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Human Resources for Health (HRH): from theory to practice
Dr Stefaan Van Bastelaere Senior Health Expert
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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
September 2013
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3European Congress on Tropical Medicine and International Health
Migration• as old as mankind • not the cause, but the solution
Drivers for migration• stick
• stay
• push
• pull
September 2013
The global context of HRH
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4European Congress on Tropical Medicine and International Health
Components of a solution :
• Comprehensive HRH policies and management
Source: WHO 2006
September 2013
The global context of HRH
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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…
September 2013
The global context of HRH
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6European Congress on Tropical Medicine and International Health
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
September 2013
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7European Congress on Tropical Medicine and International Health
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
September 2013
From theory to practice : implementing the charter
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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
September 2013
From theory to practice : implementing the charter
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9European Congress on Tropical Medicine and International Health
Improve professional motivation
• Performance-Based Financing
(Rwanda, Burundi)
• Better professional environment :
Investing in communication ICT
Better equipment
Housing
September 2013
RA 2 : HRH policies and development plans
From theory to practice : implementing the charter
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10European Congress on Tropical Medicine and International Health
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
September 2013
RA 2 : HRH policies and development plans
From theory to practice : implementing the charter
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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
From theory to practice : implementing the charter
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• 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
September 2013
RA 3 : Training
From theory to practice : implementing the charter
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13European Congress on Tropical Medicine and International Health
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
September 2013
RA 3 : Training
From theory to practice : implementing the charter
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14European Congress on Tropical Medicine and International Health
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
September 2013
From theory to practice : implementing the charter
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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
September 2013
From theory to practice : implementing the charter
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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