What are the workforce implications of UHC?

Briefing to MoHMETeheran, 15 September 2014

James Campbell, Director Health Workforce, WHO

Executive Director, Global Health Workforce Alliance

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Time to “rethink and improve”...

“The foundations for a strong and effective health workforce for the future are being corroded in front of our very eyes by failing to match today’s supply of professionals with the demands of tomorrow’s populations.

To prevent this happening, we must rethink and improve how we teach, train, deploy and pay health workers so that their impact can widen.”

Dr. Marie-Paule Kieny, WHO Assistant Director-General for Health Systems and Innovation.

“Global health workforce shortage to reach 12.9 million in coming decades”http://www.who.int/mediacentre/news/releases/2013/health-workforce-shortage/en/

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HRH for UHC

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Overview

Campbell J, Dussault G, Buchan J, Pozo-Martin F, Guerra Arias M, Leone C, Siyam A, Cometto G.

A universal truth: no health without a workforce.

Forum Report, Third Global Forum on Human Resources for Health, Recife, Brazil. Geneva, Global Health Workforce Alliance and World Health Organization, 2013.

Campbell J, Dussault G, Buchan J, Pozo-Martin F, Guerra Arias M, Leone C, Siyam A, Cometto G. A universal truth: no health without a workforce. Global Health Workforce Alliance and World Health Organization, 2013.

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Human resources for health: global challenges, global opportunities

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Estimates of shortages and deficits

Global health workforce shortage to reach 12.9 million in coming decades

11 November 2013 | RECIFE, BRAZIL - The world will be short of 12.9 million healthcare workers by 2035; today, that figure stands at 7.2 million. A World Health Organization (WHO) report released today warns that the findings - if not addressed now - will have serious implications for the health of billions of people across all regions of the world.

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Different estimates of shortage and deficits

ILO – World Social Protection Report (2014)

The ILO estimates that at least 41.1 health workers per 10,000 population are necessary to provide services to all in need. The figure is based on calculations of median values of the density of health workers in countries where socio-economic conditions and health financing characteristics are conducive to universal coverage.

http://www.ilo.org/global/research/global-reports/world-social-security-report/2014/lang--en/index.htm

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The Recife Declaration and WHA67.24

Recife Political Declaration (Third Global Forum on HRH,

Brazil, November 2013)

"We as leaders are committed to attaining universal health coverage and recognize that we need an improved health workforce to achieve it. …We commit to addressing transnational issues and work towards strengthening health systems, including global HRH governance and mechanisms."

WHA Resolution 67.24 (World Health Assembly,

Geneva, May 2014)

"The Sixty-seventh World Health Assembly ENDORSES the call to action in the Recife Political Declaration; … REQUESTS the Director-General to develop and submit a new global strategy for human resources for health for consideration by the Sixty-ninth World Health Assembly."

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Towards a global HRH strategy: key objectives and principles

Impactful strategy

accelerating HRH action at

national, regional and global levels in the post-2015

period.

Make relevant to needs

of all countries.

Build on evidence and best practicesInclusive,

participatory and

transparent consultation

process

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2013 2014 2015Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb

Nov

201

3

Jan

2014

3rd Global Forum on HRH:Recife Political DeclarationGHWA Board:HRH Strategy development decision

WHO Executive Board 134:Recife Political Declaration on HRH (EB134/55)

Towards a Global Strategy on Human Resources for Health - OVERVIEW

May

201

4 67th World Health Assembly:Resolution on Recife Political Declaration on HRH gives WHO mandate to develop global HRH strategy

July

201

4

GHWA Board:Progress review ‘Global Consultation’ & emerging findings

24-2

9 Se

pt 2

014 UNGA

High-Level Meeting:Post-2015 develop-ment agenda

30 S

ept –

03

Oct

201

4

3rd Global Symposium on HSR:Cape Town – Global Consultation on HRH broadened

Jan

2014

Prince Mahidol Award Conference:Transformative education for health equity

Mar

201

4

GHWA: Formation of 8 “Thematic working groups” to collate HRH evidence‘Global Consultation on HRH’ begins

Global Consultation on HRH

GHWA Board:Adopts recommendations on global HRH strategy

AAAH Conference:Consultations on global HRH strategy27

-31

Oct

201

4

Feb

2015

GHWA synthesis paper reflecting outcome of Global ConsultationN

ov 2

014

– Ja

n 20

15

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2015 2016Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May

Towards a Global Strategy on Human Resources for Health – OVERVIEW (continued)

May

201

6 69th World Health Assembly:Considers Global Strategy on HRH

UNGA High-Level Meeting:Post-2015 development agenda adopted

Jan

2015

Prince Mahidol Award Conference: global health post-2015

Sept

- O

ct 2

015 WHO

Regional Committee Meetings:Member States consultations at regional level on global HRH strategy

Sep

2015

Ongoing collation of evidence and consultation opportunities

GHWA Board:Adopts recommendations on global HRH strategyF

eb 2

014

Feb-

May

201

5 WHO global HRH strategy:Draft contents of WHO strategy on HRH developed (considering recommendations of GHWA consultation process)

Oct

201

5

Contents of global strategy on HRH adapted to reflect consultations of WHO Regional Committees and outcome of UNGA 2015

Jan

2016 WHO Executive

Board:Considers draft Global Strategy on HRH, review of effectiveness of WHO Code of Practice on International Recruitment Health Personnel, progress reports on HRH resolutions WHA64.7, WHA64.7, WHA66.23

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in support of UHC – WHR 2010

The basic messages:

1. Population coverage with needed health services

2. Coverage with financial protection

The emerging agenda….

“Effective Coverage” of the “needed” health services (R2H; burden; forecasts)

Coverage with financial protection – skills/capacity to manage/administer

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Health labour markets - AAAQ - UHC.

Sousa et al, Bulletin WHO. November 2013 (adapted from Vujicic & Zurn, 2006)

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Effective coverage

workforce is AVAILABLE?

workforce is ACCESSIBLE?

workforce is ACCEPTABLE?

workforce provides QUALITY CARE?

AVAILABILITY ACCESIBILITY ACCEPTABILITY

QUALITY

• A midwife is available in or close to the community

• As part of an integrated team of professionals, lay workers and community health services

• Woman attends

• A midwife is available

• As needed

• Financial protection ensures no barriers to access

• Woman attends

• A midwife is available

• As needed

• Providing respectful care

• Woman attends

• A midwife is available

• As needed

• Providing respectful care

• Competent and enabled to provide quality care.

CRUDE COVERAGE EFFECTIVE COVERAGE

Source: Campbell J. SoWMy 2014

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The health workforce implications?

Population

People-centred, integrated Services (AAAQ)

Financial protection

A

B

Where are you now?

Where do you want to be?

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The context in Iran?

Population

Financial protection

A

B

Where are you now?

Where do you want to be?

People-centred, integrated Services (AAAQ)

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Workforce intelligence

Country Briefs – Page 1 (2012) 150-word text, guiding the reader through key messages in the brief

1

Provides overview of ‘need’ for RMNH care across the continuum. #visits linked to WHO protocols/guidelines

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Availability - who are the HCPs, what to they do, how much of the need do the cover at the moment.

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Current status of education, regulation and association development/role.

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Accessibility – financial perspective5

Accessibility – geographical perspective6

Country Briefs – Page 2 (to 2035)Projection of the need from 2012 to 20351

National agreed targets for maternal and newborn mortality and current status

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Exits + entries = available staff through 2035. The actual projections

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What if… a. start with less pregnancies because of better FP, then increase numbers of students, improve productivity and reduce attrition

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Left – no additional effort – status quo scenarioRight – all the ‘what ifs’ implemented

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Footnotes and country specific qualifications6