Human Resources for Health in 2030 (HRH2030)

Overview on Human Resources for Health in Jordan Al-Balqa Applied University / Faculty of Medicine

April, 2018

Presenter: Dr. Raghad Hadidi HRH Governance Component Lead HRH2030

OUTLINE

Introduction

HRH Challenges

Country Response to HRH Challenges

Human Resources for Health 2030 (HRH2030)

National HRH Strategy in Jordan (NHRHS)

National HRH Observatory (NHRHO)

Annual HRH Report, 2016

2

Introduction Jordan is a middle income country with limited natural resources, and thus human resources

development has been made as one of the most valuable assets and strategic pillars of the country.

The healthcare system in Jordan is evolving and has to continuously respond to the:

Changing demographic, epidemiologic and risk profile of the population;

The rising expectations of a more educated population;

The fast growing private health sector;

The rapid changes taking place in medical technology;

The desire among the government to expand services and achieve universal health coverage

(UHC) and sustainable developmental goals (SDGs).

Accordingly, Jordan has been remarkably investing in HRH as a key element for scaling up health

interventions to achieve global, regional and national goals.

3

Building Blocks of the Health System (WHO)

4

A simple message: Health workers save lives!

5

HRH Challenges Governance, policy and partnership HRH management

Absence of a national HRH strategy

Inadequate generation of evidence-based HRH

decisions

Deficient endorsed national job descriptions

Absence of a national board to license/relicense

healthcare fields (LaRocco, 2015)

Lack of nursing and midwifery up to date database

(Jordan Nursing Council, 2016)

Lack of collaboration with other healthcare fields

(Jordan Nursing Council, 2016)

Adoption of the Civil Service Bureau performance

appraisal system represents a change from current

practices

Pressure, particularly in the governorates, to hire

more staff at the MOH because of the high

unemployment rate in remote/underserved areas

Lack of awareness and skills on the part of top

management team and other managerial levels of the

critical linkages between MOH strategic/operational

planning and human resources planning

Difficulty in attracting and retaining qualified health

personnel

Overemphasis on tenure and credentials over

performance

Weak performance management (unclear criteria, lack

of transparency) system to inform career path and

succession planning

Weak linkages between the current performance

appraisal system and incentives

Risk that employees will focus on behaviors that are

rewarded and neglect other work-related behaviors

High stress and low job satisfaction (Hamaideh &

Ammouri, 2011; Mrayyan, 2007; Nawafleh, 2014) in

remote/underserved areas (Nawafleh, 2014)

Workplace violence

Policy mapping and analysis identified key HRH challenges through document review and key informant interviews

Country Response to Health Workforce challenges in Jordan

6

HRH education, production and development HRH planning

Interdependence of CPD with other HR policies (e.g., employee

selection, career path planning, succession planning, and job

analysis and description)

Lack of requisite skills on the technical aspects of training and

development for those who work at training and development

directorate

Lack of national CPD system linked with re-licensing

Lack of funding for human resources development

Weak capacity building and continuing education initiatives (Jordan

Nursing Council, 2016)

Educational lags in areas related to advanced healthcare skills such

as newborn resuscitation and holistic nursing care (Kassab,

Alnuaimi, Mohammad, Creedy, & Hamadneh, 2016; Shoqirat, 2015)

Educational programs do not meet national, regional and

international health needs and technological advancements

Clinical training lags in quality and period

Fragmented research and lack of research integration into clinical

practice (Jordan Nursing Council, 2016)

Lack of internship opportunities

Limited provision of holistic care

Limited supply of specialties in the labor market as

they take considerable time to develop

Skill-mix, gender, and facility maldistribution of

human resources across the country

Weak linkages between the human resources

planning system on one hand and the performance

management, reward, incentive, training, and

development systems

Shortage of midwives

High turnover

Weak effective HRH information system especially

that of the private sector

HRH Challenges

7

Main HRH Challenges

Absence of a national HRH strategy.

Centralized HRH decisions in the public sector.

Brain drain of HRH.

Variation of HRH wages and incentives between private and public sectors.

In equitable distribution of health workforce among geographical areas, gender imbalance, skill mix and shortage of them in remote areas.

Inefficient contribution of the HHC in the national education policy.

Absence of continuous professional development system (CPD).

Weak HRH information system.

8

Country Response to HRH Challenges

9

Main Strategic plans, initiatives and projects

emphasizing HRH issues

National:

National Agenda and its EDP

Jordan 2025 and its EDP (2016-2019)

Governmental Action Plan

A National Strategy for Human Resource Development (2016-2025)

National Health Strategy (2016-2020)

Health Sector Reform (2018-2022)

Health sector strategies: MOH, RMS, UHs

Donors: WHO, USAID HRH2030 Jordan Activity

National Strategy for Nursing and Midwifery: A Road Map to 2025

10

Regional:

Framework of Action for Health Workforce Development in the Eastern

Mediterranean Region (2017-2030)

Frame work for action in strengthening Nursing and Midwifery in the Eastern

Mediterranean Region (2015- 2025)

Regional HRH Observatory

Global:

Global strategic directions for strengthening nursing and midwifery (2016–2020)

HRH2030 Program

SDGs, UHC

11

Main Strategic plans, initiatives and projects

emphasizing HRH issues

Human Resources for Health in 2030 / Jordan

The USAID Human Resources for Health in 2030 program operating since 2016 to build the

accessible, available, acceptable, and high-quality health workforce needed to improve health

outcomes and advance universal health coverage. As HRH2030’s first field-based activity, the Jordan

project works to strengthen the health workforce for better health services.

Objectives:

1. Improve human resources practices at the Ministry of Health. Strengthen human resources

systems and staff capacity in order to efficiently and effectively motivate, retain, and distribute the

workforce.

2. Improve health workforce competency. Train emerging health leaders and supervisors and

support a national system for continuing professional development for health professionals.

3. Strengthen National Human Resources for Health Governance. Improve national HRH policies

and strategic plans and improve HRH data for decision-making.

12

HRH2030 Results Framework

13

National HRH Strategy in Jordan

14

National HRH Strategy – Vision and Mission

Vision To have adequate, competent, and responsive health workforce to

maximize the performance of the health system in Jordan towards UHC

and SDGs.

Mission To strengthen all functions of HRH (governance, policy, partnership,

management, education, production, development, and planning) for

better health services.

15

Methodology

16

One to One interviews

Priority Setting Policy Dialogue Frontline Health Worker at

Governorate Level

17

National workshop

Particularity of the NHRHS

Informed by evidence (local, regional and international)

Followed an engaging process though out its development

Linked the SDGs and UHC

Linked to previous and ongoing strategies and plans (like the health sector reform strategy, the MOH strategy)

Pragmatic aspect of implementation

Will be monitored and evaluated on regular basis

18

Strategic Pillars

3

4

1

2

National HRH Strategy Framework

19

Strategic Pillar 1: Strengthen governance structure, policies, and partnerships to strengthen HRH regulation, management, and monitoring

1.1. Ensure alignment of existing laws/policies/ legislation to current needs and demands of community and providers

1.2. Scale up HR component in healthcare accreditation systems to include standards on education, occupational health and safety, work-life balance, clinical governance, shared decision making, privileging and credentialing and violence prevention

1.3. Develop or update legislated national scope of practice for physicians, registered nurses, midwives, pharmacists, dentists, and allied healthcare professionals that are aligned with required competencies

1.4. Develop and implement interventions and policies to expand the scope of practice for areas where supply of healthcare professionals is low (as remote/underserved areas and primary healthcare centers)

1.5. Establish policies to motivate and retain HR to work in remote/underserved areas

1.6. Conduct mandatory examination for licensure of clinical healthcare professionals

1.7. Strengthen partnerships in HRH among stakeholders

1.8. Revise Civil Service by-law to align with HRH needs

1.9. Develop and implement policies to address education and working abroad to align with the national needs

Strategic Pillar 2: Establish workforce planning based on current and emerging health service and community needs

2.1 Update human resources registries to integrate up to date data sources and ensure timely access to data for

evidence-informed decisions

2.2 Ensure mechanisms to collect, report, analyze, and use reliable workforce data to inform HRH decision

making

2.3 Identify priority needs of the community and burden of disease by leveraging existing national surveys to

forecast the human resources needs.

2.4 Predict the human resources needs for the next five years at both the national and sub-national (governorate)

levels based on priority HR needs and implement strategies to respond to these needs

2.5 Attract and orient youth career choices to health programs and specialties with HRH shortage

2.6 Reinforce gender balance in health institutions and within health professions

2.7 Mobilize and secure adequate funding to improve the production, employment, and capacity building for all

health professionals

21

Strategic Pillar 3: Enhance the competencies of the human resources for health based on current and emerging health service needs

3.1. Revise and unify current health profession educational strategies and tools based on the set of required profession competencies

3.2. Establish inter-profession education in universities and institutions

3.3. Develop re-licensure by-law and establish continuing professional development (CPD) system for health professionals

3.4. Scale up bridging programs in health education

3.5. Establish selection criteria for target admission of students before acceptance into health profession education

22

Strategic Pillar 4: Manage HRH with a purpose to attract, deploy, retain, and motivate health workforce in both public and private sectors and especially in remote/underserved areas

4.1 Improve work environment for health workers

4.2 Strengthen clinical governance through mentorship, clinical supervision, and preceptorship of healthcare workers

4.3 Establish shared governance (shared decision making and accountability) in hospitals and primary healthcare centers

4.4 Enhance job-person fit in all healthcare institutions and governmental positions

4.5 Conduct performance evaluation based on competencies in a manner that reflects actual performance of HR and link to credentialing and privileging in institutions

4.6 Provide financial and non-financial incentives to healthcare professionals based on performance evaluation

4.7 Promote women in health leadership

4.8 Develop and implement succession planning in the public sector

4.9 Provide training to HR departments and health managers on HR related topics

4.10 Ensure equitable distribution of health workforce throughout the country

23

Wrap Up Vision: To have adequate, competent, and responsive health workforce to maximize the performance of the health system in Jordan towards UHC and SDGs.

Mission: To strengthen all functions of HRH (governance, policy, partnership, management, education, production, development, and planning) for better health services.

Briefing Note

HRH National Strategy

HRH Implementation Plan

Monitoring & Evaluation Plan

Dashboard

24

National HRH Observatory

25

Establishment of the NHRHO

Emphasis on

HRH issues

Global initiatives to

manage the acute

HRH shortage

Need for HRH data &

information for planning

Call for establishing regional

& National observatories

Latin America/Brazil: 1999

Africa: 2005

EMRO: 2006

Jordan: 2008 26

- It is a cooperative initiative among relevant stakeholders aimed at producing HRH information and knowledge. - On-going HRH system analysis via electronic updating and reporting - 24/7 Sleepless eye on HRH dynamics - The main purpose is to monitor trends in patterns of the health workforce distribution to provide reliable and instant data and information needed for evidence-based decision-making and policy development.

What and Why is the NHRHO

27

Objectives of NHRHO

Establishing a national resource with reliable and up-to-date

information pertaining to major dynamics of the health workforce

in Jordan.

Establishing a national platform for effective and coherent

coordination among stakeholders for policy dialogue.

Promoting and using evidence based planning and decision making

process regarding HRH issues.

Installing monitoring and evaluation system to track progress

overtime according to HRH related baseline and benchmark

indicators.

Strengthening the national capacities to produce well qualified and

skilled health workforce staff.

Sharing best lessons and experiences with regional and global

HRH observatories.

28

Jordan Headways on the NHRHO

Strong commitment to HRH evidence generation (National

Agenda, NHS): 2008

Institutional ownership (Hosting at the HHC, Appointment of

focal point): 2008

Allocation of resources (Seed funds from WHO, biennium &

fundraising GHWA):2008

Poll survey: 2008

National stakeholders’ meeting: June, 2008

National platform for coordination: 2008

29

Jordan Headways on the NHRHO

Develop observatory web site: 2009

www.hhc.gov.jo

Comprehensive mapping of HRH(HRH Country profile):2010

Producing Annual HRH reports: 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016

Sharing experiences at national, regional and international levels.

30

Jordan Headways on the NHRHO

Producing HRH materials (brochures, posters and policy briefs):

1.“HRH Jordan's Coordination and Facilitation Policy”:2012

2.“Retention of MOH Physicians in remote areas of Jordan”:2013

Conducting a survey on: "Distribution of private sector physicians

in Amman Governorate”: 2013

Conducting a survey on: "Distribution of private sector dentists in

Amman Governorate”: 2016

Conducting an assessment to the NHRHO with the support of

HRH2030, 2017

31

NHRHO Publications

32

Annual HRH Report, 2016

33

1. Aim and Design

Aim of the report

To serve as a tool for providing a comprehensive picture of the health workforce situation in Jordan at both the national and sub-national levels in a comparable way to help monitoring HRH stock and trends, and so identify in-equitable geographical distribution of the health workforce in Jordan if any.

Design of the study

A cross-sectional point prevalence type of data collection method is adopted.

34

2. Study population

Dentists

•GPs, Residents, Specialists

Physicians

•GPs, Residents, Specialists

Nurses

•Registered nurses

Pharmacists

•Bachelor, Masters, PHD, Pharm D

Health Faculties’ students

• Enrolled & graduated students

Midwives

•midwives

35

3. Study Variables

Health workforce by sector

Health workforce by

Profession

Health workforce by

gender

Health workforce by Geographical distribution

Health workforce by

specialty

Healthاworkforce by qualification

Study

Variables

36

4. Data Sources

Components of Health Sector

International &

NGOs

Private Public

MoH

RاMS

UH

Pri

vate

Ho

spit

als

Pاri

vate

Clin

ics

Pri

vate

Cen

ters

UN

RW

A

KU

KC

ND

C

NG

Os

Clin

ics

Institutions & Councils

HH

C

JNC

HP

C

JFD

A

Join

t

Pro

cu

rem

en

t

JMC

37

5.Study tools

Public Sector form

Private sector form

MOH central level form

UHs form

RMS form

Customized forms for each entity

38

6. Methodology of data collection

Central

level

(reports)

Peripheral

level (field)

NHRHO

secretariat

/HHC

Data

Focal

point

Public

sector

FP

Private

sector

FP

Head of

Employee

Affaires

Departmen

t

Head of

Health

Profession &

Institutions

Licensing

Health

Director

ates (14)

39

7. Data entry, cleaning, analysis & report writing & dissemination

Data collectio

n

Data entry

& verification

Data analysi

s

Indicators extraction

presentation of findings in tables &

graphs

Sharing & discussing

results with the National HRH Policy

Forum

Report writing

Report dissemination

40

Key findings of the HRH Annual Report, 2016

41

Distribution of health workforce in the public sector by category, 2016

Cadre MOH

Prince

Hamzeh

RMS JUH

KAUH FDA

JPD NCDE JNC JMC HHC Total

Physicians

4697 339 1822 785 544 5 0 37 0 1 3 8233

Dentists

799 6 460 41 22 0 0 0 0 0 1 1329

Pharmacists

708 40 280 29 38 96 15 16 0 0 0 1222

Registered

nurses

5053 348 3810 488 764 4 1 24 4 0 0 10496

Midwives

1469

0 304 8 16 0 0 0 0 0 0 1797

42

Health workforce in the Private Sector, 2016

Cadre Private

hospital & clinics

UNRWA King Hussein

Foundation

JAFPP

KHCC

Total

Physicians

5336

103 11 26 364 5840

Dentists

5435

30 0 0 5 5470

Pharmacists

13917

2 0 0 60 13979

Registered nurses

5045

46 12 24 564 5691

Midwives

315

34 2 0 0 351

43

Distribution of National Health Workforce by category in Jordan, 2016

Physicians 26%

Dentists 12%

Pharmacists 28%

Registerdc nurse [PERCENTAGE]

Midwives 4%

44

Distribution of National Health workforce by Sector, 2016

45

Ratio of physicians per 10000 population by governorate, 2016

46

Ratio of dentists per 10000 population by governorate, 2016

47

Ratio of Pharmacists per 10000 population by governorate, 2016

48

Ratio of Registered Nurses per 10000 population by governorate, 2016

49

Ratio of Midwives per 10000 population by governorate, 2016

50

Graduates and Enrollees from Dentistry Faculties by gender, 2016

Graduates: 450 Enrollees : 2802

51

Recommendations

1. Improved HRH data production and utilization for decision making

2. Improve health workforce distribution all over the kingdom

3. Ensure adequate health workforce production to respond to growing population needs

52

Thank you!

!شكرا

53