dr carmen dolea department of human resources for health, who, geneva
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Getting and keeping health workers in remote and rural areas: the WHO global policy recommendations. Dr Carmen Dolea Department of Human Resources for Health, WHO, Geneva Presented by: Prof James Buchan, QMU [email protected] http://www.who.int/hrh/retention/guidelines/en/index.html. - PowerPoint PPT PresentationTRANSCRIPT
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Getting and keeping health workers in remote and rural areas: the WHO global policy recommendations
Dr Carmen DoleaDepartment of Human Resources for Health, WHO, Geneva
Presented by: Prof James Buchan, [email protected]
http://www.who.int/hrh/retention/guidelines/en/index.html
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Overview – developing the WHO recommendations
• Why “guidelines”?
• How did we go about it?
• What are the WHO recommendations?
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Why “guidelines” for rural retention
• "Recommendation/guideline" implies a course of action needs to be taken AND that progress can be measured against a set baseline
• "Policy options" are good, but may remain "optional", not "actioned upon"
• Systematic, explicit and transparent process of evidence gathering/assessment and of formulating the recommendations
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Factors influencing decisions to stay in or leave rural and remote areas
• Personal– Rural background (origin), values, altruism
• Family and community– Provision of schooling for children, sense of community spirit, community
facilities available• Financial aspects
– Benefits, allowances, salaries, payment system• Career related
– Access to continuing education opportunities, supervision, professional development courses/ workshops etc, senior posts in rural areas
• Working and living conditions– Infrastructure, working environment, access to technology/medicines,
housing conditions etc• Bonding or mandatory service:
– Whether obligated to serve there Source: WHO 2010
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Category of intervention Examples
A. Education
A1 Students from rural backgrounds
A2 Health professional schools outside of major cities
A3 Clinical rotations in rural areas during studies
A4 Curricula that reflect rural health issues
A5 Continuous professional development for rural health workers
B. Regulatory
B1 Enhanced scope of practice
B2 Different types of health workers
B3 Compulsory service
B4 Subsidized education for return of service
C. Financial incentives C1 Appropriate financial incentives
D. Professional and personal support
D1 Better living conditions
D2 Safe and supportive working environment
D3 Outreach support
D4 Career development programmes
D5 Professional networks
D6 Public recognition measures
The 16 WHO global policy recommendations
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Education interventions: the “rural pipeline”
Student selection: choosing the RIGHT PEOPLEtargeting admission of students from a rural background (Sudan; Thailand)
Undergraduate training: getting the RIGHT CONTEXTcreate schools outside major cities (Mali, Canada) rural clinical placements in rural areas (Australia) changes in curricula (South Africa)
Postgraduate training: creating the RIGHT OPPORTUNITIESRural residency programmes (Sudan, Australia, Canada)
Support of rural HCWs: nurturing the RIGHT ENVIRONMENTCareer ladders for rural health workers (South Africa)
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Regulatory interventions: different types of health workers or different types of contracts
• Compulsory service: not always effective, requires reinforcement and heavy administration
• Enhancing the scope of practice for rural health workers: more duties and responsibilities, not always accompanied with adequate rewards
• Different types of health workers: clinical officers a potential solution
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Professional and personal support: most likely to work, yet very little done for it– Living and working conditions– Professional networks, journals etc– Outreach support/telemedicine – Career ladders for rural health workers
– Titles, awards, public recognition
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Monitoring and evaluation:WHO framework: design, process,
Indicators, outcomes of interest
Implementation:Human resources management systems
Performance appraisal system, including awards
Choosing the interventions:Effectiveness
Relevance: time to impact, enforcement capacity,
urban underemploymentAcceptability: stakeholder analysis
Affordability: costing toolComplementarities
Understanding the problem:Scope of the problem
Factors affecting decisions of locationPreferences and choices (DCE)
Labour market survey
Roadmap and tools for implementation
Source: Draft WHO/CapacityPlus/WB roadmap to support implementation of rural retention strategies
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Choosing the most appropriate interventions
• Decisions often driven by everything else but evidence• However, some essential criteria need to be considered
before selecting a package:– Effectiveness– Relevance:
• Time to impact• Enforcement capacity• Urban underemployment
– Acceptability– Affordability– Complementarities
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Time to impact Category of
interventionSHORT-TERM MEDIUM-TERM
(or timeframe difficult to determine)
LONG-TERM
EDUCATION
A5. Continuous professional development for rural health workers
A3. Clinical rotations in rural areas during studies
A1. Student from rural background
A2. Health professional schools outside the major cities
A4. Curricula that reflect rural health issues
REGULATORY
B1. Enhanced scope of practice (task-shifting)
B3. Compulsory serviceB4. Subsidized education for
return of service
B2. Different types of health workers (mid-level cadres)
FINANCIAL INCENTIVES
C1. Appropriate financial incentives
PROFESSIONAL AND PERSONAL SUPPORT
D2. Safe and supportive working environment
D5. Professional networksD6. Public recognition
measures
D1. Better living conditions
D3. Outreach supportD4. Career development
programmes
Source: Draft WHO/CapacityPlus/WB roadmap to support implementation of rural retention strategies
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Monitoring and evaluation: a framework for measuring results
Number of students from rural background reporting their intention to practice in rural/remote/underserved area
Number of students from rural background selected/recruited into medical or health professional schools
Number of students from rural background retained in rural/remote/underserved area
Source, WHO, 2010
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A complex issue in a complex environment
Ministry of Health
Ministry of Finance
Ministry of Labour
Ministry of Public
Administration
Health workers
Populations/Communities
Civil Service Commission
Ministry of Transport
Professional Associations
Ministry of Higher
Education
GAVI
The Global Fund
PEPFAR
Development partners
World Bank WHO
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Thank you for your attention!
For further information, please contact Dr Carmen Dolea: [email protected]
http://www.who.int/hrh/retention/guidelines/en/index.html