Human Resources for Health (HRH): the Belgian Charter

Human Resources for Health (HRH): from theory to practice

Dr Stefaan Van Bastelaere Senior Health Expert

2European Congress on Tropical Medicine and International Health

The global context of HRH

Components of a crisis : • World Health Organisation 2006

• African countries = 24% of disease burden | 3% of health professionals | 1% means

• Kampala declaration 2008 - First world forum on HRH • Global shortage estimate 4 million

• US estimate for 2020 : gap of 100,000 physicians | 1,000,000 nurses | 250,000 other health

professionals

• Systematic underproduction in some countries

• Systematic overproduction in other countries

• Poor or absent HR planning

• Poor or absent HR Monitoring & Evaluation

• Resistance to change (task-shifting, task-sharing)

• Little attention paid to clinical activities

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Migration• as old as mankind • not the cause, but the solution

Drivers for migration• stick

• stay

• push

• pull

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Components of a solution :

• Comprehensive HRH policies and management

Source: WHO 2006

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Components of a solution :

• 2010 : Code of practice on international recruitment, World

Health Assembly

• 2012 : Belgian HRH Charter

• Reducing push forces – strengthen stick factors :

Self esteem!

Better connectivity : telemedicine

Results-Based Finance – Performance-Based Finance: motivation

strategy

Improving housing and working conditions…

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The Belgian HRH Charter

5 strategic result areas

RA 1 : Partnership and harmonization

RA 2 : HRH policies and development plan

RA 3 : Training

RA 4 : Recruitment policies

RA 5 : In Belgium

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RA 1 : Partnership and harmonisation

• Federal Public Service Foreign Affairs Embassies do political and policy dialogue

Long-term vision : predictability of programs 4-5 years

• BTC interventions fully embedded in local institutions Ministries of Health, Ministries of Education, Hospitals, Districts or local health

systems

Universities or local schools

Local steering bodies

• BTC actively participating in Sector-Wide Approach Development of “Compact”

Health sector cluster groups, HRH Working Group

Joint sector reviews

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From theory to practice : implementing the charter


RA 2 : HRH policies and development plans

• Support HR department of Health

Ministries

• Support development and

implementation of HRH plans

(Rwanda, Burundi, Niger, DR Congo,

Mozambique, Senegal) respecting

values :

Equity

Gender

Sound geographic distribution

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Improve professional motivation

• Performance-Based Financing

(Rwanda, Burundi)

• Better professional environment :

Investing in communication ICT

Better equipment

Housing

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Performance-Based Financing as motivational factor

• 85-95 % of delivered services compliant to quality standards

• Substantial topping up of the salaries Figure 7: Quality of services achievement in group 1

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RA 3 : Training

Support development of capacities by strengthening

professional education in partner countries • Nursing schools : paramedical public schools in Burundi and

Rwanda being upgraded, new curriculum developed, motivation

of teaching staff

• Undergraduate and postgraduate trainings

National University of Rwanda

• Internship, training of District Medical Officers

• Capacity-building program for hospital management teams in

South Africa

September 2013



• Scholarship programs in all our partner countries

• Shift from ‘individual scholarships’ to an integrated

‘institutional capacity development program’

• Individual scholarships (before 2012)o Beneficiaries: individualso Sectors: allo Based on individual training needso No follow-upo Nationwide o Yearly agreement between partner states

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RA 3 : Training



Institutional capacity development plans (as from 2012)• Beneficiaries: geographical consistency

• In line with HRH planning of partner countries and institutional

capacity development plans

• Sector-specific: in ‘concentration’ sector (health, education,

agriculture, infrastructure)

• Priority to local and regional training institutes

• Minimum 4 years’ duration

• Special focus on: Partnership with international partners (Institute for Tropical

Medicine…) | Sandwiched approaches | Distance learning | Gender balanced

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RA 3 : Training



RA 4 : Recruitment

• Respect the WHO “Code of Practice” Right to migrate, circulation of competences ?

o BTC employed international experts without restrictions on nationality (Niger, Burundi, Senegal, Peru, Cameroun, DR Congo…)

• Compensate for negative consequences Only possible in partner countries

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RA 5 : In Belgium

• Inform and raise awareness Charter signed and available on intranet

Information on partner country HRH plans on healthpl@form

Participation in HRH WG of Because-Health,

Collaboration on HRH issues with different NGO’s

• Collaboration with diaspora and universities IOM

Contracts with almost all Belgian universities

• Capitalise and share knowledge https://intranet.btcctb.org/claroline/

www.be-causehealth.be/en/themes-and-working-groups/human-

resources-for-health

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Conclusions

Development agencies can make a difference Work on planning, production and monitoring Influence on push and stick factors

Harmonisation and coordination under a

national consensus is key

September 2013

Human Resources for Health (HRH): the Belgian Charter

Health & Medicine

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