; un téléphone et/ ou connexion Internet ; une prime d'éloignement ; un moyen de déplacement ; une promotion ; une formation diplômante ou une passerelle après 5 ans de service dans une zone défavorisée – selon les ressources disponibles et selon une estimation du rapport entre couts et efficacité. Les RHS auront accès à ce paquet selon leur performance : l’appréciation de la performance leur donnera un nombre de points de crédits (par exemple, le temps séjourné dans des endroits défavorisés) : ceux avec le nombre majeur de crédits auront droit au paquet.

B3. Prioriser dans la détermination des besoins en formation les agents exerçant en milieux défavorisés pour les offres de bourses.

Dans la détermination des besoins en formation, offre 30% des bourses aux SF, IDE, MG, GYN et PED exerçant en milieux défavorisés entre 2014 et 2019 afin d’attirer et fidéliser plus de SF, IDE, MG, GYN et PED en zones défavorisées.

B4. Installer un marketing social pour sensibiliser les sages-femmes (SF) et les infirmiers diplômés d’Etat (IDE) en vue de leur faire bénéficier la prime de responsabilité existant selon les responsabilités au poste.

Les postes de responsabilité sont plus accessibles dans les zones rurales, où les IDE et SF ont plus de chance de devenir chef de poste dans les centres de santé ou la responsable d’une maternité. Le but est de sensibiliser 100% des IDE et SF entre 2014-2019 afin d’attirer 800 IDE et 775 SF aux zones défavorisées.

- Amélioration de l’acceptabilité

C1. Utiliser le FBR pour améliorer l’acceptabilité et la qualité des services fournis par les RHSMNI.

Dans les zones FBR, (i) mettre l'accent sur les résultats en qualité plus que sur la quantité; (ii) installer un carnet de score de qualité de soins, base sur les résultats en qualité de soins (par exemple l’adhésion sur les protocoles ou normes professionnelles); (iii) fournir un rôle décisionnel aux représentants du coté demande afin d’améliorer la redevabilité sur les résultats des prestataires et afin de rendre les prestataires plus répondant aux souhaits, besoins et la demande des populations (p.ex. dans la vérification ou contre-vérification des résultats ou dans la contractualisation des prestataires).

- Amélioration de la qualité

D1. Rationaliser et systématiser la formation continue et recyclage du personnel et l’utiliser comme condition pour l’avancement de carrière.

Définir les besoins en formation continue et recyclage en utilisant une bonne base de données (système de suivi et d'information RHS) base sur la performance et / ou un bilan de besoins des compétences. Impliquer les associations et ordres dans la formulation des besoins en formation et assurer un suivi des formations reçus par les prestataires. Il faut assurer une planification de la formation de bas en haut et un financement à travers un panier de fonds

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(avec les fonds du niveau national, des partenaires et des programmes prioritaires) pour la formation continue au niveau de zone sanitaire afin d’assurer que la formation s’accorde avec les besoins

- Transversaux

E1. Appuyer le fonctionnement de l'observatoire des ressources humaines en santé

Afin d’assurer le développement des stratégies et des décisions basées sur des preuves, il faut appuyer le fonctionnement du nouvel observatoire des ressources humaines en santé dans la collecte, traitement, analyse et diffusion de l'information, en vue d'utilisation de l’information comme outil dans la gestion des RHS. Les informations à collecter comprennent par exemple (i) une cartographie des besoins en RHSMNI par département ; (ii) une analyse continue du marché de travail ; (iii) l’effet du FBR sur l’accessibilité, l’acceptabilité et la qualité des RHSMNI ; (iv) une système de « crédits » basé sur la performance et années de services dans des zones desservies ; et (v) un agenda de recherche pour une évaluation des mesures prises (tableau de bord, évaluation de l’impact). Cet renforcement va couter 30,000,000 FCFA par an entre 2014-2016 (un système d’information en RHS – SIRHS – amélioré et dynamisé pour assurer que l’information nécessaire pour la gestion des RHS est actualisée à chaque moment).

2) Comment allez-vous assurer le suivi des progrès vers l’achèvement de vos engagements ? (Quels indicateurs allez-vous suivre? Quelles sources de données allez-vous utiliser)?

1. Plan de plaidoyer prêt en novembre 2013. Source : DRH.

2. Brefs rapports des visites de plaidoyer, y compris le contenu des discussions et les implications pour les interventions faisables. Source : DRH.

3. Organisation du Forum National en janvier 2014 dans lequel les partenaires se mettront d’accord sur un paquet d’interventions. Source : DRH.

4. Rapport du Forum National avec : - une sélection de stratégies retenues

- les coûts et la provenance des financements pour la mise en œuvre

- les responsables et plan d’activités par intervention

- l’agenda et la méthodologie pour une l’évaluation

- les indicateurs, par exemple :

o un recrutement d’au moins 775 par an ; o un recrutement en 2014 de 780 RHSMNI soit 350 SF, 300 IDE, 100 MG, 15 GYN, 15 PED

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o un recrutement en 2015 de 470 RHSMNI soit 200 SF, 200 IDE, 50 MG, 10 GYN, 10 PED o une reconversion de 125 AS et IB en IDE/SF par à travers le concours professionnel entre 2015 et 2019 o une contractualisation de 154 prestataires qualifiés par les collectivités entre 2015 et 2019 o une réduction de nombre de formations sanitaires sans un minimum de RHS de 45% à 90% o Une fidélisation d'au moins 58% des IB/AS reconverti dans les zones rurales pour une période d'au moins 3 ans entre 2015 et 2019 o Une stabilisation de 60% des agents dans les zones rurales pour une période d'au moins 5 ans entre 2015 et 2019 o une réduction des absences au poste de 30% à 10% dans les zones rurales o une amélioration de la qualité des services fournis à travers le FBR dans les zones rurales de 30% à 50% (moyenne nationale) o une amélioration de la quantité des services fournis à travers le FBR dans les zones rurales de 59,8% à 80% o une amélioration de l’acceptabilité des soins fournis à travers le FBR par les personnels qualifiés dans les zones rurales de 59,8% à 70% o Un plan de suivi et évaluation de la mise en œuvre des décisions prises lors du Forum National

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Voies d’engagements en matière de RHS BURKINA FASO


Le Ministère de la Santé du Burkina Faso a développé le Plan National de Développement Sanitaire 2011-2020, dans lequel les objectifs principaux concernent la santé maternelle, néonatale et infantile. Le plan vise la réduction du taux de mortalité des enfants < 5 ans de 184 pour 1000 naissances vivantes à 54,69 pour 1000 en 2020 ; la réduction du ratio de mortalité maternelle de 484 pour 100 000 NV à 242 pour 100 000 NV en 202 ; la réduction du taux de mortalité néonatale de 31 pour 1000 à 9,16 pour 1000 en 2020 ; et le taux de malnutrition chronique chez les enfants < 5 ans passerait de 29% en 2011 à 23% en 2020.

Afin d’atteindre ces objectifs et assurer une couverture universelle, la disponibilité des agents sanitaires avec des compétences adéquates pour fournir des services de qualité dans tout le pays est essentielle, y compris dans les zones démunies où la plupart de la population vit. Actuellement au Burkina Faso il y a 12 emplois qui fournissent des services en santé maternelle, néonatale et infantile (SMNI), dont 2 emplois ne sont plus inclut dans le recrutement et la formation à partir de 2018, à savoir les Accoucheuses Auxiliaires (AA) et les Infirmiers Brevetés (IB). La politique du Burkina Faso est d’assurer qu’il y a suffisamment des CSPS avec du personnel compétent dans le pays, et que dans tous les districts, il y a des Center Médicaux(CM)- 305 CSPS sont prévus d’être transformés en CM et la gouvernement prévoit que les services SMNI sont fournis par des Sages-Femmes, des Infirmiers d’Etat et les Médecins. Les Accoucheuses Auxiliaires seront remplacées au fur et à mesure par un emploi « transitionnelle » : les Accoucheuses Brevetés (AB) ; en 2013 il y a 200 AB, dont 93 dans les zones rurales. En 2013, le Burkina Faso avait un total de 12.963 agents sanitaires responsable pour les services maternelle, néonatale et infantile, dont la plupart était les AA, lB et Agents Itinérant de Santé. Le dernier emploi a relativement peu de responsabilité en SMNI. En moyen, il y a 1.334 recrutements par an, et surtout les IDE (en moyen 526 par an) et les SF (en moyen 373 par an) sont recrutés pour assurer la couverture universelle. Les projections ont montré que pour les SMNI avec une couverture de 85%-100% des SMNI, l’écart le plus grand des agents sanitaires entre offre et besoin (2013) est dans les districts ruraux 4 régions : le Sahel (offre 2013 : 291, besoin : 941), le Centre-Nord (offre 2013: 374, besoin : 1048), l’Est (offre 2013 : 434, besoin : 1168)et le Boucle du Mouhoun (offre 2013 : 677, besoin : 1183).

Il y a un nombre important des Sages-femmes (offre urbain : 310, besoin urbain : 393, rural offre : 64, besoin rural : 58) et IDE (offre : 409, besoin urbain : 257, offre rural 296, besoin rural : 65) dans la région Centre, y compris le capital de Ouagadougou.

Partout dans le pays il y a un surplus des IDE (offre 2013: 3.524, besoin : 3.976) sauf dans le Sahel rural (offre 2013 : 74, besoin: 305), et une manque des Sages-femmes (offre 2013 est de 1.624, besoin 3.825). En plus, il y a un manque des médecins généralistes (MG) dans les zones démunies (offre en 2013 : 28 et besoin : 560) ; il y a 278 MG qui sont formés toutes les années, dont 84 sont recrutés, qui travaillent surtout dans les zones urbaines. Egalement, le pays manques des pédiatres (offre 2013 : 36, besoin : 190) et des gynécologues (offre 2013 : 60, besoins : 122). Afin d’assurer une meilleures disponibilité et répartition des emplois pour les services SMNI, le Burkina Faso a développé des stratégies afin de combler l’écart entre offre et besoin. Ces stratégies seront l’objet de plaidoyer afin d’assurer la disponibilité des ressources pour leur mises en œuvre. Ces stratégies sont planifiées pour 2 zones les plus démunies en vue de l’étendre aux autres régions le plus démunie et selon des résultats de suivi de la mise en œuvre :

Engagement 1 : Augmenter l’effectif

AFRO

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Le Gouvernement du Burkina Faso s’engage à augmenter le nombre des agents sanitaires pour assurer des services SMNI à travers l’amélioration la capacité et la qualité de la formation initiale des Accoucheuses Brevetées (AB), des Sage Femmes (SF), Infirmiers d’ Etat (IDE) et des Médecins Généralistes (MG) :

1- Révision des curricula de formation des médecins, des AB, SF/ME et des IDE

2- Former (3 ans) et recruter 100 SF/ME additionnelles par an à partir de 2015 pour une période de 10 ans, à l’issu de concours direct

- affectation directe de 20 diplômés SF au Sahel (10) et à l’Est (10) par an à mettre à la disposition des communes sur engagement

3- Formation de 100 AB à SF par an à partir de 2017 par concours professionnel

- A partir de 2020 former 20 AB de Sahel (10) et AB (10) d’Est par (AA formées en AB / diplôme 2016 avec 3 ans expérience) en SF pendant 2 ans

4- Formation (2 ans) de 250 AA à AB par an à partir de 2015 pour une période de 10 ans par concours professionnel

- Parmi ces 250 AA, recrutement annuel sur concours professionnel de 20 professionnels AA du Sahel et 20 de l’Est à former en AB pour servir en

retour dans ces zones à partir de 2015

5- Développer une filière pour former des AB : 100 SF (100 Tenkodogo/Fada), 40 IDE et 100 AB (Fada) disponible en 2016

6- Etablir un partenariat entre publique et privée par donner des bourses de l’état pour former 50 AB dans les écoles privées

7- Augmenter des bourses cibles de 15 à 20, pour gynécologues et pédiatres par concours professionnel-

8- Mettre en place un mécanisme de suivi de la qualité de formation dans les écoles publiques et privées

Engagement 2 : Améliorer la répartition des effectifs en zones rurales

1- Le Gouvernement du Burkina Faso s’engage à rendre plus accessible les services de santé maternelle néonatale et infantile dans les zones les plus

démunies :

- Recrutement direct des 60 MG additionnelle par an pour le milieu rurale, avec des mesures d’accompagnement pour tous les MG en milieu rural

(28+180 pour 2015-2017) en commençant par 2 régions (Sahel et Est) à étendre pour Boucle du Mouhoun et Centre-Nord

2- Recrutement annuel sur concours professionnel de 20 professionnels IB des zones démunies à former en IDE pendant 2 ans pour servir comme IDE

dans ces zones

3- Doter les AB, IDE, SF travaillant dans les formations sanitaires les plus démunies des logements (SF/IDE/MG), des panneaux solaires, accès à l’internet

(MG) et antenne parabolique pour les formations sanitaires

4- Elaboration et mise en œuvre de plans de carrière des agents sanitaires

Engagement 3 : Assurer la qualité de prestations des services

Le Gouvernement du Burkina Faso s’engage à améliorer la qualité de services de SMNI dans les formations sanitaires au travers de :

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1- Réduire l’absentéisme et augmenter la qualité de services fournis par les agents sanitaires en rendant systématique les visites de l’inspection, suivi et

supervision formative par trimestre par les équipes cadres du district et des régions (MS, Ordres)

2- Intégrer dans la formation initiale et continue les codes d’éthique et de déontologie et suivre l’adhérence aux codes lors des visites de l’inspection

3- Mobilisation des ressources pour la mise en œuvre de plans de formation continue des IDE, SF/ME et des médecins en SONUC, SONUB, PCiME, TETU


Engagement 1

- % curricula de formation révisées/ nombre planifié

Source : rapport des ateliers de révisions des curricula- les curricula IDE, AB, SF et MG

- % des SF/ME formées et recrutées annuellement (sur 100 planifiés)

Sources : PV des délibérations, examens des fins des cycles, des décisions d’engagement, note d’affectation

- % des bourses de l’état données aux écoles privées annuellement pour former des AB (sur 50 bourses planifiés)

Sources : convention de partenariat pour la formation entre MS et écoles privées, attestations des institutions,

- % des écoles de publiques et privées avec des formations de qualité selon les normes du Ministère de Santé

Source : rapport des inspections pédagogique

- % des effectifs de SF et des AB disponibles pour les zones démunies avec des compétences adéquates par rapport aux effectifs de 2013.

Sources : Système d’information de la DRH (annuellement, en 2016) ; Système d’information de la DRH

Engagement 2

- % SF, IDE et MG affectés annuellement aux zones les plus démunies et mise à la disposition des communes sur engagement

Sources : décision et notes d’affectation et certificats de pris de services

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- % des professionnels IB dans les zones démunies formés en IDE et retournés annuellement dans les zones démunies (sur 40 planifié annuellement)

Sources : communiqué d’admission au concours professionnel, arrêtés de mise en position de stage

- % des logements construits avec les commodités dans les zones les plus démunies (sur le nombre planifié)

Sources : PV de réception des logements, des inventaires annuels

- Les plans de carrière des tous les différents emplois sont disponibles, communiqués et mise en œuvre

Sources : documents de plan de carrière

- % des effectifs de SF et des AB présents dans les zones les plus démunies par rapport aux effectifs de 2013.

Source : Système d’information de la DRH (annuellement, en 2016 )

- % des AB, SF, IDE et MG affectés dans les zones les plus démunies fidélisés pour une période de 5 ans

Source : rapport annuel de la DRH

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Voies d’engagements en matière de RHS BURUNDI


PLAN DE MISE EN ŒUVRE DES ENGAGEMENTS RHS 2013-2017 AU BURUNDI Stratégie 1 : En s’appuyant sur le pouvoir normatif et régulateur de l’Etat, généraliser la réforme du système de formation des RHS vers une production en adéquation avec les besoins

prioritaires du pays et les normes de qualité et d’éthique.

OBJECTIF RESULTAT ATTENDU RESPONSABLES CHRONOGRAMME INDICATEURS FINANCEMENT 2014 2015 2016 2017 2018 USD

1.1. Organiser un Forum nationale des parties prenantes sur la problématique des RHS et créer un cadre formel de dialogue permanent.

1.1.1. Le Forum nationale des parties prenantes sur la problématique des RHS est tenu

MSPLS

Rapport avec des recommandations disponible

30 000

1.1.2. Le Cadre de concertation des parties prenantes pour les RHS est créé et fonctionnel

MSPLS Parties prenantes

Acte de création disponible. Une réunion annuelle tenue.

10 000

1.2. Compléter/actualiser et appliquer les Normes / Référentiels et les outils de pilotage du développement des RHS

1.2.1. Les Normes et référentiels sont disponibles et appliquées à tous les niveaux de l’appareil de production des RHS

MSPLS, Ecoles de formation Parties prenantes

100% des Institutions de formation des RHS appliquent les normes

150 000

1.2.2. Le Plan national de formation initiale et continue est élaboré. MSPLS, MESRS Plan disponible et diffusé 40 000

1.2.3. Le Plan de gestion prévisionnelle des effectifs est élaboré MSPLS Plan disponible et diffusé 40 000

1.2.4. Le mécanisme de régulation est créé et fonctionne. MSPLS, MESRS 1 inspection/an réalisée dans 1/3 des Ecoles publiques/ privées

130 000

1.3. Organiser prioritairement la formation initiale ou continue des catégories de personnel insuffisants ou quasi inexistants et pourtant essentiels pour l’atteinte des objectifs du PNDS II

1.3.1. Le plan de formation en urgence des RHS essentiels y compris les profils polyvalents pour la réalisation du PNDS est élaboré.

MSPLS Ecoles de formation Parties prenantes

Le plan de formation disponible

40 000

1.3.2. Les Ecoles de formation des RHS ont mis la production en adéquation avec les besoins du pays

Ecoles de formation des RHS

100% des Ecoles publiques et au moins 50% des Ecoles privées ayant ajusté leurs priorités

1.3.3. Les formations pour le rehaussement de compétences des profils essentiels (Médecins avec compétence chirurgicales, sages-femmes, infirmiers anesthésistes….) ont démarré

MSPLS Ecoles de formation

Chaque année, à partir de 2015, au moins 15% des besoins prioritaires commencent à être couverts

2 000 000

1.3.4. Former les ECD au management du district MSPLS, MESRS, PTF Nombre de district doté d’une

ECD formé au management 200 000

1.3.5. Un programme de formation, au Burundi et à l’étranger, d’au moins 15 médecins spécialistes/an dans les disciplines prioritaires est engagé

MSPLS, MESRS, PTF

Nombre de spécialistes recrutés/an dans le secteur public

4 200 000

1.3.6. Des dispositions règlementaires concernant le recrutement international des lauréats formés aux frais de l’état sont mises en place.

MSPLS, MESRS % des lauréats formés à

l’étranger qui retournent au Burundi

PM

AFRO

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Stratégie 2 : Améliorer l’acceptabilité des prestations de services par une meilleure application des règles d’éthique et de déontologie

2.1 Renforcer la formation et redynamiser les institutions de surveillance de l’éthique et déontologie

2.1. Le Code de santé et d’éthique et le Code de déontologie actualisés sont pris en compte dans les programmes de formation des RHS

MSPLS, MESRS Ecoles de formation

• Textes disponibles • 100% des Institutions de

formation enseignent le contenu du code de santé dans leur programme

60 000

2.2. Les organes de contrôle de l’éthique et déontologie sont tous en place et fonctionnent

MSPLS, Ordres professionnels

Nombres de sanction prises/an 40 000

Stratégie 3 : Améliorer la répartition des professionnels de santé entre les différentes zones du pays pour garantir un accès équitable aux prestations de services essentielles.

3.1. Accorder la priorité au recrutement et à l’affectation selon les normes, des profils essentiels pour réaliser les objectifs prioritaires.

3.1.1. A travers une augmentation de l’enveloppe ou à défaut dans les limites de l’enveloppe allouée, le déficit des RHS essentiels pour la réalisation des objectifs prioritaires est réduit.

MSPLS, MF, PTF, MFP

Réduction annuelle de 15%, du déficit en RHS essentiels

Cf 1.3.3 et 1.3.4

3.1.2. A travers le redéploiement et l’affectation selon les normes des RHS recrutés, le déséquilibre entre les zones urbaines et rurales est réduit.

MSPLS, Chaque année, 25% des DS

défavorisés sont de RHS essentiels selon les normes

PM

3.2. Evaluer et renforcer le soutien financier à la gratuité des services pour les femmes enceinte et enfants de moins de 5 ans et au Financement Basé sur la Performance.

3.2.1. Les effets du Financement basé sur les performances, en termes d’amélioration de l’accessibilité et de la qualité des prestations, sont évalués

MSPLS, MF, PTF

Rapport d’évaluation 40 000

3.2.2. Le FBP est étendu à tous les niveaux de la pyramide sanitaire et soutenu par toutes les parties prenantes

MSPLS, MF, PTF, MFP

Rapport annuel d’évaluation de

l’accessibilité et de la qualité FBP

3.3. Améliorer la performance et la stabilité des RHS dans tout le pays et en particulier dans les zones reculées

3.3.1. Le plan de carrière pour tous les profils est élaboré et mis en application MSPLS, MFP Plan de carrière appliqué 40 000

3.3.2 Des incitatifs monétaires et non monétaires (Bonus qualité, Hébergement de fonction, contrat d’engagement, scolarité des enfants, formation) sont étudiés et mis en place.

MSPLS, MF, PTF, MFP

Chaque année, au moins 15% des districts de santé de santé, dotés de RHS selon les normes

Evaluation non disponible

3.3.3. Les performances des RHS sont évaluées grâce à un outil adapté.

Outil d’évaluation de performances disponible 40 000

Stratégie 4 : Renforcer le système de gestion des RHS pour mieux orienter le secteur

4.1. Renforcer la capacité de gestion des RHS.

4.1.1. La capacité de gestion des RHS est renforcée par un rehaussement de compétences MSPLS, MESRS

Au moins dix cadres ont une formation en gestion des ressources humaines

300 000

4.1.2. La DRH/MSPLS est doté d’un support informatique moderne capable d’héberger une base de données à jour accessible en temps réel aux parties prenantes.

MSPLS, PTF

• Ordinateurs et logiciels • Informaticien recruté • Site web opérationnel

100 000

4.2. Rendre fonctionnel 4.2.1. Le Comité consultatif, le Comité technique et le MSPLS, Parties Rapport de réunions 40 000

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l’Observatoire Nationale des RHS

Secrétariat de l’ONRHS fonctionnent selon la mission leur assignée

prenantes

4.2.2. Le profil des RHS actualisé est disponible MSPLS Profil des RHS publié 1 fois/2

ans 50 000

4.2.3. La banque et base de données sur les RHS sont disponibles. MSPLS

Base de données Cfr 4.1.2 et

4.2.2

4.2.4. Les tableaux de bord sur les RHS sont disponibles MSPLS Tableau de bord RHS publié

4.3. Renforcer la décentralisation de la gestion des RHS

4.3.1. Le plan de gestion décentralisée des RHS est élaboré MSPLS Plan disponible 40 000

4.3.2. Les structures décentralisées sont mis en place MSPLS Nombre de BPS ayant un appui

décentralisé 100 000

4.4. Engager des activités de recherche sur les RHS pour informer la prise décision et animer le dialogue entre les parties prenantes

4.4.1. Les données sur les RHS de la diaspora (fuite des cerveaux) sont disponibles MSPLS, MESRS Rapport d’enquête 40 000

4.4.2. Les données sur les RHS du secteur privé sont disponibles MSPLS Rapport d’enquête 20 000

4.4.3. Une évaluation de la capacité et de la qualité de la formation des institutions y compris la performance des lauréats est réalisée

MSPLS, MESRS Ecoles de

formation, Parties prenantes

Rapport d’évaluation 60 000

TOTAL 7 810 000

Disponibilité

Qualité

Acceptabilité Accessibilité Transversale


Les progrès seront suivis par le Comité Consultatif de l’ONRHS Pour les Indicateurs de suivi voir le tableau au point 1.

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Voies d’engagements en matière de RHS

COTE D’IVOIRE


La mortalité maternelle est passée de 700 pour 100 000 naissances vivantes en 1990 à 614 pour 100 000 naissances vivantes en 20115.

Malgré les augmentations de couverture de services, le taux de mortalité maternelle est très loin de l’Objectif du Millénaire pour Développement no 5 (OMD 5) visant un taux de mortalité maternelle de 173 pour 100 000 naissances vivantes en 2015.

Concernant la mortalité des enfants de 0-5 ans, le taux est passé de 151 pour 100 000 naissances vivantes en 1990 à 108pour 100 000 naissances vivantes en 20116.Ce taux reste encore élevé comparativement à l’objectif de l’OMD 5 (50pour 100 000 naissances vivantes) en 2015.

Face à ces défis le Plan National de Développement Sanitaire (PNDS) 2012-2015 prévoit un ensemble d’actions pour améliorer la couverture de soins des populations incluant la disponibilité, l’accessibilité, l’acceptabilité des structures de santé et la qualité des services de soins. Ces actions imposent une forte demande de ressources humaines en santé :

- 1672 médecins généralistes - 130 pédiatres - 130 gynécologues - 340 médecins de santé publique - 4515 IDE - 2742 SFDE - 1084 TSS - 620 infirmiers spécialistes - 1084 aides-soignants

Aussi, les engagements du Gouvernement ivoirien au cours du 3ème forum mondial sur les Ressources Humaines, porteront-ils, sur les orientations stratégiques sus indiquées notamment en ce qui concerne la formation, l’incitation et la fidélisation et l’éventail approprié de compétences.

5EDS-MICS 2011-2012 6EDS-MICS 2011-2012

AFRO

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1. La formation

- Stabiliser le nombre d’admission à l’INFAS7 (toutes antennes confondues) à 1200 pour 2013, 2014 et 2015 - Réhabiliter les antennes de Bouaké, Korhogo et Abidjan entre 2014 et 2016 - Accroitre les capacités de production des antennes existantes - Poursuivre le plaidoyer pour finaliser la construction de l’antenne de Daloa et la création de nouvelles antennes de l’INFAS (Abengourou, Man, San

Pedro) - Poursuivre le recrutement des diplômés de l’INFAS jusqu’en 2015 - Recrutement des diplômés (2012 et 2013) en 2014: 2951 (1867 IDE et 1084 SFDE) - Prévision de recrutement 2015: 1801 (1072 IDE et 729 SFDE)

2. L’incitation et la fidélisation

- Poursuivre le processus d’affectation en priorisant les régions en pénurie à travers la définition et l’application de mesures relatives à la durée minimale de service dans le lieu d’affectation

- Définir la stratégie nationale pour la mise en place du FBP en santé (2014 ABT Associates) - Poursuivre la réforme du statut du personnel de santé dans le cadre du projet de la réforme hospitalière

3. L’éventail approprié de compétences

- Adopter le décret de modification du statut de l’INFAS (2014) - Adopter le décret de modification du statut des enseignants de l’INFAS (2014) - Mettre en œuvre de façon effective le Système LMD à l’INFAS en 2014 - Renforcer les capacités des tuteurs de stage en suivi et encadrement des stagiaires - Renforcer le plateau technique des sites de stages - Renforcer la collaboration entre le MSLS et les syndicats en ce qui concerne les comportements contraires à l’éthique à travers la PSP8 - Poursuivre le projet de création du code de déontologie des Sages-Femmes

Le coût total des engagements d’ici 2015 s’élève à 3 278 259 896 FCFA dont 95% pour la formation, 2% pour les incitations et la fidélisation et 3% pour l’éventail

approprié des compétences.

7INFAS: Institut National de Formation des Agents de Santé 8PSP: Personnel sensibilise le personnel

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2) Comment allez-vous assurer le suivi des progrès vers l’achèvement de vos engagements ? (Quels indicateurs allez-vous suivre? Quelles sources de

données allez-vous utiliser)?

Les principaux indicateurs et sources de vérification pour le suivi des présents engagements sont :

- Nombre d’antennes de l’INFAS fonctionnelles

- Nombre de nouveaux diplômés absorbés

- Pourcentage de personnel redéployé vers les zones rurales / défavorisées ayant ténu dans la durée minimale requise

- Existence du document de stratégie nationale du financement basé sur la performance

- Taux de réalisation du projet de réforme du statut du personnel de santé

- Existence de textes réglementaires définissant le statut de l’INFAS et ses enseignants

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Montant % Montant %

Stabiliser le nombre d’admission à l’INFAS (toutes antennes confondues) à 1200 pour 2013, 2014 et 2015

3 600 49 500 178 200 000 178 200 000 100,00% - 0,00%

Réhabiliter les antennes de Bouaké, Korhogo et Abidjan entre 2014 et 2016

2 550 000 000 1 100 000 000 220 000 000 20,00% 880 000 000 80,00%

Accroitre les capacités de production des antennes existantes

5 100 000 000 500 000 000 100 000 000 20,00% 400 000 000 80,00%

Poursuivre le plaidoyer pour finaliser la construction de l’antenne de Daloa et la création de nouvelles antennes de l’INFAS (Abengourou, Man, San Pedro)

4 8 000 000 32 000 000 32 000 000 100,00% - 0,00%

Poursuivre le recrutement des diplômés de l’INFAS jusqu’en 2015 (Frais administratifs)

2 5 000 000 10 000 000 10 000 000 100,00% - 0,00%

Recrutement des diplômés (2012 et 2013) en 2014: 2951 (1867 IDE et 1084 SFDE)

2 951 269 563 795 480 413 795 480 413 100,00% - 0,00%

Prévision de recrutement 2015: 1801 (1072 IDE et 729 SFDE) 1 801 269 563 485 482 963 485 482 963 100,00% - 0,00%

Sous total 1 3 101 163 376 1 821 163 376 58,73% 1 280 000 000 41,27%

Poursuivre le processus d’affectation en priorisant les régions en pénurie à travers la définition et l’application de mesures relatives à la durée minimale de service dans le lieu d’affectation

Définir la stratégie nationale pour la mise en place du FBP en santé (2014 ABT Associates)

1 25 000 000 25 000 000 5 000 000 20,00% 20 000 000 80,00%

Poursuivre la réforme du statut du personnel de santé dans le cadre du projet de la réforme hospitalière

1 40 000 000 40 000 000 5 000 000 12,50% 35 000 000 87,50%

Sous total 2 65 000 000 10 000 000 15,38% 55 000 000 84,62%

COUT DES ENGAGEMENTS DE LA COTE D'IVOIRE

La formation

L’incitation et la fidélisation

Désignations Quantité Coût Unitaire Coût Total Répartition

PartenairesEtat

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Montant % Montant %

Adopter le décret de modification du statut de l’INFAS (2014) 1 3 000 000 3 000 000 3 000 000 100,00% - 0,00%

Adopter le décret de modification du statut des enseignants de l’INFAS (2014)

1 3 000 000 3 000 000 3 000 000 100,00% - 0,00%

Mettre en œuvre de façon effective le Système LMD à l’INFAS en 2014

Renforcer les capacités des tuteurs de stage en suivi et encadrement des stagiaires

1 25 000 000 25 000 000 5 000 000 20,00% 20 000 000 80,00%

Renforcer le plateau technique des sites de stages 4 15 000 000 60 000 000 4 000 000 6,67% 56 000 000 93,33%

Renforcer la collaboration entre le MSLS et les syndicats en ce qui concerne les comportements contraires à l’éthique à travers le PSP

1 6 096 520 6 096 520 1 250 000 20,50% 4 846 520 79,50%

Poursuivre le projet de création du code de déontologie des Sages-Femmes

1 15 000 000 15 000 000 5 000 000 33,33% 10 000 000 66,67%

Sous total 3 112 096 520 21 250 000 18,96% 90 846 520 81,04%

TOTAL 3 278 259 896 1 852 413 376 56,51% 1 425 846 520 43,49%

L’éventail approprié de compétences

Désignations Quantité Coût Unitaire Coût Total Répartition

PartenairesEtat

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HRH commitment pathways ETHIOPIA

1) What human resources for health (HRH) - related actions and pathways can your country/ institution commit to?

Within the framework of the health sector development program and the human resources for health strategic plan (2009-2020), Ethiopia has registered marked improvement in the availability of health workers and access to healthcare. Along with other investments in healthcare and socioeconomic development and 3 years projection model, the increased access to primary health care has enabled Ethiopia to meet MDG 4. One of the very reasons behind Ethiopia's achievement was the country's health extension Program (HEP) through training and deployment of more than 38,000 government employed community Health Extension workers (HEWs). Although very successful in rapidly scaling up training of health workers, Ethiopia still faces important human resources for health challenges: shortage of certain cadres like medical doctors and anesthesia professionals; assuring quality of pre-service education in the context of rapid and massive expansion.

The Government of Ethiopia sees the 3rd Global Forum on HRH as an opportunity to reinforce its commitment to avail competent, motivated and supported health workforce to ensure universal access to health services to all its citizens. To this end, the Government of Ethiopia would fulfill the following commitments:

1. The Government of Ethiopia commits to scale-up quality pre-service education of HRH focusing on those cadres in critical shortage

- Expand education of health workers to meet 100 % of the staffing standard considering the skill mix in all primary health care facilities by 2017

- Improve quality of health professionals education by implementing program level accreditation in both public and private training institutions by 2017

- Improve quality of health professionals education by instituting competency-based pre-licensure system for all health workers by 2017

2. The Government of Ethiopia commits to improve human resources for health planning and management capacity

- Improve HRH management capacity through pre-service and in-service training of human resources for health managers

3. The Government of Ethiopia commits to take into account the labour market forces in the revision of HRH strategy

- Consider international recruitment of specialized faculties to expand high level specialized training program

- Consider overseas labour market to export qualified health care workers who will not absorbed nationally by 2017.

AFRO

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2) How will you monitor progress towards achievement of your commitment pathways (What indicators will you track? What data sources will you use)?

To monitor implementation of the commitments the following indicators have been identified:

Commitment 1

- % of primary health care facilities that meet staffing standard. Data source: Service Preparedness Assessment (SPA), SARA, HRIS) - Availability of policy, legal framework and/or guideline requiring program accreditation of all public and private higher education institutions. Reports of

program accreditation in public and private higher education institutions. Data source: The Higher Education Relevance and Quality Agency (HERQA) - Availability of policy, legal framework and/or guideline requiring all health graduates to pass pre-licensure exam before entry to practice. Reports of pre-

licensure exam for new graduates. Data source: Ministry of Health and Food, Medicine and Healthcare Administration and Control Authority (FMHACA).

Commitment 2

- Availability of postgraduate training programs in human resource for health management. Percentage of HR management posts at federal and regional levels filled by staff trained in human resources for health management. Data source: MOH program reports.

Commitment 3

- Availability of high level specialized training program - Inclusion of overseas export of qualified health care workers in HRH strategic plan

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HRH commitment pathways GHANA


We commit to the development and implementation of an HRH Commitment Action Plan (CAP), through a collaborative process involving Partners and with support from CHESTRAD and IntraHealth.


We commit to developing an accountability framework as part of the HRH CAP. RH Action plan developed, costed and implemented within the overall content of the national health plan.

AFRO

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Voies d’engagements en matière de RHS GUINEE


Selon l’EDS 2005, le ratio de la mortalité maternelle en Guinée est de l’ordre de 980 décès pour 100 000 naissances vivantes, le taux de mortalité néonatale est de 39‰ et celui de la mortalité infantile de 91‰. Pour faire face à cette situation, le Plan National de Développement Sanitaire (PNDS) de 2003-2012 en Guinée a choisi la réduction de la mortalité maternelle et infanto juvénile comme priorités du secteur, suite par la maîtrise de la fécondité et la lutte contre la maladie et le SIDA surtout au niveau des groupes vulnérables.

L’efficacité du système de santé qui permettra d’atteindre ces objectifs repose sur une bonne qualité des prestations dont les facteurs déterminants sont entre autres :

- une bonne couverture nationale en infrastructures sanitaires ;

- le relèvement et le maintien de la qualité du plateau technique ;

- la disponibilité et l’accessibilité des médicaments ;

- la qualité, la disponibilité et la performance des ressources humaines.

De tous ces facteurs, le dernier est de loin le plus déterminant. En effet, les ressources humaines sont difficilement comparables aux autres, notamment dans un contexte de rareté chronique des professionnels de la santé. Malgré les recrutements de la Fonction Publique et une contractualisation du personnel de santé par le Ministère de la Santé et de l’Hygiène Publique (MSHP), un important déficit est noté en professionnels de la santé.

C’est sous cet éclairage, et compte tenu des recommandations du PNDS, que la Direction des Ressources Humaines (DRH), s’est engagée dans l’élaboration d’un Plan National de Développement des Ressources Humaines dans le Secteur de la Santé (PNDRHS) qui sera un outil d’aide à la décision. Il s’agit de concevoir et de mettre en œuvre des stratégies susceptibles de garantir une bonne couverture en personnels qualifiés sur toute l’étendue du territoire, plus particulièrement dans les zones dites « difficiles ».

A travers une évaluation et de planification des ressources humaines (RH) pour la santé maternelle et néonatale (SMN), le Ministère de la Santé et de l’Hygiène Publique a identifié des interventions acceptables, faisables et à haut impact en rapport aux stratégies RHSMN, qui s’accordent avec le Plan Stratégique pour la Développement des RHS (PSDRHS) et dans le but de les intégrer dans le nouveau plan national de développement et qui seront validées par l’ensemble des décideurs du niveau national impliqués dans la gestion des RHS. A travers l’analyse de la situation il a été constaté au niveau de:

- Disponibilité

Malgré les recrutements de la Fonction Publique et une contractualisation du personnel de santé par le Ministère de la Santé et de l’Hygiène Publique (MSHP) en 2011 et 2014, un important déficit est noté en professionnels de la santé. Au niveau national l’offre en RHSMN qualifiée couvre 48% des besoins (presque 6,000

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SF, IDE, MG, GYN et PED) en 2014 et cette couverture montre une forte tendance de baisser dans les années à venir. Si la Guinée maintient les efforts de recrutement comme à travers le recrutement en 2011 et 2014, l’ajout à l’effectif par an ne sera pas suffisant pour combler la déperdition des RHSMN qualifiée par an, et encore moins d’être au même pas que la croissance de la population. Quant aux différentes catégories professionnelles, on constate :

- une pénurie grave de 1,845 SF (soit une couverture de 18% des besoins en SF) ; - une pénurie grave de 1,485 IDE (soit une couverture de 44% des besoins en IDE) ; - une insuffisance de PED (un offre de 54 PED, soit une couverture de 92%) et un surplus de 227 MG et 59 GYN qui vont changer à une pénurie grave

dans les années à venir (couverture de 18% des besoins en PED et de 60% des besoins en MG et GYN en 2023) si aucun changement s’opère pour améliorer la situation actuelle et maintient le niveau actuel de recrutement par an.

Au niveau national il y existe un grand effectif de presque 4,000 ATS qui ne sont pas considérés comme personnel qualifié qui seront reconvertis en SF et IDE conformément à la planification faite.

- Accessibilité (géographique)

Pour les IDE, MG, GYN et PED les insuffisances se trouvent seulement dans les zones rurales (écarts de respectivement -1,762, -644, -29 et -64 agents en 2014). Par contre, dans les zones urbaines il semble que la disponibilité des RHSMN s’accorde avec les besoins et il y a des indications d’un excédent par rapport aux besoins en personnel qualifié dans ces zones. Sauf pour les SF, pour lesquelles des insuffisances existent dans les zones urbaines (-285 SF en 2014) et rurales (-1569 SF en 2014). Les zones les plus démunies se trouvent dans les régions de Kankan et N’Zérékoré ; ces deux régions ensemble comprennent 50% des insuffisances en personnel. En outre, elles sont les plus éloignées de la capitale, les plus difficilement accessibles et renferment les préfectures les plus pauvres du pays. La mise en œuvre concernera pour une première phase la période 2014-2017 et l’extension aux autres régions administratives se fera au cours de la période 2018-203.

- Acceptabilité/ Qualité

On note un taux élevé d’absence du personnel dans les zones rurales et les zones urbaines. Le personnel n’est pas toujours accueillant et n’est pas toujours apte à fournir des services, en partie à cause du manque d’équipements pour les soins obstétricaux et néonataux d’urgence de base (SONUB).

Pour faire face à cette situation :

1. A court terme, le Gouvernement de GUINEE s’engage à recruter chaque année un effectif additionnel de 51 SF et 111 IDE en 2015, 2016 et 2017 et leur déploiement dans les zones les plus éloignées (KANKAN et N’ZEREKORE) pour fournir le paquet de soins maternels et néonatals et réduire la répartition inéquitable des RHSMN qui se fait sentir actuellement le plus dans ces deux régions. Il s’agit de 30 SF et 21 SF par an respectivement dans les zones rurales de NZEREKORE et de KANKAN, ainsi que 65 IDE et 46 IDE par an respectivement dans les Zones rurales de NZEREKORE et de KANKAN. Les Ministères de la Santé et de l’Hygiène Publique (MSHP), Ministère du Travail et de la Fonction publique (MTFP), Ministère Délégué au Budget (MDB)

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sous le leadership du MTFP vont conjointement coordonner les activités permettant d’atteindre cet objectif.

2. Le Gouvernement de la GUINEE s’engage à convertir en SF durant la période 2015-2017 dans les Ecoles Secondaires de la santé Communautaire (ESSC) de Kankan et N’Zérékoré, 330 ATS travaillant dans les zones rurales de ces deux localités pour compléter les effectifs de SF préalablement recrutés. Il s’agit de 60 ATS et 50 ATS pour servir respectivement comme SF et IDE dans les zones rurales de Kankan et N’Zérékoré. Les MSHP- Ministère de l’Enseignement Technique et de la Formation Professionnelle (METFP)- Ministère de l’Administration du Territoire et de la Décentralisation (MATD)-MEF-MDB) sous le leadership du METFP sont responsables de l’atteinte de cet objectif

3. Le Gouvernement de la GUINEE s’engage à partir de 2016, à intégrer dans le statut des fonctionnaires des collectivités et à mettre en œuvre dans les régions de KANKAN et de N’ZEREKORE la rotation du personnel sanitaire dans sa région de recrutement seulement après 3 ans au moins de service en milieu rural. En fin 2014, le statut des fonctionnaires des collectivités qui tient en compte de la rotation des personnels sanitaires après 3 ans d’exercice dans les zones rurales est adopté. En fin 2017, la rotation des personnels sera effective dans les régions de KANKAN et N’ZEREKORE. Les MATD-MSHP-MEF-M.BUDGET-MTFP sous le leadership du MATD vont conjointement coordonner les activités permettant d’atteindre cet objectif.

4. Le Gouvernement de la GUINEE s’engage à décentraliser d’ici fin 2017 le recrutement des personnels de santé et sécuriser le paiement de leurs salaires au niveau des communes rurales et urbaines En fin 2017, 129 communes urbaines et rurales des régions de KANKAN et N’ZEREKORE prennent en charge les salaires des personnels de santé mis à leur disposition. Les MATD, MSHP, Assemblée nationale, MEF, M.BUDGET sous le leadership du MATD vont conjointement coordonner les activités permettant d’atteindre cet objectif.



1. Le suivi des progrès vers l’atteinte des engagements sera mesuré lors de l’évaluation à mi-parcours (milestone/repère de 2016 = 102 SF et 222 IDE recrutées) - Indicateur 1 : Nombre de nouvelles SF recrutées et déployées par an dans les zones rurales de Kankan et N’Zérékoré par rapport aux effectifs prévus - Indicateur 2 : Nombre de nouvelles IDE recrutées et déployées par an dans les zones rurales de Kankan et N’Zérékoré par rapport aux effectifs prévus

Sources de données : Division des Ressources humaines (DRH) du MSHP, Rapports Direction Préfectorale de la Santé (DPS) et Système national d’information sanitaire (SNIS)

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2. Le suivi des progrès vers l’atteinte des engagements sera mesuré lors de l’évaluation à mi-parcours (milestone de 2016 = 120 SF formées et 100 IDE formées) - Indicateur 1 : Nombre d’ATS convertis en SF dans les ESSC de Kankan et N’Zérékoré par an par rapport aux effectifs prévus - Indicateur 2 : Nombre d’ATS convertis en IDE dans les ESSC de Kankan et N’Zérékoré par an par rapport aux effectifs prévus

Sources de données : DRH du MSHP, Rapports DPS et SNIS

3. Le suivi des progrès vers l’atteinte des engagements sera mesuré lors de l’évaluation à mi-parcours (milestone de 2015 = document révisé du statut des collectivités) - Indicateur 1 : statut adopté disponible dans toutes les collectivités - Indicateur 3 : nombre de SF et IDE en fonction dans leurs postes de travail après 3 ans de service


4. Le suivi des progrès vers l’atteinte des engagements sera mesuré lors de l’évaluation à mi-parcours (milestone de 2015 = Textes d’application de la contractualisation élaborés et disponibles au niveau des collectivités et des départements ministériels concernés) - Indicateur 1 : Proportion de personnels de santé recrutés par les communes et percevant leurs salaires


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HRH commitment pathways LIBERIA




We commit to developing an accountability framework as part of the HRH CAP. HRH Action plan developed, costed and implemented within the overall content of the national health plan

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HRH commitment pathways MALAWI




We commit to developing an accountability framework as part of the HRH CAP. HRH Action plan developed, costed and implemented within the overall content of the national health plan

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Malawi’s HRH Commitment Action Plan (CAP)

The following commitments were developed through a concerted effort spearheaded by Ministry of Health –HRH Dept/SWAp Secretariat with support from various key stakeholders CHESTRAD / INTRAHEALTH, Health and Rights Education Programme (HREP-Malawi), Government of Germany (GIZ) and individuals.

Commitment Target Indicator of progress GHWA pathway

Make fresh commitments to increase volumes and predictability of funding to scale up the healthworkforce in Malawi. 2015 Increased funding available for HRH Cross cutting

actions

Standardise training of tutors for educational institutions. 2015-2020

Policy and guidelines available (or under development) to standardise training of tutors Evidence of implementation guidelines

Education pathway

Strengthenand improve HRIS. 2015-2020

Programme of work developed and implemented to strengthen HRIS Improvements in availability, timeliness, quality of data through HRIS (possibly using HMN metrics)

Cross cutting actions

Conduct Health personal audits to determine stock, density, distribution and skill mix. 2015

Audits completed Comprehensive picture on health workforce stock, density and distribution and skill mix is available

Skills mix pathway Education pathway

Support Capacity Building for MoH managers at all levels. 2015-2020

Evidence of systematic programme to build capacity of MoH managers

Incentives pathway Retention pathway

Propose effective incentives for rural workers, especially nurses/midwives and Health Survellance Assistance(HSA).

2015-2020

Incentives available for rural workers Improvements in availability of health workers in rural areas

Incentives pathway

Enhance mutual Accountability between Health Workforce with local community and stakeholders including Civil Society Organisations.

2020 Evidence of meaningful participation of CSOs in HRH accountability mechanisms Evidence of effective local community accountability mechanisms


Decentalise of HRH Administration from Central Level. 2020 Functioning sub-national HRH management structures in place

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Voies d’engagements en matière de RHS MALI

1) Quelles sont les actions – voies en matière de ressources humaines pour la santé (RHS) sur lesquels votre pays/institution peut s’engager

1. Développer le système d’information et de gestion des Ressources Humaines en Santé à tous les niveaux de la pyramide sanitaire d’ici à l’an 2015

2. Rendre disponibles les Ressources Humaines en Santé qualifiées (Médecins, Sages-femmes et Infirmiers) dans 60% des Districts Sanitaires d’ici à l’an

2018

3. Renforcer les compétences des Ressources Humaines en Santé (Médecins, Sages-femmes et Infirmiers) au moins 1 fois par an

4. Promouvoir un environnement institutionnel favorable à l’engagement des Ressources Humaines en Santé à servir dans les zones difficiles

2) Comment allez-vous assurer le suivi des progrès vers l’achèvement de vos engagements ? (Quels indicateurs allez-vous suivre? Quelles sources de données

allez-vous utiliser)?

1. Développer le système d’information et de gestion des Ressources Humaines en Santé à tous les niveaux de la pyramide sanitaire d’ici à l’an 2015

- Formation du personnel chargé du système d’information de la gestion des ressources humaines au niveau des Etablissement publics de santé - Mise à jour de la Base de données sur le personnel de santé (public, privé, communautaire et confessionnel) - Utilisation des données pour la prise de décision

Cartographie des RHS par niveau Nombre de districts sanitaires utilisant le logiciel SI-GRH

2. Rendre disponibles les Ressources Humaines en Santé qualifiées (Médecins, Sages-femmes et Infirmiers) dans 60% des Districts Sanitaires d’ici à l’an

2018

- Renforcement de la capacité de production des RHS qualifiées par les institutions de formation - Mise en place d’une stratégie de recrutement de masse des RHS prenant en compte des besoins et de l’accroissement de la population - Dotation en RHS (médecins, sages femmes et infirmiers) des établissements sanitaires public et communautaire en quantité suffisante et en

qualité

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Proportion d’établissements de santé disposant d’une équipe de santé complète (médecin, sage femme et infirmier) dans les districts sanitaires (Csréf et Cscom)

3. Renforcer les compétences des Ressources Humaines en Santé (Médecins, Sages-femmes et Infirmiers) au moins 1 fois par an

- Evaluation de base des besoins de formation continue - Formation des RHS - Suivi post formation des RHS

Nombre de RHS par catégorie formées par an

4. Promouvoir un environnement institutionnel favorable à l’engagement des Ressources Humaines en Santé à servir dans les zones difficiles

- Adoption de textes législatifs et réglementaires sur la motivation des RHS - Plaidoyer auprès des décideurs pour l’application effective du plan de motivation du plan stratégique national du développement des RHS 2009-

2015 Nombre de Textes législatifs et réglementaires adoptés

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Caminhos de compromisso em RHS MOÇAMBIQUE

1) Com que ações ou caminhos relacionados aos RHS sua instituição / seu país pode comprometer-se?

O Ministério da Saúde de Moçambique, junto dos seus Parceiros de Cooperação, pretende com a implementação do seu Plano Estratégico do sector Saude 2014-2019, assegurar progressivamente a cobertura universal de saúde de forma a contribuir para que todos os Moçambicanos, em especial os grupos mais vulneráveis, possam desfrutar de melhor saúde possível a um custo comportável (para o País e cidadãos) contribuindo, assim, para o combate a pobreza e promoção do desenvolvimento nacional.

Apesar de na última década, o Ministério da Saúde ter realizado grandes esforços para aumentar os recursos humanos de saúde, a escassez de profissionais de saúde qualificados e inequidade na distribuição ao nível das províncias e distritos continuam a ser os principais desafios para expansão dos serviços de saúde e atingir os objetivos de reduzir a mortalidade materna e neonatal, e expandir os cuidados e tratamento do HIV/SIDA.

O Plano Estrategico do sector Saude 2014-2019 do Ministerio da Saude tem três dos seus sete obejctivos estratégicos com intervenções chave relacionadas aos recursos humanos

1. Aumentar o acesso e utilização dos serviços de saude com a expansao e fortalecimento dos serviços de base comunitária, com enfoque nos

Agentes Polivalentes Elementares e outros Agentes Comunitários de Saúde.

2. Melhorar a qualidade dos serviços prestados assegurando RH motivados e com as qualificações e quantidades necessárias

3. Reduzir as desigualdades geográficas e entre grupos populacionais no acesso e utilização de serviços de saúde desenvolvendo e assegurando a

implementação de mecanismos de alocação/afectação de recursos (fundos, RH, medicamentos) baseados nas necessidades/equidade

Para atingir estes objectivos, o Ministério da Saúde, através da Direcção de Recursos Humanos compromete-se a:

1. Aumentar a disponibilidade de recursos humanos de nível médio graduando anualmente 2.000 profissionais e garantir trabalho para 90% dos

mesmos usando várias fontes de financiamento até 2019.

2. Melhorar a qualidade dos RHS adaptando 6 dos actuais currículos de formação em currículos baseados em competência ate 2016.

3. Aumentar a aceitabilidade aumentando o número de agentes polivalentes elementares a prestar serviços na comunidade 3.444 ate 2015.

4. Aumentar a acessibilidade desenvolvendo ferramentas e critérios de alocacao do pessoal visando a reduzir as desigualidades entre provincias e

intraprovincias ate 2014

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5. Continuar a desenvolver o Observatorio de Recursos Humanos para a Saude de Mocambique para cada vez mais providenciar evidencias para

tomada de decisao, melhorando a qualidade dos dados, reforcando os sistemas de informacao sobre recursos humanos para saude no pais e

promovendo as pesquisas nas areas de recursos humanos.

2) Como irá monitorar o progresso no sentido do alcance dos seus caminhos de compromisso (Que indicadores você traçará? Que fontes de dados você

utilizará)?

O Minsisterio da saude, através da Direcção de Recursos Humanos, irá monitorar o alcance dos seus caminhos de compromisso nos balancos trimestrais e anuais dos Planos Económicos e Sociais que operacionalizam anualmente o Plano Estratégico do Sector Saude. Indicadores:

- Número anual de gradudos nas instituições de formação do MISAU (fonte de informação: DRH-Formação/ actas de fim dos cursos)

- Percentagem de recém-graduados que trabalham no Serviço Nacional de Saúde (fonte de informação: DRH-Gestão: base de dados dos colocados)

- Número de currículos adaptados (fonte de informação: DRH Formação)

- Número de agentes polivalentes elementares a prestar servicos na comunidade (fonte de informação: DRH-Gestão: base de dados dos APEs)

- Ferramentas e critérios de alocação do pessoal desenvolvidos até 2014 (fonte de informação: DRH-Gestão)

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HRH commitment pathways NIGERIA


We commit to the implementation of an HRH Commitment Action Plan (CAP) that has been developed through a structured process of evidence gathering and consultation during the past months (see below for details of the commitments).


The process to develop an HRH CAP has reflected on accountability mechanisms, and each commitment includes a target date and indicator of progress. As part of follow-up work to this collaborative effort between Government and Partners, expectations have been set for ongoing support to implementation and monitoring of progress.

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Nigeria’s HRH Commitment Action Plan (CAP)

The following commitments were developed through a concerted effort spearheaded by the Federal Ministry of Health with support from CHESTRAD / INTRAHEALTH and other Partners through the HRH Brazil Reference Group.

Federal Ministry of Health (FMOH)


Update and strengthen the HRH plan to ensure effective coordination and harmonisation of the 122 implementing units at FMOH-level, and of Partners

2015 Updated plan sets out vision for streamlined/rationalised governance structure


Strengthen HRH unit with FMOH: ensure adequate budget, staffing, capacity building and clarify its role.

2015 Increased staff, increased expenditure, revised TOR discused by HRH Forum and signed off at Ministerial level.


Establish a fund to support engagement of diaspora to improve the quality of service delivery and expand access to basic health care services at all operational levels

2020 Work commissioned to review experience, set out options on scope and purpose, assess feasibility (by 2015) Fund established and functioning (by 2020)


Develop plans to ensure that there is a clear career pathway for all cadres within the health workforce, including pre- and in-service training and skills appreciation.

2015

Policy and guidelines on career pathway for mid- and community-level health workers that places emphasis on transformational education to produce the appropriate skills mix for universal health access and coverage

Education pathway Incentives pathway Retention pathway

Explore with neighbouring countries and ECOWAS, the feasibility of coordinated efforts on training of health workers (regional brain sharing)

2020 ECOWAS and Nigeria lead joint effort on regional collaboration for training health workers

Labor markets pathway

Engage states more effectively to ensure that HRH management and productivity is more effective at sub-national level including working through the National Council on Health to secure HRH commitment at state and sub-national levels

2015 – 2020

State level integration of HRH and public sector worker management State level budgets and management capacity for HRH are evident and resources


Develop and implement an effective accountability mechanism that ensures oversight and corrective actions (evidence, transparency, review – with appropriate participation) of the health workforce.

2015 – 2020

Health workforce registry is used as basis for HRH planning and review Corrective actions are agreed and reviewed periodically CSOs have influenced review and decision-making processes


Ensure the involvement of parliament and civil society in policy dialogue on health workforce issues.

2015 CSOs and MPs actively and meaningfully contribute in policy dialogue on HRH through the HRH Forum


National Primary Health Care Development Agenda

Commitment Target Indicator of progress GHWA

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pathway

Provide leadership and collaborate with other stakehholders including civil society to establish career pathways (professional and administrative) for mid- and community-level health workers based on the principles and concepts of transformational education

2015 Joint and costed action plan on carrer pathways for mid- and community-level health workforce based on the principles and concepts of transformational educaiton

Education pathway Incentives pathway Retention pathway

Partners


Commit to strengthening coordination and alignment of activities at all level, to support national priorities and plans and avoid duplication of efforts.

2015-2020

Mapping of partner efforts at federal and state level on HRH support has been conducted Evidence of efforts to fill gaps based on mapping


Explicitly support the FMOH in its efforts to coordinate and oversee scale up of the health workforce and improvements in workforce quality.

2015 Increased resources committed to support FMOH capacity on HRH

Education pathway Skills mix pathway Labor markets pathway

Provide material and advocacy support to enable the involvement of parliament and civil society in policy dialogue on health workforce issues.

2015 Increase in resources provided to CSOs for advocacy on HRH Increased participation of MPs in dialogue on HRH


Provide financial and technical support for evidence-based health workforce policy , planning, education,/production and management (including retention & improved distribution, towards UHC goal).

2014-2023

Increased health workforce production and retention in underserved reas Improved access to health care services towards UHC

Education pathway Incentives pathway Retention pathway Skills mix pathway Labor markets pathway Cross cutting actions

Support strenthening human and institutional capacities for healthworkforce leadership, stewardship and management at State and Federal levels

2014-2023

Capacity improved at States and Federal level e.g. SMOH have functional HRH units ----.


Support establishment of a functional HRH information system including a computerised national health workforce registry to account for and track all health workers in the country

2014 -2023

Informed HRH planning distribution Better accountting and tracking of HWs


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Parliament and Civil Society

The Parliament (House Committee on Health) should:


Support the allocation of sufficient resources for HRH, with explicit budget lines where necessary. Work with state level parliamentarians and political leaders to ensure effective allocation for human resources for health as a part of national human capital development

2015 -2020

2014

Clear budgets for HRH in national and state level budgets Increased resources for HRH at national and state level Inter-tier platforms for HRH advocacy and parliamentary engagement in health established and resourced


Accountability for HRH and of HRH. 2015 -2020

CSOs and Parliament participate in the update of HRH plans and provide oversight of the implementation of these plans. Increased social accountability – focus on HRH performance, attendance, etc.


Partner with CSOs on legislative action for HRH 2020 Legislative programme identified and implemented Laws relevant to HRH scale up enacted


Parliament and Civil society should jointly advocate for stronger multisectoral action to promote HRH management as an asset for national development

2015

Mutlisectoral forums for HRH functioning and focused on integration of HRH in public sector workforce issues Management of HRH alongside other public sector workers improves


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Civil society (CHESTRAD, IntraHealth/Capacity Plus working with other CS) should:


Support Nigeria to implement and monitor the commitments proposed above 2015

Engagement in policy dialogue to promote review of commitments Support data collection efforts to enable review of commitments


Support efforts to ensure accountability for HRH and of HR 2015 -2020

Evidence of ongoing dialogue (and resources as appropriate) with relevant stakeholders to support accountability for HRH Evidence of work with communities to support accountability of HRH


Advocate for and participate in policy and accountability mechanisms for HRH 2015 Evidence of active participation in accountability mechanisms for HRH


Advocate for clear and strong linkages between HRH planning and service delivery – in particular relating to health systems strengthing and universal health access and coverage

2015 Evidence of advocacy efforts on linking HRH planning and service delivery


Parliament and Civil society should jointly advocate for stronger multisectoral action to promote HRH management as an asset for national development

2015

Mutlisectoral forums for HRH functioning and focused on integration of HRH in public sector workforce issues Management of HRH alongside other public sector workers improves


Work with FMOH and NPHCDA, MPs to encourage other CSOs to support the above commitments and to make additional commitments that are relevant to the HRH agenda.

2015 More CSOs and Partners (above and beyond CHESTRAD, IntraHealth and Capacity Plus) make commitments to support the implementation of this Commitment Action Plan (CAP)


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Voies d’engagements en matière de RHS SENEGAL


Contexte

Le droit à la santé consacré par l’article 8 de la Constitution du Sénégal9 exige, de la part de l’Etat, la mise en œuvre d’une politique volontariste qui permet à

toutes les populations, où qu’elles se trouvent sur l’étendue du territoire national, de bénéficier de manière équitable, d’une couverture en soins de santé de

qualité. Le développement des ressources humaines occupe une place prépondérante dans la réalisation des politiques de santé10, lesquelles ont été longtemps

inhibées par des programmes de correction de notre équilibre macro-économique (ajustement structurel, dévaluation de la monnaie CFA…). Ces différentes

mesures ont influé négativement sur la dimension sociale de la gestion du personnel entraînant ainsi un important déficit dans la couverture sanitaire du pays.

Le Plan National de Développement des Ressources Humaines en Santé (PNDRHS) 2011-2018, constitue un élément de mise en œuvre du Plan National de

Développement Sanitaire (PNDS 2009-2018) dont les priorités majeures sont :

− la réduction de la mortalité maternelle ;

− la réduction de la mortalité infantile et juvénile ;

− la maîtrise de la fécondité.

L’efficacité du système de santé qui permettra d’atteindre ces objectifs repose sur une bonne qualité des prestations dont les facteurs déterminants sont:

− la qualité, la disponibilité et la performance des ressources humaines.

− une bonne couverture nationale en infrastructures sanitaires ;

− le relèvement et le maintien de la qualité du plateau technique ;

− la disponibilité et l’accessibilité des médicaments ;

− la lutte contre les principales maladies et les IST/SIDA;

− les prestations de services d’action sociale

9 La Constitution sénégalaise dispose en son article 17 que : « L’Etat et les collectivités publiques ont le devoir social de veiller à la santé physique, morale et mentale de la famille ». 10 Le gouvernement du Sénégal a adopté en 1989 un document de politique nationale de santé

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Le Sénégal, engagé dans l’atteinte des OMD, s’active dans la mise en place d’un système de santé adéquat répondant aux besoins de plus en plus croissants

des individus, des ménages et des communautés en matière de santé, et ce, dans un esprit d’équité et de justice sociale ; ce qui procède à l’initiative de la

Couverture Maladie Universelle (CMU) dont la finalité est l’accessibilité des soins de qualité à toutes les personnes qui en ont besoin.

NEUF ENGAGEMENTS DU SENEGAL

1. Augmenter le quota du personnel militaire et paramilitaire affecté aux métiers de la santé, en mettant l’accent sur les femmes, pour pallier l’insuffisance de

personnels de santé dans les zones reculées.

2. Allouer aux communes des ressources additionnelles afin de leur permettre de recruter au moins deux professionnels de la santé par an, pendant 3 ans.

3. Affecter dans les zones difficiles des RHS dans les 3 années à venir pour assurer la prise en charge de la santé de la mère et de l’enfant en priorité.

4. Réorganiser les services de santé pour améliorer leur productivité, en allongeant le temps de réception des patients dans le respect de la réglementation

en vigueur à partir de 2014

5. Étendre le projet de financement basé sur les résultats à toutes les structures de santé à partir de 2016.

6. Mettre en place des mesures incitatives en faveur des prestataires exerçant en zones difficiles de manière continue (enclavement, situation de conflit,

éloignement).

7. Renforcer la gouvernance au niveau des structures de santé (en continu).

8. Augmenter le nombre et le montant des bourses de spécialisation des médecins afin de rendre la formation attractive et de disposer de suffisamment de

spécialistes dans tous les domaines à partir de 2014.

9. Procéder à un recrutement massif de personnels de santé, au moins 5000 agents de santé d’ici 2015.

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Indicateurs et sources de données :

Engagement 1 : Nombre de personnel militaire envoyé en formation diplomante dans nos écoles de formation en santé. Source : arrêté portant admission à l’examen d’état.

Engagement 2 : Crédit alloué aux fonds de dotation des collectivités locales (taux de variation). Source : budget Ministère chargé de la décentralisation.

Engagement 3 : Nombre de RHS affectées annuellement dans les zones les plus démunies. Sources : Décision et notes d’affectation.

Engagement 4 : Nombre d’heure de présence dans la structure.

Source : registre de présence.

Engagement 5 : Nombre de structure ayant signé un contrat de FBR. Source : rapport annuel de la Direction Générale de la Santé sur le FBR.

Engagement 6 : Nombre de prestataires en zones difficiles ayant bénéficié de mesures incitatives Sources : distinctions ou facilités accordées (bourse formation, participation aux pèlerinages aux lieux saints) suivant note dûment signé par l’autorité.

Engagement 7 : Nombre de contrat de performance signé et niveau d’élaboration des outils de gestion. Sources : rapport du point focal Gouvernance sanitaire et nombre d’outils élaborés et mise en place.

Engagement 8 : Nombre de spécialistes formés et taux de variation de la bourse. Sources : rapports de la faculté de médecine sur les spécialisations et documents de paie de la bourse.

Engagement 9 : Nombre d’agents de santé recrutés jusqu’à 2015. Source : décisions d’engagement.

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HRH commitment pathways SOUTH SUDAN


The density of qualified health workers in South Sudan is below the African average. The average density of:

- Medical Officers per 1,000 people is 0.22 for Africa and 0.015 for South Sudan. - Nurses and Midwives is 1.17 for Africa and 0.02 for South Sudan (ORHSA, 2011).

The lower trained health workers severely outnumber the mid- to higher-level skilled health workforce at all levels of the health pyramid in both rural and urban areas. The limited competences of and support provided to the lower health cadres compromises the integrity of the overall quality of services provided. Yet, the (post conflict) country faces many challenges to address the HRH crisis, including insufficient committed funds for infrastructure development and inadequate stock of qualified Tutors to significantly scale up the production of midlevel health workers. Also, government austerity budget measures include a ban on recruitment and thus prevent a right deployment of the new graduates to ensure an optimal skills mix at the work floor.

Directorate of Training and Professional Development and the Department of Human Resource Management within the Ministry of Health (MoH) commit themselves to implementing a mix of long-term and short-term strategies to implement and monitor the South Sudan Health Sector Development Plan 2012 – 2016 and ensure availability, accessibility, and acceptability of quality health workers in South Sudan.

The priority focus will be on education, retention and skills mix and cross cutting pathway with the following actions

Cross cutting pathways

- Review and update the HRH Situation Analysis of 2011 by mid 2014, in collaboration with its partners, including EU, VSO and IGAD, and the HRD-TWG. - Review and update the sector-wide HRH Policy by mid 2014, in collaboration with its partners, stakeholders and the HRD-TWG. - Review and update the sector-wide HRH Strategic Plan by mid 2014, in collaboration with its partners, stakeholders and the HRD-TWG

Education pathway

- Solicit funds for pre-service health training and for professional and infrastructure development: ongoing. - Significantly scale up the –pre-service training of midlevel heath workers.11 - Standardize midlevel health training institutes and work towards accreditation: ongoing till December 2015. - Review and update curricula for midlevel HRH: ongoing with support from CDC, UNFPA and VSO. - Establish a National Examination Board to moderate, supervise and conduct national examinations for all midlevel cadres to ensure credibility and quality

11 In particular, the new Hon. Minister supports the scaling up of the production of midlevel health workers.

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by end of 2014. A provisional Board is operational. - Increase the number of qualified South Sudanese Tutors to be deployed at midlevel health training institutes. 15 eligible HRH will be sent to Arusha in

Tanzania in January 2014 to undertake the higher diploma in Tutorship training. Explore other opportunities for Tutorship training within the region by mid 2014.

- Support the pre-service training of eligible South Sudanese students within the African region. During 2013-2014, 20 students were selected to undergo Diploma training in Nursing, Pharmacy Technology and Laboratory Technology in Botswana.

Retention pathway

- Establish and use a functional HRIS, that is comprehensive, covering fields related to HRH training and professional development, and link it to the payroll and HMIS for effective human resource management. JICA supported initial work and the Health Pooled Fund will continue the technical and financial support from 2013-2016.

- Solicit funds for professional development of eligible HRH and strictly adhere to the Scholarship Guidelines based on civil service regulations on leave with pay and the bonding scheme.

- As a short-term measure, the MoH commits itself to targeted recruitment and equitable distribution of qualified health workers to ascertain the availability of health workforce. In this regard, recruitment of 512 health workers is ongoing as per the budgetary provision for 2013- 2014.

- Engage expatriate expertise such as the 1) civil service support staff (CSSOs) under the Inter-governmental Authority on Development (IGAD) capacity building initiative, 2) the Voluntary Service Overseas (VSOs) in teaching hospitals and training institutes and in the MOH headquarters and 3) an EU supported MoH embedded Technical Assistant in health systems strengthening/human resources for health.

Skills mix pathway

- Promote regulated task-shifting for Clinical Officers to conduct emergency operations like caesarian sections. 8 Clinical Officers have been sent to Zambia to do a course on integrated emergency surgery and obstetrics & gynecology. 20 more will be sent to Malawi in 2013. In addition, 14 Registered Nurses have been sent to Kenya to do a one-year programme in anesthesia.

- Medical Officers from South Sudan will be sent for specialized training at universities within the African region. In this regard, the MoH has nominated 30 to undertake specialization in Obstetrics and Gynecology in Uganda, Kenya, Ethiopia and Tanzania with financial support from CIDA/WHO (20) and CIDA/UNFPA (10)

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Education pathway Availability

- Total number of HRH (and density per 1,000 population), by cadre (sources MOH and partner assessments)

Acceptability - Number/ percentage of newly graduated health workers who are employed in the health labour market within 3 months of graduation (or other nationally

defined time period), per cadre (tracer studies by MOH and poartners) Quality

- Existence of an accreditation agency of health education and training institutions (source MOH reports) - Number and % of health training institutions meeting accreditation and reaccreditation standards (source MOH reports)

Retention pathway Availability

- Proportion of graduates entering the health sector(source MOH and partners institutions reports)

Acceptability - Number/ percentage of newly graduated health workers who are employed in the health labour market within 3 months of graduation (or other nationally

defined time period), per cadre (source MOH and partners institutions reports)

Skills mix pathway Quality

- % of facility staff who received in-service training, by cadre and type of training ( Department of Training consolidated reports ) - % of facility staff participating in continuous professional development, by cadre( Department of Training consolidated reports )

Cross cutting - Existence of a costed operational national strategy with explicit objectives, indicators and targets to address HRH planning and management ( source

MOH and partner reports ) - Existence of a HRH unit and its level of development ( source MOH and partner reports ) - Existence of a functional national coordinating mechanism for the HRH information and monitoring system ( source MOH and partner reports )

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HRH commitment pathways TANZANIA (Republic of)


1. Increase the availability of skilled health workers at all levels of health service delivery from 46% to 64% by 2017 based on Staffing levels of 2013: - The government of Tanzania commits to increase the density of health worker to population ratio of the districts with below national average of 1.47

health workers per 1,000 populations in 5 regions (Kigoma, Tabora, Rukwa, Shinyanga and Singida) from 0.73 health worker per 1,000 population to the

national average.

- The government of Tanzania commits to continue increasing production of skilled Health and Social workers from 4,364 in 2012 to 9,000 by 2017.

- The government of Tanzania commits to rationalize employment permits for health and social workers based on production and needs in all areas of

technical profession.

2. Increase financial base (Other Charges and Private sector investment) to operationalize the pay and incentive policy by 2017 in order to promote

retention, productivity and quality of health services. 3. Develop and implement a Task Sharing Policy on HRH by 2017

- Tanzania Ministry of Health and Social Welfare commits to develop an operational guideline based on consolidated 2013 WHO guideline on task sharing

to enhance existing Production and Quality Assurance Systems by 2015

- The government of Tanzania commits to implement a system-wide approach that includes representation from other departments across different

health cadres including professional associations, regulatory bodies, training institutions, accreditation bodies and policy makers to decide on common

areas for task sharing across healthcare cadres by 2017

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- Proportion of the number of districts achieving 70% of dispensaries and health centres with minimum staffing levels requirements as per 2013 staffing

guideline by generating 10% annually from HRH tracking report and data generated from Human Resource for Health Information System.

- Annual increase in student intake and enrolment in the health professions from reports generated by Training Institutions Information System.

- Annual proportion of employment permits granted by President Office, Public Service Management. Regions, district and health facilities reports for all

health cadres, intra and inter-sect oral collaboration meetings with Line Ministries (Ministry of Health and Social Welfare, Ministry of Finance, President

Office, Public Service Management and Prime Minister’s Office Local Government and Regional Administration) in support of HRH issues.

- Task Sharing Policy on HRH in place , and general monitoring of Task Sharing implementation and periodic reports

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Voies d’engagements en matière de RHS TOGO


Le Togo est parmi les pays qui connaissent une pénurie grave de RHS Togo12 ; avec en 2012, pour le secteur public 9.982 agents contre 3.348 pour le secteur privé. Ce qui conduit à des rations tous en deçà des normes : 1 médecin pour 18.592 hts, 1 infirmier pour 4.464 hts et 1 sage-femme pour 7.788 hts13. A ceci s’ajoute le manque criard de spécialistes (gynécologue, chirurgiens, pédiatres, sage-femme, instrumentistes etc.), une répartition inéquitable du personnel disponible avec une concentration en zone urbaine, des conditions salariales très peu attractives et un cadre de travail pas toujours adapté, un faible plateau technique un faible niveau managérial des rares ressources disponibles (financières, médicaments, infrastructure, équipements). Ce qui occasionne notamment des pratiques déviantes conduisant à une perte de l’éthique et à l’aggravation des inégalités d’accès aux soins, entrainant inévitablement une grande insatisfaction chez les usagers, mais aussi une sérieuse démotivation du personnel allant jusqu’à une déperdition marquée des compétences.

Et pourtant, diverses interventions ont été menées au cours des dernières années, pour aider à juguler la situation : le Plan de Développement et de Gestion des Ressources Humaines (PDGRH 2009-2013), qui servait de cadre d’intervention en matière RHS au Togo, jusqu’en 2010, a cédé place, avec l’adhésion du pays à l’IHP+ (Partenariat Mondial pour la santé et initiatives apparentées), à de nouveaux documents stratégiques du secteur : la nouvelle Politique Nationale de Santé (PNS de 2011), le Plan National de Développement Sanitaire (PNDS) 2012-2015, le Cadre de Dépenses à Moyen terme (CDMT) 2012-2014. Leur mise en œuvre ont permis, de répondre à certaines priorités et engagements, notamment : la révision de l’organigramme du ministère de la santé avec la création d’une Direction en Ressources Humaines (DRH) ; l’institutionnalisation d’un volontariat national au Togo (PROVONAT) qui permet de recruter plus aisément les jeunes diplômés ; le relèvement de l’âge de départ à la retraite (de 55 ans à 60 ans) pour les cadres supérieurs A1&A2, à 58 ans pour les catégories B et C et à 55 ans pour les autres) ; l’ouverture d’une école de formation d’infirmiers et de sages-femmes (ENAM et ENSF) à Kara ; la mise en place progressive d’interventions visant la Couverture Universelle des Soins de Santé avec : la gratuite (vaccination, ARV, CTA etc.) ou la subvention (césarienne, fistule etc.) de certaines interventions de santé publique ; la mise en place d’une protection sociale obligatoire (assurance maladie obligatoire) pour tous les agents de l’Etat et assimilés en 2011, etc.), l’organisation des concours de recrutement de 1.127 agents en 2008, de 867 en 2009 et de 986 agents en 2013 (recrutement régionalisé, dont les résultats sont en attente), la création encours de l’observatoire sur les RHS etc. Pour la réalisation de l’objectif spécifique de l’accès universel à la santé de la reproduction (SR) d’ici 2015, outre les stratégies mobiles et avancées en SR/PF qui ont commencé en 2008, la subvention de la prise en charge de la césarienne et des fistules en mai 2011, une évaluation des besoins en soins obstétricaux et néonatals d’urgence (SONU) ainsi qu’une cartographie de l’offre des services de SONU ont été réalisées en 2013.

Ainsi, à travers cette opportunité qu’offre ce 3è forum sur les RHS, le Gouvernement togolais a pris, pour 2014-2017, quatre (4) engagements majeurs (selon le modèle DAAQ) :

1. Mettre en place un mécanisme d’absorption de nouveaux diplômés, notamment à travers le recours au PROVONAT et le financement de la formation de spécialistes médicaux ;

12 Rapport OMS sur la santé dans le monde, 2006 13 Profil RHS au Togo

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2. Mettre en place des stratégies de fidélisation et de promotion des RHS surtout dans les zones rurales ou éloignées ou défavorisées ou difficile d’accès), à travers la mise en place de mécanismes et d’outils de gestion rationnelle et de développement des ressources humaines, d’une part, et leur mise en application d’autre part ;

3. Renforcer la formation initiale et continue des ressources humaines en santé en général (et celles de la mère et du nouveau-né en particulier) avec notamment l’amélioration de la qualité des formations, l’amélioration des capacités d’accueil des écoles de formations.

4. Améliorer la gouvernance et la coordination des ressources humaines du secteur à travers notamment le renforcement du cadre légal et règlementaire spécifique à la gestion des RHS et le renforcement de la gouvernance & du leadership (y compris le système d’information sur les RHS avec particulièrement la mise en place d’un observatoire national des RHS) etc.



Les principaux résultats attendus (et sources de vérification) retenus sont :

- 100 SFE nouvellement diplômées sont absorbées via le PROVONAT d’ici à 2016 (Contrat de travail, Note d'affectation, Note de prise de service) ; - 57 bourses de spécialisation et de formation d’encadreurs sont octroyés d’ici à 2016 (Rapport de la commission de bourses) ; - au moins 90% du de personnel redéployé vers les zones rurales/défavorisées ont tenue dans la durée minimale requise (Note d'affectation, Note de prise

de service, attestation de service justifiant la présence au poste) ; - 95% des encadreurs des sites de stage habiletés ont des compétences renforcées en techniques d'encadrement et sur l'utilisation des nouveaux

protocoles (Rapport de formation) ; - 80% des institutions de formation initiale disposent de salles de cours, de matériaux d’apprentissage, de bibliothèques, de logistiques et d’équipements

pédagogiques selon les normes (PV de réception, bordereau de livraison) ; - 90% des textes de base nécessaires pour disposer d’un cadre légal et réglementaire spécifique aux RHS sont élaborés et mis en application (arrêté

ministériel) - 100% du quota retenu chaque année pour le recrutement direct de nouveaux diplômés sortant des institutions de formation des paramédicaux (Contrat

de travail, Note d'affectation, Note de prise de service) ; - 35% de part du budget des RHS dans le financement de la santé (rapport financier du ministère de la santé).

Le coût total des engagements de 2014 à 2017 s’élève à 2.402 millions de FCFA (soit 4,805 millions d’USD) dont 39% pour 2014, 28% pour 2015, 26% pour 2016 et 6% pour 2017. Selon le DAAQ, il faut 31% du budget pour l’améliorer la disponibilité (à travers la première stratégie), 28% pour renforcer l’accessibilité (à travers la deuxième stratégie) et 41% pour améliorer l’acceptabilité et la qualité (à travers les deux autres stratégies). Pour une contribution attendue de 11% de l’Etat, de 31% de PAGRHSM et de 4% des autres PTF, les prévisions de mobilisation représentent 46% du budget avec un gap à rechercher 1.307 millions de FCFA (soit 54% du budget global).

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Le Togo est parmi les pays qui connaissent une pénurie grave de RHS Togo14 ; avec en 2012, pour le secteur public 9.982 agents contre 3.348 pour le secteur privé. Ce qui conduit à des ratios tous en deçà des normes : 1 médecin pour 18.592 hts, 1 infirmier pour 4.464 hts et 1 sage-femme pour 7.788 hts15. A ceci s’ajoute le manque criard de spécialistes (gynécologue, chirurgiens, pédiatres, sage-femme, instrumentistes etc.), une répartition inéquitable du personnel disponible avec une concentration en zone urbaine, des conditions salariales très peu attractives et un cadre de travail pas toujours adapté, un faible plateau technique, un faible niveau managérial des rares ressources disponibles (financières, médicaments, infrastructure, équipements). Ce qui occasionne notamment des pratiques déviantes conduisant à une perte de l’éthique et à l’aggravation des inégalités d’accès aux soins, entrainant inévitablement une grande insatisfaction chez les usagers, mais aussi une sérieuse démotivation du personnel allant jusqu’à une déperdition marquée des compétences. Ainsi, bien que le taux d’accessibilité géographique soit assez bon (88%) et que la couverture de l’assurance maladie obligatoire pour les agents publics et assimilés (loi n°2011-003, mars 2011) soit effective depuis mai 2012, le chemin vers la CSU reste encore émaillé d’importants goulots : la pénurie et l’inégale répartition des RHS en général (et celles en charge de la pratique sages-femmes en particulier) ; la faible capacité d’absorption du personnel formé (avec un concours national de recrutement tous les 2,5 ans) ; les capacités de production (en quantité et qualité) des écoles de formation initiale qui sont en deçà des normes internationales ; la faible accessibilité financière (alors que le coût moyen de traitement par pathologie est encore important, contrastant avec un niveau élevé de pauvreté de la population estimé à 61,7%) ; l’importante disparité dans la répartition des infrastructures et équipements de santé et du personnel entre régions et entre zones urbaines et rurales ; insuffisance de stratégies opérationnelles d’amélioration de l’utilisation des services de soins par les populations en particulier les couches vivant dans les zones reculées (activités de proximité en stratégies avancée et mobile) ; insuffisance d’information et de communication pour un changement de comportement ; faiblesse de système de financement alternatif (soins d’urgences pas toujours pris en charge ; absence de mécanismes de pré-payement ; faible couverture en mutuelles de santé et autres formes d’assurances maladie ; insuffisance de la politique de gratuité/subvention pour certains soins) etc. Le Plan de Développement et de Gestion des Ressources Humaines (PDGRH 2009-2013), servait de cadre d’intervention en matière RHS au Togo, jusqu’en 2010, où avec l’adhésion du pays à l’IHP16+, tous les documents stratégiques du secteur ont été révisés : la nouvelle Politique Nationale de Santé (PNS de 2011), le PNDS17 2012-2015, CDMT18 2012-2014. Leur mise en œuvre ont permis, de répondre à certaines priorités et engagements, notamment : la révision de l’organigramme du ministère de la santé avec la création d’une Direction en Ressources Humaines (DRH) ; la mise en œuvre d’un projet destiné aux RHS19, l’institutionnalisation d’un volontariat national au Togo (PROVONAT) qui permet de recruter plus aisément les jeunes diplômés ; le relèvement de l’âge de départ à la retraite (de 55 ans à 60 ans) pour les cadres supérieurs A1&A2, à 58 ans pour les catégories B et C et à 55 ans pour les autres) ; l’ouverture d’une école de formation d’infirmiers et de sages-femmes (ENAM et ENSF) à Kara ; la mise en place progressive d’interventions visant la CSU20 avec : la gratuite (vaccination, ARV, CTA etc.) ou la subvention (césarienne, fistule etc.) de certaines interventions de santé publique ; la mise en place d’une protection sociale obligatoire (assurance maladie obligatoire) pour tous les agents de l’Etat et assimilés en 2011, etc.), l’organisation des concours de recrutement de 1.127 agents en 2008, de 867 en 2009 et de 986 agents en 2013 (recrutement régionalisé, dont les résultats sont en attente), l’opérationnalisation encours de l’observatoire sur les RHS (décret n°2012-006/PR du 7 mars 2012 portant organisation des 14 Rapport OMS sur la santé dans le monde, 2006 15 Profil RHS au Togo 16 IHP+ = Partenariat Mondial pour la santé et initiatives apparentées 17 PNDS = Plan National de Développement Sanitaire 18 CDMT = Cadre de Dépenses à Moyen terme 19 PAGRHSM= Projet d’Appui à la Gestion des Ressources Humaines en Santé et aux Médicaments 20 CSU = Couverture Universelle des Soins de Santé

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départements ministériels), l’adoption en 2013, de nouvelles normes sanitaires etc. Pour la réalisation de l’objectif spécifique de l’accès universel à la santé de la reproduction (SR) d’ici 2015, outre les stratégies mobiles et avancées en SR/PF qui ont commencé en 2008, la subvention de la prise en charge de la césarienne et des fistules en mai 2011, une évaluation des besoins en soins obstétricaux et néonatals d’urgence (SONU) ainsi qu’une cartographie de l’offre des services de SONU ont été réalisées en 2013. Ces résultats obtenus depuis Kampala et Bangkok, ont bénéficié de l’appui de certaines initiatives telles que MUSKOKA, le projet ADAMA, le PAGRHSM financé par l’AFD, dont le volet RHS a contribué entre autres à la conception encours du paquet incitatif, à la révision des curricula et référentiels des écoles de formation initiale. Avec l’appui de l’AMPS, une analyse des parties prenantes a été effectuée pour la mise en place d’un Comité multisectoriel de Coordination et de Facilitation du développement des RHS en santé (CCF) et des études ont été réalisées pour aider à disposer de données factuelles sur les RHS impliquées dans la pratique sage-femme. Toutefois, d’importantes difficultés demeurent : le faible niveau de financement du secteur (environ 4% du budget national en 2011 et 2012, alors que, le Togo ne bénéficie que de l’appui que quelques rares PFT et pour des montants assez moyens) ; le faible niveau de respect des promesses et engagements de tous les acteurs du secteur (ex : la signature du compact IHP+ n’ayant pas amélioré de façon significative, la mobilisation des ressources au profit des PAO 201321), le poids du financement de la santé qui pèse sur les ménages (50,5% selon les CNS22 de 2008), financement essentiellement caractérisé par le paiement direct (source d’inégalité), étant donné que l’assurance maladie obligatoire actuelle ne couvre pas encore les couches les plus vulnérables etc. Dans le but de contribuer à remobiliser les parties prenantes en vue d’accélérer les efforts du Togo pour l’atteinte des OMD et l’amélioration de façon générale de la santé de la population d’ici 2015, ce 3è forum sur les RHS, offre l’opportunité d’activer les précédents engagements internationaux et nationaux afin de contribuer à solutionner les problèmes des RHS. Le contexte national serait encore plus favorable, en ce moment où le ministère de la santé est provisoirement rattaché à la primature, et donc le secteur tient là une opportunité de faire porter ses besoins à un niveau de décision plus élevé. Pour ce faire, les autorités Togolaises, ainsi que des parties prenantes aussi bien nationales qu’internationales ont pris les présents engagements en faveur de l’accélération des mesures visant à promouvoir la composante Ressources humaines, du système national de santé. Il s’agit essentiellement d’interventions/actions en faveur des RHS, dont l’efficacité et la pertinence ou le caractère innovant ont été préalablement vérifiées et qui ont fait l’objet d’une démarche consensuelle (institutions de formation et de soins, associations professionnelles, société civile etc.). Ainsi, le Gouvernement togolais a pris quatre (4) engagements majeurs, alignés sur le modèle DAAQ :

1. Mettre en place un mécanisme d’absorption de nouveaux diplômés, notamment à travers le PROVONAT et le financement de la formation de spécialistes médicaux. Cette stratégie du recourt au PROVONAT est déjà en cours de mise en œuvre, mais il se pose un autre problème de pérennité après les deux années ; notamment de trouver des mécanismes d’intéressement, tels que recrutement direct à la fonction publique pour ceux qui ont travaillé en zones rurales/défavorisées. Avec l’ouverture des masters à l’EAM, et la possibilité d’ouvrir progressivement des nouvelles options en fonction des besoins du marché, les possibilités de formation en interne et à l’extérieur de spécialistes est à ce jour essentiellement tributaire de la disponibilité des ressources. Le recours à la diaspora peut aussi être une alternative. Les résultats attendus de la stratégie sont : 100 SFE nouvellement diplômées sont absorbées via le PROVONAT d’ici à 2016 et 57 bourses de spécialisation et de formation d’encadreurs sont octroyées d’ici à 2016.

21 PAO = Plan d’Actions Opérationnel 22 CNS = Comptes Nationaux de la Santé

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2. Mettre en place des stratégies de fidélisation et de promotion des RHS surtout dans les zones rurales ou éloignées ou défavorisées ou difficile d’accès). Ces stratégies incluront la mise en place de mécanismes et d’outils de gestion rationnelle et de développement des ressources humaines, d’une part, et leur mise en application d’autre part. Les questions liées à l’acceptabilité prennent en compte des aspects qui sont du ressort d’autres secteurs. Il s’agit notamment des aspects relatifs à l’aménagement territorial (eau, électricité, téléphone, route, écoles etc.). La décentralisation encours et la mise en place des comités sectoriels aideront à la gestion de ces problèmes. Avec le PAGRHSM, le paquet incitatif est en cours de conception mais il nécessite des ressources additionnelles (à mobiliser à court terme). Le paquet pourra également aider à résoudre les problèmes de disponibilité de spécialistes par l’octroi des bourses de spécialisation. Le résultat attendu de la stratégie est : au moins 90% du de personnel redéployé vers les zones rurales/défavorisées ont tenue dans la durée minimale requise.

3. Renforcer la formation initiale et continue des ressources humaines en santé en général (et celles en santé de la mère et du nouveau-né en particulier) avec notamment l’amélioration de la qualité des formations, l’amélioration des capacités d’accueil des institutions de formations. De nouveaux curricula sont disponibles ou en cours de révisions et le secteur vient d’adopter les normes et standards sanitaires pour les institutions de formation initiale. Les vraies difficultés résident dans le respect de ces différents documents au moment de la mise en œuvre (et cela nécessite d’importantes ressources en plus de l’engagement politique) Comme résultats attendus, on a : 95% des encadreurs des sites de stage habiletés ont des compétences renforcées en techniques d'encadrement et sur l'utilisation des nouveaux protocoles et 100% des institutions de formation initiale disposent de salles de cours, de matériaux d’apprentissage, de bibliothèques, de logistiques et d’équipements pédagogiques selon les normes..

4. Améliorer la gouvernance et la coordination des ressources humaines du secteur à travers notamment le renforcement du cadre légal et règlementaire spécifique à la gestion des RHS et le renforcement de la gouvernance & du leadership (y compris le système d’information sur les RHS avec particulièrement la mise en place d’un observatoire national des RHS) etc. Les textes pourront êtres adoptés sans être mis en œuvre (comme pour les engagements précédents). Le renforcement du système d’information est encours à travers le DHIS23 pour l’ensemble des données du secteur, d’une part, et, à travers iHRIS (progiciel spécifique aux RHS) d’autre part. Comme résultats attendus, on a : 90% des textes de base nécessaires pour disposer d’un cadre légal et réglementaire spécifique aux RHS sont élaborés et mis en application, 100% du quota retenu chaque année pour le recrutement direct de nouveaux diplômés sortant des institutions de formation des paramédicaux et 35% de part du budget des RHS dans le financement de la santé.

Le coût total des engagements de 2014 à 2017 s’élève à 2.402 millions de FCFA (soit 4,805 millions d’USD) dont 39% pour 2014, 28% pour 2015, 26% pour 2016 et 6% pour 2017. Selon le DAAQ, il faut 31% du budget pour l’améliorer la disponibilité (à travers la première stratégie), 28% pour renforcer l’accessibilité (à travers la deuxième stratégie) et 41% pour améliorer l’acceptabilité et la qualité (à travers les deux autres stratégies). Pour une contribution attendue de 11% de l’Etat, de 31% de PAGRHSM et de 4% des autres PTF, les prévisions de mobilisation représentent 46% du budget avec un gap à rechercher 1.307 millions de FCFA (soit 54% du budget global).

23 DHIS = District Health Information System

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Annexe1 : Plan d’actions 2014 à 2017

Stratégies & Interventions Actions Responsable IOV Source de

vérification

Période d'exécution et coût (en million de FCFA)

Description du coût

Cout Total 2014 2015 2016 2017

Disponibilité 734 346 194 194 0

1. Mise en place d’un mécanisme d’absorption de nouveaux diplômés et de formation de spécialistes 734 346 194 194 0

1.1. Recourt au PROVONAT

1.1.1. Recruter cent vingt (120) jeunes sages femmes pour améliorer la couverture dans les zones défavorisées

MS/PTF Nombre de sage femmes recrutées via le PROVONAT et affecté en milieu rural/défavorisé

Contrat de travail Note d'affectation/Note de prise de service

Rémunération des 120 jeunes SFE

130 43 43 43

1.1.2. Faire le plaidoyer auprès du PROVONAT, du MFP et des PTF

CAB/MS

Outils de plaidoyer Rapport de plaidoyer

Coût du plaidoyer PM

1.2. Financement de la formation de spécialistes

médicaux et formateurs des institutions de

formation

1.2.1. Mettre en œuvre le plan de formation en mettant l’accent sur la programmation et la formation de médecins spécialistes (35 bourses pour 4 ans-pédiatres-chirurgiens-gynécologue), des formateurs des institutions de formation (22 bourses)

MS/FMMP

Nombre de bourses octroyés

Rapport de la commission de bourses

Coût de formation pour 35 spécialistes pendant 4ans et de 22 encadreurs pendant 2ans

605 302 151 151

1.2.2. Faire le plaidoyer auprès du MEF et des PTF

CAB/MS


Coût du plaidoyer PM

Accessibilité 671 234 219 219 0 2. Mise en place de stratégies de fidélisation et de promotion des RHS surtout dans les zones rurales/éloignées ou défavorisées

ou difficile d’accès) 671 234 219 219 0

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vérification



Cout Total 2014 2015 2016 2017

2.1. Mis en place de mécanismes

et d’outils de gestion

rationnelle et de développement

des RHS

2.1.1. Elaborer un manuel de procédures d’incitation, de rétention et de motivation du personnel (financements basé sur la performance)

DGEPIS Disponibilité du draft du manuel de procédures

Draft du manuel de procédures

Deux consultants (1 national et 1 international) pendant 15 jours

6 6

2.1.2. Organiser deux ateliers d'élaboration et un atelier de validation du manuel de procédures d’incitation, de rétention et de motivation du personnel (Financement basé sur la performance)

DGEPIS Disponibilité du manuel de procédures validé

Manuel de procédures Rapport d'atelier

Atelier de 3 jours chacun pour 30 participants

9 9

2.2. Mise en application des ces mécanismes et outils

2.2.1. Mettre en œuvre le projet pilote du paquet incitatif (mécanismes de gestion des RHS orienté vers la performance)

CAB/MS Disponibilité du personnel dans les zones ciblées


Coût d'implémentation dans les 2 régions sanitaires

656 219 219 219

Acceptabilité & Qualité 997 363 269 218 147 3. Renforcement de la formation initiale et continue des ressources humaines en santé en général (et celles de la mère et du

nouveau né en particulier) 877 322 234 196 125

3.1. Amélioration de la qualité des

formations

3.1.1. Réviser les référentiels de compétence, de formation et d'évaluation de formation des institutions formant le personnel impliqué de la pratique SF en y intégrant les aspects de prise en charge des maladies de l’enfant et de l’adulte

CAB/MS Disponibilité des drafts de référentiels

Drafts de référentiels

Accompagnement par un consultant 3 1 1

3.1.2. Organiser deux ateliers pour l'élaboration et la validation du référentiel d'évaluation

CAB/MS Disponibilité des référentiels validés

Référentiels validés Rapport d'atelier

Elaboration: atelier de 5 jours pour 10 participants Validation: atelier de 3 jours pour 30

7 3 5

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vérification



Cout Total 2014 2015 2016 2017

participants

3.1.3. Renforcer les compétences des encadreurs des sites de stage en techniques d'encadrement et l'utilisation des nouveaux protocoles

CAB/MS Nombre d'encadreurs formés

Rapport de formation

Atelier de 6 jours pour 50 participants par an

62 15 15 15 15

3.1.4. Renforcer les compétences des formateurs des institutions de formation et les encadreurs APC et en andragogie

CAB/MS Nombre de formateurs/encadreurs formés


Atelier de 15 jours pour 50 participants par an

155 39 39 39 39

3.1.5. Créer par région un centre de formation à distance (Learning center)

CAB/MS Nombre de centres de formation à distance créé

PV de réception

Coût du matériel (laptop, desktop et accessoires, vidéoprojecteurs, matériel de visioconférence etc.)

425 71 142 142 71

3.2. Amélioration des capacités d’accueil des

institutions de formations

3.2.1. Acquérir quatre (4) bus de soixante (60) places pour l’organisation des stages pratiques des apprenants

MS/MEF/PTF Nombre de bus acquis PV de réception Coût des 4 bus (2/an) 160 160 0

3.2.2. Acquérir le matériel pédagogique et de démonstration pour les institutions de formation

CAB/MS Nombre de matériel acquis PV de réception Coût du matériel 65 32 32

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vérification



Cout Total 2014 2015 2016 2017

4. Amélioration de la gouvernance et de la coordination des ressources humaines du secteur à travers notamment le renforcement du cadre légal et règlementaire spécifique à la gestion des RHS et le renforcement de la gouvernance & du

leadership 120 42 35 22 22

4.1. Renforcement du

cadre légal et réglementaire spécifique à la

gestion des RHS

4.1.1. Elaborer des arrêtés réglementant l’affectation du personnel médical, pharmacien et paramédical du MS

CAB-MS/DRH Arrêtés disponibles Arrêtés PM PM

4.1.2. Diffuser et mettre en application les arrêtés élaborés CAB-MS/DRH

Nombre de structures (niveaux central et déconcentré) disposant les arrêtés élaborés et qui les appliquent

Rapport d'affectation des structures concernées Rapport de mission de dissémination

Coût de la diffusion 2 0,45 0,45 0,45 0,45

4.1.3. Elaborer un arrêté interministériel instituant les recrutements annuels sur ouverture de poste au MS (en compensation de l’attrition naturelle)

MS/MFP Disponibilité de l'arrêté interministériel

Arrêté interministériel PM PM x x

4.1.4. Elaborer un arrêté interministériel instituant un mécanisme de recrutement direct des diplômés sortant des institutions de formation des paramédicaux

MS/MFP/MEF Disponibilité de l'arrêté interministériel

Arrêté interministériel PM PM x x

4.1.5. Prendre un texte instituant un quota pour les fonctionnaires lors des recrutements dans les institutions de formation des professionnels de santé

CAB-MS/DRH Disponibilité de l'arrêté interministériel Arrêté ministériel PM PM x x

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vérification



Cout Total 2014 2015 2016 2017

4.2. Renforcement de la gouvernance &

du leadership

4.2.1. Réviser le PDGRH 2009-2013 DRH

Disponibilité du nouveau PDGRH Nouveau PDGRH

Consultant international pour l'élaboration pendant Atelier de validation de 3 jours pour 100 participants

15 15 0 0 0

4.2.2. Editer et diffuser le nouveau document de PDGRH DRH Edition de 2.000

copies 5 5 0 0 0

4.2.3. Accélérer la mise en place du Comité multisectoriel de coordination et de facilitation de la mise œuvre du PDGRH (finalisation du processus de création de l'observatoire des RHS et création du CCF)

SG/DRH

Disponibilité des arrêtés de création de l'observatoire des RHS et création du CCF

Arrêtés de création PM PM x x

4.2.4.Sensibiliser les prestataires et clients sur les pratiques déviantes (pratique de soins parallèle / absence non-autorisée), vente de médicaments, détournement des clients) à travers les affichages publicitaires (physique et lumineuse) dans les salles de consultation, halls, galeries)

MS/DESR Nombre de structures ayant des affichages publicitaires

Structures bénéficiaires

Coût des campagnes de sensibilisation

26 6 6 6 6

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vérification



Cout Total 2014 2015 2016 2017

4.2.5. Renforcer les compétences des prestataires sur l’accueil (services d’aide au diagnostic, urgences chirurgicales médicales, pharmacie, régie des recettes, agents de recouvrement et agents de sécurité)

MS/DESR Nombre de prestataires formés


Atelier de formation de 2 jours

73 15 28 15 15

4.2.6. Faire le plaidoyer pour le financement en faveur des RHS

PTF (OMS, AMP…)

Pourcentage du budget accordé aux RHS par rapport au budget alloué à la santé

Loi des finances PM PM x x x x

Coût Total (en million de FCFA) 2 402 943 682 631 147

Coût Total (en million d'USD) 4,805 1,885 1,365 1,261 0,293

% 100 39 28 26 6

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HRH commitment pathways UGANDA


1. Improving Availability: Scaling up pre-service education and training - The government of Uganda commits to scaling up the training of professionals in scarce supply, namely; Anesthetic officers from current annual

enrollment of 20 to 60 ; increase annual enrollment of laboratory technologists by 100 by 2015; and increasing the annual enrollment into midwifery

training by 200 per year through to 2015.

- The government of Uganda commits to work jointly with professional councils to enhance the quality of pre-service education through synthesis and

implementation of harmonized standard guidelines for establishment, accreditation, licensing and operation of health training institutions from 2014.

2. Provision of Incentives for attraction and retention

- Government of Uganda commits to ensure that at least 60% of technical staff at health centre levels III and IV and general hospitals have decent

institutional accommodation at the place of work by the end of 2015. - Government commits to enhance salaries of health workers at health centre levels III and IV and general hospitals by 50% of current gross pay by 2015;

and to ensure that the salaries are paid in a timely manner. - Government commits to provide full tuition support for post basic professional training to health workers who serve in remote rural facilities for at least two

years. - Government commits to complete establishment of the Village Health Teams in all the districts and institute appropriate mechanisms for maintaining them.

3. Improving health workforce productivity and accountability

- Government commits to strengthen performance management by institutionalizing individual performance planning, monitoring and appraisal for all staff

at health centre levels III and IV and general hospitals by 2015. - Government commits to apply workload indicator of staffing need methodology nationally for determining staffing requirements and efficient deployment of

staff at health centre levels III and IV, and general hospitals by 2015. - Government commits to apply appropriate measures to reduce absenteeism currently estimated at 50% by 60% at all levels by 2015.

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4. Strengthening partnerships with the private not-for-profit service providers - Government commits to increase financial support to PNFP service providers to achieve 100% established staffing standards at health centre levels III

and IV, and general hospitals by 2015 - Government will strengthen the HRH Technical Working Group to effectively embrace the functions of CCF and Observatory by 2014.


- Increase in annual training enrollment from admission reports; pass rates at final examinations from examination reports; periodic client satisfaction

surveys at health facilities

- Proportion of technical staff accommodated from annual health facility and district reports; proportion of health staff whose salaries have been enhanced

by 50% from monthly payrolls; proportion of post basic trainees from remote rural work places with full government tuition support

- Proportion of staff appraised on the basis of their individual performance plans from district annual performance appraisal report; proportion of districts

using WISM methodology in staff deployment from surveys; rate of absenteeism from surveys

- Staffing level in PNFP HCIII, HCIV and general hospitals from routine periodic reports and annual special staff audits

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HRH commitment pathways AFGHANISTAN


Afghanistan has 3 main health service providers, including:

1- Ministry of public health running 16 major national hospitals in Kabul and 9 provincial hospitals through hospital reform project in the provinces and urban health in Kabul city,

2- BPHS and EPHS in the provinces, which is major health project in the country and running by counteracting out mechanize with national and international HGOs,

3- Private sector (which is also big and semi regulated.).

In Afghanistan, Ministry of Public Health is providing national steward ship for all health sectors.

HRH (Human Resource for Health) is critical challenge in Afghanistan. In 2010 country had 5.4 health service provider (doctor, nurse & midwifes) / 1000 Afghans. With some progress during the last 2,5 years, now it has 7.4 health service providers / 1000 population of the country.

In addition to critical shortage of essential categories of health workforce, there are 3 major HRH issue / problem in Afghanistan:

1. HRH distribution in the country as more than 70% of country population of Afghanistan is living the rural provinces whereas around 60% of health staff HRH is concentrated in the 4 major cities (Kabul, Jalal Abad, Herat and Balkh) provinces.

2. Gender Imbalances, as only 25% of health workforce is female and 75% is male 3. Skill mixed, because some very important categories of health professionals are missing, like biomedical engineer/ technician, educated hospital manager,

etc. and likewise 30 areas of specialties are missing in the country.

Complementing to these, some other potential risk factors still exist in the country negatively impacting HRH in the country, like: (1- Absents of regulation system / regulatory bodies like Medical council, Nursing and Midwifery council and other regulatory bodies in health personnel areas. 2- there is CCF started from one year before, and country profile is updated but HRH production by training institutions are still not aligned with the need of MoPH and health sector in Afghanistan.

With this backdrop, the Ministry of Health and Population of Afghanistan will follow three priority objectives for 2013-2018 to reach the national goal and

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commitment together with the national and international partners.

1. Finalization and prioritizing the national HRH strategy 2013 – 2020 for health sector

2. Establish and institutionalize regulatory mechanisms for accreditation of health professionals’ education for all cadres and medical qualifications for the

national and international health staff works in Afghanistan.

3. Strengthening regulation and control for provide institutions training HRH in the country:

Objective 1: Finalization and prioritizing the national HRH strategy 2013 – 2020 for health sector. This objective will be reached through the following activities: Developing two years operational plan (by March 2014)

Carry of cost of the planned activities (by June 2014)

Bring all stakeholders on board and engaging them in the implementation, monitoring and accountability (2014 onwards)

Objective 2: Establish and institutionalize regulatory mechanisms for accreditation of health professionals’ education for all cadres and medical qualifications for the national and international health staff works in Afghanistan: Following activities will be carried out toward s this objective: Official establishment of AMC (Afghanistan Medical Council.) and AMNC (Afghanistan Midwifery and Nursing Council.) (by Dec 2014)

Develop process for registration for HRH in the country level (June 2015)

Develop accreditation mechanism and criteria for health professionals in the country (by Dec 2015)

Implementation of newly developed PGME (post-graduate medical education/ clinical specialization program.) in the health system. (by Dec 2016)

Develop and implement a licensing Examination system to register doctors, nurses and midwifes etc. in the country (by Dec 2016)

Objective 3: Strengthening regulation and control for provide institutions training HRH in the country. This objective will be achieved through: Registration and Accreditation of private health institutions training mid-level health workers, and to regulate the private institutions training for doctors, Pharmacist and other health professional cadres

Specific role of stakeholders:

In order to implement the national HRH strategy and plan MoPH will engage all stakeholders and bong them on the board contributing and do advocacy for fund

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raising and follow up with donors and other relevant ministry implements the strategy and action plan by showing each stakeholder commitments and support.


In order to pursue and monitor the implementation of the commitment, following monitoring indicators have been determined : Official establishment of AMC (Afghanistan Medical Council.) and AMNC (Afghanistan Midwifery and Nursing Council.)

Registration of HRH in the country level

Established and functional accreditation system and criteria for health professionals in the country

Postgraduate medical education started with newly developed PGME (post graduate medical education/ clinical specialization program.).

well established and functional licensing Examination system to register doctors, nurses and midwifes … in the country

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HRH commitment pathways

DJIBOUTI


The primary challenge for human resources for health in Djibouti had been a lack of health workers in all categories to match the development in health infrastructu and population needs.

The establishment of the Institute for Health sciences with its training for Nursing, midwifery and laboratory technicians has provided the country with the minimum required health care staff to ensure the functioning of health facilities especially outside of the capital. The past Five Year National Health Policy (NSDP 2008-2012 includes the HRH objectives related to quantity and quality, strengthening the administrative management systems, enhancing performance; and efficient training o health workforce recruitment of doctors from other countries, resulting in 1 nurse per every 10,000 inhabitants; 0.71 midwives per 10,000; 0.42 laboratory technicia per 10,000; 0.59 general practitioners per 10,000; and 0.40 medical specialists per 10,000 (Plan National de Développement Sanitaire de Djibouti 2008-2012, République Dijbouti Ministère de la Santé). The assessment of the situation in end of 2012 had shown that progress had been made in many fronts at the national level with these numbers achieved however there are many disparities in regional distribution with the concentration of staff in the capital, large turnover and possib many leaving out the country for better options one or 2 years after graduation. The number of specialists may have been reached but many specialties are still missing. Currently a school of medicine will be providing the country with 20 medical doctors per year, in addition to outside country training. The number of doctors each region is still very low and the GPs in 5 districts do not all have essential surgical skills such as the ability to perform cesarean sections. These challenges are complemented by a number of others including: limited opportunity for applied and refresher training for nurses, midwives, laboratory, and pharmacy technicians; la of human resources for health national strategy and projection data ; absence of national standards for curriculum development for all health professions; lack of regulations and continuing education for health workers; limited resources for renewing and expanding teaching equipment and educational resources, as well as coordination issues between Ministry of Higher education which oversees the faculty of medicine and the ISS, producing the health care practitioners and MOH. As many doctors are also being trained in a variety of countries, the need to harmonize and ensure quality and certifying doctors is critical. The MOH is giving due priority to HRH a priority and has taken several steps, but due to limited capacity and resources, these critical challenges persist. The MOH with support of WHO, GHWA and other patterns initiated the HRH situation analysis and building an evidence base for strategic decision making. The MOH Djibouti hereby announces the commitment to carry forward the policy development and planning process and will peruse the following priority objectives with defined interventions.

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Objective 1: Engage the patterns and stakeholders in HRH planning, investment, implementation and accountability

• Strengthen the HRH Multistakehodler coordination process, ensure continuous policy dialogue, engaging them in related processes with an accountability system

• Develop National HRH observatory and create a computerized multisectoral HRH information system • Mobilizing national and partners resources of enhanced HRH funding to meet the development and maintenance needs

Objective 2: Enhancing the national capacity to plan, implement, manage, and monitor the HRH polices and interventions

• Strengthen HRH directorate of MOH and build a national team to manage HRH • Assess HRH staffing needs and develop projections, strategic plan and costing • Adapt WHO guidelines for retention of health workforce

Objective 3: Increase the production of essential health workforce ensuring quality and adequate accreditation systems

• Build national capacity for education and training of essential cadres to meet the HRH needs with indigenous resources • Develop/adapt/update curriculum for education and training • Streamline on job / continuous trainings for different cadres using modern technologies • Developed and implement quality standards for education, training and staff performance • Establish/strengthen national accreditation systems

The below targets for above indicated HRH interventions will be pursued:

1- Engage the patterns and stakeholders in HRH planning, investment, implementation and accountability • Establishment of formal HRH coordination committee (MOH, related sectors and stakeholders - Jan 2014) • Start establishing national HRH Observatory (MOH, WHO - June 2014) • Biannual local patterns’ meetings on resources mobilization and accountability (MOH, MOF, WHO, Partners - from June 2014)

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2- Enhancing the national capacity to plan, implement, manage, and monitor the HRH polices and interventions • Make a need assessment for strengthening HRH directorate of MOH and building national HRH team to district level, develop an evidence based

plan and disseminate to partners (MOH, WHO – Dec 2014) • HRH projections and planning through international consultant (MOH, WHO – June 2014) • Adaptation and start implementation of WHO guidelines on HRH retention (MOH, WHO – March 2015)

3- Increase the production of essential health workforce ensuring quality and adequate accreditation systems • Assessment of national training needs and develop a master plan to attain self-sufficiency in development of essential health cadres (MOH, MOE,

WHO, related stakeholders – December 2015) • Development / updating of curriculum for CHWs, Midwives, Nurses and Physicians (MOH, MOE, WHO, related stakeholders – December 2015) • Link the continuous training programmes with online e-leaning opportunities available with WHO and other partners (WHO, MOH, MOE, related

stakeholders – December 2015) • Develop quality standards and accreditation systems by using experience of other countries in the region and beyond (MOH, WHO, Partners and

stakeholders - Dec 2016)


The commitment pathways will be monitored through following key indicators: 1. Multisectoral HRH committee is established and engaged in HRH processes planning, implementation and monitoring (information source: HRH plan

validation meeting report) 2. National HRH observatory is being established (information source: HRH report) 3. HRH projections and plan has been developed and validated by the stakeholders (information source: HRH plan) 4. WHO retention guidelines have been adapted and national strategies adjusted accordingly (information source: HRH report) 5. Master plan for HRH development has been established (information source: Master plan document) 6. Curriculum for essential health cadres developed/updated (information source: HRH report) 7. Health workforce have access to e-learning facilities (information source: HRH report) 8. National quality standards for key HRH aspects available and implementation started (information source: related documents)

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EGYPT


Whilst the MHOP has overall responsibility for health in Egypt, it does not have authority to control the many factors that influence health or the health workforce. This is far from unusual and could be said about any country. Nevertheless, it is vitally important that this situation is recognized.

The overall goals of the health human resource development in Egypt are to ensure that the workforce:

- Be of the right size: the number of doctors, nurses and other health professionals in Egypt should be adequate to meet the health needs of the Egyptian

population.

- Be in the right place: the health workforce should be distributed throughout Egypt in a way which parallels the needs for health care in each region of

Egypt.

- Have the right mix and level of skills: the ratio of doctors, nurses and other health professionals should match the workload involved in providing the

various components of health care. Furthermore, the level of skills should be sufficient to provide adequate quality care.

- Be employed and managed appropriately: the conditions of employment should be such that the health workforce is motivated and has adequate

resources to provide a good standard of health care. Furthermore, the management of the workforce should be such that good standards of work are

required. Human resources for health in Egypt face many challenges in policy, management, leadership, partnership, education, and financing.

Challenges in the HRH system in Egypt are the drivers for setting priorities for action to address it. These are the following:

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Challenges Action pathways Indicators Stakeholders

- Fragmentation of HRH information management and absence of staffing figures for facilities other than the MOHP and HIO or private health providers, making it difficult to determine accurate information about HRH

Initiate and make functional the national HRH observatory

National HRH Observatory is in place with multi-stakeholder engagement and reports are produced on regular basis

MOHP – Syndicate for medical professions, ministry of education, of higher education, military, police, other ministries providing healthcare services

- Serious imbalances within staffing groups with excess of physicians while at the same time a serious shortage of qualified nurses, especially graduate nurses, a complete lack of well-qualified midwives and a shortage of paramedical staff.

- Mal-distribution of human resources not appropriate to the pattern of health status of the various regions in Egypt

Identify standard norms for staffing patterns, levels and ratios based on the demographic and health profile and the socioeconomic conditions in Egypt and utilizing international practices in that respect, aligning with the national disease burden

- Standards for staffing patterns developed and disseminated

- National HRH deployment Masterplan is developed and implemented

MOHP, universities and collaborating centers, development partners and other

- HRH in Egypt has shortages and weaknesses in certain specialties including community nurses, family medicine, primary health care doctors, and others.

Produce required specialists through effective training and education and sound deployment strategies

Increased numbers of needed specialty practitioners & formulation of effective deployment strategies

MOHP, universities and collaborating centers, development partners and other

- Continuing education for all categories of health workers is fragmented and uncoordinated.

- Enhance MOHP in-service training programs through a clear national plan using technical support from universities

Ministerial level coordination committee formed with membership of ministers of health, higher education, manpower & immigration

MOHP – Syndicate for medical professions, ministry of education, of higher education & other

- There is no clear, efficient and effective HRH policy spelling out remuneration, employment, deployment, career development, retention, and other

- HRH policy formulation for setting Professional standards, licensing and accreditation and credentialing

- Political, social and financial decisions and choices that impact HRH

- HRH policy formulated and disseminated

- Legislations developed regulating rules of employment and practice, remuneration, career development paths

Policy document formulated and disseminated

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1- Through M&E Team for establishment the HR observatory, step by step, formulation of 3-4 technical teams to work with consultancy on CME and E-

learning, measure the staff retention on yearly bases and every 3 years for different specialties through (NATIONAL INFORMATION INESTETUTES AT

MOHP) & Vocational leaves from employment affairs

2- Detailed operational plan with required cost is developed for institutionalization of regulatory mechanisms and establishing Licensing Examination System

and is agreed by MOH and other key players (Information source/s: Operational plan report)

3- Adequate funding and system support has been provided to implement both initiatives (Information source/s: progress report)

4- Accreditation criteria for medical education for doctors and nurses is available and agreed by MOH and related stakeholders (Information source/s:

progress reports and related documents)

5- Relicense and revalidation committee were developed and draft of policy paper were delivered to all stakeholders (MOHP , Egyptian Medical Syndicate )

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HRH commitment pathways Iran (Islamic Republic of)

1) What human resources for health (HRH) -related actions and pathways can your country/ institution commit to?

Accelerate progress towards health MDGs, progressive realization of UHC

Increased and more equitable coverage of quality health services

Governments across different sectors and partners across different constituencies collaborate to ensure that all people everywhere have access to a skilled, motivated health worker, within a robust health system

Colour code Key Education pathway

Retention & incentives pathway Skills mix pathway

Labor markets pathway

Figure 1.1

Total HRH commitments

Ensure an adequate stock and equitable distribution of health workers, responsive to the population’s socio-cultural needs, fit for purpose and fit to practice

(Government of Islamic Republic of Iran commits to increase its HRH production by 10% per year over next 5 years fitting with the required jobs and qualification , to absorb in the health system and deploy new workers preferentially to underserved areas through appropriate incentives, and to ensure appropriate gender balance and quality standards of new HRH graduates)

Availability Accessibility Acceptability Quality

Based on the health needs of the society and the health labour market, MOHME of I.R Iran commits to develop the required new academic disciplines, and extend the entries to the majors with shortage or moderate the entries of excess majors.

Within the framework of Health Services Allocation System, MOHME of I.R Iran commits to supply %30 admissions to medical fields through absorbing local students, especially those from deprived and underserved areas based on the needs of the province.

Government of I.R Iran commits to provide all necessary supports including financial facilities and resources for the establishment of knowledge-based enterprises.

MOHME of I.R Iran guarantees and ensures the continuity of the program for training and recruiting frontline health workers who are % 100 local residences and also upgrade of the knowledge and skills of current employees for the improvement of the very program.

MOHME of I.R Iran commits to calculate and finance the cost per capita for training the demanded human resources for health sector in its annual operating budget framework.

With the aim of increasing the retention of human resources, MOHME of I.R Iran commits to supply its staffing needs with the priority of recruiting local human resources, having provided the required condition and competency qualifications

MOHME of I.R Iran commits to review and update educational curriculums (as well as educational contents) of medical and paramedical courses to be tailored to the needs of health system and the aim of universal health coverage.

MOHME of I.R Iran commits to take action in reviewing and revising the educational accrediting system in relation with faculty members and students.

MOHME of I.R Iran commits to provide the position pyramid of full-time faculty members (from instructor and assistant to associate and full professor) in the subset universities, both governmental and non-governmental, through providing the essential infrastructures and emphasis on meritocracy.

MOHME of I.R Iran will be obliged to provide the necessary mechanisms to enhance the role and status of the Central Headquarter of MOHME as the health policy making authority.

Government of I.R Iran commits to remunerate the salaries and other benefits of full-time service of medical specialists who are passing their obligatory service commitments in deprived and underserved areas in appropriate rates and in form of a fixed payment system

MOHME of I.R Iran commits to plan and implement continuous training at the staff & managerial to maintain and improve pertaining to their knowledge, skills and appropriate attitudes standards towards their work environment.

Government of I.R Iran commits to continually revise the professional boundaries and the skill mix of health care staff with priority

MOHME of I.R Iran commits to formulate necessary protocols and guidelines to provide human resources enclosure (including HR number and combination) for all vertical projects (stand alone) and newly established units in health sector.

Within 2 coming years, MOHME of I.R Iran commits to estimate human resources requirements from the needed majors in different geographic regions for a period of 10 years

Government of I.R Iran commits to provide the mechanisms for the retention of elites and specialists in the public sector (in order to increase financial access with the aim of universal health coverage) and also in the country (avoiding brain drain and human capital flight)

In compliance with the WHO code of practice, MOHME of I.R Iran tends to introduce medical and paramedical workforces, surplus to the need of Iran, to the applicant countries for their recruitment and will make the necessary collaborations in the process of sending the forces.

MOHME of I.R Iran commits to recruit and absorb medical specialty disciplines graduates from different medical and paramedical groups for delivering specialized services in the needed areas decided by MOHME with public governmental fee rate payment in the relevant major, after gradation for the duration of at least one-half and at most three times their study period (according to the deprivation index of the employment location in return for their free education)

MOHME of I.R Iran commits to update the required competencies of all health professions through reviewing job classification schemes according to the needs of the health system.

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MOHME of I.R Iran commits to recruit the faculty members as full-time for at least 5 years in order to boost their sustainability and also increase the public access to qualified and specialized services appropriate with the community affordability

In order to increase the human resources retention in deprived and underserved areas MOHME of I.R Iran commits to use the employed health care providers in those areas for at least 10 years

MOHME of I.R Iran commits to consider and pay extra amounts for severe weather conditions, hardship of job, shift working, being full-time and etc. in order to escalate the retention and motivation of the public sector staff in deprived and underserved areas.

MOHME of I.R Iran commits to absorb general practitioners and other health care disciplines after their graduation maximum for 2 years in return for their free training.

Government of I.R Iran commits not to absorb and recruit health workforces from impoverished and low income countries.

MOHME of I.R Iran commits to design and deploy the comprehensive information system of human resources for health

Cross-cutting actions:

o MOHME of I.R Iran commits to establish a committee entitled as “National Committee for Coordination, Policy Making and Planning of Human Resources of Health Sector” and provides its

implementation mechanisms in order to centralize and integrate policy making, human resources planning of health sector (including health care organizations in public & private sector)

o MOHME of I.R Iran commits to establish and deploy “Health sector Human resources Observatory” (including health care organizations in public & private sector) and provides its

implementation mechanisms.

o MOHME of I.R Iran commits to formulate and implement necessary protocols and guidelines to provide human resources enclosure (including HR number and combination) for all vertical

projects and newly established units in health sector (including health care organizations in public & private sector)

o Government of I.R Iran commits to a suitable proportion of its resources earned from “The Iranian Targeted Subsidy Plan” to the human resources of health sector.

o While maintaining sovereignty, government of I.R Iran commits to delegate executive and outsourcing affairs to the private sector.

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Iran’s Commitments table

No. commitment Responsible

organization target Expected completio

n date

1 Develop and maintain HRH competences through updated/ improved curricula

Ministry of Health and Medical Education

Based on the health needs of the society and the health labour market, MOHME of I.R Iran commits to develop the required new academic disciplines, and extend the

entries to the majors with shortage or moderate the entries of excess majors. 2017

2 Adopt education policies favouring rural retention


Within the framework of Health Services Allocation System, MOHME of I.R Iran commits to supply %30 admissions to medical fields through absorbing local

students, especially those from deprived and underserved areas based on the needs of the province.

continuous

3 Enhancing the role of private sector in

knowledge production and health services delivery

National Government

Government of I.R Iran commits to provide all necessary supports including financial facilities and resources for the establishment of knowledge-based

enterprises. 2017

4 Adopt appropriate skills mix to increase service uptake


MOHME of I.R Iran guarantees and ensures the continuity of the program for training and recruiting frontline health workers who are % 100 local residences

and also upgrade of the knowledge and skills of current employees for the improvement of the very program.

continuous

5

Ensure the funding for training is predictable, effectively harmonized and aligned with national human resources

requirements within the context of integrated support to the health sector


MOHME of I.R Iran commits to calculate and finance the cost per capita for training the demanded human resources for health sector in its annual operating

budget framework. continuous

6 Ensure adequate absorption of HRH graduates


MOHME of I.R Iran commits to recruit and absorb medical specialty disciplines graduates from different medical and paramedical groups for delivering

specialized services in the needed areas decided by MOHME with public governmental fee rate payment in the relevant major, after gradation for the

duration of at least one-half and at most three times their study period (according to the deprivation index of the employment location in return for their free education)

continuous

7 Ensure adequate absorption of HRH graduates


MOHME of I.R Iran commits to absorb general practitioners and other health care disciplines after their graduation maximum for 2 years in return for their free

training. continuous

8 Provide incentives for retention and equitable deployment


With the aim of increasing the retention of human resources, MOHME of I.R Iran commits to supply its staffing needs with the priority of recruiting local human resources, having provided the required condition and competency qualifications

continuous

9 Review the academic disciplines based on the health needs of the population and the

health labour market


MOHME of I.R Iran commits to review and update educational curriculums of medical and paramedical courses to be tailored to the needs of health system and

the aim of universal health coverage.

10 Enhance quality of medical education through accreditation


MOHME of I.R Iran commits to take action in reviewing and revising the educational accrediting system in relation with faculty members and students. 2016

11 Enhance quality of health services through providing the essential infrastructures and

emphasis on meritocracy


MOHME of I.R Iran commits to provide the position pyramid of full-time faculty members (from instructor and assistant to associate and full professor) in the

subset universities, both governmental and non-governmental, through providing the essential infrastructures and emphasis on meritocracy.

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nued)Iran’s Commitments table (conti

No. commitment Responsible organization target

Expected completion

date

1 Adopt recruitment policies

favoring deprived and underserved retention


MOHME of I.R Iran commits to recruit the faculty members as full-time for at least 5 years in order to boost their sustainability and also

increase the public access to qualified and specialized services appropriate with the community affordability

continuous

2 Adopt recruitment policies

favoring deprived and underserved retention


In order to increase the human resources sustainability in deprived and underserved areas MOHME of I.R Iran commits to use the

employed health care providers in those areas for at least 10 years continuous

3 Provide incentives for retention and equitable deployment


MOHME of I.R Iran commits to consider and pay extra amounts for severe weather conditions, hardship of job, shift working, being full-

time and etc. in order to escalate the retention and motivation of the public sector staff in deprived and underserved areas.

continuous

4 Actualization of medical tariffs National Government

Government of I.R Iran commits to calculate the actual cost of diagnostic and medical treatment services and apply it in public

and private sector for the calculation of medical tariffs and fees paid to medical specialists.

continuous

5 Provide incentives for retention and equitable deployment National Government

Government of I.R Iran commits to remunerate the salaries and other benefits of full-time service of medical specialists who are passing their obligatory service commitments in deprived and underserved

areas in appropriate rates and in form of a fixed payment system.

continuous

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Iran’s Commitments table (continued)


Expected completion

date

1 Lay the ground for HRH stewardship


MOHME of I.R Iran will be obliged to provide the necessary mechanisms to enhance the role and status of the Central

Headquarter of MOHME as the health policy making authority. 2016

2

Updating the KSA (knowledge, skills and attitudes) of Health

Care Professionals to be consistent with international

standards


MOHME of I.R Iran commits to plan and implement continuous training at the staff & managerial to maintain and improve

pertaining to their knowledge, skills and appropriate attitudes standards towards their work environment.

continuous

Enable health workers to operate within full scope of profession National Government Government of I.R Iran commits to continually revise the professional

boundaries and the skill mix of health care staff with priority 2016

Lay the grounds for HRH stewardship


MOHME of I.R Iran commits to formulate necessary protocols and guidelines to provide human resources enclosure (including HR

number and combination) for all vertical projects (stand alone) and newly established units in health sector.

2016

update the required competencies of all health professions


MOHME of I.R Iran commits to update the required competencies of all health professions through reviewing job classification schemes

according to the needs of the health system.

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Iran’s Commitments table (continued)


Expected completion

date

1 Secure adequate supply qualified entrants


Within 2 coming years, MOHME of I.R Iran commits to estimate human resources requirements from the needed majors in different

geographic regions for a period of 10 years 2016

2 retention of high-qualified specialists in the public sector National Government

Government of I.R Iran commits to provide the mechanisms for the retention of high-qualified specialists in the public sector (in order to increase financial access with the aim of universal health coverage)

and also in the country (avoiding brain drain and human capital flight)

3 Address HRH excess through WHO Code


In compliance with the WHO code of practice, MOHME of I.R Iran tends to introduce medical and paramedical workforces, surplus to the need of Iran, to the applicant countries for their recruitment and will make the necessary collaborations in the process of sending the

forces.

4 Address HRH loss through WHO Code of practice at international

level National Government Government of I.R Iran commits not to absorb and recruit health

workforces from impoverished and low income countries.

5 launch “Health sector Human resources Observatory System


MOHME of I.R Iran commits to redesign and launch a comprehensive information system for HRH 2016

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(continued)Iran’s Commitments table


Expected completion

date

1 Lay the grounds for HRH stewardship


MOHME of I.R Iran commits to establish a committee entitled as “National Committee for Coordination, Policy Making and Planning

of Human Resources of Health Sector” and provides its implementation mechanisms in order to centralize and integrate policy

making, human resources planning of health sector (including health care organizations in public & private sector)

2 launch “Health sector Human resources Observatory System


MOHME of I.R Iran commits to launch “Health sector Human resources Observatory System” (including health care organizations

in public & private sector) and provides its implementation mechanisms.

3 Develop, implement , monitor and

evaluate the comprehensive and coasted health plans addressing

HRH strategies


MOHME of I.R Iran commits to formulate and implement necessary protocols and guidelines to provide human resources enclosure

(including HR number and combination) for all vertical projects (stand alone) and newly established units in health sector (including health

care organizations in public & private sector)

2016

4 Allocate and spend more

productively an adequate proportion of health sector

funding to the health workforce

National Government Government of I.R Iran commits to a suitable proportion of its

resources earned from “The Iranian Targeted Subsidy Plan” to the human resources of health sector.

continuous

5 Enhancing the role of private

sector in knowledge production and health services delivery

National Government While maintaining sovereignty, government of I.R Iran commits to delegate executive and outsourcing affairs to the private sector.

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2) How will you monitor progress towards achievement of your commitment pathways (What indicators will you track? What data sources will

you use)? Indicators for Monitoring Iran’s Commitments

Availability Accessibility

o Number/Percentage of newly established majors according to the high priority health needs of the population

o Number/Percentage of graduates by newly established/modified majors

o Number/Percentage of new student entries to the majors with shortage

o Number/Percentage of excess and modified majors by disciplines o Existence of implementation plans for delegating affairs related to

education, research and medical treatment to private sector and also liberalizing executive and outsourcing affairs to it

o Number/Percentage of absorbed local students in deprived areas by major disciplines

o Retention rate of local human resources by geographic regions o The amount of financial resources and facilities dedicated for the

establishment of knowledge-based enterprises o Number/Percentage of annually trained local students by cadre o Number/ Percentage of annually absorbed local graduates by

cadre and locations o Amount of cost per capita for training needed human resources of

health sector decided in the annual operating budget framework o The allocated funds to training the needed human resources by

major disciplines o Percentage of the absorbed graduates (local and non-local) annually

by cadre and recruiting locations Acceptability Quality

o Human resources distribution by geographic region, major disciplines and skill mix

o Existence of a plan for the recruitment and retention of human resources based on meritocracy

o Percentage of absorbed human resources out of the total number of the trained forces annually

o Percentage of modified curriculums according to the health needs by major disciplines

o Percentage of implemented amendments/modifications in the curriculums based on PHC

o Existence of appropriate policies and implementation plans in order to revise and reform accreditation system based on the international/global standards and frameworks

o Existence of documented policies and implementation plans in order to implement meritocracy system in recruitment and retention of full-time faculty members

Potential data sources: population census, labour force survey, health facility assessment, civil service payroll registries, registries of professional regulatory bodies.

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Indicators for Monitoring Iran’s Commitments (continued)

Availability Accessibility

o Percentage of full-time employed faculty members, by cadre in different locations

o Human resources distribution by geographic region (less advantaged and advantaged areas)

o Satisfaction level of the employed human resources who work in public sector, by cadre and geographic regions

o Retention rate of employed human resources in public sector, by cadre and geographic regions

o Existence of reformed/revised tariff packages for diagnostic services and medical treatment

Acceptability Quality

o The amount of cost(total and per capita) for employing medical cadre (GP, dentist, pharmacologists) in deprived/underserved areas

o Percentage of revised curricula according to the health needs with regard to different major disciplines

o Inclusion of PHC contents in the curricula o Existence of appropriate policies and implementation plans in order

to revise and reform accreditation system based on the international/global standards and frameworks

o Existence of documented policies and implementation plans in order to implement meritocracy system in recruitment and retention of full-time faculty members

Potential data sources: population census, labour force survey, health facility assessment, civil service payroll registries, registries of professional regulatory bodies

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Availability Accessibility o Existence of policies and implementation plans for developing the

position of Health Ministry’s headquarter regarding its regulatory and policy making functions of human resources stewardship in health sector

Acceptability Accessibility o Existence of inter-disciplinary educational strategies in medical

sciences universities with the aim of revising professional boundaries o Percentage of employees (managerial and staff level) who received

training services annually, by cadre and the type of training service o Creating/Establishing databases for storing the knowledge, skill,

attitude (KSA) and competencies of employees in all levels of health sector with the aim of continuous evaluation of training needs

o Existence of documents for reviewing job classification and evaluation plans


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Availability Acceptability o Existence of a program/document for the estimation of health sector

human resources demand by sex, profession, geographic region and other attributes of skill mix

o Retention rate of elite workforce, by cadre and serving location in public sector of the country

o Immigration rate of professional workforce from public to private sector

o Formulating human resources recruitment code in international level according to WHO Code


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Indictors for cross-cutting actions o Existence of an HRH observatory unit o Existence of comprehensive information system for HRH o Existence of necessary protocols and guidelines for human resources enclosure (including HR number and combination) o Existence of laws and regulations as necessary implementation guarantees for the formulated protocols and guidelines o Amount of allocated resources to HRH from the total amount of resources earned from “The Iranian Targeted Subsidy Plan” o Existence of implementation plans for delegating affairs related to education, research and medical treatment to private sector and also liberalizing executive and

outsourcing affairs to it o Percentage of educational affairs delegated to private sector o Percentage of research affairs delegated to private sector o Percentage of medical treatment affairs delegated to private sector


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IRAQ


The Ministry of Health (MOH) in Iraq is the main health care provider and about 80% of health care is funded and provided by the public sector and health system

based on universal coverage of health services with minimal user charges. There is 237901 staff working in MOH, and about47% of the health budget is allocated

for human resources. One of the biggest challenge faced planning & developing resources directorate to implementing the planned service delivery model is the

availability of high skill staff. There is a shortfall of many health professionals in numbers and skills like (Anesthetist, family medicine practitioners, community

medicine specialist, hospital administration specialists, professional nurses and midwives - etc.) and a relatively large ancillary and administrative workforce with a

low level of schooling (nine years or below).

Although, HR is a component of the national health policy of Iraq, there is strong need to develop a comprehensive national strategy of HRH with participation of

other stakeholder to improve the collaboration among MOH, the Ministry of Higher Education (MOHE) and other stakeholders in planning for HRH production and

redesigning the pre-service education to achieve intended objectives of health system. The health workforce is employed and distributed centrally by MOH

because of limited health workforce availability. Most of the health professionals have sharing practice between the public and private sectors and other sectors

related to the health services delivery, which is allowed dual practice by the law of civil service. Because of this, the performance of health workforce is affected

with reduction in their productivity and quality of health-care services provided in public sector. It also makes it difficult to monitor and regulate the work of health

professionals in the private sector.

To achieve universal health coverage and Millennium Development Goals, MOH developed policy direction of Human Resources (HRH) in national health policy

(NHP) to ensure adequate qualified professional health workforce which is oriented by " Developing health policies of human & financial resources based on a firm

information system with a developed planning approaches" vision of planning & resources developing directorate-MOH .

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To this end, Iraq is proclaiming its commitment at the occasion of the 3rd global forum on HRH policy development in Iraq:-

1. Building MOH capacity of HRH projections and planning for mid and long term based upon the health needs of population. 2. Promoting and developing capabilities of HR management in recruitment, employment, retention, performance improvement, payment and incentive

system. 3. Developing of HRH through their capacity building by determining the needs, redesigning the priorities of the education & training programs,

accreditation of continuous Professional Development (CPD) and training on job to increase the quality of services.

In this respect, following targets have been determined with possible timeframe and potential roles by stakeholders towards resources deployment, implementation and stewardship:

Targets related to building capacity or HRH prediction:-

- Developing program of HRH fellowship & scholarship for manager of health workforce department in Planning & resources developing (MOH, WHO = February 2014 - December 2015)

- Coordination with MOHE for development educational health institutions capacities for undergraduate & postgraduate studies (MOH, MOHE, WHO and related stakeholders = January 2014 onwards)

Targets related to providing & allocation of professionals health workforce:

- Developing regulation & procedures of HRH allocation for all governorates (centrally and locally) (MOH and relate stakeholders = August-October 2014) - Developing regulation & procedures of postgraduate studies for HRH (MOH, MOHE, WHO and related stakeholders = February – May 2014) - Developing plan to increase feminist percentage in nursing staff (MOH, Related sectors and stakeholders = January 2013-December 2014)

Targets related to developing skills and capabilities of professionals health workforce:

- Training & developing national plan (MOH, Related stakeholders = January 2014 to December 2015) - Developing performance standards for HRH & quality norms with related stakeholder (MOH, WHO, related stakeholders = January-June 2014) - Coordination with MOHE for developing educational materials & subjects for undergraduate study to fit with new and emerging health needs (WHO,

MOHE and related stakeholders = April 2014 to September 2015) - Nursing Bridging programs to raise level of nursing staff and reduce nursing classes (from 5 -3)(MOH, MOHE and other sectors = August 2014 onwards)


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In order to pursue and monitor the implementation of the commitment with its competent areas, following monitoring indicators have been determined according to the targets :

- Number of health workforce department participants in HR prediction & management fellowship & scholarship .(information source /:MOH-HRH

information system and MOHE information system)

- Number of qualified professional health workforce graduate from Educational institutes of MOHE (information source /: MOHE information system)

- Number of female nursing secondary schools & institutes.(information source /:MOH-HRH information system and MOHE information system)

- Feminist percent in nursing staff .(information source /:MOH-HRH information system

- Approved updating regulation and procedures of HRH allocation .(information source /:MOH-HRH department)

- Number of specialists per population (information source /:MOH-HRH information system)

- Strategies related to allocation HRH & indicators of professional health workforce per population have been included distribution of HRH in strategic

plan.(information source /:MOH-HRH information system)

- Approved updating regulation and procedures of postgraduate studies.(information source /:MOH-HRH department and MOHE -researching&

developing directorate)

- Number of approved postgraduate seats in educational institutes (information source /:MOHE information system)

- Indicator of Operational plan of training & developing center (information source /:MOH - information system of TDC )Number or percent of nurses in

each class (information source /:MOHE information system)

- Number of updating and modernizing educational material & subject of undergraduates study (information source /:MOHE information system)

- Number of nurses whom developed their classes (information source /:MOH-HRH information system)

- Developing job description and Number of Work guidelines (information source /:MOH-HRH department)

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HRH commitment pathways LEBANON


1-The Organization of Ministry of public health:

The organization and the regulation of the health system in LEBANON is mandated to the Ministry of public health that the Mission is to enhance the health and wellbeing of all the people of LEBANON.

A series of reforms has been taken from the Lebanese ministry of public health. The key components of these reforms have been: a revamping of the public-sector primary-care network; improving quality in public hospitals; and improving the rational use of medical technologies and medicines. Currently the Ministry of public health has 4 directorates: Prevention, Medical care, Central lab, and Administrative.

The Lebanese healthcare system can be qualified as an atypical system. The Lebanese Government’s determination to contain expenses and offer equitable, effective and efficient services constitutes a key element in this development process; on of the main strategies for that is to promote development of human resources for health so as to achieve the optimum utilization of health manpower.

2- HRH Management:

- The HRH is managed by the Medical professions section at the MOPH (About 19 Health professions organized by Laws in order to get the License from the MOPH to practice and appr. 2500 Licenses to practice issued by MOPH/year)

- The MOPH managed the health system in Lebanon with appr. 1372 employees (% Salaries/Budget is about 4.98%) - The MOPH managed and supervise 29 Public hospitals that contains 1642 beds and 3612 employees - Also the orders/Syndicate of medical professions develops plans and frameworks to develop their professions within the national health system (there are

6 Health orders :Physicians-Dentists-Pharmacists-Nurses-Physiotherapists-Dental Laboratories Technicians) - The MOPH is committed with the coordination of the Ministry of higher education and the Health order to adopt a plan of action in order to maintain the

quality of health programs , to provide accredited health centers for the training of HRH and to adopt supporting regulations to improve the quality of HRH (Accreditation programs for health centers and educational programs, continuous education ,laws relating to retirement plans ,retention programs, law relating to monitoring the performance of health system)

(All statistical tables show that there is a remarkable increase in all organized medical professions, especially for the nursing).

In Lebanon there are 21 Universities out of 46 that have health programs and many Vocational technical schools spread all over Lebanon.

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3- Challenges: - A regional discrepancies and imbalance in HR

- As an almost universal problem of the developing world, this is also observed in LEBANON.

- The most meaningful component of this imbalance has been the surplus of physicians, accompanied by a shortage of nurses

- The impact of supply regulations on the equitable distribution of health services.

- The multiplicity of graduating countries has an impact on quality of care; it is hard to reach a consensus on common standards and protocols among HRH with wide educational background variations.

- Limited Capacity to organize CME

- Quality of work environment (The unattractive professional status especially for Nurses and paramedical staff ( limited career development , Unsuitable working conditions, , working hours, salary scale..) leads to a short career span

- Rising violence against health professionals

- Updated data base on HRH (Discrepancy and incompleteness between the data base of the Orders and syndicates and the MOPH and MEHE need to standardize the data collected and Inaccessibility of data for policy and decision making.

4- Opportunities

- While LEBANON indicators related to health care provision are comparable to developed countries (Physicians, Dentists and pharmacists and hospital beds are close to those of most OECD countries.

- A well documented rise in number of health professionals in selected categories

- A large number of health educational universities with International accreditation standards

- The national Health strategy considers HRH for Health as main axe of intervention

- There has been some success in regulations such as:

- Pharmacies are better distributed by district than medical and dental clinics as a result of regulations enforcement (Law of Pharmacy practice 1994) that specifies a minimum distance between pharmacies to be respected in providing new licenses.

- The syndicate of Hospitals updates yearly its data base ( including the actual health workforce employed in the hospitals)

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5- Commitments:

The Ministry of public health in Lebanon hereby pronounce commit to take the necessary strategic and operations actions in order to ensure the safety of HRH and to carry out corrective measures to monitor progress and sustain the HRH development in the 3 next years through following pathways and interventions :

1- National multistakeholder committee and evidence base for HRH:

- Establishing committee for HRH from Ministry of public health, WHO, Ministry of higher education Orders, Syndicates, Health faculties in order to elaborate strategic plan and standardized data for HRH and update

2- Laws and regulations:

- Issuing Laws and regulations for the non-organized health professions

- Review and update laws for medical professions

- Adopting new laws for the continuous education for the other medical professions

- Creating and supporting of new health professions orders (Midwifes, Nutritionists, Optometrists ,Psychologist…)

3- Quality of education:

- Adopting and financing HRH education programs

- Adopting new measures to regulates licensing requirements (colloquium exams…)

- Conducting training programs (as the contract between MOPH and Faculty of health –Lebanese university)

- Bridging curriculum for the vocational(technical) programs (BT-TS) towards university programs

- Promote affiliation and twinning programs (educational )

4- Quality of work environment:

- Adopting policies and incentives for retention. Retention challenges included unsatisfactory salary, unsuitable shifts and working hours, better opportunities in other areas within or outside Lebanon

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- Adopting remuneration scale based on performance for HRH

- Improving of financial and work conditions (Work environment, Poor management, High patient/nursing ratio, Lack of autonomy, poor commitment to excellence, lack of supportive environment, lack of decision making, lack of tool of measurement)


Monitoring (Indicators proposed):

- Number of new regulations regarding HRH issued

Means of verification: copies of the regulations/ decrees

- Number of revised/ updated regulations regarding HRH

Means of verification: copies of the regulations/ decrees

- National HRH strategic plan developed

Means of verification: National strategy document developed and disseminated

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HRH commitment pathways LIBYA


The primary challenge for human resources for health in Libya has been the breakdown in communication across the country following the revolution in 2011 which has made it difficult to quantify the numbers of staff working nationally in the public health system. A secondary issue has been a breakdown in control of professional regulatory systems and a consequent lack of trust by the population in the medical services provided across the country. This manifests itself in large numbers seeking health treatment abroad when it can be afforded. A further problem is a substantial oversupply of doctors, dentists and pharmacists from the Universities each year which are unable to be fully utilized geographically by the MOH coupled with low standards of nursing care.

The Libyan Health Strengthening System (LHSS) supported by the EU is attempting to provide a strategic HR perspective to this myriad of HRH issues and in its first year is concentrating on (i) reforming the professional regularity system allied to reforms of the postgraduate medical education system (ii) undertaking a comprehensive workforce analysis leading up to the production of a national HR Plan (iii) undertaking a review of the HR Function in the MOH and associated Ministry’s that impact on the national role and (iv) working alongside the Finance and Strategy Working Group to develop an incentives package to aid geographical distribution and standardize job descriptions and job plans for professionals. The MOH is giving due priority to make HRH a priority and has taken several steps, but due to limited capacity and resources, these critical challenges persist. The MOH with support of the Libyan Health Strengthening System (LHSS) supported by the EU and WHO has initiated the HRH situation analysis that will lead to the HRH planning process and related decision making.

The MOH Libya hereby announces the commitment to carry forward the policy development and planning process and will pursue the following priority objectives with defined interventions.

Objective 1: Reform the professional regularity system allied to reforms of the postgraduate medical education system

Publish proposals supported by position papers describing the reforms in more detail and consult across the country on these proposals (November 2013).

With the support of the General National Council develop legislation for Parliamentary approval for introduction of a General Healthcare Council (GHCC) and supporting professional Regulatory bodies (Feb 2014)

Splitting of Libyan Board of Medical Specialties into a Libyan Board concerned with examinations and the creation of new Postgraduate Medical Training Boards to oversee the education process (Aug 2014)

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Objective 2: Increase the production of essential health workforce ensuring quality and adequate accreditation systems

Undertake a comprehensive workforce analysis ensuring cooperation across the MOH to take advantage of surveys undertaken by both the HR Department and the Data and Information Department (Dec 2014)

Development of a national Human Resource Plan to address national and geographical in -balances of staffing across the country (Oct 2015)

Establish/strengthen national accreditation systems (Dec 2015)

Objective 3: Enhancing the national capacity to plan, implement, manage, and monitor the HRH polices and interventions

Assess HRH staffing needs – review 2010 WHO EMRO study and update in light of changes since the revolution (July 2014)

Development of an Appointments Unit to initially assist the changes to the Regularity system (See Objective 1) (April 14)

Develop projections, strategic plan and costing for the HRH function as a whole (Dec 14)

Strengthen HRH directorate of MOH and build a national team to manage HRH (Oct 14).

The below targets for above indicated HRH interventions will be pursued:

1- Engage the patterns and stakeholders in HRH planning, investment, implementation and accountability Maintenance and development of the HR Working Group as the main strategic body in HRH planning

2- Enhancing the national capacity to plan, implement, manage, and monitor the HRH polices and interventions HRH projections and planning through international consultant Adaptation and start implementation of WHO guidelines on HRH retention

3- Increase the production of essential health workforce ensuring quality and adequate accreditation systems

Assessment of national training needs and develop a master plan to attain self-sufficiency in development of essential health cadres (MOH, MOE, WHO, related stakeholders – December 2015)

Development / updating of curriculum for CHWs, Midwives, Nurses and Physicians (MOH, MOE, WHO, related stakeholders – December 2015)

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The commitment pathways will be monitored through following key indicators:

- Multisectoral HRH Working Group is established and engaged in HRH processes planning, implementation and monitoring

- HRH projections and plan has been developed and validated by the stakeholders (information source: HRH plan)

- WHO retention guidelines have been adapted and national strategies adjusted accordingly (information source: HRH report)

- Master plan for HRH development has been established (information source: Master plan document)

- Curriculum for essential health cadres developed/updated (information source: HRH report)

- National quality standards for key HRH aspects available and implementation started (information source: related documents)

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HRH commitment pathways OMAN


The health system in the Sultanate of Oman has witnessed major developments during the past decades. This has been manifested in remarkable achievements such as the universal health coverage with quality health care services for all citizens, reduction in morbidities and mortalities in addition to the improvement of the quality of life indicators such as the increase in life expectancies both for males and females.

In 2011, the Ministry of Health in Oman has taken the initiative to develop a long-term strategy for the next forty years namely “Health Vision 2050”. It is the first of its kind in the region and it focuses on strengthening the health system and taking the advantage of the most recent advancements and evidences to face the expected demographic and epidemiological profiles. Bearing in mind the socioeconomic development, the Vision made demographic, epidemiologic and health workforce projections till 2050.

As for the human resources for health (HRH) in Oman, there was a major transformation from personnel management and planning in terms of crude numbers and ratios to the notion of HRH development. The HRH production has grown significantly over the years, not only in numbers but also in term of skill mix and specialties.

- The Health Vision 2050 drew the road map for HRH development and stated the following inter-linked pathways: Transformative education and health workers professional development

- Evidence-based HRH policy, planning and projections - HRH management including retention, motivation and performance management and development - HRH finance and labour market dynamics - Research and studies, HRH observatory and knowledge hubs - Effective partnership with relevant stakeholders and partners

The pathways emphasized that HRH development will be seen as integral part of the overall health system and not isolated from the other health system inputs and functions. They reflect the idea of linking the HRH interventions to better health services and ultimately better health outcomes.

The inter-linked pathways will be implemented in phases starting from the remaining period of the current 8th five-year national strategic plan (2011-2015) and the reviewed on termly basis. Each pathway encompasses several targets and commitments. For instance, in the transformative education and health workers professional development pathway, the Sultanate of Oman is committed to increase the percentage of Omani nurses from 77% at current to 90% by 2025.

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The implementation of the pathways is a shared commitments as well as responsibility among all HRH stakeholders and partners both governmental and private.

Based upon the current challenges and the available evidence and to ensure universal health coverage, the Sultanate of Oman hereby pronounces its commitment to peruse and implement the following pathways for human resources:

1. Focus on Education 2. Focus on Incentives 3. Focus on Retention 4. Focus on Skills Mix 5. Focus on Labour Markets

These pathways are part of the five-year development plans, particularly the eighth five year plan (2011 - 2016). They are significantly covered within the long strategic plan (Health Vision 2050) which the Ministry of Health has committed to undertake. This will be implemented on phases starting from the ninth five year plan (2016 - 2020) and then reviewed every ten years starting from 2020.

The partners to implement this commitment include: Ministry of Higher Education, Ministry of Civil Services, Ministry of Manpower, Ministry of Finance, Sultan Qaboos University, Governmental and Private Academics, Other health related Governmental ministries, Oman Medical Specialty Board, Health professional Councils and other governmental and private health institutions.


The monitoring of the progress and achievements will be done through a robust monitoring and evaluation framework which identified a set of core indicators with clear baseline, targets and timeframes. The HRH observatory is mandated for monitoring the progress in HRH development.

Beginning from the first year of the ninth five-year plan (2016 - 2020) there will be monitoring indicators evaluated on a yearly-basis on the achievements and obstacles encountered in implementing the HRH strategy highlighted in the ‘Health Vision-2050’.

Then every ten years starting from 2020 there will be a revisit of all these strategies and visions of HRH.

Monitoring Indicators on AAAQ as outlined in the HRH document (to be discussed in the third Forum on Human Resources for Health in Brazil) will be the basis for the monitoring setup in the Ministry of Health in Oman.

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HRH commitment pathways PAKISTAN


MINISTRY OF HEALTH

The Ministry of Health and Regulation is the main planner and regulator of health care provision in Pakistan. All the regulatory bodies like Pakistan Medical & Dental Council, Pakistan Nursing Council, Pharmacy Council etc. are under this Ministry. These councils oversee and accredit the education of health workforce. Similarly, Pakistan’s one of the premier post-grad institution College of physician & Surgeons Pakistan is also regulated by this Ministry. Although, service delivery has been entrusted to provincial government, the HRH for the healthcare system is still regulated by Ministry of Health & regulation.

The imbalances in health workforce in terms of cadre, gender and distribution are well known in Pakistan. There is a growing interest to address the identified shortcomings in human resources including scarcity of dentists, pharmacists, nurses, midwives and skilled birth attendants. Pakistan is witnessing a mushrooming of educational institutes in private sector. On one hand this is helping to scale up the HRH, but it has raised lot of quality issues and regulation and accreditation of these colleges/school is a now a priority agenda for the Ministry.

Toward achieving the national vision on Human Resources for Health (HRH) to ensure ‘Access for all to competent and sustainable health workforce within the robust and enabling health system towards achieving the Universal Health Coverage, Millennium Development Goals 2015 and beyond’; Pakistan is adopting an holistic approach to address HRH issues with particular focus on quality of education through development and implementation of revised HRH accreditation process at National and sub-national levels. To this end, Pakistan is proclaiming its commitment at the occasion of the 3rd global forum on HRH for ‘Improving the quality of education through enforment of standards and accreditation to enhance health workface productivity.’

Planned Interventions:

1. Structural reform of regulatory bodies

2. Review of their Term of references

3. Enforcement of accreditation rules and regulations

4. Review of standards and curricula

5. Consensus building with provinces in the context of 18th constitutional amendment

Following targets have been determined with realistic timeframe and potential roles for resources deployment, implementation and stewardship.

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1. Targets related multi-stakeholders coordination mechanism:

Targets Expected Date Responsible Organization

Stakeholders meeting to assess the current situation Dec 2013 MoH, DoH, WHO, USAID, GIZ

Constitution of core working groups to review standards April 2014 MOH and DoH

Constitution of core working groups to review accreditation processes June 2014 MOH and DoH

Consultation with provinces to identify local needs for incorporation into standards/curricula Dec 2014 MoH, DoH, WHO, USAID, GIZ

Approval and implementation of new accreditation process for private and public colleges/schools Jan 2015 MOH and DoH

PLANNING COMMISSION OF PAKISTAN The Planning Commission (PC) of Pakistan is the main overall planner of health care provision in Pakistan. Development of policy and plans is the constitutional responsibility of planning commission. Although, service delivery has been entrusted to provincial government, the HRH for the healthcare system is still regulated by Federal level. The imbalances in health workforce in terms of cadre, gender and distribution are well known in Pakistan. There is a growing interest to address the identified shortcomings in human resources including scarcity of dentists, pharmacists, nurses, midwives and skilled birth attendants. Future scenarios for tackling the maldistribution of health professionals and the imbalances in skill mix across the country needs robust HRH strategy and plan to be developed and implemented.

Therefore; HRH profiles of all the provinces are being conducted which will help to formulate comprehensive provincial HRH strategies and implementation plans to address these overwhelming key issues like; Lack of National and sub-national HRH strategy, Regulation and accreditation of HRH, Migration and mal-distribution of health workforce, Deployment and Retention strategies, shortage and scaling up of nursing and Allied health workers, Skill mix, Continuing Professional Development, work environment etc.

The HRH strategies development process will be conducted through a multi-stakeholders coordination approaches like Country Coordination and Facilitation (CCF) mechanisms. Aligned with the health system policies, and duly considering the WHO Global Code of Practice on international recruitment of health personnel, Pakistan is committed to implement the following interventions:

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Planned Interventions:

1. Establish and strengthen HRH coordination mechanisms at national and sub-national levels

2. Develop / update HRH profiles and information base at National and sub-national levels

3. Develop evidence-based National and sub-national HRH strategies and implementation plan for HRH strategies

4. Finance HRH strategies with a sound accountability and monitoring processes


Targets related development of HRH strategies and plans Expected Date Responsible Organization

Stakeholders analysis will be conducted and completed Feb 2014 PC, MoH, DoH, WHO, USAID, GIZ

Notification of HRH coordination committees June 2014 PC, MOH and DoH

HRH profiles will be completed Sept. 2014 PC, MoH, DoH, WHO, USAID, GIZ

HRH strategies will be developed Dec 2014 PC, MoH, DoH, WHO, USAID, GIZ

Implementation of HRH plans will commence March 2015 PC, MOH and DoH, GIZ, USAID


MINISTRY OF HEALTH, PAKISTAN

In order to pursue and monitor the implementation of the commitment with its competent areas, following monitoring indicators have been determined:

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- Stakeholders meeting reports

- Availability of revised standards

- Availability of revised curricula

- Notification of revised accreditation process

- Number of private colleges de-recognized under new process

PLANNING COMMISSION OF PAKISTAN


- Stakeholders analysis (information source/s: SA reports)

- HRH coordination committees/mechanism (information source/s: Notifications of committees)

- HRH profiles and évidence base (information source/s: Profile documents)

- HRH stratégies (information source/s: Documents)

Funding for Implementation of HRH plans (information source/s: report for funds availability and allocation)

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HRH commitment pathways SOMALIA


The Directorate of Health together with the private sector and partners (UN, NGO's) is the main health care provider in Somalia. One of the biggest issues related to health workforce faced by Somalia is the shortages, misdistribution and imbalance, resulting in a lack of right numbers in the right places. There is a Health policy framework and Health Sector Strategic Plan (HSSP) in Somalia, both highlighting the human resource development and one of the key priorities. With technical support from WHO, Directorate of Health is planning to develop human resource management and development policy and plan by the end of this year 2013. Towards achieving the national vision on Human Resources for Health (HRH) to: Increase the health workforce, improve their skill balance and strengthen their capacity and enabling health system towards achieving the Universal Health Coverage, Millennium Development Goals 2015 and beyond’; Somalia, in addition to its Health Sector Strategic Plan (HSSP), is determined to ensure adequate quality standards in training and services to deliver health care to the population with high professional standards .

With this backdrop, Somalia is hereby announcing its commitment at the 3rd global forum on HRH for ‘Improving HRH regulatory frameworks and institutionalize quality assurance towards enhanced health workface productivity.’ This will be definitely added as a priority objective in the HRH strategic policy and plan for 2013-2016. In order to realize this commitment, Somalia, with the help of other multi stakeholders and partners, efficient coordination mechanism and inclusive partnerships, under the overall leadership of Directorate of Health (DOH), and aligned with the health system policies, will implement the following strategies and interventions:

1- Establish regulatory mechanisms for accreditation of health professional’s education for all cadres and medical qualifications from other countries. The objective will be achieved through the following main activities: - Develop accreditation criteria for health professions education for doctors, dentist and nurses. - Develop a list of approved Medical and Nursing institutes for recruitment of health workforce with the help of other line ministries - Develop a mechanism to enroll new institutes if not endorsed by any competent global or national process.

2- Establish a licensing system for health professional’s recruitment. The related activities will include: - Develop professional standardization for doctors, dentist and nurses to clarify required competencies, knowledge and skills. - Develop and implement a Licensing Examination System to register the international medicos

3- Establish new Midwifery schools. This objective will be accomplished through the under mentioned actions and products: - Develop curriculums for basic and post basic midwives - Establish three new schools - Produce at least 100 midwives for the next 2yrs

4- Training more Health professionals. Following actions will contribute toward this objective:

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- Opening Somalia & Turkey Research & Training Hospital -Digfer Hospital - - Nine month Diploma of Emergency Obstetric Surgery for clinical officers - Recruit and train and deploy more Community based lady health workers in the rural areas - Develop comprehensive pre- and in-service training program of work including Doctors.

It is expected that through this process and pathway, Somalia will be able to address the shortages of health professionals, standardize and improve quality of the physicians and nurses, which will in turn lead to sustainable solutions towards ensuring access to competent medical personnel and delivery of adequate health services in accordance with the national health needs.


Targets related to accreditation of health professionals’ education:

1. Institutional review and report (DoH with engagement of related stakeholders)- Dec 2013 2. Establishing/ Re-establishing Nurse & Midwife Association, Pharmacist Association & Medical Association (DoH with engagement of

related stakeholder) Quater1 of 2014 3. National Associations validating health professionals (DoH with engagement of related stakeholders) Quater2 2015

Targets related to produce new midwives:

1. Curriculums to finalize and published (DoH with the help of WHO ) Jan-2014 2. Rehabilitate parts of Health Personal Training Institute -HPTI- (DoH collaborating UNFPA) Dec -2013 3. Taking second batch (40) female ( Reproductive Health unit and HR department progressive report) Dec- 2013

Targets related training of health professionals:

1. Bringing trained man power including doctors in Somali health care system (Targets and outcomes of Somali-Turkey Hospital ) 2016 2. Selecting Institution and training center for Emergency Obstetric Surgery ( DoH & WHO with Health Institution) Jan-2014 3. Start training of Clinical officers and Anesthesiologists (DOH & WHO) March-2014 4. Recruit, train and deploy 100 Community based Lady health workers (DOH, WHO) June 2014


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6- Number of health professionals registered with health associations (Information source/s: professional association data base report)

7- Standard remuneration levels for all public sector health workers, agreed, and circulated to donors and service (Information source/s: Annual

work plan report)

8- Consultative meetings held with the Medical Associations in order to speed up licensing (Information source/s: progress report)

9- Accreditation criteria for medical education for doctors and nurses available and agreed by DoH and related stakeholders (Information source/s:


10- List of approved Medical and Nursing institutes in the country for recruitment of doctors and nurses (Information source/s: Assessment report for

health institutions in Somalia with WHO)

11- Country specific set of professional standards for doctors and nurses (Information source/s: Assessment report for health institutions in Somalia

with WHO)

12- Number of new midwives trained (Information source: Training reports from UNFPA)

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HRH commitment pathways SUDAN


Background Ministry of health (MOH), despite a growing private sector, remains main healthcare provider and major employer of health workforce. However, the workforce is distributed inequitably between rural and urban and at different levels of care. Nearly 70% of health workforce is in urban areas, of which 38% are in Khartoum state, serving 30% of population. This urban bias is more for specialized cadres as 65% of specialist doctors and 58% of technicians are in capital. 67% of health workers are in secondary and tertiary care as compared to 33% in PHC settings. With a ratio of 1.23 health professionals per 1000 population, Sudan is within the critical shortage zone according to the WHO benchmark of 2.28 per 1000 population (WHO, 2006). Whereas, doctor v/s population ratio is closer to international benchmarks, this is not the case with other cadres, resulting in a skill mix imbalance. Doctor to nurse ratio was estimated at 6:1 (2010) taking into account also those in the education pipeline. The administrative and support staff represent 26% of the total health workforce which is consistent with recommended EMRO-WHO figure of 25%. Sudan medical council is responsible for the licensing and registration of physicians, dentists and pharmacists; accreditation of medical dental and pharmacy schools; and ensures safe medical practice and dealing with public complaints. Only few pre-service training facilities received accreditation and that too voluntary. The Sudan national council for medical and health professions grants licenses and registers nurses, technicians and other paramedical staff; and accredits related schools – a function that as yet is not institutionalized.

The Sudan pathway to HRH development In order to avert this situation and improve health workforce, MOH is implementing a number of initiatives. These include academy of health sciences (AHS) established as degree awarding body for scaling up production of nurses and allied health professionals and correcting skill mix imbalances. The health system development council of Sudan medical specialization board, a seat of postgraduate clinical training for doctors, recognized public health institute (PHI) for training health management cadres at masters and diploma level. Continuing professional development (CPD) established as a directorate of MOH in Khartoum has branches in all states. Its mandate is limited to in-service training, although an effort was made to link it to licensing and relicensing of specialists. In addition, national HRH observatory maintains the database and hosts a forum to seek collaboration of stakeholders in HRH issues.

The Sudan commitment The Sudan national health sector strategy (2012-16) aims to achieve universal health coverage through expanding primary health care that is available equitably to the entire population; be in rural or in urban areas. To assure successful implementation of the strategy, while a number of HRH initiatives are underway (see above), through this communiqué, at the occasion of the 3rd global forum on HRH, the Sudan MOH commits to, in the next 3 years, consolidate its efforts and takes the pathway to assure the quality across the production and continuing professional development with the overall aim to improve the productivity of health workforce.

HRH interventions and targets

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Within the remits of this aim, and in line with WHO global code of practice on international recruitment of health personnel and WHO global strategy on human resources for health, the following interventions will be undertaken with the target and stakeholders identified:

2) Enhanced performance through:

- availability of adequate number of health managers, who has appropriate competencies and skills:

By the end of 2016, through in-service training at PHI and supported by MOH, health management positions at state and localities will have been filled.

- efficient critical management support systems - planning and budgeting; financial management; personnel management, infrastructure & logistics

management; procurement and distribution of drugs and other commodities; information management and monitoring etc.;

By the end of 2016 the MOH in collaboration with State ministries of health will have designed and documented the critical support systems and

orientated health workforce and prepared for implementation at all levels of health system hierarchy.

- enabling working environment - degree of autonomy, clear definition and communication of roles and responsibilities, fit between the roles and structures,

existence of national standards, rules and procedures, regular meetings, supportive supervision, etc.;

By the end of 2016, MOH in collaboration with State ministries of health will have defined and documented the elements necessary for a good working

environment and orientated health workforce and prepared for implementation at different levels of health system hierarchy.

- updating CPD policy that in-service training/ continuous medical education is accredited as a means for licensing and relicensing

By the end of 2016, the MOH in collaboration with Sudan medical council and selected training sites with the involvement of different medical and health

professional bodies will have designed a policy and system for CPD; and sought approval by competent authority.

3) Enhanced quality of pre-service education through:

- improved postgraduate and undergraduate curricula for medical, dental and pharmacist disciplines;

By the end of 2016, in collaboration with stakeholders, the curricula for different disciplines taught in the PHI will have been standardized and tested. In

addition, work to update the curricula and training techniques for undergraduate medical, dental and pharmacist will have initiated.

- improved pre-service curricula for the allied medical and health professions;

By the end of 2016, in collaboration with Sudan national medical and health professions council curricula for all disciplines taught in AHSs will have been

standardized and tested.

- accreditation of postgraduate and undergraduate training facilities for medical, dental and pharmacist disciplines;

By the end of 2016 the system will have been brought in place at Sudan medical council for mandatory accreditation, and at least one training facility in

each state will have been accredited.

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- accreditation of pre-service training facilities for the allied medical and health professions;

By the end of 2016 the system will have been brought in place at Sudan national medical and health professions council for mandatory accreditation and

at least one training facility in each state will have been accredited.

- instituting a teaching and learning course for teaching faculty at AHSs for allied medical and health professions;

By 2016, the faculty teaching at academies of health sciences will possess an accredited certificate of teaching and learning.


In order to monitor the progress towards fulfilling the commitments, the following indicators will be used:

1. Enhanced performance:

- Number of health managers at state & locality health management teams trained at postgraduate level in health management (MOV: HRH database)

- Number of documented critical management support systems for states and localities (MOV: documents)

- Number of documented elements necessary for a good working environment at state and locality levels (MOV: documents)

- Policy and system for CPD linked to licensing and relicensing of medical and health professionals (MOV: policy document)

2. Enhanced quality of pre-service education:

- Number of disciplines taught in PHI that have standardized and tested curricula (MOV: curricula);

- Number of disciplines taught in AHSs that have standardized and tested curricula (MOV: curricula).

- Number of states that have at least one postgraduate and one undergraduate training facility that have been subjected to mandatory accreditation by

Sudan medical council (MOV: accreditation certificate).

- Number of states that have at least one pre-service training facility for allied medical and health professions that have been subjected to mandatory

accreditation by Sudan national medical and health professions council (MOV: accreditation certificate).

- Number of teaching faculty at different academies of health sciences who possess an accredited certificate of teaching and learning

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HRH commitment pathways YEMEN


Yemen according to the Situation Analysis Report and other sources the main issues and challenges facing the management of HR in Yemen are:

- Yemen is still in the crisis zone in terms of overall number of HRH with ratios below the WHO benchmark. - There is significant skills mix imbalance among the health workforce which is likely exacerbated by the trend of HRH education and production. - There is inequitable geographic distribution of health workers with adverse effects on health care coverage and quality in some provinces and in rural

areas. - Issues around HRH quality relate to the relevance of health professions education to population health needs in addition to the weak framework and

interventions in regulating professional practice. - The lack of effective human resource management systems in many facets has adverse consequences on health workforce morale and productivity. - Migration of health workers into and out of the country poses challenges in terms of regulation, quality assurance and dealing with contingent

migration issues. - Shortcomings in policy development and strategic planning for HRH have consequent implications to information system, leadership, coordination,

supervision, and monitoring and evaluation.

The MoPHP will play the necessary leadership and governance roles to improve the management of HRH and coordinate the work of all national and international stakeholders in this area. The efforts in this area will focus on:

1. Strategies: - Developing a HRH strategy and strategic plan

- Strengthening the capacity and capability of stakeholders at central and governorate level to ensure an effective coordination and governance of HRH

services

2. Specific objectives: - The MoPHP is enabled to effectively coordinate, govern and monitor the HRH services

- The Directorate General for Human Resources Development and the Directorate General of Human Resources are enabled to play their stewardship role

3. Targets: - A national HRH strategy that is feasible and cost effective developed with the participation of the stakeholders implemented.

The main stakeholders are the Ministry of Higher Education, Ministry of Finance, Ministry of Civil Service, Ministry of Local authority, Ministry of Technical

and Vocational Training, Medical Council, Yemeni Board for Medical Specializations, WHO, UNFPA, SFD, USAID, EC, GIZ, Dutch, and Local NGOs and

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working international NGOs. The expected date for achievement is May 2014.

- HRH policies, regulations and guidelines revised, updated and/or created. The main stakeholders are the Ministry of Higher Education, Ministry of Finance,

Ministry of Civil Service, Ministry of Local authority, Ministry of Technical and Vocational Training, Medical Council, Yemeni Board for Medical

Specializations. The expected date for achievement is end of 2014.

- The HRH products/outputs of the education/training process (training institutions, training programs, trainers and trainees) is improved in terms of quantities

and quality. The main stakeholders are the Ministry of Higher Education, Ministry of Finance, Ministry of Civil Service, Ministry of Local authority, Ministry of

Technical and Vocational Training, Medical Council, Yemeni Board for Medical Specializations. The expected data for achievement is end of 2014.

- The HR financial planning, budget negotiations and disbursement improved. The main stakeholders are the Ministry of Higher Education, Ministry of

Finance, Ministry of Civil Service, Ministry of Local authority. The expected date for achievement is June 2014.

- An integrated human resources management system supported to enable the production of annual roll out HRH plans. The main stakeholders are the

Ministry of Finance, Ministry of Civil Service, Ministry of Local authority. The expected date for achievement is end of 2014.

- The governorate Health offices with increased capacity to manage HRH. The main stakeholders are the Ministry of Higher Education, Ministry of Finance,

Ministry of Civil Service, Ministry of Local authority, Ministry of Technical and Vocational Training, Medical Council, Yemeni Board for Medical

Specializations. The expected date for achievement is end of 2014.


One of our aims to develop a plan for monitoring and evaluation of the HRH strategy which will be trace of all what mentioned targets.

The main indicators will be the following: - Develop the National HRH strategy

- Develop the HRH policies, regulations and guidelines

- Improve Production of HRH

- Improve Financial and contracting aspects of HRH

- Improve the HRH management systems

The HRH system and data base will be used to track the achievement of HRH commitment

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HRH commitment pathways IRELAND


1. Implementation of WHO Code

Commitment: The Government of Ireland is committed to implementing the WHO Code through a coherent approach involving the Department of Health and Department of Foreign Affairs (Irish Aid) and their funded programmes and services, including the Health Service Executive.

Following a period of insufficient production, Ireland is now training sufficient doctors and nurses to meet domestic needs. Medical manpower planning has also been strengthened to protect training posts that are needed for the Irish health service. In this context, existing measures to strengthen health workforce development and health systems sustainability will be further developed and enhanced.

Measures will also continue to be undertaken to improve retention rates of doctors and nurses in the Irish public health system. These include inter alia: - the implementation of an internship scheme for nursing graduates; - follow-up to the outcomes of the current Strategic Review of Medical Training and Career Structure, which was initiated by the Minister for Health in July

2013. Specific measures to strengthen the domestic health workforce will also be undertaken in the context of Future Health: Strategic Framework for Reform of the Health Service 2012-2015 (Department of Health, 2012), with a focus on effective management of human resources through recruiting and retaining the right mix of staff, training and up skilling the workforce, providing for professional and career development, and creating supportive and healthy workplaces.

2. International Cooperation and Support to Developing Countries

Commitment: The Government of Ireland is pleased to pledge funding up to €1,500,000 over the next three years towards the implementation of the Strategic Plan 2014-16. This funding is complemented by continued bilateral support to Ireland’s key partner countries.

The Irish Government has committed to HRH in its new Policy for International Development, 'One World, One Future', published in 2013 – “In health, we will concentrate on the strengthening of systems including a trained health workforce to oversee and deliver quality, basic health services, reaching those most in need.” Support for HRH will be provided through the different modalities of international engagement and bilateral country programmes. HRH will continue to be a priority in the relevant bilateral health programmes in Africa.

3. Ethical International Recruitment and Fair Treatment of Migrant Health Personnel

Commitment: The Health Service Executive, in collaboration with the Forum of Irish Postgraduate Medical Training Bodies, is committed to

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implementing an International Medical Graduate Training Initiative for doctors from low- and middle-income countries, utilising HSE-funded posts.

Ireland’s dependence on foreign trained doctors is being principally addressed through increasing the number of Irish trained medical graduates and ensuring there are sufficient post-graduate training posts to satisfy domestic requirements for medical specialists.

Additional non-consultant hospital doctor posts exist in the system, which are not required for domestic training purposes. The International Medical Graduate Training Initiative has been developed to leverage these posts to enable overseas doctors to gain access to clinical experiences and training that may not be available in their own country, with a view to enhancing and improving the individual’s medical training and learning and in the medium to long term, the health services in their own countries.

Participants will have access a structured period of training and experience as developed by an appropriate Irish postgraduate training body, and then return to their country of origin. Application, selection and appointment of overseas doctors to IMG programmes will be managed in coordination and collaboration with identified overseas sponsoring states and/or overseas national medical training colleges. Appropriate bilateral arrangements will be put in place for governance of the initiative.

The IMG Training Initiative was launched in June 2013 and the National Framework Document was adopted in October 2013. Following piloting in 2013, this will move to full implementation in 2014.

4. Support to Developing Countries

Commitment: The Health Service Executive and Irish Aid are committed to implementing a programme of institutional partnerships in order to strengthen HRH in partner institutions in less developed countries.

The Health Service Executive and Irish Aid signed an MOU in 2010 to collaborate towards improving health is less developed countries. One of the main strategies is to facilitate institutional partners by health institutions and organisations – hospitals, health training institutions, NGOs – with other countries. In 2012 Ireland joined the European ESTHER Alliance which is an established programme of institutional twinning and partnerships. The ESTHER Ireland programme was launched in June 2013 by the Minister of State for Trade and Development. Ireland’s ESTHER Programme will focus on HRH capacity development, which will be achieved through on-site training, distance learning, exchange visits and mentoring.

5. Data Gathering and Information Exchange

Commitment: Irish research institutions will conduct research to analyse the emigration of doctors from Ireland

Research by a number of Irish institutions is playing an important role in informing policy relating to health worker migration. The Health Research Board (HRB), funded by the Department of Health, awarded grants in 2006 and 2011 for projects on nurse and doctor migration to Ireland. The doctor project, still underway, aims to quantify and analyse Ireland’s dependence on non-EU doctors.

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Training of medical graduates has increased to meet domestic health service needs, however retention of these doctors remains a challenge. A new project from 2013-2016, funded by the HRB and conducted by the Royal College of Surgeons of Ireland, will focus on emigration of non-consultant hospital doctors.


1. Implementation of WHO Code The Department of Health, as designated national authority, will report on implementation of the WHO Code, in collaboration with the Health Service Executive and Irish Aid. Data sources: Medical Council; An Bord Altranais (Nursing Board); HSE; Medical Education and Training; ESTHER Ireland; RCSI and TCD research reports.

2. International Cooperation and Support to Developing Countries This will be monitored by Irish Aid. Indicators will be funding for HRH through different aid modalities and programmes. Date sources: Irish Aid programme and financial reports.

3. Ethical International Recruitment and Fair Treatment of Migrant Health Personnel This will be monitored by the HSE and HSE MET (Medical Education & Training). Indicators will be number of doctors recruited and trained under the International Medical Graduate Training Initiative; number of countries participating in Initiative. Data sources: HSE MET.

4. Support to Developing Countries This will be monitored under the MOU between Irish Aid and the HSE. Indicators will be number of partnerships; quality of partnerships; and number of personnel trained. Data sources: ESTHER Ireland.

5. Data Gathering and Information Exchange Implementation of research projects will be overseen by the Health Research Board. Indicators will be the provision of information and evidence to Irish health workforce planners.

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HRH commitment pathways REPUBLIC OF MOLDOVA


Challenges of the health system in the Republic of Moldova are similar to those of other countries, namely: ageing of the population, increased burden of non-communicable diseases and of infectious diseases as there is still a high prevalence of tuberculosis and the rapid development of medical technologies by using expensive devices and medications is not always available, along with the continued growth of the demand of health services leading to inequities and issues of accessibility for the people. The Republic of Moldova is a country facing in HRH with health personnel shortage, uneven distribution, external migration, and lack of segregated data on health workers distribution ( by sex, age groups, and specialists graduated from medical education institutions etc.) The Republic of Moldova faces in the geographical distribution of health workers the same difficulties, as most countries with HR issues – their insufficiency or lack in rural areas and their excess in urban ones. In addition, there are regions with better provisions of health workers versus regions with insufficiencies or lack in some specific areas.

To respond to these challenges, the National Health Policy (2007-2021) and the Strategy for Health System Development for 2008-2017 were approved by Government Decrees in 2007. The Strategy for Health System Development for 2008-2017 emphasizes the need for continuous development of human resources management, the rational use of existing personnel, the appropriate and diversified training of advanced personnel for the health system by the following measures: a) evaluation of needs and planning of provision with human resources in the health system; b) provision of coverage with personnel of institutions from rural areas, c) motivation and stimulation of the health system personnel; d) improvement of policies of training of personnel in medical and pharmaceutical education. In order to implement this, in 2012, the Ministry of Health approved the Conceptual Framework of development of human resources in the health system.

In recent years Moldova has taken steps to develop a series of actions in HRH development with the support of many partners like the World Bank, the European Union, the World Health Organisation, the International Organisation of Migration and other international actors. These actions concentrate on issues such as the implementation of WHO Code of Practice on the International Recruitment of Health Personnel, the development of Informational System (database) on HRH, adjustments of curricula to international requirements, establishment of National Observatory on HRH and Sub-regional South East European Observatory on HRH in Chisinau, as well as conducting a series of studies on HRH and on health professionals’ migration etc.

In this context, the Republic of Moldova is hereby announcing its commitment at the 3rd Global Forum on HRH and proclaims to undertake the following pathways to move forward the HRH agenda:

1- Focus on education: - enhance quality of education through accreditation of educational institutions that train doctors, public health specialists, nurses and other health care

specialists; - ensure regular update/further development of the HRH competencies through training, including e-learning, revision of curricula, etc.

2- Focus on incentives: - to develop packages of financial and non-financial incentives;

3- Focus on retention of HRH:

EURO

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- to develop incentives for the retention and equitable deployment, especially in rural areas (regulations, local authority support);

4- Focus on skill mix: - training of nurses, especially in primary health care system that emphasize team-based approaches to the delivery of care that authorize health workers

to operate within the full scope of their profession;

5- Focus on Labour market: - the further implementation of the WHO Code of Practice on the International Recruitment of Health Personnel; - flexible updated labour regulations for the health care workforce; - employment of new graduated health workers; - negotiations and use of Bilateral and Multilateral Agreements on HRH mobility.


1- Focus on education: - existence of a national accreditation agency that will also cover medical education; - number of health training institutions meeting accreditation and reaccreditation standards; - inclusion of PHC/public health contents in the curricula for undergraduate and postgraduate levels; - number of curricula adjusted to international requirements;

2- Focus on incentives: - number of financial and non-financial incentives implemented;

3- Focus on retention of HRH: - number of incentives for retention and equitable deployment, especially in rural areas (regulations, local authority support) implemented

4- Focus on skill mix: - health care personnel (nurses) in PHC authorized to administer core set activities;

5- Focus on Labour market: - number/ percentage of newly graduated health workers who are employed in the health labour market within 3 months of graduation (or other nationally

defined time period); - existence of a functional national monitoring mechanism for the HRH information and monitoring; - number of Bilateral Agreements and Multilateral Agreements signed and in force .

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Vías de compromiso en materia de RHS REPÙBLICA ARGENTINA

1) ¿Con qué acciones e intervenciones relacionadas con los recursos humanos para la salud (RHS) se quiere comprometer su país/institución?

Argentina se compromete a fortalecer las políticas integradas en salud educación para mejorar la educación para la salud de los docentes, proteger la salud integral de la comunidad educativa, jerarquizar la formación de técnicos para la salud, facilitar la formación en carreras de ciencias de la salud en poblaciones de difícil acceso y priorizar áreas de vacancia en las trayectorias de posgrado. Argentina se compromete a fortalecer las políticas integradas en salud educación para:

- mejorar la educación para la salud de los docentes, - proteger la salud integral de la comunidad educativa, - jerarquizar la formación de técnicos para la salud, - facilitar la formación en carreras de ciencias de la salud en poblaciones de difícil acceso y - priorizar áreas de vacancia en las trayectorias de posgrado

2) ¿Cómo va a llevar a cabo el seguimiento del progreso logrado en cuanto al cumplimiento de sus compromisos? ¿Qué indicadores va a controlar? ¿Qué fuentes de datos va a utilizar?

Disponibilidad:

- Identificar zonas de difícil acceso para la formación en ciencias de la salud. Ampliar a tres regiones del país las experiencias de trayectos protegidos para el ingreso a las carreras de medicina.

- Desarrollar un diagnóstico nacional de las áreas de vacancia de especialistas y formación de posgrado en salud. - Conformar una mesa de planificación de posgrados de medicina junto al Foro de Facultades y Escuelas Públicas de Medicina

Accesibilidad

- Aumentar un 50% las mesas locales o provinciales salud-educación que faciliten la atención integral de la comunidad educativa. - Fortalecer a los equipos técnicos para la gestión intersectorial tanto a nivel nacional como provincial

Aceptabilidad

- Participar activamente dentro de la Comisión Nacional Asesora para la Integración de Personas con Discapacidad (CONADIS)

Calidad:

- Desarrollar los marcos de referencia para la regulación de 3 carreras prioritarias en la formación de técnicos para la salud (ya se han regulado 8) - Continuar con la acreditación de carreras de posgrado y residencias en el campo de la salud. - Incorporar a los Hospitales Universitarios en el marco de la Red de Hospitales Nacionales

La Argentina tiene una importante presencia institucional y federal en este Foro Mundial. Se ha conformado una delegación de 40 personas entre autoridades nacionales y provinciales de Ministerio de Salud Nacional y de las jurisdicciones. Asimismo, compone la delegación representantes de las Facultades de Medicina de gestión estatal del país.

PAHO

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Recursos Humanos para el acceso universal a la salud

Importa abordar la cuestión de los recursos humanos en salud desde la perspectiva de acceso universal a la salud y desde la determinación social de la salud, lo cual implica la integración de aspectos tales como educación, justicia, seguridad, ambiente, trabajo, cultura y democracia.

Asumiendo que la ciudadanía es un actor fundamental en la construcción de la salud, entendiendo por ciudadanía al conjunto de sujetos dotados de igualdad de derechos y capacidades; es coherente pensar que se abren nuevos espacios que favorecen la construcción de salud a través de las familias, las escuelas, las organizaciones comunitarias, culturales y deportivas, junto con los lugares de trabajo.

El Estado tiene un rol principalísimo, como rector de un proceso de regulación de esos entornos, incorporándolos a una perspectiva de salud innovadora, que favorezca una real oportunidad de acceso universal, especialmente a los sectores más vulnerables. Eso supone un cambio en el horizonte de formación de recursos humanos que amplía la clásica composición del equipo de salud.

Determinación social, Atención Primaria de Salud, acceso universal son una combinación que entendida en su plenitud, aboga por una ciudadanía involucrada y comprometida cuya repercusión sobre el recurso humano posee un enorme y beneficioso potencial que necesita ser perfilado para imaginar el escenario post 2015.

El entendimiento de la educación como bien público, ya sea de gestión pública o privada, permite pensar en distintas ofertas formativas. Pero es el Estado, a través de la educación pública quien garantiza el real acceso y oportunidades y quién debe fijar los marcos de referencia. Es la presencia de universidades públicas y gratuitas lo que permite la formación del recurso humano para el acceso universal y la consiguiente movilidad social ascendente.

Argentina, con una democracia joven, que padeció décadas de sangrientas dictaduras militares y gobiernos neoliberales, está aún en la búsqueda del equilibrio entre los derechos individuales y colectivos, que se expresan en qué tipo de relación pretendemos entre el Estado y la Sociedad. Un Estado que combina intervenciones de regulación, fiscalización, financiamiento y provisión de servicios atendiendo los derechos de toda la ciudadanía.

En los últimos años, luego del fracaso de las políticas de ajuste y desmantelamiento que se ensayaron en varios países, muy en especial en el nuestro, la sociedad en su conjunto acepta que el Estado sea rector y fiscalizador de todos los sectores que brindan estos servicios, además de financiador y proveedor en el sector público para garantizar el acceso a los sectores más desprotegidos interviniendo en un mercado imperfecto en bienes que son tutelares. Como también la mayoría de la sociedad está de acuerdo con mecanismos

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solidarios de seguridad social y de seguro privado donde otros sectores puedan financiar su cobertura de su salud y acceder a prestaciones diferenciadas.

Dr. Gabriel Yedlin Secretario de Políticas, Regulación y Fiscalización

Ministerio de Salud de la Nación

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Índice Portada ………………………………………………………………………………………1

Recursos Humanos para el acceso universal a la salud ………………………………..........2

Índice…………………………………………………………………………………….......4

Contexto geográfico y socio político.…………………………………………………….…5

Contexto económico reciente………………………………………………………………..5

Argentina en números.………………………………………………………………………8

Políticas públicas hacia la cobertura universal: El caso de los recursos humanos en salud………………………………..……………….......................................................9 Acceso universal y requerimientos en materia de recursos humanos en salud…………….11 De las políticas sectoriales a las políticas integradas. El caso de las políticas de salud y de educación……………………………………………….......................................................13

Antecedentes y objetivos de la Mesa Intersectorial de Políticas Integradas de Salud y Educación ………………………………………………………………………………..16

La agenda de políticas integradas, logros y perspectivas de desarrollo……………………17

Experiencias de políticas integradas en el nivel provincial y regional…………………….22

Conclusiones y compromisos………………………………………………………………23

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Contexto geográfico y socio político

La República Argentina se encuentra en América del Sur, limita al norte con el Estado Plurinacional de Bolivia y la República del Paraguay, al sur con la República de Chile y el Océano Atlántico Sur, al este con la República Federativa de Brasil, la República Oriental del Uruguay y el Océano Atlántico Sur y al oeste con la República de Chile.

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De acuerdo con su Constitución Nacional, la nación argentina adopta para su gobierno la forma representativa republicana federal. Las provincias, al ser consideradas preexistentes a la nación, conservan para sí y ejercen autónomamente todos los poderes no expresamente delegados al gobierno federal.

En base al ordenamiento jurídico vigente, el Estado nacional está integrado por tres poderes: a) Ejecutivo, dirigido por un presidente que es asistido por un consejo de ministros. La actual presidenta es la Dra. Cristina Fernández de Kirchner; b) Legislativo, integrado por el Senado y la Cámara de Diputados y c) Judicial, conformado por la Corte Suprema de Justicia y por los demás tribunales inferiores, tanto a nivel federal como a nivel provincial.

Políticamente la estructura federal incluye los gobiernos de las 24 jurisdicciones (23 provincias y la Ciudad Autónoma de Buenos Aires, la cual es también sede del gobierno nacional). Las cinco jurisdicciones principales ((Buenos Aires, Ciudad de Buenos Aires, Córdoba, Santa Fe y Mendoza) concentran el 67% de la población y generan el 78% del producto bruto geográfico total. Dentro de la estructura provincial, se encuentran los municipios, que ascienden a 2.171 en total.

Contexto económico reciente

Argentina es la tercera economía más importante de América Latina con un PIB per cápita en el año 2012 de 11.492 U$D. La preceden las economías de Brasil y México, con quienes además integra el Grupo de los 20 países más industrializados y emergentes a nivel mundial.

El país posee importantes recursos naturales, una población alfabetizada, un sector agrícola-ganadero orientado a la exportación y una base industrial diversificada. En la actualidad se ubica como un mercado emergente de renta media-alta.

Entre los años 2001/2002, se produce el mayor colapso económico, político y social de la Argentina, con una brusca caída de todos los indicadores desde la crisis mundial de 1930. En un contexto de fuerte endeudamiento externo, el PIB real sufrió una caída de un 20% en cuatro años (Gráfico I) y la moneda se depreció en un 70%.

Gráfico I. Evolución del PBI. Años 2000-2011

PIB en dólares corrientes (millones)

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

284.204268.697

103.866128.078

152.158181.967

212.868260.682

326.872306.754

368.399

445.652

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Fuente: Elaborado sobre datos de la Dirección Nacional de Programación Macroeconómica

Producto de la grave crisis, el desempleo superó los valores históricamente conocidos en el país, alcanzando en su peor momento, al 25% de la población económicamente activa. Como correlato se produjo una mayor vulnerabilidad en las condiciones de vida de sectores cada vez más amplios de la sociedad, que se expresó en el aumento de la pobreza y la indigencia (entre octubre de 2000 y octubre de 2002 se pasó de un 20,8% de hogares pobres a 45,7%) y también en un significativo aumento de la desigualdad en la distribución del ingreso. A partir del año 2003 comienza a revertirse la curva negativa de la pobreza y la indigencia. (Gráfico 2).

Gráfico Nº 2. Porcentaje de hogares bajo las líneas de pobreza e indigencia en los aglomerados urbanos. Años 2003-2012

Fuente: INDEC. Encuesta Permanente de Hogares Continua.

Al término de 2002, el estado de la economía seguía siendo frágil, aunque mostraba signos de incipiente normalización; se detuvo la recesión y desde el año siguiente, el país entró en una etapa de avance de su economía. Las políticas de exportación de productos básicos, junto con la mejora de sus precios relativos, y la expansión del mercado interno con políticas sociales activas, permitieron una recuperación del PIB a partir del 2003.

También ha sido evidente un cambio en la matriz exportadora del país. De ser un país fundamentalmente exportador de materias primas (en especial granos), Argentina incorporó productos industrializados a su intercambio con el exterior. La creación del Ministerio de Ciencia, Tecnología e Innovación Productiva apuntala esta búsqueda de valor agregado con mayor presencia del conocimiento científico y tecnológico.

Desde entonces la Argentina se plantea un nuevo modelo de desarrollo con inclusión social, teniendo como eje la integración regional. Desde esta perspectiva, el desarrollo busca incluir nuevas

20.415.1 12.1 10.7 9.7 8.4 8.0 6.3 5.7 4.4 3.8 3.3 3.1 3.0 2.7 2.1 2.2 1.8 1.8 1.5

42.7

36.533.5

29.8 28.824.7 23.1

19.216.3

14.0 11.9 10.1 9.4 9.0 8.1 6.8 5.7 4.8 4.8 4.00

10

20

30

40

50

60

70

Indigencia Pobreza

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oportunidades para las personas que habitan en regiones históricamente rezagadas. La estrategia macroeconómica se asienta sobre tres ejes: el sostenimiento de un tipo de cambio real competitivo, el mantenimiento del superávit fiscal y comercial y una política de ingresos tendiente a incrementar la capacidad adquisitiva de los distintos sectores sociales, en particular de los asalariados en el sector formal de la economía. Durante el período 2003-2008 el crecimiento económico fue constante, registrando tasas cercanas al 9 por ciento anual en promedio. El desempeño productivo estuvo motorizado por la persistente mejora que presentaron el gasto doméstico privado (consumo e inversión) y las exportaciones. La distribución del ingreso en la Argentina posee un nivel moderado a bajo. Su coeficiente de Gini es de 37,9 (1º trimestre de 2011), inferior al de Brasil (55,0), Chile (52,0), Colombia (58,5), México (51,6), Uruguay (47,1), o Venezuela (43,4). Hacia mediados de los años 70´s, el 10% más rico de la población poseía un ingreso 12 veces mayor que el 10% más pobre. Esa cifra aumentó a 18 veces en la década de 1990, y en 2002, durante el pico de la crisis, los ingresos del segmento más rico de la población, eran 43 veces mayores que los de los más pobres. Estos elevados niveles de desigualdad, se redujeron a 26 veces durante el año 2006 y a 16 veces a finales del 2010. De modo que la recuperación económica posterior al 2002 estuvo acompañada por una mejora significativa en la distribución del ingreso. Argentina en números

La información que aquí se presenta es una recopilación de indicadores generales del país provenientes de distintas fuentes oficiales disponibles al año 2013.

Población total ambos sexos, 201024 40.117.096 Población total de varones, 201025 19.523.766 Población total de mujeres, 2010. 20.593.330 Tasa de crecimiento anual medio de población (0/00) (proyecciones 1991-2001). INDEC.

10,1

Esperanza de vida al nacer en 2005-2010 (en años). Ambos sexos. INDEC. 75,24 Esperanza de vida al nacer en 2005-2010 (en años). Mujeres. INDEC. 79,10 Esperanza de vida al nacer en 2005-2010 (en años). Varones. INDEC. 71,60 Porcentaje de población urbana. Total.26 92,8 Índice de desarrollo humano, 2012. PNUD 0,811 Tasa de desocupación. Total de 31 aglomerados urbanos. 2to. trimestre 2013. Encuesta Permanente de Hogares Continua 2013. INDEC

7,2

Porcentaje de alfabetismo en población de 10 años y más, 2010. INDEC. 98,1 Cantidad de médicos en edad activa27 160.041

24 Censo Nacional de Población y Vivienda 2010, INDEC. 25 Ídem 26 Ídem

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Relación de médicos cada 1000 habitantes28 3,88 Total de establecimientos REFES29 20,323 Centros de Atención Primaria (CAPS)30 7,946 Establecimientos con internación31 4,726 Total de camas32 193,459 Tasa bruta de natalidad, 2010 (por 1.000 habitantes)33. 18,7 Tasa bruta de mortalidad general, 2010 (por 1.000 habitantes)34. 7,9 Tasa de mortalidad infantil, 2010 (por 1.000 nacidos vivos)35. 11,9 Producto interno bruto per cápita en dólares, 1er trimestre 2013.36 Ministerio de Economía

11,117

Gasto público consolidado de salud - Total (como % del PBI), 2009 (*)37 6,21 Gasto público consolidado de educación, cultura, ciencia y técnica - Total (como % del PBI), 2009 (*)38

6,68

*Datos provisionales.

Políticas públicas hacia la cobertura universal: el caso de los recursos humanos en salud

Argentina adhiere con fuerte convicción a las metas de cobertura universal en materia de salud y educación. Lo hace desde su compromiso con políticas de inclusión social que se expresan en la generación de 5 millones de nuevos puestos de trabajo en el lapso 2003-2012; la incorporación de 2 millones de personas al régimen jubilatorio y la asignación universal por hijo (AUH) que brinda protección social beneficiando a más de 3.5 millones de niños y adolescentes. Con la asignación universal el Estado busca que los niños y adolescentes asistan a la escuela, se realicen controles periódicos de salud y cumplan con el calendario de vacunación obligatorio; requisitos indispensables para cobrar la asignación.

El Plan Médico Obligatorio, creado en 1995 y sus modificatorias posteriores puede considerarse otro hito relevante dentro de las estrategias que el país se propuso para mejorar la calidad y acceso a la salud. El mismo establece un nivel de prestaciones al que todas las personas deben tener acceso y se acompañó con la ampliación del calendario de vacunación, la distribución gratuita de medicamentos esenciales en el primer nivel de atención, y la cobertura universal a las embarazadas,

27 Ministerio de Salud, SISA 2013 28 Ídem 29 Ídem 30 Ídem 31 Ídem 32 Ídem 33 Ministerio de Salud Serie 5 N° 54/11. 34 Ídem 35 Ídem 36 Ministerio de Economía 37 Secretaría de Política Económica - Ministerio de Economía. 38 Ídem

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madres y recién nacidos, la entrega gratuita de métodos anticonceptivos, acompañada de acciones integrales en salud reproductiva, todo ello desde el sector público.

El abordaje de las enfermedades crónicas, la obtención de sangre segura, y la protección y tratamiento de personas con VHI/SIDA y tuberculosis son considerados problemas sobre los que se han priorizado estrategias en la agenda sanitaria nacional.

Todas las acciones citadas han estado orientadas a coordinar con el sector social y educativo de manera de aportar a avances genuinos en la inclusión social. Se considera muy oportuno que este III Foro Global se centre en torno a la temática de los recursos humanos en salud con los desafíos de la cobertura universal. El marco de la cobertura universal se emparenta con los principios que la Argentina viene planteando en materia de inclusión y equidad social, y también con la mejora de la disponibilidad, la distribución, la calidad y los procesos de formación y educación continua de los equipos de salud.

En Toronto, Canadá, los países de las Américas establecieron en 2005, la década de los recursos humanos en salud39. Esto significó priorizar a la fuerza de trabajo en salud en las agendas nacionales e internacionales. Los servicios de salud en cualquiera de los niveles de complejidad no llegan a las personas que los necesitan si no hay trabajadores de la salud que posibiliten ese encuentro.

A su vez, la meta de la cobertura universal permite vincular los derechos humanos con la salud, la educación, el trabajo, la vivienda, y las identidades culturales y de género. Vale destacar que Argentina adhiere a la premisa que la salud integral se logra a través de todas las políticas públicas, no sólo a través de las de salud.

Acceso universal y requerimientos en materia de recursos humanos en salud

Tal como se sostiene en el documento de convocatoria a este III Foro Global, los ejes de calidad, accesibilidad, disponibilidad y aceptabilidad deben ser componentes principales que conformen los futuros planes de recursos humanos en salud en la próxima década.

39 OPS/OMS: VII Reunión Regional de los Observatorios de Recursos Humanos en Salud. En este encuentro regional surge el “Llamado a la Acción”, donde se definen cinco desafíos críticos para el desarrollo de los Recursos Humanos en Salud en la región de las Américas. Esos desafíos abarcan: la superación de los problemas de disponibilidad de personal capacitado y distribuido con criterio de equidad, la rectoría del Estado, la importancia del desarrollo de competencias para trabajar desde la perspectiva de los sistemas de salud basados en la atención primaria de la salud, y la necesidad de coordinación intersectorial.

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En gran medida, y aunque aún existan importantes logros a alcanzar, estos desafíos han ocupado un lugar central de la agenda del Ministerio de Salud de la Nación y en la de los 24 Ministerios de Salud Provinciales.

Argentina está desarrollando un enfoque sistémico en lo referente a los desafíos principales en materia de recursos humanos para acompañar el logro de la cobertura universal en salud. Esto se puede visualizar en una política activa que tiene los siguientes ejes:

1) Mejora de la rectoría del Estado a través de estrategias sostenidas de concertación de la Nación con los estados provinciales.

A través de la construcción de la red federal de recursos humanos se comparten las estrategias de resolución de problemas relativos a la formación y gestión de los equipos de salud propios a la diversidad del territorio nacional, posibilitando la medición y la priorización de metas (jurisdiccionales, regionales, nacionales) y acordar acciones conjuntas para su cumplimiento.

El Ministerio de Salud de la Nación decidió, en cooperación con la Organización Panamericana de la Salud (OPS), aprovechar las potencialidades del Campus Virtual de Salud Pública, de las nuevas tecnologías en comunicación y educación a distancia para construir competencias en materia de liderazgo en recursos humanos en salud y espacios compartidos de políticas entre las provincias.

2) La calidad de los abordajes en salud a través de la formación y capacitación de los trabajadores y en base al desarrollo de políticas de acreditación, regulación y evaluación.

La formación en el campo de la salud requiere de estrategias de intervención conjunta entre los sectores Salud y Educación, las que se están orientando desde la perspectiva de la atención primaria integral, garantizando la equidad y la calidad en la formación en todo el territorio nacional y promoviendo la elección y retención de los estudiantes en carreras de alta vacancia social y territorial.

La creación del Sistema Nacional de Residencias del Equipo de salud financia especialidades prioritarias y regula la calidad de estos procesos formativos mediante un sistema de acreditación con participación de sociedades científicas y la aplicación de instrumentos consensuados y estandarizados a nivel nacional y a su vez contextualizados en relación a la diversidad de situaciones sanitarias y formativas que existen en el país.

También se ha avanzado en la definición de estándares para la formación en enfermería y los aportes para la renovación de los planes de estudio de las facultades de medicina.

La regulación profesional y de especializaciones en salud está siendo posible de manera concertada gracias a los acuerdos logrados entre instancias gubernamentales, sociedades científicas, gremiales y universidades convocadas por el Ministerio de Salud de la Nación.

La Comisión Nacional de Acreditación de la Calidad de la Educación Universitaria (CONEAU) dependiente del Ministerio de Educación de la Nación lleva más de 10 años en los procesos de

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acreditación de las carreras de medicina y de posgrado en ciencias de la salud y se están iniciando las gestiones para implementar estos procesos en las carreras de enfermería.

3) Articulación intersectorial y políticas integradas con otras instancias gubernamentales como Ministerios Nacionales de Hacienda, Educación y Trabajo.

La creación de una Mesa de Políticas Integradas entre los Ministerios de Salud y Educación permitió encarar problemas de carácter nacional como los relacionados con los estándares en la formación en enfermería, la formación docente en temas de salud, la jerarquización de las carreras técnicas en salud, la reorientación de las currículum de las carreras de medicina hacia un enfoque de salud integral, entre los más relevantes.

El establecimiento de instancias de consulta e investigación con el Ministerio de Trabajo de la Nación están permitiendo actualizar una base de problemas y de datos relativos a la situación laboral de los trabajadores de la salud, problemática antes invisibilizada en el marco de las políticas sanitarias.

4) Generación de capacidades para la toma de decisiones para la planificación de los recursos humanos.

Con el fin de contribuir a la toma de decisiones basadas en información sistemática y actualizada se ha generado un Sistema Integrado de Información Sanitaria Argentino (SISA). Entre sus primeros logros puede referirse la reducción de la fragmentación de la información sanitaria a través de la articulación de los distintos registros federales en una misma plataforma de tecnología moderna y confiable. Dentro del SISA, la Red Federal de Registros de Profesionales de la Salud (REFEPS) ha posibilitado la articulación de los registros de profesionales de las 24 provincias, en concordancia con los requerimientos establecidos en la Resolución 604/2005 del Mercosur, que fija la matriz mínima de registro de profesionales de salud.

El Observatorio Federal de Recursos Humanos de Salud busca constituirse en el nodo que articula una Red de Observatorios de Recursos Humanos de la Argentina. Reúne la información aportada por distintas fuentes del campo laboral y de la formación en salud- provinciales, sistemas de gestión institucionales y diversos sectores que generan datos relativos a la educación y al trabajo- , facilitando el acceso a decisores e investigadores. Lo integran representantes de las 24 jurisdicciones y establece relaciones de cooperación técnica con la Organización Panamericana de la Salud (OPS/OMS) y las distintas unidades de los Ministerios de la Nación Argentina.

De las políticas sectoriales a las políticas integradas. El caso de las políticas de salud y de educación. El proceso de crecimiento del país, ha sido sostenido por la recuperación de las políticas públicas destinadas a dar respuestas equitativas a las necesidades sociales. Ello ha implicado potenciar la rectoría del Estado y la participación ciudadana, así como promover y garantizar una estrecha coordinación y trabajo conjunto entre las instituciones que forman parte del Estado nacional, provincial o municipal.

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En el caso de la Salud y la Educación, la integración de políticas públicas ha resultado fundamental para lograr la reducción de las brechas e inequidades sociales existentes. Esta articulación de políticas constituyó además uno de los motores fundamentales del desarrollo; dado que un mejor acceso a la educación tiene impactos positivos como determinante de la salud de la población. A su vez, el acceso a una buena salud, repercute de manera virtuosa en el acceso y permanencia en el sistema educativo.

Por otra parte la salud, junto con la educación y el ingreso, constituyen los tres componentes del índice de Desarrollo Humano de Naciones Unidas (índice que tiene una amplia aceptación como indicador de desarrollo, aún por encima del ingreso per cápita).

La Argentina tiene una tradición histórica de acceso universal a la salud y la educación.

Respecto de la educación, ya en el año 1884, la Ley 1420 sancionó para toda la población entre 6 y 14 años, la educación obligatoria, gratuita y laica. La Ley integral que hoy rige el sistema educativo nacional, es la Ley de Educación Nacional 26.206 del año 2006, que impuso la obligatoriedad de la educación secundaria, ampliando la permanencia de los jóvenes en la escuela. En el año 2005 se sanciona la Ley de Financiamiento Educativo 26.075 por la cual se establece que el presupuesto del gobierno nacional destinado a la educación, la ciencia y la tecnología, se incrementará progresivamente hasta alcanzar en el año 2010, el 6% del PIB nacional. Actualmente el porcentaje del PIB destinado a la educación corresponde al 6.7% del presupuesto nacional.

En el nivel superior, en el año 1918 se produce la Reforma Universitaria a partir de una protesta estudiantil iniciada en la Universidad Nacional de Córdoba -que luego se extiende al resto las universidades nacionales y provinciales-, por la cual se proclamaba la democratización del gobierno universitario, la gratuidad, la promoción de la ciencia, la libertad de pensamiento y la autonomía.

Hacia 1918, había en la Argentina tres universidades nacionales –las de Córdoba, Buenos Aires y La Plata– y dos provinciales –las de Tucumán y el Litoral–. Desde principios del siglo XX habían comenzado a formarse organizaciones estudiantiles que reclamaban participar en las decisiones del gobierno de las diferentes universidades. Pero para que la participación de los estudiantes fuera posible, era necesario modificar los estatutos universitarios. El conflicto planteado en la Universidad Nacional de Córdoba tuvo una gran repercusión política en el ámbito nacional, con intervención del presidente de la Nación y Congreso Nacional.

Desde el año 1949 el decreto 29.337 establece la enseñanza gratuita en las universidades nacionales. El impacto de esta norma se evidenció en el aumento inmediato de la matrícula estudiantil que pasó de 40.284 alumnos en 1945 a 138.871 en 1955, crecimiento que se mantuvo a lo largo del tiempo. Esta normativa marcó un punto de inflexión en la educación universitaria, puesto que la gratuidad abrió la posibilidad real del ingreso a la universidad.

En la actualidad, el sistema de educación superior universitario constituye un conglomerado institucional complejo y heterogéneo, conformado por más de 100 instituciones universitarias, que en su conjunto recibe a 1.600.000 estudiantes, de los cuales 1.343.597 asisten a instituciones del Estado y 336.166, aproximadamente a instituciones privadas.

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El sistema educativo ha sido considerado un aspecto clave del desarrollo a lo largo de toda la historia del país; en ese contexto, los logros educativos eran vistos como la mejor forma de mostrar el promisorio futuro del país. A partir de fines del siglo XIX las escuelas y las leyes educativas se convirtieron en un emblema del país y en la identidad de sus habitantes.

Respecto de la salud, se trata de es un sistema mixto compuesto por tres subsistemas: el de la oferta estatal, el de las obras sociales y el de las pre-pagas o medicina privada. Estos tres subsistemas cubren a toda la población que reside y transita por el territorio nacional.

Argentina, brinda a través del subsistema público, una cobertura amplia de servicios a la que tienen derecho todos los habitantes del país, aunque una gran parte de ellos (67%) también pueden estar cubiertos por la seguridad social o la privada (8%). Lo anterior constituye un importante piso de protección, aunque queden aún por resolver problemas de articulación entre los subsectores, fragmentación entre los niveles de atención y brechas en el acceso relacionadas con factores geográficos, económicos o culturales.

Es posible distinguir en la historia Argentina distintas etapas en la conformación de su propuesta de cobertura sanitaria. El primero corresponde a la organización del Estado moderno y abarca de 1880 a 1920. En ese lapso se organizó la responsabilidad estatal en materia de salud pública, así como la creación de centros formadores de recursos humanos en salud. Se construyeron servicios hospitalarios públicos en las principales ciudades, que incorporaron los avances científicos.

Un segundo y crucial período abarca desde 1946 a 1955, años durante los cuales se duplicó la capacidad instalada de servicios públicos (se pasó de 70.000 a 140.000 camas hospitalarias en todo el país) y se construyeron establecimientos a lo largo y ancho de la Argentina. Se registró un fuerte impulso y apertura al acceso a la educación médica y de otras profesiones en el campo de la salud, muy especialmente mediante la valorización de la enfermería y el apoyo a la incorporación de las mujeres al mercado de trabajo en salud.

En la década del 60 e inicios de los 70 se expandió el sistema de obras sociales nacidas en asociación con las organizaciones sindicales, por lo que vincularon el derecho al trabajo con el derecho a la salud y cambiaron de forma notable la configuración de las prestaciones en salud mediante el aporte solidario de los trabajadores. El Plan Médico Obligatorio, creado en 1995 y sus modificatorias posteriores puede considerarse otro hito relevante dentro de las estrategias que el país se propuso para mejorar la calidad y acceso a la salud. El mismo establece un nivel de prestaciones al que todas las personas deben tener acceso.

Integrar políticas sociales es más que una simple coordinación administrativa, ya que apunta a formar un espacio de cooperación, de diálogo político y concertación de actores para posicionar al Estado y sus políticas públicas. En esta integración, la formación de los recursos humanos, tanto del sistema educativo como del sistema sanitario, requiere de un abordaje específico para acercar el perfil de desarrollo de los equipos a las necesidades de la población.

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Por tratarse de un país federal, existen responsabilidades concurrentes entre los Ministerios de Educación y Salud provinciales y las carteras nacionales para la formación de los recursos humanos en salud. A este marco de autonomías provinciales se suman también las autonomías universitarias.

El fortalecimiento de los recursos humanos en salud requiere partir de una visión global de las necesidades en términos de composición, distribución y calidad de los equipos, con capacidad para mirar la realidad con independencia de la lógica de los servicios y programas, que tienen una fuerte tradición ligada a perspectivas disciplinarias fragmentadas y con énfasis en la enfermedad.

En un contexto de creciente complejidad, caracterizado por un proceso de cambio social, epidemiológico y demográfico, se requieren abordajes integrales de los distintos problemas relacionados a la salud y los niveles de atención, para enfrentar los efectos de envejecimiento de la población y el predominio de las enfermedades crónicas no transmisibles como prioridad. El nuevo paradigma requiere contar con equipos de salud acordes a estos cambios que están ocurriendo en el país y los que se presentarán en las próximas décadas.

En el caso del sector salud, educar profesionales es un proceso que demanda entre 3 a 10 años y supone una estructura institucional sumamente compleja. Toda planificación debe partir entonces del reconocimiento de que se trata de una política de largo plazo, que debe sustentarse en acuerdos entre múltiples actores y contar con un compromiso de inversión sostenida. La formación en servicio necesita estar acompañada de una regulación por parte del Estado, que asegure la calidad y excelencia en el desempeño de las instituciones formadoras y de los propios profesionales.

Varias de estas acciones exceden el campo de acción de un Ministerio y deben ser contempladas como políticas interministeriales e inter-jurisdiccionales, razones que justifican la permanente articulación y la búsqueda de consenso con todos los actores relevantes; en especial con los Ministerios de Salud, Educación, Trabajo, Infraestructura y Desarrollo Social. En esta búsqueda, los Ministerios de Salud y Educación a través de un convenio, formalizan un espacio permanente de trabajo y se crea la Mesa Intersectorial de Políticas Integradas de Salud y Educación.

Antecedentes y objetivos de la Mesa Intersectorial de Políticas Integradas de Salud y Educación

La conformación de esta mesa tiene como antecedente los ejes de trabajo y los compromisos asumidos por Argentina en la XII Conferencia Iberoamericana de Salud “Hacia la Construcción de una Agenda Renovada de Integración de Educación y Salud” y en la XXI Conferencia Iberoamericana de Educación “Transformación del Estado y Desarrollo”40.

40 La XII Conferencia Iberoamericana de Salud se realizó en Buenos Aires en el año 2010, en el marco de la XX Cumbre Iberoamericana de Jefes de Estado y de Gobierno subordinada al tema Educación para la Inclusión Social con el objetivo de avanzar en la construcción de una Agenda Renovada de Integración de Educación y Salud. Un año más tarde, en la ciudad de Asunción de la República del Paraguay, se llevó a cabo la XXI Conferencia Iberoamericana de Educación, en el marco de la XXI Cumbre Iberoamericana de Jefes de Estado y de Gobierno cuyo tema central fue la Transformación del Estado y Desarrollo, centrada en analizar los avances y desafíos respecto a las Metas Educativas 2021.

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El objetivo buscado fue el de acelerar y fortalecer los procesos de inclusión social mediante una mayor integración entre las políticas de salud y de educación a través de servicios de calidad, capaces de promover la salud y fomentar la participación social de la población.

Los acuerdos establecidos se presentan al Consejo Federal de Salud y al Consejo Federal de Educación (que son los organismos de concertación, acuerdo y coordinación de políticas en materia Educativa y de Salud), para su validación a nivel federal.

Este espacio de integración permite apuntar hacia un paradigma de política social que avanza más allá de las prestaciones y de los servicios en sí mismos. En el caso de Salud y Educación, al actuar conjuntamente, se puede abordar la promoción de la salud para educar a las nuevas generaciones en la adopción de estilos de vida y valores que apunten a una sociedad más sana, solidaria y equitativa; así como también fomentar la formación de equipos de salud adecuados a las necesidades de salud de la población y las políticas sanitarias.

La agenda de políticas integradas, logros y perspectivas de desarrollo

La Mesa Intersectorial de Políticas Integradas de Salud y Educación la conforman referentes políticos y técnicos de ambos ministerios41 y trabaja sobre las necesidades de los distintos niveles de educación superior. A medida que se acuerda una agenda común, cada Ministerio actúa en consecuencia para el logro de los objetivos fijados con sus equipos técnicos.

La Mesa definió su ámbito de intervención en el campo de los recursos humanos en tres grupos: a) las necesidades de formación de recursos humanos de salud, b) los docentes que se están formando y c) los docentes en ejercicio.

De manera transversal a cada uno de estos ámbitos de intervención se priorizan los entornos saludables como estrategia de regulación para la promoción de la salud, las escuelas saludables y las universidades saludables.

Áreas de trabajo:

Formación Docente: Dentro del nivel superior no universitario, se promueve la incorporación de contenidos de educación para la salud, con foco en los determinantes sociales de la salud, en la currícula de formación de los docentes.

41 Conformada por: Ministerio de Salud, a través del Secretario de Políticas, Regulación e Institutos, la Dirección Nacional de Capital Humano y Salud Ocupacional (DNCHySO), el Plan Nacional Argentina Saludable y el Programa de Hipoacusia; Ministerio de Educación: a través del Subsecretario de Equidad y Calidad Educativa, la Subsecretaría de Coordinación Administrativa, la Secretaría de Políticas Universitarias a través de la Dirección Nacional de Gestión Universitaria y del Programa de Calidad Universitaria, el Instituto Nacional de Formación Docente, el Instituto Nacional de Educación Tecnológica, la Coordinación Nacional de la modalidad de Educación Especial; cuenta además con participación de la representación de la Organización Panamericana de la Salud en Argentina.

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Docentes en actividad: Se aborda el tema de la salud del docente desde una visión compartida por los ministerios sobre la promoción de la salud, dotando al sujeto de la capacidad de proteger y construir su salud desde una perspectiva integral. Para ello se desarrollan materiales sobre el cuidado de la voz y la postura y también se realiza una campaña42, que cuenta con el aval de los gremios, orientada a la concientización de este tema dentro de la comunidad docente.

Educación Especial: Dentro de esta modalidad, con el propósito de sostener y acompañar las trayectorias escolares de alumnos con discapacidad, se han delineado estrategias de articulación para la construcción de configuraciones de apoyo. Se entiende por apoyos a las redes, relaciones, posiciones, interacciones entre personas, grupos o instituciones que se conforman para detectar e identificar las barreras al aprendizaje y desarrollan estrategias educativas para la participación escolar y comunitaria. Estos apoyos procuran diseñar, orientar, contribuir a la toma de decisiones educativas para el desarrollo de capacidades y potencialidades del sistema, las instituciones y los equipos. Las configuraciones prácticas que pueden adoptar los apoyos educativos son: atención, asesoramiento y orientación, capacitación, provisión de recursos, cooperación y acción coordinada, seguimiento e incluso investigación.

El eje de trabajo apunta a la prevención y detección temprana de los trastornos en el desarrollo para la primera infancia en jardines maternales y de infantes a través de dispositivos de comunicación para padres y escuelas.

Conjuntamente con la Comisión Nacional Asesora para la Integración de Personas con Discapacidad (CONADIS) y los referentes de Autismo de los Ministerios de Salud jurisdiccionales, se busca establecer pautas o indicadores que permitan la detección precoz de niños y niñas con problemas de autismo a fin de generar lugares de diagnóstico.

Estos lineamientos buscan avanzar en la generación de una cultura inclusiva que integre a estos niños, niñas y adolescentes a las escuelas comunes, lo que supone un cambio profundo, especialmente para los profesionales de la educación, quienes deberán adecuar la planificación, la organización, la implementación y la evaluación de su labor cotidiana al nuevo paradigma.

Educación Técnico Profesional: Se prioriza la mejora continua de la calidad de la formación de técnicos del área de la salud mediante la elaboración de Marcos de Referencia para el proceso de homologación de títulos en todo el país, bajo la convocatoria y el liderazgo del Instituto Nacional de Educación Tecnológica (INET) y del Ministerio de Salud. Una vez elaborado el documento marco, donde se define el perfil profesional, trayectoria y entorno formativo de una oferta educativa, se valida federalmente por el Consejo Federal de Salud (CO.FE.SA.) y se aprueba por el Consejo Federal de Educación (CFE).

Algunos marcos de referencia ya aprobados por el CFE son las Tecnicaturas Superiores en: 42 La “Campaña Integral de promoción y prevención de la salud docente” busca atender el derecho de los docentes al acceso de programas de salud laboral y prevención de enfermedades profesionales, incluidos dentro de la Ley de Educación Nacional, mediante la reflexión sobre las condiciones de salud en el trabajo docente, brindando información sobre prevención y cuidado de la salud del docente y fomentando la incorporación de hábitos saludables en la comunidad educativa.

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• Instrumentación Quirúrgica • Hemoterapia • Esterilización • Medicina Nuclear • Prácticas Cardiológicas • Neurofisiología • Enfermería • Radiología • Mantenimiento y Gestión del equipamiento biomédico • Laboratorio de Análisis Clínicos

Otra línea, es el fortalecimiento de las entidades formadoras de enfermería. Durante el 2012 se acordó con todos los actores del sector (reunidos en la Comisión Nacional de Enfermería) un Marco de Referencia para la homologación de la formación de la carrera de enfermería en escuelas técnicas. Dicho marco también introduce un avance en la articulación de la formación universitaria y no universitaria, ya que es uno de los documentos base para la incorporación de la carrera de enfermería a las carreras de riesgo social contempladas en el Art. 43 de la Ley de Educación Superior43.

El plan federal de fortalecimiento de las entidades formadoras de enfermería 2013-2015 implica una serie de acciones a nivel institucional, docente y de apoyo a las trayectorias educativas tendientes a disminuir el desgranamiento estudiantil, a aumentar la terminalidad y a mejorar la calidad de formación en enfermería en todo el país.

Formación Universitaria de grado: Desde el Programa de Mejora de la Calidad Universitaria dependiente de la Secretaría de Políticas Universitarias se promueve la formación universitaria de recursos humanos para la salud, a través de la mejora y el fortalecimiento de las carreras de medicina, odontología y enfermería. En el marco del proyecto de mejoramiento de la enseñanza de medicina iniciado en 2011, se conformó el Foro Argentino de Facultades y Escuelas Públicas de Medicina (FAFEMP) integrado por las 13 escuelas y facultades públicas de medicina del país. El Foro tiene por objetivo abordar las necesidades y desafíos que plantea la formación de médicos en el ámbito de la universidad pública y contribuir a la generación de políticas educativas en salud adecuadas a las necesidades de la población y los sistemas de salud, interactuando con el Ministerio de Salud, el Ministerio de Educación y la Comisión Nacional de Evaluación y Acreditación Universitaria (CONEAU).

A partir de un relevamiento del Ministerio de Salud y de los Consejos Regionales de Salud en conjunto con las facultades en regiones y localidades con necesidades o vacancia de recursos humanos de la salud, desde el 2012 se empezó a implementar un diagnóstico para trabajar en la creación de “carreras o trayectorias formativas protegidas” como estrategias para facilitar y acompañar el ingreso de estudiantes de escuelas medias de esas zonas a las carreras de Medicina dictadas en ciudades alejadas de las comunidades donde residen. Las regiones identificadas con

43 La incorporación al art. 43 de la ley de Educación Superior implica la regulación por parte del Estado Nacional de la formación de la carrera y de las actividades reservadas que le competen.

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mayores problemas de formación e inserción de profesionales de la salud son: Noroeste, Noreste y Patagonia.

Actualmente se están generando los acuerdos necesarios entre todos los actores involucrados (Universidades, Ministerio de Salud de la Nación, Ministerio de Educación de la Nación, jurisdicciones provinciales y municipales) para establecer responsabilidades compartidas que permitan cierta previsibilidad en la planificación de esta política de formación de recursos humanos y la inserción laboral en el mediano y largo plazo.

Desde el 2014, el Ministerio de Educación se ha comprometido a financiar durante siete años y a través de becas de estudio y mecanismos de seguimiento académico, la carrera de medicina de 40 jóvenes descendientes de comunidades indígenas residentes en los Valles Calchaquíes, la Quebrada de Humahuaca y la Puna, en las provincias de Tucumán, Catamarca y Jujuy.

Esta iniciativa tiene como antecedente al “Programa de Acción Afirmativa” que funciona desde 2012 en la Universidad Nacional de Tucumán. Consiste en la creación de 15 vacantes destinadas a alumnos del último año de escuelas medias (secundarias) de gestión pública provenientes de pueblos originarios de las zonas de los Valles Calchaquíes, a fin de mejorar sus posibilidades de acceso a la carrera de medicina. El programa cuenta con un dispositivo de acompañamiento y seguimiento de las trayectorias formativas de los estudiantes que ingresaron a la carrera de medicina, quienes disponen además de un sistema de becas para estudio y vivienda. Además de la Universidad Nacional de Tucumán, cuenta con el apoyo de los gobiernos locales de las provincias involucradas y el compromiso para la posterior inserción laboral de los futuros profesionales.

Con el propósito de ampliar la cobertura y mejorar la atención de la salud de la población, se están desarrollando acciones para que los Hospitales Universitarios dependientes de las universidades públicas se integren a la Red de Hospitales Nacionales bajo jurisdicción del Ministerio de Salud. Esta estrategia busca redefinir la relación de las carreras de salud con la red pública, independientemente de su dependencia, ya que la mayoría de los hospitales donde se realizan los ciclos clínicos no son ni universitarios ni nacionales.

Uno de los objetivos de esta iniciativa es constituir redes integradas de servicios, organizadas por niveles de complejidad creciente en las que el acceso, la calidad y la oportunidad de atención se encuentren garantizadas. Precisamente garantizar el acceso gratuito y universal de toda la población a las prestaciones asistenciales es una condición indispensable para la integración de esta red.

Un segundo desafío responde a intensificar la vinculación entre los hospitales y la capacidad formativa de los establecimientos en los que los nuevos profesionales completan sus ciclos de perfeccionamiento con el fin de alcanzar una mejor formación y una mejor calidad asistencial.

Formación universitaria de posgrado: se está trabajando en la conformación de una subcomisión para tratar el analizar las ofertas de formación, las áreas de vacancias, la factibilidad de ofrecer la gratuidad de determinadas especialidades por región y por tiempo determinado.

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Durante el 2013 se firmó la primera resolución conjunta entre los Ministerios de Educación y de Salud, por la cual se logró el reconocimiento de títulos extranjeros de grado universitario del área de salud; constituyendo un gran avance en materia de integración de políticas. Argentina firmó convenios de reciprocidad para el reconocimiento de títulos de nivel universitario de grado con los siguientes países: Bolivia, Perú, Ecuador, Colombia, Chile, Cuba, España y México. La convalidación provisoria y la matriculación provisoria para la realización de estudios de posgrado, implica que cualquier ciudadano de los países mencionados puede continuar con su formación de posgrado en Argentina.

La articulación entre los actores está dada por las responsabilidades compartidas que cada uno debe asumir: las universidades nacionales tienen que evaluar la razonable equivalencia del título extranjero del candidato, el Ministerio de Educación de la Nación tiene la responsabilidad de otorgar la convalidación provisoria del título para la realización de los estudios de posgrado en un tiempo no mayor a los seis meses, y el Ministerio de Salud es quien otorga la matrícula provisoria.

Además de la disminución del tiempo del trámite de convalidación, lo novedoso de este procedimiento es que una vez que el Ministerio de Salud otorga la matrícula provisoria, ésta queda en custodia de la institución universitaria formadora hasta que el profesional extranjero finalice sus estudios de posgrado. De manera tal que la matrícula provisoria tiene validez solo a los efectos de continuar una formación de posgrado y no para el ejercicio profesional.

Experiencias de políticas integradas en el nivel provincial y regional

Esta experiencia de trabajo conjunto que se inicia en el nivel nacional, está en concordancia con otras agendas de trabajo integradas en el campo de la salud y de la educación tanto en el nivel provincial como regional.

En el ámbito provincial es posible citar a modo de ejemplo, el caso de la Provincia de Santa Fe, en la región Centro, cuya articulación de políticas se sustenta en la concertación de actores provenientes del sector público y privado; el caso de la provincia de Tucumán con el Pacto de San Javier que contempla los lineamientos del plan estratégico 2011-2015 para el desarrollo y la formación de los recursos humanos en salud de las provincias que integran la región Noroeste (NOA); o el caso de la Declaración de Resistencia, firmada en la provincia de Chaco por las provincias que componen la región Noreste (NEA), donde se establece un compromiso para establecer mecanismos de articulación entre las instituciones del sistema de salud de esta región y las instituciones académicas a fin de adecuar el perfil de formación de médicos y otras profesiones de la salud, conforme a un modelo de atención de salud integral centrado en una estrategia de atención primaria para la salud que responda a las necesidad de salud de su población.

En el ámbito del MERCOSUR se creó, desde 1991, el Sub Grupo de Trabajo 11 (SGT11), destinado a atender cuestiones derivadas de los procesos de integración, relacionados con la salud de las personas, el medio ambiente y los aspectos sanitarios del flujo de bienes y servicios.

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Dentro de este Subgrupo, la Sub Comisión de Desarrollo y Ejercicio Profesional es la encargada de discutir las regulaciones para el ejercicio de las profesiones de salud con el objetivo de alcanzar la libre circulación de profesionales prevista para el año 2015.

A partir de la XXXIV Reunión ordinaria del SGT11, llevada a cabo en la ciudad de Asunción – Paraguay en el año 2011, se propuso iniciar un proceso de reuniones comunes con el MERCOSUR Educativo para analizar en conjunto la problemática de la homologación de títulos de profesiones sanitarias.

Conclusiones y compromisos

La agenda post 201544, luego de un proceso de consulta mundial señaló que la salud es beneficiaria del desarrollo sustentable e integral y a su vez contribuye al mismo; y constituye un interesante trazador para saber si las políticas están centradas en las personas, sus derechos, y la meta de la inclusión social. En este contexto, la salud como fin y como medio tiene un rol central en la búsqueda armónica del bienestar material, social, cultural, educacional, laboral, ambiental y político de las personas. El diseño de políticas públicas activas requiere la observancia de la incorporación de estas ideas a través de líneas de acción transversales en la capacitación y formación de los equipos de trabajo en salud.

Las evaluaciones realizadas de las acciones encaradas hasta el momento permiten concluir la concordancia de perfiles entre las políticas de recursos humanos y las metas de la cobertura universal en salud. A pesar de ello, Argentina sostiene que es necesario generar nuevos compromisos que doblen la apuesta en términos de impacto en la salud de la población. Para ello, nos proponemos:

• Continuidad de la Mesa Intersectorial de Políticas Integradas de Salud y Educación y de las líneas de trabajo arriba mencionadas

• Fortalecimiento de los equipos técnicos para la gestión intersectorial tanto a nivel nacional como provincial

• Conformación de mesas provinciales de políticas integradas de salud y educación (asistencia técnica, encuentros nacionales / regionales)

• Generación de evidencia empírica de las necesidades de formación de equipos de salud • Fortalecimiento de Hospitales Universitarios en el marco de la Red de Hospitales

Nacionales • Conformar una mesa de planificación de posgrados de medicina junto al Foto de Facultades

Públicas de Medicina • Participar activamente dentro de la Comisión Nacional Asesora para la Integración de

Personas con Discapacidad (CONADIS) • Incluir al Ministerio de Ciencia y Tecnología e Innovación Productiva en una comisión

conjunta

44 http://www.worldwewant2015.org/health

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HRH commitment pathways BELIZE


The Ministry of Health Belize is currently developing a health sector strategic plan. The overall objective is to provide broad based multi-stakeholder pathway that

will systematical address various health sector challenges with emphasis on, among other strategic areas, Human Resources in Health.

In furtherance to that objective, the Belize Human Resources in Health Steering Committee, an arm of the Belize HRH observatory have been mandated to

develop a five year HRH Strategic Plan(2014 to 2019). The committee, which has commenced their planning process, reviewed the document (Human Resources for Universal Health Coverage: a template for eliciting commitments) that detailed various pathways that member countries could commit to

during the 3rd Global Health Workforce Forum. The Committee while acknowledging the usefulness of the outlined pathways came up with a commitment that will

be in tandem with the Belize HRH Strategic Plan and by extension the Health Sector plan, both of them currently under development. In view of that realty, Belize

would like to make a commitment at the 3rd Global Health Workforce forum as outlined below.

Overall Objectives for the Belize HRH Plan:

To ensure the availability of a sustainable health workforce that is knowledgeable, skilled and adaptable.

Belize will strive to have a workforce that is distributed to achieve an equitable health outcome, suitably trained, competent, and culturally sensitive and that works

in a supportive environment. A workforce that could provide a safe, quality, preventative, curative and supportive care that is population and health consumer

focused and capable of meeting health care needs of our people within the context of the National Health Insurance of Belize.

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The strategic directions and specific goals which underlie the aforementioned objective are:

1. Policy direction: Belize commit to appropriate legislation, regulations and guidelines for conditions of employment, work standards, and development of the health workforce.

a. Goal: To ensure that legislation, policies and guidelines for conditions of employment positively support the development of the Belize health workforce for the next five years.

2. HRH Management System strategic direction: We commit to ensure that appropriately trained HR managers are in place with the systems, capacity, and authority to facilitate processes for adequate staffing, retention, teamwork, and performance.

a. Goal: To establish and maintain a comprehensive, up-to-date and accurate HR information system b. Goal: To develop and maintain a motivated workforce, content with working conditions and opportunities for growth. c. Goal: To establish HR unit/functions within the Ministry of Health. The key functions will be to develop HRH policies and plans, define strategic

directions and monitor & evaluate implementation of new and existing HRH policies. d. Goal: To improve institutional and health worker performance

3. EDUCATION: We will continue to involve our stakeholders to ensure that pre-service and in-service training will result in the production and maintenance of a skilled workforce that will meet the health needs of the Belize population.

4. FINANCE: We commit to developing & implementing processes to ensure adequate funding is obtained and that evidence based budgets are adhered to .Also to ensure strong capacity for public financial management at the Ministry of Health Belize.

5. PARTNERSHIP & LEADERSHIP direction: To continually improve the capacity to deliver health services through formal and informal linkages among donors, sectors, professional associations, health programs, and the private sector. We also commit to establishing coordination and linkages among community-based organizations and NGOs.

a. Goal: To increase and maintain the capacity to provide direction, align stakeholders, and mobilize resources


Belize is committed to the SICA sub regional initiatives towards a healthy workforce through the attainment of the 20 HRH regional goals. The strategic directions for the proposed 5 year plan are in line with the five principal challenge areas that the regional goals set to address. Belize will continue to monitor those 20 regional indicators in addition to other country specific indicators that will identified in the new plan.

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Vías de compromiso en materia de RHS

CHILE


Organización Responsable: Ministerio de Salud En Diciembre de 2011, el Ministerio de Salud lanzó el secundo Plan Nacional de Salud: “Estrategia para el cumplimiento de los Objetivos Sanitarios de la década 2011-2020”. Los Objetivos sanitarios definidos abarcan 8 temas: enfermedades transmisibles, enfermedades no transmisibles y violencia, factores de riesgos, ciclo vital, determinantes de la salud, ambiente-alimentos -trabajo, acceso y calidad de la atención de salud, emergencias y desastres. Está incluido un 9° componente transversal: fortalecimiento del sector salud, dentro del cual se encuentra un subcomponente de Recursos Humanos. El Plan constituye la carta de navegación del sector salud para la década y está actualmente en su primera fase de implementación. El componente de Recursos Humanos se concibió como un conjunto de estrategias transversales destinadas a apoyar el logro de los objetivos sanitarios, a través de 3 metas de impacto, 30 objetivos estratégicos e indicadores que reflejan las transformaciones y cambios a llevar a cabo en los 10 años del Plan, incluyendo a todos los niveles de atención (primario, segundario y terciario) y a las funciones de Salud Pública. En este contexto, el Plan de Salud 2011-2020 contiene una Política Integral de Recursos Humanos que se publicó y difundió en el año 2012, dentro de la cual se inserta la mayoría de los objetivos estratégicos de Recursos Humanos, organizados en 6 capítulos: Política Pública, Dotación de Personal Adecuada, Competencias Adecuadas, Condiciones Laborales Adecuadas, Formación Médica y Sistema de Información en Recursos Humanos. Compromisos de Chile:

1. Implementar los planes operativos de la Política de Recursos Humanos tanto a nivel central como en los niveles locales (Servicios de Salud y Hospitales, y Atención Primaria de Salud): el Plan Nacional de Salud incorpora para los niveles locales del sistema el compromiso de diseñar un Plan operativo de la Política Nacional de Recursos Humanos cada dos años durante el periodo 2013-2020. Primera fecha de monitoreo prevista en el Plan Nacional de Salud: diciembre de 2015.

2. Lograr progresivamente, y en función del presupuesto que el país decida cada año dedicar a la Salud, una dotación de Recursos Humanos adecuada, definida como la que asegure una distribución equitativa (asignación de los recursos humanos en función de las necesidades sanitarias y prioridades del plan de salud, y considerando los aspectos de acceso de la población), que optimice la capacidad instalada, consolide el modelo de atención integral de salud familiar y comunitaria, y provea las redes específicas de urgencia y unidades de pacientes críticos. La definición de la dotación de Recursos Humanos adecuada incluye la dimensión de la calidad en términos de competencias adecuadas y objetivos estratégicos que se reflejan en indicadores de formación previa al empleo y formación en el empleo. Primera fecha de evaluación prevista en el Plan Nacional de Salud: diciembre de 2015.

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2) ¿Cómo va a llevar a cabo el seguimiento del progreso logrado en cuanto al cumplimiento de sus compromisos? ¿Qué indicadores va a controlar? ¿Qué

fuentes de datos va a utilizar?

A nivel nacional, la conducción del seguimiento y monitoreo de la Estrategia Nacional de Salud 2011-2020 está a cargo de la División de Planificación Sanitaria:

en este contexto, los indicadores a controlar, las fechas de control, los responsables de los indicadores, las fuentes de datos o información y los medios de

verificación están descritos e incorporados a una plataforma informática diseñada para estos efectos.

En este marco:

1. Respecto del primer compromiso presentado por Chile, el indicador es la existencia de un plan operativo de implementación de la Política Nacional de

Recursos Humanos a nivel central, además de la proporción de los 29 Servicios de Salud (nivel descentralizado de la red asistencial) del país que hayan

elaborado su plan de implementación de dicha política a nivel local. A este indicador se agrega una evaluación de la conformidad de los planes

diseñados con criterios de contenidos y calidad pre-establecidos.

2. En cuanto al segundo compromiso, el indicador es la proporción de Servicios de Salud que tengan una dotación adecuada de RHUS (según la definición

antes señalada y las metodologías de estimación de déficits adoptadas por el país), en algunas áreas priorizadas por la Autoridad de Salud, tales como

atención abierta, centros de salud del primer nivel de atención, redes de urgencia, redes de camas de cuidados críticos, por ejemplo.

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COLOMBIA


Fortalecer el enfoque de APS y de salud y medicina familiar, en todos los programas de formación de talento humano en salud y formar 4000 médicos familiares en los próximos 10 años. Formación continua en APS para todo el personal sanitario (10 años). Fortalecer la capacidad resolutiva de los técnicos y profesionales del área de la salud (permanente). Definir las competencias de las profesiones de la salud, que respondan a las características y necesidades de la población y el sistema de salud (2 años).



1. Implementando el Registro Único Nacional del Talento Humano en Salud. 2. Fortaleciendo y dinamizando el Observatorio de Talento Humano en Salud, haciendo especial énfasis en la Sala de Salud y Medicina Familiar. 3. Haciendo uso de los indicadores de seguimiento y evaluación de los Recursos Humanos para la Salud que apliquen para Colombia, en un marco de corto y

mediano plazo, y la disponibilidad de información. 4. Información de programas, cupos, matrículas y egresados delos programas de formación del área de la salud. 5. Información de programas de formación continua.

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ECUADOR


El Ministerio de Salud Pública del Ecuador dentro de su planificación ha identificado las necesidades de talento humano y definido las brechas existentes en cada uno de los niveles.

Una serie de estrategias está implementando el MSP Ecuador para asegurar que se cuentan con los suficientes talentos humanos y se ofrece servicios de salud para toda la población, entre estas estrategias están:

1. Convocatoria a concursos de merecimientos.

2. Incrementos salariales

3. Inclusión de mecanismos de incentivo salarial como Bono de residencia y Bono geográfico

4. Implementación de plan de retorno para profesionales de la salud que migraron en l década de los 90

5. Plan multianual de formación de talento Humano en Salud

El Plan Multianual de formación busca formar de manera intensiva a más de 10,000 profesionales de la salud en el período 2013-2017, cuenta con compromiso Presidencial y con un financiamiento aprobado de US $ 535,000,000.

Para que el plan de formación consiga los resultados planteados, el MSP trabaja muy estrechamente con Universidades con quienes ha suscrito convenios de cooperación para el auspicio financiero de becas, uno de los logros del trabajo estrecho con 8 universidades es la construcción de una malla curricular nacional para el programa de Medicina Familiar y Comunitaria el cual tiene un fuerte énfasis en la APS renovada y tiene previsto

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1. Mediante el monitoreo de indicadores establecidos en el plan de acción 2013 -2017 2. Reuniones anuales de trabajo con Universidades e Institutos técnicos de educación superior para evaluar cualitativa y cuantitativamente el avance,

identificar problemas y plantear soluciones. 3. Monitorear la asignación de becas con Consejo de educación Superior, Secretaría nacional de Ciencia y tecnología y Universidades Participantes. 4. Reuniones de Monitoreo con Becarios del programa para conocer logros y nodos críticos y rescatar aprendizajes. 5. Evaluaciones anuales 6. Manteniendo como prioridad en la agenda política del MSP Ecuador el plan de formación de talento humano en salud.

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Vías de compromiso en materia de RHS EL SALVADOR


INTERVENCIONES

1. Confirmar el compromiso del país de continuar con la medición de las metas de recursos humanos y ratificar su monitoreo al 2015 en congruencia con el

Compromiso Regional de los Gobiernos (2007-2015)

a. Objetivo: Identificar avances en el cumplimiento de los cinco desafíos y 20 metas de RHS así como los factores impulsadores y restrictivos

relacionados a los resultados.

b. Fecha tercera medición: Primer trimestre 2015 (tabla de indicadores adjuntos)

c. Descripción: En el 2010 el país realizó la medición de la línea base de las 20 metas de recursos humanos y en el 2012 se ha realizado su

primer monitoreo, cuyo resultados han demostrado avances significativos especialmente en el primer desafío y sus cinco metas, mejorando el

acceso a la salud de la población, aumentando la dotación y mejorando la distribución de los recursos humanos en salud, especialmente en los

territorios más alejados a las ciudades; además se ha mejorado el índice de relación en la distribución de trabajadores urbano/rural entre otros

resultados, los cuales están disponibles en el observatorio de RHUS (http://rrhh.salud.gob.sv/?q=node/4).

d. Organismo responsables: Instituciones del Sistema Nacional de Salud , Instancias Reguladoras del Ejercicio Profesional y Universidades

2. Oficialización e implementación de la Política Nacional de Desarrollo de Recursos Humanos en Salud.

a) Organismo responsable: Ministerio de Salud como ente Rector del Sistema Nacional de Salud y sus Instituciones, además de las

Instituciones Formadoras y reguladoras del ejercicio profesional

b) Objetivos: Impulsar el Desarrollo Integral de los Recursos Humanos en Salud a nivel nacional a través de la implementación de la Política

Nacional de Desarrollo de RHUS.

c) Fechas: 2014-2016

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d) Descripción:

La política Nacional de Salud de El Salvador, define el modelo de atención de salud familiar y comunitario, basado en la Atención Primaria de Salud Integral, con

un modelo de gestión organización en redes integrales e integradas de salud, por tanto para implementarlos se demanda de recursos humanos calificados,

motivados, comprometidos y con una buena dotación y distribución; al 2013 hay avances significativos que han mejorado el cumplimento del derecho a la salud

de la población, especialmente en los municipios de más alta pobreza, a través de la mejora en la dotación, distribución y educación permanente y formación de

los trabajadores.

Los diversos compromisos contemplados en la Política Nacional de Salud son cuatro compromisos:

i) La salud de los trabajadores,

ii) El desarrollo de los recursos humanos;

iii) La coordinación con las instituciones formadoras;

iiii) La formación de capacidades de los agentes comunitarios de salud (Promotores de Salud); en ese sentido se ha avanzado en cada uno de estos

compromisos, pero aun existen brechas que hay que mejorar e impulsando nuevas estrategias, por tanto se ha elaborado con amplia participación, la Política

Nacional de Desarrollo de Recursos Humanos en Salud, que contiene seis estrategias cuyo desarrollo es de carácter intersectorial, de tal manera que pueda

incidir en la profundización de los cambios positivos generados hasta ahora, sus estrategias que se convierten en compromisos para la acción son:

- Fortalecer los procesos de planificación de los RHUS para adaptar de forma gradual la fuerza laboral a los requerimientos del Sistema

Nacional de Salud.

- Establecer un Sistema Nacional de Especialidades en Salud concertado.

- Reorientación de la formación profesional y técnica en salud acorde a los requerimientos del SNS.

- Impulsar el diseño y desarrollo de

- la carrera sanitaria para el conjunto de los trabajadores de la salud.

- Propiciar condiciones de trabajo digno para la fuerza laboral en salud

- Asegurar la educación permanente para todos los trabajadores

- Favorecer la generación de información y conocimiento científico en el campo de los RHUS.

El plan de implementación de la política para el siguiente bienio define una serie de indicadores que permitirá su monitoreo y su eficacia a mediano y largo plazo.

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SEGUIMIENTO DEL PLAN DE ACCIÓN REGIONAL DE RECURSOS HUMANOS PARA LA SALUD 2007 – 2015 DESAFÍOS, METAS E INDICADORES.

INDICADORES CUANTITATIVOS

DESAFIOS Y METAS

INDICADORES cuantitativos

FUENTES

DESAFÍO 1 Meta 1

Razón de densidad de recursos humanos en salud por 10.000 habitantes, general y por departamento

Institutos de Estadísticas y Censos y el Sistema de Información de las Unidades de RHUS del Sistema Nacional de Salud

Meta 2 Porcentaje de médicos trabajando en atención primaria de salud. General y por departamentos Institutos de Estadísticas y Censos Sistema de Información de las Unidades de RHUS del Sistema Nacional de Salud

Meta 4 Razón de médicos por enfermeras, general y por departamento Institutos de Estadísticas y Censos y Sistema de Información de las Unidades de RHUS del Sistema Nacional de Salud

DESAFÍO 2 Meta 6

Porcentaje de recursos humanos trabajando en el área rural del país Institutos de Estadísticas y Censos Sistema de Información de las Unidades de RHUS del Sistema Nacional de Salud

DESAFIO 4 Meta 13

Porcentaje de puestos de empleo de atención de salud que son precarios y/o sin protección social Institutos de Estadísticas y Censos Sistema de Información de las Unidades de RHUS del Sistema Nacional de Salud

DESAFIO 5 Meta 19

Porcentaje de alumnos que ingresan y egresan en el tiempo esperado por cada carrera Sistema de Información de las Universidades

INDICADORES CUALITATIVOS

DESAFÍO 1 Meta 3

Equipos de atención primaria de salud con una amplia gama de competencias Grupo focal de informantes claves

Meta 5 Unidad o dirección de recursos humanos para la salud responsable por el desarrollo de políticas y planes de recursos humanos, la definición de la dirección estratégica y la negociación con otros sectores.

Grupo focal de informantes claves

DESAFÍO 2 Meta 7

Porcentaje de trabajadores primarios de la salud que tienen competencias de salud pública e interculturales Grupo focal de informantes claves

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DESAFIO 2 Meta 8

Porcentaje de programas de educación en el trabajo para el grupo de trabajadores de la salud definidos en el indicador (enfermeras, auxiliares de enfermería, técnicos de la salud y trabajadores de la salud comunitarios) dirigido a perfeccionar aptitudes y competencias de acuerdo a la complejidad de sus funciones actuales


DESAFÍO 2 Meta 9

Porcentaje de trabajadores de salud cuyo lugar de práctica de atención primaria de salud es la misma ubicación geográfica de su comunidad de origen Grupo focal de informantes claves

DESAFÍO 3 Meta 10

País: Ha adoptado un código global de práctica. Si o No. Ha establecido normas de ética para el reclutamiento internacional. Si o No


DESAFÍO 3 Meta 11

Existe una política de auto-suficiencia de recursos humanos (Debe existir coherencia con la respuesta de la meta 5, donde se indaga sobre la existencia de una política de planificación). Si o No.


DESAFÍO 3 Meta 12

El país tiene un mecanismo formal para el reconocimiento de profesionales capacitados en el extranjero. Si o No. Grupo focal de informantes claves

DESAFIO4 Meta 14

Porcentaje de trabajadores en el sector salud cubiertos por medidas de salud y seguridad específicas para los riesgos de su tipo de trabajo Grupo focal de informantes claves

DESAFÍO 4 Meta 15

Porcentaje de gerentes de servicios y programas de salud con certificados de cursos de gerencia en salud. Grupo focal de informantes claves

DESAFÍO 4 Meta 16

El país cuenta con mecanismos formales para resolver conflictos laborales Grupo focal de informantes claves

DESAFÍO 5 Meta 17

Porcentaje de Universidades que han Integrado en el currículo de contenidos de APS Porcentaje de Universidades que han Integrado en el currículo de prácticas en APS Porcentaje de Universidades que tienen estrategias de formación interprofesional en las escuelas de ciencias de la salud Porcentaje de Universidades que tienen soporte financiero para la formación interprofesional


DESAFÍO 5 Meta 18

Porcentaje de universidades con programas específicos para estudiantes de poblaciones subtendidas. Porcentaje de Programas específicos de formación de estudiantes que provienen de poblaciones indígenas, afros o que tienen escasos recursos o que viven en distancias geográficas inaccesibles


DESAFÍO 5 Meta 20

Existencia de instancia evaluadora de la calidad educativa universitaria Sí/No Porcentajes de Facultades y/o Escuelas de Ciencias Médicas (o Ciencias de la Salud) acreditadas Porcentaje de Escuelas de Salud Pública acreditadas


Otras fuentes de información: El Observatorio de RHS, fuentes primarias en los territorios a nivel nacional (Directores) y la Comisión Intersectorial de Recursos Humanos de El Salvador; para el caso de la Política Nacional de Desarrollo de Recursos Humanos hay indicadores de proceso y resultado en su plan de implementación.

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Vías de compromiso en materia de RHS GUATEMALA

NOTA:

Las presentes propuestas de vías de compromiso en materia de Recursos Humanos de Salud es el resultado del trabajo que se realiza dentro de la Comisión Interinstitucional de Acciones Conjuntas entre el Sector Académico y de Salud; mismo que fue consensado entre las autoridades de las Facultades y Escuelas de Ciencias de la Salud de todo el país: Medicina y Enfermería y las autoridades del Seguro Social y del Ministerio. Luego se revisó por la Dirección de Recursos Humanos y la Dirección del Centro Nacional de Ciencias de Salud del Ministerio, para proponerse como compromiso de país. Durante los próximos dos años se hará un seguimiento, medición y evaluación a cada uno de los compromisos que aquí se describen, y que para el efecto se han diseñado tablas de control de mando e indicadores que se anexan. Mismos que se estarán actualizando continuamente dentro del Observatorio de Recursos Humanos.


Organización Responsable: Ministerio de Salud

Disponibilidad:

1. Formar 300 parteras durante los años 2014 y 2015 (150 cada año). Se formarán en Centros ubicados a su lugar de origen. 2. Contratar por un año a 30 médicos recién egresados de la Universidad Estatal en los años 2014 y 2015 y ubicarlos en la red de servicios hospitalarios

del país, con rotación áreas prioritarias de formación recursos humanos: Centros de Salud, Anestesiología, Radiología y Patología. Durante el año a contratar se les brindará un curso de especialización en Medicina Familiar y Comunitaria a la mitad de los contratados y un curso de especialización de Atención Primaria de Salud a la otra mitad, a fin de que al terminar el año, se sometan a plazas de oposición para realizar residencias médicas en Medicina Familiar, y Especialidades básicas: medicina interna, cirugía general, pediatría, gineco-obstetricia, anestesiología, radiología y traumatología.

3. Disminuir un 20% de deserción de las estudiantes de enfermería en todas las Escuelas de Enfermería del País.

Accesibilidad:

1. Contratar a la totalidad de parteras egresadas del Programa de Partería, y ubicarlas en su lugar de origen. 2. Contratar al 50% enfermeras egresadas de las escuelas técnicas universitarias de enfermería y auxiliares de enfermería y ubicarlas en su lugar de

origen.

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Aceptabilidad:

1. El 50% del personal de salud (enfermeras y parteras) egresado de las 8 regiones del país se contratará y se ubicará en su lugar de origen. 2. Se contratarán equipos básicos de salud compuestos por: médico, enfermeras, obstetras, parteras, técnicos de saneamiento básico y trabajadores

comunitarios, para los municipios priorizados del Programa de Gobierno Plan Hambre Cero.

Calidad:

1. Revisión y actualización de todos los programas de especialidades médicas, que incluye todo el proceso académico y normativo. 2. Revisión, actualización y unificar los programas de pregrado de las diferentes Escuelas y Facultades de Ciencias de la Salud: Medicina. 3. Medición y seguimiento al programa unificado de Enfermería y que se está aplicando por todas las Escuelas de Enfermería a partir del año 2013. 4. Mantener un Programa de Capacitación Continua acorde a cada área de trabajo y región, según el Diagnóstico de Necesidades de Capacitación anual.

Aceptabilidad y Calidad:

1. Incentivos: recategorización de puestos especializados Coordinados por ONSEC durante el año 2014 se tiene programado el aumento salarial del 15% y los contratos del Renglón 18 y 029 disminuyen en un 30% y se transforman en contratos 011 y 029 a fin de disminuir la brecha de precariedad laboral

2. El Ministerio de Salud Pública y Asistencia Social en conjunto con el Instituto Guatemalteco de Seguridad Social están elaborando un Programa de Salud y Seguridad para los trabajadores que se implementará a partir del segundo trimestre del año 2014.

3. El Ministerio de Salud Pública y Asistencia Social se encuentra elaborando el Programa de Planeación Estratégica 2014-‐2019 que incluye Gestión por Resultados, Gestión de la Calidad y Satisfacción Laboral.



Se adjuntan tablas de control para los indicadores a seguir y con mediciones semestrales y evaluaciones anuales de los avances y evolución que se guarda.

Indicadores para: Disponibilidad:

- Razón de densidad de RHS: Nº de médicos + enfermeras + parteras /total de la población de Guatemala a mitad de período x 10,000 habitantes - % de médicos trabajando en atención primaria de salud: Nº de médicos trabajando en atención primaria / número de médicos trabajando en el país - % de trabajadores primarios de la salud que tienen competencias de salud pública e intercultural: Nº total de trabajadores de APS con competencias en

salud pública / número total de trabajadores de APS en el país x 100 - % de estudiantes de medicina y de enfermería que terminan la carrera en el tiempo previsto

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Accesibilidad:

- Razón de densidad de RHS: Nº de médicos + enfermeras + parteras /total de la población de Guatemala a mitad de período x 10,000 habitantes - Personal de salud de atención primaria reclutado en sus propias comunidades: Nº total de trabajadores de APS practicando en su propia comunidad / Nº

total de trabajadores de APS empleados en el país x 100

Aceptabilidad:

- % de médicos trabajando en atención primaria de salud: Nº de médicos trabajando en atención primaria / número de médicos trabajando en el país - Grado en que los equipos de atención primaria han sido desarrollados en cada una de las 8 regiones del país - % de recursos humanos en salud trabajando en el área rural del país: Densidad de recursos humanos en salud: médicos, enfermeras y parteras por

cada 10,000 habitantes en las áreas rurales del país / densidad de recursos humanos en salud. Médicos, enfermeras y parteras por cada 10,000 habitantes en las áreas urbanas.

Calidad:

- % de Universidades que han integrado en el currículo el eje de APS - % de Universidades que han integrado en el currículo prácticas en APS - % de Universidades que tienen estrategias de formación interprofesional en las escuelas de ciencias de la salud - Porcentaje de universidades con programas específicos para estudiantes de poblaciones subtendidas - % de programas específicos de formación de estudiantes que provienen de poblaciones indígenas, o que tienen escasos recursos o que viven en

distancias geográficas inaccesibles - Eficiencia de los cursos de capacitación continua: Nº de cursos programados / Nº de cursos realizados x 100

Aceptabilidad y Calidad:

- % de médicos y enfermeras que tienen empleo precario: Número total de médicos y enfermeras con condición de empleo precario / el número total de médicos y enfermeras que trabajan en el país x 100

- % de trabajadores en el Sector Salud cubiertos por medidas de salud y seguridad específicas para los riesgos de su tipo de trabajo: Nº total de trabajadores en el SS cubierto por medidas de salud y seguridad / Nº de trabajadores en el sector salud x 100

- % de gerentes de servicios y programas de salud con certificados de cursos de gerencia en salud: Nº de gerentes con cursos de gerencia en salud certificados / total de gerentes dirigiendo unidades y programas de salud x 100

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Voies d’engagements en matière de RHS HAITI


Système de gouvernance : Développer des capacités qui vont permettre au MSPP, au travers de sa DRH, d’exercer de manière durable un leadership mobilisateur pour la résolution des défis de ressources humaines en santé et une coordination efficace des actions des différents intervenants

- Assurer la diffusion et l’appropriation de la planification stratégique RH du MSPP

- Définir un plan et un budget de mise en œuvre de la planification stratégique

- Renforcer la DRH centrale

- Renforcer les services GRH décentralisés

- Mobiliser les acteurs politiques nationaux

- Mobiliser l’ensemble des acteurs nationaux et internationaux (comité stratégique)

- Consolider le partage des responsabilités en matière de GRH

- Définir un plan de suivi et de monitorage de la mise en œuvre de la planification stratégique

o Résultats attendus :

Une planification stratégique RH entérinée par l’État haïtien Conseil Supérieur de l’Administration et de la Fonction Publique)

Un comité stratégique responsable de la mise en œuvre de la planification stratégique et de son monitorage

Des responsabilités relatives à la GRH clairement définies (loi organique du MSPP)

Une DRH renforcée qualitativement et quantitativement

Une capacité de GRH renforcée au niveau décentralisée

o Entités responsables : Haute instance du MSPP, OMRH, DRH du MSPP

Système de planification et de dotation : Améliorer les capacités du MSPP en matière de planification des RHS de manière à lui permettre d’optimiser le niveau des effectifs sanitaires, leur répartition entre les secteurs de soins et leur distribution géographique et de garantir l’accès des populations à des services appropriés et de qualité dans l’ensemble des communes et sections communales

- Constituer un système d’information national relatif aux RH en santé (y intégrer les données des secteurs privés associatif et libéral)

- Constituer une équipe et une expertise en matière de PMO au sein de la DRH

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- Mobiliser l’ensemble des acteurs nationaux et internationaux relativement afin de fédérer leur apport en matière de planification et de dotation

- Constituer une expertise technique en matière de PMO au sein du MSPP

- Élaborer un plan afin d’améliorer la répartition et la retentions des RH en santé

- Assurer le monitorage de l’accès aux soins de santé dans l’ensemble des départements


Un système d’information RH valide et accessible

Un modèle d’organisation des services appliqués

Une équipe de planification de main d’œuvre compétente

Des outils de modélisation de la planification de la main d’œuvre

Les différents apports des PTF en matière de RHS fédéré

Une répartition plus équitable des RHS sur le territoire national

o Entités responsables : Haute instance du MSPP et DRH

Système de formation : Développer les capacités nécessaires afin de permettre au MSPP de mettre en place, dans le cadre d’actions coordonnées avec le système éducatif, un corps professionnel doté des compétences requises pour fournir des services de santé de haute qualité

- Documenter de manière systématique les besoins en matière de production de main d’œuvre

- Maintenir le développement continu du référentiel des emplois et des compétences et en assurer son application

- Renforcer la capacité de régulation des institutions de formation en santé sur le territoire national

- Réviser le cadre légal régissant la formation supérieure

- Réviser le cadre légal du statut des institutions de santé à vocation universitaire

- Renforcer les programmes de formation pratique (service social, stages, résidences, …)

- Renforcer les institutions de formation

- Augmenter la capacité de production de main d’œuvre

- Mobiliser l’action de l’ensemble des acteurs impliqués dans la formation de la main d’œuvre et la formation continue

- Doter le MSPP d’une stratégie nationale en matière de formation continue


Un répertoire des besoins et des capacités de formation de la main d’œuvre sanitaire

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Un référentiel des emplois et des compétences continuellement à jour et mis en application

Des institutions et des programmes de formation accrédités

Un cadre de régulation de la formation supérieure adéquat

Des institutions de santé à vocation universitaire renforcées pour assumer pleinement leur fonction de formation

Des programmes de formation pratique (internat, résidence, stage et le service social) renforcés

Une concertation garantissant un programme de formation continue pertinent et adapté aux besoins du secteur

o Entités responsables : Haute instance du MSPP, DRH et DFPSS

Système d’administration du personnel et de la performance : Mettre en place des pratiques de gestion du personnel et des conditions de travail pouvant concourir à une utilisation optimale des différentes catégories de ressources disponibles et à l’amélioration de la motivation du personnel

- Réviser le Cadre règlementaire et légal d’exercice des professionnels en santé en fonction de la qualité des services souhaitée

- Mettre en place

- Doter le MSPP d’un programme de développement de carrière

- Doter le MSPP d’une politique de rémunération favorisant l’attraction et la rétention du personnel

- Définir les responsabilités GRH des différentes instances administratives du système

- Revoir les modalités d’organisation du travail

- Revoir les processus administratifs associés à la GRH


Un programme d’appui aux associations professionnelles existantes pour favoriser l’émergence d’ordres professionnels chargés de la

régulation de leurs membres

Des conditions globales de travail qui favorise la disponibilité de main d’œuvre qualifiée dans toutes les zones géographiques du pays

Un partage adéquat des responsabilités entre les différentes instances (centralisée et décentralisée) et un cadre d’imputabilité

Des modèles d’organisation du travail plus performants

Des processus administratifs renforcés (plus systématiques, plus rigoureux et plus transparent) et décentralisé

o Entités responsables : Haute instances, OMRH et DRH

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Mise en œuvre de la planification stratégique - Un programme de monitorage de la mise en œuvre de la planification stratégique doit être développé par le comité stratégique. À cette étape, ce

programme n’a pas encore été défini même si déjà certains indicateurs sont disponibles

Répartition plus équitable des ressources (accessibilité des services) - Catégories d’indicateurs

o Disponibilité des effectifs (principaux prestataires) par zone géographique (SIGRH)

o Mouvements du personnel (nomination ou transfert) pour la dotation de zones éloignées ou de prestataires spécifiques (SIGRH)

o Dépenses associées à des programmes de dotation spécifiques (SIGRH, DAB)

Augmentation de la qualité et de la capacité de formation - Catégories d’indicateurs

o L’accréditation des programmes et des institutions (Source de données à définir)

o Capacité de formation selon les filières (Source de données à définir)

o Capacité d’accueil pour la formation pratique (Source de données à définir)

o Nombre de nouveaux diplômés en fonction des catégories de prestataires (Source de données à définir)

o Nombre d’activités de formation pratique (SIGRH et source de données à définir)

o Participation aux activités de formation continue (SIGRH)

Amélioration des pratiques de gestion des ressources humaines - Catégories d’indicateurs

o Quantité de différentes procédures de GRH (SIGRH)

o Dépenses associées à la GRH (SIGRH, DAB)

o Dépenses associées à la formation des cadres en GRH (SIGRH, DAB)

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Vías de compromiso en materia de RHS PANAMÁ


Con el propósito de avanzar en la extensión de la cobertura en salud, de aumentar el acceso a personal sanitario de calidad, de reducir las muertes maternas e

infantiles, de controlar otros problemas de salud pública y de reducir las desigualdades en salud, el MINISTERIO DE SALUD DE PANAMÁ se comprometa a:

1. Realizar acciones que garanticen un liderazgo sólido en materia de desarrollo y gestión de los RHS, fundamentado en información y pruebas, y apoyado

en el respaldo político del más alto nivel y con un nivel de inversión adecuado; entre ellas, mejorar las condiciones para mantener una información

actualizada para la gestión de los recursos humanos. 2015.

2. Trabajar en asegurar un suministro adecuado y equitativo de trabajadores de salud cualificados, que responda a las necesidades socioculturales de la

población en todas las áreas, principalmente en aquellas donde la cobertura es significativamente baja; a través de:

a. El establecimiento y fortalecimiento de una Comisión Nacional de RHS que analice y proponga las acciones estratégicas en materia de

planificación, gestión y desarrollo de RHS.

b. Revisión del plan de incentivos para personal sanitario en áreas apartadas, para el año 2015.

3. Garantizar una absorción adecuada de los nuevos RHS que acaban de terminar su formación, a través del aumento de las plazas para médicos,

médicos especialistas, enfermeras, técnico en control de vectores y promotores de salud.

Garantizar actualizaciones regulares y un mayor desarrollo de las competencias de los RHS a través de formación en el empleo, mediante el fortalecimiento de la

Unidades Docentes Regionales (UDR), en cada Región de Salud del país para el año 2014.

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Para el seguimiento se utilizarán los siguientes mecanismos

Indicadores para el compromiso 1:

- Existencia de una unidad de RHS y su nivel de desarrollo

- Existencia de un mecanismo de coordinación nacional funcional para el sistema de seguimiento e información sobre RHS


- Existencia y fortalecimiento de la Comisión Nacional de RHS

- Distribución de RHS por área geográfica adecuada

- Ratio de la densidad de RHS en las zonas rurales / densidad de RHS en las zonas urbanas del país


- Proporción de profesionales recién formados que entran a trabajar en el sector sanitario

- Proporción de agentes de salud formados a nivel nacional


- Existencia de la Unidad Docente Nacional (UDN)

- Existencia de Unidades Docentes Regionales en cada Región de Salud del país.

Los datos serán proporcionados por la Dirección Nacional de Recursos Humanos del Ministerio de Salud, por la Dirección Ejecutiva Nacional de Recursos

Humanos de la Caja de Seguro Social y por el Instituto Nacional de Estadística de la Contraloría General de la República.

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Vías de compromiso en materia de RHS PARAGUAY


Responsable: DNERHS

Acción 1: Fortalecimiento de la capacidad de conducción política y técnica de los RHS:

Cursos de Gerencia en Sistemas y Servicios de Salud, Curso de Alta Dirección en Sistemas y Servicios de Salud.

Cursos de Gestión de Recursos Humanos de la Salud

Cursos de actualización con enfoque en la APS: en Protocolos de Atención (PARTO SEGURO/AIEPI, VIH/SIDA, Tuberculosis) y Seguridad del Paciente.

Objetivo: mejorar la formación de los directivos y otros profesionales del Sistema Nacional de Salud para GESTION SOCIAL y brindar un servicio excelente.

Fechas: noviembre 2013 a diciembre 2014

Acción 2: Carrera Sanitaria

Continuar los trabajos para lograr la aprobación del Proyecto de Ley de la Carrera Sanitaria.

Objetivo: Mejorar las condiciones laborales de todos los RHS, disminuir la precarización laboral, lograr beneficios (jubilación, seguro de salud), tener un instrumento de política y gestión.

Fechas: noviembre 2013 a diciembre 2014.

Acción 3: Cibersalud

Lograr la instalación de infraestructuras para la Cibersalud, para reforzar los sistemas sanitarios y desarrollar las TICs aplicadas a la salud, en todas las Regiones Sanitarias del país y aplicación de la plataforma de Telemedicina generando sinergia para el mejoramiento de las competencias de los recursos humanos en servicios

Objetivo: Optimizar la atención y mejorar la gestión en todos los niveles de la Red de Servicios de Salud

Fechas: marzo 2014 – diciembre 2014

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Dirección Nacional Estratégica de Recursos Humanos de la Salud (DNERHS) responsable de la coordinación y conducción política y técnica

Desarrollo de una matriz de objetivos estratégicos con resultados, actividades y cronogramas definidos

Indicadores:

- Registro de participantes en los cursos.

- Número de aprobados.

- Planillas, fichas de inscripción.

- Registro de actividades en la plataforma virtual.

- Realización del ROI al finalizar las capacitaciones: retorno de la Inversión.

- Ley de Carrera Sanitaria aprobada

- Infraestructuras para la Cibersalud instaladas y funcionando en las XVIII Regiones Sanitarias del país

- Instalación de la plataforma de Telemedicina a través de un modelo piloto

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Vías de compromiso en materia de RHS PERU


1. Implementación de una nueva política integral de remuneraciones basada en mérito, desempeño y riesgo según el nivel de atención.

2. Estrategias para disminuir las brechas cuantitativas y cualitativas de recursos humanos en salud a nivel nacional y regional.

3. Aplicación de esquemas de incentivos no monetarios para reclutar y retener al personal que labore en las zonas de menor desarrollo relativo.

4. Fortalecimiento del sistema de información de Recursos Humanos en Salud a nivel nacional y sub-nacional (INFORHUS).

5. Fortalecimiento de las competencias en el primer nivel de atención a través del Programa Nacional de Formación en Salud Familiar y Comunitario.


El seguimiento del progreso se hará a través del Observatorio de RRHH del país (http://www.observatoriorh.org/peru/)

Los indicadores a usar serán las 20 metas e indicadores regionales de Recursos Humanos.

Las fuente de datos serán provistos por el Observatorio de Recursos Humanos en Salud del país.

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Vías de compromiso en materia de RHS REPUBLICA DOMINICANA


De acuerdo con los compromisos firmados por los Ministros de salud en la 27.a CONFERENCIA SANITARIA PANAMERICANA el 5 de octubre de 2007,

contenidos en la RESOLUCIÓN CSP27.R7, y basados en las experiencias y lecciones aprendidas producto de los procesos de evaluación llevados a cabo en la

región durante la última década, y más recientemente el análisis de programas prioritarios de RHUS, el Ministerio de Salud de República Dominicana se

compromete con:

1. Relevar y ratificar la medición y monitoreo del avance de las Metas Regionales En Materia de Recursos Humanos para la Salud 2007-2015 buscando

profundizar en aquellos aspectos que el país ha logrado mayores desarrollos.

2. Desarrollo de procesos para la aplicación de un modelo de gestión eficiente de recursos humanos con énfasis en:

a. Impulsar la Ley de Carrera Sanitaria.

b. Institucionalización de política de gestión de recursos humanos que impacte la productividad, calidad en los servicios y cobertura universal,

c. tales como: Políticas de incentivos, políticas de gestión del desempeño, políticas de reclutamiento y selección.

3. Al 2015 el MSP habrá identificado mecanismos para elevar el nivel profesional y competencias para los RHUS

4. Conformación y consolidación de una masa crítica de líderes con competencias especializadas en la gestión de la planificación y las Políticas de

recursos humanos a nivel central y en los niveles descentralizados.

5. Fortalecer la función de rectoría y conducción estratégica de recursos humanos, mediante la promoción y convergencia de las políticas de los sistemas y

servicios de salud y de coordinación intersectorial para la renovación de la Atención Primaria de Salud (APS) y el logro de la Cobertura Universal de

Salud (CUS).

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Indicadores

No. Del COMPROMIOSO INDICADORES PERIODO DE CUMPLIMIENTO

1 - Sistema de monitoreo de las metas regionales tercer trimestre del 2014

2

- Reintroducir el proyecto de Ley de Carrera Sanitaria - Número de Mesas de trabajo para el elaboración de los reglamentos de

la Ley de Carrera Sanitaria - Existencia de un Manual de Políticas y procedimientos para la gestión

de los RHUS. - Mapa de procesos definidos para la gestión de RHUS

segundo trimestre 2014 tercer trimestre 2014 cuarto trimestre 2014 final de Primer trimestre 2014

3 - Realizar un mapa de actores de formación para los RHUS - Diagnostico de situación de la formación para los RHUS

cuarto trimestre 2014 primer trimestre año 2015

4 - Número de RRHH capacitados en el nivel central y en las áreas descentralizadas. primer trimestre 2015

5 - La DGRH dispone de Plan estratégico, orientado a su nuevo rol rector - Disponibilidad de manuales de políticas y procedimientos para el nivel

centra y los niveles descentralizados, - d) Se habrá establecido una mesa de coordinación intersectorial

Cuarto trimestre 2013

Se utilizará el sistema de monitoreo de cumplimiento de las metas que OPS, en coordinación con los países, viene aplicando desde el 2009 y que incluye un conjunto de 20 indicadores 4 cuantitativos y 16 cualitativos medidos a través de una metodología estandarizada ya en la región, a fin de mantener la cultura de medición y estimular el compromiso de los países para alcanzar objetivos sobre metas concretas” para la Agenda post 2015 http://www.observatoriorh.org/sites/default/files/webfiles/fulltext/2013/manual_medicion_v2013.pdf

http://www.observatoriorh.org/sites/default/files/webfiles/fulltext/2013/manual_medicion_v2013.pdf

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HRH commitment pathways SURINAME

Ministry of Health / Diakonessen Hospital


- National policy development, education and training.

- Nationally increased number of nurses in training.

- In house hospital training started en expanded with specialized areas for infection and chemotherapy


Output indicators of training provided and policy developed.

Outcome that the trained personnel is making a contribution

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URGUGUAY


1° ACCIÓN - Dimensión Observatorio de Recursos Humanos en Salud del Uruguay

Fortalecer el andar del Observatorio de Recursos Humanos en Salud del Uruguay (ORHSU).

2° ACCIÓN - Dimensión Proceso de Formación de los RHS

Fortalecer los espacios de intercambio de estrategias para el desarrollo de los RHS entre el MSP y las Instituciones que regulan la formación de trabajadores de la salud.

3° ACCIÓN - Dimensión Estructura de la Fuerza de Trabajo

Contribuir a la formulación de una política de dotación de recursos humanos de enfermería, a fin de mejorar la calidad de la atención de salud de la población. Acción conjunta MSP, UdelaR (Fac. de Enfermería), OPS y Ministerio de Salud de Brasil.


1° ACCIÓN

- Incentivar, coordinar y movilizar espacios para la producción y análisis de información sobre los RHS entre las distintas Instituciones que componen el campo de la Salud.

- Construir estrategias activas y colaborativas para el desarrollo de los RHS dentro de la órbita del ORHSU. - Fortalecer el Rol rector del MSP en el ámbito de la formación, a partir de convenios con las Instituciones Formadoras de RHS que integran el ORHSU. - Indicadores de resultados: Numero de Comisiones Técnicas trabajando, N° de Boletines, investigaciones realizadas en ORHSU.

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2° ACCIÓN

- Promover la formación de grupos interinstitucionales entre Ministerios (MSP y Ministerio de Educación y Cultura (MEC)) para la implementación de acciones de mejora de la formación de los RHS.

- 1° acción generar aportes para la elaboración de un nuevo perfil de los y las auxiliares de enfermería en el marco de la modificación de la ordenanza 930 de 1981. (Reorientación de la formación de las Auxiliares de Enfermería para el Primer de Atención con base en desarrollo de la APS).

- Año de referencia para resultados esperados 2015 (Escuelas de enfermerías - formación de auxiliares con nuevo perfil entre 900 y 1.000 auxiliares formadas para ese año, incremento de un 4% de la población de auxiliares de enfermería)

- Fuentes de datos a utilizar: Sistemas de información del MSP: Sistema de Habilitación y Registro de Profesionales de la Salud (SHARPS) – Registros de egresos de las Escuelas formadoras de Auxiliares de Enfermería)

3° ACCIÓN

- Obtener, actualizar y profundizar la información estratégica sobre la fuerza de trabajo de enfermería. - Realización de un estudio descriptivo de las características de formación y condiciones de trabajo del personal de enfermería. - Fuente de datos primaria: Aplicación de un cuestionario estandarizado a una muestra representativa del personal de enfermería a partir de un marco

Censal (Censo en transcurso). - Cuestionario estructurado por zona, condición laboral y categoría profesional. - Aplicación del cuestionario entre los meses marzo y mayo 2014. - Finalización de proyecto agosto 2014.

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HRH commitment pathways BANGLADESH


The Ministry of Health and Family Welfare (MOHFW) is the largest employer and health service provider in Bangladesh. Stewardship functions of health primarily relies on this ministry. Though the country has achieved some commendable progresses in achieving MDG goals, achieving universal health coverage has been a challenge due to several reasons including health workforce issues. Studies and repeated rounds of service delivery surveys carried out in Bangladesh recognized several pitfalls with regard to the health workforce. There is a huge shortage of qualified practitioners and paraprofessionals in the country’s formal health system. A large number of unqualified and formally unrecognized allopathy providers and homeopaths provide services and act as the first point of contact for many patients. There is severe imbalance and a dire shortage in the spectrum of essential competent workers such as the ratio of nurses and paramedics to doctors, public health specialists, health policy planners and managers. Along with the inappropriate skill mix, improper distribution characterized by urban concentration and rural deficits is another dimension of the shortage of health professionals. Given all of those pitfalls, the Government recognizes the need for a comprehensive review of HRH issues with a view to maximizing the utilization of the human resources in health and family planning as much as affordable.

MOHFW has been committed to addressing the issues of shortages, mal-distribution, skill-mix imbalance, performance management and quality of the existing workforce in both the formal and the informal sectors. Steps will be undertaken to expedite development of additional workforce (Specialists, doctors, nurses, paramedics, technologists, etc.) in the public and private sectors.

To this end, MOHFW of Bangladesh is proclaiming its commitment at the occasion of the 3rd global forum on HRH for “Improving the processes of production, recruitment, deployment, development and retention of the health workforce in close collaboration with the public and private sectors for reasonably balanced distribution of each type of workforce in optimum number to meet the health needs of each specific population group of the country.”

To achieve this priority objective the following interventions / strategies will be implemented in alignment with the Health Policy 2011.

- Develop a need-based comprehensive Human Resource Plan with a reasonably long term vision addressing key issues and challenges with provisions for immediate interventions to solve the priority issues ie focusing on scaling up the production and deployment of each type of health workforce, particularly those in acute shortage, keeping in view the country and global perspectives;

- Revising the recruitment rules of the Government for the health and family planning cadre to attract and select the best qualified people into health care work

- Develop responsive and effective policies/ processes for staff recruitment, deployment, development and retention including incentives for working in remote/hard to reach areas.

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- Enhance continuing education of the teaching staff to support quality education and training of the health workforce; - Give special attention to improving production capacity of nurses, Medical Technologists, Medical Assistant, Family Welfare Visitors, birth attendants and

community health workers - Establish a formal and effective accreditation system for medical education and health care institutions/facilities irrespective of public, private and NGO

sectors; - Scale up the Individual Performance Management System (IPMS) and expand its application to the Organization Performance Management System

(OPMS); - Improve the role, function, organization and effectiveness of current Human Resource and other regulatory functions of the Ministry and Directorates; - Establish effective and functional HR systems at the national level and health facilities /organizations at the local level.


1. Targets related to Overall planning and coordination: National assessment of the capacity of public and private pre-service training institutions completed to determine the HR gap by categories

(A study initiated by June 2014 and developed recommendation for post 2015 agenda) Finalization of Bangladesh HRH Strategy - (Initiated by February 2014 and Finalized by May 2014). HR Projection (Conduct a study to project workforce requirements (numbers, types of staff) take-in consideration of various factors such as

population growth, disease patterns/ burdens, per population ratio, re-determined service packages/function of health facilities and organizations) - developed by Mid- 2014 and utilized by Mid- 2016

HR Planning (Establish/revitalize high-level sector-wide HRH steering committee, develop 10-year HR plan for 2014-2024 and annual plans-developed by Mid- 2014 and in implementation by Mid- 2016

Policy on introducing incentive packages (financial and non-financial) for hard-to-reach/rural areas - Incentive package developed and process for piloting initiated by Mid- 2014 and pilot for introducing incentive packages implemented by Mid- 2016

Strengthening HRM functions through assessing its HRM departments across the MOHFW- An Assessment initiated by April 2014 and implemendation by December 2014.

Central Human Resources Information System (HRIS) with MOHFW- Review the present HR information systems in consultation with relevant directorates, Initiated by Mid 2014 and produced recommendation and implementation by Mid 2016

2. Targets related to health professional recruitment:

Review and update Recruitment rules for (a) Health, (b) Non-medical, (c) Family Planning and (d) Nursing cadres – revised b, d by Mid- 2014 and a, c by Mid- 2016

Review and update the Job description for (a), (b), (c) and (d) - updated and oriented for implementation by 2016

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National assessment of the capacity of public and private pre-service training institutions (Information source/s: progress report)

HRH Strategy finalization- (Information source/s: Final report)

Strategies and interventions adopted to formulate and implement the HRH Plan and projection (Information source/s: Mid Term Review (MTR),

2014)

Detailed operational plan with required cost is developed for institutionalization agreed by MOHFW and other key players (Information source/s:

Operational plan and progress report)

Action plan has been designed and stakeholder consultations are put into place to generate evidence for developing an incentive package

(Information source/s: progress report)

Assessment of the capacity of HRM Unit, MOHFW for strengthening. (Information source/s: MTR report and progress report)

Central framework of the HRIS is developed in consultation with relevant directorate and professional bodies. (Information source/s: progress

report and related documents)

Recruitment rules and updated job descriptions- (Information source/s: MTR report and progress report)

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HRH commitment pathways BHUTAN


The Ministry of Health is the main health care provider in Bhutan. The Primary Health Care approach with the appropriate technical backup of secondary and tertiary health services is the guiding principle of health service delivery in Bhutan. The Section 21 and 22 under Article 9 of the Constitution of the Kingdom of Bhutan states that, “the state shall endeavor to provide free access to basic public health care services both in modern and traditional medicines” and “the state shall endeavor to provide security in the event of sickness and disability or lack of adequate means of livelihood for reasons beyond one’s control” respectively stands as a testament to the Government’s commitment in the provision of free and quality universal health care.

Health, being one of the largest social sectors, plays a pivotal role in realization of Gross National Happiness which is the guiding philosophy of country’s development. The availability of adequate human resources with required skills and management system remains critical to the realization of these goals. Therefore, the Royal Government of Bhutan shall continue to accord high priority for the development of appropriate health human resources.

While Bhutan has made significant achievements in the overall system of the health care services as clearly reflected by the marked improvement in the health indicators, the country faces acute shortage of health professionals particularly in the technical categories. The doctor and nurse to population ratio per 10,000 population are <1 and 4 respectively which are lower compared to the WHO’s average in the SAARC region standing at 4.625 and 9.75 respectively (WHO Annual Report 2009). There is a need to increase the number of doctors and nurses to improve this ratio to a level that is comparable to the Regional standards. Given that Health is a fast evolving science, the existing human resources need to update their knowledge and skills through short and long term training programs. With the expansion of health services as well as in view of the emerging health issues, both the quantity and quality of human resources needs to be ensured. Therefore, management of human resources in areas of deployment, recruitment and retention require professional approaches through scientific forecasting, development of appropriate strategies and alignment.

With this backdrop, the Ministry of Health, Royal Government of Bhutan hereby announces its commitment at the 3rd Global Forum on the HRH “to adopt three priority objectives for 2013-2018 to reach national goals and commitment in partnership with the national and international stakeholders.

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Objective 1: Device appropriate deployment and recruitment systems and processes to address the shortages of skilled health workers at all levels of the health sector. The objectives will be achieved through the following activities;

- Develop rational deployment of health professionals based on epidemiological, demographic profile and evolving needs.

- Review and finalize the 5 year HRH projections and requirements.

- Develop Annual Recruitment Plans with targets and indicators to achieve proposed HR requirements.

- Assess workload of various health facilities.

- Coordinate and collaboration with the health institutes (RIHS/UMSB) on the health workforce production plan.

Objective 2: Strengthen Continuing Professional Development programme to upgrade qualifications, improve skills and performance of health professionals through different approaches of training and education programmes. Following activities will be carried out towards this objective;

- Conduct training need assessment.

- Conduct Bachelor of Nursing Conversion Programme and Bachelor of Public Health Programme.

- Carry out Basic Health Workers upgradation Programme.

- Review and conduct up-gradation programme of other health professional such as Technician categories.

- Coordinate training in consultation with various programmes for Continuing Medical education.

- Develop institutional linkages with the institutes and universities in the region and beyond where health professionals can pursue capacity building

programmes in medical field.

- Conduct Training of Trainers to strengthen in-house capacity of Bhutan.

Objective 3: Strengthen and sustain achievement of Universal Health Coverage. Following actions will contribute towards achieving this objectives:

- Develop rational deployment of community health professionals.

- Provide incentives to motivate postings to rural or underserved health centers.

- Conduct capacity development training for community health workers.

- Strengthen Village Health workers programme to encourage Community Participation in the health care delivery system.

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In order to pursue and monitor the implementation of the commitment, following strategies and monitoring indicators will be adopted: - Number of health professional entering the civil service on an annual basis and posted at various health centers.

- Number of Institutional linkages established.

- Number of up-gradation course conducted for health professionals.

- Number of Community Health Workers and VHW trained.

- Number of Community Health Workers posted in the rural or underserved areas.

- Number of Village Health Workers registered on voluntary basis.

- Number of trainings conducted.

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HRH commitment pathways INDONESIA


Early 2000, Indonesia implemented the decentralization system, with health sector as one of the authorities delegated by the central government to the local government. Following this policy, management of health workers in public facilities was transferred to the local government, resulting in the complexity of personnel transfer among regions. Indonesia continuously put big efforts to improve the HRH situation. Although the ratio of health workers to population and their geographical distribution have improved, maldistribution between urban and rural remote areas remains a big challenge. Other highlight issues include the increase migration of Indonesian health workers, poor HRH requirement planning, lack of appropriate training, and lack of quality control.

Considering that addressing HRH issue is not solely the responsibility of the Ministry of Health, Indonesia has established the Country Coordination and Facilitation Committee called the KF-PTK team, comprising many stakeholders of government, professional associations, academia, health facilities health facilities associations and representatives of some international agencies under leadership of the coordinating Ministry of People’s Welfare. The multisectoral team has produced the Indonesia Human Resources for Health Development Plan Year 2011 – 2025 (HRH Plan), which reflected the stakeholder commitment to work together in HRH development. The HRH plan is built on the vision that “all people have access to qualified health workers’. The HRH plan deal with 6 strategies including HRH regulation, planning, production, utilization, supervision and quality control.

Indonesia uses the opportunity of the 3rd Global Forum on HRH to pronounce its commitment to improve distribution and retention of health workers across the country and to ensure quality control of the health workers. Under the leadership of the Ministry of Health and politically supported by the Coordinating Ministry of People Welfare, the strategies will be focused on the following objectives and priority interventions:

1. Harmonize supply and demand of health workers in improving the quality of health workers • Develop an annual HRH requirement plan as the reference/consideration in processing the licensing of education institutions • Develop the Distance Learning program to upgrade the education level of nurses and midwives from Diploma 1 to Diploma 3 level in remote

regions. • Develop a Health workforce registration mechanism through competency certification (using exit exam as the certification exam to ensure the

competency of HW before registering to the health professional council).

2. Improve the HRH distribution and retention • Affirmative action by provision of scholarship with bonding service to HWs in remote and underserved areas. • Develop task shifting model for HWs in remote areas

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Targets and stakeholders’ roles related the interventions for HRH development include:

1. Targets related to production and certification o An application of Integrated HRH information system, using HRH observatory approach as the reference (MOH with engagement of other

stakeholder including Developing partners such as WHO and Ausaid, March 2014) o Annual HRH requirement plan (MOH with engagement of other stakeholder including Developing partners such as WHO and Ausaid, December

2013, every December) o Curriculum and modul for Distance learning program and implementation (MOH with engagement of other stakeholder including Developing partners

such as WHO and Ausaid, September 2013) o Mechanism of competency certification through exit exam (MOH with engagement of other stakeholder, October 2014)

2. Targets for HRH distribution and retention o Guidelines of Scholarship with bonding service for remote and underserved areas (MOH with engagement of other stakeholder, June 2014) o Recruitment of students from remote and underserved of medical graduates (MOH with engagement of other stakeholder November 2013- onward) o Recommendation and Guidelines on task shifting (MOH with engagement of other stakeholder, April 2014) o Modul and curriculum of trainings (MOH with engagement of other stakeholder, September 2014)


In order to and monitor the implementation of the commitment with its component areas, following monitoring indicators have been determined : 9. Strategies and interventions in Integrating HRH information system and HRH observatory framework have been developed and agreed by key

stakeholders (information source: Action plan of Integrated HRH information system) 10. Adequate funding support to develop annual HRH analysis situation and planning at central and local level have been secured (information source: annual

HRH country profile) 11. Teaching learning process of the Distance Learning program for Diploma 3 nursing and midwifery has used a standardized modul and curriculum

(information source: PJJ report) 12. Students of health workforce educations take compulsory certification assessment in the exit exam (information source: HWF education report) 13. Policies and Procedures of scholarship management for students in remote areas has been developed and approved. (information source: fellowship

report) 14. Adequate funding for scholarship have been allocated by the central and local government (information source: fellowship report) 15. A set of recommendations on health service programs require task shifting for remote and underserved areas and the procedures have been approved by

professional organizations (information source: policy paper on task shifting) Modules and curriculum of training on task shifting for health workers have been approved and accredited (information source: training report)

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HRH commitment pathways MALDIVES

1) What human resources for health (HRH) - related actions and pathways can your country/ institution commit to

The Ministry of Health is the main health care provider in Maldives and about 90 percent of health professionals were employed in the public sector in 2010. One of the priority issues related to health workforce faced by Maldives is variation in the quality of pre-service and postgraduate training, as 81 % of the doctors are expatriates. Doctors registered by Maldives Medical Council to date represent over 300 medical schools worldwide, leading to a wide variation in the quality of training. Currently Maldives Medical Council and Maldives Nursing Council do not have a list of accepted medical and nursing schools, therefore at the time of recruitment, it is difficult to be assure the quality of expatriates nurses and doctors.

Toward achieving the national vision on Human Resources for Health (HRH) to ensure ‘Access for all to competent and sustainable health workforce within the robust and enabling health system towards achieving the Universal Health Coverage, Millennium Development Goals 2015 and beyond’; Maldives, in addition to a number of other strategic and policy actions, is endeavoring to ensure adequate quality standards in training and services to deliver health care to the population with high professional standards.

To this end, Maldives is proclaiming its commitment at the occasion of the 3rd global forum on HRH for ‘Improving HRH regulatory frameworks and institutionalize quality assurance towards enhanced health workface productivity.’ This will be included as a priority objective in the HRH strategic plan being designed for 2013-2018. In order to realize this commitment, Maldives, with multistakehodler coordination and inclusive partnerships, under the overall leadership of Ministry of Health (MOH), aligned with the health system policies, and duly considering the WHO Global Code of Practice on international recruitment of health personnel, will implement the following strategies and interventions:

5- Institutionalize regulatory mechanisms for accreditation of health professionals’ education for all cadres and medical qualifications from other countries. - Develop accreditation criteria for health professions education for doctors and nurses. - Develop a list of approved Medical and Nursing institutes for recruitment of health workforce - Develop a mechanism to enroll new institutes if not endorsed by any competent global or national process.

6- Establish a licensing system for health professional’s recruitment - Develop professional standardization for doctors and nurses elucidating required competencies, knowledge and skills. - Develop and implement a Licensing Examination System to register the international medicos

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It is expected that through this process and pathway, country will be able to standardize and improve quality of the physicians and nurses, which will in turn lead to sustainable solutions towards ensuring access to competent medical personnel and delivery of adequate health services in accordance with the national health needs.


2. Targets related to accreditation of health professionals’ education: - Operational plan for institutionalization of regulatory mechanisms to accredit health professionals’ education for doctors and nurses (MOH

with engagement of related stakeholders, facilitated by WHO)- January to March 2014 - Accreditation criteria for medical education for doctors and nurses (MOH with engagement of related stakeholders, facilitated by WHO)- April to

June 2014 - List of approved Medical and Nursing institutes for recruitment of health workforce (MOH with engagement of related stakeholders, facilitated

by WHO)- July to December 2014 - Mechanism for enrolment of new institutes if not already endorsed by any competent global or national process (MOH with engagement of

related stakeholders, facilitated by WHO)- January to May 2015

3. Targets related to licensing system for health professionals recruitment: - Operational plan to initiate a licensing system for recruitment of doctors and nurses (MOH with engagement of related stakeholders, facilitated

by WHO)- January to March 2014 - Set of country specific professional standards for doctors and nurses in line with the recommendations by WHO and global partners (MMC

and MNC with engagement of related stakeholders, under leadership of MOH)- April to June 2014 - Government regulation for initiating a Licensing Examination System to register the international medicos (MOH and parliament)- March to

July 2014 - Establishment of website and other related tools and materials including prospectus, programme, questionnaires bank and examination

system (MMC and MNC, under leadership of MOH, and supported by WHO)- August to December 2014 - Launching of the licensing examination (Maldivian Medical Council with engagement of stakeholders, under leadership of MOH and facilitated by

WHO)- January to March 2015 - System arrangements to ensure adequate mechanisms for using the licensing examination results in the health professionals recruitments

(MOH with engagement of related stakeholders, facilitated by WHO)- March 2015 onwards


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In order to pursue and monitor the implementation of the commitment with its competent areas, following monitoring indicators have been determined :

- Strategies and interventions related to the institutionalization of regulatory mechanisms and establishing Licensing Examination System have been included in the HRH strategic plans (Information source/s: HRH strategic plan)

- Detailed operational plan with required cost is developed for institutionalization of regulatory mechanisms and establishing Licensing Examination System and is agreed by MOH and other key players (Information source/s: Operational plan report)

- Adequate funding and system support has been provided to implement both initiatives (Information source/s: progress report)

- Accreditation criteria for medical education for doctors and nurses is available and agreed by MOH and related stakeholders (Information

source/s: progress reports and related documents)

- List of approved Medical and Nursing institutes is available for recruitment of doctors and nurses (Information source/s: progress reports with

list) - Country specific set of professional standards for doctors and nurses is available and validated by stakeholders (Information source/s:


- A regulation for initiating a Licensing Examination System has been issued by competent authorities of the government (Information

source/s: regulation/notification copy)

- The Licensing Examination System has been established with development of related tools and materials and is functional (Information

source/s: progress reports and related documents)for pharmacists only

- Adequate system arrangements have been made to use the licensing examination results in recruitments of doctors and nurses (Information source/s: progress reports and related documents).

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HRH commitment pathways MYANMAR


A 5-year National Health Plan(2011-2016) developed by Ministry of Health, Myanmar stipulates the urgency of implementation of a National health workforce strategic plan with emphasis on compiling information concerning HR supply, demand and critical gaps in both the public and private sectors. And thus, high-level consultation on Development Policy Options (DPO) for Myanmar held in Nay Pyi Taw in Feb, 2012 resulted a 5 year National Health Workforce Strategic Plan through extensive consultation involving all relevant stakeholders.

The vision for health workforce strategy is to achieve comprehensive health benefits, by providing quality and equitable health services for all peoples through a financially sustainable health system with and adequate, competent and productive health workforce that is responsive to changing health needs, especially of remote and rural populations and that is completely compliance with Myanmar Vision for Health Development.

Health Workforce Strategic Plan, Myanmar identified five key pillars which is in line with the development objectives which again in line with AAAQ pathways.

- Targets to enhance quality of education through accreditation, Ministry of Health commits improving quality of human resources for health by major investment in strengthening universities and training institutions to provide quality education, promote and regularly monitor the professional competence of health workers, streamlining of certification and licensing procedures in order to ensure compliance with professional standards.

- Targets to scale up pre-service education and training to meet population needs and adequate supply qualified entrants MOH commits improving availability of HRH through determination and implementation of affordable and sustainable staffing norms that reflect service requirements and promotion effective use of scarce resources within a Primary Health Care(PHC) conceptual framework to respond to users’ needs and ensuring adequate mix of skills, both individual skills and team skills required to perform agreed services using a multidisciplinary approach.

- Targets to adopt education policies favoring rural retention is not just confined to the specific targets but with more wider spectrum using affirmative Action Stragies which will overlap with the targets of developing HRH responsive to population cultural needs. Ministry of health commits to ensure equity in HRH by a comprehensive monitoring equity issues in HRH as an essential part of regular workforce monitoring. There still need to devise an equal opportunities policy framework which will prevent unfairness, promote safe and supportive working environment. Ministry of Health proactively increase the proportion of female and ethnic minority recruits to health worker pre-service training courses at all levels but particularly for courses where women and ethnic minorities are currently under-represented. Integration of inter-personal communication and counseling skills in all medical curricula and integrating training on women-friendly and culturally appropriate service delivery in training curricula of all front-line health providers and health managers, are also the overlapping targets which will be included in the Affirmative Action Strategies.

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- Moreover, as a cross-cutting actions, Strengthening leadership and management of HRH by identifications of specific focal points according to formulation of policy and monitoring the aspects of education and training of health workforce at all level, developing and implementing the health workforce strategic plan to guide adjustments in the national workforce size, staff distribution, staff mix and staff performance, establishing a unit like Health Workforce Management Division with adequate authority and expertise. Cooperation with other sectors, agencies, councils and authorities will provide effective human resource management at all levels. Ministry of health commit to formulate regulations and laws concerning HRH and monitor by developing an information system on health personnel, coordinating among all HRH stakeholders, ensuring donor support complies with principles of aid effectiveness and designating the duties and responsibilities of stakeholder units.


In order to pursue and monitor the implementation of the commitment with its competent areas, following monitoring indicators have been determined : 1. For Strengthening Leadership and Management

- Policy Development and plans on HRH (Information source- Department of Health Planning) - Legislative procedure (information source- Ministry of Health) - Monitoring (recruitment deployment, career progression, and retention to ensure compliance with HRH policy directions)(information source- relevant

stakeholder units) - Coordination of national human resource effort and development partner support(information source- Ministry of Health, Health workforce

management Division)

2. For Improving availability of HRH - Work force size and characteristics (information source- Department of Health Planning) - Classification of categories of staff(information source- Health workforce management division, relevant stakeholder units) - Staff mix (information source- Department of Health, Department of Medical Science) - Staff distribution (Information source- Department of Health Planning) - Staff performance and motivation(Information source- Ministry of Health, all stakeholders) - Remuneration(Information source- Ministry of Health, other coordinated sectors like ministry of Finance, donor)

3. For Improving Quality of HRH - Major investment in strengthening the capacity of health professions, universities and other training institutions(Information source- Department of

Medical Science) - Professional competence(Information source-DMS, Professional Councils)

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- Certification and Licensing (information source- MOH with MMC, MAMS and MMA)

4. For Ensuring equity in HRH - Regular workforce monitoring (Workforce entry, composition, performance, motivation and retention from gender, ethnicity, age, geographic location

and other perspectives) (Information source- Department of Health Planning, Health workforce management team) - Equal opportunities framework in line with enacted Government Service Law (Information source- Union Civil Service Board, Ministry of Labor,

Ministry of Health)

5. For Strengthening HRH responsive to Population Culture(Ethnic Minority and Gender) (Affirmative action Strategies) - applications from ethnic minority and women (Information source- Department of Medical Science) - Strengthening regional training institutions (Information source- Department of Medical Science) - Incentives programs (scholarship programs, hardship allowance, career ladder development, supportive supervision) (Information source- Ministry of

Health) - Integrated training programs on communications skills development and appropriate service delivery. (Information source- Department of Medical

Science, Department of Health)

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HRH commitment pathways NEPAL


The Ministry of Health and Population is the main health care provider in Nepal. Nepal has made a commitment to provide free basic health as a fundamental right in the interim constitution of Nepal in 2007. In order to meet that commitment Nepal has been engaged in policy reform, restructuring of current institution and improving legal and working modalities. Realizing the importance of private, INGOs, NGOs, Community to improve health of citizen, government of Nepal has brought liberal policy in health sector. Consequently, a large number of private and community hospitals and medical colleges are working together to provide health services. State has been mobilizing necessary resources in collaboration with concerned stakeholders and pursuing public private partnership to deliver services. Government is providing health service through 95 hospitals, 214 Primary Health Centers, 3816 Health and sub health posts. Apart from that some 105 private hospitals and 20 medical colleges are also provide services to the people. Despite government's effort to provide health services, Nepal still faces shortage of human resources in Health sector.

Nepal has identified following critical issues/challenges related to Human resource on Health.

- shortage of skilled health worker

- approved positions are vacant and not filled in time

- deployment and retention of health worker especially in rural and remote area

- Poor staff attendance

- Improving the skills of the health workforce.

Nepal Health Sector Plan II (2010-2015) has identified four HRH areas to be intervened during the plan period.

- Recruitment intervention:

- Training and capacity Development

- Productivity and performance

- Public Private partnership

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Government of Nepal has approved Human resources for Health Strategic Plan 2011/12- 2014/15 to address the commitment in NHSP II. About 330 higher post creations for addressing the career development issue has been forwarded to ministry of Finance and Ministry of General Administration for their consent. The strategic plan has identified 14210 additional health workers requirement to cater the current demand.

With this backdrop, Nepal is hereby announcing its commitment at the 3rd global forum on HRH for ‘Human Resource for Health Strategic Plan’ with following overall aim ’ to ensure the equitable distribution of appropriately skilled human resources for health (HRH) to support and achieve the goal of free basic health care as guaranteed by constitution of Nepal’. This will be achieved through the following priority objectives and strategic interventions:

Objective 1: National Human Resource Plan will be developed and implemented

- Developing National Human Resources Plan

- Developing incentive scheme and get approval from government to retain skilled HR in rural and remote area.

- Affirmative action by provision of scholarship with bonding service to HWs in remote and underserved areas

Objective 2: Public private partnership promoted to provide skilled HR in rural and remote hospital.

- Partnership with medical college or NGO/INGO to provide skilled HRH in rural and remote hospital

Targets related to objective 1:

- National Human Resource Plan document will be prepared consulting National Planning Commission, Ministry of Education, Ministry of Finance, and

Ministry of General Administration, WHO, World Bank, DFID and other developing partners by June 2014.

- Incentive plan will be developed by MOH in consultation with ministry of finance and other stakeholders and submit for approval to government by end

of July, 2014

- Affirmative action plan will be revisited and make it more rural and remote area friendly through a policy dialogue among the stakeholders by Mid

2015

Targets related to Objective 2

- MoU will be developed and signed with private medical college or NGo/INGO for providing skilled HR in rural area by end of July 2014.

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Following monitoring activities will be carried out in order to monitor the implementation of the commitment:

- Annual work plan and budgeting is linked with medium term budget plan.

- Joint Annual Review meeting comprising, government stakeholders, WHO, world Bank, DFID and other development partners is carried out.

- Monitoring and Evaluation Division in MoHP is regularly monitored

Progress Indicator and information source:

- National Human Resource Plan is in place( data source: Plan document)

- Performance based incentive system is in place and increased retention (Data source: cabinet decision, payroll and HMIS)

- More skilled professional(doctor) available for in rural and remote area ( Data source: presence book, less position vacant and HMIS)

More hospitals are run by medical colleges or NGOs/INGOs in rural and remote area( data source: MoU with those institutions)

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HRH commitment pathways SRI LANKA


Ministry of Health of Sri Lanka is the second largest ministry in terms of number of employees and the number exceeds 100,000. According to the health facility survey 2011, there were 1,486 medical specialists, 11,062 medical officers, 28,785 nursing officers and 35,892 health assistants employed within the Ministry of Health. Therefore, It has the most diversified human resources with more than 390 categories. Sri Lankan human resources for health must face variety of challenges in future, in the midst of these complexities and diversities. These challenges are demographical transition (rising proportions of the ageing population), epidemiological transition (more burden from Non Communicable Diseases than infectious diseases) and transitions of social and behavioral patterns of the community (increased levels of education, social status and income and related changes life styles of the people). Furthermore, demands and needs for advanced health care services from service providers are also changing due to the rapid development and integration of technology and the knowledge into the medical, diagnostic, laboratory and clinical services. This is further aggravated due to the wants and demands from the service recipients or customers due to rising expectations and knowledge of them.

Education, Training and Research unit is responsible for the coordination, facilitation and regulation of basic training of all human resources for health in Sri Lanka (except undergraduate and post graduate training of medical officers) and all in-service, induction and special training programs. During the year 2013, 7019 trainees are undergoing training at 18 Nursing Schools and 12 other basic training institutions under the purview of the unit. Additionally, in service training programmes were conducted for 2,429 health staff in 2013 and total amount of funds released was Rs. 5,078,640.00. Ministry of Health of Sri Lanka, formulated the Human Resources for Health Strategic Plan for the period from 2009 to 2018 and the third strategic objective of the said document was Improving the production and quality of training to meet skill and development needs in changing service environments. Therefore, quality of training must be improved to meet the above emerging challenges for the Sri Lankan health care delivery system and this (Improving the quality of training to meet skill and development needs in changing service environments) will be Sri Lankan health sector commitment at the occasion of the 3rd Global Forum on HRH. Following interventions will be proposed to implement under this commitment by the Ministry of Health, Sri Lanka:

- Development of standards for training institutions, training programs and trainers

- Establish quality improvement mechanisms for training programs conducted including reviewing and updating of training curricula and formulating

mechanisms for training evaluations

- Establish mechanisms of accreditation for training institutions with the collaboration with external stakeholders

- Strengthen and streamline the processes and practices of training institutions according to the developed standards

- Strengthen the infrastructure facilities in the training institutions according to the developed standards

- Strengthen the capacities of training institutions to update knowledge through access to information technology and knowledge dissemination facilities

- Strengthen the capacities of the trainers in the training institutions

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- Streamlining of in service, induction and special training programs to suit changing environments by formulating mechanisms for training need

assessments, formulating standards and guidelines and formulating mechanisms for training evaluations

- Provision of policy guidance for other units of Ministry of Health (Management Development and Planning Unit in HRH Planning and other

Directorates involving with HRH Management) in order to improve quality of training

- Provision of technical guidance for private sector training institutions to improve quality of their training programs and regulation of these training

programs in view of streamlining and improving quality


Following targets will be formulated to monitor and evaluate the above commitments with relevant specific time frames - Availability of standards for training institutions, training programs and trainers

- Percentage of curricula reviewed and updated within last 5 years out of all basic training programs

- Percentage of basic training program evaluations done out of total HRH categories trained by Education, Training and Research Unit

- Percentage of basic training institutions achieved accreditation status through an external agency

- Percentage of training institutions improved according to the developed standards on infrastructure, processes, human resources and information

technology

- Number of in service / special / induction training need assessments done

- Percentage of in service / special / induction training programs conducted out of total need assessments

- Number of in service / special / induction training evaluations done

- Number of collaborative activities with other units of the Ministry of Health and private sector training institutions

Standards will be developed in relation to training institutions, training programs and trainers with the collaboration of all the relevant stakeholders. A situation analysis will be done to identify gaps between existing situation and developed standards Financial assistance will be sought from Government of Sri Lanka and external donor agencies to develop the training institutions, training programs and trainers according to the standards Collaborative external assistance will be sought for accreditation of training institutions Training need assessments and training program evaluations of in service / special / induction training programs and basic training programs will be done through facilitating and funding of research of the post graduate trainees and with the collaboration of universities and other research institutions

HRH commitment pathways CAMBODIA

WPRO

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The Royal Government of Cambodia (RGOC) has prioritized the development of HRH as critical for the attainment of universal health coverage. Beyond planning and capacity building within the MOH, the RGOC is dedicating major efforts to improving the competence of HRH through better education and quality management.

Cambodia, in line with its Health Workforce Development Plan Strategy 2006-2015, is committed to:

1. Strengthen pre-service education as a pillar to improving quality of new graduates:

Toward this end Cambodia has established a mechanism to regulate the production of health workforce through national exams. In 2007 an Sub-decree on education in the health sector and subsequently established a National Examination Committee chaired by a representative from the Council of Ministers and with participation of the Ministry of Health, Ministry of Education, and Institutions in charge of medical education to conduct national entry and exit examinations for all public and private medical schools in the country. National entry examinations for medicine, pharmacy, dentistry and nursing have been conducted every year since 2008, and national exit examination for newly graduates in pharmacy, dentistry and nursing had been organized in 2012, and in 2014 for medicine. National exit examinations consist of MCQ/SBA for written examination and OSCE for clinical examination, and students who pass the exams will be licensed for practice. In the future, national entry and exit examination will apply to other disciplines countrywide.

In addition, the MoH is going to strengthen the role of Center for Educational Development of Health Profession – CEDHP initiated by WHO to develop/review competency-based curricula based on CCF, capacity building of Faculty members and other training materials for quality of education. A mechanism should be considered to implement these curricula and other educational requirements by all medical schools, including facility and faculty development, clinical practices as well as programs and schools accreditation.

2. Systematic capacity building and continuing education through the development of Licensing and Registration system for Health workforces to improve quality care services to the population with the delegation and empowerment to the professional councils.

3. Universal Health Coverage through: - Strengthening existing MoH Regional Training Centers (RTCs) in order to boost the production and quality of health workers to serve their

communities, including mechanism for financial and technical support (such as financial incentives for staff and scholarship for students, etc.)

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- Financial and training incentives to deploy and retain health workers in remote and underserved areas (such as government incentives for midwives in child delivery)

- Ensure employment and distribution of qualified health workforces for equity access and safety of population


1. Strengthen pre-service education: (a) National entry exams so far compulsory for medicine, pharmacy, dentistry and bachelor of nursing since 2008 and consideration for associated degree programs by 2015. (b) National exit/ licensing exams so far organized for new graduates in pharmacy dentistry and bachelor of nursing have been conducted in 2012 and will be applied for new graduates in medicine in 2014. Possible implementation for associate degree programs by 2015. (c) Enforcement of CEDHP roles to start developing competency-based curriculum for undergraduates in dentistry, medicine, pharmacy, and bachelor in nursing from 2014 in collaboration with relevant universities and stakeholders. The new curriculum to be implemented by 2018. The implementation of new curriculum will be accompanied by capacity building of faculties in both teaching and assessment methods will lead to accreditations of above mentioned programs for public and private universities by 2016. Data sources: National Exam Committee, MoH, and Medical schools.

2. Systematic capacity building and continuing education: Licensing and Registration of health professional practitioners by 2015. Establishment of National Board for Licensing and Registration with the involvement of Professional Councils is needed for the implementation of system. Data sources: Professional councils and MoH.

3. Universal Health Coverage: By 2020: (a) High passing rate for RTCs associate degree at national exit exams; RTCs to generate enough incomes through its Semi-Autonomous Institutions status to retains and recruit qualified teachers and to enhance teaching and learning; (b) RTCs produces qualified nurses and midwives to serve in rural and remote areas; (c) infant and maternal mortality substantially decreasing in rural and remote areas. Data sources: MoH, National Health Strategic Plan 2008-2015.

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OTHERS INSTITUTIONS

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HRH commitment pathways AEMRN Network

(Afro-European Medical and Research Network)


The Afro-European Medical and Research Network (AEMRN) is a non-governmental and not-for-profit -organization, working with a strong vision of partnerships to improve quality of life, especially the health of people living in resource-limited settings. The members and activities of AEMRN focus on public health issues, including medical, mental, social, Continuous medical education and continuous professional development. AEMRN works with individual professional volunteers and also works in partnership with public health organizations.

AEMRN is both a network and an organization that implements specific projects. The AEMRN network is multi-disciplinary and brings together active health workers professionals in education, medicine, nursing, nursing midwifery, laboratory technicians, and medical logistics to work together in supporting people in need. AEMRN activities include training and conferences for sharing and professional development as well as special mobile outreach clinics with community based research to promote evidenced based practice.. The combination of our network, activities and mobile clinics provides a platform for health promotion, training and clinical service delivery in complementing the efforts of the World Health Organization and other UN agencies as well as the various country healthcare delivery systems.

Thus in line our vision we very much support the Global Health Workforce Alliance and are firmly committed to the following:

- Focus on education as we firmly believe health information is inspiring and when once it get translated into knowledge is the great force for change for the policy makers, healthcare workers and all other players and stakeholders

- Focus on skills mix as there is no one magic bullet or single group of health professional in solving the shortage of health workers but with collaborative efforts working as a team in synergizing our efforts to maximize our output we can achieve a lot and hence the motto of AEMRN “Together We can Make It Happen”.

Our main target will be our members and other colleagues cutting across all cadres of health workers.

We plan to have a five year plan from June 2014 to June 2091 in expanding our current services of using the outreach clinics as an entry point to engage all stakeholders and build upon their successes and challenges so we do not reinvent the wheel but work closely together. We will build upon our AEMRN executive, members and focal points in the following countries: Cameroon, Congo DRC, Eritrea, France, Germany, Ghana, Kenya, The Netherlands, Nigeria, Portugal, Rwanda, Sierra Leone, South Africa, Spain, Sweden, Togo, United Kingdom, United States of America, and Zambia.

From the beginning we will do baseline surveys to see where each country stands using the current data as regards acute shortage of health workers and

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secondary verification. Our AEMRN country based executive will be very helpful with this as most of them are working for the ministries of health of their countries.

The post intervention will be to see 70% – 85% increased knowledge of the health workers in various aspect of their duties using indicators such as decrease morbidity and mortality in there clinical settings, increase public health interventions, increased scientific presentation and or publications, grant applications to have extra resources so as to motivate them to stay in their locality and contribute more to their community whilst keeping abreast with the international fast moving world of science. A monitoring and evaluation will be done after three years and data with a view of adding upon or modifying the educational delivery strategies to guarantee sustainability.

Commitments:

- five year plan from June 2014 to June 2091 in expanding our current services of using the outreach clinics as an entry point to engage all stakeholders

- build upon our AEMRN executive, members and focal points in the following countries: Cameroon, Congo DRC, Eritrea, France, Germany, Ghana,

Kenya, The Netherlands, Nigeria, Portugal, Rwanda, Sierra Leone, South Africa, Spain, Sweden, Togo, United Kingdom, United States of America, and

Zambia.

- baseline surveys in each country as regards acute shortage of health workers

- achieve 70% – 85% increased knowledge of the health workers in various aspect of their duties using indicators such as decrease morbidity and mortality,

increase public health interventions, increased scientific presentation and or publications, grant applications to have extra resources so as to motivate

them to stay in their locality and contribute more to their community whilst keeping abreast with the international fast moving world of science.

- monitoring and evaluation will be done after three years and data with a view of adding upon or modifying the educational delivery strategies to guarantee

sustainability.

- Intend to work closely with GHWA in taking this forward

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HRH commitment pathways AMREF


Current trends indicate that the majority of countries in Sub-Saharan Africa will not attain the Millennium Development Goals (MDGs) by 2015. MDGs 5 and 6, to reduce maternal mortality and reverse the impact of HIV and AIDS are among the goals towards which progress has been slow in Africa. A majority of maternal deaths in Africa (about 40%) are as a result of excessive bleeding at child birth. The other caused include hypertensive disorders. These deaths are largely preventable by simple measures like: Administration of parenteral antibiotics, uterotonic drugs, anticonvulsants for pre-eclampsia and eclampsia; Manual removal of the placenta and retained products; Assisted vaginal delivery; Performing basic neonatal resuscitation; Blood transfusion and Performing emergency surgery. No woman should fear giving life however, available evidence indicates that countries with a high proportion of births assisted by skilled attendants that are trained, qualified and accredited have low maternal mortality ratios.45 To increase the number of trained midwives and to draw attention to the plight of African mothers and to mobilize citizens worldwide to ensure that mothers get the basic medical care they need during pregnancy and childbirth, AMREF launched the international Stand Up for African Mothers campaign in October 2011 at the symbolic place of the Women’s Forum.

Stand Up for African Mothers campaign aims to train 15,000 midwives (25 % new midwives and 75% in service midwives) by 2015 and contribute towards reduction of maternal deaths by 25%, in partnerships with governments, training institutions, UN and private sector. The campaign targets 13 first countries to implement the training programmes: Angola, Burundi, Lesotho, Malawi, Mozambique, Rwanda, South Sudan, Tanzania, Uganda, Zambia, Ethiopia, Kenya, and Senegal.

The priority focus will be on education, retention and skills mix and cross cutting pathway with the following actions

Cross cutting pathways

- Solicit resources for training of midwives in the 13 target countries

- Raise funds for training midwives from Africa through the 1 dollar per African drives of the campaign

- Support development and implementation of country plans to develop midwives in the target countries

45 Campbell, O M R, and Graham W, 2006 Strategies for reducing maternal mortality: getting on with what works. The Lancet vol 368. Maternal Survival 2.

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Education pathway

- Building and equipping classes, laboratories and practical facilities

- Increasing number and competencies of tutors - Using technology – e and m learning solutions to have more midwives trained

- Tutor exchange and import between African countries

- Strengthening government mechanisms to provide financial aid for studying - Work with private sector – banks and foundations to provide affordable loans for studying. Setting up rotating funds

- Providing partial scholarships

Retention pathway

- Work with governments and other partners to strengthen the position of midwives and the recognition of midwives role in saving lives in Africa

- Seek to get a symbolic midwife (Esther Madudu from Uganda) nominated for the nobel peace prize by 2015 to create a platform for recognition and

support for midwives across the globe

- Working with Government to get commitment to employ and improve working conditions for the midwives trained

Skills mix pathway

- Support the reviewing and updating curricula for midwives to respond the country needs and standards and enhances acceptability of midwives and the

quality of services they provide

- Support and work with the regulatory bodies, schools and associations to support policies that enhance the midwives accessibility and acceptability

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Education pathway Availability

- Total number of midwives (and density per 1,000 population), by cadre (sources MOH, councils and associations assessments) - Improvement in quality of training through Surveys on quality of training

Acceptability - Number/ percentage of newly graduated midwives who are employed in the health labour market within 1 year (tracer studies public sector and

private sector )

Quality - Number and % of health training institutions meeting accreditation and reaccreditation standards (source MOH reports and surveys )

Retention pathway Availability

- Proportion of midwifery graduates entering the health sector(source MOH and partners institutions reports)

Acceptability - Number of in service midwives with competency to provide basic emergency obstetric care services – post training evaluations

Skills mix pathway Quality

- % of facility midwives who received in-service training, by cadre and type of training ( Department of Training consolidated reports ) - % of facility midwives participating in continuous professional development, by cadre( Department of Training consolidated reports )

Cross cutting - Existence of a costed operational strategy for training of midwives in target countries source MOH and partner reports

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HRH commitment pathways ANSWERS (India)


Introduction: ANSWERS was established as a non government organization in 1994 to improve quality and equity in health care through qualified health care

providers. The key words in the title of the Organization are nursing and women’s empowerment, which we feel are closely associated. ANSWERS has its

headquarters in a small village 60 kms from a city (Hyderabad) in south India and reaches out to nurses, midwives, auxiliary nurse midwives and all categories of

health workers across India, and of late has started to work in the South east Asian countries. ANSWERS has been an active partner for human resource

development at national and international level, and has participated in the first Global Forum at Kampala, and the second at Bangkok. During the third Global

Forum, ANSWERS has put up its ideas, experiences and activities at a booth for dissemination to participants and governments. At the Third Global Forum,

ANSWERS commits to the following for the next 20 years of its work for enhancing human resources for health:

1. Training and capacity building of health workers, especially nurses, midwives, auxiliary nurse-midwives and other community health workers, not

only in skills and knowledge, but in confidence and morale through career building.

2. Faculty development for preparing teachers for health workers at different levels so that basic education of nurses, midwives and community

health workers is done at a high quality.

3. Review, critique, and provide technical inputs into national and state level policies and programmes for preparation and management of human

resources for health in India to ensure quality, rational preparation and distribution, and regular support and enhancement including career

building.

4. Conduct analysis of health workforce situation in different parts of the Country and the South East Asia region to identify gaps, design and

develop alternative models for human resource preparation and utilization.

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5. Design health worker work and performance models including worker time and workload analysis for different categories of nursing and other

health workers in order to provide inputs into policies for rational deployment, management, remuneration, and retention.

6. Strengthen and persevere to advocate with governments at national and state levels, with professional organizations, regulatory bodies, including

helping professional association to advocate, for rational utilization and support to all categories of health workers.

7. Engage in discourse on language - such as mid-level providers and paramedical workers - related to health workers, that is belittling and

derogatory, and therefore counter to enhancing self respect and respectful service.

8. Strive for reducing gender inequities through highlighting gaps so that gender disparities are not barriers to quality health care with special focus

on nurses, midwives, female community health workers, female doctors, etc

9. Build bridges among health professionals of all categories so that working atmosphere is conducive and more is achieved.

10. Sustain work on human resources whether external funding is available or not so that the goal of quality and equity is realized and continuously

enhanced. 11.

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HRH commitment pathways CHESTRAD


Methodology and tools

A range of indicators were identified by CHESTRAD in consultation with Intrahealth, covering the following areas relating to human resources for health: Context – health outcome and service delivery indicators; Policy and Plan; Financing; HRH Information Systems; Transformational Education and Training; Stock, density, distribution and management of the health workforce; Retention and Migration (including the Code of Conduct). These themes were used to structure a data collection instrument that also made linkages with the AAAQ framework that is at the centre of preparations for the 3rd Global Forum (3GF) and with the commitment pathway set out by GHWA.

The data collection instrument distinguished between those indicators that could be collected through from secondary sources and those that required inputs from country representatives – usually Ministry of Health officials. Secondary data was collected through a desk review, which was conducted by one person using 4 main sources of data: Health Systems 2020, WHO AFRO HRH Observatory, WHO Global Health Observatory, World Bank country profiles. Secondary data was collated in the data collection instrument and sent to Ministry of Health (MoH) officials for verification, to fill gaps, and to address qualitative indicators. MoH officials were encouraged to use the data collection instrument as the basis for internal discussions in order to answer a range of qualitative questions. Follow-up interviews were conducted to clarify any indicators or points of process, and to discuss the data that the MoH had submitted.

MoH were also encouraged to collect data from stakeholders in HRH issues, using a tool also developed by CHESTRAD. Stakeholder inputs were gathered to provide some sense of external support to HRH development and to complement the emerging picture on HRH challenges and opportunities for strategic, catalytic action.

Analysis

Completed government and stakeholder returns were analysed by CHESTRAD with a view to identifying a menu of potential commitments as the basis of subsequent dialogue and negotiation. Selection of potential goals was based on reviewing the evidence assembled, identifying priority needs and gaps in responding to priorities, with a particular focus on issues that could catalyse additional action and accelerate progress on HRH scale-up as a fundamental prerequisite of achieving Universal Health Coverage and any post-2015 health goals. The interim goal was to enable governments to make commitments at 3GF and to have a measure of possible support from its partners (and ideally firm commitments from them to support implementation under the GoM’s leadership).

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Following 3GF, CHESTRAD and Intrahealth would like to support the four countries to complete further analysis and negotiation of HRH commitments, including to establish effective means through which accountability for HRH commitments can be ensured.

Preliminary Country Commitments

Proposals have been identified for each country, and CHESTRAD is in discussion with government and country stakeholders to refine and strengthen proposals ahead of 3GF in Recife (including to make commitments measurable as the basis for future accountability efforts). An indication of the number of proposals for each country is listed below:

- Malawi (4) - Nigeria (12): FMoH (6), Partners (3), Parliamentarians (3) - Liberia (2-3) - Ghana (1-2)

CHESTRAD/IntraHealth and CapacityPlus

Together these three organisations feel it is important to make their own commitments to support country level efforts to meet the health workforce challenge. Indicative commitments include:

- Support countries, especially these 4, and others in Africa to implement and track progress of the HRH-CAPs

- HRH Accountability framework and process

- Strengthen country CS action on HRH with a focus on mid-level and community workforce (focus on transformational education, skills mix and health

team)

- Linking HRH investment to HSS, service delivery and universal access to life saving health inputs

They are spearheading collaborative process in four countries (Nigeria, Malawi, Ghana and Liberia) where cross sectoral joint commitments will be produced - these are in the process of being finalized. In addition CHESTRAD are finalising their own commitments to (i) the production of a health workforce (ii0 motivating and retaining health workers (iii) an accountable health workforce (iv) supporting the four countries to implement their agreed actions (v) enabling civil society at country level to advocate and hold actors to account

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HRH commitment pathways College Of Physicians And Surgeons Pakistan


The College of Physicians and Surgeons Pakistan together with its accredited institutions in public and private sector is the premier postgraduate institution of Pakistan for medical and dental education and in this capacity provides about 85% specialist manpower to the country. Since the faculties of the majority of its accredited institutions are primarily involved in undergraduate education of medicine and dentistry, the College has played a pivotal role in shaping the quality of medical as well as dentistry graduates. Thus it not only determines the quality of specialist care but also indirectly affects primary and secondary care.

One of the biggest issues related to health workforce faced is the Continuing Medical Education of the general practitioners of the country, who after graduation do not have systemic opportunities to build their capacities and hone their skills to effectively and efficiently manage the primary care problems. Utilizing its country wide resources College commits to start a program of capacity building of general practitioners, who are the grass root healthcare providers through Focused Continuing Medical Education This activity is aimed at Strengthening their capacity and enabling health system towards achieving the Universal Health Coverage, Millennium Development Goals 2015 by enhanced health workface productivity and improving the health indicators.

The activity is proposed to begin in January 2014 from Sindh Province as a pilot project of six months and will be subsequently replicated to other provinces and expected to complete by December 2015. Medical Colleges in the region would be invited for partnership in the activity. The planned interventions with timeline is as under:

Targets related development of CME program Expected Date Responsible Organization

Training needs assessment (TNA) March 2014 CPSP, WHO, USAID

Curriculum designing on the basis of identified needs June 2014 CPSP, WHO, USAID

Printing of the guidelines and Background reading material for CME workshops August 2014 CPSP, WHO, USAID

Pilot testing of CME program Sep 2014 CPSP, WHO, USAID

Evaluation of pilot project March 2015 CPSP, WHO, USAID

Launching of country wide CME program Dec 2015 CPSP, MOH and DoH, USAID

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- Evidence on training needs (Information source/s: TNA report)

- Needs based course curriculum (Information source/s: course curriculum).

- Number of people trained (Information source/s: progress reports).

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HRH commitment pathways Community Health Workers


The role of community health workers (CHWs)46 and other frontline health workers (FLHWs) is increasingly recognized for their potential contribution in meeting the urgent health workforce challenges in the context of primary health care (PHC) and moving toward universal health coverage (UHC). CHWs can go beyond providing basic care to foster community-based action and enhance the interface between community and the formal health system. The Third Global Forum on Human Resources for Health presented an unprecedented opportunity to consolidate experiences on the ground and move from fragmentation to synergy to support government, civil society and other stakeholders to build and strengthen PHC systems.

The side session presentations and deliberations captured a rare moment to bring together countries and a broad range of partners with shared desire to optimize the role and contribution of CHWs, working with other FLHWs to scale up effective access to PHC, accelerating efforts to achieve the Millennium Development Goals (MDGs) by 2015 and moving forward to UHC.

Experience from most countries shows fragmentation, overcrowding, duplication and gaps at the frontline level of the health system, underscoring the need for better coordination and synergies across partner initiatives and increased alignment with national plans. Many countries and partners have not given adequate attention to ensuring approaches that integrates the different types of community health workers and volunteers with the national health system, with stronger interface between that system and the community, CSOs, NGOs and the private sector.

Convened by Global Health Workforce Alliance (the GHWA), partners and networks supporting programs for CHWs and other FLHWs, engaged through a number of consultations, collaborative working papers and broad interaction among stakeholders and contributed to the development of a "CHW Framework for Partner Action", that recognize:

CHWs and other FLHWs play a unique role and can be essential to accelerating MDGs and achieving UHC Without trained and supported CHWs and integrated front line health teams, national stakeholders and international partners will not be able to deliver on the commitments to accelerate achievement of the MDGs, stop preventable maternal and child mortality, end new HIV infections and HIV-related deaths and move forward to achieve UHC. Programs for strengthening CHWs and other FLHWs must be integrated within national health systems National strategies and plans that incorporate the contribution of CHWs and other FLHWs and empower community action in national health delivery systems are required as a basis for achieving synergies, alignment and integration among actors involved in CHW and FLHW programs.

46 The term “CHW” is used this summary paper, and in the three background documents to refer to the wide range of both volunteer and remunerated health providers that work within and among the community.

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Based on this shared understanding, and considering the three background papers that framed the consultation47, the global, regional and national partners, governments and stakeholders participating in the side session, "Community Health Workers and other Front Line Health Workers: Moving from Fragmentation to Synergy to Achieve Universal Health Coverage," confirmed the principles for moving from fragmentation to synergies put forward in the CHW Framework for Partner Action and their readiness to act together on taking steps both at national and global level. In order to take this work of alignment and harmonization forward, the partners hosting the side session, together with other participants, initiatives and key stakeholders that endorse these principles made the following Commitment: We will work together to adapt, apply and implement the CHW Framework for Partner Action, fostering harmonization and synergies, accountability and joint action on critical knowledge gaps, and reaching out to all stakeholders engaged with CHW Programs in order to:

- optimize synergies to overcome the fragmentation that undermines sustainable results, joining hands as public and non-state actors in seeking

harmonization of CHW principles, policies, plans and practices;

- accelerate program innovations for effective, equitable and sustainable access

- enhance collaboration towards efficient use of available resources, robust accountability, sharing of knowledge and best practices, and use of evidence to

inform policies, plans and vision; and

- strengthen health systems to achieve UHC by improving the availability, accessibility, acceptability and quality of health services by optimizing CHW’s role

as recognized partners within the health system.

We will advocate, endorse and apply the principles and processes delineated in the CHW Framework for Partner Action by:

- prioritizing solutions that leverage the CHW Framework for Partner Action to achieve high priority health goals in response to national and regional

commitments;

- making use of all potential opportunities to align and harmonize our engagement in CHW programs and initiatives at all levels;

- advocating and encouraging national governments to integrate CHWs into the broader health system;

- supporting the development and implementation of national government roadmaps that integrate principles of the Framework; and

- advancing those programs that are embedded and/or supported by community and civil society groups that integrate principles of the Framework.

47 Møgedal S, Wynd S, Afzal MM. 2013. A framework for partners’ harmonized support. Global Health Workforce Alliance Working Paper on CHWs and Universal Health Coverage. Foster AA, Tulenko K, Broughton E. 2013. Monitoring and accountability platform for national governments and global partners in developing, implementing, and managing CHW programs. Global Health Workforce Alliance Working Paper on CHWs and Universal Health Coverage. Frymus D, Kok M, de Koning K, Quain E. 2013. Knowledge gaps and a need-based Global Research Agenda by 2015. Global Health Workforce Alliance Working Paper on CHWs and Universal Health Coverage.

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We will jointly promote the culture of self and mutual monitoring and accountability (M&A) of commitments and plans by: - championing and instigating M&A process through transparently sharing the information among the collaborating partners and related stakeholders;

- empowering and endowing global partnerships like GHWA and national mechanisms for multi-stakeholder coordination to spearhead robust monitoring

and accountability processes;

- upholding and promoting use of revealed evidence from M&A in streamlining the synergy and harmony of partner actions; and

- supporting systems of various monitoring platforms that increase visibility of ongoing CHW programs to highlight current achievements and opportunities.

We will reciprocally respond to knowledge gaps and promote a coordinated response to needs-based research on CHWs by: - promoting and supporting research better designed to address the outstanding questions pertaining to CHWs effectiveness, systems factors influencing

their performance and other key concerns impeding CHW programs from operating at scale;

- encouraging and inspiring a global consensus and collaboration to foster sharing of CHWs research efforts and to establish a robust coordination process

to identify future research priorities aligned to country needs;

- fostering and nurturing partnerships in a global research agenda through increased dissemination and coordinated knowledge sharing through platforms

such as GHWA; and

- applying the conclusions of available evidence to strengthen and shape ongoing implementation programs in a harmonized manner.

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List of partners aligned with achieving this commitment at Recife:

1 Norwegian Agency for Development Cooperation (Norad), Norway

2 United States Agency for International Development (USAID), USA

3 Department of International Development (DFID), UK

4 Irish Aid, Ireland

5 The Joint United Nations Programme on HIV/AIDS (UNAIDS)

6 Frontline Health Workers Coalition

7 World Vision International

8 MDG Health Alliance

9 One Million Community Health Workers Campaign

10 African Medical and Research Foundation (AMREF)

List of partners aligned with achieving this commitment after Recife:

11 Royal Tropical Institute (KIT), Amsterdam, The Netherlands

12 Asia Pacific Action Alliance on Human Resources for Health (AAAH)

13 African Platform on Human Resources for Health (APHRH)

14 African Centre for Global Health and Social Transformation (ACHEST)

15 IntraHealth International, Washington DC, USA

16 CapacityPlus, Washington DC, USA

Note: The above list will be regularly updated as new partners, organizations or entities align and concur with this commitment.

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HRH commitment pathways Health Services Academy (HSA), Pakistan


The HSA was established in 1988 to provide short training courses to in-service public health practitioners & professionals. The promulgation of HSA Ordinance, 2002 gave it an autonomous status. Over the years, it has established itself as the premier research & teaching institution of public health. Today, it is the only institution that offers PhD in Public Health in Pakistan. It also offers FCPS, MS in Public Health, & MEDVC, M.Sc. in Health Economics & Management & a PG Cert Human Resource in Health.

The Academy remains committed to strengthen the capacity of public health professionals by excellence in teaching, research, and policy advice. Realizing the fact that health workforce is the backbone of any health system, the academy is planning to start a master course in collaboration with Queen Margaret University UK. This course will help to Strengthen the capacity of key policy makers, HRH managers both from public & private sector to establish enabling health system towards achieving the Universal Health Coverage, Millennium Development Goals 2015 by enhanced health workface productivity and improving the health indicators.

The activity is proposed to begin in January 2014 from Sindh Province as a pilot project of six months and will be subsequently replicated to other provinces and expected to complete by December 2015. Medical Colleges in the region would be invited for partnership in the activity.

The planned interventions with timeline is as under:

Targets related development of CME program Expected Date Responsible Organization

Training needs assessment (TNA) March 2014 HSA, WHO, USAID, MoH, QMU

Curriculum designing on the basis of identified needs June 2014 HSA, WHO, USAID, MoH, QMU

Hiring of additional faculty August 2014 HSA, WHO, USAID, MoH, QMU

Advertisement and induction Sep 2014 HSA, WHO, USAID, MoH, QMU

First master Course March 2015 HSA, WHO, USAID, MoH, QMU

Evaluation and planning more courses Dec 2015 HSA, WHO, USAID, MoH, QMU

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- Evidence on training needs (Information source/s: TNA report)

- Needs based course curriculum (Information source/s: course curriculum).

- Number of people trained (Information source/s: progress reports).

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HRH commitment pathways Health Workers Count

Ensuring that Health Workers Count: A Civil Society Pledge


Health workers have been essential to impressive progress on the Millennium Development Goals (MDGs) for health. With less than 1,000 days until the target date of the MDGs, we must accelerate efforts to strengthen the health workforce capacity needed to meet them. Realizing bolder goals such as achieving universal health coverage (UHC) cannot be achieved without strengthening the health workforce.

Therefore, at the 3rd Global Forum on Human Resources for Health in Recife, Brazil, we, the undersigned representatives of civil society organizations and other non-state partners, hereby commit to:

1) Champion a movement for health workers

- We will advocate that governments at all levels institute human resources for health (HRH) action plans to ensure that every person has access to a trained, supported, and equipped health worker.

- We will work with training institutions and regulatory bodies to foster quality in health worker education so that every health worker is competent to provide quality care.

- We will work with professional associations to raise the profile of health workers, promote adherence to high standards of care, foster collaboration, and institute solid governance structures.

- We will press global organizations and other civil society actors to support health workforce strengthening efforts in accordance with government commitment to action plans.

- We will leverage our resources and expertise to turn HRH policy and commitments into global action. - We will advocate for donors and governments to prioritize and scale up efforts to address HRH.

2) Support health workers and civil society to advocate for better recognition, support, security, and working conditions

- We will ensure the voices of health workers, especially those on the frontlines of care, are valued and represented in national and global health policy discussions.

- We will help amplify the voices of local civil society organizations to ensure that they are being consulted and engaged in global and national health workforce policy discussions.

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- We will engage with patient and client advocacy groups to effectively advocate for access to quality services and competent health workers at all levels of care.

3) Support accountability

- We will work with governments, the Global Health Workforce Alliance, and other stakeholders to develop evidence-based frameworks to measure progress toward the goal of health worker access for every person.

- We will track and report periodically on progress of public HRH commitments made by governments, including legislation, policies, budgets, strategies, and official speeches.

- We will provide citizens and health workers with mechanisms to participate in accountability efforts. - We will increase transparency of our programmatic and technical contributions to national HRH strategies, making our activities easier to track.

We call on governments, donors, and multilateral entities to:

- Provide the leadership, investments, and stewardship needed to fulfill commitments made to end the health workforce crisis and ensure that every person has access to a health worker.

- By 2015, develop, finance, and implement HRH action plans with concrete targets and integrate them into national health plans and other global health commitment plans.

- Establish integrated platforms with health workers and civil society organizations as active partners in the planning, coordination, and decision-making process involved with HRH.

- Improve the financial sustainability and equity of health systems by supporting frontline health workers to deliver services to the most-marginalized groups and hard-to-reach populations.

- Integrate community and other frontline health workers into the formal health system. - Support strong HRH information systems so that all health workers can be counted. - Improve diplomacy and governance on international issues such as health worker recruitment.

This pledge was developed by members of the Health Workforce Advocacy Alliance (HWAI), the Frontline Health Workers Coalition (FHWC) and other civil

society organizations around the world.

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Organizations

Abt Associates, Inc.

Accordia Global Health Foundation

Action Group for Health, Human Rights and HIV/AIDS (AGHA)

African Medical & Research Foundation (AMREF)

American College of Nurse-Midwives

American Heart Association

ANSWERS

Asia Pacific Action Alliance on Human Resources for Health (AAAH)

Bangladesh Cancer Support Group

BRAC

CARE USA

CHESTRAD

CleanBirth.org

CORE Group

Elizabeth Glaser Pediatric AIDS Foundation

Eminence Associates for Social Development (Eminence)

Family Care International

Global Alliance to Prevent Prematurity and Stillbirth (GAPPS)

Global Healthcare Information Network

goal4.org

Health and Rights Education Programme (HREP)

Healthy Newborn Network

Helen Keller International

Hesperian Health Guides

Human Resources for Health Coalition - Malawi

IMA World Health

Instituto de Cooperación Social Integrare (ICS Integrare)

International Agency for the Prevention of Blindness (IAPB)

International Children's Heart Foundation

International Confederation of Midwives

International Medical Corps

IntraHealth International

Jhpiego

Malaria Consortium

Management Sciences for Health

Non Communicable Diseases Forum (NCD-F)

One Million Community Health Workers Campaign

Pathfinder International

Population Communication

Population Services International (PSI)

Public Health Institute

RESULTS UK

ReSurge International

Save the Children

Shehu Idris College of Health Sciences and Technology (SICHST) Makarfi, Kaduna State, Nigeria

University Research Company, LLC Community Nutrition and Health Care project, Nutri-Salud - Guatemala

VSO

White Ribbon Alliance for Safe Motherhood

WellShare International

Women and Health Alliance International

Women’s Refugee Commission

Individuals

Dr. Tsatsi David Thekisho, South Africa

Dr. Henry B. Perry, Bloomberg School of Public Health, Johns Hopkins University

Marilyn A. DeLuca, Principal and Executive Director of "Global Health - Health Systems - Philanthropy" consultancy

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HRH commitment pathways Health Workers For All


In the lead up to the eventual adoption of the WHO Code of Practice on the International Recruitment of Health Personnel (CoP), European NGOs have been closely involved at both national and international level to raise the issues of fair recruitment, retention strategies, data sharing, freedom of movement and the right to work, as well as the obligation by states to provide essential health care for all its citizens. After CoP adoption by WHA in 2010, for European Civil Society Organizations (CSOs) a number of new challenges have come to the forefront in relation to health workforce mobility. First, their role as advocates has changed to one of cooperation and promotion of the CoP at national level at a time that national health systems are under pressure for budget cuts because of economic austerity measures. Secondly, as a result of the treaty of Lisbon that facilitates mobility of employees within the EU as well as more stringent EU migration policies, the attention has now shifted towards internal imbalances within the distribution of health workers in the EU. Thirdly, the NGOs involved in health workforce migration often have a background in international development cooperation. It is a serious effort to unite organizations, which also work on health system sustainability at national level, like patient federations, labour unions and professional associations. From the government side several ministries should be involved in the matter, e.g. foreign affairs, health, education, labour, and migration. This needed multi-sectoral approach has proven challenging but feasible.

The “Health Workers for all and all for Health Workers” (HW4ALL) project (2013-2015, 3 years) takes up these challenges in a partnership bringing together civil society actors from 8 EU countries (Belgium, the UK, Italy, Germany, Poland, Romania, Spain and the Netherlands) and supported by the European Commission. Advocacy activities of this partnership – carried out in alignment with WHO – include the development and dissemination of tools for policy analysis (as users’ kits, stakeholder analysis and a collection of best practices) and the creation of a community of practice of national and international stakeholders (through workshops at national and European level, the involvement of health workers representative bodies and through the launch of a Call to action), in order to achieve a sustainable health workforce. The UK national workshop, taking place at 28 October 2013, is an excellent example of how in different countries with different contexts national workshops. Other national workshops will take place at the end of this year and first half year of 2014.

The initiative “Health Workers for all and all for Health Workers” also intends to develop a dialogue at EU level, building on the Action Plan for the EU Health Workforce, proposed by the European Commission in 2012. In particular, it will monitor the way in which Member States equip themselves to foresee future shortages of health workers and plan accordingly, in the perspective of a sustainable domestic health workforce provided by the WHO CoP. Parallel, CSOs will have a role in the coming years in monitoring the use of the European Blue Card, which has been so far adopted by 24 EU countries and is designed to attract third country highly educated professionals - including health professionals - to the European Union, by giving them preferential access to residence and work permit.

It should however be noted that all these aspects of health workforce development are discussed at a time when financial austerity is the mantra in the continent and affects directly health budgets. The question underlying European - and EU member States’ - capacity to provide for a sustainable health workforce, which is

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a major part of health expenditure, is closely linked to their capacity to complete the path towards Universal Health Coverage and – ultimately – to claim fiscal space as a condition to advance on this path.

Commitments:

- development and dissemination of tools for policy analysis

- creation of a community of practice of national and international stakeholders

- a series of national workshops will take place at the end of this year and first half year of 2014.

- dialogue at EU level, building on the Action Plan for the EU Health Workforce, proposed by the European Commission in 2012

- monitoring the way in which Member States equip themselves to foresee future shortages of health workers and plan accordingly

- monitoring the use of the European Blue Card

- strong collaboration with GHWA and WHO in taking this forward

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HRH commitment pathways Institute for Collaborative Development


Institute for Collaborative Development have worked on many HRH assessments, policies and plans at the national and sub-national levels. In our experience, many plans are not successful following their development and dissemination. There are various factors impeding successful implementation of plans, for example: they were written by a consultant with a minimal process of country ownership, plans are overly ambitious due to political agendas and not rationally prioritized, there is turnover/change in Ministry leadership, there is a lack of knowledge of, or capacity for, implementation.

Collaborative Development's commitment is to support governments to move from planning to implementation. Solid knowledge and capacity for implementation is an area that needs to be built. By focusing on smart implementation, countries will benefit by having better ability to achieve their national health plans. Strengthening systems for implementation contributes to overall health systems performance.

GHWA has called for members to contribute to delivering results. Collaborative Development commits to the following:

- participation in joint working groups at the global and national levels;

- advocacy;

- support through mentoring and capacity building (for implementation);

- sharing best practice at local and global levels, through GHWA, through publications, platforms, and conferences; and

- encouraging and facilitating health workers to have a voice.

...in support of closing the implementation gap.

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Voies d’engagements en matière de RHS Institut Supérieur En Sciences Infirmières (ISSI)

situé à KINSHASA - République Démocratique du Congo


Pour contribuer à l'Accélération du progrès vers les OdM en matière de santé, l'ISSI s'engage à offrir, dans une approche systématique, une formation aux Infirmières et aux Sages-femmes adaptée aux besoins de la population en soins de santé de qualité ainsi qu'aux membres de l'équipe multidisciplinaires

répondant aux besoins de renforcement des principaux acteurs du système sanitaire de la RDC.

En concret, il s'engage à former par la voie :

- du Master en Administration de Programmes de Santé, au moins 60 cadres infirmières et sages-femmes contribueront à la mise en place et à l’évaluation des programmes de formation des Infirmières et des sages-femmes de niveau Licence dans un cheminement « L, M, D » et dans la formation continue et ce, selon les standards internationaux, d'ici l’an 2018;

- de la mise à niveau, au moins 90 infirmières accoucheuses (IA) recevront la formation pour devenir SF d'ici à 2018; - de la reconversion, au moins 60 Infirmières polyvalentes seront formées pour devenir SF; d) de la formation initiale des SF: au moins 30 candidates SF

seront admises par année dans le programme de Licence SF à partir de 2016 avec un total de 120 SF qui seront admises et 30 d’entre elles seront diplômées l’an 2020;

- de la formation initiale des Infirmières, au moins 30 candidates seront admises par année dans le programme de Licence Infirmière d'ici à 2018 ; un total de 180 Infirmières seront admises et 60 d’entre elles seront diplômées d'ici l’an 2018;

- de la formation continue, incluant le programme GESTA International " spécial sage-femme"et des modules sur les soins en néonatologie,: renforceront les capacités de 150 infirmières accoucheuses et infirmières en néonatologie dans les prochains 3 années;;

- de la formation continue incluant le programme GESTA International, favorisera le transfert de compétences aux diverses équipes multidisciplinaires (médecin généralistes et spécialistes, infirmières, sages-femmes), environ 270, parmi lesquels seront formées au moins 4 équipes d'instructeurs GESTA locaux d'ici à 2016;

- de la formation et l'accompagnement du personnel d'une clinique modèle de la pratique SF de première ligne qui favorisera l'apprentissage des attitudes de soins humanisés et qui sauvent des vies ; cette clinique sera mise sur pied à Kinshasa ; un grand nombre de sages-femmes provenant de partout dans la province Kinshasa mais d’autres provinces également, pourront réaliser des stages cliniques dans des conditions optimales;

- de la formation et l'accompagnement du personnel du service de gynéco- obstétrique ainsi que de celui de néonatologie de l'Hôpital de référence Monkole (à Kinshasa).

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Disponibilité

- Nombre et % de candidats acceptés qui s’inscrivent pour la formation, par cadre - Nombre de candidats SF diplômés par année, par cadre - Nombre de candidats Inf diplômés par année, par cadre - Proportion de diplômés qui intègrent le secteur de la santé - Programme de formation Inf Licence pour les candidats et pour les échanges inter-établissements… - Programme de formation SF Licence pour les candidats et pour les échanges inter-établissements… - Programme de 2e cycle Inf et SF pour les cadres - Nombre d’instructeurs GESTA formés - Répartition des RHS par sexe - Répartition des RHS par profession, spécialisation ou autres critères relatifs aux compétences - Accessibilité - Nombre et % de candidats inscrits pour la formation, par cadre, venus des différentes provinces - Collaboration avec les autres établissements - Diplômés engagés dans différents établissements et différentes provinces

Acceptabilité

- Satisfaction des diplômés (fidélisation !) surtout dans le régions - Satisfaction des établissements de santé - Collaboration avec les différents établissements de formation et de santé à Kinshasa et dans les autres provinces - Existence de stratégies de formation interprofessionnelle à l’école des sciences de la santé - Proportion de médecins de premier recours fidélisés dans le rural et les régions à moindres ressources/nombre total de médecins

Qualité

- Satisfaction de la clientèle des milieux où la formation continue a été disponible et où les nouveaux diplômés sont établis…. - Indicateurs de morbidité/mortalité maternelle et infantile améliorés par établissement concerné ne 2018 - % de personnel de la structure sanitaire ayant reçu une formation continue, par cadre et par type de formation - % de personnel de la structure sanitaire participant à une formation continue de perfectionnement professionnel, par cadre - % de personnel de la structure sanitaire ayant un projet d’amélioration des performances

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HRH commitment pathways International Nurses and Midwives

/ International Confederation of Midwives (ICM) - International Council of Nurses (ICN)


Nurses and midwives attending the Third Global Forum on Human Resources for Health are confirming the commitment to advancing universal health coverage by working with governments; education and research institutions; professional associations, unions and regulators; national, regional and international organizations, civil society and other partners in health to:

- develop and support policies that advance equity and the provision of high quality care and services that are available, accessible, and acceptable;

- promote quality clinical practice that is person and population-centered, advances continuity in the provision of care, promotes health and well-being and

facilitates the prevention of non-communicable diseases;

- develop and demonstrate excellence in educational programs that are competency- based and available across settings to prepare sufficient numbers of

competent nurses and midwives that are capable and motivated to practice in various settings and with diverse population groups;

- promote health workforce leadership and management that enhances recruitment and retention of all cadres of health care workers, addresses motivation

and accountability, and fosters supportive, safe and healthy workplace environments;

- practice in collaboration with other health professions, advancing interdisciplinary care team models and;

- advance knowledge through inquiry and research to improve evidence-based practice and facilitate translation of research to practice, it's dissemination,

implementation and sustainability;

- support country specific workforce analytics to inform decision making at the local, regional and international level.

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HRH commitment pathways IntraHealth International


IntraHealth International has a long-standing organizational commitment to ensure that all 7 billion members of the world’s population have access to health workers who are present, ready, connected, and safe. On the occasion of the Third Global Forum on Human Resources for Health (HRH), we join the movement of countries and entities from around the world in making a commitment to the global health workforce.

IntraHealth commits to engaging with the global community of health workers, governments, leaders, advocates, donors, civil society, and human resources for health professionals, to accelerate the application of existing and emerging solutions to health workforce challenges. We also commit to promoting and advocating for workplaces that ensure the safety and well-being of health workers.

IntraHealth will follow a three-pronged pathway to fulfill our commitment:

COUNTRY LEADERSHIP

1-We will facilitate a robust and active -- including virtual -- network of national HRH senior leaders. We will support these global leaders with real-time technical support, training and leadership development, and will foster good governance, capacity building, and South-to-South cooperation and innovation.

We will monitor progress annually on the following indicators: number of leaders by gender, type of leaders and countries; effectiveness of the network (index to be defined)

TARGET:1,000 leaders engaged by 2020; engagement index to be defined and applied beginning in 2014 ;

KNOWLEDGE ON THE HRH PATHWAYS TO HEALTH OUTCOMES

2-We will work with the wider community to generate evidence around the impact of HRH interventions designed to increase availability, access, acceptability, quality, equitable coverage and use of health services. We will further develop our organizational research agenda and seek partnerships with national and regional stakeholders and research firms to expand this knowledge and promote its use for improved service delivery.

We will monitor progress on the following indicators: number of studies advancing HRH knowledge; number of policies formulated from new HRH knowledge.

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TARGET: 100 studies published by 2020; policy analysis methodology to be developed and applied beginning in 2014

HEALTH WORKERS

3-In 2013 IntraHealth reached more than 178,000 health workers with training, enhanced supervision, better remuneration, and more positive working conditions. We commit to increasing the number of health workers reached to 475,00048 by 2020.

TARGET: 475,000 by 2020


1-We will facilitate a robust and active -- including virtual -- network of national HRH Directors and senior leaders. We will support these global leaders with real-time technical support, training and leadership development, and will foster good governance, capacity building, and South-to-South cooperation and innovation.

Indicators Data sources Number of leaders by gender Active contacts list Number of leaders by type Active contacts list Effectiveness index (in development)

2-We will work with the wider community to generate evidence around the impact of HRH interventions designed to increase availability, access, acceptability, quality, equitable coverage and use of health services. We will further develop our organizational research agenda and seek partnerships with national and regional stakeholders and research firms to expand this knowledge and promote its use for improved service delivery.

Indicators Data sources Number of research studies publishing data HRH Global Resource Center (criteria for inclusion in development) Number of policies formulated from new HRH knowledge (Review of best data sources and methodology in development)

3-In 2013 IntraHealth reached more than 178,000 health workers with training, enhanced supervision, better remuneration, and more positive working conditions. We commit to increasing the number of health workers reached to 475,00049 by 2020.

Indicators Data sources Health workers reached (direct) Quarterly project reports (count) Health workers reached (indirect) Quarterly project reports on systems interventions (formula to calculate in

development)

48 Assuming at least similar levels of business as current fiscal year. 49 Assuming at least similar levels of business as current fiscal year.

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HRH commitment pathways International Pharmaceutical Federation (FIP)


Background

Through its’ 2020 Vision Strategic Plan, the International Pharmaceutical Federation (FIP) set a strategic focus in 2008 on addressing pharmaceutical education because better health for populations, through advancement in science, practice, innovation and in healthcare delivery, requires:

- a professionally educated pharmaceutical workforce as part of the healthcare workforce, - an appropriate academic and institutional infrastructure, and - high quality competency-based education.

The best health outcomes will only be possible through the Responsible use of medicines and it is imperative that a quality pharmaceutical workforce is available that has the medicines expertise needed to support the best use of medicines. Practice standards and improvements to be used by countries to improve access and quality of services of pharmacists have been developed to guide this work. The World Health Organization and FIP have published a joint Statement on “Good Pharmacy Practice: standards for quality of pharmacy services" in 2011. As well as FIP published the Basel Statements in 2008 reflecting the profession's preferred vision of practice in the hospital setting.

FIP’s strategic focus on pharmaceutical workforce development led to the launch and implementation of the Global Pharmacy Education Taskforce from 2008-2010, which delivered on a number of actions. In 2011, the FIP Education Initiative (FIPEd) was established as a long-term coordinating body that will engage in pharmaceutical workforce development at the global level with its members, including national organisations involved in education, educational institutions and individual educators. The FIP Education Initiative (FIPEd) has agreed a strategic and action plan that outline how FIPEd will stimulate change in education to positively affect health.

FIPEd Strategic Plan

FIPEd Vision

FIPEd, as the global professional leader, ensures that education and training provides the foundation for pharmaceutical services and professional development and advancement, in order to meet global societal needs for medicines expertise.

http://www.fip.org/www/uploads/database_file.php?id=331&table_id=

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FIPEd Mission

To meet the Vision, our Mission is to bring together organisations and leaders who are working to improve health through advancing pharmacy and pharmaceutical sciences education. We will stimulate transformational change in professional pharmacy, pharmaceutical sciences and pharmaceutical education to advance and develop our diverse profession towards meeting present and future health care needs around the world.

FIPEd Strategic Objectives

1. To provide a global platform for exchange, mentoring and learning for all professional leaders, focusing on the development of leadership skills, academic

provision and pedagogic skills.

2. To build, advocate for, and disseminate evidence-based frameworks, consensus-based standards, tools and resources for educational development and

support for members.

3. To develop and facilitate education-related policy that supports advancement of pharmacy and pharmaceutical science professions; these policies will be

advocated and implemented with, and by, our stakeholders at global, regional and local levels.

4. To foster innovation that will advance professional pharmacy and pharmaceutical science education, which will lead to improving global health services

quality, delivery and productivity.

FIPEd Action Plan

FIPEd will oversee the implementation of a 5-year Action Plan from 2014 to be completed by 2018, that encompasses 7 Pillars towards stimulating the transformation of education to deliver better patient care and health. The Pillars focus on developing tools, methodology and services to facilitate the transformation of education, and include:

1. FIP Annual Congress Educational Sessions and For a- target: to share best practices and innovations each year between members.

2. Global conference on pharmacy & pharmaceutical science education – target: to hold this conference in 2016.

3. Education Development Projects and Annual Technical Reports – targets: data and country case studies collected and published every year on a specific

topic related to the workforce- the 2013 Report provides a global status on pharmacy education (available at www.fip.org/educationreports) and the 2014

report will focus on Continuing Professional Development/Continuing Education in pharmacy.

4. Centres of Excellence – target: to create up to 4 Centers of Excellence to stimulate further research, evidence generation and delivering of education

http://www.fip.org/educationreports

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programmes, to share best practice and resources amongst educators and their institutions. To note this is part of a FIP UNESCO UNITWIN programme

to stimulate exchange and cooperation between educational institutions.

5. Global Leadership – Training and Networks – target: to actively engage with the leaders of Academic institutions to stimulate change in their education

programmes for better health service delivery.

6. Education consultation services – target: to develop and pilot a consultation service in 6 countries for academic institutions and governments on

transforming education.

7. FIPEd Infrastructure & Global Representation – target: ensure appropriate representation and communication of FIPEd in the global education, healthcare

and pharmacy community.

8. For more details see the attached description of the FIPEd Action Plan.

In addition, FIP and The Royal Pharmaceutical Society (GB) have agreed to launch a Global Pharmacy Workforce Observatory in 2014, that will contain all relevant data collected concerning the pharmaceutical workforce.


FIPEd plans to track a number of indicators, as below, and utilise a number of data sources including member surveys and contacts (individuals, education institutions and professional organisations) and online resources.

Indicators to include, but not limited to the following adapted from the GHWA HRH indicator examples:

General

- Pre-service pharmacy and pharmaceutical sciences education and training offered in countries (World List of Pharmacy Schools available at http://aim.fip.org ). - Capacity for informed pharmaceutical HRH response based on evidence from member organisations.

Quality

- Existence of accreditation agencies for training institutions. - Number and % of health training institutions that are accredited. - Existence of inter-professional training strategies in the schools.

http://aim.fip.org/

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- Mechanisms and regular updating/ improvement of curricula. - Competency-based frameworks informing regular update/ further development of pre-service and in-service training.

Acceptability

- Distribution of pharmaceutical HRH by gender. - Distribution of pharmaceutical HRH by occupation/practice area, specialization or other skill-related characteristic. - Existence of inter-professional training strategies in the schools. - Existence of enrolment programs (selective candidate recruitment, affirmative action) to include students from underserved population. - Specific training programs for students from indigenous populations, or with a low socio-economic status or that live in geographically inaccessible areas. - Adoption of education policies favouring rural retention. - Development of the pharmaceutical HRH responsive to population cultural (ethnicity, language) needs.

Accessibility

- Distribution of pharmaceutical HRH training insititutions by geographical location. - Distribution of pharmaceutical HRH by geographical location. - Density of pharmaceutical HRH for rural areas / density of HRH for urban areas in countries.

Availability

- Total number of pharmaceutical HRH (and density per 1,000 population). - Number of pharmaceutical students graduating each year. - Proportion of pharmaceutical students that are nationals.

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Vías de compromiso en materia de RHS COMISCA

CONSEJO DE MINISTROS DE SALUD DE CENTROAMERICA Y REPUBLICA DOMINICANA


El Consejo de Ministros de Salud de Centroamérica (COMISCA) es la instancia política del Sistema de la Integración Centroamericana, SICA, que tiene como propósito la dirección del Sector Salud Regional; la identificación, abordaje y solución de los problemas regionales de salud, que son tratados conjuntamente mediante la Agenda y el Plan Mesoamericano de Salud y otros Foros y reuniones que garanticen a la población Centroamericana su derecho a las Salud.

El COMISCA está presidido por el Ministro de Salud del país sede de la respectiva Reunión Ordinaria, quien ejerce sus funciones hasta la próxima rotación, y el Secretario Ejecutivo de COMISCA actúa como principal administrador del trabajo de la misma.

En su calidad de organismo clave en la integración de los países de la región en los temas de Salud, y en el marco de su Agenda y Plan Regional de Salud, con la anuencia de los Ministros de los ocho países miembros, se aprobó la constitución de la COMISION TECNICA DE RECURSOS HUMANOS, la misma que impulsa y dinamiza el trabajo en pro del desarrollo de los recursos humanos de la salud.

En esta oportunidad la COMISCA, reconociendo la diversidad de los sistemas de salud de la región se compromete a: 1. Mantener en la agenda política de la región el DESARROLLO DEL RECURSO HUMANO EN SALUD como elementos fundamental para alcanzar la

cobertura universal en salud.

2. Generar directrices que respetando las particularidades nacionales, establezca lineamientos consensuados para que los países “asuman su responsabilidad

de gestionar tanto la educación como el trabajo en salud para garantizar el Recurso Humano en las cantidades y con las competencias que un sistema que

avanza a la cobertura universal de salud requiere acorde a las diversas realidades de los países de la región.

3. Mantener el monitoreo de los avances en la consecución de las Metas Regionales de RHUS 2009 al 2015 en coordinación permanente con los países

miembros

4. Participar activamente en la definición de la Agenda de desarrollo post 2015 en asuntos de RHUS y realizar la abogacía necesaria con los países miembros

para su análisis

5. Cumplir con el Plan de trabajo propuesto por la COMISION TECNICA DE RHUS 2014 – 2015 (anexo)

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Utilizando los mecanismos oficiales de planificación y seguimiento de los planes operativos de la COMISCA (Conjunto de indicadores definidos y aprobados por

los miembros de la comisión técnica)

Sistema de Medición de metas Regionales de RHUS del Observatorio de RHUS gestionado por los países en coordinación con OPS/COMISCA, Indicadores

disponibles on line

Seguimiento de las resoluciones de las Reuniones de Ministros, mecanismos de evaluación anual a cargo de las Presidencias Pro témpore.

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Vías de compromiso en materia de RHS ORGANISMO ANDINO DE SALUD – CONVENIO HIPOLITO UNANUE


Los países de la subregión andina (Bolivia, Chile, Colombia, Ecuador, Perú y Venezuela) integrados en el Organismo andino de salud (ORAS-CONHU) elaboraron y aprobaron mediante Resolución REMSSA 474 del 23 de Noviembre del 2012 (Reunión de Ministros de Salud la región andina), la Política Andina de Recursos Humanos en Salud y la implementación de su Plan de Acción.

Esta Política Andina de Recursos Humanos expresa la voluntad política al más alto nivel de los países miembros del ORAS CONHU de buscar juntos las soluciones más adecuadas a las necesidades actuales de región. Incluye una metodología de trabajo basada en cooperación sur-sur compartiendo fortalezas y experiencias propias de cada país pero que pueden servir al resto de países andinos, y persigue apoyar a las políticas nacionales de recursos humanos. La Política ha sido construida en base a los principios y valores de derecho a salud, equidad, universalidad, participación social, integralidad en el cuidado de la salud y se basa en los modelos salud familiar, comunitaria e intercultural que tienen los sistemas de salud de los países andinos.

Esta Política es un paso adelante en el proceso de integración en salud a nivel andino y surge como el producto del trabajo de los técnicos de los países, expresado en planes y acuerdos de trabajo que se han desarrollado en los últimos años en la región, acompañados de asistencia técnica de OPS y del ORAS. Su construcción e implementación refleja también procesos de articulación y complementación de agendas de trabajo entre los países la OPS/OMS y el ORAS-CONHU, lo cual permite potencializar recursos y tener una agenda única en la región andina. La Política tiene 5 líneas estratégicas que abordan los temas de preocupación común de los países y que coinciden en gran medida con los compromisos internacionales como los desafíos de Toronto y el código de ética de contratación de personal de salud de la OMS:

1. Fortalecimiento del rol rector de la autoridad sanitaria en los países andinos

2. Desarrollo de capacidades para sistemas de salud basados en la atención primaria, atención integral, salud familiar e interculturalidad

3. Fortalecimiento de la capacidad de planificación para disminuir la brecha de recursos humanos, incluyendo la gestión de la migración.

4. Desarrollo del trabajo decente y competencias para la gestión del trabajo en salud.

5. Desarrollo de la inteligencia colectiva en recursos humanos.

Los países andinos planteamos 2 compromisos:

1. Implementar el Plan de acción de la política andina de Recursos humanos planificado para el período 2013-2017

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2. Compartir este proceso con otras subregiones de las américas y de otros continentes



1. Mediante el monitoreo de indicadores establecidos en el plan de acción 2013 -2017

2. Evaluaciones anuales

3. Manteniendo como prioridad en la agenda política de los ministros de salud y tomadores de decisiones de los países de la región

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Vías de compromiso en materia de RHS UNASUR

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


El Grupo Técnico de Desarrollo de Recursos Humanos en Salud (GT RRHH), la Red de Escuelas Técnicas de Salud (RETS) y la Red de Escuelas de Salud Pública (RESP) del Consejo de Salud Suramericano – UNASUR reafirman los compromisos previamente asumidos acerca de los Recursos Humanos en Salud (RHS) en nivel Global (OMS y Declaración de Kampala), Regional (Metas Regionales de los Recursos Humanos en Salud de la OPS) y Subregionales (Mercosur, ORAS-CONHU, CARICOM y UNASUR); sobre todo al que se refiere al Plan Quinquenal 2010-2015 del Consejo de Salud Suramericano – UNASUR, en que se plantea entre sus resultados:

RESULTADO 27. Desarrollo de investigación y promoción de liderazgo en áreas prioritarias con base en las promociones del ISAGS. - Listado de estudios multicéntricos en la Región MERCOSUR, ORAS - CONHU - Definir una Agenda de Investigaciones Multicentricas relacionadas a la brecha de RHUS en los países integrantes del UNASUR Salud

Resultado 28. Impulsar la capacitación permanente en las redes de instituciones estructurantes en las áreas prioritarias de la Agenda de Salud de UNASUR.

- Diseñar dispositivos en capacitación en gestión

COMPROMISO 1: La Red de Escuelas Técnicas de Salud de UNASUR y el ISAGS se comprometen a impartir los esfuerzos para Identificar y analizar los contextos nacionales de la Educación y el Trabajo de los técnicos en salud, con vistas a elaboración de proyectos que puedan orientar y regular la oferta de educación técnica/profesional en salud en los países miembros de UNASUR, y promover políticas de organización e fortalecimiento de sistema de salud e de cooperación internacional entre os países miembros.

6. Nombre de la organización responsable: Rede de Escuelas Técnicas de Salud (RETS-UNASUR) e Instituto Suramericano de Gobierno en Salud (ISAGS)

Objetivo general: Fortalecer el área de formación de trabajadores técnicos en salud en los países integrantes de la UNASUR, a través del intercambio de experiencias y desarrollo de cooperaciones técnicas, con el objetivo de ampliar y mejorar las actividades de enseñanza, investigación y desarrollo tecnológico, conduciendo a la mejoría de los sistemas nacionales de salud y a su adecuación a las necesidades de sus poblaciones, y la integración regional. Objetivos Específicos: Monitorear y sistematizar, permanentemente, las informaciones relacionadas con el área de formación de los trabajadores técnicos de la

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salud y su interface con la organización del trabajo en salud, facilitando la identificación de tendencias y necesidades educacionales, con la finalidad de apoyar la definición de políticas públicas para el área; Fechas de finalización esperadas: Mapear, hasta 2015, a través de consulta a los Ministerios de Salud y Educación de los países miembros la situación actual de la formación de trabajadores técnicos de la salud en cada uno de los 12 países miembros de UNASUR, con identificación de los órganos de gobierno responsables de la formulación de políticas de educación de técnicos en el área de la salud, el marco legal de esta formación, y otras informaciones relevantes. Accesibilidad: Identificar similitudes y diferencias entre los distintos contextos nacionales, y las especificidades de cada país en esta área de formación. Aceptabilidad: Publicar informe con la sistematización de la información recogida en el 12 países de la región con el fin de permitir la construcción de futuras propuestas de ampliación de la oferta de educación técnica de acuerdo a las necesidades de cada país, en un contexto de colaboración y trabajo conjunto. Calidad:

1. Discutir los modelos de gestión del trabajo de los técnicos en salud vigentes en los países, para generar recomendaciones o estimular modelos de buenas prácticas.

2. Discutir los modelos de formación técnica/profesional vigentes en los países. COMPROMISO 2: Impartir los esfuerzos para ampliar La formación en Salud Pública en los países. Nombre de la organización responsable: Red de Escuelas de Salud Pública (RESP) e Instituto Suramericano de Gobierno en Salud (ISAGS)

Objetivos: 1. Identificar y analizar la oferta cuantitativa y cualitativa de educación en Salud Pública en Suramérica 2. Fomentar la creación de al menos un curso/centros/Institución formador en Salud Pública hasta 2015, en los países que no poseen ningún. 3. Discutir los modelos formadores en salud publica vigentes en los países. 4. Definir Lineamientos comunes sobre conceptos y prácticas de las Escuelas de Gobierno en Salud.

Fechas de finalización esperadas:

1. Identificar el cuantitativo de los de alumnos que han sido formados en cursos de grado y/o posgrado en Salud Pública en los países por esas instituciones en los últimos 2 años.

2. Generar capacidades a nivel nacional para ampliar el número de plazas. 3. Identificar el perfil de los de alumnos que han sido formados en cursos de grado y/o posgrado en Salud Pública por esas instituciones en los últimos 2

años y realizar una investigación sobre inserción laboral de los graduados en los últimos 2 años. COMPROMISO 3: Mejorar La calidad de los gestores de Recursos Humanos en Salud en los países de UNASUR.

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Nombre de la organización responsable: Red de Escuelas de Salud Pública (RESP) e Instituto Suramericano de Gobierno en Salud (ISAGS) Objetivos:

1. Identificar las ofertas en vigor de capacitación para gestores en RHS en los países. 2. Identificar las experiencias desarrolladas en cooperación entre los países en el ámbito subregional. 3. Identificar instituciones nacionales que se comprometan a impartir de forma coordinada con los Ministerios de Salud de los países capacitación para los

gestores en RHS. 4. Diseñar al menos 1 propuesta de capacitación en gestión de RHS, acordado entre los países, a partir de las experiencias en vigor y previamente

ejecutadas. Fechas de finalización esperadas:

1. Identificar el cuantitativo de los de gestores en RHS que han sido formados en cursos desarrollados en los países en los últimos 3 años. 2. Establecer acuerdos con las instituciones nacionales para ser tornaren multiplicadoras y así impartir de forma coordinada con los Ministerios de Salud de

los países capacitación para los gestores en RHS en los próximos 2 años.



Seguimiento Del Progreso: Reuniones periódicas – 1 al año presencial y las que se hicieren necesarias virtualmente – entre el GT RRHH, RESP, RETS e ISAGS para verificación dos avances alcanzados y compartir resultados y dificultades verificadas. Indicadores:

1. Número de ofertas de formación en educación técnica/profesional analizadas. 2. Número de plazas ofrecidas en el cada país para La formación en Salud Pública. 3. Número de becas /vagas ofrecidas por los gobiernos /Ministerios de Salud. 4. Número de propuesta de capacitación en RHS dibujada e impartida en los países.

Fuentes de datos: - Informaciones presentadas por el MS de los países, las instituciones miembros de La RESP y RETS. - Informaciones y estudios correspondientes disponibles en OPS. - Estudios desarrollados por expertos en los temas.

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HRH commitment pathways PALESTINIAN AUTHORITIES


The provision of efficient human resources capable of providing health services of high quality

The members of the health care teams are the main tools in the process of change, reform, innovation, and continuous improvement in the health care delivery services. Therefore, human resources for health (HRH) must be chosen carefully, developed professionally, and given respect and appreciation. The recruitment and retention of the appropriate HRH is becoming more difficult in Palestine; in addition to the shortage of qualified human resources - physicians, specialized physicians, registered nurses, registered midwives, and other health care workers – which is one of the important obstacles for advancements in health care.

There is a need to find a comprehensive strategy for the health workforce focused on building and the promotion and development of national human capacity in the long term to ensure the sustainability of the health care system. This requires a data base to include all the forces operating in the field of health for the establishment of the National Observatory of health human resources (HR Observatory) and the provision of a highly qualified workforce possesses the administrative and leadership skills necessary to ensure the construction of a health care system of high quality. The Palestinian Ministry of Health highly appreciates the efforts of all the forces working in the health field in order to better health in the State of Palestine , and in this context , the Ministry seeks as the main sponsor of the health sector to support the following actions:

MOH objectives and action plan for 2014-2016 to develop human resources for health.

أهداف تنمية الكوادر البشرية الصحية Objectives for Human Resources for Health

2014-2016

التدخالتActions

2016المخرجات بحلول العام Expected Outcomes Timeline Stakeholders roles

1

The establishment of the National Observatory of human resources for health انشاء المرصد الوطني للموارد البشرية الصحية

Creation of a database of the workforce in the Palestinian health sector

في القطاع الصحي الفلسطينيانشاء قاعدة بيانات للقوى العاملة

National Observatory of the workforce in the health sector established

أنشىء المرصد الوطني للقوى العاملة في القطاع الصحيDec, 2014

Public Health Institute (PHI) /WHO in coordination with MOH

Using evidence from HRH observatory as the base for HRH decision making, management, and monitoring of Human Resources in Palestine. االستفادة

راهين في بمن المرصد الوطني في وضع سياسات مبنية على الدالئل وال تنمية الموارد البشرية الصحية

National Observatory of the workforce in the health sector is used by decision-makers. المرصد الوطني للقوى العاملة في القطاع الصحي يعمل ومستخدم من قبل اصحاب القرار

Jan, 2015- to Dec, 2016

MOH in coordination with PHI/WHO

2

Professional development to ensure the health of the forces

Development and adoption of the system of incentives تطوير واعتماد نظام الحوافز

Incentive system adopted and implemented Dec, 2015 نظام الحوافز معتمد ومطبق

MOH, General Personnel Council, and related stakeholders

Adoption of the job description for the government Job Description adopted and implemented. Dec, 2014 MOH, General

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operating in the Palestinian health sector

ضمان تطوير مهني للقوى الصحية العاملة في القطاع الصحي الفلسطيني

health sector workers الحكومياعتماد الوصف الوظيفي للعاملين بالقطاع الصحي

Personnel Council, and الوصف الوظيفي معتمد ومطبقrelated stakeholders

The development and institutionalization of continuing education programs تطوير و مأسسة برامج التعليم المستمر

Accredited continuing education program adopted and implemented. برنامج التعليم المستمر معتمد ومطبق

Dec, 2015 MOH, and related stakeholders

The development of e-learning programs as part of the continuing education programs

االلكتروني كجزء من برامج التعليم المستمراستحداث برامج التعليم

E-learning continuing education program adopted and implemented. برنامج التعليم المستمر معتمد ومطبق


Provide the necessary training for specialists and technicians build on the basis of clear needs assessment

والفنيين بناء على اسس واضحة من توفير التدريب الالزم لالختصاصين تقدير االحتياجات

Updated needs assessment for HRH specializations is sent yearly to possible scholarship sponsors

يتم إرسال تحديث سنوي لإلحتياجات التعليمية و التخصصات المطلوبة للكوادر الصحية للجهات الممولة

June, 2014- June, 2016

MOH and related stakeholders

Institutionalize the process of directing the staff and facilitate the process of integration in the enterprise through the "induction program for new employees"

من مأسسة عملية توجيه الموظفين و تسهيل عملية الدمج في المؤسسة.خالل "البرنامج التعريفي للموظفين الجدد"

Induction program for new employees adopted and implemented

معتمد و مطبقالبرنامج التعريفي للموظفين الجدد

June 2014-Dec, 2016

MOH, and related stakeholders

Focus on the cycles of continuous professional development mandatory for health professionals التركيز على دورات التطوير المهني المستمر االلزامي للمهنيين الصحيين

Mandatory CPD courses adopted and implemented دورات التطوير المهني المستمر االلزامي للمهنيين الصحيين معتمد و مطبق

June 2014-Dec, 2016


3

Keep up with scientific and technological progress in health مواكبة التقدم العلمي والتقني في المؤسسات الصحية

The use of information and communication technologies in the health monitoring

استخدام نظم تكنولوجيا المعلومات واالتصاالت في الرصد الصحي

Various health monitoring systems operate effectively and accurately. أنظمة الرصد الصحي المختلفة تعمل بشكل فعال و دقيق

Jan, 2015-Dec, 2016


Develop and support health research in collaboration with the Institute of Public Health

تطوير ودعم البحث الصحي بالتعاون مع معهد الصحة العامة

Increase in the number of health research carried out.

عدد االبحاث الصحية المنفذةزيادة

June, 2014-Dec, 2016

MOH, PHI/WHO, , and related stakeholders

Benefit from international expertise and medical delegations through on job "training" and distance learning.

"التدريب خالل االستفادة من الخبرات الدولية والوفود الطبية من خالل واإلتصال عن بعد. العمل"

Telemedicine program is used by health professionals.

مستخدم من Telemedicineبرنامج التطبيب عن بعد المهنيين الصحيين.

June, 2014- Dec, 2016


Provide the infrastructure and adequate support for the establishment of libraries and centres for continuing education in health institutions توفير البنية التحتية والدعم الكافي النشاء مكتبات ومراكز للتعليم المستمر

في المؤسسات الصحية المختلفة

Continuation of "on job training" method and teaching hospitals. The infrastructure and adequate support for the establishment of libraries and centres for continuing education in health institutions are available.

التدريب خالل العمل" والمستشفيات التعليمية“استمرار ومراكز للتعليم البنية التحتية والدعم الكافي النشاء مكتبات

متوفرة. المستمر في المؤسسات الصحية المختلفة


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The general directorate of continuous and higher education (GDCHE) is one of the main directorates at MOH that aims at development of human resources in Palestine. The following represent the vision and mission of the GDCHE:

Vision: To maximize the professional development of health workforce by using the best CPD methods that meets the global demands and standards

for health work force.

Mission: To promote training, education, continuing professional development, and research essentials to advance the competence and performance of

healthcare professionals through the creation of scholarly services that foster professional development of health work force to ensure safe and quality

health care services.

The GDCHE is aspiring to develop a detailed strategic plan for 2014-2016 which focus mainly on the three main strategic objectives listed in the MOH strategic

plan for developing HR:

1- The establishment of the National Observatory of human resources for health

2- Professional development to ensure the health of the forces operating in the Palestinian health sector

3- Keep up with scientific and technological progress in health

Furthermore, the GECHE strategic plan will addresses the capacity building of the cadres working at the GDCHE as well as other strategic priorities that are

recommended by other important stakeholders including the Ministry of Higher Education, local universities having academic health programs, NGOs, health

syndicates, and international organizations. These priorities include:

1- Integration of the following globally highlighted knowledge and competencies within the local basic academic health programs:

• Orientation to the electronic health information system (HIS)

• Nationally adopted health guidelines and protocols.

• Foundations of quality and patient safety.

• CPD system for faculty development.

• Update for the students clinical training system. i.e. use of trained preceptors to facilitate clinical training.

2- Develop clear policies regarding the follow-up and evaluation of health professionals who receive trainings and specialization programs.

3- Participate in the update of licensing systems for health professionals to ensure safe health care practices.

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In order to pursue and monitor the implementation of the commitment with its competent areas, following monitoring indicators have been determined by the end of 2016 :

Indicator Information Source

The percentage of HRH covered by the National Observatory of the workforce in the health sector. PHI, and syndicates information system

The number of Health institutions in Palestine adopting and implementing incentive system for HRH. MOH information System

The percentage of HRH who has Job Description that is adopted and implemented. MOH & stakeholders information System

The number of accredited continuing education programs that are adopted and implemented. MOH-GDCHE

The percentage of improvement in job satisfaction of HRH. MOH-baseline and follow-up study

The percentage of new employees at health institutions in Palestine who received an induction (orientation) program. MOH-GDCHE

The number of HRH who received Mandatory CPD courses according to approved national list for each HRH category. MOH Information System

The number of HRH decision makers using HIS data for HRH decisions. MOH Information System

The number of health research carried out within the state of Palestine. MOH and PHI

The number of health professionals who used Telemedicine program technology. MOH and related stakeholders

The number of newly established libraries and CPD centres within health institutions in the state of Palestine. MOH and related stakeholders

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HRH commitment pathways Réseau des sages-femmes francophones / Midwives French Speaking Network:


Counting on the nucleus of multidisciplinary, clinicians, academicians, investigators, international, inter-institutional … members

- Provide the Network with a formal support structure and with French speaking midwives’ collaborators;

- Connect the Midwives from the North and the South to exchange their capacities and experiences and provide mutual support related to their needs (N-N,

N-S, S-N, S-S);

- Assemble the partners and collaborators, national/international, multidiscplinary, etc.

- Benefit from the support of NGOs and GOs favoring the women, infants… societies (AMPS-GHWA, OMS, UNICEF, UNFPA, AMREF, Save the children),

etc.

- Develop a 5-year strategic plan to implement different activities that allow the attainment of the main objectives … and that through …

Activities targeting the 3 systems that are involved in the development of the professional role:

- Pedagogic System: Initial and continuing training; contribution to the development and disseminating of their own and specific disciplinary knowledge;

training the trainers (Competency Based Program), etc.

- Professional System: Organizing the professional practice; evidence-based practice; collaboration; professional autonomy (College & association); etc.

- Socio-politico-cultural System: Rules; Bill; Place and image in the society; etc.

And that, while respecting the international standards (ICM, WHO, UNFPA, etc.) and according to the members needs.

//

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1. Quelles sont les actions – voies en matière de ressources humaines pour la santé (RHS) sur lesquels votre pays/institution peut s’engager?

Tablant sur le noyau de membres multidisciplinaires, cliniciens, académiciens chercheurs, internationaux, inter-institutionels, etc. déjà existant:

- Donner au Réseau une structure formelle de support et de collaborateurs avec les SF francophones;

- Rallier les SF du Nord comme du Sud pour s’entraider et échanger leurs capacités et expériences…. (N-N, N-S, S-N, S-S);

- Rallier les partenaires et collaborateurs nationaux/internationaux, multidisciplinaires, etc.

- Bénéficier du support et du parrainage d’ONG, d’OG… favorables à la cause de la SF et par là-même à la cause de la femme, de l’enfant… des sociétés

(AMPS-GHWA, OMS, UNICEF, UNFPA, AMREF, Save the Children, etc.)

- Mettre en place un plan stratégique quinquennal pour implanter les activités qui lui permettent d’atteindre son but et ce par le biais …

… Activités cibleront les 3 systèmes entourant le développement d’un rôle professionnel :

- Système pédagogique : formation de base et formation continue; contribution au développement et à la dissémination des connaissances propres à la

profession; formation des formateurs (Programme basé sur les compétences); etc.,

- Système professionnel : organisation de la pratique professionnelle; pratique basée sur les données probantes; collaboration; autonomie

professionnelle (ordre et association); etc.

- Système socio-politico-culturel : règlementation; loi; place et image dans la société; etc.

et ce, dans le respect des standards internationaux (ICM, OMS, UNFPA, etc.) et selon les besoins des membres.

1. ORIGIN OF THE NETWORK

The Francophone Midwives Network has been created following the first International Congress of Francophone midwives of the International Confederation of Midwives (ICM) held at Montpellier-France in 1998. Many participating midwives, independently of their origin, expressed their need to grant more importance for research in the development of their professional practice. This need was materialized through raising awareness for the necessity to resort to the development of research projects. Those projects would help to review their practice and promote its visibility as well as to develop specific midwifery knowledge adapted to their specific cultural context. Moreover, the francophone midwife realized (acknowledged) the necessity (importance) of

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diffusing the results of her researches and of research in general thus favoring the development of the profession and its evolution according to the general norms and standards required.

On the occasion of our participation to this congress, we were solicited by the midwives from different francophone countries to contribute and help them contribute to the development of the Reproductive Health in general, the safe-motherhood and the midwifery practice particularly as well as the dissemination of knowledge using the French language. The decision was to create a Network for the development of research covering the safe-motherhood and the midwifery profession in the francophone world. It was thought that such a network will consider the contribution of investigators from different disciplines from Quebec and all over the Francophone world, the World Health Organization, and the International Confederation of Midwives.

In June 1999, we received a grant from the Social Sciences and Humanities Research Council (SSHRC-CRSH) (40,000 $CA) to establish the strategic planning of the Réseau francophone interdisciplinaire pour le développement de la recherche sur la maternité sans risques et de la profession de sage-femme. This project allowed the meeting of investigators, clinicians, professors/lecturers from different disciplines as well representative from regional, national and international organisms interested by the development of knowledge in the domain of perinatality and reproductive health in the francophone world. These partners defined the mandate, the objectives and the principal strategies of the Network.

The objectives of the network at its creation were formulated as follows… The Network for the development of research covering the safe-motherhood and the midwifery profession in the francophone world (Le Réseau Francophone Interdisciplinaire pour le Développement de la Recherche sur la Maternité sans risque et de la Profession de Sage-femme) will aim at :

• “Creating a community of francophone midwives that target the improvement of the quality of services and care offered by the midwife and the development of the profession through the development of research activities about as regard to the midwifery practice and its collaboration to the multidisciplinary team in reproductive health;

• Allowing the francophone midwife to contribute more adequately to the development of promotional, preventive, rehabilitating and curative health programs for mother-newborn and infant and particularly for a safe-motherhood ».

In order to attain these objectives at the planning phase, two workshops –regrouping investigators from different disciplines as well as from national

and international institutions – took place in Montreal (February 16-17th 2000 and October 30-31st 2000). The basic structure of the Network was established (see the list of participants in the Appendix) with a plan for the starting activities. 2. Evolution

In the absence of financing, the Network’s activities were limited and couldn’t attain the desired volume. Its evolution was realised through:

- A smooth light structure adapted to the situations and needs In fact, in the absence of real financing, the Network functioned on a virtual fashion i.e. according to a light structure that aim to mobilize the members related to the specific need expressed by francophone colleagues midwives. The solicitations are received via the Université de Montréal (UdeM) or the midwives

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activities such as the triennial congress of the ICM, the Réseau Mère-Enfant de la Francophonie, etc. The invitation of the members to participate is based on their expertise and specialty corresponding to the activity to be implemented as an answer to the solicitations and the needs.

- Broadening the connexions Since its creation in 1999, the network broadened its connections and collaborations in the North and the South. Thus, in the South, the Network developed its contacts with the Fédération des Associations de sages-femmes de l’Afrique de l’Ouest et Centre-Africaine (FASFACO) as well as with a few national associations. Presently, we are producing a collective book50, representing 14 countries, written by francophone midwives to tell present their situation while facing the MDGs 4 and 5 in their respective countries. The book have been edited by the publisher at the Ste-Justine’s hospital, Quebec’s Mother and Child’s Center, head office of Mother and Child’s Francophone Network (Réseau Mère-Enfant de la Francophonie) (http://www.rmefrancophonie.org/).

In the North, the collaborations are developed gradually with the midwives’ associations in France (association of educators, Conseil de l’Ordre des sages-femmes, etc.), in Switzerland with the Federation des associations des sages-femmes, educators/ researchers from the schools of Geneva and Lausanne as well as midwives from Belgium; among these midwives, figure a few members who received/or are preparing a doctorate in epidemiology/clinical research at the INSERM. We also can count on the collaboration of a Swiss Midwife, Senator and President of the Federation des associations des sages-femmes suisses, Mrs Liliane Maury-Pasquier; she accepted to be the God-mother of the Network. These are co-authors of the collective book; they present the lessons learned across the centuries and offer their services to collaborate with the South midwives. We are facing presently many offers asking for collaboration with the colleagues from the South in the context of different projects (e.g. project currently in development in D.R.Congo; solicitation from Cameroon and Burkina-Faso). Nevertheless, it is essential that we consolidate the involvement of the MW from the North and benefit from their collaboration for the global need of advocacy for the profession as well as for the beneficiary of their services – mainly Mother and child – and that in the North and in the South countries.

Moreover, the Network has been developed through the evolution of the members’ career and their collaborations which offers the access to a variety of disciplines and to multiple resources from a variety of national, international francophone and other origins. For example, the main investigator is a key-mentor investigator through the strategic initiative financed by the Canadian Institutes for Health Research (CIHR-IRSC) and entitled : “CIHR - Quebec Training Network in Perinatal Research – QTNPR)”; she is also a mentor investigator through the CIHR-strategic initiative entitled : “Global Health Research Capacity Strengthening Program (GHR-CAPS)”. Many mentors in these initiatives are already members of the Francophone Midwives’ Network.

- A contribution to the development of a core group of midwives having a graduate level diploma and up Along these years, we contributed to the training of francophone midwives at a 2nd level or graduate studies (Lebanon, Morocco, D.R.Congo) and at a postgraduate level or doctorate at the UdeM and elsewhere (candidate from Lebanon, Tunis, Iran). Many demands for supervision through Master’s and doctorate studies are expressed. Nevertheless, the main obstacle is always the financing of such studies which, unfortunately in the francophone world, is not 50 The countries are : Belgium, Benin, Mali , Burkina-Faso, Cameroon, Côte d’Ivoire, France, Haiti, Lebanon, Morocco, Democratic Republic of Congo, Senegal, Switzerland, Togo, Tunis.

http://www.rmefrancophonie.org/

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easy to find for the midwife; these health personnel is labeled as a “technician insufficiently developed” which does not offer the best candidates’ profile for such studies.

- An expertise and specialization in the domain of reinforcement of midwifery profession, to attain particularly the MDG 4 and 5 The responsible for the creation of the Network, Dr. Marie Hatem is an associate professor at the Department of Social and Preventive Medicine - UdeM. Nurse and Midwife trained at the Université Saint-Joseph – Beirut, Lebanon. She holds a M.Sc. in Health Administration and a Ph.D. in Public Health, from the Faculty of Medicine-UdeM. Her thesis covered the development of health professionals’ educational curricula; her population study was the rebirthing midwifery profession in Quebec (1990s). She had also participated to the evaluation of the midwifery profession in the pilot-projects in Quebec through the process of its legalization. Her research domain of interest embraces the health professional’s education and practice particularly those working in the reproductive health services. She is the first author of the Cochrane Systematic Review on the midwifery practice51 and the director of the collective book on midwifery in the francophone world that has been recently published. She assumes the advocacy of the Network to ensure its contribution to the efforts aiming the reinforcement of the francophone midwives through the strategies intended to reduce the mother-new-born-infants’ morbidity and mortality particularly through the France-Muskoka Initiative.

She also accomplished, since the creation of the Network, different consulting activities (e.g. WHO, UNFPA, private sector) for the development of the midwifery profession in different countries: Lebanon, Morocco, Djibouti, Iraq and DRCongo (current project). All this, led her to realize a sabbatical stay of 7 weeks at the WHO-Geneva, at the Reproductive Health Research in collaboration with the Department of Mother and Child and the Department of Human Resources. Her global aim during this stay was to provide the Network with a potential of formal functioning and utilization of all its resources thus to allow the francophone midwives to be more effective in their contribution to attain the MDGs4 and 5.

- A utilization of the electronic resources and a connection with the francophone midwives During the sabbatical stay at WHO_Geneva, M. Hatem was involved, among others, in a training activity aiming to empower the midwives through the utilisation of the electronic resources: cell phone and Internet (mHelath & eHealth). The program called EMANIT, was developed by Dr H. Bathija at the Department of the RHR, WHO-Geneva. It offers an online training, one session per week, via a network for eHealth in Africa called the RAFT (Réseau en Afrique Francophone pour la Télémédecine), coordinated by the Geneva University Hospitals (HUG), since 2000 (http://www.raft.hcuge.ch; http://www.who.int/workforcealliance/members_partners/member_list/hugraft/en/index.html). The sessions covering the francophone midwives’ context and the means to bring a change to the quality of their reproductive health care and services starting with the main concepts that must orientate their efforts: 51 Hatem M, Sandall J, Devane D, Soltani H, Gates S. Midwife-led versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667- Oct. 2008

http://www.raft.hcuge.ch/

http://www.who.int/workforcealliance/members_partners/member_list/hugraft/en/index.html

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Human rights and reproductive health rights, humanized and continuity of services, empowerment, relation/communication caregiver-client, Competency based education, etc. To mobilize the francophone midwives community and invite them to participate, she mobilized the Network’s list which comprises 50 names and e-mail addresses in many African Sub-Saharan and North African countries, French overseas territory and Haiti.

These midwives are mostly state employees in their country, in charge of midwives’ training, presidents of midwives associations and Federation of associations, representatives of international organisms (UNFPA, WHO, ICM) and a few individual members. The answer to the invitation was positive and we started the first session on May 10, 2012. These activities are currently pursued from Montreal, UHC Saint-Justine, Quebec’s HC Mother and Child.

- Involvement with GHWA through the Muskoka French Fonds Initiative Since August 2012, our Network is offering its services and collaboration to GHWA through the HHA activities with collaboration of H4+ in different

projects: desk review of the literature covering the management of Human Health Resources; analysis of the situation of the Health personnel responsible for Mother and Child’s Health (MCH) in different French Speaking countries (Guinée, Togo, D.R.Congo); planning and implementing presently an action-research on the retention of the HR responsible for MCH in Bénin, Burkina-Faso and Senegal (UNICEF Fonds); etc.

Finally, during 2011-2012, M. Hatem developed, at the UdeM, a micro program in interdisciplinary research in reproductive health, at a graduate level. It will be accessible to the francophone midwives who are eligible to complete studies at a graduate level.

3. Structuring Network Current mobilisation

The Network is presently in a period of restructuring to be able to intervene officially. We are developing a progressive strategic plan that consists on restarting the earlier members who stayed tuned to check for their interest to be associated to this rebirth; the aim is to constitute a group ready to contribute to the efforts aiming the attainment of the MDG4 and 5 beyond the 2015 deadline for the MDG Initiative. Until now, the results of the solicitation have been productive and most of the individual and groups approached answered positively. It is clear at this phase, that the Network will devote itself a formal structure once it will hold its 1st general assembly.

We consider the creation of different styles of membership or implication/engagement in the Netwrok’s activities independent from their affiliation or origin (North/South), coming from different professional practice settings: academic (researcher/teacher), clinic (cadre clinician from different settings) and/or organizational (order, association, etc.); thus:

Among midwives:

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1. The main nucleus of experts includes the participants with a senior practice profile. They will be responsible, among others, to process the demands for service and to prepare the offers directly themselves or by inviting the members whose profile is the most adequate to accomplish the mission expected;

2. The supporting members coming also from the 3 professional domains : it is every midwife who is willing to offer her services in the context of any mission identified by the main nucleus;

3. The members in training or those who can benefit from the Networks’ services: students, associations, etc. 4. The honorary members whose social and professional role can help advocate the Network and the Midwife in general, and particularly the women and

children.

Among the partners:

5. The professionals members of the multidisciplinary team working in the domain of maternal and child’s health : MD, nurse, psychologist, physiotherapist, pharmacist, etc.;

6. The institutions that offer maternal and child’s health services: WHO, Francophone Mother and Child’s Network (RMEF), INSERM, Ste-Justine’s Hospital, Universities, Orders, etc.;

7. NGO and beneficiary groups particularly from southern countries.

While constituting the Network’s formal structure, a place will be reserved to each category. A general assembly is being prepared to grant the Network a formal structure as soon as possible. We would have loved to hold this assembly on the occasion of the 3rd Global Forum in Recife. The delay in receiving the decision of acceptance of our proposal of side-event may prevent us from having the event that we would like to have: in general, it is difficult for Midwives from French Speaking countries to find a financial support for global activities, continuing education, etc.; on a short term it will be more difficult, but we are still working on!

4. Proposed services : framework and potential projects

Our target is to combine the resources that we have at our disposal presently – with that of the Muskoka’s intitiative Programs through GHWA or others – related to the French speaking midwives’ needs and expectations. To do so, we apply a global framework developed on the occasion of the context analysis in which a new profession is implemented52; in the present case it is the profession’s remodeling to adjust it to the actual current realities.

According to this framework, a profession evolves through the interaction of 3 systems (or paradigms)(Figure 1 below) having each of them the following dimensions: i) axiology (vision, mission, values, rules, etc.), ii) teleology (finality or specific goals), iii) methodology (strategies, human resources,

52 Hatem-Asmar M, Fraser W, Blais R, Levy R. Choix du Paradigme Éducationnel pour la Formation de Sages-femmes au Québec. Ruptures, 2003: 9 (1), 86-102.

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financing, etc.), and iv) ontology (different individual or collective concerned actors, involved or engaged). For a health profession to be able to evolve correctly, the 3 systems must present inter and intra coherence. Thus, to favor the development of the midwifery profession (disciplinary system) and to allow its contribution to the governments’ efforts to attain the MDGs 4 and 5, her practice and training must be coherent with the socio-cultural system and must adhere to the MDGs underlying values : Human rights vision, women centered care, etc. In the absence of a complementary, cohesion and positive interaction between and among these systems, the aimed objectives cannot be attained easily and the obstacles will remain numerous. Thus, an intervention in such context cannot be limited to a specific intervention as a continuing education, or the reinforcement of an association, etc. A global strategy is required; this must target the elements that represent a barrier at any level or component of the 3 systems.

Figure 1. Structure of the different paradigms disciplinary, socio-cultural and éducational2

In this context, the Network considers itself as a nucleus of a Community of Practice – North-South, North-North and South-South – ready to be mobilized judiciously. Based : 1) on our global vision already applied in the analysis and the development of action plans targeting the midwifery profession in the North as well as in the South countries; and 2) on the human resources from a variety of disciplines and on the individual and institutional international collaborations engaged in the maternal and infant health among which we mobilize the required resources, our Network have already been involved and is ready to dedicate its resources to establish different activities such as: diagnosis studies; development of pilot-projects of new evidence-based intervention and their generalisation; revision of the basic curriculum and continuing education based on the competencies; collaboration to the continuing education of the multidisciplinary reproductive health team; and, evaluation of the interventions. (see proposed services above).

The Francophone Midwives’ Network is located at the, Research Center of the UHC- UdeM in collaboration with the UHC Mother and Child, Ste-Justine Hospital at least until establishment of the next official general members’ assembly.

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APPENDIX

Members who participated to the initial activities of the Network 1999-2000 (their titles then):

• Sabina Abou-Malham, M.Sc. midwife lecturer, School of midwives- USJ Beirut, Lebanon • Heli Bathija, MD, Department of Health Reproductive research, WHO, Geneva • José Belizan, MD, Center for Perinatology and Human Development (CLAP, OPS-WHO) • Béatrice Blondel, INSERM, Paris, France • Michel Boulvain, Obstetrician Gynecologist, Hôpitaux Universitaires de Genève, Switzerland • Anne Burkhalter-Fasnacht, Midwife, Switzerland • Marianne Carayol, Midwife, INSERM, Paris, France • Michèle Champagne, Midwife, Ordre des sages-femmes du Québec • Nayla Doughane, School of midwives- USJ Beirut, Lebanon • Atf Gherissi, Midwife, Tunis • Marie Hatem-Asmar, principal investigator, professor, Faculty of Nursing Sciences- Université de Montréal • René Hivon, Ph.D. Medical Pedagogy, Université Sherbrooke • Hélène Delisle, Department of Nutrition, Faculty of Medicine, Université de Montréal • Michèle Deschamps, Nurse, Ph.D. Women’s Health (autochtones) and cancer, Direction of Public Health, Montreal. • Ema Ferreira, perinatal Pharmacology périnatale, Hôpital Ste-Justine • Lucia Floris, Midwife, Hôpitaux Universitaires de Genève, Switzerland • Diane Francoeur, MD, Hôpital Ste-Justine – Collège des Médecins du Québec and Association of Obstetrician and Gynecologists of Quebec. • William Fraser, MD, M.Sc. Expert in Perinatal Epidémiology– Clinical Trials and Professional Practices Unit – Université Laval • Suzanne Kerouac, Nurse, M. Nursing, M.Sc. épidémiologie - Professor – Management of Nursing care and academic program in nursing care – dean, Faculty of Nursing -

Université de Montréal. • Jacques Lacroix, Hôpital Ste-Justine and Representative Université de Montreal’s Cochrane site • Lyne Leduc, Obstetrician Gynecologist, Hôpital Ste-Justine, Université de Montreal • Rona McCandlish, midwife investigator, UK • Marianne Mead, midwife, London UK, representing the International Confederation of Midwives (ICM), section francophone • Jeanne-Clémence Moukabi-Nkembongani, Midwife, Gabon • Jean-Marie Moutquin, MD, Department of Obstetrics and Gynecologists, Université de Sherbrooke • Mathy Ndoye, Midwife, Senegal • Christine Paradis, Midwife, Quebec • Liette Perron, Society of Obstetrician and Gynecologists of Canada (SOGC) • Daniel Reinharz, MD, Ph.D. Public Health – Health Economy and health care organisation – Clinical Trials and Professional Practices Unit – Université Laval • Marie-Claude Renault, Midwife, France • Fatima Temmar, Midwife, Morocco • Réjean Tessier, psychologist specialised in perinatality, Ph.D, Université Laval, Clinical Trials and Professional Practices Unit – Université Laval • Sylvie Vandal, Nurse, Ph.D in measures and evaluation – Ste-Justine’s Research Center– Faculty of Nursing Sciences – Université de Montréal. • Bilkis Vissandjée, Nurse, Ph.D. Faculty of Nursing Sciences – Université de Montréal; Centre d’excellence pour la santé des femmes

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Collaborators and partners In Quebec, the network will be supported by: • The research Center of Ste-Justine’s Hospital –multidisciplinary team: Dr Émile Levy, director • Clinical Trials and Professional Practices’ Unit – Université Laval : Dr William Fraser, chef d’unité • Faculty of Nursing Sciences – Université de Montréal : Mrs Suzanne Kerouac, dean It receives, on the national and international levels, the collaboration of: • The International health Unit – Fac of Medicine – U. de Montréal (GRASP – GRIS) • le Centre d’excellence pour la santé des Femmes - U. de Montréal • The Department of Social and Preventive Medicine – U. Laval • Faculty of Nursing Sciences – U. Laval. • Faculty of Medicine – Université Sherbrooke • ICM – International Confederation of Midwives – section francophone • WHO – World Health Organization – Geneva – Safe Motherhood • Institut National de la Santé et de la Recherche Médicale (INSERM) – Paris. • Associations of Midwives from different francophone countries (Africa, Asia, Europe, Middle-East; North Africa and Quebec). Presently… Our member list comprises over 125 names and coordinates of individual and group members from the North and the South…

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HRH commitment pathways Save the Children, India


Challenges: In the last 7 years India has made great progress in terms of improving its mortality and morbidity figures. Some states have already achieved MDGs, few are very near it, and only few of them are lagging behind. But states, lacking behind are those that house large population in them. World Health Report 2006 placed India among the 57 countries in HRH Crisis (density of health workforce less than 23 per 10,000 populations), India has made significant progress since then but still a lot has to be done to reach the WHO norms.

The density of Human Resource for Health is further disproportionate between High Priority districts (as identified by Government of India) and other districts of India. Some of the well-known reason for these skewed distribution is, low local production of skilled manpower in these areas, irrational deployment of skilled manpower and poor retention of the human resource in these high priority districts.

Some of the underlining reasons for poor retention of skilled manpower in these areas is lack of incentives for better performing staff, improper transfer policies,non transparent promotion policies etc.

Thus all these factors together have a cascading effect, poor availability of manpower, leading to overburdened existing manpower, compromise in quality of care and finally affecting quality of service delivery.

Some of these observations were confirmed by studies done by Save the Children on some of these issues in various part of the country.

Commitment:

Save the Children India commits to work in synergy with Government of India and other partners to:

1- Policy

Provide technical assistance for the development of national guidelines/policy for HRH, which can set a framework for state HRH policies to follow.

2- Advocacy

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We will conduct advocacy and campaigns to highlight the importance of increasing the number of health workers, and strengthening their impact through funding, capacity-building, equipping and role rationalization. In particular, Save the Children India will facilitate annual “Real Awards” for frontline health workers to be given out at events relating to Safe Motherhood Day in April every year. The Real Awards is a global initiative by Save the Children to reward and recognize the contributions of health workers, and partnership with GOI in instituting these awards at the national level would facilitate great prestige, visibility and sustainability even internationally. Measurement: Time frame : 5 years Indicators: Draft national policy on Human Resource for Health Institutionalisation of Real Awards.

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HRH commitment pathways SWASTI


Introduction Swasti (meaning –well being) is an international health resource centre based in India and working across Asia and Parts of East and South Africa. We work with and our commitments are towards vulnerable and marginalized communities, civil society organizations and other development partners. By energizing systems behaviours and social determinants we focus on comprehensive development approaches towards achieving better health outcomes for the poor and the marginalized. We have three approaches:

1. Innovative Models for Impact: This means we develop innovative, replicable and sustainable models to solve complex public health challenges.

2. Partnership for Results: Build and maintain partnership for results – this means we support our development partners achieve their results through need

based technical support

3. Knowledge Management and Policy Shaping: This means we contribute to public health knowledge to shape program design and policies in critical

niche areas.

HRH Commitment Swasti is committed to Global efforts in addressing health workforce issues through:

1. Generating and sharing knowledge on good practices in HRH by conducting research, documenting good practices, developing knowledge capsules,

and fact sheets.

2. Developing, testing and influencing policies by working closely with policy makers, using evidence from research to showcase ‘what works’ and

build capacity of the government officials, provide evidence to build policies and build systems for implementation of the policies.

3. Developing and testing strategies and practices (including tools and guidelines) by developing models of HR systems and practices in health,

developing tools to improve HR practices, dissemination of good practices and learning through global and regional forums.

4. Support state and non-state actors in implementing change by developing and building capacities, provide technical assistance, develop protocols

and systems and support in mobilizing resources to facilitate implementations

‘No health without health workforce’ Swasti invites all of you to join us in committing to innovate and invest towards impacting on People for Health to generate Health for the People

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HRH commitment pathways Tanzanian Training Centre For International Health


HRH commitments: eLearning in Maternal ,Neonatal and Child Health for Associate clinicians Targets: First batch of 25 grandaunts by April ,2014 (3 months duration programme)


Using the Objective Structured Clinical examination (OSCE) - Supervision reports

- Learning assessment tools

Data sources:

- Registration

- examinations results

- Observations

- Interviews

- Inputs of eLearning staffs

- eLearning working procedure

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HRH commitment pathways The Voices Of Women Health Workers In India


Scope:

1. Addressing research and documentation gaps that help towards strengthening the contribution of the CHW in health services with special reference to India.

2. Facilitating the voice of woman health workers with special reference to India.

Commitment One: A country case study from India on CHWs

Date of submission: December 16. 2013

Title of the proposed report: Country Case Study India: The Accredited Social Health Activist (ASHA), a Community Health Worker program

Background: India has been running a large scale CHW program with women village health workers called ASHAs since 2005. ASHA which means hope in Hindi, functions within the public health services in the rural areas. Success includes training, monitoring and supervision of ASHAs by local health functionaries. ASHAs carry out basic curative functions, referral and escort, home visits and information – giving activities in their own villages. Their performance is closely documented in recent national studies and found successful in increased referral of pregnant women for institutionalized delivery; facilitation of increased immunization coverage and basic curative care across all regions.

Scope of the proposed report:

A pan India review of the ASHA program referring global literature, government reports and recent studies.

Structure of the findings of the proposed report:

1. CHW s in India 2. The ASHA program

2.1 Program design 2.2 Population coverage

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2.3 Training 2.4 Monitoring 2.5 Performance: successes and limitations

3. Progression and gaps: a historical analysis

4. Conclusions : Identification of national and global strategies for strengthening the ASHA program. The ASHA program is seen as the latest in a tradition

of CHW programs and the strategies will apply to all large scale CHW programs. Resources for commitment: Self funded

Commitment Two: An unpublished qualitative research study on a large scale CHW program from India

Date of submission: January 30, 2014

Nature of submission: A qualitative study on motivations and critical job attributes most valued by CHWs in a large scale public health CHW program in India, namely The Accredited Social Health Activist (ASHA) program. This unpublished study was completed in 2012.

Title of the study: Challenges of sustainability in large scale CHW programs : a qualitative study on the ASHA program of India

Scope of the study: A qualitative research study using mixed methods on 244 ASHAs and stakeholders working in one block of rural India.

Structure of the study:

1. ASHAs 1.1 A profile of the CHW/ASHA 1.2 Reasons to join 1.3 Motivations to remain 1.3 Creating and retaining spaces to work: experiences of ASHAs in the community and family 1.4 Role perceptions and future aspirations 2. The ASHAs within the public health system: perspectives of ASHAs and stakeholders 2.1 Understandings of the location of the ASHA functionary within the health services system 2.2 Understandings of the duties of the ASHA functionary 3. The ASHAs and the Community: perspectives of ASHAs and stakeholders

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4. Mapping the perspectives of ASHAs and Stakeholders: Gender, Hierarchy and Gender-hierarchical influences upon the CHW/ASHA programs 5. Conclusions: A rights-based framework for health workers

Resources for commitment : Self funded

Commitment Three: A qualitative research study and a video film on a large scale CHW program from India (ASHAs and ASHA trainers )

Date of submission: December 16, 2014

Scope:

1. A fresh exploratory qualitative study in four selected regions in the East, West, North and South zones of India on the ASHAs and ASHA trainers to highlight their voices. (A larger study based on the exploratory study in one block mentioned in contribution two)

2. A video film on ASHAs and ASHA trainers subtitled in English.

Resources:

1. Collaboration with local NGOs : self funded

2. Collaboration with video technicians: self funded

3. Conducting the research study as principal investigator: self funded

4. Participation in scripting and logistics of the film: self funded

5. Funds for the research investigators and video technicians: Funding to be raised through local resources/GHWA members/both

Proposed global alliance:

Similar studies and films of other successful programs from Pakistan and South African countries by respective members. I can co-ordinate for content.

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Commitment Four: A fresh research study on women health workers in India

Date of submission: June 30, 2015

Scope: A qualitative research study on experiences of women health workers in the public health sector of India. The implications will be globally applicable.

Resources: To be raised

Conflict of interests: None since I am an independent researcher based in India. The funding for the proposed report and future commitments will be raised locally.

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HRH commitment pathways THET


Summary

Our mission is to educate, train and support health workers through partnerships and enable people in low and middle income countries to access essential healthcare.

We believe that structured institutional Health Partnerships, which harness the skills and expertise of health professionals, can play a role in improving the quality and capacity of the existing global health workforce. While the primary focus of these coordinated projects is to bring about lasting improvements to healthcare in developing countries, at the heart of health partnerships is the acknowledgement of the mutual benefits of working in this way.

As such, we commit to

- Supporting Health Partnerships and delivering international programmes which support and respond to HRH development objectives and are characterised by collaborative relationships based on inclusivity, respect, reciprocity and mutual accountability.

- Actively supporting the development of a policy environment in the UK that enables international volunteering from the NHS and other healthcare professionals for the benefit of the global health workforce

- Working to improve the quality and impact of Health Partnership working, and facilitate the growth of the health partnership community by o Gathering evidence: Looking at what works well and what does not, o Providing technical support to Health Partnerships to deliver increasingly diverse and effective projects across a wide range of specialisms o Sharing good practice: Acting as a hub and providing platforms and opportunities to accelerate the sharing and adoption of good practices.

Responding to the HRH Crisis using an Institutional Partnership Approach

THET welcomes the opportunity to highlight to the Third Global Forum on HRH the role structured ‘Health Partnerships’ can play in improving the quality and capacity of the existing workforce in low and middle-income countries.

THET, a UK-based specialist global health organisation, has been working with health professionals and Health Partnerships or ‘links’ between healthcare institutions in the UK and low or middle income country counterparts for twenty five years. These institutions may be hospitals, professional associations or

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universities whose primary focus is delivery of health services or the training and education of health workers.

Health Partnerships are designed to support HRH development through the training and education of health workers overseas. Training and peer-to-peer support is delivered by UK volunteers as part of strategic and long-term organisational agreements which respond to locally identified needs. THET Partnerships are characterised by collaborative relationships based on inclusivity, respect and mutual accountability and exist beyond the delivery of time-bound projects

THET currently supports some 200 Health Partnerships that connect UK health professionals with colleagues in over 20 low and middle-income countries and has been managing the Health Partnership Scheme on behalf of the Department for International Development (DFID) since 2011.

The Health Partnership Scheme enables Health Partnerships to access the financial and technical support necessary to deliver increasingly diverse and effective projects across a wide range of specialisms such Accident & Emergency Care, Child Health, Eye Health, Maternal & Newborn Health, Mental Health, Non-Communicable Diseases, Sexual & Reproductive Health, Palliative Care, and HIV/AIDS TB & Malaria. The scheme represents an increased investment by the British government into this approach, and an important opportunity for THET to continue to gather evidence on what works well and what does not.

THET also directly manages long term partnerships with civil society and Ministry of Health institutions in Somaliland and Zambia and delivers large scale programmes to support national health workforce development objectives in those countries.

Health workers from the UK are supporting the capacity development of health workers overseas using a range of approaches

Health Partnerships tailor their activities, using a range of educational tools, to offer a relevant and practical approach to health systems support responding to specific needs and engaging with health workers to achieve local ownership.

Multi-disciplinary training

Working to strengthen palliative care integration into national health systems in Kenya, Rwanda, Uganda and Zambia, the University of Edinburgh Palliative Care Partnership has delivered basic training to a total of 176 health care workers including doctors, nurses, social workers, pharmacists, physiotherapists and midwives. The core training material used was the Palliative Care Toolkit which is modular and good for multi-disciplinary team teaching. The mix of participants was targeted to ensure understanding and a culture of palliative care with acceptance of its values at all levels from senior hospital management through all cadres of health workers.

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Intensive Specialist Training

A three-day obstetric anaesthesia course delivered by the Association of Anaesthetists of Great Britain and Ireland (AAGBI) – Ugandan Society of Anaesthetists (USA) partnership uses a variety of teaching methods including lectures, scenario-based teaching and practical skills sessions to train anaesthetic providers across Uganda. Knowledge and clinical skills are tested before and after the course and the results indicate a statistically significant improvement. Changes in clinical practice are measured 3 months later. One delegate reported: “I couldn’t intubate the patient… only because I had learnt how to do the airway manoeuvres was I able to ventilate the patient.” (February 2013)

Specialist training alongside general training

Long-term volunteers working with the Kambia-Cheltenham Partnership in Sierra Leone have observed improvements in both the confidence and competence of local staff as a result of mixed activities. Specialist resource teaching trips are supported by 6 month volunteers who also deliver a continuous programme of general training and on-the-job mentoring as well as various quality improvement projects. The synergistic effect of this approach is demonstrated in the following quote: “Trained in the use of spinals, Amadu did however state that he felt a little out of practice. After a refresher session in spinal insertion and a few joint sessions in theatre his confidence in the procedure returned to its former levels. We were also able to advocate for spinal anaesthesia in general and now the choice of anaesthetic is based on clinical grounds. Further improvements in documentation of anaesthesia and administration of peri-operative antibiotics also followed on from these joint working sessions and Amadu also came forward with his own suggestions for quality improvement (e.g. pre- and post-operative care teaching for ward staff, negotiating a consistent supply of iv fluid and antibiotics from pharmacy) which we undertook together.” (April 2013)

Coaching

Coaching is described by a UK obstetrician working in Hoima Regional Referral Hospital, Uganda as part of the Liverpool Mulago Partnership):

“In my ward round with two interns and a midwife the first patient was in obstructed labour at fully dilated. I discussed with them the use of syntocinon and how it should not be used in multips [a mother who has given birth before] for augmentation. I discussed the indications and contraindications for instrumental delivery. I discussed with them the value of being able to ascertain positions and the likely causes of obstructed labour in a multip… The third patient had premature rupture of membranes. We discussed the role of augmentation and antibiotics… I then assisted the intern at a C-section. I talked him through what to do in a transverse section. He struggled to deliver the head so I took over. We then discussed techniques to help in the delivery of the head… At all three caesarean sections I went through the theatre check list with the interns, including checking of the foetal heartbeat where appropriate. I also discussed with them both the importance of counting swabs afterwards and initiated this with each case… In the breaks between theatre I discussed a topic that we talked of yesterday, the exteriorisation of the uterus and closure of the peritoneum. I brought along some papers and evidence including Cochrane reviews for this and we discussed briefly… At the end of the day one of the interns discussed with me the value of vaginal birth following caesarean section… This is just one day, and it is not unusual… I try to do no

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clinical activities without it being an educational exercise.” (April 2013)

Mentoring & Peer Support Groups

Local and international mentoring forms part of the mental health link between East London NHS Foundation Trust – Butabika Hospital, Kampala. Community Psychiatric Nurses and service users have been trained to provide on-going supervision to peer support workers on an individual and group basis. Mutual support groups occur every two weeks with sixteen recorded by the end of February 2013. Further assistance is offered by UK volunteers.

Towards an enabling environment for health professionals working internationally

Beyond improving health in resource-limited settings, individuals who volunteer also gain personal and professional skills that can be transferred to benefit the NHS. International Health Partnerships can also stimulate innovation in both UK and overseas settings.

THET’s vision for volunteering is for it to strengthen the UK’s contribution to developing country health systems and for an environment where effective and appropriate international volunteering is regarded as the norm, not the exception, for all UK health professionals.

THET will continue to actively support the development of a policy environment in the UK that enables international volunteering for NHS and other healthcare professionals.

“The team believe that the UK National Health Service, imperfect as it is, can offer guidance to those countries looking towards developing more equitable and comprehensive services, albeit within limited financial resources. We also believe that through liaising with health professionals in developing countries, we in the NHS can be reminded of the core values of healthcare in its broadest sense and reaffirm that many of the most effective health care interventions are still relatively inexpensive and within the grasp of most people in the world” Partners from the THET funded Wessex-Ghana Stroke Partnership, supporting colleagues from Korle-Bu Teaching Hospital in Accra, Ghana, over several years to develop the first specialist stroke unit in West Africa.

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HRH commitment pathways UN RC, KUWAIT


Health system in Kuwait is undergoing a rapid change in the effort to aligning to the new challenges, including altering demographics, disease patterns, emerging diseases and the rising costs of health care delivery. Kuwait has one of the most modern health care infrastructures in the region. The health system consists of both public and private sectors. Public sector is the main health care providers (80% of all health services), with an increasing share of the private sector that is mainly focusing on curative services, and are concentrated in central and commercial areas. Kuwait is relying on expatriates’ labor force that is currently around 80%. The trends indicate that for many years the country will continue to rely on expatriate work force including the health professionals in the public and private health sector. This has many underlying challenges, specific to the health sector as well as to the other sectors, where Un system can play key roles. Since there is no WHO country office in Kuwait, the United National office of the Resident Coordinator being the lead of the UN system is determined to provide required support in the relevant areas. Specially, UN RC office can be instrumental in promoting the implementation of the WHO’s Global Code of Practice for International Recruitment of Health Personnel, and supporting the country in aligning its systems towards health workforce self-suitability.

With this backdrop, availing the opportunity of the third Global Forum on HRH and having the previous association with the Global Health Workforce Alliance as Executive Director, the UN RC Kuwait proclaims to undertake two pathways in supporting the country on HRH:

1- Promotion and advocacy for implementation of WHO’s Global Code of Practice on recruitment of international personnel

2- Support in designing policies and processes towards sustainability in essential workforce, including human resources for health

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The related interventions, timeline and partnerships are expected as below:

Pathway Interventions Timeline Potential partners

Promotion and advocacy for implementation of WHO’s Global Code of Practice on recruitment of international personnel

- Nominating a focal point in the UN RC / UNDP office March 2014 UNRC - Meeting with the government authorities and related stakeholders for their

orientation on the Code June 2014 UNRC, MOH

- Motivating establishment of a multisectoral and multistakehodler working group on the related issues August 2014 MOH, UNRC

- Encouraging adaptation of the Global Code and develop national guidelines and developing policies March 2015 UN RC, MOH, other

stakeholders

- Progress review during meetings with the authorities and partners 2014- 2016 UNRC, MOH, other stakeholders

Support in designing policies and processes towards sustainability in essential workforce, including human resources for health

- Identifying focal points in UNDP and other related agencies March 2014 UNRC and other agencies - Advocacy and dialogue with the government on the needs and rationale of

sustainable workforce initiative June 2014 UNRC, Focal points, MOH, other stakeholders

- Supporting a rapid review of the situation and making inclusive recommendations with a HRH component

October 2014

UNRC, Focal points, MOH, other stakeholders

- Encouraging the government health sector to adapt the recommendations and develop strategic specific interventions March 2015 UNRC, Focal points, MOH,

other stakeholders

- Progress review during meetings with the authorities and partners 2014- 2016 UNRC, Focal points, MOH, other stakeholders


The major monitoring tools will be as below:

1- Nomination letters of focal points (Information source/s: notifications)

2- Adapted of the global code (Information source/s: documents)

3- Situation review and recommendation on sustainable workforce ((Information source/s: assessment report)

4- Plans and policies on sustainable health workforce (Information source/s: documents)

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HRH commitment pathways WONCA WORKING PARTY ON RURAL PRACTICE


We represent rural doctors around the world (please see our website for our aims and objectives and the resources that we have already built up : http://www.globalfamilydoctor.com/groups/WorkingParties/RuralPractice.aspx). We have worked with WHO on our HARP initiative (Health for rural people), on the WHO programme “Access to Health Workers in Rural & Remote Areas through improved Retention” and we are currently working on a guidebook / textbook of Rural medical education that we are launching in Brazil in April 2014.

We are committed to Universal Health Care Coverage and keen to continue the important work that we have been doing with WHO. Members of the Working Party attended the last Global Forum meeting

2) How will you monitor progress towards achievement of your commitment pathways?

We have a full 3 year programme that we constantly evaluate and measure our progress against. Our next main aim is the launch of the guidebook at our 12th World Rural Health Conference in Brazil in April 2014

Other indicators are gender and age equity in the organisation, review of previous documents, and working with other organisations in and outside Wonca to promote Universal Health Care Coverage. We are looking at patient safety, promoting rural research and models of integrated acre in rural areas

http://www.globalfamilydoctor.com/groups/WorkingParties/RuralPractice.aspx

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HRH commitment pathways WORLD VISION INTERNATIONAL


Background

World Vision is a global Christian relief, development and advocacy organization dedicated to improving the health, education, protection of children and humanitarian action in emergencies. Our global health programming currently reaches over 60 countries around the world. In recent years World Vision has been scaling up and improving the quality of our health programming through our 7-11 initiative, which promotes 7 key evidence-based interventions for pregnant women and 11 key interventions for young infants to be integrated in all our health programmes53. In partnership with governments and communities we are making substantial investments in supporting diverse cadres of community health workers and volunteers, which includes support for community case management of childhood illness (CCM), community based management of acute malnutrition (CMAM), community prevention of mother to child transmission (C-pMTCT) and integrated reproductive, maternal and child health behaviour change counselling through a Timed and Targeted Counselling (TTC) approach. We work in partnership with health authorities and endeavour to ensure community systems and health systems strengthening approaches. We are currently working to improve our CHW systems through research and innovations, harnessing mobile technology for training and monitoring, and promoting CHW scale up through advocacy and multi-partner networks at local, national, and international levels. Our global Child Health Now campaign to end preventable child deaths is active in 30 countries, with health systems strengthening including human resources for health being a focus for national advocacy in the majority of those. Additionally we are working to strengthen health systems through local level advocacy, including our Citizen Voice and Action programme.

53 The interventions identified in World Vision’s 7-11 Strategy are as follows: Pregnant women Children (0-24 months)

1 2 3 4 5 6 7

Adequate diet Iron/ folate supplements Tetanus toxoid immunization Malaria prevention and treatment (including IPT) Birth preparedness and healthy timing/spacing of delivery De-worming Access to maternal health services (antenatal care, postnatal care, delivery by skilled birth attendant, PMTCT, HIV/AIDS, tuberculosis, screening for STIs)

1 2 3 4 5 6 7 8 9 10 11

Appropriate breastfeeding Essential new-born care Hand washing with soap Appropriate complementary feeding Adequate iron Vitamin A supplementation Oral rehydration therapy (ORT/zinc) Prevention and care seeking for malaria Full immunization for age Prevention/treatment of acute respiratory infection De-worming (+12 months)

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Commitment to 3rd Global Forum for HRH

1. To expand our support to community health workers and their supervisors in at least 40 countries where we are currently working, especially those countries in which human resources for health are in most need, with the aim to extend our support to 100,000 CHWs by 2015.

2. To promote country-led national scale up of CHW programming in countries where World Vision is working, including through the establishment of coordination frameworks that enable integration of civil society and government contributions to CHW programming for improved health outcomes.

3. To continue our efforts to harmonise CHW working practices amongst civil society actors through promoting the adoption of the CHW Principles of Practice and other platforms and initiatives.

What the commitment will achieve, who will benefit and how does this contribute to health systems strengthening, universal health care and cross-sectoral approaches?

1. To expand our support to community health workers and their supervisors in at least 40 countries where we are currently working, especially those countries in which human resources for health are in most need, with the aim to extend our support to 100,000 CHWs by 2015. Under this commitment, we have plans to increase our support to 100,000 CHWs by 2015. This will be achieved through the expansion of our CCM, c-PMTCT, CMAM and TTC home-based counselling programmes in the 40 countries where we are currently working with CHW and volunteer cadres. At this point we have already adapted and launched TTC in 20 countries, 2 of which have already taken steps towards national scale up. Our CCM programming is also under expansion in 15 countries, and we have recently won substantial grants to support large scale CCM national expansions in Niger and DRC. Through our m-Health programme we are currently deploying mHealth data monitoring applications for community health workers in 12 countries. In line with the 2015 deadline for the MDGs and World Vision’s own Strategic Health Targets (2016) our intention is to expand coverage in those countries, as well as incorporate solutions for diagnostics, stock control, remote supervision, and low literacy training solutions for CHWs and their supervisors. Beneficiaries: The primary beneficiaries will be children under 5 years, pregnant women and breastfeeding mothers, and families affected by HIV. Secondary beneficiaries include CHWs, their supervisors and facility-based staff who we hope will experience improved confidence and skills, improved client satisfaction and community health systems management.

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In addition to their positive impact in reducing preventable child death, CHW programme models can enhance access to health services and contribute towards the achievement of universal health coverage, especially in the hardest to reach and most underserved areas in countries where they may be the only health workers accessible to communities. When well realised and integrated, CHWs can strengthen health systems through improving service uptake, providing basic and relieving pressures on already stretched health facilities.

2. To promote country-led national scale up of CHW programming in countries where World Vision is working, including through the establishment of coordination frameworks that enable integration of civil society and government contributions to CHW programming for improved health outcomes. In the last 3 years World Vision has reviewed CHW programming methods and engaged in high level dialogue with health ministries, especially in the planning of implementation of CCM, cPMTCT and Timed and Targeted Counselling. In a number of countries such as Sierra Leone, Uganda and Zambia, we have contributed to the establishment of coordination platforms bringing together NGOs in partnership with government to improve and coordinate CHW programming. We believe such platforms when established at the national and sub-national level are an essential component of establishing improved working practice for community health and harmonise work among existing actors. The coordination frameworks that have emerged in those countries with successful national CHW programmes take systems-based approaches, avoiding problems created by short-term vertical funding for CHW initiatives. Successful frameworks permit positive country leadership to take place, enhance cross-sectoral working and sharing of best practices and data and yet are also agile and flexible enough to respond to the contextual needs of communities, harnessing the diversity amongst NGO approaches to contribute to research and innovation. Through national and regional advocacy initiatives we will call for the promotion of country-led harmonised systems. Through local level advocacy initiatives we can promote citizen engagement in health system delivery and increase demand for good quality services. Beneficiaries: Systems based approaches to CHW and frontline health worker programming benefit the communities they serve and also promote the efficient use of existing health finance in the long term. Collaborative platforms at national and sub-national levels can promote minimum standards of programming, and serve as a platform for cross-sectoral integration including water, agriculture and education.

3. To continue our efforts to harmonise CHW working practices amongst civil society actors through promoting the adoption of the CHW Principles of Practice and other platforms and initiatives.

CHW programming is currently variable within and between countries and diverse approaches are taken in projects and organizations. The effect is that minimum standards, processes, quality and coverage, as well as long-term sustainable health systems strengthening approaches fail to be consistently established. In countries with severe shortages of health staff especially those where CHW scale-up is a high priority, country-ownership, quality training and implementation standards are particularly weak. World Vision has been working together with the CORE group and member organisations to develop the CHW Principles of Practice in which the unification of CHW programming approaches amongst civil society actors are

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articulated within the advocacy, programming and partnership approaches recommended therein. In particular this promotes country led initiatives in establishing minimum standards for training, supervision and data monitoring of CHWs, as well as steps to legitimisation of specific curative cadres of CHWs. Benefits: World Vision’s ongoing commitment to promote endorsement of these approaches amongst other NGOs and in countries will contribute to health systems strengthening through the establishment of coordinated methods, that in the long term will improve both quality and access to universal health care through the CHW model.

Contribution to the work of GHWA and making the alliance a success We believe that the commitments made here will contribute to strengthen CHW programming globally and health systems strengthening through improved coordination and planning. In order to achieve these goals we will need to leverage the opportunities afforded by the GHW Alliance to engage other members of the alliance. At the international level this will take the form of:

- Joint working - Contribute to GHWA working group activities and contributions to online events, fora and discussions on CHW programming. - Sharing our experiences and best practice through the GHWA platform as required, especially related to experience in mHealth and CHW

programming. - Encourage participation in the GHWA platform through our communities of practice.

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HRH COMMITMENTS

Documents

Transcript of HRH COMMITMENTS